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Community Affairs Legislation Committee
16/05/2014

SKINNER, Ms Marie Denise, Senior Policy Adviser, National Seniors Australia

[10:19]

Evidence was taken via teleconference—

CHAIR: Good morning. National Seniors Australia has lodged submission No. 3 with the committee. Do you wish to make any amendments or alterations to your submission?

Ms Skinner : No.

CHAIR: Would you like to make a short opening statement, and then we will have members of the committee ask questions.

Ms Skinner : Thank you. National Seniors are quite concerned at the amount of money that some of our members and older Australians generally are having to spend on maintaining their health, and it is particularly extreme for those members who have a chronic health condition that requires them to attend quite a few health visits but who are not actually ill enough to have to be in hospital in the public system and who are not in aged-care facilities. Quite a few of the people in the general community who are not over 50 would have the same problems in terms of being able to manage the cost of their health care.

We had quite a big response from our members when we asked them to provide comment on their out-of-pocket health expenses and how they manage their budgets. I think the very strong message that came through from quite distinct groups was as follows. Pensioners do have some protection in terms of the concessional arrangements for payment for their health care, but when they have a chronic health condition that requires, for example, services such as private allied health services—or they might have a condition that has them on a wait list where it may be several years or several months before they can get in to the elective surgery, and they often find that their function and their health is so affected that they then seek private services—they have great difficulty in meeting those costs. Members who are not on concession cards and who hold private health insurance tell us that, even though they have the private health insurance and they have done their best to cater for their own healthcare needs, when they need services, particularly when they have a chronic condition, they are not able to meet the gap payments between what they might get from Medicare or what they might be able to get as reimbursement from their private health insurance and a specialist charge.

So those particular groups of people become severely stressed financially because of the fact that they are paying so much in out-of-pocket expenses. For people with some chronic health conditions, that is an ongoing issue. For those who have an acute condition, the escalation in costs can be enormous. People have told us that they have had to spend between $9,000 and $30,000 for some procedures. Admittedly, they are procedures in the private system, and they are often procedures that the person would not have been able to access.

Apart from those kinds of situations where you have people with concession cards and people who do not have them and are on private health insurance, there are a whole group of people who are telling us that there are limits to the number of services they are able to access. For example, people with a chronic condition can get five allied health referred appointments a year, and many of them are telling us that they have to access far more than just five in any one year. Some people have ongoing needs where they have to go and have monthly treatment, and they are telling us that they are cutting back on their daily living expenses in order to do that. They are doing things like trying to save money on food and utilities. People who own their own home and have got expenses in maintaining their own home are also finding it extremely difficult—especially if they are a single person or a couple in which one of them becomes quite ill.

We raised in our submission the fact that there are quite a few services that people need to access that are not covered by Medicare or the extended Medicare safety net—these include things like dental health services, low-vision health services, assistive technologies, and I have mentioned the private allied health services.

Although it is not within the scope of this Senate inquiry, a lot of our members and older Australians are finding that the in-hospital gap payments they have to pay are far in excess of some of their out-of-pocket expenses within the community.

The other main concern that patients and people who are accessing health services have is that if you are a member of a couple, you only have to reach the same threshold as if you were a single person—and that is considered to be quite inequitable. We have had lots of comments from our members about that inequity. We continue to raise that in our submissions.

I think that is all we wanted to say generally, apart from the fact that there is mass confusion about the various safety nets and the eligibility requirements for those safety nets, and so people are sometimes not quite sure what they can claim and what safety nets they are eligible for.

CHAIR: Thank you. What do people currently do to try to ascertain what is within the safety net?

Ms Skinner : I think they talk amongst each other. That seems to be the preferred information source for the older population. They also rely quite heavily on their healthcare providers to give them that kind of information, if they are aware and are able to do it. Not all older people are on the internet, although a lot of the younger age groups are. Our membership is from 50-plus, and a lot of the younger people are quite familiar with the internet and can use it, but for older clients, they tend to rely on more traditional methods of information. While the clients might get the information on each particular safety net, each safety net is slightly different and might have different thresholds and apply to different services. So, people get a bit confused, even if they have the information.

