Rachel Siewert (WA, Australian Greens) Share this | Hansard source

I rise to make a contribution in this second reading debate on the Health Insurance Amendment (Revival of Table Items) Bill 2009. The Greens have struggled with this issue. We will be supporting this bill because—as we have highlighted on other occasions in the chamber and in fact when the Greens made a contribution to the debate over the extended Medicare safety net—we are concerned about the issues around the rebates. We think that patients are being caught in the middle of a failure to resolve this issue. The government and, to our mind, many ophthalmologists have not engaged in a meaningful debate over the excessive costs that are being charged in some areas. There is no doubt that technology has decreased the amount of time that is required to do fairly standard operations; there is no doubt that some more complex operations require further time; and there is no doubt that some ophthalmologists are churning a number of patients through their operation in a single day. That has increased the rate and has led to the need for the government to start to look at issues around the rebates.

During estimates, as Senator Cormann referred to, there was much evidence presented. There was also a lot of evidence presented around the number of patients that are now being dealt with. There was some fairly convincing evidence about the reduced time it takes to carry out these procedures. But the point here is that people on low incomes and people in rural and regional areas in particular are being caught in the middle. There is no doubt that some patients will end up on the public waiting list. The government’s response to that is, ‘Well, ophthalmologists will be coming out of the private system. They won’t have as many patients in the private system, so they will then be working in the public system.’ I think that is a pretty haphazard way of dealing with patients who are not going to be able to access the private system to get treatment and who will have to go on quite long waiting lists in public hospitals.

The other issue here is that some ophthalmologists, not all of them, instead of engaging in a meaningful debate with the government—and the government has shown some resistance, as I understand it, to engaging in debate—have gone into a scare campaign. That has made the situation worse. They have chosen to engage in the debate through the media and through a media campaign. I do not think that has helped the debate. When the issue arose over ART procedures the government and the profession entered into some negotiations and came up with what seems to be a very reasonable outcome of changing some payments for some scheduling, agreeing to cut some payments for some scheduling and some rearrangement. It did require on that front the government bringing in a cap or threatening to bring in a cap without engagement with the profession. It required a fairly heavy hand in bringing everybody to the negotiation table. That does not appear to have happened here.

There are definitely issues to be resolved. There is not just blame on one side; I think there is blame on both sides. But this issue needs to be resolved because the bottom line here is that patients are getting caught in the middle. I think this is a very heavy-handed approach to dealing with what is a quite complex area. I think the government has been somewhat disingenuous by saying that it is dealing with this issue by bringing in the payment for complex procedures and that that might help in some way to deal with the rural and regional issue where there are more expenses involved as it is harder to access either public or private hospitals for the procedure. The item number for the complex procedure was in fact announced in the budget—it was not brought in as some concession to the ophthalmologists to try and show that the government has been listening and in fact will now be paying for complex procedures. As I understand it, it will be quite hard to access that complex procedure process. It will not deal with the issue that the ophthalmologists have been bringing up of some procedures taking longer, as I understand it from both previous discussion in estimates and talking to ophthalmologists.

There is no doubt that there are issues here. There is no doubt that there is an increase in costs to do with cataracts and that those costs can be reduced. Our concern is that the methods of reducing those costs are not being adequately dealt with by this fairly blunt instrument. The coalition previously, with Senator Fielding and Senator Xenophon, were bringing in an amendment to the compliance bill as a way of ensuring that the schedule item continued—because if a disallowance was moved and it was supported by the chamber then that item number would disappear completely, and that of course is an unacceptable outcome. We are left with an unacceptable outcome if this rebate goes through because we are not convinced that there will not be adverse impacts on patients.

The Greens absolutely recognise the need to deal with runaway health costs and we have also raised those issues. We do understand the issue around large cost increases for cataract surgery. We do not think this is necessarily the way to do it. We do think the government and ophthalmologists should be required to sit down—with an independent facilitator or negotiator if that is what it takes—to try and resolve this issue. Using these blunt instruments in this manner and trying to fix this through counterprocedure after counterprocedure in the Senate is not effective. It looks like this is going to have the support of the Senate. We know very well that, when it goes through, it will go down to the House of Representatives and they will knock it off or they will not support it.