Laurie Ferguson (Werriwa, Australian Labor Party) Share this | Hansard source

It might be said that this budget has many facets that have attracted criticism from the general public and from the media. An instance of that was the presentation in this parliament today of a petition by thousands of Australian doctors concerned about what the Prime Minister, on his high income, believes is just a modest co-payment to visit a doctor. There have been major assaults on the living standards of pensioners through the indexation change. Family payments have been severely cut. This measure is also of deep concern. It requires a higher co-payment by the general public and it increases the safety net threshold each year.

It has been argued that this is all about making sure that our Pharmaceutical Benefits Scheme does adhere to the long-term aims of timely access, quality, safety, efficiency, efficacy, quality use of medicines et cetera. However, I would argue that it is not driven by those facts. It is driven more by an ideological determination by this government to shift the cost of the system to the average person in this country. Obviously, in the end that means those people whose health situation means that they are more likely to have these prescriptions and are more likely to visit doctors.

The real factors driving the cost of our health system are not the visits by people to doctors or the use of pharmaceuticals that are subsidised by the Australian taxpayer. The reality is that other facets of the system are driving that cost—a tripling of the population between 1973 and 2013, or the increase in the population aged over 65 years of age to 3.3 million. The wider use of far more costly technologies has some relationship not only to medical research and drives by the pharmaceutical sector but also to the consequences of the ageing of the population. It is not a surprise that the health system's costs are going to rise. It is not a phenomenon that in any way is found only in Australia. It is not something that is identified only with a system that has a first-world pharmaceutical benefits scheme. It is a reality that is consequent upon factors such as those I just mentioned.

The government's invented emergency should be seen in the context of international comparison. The last OECD figures I have come across gave figures for health care as a percentage of GDP amongst OECD countries, in document 2010/09/028. At that stage, health care as a percentage of Australia's GDP was at 8.7 per cent. That compared with Canada at 10.1 per cent; France at 11 per cent; the United States at 16 per cent and Sweden at 9.1 per cent. Our rate is lower. That is who we should compare ourselves with—first-world developed nations. I know this government likes to compare our debt levels with those of Swaziland, Lesotho, Chad, Niger et cetera, but I think the comparisons this country should make are with these first-world countries. Another interesting statistic is that in the much-vaunted US system that the government would like to go towards—which is such a disaster and which American presidents from Theodore Roosevelt onwards have tried to change more to what Australia now has—the percentage of government revenue spent on health care as a percentage of the overall cost is 18.5 per cent. In Australia it is 17.7 per cent.

We have a situation where that much-loved Canadian administration of Mr Harper still has a pharmaceutical benefits scheme that is so attractive that $1 billion a year is spent by Americans crossing the border to utilise Canadian pharmaceuticals. The Prime Minister is at pains to associate with the Canadian Prime Minister—who of course gained a mere 38 per cent at the last Canadian election—on matters such as Tamils and human rights, but in regard to health care he is very significantly out of tune with Canadian practice.

This is an extremely serious measure. In 2012-13, 197 pharmaceuticals were subsidised by the PBS at a cost of $8.8 billion. It is a very serious matter, particularly for those people who are going to be impacted upon by these changes. I note that this is not the first time that a government of the other stripe has ventured in this direction. The Howard government was guilty from January 2005 of a 21 per cent increase. It had an outcome. It had a result. It had something they desired—an 11 per cent reduction in people filling and utilising their prescriptions.

Whilst those opposite might congratulate themselves on this change, significant players in the health sector are extremely critical of the change. The Consumers Health Forum of Australia has made the following comments:

As highlighted by CHF’s 2013-14 Federal Budget Submission, rising expenses for both government and individuals have underlined the need for new approaches to pay for healthcare that will result in more effective, targeted treatment, and reduced out-of-pocket costs.

The CHF is also disappointed in the failure of the budget in critical areas such as rising out-of-pocket costs. It went on to say:

Costs present a considerable barrier to access to health services for some consumers as the COAG Reform Council’s recent report showed with findings that the proportion of people who delayed or did not see a GP due to cost has increased—

that is, the people who are actually affected by this—

from 6.4 percent in 2009–10 to 8.7 percent in 2010–11, along with other evidence of financial barriers in access to specialists, dentists, prescriptions and diagnostic tests.

