Monique Ryan (Kooyong, Independent) | Hansard source

by leave—I move amendments (1) to (6), circulated in my name, together:

(1) Schedule 1, item 1, page 4 (after line 11), after paragraph 124ZY(2)(b), insert:

(ba) information about amounts of medical expenses incurred in respect of particular kinds of professional services, including median and interquartile ranges for particular kinds of professional services;

(bc) information about amounts of medical expenses incurred in respect of particular kinds of professional services that exceed the high fee threshold for those kinds of professional services;

(2) Schedule 1, item 1, page 4 (line 21), at the end of subsection 124ZY(2), add:

; (e) quality indicators such as complications rates, re-admissions and patient-reported outcomes for particular medical professionals;

(f) information on professional services rendered by or on behalf of particular medical practitioners that incur upfront fees;

(g) information on professional services rendered by or on behalf of particular medical practitioners that utilise gap cover arrangements.

(3) Schedule 1, item 1, page 4 (after line 21), after subsection 124ZY(2), insert:

(2A) The Minister must publish any formula used to work out an amount of medical expenses for the purposes of publication under this section.

(2B) If the Minister publishes information about medical expenses in respect of particular kinds of professional services rendered by or on behalf of particular medical practitioners, and the Minister becomes aware of a material reduction in those expenses, the Minister must update the published information as soon as practicable after becoming so aware.

(4) Schedule 1, item 1, page 4 (after line 36), after subsection 124ZY(6), insert:

(6A) The Minister must, by legislative instrument, determine formulas for working out amounts of medical expenses in relation to particular kinds of professional services.

(6B) The amount worked out in relation to a particular kind of professional service, in accordance with a formula determined under subsection (6A), is the high fee threshold for that kind of professional service.

(5) Schedule 1, item 1, page 5 (after line 19), after section 124ZZA, insert:

124ZZB Annual report

(1) As soon as practicable after the end of each financial year beginning after the commencement of this section, the Secretary must publish a report about trends identified in the information published under section 124ZY.

(2) Such trends may include:

(a) movements in median price ranges in respect of particular kinds of professional services; and

(b) geographical variation.

(3) The Minister must table the report in each House of the Parliament no later than 6 months after the end of the financial year.

(6) Schedule 2, item 8, page 26 (after line 26), after section 66-12, insert:

66-13 Annual audit of product phoenixing practices

(1) The Minister must cause a review of private health insurance product changes during each financial year beginning after the commencement of this section to be conducted as soon as practicable after the end of the financial year.

(2) The review must consider:

(a) each application made in the financial year in respect of a *product subgroup under section 66-8; and

(b) each application made in the financial year in respect of an insurance premium under 66-10; and

(c) each designated change to a *complying health insurance product in the financial year; and

(d) the number of cases where product phoenixing behaviour was identified in the financial year; and

(e) any issues or recommendations.

(3) The Minister must table the report in each House of the Parliament no later than 6 months after the end of the financial year.

Australians deserve clear, accessible information about the true costs and quality of medical care. For much too long, we've been forced to navigate a system in which price signals have been opaque and quality indicators virtually invisible. These amendments will strengthen the government's bill such that patients and practitioners have meaningful transparency, information asymmetry is reduced and we can potentially create downward pressure on specialist fees.

Firstly, amendment 1 explicitly allows the publication of median fees, interquartile ranges and information on fees that exceed a new high-fee threshold. Patients need to know more than just an average single fee. That's what the government is proposing under this legislation. Patients need to know what a physician's or surgeon's typical costs look like, but they also need to be able to identify those doctors who bill a lot more than their peers. Publishing distributional price information will help patients recognise unusually high fees and compare specialist fees more readily—and, in time, could shift demand away from those outliers who bill excessively.

Amendment 2 broadens the information that may be published under this bill to include quality indicators, things like complication rates, readmissions, repeat procedures and patient reported outcomes. Many people innocently assume that, when it comes to medicine or even the law, higher fees signal higher quality. But the evidence—and my experience as a doctor—does not support that assumption. The quality of specialist service varies, sometimes significantly, but not in the way that fee structures imply. Publishing quality indicators will empower patients to choose medical practitioners on their merits, and it provides the system with an important signal: quality matters just as much—in fact, even more than—fees. Amendment 2 also enables the publication of information about practitioners who charge upfront fees or who rely on gap cover arrangements. These can be key drivers of unexpected out-of-pocket costs.

Next, access to timely data matters. If a specialist materially reduces their fees, the Medical Costs Finder should reflect that. Amendment 3 ensures that doctors who lower their fees will not be punished by outdated, high, historical figures presented as their fees of record. Amendment 3 will create a culture in which specialists can be confident about adjusting fees downward, knowing that the system will recognise, reflect and reward those actions.

The legislative objective of this bill centres on transparency. In my view, the bill must not allow fee figures or the high-fee threshold to be determined behind closed doors. Amendment 4, therefore, requires the minister to publish, through legislative instrument, the method used to calculate those figures. The medical sector should be able to see, to understand and, where necessary, to scrutinise how the system assigns a fee against the services that they deliver. An opaque methodology would undermine trust, and it would contradict the transparency that this legislation is designed to deliver.

Finally, transparency is meaningful only if its effects are monitored, and amendment 5 introduces an annual reporting requirement on trends identified in pricing and billing data. This would enable a parliament to monitor whether or not this legislation is working, whether specialist fees are moderating and whether the millions of Australians who access specialist care every year are actually and genuinely benefiting from the information that will be available to them as a result of this legislation. By embedding these amendments in the primary legislation, we will give those millions of patients greater certainty. Together, these amendments strengthen the bill's legislated objective of empowering consumers, of improving transparency and fairness and of restoring confidence in a private health system that has to work for patients, not against them.

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