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Thursday, 10 May 2007
Page: 60

Ms BIRD (1:13 PM) —In speaking on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007, I take the opportunity, firstly, to address the bill directly and, secondly, to raise some local issues in my electorate about the provision of MRI services.

This bill before the House appears to be quite timely. I am aware that, in recent times, there was controversy in the Sydney media about an MRI service provider using their facility after hours to conduct scans on animals for veterinarian services. I certainly hope that they were not being bulk-billed or charged under Medicare for those services! There are issues around the standards that would create concern if a machine were being used for both people and animals. I think this bill addresses the debate that occurred as a result of that controversy and the need to ensure that we have an accreditation system that, I would suspect, makes such a situation impossible to occur.

Labor supports the bill before the House today. The bill proposes to amend the Health Insurance Act 1973 to create an overarching framework for the establishment and operation of accreditation schemes for diagnostic imaging services. I understand that the proposed accreditation scheme was agreed to by the government and representatives of the diagnostic imaging sector as part of the negotiations for the radiology memorandum of understanding in 2003.

Diagnostic imaging, it is important to note, includes a range of medical services, including: ultrasound; computerised tomography—which we know generally as CT scans; nuclear medicine; radiography, or X-rays; magnetic resonance imaging, MRI scans, which I have referred to; positron emission tomography, or PET scans; and bone densitometry. With an ageing population, that last one is also a very important one. The Australian government provides Medicare rebates for a number of diagnostic imaging services, and the managing of the Medicare provision is undertaken through the radiology MOU. We should acknowledge that there were approximately 12.6 million services provided under this MOU in 2005-06, accounting for more than $1.3 billion per annum in Medicare benefits for services across approximately 3,100 practice sites. The very size of the government provision of service here is important to acknowledge, because it is part of the driving need for an accreditation process to be in place. This is certainly a field of medicine that is expanding at a rapid rate as technology develops. There is absolutely no doubt that it is timely that we address the issue of accreditation.

As part of the negotiations for the radiology MOU the government and the diagnostic imaging sector have agreed to an accreditation scheme for radiology practices. This will be a process of externally reviewing an organisation’s performance against a defined set of standards. This is important because radiology services are increasingly being provided by a wide range of providers, including specialist radiologists, vascular surgeons, cardiologists, general practitioners, obstetricians and gynaecologists, and sport physicians. These providers operate in a variety of settings, including hospitals, single practitioner premises and multi-site corporate practices, and often in conjunction with surgical procedures. Clearly, in such a diverse industry there is a potential for inconsistency in the delivery of the services. When the government is actually deciding to allocate funding capacity to services it is important that we ensure that they are the best available.

This bill creates a scheme under which all diagnostic imaging practices providing services under the MOU will need to be accredited by an approved accreditation provider in order for Medicare benefits to be payable for such services. The bill allows the minister to establish, through a legislative instrument, the rules and operational details of the accreditation scheme. This would include the standards, the approved accreditors and the process and period of accreditation.

Whilst Labor supports the bill, we are critical of the fact that, as the previous speaker outlined, so much of the detail is not contained within the bill but is left to the minister. For example, the bill does not provide operational details of the proposed scheme, and Labor shares the concerns of the representatives of the diagnostic imaging sector about this. Whilst the proposal of the scheme as it is presented in principle in this bill appears a good and useful development, it is also true that the detailed implementation and operation of the scheme will, in the final analysis, determine the value or detriment of the scheme.

