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Monday, 15 June 2009
Page: 5920


Ms ROXON (Minister for Health and Ageing) (4:57 PM) —in reply—In summing up I would like to thank members for their contributions to the debate on this bill. It gives me great pleasure to follow the member for Parramatta, who canvassed so many health issues for her electorate. This is important to many people in the community, so I appreciate that people have taken the time to speak in the debate.

The Health Insurance Amendment (Extended Medicare Safety Net) Bill amends the Health Insurance Act 1973 to enable the Minister for Health and Ageing to determine by legislative instrument the maximum benefit payable under the extended Medicare safety net for each Medicare Benefits Schedule item. These changes, made by the government in the budget, ensure that all items currently covered by the safety net remain covered by the safety net and no items will be means tested for eligibility. Importantly, IVF services will remain covered, with no age limits and no limitations on the number of cycles.

Members, including the member for Cook, who have very personal stories and genuine concern about these changes should be assured that all IVF procedures that are currently covered will continue to be covered. There is still, I think, some remaining concern in the community, some confusion, about the speculation compared to the reality that all items will continue to be covered, with no age limits, no limitation on the number of cycles and no means-testing. The changes, of course, go to a cap on the amount that can be charged—and I will come to that later—but I think that they should address the concerns, genuine as they are, from people like the member for Cook. Cancer services, as well, will not be affected at all by these changes. The changes that we have made are to restrict taxpayer funds being spent on excessive fees that have been charged by some specialists. We are protecting the taxpayers, we are protecting the patients, and we are protecting those doctors who are doing the right thing in charging moderate fees.

A recent independent review of the extended Medicare safety net, a report tabled before this debate began, clearly showed that in certain areas, such as obstetrics and IVF, the safety net had been used by specialist doctors to raise their fees knowing that the taxpayer would be called on to cover 80 per cent of the cost of the fee rise. For example, according to this report, between 2003 and 2008 the fees charged by obstetricians for in-hospital services reduced by six per cent while the fees charged for out-of-hospital services increased by a staggering 267 per cent. The report also showed that the safety net is not making some medical services more affordable for some patients—which, of course, was the purpose for which it was originally intended.

One of the reasons for this is that the amount of benefit available through the extended Medicare safety net is unlimited, and some specialists have taken advantage of this arrangement to increase their fees and their incomes, unfortunately with no particular benefit to the patient. The current nature of the safety net means that doctors feel little pressure to moderate their fees. Due to these fee rises for some services some patient out-of-pocket expenses have even increased as a result of the extended Medicare safety net. Unless we act now we will not be able to stop this increasingly silly situation and the extended Medicare safety net will become unsustainable.

In 2008, expenditure on the extended Medicare safety net was $414 million, 30 per cent more than the previous year. In some areas the increase is being driven by increased fees rather than the provision of more services. This bill creates a mechanism for the government to responsibly manage expenditure on the extended Medicare safety net. As part of the 2009-10 budget the government is capping the benefits for some services where there is evidence of large increases in the fees charged, services where the majority of the extended Medicare safety net benefit is going to doctors rather than to helping patients. The new caps will apply for the following services: obstetrics, assisted reproductive technology, hair transplantation, the injection of a therapeutic substance into an eye, one type of cataract operation and one type of varicose vein treatment.

Some members in the debate have expressed the concern that this measure will increase the cost of obstetric services but I note that as part of this measure the government will also be investing $156.7 million to increase the Medicare rebates for private obstetric services. This means that the changes will allow all mothers who have their babies delivered by a private doctor to receive a standard Medicare rebate that is 30 per cent higher than the current rebate. The government is also investing $120.5 million in a maternity services package. Part of this package will introduce Medicare items for midwifery services and will support greater choice for women—one of the issues touched upon by the member for Parramatta.

The cost of IVF should not increase for most patients. On average, patients are charged around $6,000 per IVF cycle, yet there are some doctors charging in excess of $10,000 per cycle. Patients who see specialists who charge $6,000 or less for a typical IVF cycle will not be worse off under these changes. In relation to the cap on the cataract item, I think that the opposition health spokesperson is confused. The extended Medicare safety net only applies to out-of-hospital services. There is, of course, a separate measure which affects cataracts, to which he may have been referring. While I acknowledge that there is a crossover for a small number of services, 95 per cent of private cataract procedures take place as in-patient services so the extended Medicare safety net does not apply.

I note, also, the closing comments of the opposition spokesperson for health, who offered to work with the government to identify alternative savings. That was a very kind offer in this debate, but we have not had one suggestion from the opposition for any savings in any health related measure, let alone any measure relating to this bill or in this budget debate. We have had no suggestions, no policy proposals—nothing. In fact, all we have had so far is opposition to any of the measures that we have proposed in Health. So I do ask where those suggestions are. I would be happy to see them and consider them but they have not been forthcoming to date and I am not intending to hold my breath while I wait for them. I did wonder if the opposition spokesperson was suggesting that the opposition would now be opposing this bill. Of course, the shadow Treasurer clearly stated, following the budget:

We’re not going to block any initiatives other than the private health insurance initiative. So that’s our position. We’re not changing from it.

So I wonder whether the member for Dickson and the member for North Sydney are not in agreement here, because it seems that the shadow minister is raising some sort of issue that might be walking away from the commitment made by the member for North Sydney.

The important point here is that the extended Medicare safety net is a patient benefit. It is not intended to be a mechanism by which doctors can simply increase their incomes. The changes we have made will restrict taxpayer funds from being spent on excessive fees that have been charged by some specialists while protecting those very many doctors who are doing the right thing. Importantly, it will continue to protect patients with high medical costs and protect taxpayers.

The changes in this bill are necessary to assist us in keeping the safety net sustainable and available to all Australians into the future. These changes will allow Australian families to continue to have access to the safety net for IVF services into the future and they will allow access to the safety net by families of cancer patients, who have very high costs that need to be covered in difficult circumstances, and by many other worthy recipients, without this money being unfairly skimmed off by that small number of doctors who are charging excessive fees. The government is determined to put the patient first and foremost in all of our considerations, and we believe that this bill does that.

Question agreed to.

Bill read a second time.