Monique Ryan (Kooyong, Independent) Share this | Hansard source

I rise to speak to the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022 as a relatively new member of this House but also as a medical clinician with long professional experience of Medicare. This amendment in and of itself is appropriate. It's not particularly consequential, but my concern is that it reflects several aspect of the systemic malaise of our public healthcare system. Many of these aspects were spoken to earlier by my friend and colleague the member for Macarthur. I wish to take the opportunity to note my concerns in the House today. Medicare is an extraordinarily important part of the Australian healthcare landscape. The fundamental principles of the Medicare system are true to what the Australian people want, need and deserve: universality, shared Commonwealth and state responsibility for public hospital care and a universal insurance against medical costs, including via bulk billing.

The Health Insurance Act, National Health Act and Dental Benefits Act set out the legislative framework for the provision and claiming of services and benefits with respect to all three of our major public health funding schemes: the Medicare Benefits Schedule, the Pharmaceutical Benefits Schedule and the Child Dental Benefits Scheme. The Medicare Benefits Schedule is Australia's most important health insurance scheme. It subsidises the cost of selected medical services for eligible patients provided by eligible practitioners.

Under the PBS, the Australian government subsidises the cost of medicine for most medical conditions. Services Australia administers MBS, PBS and CDBS on behalf of the health department and makes its payments. The purpose of the Professional Services Review scheme is to review and investigate the provision of services by practitioners and to determine whether those practitioners have engaged in inappropriate practice. To overcome issues with inappropriate billing for services, this parliament has already in recent years passed three other bills aimed at improving health provider compliance arrangements. These were the health legislation amendments of 2018 and 2019 and the Health Insurance Amendment (Administration) Bill 2020.

The bill before us today includes a single schedule divided into four parts, which includes several amendments to the Professional Services Review scheme, changes around appeals to the Administrative Appeals Tribunal and revisions to the Commonwealth's debt recovery arrangements for the HIA, the NHA and the DBA. Put broadly, the intent of this bill is to extend the scope of the Professional Services Review to enter into agreements with corporate entities and to ensure consistency across the health administration sector on the Commonwealth's debt recovery processes and in relation to the giving of false or misleading information.

We all know that the Medicare system is not perfect. In the 2018-19 financial year, the Australian National Audit Office reported that Health recovered $49.3 million in claims which should not have been paid and $123 million in estimated savings through changes in the claiming behaviour of providers. All principled medical professionals will support measures aimed at preserving the integrity of Medicare and optimising the use of our limited healthcare resources by preventing wrongful claiming.

There are, however, concerns which have been expressed by the Royal Australian College of General Practitioners amongst others about the proposed procedural fairness and the transparency of this expansion of the PSR scheme as proposed in this bill. Firstly, this bill proposes that the director of the PSR should be able to enter into agreements with non-practitioners and bodies corporate. While most general practices are privately owned by GPs, there are many other ownership models, including shareholder owned, publicly listed companies.

This government needs to have different regulatory expectations of corporate entities of varying sizes and resources as compared to smaller individual practices. There is with this bill a real risk of increased compliance burden on smaller practices, particularly in rural areas, which could reduce the capacity for those doctors to provide high-quality care to patients while their practices are under investigation.

Similarly, the increased penalties in this bill for the refusal or failure to produce documents or information suggests a focus on cost recovery and punitive approaches to compliance, which may exacerbate existing concerns in the profession about the intent of compliance activities. Expansion of the power of the director to publish information about a person who has not fulfilled their obligations under a section 92 agreement is a breach of privacy which could have a significant impact on individual practitioners. The increase in sanctions and the broader debt collecting powers prescribed by this bill reflect a really punitive approach to compliance, rather than an educator focus helping practitioners to bill correctly.

The truth is that anyone who has engaged with this process will tell you that Medicare billing is extremely complex. There are innumerable legal instruments around Medicare billing. These add up to more than 7,300 pages of acts, regulations, determinations, rules, directions, terms and conditions, schedules, website pages and guides. This excludes private health insurance medical fee schedules, the state and territory health acts, the contents of the MBS Online website and various other sources.

