Deputy Speaker, before I begin speaking on the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2024, I have to call out the emotive, manipulative spin Labor uses in the health portfolio when this Bill and Labor’s track record demonstrates the outcomes do not match the pre-election rhetoric.

Those of us on this side of the House believe in outcomes rather than spin.  Labor’s  rhetoric about saving Medicare and celebrating anniversaries,  is desperate, when you compare actual outcomes, because their record is pathetic.  Not only do they keep the Department of Health under the thumb and unable to provide us or the public data on outcomes, they manipulate Departmental resources to claim bulk billing rates are improving.

They are not.

GP bulk billing has fallen 11 per cent under the Albanese government to 77 per cent , while out of pocket costs have increased by 11 per cent and that is just in the past year alone. To put this into perspective – the GP bulk billing rate rose under Peter Dutton as Health Minister to 84 per cent, and it continued to rise under the former Coalition government to 88 per cent before we left office in 2022. But under the Albanese government, Medicare is currently covering the lowest percentage of GP fees on record. On average, Australians are being forced to cover 45 per cent more of the cost from their own pocket to see a doctor from their own pocket, in comparison to under the former Coalition Government.

Labor loves talking about when Mr Dutton was the Health Minister but they don’t like to talk about those facts, Deputy Speaker.

This Bill implements measures intended to protect the integrity of Medicare, enhance the regulation of goods under the Therapeutic Goods Act and amend to the Tobacco Act.

Some amendments in the Bill form part of the response to the recommendations of the independent Review of Medicare Integrity and Compliance undertaken by Dr Pradeep Philip. The Philip Review identified potential improvements to administering health benefits schemes – in particular, the power to detect, respond to, investigate, disclose and deter misconduct, fraud and non-compliance.  The Bill seeks to address a range of impediments to the Department conducting efficient, timely, and effective compliance activities.

Given the widespread implications of this bill, the Coalition is seeking further scrutiny of its effect and implications through a senate inquiry. While we support measures to strengthen the effective administration of Australia’s important health benefits schemes – including the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme, and the Child Dental Benefits Schedule – we want to make sure that there are no unintended negative consequences created by this bill for Australia’s healthcare professionals.

It is rather ironic that this legislation aims to make efficiencies in the way Medicare works and improve its integrity, yet under this government wait times for Australians trying to access vital health services through Services Australia have blown out dramatically, with Australians waiting almost three times as long for PBS Patient Refunds to be processed. Now who would have thought it? This Labor government is excellent with the headlines, but not so great on the implementation.  They are great at beating their chests and two-word slogans with the word Medicare in it, but not great at beating the delays and delivery of Medicare funded services to needy Australians especially in the regions.  New data obtained by the Opposition through Senate Estimates reveals a massive spike in the time it took for the agency to process key health claims on during a cost of living crisis. The new data also shows that more health claims in 2023-24 were completed outside the agency’s own internal time standard than not, with 8.3 million  completed after the official deadline compared with 5-and-a-half-million claims completed on time . At that level, you could excuse Australians for thinking that under Labor, waiting inordinate time for outcomes is the norm.

77 per cent  of all bulk billing claims were completed past their official deadline in 2023-24, the second worst result across Services Australia’s entire health work programme. Now more than ever before, it is critical that the government ensures Australians can have their Medicare and PBS claims paid on time, but instead they have sent the system backwards.

Residents in my electorate of Mallee have not seen improvements to Medicare under this government. Labor promised to strengthen Medicare, but they have weakened it. It has never been harder or more expensive to see a doctor than under the Albanese Labor Government. Bulk-billing rates are falling and the cost of seeing a doctor is rising.

The bulk billing data I gave earlier points to a primary care system at crisis point. When primary care becomes unaffordable, difficult decisions must be made within families, households and by individuals regarding how to spend their limited resources. Australians are making the trade-off between paying their bills and seeing their doctor.  Under the Albanese Government, health costs have gone up 10 per cent.  We know that 1.5 million Australians avoided going to a GP in 2023-24 due to cost concerns. The proportion of people who reported that cost was a reason for delaying or not seeing a GP when needed increased to 8.8 per cent in 2023-24, from 7.0 per cent in 2022-23.

This is not only a concern in and of itself, but also because people who do not receive the primary care they need in a timely manner, often become sicker and need to access the hospital system – including overburdened emergency departments - when their symptoms become more severe. This is not good for patients and is costly for the health system.

