Tanya Plibersek (Sydney, Australian Labor Party, Minister for Health) Share this | Hansard source

I want to respond very quickly to what the member for Paterson and the shadow health minister have said in this debate on the second reading of the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2012. It is pretty interesting hearing the member for Paterson, as part of a party that destroyed Medicare, claiming to be a great defender of it—not once but twice we on this side of the House have had to introduce Medicare. Talking about the health care of his constituents, no government has invested more. No government has invested more in hospital services; no government has invested more in primary care; no government has invested more in training doctors and nurses and allied health professionals. When we look at the record of the previous government, including when the Leader of the Opposition was the health minister, we see that there were caps to GP training places, there were too few health professionals, there was $1 billion taken out of hospitals, in contrast to the $20 billion we have put in. We can see their record. You have only to look at the states and territories, as well, to see the record of Liberals when it comes to cutting health services rather than investing in them.

The shadow minister was talking about bulk-billing and Medicare services. Bulk-billing has never been higher than it is now. We hit a GP bulk-billing rate of 81.2 per cent in March this year. In 2003, when the Leader of the Opposition was the health minister, bulk-billing was at a historic low of 67 per cent. As a government, we spend about $17.64 billion on Medicare benefits—that is the 2011-12 figure—an average of $784 in Medicare benefits for every Australian. Bulk-billing rates are higher under us because we have invested in the system. Since 2008 we have invested a record $2 billion to drive up bulk-billing rates with incentives for GPs, pathology, diagnostic imaging and telehealth services. It is also worth reminding ourselves that the average GP receives over $300,000 from Medicare each year. Over the past 12 months we have expanded Medicare to provide rebates for nurse practitioners and midwife and telehealth services.

The Extended Medicare Safety Net exists to give extra help to patients with high out-of-pocket medical costs. While the vast majority of doctors do the right thing, unfortunately some providers have exploited the extended Medicare safety net to increase their fees in excessive ways. For example, for a standard GP consultation of up to 20 minutes in length 99 per cent of services had a fee of less than $90, but some providers have charged $5,000 and one provider has charged $8,000. The member for Paterson mentioned anaesthetic for cataract surgery: for services out of hospital, the top 10 per cent of fees increased from less than $500 to nearly $2,000 in the space of one year—between 2009 and 2010. For electrocardiography—heart tests—81 per cent of services had a fee at or below $30.65; one provider charged $800. Removal of skin lesions without biopsy: 82 per cent of services had a fee at or below $33.35, but one provider charged $3½ thousand. The Extended Medicare Safety Net is a government benefit intended to help patients; it is not intended to subsidise excessive fee charging. I make the point also that the measures we are discussing today have had support from the vast majority of doctors and health professionals, who are doing the right thing and who see the importance of sustainability in our Medicare system. The AMA President, Steve Hambleton, said:

The changes to the Extended Medicare Safety Net (EMSN) appear to have been based on clinical and economic evidence and do not involve services or procedures that are regularly required by families.

The Consumer Health Forum Chief Executive Officer, Carol Bennett, said:

We can't expect wrinkle reduction, eye lifts, nose and ear jobs to be subsidised by taxpayers.

And Arthur Karagiannis, the President of the Australian Society of Ophthalmologists, whose members are actually affected by these rules, said:

Patients suffering macular degeneration now have peace of mind that they will have ongoing access to what is becoming an increasingly common procedure.

I thank members for their contributions to the debate on this bill. More than ever, we need to make sure that every precious dollar of our health investment is used as it should be. We are being guided by the evidence and we are investing wisely. We are finding efficiencies and we are returning those benefits to patients. Where the evidence says that things are not working, the government has done things differently and the bill before the House is part of that. We have looked at the evidence on how the Extended Medicare Safety Net works, and it says that we need to close a loophole to protect the integrity of the system.

The Extended Medicare Safety Net provides individuals and families with an additional rebate for their out-of-hospital Medicare services once an annual threshold of out-of-pocket costs is reached. Once the relevant annual threshold has been met, Medicare will pay for 80 per cent of any future out-of-pocket costs for out-of-hospital services for the remainder of the calendar year, except for a number of services where an upper limit Extended Medicare Safety Net benefit cap applies.

The government introduced benefit caps for certain services following an independent review that found some providers had used the EMSN to increase their fees to excessive levels—and I have given you some examples of that. The Extended Medicare Safety Net was designed to help patients with out-of-pocket costs, not to subsidise excessive fee charging by a minority of doctors.

Under the current legislation, in certain circumstances where more than one Medicare item is claimed by the same patient on the same occasion and the items are deemed to constitute one professional service, Extended Medicare Safety Net benefit caps are unable to apply as originally intended. An example of this is where patients have more than one operation performed at the same time. Some doctors are performing multiple operations to avoid EMSN benefit caps.

This bill amends the Health Insurance Act 1973. It allows EMSN benefit caps to apply even when multiple services are performed. This means that the Medicare benefit goes towards helping patients with out-of-pocket costs, not on subsidising those excessive fees charged by a minority of doctors. Importantly, it helps protect the integrity and the sustainability of the Extended Medicare Safety Net. I commend the bill to the House.

Question agreed to.

Bill read a second time.

Ordered that this bill be reported to the House without amendment.

See this speech in context