Feedback from GPs tells us that increased Medicare compliance activities and the fear of being audited are distracting them from their primary focus, which is and should always be the delivery of high-quality, patient-centred care. This fear creates a significant conflict between the administrative obligations that GPs need to adhere to, as set out by this legislation, and their commitment to patient care.

GPs are the foundation of our healthcare system. General practice provides 177 million services a year to approximately 24 million people in Australia. There has in recent years been unprecedented demand for healthcare services as our population ages and rates of chronic disease and psychological stress increase. Hospital and emergency department demands continue to skyrocket, resulting in ambulance ramping, suboptimal healthcare delivery, poorer patient outcomes and increasing secondary and tertiary health expenditure. Decades of significant underfunding and cost cutting have left our general practices on the verge of collapse. Almost half of our practising GPs have indicated that it is no longer financially sustainable for them to continue working in general practice. The proportion of bulk-billed GP services recently dropped for the first time in two decades. Experts predict a shortfall of 11,390 GPs, or almost 28 per cent of the GP workforce, by 2032. Medical student interest in general practice as a career is now at a low of just 13.8 per cent.

The COVID-19 pandemic, recent natural disasters and the health and mental health issues resulting from them have compounded these issues, highlighting the gaps and inequities in the current delivery of primary care, exacerbating workforce burnout and draining resources within general practices. It was a peculiar, cruel insult that the previous government did not consider GPs to be frontline workers, although they were in the vanguard of the COVID-19 pandemic response. In addition to the increasing costs of living, out-of-pocket costs for patients accessing their GPs have increased by 48 per cent in the past decade, reflecting how Medicare patient rebates have failed to keep pace with the growing cost of delivering health care. We need to support our GPs. We have to make general practice more attractive to medical graduates.

We need to stop accusing overworked, often underpaid professionals of widespread systemic abuse of the Medicare system. There have been recent claims of widespread Medicare abuse by doctors and other healthcare providers made by the Sydney Morning Herald, the Age and the ABC which suggest that the realities of ambulance ramping, public hospitals not coping and general practices being in tatters are all due to doctors defrauding Medicare. In fact, instances of proven Medicare fraud are minuscule. The most recent report of the Professional Services Review itself found fewer than a hundred instances of proven inappropriate practice in 2020-21. The sum total of these ill-gotten gains, all of which was recovered, was $24 million, a far cry from the fanciful $8 billion claimed by a gotcha media culture concerned less with the truth than with a cheap, demeaning headline.

In fact, a recent Healthed survey confirmed that most doctors actually deliberately underbill. More than two-thirds of doctors surveyed underbilled most days. GPs, especially female GPs, spend as much as 14 per cent of their time on non-billable activities. These non-billable activities include patient care, arranging tests, arranging referrals, consulting specialists, talking to allied health professionals, renewing medications and providing advice and education. If the true cost of under-billed services was included in this accounting, the figures would show that in fact Medicare is rorting our GPs, so we should not be surprised, when our GPs were asked about the impact of that recent media coverage on their view of their own practice, that they described it as soul-destroying, disappointing and insulting. Many felt that the conflation of unintentionally incorrect billing, mostly due to very understandable confusion about Medicare rules, with intentional rorting was a very serious flaw in the media representation of why Medicare is failing GPs and the public. I received a letter from a GP in my own electorate of Kooyong that called these claims 'damaging' and 'sensationalist'. He said that he will continue to be 'scared to bill appropriately for fear of appearing to rort the system'.

The amendment we're debating today is a small thing. It's just a tinker on the edges of a very large problem. There seems to be no appetite or vision from this or other governments for what we need, which is large-scale generational reform of our healthcare system. Medicare is 50 years old. We need our federal government to work with our states and territories to provide better primary care across our jurisdictions. We need to prevent health care from being just another political football between the federal government and state jurisdictions. We need to protect our GPs. We need to treat them with respect, not suspicion.

We need Medicare—that wonderful universal scheme—to be better, smarter, more generous and more suited to the 21st century. We need to stop tinkering around the edges. We need a better and clearer vision of what we can achieve together. I commend this bill to the House.

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