House debates

Wednesday, 28 October 2009

Private Health Insurance Legislation Amendment Bill (No. 2) 2009

Second Reading

Debate resumed from 17 September, on motion by Ms Roxon:

That this bill be now read a second time.

10:29 am

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | | Hansard source

The Private Health Insurance Legislation Amendment Bill (No. 2) 2009 will amend the Private Health Insurance Act 2007 to allow the minister to conditionally list prostheses on the Commonwealth prostheses list and to allow for the creation of rules for listing criteria.

The Private Health Insurance Act requires private health insurers to pay benefits for prostheses for hospital treatment or hospital substitute treatment that is eligible for a Medicare rebate. Currently more than 9,500 prostheses are listed. Prostheses are listed on the advice of the Prostheses and Devices Committee according to mandatory and non-mandatory criteria. The mandatory criteria include: the prostheses must be registered on the Australian Register of Therapeutic Goods; the prostheses must be provided to a person as part of an episode of hospital treatment or hospital substitute treatment; and a Medicare benefit must be payable for the service associated with the prostheses.

As stated, there are also non-mandatory criteria. A non-mandatory criterion states that a listed prosthesis should be surgically implanted in the patient and be purposely designed in order to replace an anatomical body part, combat a pathological process or modulate a physiological process. As highlighted in the minister’s second reading speech, the bill will have particular relevance for insulin pumps. Whilst insulin pumps are currently listed, there has been some ambiguity concerning their status due to the fact that they are not surgically implanted and do not require hospital admission. Insulin pumps may not be surgically implanted but they do replicate the function of pancreatic cells, which produce insulin, and accordingly they may be considered a prosthetic. Insulin pumps provide improved glucose stability and assist in reducing the risk of the complications from diabetes, such as retinal eye disease, nerve disease and kidney disease.

Type 1 diabetes currently affects 140,000 Australian children and adults. All stakeholders would recognise the importance of removing the ambiguity surrounding insulin pumps on the list, and the coalition supports such a move. There have been important initiatives over a number of years now to improve access to appropriate medical services and products for people with diabetes. This is particularly important given Australia has one of the highest incidences of type 1 diabetes, currently the sixth highest incidence globally. The coalition government provided $442 million between 2000-01 and 2005-06 for Diabetes Australia and the National Diabetes Service Scheme. The National Diabetes Service Scheme enables people with diabetes to access subsidies for essential products such as syringes, insulin infusion pump consumables and diagnostic products. The coalition government committed a further $667 million for the period beyond 2006-07.

The current minister made reference to other measures being provided for people with diabetes in her second reading speech. Most notably, the minister mentioned the government subsidy for insulin pumps. The subsidy the minister referred to provides $2,500 for people with type 1 diabetes under the age of 18. Access to the subsidy is also means-tested. However, this subsidy has not been delivered as promised. The minister claimed that the subsidy would benefit nearly 700 children and young adults in a press release of 2 July 2008. Only families with incomes less than $60,000 are eligible for the full subsidy of $2,500. The government budgeted $1 million for the program in 2008-09; however, in Senate estimates it was stated that only $419,000 had been claimed. As of this month, I am advised that only 38 insulin pumps out of the anticipated 700 have been provided to eligible applicants.

The Juvenile Diabetes Research Foundation has been very effective in managing the scheme and communicating with families and health professionals and has successfully generated a high level of interest in the scheme. There have been over 500 enquiries and 164 applications, but uptake has continued to remain very low. With the existing means-testing thresholds, eligible families have been left with too great a co-payment. The co-payment on an average pump costing $7,500 is $5,000 for families earning less than $60,000 per annum. With this bill removing any ambiguity of the status of insulin pumps on the prostheses list, there is a clear incentive for families to take out private health insurance and claim reimbursement after the waiting period if they are in a position to do so, rather than incur the $5,000 co-payment.

The coalition supports the provisions of this bill affecting insulin pumps. However, it seems contradictory for the minister to be prosecuting an ideological crusade against private health insurance whilst expecting insurers to cover for the underperformance of government programs, especially when 75 per cent of new pumps are already purchased through private health insurance. With respect to the conditional-listing component of the bill, there is an argument that certain devices which may not otherwise have been listed should be listed for limited interventions which are shown to be clinically appropriate and cost effective. There is a clear benefit to patients to have access to life-saving devices without blowing out costs to private health insurance.

How conditional listing is implemented in practice may nevertheless prove problematic without careful consideration. Unfortunately, this bill and the minister’s speech provide very little detail as to the process for conditional listing and the conditions which may be imposed. Without sufficient detail, concerns may arise that ministerial power to impose conditions may be too great and curtail clinical decision making of surgeons. Will conditional listing just be imposed on certain types of surgery or will it extend to where surgery is provided, who provides it or to whom it is provided? As stated, there is a compelling argument for conditional listing, but the government needs to provide greater detail regarding the process of imposing conditions to alleviate such concerns. Similarly, without sufficient detail regarding the conditional listing process there is a risk that interest groups will intensively lobby for prostheses which have failed to meet listing criteria and whose clinical effectiveness and cost-effectiveness may be doubtful.

The Health Technology Assessment Review is due to report in late 2009. The scope of the review includes ‘listing of prostheses for private health insurance coverage, as currently informed by the Prostheses and Devices Committee’. It would have been more prudent, in my view, for the minister to have waited for the release of the recommendations of this review before progressing with conditional listing. Waiting for its release may have alleviated the aforementioned concerns regarding ministerial power under this bill for the conditional listing process.

Whilst the coalition do not object to the intentions of this bill, we have concerns about the lack of consultation undertaken, the lack of detail provided in relation to the conditional listing process and the adverse consequences that may result from any rushed implementation. On that basis, we provide support to the bill. We do have a number of concerns, which we hope the government may be able to turn their minds to.

