Jill Hall (Shortland, Australian Labor Party) Share this | Hansard source

The Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Bill 2007 is important legislation because it guarantees the integrity of the system and ensures that we get the best use of our health dollars. The bill amends the Health Insurance Act to replace existing provisions regarding the payment of benefits between providers and requesters of pathology and diagnostic imaging services with new provisions aimed at prohibiting certain practices in relation to rendering pathology and diagnostic imaging services, including prohibiting inducements and other relationships between requesters and providers of pathology services and diagnostic imaging services, preventing payment for pathology and diagnostic imaging services that do not benefit patients and encouraging fair competition between pathology and diagnostic imaging providers on the basis of quality of service provided and cost to patients. These are very important issues. It is extremely important that the integrity of the system is guaranteed and that patients are not referred off for services that they do not need—that is contraindicated; it is against the best interests of those patients. Ensuring that the system is fair, that there is a level playing field, is vital.

I note the recommendations of the review commissioned by the department of health and undertaken by Phillips Fox lawyers, which specifically examined the enforcement and offence provisions of the Health Insurance Act as they relate to the provision of pathology services under Medicare. The Phillips Fox review was a response to claims that a minority of providers—I emphasise here that it is a minority of providers; it is not widespread—particularly within the pathology industry, were providing payments or other inducements to practitioners so that practitioners would refer patients to them.

The member for Riverina referred to service providers’ referral forms. Most doctors will fill out the referral form of a particular service provider. Doctors will refer a patient to a pathologist or a diagnostic imaging service that is appropriate for the test or service that their patient needs or, alternatively, one that is located in the vicinity of where they live or one that they can easily access.

I do not see the fact that a doctor fills out a particular referral form to a particular pathologist or diagnostic image provider as the issue. The issue is where inappropriate inducements are offered. Whilst the Phillips Fox lawyer investigation did not go into this in detail, they said there was clear anecdotal evidence that it did occur and therefore it was very important that this issue be addressed.

It is important to put on the record that for the 2005-06 year, there were 83 million Medicare funded pathology services performed, with approximately 10 million Australians accessing these services. During the same period, approximately 15 million diagnostic imaging services were performed. That is X-rays, ultrasounds, and MRIs, which benefited 6.5 million Australians. This equated to $3.2 billion. That is approximately 30 per cent of the total Medicare outlays in 2005-06. Therefore, it is imperative to ensure that the services that are paid for are appropriate services and that there is no inappropriate servicing prompted by providers paying inappropriate benefits to requesters. It has not been quantified, but the anecdotal evidence is there and it has been tagged at about $16 billion a year.

This legislation will, I believe, remedy the situation. This legislation will ensure the integrity of the system. I probably should mention the kind of inducements that have been referred to anecdotally. They include things such as gifts, lump sum payments, providing staff to practices and inducements to encourage referrers to refer to particular services. I think one of the most important things for us as a society, when we are looking at the kinds of services that are prescribed and the kinds of services that patients have, is to know that those services are needed and that the integrity of the system is guaranteed.

It is interesting to note that the interest groups have basically supported this. The AMA do not oppose the actual legislation although they have stated that they do think that there are currently sufficient regulatory mechanisms in place. The Chief Executive Officer of the Royal College of Pathologists of Australasia, Dr Debra Graves, is reported as having argued that while the problem is not widespread, there are reports of a small number of practices that have not acted appropriately. It is this behaviour that the anti-rorting legislation will target. So the pathologists themselves see that this is important legislation. It is important that it is supported.

It is clear that the current legislation has proved ineffective in tackling this problem. That is why we need this new legislation and why all members in the parliament should support it. Persistent claims of overservicing and prohibited practices within the pathology and diagnostic imaging sectors undermine the integrity of the system and increase the cost of payments to that sector when scarce healthcare dollars could be used in other areas. On that point alone the legislation that we are debating today should be supported.

These changes to the Health Insurance Act arise from several thorough reviews of the operation of Commonwealth legislation for pathology arrangements under Medicare and have been the subject of extensive consultation with pathology providers, professional and peak industry groups, state and federal government agencies, and consumer groups, so they have the support of people and organisations that are involved in the industry. We support this legislation because we are confident that the new provisions will be more effective than the current enforcement and offence provisions of the HIA in tackling the problem that has been outlined.

There have been persistent reports of overservicing and prohibited practices in the pathology system and also in diagnostic imaging services and it is imperative that these things be removed. The overservicing in some cases, particularly when you are looking at people being overexposed to diagnostic imaging, can actually be harmful, so it is a health issue as well as a dollars and cents issue. As a person who is passionate about health and passionate about Australians getting the best quality health services available, I see that this legislation will lead towards that. I am totally committed to Medicare and see it as the cornerstone of our health system, and I see this as a way of strengthening Medicare and stopping some practices that could be undermining Medicare. I know it is important that we get the most we can out of the health dollar and I think that, if certain sectors are overservicing and inappropriately spending that health dollar, it is not in Medicare’s interests or the interests of the Australian people.

All of us in this parliament should be committed to seeing that the health services Australians get are the health services they need and not health services that are being driven by alternative mechanisms. I am very happy to support this legislation. Legislation like this is definitely in the interests of Medicare and in the interests of the Australian people.

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