Ben Small (Forrest, Liberal Party) Share this | Hansard source

It might seem old-fashioned when we talk about our health system to talk about triage. But, at the end of the day, I think that lights are unfortunately flashing red on the dashboard—because every symptom that we look at indicates we've got a very sick patient on our hands indeed. In fact, rather than the strengthening Medicare policy doing what it says on the tin, I worry that in regional communities like mine it will actually undermine health outcomes entirely by pushing regional general practices closer to the brink than they already are today.

I think that we've got to get our regional health system off life support. Unfortunately, the only way we can do that is by recognising that the system doesn't do better with volume over value. The domino effect that we've seen with hospital blockage and GP overload is the first point of failure. The government's failure to recognise that core funding is now having a devastating domino effect across the health system is manifesting itself through record ambulance ramping and acute bed block in our public hospitals in Western Australia. This crisis means that patients with complex needs or those requiring just minor procedures as day patients can't get timely care in a hospital setting. It's reasonable to ask, 'Where do these patients go?' They present to the last accessible link in the chain in regional Australia—that is, of course, their local GP clinic. But our GPS are increasingly being asked to manage advanced care that far exceeds the scope of a standard consultation. This is where the funding model creates an impossible paradox for our doctors on the front line.

The average length of a GP consult might be around 19 minutes, but the economics of the bulk-billing incentivisation rather promotes the shortest possible transaction. So our GPS can't simply flex their patient throughput to absorb the hospital overflow that we're seeing. Complex cases that do require longer consultations—level C or D consultations of 40 minutes or more—are being diverted, yet the government's new bulk-billing incentives don't adequately fund this time that the doctor invests in the care relationship. Instead, they reward volume, frequency and shorter consults. I suspect that we'll see the consequences of this policy being quite severe.

For a regional practice in the south-west, like those in Bunbury and Busselton, if they dare to stick with a mixed-billing model to survive as businesses, the consequence is of course that they forfeit the significant bulk-billing practice incentive that requires 100 per cent of consults through the business by 100 per cent of doctors for 100 per cent of patients to be billed accordingly. Unfortunately, by being unable to access those incentives, they face the immediate erosion of their patient base, as the patients most sensitive to cost are being forced to migrate to fully bulk-billing clinics to stabilise the practice's patient loyalty and long-term viability. These are small businesses that we're talking about here, and the compounding risk of vertical integration in the health system and block funding is a critical concern because local clinics are raising with me the issue that conditional funding is structurally dangerous in our health system.

Centralised control occurs the moment the large private entities—we're seeing it through private health insurers or private equity groups—consolidate GP practices in Australia, which forces GPs to rely on a single conditional funding stream, whereas in fact we've seen significant benefits to the taxpayer through a health system that focuses on improved preventive health consultations, and they of course take time and cost money. That cost is an investment in better health outcomes in the longer term.

So we're undermining the quality of health care, and we're generating churn within GP practices, and I think that that is going to manifest over time. We're allowing isolated and frankly unsafe outcomes. We're implementing a flawed MyMedicare registration process that registers patients to a single doctor instead of a practice, creating endless administrative churn and placing yet further burdens on the small-business operators who are at the heart of regional medicine in communities like mine. At the end of the day, this leaves overheads rising and practices unsustainable, putting regional health at risk.

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