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Monday, 18 November 2002
Page: 6636

Senator ALLISON (6:16 PM) —The Democrats are also supportive of the Health Insurance Amendment (Professional Services Review and Other Matters) Bill 2002, which, as Senator Evans has said, is largely technical. The Professional Services Review has a long and, some would say, traumatic history. The review does not monitor the quality of service a doctor gives, of course, but it monitors the conditions under which doctors bill Medicare. This is an administrative means of controlling Medicare claims. The review process is triggered by assessing in a statistical manner the number of services, prescriptions or referrals a doctor does in relation to his or her peers.

The amendments seek to fix the problems identified in the 1999 amendments. They relate to four main areas: firstly, the objects and outline clauses and the replacement of the investigative referral process with a request process; secondly, the inclusion of a formal review stage following the investigative referral request; thirdly, clarification of the need to particularise conduct and its effect on jurisdiction; and fourthly, the increasing of procedural fairness protection at various stages. The PSR scheme has four tiers. The first three relate to determining where a medical practitioner has engaged in inappropriate practice and the fourth involves the imposition of a sanction. As I understand it, this matter was not referred to a committee. There are a number of questions I would like to ask about how this affects rural doctors and arrangements with regard to specialists. But I will raise some questions during the committee stage of this bill.

The Democrats will be supporting Labor's amendment with regard to cleft lip and cleft palate. Under schedule 3 presently, a prescribed dental patient is a person under 22 years of age who suffers from a cleft lip or palate and has been certified by an approved doctor or dentist. It is also any person who suffers from another condition that has been certified by an approved doctor. The bill extends the definition of a `dental patient' to persons under 28 years who have been certified as suffering cleft palate or lip before the age of 22. It does not attempt to increase the age for people suffering those conditions and, as Senator Evans has indicated, the jaw continues to grow during this period, apparently. This is an important reason for supporting the bill.

We can also see that there are inequalities. In fact, according to the library alert, consultation with the Australian Dental Association has indicated that, while that organisation supports the extension of the age limit to 28 for clinical reasons, the Dental Association also supports the extension of access to the scheme throughout life. This corresponds with the position of Cleftpals, a volunteer non-profit organisation that supports people who are involved with cleft lips and/or palates. Cleftpals maintains that access to treatment over the life span more accurately reflects the clinical needs of people born with cleft lip or cleft palate. This position is informed by the need for some people with cleft lip and/or palate to continue to receive treatment after the age of 28 for their condition. Additionally, Cleftpals argues that those people who initially received treatment many years ago are unable to access more advanced clinical procedures because of the age cut-off. An extension of this cut-off period to the age of 28 will not significantly help those people who have been unable to access more advanced clinical procedures because of age.

The Democrats will be keen to see Labor's amendments. At this stage I doubt that we will have amendments to the bill, but I do know that anyone, whether it is a person with a cleft palate or otherwise, has a great deal of difficulty accessing appropriate dental services. I note that, in Victoria, the waiting list for dental health services has now reached 200,000 people. So it is urgent, I think, that this is solved.

Senator Patterson —Let the states do something about it!

Senator ALLISON —The minister would no doubt say that it is the business of the states but, as we all know, in 1996 that service was cut as a federal program. I look forward to the debate on this bill.