Jenny Ware (Hughes, Liberal Party) Share this | Link to this | Hansard source

I rise to speak about the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025. I do not agree with the amendment that was moved by the member for Brisbane, and I support the amendment that was moved by the member for Farrer.

This entire legislation is essentially an omnibus of health measures following legislative changes in the course of this parliament. The provisions relate to the effective administration of health benefit schemes—in particular, the power to detect, respond to, investigate, disclose and deter misconduct, fraud and noncompliance. It is intended that this bill will amend a number of acts, including the Health Insurance Act, the National Health Act, the Human Services (Medicare) Act, the Dental Benefits Act, the Therapeutic Goods Act and the Public Health (Tobacco and Other Products) Act.

In view of the title of this legislation and the fact that the Minister for Health and Aged Care today in question time referred to the fact that Medicare has recently turned 41, I think it is entirely appropriate that we look at how Medicare is performing, and I want to draw attention to some of the issues that I am confronting and my electorate of Hughes is confronting within southern Sydney and south-west Sydney.

First of all, we hear over and over again from those in government, particularly the health minister, that bulk-billing rates have improved and that there are more GPs now than there were under the former government. It did not take me very long to do a tiny little bit of research to understand that that is certainly not the case in most parts of the country and not the case in my electorate.

Only four practices in my electorate now bulk bill in their entirety. Sixteen per cent of general practices in Hughes bulk bill in some instances, usually for children 16 years and under and for those with a health services card. But, most tellingly, during the lifetime of this Albanese Labor government more than 20 general practices in my electorate have changed the way that they bill. Over two years and nine months, most of the GPs in my electorate have found that they can no longer bulk bill. I found that, overall, bulk-billing services have plummeted by 11 per cent since the Albanese Labor government came to office. That is 2.4 million fewer GP services being provided to Australians. Out-of-pocket costs overall have risen by 5.5 per cent during the term of this government.

So, when those in government, particularly the minister for health, stand there and say that we have more GPs than ever, that health services have increased and that the cost of health has decreased—we hear about cheaper health care—that is simply not true. It is disingenuous for the Albanese Labor government and a very senior minister to be floating that particular line.

The Australian Institute of Health and Welfare recently published data—this was at the end of last year, so it is very current—showing the Medicare bulk billing of GP attendances by month. What that has shown in my electorate particularly is that the rates have declined from about 80 per cent in 2022 to 68 per cent. Again, this is more evidence, not from our side but from other organisations, to say that Medicare bulk-billing under this government has failed. The Australian Medical Association announced just this week that it is putting forward a $4.5 billion plan to modernise Medicare and lift bulk-billing. So not even the Australian Medical Association supports the government's—and, particularly, the health minister's—proposition that it has provided cheaper health care and that Medicare is a success under it. I would certainly consider that if the government intends to continue with the line that Medicare is safe in its hands and that it has boosted our public health system. Again, that is simply, completely disingenuous. We've now got three reports from three different organisations that support that position.

If I can turn now to another couple of issues that the government, those on that side, have championed and called their own, we'll start first of all with endometriosis and pelvic pain clinics. Endometriosis is a debilitating chronic condition that can be very hard to diagnose. Often, those suffering wait an average of seven years before diagnosis. It can lead to infertility in women, and it is extremely, extremely painful. It is pleasing to see that the government and the health minister have opened some endometriosis and pelvic pain clinics across the country. However, this was done on the back of the initial inquiry that commenced under the former coalition government and came about as recommendations from that report.

I've written to the minister on this issue. I notice that the assistant minister is here in the chamber; I have also met with her, and I thank the assistant minister for her time on this issue. For women in my electorate of Hughes to access one of those clinics, it is at least an hour and a half's drive. I'm in southern Sydney, in the Sutherland Shire, and our nearest clinic, which the health minister very helpfully directed me to, is the Women's Health Centre in the Southern Highlands. That's in Mittagong. From Sutherland, it would take close to two hours to drive there, and the minister thought that that was acceptable for the women in my electorate. It's simply not acceptable. When I look through the list of where those clinics have been located, it appears that this has been Labor very carefully, very strategically choosing to locate those clinics in areas that are either very marginal or that supported Labor coming into power in 2022. There has been no help here for the women in my electorate, for women of southern Sydney and for women of south-western Sydney.

