Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

This package of three bills—the Private Health Insurance Legislation Amendment (Medical Device and Human Tissue Product List and Cost Recovery) Bill 2022, the Private Health Insurance (Prostheses Application and Listing Fees) Amendment (Cost Recovery) Bill 2022 and the Private Health Insurance (National Joint Replacement Register Levy) Amendment (Consequential Amendments) Bill 2022—is really important. The package is a way of modernising and improving how patients who have private health insurance can access implantable devices as treatments for things such as fractured hips or cardiac abnormalities. This includes cardiac valve replacements and a whole range of prostheses.

This is very important because Australia has an almost unique health system that is one of the best, if not the best, in the world. It's being assailed at the moment by the cost pressures not just of the pandemic but also of increasing medical costs around the world and of increasing age, which puts further pressure on our health systems. And of course the pandemic, by itself, changed health care in Australia dramatically.

There's also been lots of publicity recently about access to primary care and the effect the coalition's 10-year freeze on GP rebates has had on not just access to GPs now but also recruitment of medical students into the GP training schemes. That has been absolutely decimated by the coalition's policies. People don't like to hear about the effects of governments past, but this has really had a dramatic effect on our healthcare system. It has put enormous pressure on our health system's ability to provide services. Our government, the Albanese Labor government, is in the process of trying to repair the neglect and the damage that has been caused by 10 years of very poor coalition oversight of the health portfolio.

I grew up in the health system. It's a bit scary to think that I have now been a member of the AMA for over 50 years. I started my private practice in Campbelltown and Camden in the same week that Medicare started, 39 years ago. It is a bit scary to think of those figures. I still see myself as a young boy with a dream, but that's probably not how others see me!

This is a very important bill, and I must commend all stakeholders for coming together, agreeing that this bill is necessary and appropriate and working in a way that will help our health system in the future to deal with all the many, many challenges of a health system. It's a complex issue. I must admit as a practising doctor I did often find it difficult to explain why the costs of, for example, hip replacements were so different in the public system versus the private system and why different devices seemed to cost more money here than overseas—and, in some cases, I must say, vice versa. Just as an example, the hip joint replacement available now in Australia can cost more than $4,000 for some people, and similar devices in countries like the United Kingdom and New Zealand cost less than $2,000 in the private system. So there are differences in costs. This bill is an attempt to try and make the costing more transparent and make these devices available to Australians at a cost similar to overseas.

The Medical Technology Association of Australia has agreed to work very collaboratively with the government in getting what we would call fit-for-purpose reform in this area, and I commend them for that. They certainly have worked very hard with their members to make sure that Australians are getting devices at the most appropriate cost in both the public and private system.

There will still be some cost differences between the public and private systems. The public system is able to order in bulk and is able to have much more simple supply chains, whereas private insurance tends to work in smaller numbers and has a wider variety of ordering capacities and supply chain capacities. These bills will attempt to simplify some of that, and there will be cost savings for both the private health insurance industry and also for the government.

I would also say, though, that it is important to understand the importance of maintaining a private health insurance industry. In the health industry, we know that chronic and complex illness tends to be better managed in the public hospital system because of time constraints, cost constraints, the availability of a variety of different services to deal with other social impacts that chronic disease often inflicts upon sufferers. So the public hospital system will always be needed to deal with chronic and complex illness, particularly in multisystem diseases, and for people who are getting older and who don't have as many social supports as in the days of the nuclear family. It is sometimes the case that as people get older they lose those family supports. The public hospital system often has to provide things other than acute medical treatment.

However, the private hospital system and the private insurance system do volume very, very well. They are able to very efficiently deal with short-stay admissions to hospital, day surgery. These days, for joint replacement surgery, hospital stay time is often very short, and the private health industry is very efficient in the way it deals with these sorts of issues. We know that there are already enormous pressures around the public hospital system. Because of that, we need our private health insurance to be maintained and we need to have people in the private health system. If we don't, the pressures on our public system will be completely overwhelming. We are already feeling those pressures.

