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Thursday, 24 May 2001
Page: 27017


Dr SOUTHCOTT (1:29 PM) —It is a pleasure to speak on the Health Legislation Amendment Bill (No. 2) 2001. There are four measures in this bill, most of which are of a technical nature. The first section relates to the Australian Institute of Health and Welfare. This is a great organisation which produces valuable research in the area of health and welfare. They have also been good at establishing national priorities in areas like asthma, diabetes, spinal injury and so on. The first section will allow greater flexibility in the appointments to the Australian Institute of Health and Welfare. It will allow, in effect, the minister to choose the best available for the Australian Institute of Health and Welfare. Previously the minister has been constrained by recommendations made by various groups. The bill also allows a change to the name of the ethics committee which will better reflect the responsibility of the institute now—not just for health but also for welfare. The bill will also allow a change to a confidentiality matter to allow non-identifying material to be released for welfare related information and statistics. That is already allowed in relation to health information and statistics.

The second section of the bill deals with the recognition of specialist medical practitioners. This will simplify the process for recognising medical practitioners as specialists. Presently that can be done by the minister and also by a specialist recognition advisory committee. The amendment will allow specialists to be recognised without the need for ministerial determination or consideration by a specialist recognition advisory committee.

The third section of the bill relates to the direct payment of Medicare benefits to doctors. I support this. It was foreshadowed in the memorandum of understanding with general practitioners. This has prevented Medicare from operating efficiently. It has been a longstanding problem. It applies only to two per cent of `pay doctor via claimant' cheques but, even so, I think this will improve the operation of the system. Previously, if a `pay doctor via claimant' cheque was not presented, the medical professional who had offered the services did not receive the benefit for the services they had provided. That either led to a problem with bad debts or meant they just did not receive the benefit at all. So this amendment will see a significant improvement, which will allow the Health Insurance Commission to cancel the cheque if it has not been presented after 90 days and transfer it directly to the medical professional.

The fourth area relates to the 30 per cent private health insurance rebate. This has been a very successful measure of this government. It was opposed by the Australian Labor Party and the Australian Democrats. The measure was passed in late 1998 and has been operating since 1 January 1999. It allows members either to claim a 30- per cent rebate and a reduction in price or to receive the rebate through the tax system. I recently received an estimate of the numbers privately insured in my electorate of Boothby. It was estimated that at the end of last year 65 -per cent of my electorate had some form of private health coverage. So both the Australian Labor Party and the Democrats were in effect denying this reduction in price in order to make private health more affordable. I am proud that I have been part of a government which has seen a key role for private health insurance, recognising that it does play a role in reducing demand in the public system. The amendment will allow funds to apply to the Health Insurance Commission for additional reimbursement if they underclaimed or if they lodged their claim after seven days. It will also allow some minor changes to the calculation of the claim.

I would also like to talk about one of the budget measures which I think has been misunderstood. This relates to the clarification of the PBS guidelines for cholesterol lowering drugs. These drugs are known also as the statins. They are actually a HMG-CoA reductase inhibitor. They have been prescribed for a little bit over 10 years now. Contrary to media reports and a scare campaign by the opposition, the measures that were announced in the budget are not going to alter the availability of the cholesterol lowering drugs. What they are going to do is clarify the clinical guidelines that surround their use. It is not going to change the criteria for eligibility for these drugs under the Pharmaceutical Benefits Scheme. People who are currently eligible for the Pharmaceutical Benefits Scheme subsidy will not be affected. What will happen is that the National Prescribing Service will undertake an education campaign about the place of cholesterol lowering drugs in the overall management of high cholesterol. The Health Insurance Commission will also undertake targeted activities to raise awareness of the PBS subsidy requirements. Patients are going to receive dietary advice and will have to be shown to have cholesterol levels unresponsive to diet and lifestyle modification prior to the commencement of any medication.

As with all treatment, the decision to prescribe these medicines is a matter for the doctor in consultation with their patients. This measure is not going to force patients to stop taking medicine that their doctor has decided is appropriate for their treatment, and the range of cholesterol lowering medications on the PBS will not be affected by this measure.

The guidelines for people currently on the Pharmaceutical Benefits Scheme relate to various levels of risk. Patients who have existing coronary heart disease are currently eligible for the simvastatins based on a cholesterol greater than four. Other patients who are at high risk, who have one or more of the following—diabetes, familial hypercholesterolemia, a family history of coronary heart disease, high blood pressure or peripheral vascular disease—are eligible to be on the PBS if they have a cholesterol greater than 6.5 or a cholesterol greater than 5.5 and an HDL less than one millimol per litre. Patients who have a low HDL, less than one millimol per litre, are eligible to be on the PBS if their cholesterol is greater than 6.5. Patients who are not covered by those three previous categories are men aged 35 to 75 or post-menopausal women up to 75, and they are eligible for PBS, statins—simvastatins and so on—with a cholesterol greater than 7.5 or triglyceride greater than four millimols per litre. Other patients who are not covered in the above are eligible if their cholesterol is greater than nine or their triglyceride level is greater than six millimols per litre.

The Australian National Heart Foundation has been looking at clinical guidelines for where prescription of simvastatins is going to be clinically recommended. They will be publishing their guidelines in the next month or two. The American Heart Association has just published their guidelines, which are consistent with the guidelines that the Pharmaceutical Benefits Advisory Committee has established, which says that existing disease should be treated aggressively. There is also a feeling that perhaps diabetes mellitus should also carry the same risk as existing heart disease and it questions whether family history is as important as those other risk factors.

But the important thing to recognise is that these guidelines are established so that the prescription of these drugs is cost-effective. It also has to be evidence based. Around the world, there is a Sheffield table for the primary prevention of cardiovascular disease. There are also the New Zealand guidelines, which look at things like age, existence of high blood pressure, smoking, diabetes, and then look at serum cholesterol levels to work out people's risk of coronary heart disease in the next 10 years. It looks like, in Australia, we are prescribing these drugs at something like three or four times the rate of most European countries. In fact, they have been growing at something like 29 per cent per year, year in year out.

This measure from the budget is an important one. It is based on evidence. All it will do is make sure that people are aware of the existing guidelines of where the Pharmaceutical Benefits Advisory Committee believes that the statins should be clinically recommended. In other people, dietary changes and behavioural changes will be just as effective as cholesterol lowering drugs. In conclusion, the bill contains a number of technical measures which relate to the Australian Institute of Health and Welfare, the 30 -per cent private health insurance rebate and also the recognition of medical specialists. I commend the bill to the House.