Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Hansard source

The Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 is another example of the government's shambolic approach to the management of the health portfolio. It is an approach that we can see in so many other areas in the health portfolio, the government flip-flopping from one side to the other and ultimately landing on a position to try to get itself out of the mess. That is exactly what it's doing with respect to pathology fees.

It reminds me very much of the government's approach to the out-of-pocket costs or the co-payments that it wanted to introduce when the coalition took office in 2013. Firstly, it was a $7 co-payment, then a $5 co-payment. Then, if I remember correctly, there was meant to be some $20 cost on GPs. Ultimately, the government landed on just continuing the Medicare rebate freeze from 2014 right through to now, which effectively has caused doctors to apply their own co-payment in order to continue to make their businesses viable.

Not surprisingly, we don't have any government speakers that are prepared to come into the chamber and speak about this legislation. I get that this legislation isn't exactly exciting legislation; it deals with, I guess, an administrative matter when it comes to pathology specimen collection centres and the licence fee they pay to the government each year. Nevertheless, it goes to the heart of our health system, because there are few medical procedures carried out in Australia today, or medical appointments made with GPs and the like, that don't ultimately involve a pathology service of one kind or another, or an MRI service. Without those services, it's obviously very difficult for the doctors to pinpoint what the problem is. So it does go to the heart of the funding and the costs that a patient has to bear every time they go to see a doctor or a specialist.

We saw, with respect to this particular issue, the government first coming out and saying, prior to the 2016-17 election, that they would abolish the bulk-billing incentive payments for pathology services and MRI services. That, of course, created a huge backlash from the pathology industry itself, and quite understandably so, because this is an industry that made it absolutely clear that it was because of those incentive payments that they were able to keep their fees down for the patients. So the government then, in turn, said, 'Okay, we will raise the same revenue by promising that the pathology collectors get lower rents in the premises from which they have their services.' Most of those services are provided from within medical centres—medical centres generally run by a group of GPs. Of course, those GPs rely on the rent space that they get from the pathology collection agency to run their own medical practices. I'm sure that they have factored in the income they would receive from those pathology collection companies that are there as part of their business running costs. So when they protested, and understandably so, the government realised it now had an even bigger fight on its hands because it was fighting with the whole medical profession more broadly. The government had to backtrack, and it did so.

It is now looking at a way of trying to save some dollars in order to ensure that it finds savings in the pathology section of its budget. The reality is that the savings the government will find out of this legislation are minimal. We don't have a problem with the savings themselves on this side of the House. It means that instead of the centres paying their fees once a year, they pay them every second year. I'm not sure why they didn't suggest it be every third year. If it is the case that it saves money to the government in terms of the administrative costs, I'm sure it will also provide some savings to the individual practices or pathology centres that have to make the payments for their ability to continue their business.

However, I do ask this question: it's not clear as to whether the money would go back to a pathology service provider if, for some reason, after having paid for two years in advance, they decide halfway through to cease their business. Whatever the case is, I don't know, but perhaps that is something the government might want to think about. The idea of biannual tax payments is nothing particularly new, and it's nothing that has any particular consequences of concern to us. What does concern me about it is that it is just another example of this government's ad hoc approach to its healthcare responsibilities.

Right now, we're seeing another example of this with the Australian Dental Industry Association. The government has proposed to introduce a new fee for new dental products that are defined as low-risk medical devices. These fees will apply, from my understanding, to products that come from dental suppliers who are generally small business people in this country. Most of them are not big organisations. The fee proposed is $530 for each new low-risk medical device entry on the Australian Register of Therapeutic Goods. Now, $530 doesn't sound like a lot of money, but when you add it up at the end of the year, for many of the small businesses associated with the Australian dental industry, it will amount to anywhere between $4,240 and $13,250, according to the industry itself. When you are starting to talk of amounts between $4,000 and $13,000, it does start to make a difference to small businesses in this country.

The concerning thing about this proposition is that the government is proposing to introduce it, I think, by 1 July, with no public consultation, no business impact analysis and no cost recovery impact statement ever having been carried out with the industry in respect of those new charges. This is all from a government that constantly comes into the chamber and tells us how they are the friends of small business, how they are the ones who will support small business and how they are the ones who are backing small business in this country. I couldn't think of a worse example of small business being betrayed by a government—no consultation, no discussions but, 'We're going to hit you with some new fees'. Clearly it is another example of the chaotic way that this government manages the health portfolio.

