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Monday, 21 November 2011
Page: 9091


Senator FIERRAVANTI-WELLS (New South Wales) (20:57): Before the break I was speaking on this amendment and the parliamentary secretary was making comments in relation to the current Leader of the Opposition during his time as Minister for Health and Ageing. She made some misleading comments and I want to correct the record. She was clearly reading from a script that had been written for her by Minister Roxon in what I can only describe as the usual spiteful and vitriolic diatribe we know Minister Roxon for. I will correct and refute the misleading comments that those opposite keep parroting about Tony Abbott's record when he was health minister.

The claim that funding for public hospitals decreased by $1 billion under the coalition government is false. It is wrong, it is misleading and it is a lie. The Australian government's funding for health, including public hospitals, increased significantly under the coalition government. According to the Australian Institute of Health and Welfare, Australian government expenditure on public hospitals increased every year, from approximately $5.2 billion in 1995-96 to over $12 billion in 2007-08. Annual spending on health and aged care by the Australian government more than doubled, from $19.5 billion in 1995-96 to $51.8 billion in 2007-08. Australian government funding to the states under the Australian Health Care Agreements was $42 billion between 2003 and 2008 compared to $31.7 billion between 1998 and 2003, and $23.4 billion between 1993 and 1998. The 2003-08 Australian Health Care Agreements provided a 17 per cent real increase in funding compared to the previous agreement.

The constant misrepresentation of this point by the Australian Labor Party is the sort of thing one expects from a government with a Prime Minister who went to the last election saying to the Australian public, 'There will be no carbon tax under a government I lead.' That was an outright lie to the Australian public, so what else would one expect from this sort of government? It is not surprising that the parliamentary secretary was parroting misleading and wrong information. The government's claims are untrue.

In 2003, the coalition government provided an extra $10 billion for public hospitals in the Australian Health Care Agreements. Funding for public hospitals from 2003 was 83 per cent higher than under the previous Keating Labor government. A change in the growth rate of the Australian Health Care Agreements due to higher private health insurance coverage and other demographic changes was reflected in the forward estimates of 2003. However, public hospital expenditure continued to increase by 17 per cent in real terms in the 2003-08 Australian Health Care Agreements, contrary to the constant false accusations made by this government.

In relation to this, Parliamentary Secretary, I am correcting the record with respect to your misleading comments about Mr Abbott's record. If the parliamentary secretary does not believe what has been put on the record, I refer her to the statistics provided by the Australian Institute of Health and Welfare to me and to other senators during the estimates process both at additional estimates in 2009 and on 10 February 2010. I particularly refer the parliamentary secretary to question E10-407, which provided information to me which I have already put on the record, and question E10-408, whereby documents in relation to this data were provided to me. Those documents have also been put on the record.

I really thought I should correct this situation, because it is typical of this government to constantly trumpet false and misleading information in relation to the time when Mr Abbott was health minister. Parliamentary Secretary, if you are going to come in here and give us this sort of diatribe, get your facts right. Your facts are drawn from what your government has put on the record and they are as I have stated—that is, your claims are absolutely and totally false, misleading and wrong, and it is a lie that funding for public hospitals decreased by $1 billion under the coalition government.

I now return to the coalition's amendment. I was talking about some of the evidence that Catholic Health Australia provided in relation to this. In his evidence to the committee, Mr Laverty pointed out issues pertinent to non-government owned providers of public hospital services and he stated:

... we have to account for capital, depreciation, insurances, council rates, long-service leave and information technology, even down to whether or not a Microsoft licence per user is applied to each cost of patient admission. Different states and territories use different accounting systems, which affects whether or not these various components will ultimately make their way into what is an efficient price. For an NGO provider of hospital services, all of these form the component of what is the price or the cost of delivering a service. Some states and territories account for these things differently; indeed, within states different areas at present can account for them differently.

Coalition senators believe that this experience and perspective should be reflected in the pricing authority legislation. In further evidence to the committee, Mr Laverty stated:

... we argue that the governance of this new authority should allow for the appointment to its board of someone who has experience in the delivery of NGO hospital services.

Just as clause 144 of the bill requires that at least one member of the authority has substantial knowledge or experience in the provision of health care in regional or rural areas, coalition senators support the submission of Catholic Health Australia that non-government hospitals should also be guaranteed representation.

I will now highlight in general terms some other aspects of this bill. Clearly, this bill does not match the rhetoric of the health minister and the former Prime Minister from the time the Independent Hospital Pricing Authority was first mooted. Whilst this new authority is supposed to set the national efficient price for each activity conducted in hospitals, that price will only be a guide to the Commonwealth's contribution to growth funding for public hospitals. As was pointed out in one of the submissions to the Senate inquiry, the bill needs to be understood for what it does not do. It does not set a nationally agreed public hospital payment. As Catholic Health stated:

It is therefore understood that whereas the authority will determine a national efficient price, it will remain a responsibility of state and territory governments to determine the actual amounts paid for hospital services. There may not be certainty on how much the states or territories will actually contribute.

So, as far as the states are concerned, the national efficient price that will be set by the pricing authority will only be advice. It will not be binding on them. The payments that the states make to their local hospital networks could be above or below that price—it is at their discretion—which will mean that all that rhetoric about ending the blame game means absolutely nothing. Australians were told that this grand hospital reform would end the blame game, but I point the Senate to the Bills Digest which says:

It is likely that debates about the adequacy of public hospital funding by each level of government will continue for some time.

That means all the hollow rhetoric about ending the blame game means absolutely nothing.

The COAG communique of April last year also had another commitment about the pricing authority that was to end the blame game. The communique makes reference to that, not that it is unexpected—another commitment that appears to have disappeared when this bill was finally brought before the parliament. I refer to the Bills Digest's assessment on this particular point. The digest says the bill empowers the pricing authority to investigate and define cost shifting and cross-border disputes, but then the digest says:

It is silent, however, on what actions jurisdictions must take if they are found to be complicit in either cost shifting or in a cross border dispute. In the event of a cross border dispute, the IHPA may provide advice to the Commonwealth about funding adjustments to relevant jurisdictions.

It goes on to say:

The Commonwealth has limited powers with regard to the operation and management of public hospitals and is unable to compel a jurisdiction to make payments to other jurisdictions or to alter their policy settings.

As the digest correctly points out, this would appear to undermine transparency and the extent to which these disputes can be resolved.

There we have it—empty rhetoric. The blame game will continue and there is nothing that can be done in relation to price shifting. Throughout this odyssey of grand reforms under both the Rudd and Gillard governments, all these measures have been trumpeted to the public as increasing transparency, accountability and all sorts of things. It is very clear that the stakeholders do not agree with this. Throughout the submissions this perceived lack of both transparency and accountability of the pricing authority was very evident. For example, the Australian Private Hospitals Association in its submission says:

APHA believes these provisions fall a long way short of the practice of the board of the Reserve Bank of releasing its decisions and its monthly minutes publicly with no prior commitment by the executive.

So, when making the comparison with other disclosure regimes, it is very clear that this authority falls short.

The other main concern in the submissions was the burden of compliance on hospitals. The Heath Care and Hospitals Association—the peak body of public hospitals, which will be affected by the pricing authority—warned in its submission that the government must take care because the authority's decisions would have immediate and wide impacts on hospital services. In my previous comments, I mentioned duplication or even triplication. As the Australian Institute for Primary Care and Ageing stated:

There is very little integration between the statutory bodies. There is a risk of duplication or even triplication, which could create a significant burden for health services. Their isolation from each other is counterproductive.

These are comments which the coalition certainly agrees with. (Time expired)