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

I rise today to speak on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. This bill proposes to amend the Health Insurance Act to create an overarching framework for the establishment and operation of accreditation schemes for diagnostic imaging services. It is a very important bill, obviously, because it regulates such an important division of our health sector. Diagnostic imaging includes a range of diagnostic medical services, including ultrasounds, computer tomography, nuclear medicine, radiography, magnetic resonance imaging, positron emission tomography and bone densitometry.

The Australian government provides Medicare rebates for a number of diagnostic imaging services listed in the Diagnostic Imaging Services Table and a legislative framework is made up of the Health Insurance Act, which is being amended by this bill, the Health Insurance Regulations and the Health Insurance (Diagnostic Imaging Services Table) Regulations. Management of diagnostic imaging services under Medicare is undertaken cooperatively between the government, represented by the Department of Health and Ageing, and sector representatives, represented by the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association, through the radiology memorandum of understanding.

The radiology MOU is one of four collaborative agreements between the government and diagnostic imaging representative organisations made as part of the 2003-04 budget process for managing Medicare funded diagnostic imaging services. There are additional MOUs for cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasound. The radiology MOU is the largest of the diagnostic imaging MOUs and accounts for around 80 per cent of all the diagnostic imaging services under Medicare.

By way of background, for those who might be listening to this debate and who might not be aware of the extent of coverage of the issues we are debating today, approximately 12.6 million services were claimed under the radiology MOU in 2005-06, accounting for more than $1.3 billion in Medicare benefits for the services covered by the MOU. The point I am making is that this is not an insignificant part of the health sector; it accounts for around 10 per cent of the total Medicare budget. That is why it is so important that we ensure not only the quality of diagnostic imaging services provided to the millions of patients but also that the investment of Australian taxpayers in Medicare is well protected.

We also do not want to find ourselves in a repeat performance of late last year when the Minister for Health and Ageing was forced to provide $32.7 million in additional funding to Medicare for diagnostic imaging services because of a massive blow-out arising from changes in government policy. The blame for this blow-out lies fairly and squarely at the feet of Minister Abbott, who himself conceded that the original level of funding allocated by the government was not going to be adequate. Unfortunately, it is an all too familiar scenario for us with this minister, who is far more interested in short-term political fixes and abuse across the chamber than he is in long-term planning for Australia’s health system.

As I said earlier, the bill seeks to create an overarching framework within the Health Insurance Act for the establishment and operation of accreditation schemes for diagnostic imaging services as agreed by the government and the representatives of the sector as part of the negotiations for the current MOU. Under the scheme being implemented through this bill, all diagnostic imaging practices providing services under the MOU will need to be accredited by an approved accreditation provider in order for Medicare benefits to be payable for the services they provide. Obviously this is important for us, and we see it increasingly rolled out in the health sector that accreditation processes are the one way of ensuring that patients get quality services and ensuring that Medicare is being paid appropriately to those providers who are meeting set standards.

By allowing the minister to establish the rules and the operational details of the accreditation scheme through a legislative instrument, the bill has been designed to enable the introduction of accreditation schemes for other diagnostic imaging services in the future without further need to amend the act. Labor supports the legislation. We are disappointed that there is scant detail available as to how this accreditation process will actually work in practice, but we support the intention and the need to establish such a process.

We recognise that accreditation schemes are widely utilised within the health sector as a method for reviewing and improving systems of care and ensuring that consumers receive quality services irrespective of who provides the services or the facilities in which they are provided. Labor also knows how important it is to get the most out of the scarce health dollar. We support measures which will result, hopefully, in efficiencies under Medicare and in the health system more broadly.

Given that diagnostic imaging services account for such a chunk of Medicare benefits, we recognise that it is in the interests of the efficient working of Medicare and the broader health system that services are provided within a framework for continuous improvement in the delivery of safe and high-quality care. Just as past Labor governments built Medicare, we believe that we should retain, defend and strengthen it, and an accreditation system for providers of diagnostic imaging services will help to protect Medicare, which is the cornerstone of our health system.

I turn now to the provisions of the bill. The most significant changes are effected by items 5 and 11 of schedule 1. Item 5 inserts a new section 16EA to the Health Insurance Act 1973, which precludes the payment of Medicare benefits for diagnostic imaging services unless the procedures are carried out at premises that are accredited under a diagnostic imaging accreditation scheme to undertake the particular type of diagnostic imaging procedure. Where the images are captured off site—for example, by mobile services—they must be captured on equipment that is ordinarily located at a base for mobile diagnostic imaging equipment or diagnostic imaging premises accredited to undertake that procedure. So, obviously, the purpose is to make sure that using Medicare as the payment mechanism is actually the incentive. I would not say it is the ‘stick’, when you talk about carrots and sticks, but it is the way to ensure that all the providers will participate in this accreditation scheme.

Item 11 inserts a new division into part IIB of the act, which sets out the framework for the establishment and operation of diagnostic imaging accreditation schemes. New section 23DZZIAA allows the minister to establish, via legislative instruments, the accreditation schemes and to approve persons who will be accreditors—able to accredit practices for the purposes of the scheme. Under the section, the legislative instrument can specify the conditions for accreditation and provide for any matters needed to create and administer the scheme. If the legislative instrument establishing a scheme confers a power or function on the minister in administering the scheme, the minister will be allowed to delegate those powers or functions to an officer as already defined in section 131 of the act, to the department, to a person performing the duties within the department, to the CEO of Medicare Australia or to an employee of Medicare Australia.

