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Tuesday, 7 March 2023
Page: 1

Senator RUSTON (South AustraliaManager of Opposition Business in the Senate) (12:02): I rise to speak on the Private Health Insurance Legislation Amendment (Medical Device and Human Tissue Product List and Cost Recovery) Bill 2022, the Private Health Insurance (Prostheses Application and Listing Fees) Amendment (Cost Recovery) Bill 2022 and the Private Health Insurance (National Joint Replacement Register Levy) Amendment (Consequential Amendments) Bill 2022. These three bills before the Senate relate to the Prostheses List and private health insurance. This is the first step in the legislative process. These are the most comprehensive reforms to the Prostheses List that have ever been undertaken. These reforms come after more than four years of detailed work and collaboration by a number of people in the medical technology community with the former department and the former government. Stakeholders—MTAA, the Australian Medical Association, the Australian Private Hospitals Association, Catholic Health Australia and the Consumer Health Forum—have all been engaged in this years-long process to get us where we are today to ensure that this reform package both helps private health insurers remain sustainable and protects patient access and doctor choice to this very important part of our medical sector—that is, the Prostheses List. Getting these reforms right is really important. That's why I make a particular point of thanking all of those people who have been involved in getting this debate to where it is to enable the start of the legislative process.

We know that medical devices and medical technology have had a major impact across the health sector. There has been a 30 per cent decline in annual mortality rates in the last 20 years, an overall increase in life expectancy of 4.1 years, and a 56 per cent reduction in the number of hospital days per capita. This is extraordinary. These statistics are not just numbers; they actually relate to fathers, husbands, wives, children, friends and loved ones.

It's really important that we pass this legislation as the process has been undertaken in great faith. These bills present the first tranche of the legislative changes required to actually implement a coalition 2021-22 budget measure—modernising and improving the private health insurance Prostheses List. It has been hard fought. The coalition are absolutely happy to support the process and the progression of these bills because they do some very important things.

In saying that, I note that, whilst the importance of this legislation cannot be overstated, there are some real concerns about the fact that so much of the information that is needed to underpin the moving forward of this initiative is completely absent and nobody has any line of sight whatsoever. This sector has no line of sight, this Senate has no line of sight, certainly the opposition has no line of sight and, in a funny way, I'm actually quite concerned that those opposite don't have any line of sight, because we have no information whatsoever. However, these three bills seek to do some reasonably sensible things. They ensure the ability to better define products that will be eligible to be on the list, they define the register levy and allow it to be implemented, and they better define the cost recovery framework that sits here.

The coalition are really pleased to be able to stand here today and talk about these bills, because I think our track record demonstrates that we have a really strong record when it comes to strengthening private health insurance in this country. We believe that it is a fundamental part of Australia's health system. When we left government, private health insurance membership was at an all-time high, with more than 14 million Australians being covered. Our reforms included the 2022 premium charge, which was the lowest increase in premiums in more than 21 years and the eighth successive decline in premium charges since the last year that Labor was in government in 2013. We also increased investment in the patient rebate for private health insurance from $5.4 billion in 2012-13 to $6.9 billion in 2022-23. We also implemented the new easy-to-understand gold, silver, bronze and basics classifications for private health, standard clinical definitions and better access to mental health services which, sadly, we've seen this government start to unwind.

We know intrinsically that Labor governments are not great supporters of the private health insurance sector in this country, but I would encourage you to make sure that, when voting on these bills, we actually support a very strong private health insurance sector because that is what makes our overall health sector so strong in Australia. We are the envy of the world because we've got the right balance between the private sector and the public sector so that we are able to offer that choice and control to Australian consumers when they are patients so that they can access the broadest range of choice in health care of just about anywhere in the world.

But, as I mentioned a minute ago, the greatest problem with this legislation is the lack of transparency around the detail that sits behind it. There are certain key elements which aren't enabled by these bills and which we have no information on. Once again, we have a Labor government coming in here and rushing in legislation when they haven't actually done the work that sits behind it. The question has to be: is this government incompetent or is it trying to hide something from Australian consumers by refusing to provide the information that would set the minds of most of us at rest, if we knew what was sitting behind this?

There are a number of key areas of great concern that I particularly want to raise here today and put on the record. First of all, the cost recovery framework regulations and rules haven't even been out for consultation yet, and yet we are seeking to put in place the mechanism for cost recovery with this legislation. Another example is the definition of a medical device. In terms of the guidelines, we need to know what will be included in future on the Prostheses List. We know that this legislation enables the process by which, going forward, many items that are currently on the Prostheses List will be removed, so we need to know what will be included in the future. As an example, an insulin pump would not necessarily be categorised as an implantable device, but obviously it's a very important device for those people with diabetes. So we need to know where that product will be going in the future.