In closing, I acknowledge the wonderful work of many people in this parliament, on both sides of the House, in providing their support to the sufferers of type 1 diabetes. In particular, some of the young children who come to Parliament House on a yearly basis are afforded a very warm reception, and rightly so. The involvement of some of my colleagues has been nothing short of outstanding. Mr Deputy Speaker Washer, your involvement in the health area has been quite amazing. It is appropriate that Judi Moylan is in the chamber today. People right across the country have acclaimed the work that she has done for sufferers of diabetes over a very long period. The passion that she brings to the debate has resulted in better outcomes for sufferers of diabetes, in particular type 1. Long may she continue to do that work for the betterment of sufferers in this country.

10:38 am

Photo of James BidgoodJames Bidgood (Dawson, Australian Labor Party) Share this | | Hansard source

I rise to speak on the Private Health Insurance Legislation Amendment Bill (No. 2) 2009. The purpose of the bill is to amend the Private Health Insurance Act 2007 to allow for conditional listing of prostheses in the Private Health Insurance (Prostheses) Rules and to allow the Minister for Health and Ageing to make rules specifying criteria for listing prostheses in those rules.

Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits for a range of prostheses that are provided as part of an episode of hospital treatment or hospital substitute treatment for which a patient has cover and for which a Medicare benefit is payable for the associated professional service. The types of products on the prostheses list include cardiac pacemakers and defibrillators, cardiac stents, hip and knee replacements and intraocular lenses, as well as human tissues such as human heart valves, corneas, bones—part and whole—and muscle tissue.

Under the current provisions of the Private Health Insurance Act 2007, the act, there is some ambiguity as to whether a device can be conditionally listed where a Medicare benefit is payable for the professional service associated with the provision of the device. Conditional listing will require private health insurance benefits to be paid for recipients of the device where the conditions set out in the rules are satisfied. With further developments in medical technology, it is expected that there will be a greater need for listing prostheses on a conditional basis in the future.

Conditional listing of prostheses in the prostheses rules will require private health insurance benefits to be paid in relation to a high-cost life-saving device to patients who are waiting for a heart transplant. It is expected that patients will be able to maintain a high quality of life with this device, which would be prohibitively costly without private health insurance benefits.

Specifying criteria in the prostheses rules that must be satisfied in order for a prosthesis to be listed in those rules will enable listing of, for example, prostheses that are useful and cost-effective, such as insulin pumps, which will provide benefits to many privately insured families contending with diabetes. Mr Deputy Speaker Washer, we know from all the reports that are coming out, and as you are well aware, diabetes is becoming a major national and international issue. It is very much a lifestyle disease. Through the technologies of our age and through the provision of different types of food, the way those foods are made and preserved, we are seeing a steep rise in diabetes across the nation, and it is something that we do need to try to prevent. Once people have diabetes, particularly type 1, it is really disabling of their whole lives and lifestyle. It is a gross inconvenience to them and anything that we can do to make those people’s lives more contented and satisfied will be of benefit. The means and measures in the changes to these rules and the enablement of private health insurance to help meet the cost of some of these insulin pumps will be greatly beneficial to the lives of people suffering from type 1 diabetes and also the lives of type 2 sufferers who may need some help.

As stated by the minister, products will only be listed where they are clinically effective, cost-effective, provide significant health benefits to patients and can prevent the need for expensive downstream medical costs. The whole decision-making process has been based on clear evidence that it is clinically effective and that it is the best means of dealing with a diabetic situation or any other situation whether it concerns the heart or any of the other organs that I have mentioned, particularly with human heart valves and things like that. It has to be clinically effective, cost-effective, proven and provide significant, not just slight, health benefits to the patient.

At the end of the day the laws and the rules which we are putting down here are all about benefiting the patient and looking after the patient for their whole life—in the community, in the family and at work. If we can help people have a more wholesome, effective life then we have done a good thing. I believe that this legislation before the chamber right now is a good thing and that is why we are backing it wholeheartedly. The new criteria will not override any of the current legislative criteria for listing—that is very important. What it is doing is helping with medical cost. These changes will deliver significant benefits to consumers who are privately insured and seeking to use these and other devices.

Once again, I go back to the fact that as we get older so many things come along which we just do not expect will happen to us. I have just turned 50 and I am beginning to discover a few health issues myself which I never thought would occur to me. God forbid that I should have to action some of the things that need to be done in some people’s lives; there but for the grace of God go we. Good government, good laws and good rules are about thinking about other people, not just ourselves. Even though things that I have mentioned here may not be happening to me personally, or to any of us personally, they are happening to people across the nation. While they may not be occurring in massive numbers, nevertheless, they are affecting people’s lives and their quality of life. People’s health is important and legislation like this goes to that. If we can prove clearly that we have things that are clinically medically effective and that are the most cost-effective and there is clear evidence that they improve a patient’s quality of life then I think we are doing a good thing. The Private Health Insurance Act 2007, which this bill amends, and the recommendations that are before us are good. It is a good act, it is a good amendment and it makes good provision for the Prostheses List. I can not say more plainly or more clearly how wholeheartedly I back this bill and commend it to the House.

10:46 am

Photo of Judi MoylanJudi Moylan (Pearce, Liberal Party) Share this | | Hansard source

I spoke in this place recently about this matter but I think some of my comments bear repeating as there are some very important issues for this debate. The Private Health Insurance Legislation Amendment Bill (No. 2) 2009 provides that opportunity. Back in 2005 the Commonwealth government made a series of improvements to the Prostheses List arrangements so that insured patients had access to a range of clinically effective and appropriate prostheses at a reasonable cost. For us in this place one of the great challenges is how we can deliver best-practice medicine to people and at the same time make sure that the systems we put in place are cost-effective and make the best use of the available money in the health portfolio. Those tensions are not easy to manage.

