Sussan Ley (Farrer, Liberal Party, Minister for Health) Share this | Hansard source

I am pleased to sum up on the Health Insurance Amendment (Safety Net) Bill 2015. I thank members for their contributions to the debate. I present a slightly amended explanatory memorandum which simplifies some of the example calculations and also takes into consideration the indexing of the amount for the greatest permissible gap which occurred on 1 November. This bill amends the Health Insurance Act 1973 to remove the two existing Medicare safety nets and the greatest permissible gap and replace them with a new Medicare safety net. These amendments address issues with the current arrangements and introduce a more efficient Medicare safety net that will strengthen the system for patients and medical practices into the future. Most importantly, the new Medicare safety net addresses issues of fairness. More Australians will be able to access safety net benefits, many of them for the first time. The reduced threshold for access will see an additional 80,000 concession card holders able to access safety net benefits.

Unfortunately, constant chopping and changing of the safety net has seen it become overly complex and failing to support those who need it most. In fact, Labor's shadow health spokesperson admitted on Sky News recently that it has become too complex and it does need to be simplified. I do also ask Labor to justify how in opposition they can continue to support a system that pays patients in some of Australia's wealthiest suburbs an average of $60 of safety net benefits per capita versus just $2 per capita in more disadvantaged areas. The member for Lingiari, whose commitment to Indigenous Australians will certainly never be questioned by me, raised in detail in his remarks the circumstances of Indigenous Australians. We all agree in this place that closing the gap in Indigenous life expectancy should be one of the highest priorities of any health minister, but I do note from the table of distribution of Medicare safety net benefits that I have provided the opposition spokesperson with, divided into SA4 regions, that the North Sydney and Hornsby region has $23 million of safety net benefits in the last financial year and the member for Lingiari's electorate, specifically the Northern Territory outback, has $120,000 of Medicare safety net benefits—$23 million versus $120,000. I hope that gives an indication of the determination of this government to address the issue of fairness in the context of the Medicare safety net.

In government Labor criticised the current safety net arrangements and unsuccessfully tried to fix the very problem that we are here trying to address today. Labor claims to be the party of the fairness test but when it comes to scoring a cheap political point they have no problem with disadvantaging our most disadvantaged. Let me be quite clear about this. Contrary to Labor's claims, and as the evidence of their own reviews show, the people accessing the safety net are by and large from Australia's more well off areas. Those from the most disadvantaged areas rarely access the safety net, because they never pay sufficient out-of-pocket costs to meet the very high thresholds. That is principally because Australia enjoys a very high and growing bulk-billing rate. This bill will address this very issue of inequality, lowering the threshold and ensuring more Australians will access safety net benefits, many for the first time.

Labor has also made some quite outlandish claims about out-of-pocket expenses. Rather than blithely mouthing the inflated numbers provided to them by vested interests, let us look at the facts. In radiation oncology, more than 80 per cent of all radiation oncology services are charged at MBS fees or less. If current billing practices continue, these patients will not experience any appreciable changes under the new arrangements. A standard course of treatment is defined by industry as 20 treatments of three-field radiotherapy. If this treatment were charged at the 2014 average fee, a patient would have a charge of $11,433. Under the extended Medicare safety net, the patient would receive $8,807 in Medicare benefits including safety net benefits, leaving out-of-pocket costs of $2,626. Under the new arrangements, for this course of treatment a patient would receive $8,784 in Medicare benefits including safety net benefits, leaving an out-of-pocket cost of $2,649—a difference of $23 for a standard course of treatment, a far cry from the hysterical $10,000 or $12,000 which has been mentioned by those opposite in the course of this debate. A similar pattern emerges in IVF. Labor overinflates the costs. The member for Ballarat said the average out-of-pocket costs for IVF were $4,000 rising to $10,000 or $15,000 under the government's proposal. Once again let me present the facts. The average out-of-pocket costs are $2,720 for the initial IVF cycle and $5,085 for a second cycle. Under the new safety net proposal these would rise to an average $2,730 and $5,938 respectively. Yes there is a small difference, but not $11,000 as Labor would like to have us believe. This is true in every example Labor gives—an inflation of the out-of-pocket costs or the number of people impacted.

Let me try one more time to appeal to the common sense of my political opponents on the other side of the chamber. The new Medicare safety net will continue to provide additional financial support to those with high out-of-pocket costs for their out-of-hospital medical services. It will continue to be a benefit that is paid automatically once an annual threshold is met. The new Medicare safety net will be much simpler for patients and health professionals to understand. For the first time patients will have some prospect of being able to calculate their out-of-pocket costs in this streamlined safety net approach. The introduction of accumulation caps and universal benefit caps reduces the incentive for some doctors and other health providers to charge excessive fees. Labor's ad hoc approach to capping has proved not to work in reviews undertaken by their government. Their approach allows creative billing in order to game the safety net system. That is why it is essential that we do not vary the caps from one MBS item or condition to another.

As I have said, the eligibility thresholds for the new Medicare safety net are significantly lower for most people, meaning that more patients will benefit. For families and single people who are concession card holders, the threshold will be reduced from $638 in 2015 to $400. For families without concession cards, the threshold will be reduced from $2,000 in 2015 to $1,000. For the first time, single people without concession cards will be placed on a lower threshold than families. Their threshold will be reduced from $2,000 in 2013 to just $700. This is to acknowledge the fact that they are required to meet their health costs on their own.

The new safety net will also address some of the operational and administrative issues relating to the program. The Department of Human Services will be writing to a large number of people to advise them of their safety net entitlements. A number of different ways to facilitate this communication about the safety net will be introduced, including web-based applications to allow people to register their families. This will be more convenient for patients and will build consumer awareness about the program.

There will also be other administrative changes that aim to assist families undergoing difficult times, such as divorce and separation. The definition of a dependent child will be broadened to include children between 16 and 25 who are temporarily unable to study due to ill health. The definition of a spouse will also be broadened to include couples that are separated by illness or infirmity. For example, where one member of a couple is in a nursing home, the new safety net allows the couple to be recognised as a safety net family. This directly addresses some of the inequity that has been raised by consumer groups and patients in the past. These initiatives all serve to make the new safety net fairer for all Australians.

In summary, this bill will introduce a new Medicare safety net that more closely aligns with the original purpose of the safety net arrangements. It will continue to direct assistance to people who have ongoing costs for out-of-hospital care, such as those with chronic conditions. This comprehensive change to the safety net is an essential component of ensuring that we have an accessible Medicare system that is affordable for the individual and the community—a Medicare safety net that is fairer for all Australians. If Labor is as serious about the concept of fairness as they claim, they should support this measure unamended.

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