Nick Xenophon (SA, Independent) Share this | Hansard source

I think the Minister for Health and Ageing, Nicola Roxon, does a lot of good things. Her focus on preventive health is laudable, but that is for another debate, perhaps later today. The focus on getting to the cause of illness and to the cause of people getting sick in the first place is a fundamentally good thing. I also think that the minister’s reforms to the dental program—which, with some relatively minor amendments, I support—need to be done, and it is regrettable that after a year that has not been dealt with.

I do have an issue in relation to the changes to cataract surgery. I think a mistake has been made. I think the government’s concern about some ophthalmologists not doing the right thing has been dealt with with a very blunt instrument. This instrument has been to have an across-the-board change to the cataract rebate. This bill is the same as the Health Insurance Amendment (Compliance) Bill 2009 but with one important difference: it ensures that if any regulation to change in a time in an item to a table of medical services is disallowed them the situation will revert back to the previous regulations.

Currently if such regulation is disallowed then the result is as if no regulation existed. This is vital because items in a table of medical services provide rebates for important procedures such as cataract surgery. The government has cut the rebates for items Nos 42699, 42701 and 42702 by 50 per cent. These items are for medical services associated with cataract surgery, and the information provided by the Medicare benefits branch in estimates last week indicated that in the 2007-08 financial year there were 187,912 cataract procedures provided. Of these, 131,675, or roughly 70 per cent, were provided in the private system, which would have had the rebate level halved under the government’s changes. Meanwhile, the remaining public sector patients would have continued to get their treatments for free, but I think it is important to have that balance between the public and private systems and that you do not overload an already stretched public system.

My office has been inundated with correspondence from constituents and individuals opposing these changes by the government. It has not been just about lobbying by medical practitioners or private health groups; bodies such as COTA—the peak advocacy body for senior citizens in this country—have publicly criticised this move by the government and so have those who have practised in the area for many years. I will quote from an email from one ophthalmologist:

The proposed change will reduce surgeons’ income—but not in the way the Government might think. Almost none of my colleagues will reduce their fees. There will be some reduction in demand for surgery with patients putting off their surgery or electing to go public—more on that in a minute. Most ophthalmologists (myself included) use safety for driving and safety from falls causing fractured hips as the primary indication for determining readiness for surgery. You can see that deferral of surgery is potentially dangerous. It is also true that the demographic that suffers from cataract surgery is very price sensitive. The capricious way that this extreme measure has caused a lot of anger within the ophthalmology community. The ophthalmology community is not politically divided and is strongly united in response.

The general public has been contacting me about this as well. I have been getting many faxes, emails and letters—many handwritten—from constituents who are concerned about this. It has been put to my office that the department were looking for cost cuts, they saw these large items and they made the cut without looking at the consequences. I think it really is a case where the government has used a very blunt instrument to deal with a perceived problem.

While it is true that there have been significant improvements in technology with this surgery in Australia since 1984, this needs to be put in perspective. Prior to 1984, a cataract operation was an intracapsular lens extraction which took about an hour to perform, depending on the proficiency of the surgeon, and had a relatively mediocre result. At that time, one waited until patients were virtually blind before performing surgery. In 1984, in South Australia, extracapsular lens extraction was introduced and this improved results dramatically and reduced the time for the operation considerably. As a consequence, the fees were reduced in 1987 by a federal Labor government. I have been reliably informed that there have been no significant advances in the last 10 to 15 years.

I think that the government is using the new technology as an excuse when in fact that was previously dealt with back in 1987. That is why I cannot support the government on this issue—because of the impact on patients. I think if the government wants to deal with issues of overcharging and informed financial consent, these are separate issues and this is not the way to do it, because of the impact it will have on patients.

Yesterday an amendment to the Health Insurance Amendment (Compliance) Bill 2009 was circulated in the names of Senator Cormann, Senator Fielding and myself. That amendment would have achieved the same purpose as this bill. It was an amendment drafted in support of a disallowance motion for changes to cataract surgery rebates. Essentially what the government was seeking to do was to make easy cost cuts at the cost of those with cataracts. The disallowance motion would have prevented this. To protect cataract patients we also sought to amend the Health Insurance Amendment (Compliance) Bill to ensure that if any change to an item in a table of medical services were disallowed, then the situation would revert back to the previous regulations. However, the government recognised that it would still end up providing the previous rebates for cataract surgery, so I think it is a fair assumption to make that the bill has been stalled. That is why I have reluctantly agreed to this course of action. I do not think there is any other course in order to protect those who require cataract surgery in terms of their not being out of pocket.

I think it is also relevant to point out that in estimates last week—and Senator Cormann is well aware of this, because I think he is the person who asked the question—the advice from a senior official in the department was that the item would revert back to the previous rebate level if the new lower rebate were disallowed. Because there is ambiguity in relation to that, I think it is important that we remove any ambiguity with this particular bill, and I think that is the most sensible approach. If this bill does not get up—if the government maintains its position that there will be no rebate—I think that we will find ourselves with an urgent legal challenge being made by a representative group or by an individual taking on a test case, presumably in the Federal Court. That is something that we need to avoid, given the uncertainty and the fact that there will many Australians who will defer their cataract surgery pending this.

I think there is a way forward in this. I know that the opposition does not say this, but I think that the Minister for Health and Ageing, Nicola Roxon, has done a lot of good things in her portfolio. I have supported many of those things, but this particular measure is not one that I support, because I think it is too blunt an instrument to achieve a good policy outcome and I am concerned about patients being significantly disadvantaged. Therefore, I support this bill and I am still hopeful that there can be a reasonable compromise that will not disadvantage patients who require cataract surgery.