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Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Bill 2009 Fairer Private Health Insurance Incentives (Medicare Levy Surcharge—Fringe Benefits) Bill 2009 Fairer Private Health Insurance Incentives Bill 2009 Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009

CHAIR —Welcome. I invite you to make an opening statement.

Mrs Hill —Thank you for the opportunity to bring the perspectives of Access Australia to your deliberations. Access CEO Sandra Dill sends her apologies owing to ill health. I am a member of Access, my husband is an Access director and my sister is currently going through an IVF cycle. Access Australia is a consumer-led, independent, not-for-profit charity committed to providing whole-of-life support for women and men who experience difficulties conceiving their families. Access strives to raise community awareness about infertility by being a national voice to bring the social, psychological and financial concerns of couples to governments and medical and scientific communities. Our patrons are Olympic gold medallist Glynis Nunn-Cearns OAM and Candice Reed, Australia’s first born IVF child.

Access serves as a lifetime resource for support and information on reproductive health needs. Infertility is not a choice. The one in six people who need medical help have no control over this condition. IVF is a standard, proven and highly successful treatment for infertility. In some cases it is almost twice as successful as natural conception. The main concern of Access in relation to this bill is that, if passed, it will deny many hardworking Australian families their last chance to have a child. The Medicare safety net has ensured that every Australian has had that opportunity. In explanatory notes, the minister says that the reason for introducing a cap is that some doctors are overcharging. If the minister believes this to be true, we do not understand why she is not dealing with those doctors directly, rather the penalising all families who need IVF to have a family.

It is not surprising to us that government expenditure increased when the safety net was introduced. Prior to the safety net, the out-of-pocket costs of patients were paid directly to the clinic. When these costs were directed through the safety net, of course government spending would have increased, without any increase in clinic fees. More than 40,000 individuals were able to access IVF services with the support of the Medicare safety net in 2008 and nearly 11,000 babies are born each year as a result of IVF. Based on estimates reported in the Australian newspaper on 2 April 2009, the $42 million spent on IVF in the safety net equates to approximately $4,500 for each of these IVF children born last year. IVF is a valuable investment, given the considerable return each of these children as a productive Australian will bring their families and this country of ours. That is not to mention the heartfelt joy they give their parents.

The cruellest blow is to IVF patients trying to manage the expense of treatment on the one hand with the government’s token $900 stimulus check on the other. There has also been the news that the government has raised the baby bonus to around $5,000. If you think of an average classroom, around one child in each classroom is an IVF baby. In terms of the future of our nation, the government’s decision will remove this child. Many children born through IVF are now adults and asking why the government appears to value their existence less than children whose parents did not need medical help to conceive them. Access asks senators to give every Australian the chance to share in the joy that having a family can bring by providing equity of access to the Medicare safety net.

Senator XENOPHON —In relation to the proposed changes we heard evidence from Professor Illingworth about the likelihood of multiple implants with the increased possibility of multiple births. Have you surveyed your members as to whether, if these changes go through, people would try to maximise the chance of getting pregnant on fewer cycles by having multiple embryos implanted?

Mrs Hill —I am not sure that I have my finger on the pulse of that one exactly but I do know that this will be very tempting, I would think, for those people who are trying to establish their family to pressure doctors into providing the opportunity in this way. Certainly, I suppose, there are more risks involved when there are multiple embryos re-implanted.

Senator XENOPHON —Thank you. One of the reasons that the government has said that it has gone down this path is that it is concerned about the costs involved. I think it is about overcharging or some specialists making extraordinary amounts of money and Professor Illingworth has dealt with that. Amongst your members, have there been concerns in relation to either overcharging or that consumers or patients have not been fully informed before they have consented to treatment as to the likely costs involved?

Mrs Hill —Whether there is overcharging or not is something that we feel the minister needs to take up with the doctors themselves. Our concern is for the penalising of and the equity of access for the people who are trying to have children and establish their families and homes in this way. What the minister wants to do about that we feel is something she ought to take up with the doctors themselves.

Senator XENOPHON —Your main issue is that if there is an increase in payments for each cycle, that will discourage a lot of prospective families from taking this up?

Mrs Hill —Absolutely.

Senator XENOPHON —Thank you.

Senator SIEWERT —I want to explore that just a little bit and then I want to ask you about any proposals you have for the way forward. If I understand Access’s position correctly, it is that government needs to tackle doctors around their fees. Is that not in a way setting a cap as well by saying, ‘We will only pay this much.’ I apologise if I am not asking this correctly. The government is proposing a cap now which in effect can be a signal to doctors by saying, ‘Right, this is how much we will pay, so operate within that scope.’ In terms of overcharging—I suppose it is to a certain extent in the eye of the beholder—but what the government is trying to do with this measure is to say, ‘We think this service can be provided for this amount of money.’ I am at a bit of a loss as to how the government would say to doctors, ‘You’re only allowed to charge this much’ if they did not set a cap. Isn’t this in effect what they are doing?

Mrs Hill —The major concern of Access is the availability of this service to the typical working Australian family. A cap may impact the doctors and the medical people in some way, but the main concern of Access is for the people who are trying to establish a family.

