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Tuesday, 8 March 2005
Page: 89


Senator ALLISON (Leader of the Australian Democrats) (6:39 PM) —I move Democrats amendment (1), the only amendment on sheet 4524:

(1)    Schedule 1, item 12, page 10 (after line 6), after subitem (1), insert:

(1A)  The review must include:

              (a)    an assessment of the adequacy of informed financial consent arrangements; and

              (b)    an examination of the extent of out-of-pocket costs experienced by patients for clinically appropriate prostheses.

This amendment goes to the question of the review. Senator McLucas may wish to add to my comments. It was our understanding that the amendment to put in place a review had not actually been accepted in the lower house, but I now understand that the government has done so. Therefore, the Democrats amendment will be to the bill as presented in the chamber today.

As I said in my contribution during the second reading debate, we felt it necessary for the review to look in particular at the adequacy of informed financial consent arrangements and to also examine the extent of out-of-pocket costs experienced by patients for clinically appropriate prostheses. Those informed financial consent arrangements to which I am referring are for prostheses. If patients choose to have a medical device or prosthesis they will pay more under this arrangement, which is outside the no gap arrangement. Of course, like legislative arrangements concerning other potential gaps, such as with doctor or hospital costs, there are no legislative requirements to ensure informed financial consent.

We are all very well aware of the many cases of people who believe that, having held private health insurance, they will be covered for the costs of their treatment. It is only when they go for treatment, often after they make a decision or perhaps even have the treatment, that they discover they will be faced with substantial bills. In fact, the 2004 Private Health Insurance Ombudsman report said:

Consumers generally do not have a good understanding of how much it costs to be treated in a private hospital. If a health fund member finds they are not fully covered by their health insurance … the amount of money involved can come as an unpleasant surprise.

PHIAC statistics for the June quarter of 2004 indicate that around 20 per cent of in-hospital medical services provided to patients involved out-of-pocket costs. That means that a substantial minority of people are already facing out-of-pocket costs. We can assume from the complaints made to the ombudsman that some of these people were have not been well informed about it. The AMA has said that it is not the responsibility of doctors to ensure patients are informed about the costs that may flow to them because of the existence of this legislation. As I said earlier today, we need to pin down just whose responsibility this is. Hopefully, as part of the clinicians’ decision-making process they will take into account the cost-effectiveness of a particular prosthesis when deciding which prosthesis is right for a patient. It will be essential that doctors are well informed as to which prostheses attract gaps and which do not. As I said, failure to obtain informed financial consent can have substantial consequences for consumers.

We put this amendment forward. I understand the government is not going to oppose the amendment and that the ALP will also support it, although I leave Senator McLucas to say that for herself. I think it will make a real difference to the review if we spell out the need for informed financial consent to be part of that review so that we look at how well it is working, at whether doctors are able to work with their patients to make sure that they understand what the financial commitments are that are being entered into and also at the extent of out-of-pocket costs that patients experience for clinically appropriate prosthesis. We look forward to seeing that review and suggest that this will be an important part of that.

At this stage, I say again that this just relates to prostheses, although the Democrats would like to see a broader application of this informed financial consent arrangement and, indeed, an examination right across the spectrum of what informed financial consent means when it comes to private health and private health insurance. In fact, it may result in quite a substantial saving to private health insurance if patients were across those arrangements.