Then, while we're on the issue of female health, last week I was doing a mobile office, and a lady called Jodie Treuil came to me. She said that I could mention her in parliament. She said, 'If there is one thing that I could ask you to do, Jenny, it is to look at female health particularly.' I said, 'Yes, I've got a particular interest in it.' She raised a couple of things. She said first of all that, only a couple of months ago, one of her very close friends took her own life as a result of depression caused by symptoms of menopause. She said, 'We are not doing enough for menopause.' I said, 'There has been a Senate inquiry into menopause, and so far the health minister has not acted on all of those recommendations that were made.' Again, that is saying to me that this health minister and this Albanese Labor government do not care about women's health. Jodie also said to me, 'Jenny, why is it that hormone replacement therapy is generally not covered on the PBS and yet Viagra is?' She said, 'I don't want to take Viagra off the PBS, but I want women's hormone replacement therapy put on there.' She said maybe it could have saved her girlfriend's life.

That is also a very serious issue, and, again, although there are some menopause clinics that have been established throughout Sydney and throughout the country, there are none available in my electorate. My electorate stretches across Sutherland Hospital, Liverpool Hospital and Campbelltown Hospital in the south-west of Sydney, which is one of the areas growing fastest in population. There are no menopause clinics available to women in my electorate. Again, I see this as a massive failure by the Albanese Labor government, a massive failure for women, showing that the noise that they make about caring about women's health is simply not borne out by their actions. They do not seem to want to put any money into women's health in my electorate or in southern Sydney overall.

I will now talk to one other issue that I have been battling the health minister about. I have a practice in my electorate at Holsworthy. It's called Wattle Grove Family Medical Practice. It has over 3,000 patients on its books. There are currently three GPs only. Many of the patients are veterans' families because of the location at Holsworthy. Dr John Stanford, who runs that practice, has been trying now for close to a year to get another GP registrar into that practice. He said that the failure to have that other registrar is providing much longer wait times for patients, and he's also concerned about the mental health of his other GPs because of their workload with this.

I have written to Minister Butler. He doesn't reply; his chief of staff does—'a matter for the minister'. I wrote to Minister Butler on this. He kicked the can down the road and said, 'Oh, it's not me; it's the RACGP.' I went to them. I met with the president, who is in my electorate, and she said: 'No, no, no. This is firmly in the hands of the minister.' After 12 months I am still unable to get any assistance from the minister to help the men, women and children of Holsworthy and of my electorate with an extra GP registrar. Again I say that this shows that this minister and this Labor government do not care about the health of my electorate. They do not care about the health of women, men and children in southern and south-western Sydney.

When I have to sit here in question time or at other times and hear the Minister for Health and Aged Care talking about great announcements and how they've produced cheaper Medicare and more bulk-billing, that is simply not borne out by the evidence. When I have to hear him saying that Labor is the party for women, that is simply not borne out by the evidence that I have seen in my electorate. I would like the health minister to answer this: why is it that he does not care about the health of women, the health of men and the health of children in my electorate of Hughes?

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

The Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025 proposes amendments to improve enforcement of several integrity measures for Medicare, some minor amendments to the Therapeutic Goods Act 1989 and amendments related to the government's tobacco and vaping reforms. I'd like to speak to the changes to the Therapeutic Goods Act 1989, which the government hopes will enhance its capacity to manage and alleviate the consequences of therapeutic goods shortages in Australia.

Medication shortages have been a significant and ongoing issue in this country for a number of years. I have drawn attention to this issue in question time on several occasions and in questions on notice to the minister. The fact is that we lack appropriate mechanisms in this country for anticipating or dealing appropriately with medication shortages. Today, the TGA lists 416 medication shortages and 67 anticipated shortages on its website. It receives an average of 120 notifications of new medical shortages every month, at least 10 per cent of which are critical. Last year, we had a national shortage of intravenous fluids for months. This was a shortage which the health minister himself admitted he did not see coming. It was a shortage which necessitated postponement of hundreds of elective surgeries and which prolonged inpatient stays in hospitals around Australia. Medication shortages are a global problem. The WHO recently reported 300 essential drugs in shortage worldwide. This longstanding problem was exacerbated by the COVID-19 pandemic, sequelae of which included increased production costs and increasingly complex logistic challenges. But these issues are and remain compounded by a lack of Australian domestic manufacturers. More than 90 per cent of the medications that we prescribe in this country are imported, most commonly from India and from China.

There is already an existing mechanism in the Therapeutic Goods Act to allow the secretary of the department to approve the importation or supply of substitutable unapproved products from overseas where the secretary is satisfied that the approved medicine or biological or medical device is already unavailable or is in short supply. The amendment before the House today gives similar powers to the secretary where there is an anticipated shortage of these registered goods. It's important to note that substitutable overseas goods are often in limited supply overseas, and they are often the subject of significant competition between countries which are seeking to secure supplies for their citizens. So this amendment will enable the secretary to try to secure and ensure ongoing supplies of necessary medications for Australians ahead of time, before we get to the situation where the medications are already in short supply.

