House debates

Wednesday, 12 May 2021


Health Insurance Amendment (Prescribed Fees) Bill 2021; Second Reading

10:54 am

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

First of all I would like to acknowledge the contribution by the Member for Higgins. I would also like to acknowledge the Member for Lyne as being, with myself and the Member for Higgins, one of three people who have direct knowledge of this particular amendment. I would like to commend the shadow minister for health, Mark Butler, for his deep understanding of our healthcare system and knowledge of this particular amendment. As with many things that this government does, we support the amendment but understand that this is tinkering at the edges of a healthcare system that is under increasing stress.

It is good as a specialist to receive your specialist acknowledgement by achieving the fellowship of your royal college, be it the college of physicians or the college of surgeons or psychiatrists or whatever specialty. That's very important and a great part of our joy in receiving specialist recognition. But part of that also is the time when you can get specialist recognition for payment through Medicare. I remember in 1983 having to get either a bank cheque or a money order rather than a personal cheque to pay my contribution for this. Every specialist really waits for that moment and it is a really important time. The fact that we are now allowing it to happen in a much more ordered and modern way is really correcting an anachronism that should be long past, as the shadow minister commented. However, it is tinkering at the edges of what is a very significant problem in our healthcare system, and that is access to higher level specialist care.

Across the board we see in Australia a degradation in life expectancy from inner-city and metropolitan to outer metropolitan, rural, regional and remote areas. Life expectancy gradually decreases along that line. Access to higher level care increasingly is restricted to people living in inner metropolitan areas. We see that in a whole range of mortality and morbidity figures. With the advent of modern health care, we are seeing increasingly complex procedures available. For things like for coronary artery disease, urgent stent insertion is now the treatment of choice and has contributed markedly to a reduction in mortality and, indeed, a reduction in morbidity in our major capital cities. This is less and less available the farther we move from the inner city of all our major capital cities. These treatments mean that people live longer and are able to return to the workforce following a heart attack much more quickly and with much less disability. We see those available increasingly in our capital cities, but it's still a major difficulty in our rural and regional areas and also in our outer metropolitan areas. There are new treatments—for the management of stroke, for example, with clot retrieval—which are essentially available only in our inner cities on a regular basis, and little effort is being made by the government to try to provide these higher level medical services to outer metropolitan, rural and regional areas. There seems to be little acknowledgement from the government of the difficulties in getting these procedures made available to all Australians.

One issue that the government has spoken about is the increases in Medicare payments to GPs living in rural and regional areas. Yet, for the last five years, I have been writing to the minister for health, explaining to him how difficult it is to recruit GPs to our outer metropolitan areas. More recently, the changes to the area-of-need classifications for the outer metropolitan areas, as the shadow minister for health spoke about, are making it very, very difficult to recruit general practitioners to our outer metropolitan areas.

In my electorate of Macarthur, one of the fastest-growing electorates in the country, I have general practices contacting me every week saying they can't recruit GPs to work in their already overburdened clinics, which puts enormous pressure not only on our patients but also on our public hospitals, which are now being used as general practices by many people because they can't access general practice care. This is a failure of the government to understand that their responsibility is to deliver the best health care they can to all Australians, not just some. This is, again, a failure of understanding the importance of health care to everyone.

There are other issues that the government is also failing on. The member for Higgins mentioned private health insurance. Some of the changes that the government recently made to private health insurance, in particular in the area of disability, allowing people with disability to remain on their parents' health insurance indefinitely, have been very important changes. But it is too little, too late. The numbers in private health insurance are dropping, which is putting more and more pressure on our public health system, which the government seems to be quite happy to let happen, without any real move to improve the viability of private health insurance for all Australians.

In terms of technology, the government's idea of how My Health Record is working is deeply flawed, yet there is little commitment from the government to try and improve our electronic healthcare records. This is very poor. This is the future of health data, and how we store and use that data is increasingly going to impact on all our health care as the future evolves. Yet the government has done nothing to improve My Health Record, to the point where the whole system needs to be redesigned and re-established because the majority of Australians are not using electronic healthcare records. This is increasingly important as we develop an understanding of the genetic nature of disease and how we apply that to health management across a whole range of fields, from cardiovascular disease to obesity and diabetes, to cancer therapy and cancer management.

