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Wednesday, 18 March 1987
Page: 1081


Ms MAYER(6.57) —The Minister for Health (Dr Blewett), in his second reading speech on the Australian Institute of Health Bill, pointed out that the Australian Institute of Heath to be established by the Bill will, among other responsibilities, undertake studies into the provision and effectiveness of health services and health technology. That is the aspect that I would like to deal with tonight. The Institute will bring under one umbrella the assessment of both new and present technology in the health area. That is a very great need. It is important that those assessments are made by a skilled body which is, and which is seen to be, independent; hence the importance of establishing the Institute as a statutory authority. I will refer to the importance of that a little later.

The introduction of new high technology in medicine has many implications for the practice of health care. It has the possibility of providing for better diagnosis of and better treatment for the patient. It has the possibility of balancing high capital costs against lower actual and social costs of treatment, and also the possibility of providing highly profitable procedures to the benefit of medical entrepreneurs. We must be extremely careful that the profit motive in medical practice does not overtake the health care motive.

Technology assessment addresses the issues of effectiveness, safety, need and a whole range of considerations and issues which arise from the possible implementation of these expensive technologies. How expensive these technologies can be, how useful, and just what implications there can be for individuals can be illustrated by looking carefully at a very interesting piece of medical technology, the extracorporeal shock wave lithotripter-which is a pretty fascinating name, I think. It is a machine which can, for the appropriate patients, destroy kidney stones without the need for invasive treatment-or surgery, as it is probably known amongst us non-medical persons. The machine was assessed by the National Health Technology Advisory Panel, which will be supported by the Australian Institute of Health, and found to be effective, safe and, given a reasonable number of patients treated by the machine, cost effective. The machine, however, costs around $3m so that its introduction needs careful consideration. Two have so far been placed in public hospitals, one each in Sydney and Melbourne, and one has been acquired by a private hospital in New South Wales. That leads us to be able to examine directly the difference in costs for patients between public hospital services and private hospital services of the nature of this high and expensive technology.

The machine offers a capacity, under the right circumstances, for a patient to be treated, probably once only, although about 10 per cent of patients come back for further treatment, with an overnight stay in hospital. Even though the cost of each treatment is up to about $2,000 a time, not including any other costs such as the professional costs and the bed day costs, the alternative surgery means a stay in hospital from 11 to 14 days. Because of that and the high cost of surgical beds, it is more costly in total. This piece of high technology therefore offers, for suitable patients, a non-invasive treatment, it frees hospital beds for other patients and provides for a much lower social cost, and personal cost in terms of the cost of lost wages, for patients. However, there are factors in this otherwise rosy picture of which people should be aware and I hope that I shall be forgiven if I go into some rather complex details.

The cost of the machine is such that a special arrangement was made with the States by the Commonwealth to cover its acquisition. In the public hospitals in which it was placed, 60 per cent of the use was likely to be for private patients and 40 per cent for public patients. Therefore, the size of the subsidy and the size of the State contribution was decided by that sort of percentage. If one goes to a public hospital which has one of these machines and is treated as a public patient, the four elements of the cost-the capital cost recovery, the operating cost, bed day cost and professional costs-are totally covered. If one carries basic table private health insurance and exercises one's right of choice of doctor and to be treated as a private patient in a public hospital, one's basic table covers bed day costs and other costs are covered by the hospital system. However, should one choose a private hospital, one's basic cover will cover bed day and professional costs, leaving one with between $2,000 to $2,500 to pay out of one's own pocket to cover the capital cost recovery and operating costs of the machine. That sum is paid by the patient.

That illustrates the extreme care that people need to take in deciding whether or not to go to a private hospital for treatment. They can find themselves, as several of my constituents have found, with a bill they did not expect, which was beyond their capacity to pay and which left them in a very poor situation. I believe that it is necessary that doctors, and patients also, take the responsibility of inquiring about the cost of any treatment suggested and ascertaining the full cost of the treatment before agreeing to it. This shows no clearer illustration of the care needed in determining the use of high technology in health care. While it can offer a more cost effective way of dealing with a condition, the capital costs of such technology demand some real knowledge base upon which to determine usage. There are about 3,000 cases a year of people suffering from a condition which can be treated by lithotripsy. Should the machines be allowed to proliferate, the need to recover capital expenditure and the high operating figure would see treatment costs soar to very dizzy heights and would see a demand that Medicare health insurance should cover those costs. It could distort the costs of the health system, and I think that in some cases already has.