The Review of the Prostheses Listing Arrangements, which was chaired by Mr Robert Doyle, stated that the fundamental logic of the new arrangements was that prostheses should be listed if they were clinically effective; that items of equivalent clinical effectiveness should receive the same benefit, and that incremental benefits should be available for incremental improvements in clinical effectiveness and cost effectiveness; that there must be a prosthesis available for every Medicare Benefits Schedule item, provided at no additional cost to the patient; and that sponsors wishing to charge more than the assessed cost-effective benefit could do so and the patient would then pay the gap. The arrangements were constructed so that independent clinical advice was central in determining questions of clinical effectiveness.

We know that any debate about anything, particularly to do with medicine or science, is fraught with difficulty for ministers and for those of us in this place trying to pick our way through some of these complex bills, because there are a variety of viewpoints. You just have to read some of the literature on this subject to see the different opinions about the clinical effectiveness of some devices. The minister will have power to conditionally list prostheses. It has been argued that this power could be used as a tool to impose limitations on the clinician’s ability to choose the most appropriate listed prosthesis. Others have argued that without sufficient detail and safeguards governments will be relentlessly lobbied to include items on the list item which may not be cost effective. So we can immediately begin to grasp the complexities of administering such a program.

On 9 September 2009, Amy Corderoy wrote an article in which she said:

Identifying which Type 1 diabetes patients will benefit from public hospital-funded insulin pumps may be difficult, according to a clinical audit undertaken in Western Australia.

“Patient selection [for insulin pump use] is important, as insulin pumps are cost-effective only if they reduce levels of glycated haemoglobin (HbA1c) and the frequency of hypoglycaemia – although quality of life may also be an important benefit,” Dr Ken Thong and colleagues from Fremantle Hospital and the University of Western Australia wrote in the MJA.

The endocrinologists identified over 100 patients who had received both public hospital-funded insulin pumps and privately health insurance-funded pumps (32 public and 77 private) over an eight year period.

The public patients had had more hospital admissions than the private patients both before and after the commencement of insulin pump therapy (0.7 vs 0.3 admissions per year p=0.02).

After commencing pump therapy, HbA1c levels fell significantly in the private patients (8.7% vs 8.0% p<0.005) but not in the public patients (9.2% vs 8.9% p=0.17).

There was also no significant difference in diabetes-related admissions before and after commencement of pump therapy in either group.

“We need to think very carefully about which patients we should be offering pump therapy to,” co-author Professor Bu Yeap told Endocrinology Update.

However, he added that the study was too small to conclude that it was not cost-effective to treat patients with publically-funded insulin pumps.

“The public patients tended to have more difficult to control diabetes in the first place and that may be why we didn’t see a similar improvement in HbA1c,” he said.

“It’s a glass half empty half full kind of thing. It’s very pleasing that in the [private] group we did see a reduction in HbA1c… but it has made us think much more carefully about whether we should set up more formal criteria for pump usage”.

I draw that to the attention of the House firstly to illustrate the complexity of the differing views and some of the studies that have been done on this but also because I wanted to focus on insulin pumps in particular in my remarks on this bill, which basically stipulates that private health insurers must pay benefits for prostheses that are provided as part of an episode of hospital treatment or hospital substitute treatment and for which a Medicare benefit is payable for the associated professional service.

The Commonwealth prosthesis list contains all those products that fit the above mandatory criteria. The Minister for Health and Ageing determines what products are on the list, having regard to the mandatory criteria and also non-mandatory criteria. Currently, a product is either listed or it is not. This legislation will establish a conditional listing category on the list for products that are not appropriate for general use but are clinically effective in specific circumstances. In the second reading speech, the minister for health specifically pointed to insulin infusion pumps as an example of a product that should be conditionally listed. In that speech the minister said:

The amendments proposed in the bill would enable the device to be listed on a conditional basis, ensuring patients have access to life-saving treatments in a way that controls the additional costs to private health insurance.

All private health insurers make payments towards insulin pumps, as they are on the prosthesis list; however, there has always been some uncertainty about their long-term status on the prosthesis list because they are not surgically implanted, do not require hospital admission for initialisation and are not associated with a Medicare Benefits Schedule item. This uncertainty was recognised in the government’s review from which I just quoted. The review noted:

Under current arrangements insurers are not required to pay benefits for products provided in these circumstances, even though the items are included on the List.

Therefore, this legislation is aimed at resolving the uncertainty by creating a new sublist for devices such as insulin pumps that do not meet the mandatory criteria but should still be on the list in certain circumstances.

Where an individual has access to private health insurance, they are not then eligible to receive the means tested insulin pump subsidy, and this is one of the matters I would like to raise in addressing the issues around this bill. There are other challenges, as well, in relation to insulin pumps. The devices are constantly being improved, there is new technology, and there are already other challenges facing us with new insulin pumps incorporating continuous glucose monitoring devices. The cost of the transmitter components of these devices is reimbursed through ancillary health insurance by only some private health insurers. The sensor components are not covered, nor are they eligible for any government subsidy. The insulin pump program has also not been as effective as we would have liked it to have been. I am pleased to see that the Minister for Health and Ageing is currently reviewing that program; that is welcome.

I raise these issues around insulin pumps because, as I have said in this place before, back in 2000 we started the Parliamentary Diabetes Support Group. I would like to acknowledge the participation and incredible work of the member for Moore, who is currently in the chair today. He has been a tower of strength in that group and has been able to help draw greater attention to the issue of diabetes within the community. Many of my other colleagues have joined us in that group as well. There are Senator Guy Barnett, who is part of the executive, and my colleagues the member for Lyons and the member for Isaacs. All of the members who agreed to join that group participate in the many activities that from time to time take place.

