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Tuesday, 8 March 2005
Page: 87


Senator LEES (6:26 PM) —I rise to speak on the National Health Amendment (Prostheses) Bill 2004 and I would like to go back to the stated objectives of this piece of legislation. In the explanatory memorandum there are three dot points:

  • reduce the pressure on the level of private health insurance premiums by limiting the growth in benefits for prostheses;
  • reduce the administrative burden on the industry; and
  • provide contributors with more choice in the provision of prostheses.

I will make some more comments on that last point as we get into committee because it is on the choice issue that I want to talk about podiatry and podiatric surgeons. First I will look generally at the aims of this piece of legislation. Some of the earlier speakers have also raised issues of proof of whether or not this is really going to happen or if we are going to have to wait and see what the process is. This is why I am pleased to see that the Labor Party’s amendment is already enshrined in the bill. It has come across from the House of Representatives. It will keep us looking at and reviewing this process and seeing whether or not we have results.

While private health insurance premiums may generally go down—we are not going to have a full range of options, a full suite of possibilities, for various prostheses; we are only going to have the basic model—across the board there might at least be some holding of increases. I cannot see private health insurance premiums coming down, but there might be some levelling. We have seen some significant increases and apparently some of that is due to this area. But for the individual whose medical specialist perhaps recommends an alternative or who wants the latest technology, the best available model of whatever the particular item is, they are going to have to pay and probably pay quite substantially. So the first aim—to reduce the pressure on the level of private health insurance premiums—is going to be achieved across the board at least in the very short term, but that is not going to do anything for those who are going to need an up-to-date or simply a different model or option if they ever need this kind of support.

On the issue of choice I think the ultimate way to ensure that we have choice is to make sure that all of those who are qualified in this area to perform procedures are actually able to do that. On this issue my primary concern is that we enhance choice if we include podiatric surgeons in the provision of prostheses and professional services. Surely we have to recognise the role of all health professionals. We went through this debate with the Medicare legislation a year or so ago when four of us on this side of the chamber were able to negotiate into Medicare, for those able to access enhanced primary care programs, the opportunity to access allied health professionals. This is often not just the very best outcome for the patient but it is also cost-effective and it helps us in Australia to cope with a growing problem—the shortage of specialists and the shortage of doctors generally, particularly those who specialised as GPs. Why don’t we include all of those people who are able to do the particular procedure or process or give whatever advice it is that we are looking for?

If the legislation were to go ahead as it is originally written, because of the way that the public hospital system in particular operates, it would simply not be possible to have the option of seeing a podiatrist and going through the processes that might ultimately be necessary by way of an operation and potentially the use of a prosthesis. Apparently in the public hospital system there is a set of guidelines or rules that generally discriminate and limit access. Through these amendments—and I will speak to them on an individual, one-by-one basis when we get to them—we want to reinforce both choice and the issue of cost. If we keep focusing on a few very scarce surgical resources and expect people to simply do more and more, cost will often become an issue, as will delays and waiting. If we are able to make sure that all of those who are able to perform these operations do so, then it will be better for all concerned.

Podiatric surgeons provide specific professional services and perform minor, mostly straightforward, surgical procedures on feet and toes. As I have stated, this really is a fairly simple set of amendments to make sure we enshrine, for private health insurance funds, the ability to provide benefits for in-hospital foot surgery performed by podiatric surgeons. The issue was raised with the Community Affairs Legislation Committee and, as we saw from the evidence there, it is simply not enough to just encourage, because it will not happen. If we just ask the private health funds to do it out of the goodness of their hearts, I do not think we will ever get there. I quote from page 5, paragraph 1.21 of the Community Affairs Legislation Committee’s report:

The Private Health Insurance Ombudsman commented that ‘many consumers might see the introduction of a patient gap for prostheses that would otherwise have been available with no gap, as a reduction in patient choice’.

In paragraph 1.36 it goes on to say:

Private insurance companies have indicated that they will not pay for these [prostheses] unless podiatric surgeons are specifically allowed for in the legislation … The ACPS applauds the intent of the Government in this matter but is nonetheless concerned that without specific legislative amendment to the Act the insurance industry will not comply with the intent of the Government.

The amendments simply cement in place what the government has indicated. As the ombudsman said in relation to patient choice, we cement in this choice if we make sure that this is catered for. Indeed, one of the recommendations of the Senate committee is:

... that the Private Health Insurance Ombudsman monitor the implementation of the new podiatric surgical cover provisions and report on progress in the Ombudsman’s annual State of the Health Funds report.

The committee also recommends in 1.45:

... that future reviews of private health insurance cover should consider whether benefits should be paid for the professional services of podiatric surgeons ...

I argue that we cannot leave it to the future intent but that, as we have such people already qualified, we should immediately give this opportunity. In relation to podiatric surgeons and prostheses, the committee report states on page 7:

Podiatric surgeons provide a specific professional service. They perform minor and mostly relatively straightforward surgical procedures on the feet and toes. Podiatric surgeons generally are qualified podiatrists, but they are licensed to provide their specialist and highly-skilled services on the basis of extensive relevant further experience and postgraduate training.

For those who are concerned that perhaps those that we are recommending be involved in this legislation are not qualified, that was one of the issues looked at by the committee and they found that most certainly these people are qualified in this area. The committee also notes:

As podiatric surgeons are not qualified medical practitioners, services provided by them are not eligible for Medicare benefits. In 2004, however, the Government amended the National Health Act to allow podiatric surgeons to receive private health insurance benefits notwithstanding their lack of Medicare eligibility.

The committee report goes on to quote the Minister for Health and Ageing’s second reading speech, in which he said:

There have been recent changes to health insurance legislation that enable members to access basic hospital accommodation and nursing care costs for services performed by accredited podiatrists. In those circumstances, I encourage health funds to cover the prostheses implanted by podiatric surgeons.

As we see from the committee evidence, the fact is that if it is only encouragement then it simply is not going to happen. In summary, I believe that we need to look at the two issues of choice and cost. Again, I suppose the proof will be in the results in years to come, but I believe that consumers will be facing lower, if not no, gap payments with podiatric surgeons and they will be given the additional opportunity and benefit of accessing other trained professionals.