Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I move:

(1)    Clause 172-5, page 136 (lines 7-12), omit the clause, substitute:

“172-5 Agreements with medical practitioners

                 Medical Purchaser Provider Agreements

        (1)    If a private health insurer enters into an agreement with a *medical practitioner for the provision of treatment to persons insured by the insurer, the agreement must not limit the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify and provide appropriate treatments.

                 Hospital Purchaser Provider Agreements

        (2)    If a hospital or day hospital facility enters into an agreement with a *medical practitioner, under which treatment is provided to persons insured by the insurer, the agreement must not limit the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify and provide appropriate treatments.

                 Other Purchaser Provider Agreements

        (3)    If a private health insurer enters into any agreement for the provision of services or goods intended to manage a disease, injury or condition, the agreement must not limit the freedom of medical practitioners and/or other health professionals involved in the provision of the service or good, within the scope of accepted clinical practice, to identify and provide appropriate treatments.”.

This amendment deals with a very important issue that the medical profession in particular but also the community are concerned about, and that is the issue of a doctor’s clinical autonomy under this new regime. We believe that the amendment is necessary to make it absolutely crystal clear that, despite the changing procedures that will be available for people with private health insurance, the doctor who is treating an insured patient is still given absolute clinical autonomy to advise and to act in the best interests of the patient. We do not believe that the provisions in the bill at the moment are clear enough as they stand. The House will note that we have inserted three new provisions which go to a doctor’s clinical autonomy in a number of different situations: where there are medical purchaser provider agreements, where there are hospital purchaser provider agreements, and other purchaser provider agreements. The last one is intended to catch those services that are likely to be hospital substitute services, the types of services that will no doubt grow quickly and will be accessed by many more people as a result of the changes in the broader healthcare package.

Our major criticism of the existing section 172-5 is that it is limited to only medical purchaser provider agreements—that is, agreements between health insurers and medical practitioners directly. Whilst that is important, we are concerned that these other circumstances do not have the express protection that they need to. Both the AMA and the Australian Private Hospitals Association argue that the legislation specifically needs to include these protections in other circumstances and contexts, as I mentioned, such as hospital purchaser provider agreements. I think that it is welcome, of course, that the minister has indicated he will consider these and other issues if they come up as a result of the Senate inquiry that will occur in the other place. But I do think it is important for us in the House of Representatives to be able to indicate our clear and strong concerns about issues that are a matter of consumer protection.

I think there are very important issues around the professional practice that doctors need to feel that they are able to provide. I do think there are some more extreme concerns that have been expressed by others, not in this House, that this is just going to give the insurers direct control. I do not necessarily adhere to that view, but I think that one way we can give both consumers and doctors that assurance is by ensuring that their clinical freedoms are protected. I understand that both the minister and the health insurance industry have clearly indicated that they do not want that changed. In that case, even if it is out of an abundance of caution, it is worthwhile having these sorts of provisions in the act, particularly where we are changing the system as it applies to very many people.

The proposed new clause regarding hospital purchaser provider agreements is similar to what is currently in the National Health Act. The clause regarding other purchaser provider agreements is designed to cover those other circumstances, including circumstances in which medical practitioners provide care and treatment in other contexts, such as hospital substitute services. These services might be in a community setting, at home or any number of other settings where we still want to make sure that the doctors have the autonomy that they need, as well as circumstances in which other health professionals, such as allied health professionals, are involved in the provision of services.

We accept that the drafting we have opted for may not be the only way of delivering this outcome, but we do believe that it is vital to have it in here. We urge the minister to reconsider his position in this House. We should be able to make good law in this House, not just in the Senate. I ask him to consider this amendment.

Question negatived.

I move:

(2)    Clause 264-5, page 220 (line 3), after paragraph (b) insert:

    “(ba)    minimising the level of health insurance premiums;”.

This is the amendment that the minister has already referred to in his summing-up debate. It deals with the issue of minimising the level of health insurance premiums. I certainly think that the minister has got one thing right in respect of this: no-one does like premium increases. That is not news to anybody here. But we do believe, as legislators, that we should make sure that we regard it as our obligation to do what can be done to minimise premiums. We do not accept the government’s view that this is a change that has no impact.

As things currently stand in the National Health Act, the Private Health Insurance Administration Council has an express objective—one of only a few—of minimising the level of health insurance premiums. We cannot understand, when the government is so sensitive to any suggestion by any of us on this side of the House that premiums may go up as a result of this package, why the government would not be falling over itself to leave the existing protections in the legislation that make sure there is at least some hope the insurance administration council can have some control over insurance premiums. It has not been included in the bill, and I have seen argued in the media that the reason this specific clause has been removed is that there is a more general clause about protecting the interest of consumers.

The minister himself referred to the public interest test, but we need to separate what the administration council’s objectives are. It is not as if a new provision has been drafted that deals with public interest or protecting consumers. Those provisions are already there. This minimisation of the premiums is an additional existing protection and objective for the administration council. I cannot understand why the government would want to remove those protections that are already in there. This amendment is simply to reinsert the specific clause that is there into the relevant section of the act.

The government’s argument for taking this clause out also seems to be based around an argument that because PHIAC does not set the premiums it should not be required to have the minimisation of premiums in the legislation. I think there are two very important answers to that for the minister to consider. One is that PHIAC does have a role to play in keeping premiums down by virtue of its role regulating the private health insurance sector. Its regulatory role includes looking at the passing on of benefits, particularly if there might be any sharp practices or others. Then there would be a role for the regulator to be involved. Those sorts of things can have a particular impact on premiums, and I do not think we could argue that they do not. Of course they may not have the key role in setting the premiums, but that does not mean that they cannot have some important influence and role to play in the minimisation of them, particularly in circumstances where, as I said, sharp practices were involved.

But, even more importantly, if the government says that PHIAC should not have an objective of minimising premiums because it is the government that approves the premiums then I would challenge the minister to agree to this amendment or perhaps move his own, where the minister takes responsibility for the minimisation of premiums. There is nothing in the act that requires that to be an objective that he considers. If he believes that it is inappropriately an obligation for PHIAC because he has that responsibility then it would be appropriate for that protection, if it were to be moved, to be moved to his specific obligations. We have not had any indication that the government is interested in taking on responsibility for the reduction in premiums. In fact, we have just had attacks made on us that we are being hysterical about the risk of an increase in premiums.

I know that the minister has not promised that premiums are going to go down this year and he has not promised that premiums will be at a particular rate. Certainly, the general rumours are that they will be lower than usual, but there is no suggestion that there will not be an increase this year and there is no suggestion that the increase will not be higher than CPI. No-one could honestly suggest that the community does not feel those increases extremely acutely. In that case, why would we as legislators take away an existing protection? If the minister truly believes it is just inappropriately placed with PHIAC, he should have the guts to say he will put that commitment in as an obligation for him expressly under the act.

Question put:

That the amendment (Ms Roxon’s) be agreed to.