That accreditation status of accredited practices for Medicare benefits will be recorded on the diagnostic imaging register or the location specific practice number—commonly known as LSPN—register. The type of information that will be recorded will be prescribed by the regulations when the regulations for the scheme are made. Obviously, again, the purpose of the accreditation process is for governments to be able to play a role in ensuring that appropriate standards are met, but making this information available will also be of use to consumers and other health providers.

The bill requires that the regulation should include full and proper review mechanisms for reconsideration of any accreditation decision. I note that the new section 23DZZIAD sets out the reconsideration mechanism by the minister of accreditation decisions. This applies where an accreditation provider does not grant accreditation to a service, will not renew the accreditation, or revokes or varies accreditation such that there would be a reduction of Medicare benefits entitlements. According to the explanatory memorandum, the minister’s decision following a reconsideration of that accreditation decision will not be reviewable by the Administrative Appeal Tribunal ‘because the minister’s decision is a review of a decision of an approved accreditation provider, which itself will be required to have a full and proper review mechanism in place’. We will, of course, be keeping our eye on the process that is established in the regulations to make sure that adequate and appropriate review processes are in place. Obviously the decisions to provide accreditation or not will be very serious ones for the industry. It is a little frustrating to deal with overarching legislation that is giving power to the regulatory process when we have not seen the regulations. We are asked to understand that the things that will go in the legislation will be okay because there will be other guarantees in the regulations which we have not seen. Obviously we will keep our eye on it to ensure that the government does live up to the commitment that it has made.

Importantly, the new section 23DZZIAE makes it clear that the proprietor of an unaccredited premises or base must notify their patients that Medicare benefits are not payable before the patient undertakes any diagnostic imaging procedure. The proprietor must also advise the patient that the reason no Medicare benefits are payable is that the premises are not accredited for the procedure that the patient is having. The offence for unaccredited sites is a strict liability offence, carrying a fine of 10 penalty units for an individual and 30 penalty units, being $3,300, for a corporation. Obviously these are very important things. It is very important that the consumers are told beforehand. They might otherwise be expecting or understanding that there is a Medicare benefit payable to them when that will not in fact be the case. We have in this place also just debated a related bill changing the offences regarding inappropriate practices relating to requesters and providers of radiology services. These will no doubt tie in with those so that the two, when looked at together, will ensure that high-quality standards and the cutting out of any inappropriate practices can go hand in hand.

New section 23DZZIAF provides that, where the proprietor failed to provide that notification of the accreditation status that no Medicare benefit was payable to a patient, the amount of the Medicare benefit paid to a patient in respect of that service is recoverable from the proprietor of the diagnostic imaging premises. This debt will be in addition to any fine that can be imposed on the proprietor and is obviously aiming to ensure that there is a clear disincentive to this approach. Not only should the consumer be protected but the government also should be protected in being able to reclaim this money if it has been inappropriately claimed. These are the substantial changes proposed by this bill. The introduction of an accreditation scheme via legislative instrument for radiologists is clearly aimed at improving standards within the sector and making proprietors liable if correct procedures are not followed. These are worthy objectives. Obviously these accountability measures will also enhance the service experienced by consumers as well.

Subject to the passage of the legislation, the government has indicated the commencement date for the proposed scheme to be 1 July 2008. This will presumably coincide with the commencement of the new memorandum of understanding between the Commonwealth and the diagnostic imaging sector, as the current MOU runs out on 30 June 2008. Among the current MOU principles and objectives are those to promote access to quality, affordable radiology services and to improve the quality and delivery of radiology services—very worthy objectives that we support. Labor considers that these objectives would be even better served by a greater investment and emphasis in e-health broadly and in teleradiology in particular.

In March this year my colleague Senator Conroy announced Labor’s broadband policy, an area where the government has buried its head in the sand and continues to do so. As announced in March, federal Labor will revolutionise Australia’s internet infrastructure by creating a new national broadband network that will connect 98 per cent of Australians to high-speed broadband internet services at speeds over 40 times faster than most current speeds. ‘Why is this relevant here?’ you might ask, Mr Deputy Speaker.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

If he doesn’t, I will.

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

If the member would like to listen, he will understand why it is so important. Broadband offers enormous opportunities for e-health, enhancing the potential for a range of cost savings and service improvements for Australian citizens. E-health particularly has the potential to significantly improve access to health care services to Australians living in rural and regional areas, as well as to those Australians who find it difficult to leave their homes, such as the elderly and the disabled. It also offers ways to more flexibly and conveniently utilise our stretched health workforce. It surprises me, Mr Deputy Speaker, that a member from Queensland would be so dubious about the connections that there might be in this area.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

He has more knowledge than you about what is actually going on.

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

Although he does represent an urban seat, I know he has been involved in Queensland for long enough to know that the access to many of those who do not live in the city to these sorts of services could be greatly enhanced if people were able to consult with specialists—if they were able to have a mammogram taken in Longreach that might need to be sent down the system—

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

It is already happening.

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

It does not happen in very many places yet, and that is the issue. If you would let me finish my speech, you would understand the point that is being made.

Kim Wilkie (Swan, Australian Labor Party) Share this | Link to this | Hansard source

Order! I remind the member for Gellibrand that she should be referring to members by their electorate. I also remind the member for Moreton that he should not be interjecting. He will have an opportunity to speak shortly.

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

Thank you, Mr Deputy Speaker, for that reminder. It is very important, because the point I am making is that the ability to maximise the use of this technology cannot be achieved when there is not actually high-speed broadband. In some parts of the country, there are hospitals, for example, that can talk to each other because they have those connections between the hospitals. In Tasmania, for example, they do have a good system, but they do not necessarily have it connecting adequately to the rest of the country, so that the place to where they want to send some material does not have the speed to make the transmission effective.

