Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I rise to speak on the National Health Amendment (Pharmaceutical Benefits) Bill 2016. This bill puts into effect three minor technical changes to the administration of the Pharmaceutical Benefits Scheme, and Labor is, I will say the outset, supportive of this bill. Labor welcomes the practical benefits which will arise from the passage of this bill in making the administration of the PBS more efficient for pharmacists and for patients. The bill allows the Minister for Health, the Secretary of the Department of Health and the Chief Executive Medicare to delegate administrative actions, including decision making, to computer programs. This will allow for the automated online processing of PBS claims so that pharmacists do not have to submit hard-copy prescriptions to the Department of Human Services for reconciliation. It will also allow approvals for certain prescriptions to be granted online rather than on the phone or in writing as at present.

The bill allows pharmacists whose premises have been affected by disaster or exceptional circumstances—flood or fire, for example—to supply pharmaceutical benefits at nearby alternative premises for up to six months. Affected pharmacists will apply to the secretary of the health department for permission to operate from alternative premises. The secretary will exercise discretion over whether the usual premises have been affected by a disaster or exceptional circumstances and whether the alternative premises are substantially in the same location, and other administrative questions. The bill is intended to help maintain access to medicines for communities that have been affected by a disaster or exceptional circumstances. It will also improve arrangements for affected pharmacists, who are currently required to submit a full pharmacy application for temporary premises and are only paid 90 per cent of the value of claims until that application is approved. The bill also clarifies that PBS benefits can be provided to concessional beneficiaries and their dependants on the day of their death. A quirk in the current law provides that benefits cease on the day prior to death, consistent with social security legislation, because other social security benefits apply from the date of death.

These are, as I said at the start, largely administrative changes which have been welcomed by stakeholders across the sector. However, I want to flag that Labor will be watching the rollout of computerised decision making very closely. Automated processing of claims and prescription approvals should reduce red tape for pharmacists and prescribers. I know many GPs in particular have seen the authorised prescribing process as a bugbear for quite some time. The automated processing of claims should certainly assist with reducing the time that GPs are spending on the phone waiting for approvals rather than having that done through a computer system, which will hopefully mean that GPs are able to spend more time with their patients than waiting on the telephone.

But, as have seen on a number of occasions, this government has bungled IT projects, including of course the census, the availability of Medicare rebates and the problems with Medicare and PBS data on data.gov.au being de-identified, and with the way in which the government or the health department released that data. More recently, we have seen the government's farcical approach to the implementation of the National Cancer Screening Register—frankly, a complete and utter bungle which has pushed back the rollout of a lifesaving cervical cancer screening test. This government has an appalling record on IT, and we hope that the rollout of the technology that this bill allows for does not have the same fate. I acknowledge that this bill does include some safeguards: the minister, secretary and chief executive will remain responsible for decisions made on their behalf by computer programs; the minister, secretary and chief executive will be able to override a decision made by a computer program; and decisions that are currently reviewable by the Administrative Appeals Tribunal will remain reviewable, regardless of whether or not they are made by a computer program.

While this bill makes three minor improvements to the administration of the Pharmaceutical Benefits Scheme, it does nothing about the real threat to the PBS: the government's plan to increase the price of every medicine by up to $5. The so-called zombie measures from the notorious 2014 budget remain government policy to this day. In the horror budget of 2014, the government announced cuts of $1.3 billion from the Pharmaceutical Benefits Scheme, to be achieved by increasing co-payments and safety net thresholds. The measures include increasing co-payments for general patients by $5 and for concessional payments by 80c for every single script. PBS safety net thresholds would also be increased each year for four years, with general safety net thresholds to increase by 10 per cent each year and concessional safety nets to increase by the cost of two prescriptions each year, making it harder and harder for patients to reach that safety net. These increases are in addition to the existing annual indexation of co-payments and safety net thresholds in line with the consumer price index.

Labor has consistently fought these cuts, and so far we have prevented them from becoming law—despite the fact that, having passed this place, they have never been presented before the Senate. The government knows that Labor has the numbers in the Senate to block them, and we have consistently done that since the 2014 budget. Despite this, the Prime Minister included the PBS price hike in the 2016 budget. It has been included in the mid-year economic and financial outlooks and, frankly, it has continued in the government's rhetoric—a clear signal of the commitment to continue with this measure. The most vulnerable, the poor, the elderly and the sick will be hit worst by this plan to cut the PBS. As an example, a general patient filling two scripts per month will be $100 per year worse off on medicines alone.

The more expensive a medicine becomes, the less likely people are to fill their prescriptions. The latest Bureau of Statistics Patient Experience Survey shows that up to 10 per cent of people already delay or avoid filling a prescription due to cost, and of course the impacts are unequal. People living in areas of greatest disadvantage are twice as likely to skip prescriptions as people living in areas of least disadvantage. I note we just had a really good debate about rural health; I would like the government to consider perhaps some of the other measures that it has in the health policy area and the impact that they have on the health of those Australians who live in rural and regional Australia.

Affordable medicine is at the heart of Medicare, yet if the government get their way, Australians will be forced to pay more for every script every time they get sick. The changes to the PBS, which are budgeted to start on 1 July this year, will drive up the cost of health care for every Australian. Pensioners, families and the chronically ill will be the hardest hit. During the election, Labor stood up to protect Medicare by reversing the Prime Minister's plan to increase the cost of medicines. Delaying access to medicine and treatment can result in illnesses worsening and the ultimate cost of health care increasing. Labor believe all Australians should be able to access affordable, quality health care when and where they need it. That is why Labor built Medicare and the PBS and why we will always fight to protect access to universal, affordable health care for all Australians.

