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Wednesday, 2 November 2011
Page: 12439


Dr STONE (Murray) (10:42): I rise to add my contribution to the National Health Reform Amendment (Independent Hospital Pricing Authority) Bill 2011. Australian communities, whether large or small, are sustainable only if their citizens have access to affordable, skilled and timely health services. This is the same whether we are talking about a small outback community or part of metropolitan Australia. The Australian Constitution does not decisively assign responsibility for the managing and funding of Australia's health sector, so for generations there has been a need to engage federally and with our states and territories as to who pays, who makes the policies, how we coordinate all of that and how we make sure that Australia—as a developed wealthy nation—keeps up with access to the best medical technologies, medicines and therapies to keep its population well.

I am very concerned that this government is in an era where we are seeing mounting costs. We are seeing skills shortages across the health service sector. We are seeing growing waiting lists for both essential surgery and elective practice or surgery. We are seeing a growing divide between the sort of health service that a person in a country community can expect versus someone who is on the tram tracks in a metropolitan centre like Melbourne. I am very concerned that this bill ushers in another part of the new architecture that the federal government has designed under its banner of national new health reforms, but it does not give me or the people that I work with in my rural electorate any great joy in the sense that there will be more efficiency, less red tape, more coordination between the states and access to more funds for the delivery of services on the ground. This bill in fact establishes the Independent Hospital Pricing Authority, the IHPA. It is an integral part of the new National Health Reform Agreement signed by COAG on 2 August 2011. This is the third statutory authority which will be part of the new health reform architecture. We already have the Commission on Safety and Quality in Health Care and the National Health Performance Authority, and now we have the Independent Hospital Pricing Authority, which is the subject of this bill's discussion today.

The IHPA will decide which hospitals will be funded solely by activities based funding and which will continue to be provided with block funding. Those decisions, presumably, will be based on whether the hospitals are small and regional or large and metropolitan. Some states like Victoria and South Australia already have this mix of types of funding. Other states have some elements of activities based funding and block funding.

It is an extremely complex matter for a central agency to determine the number of patients, what level of skills in staff should be represented and what the cost or price should be for a whole range of different health service providers across the country. I am also somewhat concerned to find that, in this new activity based funding or block funding, advice is not going to be binding on the state governments. They will be free to make payments to hospitals at their discretion. This just continues the uncertainty of who pays and when, and the ongoing debates and endless argument across the nation in the foreseeable future. This is a very concerning element.

As the member for Murray on the border regions of New South Wales and Victoria, I am particularly concerned about rural and regional Australia. Our health services are only two and three hours from a capital city, Melbourne, but we have difficulty in finding specialists, particularly anaesthetists, surgeons and psychiatrists, or any of the other essential health service specialists that you take for granted in metropolitan areas. Those difficulties have just recently been compounded, particularly in the Shepparton area, which has been designated as no longer an area of workforce shortage. So, on top of these changes that we will have to take on board, we are now faced with the fact that if a newly arrived overseas trained doctor—or, indeed, a well-established medical practitioner from a metropolitan area—wants to come and practise in the Goulburn Valley, or particularly in the Shepparton or Mooroopna area, they will not have the additional Medicare benefits and the clinic they work with will be financially worse off if it employs these people. I have an enormous concern that the way that calculation was done simply does not take on board the realities on the ground.

I repeat, the lack of specialists is a real problem. We have to wait six to nine months for an adolescent in a desperate situation to get an appointment, for example, with a psychiatrist. We have others having to wait many months for access to dermatologists. We have many people forced to travel to Melbourne regularly for treatments because they just cannot wait for the treatment to be available through visiting specialists or physicians in our region. Yet we have now been designated as not an area of workforce shortage. I am begging the minister to review the situation.

The whole business of the Independent Hospital Pricing Authority must take on board the enormous differences in types of hospitals that have evolved historically in Australia. In the new part of my Murray electorate, the Strathbogie Shire, there are three hospitals or community health centres, one at Nagambie, one at Violet Town and one at Euroa. Both Euroa and Nagambie take in in-patients for acute and other care; however, throughout the entire Strathbogie Shire there is not a single public hospital bed. If you are not privately insured and you have your heart attack in Euroa, you will be waiting for the ambulance to be called and then be transferred—ideally perhaps—to Shepparton or maybe to Wangaratta. The whole process will take well over an hour and sometimes two hours, and obviously the health of that person is severely compromised. That is because there is no public hospital bed in the Strathbogie Shire.

