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Monday, 24 March 2003
Page: 13380


Ms GILLARD (8:35 PM) —I rise to speak on the Health Insurance Amendment (Diagnostic Imaging, Radiation Oncology and Other Measures) Bill 2002. As previous speakers have said, this bill seeks to amend the Health Insurance Act 1973 in three principal respects: firstly, to require the registration of premises that offer diagnostic imaging and radiation oncology services before Medicare benefits are payable for such services; secondly, to make changes in patient referral procedures in relation to diagnostic imaging services; and, thirdly, to allow osteopaths to refer patients for diagnostic imaging services. During my contribution, I intend to speak to the question of diagnostic imaging services—most particularly, magnetic resonance imaging services—and then to deal with the question of the spread to osteopaths of the ability to refer patients for these services.

We know that diagnostic imaging, including magnetic resonance imaging, is a growing technology in health care in Australia. That seems logical, given that it is a breakthrough technology that enables the early diagnosis of a number of diseases, most particularly cancers. Diagnostic imaging accounts for approximately 15.5 per cent of Medicare benefits paid in 2001-02. The fact that this is a growth area is further verified by the statistic that the number of health professionals entering medical imaging as an occupation rose by 27.6 per cent between 1996-97 and 2000-01. We have a breakthrough technology that can make a real difference for people by the early detection of chronic illnesses, most particularly cancers. As the take-up of the technology grows, then obviously the work force involved grows exponentially.

You would think that, with the introduction of a new technology, the government would take some steps to ensure equitable provision. Australia, as we know, is a big place. Whilst people tend to live in major cities, obviously we have substantial communities in rural and regional Australia. We also have substantial growing communities on the outer suburban fringes of our major cities, including my electorate of Lalor. Therefore, you would think that the government would take some steps to ensure that the introduction of this new technology is planned, that there is an equitable spread of services and that people, insofar as possible, are able to access services locally. You would not then get a situation where some of the more affluent suburbs end up disproportionately serviced by this new technology, whilst lower income suburbs, growth communities on the fringes of our cities and rural and regional Australia end up with not enough access to this technology.

Of course, we know from this bill that the provision of the new services has been largely unplanned. Indeed, it has been so unplanned that we need this bill to go through the parliament—and Labor do support this bill—so that we know where these services are being provided. Despite the growth in this technology, despite the fact that it is putting an increasing amount of bite on the medical budget in Australia, we do not know what is going on out there. We need something as basic as a registration system to ensure that we do know. Currently, without that data, there is no ability to examine and ensure that services are being provided equitably in a geographic distribution. There is no ability to target education and information campaigns. Obviously, the capacity to track the provision of services to deal with issues like overservicing and fraud is not sufficiently honed. This bill will create a registration system which will enable us to have that kind of basic information.

It seems odd that we should find ourselves in this position where we have new technology and its use is growing but we do not have even a registration system to tell us what is going on. If we cast our minds back, I think we can recall how we got here. We got here by a series of steps starting with the former minister for health's noted scan scam, as members of this parliament who served in the last term would remember and as many members of the Australian public would remember also. What was the scan scam? It was a system engaged in by the former minister for health, on the eve of a budget arrangement that was going to create a cut-off date for the purchase of Medicare rebateable machines capable of doing this magnetic resonance imaging work. If you purchased your machine before the cut-off date then you were right—when you put that machine into service, you would get a Medicare rebate. If you purchased the machine after the date then you were not going to necessarily qualify for a rebate. Of course, as history records, there was an enormous number of purchases in the few days before that cut-off, leading to many questions in this place, an Auditor-General's report and then a report by the Joint Committee of Public Accounts and Audit further inquiring into the Auditor-General's report. It seems to me that, had the former minister for health not retired at the last election, we still would be hearing the words `scan scam' routinely uttered in this place.

In serving as a member of the Joint Committee of Public Accounts and Audit in the last parliament, when we inquired into the Auditor-General's report on the scan scam, I know that one of the principal ongoing problems the scan scam left in Australian politics—apart from the fundamental probity questions going to the nature of arrangements in Australian politics, particularly the nature of trust that people can place in ministers of the Crown—was that we had who knows what kind of geographic or equitable spread of MRI technology. There was this unseemly rush to purchase machines for which practitioners were eligible for a Medicare rebate. You could pop them wherever you chose to pop them, where you could make the most money out of them; yet there was no system of planning, no system for the equitable distribution of these machines. It seems to me that the government is still playing catch-up with this bill to try and get back to where it should have been had the scan scam not happened and had it taken the necessary steps to introduce this technology in a way which would have included equitable provision across communities.

