Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Hansard source

I thank the member for Maranoa for that question because I know there is a lot of genuine concern, particularly in our rural and regional areas, about the impact of this savings measure. I do think it is worth my taking you through some of the data. We are certainly happy to talk, as we are continuing to, with Dr Bill Glasson and other ophthalmologists who are putting forward different proposals about how we might still be able to make a significant saving, which we think is appropriate when the technology has changed so significantly, but also make sure that we protect regional communities.

I need to highlight that we have only 23 per cent of cataract services performed outside large metropolitan areas, and only 0.4 per cent of these services are performed in remote areas. Most of those services, even in remote communities—probably the member for Solomon would be aware, although it is outside his electorate, of the arrangements at Alice Springs Hospital, for example—are actually for privately funded services to be conducted, although on the site of the public hospital.

People need to remember that this is a procedure which currently is being remunerated with hundreds of dollars. You used the figures of $600 and $300. The figures that we use are the cost when the measure would be introduced, which is $830, being reduced to $409—but proportionally, obviously, the point is the same. For the vast majority of these services, another $1,700 is paid by private health insurance funds for the hospital costs on top of the MBS rebate. What we are trying to ensure is that, when we are being constantly asked, as we should be, by the community to invest in new technology, new medicines, new breakthroughs—and that costs money—we are able to reap some return when medical technologies give us the ability to do some of these procedures in a cheaper or quicker way.

No-one likes it if they are providing services that they can get a certain amount of money for and that amount is cut. I understand why the ophthalmologists do not like that; it is their income. But, ultimately, as the health minister, I have to make decisions on the best use of taxpayers’ money, and that needs to be targeted towards to delivering the best health services to people. I am not going to be in a position where the government and the taxpayer keep being asked to put new drugs, new technologies and new procedures into the healthcare budget and are never able to reap any benefit for savings that should be able to be recouped by the taxpayer.

Let me also tell you that we do understand, as I say, the rural and regional impact of this. It is why we have provided more than $800,000 for additional ophthalmology services through the medical specialist outreach program. You would be aware, I am sure, in your electorate of Maranoa that there are ophthalmologists who visit your electorate as a result of that. We have just made a commitment to add another $58.3 million to improve access to eye and ear health for Indigenous Australians, so in some of the communities, where there is fear that they might be affected by this, they will actually get extra services through a more direct funding process.

One of the challenges for us is that the Medicare schedule is a blunt instrument for differentiating between those ophthalmologists who might make quite a lot of money in their metropolitan practices and then cross-subsidise, effectively, by going to regional areas where they simply bulk-bill, as the member for Maranoa suggested in his question, and the vast majority of ophthalmologists who are not doing that. The taxpayer is still paying the extra amount for a procedure which is no longer as time consuming, although, in many cases, it can still be complex.

What I can undertake to do, and I have said this publicly, is continue discussions with the ophthalmologists and with members as to whether there is a different way to ensure that those services being provided in rural and remote communities are maintained and properly supported. I am also happy to work with the ophthalmologists who have suggested that looking at a complex item for those procedures that are more difficult than the standard cataract procedure might also be a better way to balance things. I am not ashamed of trying to protect the taxpayers’ interest because it will allow us to invest in new technologies and new medicines as they become available, and that is something we need to be able to get our medical community to understand we have to keep doing over time.

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