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Monday, 15 June 2009
Page: 5866


Ms HALL (1:04 PM) —The Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 amends the Health Insurance Act 1973 to enable the Minister for Health and Ageing to determine the maximum benefit payable under the extended Medicare safety net—I will refer to it from here on in as the EMSN—for each Medical Benefits Schedule, MBS, item. The bill creates a mechanism by which the government can responsibly manage the expenditure on the EMSN. I need to state very clearly at the commencement of my contribution to this debate: this legislation does not remove any item from the MBS; all items remain on the schedule. What it does is put a cap on the MBS item which is determined in line with the median cost or charge that is made by specialists. Median cost means that that is the midpoint in the cost schedule. There are some specialists who are charging rather exorbitant fees, but I will come to that later in my contribution to the debate.

As I have already mentioned, the EMSN benefit cap will apply to benefits for MBS items, which will be payable in addition to the standard Medicare rebate once a patient reaches the EMSN threshold. Each patient will be eligible to receive up to the EMSN benefit cap each time they receive a service. There will be no limit on service; each time they will be able to receive that benefit. Once an individual or a member of a registered family reaches the applicable out-of-pocket EMSN threshold, the person is entitled to an increase in the Medicare benefit equal to 80 per cent of their out-of-pocket expenses for that claim for the rest of the calendar year. I am sure that members on both sides of this House are acquainted with constituents within their electorates who fall into this category.

The increased amount of the Medicare benefit payable under the EMSN is commonly referred to as EMSN benefit. A different level of EMSN benefit cap can apply to different EMSN items. The EMSN benefit cap would be a dollar value. For example, an EMSN benefit cap of $100 may apply to one item and for a different item it may be $500. There are three things that I have sought to establish here: (1) no item is excluded from the MBS (2) the caps can vary according to the item number and (3) those people who reach the EMSN threshold will continue to receive a refund equal to 80 per cent of their Medicare benefits.

Currently there is no limit on the amount of benefit payable under the EMSN and a person will receive 80 per cent of out-of-pocket expenses for services, which means that, if a doctor chooses to charge an exorbitant fee, that patient will still receive an 80 per cent refund. One patient may go to a doctor who charges $500 for an item on the MBS and another patient may go to one who charges $2,000 for the same service. This legislation provides for the fact that some doctors are charging three or four times what other doctors charge for the same item number. Taking a midpoint from the example I just gave, the median figure would be $1,000.

This legislation enables the minister to determine the cap on the EMSN benefit, which will be set out in the legislative instruments. The bill will cover 15 obstetric items, which will generate a saving of $451.6 million over four years. As has been mentioned in the debate so far, these savings were part of the 2009-10 budget. The implementation date for the bill is 1 January next year.

As the shadow minister for health and ageing rightly pointed out, one area that will be impacted is IVF. As a member of this parliament, I am very supportive of IVF. Assisted reproduction has helped many people, including people I know—family and friends—to have that much sought after child. This legislation in no way seeks to stop that. The shadow minister gave an example in relation to a woman who underwent eight cycles. She will still be able to undergo eight cycles under this legislation. There is no limit on the number of cycles a person may undergo. If members on the other side of this House are going to argue that the legislation limits the number of cycles, they are misrepresenting the legislation. I emphasise yet again: what it does is put a cap on particular MBS services.

The extended Medicare safety net service will continue for all Australians and for all services currently covered. The safety net threshold has not been changed from the $555.70 for Commonwealth concession card holders and $1,111.60 for all others in each calendar year. It is indexed each year, and will continue to be indexed each year, in line with the consumer price index. The government is not seeking and will not seek to means test access to the EMSN. It seems to me that a lot of the speakers on this debate from the other side of the House have sought to scare people in the community. I find that the approach of the opposition in relation to this has been less than optimal.

Another matter was brought up by the member for Dickson that I would like to touch on. He referred to ophthalmic surgeons. Yes, that is one area upon which a cap will be placed, but he also referred to how that would impact on Indigenous Australians, linking it into private health insurance. I suspect that the member for Dickson should undertake a little research into how many Indigenous Australians will actually be affected by this. The answer would be: next to none. To come into this House and use that as part of his argument shows that he has very limited knowledge of health and very little knowledge particularly of Indigenous health and the needs of Indigenous Australians. I would like him to consult with experts in this area, people who work on a day-to-day basis with Indigenous Australians, to put some facts to the fiction he has been putting forward in the parliament today.

The government chose to put this measure in place, to cap benefits at a level which covers average payments. Reasonable amounts will not be affected. If a person visits a doctor who charges a reasonable amount, an average fee, they will receive a refund of 80 per cent. There is no cycle limit and no items are being removed. Another thing the opposition were touting is that it is going to affect cancer patients, but cancer patients will not be affected.

This measure has been well researched. The government commissioned a review to which evidence was given. The opposite side are saying that those in greatest financial need will miss out on the benefits. It is the patients with higher incomes who are claiming higher out-of-pocket expenses. The review found that for every EMSN benefit dollar paid to patients 78c went to meeting the doctor’s higher fee rather than to reducing the patient’s out-of-pocket expenses. I put very strongly to this parliament that the EMSN is about making services that Australians need more affordable, to enable them to purchase services, to undertake IVF or to have a cataract operation. I would strongly argue that, if 78c of each benefit dollar goes to meeting the doctor’s higher fees rather than to reducing the patient’s out-of-pocket expenses, this scheme is not working in the way it was meant to. Putting the cap in place will ensure that patients benefit rather than doctors. As I mentioned earlier, those who have benefited most from the more affordable services have tended to be wealthier and in a better position to access some of the more expensive services in the first place.

The EMSN did create some problems for the Howard government, who raised the safety net expenditure threshold so that they could reduce the number of people who would qualify for the EMSN and they did that to rein in the cost. We are not doing that; in this legislation, we are putting in place a cap designed to come into play at the average fee point.

I do not support what those on the other side of the parliament have been saying—that this is about stopping women or families receiving IVF assistance; rather, it is about ensuring that they see doctors who charge an average fee. They will still get 80 per cent of the EMSN. This is only about the high end, about doctors who charge exorbitant fees. There are doctors involved in IVF who earn incomes in excess of  $4 million a year—rather a large salary. We support women continuing to receive funding for an unlimited number of cycles and we support all items remaining on the MBS, but we do not support paying 80 per cent when doctors charge exorbitant fees.

I support the legislation and I encourage those on the other side of the House to look at what the legislation does, rather than putting out a smear and fear campaign, as they always do. I encourage them to provide the correct information to their constituents, telling women or pensioners who visit them, ‘Yes, you can still get 80 per cent of your fee back, but you must go to a specialist who will charge a median fee and not an exorbitant fee.’