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Wednesday, 12 May 2010
Page: 3318


Mr LAMING (5:21 PM) —This debate would be incomplete were we not to talk about the other part of the Rudd government’s record in pathology services. No-one in this country—no pensioner, no child and no patient sitting in any GP practice—will forget the Rudd government’s decision to slice, to excise and to remove the ability of a pathologist to charge for more than three services in a single request. This has had enormous financial implications for pathologists and it has had enormous implications for seniors who in particular face multiple testing through pathology. This relatively minor bill, the Health Insurance Amendment (Pathology Requests) Bill 2010,is merely an opportunity to remember the three years of this government’s destructive interference in pathology.

No-one could disagree with the idea that a patient should be able to see any pathologist that they wish, but let’s have a small dose of GP-centered reality, which is that most GPs sit there with a bundle of referral pads from which patients can choose for themselves which provider they wish to attend. Let’s be completely honest that the overwhelming majority of patients walk straight outside the GPs surgery and around the corner into a pathology laboratory and have the tests done. And let’s make one other obvious economic observation, and that is that pathology services are pretty interchangeable. They all have sharp needles, haven’t they? They all sting when they go in. It is not as though you are trying to buy a car or a house. This is so often about a blood test or other kind of test, and when it comes to getting that test the services are often completely indistinguishable to patients that attend them. The services are almost identical except for how comfy the chair is that you sit in when you have the test done. So let’s remember the size and scope of this very unambitious and underwhelming bill that is dressed up in the guise of increasing competition.

The previous speaker, the member for Deakin, talked about $2 billion that is spent every year processing 30 million tests. That is a mind-boggling figure in the Australian health system. It represents 13 per cent of all MBS spending. But do not forget that in pathologists we are dealing with the foot soldiers of the health system, who are often unrecognised and go to extraordinary lengths to deliver services in every corner of this country. If you were to ask me what aspect of pathology services for this country is in most urgent need of reform, I do not think I would be wasting legislative time on only one minor reform enabling a patient to go to any provider they wished. I will give you one priority that is far, far bigger than that: a concessional patient who needs five, six, seven or 10 pathology tests and has a federal government which refuses to rebate the cost of those tests to the pathologist and instead puts the pathologist in the abhorrent position of having to decide whether or not to bulk-bill for the increasing number of tests and increasing expenditure needed to give the care to the patient that Australians expect. That is what the Rudd government did surreptitiously. It introduced an untrustworthy process that it tried to hide and obfuscate which took away the ability of a patient to be a bulk-billed for a test. In doing that, you simply disadvantage the patients who need more tests done.

I recognise in this chamber the private pathologists, because they stood up to the Rudd government. In the last three years, they started one of the most compelling postcard campaigns that we have seen, saying to this Rudd government, ‘What is the difference between the first and the fifth and the sixth and the seventh pathology test?’ There is no difference. They are ordered by a doctor for good reason. Our Prime Minister decided, ‘No, some tests are more equal than others’, but if you remove the ability to bulk-bill those and even remove the capacity of our health system to fund those tests you leave the patient and the pathologist in that awkward position. In the discussion between a doctor and a patient in every corner of this country, the patient would not say, ‘I want to go to a different pathologist’ but, ‘Why can’t I have those tests bulk-billed? Why must I pay an out-of-pocket cost?’ These changes were implemented by the Rudd government in the hegemony they enjoyed when Mr Rudd had a 70 per cent approval rating. This government thought they could get away with it, but is not forgotten today and it is not forgotten in this legislative debate.

Who are we talking about here? We are talking about nursing-home patients, children who might be 13 or 14 and do not qualify as children under the bulk-billing rules for a pathology practice, and patients who have a pension card or a seniors card and who are worried about no longer being eligible for bulk-billing. What is set up is that invidious situation where patients start choosing for themselves not to have a pathology test because of the cost. They make their own decisions not to get the care they need, because they simply cannot afford it. There is a simple principle at play here, and that is that it is obviously the GPs decision how they charge. Some bulk-bill, some do not and some have mixed practices. But in talking about pathologists, I cannot see the justification for Mr Rudd saying, ‘We will not provide an option for those services to be refunded,’ and that is what this government did.

I spoke earlier of pathologists being the foot soldiers of our health system. They are rarely recognised and rarely congratulated, but they often work in large practices to bring costs down and operate efficient services in pathology. So I think it is really important for us to have a look at pathology’s dedication to bulk-billing. Back in 1996, bulk-billing was used for 80 per cent of all services, and in 2010 it still sits at around 80 per cent. That is in stark contrast to other diagnostic imaging, where bulk-billing is at just over 60 per cent; to Medicare, where it sits at around 75 per cent; to general practice at just under 80 per cent; to specialists at 30 per cent; to obstetrics, where it has climbed from 20 to 39 per cent; and to anaesthetics, at around 10 per cent. Pathologists have stuck by Medicare more than any government ever has. They were loyal and they were absolutely determined to make pathology as cost-free as possible to patients, and this is how they were thanked on the other side of the chamber. It was a disgraceful decision at a time when this Prime Minster cared little for the views of people who attended pathologists for their essential care.

I also want to read in exactly what has happened to pathologists while many other benefits have flowed to other parts of the health profession. It is only right to know the context when we consider how they have been treated by the Rudd government. In Medicare payments, we have seen significant growth to the point where, since 2000, we have seen a 77 per cent expansion in payments made to GPs compared to an increase in average weekly earnings of 56 per cent and a CPI increase of 34 per cent. But pathology, with that $1.8 billion that is spent every year, has seen a growth of just seven per cent since 2000.

I will drill back a little further. Since 1996, we have seen an increase in the CPI of 149 per cent and an increase in average weekly earnings of over 200 per cent while pathology rebates have gone down by 4.9 per cent. You can only use improving technology as an excuse for that up to a point. There are bands within which pathology loyally stays to make sure that prices are as low as possible and then, overlaid upon that, there is a Rudd government that rips the carpet out from under pathologists and simply says to Australia, ‘If you have a few tests we will bulk-bill you, but if you have a few too many it doesn’t matter if you are a retiree, a child or on a concession card, we will not allow those services to be billed through Medicare.’

It was short-sighted. It was foolish. It was penny-pinching, nickel and diming, from the Rudd government. That is what we saw in so many cases until they hit the screen and there was a need for a political pre-election escape. Then the money flowed, and we are now learning just how much of that will be spent on wasteful regional bureaucracies. There is no health revolution in this country; there is merely a revolution in the government of health care.

What they have done with pathology is one of the darkest moments in Rudd’s so-called health reforms. We have seen over the last 2½ years very little that pathology can be thankful for. This government in this term had a chance to fix that, to amend it, and make good with pathology, but instead it came up with this piece of minor, flimflam, insignificant legislation about increasing choice for pathology services. It is a great smokescreen. It is a complete tragedy for the thousands of people employed in pathology around this country who devote their lives to serve the people who under the Rudd government are now least able to afford it.