We know that teleradiology—that is, electronically transmitting radiographic patient images and consultative text from one location to another—is already being utilised in Australia, but enhanced broadband technology provides the key to significantly expanding these services. Given we know that there is a national shortage of radiologists—another area given insufficient attention by this minister—expanding the use of tele-radiology could also be the focus of the next radiology MOU.

When we are seeing reports such as the one that appeared in the Hobart Mercury on 29 March 2007 that Tasmanian women are waiting weeks for the results of breast screening mammograms that are being sent to New South Wales to be read, we can see the advantages of technology that would allow digital images to be transmitted and viewed instantaneously between surgeries and clinics and between hospitals—or, in this case, between specialists in different states.

As I said, the proposed start date for the accreditation scheme is 1 July 2008, so this gives plenty of time for these sorts of issues to be explored properly for the new MOU and for it to tie in with the accreditation scheme. The introduction date of the accreditation scheme was postponed from 1 September 2007 after concerns were expressed by stakeholders.

We retain concerns that the proposed scheme will not be ready to commence in July next year. The government has failed to provide sufficient detail about how this scheme will operate. Obviously, if it acts very fast, there may still be time, and we hope there will be. But this bill does not provide the operational details of the proposed scheme, such as the standards to be used, the names of the approved accreditors, the accreditation process and the period of accreditation. Rather, it simply allows, as I have already highlighted, the minister to establish through the regulations the rules and operational details of the scheme.

While we recognise sector support for the introduction of the scheme, we note that representatives of the diagnostic imaging sector have also previously raised concerns relating to these operational details, and we share those concerns that the full policy implications are yet to be announced and are not apparent from this bill.

We are also critical that the full costings for the introduction of the accreditation scheme are yet to be determined. According to the explanatory memorandum to the bill, the introduction of the accreditation scheme will require enhancements to Medicare Australia’s processing systems. The costs have yet to be quantified but are estimated to be around $1.2 million, based on previous similar policies.

According to the explanatory memorandum, these full costings will be provided when the subordinate legislation is developed. It is expected that these costs will be funded from existing budgetary measures for the provision of diagnostic imaging services, but we will have to wait until the government provides us with this information. Unfortunately, this is typical of the lack of detail and slightly shabby approach that we are seeing on health. We hope that the government will allocate the requisite resources to get this accreditation process sorted out and off the ground in time for the 1 July deadline next year. We look forward to receiving more detail in due course. I commend the bill to the House.

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

Before I call the honourable member for Moreton, I remind members who are present that they need to make sure their mobile phones are turned off or on silent before they enter the chamber.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, being a heretic about these matters, my mobile phone is switched off and in my office, but thank you for the general advice. They are ergonomically designed to mark the low-water mark on the beach, as far as I am concerned. Nevertheless, apparently they are a tool of the trade these days.

I am delighted to support the best friend that Medicare has ever had—the Howard government—and its efforts to continue the revolution of our health services in Australia. I apologise to the member for Gellibrand for being so bold and enthusiastic as to try and prompt her, because a lot of what she has just had ambitions about is actually happening, and particularly in the good state of Queensland. I have been to Greenslopes Private Hospital, and I recommend that she does the same. It is now no longer in my electorate of Moreton; it is in the electorate of the Leader of the Opposition. On the occasions when he actually visits his electorate, he should go to Greenslopes and take the member for Gellibrand with him. They will find that the Greenslopes Private Hospital is doing all of these sorts of things. In fact, it is even doing operations online, helping GPs in far-flung parts of Queensland with technical advice when the need arises. So it is absolutely true that a lot of that is going on.

The only point I would make to members opposite is that they should not listen just to Telstra when they want to talk about broadband. Telstra is banging on about stealing from the Future Fund, and the Labor Party want to go along for the ride and steal from my children’s and grandchildren’s potential tax take, to try to pay for things today. I simply say to the member for Gellibrand: well done and thank you, but you just have to understand that Telstra is not the only provider of telecommunications. Embarrassingly for the Labor Party, in Queensland the state government have their own internet broadband system which they have installed because of Queensland’s regionalisation and enormous diversity. So universities, hospitals and so forth are linked through the Queensland government system. But if you talk only to Telstra, you will not hear any of that.

Let us talk about the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. It is one of the key, quality areas of our health sector. The bill seeks to ensure the accreditation of these practices and to ensure that the consumers of these services are able to be certain of the professional standards which, in the main, are delivered. Radiologists and other people involved in this sector, because of their own professional and organisational ethics, have to deliver quality services to their patients, and they have to deliver to the caregivers the sort of advice which can come from a variety of diagnostic imaging services. I refer to MRIs all the way through to a variety of dental and other services such as computed tomography, mammography, the interventional radiology services and general X-ray and ultrasound.

These are the things that are covered by this bill. They include the sorts of practices that need to be registered under this accreditation: private specialists; radiologists; nuclear imaging or radiation oncology practices; specialist radiology, nuclear imaging or radiology oncology departments or other departments in private and public hospitals; medical practices such as sports medicine clinics; cardiology practices; vascular practices and laboratories; orthopaedic or urology practices; general practices; and chiropractic and dental practices. These practices will be asked to sign up to this accreditation to provide the sort of consumer certainty that we want and in order to be eligible for Medicare benefits.