I suppose that one of the most successful and moving of those activities co-sponsored by the Parliamentary Diabetes Support Group and the Juvenile Diabetes Research Foundation was the Kids in the House program, where 100 children from all over Australia were flown to Parliament House with their carers to talk about what it is like to be a kid with type 1, insulin dependent, diabetes. Their stories, quite frankly, were heart wrenching. I think I have rarely, if ever, attended a function in this place where I have seen some of my colleagues actually openly weeping. They were very moving stories indeed. Juvenile diabetes really does rob young people of many opportunities, and that is what these young people talked about: the limitations that were placed on their lives, often from soon after they were born and diagnosed with insulin dependent, or juvenile, diabetes.

These children also have a lifetime of high-level care to manage this disease. Every day, they have to pay attention to their insulin levels: to monitor them, to have multiple finger pricks to test the levels of insulin in their system and then, of course, to administer a dose of insulin where that insulin level falls too low. If their insulin levels fall too low, these young people can fall into a coma. I will talk more about that in just a moment, but it does have a dramatic impact. These young children who came to Parliament House on two occasions—and I think there is soon to be a third—had an opportunity to go around this parliament and talk one-on-one with their member of parliament and the senators for their state and to express to them the difficulties and the challenges they confront as insulin dependent diabetics and to plead with this parliament to consider directing funding to research. to find a cure for juvenile diabetes. The theme of the young people was ‘promise to remember me’. I do not think that anyone who spoke to the young people visiting here was not profoundly touched by that experience.

Type 1 diabetes is an autoimmune disease, which is something people sometimes get mixed up about. Young children have said to me, ‘We’ve often been teased at school that we’ve got diabetes because we eat the wrong things and we’re overweight, or we’re overweight because we don’t look after our health,’ so there is a lot of confusion in the community. Type 1 diabetes is an autoimmune disease affecting some 140,000 Australian children and adults. There are a lot of children affected by this, and we have to be concerned that we have one of the highest incidences of type 1 diabetes globally—in fact we are sixth in the world—and that rate is continuing to increase in Australia by three per cent per annum.

Ninety-five per cent of diabetes in children is type 1 diabetes. Type 1 sufferers experience more than 40 dangerous hypoglycaemic—that is, low blood sugar—episodes a year. As one mother said, ‘My biggest worry when I go into my son’s bedroom every morning is whether I can wake him up.’ The origin of setting up the Parliamentary Diabetes Support Group was a visit to my office by a couple and their very young boy in his early year of primary school who had type 1 diabetes and was experiencing great difficulty. His medical practitioners were experiencing great difficulty even in levelling out his insulin levels. His parents would have to wake him up several times during the night, test his insulin levels and administer medication as required. This was interfering with this young boy’s ability to do his schoolwork. Being woken two or three times during the night for testing and then medicating, he would go to school the next morning feeling pretty lousy, so his schoolwork was not going well.

This family, who were not wealthy people at all, scraped up the money to get him onto an insulin pump, which made a huge difference to their peace of mind and to his lifestyle. This young man went on to be dux of his school, and the family generally come to me once a year around Christmas time and he gives me an update. The difference has been really remarkable. What I want to do in this debate today is stress the importance of not just stating—as governments have done successively, which is good—that diabetes is a national health priority but then matching that rhetoric with the best possible medication and the best possible access to devices that will give children in particular a good quality of life and perhaps increase their lifespan. Young people with juvenile diabetes on average live fewer years than the rest of us do, even with the best of care, and they face a lifetime of really quite horrendous health complications. So we need to recognise that there are major lifestyle and quality-of-life issues around access to the best possible medicine and the best possible devices. When it comes to children, we should be generous in making sure that they have the best possible access.

Every hypoglycaemic episode causes physical and psychological harm. Hypoglycaemic episodes affect cognitive function and memory as well. These pumps are not for everyone, but for many young people they can be a very important part of the management regime. Twelve to 15 years after the onset of diabetes, devastating complications can set in, and I have mentioned those many times in this place. Diabetes is the leading cause of adult blindness, heart attack, stroke and lower limb amputation and is the most common cause of kidney failure, at 40 per cent. Fifty per cent of people with diabetes die of cardiovascular disease. So there are myriad complications around this disease, and it is particularly tough for children and their families knowing that they have to face such life-threatening illnesses along the way.

I also pay tribute to the work of the Juvenile Diabetes Research Foundation because it was with them that we pushed to get the consumables that go with the pumps. These are things that have to be changed every couple of days. They are the devices that allow the pumps to do their work. In addition to the $7,000 or $8,000 that the pumps cost, the parents of the young boy that I saw came to me and said: ‘We’re paying out $2,600 a year for these devices. Can you get them listed on the NDSS?’ That is why we started our group. We went to work and convinced the then Howard government to list these devices on the NDSS and assist parents. Some families have several children with diabetes, so it can become a huge imposition.

The insulin pumps are used to closely mimic the insulin delivery of a healthy pancreas for more predictable and tighter blood glucose control, and that is why these are so important. So, whatever we are doing in legislation—and with this legislation in particular—we need to be very mindful that we do not deny people the opportunity for improved long-term health outcomes by them not being able to access insulin pump therapy. I ask the minister to closely examine this legislation to iron out any of the glitches and also to look at the subsidy program that currently is not working as successfully as it should. I look forward to the outcome of that review and making sure that more low-income families can access insulin pump therapies for their children.

11:06 am

Photo of Shayne NeumannShayne Neumann (Blair, Australian Labor Party) Share this | | Hansard source

I speak in support of the Private Health Insurance Legislation Amendment Bill (No. 2) 2009 and, like the previous speaker, I want to focus on diabetes, but I will go through the conditional listing issues first. This is a good piece of legislation because it allows the minister to engage in conditional listing. It really means that in those circumstances where a prosthesis is necessary on the basis of clinical circumstances a listing can be given. There has been some commentary about ministerial discretion here and whether or not this is the right thing to do, but in the circumstances I think it is clear that we need to make these changes.