Legislation to establish the PBS was first introduced by Labor Prime Minister John Curtin during the Second World War. It was part of the government's social compact with Australian citizens. This was Labor's response to the need to provide access to newly available antibiotic drugs for the whole population, not only for the minority of people who could afford them. At the time, the Conservative opposition opposed the plan, seeing universal health care as an underhand plan to nationalise medicine. It was not until 1960 that Australians had access to the comprehensive PBS that Curtin had envisaged in 1944.

Then, as now, the Liberals cannot be trusted with the universal healthcare system that is so important to all Australians. Millions of Australians voted against the Prime Minister's price hikes to medicines and his other cuts to health. So far, he has not been listening. But today we again call on him to do so. While Labor support the passage of this legislation to make minor improvements to the administration of the PBS, we once again call on the Prime Minister to drop his plan to raise the price of medicines. The PBS is a central pillar of Medicare and our universal healthcare system, and Labor will continue to fight for it.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to speak on the National Health Amendment (Pharmaceutical Benefits) Bill 2016. While this side of the House support this bill in principle, there is some hesitation. The hesitation is there because the government has a tendency to slowly but surely chip away at our country's most important safety nets. We have seen this in the past. This means that we on this side must be absolutely vigilant. We have seen it, for example, in the government's refusal to support our legislation that would reverse cuts to penalty rates. We have also seen it in respect of pensioners, people with disabilities and the unemployed. Most of all, we have seen it with respect to our universal health system—that is, Medicare.

Just last month we celebrated Medicare's 33rd birthday. It was a Labor government under Bob Hawke that introduced the reforms to make universal health care a reality in our country. Medicare is one of the most significant reforms in Australia introduced by the Hawke government. These were very hard-fought reforms that were opposed by Conservative governments and Conservative oppositions at every point. As I have said before in this place, it took two Labor governments more than two decades to embed what is now Medicare, and we will not see it undone.

The PBS is an integral part of our healthcare system, just as Medicare is. The Pharmaceutical Benefits Scheme began as a limited scheme in 1948. We just heard the shadow minister and member for Ballarat speak about Curtin, who introduced this particular scheme with free medicines for pensioners and with a list of 139 life-saving and disease-preventing medicines free of charge for others in the community at the time. It is now part of the Australian government's broader National Medicines Policy. People on low incomes, especially aged pensioners and disability support pensioners, rely heavily on the PBS. These are our most vulnerable people, and any proposed changes can have a significant effect and impact on their ability to access affordable medicines. As I said earlier, this is why we must be vigilant about these issues.

The bill that we are discussing today makes three technical changes to the administration of the Pharmaceutical Benefits Scheme. Firstly, the bill regulates the use of computer programs in respect of the PBS. It allows the Minister for Health, the Secretary of the Department of Health and the Chief Executive Medicare to delegate administrative actions, including decision making, to computer programs. This will allow for automated, online processing of PBS claims so that pharmacists do not have to submit hard copies of prescriptions to the Department of Human Services for reconciliation. It will also allow approvals for certain prescriptions to be granted online rather than on the phone or in writing, as at present. I know that some pharmacies already have their own systems in place to allow prescriptions online if they are repeat prescriptions over a long period of time.

While this seems like a relatively benign aspect of the bill and one that will hopefully simplify the process for both pharmacists and customers, we have seen other implementations of IT systems that are meant to streamline processes, make it easier for the public, reduce the paperwork and make it quicker turn into a debacle. For example, the census was the last one that I can remember. The Centrelink debt recovery program, which is a new, automated system, is also a debacle. This government has a history of bungling the transition to automated computer systems. I hope it is not the case with this one. It is often our most vulnerable Australians who pay the price. Certainly, those who rely on the PBS are some of our most vulnerable people.

This is why I am relieved that the bill includes a number of safeguards regarding the use of computer programs. Firstly, the bill stipulates that the minister, secretary and chief executive will retain ultimate responsibility for decisions made on their behalf by these computer programs. This is vital, because when things go wrong, as they have a habit of doing under this government, someone needs to be held responsible. An example of this was the census debacle, where the responsibility was not handled by anyone—not one, single minister wanted to take responsibility for that debacle with the census back in September. In addition, the minister, secretary and chief executive, or their delegates, will be able to override a decision made by a computer program if they are satisfied that it is incorrect, and decisions that are currently reviewable by the Administrative Appeals Tribunal will remain reviewable, regardless of whether they are made by a computer program or not. These are important safeguards, and I sincerely hope that these changes do not cause more problems than they are trying to solve, as occurred with the census debacle that we had last year.

Secondly, this bill addresses the supply of pharmaceuticals after a disaster or in exceptional circumstances. It enables pharmacists whose premises, for example, have been affected by disaster or exceptional circumstances such as fire, flood or a natural disaster to supply pharmaceutical benefits at nearby alternative premises for up to six months. This is a good thing because they continue to serve that community around them, and we know that pharmacists do a great job serving the community, so this would be an added benefit. Of course, there would be some disruption for a short period but, as quickly as possible, they would be able to continue those services within their communities. The bill is also intended to help maintain access to medicines for communities that have been affected by disaster or exceptional circumstances. It will improve arrangements for affected pharmacists, who are currently required to submit a full pharmacy application for temporary premises. It is taking out some of the paperwork and time delays to get up and running again for the benefit not only of the pharmacist, so he can keep his business viable, but also for the community in and around that area.

Thirdly, the bill will also address and rectify an inconsistency about the supply of medication through the PBS benefits on the day of a person's death. A quirk in the current law provides that benefits cease on the day prior to the death, but we know that people cannot predict nor say when that period will occur. So it is a bit silly that the law provides that the benefits cease on the day prior to the death because, obviously, pharmaceuticals and drugs can be taken right up to the end. This brings the PBS legislation in line with social security legislation because other social security benefits apply from the date of death. Therefore, the bill will enable PBS benefits to be provided to beneficiaries and their dependants on that day of their death.

