Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

Yes. I understand I have put you in a difficult position, Minister, by not talking to you about it before. Unfortunately there was a changeover in the middle of that, so my apologies for that. So, for any of your whips or the Leader of the House, I understand that he has done the right thing. Thank you.

We are potentially talking about patients who have experienced some very substantial form of trauma, and for these patients it will mean either that their out-of-pocket costs increase unimaginably or that they forgo treatment altogether, potentially ending up in hospital or worse. It is clear from all the discussions I have had that the government has really not engaged with these impacts—certainly not enough to answer some of these questions. There are, of course, other groups. The Fertility Society of Australia IVF Directors Group has written to the Leader of the Opposition warning:

The proposed changes will affect patients who are chronically ill requiring regular medical attendances and those patients who need access to higher cost medical interventions. The changes will particularly impact cancer patients, fertility patients, patients requiring higher cost imaging services and those needing regular access to psychiatric services.

The government's budgets have estimated these cuts to patient benefits at $266.7 million however our initial work indicates the actual budget saving may be double this. The proposed changes would represent a sharp and strongly regressive barrier for less well off patients to access necessary medical services.

The government obviously contests this point, but again it has not engaged in this particular debate. With IVF patients already currently facing out-of-pocket costs of $4,000 a cycle, the Fertility Society of Australia says these could rise to $10,000 to $15,000 per cycle, which, when you consider it can take many cycles, will be simply unaffordable for many. Despite the fact that there are some bulk-billing IVF clinics, they are certainly not very widespread at the current point.

The College of Radiation Oncologists have written:

The proposed changes to the Safety Net will mean that those patients paying for private radiation therapy services may face significant out of pocket costs. This represents an unacceptable barrier to accessing cancer treatment.

Now the government has suggested that in some of these areas there have been substantial increases in fees, some of them well out of proportion to the actual costs of delivering services, and that billing practices have been driven by the extended Medicare safety net. I do not disagree with the government here. That has particularly been the case where there has been very limited private sector competition and where there has been very strong corporatisation of what often started out as very small private services. The problem with the bluntness of the measures contained in the bill is that it is not clear that these services will in fact, given their profit drivers, substantially change their billing practices, and if they do not it is patients who will foot the bill.

We faced a very similar circumstance when we changed the MBS and the number of visits provided under the Better Access program. We went about that change. We conducted an evaluation, and the results of that evaluation showed that billing practices meant the skew of benefits was going largely to wealthier postcodes, and that was of concern. So what we did in making the change—and it was not an easy change to make—is that we utilised the savings that we realised through that measure to redirect the money. It was that money that funded the ATAPS program, the expansion of headspace, and EPIC, largely targeted specifically to disadvantaged communities. So we used the opportunity of making those changes where we were concerned about exactly the same issues the government is, about higher billing behaviour and lack of good, targeted access. We utilised that money and redirected it so we were getting services to where they were most needed. As I said at the start, often what we are seeing is that people are not getting access to services and they are not, therefore, reaching the safety net.

The government might have been able to make a case for better targeting of this funding to services for disadvantaged communities, particularly, for example, trying to get better access to psychiatry in rural communities, but that is not what it is doing with this bill. The savings in this bill are going back into the Medical Research Future Fund, not back into direct service provision. If we are serious about better targeting safety nets to those who have the least advantage then perhaps improving access to services where there is very little access could have been considered in the context of this bill.

That being said, Labor will not be supporting the bill. These are cuts to the safety net that, as I have said, were developed in the context of the 2014 budget. That budget, as has now become very clear, was not a reform budget or a budget focused on improvements to the health system. It was a budget focused on some very blunt instruments to find savings: the GP tax now implemented through the ongoing freeze of MBS indexation; the cuts of more than $60 billion from public hospitals; the cuts hundreds of millions of dollars from preventive health programs, public dental and ongoing plans to increase the cost of medicines for every Australian—and the list went on.

This measure, unfortunately, continues to bear all the hallmarks of the 2014 budget. While Labor remains happy to talk to the government about safety net reform, and in particular how they can be better targeted, we are of the view that the consequences—perhaps unintended—of this bill mean that we simply cannot support it. Therefore I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the Bill a second reading, the House notes the Bill will have significant and adverse consequences for hundreds of thousands of patients, especially those who need frequent sessions with psychiatrists, those accessing ART services, and those receiving radiation oncology".

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