In this budget—this is another piecemeal measure—the government has put in some funding to provide support for breast cancer genetic screening. That's very important but it's only part of the answer. There is no commitment from the government to an overall picture of gene and cell management. We need to be doing this as a whole-of-health approach, not just as a piecemeal approach all the time. That's what we get from this government.

Unfortunately, it's not just in electronic health records and other technology; little is being done to support the telehealth and telemedicine regime. The recent changes were announced by the minister without consultation and without any proper engagement with the healthcare workforce, yet this is going to be a very important part of our health future. This should have entailed consultation with a whole range of health providers—not just doctors and general practitioners but specialists, nursing staff, allied health staff, physiotherapists and occupational therapists. A whole range of options could be made available to try and improve our telehealth system, futureproofing it and enabling the expansion of services for the benefit of all patients.

Telehealth is not just very important in rural and regional areas; it's very important in electorates like mine, which have a high level of disadvantaged patients, a high level of Indigenous patients and a high level of people with disability. Access to telehealth is very important and should have been expanded by the minister, with support given to practices to establish more telehealth facilities. The ability to conference telehealth and engage other practitioners for case conferences et cetera should have been expanded. As a paediatrician I found access to case conferences vitally important for my patients, often those with multiple disabilities. A process should have been put in place by the minister to allow this to happen rather than restricting access to telehealth practices.

Again, whilst this amendment gets agreement from both sides of the parliament, it's piecemeal, it doesn't look at the overall health picture and it could have been done a whole lot better with a philosophy of improving health care for all Australians. If you live in the inner city it may well be that you get good access to a whole range of health services, but, in outer metropolitan, rural and regional areas, access to high-level specialist care is increasingly being rationed, and the health outcomes in terms of both mortality and morbidity are being paid for by some of the most disadvantaged groups in our country.

This change is a very small change. Whilst I welcome it, I want the government to look at putting in more processes that enable high-level specialist care to be given to people living in rural, remote and isolated areas. It can be done. Teaching-hospital-level health care should be available to everyone in Australia. There are ways of doing this. The health cardiology bus that is used in remote and regional areas of Queensland to provide high-level cardiac care to the teaching-hospital level should be available across the country. Our most remote Indigenous families should have access to high-level eye care, high-level ENT care and high-level cardiovascular and diabetes care. We know that can be done with a commitment from a government that philosophically understands the importance of universal access to the best health care possible.

The government has approached the whole health issue in a piecemeal and very political way, without a philosophy of providing the best care to everyone. We've seen rollouts of some innovative health policies occurring in very advantaged communities and not in disadvantaged communities. Once again, the health workforce is not being evenly supported across the country. In my own area, the electorate of Macarthur, we have had major problems recruiting GPs to work in our GP clinics, major difficulties recruiting specialists to work in our hospitals and major difficulties providing tertiary-level health services in the outer metropolitan area. There are ways of doing this much, much better.

Whilst we support this amendment, the government needs to do more to support health care for all Australians. In particular, we need to look to the future and we need to futureproof our health care for everyone. That means a commitment to electronic healthcare records for everyone, a commitment to supporting telehealth, a commitment to supporting the most disadvantaged and, overall, a commitment to supporting our workforce that has supported us so well throughout the pandemic.

One of the reasons Australia has done so well in the pandemic is our health workforce. I don't just mean the epidemiologists and the infectious-diseases consultants; I mean the nursing staff, the contact tracers and the IT specialists—the people who work on the ground to make sure we are all protected. I really thank them so much for this, but we need more from the government for overall health care as we emerge from the pandemic so that there is justice for all within our health system. I thank the House. I thank the shadow minister for his amendment, and I reiterate our approval of it.


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