Kay Hull (Riverina, National Party) Share this | Hansard source

Today I rise to support the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Bill 2007. This bill will ensure that a patient’s access to pathology and diagnostic imaging services is not clouded by considerations other than a clinical need. The bill will strengthen Medicare, and allow the government to deliver on its commitment to act on the recommendations of the Phillips Fox review of enforcement and offence provisions of the Health Insurance Act as they relate to the provision of pathology services under Medicare.

Claims have been made, whether or not they are substantiated, that a minority of providers, particularly within the pathology industry, may make payments or other considerations so that practitioners will be more likely to refer their patients to them for service. This could, if it were true, lead to the ordering of excess services that may not be clinically necessary and may cause undue alarm and concern to patients about their health status. This perception by patients is of concern, and I believe this bill is a sensible way to overcome the potential of this issue arising. Clinical need should be the most important consideration in referring patients for tests to diagnose illness. Health, especially in rural and regional areas, has always been of great concern to me. I am pleased that this amending legislation will enforce penalties if this issue arises and medical practitioners are encouraged or induced by payments or other benefits to direct their patients to a particular provider.

I feel confident that I have a very good relationship with medical service providers within the Riverina, particularly the diagnostic services and pathology laboratories. I believe that each and every one of them is dedicated to providing the best service, and at a minimal charge to the patients at most times. But if there are concerns, particularly in the patient arena, then this legislation offers great comfort to patients. Particularly when you note the difficult times that people in the Riverina are experiencing with the ongoing drought and the downturn in their employment opportunities because of it, to have to pay for services that may not be required is just another burden. It is an extraordinary strain on the household budgets of the many people who have chronic and ongoing diseases and who require more frequent treatments or visits to pathology and diagnostic imaging facilities than the general public.

I have great sympathy with the upsurge in the referral of patients, particularly to pathology and diagnostic imaging providers, by doctors. Consumer litigation has increased substantially in our modern age. If, as a doctor, I were in the position of diagnosing and treating a patient, first and foremost I would go to all lengths to ensure that the patient’s needs were addressed because doctors, specialists and others in the medical profession are dedicated to patient care above and beyond all.

But underlying this there must be a certain feeling that, should you misdiagnose a patient for the lack of getting some other diagnostic tests done, now, more than ever before, there is the potential for a litigation case to be brought against you. It is a sad indictment on our community that we have become so focused on litigation and on making everybody personally responsible for outcomes that there is an underlying insecurity in many of the professions, not just the medical profession. I certainly feel that, in order to ensure that diagnostic facilities and pathology facilities are appropriately used clinically, there is a need to put in place comfort legislation such as this.

The amending legislation has three aims. One is to prohibit certain practices relating to the rendering of pathology and diagnostic imaging services, including prohibiting inducements between requesters and providers of those services. When you go to a doctor and get a pathology service referral or a diagnostic imaging referral it is written out on a particular service provider’s letterhead. That may lead the patient to falsely assume that there is some type of connection between that doctor or that surgery and the provider of that service when that may not be the case.

It certainly has led to some confusion when patients maybe feel that they have to attend this service provider in lieu of the service provider that they may be more comfortable with. But of course we know that this is not the case. Even if a request is written out on a service provider’s form, it can easily be taken to another service provider to fulfil the same tests—but sometimes the patient gets confused with that.

Another part of this amendment will prevent payments for pathology and diagnostic imaging services that simply do not benefit patients. In addition, these amendments will encourage fair competition between the many providers of services on the basis of quality of services provided and cost to the patient. Referrals should be made in the best interest of the patient, and in most cases predominantly those are the circumstances. Medical tests can be daunting for people, as they can indicate a new illness or an extension of an existing illness that could be worsening and could have become more serious. Patients do not need the added stress of potentially being part of a non-permitted transaction through medical professionals and diagnostic providers who may do deals to ensure that referrals are made to a particular practice.

The reforms are proposed to take effect from 1 March 2008, and the bill sets out new prohibitions relating to both pathology and diagnostic imaging services, as I have outlined. It would not be permitted for a commercial transaction between requestors and providers to be linked in any way to the number, type or value of the services requested. The provisions prohibit both requestors and providers from being involved in non-permitted transactions, including those that are channelled through third parties. These also include civil penalties where pathology or diagnostic imaging providers offer or provide non-permitted benefits or make threats to requestors. I find it hard to believe that that could happen, but obviously there has been some view that this may be a practice in some areas. At no time do I think that the providers in my electorate are actually stooping to such a low level. I am very comforted that this bill will give them—and also the provider—the protection that they need. When some of these allegations may be made after this legislation is enacted, the providers and the referrals can clearly say, ‘That simply can’t be the case because there is legislation that prohibits that from happening.’ So everyone will be protected by the introduction of this legislation.

