Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

I've previously used my time in this place to discuss inequities in relation to women's health and, in particular, the intersectional health inequities for women who live in the regions. Women who live in the regions have drawn the short straw, particularly in remote Australia. Underfunding of women's health is not just occurring here in Australia; it's observed internationally. In the US, reported reimbursement for obstetric care is low in comparison to other services. As in the US, the undervaluing and resulting poor reimbursement for women's health means private hospitals have less interest and, as a result, we see, for example, private maternity units closing.

Doctors in my electorate also tell me that women in regional Australia are suffering because, whether it be for birthing, pelvic pain or prolapse, there are not enough specialists, expert nurses or allied health professionals to care for women in the regions. This means women travel long distances away from their family, paying for accommodation, just to be able to access birthing support. They are often without their partner. It's fair to say the audit of gender inequity in aspects of Medicare announced in the 2024-25 budget is overdue and welcome; however, solutions will need to be identified and implemented properly.

Further, the Royal Australian College of General Practitioners has said that the audit 'misses the bigger picture' as it overlooks GPs as the major providers of health care for women. The college has also expressed that Medicare lacks item numbers or provides very low rebate loadings for complex women's healthcare services provided by GPs, including the support of women going through menopause, chronic pain or endometriosis. These are health issues which medical professionals are still building their knowledge and capacity on, and they're not addressed in a short and simple consultation. I suggest the audit also needs to consider the interactions of multiple inequities which impact the health of those women who live in regional, rural and remote Australia.

There are a number of areas where we can see women's health inequity at play. Let's look at endometriosis. One in seven women live with endometriosis. The average waiting time for a diagnosis after experiencing initial symptoms is a staggering eight years. Many women's symptoms are not taken seriously. They're told to go home and just have panadol. If they do get to see a doctor who is aware of endometriosis, there is a long wait for a laparoscopy to confirm the diagnosis. Indeed, one of my constituents was sadly left with no alternative but to have a very early hysterectomy due to a too-late diagnosis and treatment of endometriosis. It needs to be caught early, and treatment needs to happen early.

Reportedly, work is being done overseas on development of a simple urine test which would allow GPs to administer a diagnostic kit. It would take days instead of years to detect endometriosis. The government's endometriosis and pelvic pain clinics are welcome. However, I note the additional new clinic announced in Adelaide was a pre-existing clinic at which waiting lists blew out shortly after it was rebadged under the national program in September last year. The only other place in South Australia as Kadina, which is hours away from where the majority of South Australians live. A shiny new announcement doesn't hugely increase the number of women who are able to get the diagnosis and treatment that they need in a reasonable timeframe.

On objective measures, waiting time figures for gynaecology-specialist outpatient clinics published quarterly by the South Australian health department, known as SA Health, show there was very little change in the average wait times for these outpatient services, which cover endometriosis and pelvic pain, since 2022. Even after those new clinics were announced between September and December, which are the most recent figures we have, average wait times for two major metropolitan hospitals—those being the Lyell McEwin Hospital and the Flinders Medical Centre—remain at 15 and 10 months, respectively. The maximum wait time at Flinders Medical Centre for these patients remained at 44 months and, in the case of the Lyell McEwin Hospital, grew from 41 to 44 months. That is an incredibly long period of time to have an outpatient appointment, particularly when the pain is so significant for women experiencing endometriosis.

I'd like to talk about the out-of-pocket costs of cancer. Nobody dealing with cancer should have to participate in a postcode and financial lottery in terms of accessing the best care that they can. I have a constituent—her name is Bronwyn—and she has been sharing with me her journey of living with cancer and requiring out-of-hospital radiotherapy and other treatments. She told me about the prohibitive cost of many treatments which are not covered by expensive private health insurance. I would like to quote Bronwyn. She says:

The costs of cancer are huge. We pay high premiums for private health insurance and then to be told that it is not a requirement that the private health companies pay the medicare gap for radiotherapy is such a let down.

In a time when you are going through cancer treatment, adding the financial stress makes it worse.

Add to this the process and fight that you have to do to even get to be heard is really tiring.

She continues later to describe the ongoing cost of cancer-related lymphoedema treatment, physiotherapy, compression garments and even bone-density infusions. She says, 'The costs of cancer continue to be expensive,' and that this all:

… highlights the cost of cancer at every stage—financial, emotional, time away from family and work. It's such a tiring, exhausting battle.

I'd also like to talk about breast cancer MRIs. I wrote to the Minister for Health and Aged Care in February this year to share concerns raised with me by several of my constituents regarding the access to and affordability of Medicare magnetic resonance imaging, MRIs, for breast cancer detection. Women who have denser breasts are at increased risk of having breast cancer. The density can obscure cancer when they have a mammogram, so many women opt to have an MRI, and their doctors tell them to do so. Medicare items cover MRIs for many parts of the body, but only in very limited circumstances are Medicare subsidies available for MRI breast scans, such as for people aged under 60 but with specific high-risk criteria.

One Strathalbyn constituent of mine who survived breast cancer and has a strong familial history of it has told me that her first cancer would not have been detected, due to her breast density, if she had been relying on a mammogram alone. She credits her access to a Medicare-subsidised MRI scan before she turned 50 as the reason she is alive today. Even if medical professionals recommend MRI breast scans due to breast density, there is no Medicare subsidy available for this procedure based on breast density alone. Add in limited facilities in regional locations, and it is a real challenge for many women to gain access. This leaves many women—usually, but not always, women suffering from breast cancer—paying up to $400 for a scan.

When this is coupled with high transport costs from places like, for example, in my electorate, Kangaroo Island, which is very remote, it is problematic, and so often women just stop getting those diagnostic tests. Further, growing out-of-pocket costs for services not subsidised by Medicare and not covered under private health insurance are not sustainable, particularly for vulnerable people on a low income or those who are unable to work due to having a serious illness. Therefore I asked the minister to investigate better availability of rebates for MRI diagnostic imaging screening if an MRI is recommended by a medical professional as a result of breast density. While the minister pointed out that there were two relevant reviews and projects being undertaken which may have a bearing on these issues, nearly six months later neither the BreastScreen program nor the Breast MRI Evaluation reports have been handed down.

In a final piece of bad news, in my community one of the state's major radiology providers has announced that it will no longer bulk-bill at its regional clinics unless patients have a concession card. Surely women—in particular, regional women—have waited long enough for their health conditions to be properly understood and for the gap in health care to be addressed.