Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

The Health Insurance Amendment (Pathology Requests) Bill 2010 was previously considered by the House in the last parliament. The bill removes the legislative requirement for a request to be made to a particular approved pathology provider for Medicare benefits to be payable. The change will allow patients to access pathology services at any approved pathology provider. In order for a Medicare benefit to be payable, the act requires a pathology provider to be specified on the request. It is common practice for medical practitioners to use pre-branded request forms, which include details of the pathology provider. The changes under this bill would mean that a patient in possession of a request would be permitted to go to any approved pathology provider. The regulations will require pre-branded forms produced by pathology providers and used by treating practitioners to include a prominent and understandable statement that pathology requests can be taken to any approved provider.

The coalition does not oppose the intent of this bill but holds some concerns about the practical effects of its implementation and the lack of consultation that occurred prior to its initial introduction into the parliament. The coalition supports patient choice in accessing health care but, as with any change in policy in this portfolio, proper consideration should be given to patient safety and the quality of care.

As I noted in my speech in the second reading debate in the previous parliament, this was a 2009 budget measure and was not subject to consultation. Submissions to the Department of Health and Ageing on the implementation of this measure only closed on 22 February—12 days after the Minister for Health and Ageing first introduced the bill in the last parliament. In addition, the government has initiated a review of funding arrangements for pathology services. Submissions were due by 30 April 2010 and the government’s decisions are to be reflected in the 2011-12 budget.

The government pursued a number of measures affecting pathology services, including the one before us today, while this review was being conducted. In previous budgets, Labor has reduced Medicare rebates for pathology collections, reduced Medicare rebates for some 259 pathology tests and imposed tighter caps on rebates for multiple tests performed on a single sample. There is nothing wrong with reviewing and making changes where necessary, but it should not be done in isolation from those on the front line of service delivery.

Again, these changes were made without consultation and that is the real issue of concern. Perhaps, though, it is no surprise that providers are closing facilities and shedding jobs. Only last week a major healthcare provider closed 23 facilities and cut 290 jobs, and it cited the effect of federal government cuts, including those affecting pathology. The intent of measures such as this may be good but the problem is the process—or lack thereof—that this government follows.

There is a distinct lack of consultation. It is incredible that at the same time it is undertaking a review the government is announcing measures that directly affect patients and providers. Surely it would have been more appropriate to undertake an open and transparent review that engaged with patient and clinician groups on possible proposals before drafting legislation and implementing measures. Who knows what is going to hit the sector in the next budget as a result of the supposed review?

I would like to outline a number of concerns about the bill that were first canvassed in the original debate and in evidence to the Senate inquiry. There is variation in the range of services offered by pathology practices, in the methods and equipment used, and in the methods of communication between pathology practices and referring doctors.

Whilst cost is a very important consideration for patients, it may not always be the most appropriate basis for deciding on a service provider. In the Minister for Health and Ageing’s second reading speech, she admitted:

… there are often valid clinical reasons for recommending a particular pathology provider over another.

The minister’s only comment on this issue was to say that the government will continue to encourage medical practitioners to discuss options with patients. As I stated at the time, that is an insufficient response to a core issue in this legislation that the minister herself identified.

There are also clear lines of communication between referring doctors and pathology services. Pathology practices ensure results are provided to GPs and other medical practitioners in a timely manner by means of established delivery systems and compatible IT systems. Also, pathology practices often have established means of contacting referring doctors after hours and in cases of emergency. The government has failed to explain how new referral pathways will operate in cases where the pathology practice is unknown to the referring doctor. A lost or delayed result may have very serious consequences for patients and medico-legal implications for the referring doctor. Stakeholders have flagged to the government concerns regarding lines of communication and it is important that the issues are resolved prior to implementation. In fact, it would be prudent of the minister to advise the House of progress in this area in her final comments.

