Wednesday, 12 May 2021
Health Insurance Amendment (Prescribed Fees) Bill 2021; Second Reading
I rise on behalf of the opposition to speak in relation to this bill, the Health Insurance Amendment (Prescribed Fees) Bill. I indicate that the opposition will be supporting the bill, but I foreshadow that I will be moving a second reading amendment at the end of my remarks.
This bill is a very modest one in its impact, to say the very least, but it is important. It highlights the difficulty that the health system in Australia is having with coming to grips with modern information management systems and digital technology, with what many other if not almost all other sectors of our economy and society have done in relation to grasping the opportunities of modern information technology. I well remember when former Prime Minister Tony Abbott was the health minister, close to two decades ago, and said that his No. 1 KPI as health minister was to introduce an e-health record. Yet still we struggle with having good digital systems that ensure that people are able to have confidence that their health records are stored digitally and are available, subject to their consent, obviously, by all of their clinicians—but I digress.
This bill deals with a particular challenge that is fairly extraordinary. I make no criticism of the government for the fact that we've found this challenge. It just reflects the slow transition of the health system to modern information systems. The challenge is that, under current legislation, once a medical practitioner gains fellowship with their specialist college—when a medical practitioner is admitted to the College of Surgeons or the College of Psychiatrists, for example—they are then able to charge higher Medicare rebates. The way they do that is by making an application to Services Australia, which in the ordinary course of events is approved. They are then able to charge the higher Medicare rebates. The current system as legislated requires that medical practitioner to pay a prescribed fee of $30 and to pay that fee by way of cheque or money order. I'm not sure whether they're required to fax through a copy of the money order or send it by telegram or carrier pigeon, but the system requires them to pay by cheque or money order. It is highly prescriptive. One could argue reasonably that this system was slightly outdated even before the COVID pandemic, but it became a particular challenge, obviously, during the pandemic. It became very difficult because of movement restrictions and suchlike that really made it very difficult for medical practitioners to move up through their specialist registration with their college and then be able to charge a higher Medicare rebate.
We're told that the government explored the option of implementing more-modern payment systems for these fees—one could ask why they weren't already in place—but the advice from government is that the cost of an upgrade to something slightly more modern than the payment of a fee by money order or cheque was assessed as being far greater than the loss in revenue from scrapping the fee. If there are younger people watching these proceedings, I wonder whether we'll have to explain to them what a cheque is. I've talked to members on our side—I'm sure it's the same on the other side—about when you bring a new staff member into your electorate office and pay a sponsorship to a local sporting club or suchlike by cheque. A number of us have stories where much younger members of staff have literally looked at this oddly sized piece of paper and asked, 'What is this?' Anyway, apparently the cost of moving to a more modern payment system was going to cost more than simply scrapping the $30 fee, so the government has taken the decision to remove the fee entirely, which is the decision this bill gives effect to. That seems a sensible approach to this rather peculiar information management challenge that the government has identified, and we will support it. What we want to see, obviously, is medical practitioners who have done all of that hard work to gain admission to their specialist college able to continue to practise as a specialist as soon as possible and, obviously, charge the higher Medicare rebates that go with that specialisation.
As I said at the beginning of my remarks, this particular challenge really does reinforce the ongoing challenge that our health system has in moving towards more modern information management systems. I know there are a couple of members in the House on both sides of this chamber—the member for Macarthur and the member for Higgins—who will be speaking on this bill who have much more direct experience of this than me. But I hark back to that KPI that former health minister Tony Abbott identified in 2004, almost two decades ago. His first KPI, his most important KPI, as he said then, was to transition the health system to one based around a functional, personally controlled electronic health record. We still grapple with these things today, as this bill has reminded us.
I want to give a couple of examples of some of the ongoing challenges in the health system—firstly, in relation to the use of new and sometimes not-so-new information technology, and that is in relation to telehealth; and, secondly, in relation to the broader workforce challenges that this bill, indirectly, is dealing with as well, in terms of medical practitioners moving to specialist colleges.
The issue of telehealth is one that the medical health system has been grappling with for some time. The use of telehealth has been in place for some time for a range of different assessments and therapies. But, as the pandemic really hit last year, the member for McMahon, when he was the shadow health minister, spent a lot of energy and time calling on the government to mainstream telehealth at a time when Australians were, to varying degrees around the country, locked down in their homes but still needed to be able to consult their treating doctors. To the government's credit, they heard those calls not just from the member for McMahon but from the health system and the community more broadly and introduced telehealth as a broad based MBS measure, albeit on a temporary basis.
The minister said in November, I think, that it was his intention to make telehealth a permanent measure, but all we've had since then is a rolling series of six-month by six-month extensions by the minister, which are good as far as they go but don't give that ongoing, permanent confidence to the community and, importantly, to the health workforce that this is a permanent transition in the way in which health services are delivered. A couple of weeks ago—I can't remember the exact date—the minister did make a decision to extend the telehealth measures that were due to expire on 30 June to the end of the 2021 calendar year. Again, it's better than nothing but a far cry from the permanency that the minister promised back in November.
