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Legislative Assembly for the ACT: 1995 Week 10 Hansard (6 December) . . Page.. 2716 ..

MR MOORE (continuing):

I do not believe it does to say, "The point is that we want to save $600,000, which is equivalent to the methadone program or two lots of women's health centres, or something else". That is a digression from the point at hand. The point at hand is that the Assembly gave an instruction and that instruction ought to have been carried through.

In my own discussions with the Chief Minister she has argued that she believes she did, that she tried to carry it through. If personally she tried to carry it through and it was undermined by someone in her office, or her officers, then her instructions will follow from this particular action. I do not know where the problem was. I do know that Mr Osborne put up a motion, which was supported by the Assembly, and effectively it was undermined. That is why I will be supporting this censure motion.

MS TUCKER (12.41): The Greens will be supporting this motion, but it is with regret. We regret having to do this because, basically, we feel that Mrs Carnell is doing things hard when she really does not need to. She came into this place claiming that she would be open and consultative, but we have found that the minority Government is continually presenting us with a fait accompli, which is not going to work in the long run in this place. I suggest that Mrs Carnell and her Government think very seriously about the implications of continuing to do that. I heard her say this morning that, because of the result of the first motion, two days later when Mr Osborne's motion was passed - there were only two days between the two motions - things were already set in progress. It is amazing how quickly things can happen. Mr Osborne's motion did make it quite clear that, unless the health centres were managed as 100 per cent bulk-billing, the salaried medical practitioners should not be removed. It seems totally inappropriate that processes such as redundancy and so on were put in place before she knew that there was going to be the possibility of staffing the centres with 100 per cent bulk-billing doctors.

I have to comment also on the fact that Mrs Carnell is pleased with the number of doctors we have in this Territory who bulk-bill, but it is interesting to note that we are at the bottom of the percentages of practitioners in all States who bulk-bill and also of practitioners who charge the standard fee or below. With job losses and unemployment, we are seeing a growing group of people in our community who are not eligible for a health care card but who suffer economic hardship. I stressed that yesterday and I will continue to stress it.

Mrs Carnell just claimed that we want to improve the health status of this community - they are her exact words - and I believe she is sincere in that, but she has a very different view from that of a lot of people of the role of the GP in primary health care. Unless you have GPs there who are accessible to all members of the community, including those in a low income bracket - we all know that there is a correlation between that socioeconomic group and ill health - and it is more difficult for those people to access medical attention when they need it, and preventative care, we are not going to be looking after the health status of the whole community at all. In Canada recently a report has come out saying quite clearly that the fee for service method of payment for doctors is obviously not working. So there are very influential groups around the world now recognising that this is not the way to go. Anyway, there are disincentives for good primary health care in the fee for service method of payment. It is also interesting that doctors often had to close their books in the health centres here, so there obviously is a need. I support Mr Osborne's concerns that we need to look after these people.

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