Another area of great concern is that in relation to all of the items that have been removed from the Prostheses List by this streamlining—often described as 'non-implantables'—the minister has made a verbal statement that he is going to mandate the requirement for those items to be included in general use to enable them to continue to be part of the refunding from the private health insurers. We have a promise of inclusion, but at this stage we still do not know what that is going to look like. IHACPA, the pricing authority, is out consulting as we speak. It hasn't reported yet; it doesn't have to report until after the likely passing of this legislation today. So we don't know how that bundling is going to occur. I think we've got a reasonable idea that the Department of Health and Aged Care and IHACPA have a preferred model for care, for this bundling. It appears they have a preference for bundling by facility type, but we know that the sector knows that it is a much more targeted way to make sure that we have got the correct kind of refunding and cost mechanisms in place for bundling if they are done through a procedure-bundling exercise instead of facility type.

The minister said he's going to mandate the requirement for the cost inclusion of these items in general use for two years. The question then is: what happens after two years? Is the expectation that we're just going to set everybody against each other while they go and fight it out as to who is going to pay for these items that have been removed from the Prostheses List by this legislative framework?

But one of the greatest concerns before us at the moment is about the time lines of the requirement for this bundling to come into effect. Industry have been categorical in saying they do not believe they will be in a position to implement these changes on 1 July 2023, which is the intention of this government. Once again, we have seen the rushing of a piece of legislation, to tick and flick something they said they were going to do, with no regard to the implications of those time frames for the people required to implement them. Most particularly, I don't think there has been any regard taken for the implications for patients, and the outcomes for patients and our overall health system, of the intention to push forward with this on 1 July.

We now know that the minister intends to speak to the IT vendors, who are the ones who will have to put this in place sometime between now and 1 July. Surely, Minister, government and health department, you should have had these things worked out before you came in here and asked this parliament to vote on something with no detail whatsoever and with huge concerns being raised by the sector that these details need to be known so they can understand whether they can meet the requirements that some of this legislation intends to mandate. We've seen it before. We saw it with the aged-care bills, and now we're seeing it here with these healthcare bills. As I said, most particularly, we want to make sure that the implementation of this time frame does not have the catastrophic impacts on patients that it could potentially have if it's forced through without any regard for what happens on the ground, what happens in the hospital and what happens to the patients.

I'll be asking some of these questions because I believe the Greens intend to take these bills into committee. There are some questions the government needs to answer here. First of all, the government needs to guarantee that with the mechanisms we don't know about yet—the detail that sits behind this legislation that is only going to be under an instrument that can't even be disallowed—there will be no changes to surgeries that different hospitals are able to afford to deliver to their patients. Can it assure this chamber these changes are not going to have negative impacts on the current ability for a hospital to provide a particular process or procedure? I will ask the government a specific question, and I'd really like an answer to this: can you guarantee, as an example, that bariatric procedures will remain a cost-effective procedure for private hospitals to continue to provide to their patients, following the changes in terms of the implementation and the categorisation of both the cost framework and the bundling procedures? Will we just see many of the procedures that are currently being undertaken in public hospitals and private hospitals shoved into the public system because private hospitals will no longer be able to afford to provide these procedures?

These are questions we need to have answered. We should have had these questions answered before we were asked to come in here and vote on these bills. Despite the fact that so many people in the sector have put so much time and effort into this reform process, we stand here today with so many unanswered questions that you should have been able to answer. You should have put the work in in relation to these uncertainties that the industry and the wider private health sector continue to raise about this proposed legislation. As I said, the industry have particular concerns that the enabling legislation will proceed without the critical details that they need to know to make sure that this is in the best interests of the patients that they serve.

The legislation is currently to be undertaken between March and May. We're standing here at the beginning of March trying to push this through this place. Why are you rushing this legislation through, when you could have waited and allowed it to go through in a timely manner to ensure that no unintended consequences fall out of this rushed process? Why is it that you as a government continue to refuse to give us any oversight of the subordinate legislation that sits underneath this really important legislation? It might all be fine, but how would we know when, once again, your idea of transparency is not to tell us anything and your idea of consultation is to tell us what you're going to do?

I would say to those opposite: the simplest approach to enable these concerns to be allayed across the broader sector would be to delay any further debate on these bills until May or June, after your consultation process has finished and we have confirmed details about the subordinate legislation. Right now, as we're standing here today, it looks as if we are going to make sure that good governance gets put to the bottom of the list, for legislative expediency. I don't think that's a very good way for us to be managing what is an extraordinarily important part of the Australian culture, something that Australians are so very proud of, our world-class health system. Sure, it's got some challenges at the moment, but those challenges will only be made worse by this government refusing to give any detail of what their intention is with the details of this sort of legislation. It has become a habit of this place, a habit of this government. It was elected on a platform of transparency, and I can say to you that, in my experience as the shadow minister for health and aged care, this government has been anything but transparent since it's been here. I have never seen such an opaque government in my entire life.