Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Hansard source

On behalf of Senator O'Neill, the Chair of the Select Committee on Health, I present the interim report of the Senate Select Committee on Health.

Ordered that the report be printed.

I move:

That the Senate take note of the report.

This is the second interim report of the Senate Select Committee On Health. It covers the activities of the committee in the first half of 2015. I present this report on behalf of our chair, Senator O'Neill, who had been attending a funeral. I am so pleased that you are back, Senator O'Neill, and you may wish to speak as well.

I want to give the Senate a flavour of the work that this committee has been doing. This second report outlines the evidence received to date regarding the government's primary health care and general practice policies, and, in particular, the report will be a record of the government's frequent changes of policy since the 2014 budget.

The report goes into some detail, explaining what I call the chronology of chaos when it comes to what has been happening in the health portfolio of this government. Let us go through it. In May 2014, the budget introduced the $7 co-payment on GP visits, diagnostic imaging and pathology as well as a pause on indexation of some MBS fees. In December 2014, the then health minister, the honourable Peter Dutton, announced that the $7 dollar co-payment have been dropped. In its place the government introduced a package of reforms, including: a reduction of the MBS rebate for short consultation times; a $5 co-payment with certain carve outs; and a four-year extension of the previously announced indexation freeze across all specialist and GP services under the MBS. We all remember what happened then. There was another outcry—a similar outcry to the one that followed the $7 co-payment that was announced in the 2014 budget. The government then, at the end of December, changed ministers. Changing their minister was the answer to the $5 co-payment.

In January 2015, after a concerted campaign from GPs and health consumers, the newly appointed health minister dropped the short consultation policy and the $5 co-payment policy. However, the indexation freeze remained and the minister announced her intention to consult with GPs and other stakeholders in order, she said, 'to come up with sensible options to deliver appropriate Medicare reforms.' The minister also said at the time—and this is of concern to Senator's who sit on this side of the chamber—that consultations will include the need to:

… insert a price signal of a modest co-payment into the health system for those who have the capacity to pay

In other words, this is still the end of Medicare. Let me tell you what Dr Kamerman had to say about what that would mean. Dr Kamerman is a well-regarded doctor from the Tamworth region, from recollection. He told us that because of these changes—the $5 co-payment—he would either have to remove staff from his practice or increase his fees. He said that currently the payment to go to the doctor for a regular consultation was $35 for someone who was not concessional, and he would have to put that up to between $60 and $65.

So again, we have the minister having to respond to outcry in the community. And then in March, while the health minister's consultations continued—with little clarity about what they were actually doing—there were still concerns being expressed about the lack of detail in the government policy direction leading into the 2015 budget. The health minister then announced that the $5 co-payment 'has been taken off the table as it lacks broad support.' I could have told you that myself.

The minister continues to argue that expenditure on Medicare is unsustainable, against all advice from our committee and from what I am sure she hears across her consultation tables. She still insists that Medicare is unsustainable. That goes against all the evidence that we have received as part of that committee.

Minister Ley still insists that we need to put a price on going to the doctor. She said:

It's definitely good policy to put the right price and values signals in health to make sure number one people that people value the service that they get from doctors …

I can tell you now that people do value the service they get from their doctors and they do not need to be told that they have to pay extra for that. And then the budget we have just had in May introduced a broad-ranging review of the MBS items, and that is not a bad thing to do. But there have been some conditions that many, including the AMA, have commented on—'let's review the MBS items, but not as a cost-cutting exercise; let's make sure we make good decisions about which items should be there and what they should be paid for, so that we end up with a quality health system—an even better health system than we have now—but let's not do it just as a cost-cutting exercise'. But again, the four-year indexation freeze remains, and $57 billion is confirmed as being cut from public hospitals. Let us go to the evidence that we have received about the impact of a freeze of four years—and in some cases five years—on MBS items. The research, undertaken by the University of Sydney, indicates that the indexation freeze will cost GPs $384.32 in 2017-18 per 100 consultations, requiring an $8.43 co-payment per non-concessional-patient consultation. The research also shows that the total estimated loss in rebate income to GPs would be $603.85 in 2017-18 per 100 consultations, which equates to a reduction of 11.2 per cent. So we have the situation where either GPs just take a pay cut of 11 per cent—I do not think that is on the cards—or we will see an increase in co-payments—and, frankly, a decrease in bulk billing rates.

The final issue I want to go to in the time available is the broader question about where we are heading with health policy in this country. Where are we heading? It is a confused mess. It is chaotic. It is dysfunctional. And there is real uncertainty in the community and in the health sector about where we are going. Many of the witnesses who appeared before the committee brought this fundamental question to the table. In fact, Alison Verhoeven, CEO of the Australian Healthcare and Hospitals Association, said:

Overall, it is the AHHA's view that the health portfolio continues to have a burning need for strategic vision, for genuine consultation with all stakeholders, and not just a chosen few, and a true partnership with the states and territories and regional health bodes, rather than a penalising approach, in order to deliver what we all want: a healthy productive Australia with healthy contributing citizens.

We want to know where the government is heading. There is no understanding, there is no voicing of the policy and plan for health in this country. We are just lurching from cuts to cuts to unclear advice to the community as to where we are going. That is so evident in what we have seen with the cuts to the flexible funds.

Today, I asked the minister about the cuts to the flexible funds and I used a figure of $800 million. The minister has refuted that. I point the minister to page 16 of our report, where we quote Ms Melanie Walker, the Acting CEO of the Public Health Association of Australia. She explains what happened in the budget lock-up, where the secretary of the department told those who were in attendance—well, he did not give them a figure about how much the cuts to the flexible funds would be. 'We subsequently found out', she said, 'that another $500 million or so' was going to be cut—that is on top of the $197.1 million due to non-indexation. In Ms Walker's view, that is about $800 million. And I concur with her.

I thank the committee secretariat for everything they have done to support the committee, and I commend the committee's Second interim report to the Senate.