CHAIR: Can I just clarify by younger you mean people in their 50s and 60s?

Ms Skinner : Yes.

CHAIR: Thank you.

Senator MOORE: Ms Skinner, does your organisation put out information to the membership about these issues?

Ms Skinner : I guess we do that in two ways. If something is a new issue, for example, health services, we might do a fact sheet about it but we tend to try to refer people to the source information. We get members who may ring us up with a query, we get emails that people might send in, requesting clarity about a particular piece of information, and we respond to them. We summarise the response and we always refer them to the source material. If they are people who do not have access to the internet, we sometimes photocopy the information and send it out to them But we try very hard to always use the source information, because that is the way that we can be sure we are not going to end up having little errors creep in.

Senator MOORE: I am aware you did, I just want to get it on record that you have that kind of interaction with your membership. Ms Skinner, in terms of this piece of legislation—

Ms Skinner : Sorry, could I add one thing to that question you just asked. We also have a productive ageing centre which regularly surveys our members and at times the wider population. It sends out surveys to them and then analyses them and provides reports. That is another mechanism by which members get information. They are able to access those reports.

Senator MOORE: The legislation in front of us belongs to the previous government's last budget. Since then there have been other changes in this area through the new government's position and as recently as the budget this week with some other changes around co-payments and so on in the interaction between patients and their medical professionals. Do you think it is possible to look at one piece of legislation in isolation?

Ms Skinner : I would hope that that never happens, but meanwhile there has to be legislation for a variety of issues. I think that is how government functions fairly well all the time. There are different pieces of legislation and there are always going to be. I would hope that government would take into account the context in which this legislation is being placed.

Senator MOORE: Are you aware that there is another range of safety net and processes due to come in within six months of the legislation we are discussing now?

Ms Skinner : Yes.

Senator MOORE: Do you think that would cause confusion among your membership?

Ms Skinner : I am sure it would.

Senator MOORE: The other part of this particular piece of legislation talks about the information-sharing between Medicare recipients—members of Medicare, I suppose you would call it; I suppose we nearly all are—and Medicare about when they are getting close to their limit to access the extended Medicare benefits. This piece of legislation removes the requirement to have a written notification of that. We want to see what the options are when we talk with the department. Has there been any concern among your membership about that whole process of communication?

Ms Skinner : Specifically for that legislation, no. But generally speaking we are constantly being given feedback by a segment of our membership that they are not able to access information by, for example, email and that they do not handle internet very often and they always would like to have information that was mailed to them. So in a range of other areas we are getting very strong feedback from some people that they definitely need information provided to them—for example, in hard copy—or mailed to them.

Senator MOORE: It is my understanding and certainly in other discussions some people have feedback through the older community that that format is something they require.

Ms Skinner : Yes.

Senator MOORE: I think it is fair to say that there is no perfect form for communication.

Ms Skinner : No, there isn't . I think for some people that the good thing about the Medicare safety nets is that because the records are being held centrally people then do go on to the Medicare safety net, so I think they are often told by the health care provider, 'We don't have to charge you any more for that particular gap amount,' or, 'You're getting more back.'

Senator MOORE: Particularly if they have a long-term relationship with their provider, so they have that personal exchange of information.

Ms Skinner : Yes. I have actually been in specialists' rooms where I have heard the staff behind the desk discussing that with patients, but I am sure that it does not happen across the board every single time.

Senator MOORE: That extra bit of care. I know your organisation is aware that this committee's references committee is looking at the overall issues of out-of-pocket expenses.

Ms Skinner : Yes. We are making a submission.

Senator MOORE: Thank you.

Senator PERIS: I have been reading some of the comments made by some of your members and would like a humanised, comment on all of this. One of your members says, 'The increase in the safety net to $2,000 a year is really going to hit hard so many people.' What is your greatest fear about how this is really going impact on the national seniors?