In the budget this week the government expanded the range of Medicare benefits available in dealing with things such as dental health. To ensure that people who have been unable to get dental services can now get those services, the government is now providing, in round figures, up to $2,000 of assistance through Medicare. That in itself is a testament to the fact that the state health systems, in particular dental health systems, have been spectacular failures. The Queensland system has been brought up a few times. The great number of people who have come to me over the years and said, ‘I have been waiting in a queue for five or seven years for my teeth to be fixed through the dental services of the PA Hospital or the QE2 Hospital,’ are of course very dismayed by the way in which the Queensland government talks a lot about dental health but does not deliver on it. Yet again we have the Australian government coming to the rescue—although we will be keeping the pressure on the state authorities to maintain their role—and through Medicare providing the means to look after those with chronic health problems as a result of failing to have their dental problems fixed.

Part and parcel of that are the services that are going to be provided by radiologists in the dental sector. That sort of program in dental services, an additional $377.6 million over four years, will assist 200,000 people around Australia, and it is absolutely important, as they go to their GPs or their dentists, that the advice they get based on the particular imaging that is required is absolutely correct. That is why this bill, as the opposition have conceded, contains a great set of measures, a quality set of measures—measures that will ensure that patients receive safe, quality radiology services. That Medicare funded services will meet industry standards and consumer expectations is further proof of the way in which this government continues its role of strengthening Medicare.

We know that state and territory government legislation regulates the licensing of X-rays and other radiation equipment in a way similar to the way in which they register medical practitioners and other health professionals. The accreditation standards being introduced in this bill will require practices to comply with existing state and territory registration and licensing laws and provide evidence of compliance to the accreditation provider. It will be in the form of current registration certificates and licences. I know that the vast majority of practices and the vast majority of health-care professionals in the system are already providing those safe, quality radiology services, but some may need to review and possibly update aspects of their service delivery to ensure compliance. We do not expect that anybody is going to need radical changes in their practices.

I am very confident as I look at the list of professional organisations that have said that the government’s bill has it right and that they have no objections to its structure, and the various signatories to diagnostic imaging memorandums of understanding which have been consulted proves this point. If MOUs have been signed by the Royal Australian and New Zealand College of Radiologists, the Australian Diagnostic Imaging Association, the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Association of Physicians in Nuclear Medicine and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and they all agree that this is a sensible set of measures providing consumer assurance, professional standards and enhancement of the reputation of the sector then there is every reason why we should afford this bill a speedy passage.

The bill amends the Health Insurance Act 1973, which governs the payment of Medicare benefits. The legislation establishes a head of power and framework to enable the introduction of this scheme. It will allow the Minister for Health and Ageing to establish the scheme and approve accreditation providers by legislative instrument. The instrument will deal with some of the operative details of the scheme, including the standards and processing details. The member for Gellibrand, on behalf of the opposition, wants to see all of those now. That detail will be presented to the parliament at an appropriate time, as it should be, once the details of the scheme are fully developed. It is being done in a consultative way, not in a central planning, politburo way, as those opposite seem to yearn for and would probably impose if they were ever elected to government. It is a matter of working with professional bodies, recognising that these professional bodies have a capacity and are delivering on that capacity, that they have a responsibility and equally that they have a right to participate in the development of this process.

The government has further strengthened Medicare in the last couple of days with announcements in the budget, and after-hours GP services will improve with the $71.8 million funding increase for Medicare rebates. Many of those services rely on radiology to be available in a number of creative ways. It is not just about being a mouse click away; it is about those services being available literally 24/7. When I look at the way in which, in my electorate, the Health for All people at Acacia Ridge are operating their services and Dr Shabbir Hussein and his family are operating clinics in places like Underwood and Kuraby, I see we are getting more out of our GP services in the southern suburbs of Brisbane than ever before. It is further proof that there is a lot of confidence in the medical system when private individuals, doctors and their associates are willing to invest in themselves and expand their commitment not simply to operating between nine and five but to being there seven days a week and, in many cases, literally from before breakfast to midnight with an ambition to operate 24 hours a day. Services such as radiology must follow the pathway.

There is also no doubt that we need more radiologists, and the signals being sent by this legislation will continue to endorse the professionalism that is already stamped there and will show that radiology and the practice of radiology will be well supported by the government as a result of taxpayers’ money being deployed in this way.

A decade ago MRI was new technology. A decade ago MRIs were things that you used to have to struggle to get to. I had a lot of arguments about MRIs a decade ago with one of Minister Abbott’s senior advisers, Terry Barnes, in the days of Dr Wooldridge—I do not want to embarrass him—and Dr Wooldridge recognised MRI as a way forward and as a sensible piece of technology that would be assisted by government under Medicare. That has been further enhanced this week with three new Medicare eligible MRI units. The fact we have now gone from just a handful of MRI units to 115 units around the country means people are going to be able to access a variety of these diagnostic imaging services in a variety of different places—far more places than ever before.

This bill ensures that during that amazing enhancement—this massive additional roll-out, this urging of the sector to roll it out even further and seek private capital to invest in themselves to provide more services to people—the enthusiastic response is underpinned by credibility, quality and professionalism, things which people in this sector automatically aspire to and easily relate to. The matters contained within this diagnostic imaging accreditation bill will ensure that consumers can be very confident not only that the government is going to back them through Medicare but also that the quality of the services they receive will be most profound. I commend the bill to the House.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I will commence my contribution to this debate on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007 by concentrating on a couple of the issues that have been raised by the previous speaker, the member for Moreton. He spoke at some length about dental services and the government delivering dental services to people in this budget. I will share with this House the issues around dental services that are very strong within my electorate.