There are a variety of different prostheses. I see a few doctors in the chamber at the moment. As a humble lawyer, I do not propose to make any comments about the various natures of prostheses except that they are many and varied and that medical technology has advanced enormously in our lifetimes. We can barely imagine the kinds of changes that are going to happen in the next century. But the legislation does require private health insurance operators to pay benefits for prostheses which are part of an episode of hospital-substitute treatment and for which a Medicare benefit is payable for the associated professional service. It is the case that prostheses enhance the lives of so many people. All of us in this place would know constituents, friends and relatives who have been saved by knee replacements, hip replacements, pacemakers—various kinds of prostheses which have not only saved the lives of individuals but also enhanced their quality of life. They enabled these people to enjoy and have an abundant life which they could not otherwise enjoy, and I can think of numerous friends of mine whose lives were full of sport and recreation who by virtue of age, illness and injury have suffered the travails of being immobile, and who have now received hip replacements and knee replacements and have enjoyed a quality of life which they could barely imagine during their times of disability.

So what we are doing in this legislation is important. It is unclear, as the minister said in her second reading speech, whether a prosthesis can be conditionally listed in circumstances where a Medicare benefit is payable. I had a look at what the minister had to say, at the Bills Digest and at the other commentary on this matter, and it seems very clear that a surgically implanted device can be listed for general use or simply not listed at all. The conditional listing will enable the device to be listed in some circumstances. Where a patient can get access to life-saving treatments and other quality of life assistance, this will enable the person to live a productive, healthy life.

That is a fair and decent thing to do in our society. It is important that we enable all our citizens to be part of community life and to enjoy the kinds of activities which they would have enjoyed previously. We believe in social inclusion. Providing assistance by way of prostheses makes a real difference in our community life. There are many people who can participate in RSL groups, in church life, in sporting clubs as coaches and in other activities which they otherwise would not have been able to do. I am happy to speak in support of this legislation because I have seen the benefit of prostheses amongst my friends, relatives and constituents. I have seen what it can do for their lives.

The second aspect of this legislation deals with the issue of insulin pumps and ensuring that the Australian community can get access to those pumps. This will make a difference to people’s lives, particularly those of children suffering from type 1 diabetes. All of us see constituents in our offices on a weekly basis, but one of the things that really struck me the most was the meeting I had with a fellow in his thirties, married with a young son who, the next year, was intending to go to a local primary school in my home city of Ipswich. The parents came with their little boy and showed him to me and talked to me about him. They were extremely worried about how he would cope with primary school in 2008—the meeting took place just after I was elected in November 2007. I remember that meeting vividly because the mother had tears in her eyes and the father had a pained and anguished look. They had, because of their circumstances, had to borrow money from a relative to pay for an insulin pump. Even then, they were concerned about how their son would be able to manage it when he commenced year 1 the next year. It brought home to me the stark reality of the difficulties faced by parents who cannot afford a pump. It also brought home to me, who has been blessed with having two children who do not suffer from diabetes, the difficulties parents have to suffer—the anguish, anxiety and sheer agitation of thinking that their son or daughter might die at any moment of the day.

I was pleased that the Rudd government undertook to provide a subsidy of up to $2,500 for insulin pumps for people with type 1 diabetes. I took the opportunity, after that meeting, to have a look at the impact of type 1 diabetes, and diabetes generally, on my local community. This legislation will enable a new part of the Prostheses List to include those devices which are not surgically implanted so that people with type 1 diabetes will be able to get access to insulin pumps, which are integral to their lives, in the circumstances. I have had a look at what diabetes was doing to my community and I have had a look at what the Australian Diabetes Map said about my electorate of Blair in South-east Queensland. I also noted that the International Diabetes Federation asserts that, by the year 2010, 285 million people will live with diabetes worldwide. The 2006 census says that, in my electorate of Blair, which is about 70 per cent of the city of Ipswich, the Lockyer Valley and the Fassifern Valley to the west and south-west, some 5,743 people have been diagnosed with diabetes.

Local doctors tell me that there are likely to be vastly more people who are undiagnosed. On just about every statistic, whether it is on gestation or type 1 diabetes or type 2 diabetes, my electorate is almost always above the national average. For example, according to the 2006 census, there are 4,773 people suffering from type 2 diabetes in my electorate. The percentage of the group suffering from diabetes is 82.85 per cent but in my electorate it is 83.11 per cent.

The number requiring insulin, which is a more pertinent statistic, is about 1,967 of that group of people who are suffering from diabetes. The national average is 32.15 per cent, but in my electorate of Blair it is 34.25 per cent. According to the census, there were 47 people using insulin pumps at that stage. Again, we are above the national average with 0.82 per cent whereas the national average is 0.71 per cent. In my community there are 327 veterans with DVA, which is 5.69 per cent as opposed to 3.95 per cent nationally. Also, we have a large Aboriginal community in my electorate, and again, this is above the national average in that regard.

My electorate is more affected by diabetes than most others across the country so the legislation before the House is important. The fact that government is contributing large sums of money to the National Diabetes Services Scheme—according to the minister, it is in excess of $126 million—is important for my electorate. It is important that we enable families, like the family with the young fellow who came to see me after I was elected, to get access to the Pharmaceutical Benefits Scheme for things like insulin. We do expend more than $300 million on those types of medicine through that scheme. People without private health insurance suffer greatly because they cannot get access to the assistance they require and have to rely on family and friends or their own resources. It is one of the reasons I support the private health insurance schemes in this country. I think it is important that we do it. The conversations that I had with that family, and with other constituencies who have subsequently spoken to me, is what the member for Pearce had to say: the anxiety and the worry of going into their son and daughter’s bedroom in the morning and finding they do not wake up as they have had an ‘episode’. This is how they euphemistically described it to me. As a result, their beloved child is no longer with them. Health complications from diabetes impacts not only those young people, but also those people who suffer type 2 diabetes.

