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Thursday, 10 May 1984
Page: 1995


Senator TEAGUE(7.02) —I wish to raise a matter concerning Medicare, and its administration, and in particular about gap insurance and the inability so far for Medicare officers to tell Medicare cardholders when they exceed the limit for personal payments, for which there is provision in the legislation. The Opposition has highlighted dozens of principles for its opposition to the whole system of Medicare-its bureaucratic treatment, its evasion of market-place principles, its trespass upon the civil liberties of ordinary Australians, its inefficiencies, and its inevitable trend to higher costs. However, one of the matters we have criticised in the Medicare arrangements is gap insurance. It is well known-I think it is the only thing that is well known-about gap insurance that if a medical item costs a patient $ 10, Medicare will reimburse only $8.50 of that cost and $1.50 must be borne by the patient. So the personal cost is usually 15 per cent of the schedule fee of any item of medical procedure.

The first objection which the Opposition has made many times in the Parliament is that the Government's legislation makes it illegal to take out insurance to cover the gap. In Australia it is impossible to take out insurance to cover these 15 per cent payments. When the Government was under some pressure because of that prohibition, the Minister for Health (Dr Blewett) said: 'We will introduce a $150 per annum limit for all of these individual gap payments and if any individual Australian has personal costs exceeding $150 in a year, all the additional amounts will be paid by Medicare'. The Opposition objects to even this because it is determined by bureaucracy without reference to the market- place. The Government is acting autocratically. It is taking a figure off a shelf and saying: '$150 is the limit, and only when you exceed that will Medicare pick up the full cost'.

The Opposition's second objection is that this limit has not been accurately publicised in the community. It is still the case that the majority of Australians understand that when a family has personal costs exceeding $150 in a year Medicare will pick up all of those gap payments, but that is not so. The $ 150 limit applies to every individual in the family. Therefore, instead of the $ 150 relating to a husband, a wife and two children, they must in fact incur $600 worth of gap payments in a year-$150 for each individual-before Medicare picks up the full cost of medical items. The cost of this gap insurance for a family of four is effectively $600, and that is about the cost of private insurance in the former schemes for the whole family to be covered for all costs. It is very apparent that this limit, decided bureaucratically, is excessive and is in no way generous to individual Australians. However, this misunderstanding remains in Australia, and Medicare officers have not sought to publicise that there is this burden of the $150 limit on every individual.

With regard to the present financial year, because Medicare was introduced from 1 February there is a $62.50 limit for the five months from 1 February to 30 June. In the next full financial year the limit, presumably, will be $150 or, if the Government is honest, it will be indexed to some higher amount. If an individual Australian incurs personal payments to meet gaps in these five months that exceed $62.50, he can claim that Medicare should pay the full schedule fee for any other item incurred by him.

I have a third objection that I want to highlight tonight and that is that Medicare officers are not telling Medicare cardholders-the individuals, the Australians, the customers-as they come into the Medicare office when that limit has been exceeded. It is quite possible, indeed unless an individual is alert it would be the normal case, that the personal payments of the gap will go on and on beyond the $62.50 in the remaining five months of this financial year.

This past week a case was brought to my attention of a constituent in South Australia-it is one of a number of which I know where a mother was admitted to hospital early in February and, in connection with this admission for surgery, at least eight Medicare claims have been made in the past two months. The gap involved in these several claims has exceeded $62.50 but it had exceeded it quite considerably before the family realised that it was eligible for Medicare to pay all of the costs. When Medicare is confronted with situations like this it says: 'It is your responsibility to do your own accounting. We do not have written into our computer an automatic calculation of when that ceiling is reached'.

My request to the Government and to the Minister for Resources and Energy ( Senator Walsh) who is in the chamber, is that the Government give urgent consideration to requiring Medicare officers to use the computing facilities available to write in a program so that any individual Medicare card holder will be alerted by the Medicare office when that $62.50 is exceeded, and in the normal case, $150. I believe that government would be more open and more honest and would be providing a service to individual Australians, which is what we would expect of an administration such as Medicare.