Whilst the government may believe that it has delivered on dental services in this year’s budget, I was extremely disappointed with the announcement on dental services. This government has failed to recognise and meet its obligations to dental services. We have lengthy waiting lists for dental services within the public system. As a former state member, I can say that those waiting lists developed when this government, the Howard government, removed the Commonwealth dental health scheme. It was like turning off the light—one day people could go and get the treatment that they desperately needed and the next day they were denied that treatment. The initiative in the budget of course is welcome, but it is only an extension of a scheme that is not working at the moment. It is a scheme that requires a person to have a chronic condition before they can access dental health services under Medicare. I do not believe that is good enough. That will not help the people that I represent in this parliament.

Another issue that the previous speaker raised was the need for more radiologists. We definitely need more radiologists, but in the electorate of Shortland, which is the electorate I represent in this parliament, we need more doctors. In the suburbs of Belmont and Swansea all the doctors have closed their books and people cannot access a doctor when they need to. The government has failed the people that I represent in this parliament. I get letter after letter from ministers who respond by passing the buck, doing nothing, and failing to recognise the needs of people in the area that I represent.

That is another area that I was particularly disappointed about in the budget. Nothing that this government announced in the budget is going to help the people that I represent in the electorate of Shortland in this parliament to deal with the doctor shortage. The crisis in dental health and the crisis of the shortage of doctors was borne out in a survey that I have just conducted electorate-wide. Overwhelmingly, they were the two issues that were highlighted. The member for Moreton may have been extremely pleased with the government’s commitment in the area of dental services, but it did not work for the people of Shortland.

The member for Moreton varied quite substantially from the legislation before us, and I have taken the same liberty. Thank you for allowing me to do that, Mr Deputy Speaker. The bill proposes to amend the Health Insurance Act to establish an overarching framework for the operation of an accreditation scheme for diagnostic imaging services. Accreditation should happen—it is widely supported by us on this side of the House—but I am quite critical, as is the shadow minister, of the lack of thorough preparation of this scheme and of reliable costings in the legislation. It is quite worrying that there has not been a full investigation and a complete analysis done on this legislation, but we on this side of the House have come to expect that. I sometimes think the government is a little lazy in its approach. It is important that we are aware of these issues when we debate legislation and, unfortunately, an analysis was not included in this legislation.

The government and representatives from the diagnostic imaging sector have agreed to the introduction of an accreditation scheme. In 2003, there were negotiations for a radiology MOU. Accreditation schemes have proved to be a sound method of reviewing and improving systems of care throughout the health sector. Madam Deputy Speaker Bishop, when you were the minister for aged care you oversaw accreditation in the aged-care sector. It was a very good example of the accreditation process and has been of great benefit to the aged-care sector. Indeed, it has gone a long way to ensuring the quality of aged-care services within residential settings.

I hope this legislation will do the same thing for the diagnostic imaging sector. The legislation does not provide operational details—for example, the standards to be used, the names of approved accreditors, the accreditation process and the period of accreditation. Instead it allows the minister to establish the rules and operational details of the scheme through legislative instruments. That makes me a little nervous; I like to know the details of the process. The representatives of the diagnostic imaging sector have also raised some concerns. They would like to have a little more knowledge of the operational details of the scheme, and I understand that they are still considering this aspect of the legislation.

I would also be much happier if full costings had been included with this legislation. The accreditation will require enhancement of Medicare Australia’s processing systems. These costs are estimated at $1.2 million, based on previous similar announcements. The full costings will be announced in the subordinate legislation, which is yet to be developed, and the scheme is to commence in July 2008.

Diagnostic imaging plays a very important role in our health system. It includes a wide range of diagnostic medical services, including ultrasound, CT scans, nuclear medicine, radiography, X-rays, MRIs and PET scans. The previous speaker, the member for Moreton, spent some time talking about the expansion of MRIs within the Australian community. I am a little disappointed that the budget did not provide for a PET scanner at the Mater Hospital in Newcastle, but so be it—it is at the whim of the government but to the detriment of the people of the Hunter.

The government provides Medicare rebates for a number of diagnostic imaging services listed in the diagnostic imaging service table that is attached to the legislation. Diagnostic imaging services under Medicare are undertaken cooperatively between the government, through the Department of Health and Ageing, and sector representatives, through the college. The MOU is one of four collaborative agreements between the government and diagnostic imaging representative organisations. The MOU was part of the 2003-04 budget process for managing Medicare funded diagnostic imaging services. Additional MOUs for cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasounds are also in place. The radiology MOU accounts for about 80 per cent of all diagnostic imaging services. The explanatory memorandum, which I will refer to more in a moment, indicates that in 2005-06 approximately 12.6 million services were claimed and the government provided more than $1.3 billion in Medicare benefits for services covered by the MOU.

It is appropriate to visit the accreditation process and to consider what accreditation delivers to the healthcare industry, to government and to consumers as a whole. The memorandum of understanding attached to this legislation recognises that accreditation is a vital tool within the industry for reviewing and improving the system and ensuring that we have safe, high-quality health services. This is what accreditation provided to the aged-care industry. As set out in the memorandum of understanding, it is a means of ensuring minimum standards of practice in operations. It is a benchmark for maintaining competency and, over time, it provides feedback on the overall enhancement of quality in a professional discipline. This is extremely important to a person who is undertaking some sort of diagnostic imaging investigation. You need to be sure that the minimum standards are in place and that there is a competency benchmark. It is very important because if standards are not in place there can be enormous health implications for the person undergoing the investigation.