These barriers are greater for consumers from lower socioeconomic groups—

such as in the electorate of Werriwa, which I represent—

Australia is also comparing increasingly poorly internationally.

That is the comment of the Consumers Health Forum. It went on to say:

Delaying or reducing access to treatment will not only have implications for individual consumers. There could be major long-term budget implications, particularly if a person’s health deteriorates and they need to access care in the acute system.

It went on to attack both this and the doctors co-payment.

The Family Medicine Research Centre at the Sydney School of Public Health at the University of Sydney has also been extremely critical, making the point that in assessing the impacts it took 'a conservative approach'. It noted:

It is the high users, usually the older, sicker people in our community who will be most affected.

…   …   

There is sufficient evidence that the introduction of a co-payment will change patterns of health service use, and that there will be different impacts for different patient groups.

That is in regard to another aspect of this government's budget. It went on to say:

The average annual additional cost increases with age from $36.27 for children to $122.17 for patients aged 65+.

It also said:

Overall, there is little difference in the average additional amount that general and concessional patients would have to pay over a year … The only real difference would be among patients aged 65 years or more — as concessional patients would have their co-payments for services capped at $70, while general patients would not.

Once again, an organisation that is actually interested in the impacts on consumers and in the people who will suffer the outcome of this is highly critical. They went on to say:

It is likely that the increased costs due to these policies would deter more people from seeking early treatment or from taking necessary medications. This is a concern when areas in Australia already have 13% of their population delaying or not seeing a GP due to cost, and 15% doing the same for prescriptions.

Overseas studies have shown that there is little evidence of health care care cost reduction from introducing co-payments. The evidence suggests that long term health costs will be higher due to patients deferring necessary care, resulting in increased hospitalisation and progression of disease.

They concluded:

… these proposed policies will create a larger price signal than that suggested in the media to date.

In other words, they are saying that it is going to be far worse than what has been estimated in the general public.

In the document from the Australian Bureau of Statistics Australian social trends, March 2011still applicable today—there was comment from the ABS that many people report they are unable to access the care they require because of financial considerations. They noted that almost one in 10 delayed getting or did not get prescribed medication because of the cost. That is nine per cent, or about one million people. Additionally, they noted, more than twice the proportion of people in the most disadvantaged areas found cost a barrier to receiving prescribed medication compared with those in the least disadvantaged areas—12 per cent and 5.4 per cent respectively. We know every medical survey in this country and overseas indicates a correlation between poor health and serious illnesses in poorer socioeconomic areas, and here we have a situation where the same international and Australian statistics indicate there is going to be a tendency of people not to fill these scripts when changes such as this are made.

The Australian Institute of Health and Welfare noted:

In general, the higher people's incomes and education, the healthier they are—a phenomenon often termed the 'social gradient of health'.

People living in areas of low SES are also more likely to place themselves at risk of lifetime harm from alcohol than those in high-SES areas. There are a variety of indicators of that.

So we have a situation where there is a correlation between people's low income levels, other indicators, health problems and a situation where they in turn are less inclined to go to doctors when there is a co-payment and less inclined to take the medications necessary. This is a severe attack on the health rights of Australians. It is covered by a supposed crisis in the budget which did not stop the government reducing revenue by the abolition of the mining tax and which did not stop the government increasing massively payments to wealthy Australians for parental leave and other measures which have worsened the budget. It should not be the case that people in southwest Sydney, whether in Macarthur, Fowler or Werriwa, are the people who are the victims of these changes. This medication is life threatening in a situation where people have other huge pressures on themselves and are now being forced by a government which at the same time brings in not only co-payments but also measures to make it financially advantageous for doctors to end bulk-billing.

This is a government which is not driven by an attempt to preserve the Pharmaceutical Benefits Scheme system, which is, admittedly, historically world renowned; it is a government that is bent upon basically moving the costs of the system from the overall taxpaying public to the people who are using the service most often. As has been indicated by every indicator, they are predominantly those of the aged population in this country—the same people being hit very hard in other parts of this budget.

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