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Wednesday, 18 March 1987
Page: 1079

Mr PORTER(6.44) —The coalition opposes the establishment of yet another statutory authority, this time through the transfer of the Australian Institute of Health out of the Department of Health to have it become a new statutory authority. We oppose it because the Government has provided no valid reasons for its transfer, it is unnecessary and it will be costly.

This legislation is not establishing a new body for the collection of health data and co-ordination of research in public health and health services. Rather the Government's objective is to transfer the existing Institute from the Department of Health and to provide it with the status of a statutory authority.

There is no doubt that it is extremely important to have this data. For too long we have been denied the information about our health system which we, as policy makers and legislators, need to have to make informed decisions regarding the critical issues such as priority setting and resource allocation. The Opposition recognises that a comprehensive information base is an essential resource in health planning and policy formulation and, more critically for the States, in program management and evaluation. Timely and reliable data are needed at Federal, State and local levels on the health status of the population, the availability of health resources, the accessibility and use of services, the cost of services, and the quality and outcome of care rendered.

The Better Health Commission examined the state of available information about Australian health care and found that in comparison with like nations we ranked middle of the range in health surveys, second last in gathering usable vital statistics and last in information about our hospitals. The Better Health Commission bypassed the Department of Health and the Australian Institute of Health and recommended establishing a national centre for health statistics. It did, however, recognise the need for a national capability dedicated to research into health statistics, the gathering of pertinent health data and the generation of meaningful and useful reporting systems.

The case for a central health data gathering capability has been well established and we believe the establishment of the Australian Institute of Health was for that purpose. Nevertheless, we strongly object to enshrining the Australian Institute of Health in yet another statutory authority. We view this move as a costly and unnecessary growth in the size and the complexity of government. The Commonwealth Government already has over 500 statutory authorities, and the Minister for Health (Dr Blewett) himself has provided no valid reasons why we should agree to the establishment of yet another. In his second reading speech the only reason given for the transfer was in the following two sentences:

The Institute will be dealing with highly sensitive information relating to private health related organisations, the health of individuals and the financial position of States and Territories. It is therefore vital that the Institute be independent and be seen as independent.

So said the Minister in his second reading speech. There are a multitude of ways in which the independence and protection of privacy can be ensured without going through the expensive process of establishing a statutory authority which, like all statutory authorities, over time would feel compelled to expand and require more funds. The National Health and Medical Research Council is an example within the Minister's portfolio of an organisation which, though not a statutory authority, has, with assistance provided from the Department of Health-for example in the allocation of research funds-been an independent adviser to Government.

Another alternative would be to assist in the establishment of a real centre of excellence in this field of research into public health and health services. Examples such as exist in the research area come to mind as the sort of independent institutions one might use as a model. I cite, for instance, the Walter and Eliza Hall Institute, the Howard Florey Institute and the Baker Institute. If we want quality public health research let us aim for the best rather than the worst. A Government statutory authority is not the way to go. The Minister may want such an authority to give his cronies a job, but we will not support him.

Only three months ago the Minister published the Department of Health annual report for 1985-86 which outlined the Australian Institute of Health's activities. No indication was given then that the Institute was failing to meet its goals, but suddenly, three months later, this proposal for a new statutory authority is dumped on us. I say to the Minister that he will have to do a lot better than that to convince us that we need yet another Commonwealth statutory authority. I do not believe that any problems of confidentiality or independence cannot be solved by providing certain legislative protection. Certainly, the establishment of a statutory authority will not provide protection for the safekeeping of highly sensitive information, as we have seen with the leaking of highly confidential Health Insurance Commission Medicare data during the Government's dispute with the New South Wales doctors. On that occasion the data appeared on the front page of the Sydney Morning Herald.

The Minister in his second reading speech admits that the establishment of an independent statutory authority will mean that additional requirements of a statutory authority will have to be met, and this will inevitably mean extra costs. If this can be met within existing staff arrangements, it simply means that the existing arrangements involve an element of overstaffing which should be immediately corrected.

Another issue of concern to me is the ability of existing statutory authorities within the Health portfolio to act as a law unto themselves. I refer, for example, to the Health Insurance Commission. The Health Insurance Commission's annual report, tabled last month, notes no less than 17 breaches of the various laws, including the Health Insurance Act, the Health Insurance Commission Act and the National Health Act. These breaches occurred in a number of different areas. The Health Insurance Commission is involved in both private sector activities performed on behalf of the premium paying members of Medibank Private, and the public sector activities which the Commission performs on behalf of the Government, namely, Medicare and the Australia Card. It is therefore necessary to allocate operating and capital costs between these private and public functions. The Health Insurance Act requires the Minister to establish in advance the principles and procedures for the allocation of expenditures between the Commission's two functions. The Minister for the 1985-86 year gave himself, in violation of his own Act, the benefit of seeing the final figures before deciding how they should be apportioned.

The reason that the law sets forth this provision is a matter of good accounting principles. Apportionment of costs between lines of business requires prospective determination of a statistical base so that the integrity of that statistical basis can be assured, and so that the final apportionment is not influenced by the outcome of the total expenditures. Last financial year the Minister waited for more than three months following the close of the fiscal year before deciding on the method of cost apportionment. The apportionment of costs we are talking about here is not simply apportionment between various governmental instrumentalities, but between public sector and private activities, between tax revenues and premiums paid by privately insured citizens. This a serious breach of the law, but one which goes virtually unnoticed because it occurs within the confines of a statutory authority.

Honourable members will be interested to know that some of these breaches involved the Government's accounting for the costs of the expenditure of the Department of Health on the ID card. This is an inauspicious beginning for a project which, whilst doomed to failure, is touted by the Government to be the touchstone of economic moral behaviour, striking fear into the heart of the tax cheats and bringing the dole frauds to account. The Government's efforts to clean up the rest of the country would be much more believable if the very department responsible for the Australia Card were capable of following the rules set down by law for its own economic and accounting behaviour.

For the last two years the Health Insurance Commission has also violated the Act by spending moneys in excess of the appropriations authorised by Parliament to pay for the cost of medical services under the Medicare program. In 1986 it was over $90m; in 1985 it was $187m-that is, $187m was spent in excess of the appropriations. These over-expenditures were predictable, but once again the Minister has violated his own Act and avoided public scrutiny within the shadows of his statutory authority by subsequently appropriating funds. The Department of Health has also abused the statutory authority status of the Health Insurance Commission by concealing certain information of definite public interest from the scrutiny of the Freedom of Information Act behind the skirts of the Commission's statutory authority status.

I conclude, therefore, by saying that the role of statutory authorities in the health area under this Government has been abysmal. Costs have risen when we were told they would decline, and there have been flagrant and consistent breaches of the law. Whilst we support the need to establish a national health data base, the Government has not justified its desire to transfer the Australian Institute of Health from the Department of Health to a statutory authority. Finally, I am disappointed that the Government has adopted this cavalier attitude to research into public health and health services. This is the sort of area where a Commonwealth initiative, in assisting in the establishment of a centre of excellence in research, would have been worthy of bipartisan support. The Government has made no such approach to the Opposition. Instead, we have a shoddy excuse for the transfer trotted out in a brief second reading speech. It is not good enough and is clearly yet another area in which we will have to act after the next election to clean up the mess the Government is making.