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

As a citizen, parent, doctor, medical researcher and now proud representative of a federal electorate, I feel hugely passionate about our healthcare system and how we need to protect and improve it. There is a global consensus that effective primary health care is crucial for creating a healthier and more prosperous society. Recent evaluations of the sector have universally urged for radical reforms to modernise Medicare, which provides the foundations for primary health care around Australia. This four-decade-old scheme is now letting us down by driving up costs. It's focused on quantity of care rather than quality. Moreover, a disproportionate amount of dollars and workforce are allocated towards a smaller proportion of the population with acute health needs while many of those with chronic and complex conditions are not receiving the care that they need.

Many of the budget announcements of 2023 elicited a collective sigh of relief from health experts and commentators. The government has demonstrated a real commitment to revitalise and modernise general practice. In 2021-22 approximately 190 million consultations were recorded by Australian GPs. These amounted to a cost of $40 billion to Medicare. The new $3.5 billion allocated to triple the bulk-billing incentive will likely reduce the cost barrier for many to afford primary health care. It's a great start, but the reality is that, in electorates like my own, it is unlikely to significantly alter bulk-billing rates. The increased incentive, significant though it is, applies only to GP consultations with children under 16, pensioners and concession card holders. If the GP can't afford to bulk-bill, the reality is that these incentives are irrelevant.

This tinkering around the edges of Medicare reimbursement is insufficient to compensate for nine years of frozen rebates and the current effects of inflation. There are also concerns that these changes disproportionately reward those undertaking short consultations rather than those with a casemix of longer consultations for more chronic disorders. In fact, what they will potentially do is promote churn-and-burn medicine rather than really high-quality health care. The reality is that we have to enable doctors to see patients for as long as they need to be seen, and we have to compensate them appropriately for that.

This budget included little for mental health. Some funding was provided for programs which were otherwise about to end and some was provided for additional places in psychology training programs. The announcements earlier this week by the Minister for Health and Aged Care around additional funding for patients affected by eating disorders were also welcomed. But the reality is that mental health care services in this country remain universally understaffed and underfunded. I'm very glad that the minister has noted that this budget only just lays the groundwork for improved mental health care in Australia.

I've advocated for the extended prescription dispensing length provided in this budget. I do believe that it is good policy. Doubling the amount of medication that can be dispensed with a single prescription will increase productivity by decreasing the time that we spend in pharmacies and in GP surgeries getting routine prescriptions. It will reduce the out-of-pocket costs for many medications by $180 per medication per year. Many constituents in Kooyong will save more than $1,000 a year as a result of this change, quite apart from the cost of their GP visits. It's a really significant benefit for those individuals.

Community pharmacists have expressed concerns about this change, and I am really supportive of measures to improve the quality of care that we provide in our medical system while increasing its cost efficiency. It's entirely appropriate that we review the scope of practice of all medical and allied health care professionals. For community pharmacists, that should include arrangements around dose administration aids, vaccination, delivery services and support of residential aged-care facilities. Pharmacists also have an important role to play with the dispensing of prescription vapes. In most contexts, vaping is a scourge. We need stronger regulation and enforcement of e-cigarettes, including controls on their importation, their contents and their packaging.

Community pharmacists should be paid fairly for the services that they provide, but so should hospital pharmacists—so should physios, OTs, psychologists, ambos and all of our allied healthcare professionals. We as a country have to value the work that our most valued professionals provide for us, but we have to ensure that the care and services they provide are best practice. It has to be safe, it has to be judicious and we have to ensure that our healthcare dollars are spent such as to optimise patient outcomes.

It is fair to say, somewhat unexpectedly, that prescription medications have become a somewhat hot topic in this country. Most recently, we've learned that startups like InstantScripts, Eucalyptus, Midnight Health and Mosh are helping people access medications without them being seen by a medical practitioner either in person or via telehealth. This can be done via online quizzes, texts or emails. I welcome the changes that will come into effect on 1 September, which will effectively stop online medical clinics from prescribing drugs to patients they have never seen. This is a dangerous and exploitative model of tick-and-flick medicine. It is at odds with everything that we want to achieve in providing best practice health care for Australian patients.

The gargantuan task of rejuvenating and modernising Australian general practice has been outlined in a number of policy documents over the years, particularly the Strengthening Medicare taskforce report. Many of those documents have underscored the importance of data and digital technology in the general practices of the 21st century. But, regrettably, there are no references in the recent budget to how we can optimise the use of clinical data stored in our GPs' software, and this remains a significant and essentially untapped resource. At this point, remarkably, we cannot document the reasons that prompted the 190 million visits by Australians to their GPs last year, nor do we have any insight into the actions that those GPs took at those visits.

If we did have decent data, we could use it to identify individuals at high risk of hospitalisation, individuals whose conditions are likely to deteriorate, individuals who might benefit from early intervention or from more targeted therapies. The data we do have is problematic because we have variable coding and a lack of universally agreed terminology for common conditions, like diabetes, hypertension or depression. There have been piecemeal activities by the government and commercial operators to facilitate a collection of GP data over the last few years, but a recent survey identified more than 100 separate datasets that are currently in place. They extract data from GPs in different ways, using different tools and different data governance frameworks.

Australian general practices are now incentivised to provide a proportion of their clinical data to the Australian Institute of Health and Welfare. Ten agreed quality indicators have been recorded annually since 2020, but these record only very basic processes of care, like smoking status, weight or alcohol consumption. That's the limit of the data we record. Just consider that for a minute. For each of the 190 million GP consultations last year, we recorded only a very small fraction of the information that we could use to provide insights into the quality of the care we receive. Instead, we rely on the most basic NBS administrative data. We have not yet found the best way to record our invaluable medical data such as to optimise patient outcomes.

In an era of evidence based medicine, we've come to rely heavily on randomised clinical trials to determine the efficacy of various treatments and interventions. But we don't generally monitor their use in real-time settings, which means we are uncertain about the effects on communities, the post-hoc effects of those medications and settings that are different from those in clinical trials. This poverty of clinical data leaves us with a critical gap in our knowledge on how to apply treatments in different settings and in different populations.

The My Health Record has had a chequered 10-year history in its development. Our governments have already sunk more than $2 billion into it without any tangible public benefit. Even the minister himself, Minister Butler, recently labelled it a waste of money for patients and for the health system. It has an ongoing cost of $500 million a year to maintain. It beggars belief that the Albanese government has invested another $950 million in My Health Record. It would be wiser to establish, at a fraction of the cost, a national interest dataset, as was initially recommended by the 2017 Productivity Commission inquiry report Data availability and use. Fostering transparent, consistent, best-practice data governance processes, we can begin to build a real capacity for GPs, for patients and for researchers to analyse and use our complex clinical datasets. Critically, a national primary care data network of this nature could build trust and confidence in our community. Patients need to know that their data will be used for the public good, but they also need to note that privacy, security, access and commercialisation processes are appropriately governed using an agreed best-practice framework.

We have a wonderful healthcare system. We have a national treasure chest of world-class health professionals. Our medical research is amongst the best in the world, and our hospitals and GP services are extremely important to all Australians. I commend this government for making definite improvements to our healthcare system after years of underfunding and of lack of vision, but I implore the government to extend its vision to talk to the experts about our data collection and about all aspects of our service provision. We can and we should provide better health care in Australia. I look forward to working with the government to that end.

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