You might wonder, apart from my former service on the Joint Committee of Public Accounts and Audit, why I am particularly interested in this matter. I am particularly interested in this matter as a local member of parliament serving in the western suburbs of Melbourne. As of tonight, it still continues to be true that the western suburbs of Melbourne do not have access to this MRI technology. It is very important breakthrough technology for dealing with the detection of cancers and other severe illnesses and we do not have that technology available locally. This is a matter that the local members in Melbourne's west have been complaining about in this place for a number of years now. We were routinely raising it in 2000, and I continue to press it now.

What does this mean? It means that people who live in my community, people who live in the middle to outer suburbs of Melbourne, cannot access one of these scans locally. It means they need to travel to town to access one of these scans. Obviously, that has an inconvenience factor about it, particularly if you do not drive. It means that there is an additional burden on the machines in town and it means long waiting lists. People can wait several weeks to get an appointment to have one of these scans done. The introduction of this technology was unplanned and the provision was unplanned. There was no equity in how this technology was originally rolled out in the Australian community and there were probity issues relating to the scan scam. Here we are, all these years later, and there is still an issue about the equitable distribution of these machines. Most particularly, there is an issue of access for the people in my community, the electorate of Lalor.

I note that the government did respond to the fact that there was no equitable provision of MRI technology across Australia, particularly as it left rural and regional areas with a problem. The government sought to rectify that in the 2002-03 budget by allocating $72.7 million to the development of new facilities—that is, new radiation oncology facilities in rural and regional areas. I think the extra provision to ensure access to new technologies in rural and regional Australia is a good thing, but as a representative of an electorate in the outer suburban areas of a major capital city—in this case Melbourne—I am concerned to see health measures targeted at rural and regional Australia when, if you actually diagnose need for access, if you do not just say, `Let's define need as rural and regional and look at that,' but look across the Australian map at areas of need, outer suburban areas frequently come up as areas of need but often do not qualify for assistance under the various programs that are targeted at rural and regional areas.

Government initiatives to deal with doctor shortages were originally targeted at rural and regional areas, notwithstanding the fact that communities like my own had doctor-patient ratios far worse than those of some rural and regional areas. The government in the last budget said they would look at areas of need and allocated $80 million to do that. That $80 million has produced, at last count, two or three doctors across Australia. It has been a failure. As recently as this weekend, we have seen a new government program with an additional $20,000 or $30,000 to help doctors to go to areas of need. I note that my community has been targeted as an area of need. Given that the grand announcement in the last budget of $80 million to get doctors to outer urban communities largely came to naught, I approach the most recently announced measure with some scepticism. I trust I will be proved wrong.

The need for doctors in my community is critical. Doctors have their patient lists closed. If you move into the community, you cannot get onto a doctor's list. Obviously, if you cannot get to the doctor, there is an access problem and, if you cannot get access to the diagnostic technologies we are talking about, that problem is compounded. We need to look at the health needs of outer urban communities like my own. One of those health needs is access to an MRI scanner in the local area. That still has not been resolved. I have no doubt that, when this registration system is in place, when the government can finally forensically tell us all where these machines are and what they are doing and when they can examine what is happening with the provision of this technology for equity, they will find that outer urban communities like my own are still doing it tough and need some additional assistance.

I move to the section of the bill that deals with osteopaths being able to refer patients for diagnostic imaging services. As I have indicated, Labor is broadly in support of this bill. This section has direct support from me. In a former life, I served as the Chairperson of the Chiropractors and Osteopaths Registration Board of Victoria. It was the professional board that registered and dealt with discipline matters for chiropractors and osteopaths. It was my obligation as the legal member of the board to chair its meetings and, most particularly, to convene its disciplinary hearings, which were obviously matters where people had complained about treatment they had received from chiropractors or osteopaths.

Within the community covered by that registration board—that is, chiropractors and osteopaths—the number of chiropractors was obviously far bigger, and there was an ongoing debate within the registration board and the various professional associations about whether or not osteopaths ought to be separately registered. I think those tensions between the professions have been replicated across Australia as that debate was pursued not just in Victoria but across Australia. The debate has been resolved in a number of states by separate registration, and the consequence of separate registration can be a need for the sort of legislative amendment we see here—to make clear that osteopaths, as opposed to chiropractors, also have the ability to refer for services. I think it is important that osteopaths, like chiropractors, have that ability and I wholeheartedly support that section of the bill, having had a great familiarity with these debates when I was serving as Chairperson of the Chiropractors and Osteopaths Registration Board. In summary, Labor do support this bill but, on behalf of my community, I take this opportunity to say that we would support it a lot more wholeheartedly if we were accessing locally some of the technology with which the bill deals.