On 8 October I held a health forum in my electorate at the University of Queensland Ipswich campus. I want to commend Professor Helen Chenery from the Faculty of Health Sciences for her assistance and the University of Queensland Ipswich campus for their help. The University of Queensland Ipswich campus is undertaking an Ipswich study which is a long-term study into the health needs of a community in the Ipswich and West Moreton area. Professor Robert Bush is involved in that study. It is the site of the GP Superclinic, a $2.5 million commitment by the Rudd Labor government.

The focus of the GP Superclinic will be not only chronic heart disease but also type 2 diabetes and assistance to parents of young children suffering from type 1 diabetes, which are so prevalent in my electorate. This topic came up at the health forum because preventative health is so crucial with respect to type 2 diabetes. I urge the government to consider the Ipswich and West Moreton area being designated as a regional health innovation site. Diabetes is just another reason that the government should think about that, and I urge the government to spend far more than simply two per cent of our total expenditure on health and hospitals on preventative health. That is why I am incredulous about the fact that the coalition can simply oppose the reforms that are currently up in the Senate. I find it amazing, because there are decent and good people sitting opposite as there are on our side. I cannot believe they cannot see that this is a very important health innovation measure to improve the wellness of our community.

The legislation before this chamber is important. It is important because it will affect the lives of parents and young people suffering from type 1 diabetes, but it will also allow the minister to take a more clinical approach based on medical advice and make sure that prostheses are more available to and more cost-effective for our community. It will allow parents and patients to listen to the real needs of their bodies and their children’s bodies. This is important legislation. For this reason and for the health of my community I support this particular bill.

11:22 am

Photo of Bruce BillsonBruce Billson (Dunkley, Liberal Party, Shadow Minister for Sustainable Development and Cities) Share this | | Hansard source

I rise to add some comments to the debate on the Private Health Insurance Legislation Amendment Bill (No. 2) 2009. As it has indicated, the opposition is not opposed to this bill. We see some virtue in it but, as with many things that the Rudd government does, the virtue in the bill is not matched by dexterity in its execution. That is one of the areas I would like to touch on today. Essentially, the bill will amend the Private Health Insurance Act to allow the minister to list a prosthesis on a conditional basis that specifies the purpose for which it can be utilised and, once it has passed a number of new tests aimed to ensure that it is of a life-saving characteristic, that the prosthesis has cost and clinical efficacy—all perfectly reasonable factors—and that it has been assessed as fit for the purpose for which it is intended to be implanted in the body.

This is achieved by adding a new listing beyond the current listing arrangements which provides for the general use listing of prostheses. Broad, unconstrained use of prostheses has in some cases seen prostheses not listed because of the specificity of their intended use, and the only scope available for the current listing is on a general use basis. That of itself seems a reasonable thing to do with new technology bringing new devices, with the progress of health and medical innovation seeing new opportunities for prostheses to improve the standard of living of people to carry forward and nurture their health and wellness. We need to accommodate the new technologies where they can be listed for a particular purpose. As I said, at the moment there is only a general listing provision. This amendment seeks to offer a conditional listing facility to accompany the private health insurance industry’s funding of those particular devices.

The thing that is quite strange is that, whilst that is all positive, you would have thought some internal consultation would have been worthwhile. It is ironic and, frankly, quite worrying that we have this bill before the House to give that new power to the minister. The power is a coathanger power. It does not specify precisely what devices it applies to and how it will be used. There is a whole lot of subordinate legislation in the form of regulations that will give effect to those listings, so that is all still to come. What is strange, though, is the imposition of limitations on the clinical use of prostheses. That is something that I would imagine many in the medical profession would be wary of. They would be concerned about the government mandating particular applications of technologies where they, in good conscience and driven by the patients’ best interests, might see another opportunity for the application of that technology for lifesaving health and wellness improvement. We do not know how that will work because these are very early days. We are assured that there will be sufficient safeguards, that the clinicians will continue to be very patient centred in their approach and that where they see an opportunity for improved health outcomes which involves a prosthesis there will be some machinery there to make that case.

We hope those safeguards, though, will not see a relentless process of clinicians lobbying the government to recognise the application which they, in good conscience and considered clinical judgment, think is in the interests of the patient but is not covered by the conditional listing as it stands. They will have to say to the patient, ‘Just wait for a sec. The technology may have been designed for the purpose for which I am recommending it be used. This prosthesis is available. It is something that will have very positive and cost-effective clinical outcomes that will advantage your wellness and health. We can argue that it is cost-effective but it has not got the tick yet from the Commonwealth to allow it to be covered by your health insurer.’

We hope there will not be another group of lobbyists beating a path to Canberra. The place is jam-packed with lobbyists at the moment. It seems nothing can happen in this country unless you have sucked up to and spent a lot of time bonding with the government. Private enterprise seems to be dwindling, as businesses now need to get the Rudd government imprimatur for everything that goes on in this country. That is why the biggest growth industry in Australia at the moment is lobbyists, coming to see whether some of the taxpayer largesse that is being doled out in abundant volumes can come their way. Clinicians will have to make sure, as they come to lobby to get a prosthesis conditionally listed, that they can at least get a flight on a plane, to have the chance to get up here. They might need to arm wrestle and bump off some other people, as they all want to come to Canberra because all knowledge is here, apparently.

It is quite amazing that, with that abundant knowledge and perpetual wisdom that we have now in Canberra under Prime Minister Rudd and his team, they have not quite managed to join up some dots. We see this in so many areas of government policy. You, Deputy Speaker Washer, were instrumental in releasing yesterday the report of a parliamentary inquiry into the impact of rising sea levels on the coastal zone. It is a very interesting report. I have enjoyed reading it and I commend you for a number of the measures in it. But it did make the point that we have not quite managed to join up government decision making. It is still very bitsy. It is even bitsier in the health portfolio. The diligent professionals in the health portfolio seem to have missed that there is a health technology assessment review going on and it is due to report later this year. You would have thought that the machinery that is being enabled by this legislation would have taken account of that review. The scope of the review includes:

… listing of prostheses for private health insurance coverage, as currently informed by the PDC

that is, the Prostheses and Devices Committee. I would have thought that the work going on in that review would have informed this bill, but the bill is pushing on without having the benefit of that review’s findings. I hope some synchronicity can be achieved at some point down the track. You would have thought it would be sensible and wise to wait for the release of the review’s recommendations before acting on something that the review is designed to address. But this is the way things happen now at the ‘Kremlin’ here in Canberra, where so much is going on.

