Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

The Health Insurance Amendment (Pathology Requests) Bill 2010 was previously considered by the House in the last parliament. The bill removes the legislative requirement for a request to be made to a particular approved pathology provider for Medicare benefits to be payable. The change will allow patients to access pathology services at any approved pathology provider. In order for a Medicare benefit to be payable, the act requires a pathology provider to be specified on the request. It is common practice for medical practitioners to use pre-branded request forms, which include details of the pathology provider. The changes under this bill would mean that a patient in possession of a request would be permitted to go to any approved pathology provider. The regulations will require pre-branded forms produced by pathology providers and used by treating practitioners to include a prominent and understandable statement that pathology requests can be taken to any approved provider.

The coalition does not oppose the intent of this bill but holds some concerns about the practical effects of its implementation and the lack of consultation that occurred prior to its initial introduction into the parliament. The coalition supports patient choice in accessing health care but, as with any change in policy in this portfolio, proper consideration should be given to patient safety and the quality of care.

As I noted in my speech in the second reading debate in the previous parliament, this was a 2009 budget measure and was not subject to consultation. Submissions to the Department of Health and Ageing on the implementation of this measure only closed on 22 February—12 days after the Minister for Health and Ageing first introduced the bill in the last parliament. In addition, the government has initiated a review of funding arrangements for pathology services. Submissions were due by 30 April 2010 and the government’s decisions are to be reflected in the 2011-12 budget.

The government pursued a number of measures affecting pathology services, including the one before us today, while this review was being conducted. In previous budgets, Labor has reduced Medicare rebates for pathology collections, reduced Medicare rebates for some 259 pathology tests and imposed tighter caps on rebates for multiple tests performed on a single sample. There is nothing wrong with reviewing and making changes where necessary, but it should not be done in isolation from those on the front line of service delivery.

Again, these changes were made without consultation and that is the real issue of concern. Perhaps, though, it is no surprise that providers are closing facilities and shedding jobs. Only last week a major healthcare provider closed 23 facilities and cut 290 jobs, and it cited the effect of federal government cuts, including those affecting pathology. The intent of measures such as this may be good but the problem is the process—or lack thereof—that this government follows.

There is a distinct lack of consultation. It is incredible that at the same time it is undertaking a review the government is announcing measures that directly affect patients and providers. Surely it would have been more appropriate to undertake an open and transparent review that engaged with patient and clinician groups on possible proposals before drafting legislation and implementing measures. Who knows what is going to hit the sector in the next budget as a result of the supposed review?

I would like to outline a number of concerns about the bill that were first canvassed in the original debate and in evidence to the Senate inquiry. There is variation in the range of services offered by pathology practices, in the methods and equipment used, and in the methods of communication between pathology practices and referring doctors.

Whilst cost is a very important consideration for patients, it may not always be the most appropriate basis for deciding on a service provider. In the Minister for Health and Ageing’s second reading speech, she admitted:

… there are often valid clinical reasons for recommending a particular pathology provider over another.

The minister’s only comment on this issue was to say that the government will continue to encourage medical practitioners to discuss options with patients. As I stated at the time, that is an insufficient response to a core issue in this legislation that the minister herself identified.

There are also clear lines of communication between referring doctors and pathology services. Pathology practices ensure results are provided to GPs and other medical practitioners in a timely manner by means of established delivery systems and compatible IT systems. Also, pathology practices often have established means of contacting referring doctors after hours and in cases of emergency. The government has failed to explain how new referral pathways will operate in cases where the pathology practice is unknown to the referring doctor. A lost or delayed result may have very serious consequences for patients and medico-legal implications for the referring doctor. Stakeholders have flagged to the government concerns regarding lines of communication and it is important that the issues are resolved prior to implementation. In fact, it would be prudent of the minister to advise the House of progress in this area in her final comments.

It has been noted that similar arrangements already exist for diagnostic imaging. There are differences between pathology and diagnostic imaging procedures. The number of tests per patient is generally lower for diagnostic imaging. Imaging tests are usually undertaken with the patient present and the patient is provided with the results. It is also argued that diagnostic imaging methodology is standard across all providers and that, unlike pathology, it is not as frequently used to monitor chronic conditions or medication treatment. It is incorrect to claim that the processes that work for diagnostic imaging will work for pathology services.

The government’s record in health has done nothing to improve the situation for patients. There is growing concern in the community about decreasing levels of bulk-billing for pathology. This particularly affects older Australians, self-funded retirees and pensioners with fixed incomes. The situation appears to be deteriorating with the rapid expansion of collection centres as a result of another one of this government’s policy changes: the government has moved to reverse a policy supported by successive governments to contain pathology collection fees. Again, whilst the intent of the measure may seem sound, the policy ramifications for patients and taxpayers may be less so.

Pathology does rely on volume for economies of scale, and creating a situation where providers bid for space in a limited number of medical practices may lead to a rapid increase in the cost of operating collection centres. Increased out-of-pocket costs will lead to higher Medicare outlays. We are concerned by this government’s actions, which are leading to higher cost-of-living pressures for many Australians, particularly in the area of health care. I reiterate our ongoing concerns about the government’s approach to policy in this area and the continual bungling of legislation and issues which have general in-principle support. As stated, the coalition do not oppose the intent of the bill, but we will be seeking to address the issue the minister herself identified: the circumstances where there is a clinical need for a treating practitioner to specify an approved pathology provider.

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