Labor is supporting this bill. With respect to patients, we feel that the bill offers the opportunity to marginally improve access to PBS medicines, and stakeholders including the Pharmacy Guild of Australia and the Royal Australian College of General Practitioners have expressed their support for the bill. But it is important that we remain vigilant. We will be watching the rollout of computerised decision-making closely. As I said, the previous history of this government shows that when they roll out new IT systems they have turned into an absolute debacle. The aim of these reforms, especially the use of automated computer systems, is to simplify the processing of claims and prescription approvals. We will be keeping an eye on it. It should reduce red tape for pharmacists and prescribers. But, as I have said before, we have seen this government repeatedly bungle IT projects, including the census and the availability of Medicare and PBS data on data.gov.au. We cannot have a situation again where Australians are made to pay and suffer because these automated processes fail to work and customers end up having to prove the computer wrong, as we have seen in so many cases currently before Centrelink with its disastrous debt recovery program.

In addition, we must be vigilant because the government has shown us time and time again that it is hell-bent on diluting our public healthcare scheme. This bill does nothing about the real threat to the PBS, namely the government's plan to increase the price of every medicine by up to $5. I have spoken about these so-called measures before, but there are also the 'zombie measures' which are still there from the notorious 2014 budget. They have been reintroduced under various bills et cetera, and they have been tied to other reforms. One thing is certain: the government will not kill them off and they are still there. Make no mistake, the government is determined to increase co-payments by $5 for general patients and by 80c for concessional patients. This means that our most vulnerable citizens—the poor, the elderly, pensioners and the sick—will be worst hit by this government's plans to cut the PBS. If the government has its way, a general patient filling two scripts per month would be $100 per year worse off on medicines alone. Just as the additional Medicare co-payments that the Turnbull government wants to introduce would have the effect of discouraging people from going to see their doctor, it is the same thing with the PBS: the more expensive medicine becomes, the less likely people are to fill their prescriptions.

The latest Australian Bureau of Statistics Patient Experience Survey shows that up to 10 per cent of people already delay or avoid filling a prescription due to the cost. And, as is so often the case, those who are most disadvantaged already will be the worst hit. We know from the research that people living in areas of greatest disadvantage are twice as likely to skip prescriptions as people living in areas of least disadvantage. This will only get worse if the Prime Minister gets his way and increases the price of medicines.

We saw how Australians reacted to the Turnbull government's plan to tamper with Medicare. The opposition is committed to reversing the Prime Minister's plan to raise the price of vital medicines. Millions of Australians voted against the Prime Minister's price hikes to medicines—the shadow minister and member for Ballarat mentioned that earlier— and his other health cuts. So far he is not listening. That is nothing new, unfortunately—but we on this side are listening.

Medicare and the PBS are the heart and soul of our universal health care system and the envy of many countries around the world. Medicare ensures people can access life-saving treatment when they need it. Last year around 21 million Australians accessed Medicare services—including GP visits, vital tests and scans, and hospital treatments. Australians do not want to be like the US when it comes to health care. We do not want the Americanisation of our universal health care system, which is one of the best in the world. We have already seen a drop in bulk billing rates, with many Australians already paying more to see their doctor.

Now this government is going even further, with over $2 billion in new cuts to Medicare still to come. Middle-and working-class Australians will be paying more out-of-pocket costs for visits to their local GP, prescription medicine, medical tests and scans, cancer treatment and    dental services. Nobody wants to head down the same path as the US when it comes to health care. Access to healthcare should rely on your Medicare card, not your credit card. Labor gave Australians Medicare and we will protect it for a long as we can. We will ensure that we fight hard to ensure that Medicare is protected.

Emma McBride (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

I have been a registered pharmacist for 20 years. I have worked in both community and hospital pharmacy in Australia and overseas. My goal, in this place, is to work towards the better health of my community. The people of the Central Coast deserve accessible and affordable healthcare. They deserve to be able to see a doctor, when they need one. They deserve access to medicines, when they need them. This is only possible through support for Medicare and the Pharmaceutical Benefits Scheme.

Labor supports the National Health Amendment (Pharmaceutical Benefits) Bill, and I am pleased to support the bill, because we recognise that even modest changes can have a positive impact on the administration of the PBS. However, having grown up on the Central Coast and worked at Wyong Hospital for the last 10 years, I cannot stand by while this government undermines Medicare and the PBS and while the New South Wales Liberal government is in the process of selling off Wyong hospital. I cannot ignore their failings when it comes to the delivery of important IT reforms. And I cannot excuse their ideologically driven agenda that is hurting my community.

This bill makes three technical, but nonetheless important, changes to the administration of the PBS. It will allow online services to process PBS claims and prescription authorities, improve location rules for pharmacies affected by disasters and ensure concessional patients are covered until the last day of life. The changes to the supply of pharmaceuticals after a disaster or in exceptional circumstances will mean pharmacists whose premises have been affected by natural disaster or emergency, such as fire or flood, can supply PBS medicines from a nearby location for up to six months. Under the current location rules, pharmacies are restricted on how often and how far they are able to move from their PBS approved site. This amendment will see the relocated pharmacy receive the full PBS subsidy, not the current 90 per cent, without the need for separate PBS approval at the new site for up to six months, or in some cases longer, depending on the circumstances.