Senator SIEWERT —I understand absolutely where you are coming from. If it is acknowledged that there is some overcharging or that some services being provided at the top end are too expensive or the doctors are charging too much, I understood you were saying earlier that the government needs to address those particular doctors. In effect, that is what they are trying to do with this cap. I am trying to look at what is a better way of meeting everyone’s needs, by saying, ‘We still want to provide this service but we want to provide it within reasonable expense bounds.’ Professor Illingworth said that the IVF Directors Group are coming up with a suggestion for a way forward, trying to address very good access but with some sort of control—they did not use the word ‘control’—or sensible charging fees. If the doctors could come up with an agreement with the government that limited the top end of the expenses, would Access be happy with that approach?

Mrs Hill —Access is of course very concerned that the couples who are wanting to establish their families have top quality health care and access to medical services that are going to enable them to do that, or at least to step forward in that area. Of course we want the best treatment provision and everybody wants the best—I was going to say, quite crudely, ‘bang for buck’ but it probably does not fit in this context!

CHAIR —It probably fits very well!

Mrs Hill —Everybody wants the best quality service that they can have for the money that is expected to be paid. But Access feels that the minister must really address that with the medical people and the doctors involved.

Senator SIEWERT —If a proposal were agreed between the doctors and the government for a way forward, you would be happy with that as long as people needing access to the services were able to access those services?

Mrs Hill —If those services are able to be accessed and the working Australian families who need this medical provision are consulted with regard to it, then there needs to be some sort of forum for discussing the way forward.

Senator SIEWERT —I have one other question. In terms of the members, do you get complaints from your members around what people think have been excess costs, costs that they think have been too high? The minister said some doctors are overcharging. Have your members complained about that? Are you aware of any of those issues?

Mrs Hill —There are certain procedures that are just not rebatable. The minister has within her jurisdiction the ability to determine which of those ones are rebatable and which ones are not rebatable. From that point of view, I guess there is a reflection on the part of the membership that, yes, there are many services that are hugely costing the membership but there can be some way of meeting this in some context and addressing that. Which particular items are actually considered rebatable is completely up to the minister to determine, I understand. Certainly the membership would have an understanding and would appreciate and think that there ought to be some rebate for many of these other things that are not rebatable.

Senator SIEWERT —I should have asked Professor Illingworth this question as well. In relation to the legislation that deals with the extended Medicare safety net, are you just concerned with the cap component that relates to IVF? Do you have a problem with the concept of the legislation in itself? This legislation can be applied to other procedures as well.

Mrs Hill —In the same context as Access represents the infertile, there would be other bodies that represent other conditions that would be just as worthy of presenting a case to the minister too, but certainly our concern is for the way that the average Australian working family is penalised in this context and within this legislation.

Senator SIEWERT —So, in principle, you have a concern about the extended safety net legislation in the first place, as well as specifically around—

Mrs Hill —Yes. I would like to clarify that with Sandra, but I would say that would be the consideration.

Senator SIEWERT —Thank you.

Senator FURNER —You might or might not be able to answer this question. Professor Illingworth indicated that new technology has been introduced, naturally, as a result of an increase in the success rate. In turn, he also indicated that comes at a cost. Are you able to comment on the effect that has had on your consumers?

Mrs Hill —I personally experienced infertility many years ago and there have been a number of progressions in the technology and processes involved since then. I am at liberty to talk about my own experience there. My only current experience is that my sister is currently undergoing an IVF cycle, and she is certainly undergoing many procedures involving techniques that are a product of time passing and progress being made in many technical areas. So I guess there would be an understanding that those would be passed on to the families that are going to be assisted by them. Also, the success rate has risen. The amount of cycles that couples might be going through would be reduced to some extent because of these technologies. So the expense that they would have been incurring from trial after trial may be reduced because of those technologies and the availability of them. I guess there is a little bit of ironing out with regard to that expense.

Senator FURNER —So it becomes a neutral playing field, more or less, as a result of cycles being reduced because of the introduction of new technologies.

Mrs Hill —Yes.

Senator FURNER —Thank you.

CHAIR —Do you know whether any private health insurers offer support for people going through IVF?

Mrs Hill —I am not up to date with what that might be.

CHAIR —I was wondering, in terms of the general operation of health in the country, whether any of the private health insurers covered IVF. You do not know?

Mrs Hill —No, I do not know. I could ask that question.

CHAIR —Yes. In terms of your members, is there an acceptance that there will always be out-of-pocket expenses; it is just the size of the out-of-pocket expenses to which you object?

Mrs Hill —That would be correct, yes.

CHAIR —We heard from Professor Illingworth that there were significant charges and we have heard that over the last few years there have been lower charges, so there has been a bit of a wave effect. You object to any increase or just the size of the increase?

Mrs Hill —Any increase is objectionable, because what is currently being outlaid by average working Australian families is quite exorbitant.

CHAIR — Thank you very much for your time. You will get a copy of the transcript of your evidence. If you wish to make any changes or add anything, please contact us. I hope Mrs Dill is feeling better soon. We have met with her in the past.

Mrs Hill —Thank you. She apologises for not being here today.

CHAIR —Yes, I know she enjoys giving evidence! I will adjourn this hearing until tomorrow, when we will be meeting in Perth to look at the issues around private health insurance.

Committee adjourned at 3.56 pm