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Howard's Speech Announcing MedicarePlus Changes

November 18, 2003

This is the transcript of the speech delivered by the Prime Miniser, John Howard, at the Hungarian Community Centre in Wantirna, Melbourne, announcing the Federal Government's changes to Medicare.


John Howard, Prime Minister Thank you very much Tony. I thought those cauliflower ears were the cumulative result of your attempt to get on the Wallaby bench for Saturday night. But to my colleague Tony Abbott, the Minister for Health and Ageing, Chris Pearce, Fran Bailey, Tony Smith and Jason Wood, ladies and gentlemen.

Today is a very important day in the further evolution and strengthening of health policy for the benefit of all Australians. MedicarePlus, through the new safety net, will give all Australians, and not just those on concession cards, peace of mind against the potentially crippling costs of major illnesses to themselves or their families. MedicarePlus tackles head on the critical shortage of doctors and other health professionals in certain parts of Australia, which is the major reason why bulk billing rates are so low in particular areas of our nation. And MedicarePlus also provides a big new incentive for doctors to bulk bill those who need that service most.

This is the 20th year of the introduction of the Medicare system and the announcements that I make today represent a major strengthening of the Medicare system, they reaffirm the determination of the Government to not only maintain Medicare, but to make it better and stronger. It's worth recalling that since we were elected in 1996, we have increased public hospital and Medicare rebate funding by 17per cent in real terms, we have increased funding for pharmaceuticals by 64 per cent in real terms, and we've also spent about $2 billion on targeted rural and aged care services to promote and support access to healthcare in rural and remote areas.

And in announcing MedicarePlus today, I acknowledge and I want to pay particular tribute to the work undertaken by Tony Abbott in this area. I acknowledge the fact that the Australian people have wanted further changes and a further strengthening of the system. And Tony has done an outstanding job of going around the country, listening to the concerns of Australians, talking to the medical profession and talking to other people involved in the delivery of our health system. Under MedicarePlus, the Government responds to those expressions of concern. We committed $917 million to the Fairer Medicare package announced earlier this year. Under MedicarePlus we are going to commit an additional $1.5 billion to the support of the health system, so that the total investment in MedicarePlus including the commitment under Fairer Medicare, is some $2.4 billion.

I take the opportunity of reaffirming that the three pillars of Medicare remain - that is free treatment as a public patient in a public hospital; the payment of the Medicare rebate at 85per cent of the scheduled fee for a visit to a doctor outside the hospital; and affordable pharmaceuticals through the Pharmaceutical Benefits Scheme. I also reaffirm that the Coalition is committed to maintaining financial support for people to take out private health insurance. Unlike our opponents, we don't despise private health insurance - we believe in it and we encourage it. And we are absolutely committed, without qualification, to the maintenance of the 30per cent tax rebate. MedicarePlus strengthens and builds on the three pillars I have outlined and which have protected the Australian public well over the last 20 years.

The Government remains very strongly committed to a high level of bulk billing as a key element of the Medicare system. The levels of bulk billing vary enormously throughout Australia and clearly, and this is even acknowledged by the Labor dominated Senate inquiry which produced its report only a few weeks ago, that the main driver of levels of bulk billing is the supply of doctors. Areas that have very high levels of bulk billing are found to have a large number of doctors. Areas that have low levels of bulk billing generally have far fewer doctors. No government, and this is acknowledged by the Labor Minister who introduced Medicare, can compel a particular level of bulk billing, but it can take measures, as I announced today, to increase the supply of doctors and other health professionals and also to provide additional incentives for doctors to bulk bill.

The Government, as a major new incentive for the provision of bulk billing services, we will provide an unconditional incentive for general practitioners to bulk bill visits by concession card holders and children under the age of 16. Under MedicarePlus, the Government will provide general practitioners with an additional $5 payment for every bulk billed visit by a child under 16, irrespective of the financial circumstances of that child's family - in other words, it is completely non income or means tested - or by any one of the seven million Australians covered by the Commonwealth Concession Card. There will be no conditionality attached to that additional payment of $5. The doctor will not be required to commit to a particular level of bulk billing. For every bulk billed service for children under 16 and concession cardholders, there will be an additional payment unconditionally of $5. Children and concession card holders currently account for some 62 per cent of all the services that are provided by general practitioners, and the new MedicarePlus payment of $5 will be made automatically to all GPs around Australia whenever they bulk bill children or concession card holders. And it is worth noting that at present some 81 per cent of the services delivered in Australia by general practitioners to concession card holders are delivered either through bulk billing or with a copayment of less than $5.