The Ourimbah Pharmacy, in my electorate of Dobell, on the New South Wales Central Coast, was the victim of arson attack in May 2015. The pharmacy owner, Anna-Lee, tells me it was an extremely stressful time for her and the patients she cares for. Because of the nature of their stock, pharmacies need stringent security measures—and in fact the arsonists that destroyed Anna-Lee's pharmacy gained entry by unscrewing roof panels. Anna-Lee says the administrative burden of applying for approval to trade at a temporary location, in addition to the refurbishments needed to any commercial space to make it secure and fit for purpose, made the task an enormous one. Patients rely on their pharmacists, particularly those using Webster-paks. On the day after her pharmacy was destroyed by fire, Anna-Lee set up outside the gutted chemist shop to see patients who rely on her. The rebuild took 4½ months to complete, but Anna-Lee tells me it was more than 12 months till she felt the pharmacy was back to its original capacity. With this amendment, pharmacy owners like Anna-Lee will be better supported to continue serving patients after a disaster, a fire or a flood, which would have made a big difference for Anna-Lee and the patients she cares for.

The bill also clarifies that PBS benefits can be provided to concessional beneficiaries and their dependants on the day of their death. This replaces an anomaly in the current law where, in line with social security benefits, concessional entitlements cease on the day prior to death. According to the government, of the 146 million PBS prescriptions that were filled for concessional beneficiaries last year, less than a thousand were supplied to people on the date of death. This is a positive change, particularly for those pharmacies servicing the aged-care sector, and for those already out of pocket the backdating of the measure to 1 April 2015 will be welcome. I acknowledge the Pharmacy Guild of Australia for putting these two important issues on the government's agenda and thank them for representing the interests of their members and our community.

This bill also refers to the streamlined processing of PBS claims using online services, and online processing of approval requests for doctors to write certain prescriptions. The government says this bill 'will enable the claims computer system to match payment assessments against a pharmacy's certification of supply and take the administrative actions that would otherwise be taken by the Chief Executive Medicare'. Of course, pharmacists lodge prescription claims online as medicine is dispensed, and have done so for over a decade. According to the Department of Human Services annual report, 99.9 per cent of approved suppliers used online claiming last year.

A lot of things have changed since my graduate training year in 1996. Like a lot of new pharmacists I was tasked with processing the claim. At the time, this manual process required sorting prescriptions into categories—general, concessional, repatriation—collating them in numerical order and bundling them up with a floppy disk and a claim form and they were collected by a courier and driven to a government office in Parramatta or, in the case of my boss, Mr Drew, who did not trust couriers, they were driven by Mr Drew to Parramatta. Much has changed in the 20 years I have worked as a pharmacist, including real-time claiming through PBS Online and e-prescribing through e-prescription exchange, improving the safety and efficiency of the dispensing process. The outcome of these reforms should mean reduced payment times for pharmacists, and I welcome this. However, there is more work to be done. The integration of PBS records with general health records—a genuinely integrated approach—would improve the efficiency and safety of prescribing and treatment and improve health outcomes for Australians.

This bill also aims to reduce the time doctors and authorised prescribers spend seeking approval to write authority prescriptions by phone or in writing. Pharmacists, however, do much more than fill prescriptions. They are the most accessible of all the health professionals. You do not need an appointment to see them; they are generally open later and longer; and there is no fee to seek your pharmacist's advice. Professional Pharmacists Australia, in their submission to the King review, describe a regular day for a community pharmacist as:

…dispensing, counselling, writing medical certificates, fixing a patient's glucometer, demonstrating correct inhaler techniques, paperwork, calling doctors, preparing Webster Packs, performing medicine reviews and providing first aid advice. In addition to these health care services, many pharmacists are also expected to perform retail tasks, including home deliveries.

Having worked for more than a decade in a hospital pharmacy, where 20 per cent of PBS is expended, I would add to this list for hospital pharmacists: best possible medication histories on admission, clinical screening and intervention and collaboration with patients and carers as part of multidisciplinary teams to provide the best possible care.

Pharmacists in community and hospital settings put patients at the centre—they always put patients first—but if the demands on their time are too great, the care they are able to provide is affected. According to Professional Pharmacists Australia:

Many pharmacists report heavy and unrealistic workloads which increases the pressure to dispense more quickly, along with a range of other professional and non-professional requirements, with the possibility of an increase in the chances of errors. This is against a backdrop of an increasing number of subsidised prescriptions from 208 million in 2011-12 to 223 million in 2013-14.

Governments can, and should, support the work of pharmacists as an integral part of the healthcare system and, while this bill presents an opportunity to gain small efficiencies in the administration of the PBS, there is more work to be done if we are serious about improving and strengthening the PBS.

Importantly, we should look closely at the sections of this bill that deal with safeguards, including the responsibility for decisions to remain with the minister, secretary and chief executive. There are also safeguards in place relating to reviews. But we know this is not without risk. Even a small input error or programming mistake could see thousands of wrong decisions. We need look no further than the Centrelink robo-debt debacle to see how a system can be completely bungled by this government. My office has been inundated with complaints from people who have received incorrect debt letters from Centrelink and who struggle to clear their name. They have done nothing wrong, but to prove that often takes hours—from seeking records from past employers to phone calls and visits to Centrelink offices. With a department so drastically under-resourced and directives from a government so callously opposed to the social safety net, this is not just a stuff up—it is just cruel.

With close to 300 million prescriptions issued in the past year through thousands of PBS-approved suppliers and billions of dollars paid in subsidies each year, the government must ensure the rollout of these measures is done properly. But when we look at its record, we are right to have reservations about its ability or desire to properly manage this. This is the government that has incompetently managed e-health and has been dishonest about delays to the cervical and bowel cancer screening register. This is the government that bungled the census; it is the architect of the second-rate NBN and its patchwork of technologies. The government talks of innovation, agility and exciting times, but that is all it is—just talk. We will be watching the rollout of computerised decision making for PBS claims and approvals very closely. Please do not stuff this one up, too.