In August 2006 the Department of Health and Ageing organised a number of consultations with sector stakeholders. The problem with fully endorsing the scheme was also raised during these meetings. They listed the things that they were concerned about, including : the cost of accreditation to practice sites and the resulting impact on businesses and healthcare consumers—a polite way of saying increased costs and the potential for those to flow through to consumers, which I think would be a significant concern; the ambitious implementation timetable and the need for accreditation providers and practice sites to be well informed about assessment requirements, including the radiology accreditation standards, well in advance of 1 September 2007—and I note the implementation is now looking at July 2008; the need for the new accreditation scheme to accommodate the diversity of business structures, particularly where components of the service are undertaken by different practices such that, if the problem with quality is in one part, the whole stream of service delivery is not affected; the need for the complaints handling mechanism to distinguish between frivolous and legitimate complaints and for the investigation of complaints by accreditation providers to be limited to matters related to compliance with accreditation standards; and the importance of involving all provider groups in the development of the radiology accreditation standards to ensure their relevance and currency in both the immediate and the longer term. None of those concerns are surprising. They are the types of issues that providers would generally raise with any accreditation process. They would be familiar to us from a whole range of different accreditation schemes.

However, I think it is particularly important to note the cost issue, because many people are paying gap payments—for example, for diagnostic imaging services. To see an increase in those costs could be very problematic. And the practices themselves having to comply can be a force for driving greater concentration of services rather than diversity of provision. In many markets in our communities, particularly in rural and regional areas, that can end up in a monopoly, where people have very little choice but to be accessing the only service available. So the devil could obviously be in the detail and, whilst supporting this bill, I think it is important to acknowledge that the success or failure of the scheme proposed in the bill will rest significantly on the unrevealed details.

I would like to also take the opportunity in this debate on the provision of diagnostic imaging services to highlight a problem in my own electorate. Since mid-2002 I have been campaigning for the allocation of a Medicare MRI licence to the Wollongong Hospital. Over the five years of this campaign more than 18,000 local people have signed petitions to the minister requesting the allocation of this licence to our local public hospital. In Tuesday’s budget I note that there was funding for the allocation of three new MRI licences. Along with my community I am again calling on the minister to allocate one of these three new licences to the Wollongong public hospital. In November 2004 the state Labor government announced that it would provide a MRI machine at Wollongong Hospital. In the same month I wrote to the federal minister for health again urging the federal government to allocate a Medicare licence to the hospital so that the many outpatients who attend Wollongong to visit the wide range of specialists who are located there can access a bulk-billing MRI scan. In March 2005 I launched a petition with local community activists calling on the government to provide the licence. We hoped to show the minister and the government the importance of this service to local people. Just six months later, on 12 September, I provided the completed petition to the minister at his Canberra office. There were 16,357 signatures on that petition.

In the grievance debate on that day I gave two examples of local people who required the service and who had made contact with me in support of the petition. One was a young man called Chris, who needed a scan every 18 months and was having to travel to the Sydney Children’s Hospital at Randwick to have the scans. The other was Dean, who has, sadly, died since that time. Dean needed a scan every six months for the monitoring of his tumour. He was not able to work and relied on the public health system, and had to either be admitted to Wollongong Hospital overnight to access the MRI machine as an inpatient or travel to St George Hospital or Prince of Wales Hospital to access a bulk-billed service. Dean was only in his 30s. He was not a healthcare card holder; he had a young family and had gone from two incomes to one—trying to maintain mortgage payments and not lose the family home—only when his illness forced him to leave work. He could not afford the gap fees of private providers.

Each time the government has announced that a new round of Medicare MRI licences are to be allocated I have urged the minister to make one of these available to Wollongong’s public hospital, both to provide pressure to ensure more local people are able to access bulk-billing for MRI services and also to provide technological support to the work of the specialists who utilise Wollongong Hospital as the major regional referral hospital. In March 2006 the minister responded to my request that the next round include Wollongong Hospital by making the point:

I note that there is a Medicare-eligible unit in close proximity to the Wollongong Public Hospital. While this may not be as convenient for some patients as a unit in the Wollongong Public Hospital, it is able to provide Medicare-funded services for the people of Wollongong.

I do not accept the minister’s dismissal of the issue as one of convenience for some patients. It is my view, and that of many of the specialists located in Wollongong, that private and public services often service different patient groups and that public services often deal with the chronically ill, who need timely service.

