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Wednesday, 25 March 1998
Page: 1608


Dr SOUTHCOTT (10:06 AM) —I wish to briefly address two areas that the Health Legislation Amendment Bill 1997 touches on. The bill amends the Health Insurance Act and allows for the claiming and payment of Medicare benefits by means of electronic transmissions. One of the problems with the processing of Medicare claims is that, until now, the Medicare claims have only been available for practitioners who directly bill their patients. Items 1 to 5 of the bill will amend the Health Insurance Act 1973 to allow for the electronic transmission of Medicare claims directly from doctors' surgeries, and payments directly to accounts of patients and also medical practitioners.

Under these new amendments, the Health Insurance Commission will be able to issue a cheque to the patients where the bill has already been paid or a cheque to the doctor where the bill has not been paid. That electronic lodgment of Medicare forms will reduce the payment delays from electronic claiming. The Health Insurance Commission informed the Standing Committee on Family and Community Affairs, in its study of telemedicine and other things, that the commission is able to process claims overnight. However, at present, there is a minimum waiting period of 10 days between the Health Insurance Commission receiving the claim and the cheque being sent to the doctor. This is a sensible amendment which should provide an incentive for GPs to computerise.

Where it is most significant is in the need for Medicare offices. If general practitioners are able to electronically lodge Medicare forms, the need for a Medicare office does decline. Over the last two years, there have been closures of Medicare offices in various electorates and that has been a difficult decision in the community. But this amendment allows for electronic lodgment by the doctor which reduces the need for people to go to a Medicare office. For example, when someone is bulk-billed, the patient signs over their right to the Medicare rebate, their doctor electronically lodges the Medicare form and the Medicare rebate cheque can be posted to the doctor or it can be electronically transferred to a bank cheque account or whatever. If the doctor is charging above the schedule fee, what will happen is that, if the patient pays it at that time, the Health Insurance Commission will be able to either issue a cheque or transfer the funds direct to the patient.

Closing Medicare offices is always a delicate decision and we do need to be fair and reasonable in striking a balance across Australia between providing reasonable access to Medicare and the efficient use of taxpayers' funds. The closures of Medicare offices were decided on broad criteria of minimum disruption to the public, claiming patterns, leasing and property issues, proximity to other branch offices and the capacity to redeploy staff. The government aimed to ensure that the Medicare office network was more responsive to the needs of Australians. Changes in claiming patterns have had an impact on the branch office network. There has been a reduction in patient cash claims as the incidence of direct billing has increased. The Health Insurance Commission, which administers Medicare, was able to advise that many of the Medicare offices which have closed had very high direct billing rates which obviated the need for people to visit a Medicare office.

As I have mentioned, with electronic data interchange, we will have more efficient ways of claiming. That initiative, which was announced in the 1997 budget, is being developed and will now require claims to be directly lodged in the doctor's surgery. Not all doctors have computerised, so this is not available yet, but we are hoping that more and more doctors will computerise so you can have electronic lodgment.

But, if people do not have availability for electronic lodgment, there are alternative ways that they can claim. They can receive payment by cheque or they can receive it directly in their bank account when they lodge their claims by mail, without the need to visit a Medicare office. Alternatively, they can post an unpaid account to Medicare and a benefit cheque in favour of the doctor will then be sent to the patient who adds any outstanding amount before forwarding it on to the doctor. Claiming in that fashion ensures the patients are not out of pocket for the total expense of the medical service.

In my own electorate, we have had the closure of one Medicare office in Blackwood. There is another, closer Medicare office within 10 kilometres down at Westfield Marion, but that has been a decision which I have received an amount of correspondence on.

The second matter that I would like to briefly touch on is the release of de-identified data for research purposes from the Australian Childhood Immunisation Register. The initiatives that this government has had in relation to childhood immunisation are some of the most significant public health measures that we have seen from a Commonwealth government. The Minister for Health and Family Services (Dr Wooldridge) announced the seven-point plan in February 1997 and I understand at present he is just next door announcing an initiative with regard to measles.

As some members will be aware, in 1989-90 the ABS survey showed that 53 per cent of children were fully immunised and, while the levels for people at 18 months were much higher, it was still only 70 per cent, which was not full coverage. If you compare it with countries like China or Vietnam, those developing countries actually have levels above 90 per cent. One of the problems has been the great success of the vaccination programs. Most parents today have not seen cases of measles, mumps, rubella, whooping cough and so on. I might reflect that it is quite unusual to see a case of rubella. When I was doing my paediatrics attachment at the Adelaide Children's Hospital, I actually caught rubella myself. I do not know where I caught it from but, as some people would be aware, it used to be the habit to immunise 13- and 14-year-old women against rubella; of course men were not. Now what happens is that all infants at one year are immunised against measles, mumps and rubella, if we get to them.

In 1996 there were 4,000 children who caught whooping cough, 500 children who caught measles and 2,500 who caught german measles. Whooping cough is a very debilitating illness; it can cause convulsions and it can even lead to permanent brain damage. Regarding measles, one in 25 patients with measles can develop pneumonia; they can also get something called subacute sclerosing panencephalitis, which causes brain damage.

While rubella itself is a self-limiting mild condition, if it is contracted by women in the first trimester of pregnancy, it can lead to congenital rubella which involves babies being born with cataracts and mental retardation and so on. That condition, I might remind the House, was actually discovered by an Australian ophthalmologist in 1939. Norman Gregg discovered that the condition of congenital rubella was contracted by pregnant women. They are the two areas I would like to touch on.

I do commend the government for its initiatives on childhood immunisation. We still have a long way to go. It looks like only 75 per cent of children of 18 months are immunised. The level overall for children has only increased about three per cent. We would like to see it increase a lot more because, without that, you will continue to see the epidemics that we are starting to see at the moment and which we have not really seen for 20 or 30 years.

The electronic lodgment of Medicare claims is a very important initiative because it in some ways means that Medicare offices are now no longer as necessary as they have been in the past. It also enables payments to be made much quicker.