We know there are huge cost-of-living pressures. Today, interest rates went up again, in particular for housing mortgages. My electorate of Macarthur has one of the largest mortgage stress and rental stress populations in the country. We know with cost-of-living pressures there is a temptation for people to drop out of private health insurance. It is very important that, whatever we do, we encourage people to stay in the private health insurance system. These bills will help that by reducing the costs and, hopefully, reducing premium rises in the future and that is very, very important. We have to ensure that we have that combination of public and private health systems working together. That means that I am committed to private health insurance. I have private health insurance myself and I have encouraged my family, who are now all adults, to have private health insurance as well. Many people think that they are very similar systems, the private and public, but they are very different, they deal with different things and they are better dealing with different things.

Australia has been a profitable and good market for many of the medical technology manufacturers and they, indeed, have done well out of Australia. However, the world is changing. Increasingly, we have a larger middle-class population in South East Asia and to our north. India has a middle-class population of over 200 million people. We have large middle-class populations in South East Asia, in China and in Japan et cetera, and they also will want to use the best medical technology they can. Therefore, Australia will become a small proportion of the market. It is important that we maintain our access to the latest medical technology in Australia to make sure that we get the very best treatment.

Recently I was involved in lobbying for listing on the Prostheses List a multichannel cardiac catheter used to treat a cardiac rhythm abnormality called atrial fibrillation, where the heart's top two chambers don't pump properly. They vibrate without pumping the blood, the blood can cool in the heart, and clots can form. They can go to the brain and cause a stroke. This multichannel ablation catheter can be used to treat this atrial fibrillation and prevent stroke and that is really important. But it took years, literally years, to have this approved in the system. We don't want to see that continue to happen. We want to get access to the newer technologies as soon as possible and we want those companies that produce these devices, most of whom produce them overseas, to feel confident to bring them to Australia, to make them available to the Australian population. It is important that we make our systems as efficient as possible so that we do get these newer technologies available to the Australian people as soon as possible. They are not only life saving but they are lifestyle saving. Quality of life is really important and it can enable people to get back to work, can get them out of hospital very quickly and can prevent stroke with a catheter. There are other devices, such as joint replacement, that have changed dramatically since the days I was a resident and assisting in these operations. So it really is important that we do get this right.

I congratulate the health minister and the Albanese Labor government for bringing this bill to the House. It seeks to improve not only how we fund our devices but gives more transparency in how we fund them and it will allow the private hospitals and the private insurance providers to understand better the costs and reduce their own cost, which will, in time, reduce premiums and premium rises, and will encourage people to stay in private health insurance.

I know that there is a lot of pressure to reduce costs across the board and I congratulate the private insurers, the MGAA and the private hospital system for working collaboratively to try and get the best results. This will also allow choice in the private system for patients and for doctors using implantable devices and treatments. This can be very important with things like choosing what sort of artificial heart valve to use, choosing these days minimally invasive treatments via catheter rather than open-heart surgery. It also means that there will be better and longer lasting joint replacements for things like hips. Recently there has been new technology developed for shoulder replacement rather than shoulder reconstruction, which can lead these days now to much faster recovery, better recovery, less surgery time, less hospital time. It is important that Australians have these things available to them.

There are also some new techniques in the management of congenital heart disease that can be done by minimally invasive therapy. Via a catheter, we can now replace heart valves and repair holes in the heart. It obviates the need to have open-heart surgery on tiny newborn babies. So it is important that Australia does continue to have available the very latest technology.

On a couple of occasions I have visited companies like Edwards Lifesciences in the member for Bennelong's electorate. I have actually been able to practise using their minimally invasive surgical techniques for closing holes in the heart and for heart valve surgery, which is absolutely remarkable. It is important Australians do get these devices available to them, because if you have a newborn baby and you can prevent open-heart surgery, it will save lives, reduce hospital time, and reduce the risk of other complications like neurological damage. We must continue to have these devices available and that's done by introducing bills like this. This is a way that the Albanese government, as part of its complete overhaul of the health portfolio, will be able to make these treatments available for Australian children and their families.

In summary, these measures, these bills, support our goal as a government to make sure health care remains a priority for us in providing services to the Australian people. I commend the bill to the House. I thank the health minister for presenting this bill and I thank you for your time.

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