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Wednesday, 12 May 2010
Page: 3337


Mr DUTTON (6:37 PM) —The Health Insurance Amendment (Pathology Requests) Bill 2010 removes the legislative requirement for requests to be made to a particular approved pathology provider for Medicare benefits to be payable. The change will allow patients to access pathology services at any approved pathology provider. It is claimed that this measure will give patients additional choice and encourage price competition within the sector. On the face of it, the intent of this bill seems worthy. The coalition supports patient choice in accessing health care but we note concerns regarding the implementation of this change to pathology referrals. This is a significant change, and proper consideration needs to be given to patient safety and quality of care.

The 2009 budget measure was not subject to consultation. Submissions to the Department of Health and Ageing on implementation of this measure only closed on 22 February, some 12 days after the Minister for Health and Ageing introduced this bill into the parliament. As such, compelling concerns raised by stakeholders were not considered by the government prior to proceeding with this bill. There is variation in the range of services offered by pathology practices, the methods and equipment used and methods of communication between pathology practices and referring doctors. Cost is a very important consideration for patients, but it may not always be the most appropriate basis for deciding on a service provider.

In the minister’s second reading speech she admitted that ‘there are often valid clinical reasons for recommending a particular pathology provider over another’. The minister’s only comment on this issue was to say that the government will continue to encourage medical practitioners to discuss options with patients. That is an entirely insufficient response to a fundamental issue in this legislation. Clinical issues are not the only concern, though. Presently there are clear lines of communication between referring doctors and pathology practices. Pathology practices ensure that results are provided to GPs and other medical practitioners in a timely manner by means of established delivery systems and compatible IT systems. Pathology practices also often have established means of contacting referring doctors after hours and in cases of emergency.

The government has failed to explain how new referral pathways will operate in cases where the pathology practice is unknown to the referring doctor. A lost or delayed result may have very serious consequences for patients and medico-legal implications for the referring doctor. There are over 2,100 collection centres and almost 400 pathology laboratories in Australia. On the available information, there will be no way for referring doctors to trace results if a report goes missing or if the result is delayed. These are issues that the government should have considered and resolved prior to proceeding with this legislation.

It has been noted that similar arrangements already exist for diagnostic imaging. There are differences between pathology and diagnostic imaging procedures, and the number of tests per patient is generally lower for diagnostic imaging. Imaging tests are usually undertaken with the patient present, and the patient is provided with the results. It is also argued that imaging methodology is standard across all providers and, unlike pathology, diagnostic imaging is not as frequently used to monitor chronic conditions or medication treatment. It is incorrect to claim that the process that works for diagnostic imaging will work for pathology services.

The government’s record in health has done nothing to improve the situation for patients. There is growing concern in the community about decreasing levels of bulk billing for pathology. This largely affects older Australians—self-funded retirees and pensioners with fixed incomes. Now faced with a situation of increased patient out-of-pocket expenses, the minister is responding by rushing through another measure. Once again, she has not thought through the detail, and bungling of this measure will affect patient health outcomes. It is irresponsible for a minister of the Crown to announce a policy without having any plan for its implementation. Unfortunately, we have seen the disastrous consequences of such recklessness with the Rudd government’s Home-Insulation Program.

This minister has a long list of bungles of her own. This House, and most Australians, are all too familiar with her bungled handling of health policy, including her baseless cuts to the cataract surgery rebate, the attempted capping of Medicare benefits for macular degeneration treatment, the bungled capping and backflip on Medicare IVF assistance, the cutting of funding for chemotherapy treatment, the complete farce of amending the government’s own midwife and nurse practitioner bill and then withdrawing the amendment and her blatant broken promises on private health insurance. Whilst there might be support for the intent of the bill before us, its implementation looks set to again be a bungled episode by a minister who has not worked through the detail. The minister has introduced a simple bill on pathology referrals without any idea of how it will operate in practice. If this minister cannot get the so called small ticket items right; how on earth can Australians trust this minister—or indeed this Prime Minister—to deliver major reform for our public hospitals?