That disconnection is worrying. That is not a reason for the opposition not to support the bill. It just highlights the abundant lack of consultation, the lack of detail and the lack of connected, coordinated decision making that seems to be very much a character of this Rudd Labor government here in Canberra. On that machinery, we will have conditional listing capability that will not remove the general listing provision that is there now but add a new listing capability. That should be a good thing, but, as I mentioned earlier, how clinicians will interact with it is another matter.

As a former Minister for Veterans’ Affairs, I was highly exposed to some of the issues that the previous speaker spoke of. I regularly was approached and informed about insights clinicians could bring to the care, treatment and wellness of the veterans community, which in some cases involved the innovative use of clinical technologies and practices that had been developed and carried forward. We were very keen to accommodate that, as we aimed to give world-class health care and support to our veterans community. Here is an example where some of that innovation might run into a little bit of a roadblock with the listing process. However, the good thing is that conditional listing presents more opportunities than general use listing, which might not have seen some of these new technologies embraced in the first place.

The second part of this is the listing of the insulin pumps. I am pleased that this has again come to the government’s attention. It is quite fascinating that the government announced its own scheme after initially resisting the opposition’s case, and the opposition’s election commitment, to introduce a taxpayer subsidy for insulin pumps for people coping with the challenge—and in some cases the despair—of type 1 diabetes. We had to drag the Rudd Labor government kicking and screaming to actually pick up that national campaign, which I am pleased to say was launched by the then Leader of the Opposition, Brendan Nelson, in my electorate back in April 2008.

It was a great campaign launch. The then shadow health minister, Joe Hockey, was there, along with Richard Colbeck, the senator from Tasmania who was then opposition parliamentary secretary for health. It was a really good launch and a key outcome of the listening tour that Dr Nelson had undertaken. We had made an election commitment, one that the Rudd Labor government had not matched. We then had to go and make the case again in the lead-up to the 2008-09 budget to try and highlight to the Rudd Labor government not just the moral case for giving people with type 1 diabetes optimum opportunities to live full, rich and enjoyable lives but also the health case and the cost-effectiveness of supporting the deployment of the latest insulin pump technology.

Thankfully that message was heard by the Rudd Labor government, and I for one was encouraged to hear welcoming noises in the 2008-09 budget about a subsidy program for insulin pumps. What has been most disturbing has been the fact—and I am sure the Australian public must be waking up to this—that the publicity, the headlines, the stunts and the media spin are just like a warm-up act. What actually happens afterwards looks very different in many cases. Sadly, in the case of this insulin pump subsidy, that is exactly what has happened. We were reassured, on the back of the opposition campaign for 5,000 children, particularly, to benefit from government subsidies, that the Rudd Labor government would pick up that measure. What has happened, though, is that the implementation has fallen so far short of the promise, the hype and the headline hunting of the announcement in the first place. That is not only a political travesty; think of the implications for the people involved.

On the listening tour and at the launch that happened in a hospital in my electorate, we met parents and children who were so supportive of what the Liberal and National parties were trying to do, so encouraging of us taking the pressure up to the Rudd Labor government and bringing the case to Canberra to demonstrate the cost benefits as well as the lifestyle advantages of insulin pumps, particularly for children.

There were examples that moved us. I remember a wonderful woman from Dingley who had two children that were type 1 diabetic and insulin-dependent. She was describing to me the emotional and financial obstacles that she had to face and the demands on her parenting. Her children were some of the most stoic and spunky little humans I have seen. They had so much go to them, even though every day started with an injection, every day they had to monitor their condition and every day their blood sugar levels were uppermost in their minds, even when they were trying to work out what Dora was talking about in Spanish on the latest episode of Dora the Explorer. Such gripping things that would occupy most kids’ minds were secondary; these young kids had to keep themselves healthy. She broke down while describing to me how much it was going to cost and what a difference these insulin pumps would make to her children’s lives and how there was no way on earth by which she could possibly afford to buy one. She was totemic of why we mounted this campaign—so totemic that no-one could come away other than completely convinced that this was the right way forward.

So we have had the announcement that the government would provide these subsidies, but the subsidies have not been delivered up to what was promised. The Minister for Health and Ageing claimed the subsidies would benefit some 700 children and young adults. That was in Minister Roxon’s media release back in July 2008. The government had a budget estimate—it was about $1 million—and yet less than half of that has been claimed. Only 38 insulin pumps out of an anticipated 700 have been provided to eligible participants. That is from evidence tendered at a Senate estimates committee.

How do we explain this to that mother from Dingley? How do we explain the eligibility criteria that see the subsidy so out of reach for people, even for those on regular incomes; that they cannot access it. She must be wondering, ‘Such promise; such hope.’ It is a campaign that was led by the Liberal and National parties and is one we continue with in opposition, making the case. Then we get the announcement from the minister and, typical of the Rudd Labor government, it is all announcement and no follow-through. And we have this appalling situation.

Opposition Member:

An opposition member—All froth; no beer!

Photo of Bruce BillsonBruce Billson (Dunkley, Liberal Party, Shadow Minister for Sustainable Development and Cities) Share this | | Hansard source

Absolutely. We are now faced with a very modest percentage of families benefiting from a program that for them was just such an enormous program of hope given that the government was going to assist them and those kids, who had such spunk, would have had support from the government.

