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Wednesday, 2 February 1994
Page: 246


Senator RICHARDSON (Minister for Health) (6.30 p.m.) —I table some supplementary explanatory memoranda to the government amendments. It is minor stuff but, nonetheless, it must be done. I would like to cover a few points that have been raised during the second reading debate. Allowing for the fact that this is a cognate debate, I would like first to address some of Senator Patterson's concerns on the Nursing Home Charge (Imposition) Bill before I address the remarks made by Senator Lees and Senator Herron.

  I was asked about, if you like, the caveat emptor situation for prospective nursing home purchases. The arrangements that are in this bill complement the protection that is already provided by earlier amendments and, subject to compliance with the existing requirements relating to the giving of notice of sale, should provide the protection which Senator Patterson feels is necessary. The purpose of the notice period is to allow sufficient time for any liabilities to be identified and advised, obviously, to both parties but, in particular, to the purchaser prior to a sale. Failure to give correct notice is an offence. Notwithstanding such an offence, the vendor remains liable for any debts incurred prior to the sale.

  Obviously, because we have these new provisions does not mean that a purchaser should approach any potential nursing home sales transaction with anything less than the usual commercial diligence. On the introduction of the first stage of the amendments, the department sent a circular out to each nursing home operator and to industry representative groups explaining these new arrangements and stressing the continued importance of the buyers making sure that they are aware of any potential liability prior to the sale. The department plans to reinforce that importance at the commencement of these amendments through a further circular as well as in standard correspondence and sale situations. I think I am in a position to guarantee to Senator Patterson that, whenever the department is aware of a potential purchaser, that purchaser will be notified of these arrangements in the bill and, of course, of the need to exercise particular diligence in that situation. That having been said, I wish to turn to the remarks of Senator Lees and Senator Herron.


Senator Herron —What is your reply to Senator Patterson about the requirement for a document to be handed to the purchaser?


Senator RICHARDSON —What I have said is that, whenever we are aware of a purchaser being involved, we will send that purchaser the document. I gave Senator Patterson that assurance privately when she came around because she had to leave and she was happy with the assurance, so I do not think there is a problem. If there is a problem, I will certainly come back to it, but I am not aware of one.

  I shall return to what I was about to say concerning the remarks of Senator Lees and Senator Herron. It is interesting to listen to the two of them because one could say that they have an opposite approach. Often in health matters these days I seem to be attacked from the left and the right. It is interesting being in the middle of these attacks. As you know, Mr Acting Deputy President, I have always been a centrist, and I find myself there again. On the one hand, Senator Lees has said that in some way I have been seduced by the AMA, the dreadful trade union representing doctors. On the other hand, a former state president of that same trade union—I had never actually thought of Senator Herron as a trade unionist—offered a different kind of criticism. Both are wrong, and I shall briefly outline why.

  I do not think it is the case at all that the AMA knocked on my door and came in and said, `Please give us a peer review system in overservicing'. That is far from what I think it wanted. I think it would have much preferred that I simply go away and not talk about it at all. But in looking at the government's record over 10 years, I became convinced that a different approach was necessary. First off, I acknowledge what Senator Herron said. The figures are there for anyone to dig out. We have not been able to recover anything like the amounts that I think we should recover. I do not accept the 10 per cent figure to which Senator Herron referred. I have never accepted the 10 per cent figure. I find the seven per cent figure a bit rich as well. I do not think there is any real basis for them. Certainly I cannot provide anybody with data to back up either claim. Until I can find a base, I will not make any outlandish claims.

  That having been said, we had, first, to approach the difficulty that Brendan Nelson refers to consistently—being able to define what overservicing is. Overservicing is difficult to define. I find it hard, in looking towards the definition that we find here or in listening to anyone else's definition, to believe that I will be the appropriate person to make the decision. I think we have to look to the profession, which is, as far as I am concerned, a noble one. The people in the profession are, in the main, noble servants who do a grand job. I have enough faith in the profession and in its nobility to believe that it can take part in a genuine system of peer review and make sure that the rogues to whom Senator Herron referred are brought to justice and at least made to pay back the money that they need to from overservicing.

