Richard Di Natale (Victoria, Australian Greens) Share this | Hansard source

By leave—I move:

That the Senate take note of the report.

The out-of-pocket costs in Australian health care inquiry report makes for some interesting reading. This was an issue that I referred to the Community Affairs References Committee prior to the handing down of the budget. There was recognition that one of the great challenges in health care is the significant out-of-pocket costs for ordinary consumers and the impact they are having on access to health care.

Firstly, it is important to define the nature of the problem and to understand what sort of health expenditure is included when we are talking about out-of-pocket costs—that is, the costs borne by the consumer, not by any insurance or government funding. We learnt that in Australia we spend a lot on non-pharmaceutical, non-PBS medications. It is one of the largest areas for out-of-pocket healthcare costs. But we also know that dental care is a huge source of out-of-pocket costs and that is because we have very little in the way of state or federal support for the provision of dental services. In fact, 20 per cent of what people report as out-of-pocket expenditure was a result of dental services being provided.

We learnt about medical services that effectively relate in large part to things like the out-of-pocket costs associated with going to see a GP who does not bulk bill. Aids and appliances is another interesting area where there is very little support in the way of government expenditure. We note that 10 per cent of all out-of-pocket expenditure was in the area of aids and appliances. PBS medicines also make up a large part of the expenditure.

We have always had out-of-pocket costs. They have always been a feature of the healthcare system even though we do have the PBS to provide subsidised medicines and we do have health care funded by a universal insurer—that is, Medicare.

The question is: is this a feature of the system that is getting worse and is that impacting on accessibility to the system? One of the great concerns is that we have seen a very real increase in out-of-pocket expenditure as a proportion of household expenditure. Consumers previously spent 2.7 per cent of their household final consumption budget 10 years ago. We are now spending 3.2 per cent so it is a problem that was significant a decade ago and is now getting worse. The question then is: what impact is that having on access to health care? We heard from a number of witnesses that in fact the out-of-pocket costs associated with things like dental care and medicines are impacting on people's ability to get health care to such an extent that in many cases people are foregoing what is really important necessary medical care and imposing huge costs on the system down the track.

The issue of co-payments was raised through the inquiry. It became a significant issue during the budget and we addressed that concern. The committee made it very clear that co-payments do have an impact on people's ability to pay for medical care. It is a very blunt tool. It impacts on those people who are least able to afford it. And those people who are least able to afford it are often people who have higher rates of chronic disease, so there is a double whammy for people on low incomes. They are more sensitive to co-payments and they are more likely to have an increased burden of chronic disease so they are going to be higher users of the system.

Moving beyond the issue of co-payments—and of course that issue will continue to get ventilated through the Senate as those budget measures continue to be debated—one of the other things that was recognised through the inquiry was the issue of safety nets. We have two significant safety nets in the Australian healthcare system, the Medicare safety net and the PBS safety net. We learnt that one of the big problems is that they do not provide people with the upfront assistance they need. People who do not have the disposable income to be able to afford large out-of-pocket costs do not get the benefit from the safety nets that they need. In fact, some people will achieve the threshold for one safety net but not benefit from the other safety net. One of the clear recommendations was that we need a single safety net for out-of-pocket healthcare expenses that covers medical services, medicines and other healthcare expenditure. A recommendation to government was that they get on to implement such a significant reform.

We heard about private health insurance. One of the great ironies of private health insurance is that people take out private health insurance with a view to insuring themselves against significant out-of-pocket costs and they are precisely the sorts of people who often face the largest out-of-pocket costs, particularly when they have a surgical procedure performed. They are the people most likely to be faced with significant medical bills. One of the great concerns there is the degree to which people are aware of these costs from the outset and are able to make decisions to access health care outside of that delivered through private hospitals. We have a real problem with informed financial consent in the health system. Again, the report made it very clear that what we need to do is implement a much more transparent system to achieve informed financial consent.

Finally we heard about the evidence for implementing measures such as co-payments and for looking at addressing some of the out-of-pocket costs that currently exist in the system. We looked at many of the market drivers and the sustainability of the health system Something that we once heard from a number of witnesses, who presented to the inquiry, was—they believed and made it very clear—that the evidence supports the view that our health system is sustainable and that healthcare spending, as a proportion of the GDP, has been stable and Commonwealth health spending, as a proportion of the GDP, has, if anything, decreased.

The important measure here is not the absolute numbers but what we are spending on healthcare as a proportion of GDP, and those numbers are stable. The notion that our healthcare system is not sustainable and the drastic measures that target the accessibility of the system was dismissed by witnesses such as the AMA. It was dismissed by witnesses, such as the Consumers Health Forum of Australia whose submission made it very clear that did not support many of the changes that make accessibility worse. They made it very clear that they do not support the proposition that the drastic changes are necessary in order to improve sustainability of the health system.

In summary, we have got a document that highlights the fact that we already have a big problem in this country with people being able to access health care. For many Australians healthcare is already out of reach. If they have a medical illness that is not supported through a government program—for example, needing a medical device or an appliance, something like a pacemaker, or other cardiac procedures that are sometimes done—there is no cover at all. We heard that people particularly in rural and regional communities, where patient travel is a big factor and where bulk-billing rates are lower, often face even greater challenges. The message that came through loud and clear was the last thing that we want to be doing is to make a bad problem worse. That is what we are poised to do by increasing co-payments and by increasing the proportion that individual consumers need to spend out of their own pocket on health care. So we are at a fundamental point in healthcare reform in this country. A debate is required to answer this question. Do we believe that people's ability to pay for health care determines their access to it? This report makes it very clear that, rather than exacerbating the current problem, we should look at addressing the issue through reforms such as those recommended in the report. I seek leave to continue my remarks.

Leave granted.