In the Australian dental industry, if a new fee is introduced, dentists will have no choice but to pass on those costs to the patient. The patient will ultimately wear the costs, because we don't have a universal dental scheme in Australia. Even with private health insurance in this country, patients inevitably pay considerable out-of-pocket costs with their dental expenses. That brings me to the question of private health insurance more broadly. We know it is becoming more unaffordable for people as each month goes by. We have seen the membership rates for private health insurance falling. Indeed, in country areas, I understand that now only 45.5 per cent even have hospital cover. We have seen increases in the exclusions within those policies and the costs of those policies rise 27 per cent under this government, which adds something like $1,000 a year or thereabouts for most families who have private health insurance. Indeed, the whole concept of private health insurance is becoming so complicated that we now have a website called Health Insurance Comparisons to help people try and decipher which policy they should go for and what it will cover. That's how complicated it has got.

We now also have a health system that, in many parts of the country, is in crisis. We have hospital elective surgery wait times blowing out. Indeed, I recently dealt with a constituent in my office who was looking for elective surgery in South Australia and the response provided to that person was that the person would have to wait years for the procedure required. It's not for me to argue whether or not that procedure was urgent—that's for the doctors—but, when you have to wait years for an elective procedure, there is something wrong with the system.

We know that last year there were 7.8 million presentations to emergency services department of hospitals throughout the country. That's a 16 per cent increase over the previous years. I can only assume that that's not just attributed to the population growth but because more people are presenting to emergency services departments because they cannot afford to go to their normal GP or perhaps their specialist, depending on the issue. Again, that's borne out by the figures as well, as a result of the Medicare freeze. Ten years ago, the average GP out-of-pocket cost was $21. Today the average out-of-pocket cost is $38. For specialists, 10 years ago, it was $44. Today the average out-of-pocket cost for specialists is $88. Those costs demonstrate the shift in how much more people are having to pay to go to their doctors or to their specialists.

Not surprisingly, as a result of those increases in costs, the statistics also bear out another story. In 2016-17, according to the ABS, 1.7 million scripts were not filled by patients because, probably, they couldn't afford it and didn't see it as a priority. And 1.7 million Australians skipped a specialist visit—again, I can only assume—because they couldn't afford it. One million Australians either avoided or delayed a visit to their GP—again, I can only assume—because they couldn't afford it. Not surprisingly, also in 2016-17, 1,830 personal bankruptcies in Australia were attributed to health costs.

I think the statistics paint a very clear picture of the state of the health system in Australia. But no-one paints it more clearly than the new AMA president, elected only a month ago, Dr Tony Bartone, who at the AMA national conference in Canberra, only a month ago, said:

… our health system is ailing.

Public hospital waiting lists continue to blow out.

Private health insurance is becoming increasingly unaffordable for our patients.

The enormous bottlenecks in the training pipeline.

The continuing struggle for some doctors around their own health and wellbeing.

Variable access to care in country towns and rural areas.

General Practice has been systematically starved of funding - tearing at its heart; wearing it down; putting at risk its world class outcomes in primary care, its very survival.

Dr Bartone went on to say:

Our Health Minister needs to understand that the time for rhetoric is over. Our patience is wearing thin.

Those are not my quotes. Those are not Labor's quotes. Those are the quotes directly from the newly-elected president of the Australian Medical Association, who was summing up his perception and how he sees the health system—and, can I say, his perception is shared by people everywhere I go and by everyone I talk to throughout my electorate.

Universal health is being eroded by this government. It's being eroded little by little but, ultimately, the collective efforts or the collective changes that are being made are making a substantial difference, for the worse, to the universal health system that we have in this country—which I believe was a much better system years ago. As the member for Bass quite rightly pointed out, when universal health is undermined, the worst affected are people on low incomes. Sadly, many of the people on low incomes are also in rural, regional and remote Australia, where access to medical services is even more difficult. Again, the statistics show that their health outcomes are much worse than the health outcomes experienced in the rest of the country. Their access to services is much more difficult and, therefore, the prevalence of different illnesses is much higher in regional, rural and remote Australia.

We need to maintain the universal health system we have for all Australians. It was introduced to make sure that every Australian, regardless of income, had access to a good health service—and that's what we will be fighting for between now and the next election.

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