Broadly, at first blush, although people want permanency and some sense of confidence about how this is going to operate, this was something welcomed to a degree by the community and by the health sector—until they read the finer detail. The finer detail was to abolish all but two of the MBS items allowing phone consults. That is a very serious set of decisions that very understandably have caused a great deal of concern in the broader community as they have become aware of it but particularly in the health sector. These phone items—particularly, for example, the long consult item—have been widely used through the pandemic since they were introduced. We were told that there have been 2.8 million items for level C phone consults and nearly 200,000 items for level D consults since the measures were introduced.
There had been some talk around Canberra that the department and the minister were concerned that maybe these phone consultations were being misused or weren't the clinically optimal way for GPs, particularly, to consult with their patients. But it was very vague; it was very vague what the actual concern was. I think that we, as members of parliament, all understand that there's quite a variety of levels of comfort with different technology. The government says, 'We want people consulting with their GP, if they're not face-to-face, over video consult.' That's fine, except where, first of all, patients aren't comfortable or don't have the technology quite yet to do video consultations, or, for that matter—and I'll come to this—where the doctor says: 'Actually, we're quite comfortable with doing a phone consult. We don't need to see a person for the particular purpose of the consult in question here.'
That's really why there has been such a strong reaction from doctors groups to this decision, which was subject to no consultation with them. It was a complete surprise after they read the fine print of the announcement by the minister that he was extending—again, on a temporary basis—the telehealth items that were introduced during the pandemic. The AMA president, Dr Omar Khorshid, said that the profession had been blindsided by the government's decision. He said: 'The permanent future of telehealth must include access for people who are disadvantaged, and that means, at this stage, telephone consults. The beneficiaries of telehealth are patients, not doctors.' He further went on to say, 'We believe that the quality of care provided over telephone consultation is excellent, so long as it's being done appropriately, and is no different to what is provided over video.'
Obviously, if they're doing a telehealth consult, there are circumstances where the doctor will want to see the patient; they will want to have a video consult to see the particular rash or have some other visual assessment of their patient. We should trust GPs to make that assessment; we should trust the clinical judgement of GPs to make a decision about whether, in a particular circumstance, a phone consult is acceptable and appropriate—particularly given that they, better than anyone, understand the circumstance of their patients. They, better than anyone, understand that there are some patients who are not, at least yet, comfortable and able to access video technology. Maybe the government would have understood that better if they had actually consulted with doctor groups about this decision—I do make that point. As I said, this particular bill does highlight again the challenges that the health system is having in coming to grips with modern technology. Frankly, this government is even having difficulty in coming to grips with the appropriate use of rather longstanding technology, like telephones.
As I close my contribution I will also make some remarks generally around workforce. The measures in this budget dealing with more general health, rather than aged care and mental health, are relatively modest. To the extent that there are measures, they're broadly measures that the opposition would support. But I want to talk about one particular measure that was—as almost every measure in the budget was—leaked to the media some days ago: the decision to boost bulk-bill rebates for rural and regional Australia. The opposition supports measures to increase bulk-billing and is very aware of the particular challenges, first of all in attracting sufficient numbers of health professionals, including GPs, to rural and regional Australia; that was something which we worked very hard on when we were last in government. I had the honour of working as the parliamentary secretary to the then Minister for Health, Nicola Roxon, at the time, and this is something that we broadly support. But I want to draw attention to these ongoing challenges that are presented by the application of the Modified Monash Model. Again, this is something that leaves a number of communities in Australia out in the cold with this latest decision.
When the decision to increase bulk-billing rebates for rural and regional Australia was announced, it was presented as something that would support communities and clinics outside the big cities. As I was going through the papers, it appeared to apply to Modified Monash Model areas 3 to 7, so it leaves out areas 1 and 2. Just last week, as I was travelling through the Hunter Valley with the member for Shortland and the member for Newcastle, and then when I spent time on the Central Coast with the member for Dobell, I met GP after GP who drew attention to the challenge those communities are having attracting and retaining GPs and keeping up bulk-billing rates because of the cuts to their incomes, on top of the Medicare rebate freeze that they dealt with, through the application of the Modified Monash Model system.
The roundtables that we had with the member for Dobell on the Central Coast really highlighted a region whose population, compared to the demographic average across the country, is older than average and has a range of more complex health conditions. It gets no support from this decision. Again, it is treated as if it's part of Sydney. There are parts of Sydney that are treated as what we used to call a district of workforce shortage, but the Central Coast is not one of them. If you actually go through the Central Coast and talk to GPs who have surgeries that have no GPs in them—surgeries that were built to deal with the enormous growth in population on the Central Coast, a growth in population that is weighted towards the older part of the population—the lack of any attention in this budget to these challenges around bulk billing and the availability of workforce in regions like the Central Coast and the Hunter Valley is particularly stark.
With those remarks, I move, as a second reading amendment:
That all words after "That" be omitted with a view to substituting the following words:
"whilst not declining to give the bill a second reading, the House urges the Government to implement policies to better protect Australians' health".