This bill represents minor but important changes to the operation of the PBS. These are just some of the pressing issues facing pharmacists, health workers and patients on the Central Coast. During recent conversations with local health practitioners and practice managers at my health roundtable, unfreezing Medicare rebates and updating the data used to determine Districts of Workforce Shortage were important ways to ensure fair and equitable access to health care. The government's own figures show more than 15,000 people on the Central Coast say they delay or avoid seeing a GP due to cost, and the Medicare freeze only makes this problem worse. I am alarmed that more than 30,000 people on the Central Coast say they delay or avoid filling prescriptions due to cost. This will only get worse if the plan to increase the cost of medicines by up to $5 a script goes ahead.

For those people experiencing financial hardship, increases in the cost of medicines can mean making the choice between filling a prescription or putting food on the table. Analysis by the Family Medicine Research Centre at the University of Sydney has shown that, although the increase in the co-payment is less for concessional patients, on average the actual cost increase for medications is higher. We know that this leads to disease progression, higher rates of hospital admissions and increased costs to the health system and the individual in the long term.

I was a pharmacist at Wyong Hospital for almost a decade and for the largest part of my career I was the specialist pharmacist in the inpatient mental health unit. I have seen the challenges that vulnerable people living in my community face first-hand. Coupled with a proposal from the New South Wales government to privatise Wyong Hospital, I am deeply concerned about the future health care for my local community. Last year, the federal government provided over $111 million in funding for the Central Coast Local Health District. The Prime Minister and the health minister have a direct stake in Wyong Hospital, and I call on them to step in and save Wyong Hospital.

Labor supports this bill and will continue to support commonsense changes that improve the efficient and effective delivery of healthcare services. But so too will we continue to hold this government to account as it embarks on a callous, ideologically-driven attack on Medicare and the PBS. We will do so because it is fundamental to the values of the Labor Party. The Labor Party is the party of Medicare, the party of the PBS and the party of universal health care.

Stephen Jones (Whitlam, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

It is a great honour to follow my friend, the member for Dobell, in speaking on the National Health Amendment (Pharmaceutical Benefits) Bill 2016. She brings to the parliament and the subject matter before the parliament decades of experience as a professional pharmacist, and I understand that she is very passionate about this subject matter—as I am. So I will be supporting the bill, as will Labor. It marginally improves access to PBS medicines, and that is something we have to support. I note that it has broad support from a range of stakeholders, including the Pharmacy Guild and the Royal Australian College of General Practitioners.

The bill allows for decision making to be automated by delegating ministerial, department, secretary and chief executive decision making to computer programs. This is something that will probably concern many who are following this quite closely, for reasons which I will outline quite shortly. The authorities remain responsible for the decisions of computers and automated decisions may be overridden by those authorities. Decisions that are currently reviewable by the Administrative Appeals Tribunal will remain reviewable.

I do have concerns. I share some of the concerns of the people listening in. I am concerned that this government is not up to the task of managing this program. That is not something that I say lightly. The Turnbull government has repeatedly bungled IT projects, including the 2016 census, which is a famous bungling of an IT project, but also the availability of Medicare and PBS data on data.gov.au. In addition to that, the Centrelink debt scandal is something that the government has unfortunately visited on thousands of innocent Australians who did nothing but lawfully claim a Centrelink benefit. Data matching is nothing new—it has been going on for decades—but the way this government has managed the program has meant that there are literally thousands and thousands of Australians who are having their lives turned upside down because of the mismanagement of the Minister for Human Services and, ultimately, the Turnbull government. Against this background we have some concerns about the government's capacity to manage what would otherwise be fair and reasonable legislation.

The bill will mean that pharmacists will not have to submit hard copies of prescriptions to the human services department for reconciliation. It will also allow for approvals for certain prescriptions to be granted online. That is nothing more than this process meeting the 21st century, so it warrants our support. The bill includes a number of safeguards regarding the use of computer programs—for example, in the area of access to medicines after a disaster. The bill also allows for pharmacists to supply pharmaceutical benefits at nearby alternative premises for up to six months after a disaster such as a fire or flood. It will allow pharmacists to apply to the secretary of the health department for permission to operate from alternative premises. These measures are designed to maintain a supply and access to medicines after a disaster. That is a perfectly reasonable and sensible arrangement that warrants our support.

Currently access to PBS benefits for an individual ceases prior to the day of their death. This is consistent with social security legislation, where other benefits are payable from the date of the death. The bill extends the date of coverage until the day of somebody passing away. I think all reasonable people would think that that is something that everyone in this place should support, as well.

This bill sits within a broader context where the government has mismanaged healthcare policy, healthcare delivery and budget initiatives in relation to the health sector since that debacle of a budget, the 2014 budget. Nothing fundamental has changed in their approach to these issues. That is why people are right to be concerned about any proposition that comes before parliament that has to do with the management of either Medicare, the Pharmaceutical Benefits Scheme, funding of our health and hospitals or even the health workforce more broadly. The government, as everybody here would recall, tried to introduce a GP tax—a tax on sick people who are trying to visit their doctor. There were five attempts to get this proposition through the parliament. God knows how many attempts there were to get it through their own party room, but there were at least five attempts to get it through the parliament. When parliament refused to do the bidding of the government, they decided that they were going to try to force doctors to do what parliament had refused to do. The mechanism for doing that was to freeze Medicare rebates so that doctors would be forced to pass those extra costs on to their patients, many of whom had no capacity to pay.

In the end Medicare payments have been frozen for so long that GP clinics have started levying up-front fees on their own patients, something which the government denies, but every member in this place knows is happening, because as they make their way around their electorates they see signs on the counter which announce to them and to anybody else who walks into that doctor's surgery that because of the decisions of this government they are going to have to increase fees, cease bulk-billing and pass those costs on to their patients.

