Kimberley Kitching (Victoria, Australian Labor Party, Deputy Manager of Opposition Business in the Senate) Share this | Hansard source

CHING () (): I rise to speak on the Health Insurance Legislation Amendment (Transparent Patient Outcomes) Bill 2021. Labor supports the goals of this bill. We welcome this debate and we thank Senator Griff for the forethought, the care and the compassion that has gone into this bill.

Labor thinks there's a good philosophical point in what Senator Griff has proposed. It's hard to overestimate the importance of the ability of people to make informed decisions about their own lives. This applies to the goods they may buy, how they spend their time and their decisions about health care. Senator Griff's bill is driven by an understandable idea that people make better decisions when they have more information about the decisions they are making. I would add to that that we don't want to be patronising or patriarchal about how people spend their lives and what decisions they make. Importantly, if we consider that having good health is one of the most important aspects of our lives, this bill goes to enable people to make decisions around their health. That is very important. So we thank Senator Griff.

This has been a long-term philosophical aspect of democracy. In the century before the birth of Jesus Christ, Cicero, the great Roman statesman, lawyer and console—I'm reading The Republic at the moment—said:

The safety of the people shall be the highest law.

Thomas Jefferson followed on from that thought and said:

The care of human life and happiness, and not their destruction, is the first and only object of good government.

In light of that philosophical line of reasoning, this bill enables Australians to go to a health system that will support them in ways whereby they are comfortable with the decisions they can make about their health care. There's a view that successful leaders, true leaders, understand that true power comes from not exercising control but from empowering others, and that's what this bill seeks to do. It seeks to empower all of us to have the requisite information to make decisions about our own health care.

Whether you go through the public system, the private system or, as a lot of people do, a combination of both, what we're really asking is: should people have to rely on the good luck of having a GP who is a good diagnostician or who has an excellent rolodex with specialists' names in it? Really, that shouldn't be the measure of whether you have good health care. When you're going to see a specialist, whether it's a surgeon, an obstetrician-gynaecologist or a cardiologist, you want to be able to make that decision yourself. There would be some people who might be more comfortable with a doctor of a particular gender for some issues. This bill enables the minister for health to establish public databases of surgical procedures and patient outcomes. The intent is that people considering a particular surgical procedure will be able to make a more informed choice about their health care and, in particular, their healthcare provider.

Currently, there's little information in the public domain that allows patients to assess the performance, skills and outcomes of individual facilities as well as practitioners. This bill amends the Health Insurance Act 1973 to enable the minister to make rules to establish and maintain transparent patient outcomes registers. These registers may contain data such as the number and types of surgical procedures performed at a facility, the number and types of procedures performed by a practitioner, surgical revision rates and patient mortality rates, any prosthesis device used, patient demographics, or any other information set out in the rules by the minister. The provisions of the transparent patient outcomes bill can be applied to any medical specialty, and that's one of the beauties of it. It is not just related to one particular specialty—it can be used across the board.

Many factors determine the overall success of a surgery, including a patient's age, health and individual diagnosis, as well as their behaviour and willingness to following the doctor's orders post surgery. The bill recognises these facts and allows the minister to ensure they are accounted for so as not to provide the false impression that outcomes are always solely tied to practitioners' skills or decisions, nor to facility characteristics. But no-one can deny that a surgeon's skill and familiarity with a particular procedure is also a key determinant of outcomes. It is a key determinant that this bill aims to make transparent.

While the bill attempts to provide for information indicating a practitioner's skill to be made available on transparent patient outcomes registers, we should acknowledge that, in reality, we can measure relative practitioner skill only indirectly through outcomes. Of course, to be effective, a transparent patient outcomes register resulting from the provisions of this bill will allow for the identification of individual practitioners. It will not require practitioner-related information to be deidentified or provided anonymously. The intent being to inform patient choices, anonymous information is seen as far less useful and not consistent with the objective of the bill. To be effective, the transparent patient outcomes registers must also contain some degree of patient data. This raises questions of patient privacy, which is acknowledged by the bill. The proposed subsection 124ZCB(6) stipulates that the rules must prohibit the publication of sensitive information, including identifying health information about an individual. There's balance in this bill.

Recognising that there is a limit to what patient data can and should be provided through outcomes registers due to legitimate privacy considerations, we must also acknowledge that such limits have implications for the usefulness of outcomes data in registers to inform potential patients. The information to be provided in the transparent patient outcomes register is not intended to be prescriptive or exhaustive. The minister will have broad discretion in deciding what information is to be made public through the register. However, it is intended that the minimum information included in any such rules will allow consumers or patients to make useful comparisons and judgements about a surgeon's experience and capabilities. To do otherwise would defeat the intent and utility of a transparent patient outcomes register. However, Labor acknowledges that there's a danger in this approach, and the possibility of unintended consequences.

As I mentioned above, numerous factors play a role in the final outcomes related to medical procedures, including surgeries. If not designed carefully by the minister, the transparent patient outcomes register could have the opposite effect of its intention. Take, for example, the case of an exceptionally highly skilled surgeon who, as a result of his or her skills, tends to attract the most difficult surgeries in a given specialty and a given location. You could imagine this could skew data. Maybe this is represented by patients who have challenging comorbidities, or maybe it is represented by the needs for a particularly difficult technique employed more frequently in these cases than in others—the point being that, when measuring aggregate outcomes, by definition we lose specific information that could be relevant in making a comprehensive and objective assessment of performance and skill. This is true, of course, in any field of endeavour and is no less true in surgery.

A simple accounting for average patient outcomes by practitioner could represent this surgeon as performing worse than his or her peers when, in reality, the opposite is the case. Maybe that's the surgeon you actually want for a difficult procedure. This would not only represent a personal and professional injustice with respect to our hypothetical surgeon; it would represent a danger to patients, as patients unaware of the deeper issues at play could base decisions on simplistic, aggregate and only partially informed data. I do not know whether it's possible to collect and include all the relevant data that would be needed to guard against such unintended consequences in the context of this bill. That is an open question that Labor would like to hear the views of experts on. Even if it is the case that all data could be collected without breaching patient privacy protections, there is no assurance that the minister would require its collection and publication on transparent patient outcomes registers.

This bill represents a good-faith effort to improve patient choice and patient outcomes. It also represents a key strain in a democratic system: to inform people and to give people the right to make good decisions for themselves. Labor supports these goals, as should anyone who is interested in the welfare of all Australians. I again thank Senator Griff, and we welcome this debate.