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

I thank the member for Lalor for moving her motion. It is true that Medicare is at the very heart of our healthcare system, but, unfortunately, the ideal of universal health care is fast becoming a mirage. Universal health coverage means all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. The reality is that Medicare has been undermined by years of rebate freezes and rising costs, and Medicare schedule fees remain unrealistically low.

Australia's ageing population, the growth of chronic health conditions and our increasing mental health needs mean GPs are having to schedule longer and more complex appointments. Average consult times have risen, reflecting the increased complexity of those consultations. The fee schedule forces GPs to prioritise short consultations over complex ones and to charge significant out-of-pocket fees to patients. Female GPs on average spend more time with their patients, so they're disproportionately disadvantaged. Unsurprisingly, medical graduates are deserting general practice for the specialties.

According to the recent Health of the nation report, nine out of 10 specialist GPs regularly manage conditions that would typically be managed by specialists because patients have to wait too long to see specialists or simply can't afford to. Multidisciplinary team care in primary health clinics is valued and expanding. More than half our GPs engage in MDT care. Two-thirds say they'd like to participate more but workforce shortages, lack of funding and infrastructure gaps remain limiting factors for this type of care.

Tragically, just this week in Melbourne, I've been contacted by a number of constituents concerned about the imminent cessation of GP services at three cohealth community health clinics. These clinics serve vulnerable patients with complex needs, including refugees, people facing homelessness and people experiencing family violence. The current funding method does not adequately address the needs of these individuals.

The government's Bulk Billing Practice Incentive Program commences this week, but, for too many GPs, it's going to be too little, too late. The program means GPs and practices will receive added financial incentives if they bulk-bill every eligible service and patient. While four out of five GPs in the Health of the nation report said they wanted to provide more and better preventive care to their patients, 82 per cent said that Medicare benefit scheme rebates are simply insufficient to allow them to do that. As a result, only one-third of our GPs are able to offer preventive care to patients. Preventive medicine covers a range of services. It aims to identify problems that could lead to chronic illnesses or diseases.

Our GPs' inability to provide those services means they're going to be struggling to cover all bases in health care. They'll be struggling to test blood pressure and cholesterol, struggling to undertake weight management, struggling to screen for cancer and for diabetes, and struggling to touch on drug and alcohol diversion programs, on mental health assessments and on nutrition. The GPs are simply unable to offer us the best care possible, because of financial and time constraints.

In my electorate of Kooyong, according to the recent Cleanbill report: only 16 per cent of consults were bulk-billed in the last financial year; the average out-of-pocket costs for a GP consultation was $49.91; and only 12 per cent of GP clinics in Kooyong are able to bulk-bill every patient. Realistically, schedule fees need to double. For standard consultations, that would mean the government paying out about $100, and even that's going to be less than the call-out fee for your average plumber.

We know that young people are increasingly putting off seeing a doctor, because they simply can't afford it. These are false and harmful economies. Avoiding vital medical care often results in later and more-severe presentations to urgent care clinics or emergency rooms. If this government really values primary health care it has to be prepared to pay to have the best primary health care provided to all Australians and to look at new models of multidisciplinary and preventive care within our universal healthcare system.

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