Whilst we can be fairly certain that appropriate practices are in place currently, we cannot be absolutely certain. What we need to do and what this legislation will do is ensure that all staff in radiology practices will be appropriately qualified. I am certain that any Australian who was about to have some sort of health service would like to know that that was the case. The legislation will also ensure the effective management of resources, that proper systems are in place, that there are multi-disciplinary teams and that the health outcomes are the right ones because there is quality of service. People will know that, in every practice providing diagnostic imaging services, each person working there will be qualified—they will have the expertise—and that the service is being delivered in a safe environment. It is an area in which technological advances are constantly being made, and we need to make sure that the industry keeps up with those advances.

There is currently—and I think this is an important point—no regulatory mechanism to ensure that all elements involved in the delivery of diagnostic imaging services work together. This is a problem for the people of Australia who are relying on those services. There is no guarantee for the patient that optimal radiology services are being provided. Accreditation provides assurance that the amount of money that the government invests—and it is a large amount of money—in the provision of diagnostic radiology is being well spent and that we are getting the appropriate outcomes.

It is also important to note the kinds of people who use diagnostic imaging. Radiology services are provided by a diverse range of provider groups. There are specialist radiologists, vascular surgeons, cardiologists, general practitioners, obstetricians, gynaecologists, sports physicians and dentists. Also, their services can be provided in a wide range of settings. They can be provided in a consulting room of a one-man practice, in a large practice where there is a level of expertise with practitioners specialising in diagnostic radiology, or in a hospital. We need to be sure that there is consistency across the services provided. Hopefully, this legislation will deliver that consistency. Currently there is a potential for inconsistency in the delivery of the service, and there is a variation in the qualifications and experiences of practitioners, the standards of supervisors, the equipment used, the practice protocols and the administrative procedures—and they can all lead to inconsistency. That is why accreditation is so good. It establishes common standards and benchmarks that everyone delivering those services must meet.

I see this legislation as vitally important. My concerns surrounding the legislation, as I said at the commencement of my contribution to the debate, go to its lack of detail. There should be a little more consultation. There is also the issue of transparency. One of the most important elements in any legislation is transparency, and along with transparency comes accountability. The inclusion of these elements in legislation will deliver the best form of accreditation that can be put in place.

I support the legislation. I have my concerns about transparency and the lack of detail on costing but, given the overall picture of the legislation, those concerns are secondary to the need for a system of accreditation that will ensure the integrity of diagnostic imaging.

Sharon Bird (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

In speaking on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007, I take the opportunity, firstly, to address the bill directly and, secondly, to raise some local issues in my electorate about the provision of MRI services.

This bill before the House appears to be quite timely. I am aware that, in recent times, there was controversy in the Sydney media about an MRI service provider using their facility after hours to conduct scans on animals for veterinarian services. I certainly hope that they were not being bulk-billed or charged under Medicare for those services! There are issues around the standards that would create concern if a machine were being used for both people and animals. I think this bill addresses the debate that occurred as a result of that controversy and the need to ensure that we have an accreditation system that, I would suspect, makes such a situation impossible to occur.

Labor supports the bill before the House today. The bill proposes to amend the Health Insurance Act 1973 to create an overarching framework for the establishment and operation of accreditation schemes for diagnostic imaging services. I understand that the proposed accreditation scheme was agreed to by the government and representatives of the diagnostic imaging sector as part of the negotiations for the radiology memorandum of understanding in 2003.

Diagnostic imaging, it is important to note, includes a range of medical services, including: ultrasound; computerised tomography—which we know generally as CT scans; nuclear medicine; radiography, or X-rays; magnetic resonance imaging, MRI scans, which I have referred to; positron emission tomography, or PET scans; and bone densitometry. With an ageing population, that last one is also a very important one. The Australian government provides Medicare rebates for a number of diagnostic imaging services, and the managing of the Medicare provision is undertaken through the radiology MOU. We should acknowledge that there were approximately 12.6 million services provided under this MOU in 2005-06, accounting for more than $1.3 billion per annum in Medicare benefits for services across approximately 3,100 practice sites. The very size of the government provision of service here is important to acknowledge, because it is part of the driving need for an accreditation process to be in place. This is certainly a field of medicine that is expanding at a rapid rate as technology develops. There is absolutely no doubt that it is timely that we address the issue of accreditation.

As part of the negotiations for the radiology MOU the government and the diagnostic imaging sector have agreed to an accreditation scheme for radiology practices. This will be a process of externally reviewing an organisation’s performance against a defined set of standards. This is important because radiology services are increasingly being provided by a wide range of providers, including specialist radiologists, vascular surgeons, cardiologists, general practitioners, obstetricians and gynaecologists, and sport physicians. These providers operate in a variety of settings, including hospitals, single practitioner premises and multi-site corporate practices, and often in conjunction with surgical procedures. Clearly, in such a diverse industry there is a potential for inconsistency in the delivery of the services. When the government is actually deciding to allocate funding capacity to services it is important that we ensure that they are the best available.

This bill creates a scheme under which all diagnostic imaging practices providing services under the MOU will need to be accredited by an approved accreditation provider in order for Medicare benefits to be payable for such services. The bill allows the minister to establish, through a legislative instrument, the rules and operational details of the accreditation scheme. This would include the standards, the approved accreditors and the process and period of accreditation.

Whilst Labor supports the bill, we are critical of the fact that, as the previous speaker outlined, so much of the detail is not contained within the bill but is left to the minister. For example, the bill does not provide operational details of the proposed scheme, and Labor shares the concerns of the representatives of the diagnostic imaging sector about this. Whilst the proposal of the scheme as it is presented in principle in this bill appears a good and useful development, it is also true that the detailed implementation and operation of the scheme will, in the final analysis, determine the value or detriment of the scheme.

