Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Link to this | Hansard source

As I was saying prior to the Senate moving on to other business, the principles and objectives of the radiology memorandum of understanding include the need to promote access to quality, affordable radiology services and to improve the quality and delivery of radiology services. These are objectives that we should all aspire to and that we are hopeful this legislation will in fact deliver. Labor does, though, consider that these objectives would be even better served by a greater investment in and emphasis on e-health broadly and teleradiology in particular.

In March this year my colleague Senator Conroy announced Labor’s broadband policy—an area on which the government continues to bury its head in the sand. As announced in March, federal Labor will revolutionise Australia’s internet infrastructure by creating a new national broadband network that will connect 98 per cent of Australians to high-speed broadband internet services at speeds over 40 times faster than most current speeds. Broadband offers enormous opportunities for e-health, enhancing the potential for a range of cost savings and service improvements for Australian citizens. E-health in particular has the potential to significantly improve access to healthcare services for Australians living in rural and regional areas as well as those Australians who find it difficult to leave their homes, including the elderly and those people with disabilities. It also offers ways to more flexibly and conveniently utilise our stretched health workforce.

Teleradiology, the electronic transmitting of radiographic patient images and consultative text from one location to another, is already being utilised in Australia, but enhanced broadband technology provides the key to significantly expanding these services. Given the national shortage of radiologists—another area given insufficient attention by the current minister—expanding the use of teleradiology would also be a focus of the next radiology memorandum of understanding. When we see reports such as the one that appeared in the Hobart Mercury on 29 March 2007 stating that Tasmanian women were waiting weeks for the results of breast-screening mammograms sent to New South Wales to be read, we can see the advantages of technology that would allow digital images to be transmitted between and viewed instantaneously by surgeries and clinics, hospitals or, in this case, specialists in different states.

Recently I was on Saibai Island in the Torres Strait. There the Queensland government has installed a very high quality X-ray machine. It has installed a telehealth facility at Thursday Island hospital. This is to serve the needs, in particular, of people who are travelling from Papua New Guinea to Australia, potentially with tuberculosis, to be diagnosed quickly. That is absolutely essential not only for their health but also for the health of Australians living on Saibai Island. The Queensland government has funded that service. You can imagine what an advantage it would be if we had these e-health type services in remote parts of Australia, particularly in the Northern Territory, Madam Acting Deputy President Crossin.

I return to the bill. As I said, the proposed start date for the accreditation scheme is 1 July 2008. This was postponed from 1 September 2007 after concerns were expressed by stakeholders. Labor remain concerned that the proposed scheme will not be ready to commence by July next year. The government has failed to provide sufficient detail about how this scheme will operate. The bill does not provide operational details of the proposed scheme such as the standards to be used, the names of the approved accreditors, the accreditation process and the period of accreditation. Rather, it simply allows the minister to establish, through a legislative instrument, the rules and operational details of the scheme. Whilst we recognise the sector’s support for the introduction of an accreditation scheme, we note that representatives of the diagnostic imaging sector have previously raised concerns relating to the operational details of the scheme. Labor share their concern that the full policy implications are yet to be announced.

Labor are also critical of the situation that full costings for the introduction of the accreditation scheme are yet to be determined. According to the explanatory memorandum for the bill, the introduction of the accreditation scheme will require enhancements to Medicare’s processing systems. These costs have not yet been quantified, but they are estimated to be $1.2 million based on previous similar policies. According to the explanatory memorandum, full costings will be provided when the subordinate legislation is developed. It is expected that these costs will be funded from existing budgetary measures for the provision of diagnostic imaging services. This lack of detail is typical of the Howard government’s shabby approach to health in particular. It is a government that is tired and out of touch. Unfortunately, lack of preparation, lack of detail and lack of interest are consistent features of the Minister for Health and Ageing’s approach to legislation and the health portfolio more generally. We hope that the government allocates the requisite resources to get this accreditation process sorted out and off the ground in time for the 1 July deadline. We look forward to receiving more detail in due course.

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. The purpose of this bill is to amend the Health Insurance Act 1973 to establish a legislative framework that will enable the introduction of an accreditation scheme for practices providing diagnostic imaging services covered by the Radiology Quality and Outlays Memorandum of Understanding. The explanatory memorandum to this bill states:

There is currently no regulatory mechanism that helps to ensure all the elements involved in the delivery of diagnostic imaging services work together.

