House debates

Wednesday, 16 July 2014


National Health Amendment (Pharmaceutical Benefits) Bill 2014; Second Reading

3:20 pm

Photo of Ms Anna BurkeMs Anna Burke (Chisholm, Australian Labor Party) Share this | Hansard source

Thank you, Madam Speaker. I rise to speak against the National Health Amendment (Pharmaceutical Benefits) Bill 2014. This is a grossly unfair piece of legislation that is being forced upon the Australian public and it will hurt the most vulnerable. Labor will oppose this $1.3 billion tax grab on medicines, because it will hurt. We will see, if this goes through, that it will not create an increase in the tax base. It will actually decrease the tax base because pushing people away from going to the doctor and away from fulfilling their necessary scripts will put them back into the health system. To see this anyone need only to look at research that has been done over many years, particularly in the United States on their health system where they, bizarrely, spend more per capita on everybody's health but everybody gets a lesser benefit because it is at the emergency end. We have such a sustainable and great system because we provide the services at the front end, at the primary care end, because it is affordable to go to the doctor and it is affordable to get your scripts filled. This bill will see an increase in the pharmaceutical benefit co-payment for general patients go up by $5 to $42.70, and for concession card holders it will go up by $0.80 to $6.90.

The Prime Minister has again said today that the $7 co-payment they are proposing for GPs is reasonable. It is not a big impost. Try telling that to people on full pensions and to disability pensioners, who are already struggling to make ends meet. Try telling that to the many self-funded retirees in my electorate who are living on a part pension and rely on the Health Care Card to ensure that they have sustainable health care. That is what they rely on.

I can speak from the personal experience I have with my mother, who absolutely rattles with the amount of medication she takes. One is a cancer drug. Luckily, it is not for cancer, but it is for a very serious blood disorder she has. It is a very expensive cancer drug and if she does not take it she will die. I know she does not want to make the choice between the diabetes pill or the arthritis pill—I cannot even name the number of mediations my mother is on. Every time we have ended up in an emergency department—and, sadly, I have done that on occasion with her, and prior to my father's passing I did it with him—I have had to rattle off the number of medicines they were both on. It is quite frightening. For them, an increase in the amount would actually be a huge impost for them. Both of them had a bit of super—not a lot—and they live on part pensions. They live within their means. Any change, any slight change, to their cost of living by increasing the cost of a script will have a detrimental impact upon their existence and their way of life.

Time and again we have heard that the COAG Reform Council report released in early June found that in 2012-13, due to costs, 8.5 per cent of people delayed or did not fill their prescriptions. In disadvantaged areas this figure is 12.4 per cent, and for Indigenous people it is a staggering 36.4 per cent. Again, this legislation will hurt the most disadvantaged. So much for a budget that was sharing the pain. This is not sharing; this is inflicting pain.

Look at what happened the last time a Liberal government increased the tax on prescriptions for some essential medicines. It was in 2005. We are not talking about something that is not essential. We are talking about blood pressure tablets, cholesterol tablets, diabetes medication and so on. Prescriptions for these medications fell as much as 11 per cent.

Today in question time the Leader of the Opposition sought to table a petition from 3,000 doctors concerning this. It was not some union group. My you, I do not see why we demonise union groups. It was from GPs and specialists, who are already seeing their patients raise concerns in this area. One story within the petition talked about the patient who arrived at the doctors and went to the reception and said, 'Is the $7 co-payment already in?' The receptionist said, 'No, it has not come in.' The patient said, 'That is good, because I think I need to see the doctor as a I have a slight headache.' Sure enough the patient went in and their blood pressure was over the roof and they had to call the ambulance. The individual collapsed and was raced off to hospital for emergency surgery. Just imagine if the receptionist had said, 'Sorry, mate, the $7 is in.' The patient would have said 'I cannot afford that,' and gone home, where they would have probably passed away. This is the sort of system the government is trying to force upon Australians. It is unfair and it is unnecessary.

The co-payment in the Pharmaceutical Benefits Scheme in some ways is more insidious than the doctor's payment, because most people actually are not aware it is out there yet. But they will when they go to get their scripts filled. They will be standing at the pharmacy saying, 'Which script do I fill. Which one is more important to keep me going.' In my electorate, which has a higher proportion of people over the age of 65, this is a grave concern. They wait to reach the mark before they get their scripts. Most of them, like my mother, do it in three months, when they have got to the max and all their scripts are free. The government is proposing to increase that rate, as well. This again will be a huge impost on many people in my electorate.

My GP recently told me a tale, which the pharmacists backed up, of a young couple who arrived with a very ill baby. They were given two scripts. One was an antibiotic and one was a pain reliever for the poor child. They went to the pharmacy and said, 'Which one is the antibiotic. Just fill that one.' Mind you, the doctor had explained that the child needed both, because for the antibiotic to kick in the pain needed to be reduced so that the system would understand that the antibiotic was there to help. Those choices are genuine, and we should not be forcing them upon the public.

The ridiculous thing is that the PBS is actually growing in a sustainable manner—it actually has not blown out—because of some significant measures the Labor government took during the last parliament. We introduced price disclosure reform. At the time, the now minister and then shadow health minister, Peter Dutton, railed against these reforms requiring disclosure on pricing. He argued how it was unfair and that these drugs were coming off the list. No they were not. We were actually saying to the producers to charge appropriately for the drugs that were being dispensed. The changes in generic drugs meant that there were now many drugs that were past the stage of being listed and could now come down in price. It is just a simple matter of saying to the companies to charge an appropriate rate for the drugs they are selling and the Australian taxpayer is funding.