Providers and requestors will also be held liable when non-permitted benefits are asked for, offered or exchanged or when threats are made by someone connected to them. The relationships covered will include relatives, partnerships and any other close financial relationship. The prohibitions are supported by penalties of up to $66,000 against individual requestors or providers or $660,000 for corporations. It is not possible to quantify the Medicare outlays that may be saved through these measures, but with Medicare outlays on pathology and diagnostic imaging running at around $3.2 billion a year, even if 0.5 per cent of the outlays was being saved by preventing inappropriate practices, this would mean a $16 million saving to the budget per year that could be applied to other very worthwhile and worthy health areas.

Pathology and diagnostic imaging services, particularly in the Riverina, play a critical role in health care. In areas like the Riverina where sometimes services are few and far between, these services are almost an entire service of their own. The doctors—particularly in diagnostic imaging—play a critical role in early diagnosis and detection of breast cancer and many other cancers and many other forms of disease that can enable speedy treatment to take place for country people.

I applaud doctors who have diagnostic facilities in those areas. It is very difficult to get a workforce of diagnostic imaging doctors in country areas. We face a dire shortage of them. In the Riverina, many of these doctors have been committed to our region over long periods but have felt for many reasons that they have had to move and relocate in Melbourne, Sydney or other areas. We are now forced to fly in many diagnostic doctors from Adelaide and other places in South Australia to provide these services. By no means do I underestimate the performance of the doctors involved in diagnostic imaging services and the critical role that they play in my electorate. I congratulate them on their dedication. It is all very well to have radiographers and people who conduct tests, but to have that diagnostic facility—doctors diagnosing and reading all of these results—is absolutely imperative. We need to ensure that these doctors are still settling in regional Australia and that we are not reduced to fly-in fly-out services.

Pathology and imaging account for a significant amount of taxpayer funded outlays from the national health care budget. This is commensurate with the absolutely sensational diagnostic services that they provide. There are approximately 83 million Medicare funded pathology services such as X-ray, ultrasound, computer tomography, CTs and magnetic resonance imaging. MRIs are performed daily in my electorate. This expenditure equates to in excess of $3.2 billion, which represents approximately 30 per cent of the total Medicare outlay in 2005-2006.

It is hoped that these changes will ensure that the small number—and I suspect that it is a very small number—of requesters and providers of diagnostic services who currently engage in inappropriate practices will cease doing so or be subject to significant penalties. If there is any evidence that the provisions are not addressing such activities, the government will look at this in consultation with stakeholders further down the path. Also, criminal offence or civil penalty provisions can only be added by the passage of some additional legislation. I suspect that it will not be required and that we will find that this legislation will provide comfort and security to both the practitioner and the patient.

As with tax avoidance legislation, we need to keep pace with any potential underhanded rorting whatsoever of the system. This is not picking on pathologists and radiologists or the doctors who refer to them; it is purely providing a support and safety network for the referral, the referrer and the referee. The legislation review process has taken four years and has involved close consultation with the professions and the related industries. The final shape of the bill has taken into account that a one-size-fits-all solution simply does not fit both the pathology and the radiology industries.

The review of pathology enforcement and offence provisions included the preparation and dissemination of an issues and options paper back in January 2005. The paper was distributed for comment to all the relevant government agencies, the pathology providers, the pathology professionals, the peak industry organisations, the state and territory governments, the medical registration authorities and the peak consumer groups.

Again, I wish to emphasise my support for the amendments in this bill because not only do they ensure that patient access to pathology and diagnostic imaging services is not clouded by considerations other than clinical needs but they also provide a security that will underpin the pathology and diagnostic imaging services. If there is some allegation that inappropriate practices are taking place due to some ill-informed or little understood way of how procedures should take place, then the provider can always refer back to this bill and say: ‘This simply is not happening. It cannot possibly happen because there is legislation and there are very appropriate fines that prevent such practices from occurring.’ So the integrity of the service provider is kept absolutely intact.

I congratulate the minister on his cooperation in working with and involving all industries in the lead-up to the presentation of this bill. Again, I congratulate the industry on its cooperation with the department and the minister. The industry certainly was not dragged kicking and screaming to support this legislation. It understands the issues and perceptions that can arise. It is every bit as interested in ensuring integrity in our system as the government is interested in ensuring that the industry cannot possibly make any illegal use of the healthcare budget and that the healthcare budget is used only for its intended purposes. I commend the bill to the House.

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