The initiative that I have just announced completely replaces the graduated incentives with conditions which were contained in the Fairer Medicare package. As has been the case ever since the introduction of Medicare, doctors can choose to bulk bill any patient. Under MedicarePlus, patients who aren't bulk billed can choose to have their Medicare claim lodged electronically at a doctor's surgery and their rebate paid to their bank account within a few days. This provides a great deal more convenience for those who do not want to queue up, often during their lunch hour, at a Medicare office.

Since the inception of Medicare, healthcare in Australia has changed dramatically. GPs and specialists are diagnosing and treating more and more patients outside hospitals, and the range of medical services provided outside hospitals, such as blood tests, x-rays, tissue biopsies and radiotherapy, is increasing dramatically. That is why MedicarePlus will strengthen Medicare by providing a comprehensive national Medicare safety net for all Australians, I stress for all Australians.

Adding to the Medicare rebate, the MedicarePlus safety net will cover out of pocket costs for medical services provided outside a hospital. This safety net will provide a new level of protection against unexpected medical costs that may arise. The safety net will cover 80 per cent of the out of pocket cost for medical services outside hospital for all concession card holders and also for all families who receive at any time during a 12 month period Family Tax Benefit A once, in both cases, a $500 threshold per individual or family is reached. This will cover alone 12 million Australians, including approximately four out of five families with a child. In other words, four out of every five families with a child will have a safety net so that when you go over $500 in a year of out of pocket expenses, not only a GP, but also if you go to a specialist for a consultation prior to any surgery, if you have an x-ray, if you have a blood test, if you have a papsmear, if you have any of those procedures that attract the MBS benefit, once you go over the $500, and if your family at any time during the year is in receipt of Family Benefit A, you are reimbursed 80 per cent of the excess over $500.

And I think it is worth noting here that although, understandably, the bulkbilling debate has tended to focus on the services delivered by general practitioners, the reality is that for many people the real threat of major additional expense is when you find you may have to undertake a surgical procedure, you go off for blood tests, you go off for x-rays, you go off for a specialist attendance and the levels of bulkbilling of those services are very low. For example, it's only 58 per cent in relation to diagnostic imaging which includes x-rays and scans and so forth. And this safety net is not only going to cover any out of pocket expenses that people might be left with in relation to GP consultation, but very importantly it is going to pick up the out of pocket expenses in relation to all of those other services. Now this has been a gap in Medicare for a long time and the gap has got bigger because more and more of these services are being delivered out of hospital and that is why the introduction of this new safety net is going to make such a dramatic difference. And it is going to provide all Australian families with a peace of mind that if they do run into a major illness it's not going to send them broke, there's going to be a safety net there to provide them with assistance. Now the new safety net will also cover 80 per cent of the out of pocket costs for medical services outside hospital for all other Australians, that is the people whose, in the case of families, whose income is so high that they don't attract the Family Tax Benefit A and also in relation to people who do not have children and not in a family situation whose expenses are $1,000 a year. The threshold for them will be $1,000 for individual family and that will cover the remaining 8 million of the Australian population.

So this is a totally comprehensive safety net and what it means is that people will have the peace of mind of knowing that there is a safety net there. And, of course, coupled with our commitment to the maintenance of private health insurance support so that people can cover themselves in relation to hospitalisation. For the first time I believe in the history of this country we will have a completely comprehensive pattern of protection and a completely comprehensive safety net. Now the Medicare safety net builds on our previously announced safety net for concession card holders and, as I emphasised, it extends to cover all Australians.

Now if I can turn for a moment to what I regard and what the Senate committee, dominated by our political opponents, acknowledged is probably the major reason why levels of bulkbilling are so low in parts of our nation and that is the shortage of doctors and other relevant health professionals. This is very important because of its impact on levels of bulkbilling and therefore affordable health care. And today I'm very pleased to announce that MedicarePlus will support Australia's most extensive effort ever to attract and retain our medical workforce. MedicarePlus will ensure immediate and sustained growth in the number of doctors and nurses in the places that need the most such as outer metropolitan areas of our cities and in regional and rural Australia. MedicarePlus will support the equivalent of about 1,500 more doctors and 1,600 practice nurses by the financial year 2006-2007. And we'll do this by significantly increasing the number of doctors, including overseas trained doctors and supervised junior doctors working in rural, regional and outer metropolitan areas of workforce shortage. We'll pay a rebate, and this is an important new measure for practice nurses working in general practices who provide immunisations and wound management. We'll re-train doctors who want to return to work after a break and we'll provide payments and support to general practitioners who are delivering essential medical services in country areas. This unprecedented commitment to increase our medical workforce will particularly assist people in outer metropolitan, regional and rural areas to access a doctor when they need one. And these additional workforce measures are added to the workforce measures that were announced some months ago in the Fairer Medicare package.