The explanatory memorandum goes on to say:

As such, there is no guarantee to patients that optimal radiology services are being provided.

This is an incredible omission by the Howard government. Medicare pays over $1.6 billion a year for radiology services. Over the last two years this cost has increased significantly compared with the previous years of 2004-2005. In 2004-05 the cost of Medicare radiology services went up by 11.5 per cent. In 2005-06 the cost went up by 8.5 per cent.

No amount of rhetoric will negate the failure of the Howard government to properly support Australia’s public hospital system. Neither the government’s GP policies and its support of private hospitals through private health insurance subsidies, nor its aged-care policies have taken pressure off public hospitals, emergency departments or the demand for public hospital beds. Madam Acting Deputy President, you will understand, therefore, my scepticism that the proposed measures to change the operation of the Pharmaceutical Benefits Scheme, the PBS, will deliver all the benefits claimed by the government.

An essential point to be made from the outset is that the PBS is an integral part of the universal health system. The PBS is not just a government cost centre that needs to be managed simply in cost-accounting terms. Access to appropriate medicine has huge health and economic benefits for the country and for individuals. Access to appropriate medicine not only saves and prolongs lives; it can greatly reduce the overall cost of illness to individuals and the economy. Australia has been well served over the past 50 years by our national government’s participation in ensuring the universal availability and affordability of medical practitioner prescribed medicines.

Barnaby Joyce (Queensland, National Party) Share this | Link to this | Hansard source

Are you sure!

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

I lost my place; I will go back to the figures I was talking about earlier. Those figures would indicate that the radiology services funding agreed to and set out in the June 2003 memorandum of understanding between the radiology profession and the private providers of diagnostic imaging services has already been breached. This should be a warning sign to the government about its ability to invoke the cooperation of the medical profession and private medical service providers to ensure that Australia has a health and medical services system that is accessible and affordable to all Australians. Even though Medicare meets approximately 83 per cent of the total cost of radiology services in this country, the government is not able to assure members of the Medicare scheme that they will receive optimal radiology care. Not only that, but the government has also admitted that neither it nor Medicare Australia has the power to enforce minimum radiological service standards. This is in spite of the fact that the current MOU between the government and the radiology profession and the diagnostic imaging service providers includes a provision that mandatory accreditation of radiology practices will be introduced by November 2005. This obviously has not occurred.

It is now four years after the signing of the agreement with the radiologists, and what do we have by way of legislation? A bill merely to establish the framework to enable the introduction of a radiology practice accreditation scheme. That is not a great deal of progress in four years. Clearly, at this rate, patients are not going to see a radiology services accreditation scheme with enforceable standards any time soon. It is also interesting to note that the explanatory memorandum to this bill indicates that the peak industry body for private specialist diagnostic imaging practices—that is, ADIA—has indicated that it is not at all enthusiastic about the proposed accreditation model put forward by the Howard government. ADIA’s opposition to the proposed model appears to be because of the perceived cost of the model to diagnostic service providers, even though the cost will be minuscule compared to the revenue generated in providing government funded diagnostic medical services. With respect to the government’s radiology practice accreditation proposal, ADIA put forward an alternative model which, from the small amount of information available, seems to be very close to a form of self-regulation rather than a rigorous and independent accreditation process.

There is no question that radiology services are critical to the health of millions of Australians. What does warrant questioning is that we have large, sophisticated companies generating huge revenues annually from the government—in some cases, hundreds of millions of dollars—yet these companies appear reluctant to embrace accountability. You can see what the business strategy is. As soon as the government suggests that there should be any form of regulation to protect the interests of Australians, business immediately starts clamouring about costs in order to frighten the government into watering down the introduction of necessary standards. I have no doubt that that is what ADIA is about.

This will be a real test for the government to see whether it has the backbone to stand up to the spoiling tactics of corporate medicine when it comes to finalising the planned radiology practice accreditation scheme. But, as we know, the government’s track record on standing up to corporate medicine is pretty appalling. Corporate medicine has been rapidly building up large corporate empires on the back of the Medicare scheme and government subsidies to the private health sector through the private health insurance system. There is nothing intrinsically wrong with this if the benefits of a more cost-efficient and effective medical services system flow to all Australians. However, there is little evidence that this has occurred.

