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Monday, 18 November 2002
Page: 6634


Senator CHRIS EVANS (6:06 PM) —I rise to speak on behalf of the Labor Party on the Health Insurance Amendment (Professional Services Review and Other Matters) Bill 2002. I foreshadow that I will be moving, on behalf of the ALP, an amendment at the committee stage that removes an age based inequality relating to cleft lip and palate sufferers which the bill perpetuates in the Health Insurance Act. This bill makes some technical improvements to the implementation of the Professional Services Review Scheme as well as increasing the age past which people who suffer from cleft lip or cleft palate can claim Medicare benefits for their treatment. However, the government has, unfortunately, not seen fit to remove the age barrier entirely or to allow all those who need further treatment for cleft lip or cleft palate to claim Medicare benefits rather than just those who happen to be under 28 years of age.

Before talking further about the proposed amendment that the ALP is seeking to have inserted in the bill to correct this inequality, I will deal with those parts of the bill that change the application of the Professional Services Review Scheme. The bill amends the Health Insurance Act 1973 to clarify the operation of the professional services reviewed in the PSR Scheme. This is the scheme which regulates fraud and inappropriate practice, in particular overservicing in relation to medical services. A major focus of the Professional Services Review Scheme is to prevent, detect and investigate fraud and inappropriate practice with regard to medical services for which a benefit has been paid under Medicare. Under the PSR Scheme there is a stage process in which statistically high servicing is investigated and any resultant clinically inappropriate practice identified.

The amendments contained in this bill seek to fix the problems identified with amendments passed in 1999, which were the subject of legal challenge. The amendments relate to five main areas. These include the objects and outline clauses, which are tightened, and the investigative referral process, which is replaced with a request process. A formal review stage is included, which follows on from the investigative referral request, and the the need to particularise the conduct of medical practitioners and its effect on jurisdiction is clarified, and there is increased procedural fairness protection at various stages. These amendments are all technical in nature. They are designed fundamentally to ensure that the investigation of fraudulent and other inappropriate medical practices is not subject to legal and administrative challenge. Labor is not aware that members of the medical profession or its representative organisations, such as the AMA, have raised any concerns relating to the provisions of the bill. On that basis, and because they strike us as good policy, the ALP supports them.

The other area this bill amends relates to cleft lip and cleft palate sufferers. The bill seeks to amend the Health Insurance Act 1973 to extend the Medicare eligibility for cleft lip and cleft palate sufferers who have been certified by the minister before their 22nd birthday, allowing them to claim until their 28th birthday. Medicare treatment is currently available for a prescribed dental patient, defined in this context as a person under 22 years who suffers from a cleft lip or cleft palate condition that has been certified by an approved doctor or dentist. The bill will extend this definition to persons under 28 years of age who have been certified as suffering a cleft lip or cleft palate condition before their 22nd birthday. The extension of the age limit to 28 is in recognition of the fact that the jaw continues to grow up to this age. The opposition supports that measure. However, we argue that it does not go far enough. More specifically, we argue that it creates inequalities based on age alone.

The amendment excludes Australians who were operated on as children to correct cleft lip and cleft palate but who now need further medical care. It takes into account those who need treatment throughout the period of the maturing of the jaw, but it does not take into account a range of other sufferers of cleft lip and cleft palate; namely, those who need further treatment after age 28 because of complications and those whose lives would be significantly enhanced by the superior modern techniques that were not available to sufferers 30 years ago. Thus, we believe the amendment is inequitable because, if passed, the small number of Australians who are aged over 28 years but who suffer ongoing discomfort or disfigurement because of their childhood cleft lip or palate condition cannot claim Medicare benefits for further treatment.

The Labor Party has listened favourably to the arguments put by Cleftpals, which is a volunteer support group for people born with cleft lip or cleft palate and their families, that a small number of Australians born with this condition will continue to need treatment after the age of 28. This small but significant class of Australians—perhaps only a few hundred—who are arbitrarily cut off by virtue of their age from Medicare funded treatment may be unable to afford the more advanced clinical procedures now available. The extension of the cut-off period to the age of 28, contained in schedule 2 of the bill, will not help those people who have been unable to access more advanced clinical procedures simply because they are over 28 years of age.

The government have estimated that the amendment, as proposed in their bill, to increase the upper age limit for cleft palate treatment will result in `only a small financial increase to Medicare'. The explanatory memorandum does not quantify the amount of the increase. It states:

The Department has been advised that a minimal number of existing patients would require continuing care beyond that which is now provided.

In extending the availability of cleft palate treatment to persons aged over 28, the government acknowledges that there will be some additional costs to Medicare but that they will not be substantial. However, the government has failed to quantify what these additional costs will be, let alone tried to justify the cut-off age of 28 by reference to any estimated cost of extending Medicare benefits to all those who need additional treatment. The government, having failed to quantify the cost even for those from the age of 22 to 28, has opposed the representations of Cleftpals to extend the age limit for treatment beyond 28.

I want to take the opportunity to quote in some detail from representations made by Cleftpals. Those representations convey the extent of medical intervention some people need—some over a very long period. Cleftpals state:

Any child born with a cleft condition needs many years of ongoing treatment in a wide spectrum of specialist areas however, in some cases dental treatment and some areas of reconstructive plastic surgery may be required throughout the person's life. The level of intervention and treatment can range from minimal in the case of a cleft lip child through to intensive with many years of ongoing speech therapy, palatial surgery, orthodontic work, dental procedures, bone grafts, hospitalisations and countless hours spent in appointments and check-ups.

It goes on:

... many cleft affected adults express despair at the inability to afford essential dental and orthodontic treatment, which is directly a result of their cleft birth defect, many problems are related to dental deterioration and includes the use of implants to strengthen bridgework. Many of these adults have had treatment over 25 years ago when reconstructive maxillofacial plastic surgery and dental treatment was not as advanced as the services cleft affected children in Australia receive today.

Because it would require additional financial cost to the Commonwealth to extend treatment to those beyond the age of 28, I will be seeking to move an amendment in the committee stage which seeks to broaden the entitlement and carry through the logic of the argument I have put today. The thrust of the amendment will be to support the new categories of cleft lip and palate sufferers who can become Medicare beneficiaries under schedule 2, and to extend treatment beyond the age of 27 if certified and determined by the minister. The public policy rationale for this is that, by the government's own admission, the financial implications for the health budget are very small, yet the personal and financial implications for those aged over 28 who may need further treatment for their inherited condition of cleft lip or palate are great because of the amount of intervention that is needed in some cases.

In general, I compliment the government on the bill that has been put before the Senate. It makes necessary improvements to the efficacy of the Professional Services Review Scheme. It also increases the number of people suffering from cleft lip or palate who can have Medicare-supported treatment. This condition is a terrible affliction for the small number of people who suffer from it. However, the consequences for the taxpayer of assisting all sufferers regardless of their age are, in the scheme of things, relatively small, hence the argument for our amendment. As I said, we will move that amendment during the committee stage of the debate, but I commend the bill to the Senate.