These circumstances are amplified in the regions, where the primary care system has long been stretched and is now approaching breaking point. People living in the regions, including in my electorate of Mallee, already have reduced access to primary care, rely more heavily on emergency departments, and are admitted to hospital at a greater rate than those living in major cities.  Worse still, those emergency departments are a long distance from where rural, remote and regional Australians live.  [Today / earlier this sitting fortnight I visited the Care Flight helicopter that landed in the Federation Mall promoting their work.  Medical evacuation to capital cities for emergency treatment has become the norm in rural, regional and remote Australia.

A 2023 report published by consulting firm Nous clearly articulated the relationship between Medicare Benefits Schedule (MBS) expenditure, emergency department (ED) presentations and hospital separations – MBS expenditure reduces the more geographically remote you go and in concert, ED and acute hospital usage increases. When this existing system strain is coupled with the degradation that is occurring under the Albanese government, the outcome is magnified. People in the regions are really doing it tough when it comes to getting the primary care they need and deserve and this government has not done them any favours.

Australian Bureau of Statistics data corroborates this finding, illustrating that people living in outer regional, remote or very remote areas were more likely to report waiting longer than they felt acceptable for a GP appointment in 2023-24 than those living in major cities (36.3 per cent compared to 26 per cent). They were also less likely to see an after hours GP (5.6 per cent compared to 3.9 per cent), and more likely to visit a hospital ED (20.4 per cent compared to 13.8 per cent) or be admitted to hospital (14.2 per cent compared to 12.1 per cent).

Constituents regularly tell me of the significant challenges they face just getting to see a doctor. Here are some of their comments:

“There are no GPs in my town, the nearest is 70km away.”

“Our previous clinic closed and it took six months to find a new GP clinic that would accept new patients. My family now has three different clinics between us but we still do not have access to a regular doctor because they keep leaving town.”

“The last doctor I was seeing left the nearest town, now there are none taking new patients so I see locums in a town further away.”

All Australians should be able to access the care of a GP when they need one yet under the Albanese government, this is becoming a pipe dream of the few.

There are just not enough GPs in the regions! This longstanding workforce crisis was amplified thanks to Labor bleeding the regions of doctors through the expansion of the Distribution Priority Areas which funnelled International Medical Graduates into peri-urban settings. There is a significant and persistent maldistribution of the GP workforce, resulting in shortages in the regions, especially in small rural towns. We know that small rural towns, like Dimboola in my electorate for example, have on average almost 60 per cent fewer health professionals than major cities.

As older GPs retire, more young GPs are required to replace them as they are no longer willing to work the kind of hours that were required in the past. One retiring GP might require two or even three younger GPs to cover their workload into the future. And then there is the issue of supervision. Younger GPs are pushing back against the requirement to supervise trainee GPs in their practices, in part because they are just not remunerated adequately for the time and energy involved to train the next generation of doctors to a high standard.

These are key issues which must be addressed to make it easier for people in the regions to see a doctor, yet this government has been moving the dial in the wrong direction. And I haven’t even touched on the challenges posed by the higher costs of running a GP practice in the regions, including to fund locum doctors or incentivise GPs to move to an area by reimbursing relocation costs and providing subsidised housing; and all this coupled with patient populations who have lower incomes on average and therefore reduced ability to pay out of pocket costs.

The Coalition has put forward our plan to increase the size of the homegrown GP workforce. The package will invest $400 million to provide junior doctors with direct financial incentive payments, assistance with leave entitlements and support for pre-vocational training. This will ensure junior doctors who pursue training as a GP in the community are not financially worse off compared to doctors who remain in the hospital environment. A strong pipeline of home-trained GP graduates is critical to deliver essential healthcare to all Australians.

To make sure the required number of GPs are available in the regions, it is also essential that we support end-to-end training in the regions, so that people who wish to become doctors and then GPs do not have to move away from home and their support structures to attain their qualifications. We know from research evidence that doctors who train local, stay local. Adequate remuneration for GP supervisors is also essential to the creation of an ongoing stream of young doctors, especially in the regions.

In conclusion, I reiterate that the Coalition supports this bill’s aim to improve compliance activities in Australia’s health benefits schemes, but we condemn this Government’s record on Medicare. There is a whole lot more to be done to improve the functioning of our primary care system than what this Bill sets out to achieve.