The fact is that the government lacks a comprehensive strategy addressing these medication shortages and how to manage them better when they do occur. We have a medicines supply security guarantee. It was launched in July 2023, and it requires manufacturers to hold at least four to six months of key medications in Australia. However, it has not been enforced. All we are being given with this legislation is a minimal increase in our degree of preparedness for what we seem to be accepting as an inevitable occurrence. It's just not good enough. There are clearly no easy answers to this issue, but there are a number of things which the government could do and yet has not yet done to address the problem. A recent report, Understanding the impact of medicine shortages in Australia, found that many Australian patients have to wait a month or more to purchase medicines which are in shortage or they end up having to buy a second medication. As a result of that, 20 per cent of Australians ration their medicines to make them last longer. Clearly, this can result in adverse outcomes for patients. Fourteen per cent of patients who try to find a medication and can't find it end up not buying it at all. Four per cent purchase a non-prescription medicine, and two per cent of them end up in hospital. I'll repeat that—one in 50 Australians affected by medication shortages ends up in our hospital system.

These shortages and discontinuations disproportionately impact certain population groups, including First Nations people and Australians living in rural and regional settings. We know that Australians with higher incidences of chronic and complex diseases are those who are more likely to require specialist care. They are more vulnerable to shortages and to discontinuations. They may also have diminished capacity to advocate for alternative scripts, to find the remaining supplies of medications and to source them privately.

Medication shortages don't just cause inconvenience. For doctors, they result in a need for extra consultations, to identify alternative management options, to write additional or new scripts, to educate patients about the new medications and provide those patients with psychological support around the change, to organise collection or dispensation of new pharmacotherapies and to call pharmacies or the TGA for more information. These activities are made more time consuming when physicians are unfamiliar with alternative preparations or when those new agents require either authority scripts or access via the Special Access Scheme, the paperwork for which is considerable.

For patients and for pharmacists, uneven and inadequate distribution of medicines is a health equity problem. Delays in accessing or inability to access the best possible medication affects patients negatively. Withdrawal from medications causes side effects that affect patients negatively. Changes in medications can well result in inadvertent overdoses or unexpected side effects. Where alternative medications have to be sourced, that increases the workload of pharmacists. Patients often experience the extra cost associated with these new drugs, but they also have to pay to go back and see their GP when they have to get a second prescription because they can't access the first-choice medication.

The medications affected are often those which are in common use: medications for ADHD and antibiotics. Hormone replacement therapy transdermal patches have been in chronic supply for some years. I have explained to the health minister on a number of occasions that it is a very brave man who gets between a menopausal woman and her HRT, yet the TGA has now advised doctors to limit starting new patients on HRT patches, accepting that this will help preserve available supplies for those people who are already on them. This is what our health system is reduced to.

Similarly, copper IUDs have been in critical shortage for months at a time. Patients themselves have had to arrange to get them delivered from interstate. The HIV prevention drug PrEP has been in shortage for long periods. We have people at risk of developing HIV because we are not providing them with the medication that they need. Last year there were persistent shortages of the diabetes medication Mounjaro. The long-term national shortage of semaglutide is likely to persist until at least 31 December this year, and that is impacting patients with type 2 diabetes across this country. Finding it and accessing semaglutide, or Ozempic, has been described as being like winning the lottery. I've also heard from a constituent in Kooyong about their anxiety and fear relating to the shortage of cholestyramine powder sachets. These are used as a last-line therapy for people who have undergone an ileal resection and are at risk of severe diarrhoea related to that. There are very limited alternatives for people with that condition.

We have a duty to guarantee vulnerable Australians appropriate treatment for their serious medical conditions. At the same time, the recent discontinuation of lomustine capsules sparked a lot of concern in the Australian oncology community. There are very limited alternatives for treatment of glioblastoma, a rare and aggressive form of brain cancer. Taking away one of those alternatives just causes incredible distress to vulnerable Australians.

Worst of all, I want to draw the parliament's attention to the ongoing critical shortages of medications for palliative care in this country. Liquid morphine has been in shortage for months. I'll give you a few examples of the impact of that shortage on constituents from Kooyong. These are examples provided by my constituents. An 88-year-old gentleman had prostate cancer. He was stable on oral liquid morphine for breathlessness due to his metastatic disease. He was unable to source that medication in the community. He had to go to the emergency department with uncontrolled breathlessness. He was admitted to hospital, where he died. A 56-year-old woman with metastatic lung cancer who was stable on long-acting hydromorphone for pain was forced to change to methadone because the hydromorphone was no longer available. She required a two-week hospital admission to titrate her medications to safety. An 85-year-old man with metastatic bowel cancer was admitted to hospital for three weeks due to the need for slow titration onto methadone in lieu of long-acting hydromorphone. A 73-year-old man with end-stage cardiac disease had to attend a hospital palliative care clinic in person for the ongoing prescription and supply of his MS Contin granules because he was unable to source them in the community.