Photo of Andrew LamingAndrew Laming (Bowman, Liberal Party) Share this | | Hansard source

Will they get a laptop at school?

Photo of Bruce BillsonBruce Billson (Dunkley, Liberal Party, Shadow Minister for Sustainable Development and Cities) Share this | | Hansard source

Who knows whether they will get a laptop at school. Just being well enough to learn as well as they can at school was their first hope. They recognised that what the opposition was advocating would deliver that. They then heard the echo from the Labor Party sometime afterwards and then found, sadly, from these figures provided to the Senate estimates committee that it was a hollow echo. It in no way matched the leadership that the Liberal and National parties were offering.

What has happened now is—in a belated recognition that private health matters, that the public system has pressures and demands and plays a crucial role—we are now turning back to the private sector. We are now saying to the private sector through private health insurance, ‘Will you provide these devices? We will list these devices. Yes, we have just planned to introduce rules that prostheses need to be medically implanted, but an insulin pump is not medically implanted, therefore—gee—we had better put another listing together.’ Thankfully that listing will at least see the private health community fill this void—this void between expectation and political spin and delivery—that the Rudd Labor government has created.

So here today we are debating a bill to allow the private health insurance sector to do what the Rudd Labor government promised it would do and has not. There are so many points you could make out of that. The totemic example of how this Rudd Labor government—this federal Labor party—governs for the country is captured through this. The example of people who promise so much and deliver so little is captured through this. There has probably been more money spent promoting the program than has been delivered—more effort gone into the press release than in the execution of the support for families that desperately need it. And then, at the end of the day, all is well and there is only wisdom in Canberra! That seems to be the prevailing attitude of the current government. Now there is a recognition that the private sector has a role to play—belatedly—and the private sector will have to mop up this underperformance of the Rudd Labor government.

In my own community of Dunkley, there are about 878 people living with type 1 diabetes. The number registered with type 1 diabetes across Australia at 30 September 2006 was 122,000 plus. This has an enormous impact on young people. The rate at which type 1 diabetes is emerging in our younger population is very concerning, and the community that I represent has not been excluded from it. It has been the focus of local media coverage as those statistics about condition prevalence have come to attention. Diabetes Australia have done a remarkable job of highlighting how important this is to the local community.

The Liberal and National parties understood that, acted, provided leadership, made an election commitment and carried that through after the election. The Liberal and National parties understood what was going on and educated the Rudd Labor government. The Rudd Labor government picked up the topic and made the statements but has not delivered. So this—a belated recognition that the private health insurance industry matters in our private-public community health model in Australia—is something that we should welcome. It again makes you wonder why the Rudd Labor government is undermining private health with its changes in the subsidy for private health insurance incentives, why it is again looking to private health to perform where the Rudd Labor government could not but at the same time making it harder for the private health industry to do more, as incentives and encouragement are wound back by Canberra.

It is just another example where health policy seems to be very disconnected. I highlighted that there is concurrently a review about this very subject while we are debating the topic in the House. Here is an example of private health being asked to do more when it is actually being made less attractive for people and the private health industry is being put under pressure by this government. The Labor government is saying: ‘Do more, private health industry. We’re going to make it harder for you, but we’re going to expect you to do more.’ That is what this bill is about.

It is like the medicentre in my electorate, where the 12,000 to 14,000 category 4 and 5 attendees at the accident and emergency department at the Frankston Hospital have an option. They can go to a medicentre, an after-hours GP clinic. The Rudd Labor government is going to halve the funding for that program, a program that has been going for decades with the collaboration and support of GPs, who have been able to stay in their practices knowing they do not have to get up, possibly every night, in the middle of the night to attend to their patients because there is a collaborative after-hours service available. It has kept GPs in the practice of being doctors. It has supported the health services in our area. And now, for all of that good work, it is going to have its funding halved. All that will do, potentially, is send a large chunk of those 12,000 to 14,000 category 4 and 5 patients back into the emergency department—the emergency department that is under such pressure. Rather than increase the resources, the state Labor government has increased the size of the waiting room.

What is going on here? The collaboration that is needed in health policy is missing. It is evident in this, and we see it in so many areas. We are not opposing the bill, but there is a lot of work to be done to make it work. (Time expired)

11:42 am

Photo of Mark ButlerMark Butler (Port Adelaide, Australian Labor Party, Parliamentary Secretary for Health) Share this | | Hansard source

I think all members of the parliament recognise the passionate advocacy of the former member for Bradfield, the former Leader of the Opposition, in this area and a range of other areas in the health sector, but it is rather graceless of the member for Dunkley not to confess to the sin of omission of the previous government in doing nothing in the area of insulin pumps for 11½ years. The member for Dunkley might also like to explain to his constituents who need insulin pumps his view that we should not proceed with the Private Health Insurance Legislation Amendment Bill (No. 2) 2009 pending the health technology assessment, when, if you read the bill, you know that, when passed, it will facilitate the uptake of insulin pumps. Leaving aside the internal inconsistencies and very selective reading of history by the member for Dunkley, I thank members for their contribution to the debate on this bill and particularly note that the government has noted the contribution of the shadow minister to the debate on this bill.

The Private Health Insurance Legislation Amendment Bill (No. 2) 2009 will amend the Private Health Insurance Act 2007. The bill provides for amendments to the act to allow for conditional listing of prostheses on the Commonwealth Prostheses List and to allow the Minister for Health and Ageing to make rules to specify criteria for listing prostheses on the list. Under the act, it is currently unclear whether a prosthesis can be conditionally listed where the prosthesis is provided in circumstances where a Medicare benefit is payable. The bill will allow for the rules to set out criteria that must be satisfied for an application for listing on the Prostheses List to be granted, including different listing criteria for different circumstances. I commend the bill to the House.

Question agreed to.

Bill read a second time.

Ordered that this bill be reported to the House without amendment.