It has been noted that similar arrangements already exist for diagnostic imaging. There are differences between pathology and diagnostic imaging procedures. The number of tests per patient is generally lower for diagnostic imaging. Imaging tests are usually undertaken with the patient present and the patient is provided with the results. It is also argued that diagnostic imaging methodology is standard across all providers and that, unlike pathology, it is not as frequently used to monitor chronic conditions or medication treatment. It is incorrect to claim that the processes that work for diagnostic imaging will work for pathology services.

The government’s record in health has done nothing to improve the situation for patients. There is growing concern in the community about decreasing levels of bulk-billing for pathology. This particularly affects older Australians, self-funded retirees and pensioners with fixed incomes. The situation appears to be deteriorating with the rapid expansion of collection centres as a result of another one of this government’s policy changes: the government has moved to reverse a policy supported by successive governments to contain pathology collection fees. Again, whilst the intent of the measure may seem sound, the policy ramifications for patients and taxpayers may be less so.

Pathology does rely on volume for economies of scale, and creating a situation where providers bid for space in a limited number of medical practices may lead to a rapid increase in the cost of operating collection centres. Increased out-of-pocket costs will lead to higher Medicare outlays. We are concerned by this government’s actions, which are leading to higher cost-of-living pressures for many Australians, particularly in the area of health care. I reiterate our ongoing concerns about the government’s approach to policy in this area and the continual bungling of legislation and issues which have general in-principle support. As stated, the coalition do not oppose the intent of the bill, but we will be seeking to address the issue the minister herself identified: the circumstances where there is a clinical need for a treating practitioner to specify an approved pathology provider.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the Health Insurance Amendment (Pathology Requests) Bill 2010. These amendments make it clear that patients and consumers have choice. They have choice with respect to their doctor, their pathologist, their occupational therapist, their physiotherapist and their dentist. This is important in the areas of medicine and health. The bill proposes amendments to the Health Insurance Act 1973, removing the requirement that a request for a Medicare eligible pathology service be made to a particular pathology provider. Under the current Medicare arrangements, if a GP, for example, decides it is clinically appropriate and necessary, that particular doctor can refer a patient to an approved provider for a diagnostic test. Currently the legislation provides that there is a Medicare benefit. For that to be payable, a designated pathology provider must be named in the referral request. It means there is a cosy arrangement between the pathologist and the doctor.

We think it is important that consumers have their say in determining which pathology service they wish to choose as a result of discussions with their doctor. There is nothing in this legislation that would prohibit a referring doctor from recommending a particular pathologist to a particular patient of theirs. There has been some comment and criticism as to whether this would interfere in the communication between a GP and their patient, that there may be some miscommunication or some problem with the communication between the pathologist and the doctor. In this day of fax machines, emails and telephones there cannot be any real problems in that regard. In my community in Blair in South-East Queensland, pathology services are located very close to where GPs are located, and they communicate on a daily basis. This is not something that we should be worried about. To quote someone whom those opposite may quote from time to time, Milton Friedman said that there needs to be freedom to choose—freedom to choose who to engage and who to spend our money on to look after our health care.

These sorts of procedures are worrying for patients. When a doctor says, ‘Go off and get this diagnostic test,’ a lot of people find that very worrying. The Royal College of Pathologists of Australasia claimed that it is the professional right of doctors to determine to whom they refer patients. I think that is arrant nonsense. This legislation is about ensuring better competition and improving the quality of service. Doctors will still be able to communicate with their patients. It is really to criticise doctors to say that they cannot determine to whom they refer patients. Patients will inevitably decide for themselves whom they engage. Sometimes they will decide based on word of mouth and sometimes by geographic convenience, but more often than not it will be after consultation with their GP.

It does not stop the doctors from discussing these issues. It does not stop the idea of branding either. Pathology providers will continue to be able to produce branded request forms that include the company’s logo and address. That is not an indication that we are against communication and cooperation between pathologists and doctors and patients. It is just an opportunity for consumers to work out which pathologist they want to use and the circumstances. Branded request forms are not very common. You can see that when you get a referral. There would be plenty of people in this chamber who have had referrals to a pathologist.