The Rudd government could not manage a program putting insulation into ceilings. It is no wonder that there is so much concern about their ability to manage the health and hospital system. This will only get worse with the economically reckless Rudd government. The Rudd government cannot be trusted to run a $100 billion health system, and the minister’s inability to be across the detail is on display with this bill today. There are significant unresolved issues regarding the implementation of this measure which the government should have addressed prior to its introduction. The coalition does support measures which improve patient choice, but the government must demonstrate that a different pathology referral process can work and that patient health outcomes will not be adversely affected. A Senate committee inquiry into this bill is in its final stages and will hopefully provide some of the answers and do the work that the minister should have done.

Before I close, I want to address some of the false allegations that were made in an earlier contribution by the member for Dobell in relation to the candidate for Robertson, Darren Jameson. This was a grubby attack by the member for Dobell on the Liberal candidate for Robertson. It was a grubby, baseless attack, and it needs to be addressed. What I can say about Darren Jameson—


The DEPUTY SPEAKER (Ms AE Burke)—The member for Dickson is straying. I did not hear the comments from the member for Dobell, but this is not—


Mr Dutton —They were at length.


The DEPUTY SPEAKER —The member for Dickson will hear me out. This is not relevant to the bill. There are other forms in the House in which this matter can be taken up.


Mr DUTTON —On the point of order, if I might just point out to the House and for your consideration that this is in fact relating to this bill, not just because there was a contribution made in the member’s speech but also because the health insurance amendment bill 2010 directly relates to the issue which is in dispute. The comments that were made by the member for Dobell relate to—


The DEPUTY SPEAKER —If you can link them to the bill then I can see it, but I cannot at the moment. If you can relate it for me then please do.


Mr DUTTON —They relate to a service in relation to cancer and oncology services in this electorate, and that is how it relates to the health insurance amendment bill 2010. Some of the funding in this bill, as I understand it, is provided for these services, including those to which the member for Dobell referred earlier. So it is entirely appropriate that this be addressed because the Liberal candidate for Robertson, Darren Jameson, in a press release said that he was disappointed to learn that the new cancer clinic at Gosford Hospital announced by the Prime Minister was not a priority, is at the bottom of the list and could be some years away from becoming a reality. To quote:

Like all residents on the Central Coast I—

Darren Jameson—

welcome any funding that is directed into health services in that local area and as such I fully support the announcement made by the Prime Minster in Gosford.

However, it’s unforgivable to give false hope to cancer suffers and the impression that this facility was about to be delivered, when in reality the announcement was yet just another photo opportunity for the Prime Minister and the Premier.

Mr Jameson goes on:

I now urgently call on the government for some direct action, to commence discussions with the Central Coast Radiotherapy Oncology Centre …


The DEPUTY SPEAKER —I think the member for Dickson has made his point and is straying from the bill again.


Mr DUTTON —Madam Deputy Speaker, I of course take your counsel. But, for your consideration, this is directly related to the health insurance amendment bill and to that head act. I do think it is relevant to address it not only because of that but also because it was brought up and addressed at some length in a previous contribution, and apparently that was within the standing orders.


The DEPUTY SPEAKER —The member for Dickson, as I said, I did not see it. If the speaker did not take it up with the member for Dobell, I will actually go and view that. The difficulty I have is that if everybody bends the rules then I am left with no rules. Then I am—and every occupier of the chair is—put into an insidious position. But as the first Deputy Speaker—you have copped me, I am sorry—I actually have to set the benchmark a bit higher than the rest. I appreciate what you say. Latitude can happen in debate, but I think we are straying now and I would ask you to wind up if you are getting to that point.


Mr DUTTON —I of course would not seek to cause you any distress. In conclusion, the coalition does support this bill. We do not support grubby attacks like that from the member for Dobell. We have highlighted the concerns in relation to this bill. We hope that the minister heeds the concerns of the industry and of patients. The coalition is about choice. We are about providing better patient outcomes. We are concerned that this is going to be yet another botched attempt by the Rudd government in relation to health. The Rudd government promises so much in relation to health, not just this bill but other measures, and, regrettably, on many occasions, just gets it wrong or simply cannot deliver. They are our reservations and we highlight them again. We support the thrust of the bill but we are concerned about yet another bungle by this minister.


The DEPUTY SPEAKER —I thank the member for Dickson for his assistance.