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Monday, 21 November 2011
Page: 9068


Senator EGGLESTON (Western Australia) (18:05): The National Health Reform Amendment (Independent Hospital Pricing Authority) Bill 2011 is all about bureaucracy. It is another Gillard bureauc­racy—more Gillard-ALP red tape. It is quite unbelievable. Yet none of us should be surprised. This government's record on health reform would leave even the healthiest of Australians dazed and confused. This bill establishes the third new bureaucracy under Labor's health reform program—the third new bureaucracy. It relies on other aspects of that so-called reform, such as local hospital networks, to manage hospitals and be funded under activity based funding. Yet in some states these local hospital networks are still to be established. The idea is for the local hospital networks to work with Medicare Locals to jointly deliver health care. But Medicare Locals are still not in existence across the entire country. There are very few of them established at all. This is possibly because their role has not been clearly defined. Even stakeholders are questioning what exactly they will do.

Then there is the price tag. They come at a cost of some $400 million, which is a lot of money, especially for a government which says it is going to put itself back into a balanced budget situation by 2014. We were told Medicare Locals would be at the forefront of the Labor government's promise to end the blame game and fix hospitals. That promise was made by Kevin Rudd almost four years ago, but the Australian people are still waiting—

The ACTING DEPUTY PRESIDENT ( Senator Furner ): Order! Senator Eggleston, I think you know the requirements in referring to people.

Senator EGGLESTON: I apologise. The promise was made by the then Prime Minister, Kevin Rudd, almost four years ago, but the Australian public, as I said, are still waiting to see the hospitals fixed. One might almost say: so much for promises of historic reforms under this government.

The Australian healthcare system has been pricked and prodded by this government, but the outcomes, the benefits for needy Australians, have been thin on the ground. Labor's achievements in the health sector, when one looks at them closely, are few and far between. On 1 November changes to the Medicare benefits schedule announced in the May budget took effect. Under this budget cut, changes have been made to the allied and mental health services available under the Better Access initiative for mental health. We saw the slashing of $580 million from a scheme that had delivered some 11 million mental health services to two million needy Australians. In this scheme the federal government had for once recognised the importance of dealing with the issue of mental illness by involving general practitioners, psychologists and nurse practitioners in the management of people with mental illness. However, the program was cut.

Earlier this year the government broke the longstanding convention on the listing of Pharmaceutical Benefits Scheme medicines when it rejected the recommendation of the independent arbiter, the Pharmaceutical Benefits Advisory Committee, to list some vital medicines concerned with the treatment of, among other things, cancer. It was a decision that undoubtedly caused many Australians sleepless nights, fearing they would have to pay a great deal more for their vital medications than they would under the Pharmaceutical Benefits Scheme and, perhaps most importantly of all, that they might not be able to access the latest and best forms of treatment either for themselves or for members of their families.

Prior to that, the government capped various services under the extended Medicare safety net, with cuts amounting to some $610 million. These included reductions to the in-vitro fertilisation and obstetrics services, which some people might feel are services which are not genuinely about people who are ill but something of a luxury, helping people who are unable to conceive have children. But to those people the cutting of the subsidies and the benefits for those services was very sad indeed. I am sure it caused a lot of heartache around this country among people who, as a couple, are infertile and who hoped that IVF services would help them have a family.

Then there are the cuts to pathology services and the cuts to incentives for GPs to provide after-hours services—more cuts and a diminished medical service to the Australian public. They are mostly at the GP level, which means that the ordinary members of the community are the ones most affected. Further, hanging over our health system is the threat of closing the Medicare chronic disease dental scheme, which has provided more than 11 million treatments to almost 800,000 Australians. This is a very important service because elderly Australians and those on social security often find they cannot afford to go to private dentists.

In addition, there is the threat of cutting rebates to those who hold private health insurance. The government is threatening to cut the taxation rebate which encourages people to take out private health insurance and which has meant that many more people have retained their private health insurance than might otherwise have done so as the cost went up. That in turn means that there would be greater pressure on public hospitals, increased waiting lists and more people finding that their medical treatment is delayed. So that is the real record of Labor's so-called healthcare reform agenda. It has been a record of cuts, diminished services and poorer outcomes for the Australian public.

The coalition supports the move to activity based funding for the nation's hospitals. We are very happy with that, but we oppose further layers of health bureaucracy. This bill establishes the third new bureaucracy under Labor's so-called national health reform program. The Independent Hospital Pricing Authority, which this bill is all about, comes at a cost of almost $100 million over the forward estimates. It follows the National Health Performance Authority, which followed the Australian Commission on Safety and Quality in Health Care. Yet to come, it is some form of national health funding organisation which was promised by Prime Minister Rudd, then discarded by Prime Minister Rudd, described as 'unnecessary bureaucracy' by Health Minister Roxon and then resurrected by Prime Minister Gillard. The government is slightly confused about what to do, it would seem. The policy is all over the place—creating organisations, discarding them and then resurrecting them. It is a very inconsistent record, and all of this has come at a cost of hundreds of millions of dollars, money which could in large part have been spent on front-line services and improving health care for members of the Australian public. These various authorities were originally proposed to be formed, in place and operating by July this year. Activity funding is now due to be established by the pricing authority by July 2012. Experts are warning that even that time frame is too tight and perhaps unachievable. So it is likely to be another example of Labor's inability to deliver a program and threatens more uncertainty for the hospital system. So we can have little confidence that this government will deliver, given their record of past performance across a whole range of policy areas, not only in the health area. Stakeholders, including the Healthcare and Hospitals Association and the AMA, have warned that providing additional data needed by this new authority could impose very heavy burdens on the health sector. The Healthcare and Hospitals Association also warns that, rather than drive any reforms, there is a serious risk the introduction of activity based funding will simply reinforce the old inefficient models of care. So, significant warnings have been sounded to the government that it needs to get this change right.

Through the formation of all of these new bureaucracies the coalition has consistently warned that they raise the possibility of duplicating each other's work and imposing ever-greater burdens on the health sector. The coalition continues to hold these reservations about the policies and programs of the Gillard government in the health sector.

Activity based funding was part of this government's promises to end the blame game in health, but stakeholders warn us that it will do no such thing. Even the Bills Digestfor this bill states that 'it is likely that debates about the adequacy of public hospital funding by each level of government will continue for some time.' And 'some time', in government terms, can mean it could be 10, 20 years or even longer before decisions are made and resolutions affirmed—so it does not augur well for the future of the Australian health system.

Another major concern is that the private sector has had very little input into these proposed changes, when in many cases the private sector is already funding health care on the basis of activity. The government should have drawn on the knowledge and expertise in the private sector, one would have thought; but that has not happened so far. But, hopefully, it could be that the new pricing authority will go to the private sector and seek advice. The authority also needs to take into account the varying nature of different parts of the hospital sector. There are significant differences between public and private hospitals, and not even all public hospitals operate in the same way.

Let us have a look at Catholic Health, which operates some 21 public hospitals around Australia—some of them large, some of them iconic, well-known public hospitals, like the St John of God system in Western Australia—but they operate in a very different way to those operated by the state governments and the public sector. The amendments put forward by the coalition seek to recognise and allow for greater understanding of these differences in the modus operandi of the management programs and the impact that will have on the decisions of the pricing authority. This is just another example of the muddle-headed approach of the Labor government to health care which, if implemented, will do nothing to improve service delivery to the Australian public, I am afraid. And so, once again, I think we are going to see health care in this country not being as good as it could be and Labor missing the opportunity to make a substantial difference.