This is a rural based shire and the reason that there are no public hospital beds is that Euroa and Nagambie health centres have evolved out of bush nursing hospitals. Bush nursing hospitals are an unusual species in the hospital lexicon. They were private hospitals, that is true, but community not-for-profit, very much volunteer-supported hospitals that evolved out of the needs of country areas to have their own health services locally. These bush nursing hospitals have now been converted to health centres, but they may not have access to these publicly funded beds. It is a serious problem. Again, I am begging our federal health minister to have an understanding of the needs of such a population and the distances they have to travel to get alternative services because they are not privately health insured. Ours is a low socioeconomic population in the electorate of Murray, with less than 30 per cent having private health insurance. So you can understand that this is a very real dilemma.

It also affects, of course, the viability of the Nagambie and Euroa hospitals if they are forever calling up alternative hospitals to transfer patients whom they could otherwise have quite well served had those patients had private health insurance. I stress that this is part of the complexity of Australia's hospital landscape and I am hoping that this new Independent Hospital Pricing Authority will have sufficient expertise to understand the need to take on board all of those differences. When so-called case management funding was introduced in Victoria nearly 20 years ago now, it immediately came up against these sorts of complexities, and I certainly hope that we do not have to reinvent the wheel and go through a lot of pain and inefficient funding while this Commonwealth government's new authority, the IHPA, works out what it really means on the ground. I am also very concerned that we are going to spend a lot of time and effort via these national health reforms doing things like establishing MyHospitals web access. We are told we have a wonderful opportunity to learn about our local hospitals by going to this new interactive website that will be called MyHospitals. On that you will be able to read about your hospital profile, the services offered, the number of admissions, waiting times for emergency departments and elective surgery, safety and quality. Well, that is terrific in theory; it could be a useful thing. But, if it follows at all the My School website outcomes, this is a seriously retrograde step in terms of 'name and blame' or 'name and shame'. The data can be manipulated so it looks good on a website when the reality on the ground is very different. In terms of the connection between NAPLAN and the My School website—and we are told to anticipate salary bonuses for teachers as a consequence of the My School website—all we can say is that is leading to great despair and inefficiency in the education sector, and now we are told we are going to see that followed by MyHospitals.

I wish this government would, instead of these tricks and window-dressing, actually look at the realities on the ground. Euroa and Nagambie, for example, have no public hospital beds, and Nagambie has no ambulance—it depends on CERT teams. These are volunteers who have trained and now literally save lives when they are called out to deal with, for example, a boating accident where someone has lost a leg or a car accident where a family is trapped and have to have their lives sustained while the fire brigade and, hopefully, an ambulance get there. These CERT teams are now taking the place of professionals because these small local health services are so underfunded and do not have the adequate services that you would expect for communities of such a size.

Some of these are state issues; I acknowledge that. But where is the description of the coordination between the three new agencies that have been announced: the amazing new Commission on Safety and Quality in Health Care, the National Health Performance Authority and, now, the Independent Hospital Pricing Authority? How are they going to coordinate in turn with the states? How are we going to see better outcomes? Or are we simply going to see, as a consequence of the higher costs of running these authorities, greater red tape and a further squeeze on things like our PBS, our Pharmaceutical Benefits Scheme?

I am shocked and ashamed that our country—a modern, developed nation that has survived the global meltdown, the GFC, better than most—is one of the few nations in the world which are no longer going to contemplate putting new medicines and new pharmaceuticals on the PBS list because of the cost. So there may be a fabulous new cure found for some fatal condition that your child or grandchild has, but this government has simply taken away any opportunity for that pharmaceutical therapy or medicine to be put on the PBS. If you cannot afford that medicine and you do not have a house to sell to pay for it, then heaven help you. That is a shocking retrograde step. It is an indication of the fact that the whole health sector is not being properly managed. We are scrambling around, introducing a new website as a panacea. Waiting lists for elective surgery are growing and we are told that we can look at MyHospitals to find out what, for example, Nagambie's hospital profile is, when we might just live around the corner. That is just a nonsense response, and you have to wonder who is in charge of the sinking ship.

Let me mention another area of despair for country people. We had, as you know, divisions of general practice right across the country. The whole country was divided into regions, with funding for various activities, from research to allied health professional service delivery. We are now told they are going to be converted to Medicare Locals—with new lines on the map, the staff thrown up into the air with the new configuration of who works where, and much bigger regions.

Yarrawonga, a big region on the Murray River, are being told they will now be in a region different to Wangaratta hospital, where they get most of their networking, liaising, cooperating and coordinated services. They will no longer be able to work with the same division of GPs in Wangaratta. They will be transferred into a new region where, instead, the major hospital will be Shepparton. That is not a hospital that they have traditionally interacted with, because Wangaratta is of course a much closer option. This is an example of the nonsense that is going on—new lines on maps, more bureaucracy, more red tape and less funding for hospital services on the ground. That is a shame. (Time expired)