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Tuesday, 30 August 1994
Page: 597

Senator KNOWLES (5.23 p.m.) —Today we are debating the Human Services and Health Legislation Amendment Bill (No. 2) 1994. As Senator Patterson and Senator Lees have said, it seeks to amend a number of services being provided to people throughout Australia.

  The area on which I wish to focus has predominantly to do with problems in the provision of rural health services because I have some real concerns about this legislation which I seek to have alleviated by the minister during the course of this debate. While the coalition supports the bill, I have concerns with respect to some aspects of the area of pathology reform.

  The changes to pathology services will be implemented through necessary amendments to the Health Insurance Act 1973. With these amendments, pathology services will not attract a Medicare benefit unless the pathologist has arranged for proper supervision of the service, and the question of whether or not proper supervision is occurring will be decided in accordance with written principles set out in determinations which can be disallowed by the parliament.

  I seek some assurances from the minister in this regard because for a number of years I have been concerned that rural health services and the maldistribution of practitioners, including specialists, in Australia have been of great concern to health planners and providers. What we saw in recent years with the pharmacy restructuring authority would lead to more concern as well.

  The bill before us will allow the minister to influence the location of pathology centres to ensure, supposedly, that remote or economically disadvantaged areas will have access to pathology collection centres. Those two things combined are flashing a few lights in my mind: are we going to be making it more difficult or are we going to make it easier for those in the country to have greater access?

  According to the bill's explanatory memorandum this change will `alleviate hardship caused by the commercial decisions of pathology practices in locating their collection centres'. I hope that the profession is not hand-balling this across to the government and getting the government to make hard decisions.

  Invariably when government buys into the final decision as to where something is going to be located some of those communities are very seriously affected. Under the new subsection 23, the minister will be required to allocate annually to each person who is an approved pathology authority individual units of entitlement to operate licensed collection centres.

  Three mandatory provisions will apply, and they are: firstly, the formula for calculating units of entitlement for approved pathology authorities; secondly, the circumstances under which units of entitlement can be varied and the formula for calculating such variations; and thirdly, the number and location of licensed collection centres operable under a unit of entitlement. At first blush this seems to me a very helpful move, but history certainly shows us that government intervention in areas of locating medical services—whether it be a collection centre for a pathology authority or a pharmacy—has been fraught with a lot of danger. During the pharmacy restructuring time in Western Australia a number of pharmacies closed and in some cases people had to travel for hundreds of kilometres before being able to have access to their first pharmacy.

  Having sat through all of the public hearings of this particular committee that looked at the pharmacy restructuring authority, I am concerned that we do not set up a system whereby similar problems will occur again. The rationalisation of pharmacies was certainly highly problematical. The aim of the scheme was to restructure the pharmaceutical program whereby rationalising the number and distribution of retail pharmacies throughout Australia was thought to be beneficial. What developed during that time was that a few pharmacists—and I have to say a very few—decided that they could make a quick buck out of it and blow the patients. It did not matter what the patients had to suffer as a consequence.

  The legislation was flawed. I am very keen to make sure that this legislation is not flawed. There is always the question of who is going to be responsible for the accuracy of information on which the minister makes the decision. That was an issue that applied to the pharmacists and is bound to apply to the question of pathologists as well. It is my fear that this could happen in remote areas where there is insufficient feedback, and those areas will either gain or lose collection centres purely at the decision of the minister who may well have never visited that area and may well not know whether it is a developing area or not. Once again I speak from experience of the way this has happened in many country centres throughout Australia with the pharmacists.

  There may also be loopholes as there were with the restructuring of pharmacies because, inevitably, loopholes lead to rorts. The inherent danger is when the medical professions, or people in any business, get into bed with the government. I think we should be very much aware of those dangers to make sure that that is not going to happen as well.

  Australia has a huge problem in attracting suitable health personnel to the rural communities and retaining them there, and this is now becoming a long-term problem right throughout the country. It is one that has to be addressed very quickly because it is really getting to the stage now where many of those country people are having difficulty accessing a variety of medical services. A number of those rural areas have experienced, and continue to experience, difficulties attracting the adequately trained general practitioner, particularly to isolated areas and to areas where sole practice is involved.

  If we take an area such as the remote parts of the north-west of Western Australia, that is particularly so. Therefore, we have to be sure in any legislation that is passed through this parliament that there will not be further disincentives put in the way of making sure that there is access for those country people to a range of medical services. While many of them would simply love just to have a general practitioner, we have to be aware that a lot of those country people have no access or little access to specialist facilities, and I categorise pathology as one of those very specialist facilities that are desperately required.

  When we look at the whole area of general practice, we see that the professional difficulties faced by the rural general practice work force have been well canvassed through many major reports. It has been highlighted again and again. In fact, I am not too sure, Mr Acting Deputy President, whether it was you who raised this particular issue about country rural medical services the other day in the parliament, because I know that you too have a great interest in the facilities and services provided to country people throughout your state of Queensland, as I do in Western Australia.

Senator Newman —Victoria!

Senator KNOWLES —Sorry, Victoria. Never mind; it is warmer up there. It will do your health good for the time being. The difficulties identified as affecting rural general practice, for example, include longer hours, lack of support, lack of access to backup and specialist services, greater levels of procedural skills required, lack of suitable and continuing medical education courses and a lack of suitable and available locum relief for recreational purposes. That is why, once again, I look at some of these areas and say, `Well, hold on. Do we create a problem in this area by further restricting them?' I am not asserting that in categorical terms. I am genuinely seeking an answer to make sure that this is not going to happen in this area with regard to pathology.

  It is a very heartfelt issue for many people in the country who have consistently over many years raised this subject with me and really want very serious and concrete assurances that they are not going to be further subjected to a loss of facilities and services in their areas. With those few comments I ask the government to consider very carefully the plight of rural people and the availability of the services that are going to reach them.