Communication around medication shortages is often poor. Many GPs find out that medications are in shortage from their patients. The frustration relating to medication shortages reduces consumer credibility and trust in healthcare professionals. Many have reported higher rates of physical and verbal abuse when their patients are unable to source the medications that they need. GPs would benefit from collaborative efforts of the TGA, medication suppliers and practice management software producers, who could together relatively easily provide online advice in practice management software regarding discontinuations and supply of the medications that the GPs are prescribing. But the government has not as yet made an effort to put that in place.

Pharmacists know when medications are in short supply in their own facilities, but they don't know which nearby stores will have the medication that might be able to help them. They tell me that they spend hours sometimes calling out to try and help their patients. Some time ago I suggested to the government that it look to establishing a central information point for pharmacists so that they could know what medications are in supply in what sites and save themselves time. Clearly, there are some commercial sensitivities around knowing which pharmacies have what medications, but we could get around these. As far as I know, there has been no progress on this issue from the government to date.

The legislation in front of the House addresses one part of one aspect of an issue, but it doesn't get to the underlying problem, which is the persisting deficits in the supply chain for many medications in this country; the lack of transparency around those shortages for consumers, doctors and pharmacists; and the inconvenience, the expense and the harm which result from those shortages. We need a better process to identify impending shortages of medications, biologics and devices. Doctors and pharmacists need to know about these shortages and discontinuations sooner. They need greater transparency about the reasons for medication shortages and consistent, location-specific information about stock availability. I'm particularly concerned by the cost of the medication shortages for consumers and the fact that Australians often have to pay more for a second-line or third-line agent.

I call on the government to act on this issue: to develop effective stockpiles of critical medicines; to mandate that medication manufacturers advise the TGA of shortages well in advance; and to ensure that we have duplication of registration by the TGA for those medicines which are critical to public health and safety. I call for the government to use Future Made in Australia or other funding to invest in incentives for the development of a domestic manufacturing industry for critical medicines; to introduce taxation or fiscal incentives to ensure supply of critical medications which might not otherwise be financially viable to introduce into the small Australian market; to review the system of statutory price reductions for older medications so as to temper the price reductions that often lead to PBS delisting; to simplify the special access scheme for unapproved medicines and therapeutic goods; and to enhance the regulatory powers of the TGA to enable it to redistribute scarce medicines to priority patient groups who are at risk of poorer health outcomes.

Deputy Speaker, Assistant Minister, we have to do better to protect vulnerable Australians and to ensure that they receive the very best practice care in our country. At the very least, as a show of good faith in the face of our apparent inability to guarantee access to the optimal medications for these patients' conditions, we have to ensure that Australian patients don't have to pay more to receive lesser medical care.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

Australia has a world-class health system, largely thanks to the various health benefits schemes such as Medicare which help Australians pay for the healthcare they need. In 2023-24, payments for health benefits including medical services, pharmaceutical services and private health insurance rebates totalled at least $65.1 billion. The government is committed to protecting this investment and strengthening Medicare by improving the compliance framework that ensures its integrity. The government commissioned the independent review of Medicare integrity and compliance, known as the Philip review, in November 2022 to respond to concerns about the operation of the Medicare system. The Health Insurance Amendment (Professional Services Review Scheme) Act 2023 and the Health Insurance Amendment (Professional Services Review Scheme No. 2) Act 2023 made amendments in response to the recommendations of that Philip review.

This bill will support the integrity and sustainability of Medicare by addressing a range of issues to enable the department to conduct more efficient, timely and effective compliance activities. The bill will improve payment integrity by reducing the time for making bulk-billed claims. The bill will allow investigative powers to be used consistently and effectively across all health schemes, including Medicare and the Pharmaceutical Benefits Scheme, and will improve the processes relating to pharmacy approvals. The bill also makes several sensible amendments to the Therapeutic Goods Act 1989 to enhance the Department of Health and Aged Care's capacity to manage and alleviate the consequences of therapeutic goods shortages and support compliance and enforcement activities undertaken in relation to unlawful therapeutic goods and unlawful vaping goods. These amendments are consistent with this government's unwavering commitment to public health and mitigate the public health risks associated with therapeutic goods and vaping goods by supporting strong and effective regulation under the Therapeutic Goods Act.

The bill also amends the Public Health (Tobacco and Other Products) Act 2023. These amendments are largely clarifying in nature and have been identified as necessary during implementation to ensure the smooth and consistent operation of the act.

I thank the members for their contribution to the debate on this bill.

Milton Dick (Speaker) Share this | Link to this | Hansard source

The question is that the amendment to the amendment be agreed to.

Milton Dick (Speaker) Share this | Link to this | Hansard source

The question before the House now is that the amendment moved by the honourable member for Farrer be agreed to.