MedicarePlus will also provide another very important new initiative to improve access to doctors for older Australians. It will fund, by the introduction of a new medical benefits item, more regular GP services and comprehensive medical assessments to residents of aged care homes. The new initiative will enhance the healthcare of older Australians and provide reassurance to their families. It will involve, as well as the introduction of a new medical benefits item, it will also involve the provision of financial assistance in consultation with the divisions of general practice to establish panels of doctors that will be available to provide assistance and look after residents of nursing homes and aged care facilities who do not have their own general practitioner.

I should also confirm that the previously announced additional support for GPs treating veterans holding Gold or White Cards will continue, recognising veterans' special healthcare needs and ensuring that they are treated at no cost. And I'm pleased to say that currently there are 14,200 doctors around Australia who are participating in these new arrangements.

Although we have been conservative in our estimates of how quickly these measures can be implemented, it is my intention to have them in place as quickly as possible. In particular, I'm hopeful that the $5 bulk billing payment and the new rebate for practices nurses will commence from the 1st of February 2004, subject to necessary changes in computer software and associated administrative changes.

Today's announcement ladies and gentlemen builds on the Government's very significant investment in Australia's healthcare system. This $2.4 billion investment in MedicarePlus demonstrates our very strong commitment to an affordable, integrated, reassuring healthcare system. A healthcare system that recognises the fundamental obligation of the Government to publicly provide the sort of services available under Medicare augmented by the significant contribution of the private sector. The Government is the only political grouping in Australia that believes unambiguously in both the public and private elements of healthcare in this country. We have always supported the rights of Australians to take out private health insurance and we have always been willing to give them a taxation incentive in order to do so. But what we have demonstrated today is a willingness to provide, through the Medicare system, a safety net of unprecedented reassurance to the entire Australian community. It is a safety net that will give peace of mind to Australian families.

No ordinary Australian family wants a situation of enormous medical bills for a major illness for one of its members. Few ordinary Australian families are able without some kind of additional assistance to cope with those expenses. And that is why the introduction of this safety net is so important and is such a tangible demonstration of our commitment to the strengthening of the Medicare system.

The fundamentals of Medicare are retained. The reach of Medicare is extended. The reassurance of Medicare is greatly enlarged by the introduction of the safety net. MedicarePlus provides more opportunities and incentives for bulk billing. It provides more convenient rebate claiming. It provides a national safety net, it provides more doctors and nurses in areas of need and it provides more services and support for older Australians in aged care facilities.

Now our intention is to introduce a ministerial determination as soon as possible, and that is I hope immediately, to enable the new $5 payment for bulk bill concession card holders and children so that that may commence early next year. And that can be done by a ministerial determination or a regulation, whatever if you might like to call it, and the Minister's indicated that he's ready to sign it as soon as I've finished speaking. And in addition, importantly, when Parliament resumes we intend to immediately in the Senate amend the bill currently before the Senate to remove those elements of our previous package which we are not pursuing so as to enable the new national MedicarePlus safety net to be implemented. So next week when Parliament sits we'll immediately in the Senate take out of that legislation the things that we know we're not going to get through, such as the so called swipe card arrangement and the provision for taking out private health insurance in relation to any excess of your doctor's bill, they're not going to get through, we acknowledge that. But what can get through, and what should get through, and should get through before Christmas, before the Parliament rises, is the necessary changes to the law to bring in the new safety net and I'm asking the opposition parties in the Senate, I'm asking the Labor Party, I'm asking the Democrats, I'm asking the Greens, I'm asking the independents in the Senate to join the Government to pass this legislation before Parliament rises for Christmas.

We've had a Senate inquiry, we've had months of debate, now is the time for the Parliament of Australia to enact this safety net and I simply pose the rhetorical question : how could anybody reasonably object to the introduction of a safety net that is going to protect every Australian and every Australian family? And I hope that the sense and the national need and the interests of the Australian people is recognised by those in the Senate who hold the numbers and that together we can give this additional peace of mind and additional reassurance to Australians before Christmas.

Ladies and gentlemen, MedicarePlus is a reaffirmation of the commitment I gave on behalf of the Coalition before we were elected to government, back in late 1995, that we would maintain and strengthen Medicare. We remain absolutely committed to it, we have done that, MedicarePlus takes Medicare beyond the reach that it previous had because of the introduction of the safety net, it provides new incentives to strengthen and improve and lift the levels of bulk billing by the focus on areas of particular need for bulk billing. In short it preserves the things that we value about Medicare and importantly it builds on them. I commend MedicarePlus to all of the Australian people.

Thank you.

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