  Both Senator Lees and Senator Herron referred to fraud. I am not going to because this is not a fraud bill. As I understand it, we will get to that later, and I will deal with it when we get to it. So I will not take up the remarks that they made.

  It is certainly not true to say that the AMA walked in with this proposal and I adopted it. It is true to say that I looked at the work of the Health Insurance Commission and decided not to proceed down its path. I do not deny that. It has been working on that for a while. I did that because, as I said, in reviewing a decade's worth of work on this, I thought the basis of the approach that we had been trying was not working and that we ought to try a new one. The reason I thought the approach was not working is essentially that the profession has boycotted and frustrated the process from day one. It has done a pretty good job of it and continues to do so.

  In the punitive approach, inevitably we got ourselves bogged down in medical services committees of inquiry where legal representation meant that these things took years rather than months, and further appeals followed. In fact, I am staggered by the fact that I am getting correspondence on my desk—I was busily signing some last weekend—where doctors have been involved for seven years in a process before I get to determine the penalty at the end of the day. I find that unacceptable. It must be unacceptable to the government, and I assume that it is unacceptable to the opposition, the Democrats and anybody else who wants to examine it. We cannot have a process that takes so long because, in the end, that is justice to no-one, not even to those who have done the wrong thing in the first place.

  I knew that the frustration that the profession felt and which it had then demonstrated by its attitude to the process was going to be awfully hard to defeat. I am not one who is afraid of saying, `Let's try getting on together. Let's try a process of peer review where, if all of the noble words you have spoken are true, you will be able to make sure that if the wrong thing is being done it will be stopped'.

  Much more importantly, what the process of peer review can achieve that the processes and the path that we have been down for the last 10 years can never achieve, is an effect on the rest of the profession who are not necessarily being investigated and who are not, therefore, feeling under threat. I wanted members of the whole profession to understand that there was a problem here and that if they were to transgress, then their own peers would come down upon them. I do not think that is a bad idea. I have supported it strongly. I think it has a much better chance of success than the kind of direction that I think Senator Lees is suggesting.

  I talked not only to the AMA but also to a number of other organisations about it. If one is the health minister and one is looking at who to talk to in the medical profession, one talks to everybody, but it has to be acknowledged that the AMA is the most significant body and it would be pretty foolish to ignore it. I have obviously talked to Dr Peter Stone and his colleagues in their organisation, and all the others, but we cannot ignore the AMA. I must confess that over the last decade there have been a few times when I have wished we could, but we cannot and, therefore, I talked to the AMA. I never wanted it to be seen as the sole preserve of the AMA. I was happy when Senator Lees and others raised in the committee last year that we ought to make sure that the AMA kept to its undertakings and consulted other groups, so I am happy to accept amendments along those lines.

  I take exception to Senator Lees's remarks about it being, in some way, a terrible thing to have the AMA needing to agree before the director is appointed. I think that makes it certain that the director is genuinely independent rather than have the person questioned. If it were the case that I simply stood up and found someone who I thought was appropriate and nominated that person, then there would be no question that that person would be independent of the AMA, but there may well be a question—and certainly it would be a question in the minds of members of the profession—as to what my relationship might be with that person. It would always be a matter of controversy, as it always has been with the HIC.

  The person who heads up this organisation has, if one reads through the bill, considerable powers. Deciding whether to set up a review committee is, indeed, the heaviest of powers. I think we must have the profession onside for that appointment, otherwise we will go back to the boycott and the frustration of previous years. I am more than happy to discuss a potential head of that body with the AMA and come to an agreement on an appropriate person. That person will then have genuine independence in every decision that he or she makes. It would be very hard for either side to claim bias. That is what I believe is fundamental and necessary and so I am happy to do it.

  As to the other remark about treating doctors' crimes as less serious than social security fraud or other forms of white collar crime, I think we will demonstrate with the fraud legislation that this is a matter that will be pursued ruthlessly and toughly. Fraud is fraud. It is different to this; there is no definition. That is straight out stealing from the Commonwealth and if people are going to do that then, as far as I am concerned, they go to gaol. It is not a matter for any committee of inquiry to look into; it is a police matter and that is what it will be seen to be, but we will debate that on another day.