In addition to freezing Medicare rebates there have been cuts to hospital funding. But directly in the area of medicines policy there have been increases in co-payments for patients. The $5 hike in prescription costs is going to push the cost of medicines beyond the means of many low-income Australians. The government wants to increase co-payments by $5 for general patients and by 80c for concessional patients. The people that need the help the most, that is the poor, the elderly and the sick, will be worst hit by the Liberals' and Nationals' plans to cut the PBS. A general patient, for example, filling two scripts per month—and that is not at all unusual—will be $100 a year worse off on medicines alone. Let's not forget that they have already had to go and see their doctor, and they are probably going to see their doctor several times a month, so that person is out of pocket every time they go and see their doctor by increasing amounts.

There is an alarming trend for people to delay medical treatment because they simply cannot afford the costs. This has been modelled by the Australian Social Health Atlases and, because of this independent research, we know that the incidence of this is occurring and increasing, but not uniformly—in wealthy parts of the country, the problem is less than in areas where there are people of lower SES backgrounds. Take the Prime Minister's electorate of Wentworth: around seven people in every 100 are in the situation where they are delaying medical treatment because they cannot afford it. That is at the lower end of the scale and, for each of those seven people, that is seven people too many. But I want to compare it to regional Australia, where I have a deep and abiding interest. If you look right across regional Australia, there are 16 people per 100 who are delaying medical treatment because they simply cannot afford it. This bill will do nothing to make that situation any better. In fact, the policies of the government are doing nothing to make that situation any better.

There are many regional electorates around the country where this is a significant problem. I am very close to the Illawarra and South Coast area. I look at what is happening in the electorate of Gilmore, where 13 out of every 100 people in the Shoalhaven and Eurobodalla area are delaying medical treatment already, but the member for Gilmore is supporting policies, proposals and legislation that will increase the costs of general prescriptions by $5 and for pensioners by 80c. This is an electorate that has the second-highest number of pensioners in any electorate in the country. I would have thought that the member for Gilmore would use this as an opportunity to make a very strong statement about her opposition to the government's medicines policies, which are going to make medicines more expensive for people within her electorate.

I also would have expected the member for New England to be doing the same thing. The Leader of the National Party, the Hon. Barnaby Joyce, has some real hotspots in his area where people are delaying medical treatment because they cannot afford the bills. In some towns in his electorate, there are as many as 15 people out of every 100 who are delaying medical treatment because they cannot afford it yet he is a member of an executive and a government that are voting to make the situation worse.

In the electorate of Page, where the member has also supported initiatives, there is a very high number of retirees, low-income workers and pensioners. The member for Page is voting to increase the costs for general patients for each and every prescription by $5 per prescription and by 80c for every prescription for pensioners. This is in an electorate where 14 per cent of people—that is, 14 out of every 100 people in the Clarence Valley—are delaying medical attention because they cannot afford it. Right here, right now, they are doing it, and the policies of the government are making this worse.

The Bureau of Statistics Patient Experience Survey shows that up to 10 per cent of people are already delaying or avoiding filling a prescription due to the cost of that prescription. Now, of course, we would have even better data on this had the government not, as one of its very first initiatives, closed down the COAG data collection and reporting process, which enabled a clear line of sight to every state and region in the country to see what was happening in these critical areas of measurement and to see how we can better refine health care in the area of medicines and, in particular, in the area of the Commonwealth responsibility in relation to the Pharmaceutical Benefits Scheme.

While we are supporting the bill before the House, we are not supporting the general thrust of the government's policy, which is making it harder for people to see a doctor, making it more difficult for people to get into a hospital and making it more expensive for people to get the medicines that their doctor is prescribing to them. This is not a recipe for good health care; this is a prescription to ensure that the inequalities that exist between regional and city Australia and between the wealthy and the poor in this country will get worse, and it requires urgent attention.

Lisa Chesters (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

Previous speakers on this side of the House have said that Labor will support this bill. It makes three minor technical changes to the administration of the PBS. But we are also using this as an opportunity to flag, loudly and clearly, the problems that we have with our health sector and the impact of the ongoing attacks from this government and those opposite on Medicare and on our universal health system.

I hear weekly from people in my own electorate, which is a regional electorate, about the worry that they have with out-of-pocket costs in relation to health care. Health care is one of the triggers for which many are seeking support from welfare agencies. It could be a car service, it could be an education expense, but too often, people are citing the reason they need help as out-of-pocket medical expenses.

One of the big costs for a lot of people is the cost of medicine. I know the government has dismissed concerns that have been raised by people when they said that the plan to increase every medicine by up to $5 was nothing to be worried about. But for people who need multiple prescriptions, it is a lot. The government continues to put forward, time and time again, the so-called zombie measures from the notorious 2014 budget despite the opposition to them in this place. They are determined to push through these changes which will see a co-payment for general patients of $5.80 for concession card. This is despite the fact we hear, over and over again, that cost is a reason why people are delaying seeking medical help and medical support.

I recently, on the back of the federal election campaign, ran my own series of health inquiries and Medicare forums in my electorate to ask people directly what their concerns were and what their experiences of primary healthcare were across the Bendigo electorate. We held several forums at Woodend, Kyneton, Castlemaine, Maldon, Heathcote, Elmore and across the greater Bendigo region. So we did not just stick to Bendigo, as in the CBD. We went out and asked people. We heard from health professionals, from pensioners from families, from patients, from people working in the sector. We asked them what their experiences of health care and of primary health care were, and what their recommendations were.

The findings of our inquiry are quite alarming. They back up a lot of the evidence that we have heard about regional people accessing health care. In our survey we found that 87 per cent of people believe that the cost of health care has gone up in the last 12 months, including the cost of prescriptions. Maybe it is not just the prescription that they get on PBS but the extras that they also have to pay for to go with that prescription. Forty per cent of the people who attended and participated in the Bendigo electorate said that they had delayed seeing the doctor because of price. One hundred per cent said that they believe that the government should protect Australia's universal health care system and invest more. This is the most alarming statistic that we found: on average, the out-of-pocket patient expenses for going to the GP was $21. This is the gap fee. In a sample of 23 clinics in the Bendigo region, only four now bulk-bill non-concession card patients and only 11 bulk-bill concession cardholders. Only four across greater Bendigo 100 per cent bulk-bill, with only one in the postcode 3550.

