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Monday, 15 June 2009
Page: 5914


Mrs HULL (4:24 PM) —In continuing my speech on the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009, I would like to bring to the attention of the House many of the issues that come under this bill and the areas that will be capped. Not all of these issues concern areas where I believe people are genuinely putting themselves in a position whereby they are overextending doctors or themselves as to medical issues or are perhaps overextending themselves and they do not require these services.

I will look at the issues in respect of those people who have assisted reproductive technology, or ART. In my electoral area covering Wagga Wagga and the Riverina, there was an assisted reproductive technology service in Wagga Wagga that took place in the Wagga day surgery. Our regional area people came in there to assist with the IVF and many other assisted reproductive skills that were provided by a specialist, who set up in Wagga particularly because the day theatre and the day surgery were there. That enabled her to come in and do obstetrics and also practise her passion for assisted reproductive technology, to benefit many couples who were childless and were assisted by IVF and other procedures.

What happened was that when Calvary Hospital, a Catholic-run hospital, took over, having bought out the surgery, the theatres and the day hospital, it no longer allowed that type of activity to take place so now all of those in my region have to travel significant distances in order to access assisted reproductive technology, IVF and other assistance to be able to have children. The travel cost to them is absolutely astronomical. Generally, many city people can walk to or get a bus, a train or a ferry or some other form of public transport to a hospital system or to these kinds of facilities and not be personally out of pocket—after paying for bus fares, train fares and other public transport fares—to the degree that my constituents are. When one has got to travel significant distances, you are constantly out of pocket. You might have to stay overnight or to stay two or three nights in order to access these services. If you are staying in a motel it could be extremely expensive.

I think that there is a need to recognise the distance factor and the cost factor for many of those people in rural and regional Australia—and, in my case, in the electorate of Riverina—who simply have to incur costs just to physically get themselves to these services let alone use them. So I am very concerned that this does not cover all assisted reproductive technology services. I think that is simply unfair and quite discriminatory, because it does not recognise how much money, including out-of-pocket expenses, regional mums wishing to be mums and families wishing to be families have to spend in trying to access these in the first place.

I cannot understand the reasons behind all obstetric services not being covered. I understand that it has been reported that, 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 quite significant percentage. But I do wonder about people in those areas where you cannot get into a hospital. In particular, I am talking about the Wagga Wagga Base Hospital, which is a referral centre for all of our region and beyond. It is just so difficult to get into hospital to obtain any of these services. It is simply not possible to access the hospital service for these services. So do you not have the service at all or do you try to seek it as an out-of-hospital service? Again, I wonder what considerations have been factored in. I wonder where this is actually coming from. If the specialist has come from a city area or an area that has easy access to hospital services et cetera and those services are not being utilised, then maybe I can understand it, but I do wonder, when we are all lumped into one big melting pot and considered as an aggregate or an average, how in such cases we can play a significant part in explaining the issues to rural and regional people. I also wonder how much effect this legislation will have in pushing more and more people into the public hospital system where already you cannot access any of those services in rural and regional areas.

The one area that concerns me the most—and I spoke about this in the three minutes I had to speak on this bill before question time was called on—is cataract surgery. Only one type of cataract surgery is covered under this bill—and for it to be capped is in itself an issue. It is primarily one of those out-of-hospital services in a day surgery. It may be run on a fly-in fly-out basis or by a person that comes in when there is no ophthalmologist available in the regional areas. It might be somewhere out in the Broken Hill area, somewhere up the back of Bourke or somewhere else. Somebody comes in and does a significant caseload because there is no way to get access to an ophthalmologist unless these people come in. Of course it is going to start to blow out when you have people coming in to do significant surgery.

I am not saying that there is nobody who will rob or try to rort the safety net system. Anywhere, in anything you do, there will always be somebody who will do something that they should not be doing. I am not saying at all that that does not happen. I would hate to think that people would think that I was so naive as to think that there is not somewhere some abuse taking place of the safety net. But this bill is using a steel-capped boot to squash an ant. The fact is that some people might be abusing the system to some small degree but, on the other hand, people in rural and regional Australia are affected in the most significant ways. In the most significant ways they will be the ones that will be affected. Will ophthalmologists think it worth their while to take a day or two or three off work—generally a day and a half or more to travel to many of the outposts in Australia; it could be two days of travel each way—and then a day while they are there to undertake that day surgery? With a significant cap, will these specialist service providers consider that it is worth while for them to take all of this time out of their practice in order to go and run these day surgeries? It concerns me greatly.