Changes to the relevant regulations are planned to make sure the request for pathology services include a clear and understandable statement, obviously positioned so that a patient is aware of their consumer rights. I think that is appropriate. There will be a transition period—as we have said in the legislation—of 12 months in respect of changes to the regulations to minimise any impact on pathology practices and GPs, and to make sure that consumers have good knowledge of what is going on.

The Department of Health and Ageing will undertake an advertising and communications campaign to make sure that people understand what is involved. There will be communication with pathology providers and GPs. In her second reading speech on 20 October 2010 the minister said:

Informed patient choice is a key element of quality health care. This amendment will ensure that patients have a right to choose their pathology provider and are made aware of that fact, leading to increased competition and better service among providers.

My observation in my electorate of Blair is that doctors communicate with pathology providers regularly. Pathology providers are actually located in good geographic positions to be available to the public. For instance, my electorate office is in the Brassall shopping centre in Hunter Street, Ipswich, and next door is QML Pathology. As I drive in each day I see people sitting and waiting to go into QML for their tests to be done. And directly opposite, if you go out the front door of my electorate office in Blair, you can see that straight across the corridor, a matter of a few metres, there is Sullivan Nicolaides Pathology, which has been opened in the last few months.

It is not the case that pathologists are making it geographically difficult for the public to reach them. Brassall is the biggest suburb in terms of population for the whole of the electorate of Blair and it is not unusual to find a couple of pathology providers in very large shopping centres. There are doctors not far away in the same suburb, and the suburb of Brassall is not far away from the Ipswich CBD, where there are doctors everywhere. You will also see pathology providers in the middle of the CBD as well as in the medical precinct.

Doctors and pathologists will deal with each other and communicate each day. Doctors will deal with patients every day. Pathologists will deal with the public and patients every day. People will seek referrals. The world will not end. The government will continue to ensure that we are the champions of consumer rights, of competition and of the freedom to choose, because we think this is important for the public.

What amazes me about those opposite is that they claim they are the champions of consumers, the champions of choice, the champions of liberty and the champions of free enterprise, but it is Labor governments that bring in legislation like this and other legislation in consumer law and in relation to competition. It is Labor governments that stand up for those challenged, those in need, those sick, those ill and those injured. It puzzles me that those opposite express concerns and listen to the people who criticise our legislation. We think this legislation is in the best interests of consumers and in the best of interests of all concerned for our economy and for the medical and health industry. I commend the legislation to the House.

Kirsten Livermore (Capricornia, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to join the member for Blair and other colleagues in supporting the Health Insurance Amendment (Pathology Requests) Bill 2010. This bill removes the requirement that a request for a Medicare eligible pathology service be made to a particular pathology provider.

Currently, when a doctor sends a patient off for a diagnostic test, the patient will be handed a request form including the name of a particular pathology provider. This has been a feature of the existing Medicare arrangements according to which a Medicare benefit is only payable if a designated pathology provider is named in the referral request. The patient is, therefore, required to go to the pathology provider specified by his or her doctor. This means that the choice of pathology provider is one for the doctor to make. Usually the doctor hands the patient a form produced by a pathology provider headed up with that provider’s logo and brand, and that is the provider the patient goes to. The referral request must nominate a specific pathology provider for the service to be eligible for a Medicare rebate.

This bill seeks to amend the Health Insurance Act to remove that requirement. Our proposal is for patients to be free to take the pathology request to any approved and accredited pathology provider. The act will still require a pathology provider to be in receipt of a referral from a medical practitioner. There will, however, no longer be a requirement for that referral request to specify a particular pathology provider in order for the service to be Medicare rebatable.

Under this new system the patient will be free to go to any accredited pathology provider and a rebate will be payable for that service. There is nothing in the bill to stop doctors from advising their patients on their choice of pathology provider, and providers are still allowed to produce branded request forms and to provide these to medical practitioners. Changes to current regulations will, however, mean that the forms will now also include an obvious statement to make patients aware that requests can be taken to any approved pathology provider of their choice.

