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Friday, 3 April 1998
Page: 1965

Senator BARTLETT (10:34 AM) —I rise to speak to the Health Legislation Amendment Bill (No. 2) 1997 on behalf of the Australian Democrats, and particularly the Leader of the Democrats, Senator Meg Lees, who, as honourable senators would no doubt be aware, has been active in the health area for many years on behalf of the Democrats and would normally be the person addressing this bill. The bill, as has been outlined by previous speakers, makes some long overdue changes to a range of areas in the health system, particularly private health insurance and the private health sector. The Democrats have been concerned for many years about the inefficiency of the private health sector and, in particular, the out-of-pocket expenses associated with private health care.

Back in 1995 the Democrats moved amendments, jointly with the government of the day, to the Health Legislation (Private Health Insurance Reform) Amendment Bill 1994 ensuring that hospitals and doctors were required to inform contributors of out-of-pocket expenses. For many years, the Democrats have recognised that out-of-pocket expenses create a major barrier to people taking out private health insurance and cause significant uncertainty and stress to consumers. On that occasion, the Democrats stated their concern that this amendment did not go far enough in removing out-of-pocket expenses altogether. However, it is gratifying to see that finally the government is today moving down that track.

I should make the point that the government's first responsibility is to manage the public health system. This government has proved inadequate to this task. The public health system is clearly in crisis. Hospital waiting lists are out of control. We are hearing new reports every day of the increasing numbers of unnecessary deaths caused through the underfunding and mismanagement of the public hospital system. The Democrats believe the government would be better served by dealing with the public health crisis rather than by putting more time, energy and money into propping up the ailing private sector.

On behalf of the Democrats, I would also like to take the opportunity while we are speaking on legislation in this area to call for a health audit to sort out the crisis that this government has caused in public health and to have an informed public debate about what Australians want from their public health services. This bill makes amendments in a number of areas, most of which the Democrats support.

Our main concerns are with schedule 2 of the bill. The Democrats are very concerned that schedule 2 could lead to an inequitable financial burden being placed on older people who require nursing home care. Whilst the Democrats support the principle that care not received should not be paid for, we also recognise that the overhead and infrastructure costs in many hospitals are such that it is impossible to provide even basic care for the same cost as a nursing home. The Democrats believe that hospitals should be compensated adequately for the care they provide, but it is even more important to ensure that in the tussles between health funds and private hospitals about who pays for what that consumers are not the ones who lose out.

The Democrats are not confident that schedule 2 will address the costing issue, and we have significant concerns about its impact on consumers. There are a number of issues to be worked out in relation to this schedule, and to date the government has not convinced the Democrats that it has the solution. I also believe that the government has to bear a large amount of the responsibility here. Do not forget that this schedule deals with nursing home type patients, older people who, by definition, should be in a nursing home. A nursing home will provide the level of care that these people need in an appropriate environment. They do not need to be in hospital, and they should not be kept in hospital except as a short-term measure while a suitable nursing home bed is found.

However, as we all know, this government has a dismal record in the provision of nurs ing home care and has failed older Australians in this regard. The government's first priority should be to fund suitable nursing home beds for older people who need them, not to relegate these people to hospitals and then worry about who is paying for this care.

Whilst schedule 2 will be dealt with further in the committee stage of the debate, I am happy to outline in my second reading contribution the Democrats' specific concerns with it. They include: the amount of benefit paid by a health fund once a person has been classified as a nursing home type patient, what protocols will be put in place to ensure that these older people and/or their carers are informed of the assessment and of any financial impact it may have on them, the specific ramifications for people in rural areas and others where there is a severe shortage of nursing home beds available and what provisions there are to ensure that the maximum level of copayment that will be required by an older person once they have been classified as a nursing home type patient is the same regardless of whether they are in a nursing home or a hospital. Older people should not be penalised because the government has failed to provide sufficient nursing home type accommodation.

We are also concerned that there needs to be a clear provision that an assessment will not result in a retrospective imposition of costs and a guarantee that the application of this schedule will not result in older people being forced to leave hospitals once they have been classified as nursing home type patients because the hospital can no longer afford to keep them. That is a reasonably long list of concerns and, I believe, fairly significant issues that need to be addressed. As these issues have not been resolved by the government, the Democrats will be voting to remove schedule 2 from this bill. But, as I said earlier in my contribution, we are happy to support all the other aspects of this particular piece of legislation.