In August 2006 the Department of Health and Ageing organised a number of consultations with sector stakeholders. The problem with fully endorsing the scheme was also raised during these meetings. They listed the things that they were concerned about, including : the cost of accreditation to practice sites and the resulting impact on businesses and healthcare consumers—a polite way of saying increased costs and the potential for those to flow through to consumers, which I think would be a significant concern; the ambitious implementation timetable and the need for accreditation providers and practice sites to be well informed about assessment requirements, including the radiology accreditation standards, well in advance of 1 September 2007—and I note the implementation is now looking at July 2008; the need for the new accreditation scheme to accommodate the diversity of business structures, particularly where components of the service are undertaken by different practices such that, if the problem with quality is in one part, the whole stream of service delivery is not affected; the need for the complaints handling mechanism to distinguish between frivolous and legitimate complaints and for the investigation of complaints by accreditation providers to be limited to matters related to compliance with accreditation standards; and the importance of involving all provider groups in the development of the radiology accreditation standards to ensure their relevance and currency in both the immediate and the longer term. None of those concerns are surprising. They are the types of issues that providers would generally raise with any accreditation process. They would be familiar to us from a whole range of different accreditation schemes.

However, I think it is particularly important to note the cost issue, because many people are paying gap payments—for example, for diagnostic imaging services. To see an increase in those costs could be very problematic. And the practices themselves having to comply can be a force for driving greater concentration of services rather than diversity of provision. In many markets in our communities, particularly in rural and regional areas, that can end up in a monopoly, where people have very little choice but to be accessing the only service available. So the devil could obviously be in the detail and, whilst supporting this bill, I think it is important to acknowledge that the success or failure of the scheme proposed in the bill will rest significantly on the unrevealed details.

I would like to also take the opportunity in this debate on the provision of diagnostic imaging services to highlight a problem in my own electorate. Since mid-2002 I have been campaigning for the allocation of a Medicare MRI licence to the Wollongong Hospital. Over the five years of this campaign more than 18,000 local people have signed petitions to the minister requesting the allocation of this licence to our local public hospital. In Tuesday’s budget I note that there was funding for the allocation of three new MRI licences. Along with my community I am again calling on the minister to allocate one of these three new licences to the Wollongong public hospital. In November 2004 the state Labor government announced that it would provide a MRI machine at Wollongong Hospital. In the same month I wrote to the federal minister for health again urging the federal government to allocate a Medicare licence to the hospital so that the many outpatients who attend Wollongong to visit the wide range of specialists who are located there can access a bulk-billing MRI scan. In March 2005 I launched a petition with local community activists calling on the government to provide the licence. We hoped to show the minister and the government the importance of this service to local people. Just six months later, on 12 September, I provided the completed petition to the minister at his Canberra office. There were 16,357 signatures on that petition.

In the grievance debate on that day I gave two examples of local people who required the service and who had made contact with me in support of the petition. One was a young man called Chris, who needed a scan every 18 months and was having to travel to the Sydney Children’s Hospital at Randwick to have the scans. The other was Dean, who has, sadly, died since that time. Dean needed a scan every six months for the monitoring of his tumour. He was not able to work and relied on the public health system, and had to either be admitted to Wollongong Hospital overnight to access the MRI machine as an inpatient or travel to St George Hospital or Prince of Wales Hospital to access a bulk-billed service. Dean was only in his 30s. He was not a healthcare card holder; he had a young family and had gone from two incomes to one—trying to maintain mortgage payments and not lose the family home—only when his illness forced him to leave work. He could not afford the gap fees of private providers.

Each time the government has announced that a new round of Medicare MRI licences are to be allocated I have urged the minister to make one of these available to Wollongong’s public hospital, both to provide pressure to ensure more local people are able to access bulk-billing for MRI services and also to provide technological support to the work of the specialists who utilise Wollongong Hospital as the major regional referral hospital. In March 2006 the minister responded to my request that the next round include Wollongong Hospital by making the point:

I note that there is a Medicare-eligible unit in close proximity to the Wollongong Public Hospital. While this may not be as convenient for some patients as a unit in the Wollongong Public Hospital, it is able to provide Medicare-funded services for the people of Wollongong.

I do not accept the minister’s dismissal of the issue as one of convenience for some patients. It is my view, and that of many of the specialists located in Wollongong, that private and public services often service different patient groups and that public services often deal with the chronically ill, who need timely service.

The private provider in Wollongong is extremely busy and it often takes several weeks to book an MRI scan. The provider also does not automatically bulk-bill pensioners or healthcare card holders. Only weeks ago I had a pensioner come and see me as she had to have an MRI scan on her shoulder and was asked to pay a gap of $95. As she did not have the money and did not want to delay until she could save it a friend offered to drive her to Nowra to access a bulk-billing service.

Another reason I do not accept the minister’s explanation is that the Department of Health and Ageing’s guidelines for the provision of MRI Medicare licences indicates that the criteria used include:

... a range of demographic and clinical considerations, such as the number of referring specialists in the area.

Wollongong is the third largest city in New South Wales and is the major referral centre for the Illawarra, South Coast and significant parts of the Southern Highlands. Further, included in the criteria is:

The Government has also considered the needs of major hospitals dealing in orthopaedics, oncology, neurology and neurosurgery.

On each of the criteria Wollongong Hospital’s MRI service should have been allocated Medicare eligibility.

The Parliamentary Secretary to the Minister for Health and Ageing repeated the comments of the minister in correspondence I received in September 2006. The parliamentary secretary further made the point:

The Government does not grant Medicare-eligibility for MRI units in public hospitals simply on the basis that one has been installed.