  I have taken the view that if there were weaknesses with the HIC—and certainly the HIC never pretended that there were not weaknesses—and difficulties in it proceeding down the path of chasing doctors in the last 10 years, then a change would be necessary. I am delighted that it would appear these bills are going to be passed without any major opposition.

  I cannot finish my remarks without referring to Senator Herron's reference to bulk-billing. There are the odd magnificent obsessions that run around the place from time to time and we have another example tonight. Members of the AMA have been getting themselves into a lather about bulk-billing for a decade. I am grateful for this because it has meant that they have got their Liberal Party mates in the same lather and have dragged them along the path of opposing bulk-billing on every occasion. We have dined out very well on this and we are happy. Keep it up. This is a major plus for us—although I note that Senator Herron's colleague, Senator Newman, has now started to say, `We might have to look at bulk-billing'. Gary Nehl, the honourable member for Cowper in the other place, who put out a very nasty letter bitterly criticising Dr Hewson and some of his colleagues—I was most appalled at the strength of the language in it—has also said that we have got to do something about that.

  I want to make a couple of points about why bulk-billing is irrelevant in this argument and why it is not the case that if we get rid of bulk-billing we get rid of overservicing. Firstly, in round figures, about $3 billion of services are bulk-billed each year.


Senator Herron —That is right, and doctors can get patients to sign a blank cheque.


Senator RICHARDSON —Senator Herron should just take three deep breaths and listen. This is the time for listening. There is $3 billion worth of services; $2 billion of that is for pensioners and cardholders.


Senator Crichton-Browne —How long are you going to be? I want to make a phone call.


Senator RICHARDSON —According to the clock, I have only four minutes.


Senator Crichton-Browne —You told me you would be five minutes.


Senator RICHARDSON —Yes, but I did not realise that I was going to have all these matters raised. I thought that, out of the kindness of their hearts, other senators would stand up and say, `Senator Richardson, you have done a terrific job; we agree'. But they did not; so here I am.

  It is no good, therefore, to say that we will call for the abolition of bulk-billing except for pensioners and cardholders, which is what those opposite said in the last election and all the other elections. At the end of the day, there is still $2 billion of the $3 billion there. So if bulk-billing was the cause, two-thirds of the cause would not even be touched and opposition senators could not expect any of us to believe that the whole of the overservicing exists in the other $1 billion. That is nonsense. We have to nail that. It is a silly line, but I hope Senator Herron keeps getting people to swallow it. I do not want to discourage him, but I want at least to place the truth on the record. There is something more important—


Senator Herron —It is correct in relation to overservicing.


Senator RICHARDSON —It is just not correct.


Senator Herron —Yes it is. You give them a blank cheque.


Senator RICHARDSON —I am going to make my point anyway. When we look at the service data for what happens here, we see, and it is worth noting, that in New South Wales there is a bulk-billing rate of 64 per cent and 9 1/2 services per head per year. I think that was in 1989-90. I am using that year because that was the year the audit office used; I am sure that is right. In Tasmania, where the bulk-billing rate was much less at 45 per cent, there were only 7 1/2 services per head per year. So there is this great conclusion: less bulk-billing, fewer services.

  There is a problem with that assertion. That assertion ignores the rest of the evidence. In Western Australia in the same year, there was a bulk-billing rate of 56 per cent—a lot higher than in Tasmania but, nonetheless, less than in New South Wales—and the services per head dropped to seven per year. I would like to find out why this disparity occurs. I know that it has naught to do with bulk-billing. It is obvious, on the face of those facts, that the opposition cannot pursue it, but I am glad honourable senators opposite laugh and I am glad they keep doing it.

  The last bit of evidence from last week is that 87 per cent of Australians think that bulk-billing is a good idea. I tell you what—those 87 per cent of Australians usually work things out pretty well. When it is that overwhelming, those opposite ought to wake up and go along with it. But if they do not, we stay here and they stay there and I always like that. I commend the virtues of bulk-billing, I certainly commend all three bills and I am delighted to hear that the Senate will not be opposing them.

  Question resolved in the affirmative.

  Bills read a second time.