The private provider in Wollongong is extremely busy and it often takes several weeks to book an MRI scan. The provider also does not automatically bulk-bill pensioners or healthcare card holders. Only weeks ago I had a pensioner come and see me as she had to have an MRI scan on her shoulder and was asked to pay a gap of $95. As she did not have the money and did not want to delay until she could save it a friend offered to drive her to Nowra to access a bulk-billing service.

Another reason I do not accept the minister’s explanation is that the Department of Health and Ageing’s guidelines for the provision of MRI Medicare licences indicates that the criteria used include:

... a range of demographic and clinical considerations, such as the number of referring specialists in the area.

Wollongong is the third largest city in New South Wales and is the major referral centre for the Illawarra, South Coast and significant parts of the Southern Highlands. Further, included in the criteria is:

The Government has also considered the needs of major hospitals dealing in orthopaedics, oncology, neurology and neurosurgery.

On each of the criteria Wollongong Hospital’s MRI service should have been allocated Medicare eligibility.

The Parliamentary Secretary to the Minister for Health and Ageing repeated the comments of the minister in correspondence I received in September 2006. The parliamentary secretary further made the point:

The Government does not grant Medicare-eligibility for MRI units in public hospitals simply on the basis that one has been installed.

Further, the parliamentary secretary stated:

The Government’s decisions on where to locate these 10 additional Medicare-eligible units were informed by advice from the Department on areas with substantial under-serviced populations. Advice centred around populations of 100,000 to 150,000 people with access to a reasonable number of specialist referrers. It is also considered hospitals providing particular types of services, such as oncology, orthopaedics, neurology and neurosurgery.

Again, Wollongong Hospital is the major regional referral hospital for these specialities. It met all the criteria, except that there was a private provider in the town.

Finally, I want to address that issue. Firstly, I make the point that this private provider has a very limited bulk-billing policy. Indeed, when my office rang them we were told that they did not bulk bill. This causes local people to travel significant distances if they cannot afford the gap fee. Secondly, I make the point to the minister and the parliamentary secretary that there are many precedents in other areas where a licence is held by both a private and a public provider in the same area. A few examples from the department’s own website make this point. In the Hunter area licences are held by both Hunter Health Imaging Service in the radiology department of John Hunter Hospital and by Hunter Imaging Group, a private provider at Cardiff. In Gosford a licence has been held by a private provider, Gosford Radiology, since 1999 and Gosford’s public hospital since the October 2006 allocations. If you live on the North Shore you have even more options. Since 1999 a licence has been held by both North Shore Radiology and Nuclear Medicine at North Shore Private Hospital and by the New South Wales Department of Health’s Royal North Shore Hospital. Then in November 2004 a further licence was allocated to Mater Imaging at the Mater Hospital. In Liverpool a licence has been held by a private provider, Rayscan Imaging Liverpool, since 1999 and by Liverpool’s public hospital since May 2001. People in this area were further serviced by a licence provided to Ultrascan Radiology at Campbelltown in November 2004.

I think it would be obvious from these points that I do not accept that because Wollongong has a private provider with a licence it should be banned from accessing a licence for the public hospital, when the government’s own allocations in other areas have consistently, since 1999, not ruled out the public hospital having access to that licence for the very specific types of services and patients it deals with at the very same that a licence is held by a private provider in that area.

I have no idea whether the Minister for Health and Ageing has made a decision about where those three licences are to go. I do not know whether he intends to announce them in the lead-up to the election campaign as he wanders around the country. But, if he would like a rousing and welcoming reception at Wollongong in that process, I would suggest to him that, finally, after five years of concerted campaigning on behalf of my local community and indeed the specialists who are based in Wollongong, we would be more than happy to see one of those three licences allocated to Wollongong public hospital. I thank the House for its indulgence in that slight divergence from the bill.