At the moment the government spends about $9 billion a year on the PBS. With accelerated price disclosure the real rate of growth in the PBS is on a sustainable footing. So this budget measure is not about actually creating sustainability. That is already there in the mechanism.

We need to ensure that this is a genuine reform. That is why we are opposing it—because it is not a genuine reform. The money raised will not actually go back into sustaining the PBS or Medicare. It will go into a medical research fund. So those people who are chronically ill now are going to pay for their diseases to be cured in the future. I just do not see why the sick have to pay for medical research. Surely that is a requirement of government. Many people have contacted me expressing concern about the changes to both the Medicare co-payment and the PBS. Most of them write not on their own behalf but on behalf of concerns for others. Tammy writes:

I am horrified by the Lib Gov proposal to introduce fees for GP visits which I understand to be in place of bulk billing. I don't rely on bulk billing and am fortunate to not have to. I am writing to ask that you do what you can to resist this change - parents less fortunate than I should not have to choose between taking their children to the doctor and other expenses.

Robin writes to me:

l am sure you would agree this is a nasty tax; nothing for the rich, a burden for the poor. Yet Hockey promotes it as right and proper for the rich to pay; no mention of the burden on the poor.

This is the essence of what is coming through from my electorate. People are very concerned—not for themselves, not for their hip-pocket nerve but for those less fortunate than themselves.

We do not just need to rely upon Labor members to speak against this proposal. A recent study was conducted by the Family Medicine Research Centre at the Sydney School of Public Health, relying on data from the Bettering the Evaluation and Care of Health Program, which is a continuous national study of general practice activity. The researchers say they have been conservative in their assumptions. They found that the government's proposed Medicare co-payment and its increase in the Pharmaceutical Benefits Scheme threshold will send a bigger than anticipated price signal. I quote from an article in this regard by Michelle Grattan:

If both policies were introduced, the average annual extra cost to a patient, which increases with age, would be A$36 for children up to $122 for people 65 and older.

A young family of four would expect to pay $170 in co-payments for GP visits and tests, plus $14 for medications — $184 more annually.

That is a huge impost on the family budget. The article further states:

A self-funded retired couple without Commonwealth concession cards could expect to be up for an average of $189 in co-payments for GP visits and tests, plus $55 for medications — totalling $244 more.

An age pensioner couple with concession cards would pay an average $140 in co-payments for GP visits and tests plus $59 for medications — $199 extra.

The research comes as the Medicare co-payment faces defeat in the Senate …

…      …   …

They found that more than one-quarter of adult GP consultations involved at least one test, which would make for a minimum out-of-pocket cost for the consultation of $14 in co-payments. About 3% of adult GP consultations involved imaging and pathology — making for a minimum $21 in co-payments.

All of this adds up. The article continues:

Different people use health services at different rates, with the average number of GP visits made by the Australian population who visited a GP in 2012-13 being 6.6. The rate increases substantially with age, from an average of 4.5 for children to 10.5 for people 65 and over. …

"Therefore, the introduction of co-payments will not have an equal impact across the population. It is the high users, usually the older, sicker people in our community who will be the most affected," the report said.

…      …   …

"Compared with other OECD countries, Australia already has one of the highest levels of out-of-pocket health costs. Through introduction of the co-payments the government aims to 'ensure health services are sustainable and used efficiently'.

But this is not the case. It continues:

However there is no evidence that any modelling was performed to assess the effect of co-payments on deterring people from seeing a GP, or the flow on effect on hospital emergency department attendances."

In 2012-13, 5.8% of people delayed or did not see a GP because of cost, and this was a greater barrier for those from disadvantaged areas.

"Discouraging people from using primary care health services flies in the face of all international evidence.

"It is likely that the increased costs due to these policies would deter more people from seeking early treatment or from taking necessary medications. This is a concern when areas in Australia already have 13% of their population delaying or not seeing a GP due to cost, and 15% doing the same for prescriptions.

Why take an axe to the area that saves the budget the most money: primary health care? Why put an impost here? Study after study shows this, as the article states:

"Overseas studies have shown that there is little evidence of health care cost reduction from introducing co-payments. The evidence suggests that long term health costs will be higher due to patients deferring necessary care, resulting in increased hospitalisation and progression of disease," the study said.

"International evidence overwhelmingly suggests that the most efficient, effective and equitable health systems have a strong primary care focus.

"We believe that if Australia is to maintain an efficient and equitable health care system, general practice requires investment, not reductions."

The researchers are saying this; it is not out of the mouths of the ALP.

More and more studies go on to find that the overwhelming issue will be that more people will choose not to go and see a doctor and more people will choose not to get their medicines. This will put costs onto the health system; it will not reduce costs. This is a callous measure that does not achieve the aim it is seeking. Why are we impacting the most vulnerable to bandaid a budget emergency that is not happening? Why are we doing this to the people in our community who can least afford it? Many people in my community already pay, as I do, a co-payment to see their doctor. Many people in my community will not feel the pain, but many well. Certainly those in the older age bracket will make the choice of seeing the doctor and getting their script filled or not doing that. That is not a choice that an Australian should have to make.


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