Monique Ryan (Kooyong, Independent) Share this | Hansard source

I thank the member for Lalor for the opportunity to speak on this very important issue. As a former doctor and a medical researcher, health is very close to my heart. It is one of the most important issues in the electorate of Kooyong.

At the last federal election, both the major parties offered an extra $7.9 billion in funding to Medicare to boost bulk-billing rates. Now, $7.9 billion is a lot of money. I wholeheartedly support the concept of universal health care, I support Medicare and I support bulk-billing. But throwing more money at the system without addressing its structural issues simply is not going to ensure that all Australians can see a GP without paying out-of-pocket. Last financial year, 77 per cent of GP services in this country were bulk-billed. A metropolitan GP who bulk-bills every patient earns about $50,000 a year less than someone who undertakes mixed billing. That's a big gap, especially if you factor in rising overheads, staff wages and the complexity of care.

The government's new Bulk Billing Practice Incentive Program offers a 12.5 per cent quarterly bonus for practices that bulk-bill all their patients. But more than 90 per cent of GPs are telling us that, even with this incentive, exclusive bulk-billing may not cover their rising operational costs. The fact is that both the current and the proposed bulk-billing models incentivise shorter appointments. Essentially, they promote six-minute medicine. The longer the consult, the worse the remuneration under Medicare. This disadvantages those GPs who are undertaking important chronic disease management and those people who specialise in women's health or in mental health. In rural areas, practices face a number of additional challenges, which include workforce shortages, geographic isolation and fewer resources.

At the same time, we're facing a growing shortage of GPs, especially in rural and outer suburban areas. Young doctors are choosing other specialties because general practice is undervalued and undersupported. If we don't make general practice a viable, respected career path for young doctors, no amount of funding is going to ensure access to bulk-billing. We have to give GP trainees the same pay and conditions as young doctors who are training in hospitals, and we have to create more GP training positions.

Medicare is just one piece of our healthcare puzzle. We have a situation where we have fragmented and disconnected services and a lack of coordination between primary care, hospitals and allied health care. Our public hospitals are overfull. Their infrastructure has not kept pace with population growth and with ageing demographics. They're facing a dual crisis of increasing demand and decreasing productivity. Hundreds of thousands of Australians are currently waiting for planned surgeries. More than one-third of people wait longer than recommended times for essential procedures like heart valve replacements. We have a situation where ambulance-ramping remains a critical issue. Lives are being lost in ambulances because we can't get people through the doors of our hospitals.

The government's new urgent care clinics aim to provide free walk-in care for non-life-threatening conditions. Theoretically, that should ease pressure on emergency departments—and that is a worthy aim. Already, over 1.2 million Australians have accessed urgent care clinics. But there are legitimate concerns about them. They strain the already limited GP workforce, they divert funding from existing practices and they potentially, consistently, plausibly undermine continuity of care. The Albanese government has already spent $1.3 billion on urgent care clinics without any significant evaluation of their outcomes or their cost effectiveness.

The government is investing billions to expand bulk-billing incentives, but we need it to also address GP remuneration and training numbers, practice sustainability, hospital capacity and workforce retention. We need real reform of our healthcare system. We have to invest in digital health, in integrated care and in preventive services. We need to simplify Medicare. We need to introduce item numbers that reflect the realities of modern medicine. We need to pay doctors who are providing the very best practice care, not just seeing patients quickly. Investment in health care is the very best investment that we can make as a country. I urge the government to stay the course and to make that investment wisely.

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