Equally, the real necessity for an independent body to carry out any health technology assessment, among other functions described in the Bill, can clearly be seen. That technology at $3m a machine is a serious investment. We need to be quite certain that it is a proper investment to be made either by the public system or by any private health care system. It is essential for patients to know that new technology has been independently assessed by a body which has the capacity to employ highly qualified personnel, has a database adequate for its research and is independent from the sectional considerations of political or professional bodies. In the light of the speech made by the honourable member for Barker (Mr Porter), I would say that it is very essential that it should be independent of political bodies. Not only is the high-tech end of medical treatment dealt with in this part of the Bill, but clause 5 (1) (e) reads:

to develop methods and undertake studies designed to assess the provision, use, cost and effectiveness of health services and health technologies.

This clause also covers those technological developments such as those in pathology which are basically high-volume, low-cost procedures. It will be possible for the institute to investigate the issues of safety, quality control and cost associated with the use of automated blood testing outside specialist pathology laboratories, given proper accreditation procedures. It would seem that since the action taken by this Government to correct some of the faults found with the system of pathology by the Joint Committee of Public Accounts, with proper accreditation procedures and proper study by an independent body, such as the Australian Institute of Health, which is set up by this Bill, one could be looking at the possibility of a medical clinic doing blood testing of a particular sort and being able to inform patients very quickly and to speed up diagnosis and treatment.

The Institute will provide an independent body with the responsibility of providing a far clearer picture of health services in Australia. It is very greatly needed as we have a very complex health system with its mixture of Commonwealth and State funding, public and private hospitals, salaried and private practitioners of all kinds and health services in both the public and private sectors-not to mention two systems of health insurance for varying sorts of possibilities that may occur. If the Government is to develop policies to increase the overall health of Australians and to decrease the incidence of preventable diseases, those policies need to be based on the best possible data and research. That data collection and research not only needs to be very good, but also the direction of the research and the use of the data should be both independent and carefully protected.

It is a common and in some ways reasonable saying that our health system deals almost exclusively with illness, although the Minister for Health has made strenuous efforts to be just that, with many preventive programs which have been either established or supported under his ministry. If there are aspects of our health care system which are not providing good health care for Australians, but rather providing good or unnecessary illness care, if our system allows medical over-servicing, as I believe a number of inquiries, particularly the Public Accounts inquiry, has found, we need to know-not via sectional interests, by those who have a barrow to push, but from somebody who is totally independent of both Government and outside associations-exactly what the nature of our health care system should be. There can be nothing that is worth better advice than the health of Australians. There is nothing sillier than to suggest that setting up a statutory authority so that we have an independent assessor and researcher into the health of Australians is something to be frightened about. I rather think that the honourable member for Barker likes setting up aunt sallies so that he can throw a few coconuts, but I firmly believe that the health of Australians, the adequate, effective and least costly choices in the treatment of their illnesses, are very important matters. Australia is spending $16 billion a year on health care. We should be asking ourselves whether that money is spent cost effectively. We know that in some cases it is spent very much to the profit of individuals rather than to the good health of patients. Even if the patients acquire good health in the long run, it is usually as a side issue rather than as a major motivator.

I think we should look at exactly what this Bill asks the Australian Institute of Health to do. In Part II, which deals with the establishment, function and powers of the Institute, there are some very interesting considerations. I have already dealt with one clause and I wish to bring up a couple of others in the time that is left to me. Clause 5 (1) (f), which deals with the power to conduct and promote research into the health of people in Australia and their health services, gives the Institute a function which is extremely valuable. We want to know whether Australians are healthy. We want to know how they are healthy and what makes them unhealthy. We want to know the most effective treatment for ill health and how to prevent them from becoming unhealthy again. The Institute of Health, with that function, will prove very important to us all in the future.

Sub-clause (k), which talks about making recommendations to the Minister on the prevention and treatment of diseases and the improvement and promotion of health and health awareness of the people of Australia, is something that we must take extremely seriously. In the past we have had campaigns, and we will probably have them in the future, dealing with various issues of health care, such as diet, the prevention of transmissible diseases, the importance of exercise and the importance of diet in maintaining health. What we need is some very clear picture of what makes a person healthy, what encourages ill health in a person and how we can best get a person back to a healthy state after he or she has had some unavoidable illness. I believe that this Bill sets up a very important addition to Australia's capacity to deal with its population, to deal with making policies which are beneficial to Australians and I would commend the Bill very highly to the House. I believe that it is a step forward that we should have taken long ago. I am very glad that we are taking it now and I find the Opposition's difficulties about statutory authorities much more political than real in their basis.

Debate (on motion by Mr Cadman) adjourned.