This is a change, but it is important to note that the proposal in this bill is similar to the system that has operated in the diagnostic imaging sector for some time. In contrast to the pathology sector, when a patient is referred to a diagnostic imaging provider, there has been no corresponding requirement for a particular provider to be nominated in the request. Patients with a referral to a diagnostic imaging service can take their request for service to any provider. This change simply brings the pathology sector into line with the existing practice in the diagnostic imaging sector.

On the face of it this measure is a very simple one. It is, however, part of the government’s broader response to the challenge of preparing our health system for the future. We know that we face rising health costs due to our growing population, the ageing of the population and the increase in chronic disease. These are all big challenges that will put huge demands on our health system. We came to government knowing that we had to undertake reform of our health system to make sure it is ready to meet those demands. To do that we have to remove the duplication and inefficiencies from the current system. We have to make sure that our health spending dollar is spent as efficiently and effectively as possible. This measure to increase patient choice and encourage competition in the pathology sector is consistent with those goals.

In debating this bill the last time it was before the House, I used my time to talk about my support for the Labor government’s health reform measures generally and to talk specifically about how our investment in my electorate has made and is making a big difference to capacity for health services within Central Queensland. We had a huge investment of $75 million for the expansion of the Rockhampton Base Hospital in the 2008-09 budget and, more recently, $67 million was committed to a cancer centre for the Rockhampton Base Hospital. I was delighted with the support that the Minister for Health and Ageing gave to my electorate in making that decision. It will make a huge difference to the way in which people are treated; they can be treated for many more forms of cancer and be looked after in their home town without having to travel away from their families.

I would like to quickly mention another very exciting thing that is happening in the health sector in my electorate. The minister will find out more about this tomorrow when the Pro Vice-Chancellor of the Central Queensland University visits Canberra to speak to her about what is going on at both the Rockhampton and the Mackay campuses of the university. Commencing in 2011, in Rockhampton the university will commence a new course in paramedic science and the Mackay campus will offer a medical stenography program.

I visited the Mackay campus a couple of weeks ago, and the head of the campus showed me around the work being done to prepare the facilities for that medical stenography course to start. I was told today that the university has already received 200 first preference applications for the paramedic science degree and, similarly, 200 first preference applications for the stenography and medical imaging program at the Mackay campus. It is great to see that all sections of the health sector, whether it is facilities at our major hospitals or these investments in producing our very own local, fully trained and qualified health workforce, are moving in the right direction. With the continued support of our Labor government I am very confident that we will continue to see this improvement in health services in Central Queensland.

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

in reply—I would like to thank all members who have made a contribution to this debate. I am pleased I was here for the last few minutes of the contribution from the member for Capricornia because I know that there are lots of exciting things happening in many regional parts of Australia, yours included, Madam Deputy Speaker Bird, where our investments are really starting to make a difference in the training of health officials in the future.

The Health Insurance Amendment (Pathology Requests) Bill 2010 is about removing what might have been some practices between GPs, medical practitioners and pathologists. Essentially, it puts in place a legislative restriction on requiring a patient to take a request for a pathology service to a particular approved pathology practitioner. This is increasing competition. It is making clear that any member of the public can go to a pathologist of their choice. I am pleased that there have been some contributions to that effect within the House. The amendments will take effect from the day after royal assent. Doctors will be encouraged to continue to advise their patients of any views they have on the best choice of pathology provider for their needs.

I note that, during the last term of government, the Senate Community Affairs Legislation Committee reviewed this bill with regard to any potential impact on medical practice and recommended to the Senate that this bill be passed in its current form. I hope this means that, if the bill is passed through the House today, we might have some speedy handling of it in the Senate. I understand that the shadow minister is about to move some amendments in the consideration in detail stage, and it might assist the House if I indicate that the government is prepared to accept those amendments.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.