Coupled with this legislation, I understand that there will be further legislation coming into this House on cataract surgery itself. We have not seen this legislation yet, but I am led to believe, from a good source, that further legislation will be coming into the House severely cutting ophthalmology and cataract surgery. I cannot understand it. I am going to read from an email that I have received from one ophthalmologist in my electorate. Ophthalmologists are few and far between, let me tell you, and are very hard to come by. It is very hard to attract an ophthalmologist out into country Australia as it is. With this cap, and with the measures soon to be introduced into the House, it is going to be nigh on impossible for there to be ophthalmology services for rural and regional people, let alone for those people who live out in the wider expanses of Central Australia, in Broken Hill and other places. This ophthalmologist says that he is writing to make me aware that the government is intending to cut the rebate for cataract surgery by 50 per cent. He is not talking about this Medicare safety net but, coupled with the Medicare safety net, it is a big hit. He says:

Their justification for doing this apparently is because they believe it is too quick and easy to perform and basically, not worth the money.

Let me tell you, those people who had cataracts and had to have cataract surgery and are now free of cataracts think it is worth the money. If you lived like that you would soon find out whether it was worth the money. He goes on:

Having taken four years of specific eye surgical training to master the procedure on top of a medical degree and 3-6 years of hospital residency coupled to the fact that community expectations are for 100% success rates and the stress associated with the procedure is somewhat akin to defusing a bomb through a microscope, we would beg to differ. One wonders if when it is time for—

the Prime Minister—

Kevin Rudd or—

the minister—

Ms Roxon to have their cataract done, whether they will trot down to the local public hospital to sign up to have the junior eye registrar do the procedure or whether they’ll seek out the most competent and experienced surgeon in town.

He goes on to say:

The schedule fee for cataract surgery was around $800 in the early 1980s. The Government halved it back then and again cut it by around 30% in 1996. Now they want to cut it in half again. So in late 2009 the fee will be about half what it was over 25 years ago in face dollar terms and allowing for inflation, this puts a real dollar value of about an eighth of what it was back then. In all that time our profession has succeeded in making the procedure quicker but also safer and with a faster recovery time and better visual results. We use a lot more high tech equipment now but this makes the procedure more complex, more technically difficult and takes much longer to master, as any training registrar will testify.

Basically this ophthalmologist goes on to talk about the public hospital system and why these out-of-hospital cataract operations have expanded. He says it is because you cannot get theatre time in the hospital. In the public hospital system in rural and regional Australia you cannot get theatre time, so of course they are going to be doing more in day surgeries. He says:

Up until about six months ago—

that is the end of last year—

things were going well for our patients. A privately insured patient would get done with no out of pocket expense from me as I accepted ‘no-gap’ payments from the funds for my surgery. A patient electing to go public would wait about three months to get done at Wagga Base Hospital. If a non-insured patient wanted to go private, the all-up cost would be around $1800 out of pocket, $1100 of which went to the private hospital and the rest split between surgeon and anaesthetist. Since then—

and I am talking specifically about the Greater Southern Area Health Service, which has—

… cut our theatre lists back to 3 per month and never seem to have a dedicated theatre for emergencies, so that the lists we do get are sometimes cancelled for an emergency caesar, trauma case etc. As a result, my public waiting list has now blown out to eleven months and some of my colleagues have longer waits. The worst thing is that the wait list grows by about two months, every month.

So this obviously increases the interest and need for people to get their cataracts done outside the hospital system. I was trying to point to whether there is a recognition of the factors that show why there has been more private surgery and why more of these are being done out of hospital. You can see why when you factor in all of the issues and the challenges we are trying to meet in rural and regional areas. He goes on:

This will now cost uninsured patients an extra $312 because of the fee cutback—

on top of the increases that the hospitals have now applied and—

… hospital charges for uninsured cataract cases are now $1300 for pensioners and a whopping $2075 for non-pensioners.

He talks about how much there will be out-of-pocket charges for insured patients et cetera. The problem we have is, I think, that there has been no thought given to how to address rogue issues. (Time expired)