Ms Skinner : I guess that if you look at it in cold, hard cash that is $700 extra money that a person who may be on quite a tight budget would need to find in one year if they did have substantial healthcare costs. I have tried in my mind to work out what that might mean in terms of services, but it is pretty hard to do because it all depends on the individual. But if you looked at it as a $35 out-of-pocket payment just for a GP service and then you looked at what they might get back in terms of the 80 per cent, they are going to lose quite a bit of money and have to put out a lot more money before they reach that safety net. It is the people on the margins who are going to be quite severely affected by this—people on restricted incomes, even if they are not people on an age pension. It is also going to hit people who have a chronic health condition or who need to go quite frequently to various healthcare providers—$700 is a lot of money when you have a tight budget that you have worked out for the year.

CHAIR: You made that comment about how your members see the fact that there is just one threshold for the safety net, irrespective of whether it is for families or singles. What are your members saying should happen there?

Ms Skinner : Consistent with our submissions on a range of other issues, we think the singles threshold should be at 66 per cent of the couples threshold.

CHAIR: Lining up with the pension, basically?

Ms Skinner : Yes. If the pension shifts slightly, we think the threshold should be pegged to the same proportions.

CHAIR: You spoke earlier about the cost of procedures done in private hospitals that could not have been done elsewhere. Can you explain what you mean by that, please?

Ms Skinner : I think I said that they were on a wait list and would not get the service in a public hospital.

CHAIR: I see.

Ms Skinner : Therefore they made the choice—rather than have a decrease in their functions, rather than having worse health problems because they have not been able to fix the issue due to the long wait lists—to go and do it privately. But that comes at a considerable financial cost.

CHAIR: We had evidence earlier today from, I believe, the Consumers Health Forum about what they refer to as 'gaming' of the safety net. They identified, for example, obstetricians and IVF specialists—some in those professions—as people who would set their costs so as to encourage patients to use the system in such a way that they can tell them, 'It will all be free from here on for you.' They were setting their costs to maximise their profits, so to speak. Are you aware of anything like that happening in the professions your members might access?

Ms Skinner : I would not have used that kind of phrase, that terminology. I am aware that there are some procedures where the cost of the procedure far exceeds what Medicare might pay back. I cannot make a value judgement about whether that is appropriate or not. There are a number of our patients who have macular degeneration and who get injections on a regular basis to try to stop the progression of that condition and to try to keep their vision as long as possible. We have had members—and members of the general public—send information to us explaining that they have had a particular specialist, that the price has gone up, that a cap has been put on that particular procedure under the extended Medicare safety net and that they are now considerably out of pocket, more so than they expected to be. They do not feel that they can challenge the fee that they have been charged—they have a relationship with a particular provider and they are in the middle of a program of treatment.

We have also had some of our members talk about going in, for example, to have particular surgeries—the classic example is prostate cancer. In some cases they might be offered a certain procedure but they are then told by, for example, the practitioner that, if they were able have a new treatment that was much more expensive, then the potential outcome would be a lot better. They are then in a real dilemma: 'What do we do? They know they are not going to get much, or any, of the money back, if it is not a procedure that is in the Medicare listing. They have to decide whether to spend the money. Because of the fact that a lot of us are not well educated in quite technical procedures, they find that extremely stressful.

CHAIR: Some of them would not be able to google it, which is what the majority of us would do.

Ms Skinner : I am sure that the people who are charging some of the prices they are charging have worked out their fees in relation to what it costs them. I think it was Nova who mentioned some of the quotes from our members. We have numerous quotes from members and some of them give us quite a bit of detail explaining the cost breakdown and what other practitioners in the room charge, and they are a little unsure as to whether they have done the right or wrong thing. In many cases patients feel that if they can keep themselves healthy and keep themselves functioning at a much higher level, they will not be a burden on the system in the future.

CHAIR: Thank you very much for appearing and thank you for your patience with our earlier technical difficulties, Ms Skinner.

Proceedings suspended from 10 : 46 to 11 : 00