This has happened just recently. Under this government, we have seen a collapse in bulk-billing rates in my own electorate of Bendigo. It was actually quite shocking not only to listen to people about how 40 per cent are delaying to see a doctor but to then learn why it is only our community health service that bulk-bills now in the postcode 3550. Across greater Bendigo, if you do not go to a Bendigo community health facility then it is a Tristar, where it is a six-minute consultation. That is the only way you can see a bulk-billing doctor in the Bendigo electorate.

Some of the fees charged by doctors, even for concession cardholders, was as high as $31 out of pocket. We had someone attend the Heathcote hearing who travelled down from Rochester to say that in their town it is $50 out of pocket to see a GP. This is not the inner-city of Melbourne, where incomes are high; this is regional Australia and regional Victoria, where about 30 per cent of households in my electorate are trying to survive on $600 a week. These are households—tens of thousands of people—who are living on fixed income, whether they be people on disability pensions, aged pensions or unemployment benefits, or a group of growing underemployed people. These are people who are struggling to cover the costs of the basics and who are now paying more than ever to see the GP—and, if this government gets its way, even more for pharmaceutical benefits. This is a government that has lost touch with people on the ground when it comes to the cost of health care.

I will state the statistic again. Forty per cent of people that we surveyed in the Bendigo electorate, a regional town and a regional electorate, said that they delayed going to the doctor because of price. One particular person said, 'Yes, I've been to see a bulk-billing doctor,' but it is then the scripts on top of that. It is then the extra that they have to pay if they then have to go to the physio or an allied health service. The cost involved in accessing primary health care is continuing to increase. In one of case studies that we heard, a Castlemaine pensioner who is a two-time breast cancer survivor said, 'I now have Parkinson's. Every time I go to the specialist, like a speech therapist or a podiatrist, or a neuro nurse, it's $8.50 out of pocket.' That is what she pays on top of her service, which is currently bulk-billed. But once she hits her cap she then has to pay upfront. Last month, it totalled $200.

It is a well-kept secret that we really have a user-pays system. What we were hearing loudly and clearly from across the electorate is, whilst the ideal is to have a universal healthcare system, we do not have one currently. It is clearly a user-pays system, with people being asked to pay more and more.

There is also real concern from our GPs about workforce. We did invite a number of GPs to come and speak at our hearings. Seventy per cent of GPs in rural areas are bankrupt at some point. That is what one GP said to us. 'The cost of running private practice is going up, but the rebate remains the same. I've put in every bit of cash that I have to try and support the community. If I was sick tomorrow I would be in financial trouble. We need to increase the rebate.' Let's hope that the government and the health minister hears these concerns and, in the upcoming budget, unfreezes the rebate and lifts the GP rebate.

Burnout is a big problem for doctors in regional areas. They simply do not have patients that can afford to pay the $50 out-of-pocket expense to help the clinic break even. When you have areas like mine, where 30 per cent of people are trying to survive on $600 a week, you have a lot of concession card holders. It is no wonder that some clinics have now dropped bulk-billing concession card holders. If they want to keep their doors open, they are passing the cost onto the patient, and the result of that is what I have told you twice in this speech already: it means that 40 per cent of people in the Bendigo electorate are delaying going to the doctor, because of price. GPs who attended the hearings said that the Medicare rebate freeze is having a significant impact on their working life. For many GPs the rebate freeze was causing severe stress and anxiety, whilst the pressure to undertake shorter appointments was leading to lower job satisfaction, because they were worried about not delivering the advice that the patient needs. They were worried about poor health outcomes for their patients. We learnt in the hearings that we held how some GPs are doing their best and trying to be creative in making ways to ensure that their patient, as well as the GP, gets enough consultation time.

It should not have to be that hard for GPs in rural areas. It should not be that hard for patients in rural areas. We need to make sure that we see this government lift the GP rebate, lift the freeze in the upcoming budget, to ensure that our GPs get fairly rewarded for providing services. We also need to see this government significantly reinvest the money it has cut from primary health care, to ensure that out-of-pocket expenses are lowered. In regional areas like Bendigo, we literally now have a two-tiered system: those who can afford to pay for health care, and those who cannot. If the government gets away with its plan of reintroducing its zombie measures to increase PBS co-payments—up to $5 for general patients and then an extra 80c for concession patients—and cut the PBS even further, it will mean that the most vulnerable, the poorest, the elderly and the sick will be hit once again by this government.

I have to acknowledge that it is great to see some medicines come onto the PBS—medicines like Kalydeco, which I know is making a massive difference to some people with cystic fibrosis who are living in the area. I want to acknowledge Amelia and her family, who campaigned long and hard to see Kalydeco listed on the PBS. Amelia's parents tell me that her life has really turned around. She can now run with her sisters and not be out of breath. She is playing and she is happy, and for the first time in a long time their family have a future. Speaking of Amelia's future, their visits to the doctors are fewer and their visits to the Royal Children's Hospital in Melbourne have reduced. This is a good news story, but unfortunately it is rare. We have fewer and fewer good news stories coming from the Bendigo electorate. We have more and more stories of people delaying buying the medicines that they need, because they simply do not have the money. We have more and more people saying that they are delaying going to the doctor, because they cannot afford the out-of-pocket fees and, as I have already said, there is a growing trend amongst doctors of increasing the out-of-pocket fee, the gap fee, because of this government's freeze.