Further, the parliamentary secretary stated:

The Government’s decisions on where to locate these 10 additional Medicare-eligible units were informed by advice from the Department on areas with substantial under-serviced populations. Advice centred around populations of 100,000 to 150,000 people with access to a reasonable number of specialist referrers. It is also considered hospitals providing particular types of services, such as oncology, orthopaedics, neurology and neurosurgery.

Again, Wollongong Hospital is the major regional referral hospital for these specialities. It met all the criteria, except that there was a private provider in the town.

Finally, I want to address that issue. Firstly, I make the point that this private provider has a very limited bulk-billing policy. Indeed, when my office rang them we were told that they did not bulk bill. This causes local people to travel significant distances if they cannot afford the gap fee. Secondly, I make the point to the minister and the parliamentary secretary that there are many precedents in other areas where a licence is held by both a private and a public provider in the same area. A few examples from the department’s own website make this point. In the Hunter area licences are held by both Hunter Health Imaging Service in the radiology department of John Hunter Hospital and by Hunter Imaging Group, a private provider at Cardiff. In Gosford a licence has been held by a private provider, Gosford Radiology, since 1999 and Gosford’s public hospital since the October 2006 allocations. If you live on the North Shore you have even more options. Since 1999 a licence has been held by both North Shore Radiology and Nuclear Medicine at North Shore Private Hospital and by the New South Wales Department of Health’s Royal North Shore Hospital. Then in November 2004 a further licence was allocated to Mater Imaging at the Mater Hospital. In Liverpool a licence has been held by a private provider, Rayscan Imaging Liverpool, since 1999 and by Liverpool’s public hospital since May 2001. People in this area were further serviced by a licence provided to Ultrascan Radiology at Campbelltown in November 2004.

I think it would be obvious from these points that I do not accept that because Wollongong has a private provider with a licence it should be banned from accessing a licence for the public hospital, when the government’s own allocations in other areas have consistently, since 1999, not ruled out the public hospital having access to that licence for the very specific types of services and patients it deals with at the very same that a licence is held by a private provider in that area.

I have no idea whether the Minister for Health and Ageing has made a decision about where those three licences are to go. I do not know whether he intends to announce them in the lead-up to the election campaign as he wanders around the country. But, if he would like a rousing and welcoming reception at Wollongong in that process, I would suggest to him that, finally, after five years of concerted campaigning on behalf of my local community and indeed the specialists who are based in Wollongong, we would be more than happy to see one of those three licences allocated to Wollongong public hospital. I thank the House for its indulgence in that slight divergence from the bill.

Teresa Gambaro (Petrie, Liberal Party, Assistant Minister for Immigration and Citizenship) Share this | Link to this | Hansard source

I would like to thank all of the members who have made an enormous contribution to this debate. On behalf of the government, I acknowledge the opposition’s support for the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. This bill establishes a framework under Medicare for the introduction of an accreditation scheme for practices involving diagnostic imaging services covered by the Radiology Quality and Outlays Memorandum of Understanding. It is clear—to put it on the record—that it is really about eligibility for Medicare and not the detail of the accreditation scheme itself. That is a separate process. I just wanted to highlight that because it was mentioned by members opposite.

Billing Medicare is a privilege; it is not a right, and patients should have timely access to high-quality radiology services. The public deserves to be assured that practices provide high-quality services. From 1 July next year, accreditation against objective but realistic standards will therefore become an eligibility requirement for receiving Medicare benefits in respect of diagnostic imaging services. Pushing for accreditation is not a reflection on the quality of services as they are being provided now, but with accreditation the government and the community can be assured that the 12 million or so diagnostic imaging services supported by Medicare annually are being provided by organisations and that they are being performed against specified standards—that the over $1.2 billion taxpayer funded investment in those services is being used well.

Accreditation also adds a further quality dimension to those areas where specific Medicare billing rights are granted. This particularly relates to the allocation of Medicare licences for magnetic resonance imaging, or MRI, machines. I am sure the members opposite are very interested in this. For diagnostic imaging practices and providers, accreditation will provide more assurance that their practice can support the delivery of high-quality services to patients, and it will impose a discipline on them to ensure that they and their services stay up to the mark when it comes to excellence. Patients can also have greater confidence in services that they need and the way in which they are provided.

The transitional arrangements in the bill will ensure that existing practices will have ample time to prepare for accreditation and will not lose out if they do not have accreditation by 1 July next year. The bill also includes a mechanism to ensure that, should they not become accredited or should lose their accreditation, any such decisions will also be subjected to an independent review. No-one will lose access to Medicare without a full and fair process. The government is working closely with the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association, the relevant industry body, to develop a scheme that is practical and workable and will minimise the cost to practices, whether these be large, comprehensive diagnostic imaging businesses or small single-provider services. I stress strongly, though, that we are not setting the standards themselves; rather, we are leaving that to the experts. I can assure the opposition that there has been and is a process involving extensive consultation. The explanatory memorandum lists the wide range of bodies and groups who have been consulted in that process.

But getting the right balance between high standards and giving the community confidence—and also the realistic implementation of and compliance with those standards—is not a straightforward task. The government is aware that there are robust discussions going on right now between the college and the industry on such related matters. While appreciating their commitment, we trust that they will be able to work with goodwill in the public interest and reach an agreement on the nature and the structure of the practical accreditation regime. On behalf of the government and the Minister for Health and Ageing, I restate our willingness to give the college and the industry every assistance in ensuring that the 1 July 2008 commencement date is honoured. We want the parties to reach agreement on the standards regime in the near future so that the necessary planning and implementation arrangements are completed in good time—and the public expects as much. I therefore commend this bill to the House.

Question agreed to.

Bill read a second time.