If we are genuine about a universal healthcare system, it needs to be a system that all citizens can engage in, where all have access to good quality health care. As I said, 100 per cent of people involved in the Save Medicare hearings that we had in the Bendigo electorate—from Elmore to Woodend, from Heathcote over to Maldon—said they want to see the government invest more in health care. A hundred per cent are saying that they believe in a universal healthcare system and that they want to see the government restore the funding that they cut.

Whilst this is a minor bill that makes only three technical changes to the administration of the PBS, it has allowed me to stand and outline to the House the findings of our recent hearings and the report that I released in the electorate last week, Save Medicare: a report into the experiences of central Victorians with our healthcare system. Its findings are alarming, but, equally, its recommendations are quite compelling, and I encourage the government and the minister to listen to the people of central Victoria and to take on board their concerns: reinvest the funding that has been cut from health care, drop the zombie measures which will see co-payments increase, and unfreeze the Medicare rebate, which has been frozen now for too long. We cannot afford to have 40 per cent of people not accessing GP services, because of cost increase. Only through federal government investment will we see that percentage decrease.

Greg Hunt (Flinders, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

It is a privilege and an honour to deliver the summing-up on the National Health Amendment (Pharmaceutical Benefits) Bill 2016. On Thursday of last week I had the privilege of meeting with the doctors from The Hastings Clinic. Dr Peter Keillar and a number of his partners and doctors who practise within that clinic talked to me about many issues facing general practitioners. They echoed the words of Dr Bastian Seidel, the President of the Royal Australian College of General Practitioners, and Dr Michael Gannon, the head of the AMA. Between the three groups—the doctors, the college of GPs and the AMA—they have set out their views, which I agree with absolutely: Australians care about three things overall with their national health and their approach to individual health: firstly, the ability to access doctors; secondly, the ability to access medicines, which this bill deals with specifically, squarely and appropriately; and thirdly, the ability to access hospitals. Everything else is a means of achieving those outcomes. Our health system is ultimately and absolutely about delivering access to doctors and nurses, access to medicines and access to our hospital system. That is the means of delivering people the best possible health outcome. As part of that, and fascinatingly, the doctors at The Hastings Clinic raised with me the telephone authorisation system for the Pharmaceutical Benefits Scheme. They raised the desire to have an automated system, which is something that can be done. So I am delighted to be able to say to Dr Peter Keillar and others from that clinic that right now we are bringing this proposed law to the parliament to deliver that outcome. I think it is a very important thing for the medical professionals and an even more important thing for the patients and for the pharmacists, who, respectively, take those medicines and dispense them. So this is a significant initiative.

It comes within a broader long-term national health plan aimed at a very simple goal—that is, to take what is a world-class health system, as it is supported by some of the best doctors and nurses in the world, and turn it into the best health system in the world. That is my goal and that is why we are setting out a plan to 2030. That plan is built on four core pillars. One is a rock-solid commitment to Medicare and to the PBS, or the Pharmaceutical Benefits Scheme. We see that being strengthened with this bill. In particular, in relation to Medicare, there are two fundamentals. First, funding goes up each and every year from $22 billion, to $23 billion, to $24 billion, to $25 billion over the coming years. Secondly, we have just had the highest half-yearly bulk-billing figures for GPs in Australian history, almost 3½ per cent higher than when Labor left office. It has gone from 84.7 per cent a year ago to 85.4 per cent now. When we talk about bulk-billing what it means is that people are able to go to the doctor without having to dip into their pocket. More services, a higher rate of bulk-billing and more investment in Medicare—that is the reality of what is occurring.

Similarly, what we are seeing under the Pharmaceutical Benefits Scheme is the fact that we have listed $4.9 billion in new medicines since coming to office. That includes drugs for hepatitis C and, as the member for Bendigo mentioned, Kalydeco for beautiful young children aged 2 to 5, inclusive, to assist with cystic fibrosis. I had the fortune of meeting with some of these young children and their magnificent parents—brave young children and determined parents. This will transform their lives. These are drugs that on the open market would cost up to $300,000 a year, which is effectively beyond the reach of all but a tiny fraction of Australian families, even for those who are willing to sacrifice virtually everything. It is simply not possible without the government managing the Pharmaceutical Benefits Scheme in such a way that we can add Kalydeco and olaparib, a drug for ovarian cancer that would otherwise have cost over $100,000 a year for women suffering from this most difficult and tragic of conditions. So these are really powerful steps forward.

At the same time, as the second pillar what we also see is a commitment to strengthening the hospital system, both the public system, which is absolutely fundamental in Australia, and the private system, and the private health insurance system, to which we are fully committed as a government and as a coalition. Thirdly, the pillar of mental health and preventive health is being raised to the highest level for the first time in Australian health policy. It has equal billing with hospitals and Medicare, as it should, because mental health issues, as the National Mental Health Commission has outlined, affect four million Australians every year. Four million Australians—so we need more front-line services. Fourthly, with medical research we have the Medical Research Future Fund, the National Health and Medical Research Council and the Biomedical Translation Fund as the three core components of our commitment to creating cures and to having new diagnoses, new drugs and new devices that can assist people to manage and improve their health.

Against that background, this bill contributes to that process. In short, what the National Health Amendment (Pharmaceutical Benefits) Bill 2016 does is make it easier for doctors to prescribe. It will reduce by up to a half a million the number of phone calls each month. That is exactly what the doctors at The Hastings Clinic said to me: 'Less time on the phone. More time with the patients.' It provides a legal basis for prescriptions through an automated online system with real safeguards and real protections. It has the bipartisan support of the House. I thank the opposition, the Pharmacy Guild, the AMA, the RACGP, and the officers of the Department of Health. It is a real step forward and for those reasons I commend the bill to the House.

Craig Kelly (Hughes, Liberal Party) Share this | Link to this | Hansard source

The question is that the bill be now read a second time.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.