Corporatisation of Australia’s medical services organisations has not decreased the real cost to patients of medical and hospital services. All the returns from any efficiency gains have gone into the pockets of the large medical and hospital service corporations. So there we have it again: the Howard government letting down patients. The explanatory memorandum to the bill, in discussing the regulatory problem that the bill addresses, states: 

Effective management, available resources, information systems capable of monitoring patient progress, and multi-disciplinary teamwork contribute to a high quality service being provided. In other words, health outcomes are impacted by each element/activity carried out by the practice when delivering a diagnostic imaging service.

In other words, a patient’s care outcome depends on how effectively all elements of the diagnostic and treatment process interact. How, then, can the accreditation of one part of the diagnostic and treatment process ensure optimum patient outcomes? What is required is a medical services accreditation and standards monitoring regime that encompasses the whole of a patient’s diagnostic and treatment process rather than the piecemeal approach adopted by the Howard government.

Furthermore, a comprehensive and coordinated approach to the management of a patient does not look to be supported by the Australian Medical Association, the AMA. This to me seems very strange. Why wouldn’t the peak body for doctors advocate rigorous accountability across the network of medical disciplines that knit together to ensure a patient receives optimal care? This is where corporate medicine has something to offer in the way it is able to link up, for the patient’s benefit, GP, radiology and pathology services within the one service regime. The federal government has a responsibility to harness the benefits of corporate medicine and deliver those benefits to patients. And, from a patient’s point of view, until there is cross-discipline accreditation, patients cannot be assured that they are receiving optimal care.

In many ways, the proposed radiology practice accreditation scheme looks very much like a rerun of the Professional Services Review Scheme, or PSR Scheme—that is, lots of words and very little effect. Indeed, the PSR is a prime example of the incompetence of this government when it comes to setting up and supporting government regulatory bodies whose role is to protect the interests of ordinary Australians against the excesses of powerful medical interest groups and big business. The PSR is supposed to protect the integrity of the Medicare scheme and the Pharmaceutical Benefits Scheme.

I would like to quote from comments made by the director of the PSR, Dr Tony Webber. He obviously has very serious doubts about his organisation’s ability, as currently organised and resourced, to prevent exploitation of Medicare’s $9 billion-a-year benefit payments. In an article in the Sydney Morning Herald in January 2006, Dr Webber indicated that evidence was emerging that doctors working for corporatised medical chains had geared their software and patient management systems to maximise returns from Medicare. He further indicated that there was evidence that some of the services, including pathology and radiology, were inappropriate. More worryingly, Dr Webber is reported to have said:

My concern is that where corporate medicine is having a strong influence on doctors, it raises suspicion that there is a lot of money potentially being wasted.

Dr Webber went on to say:

Medicare benefits are not designed to give a doctor a reasonable income and give corporates a 20% return on investment without compromise to standards of care.

There is no doubt that the director of the PSR would not have made these comments if he had felt that he had either the power or the resources to even up the contest between the profit intentions of corporate medicine and the maintenance of the objectives and financial integrity of the Medicare scheme. These comments should set alarm bells ringing for the government in respect of its radiology practice accreditation plans.

We know from the PSR’s Report to the Professions 2005-06 that a review of possible inappropriate practice by an individual medical practitioner, in respect of claiming Medicare benefits, can take as long as three to four years to bring to completion. Even then, the final outcome is not certain if the medical practitioner concerned contests the PSR decision in the Federal Court. It is also interesting to note that in 2005-06, when a medical practitioner contested a PSR decision in the Federal Court, there was a high probability of the medical practitioner concerned having the PSR decision overturned. In 2005-06 the Federal Court handed down 17 decisions in favour of the person under review and six decisions in favour of the PSR. To claim that the PSR can be held up as the protector of the integrity of the Medicare scheme is highly questionable. The question needs to be asked: why do we have such an apparently ineffective watchdog? Why is it that individual doctors can incur financial sanctions for misconduct in respect of their use of Medicare but the corporations for whom they work are apparently immune from penalty?

While the corporates own the show, the government deals with the bit players. How crazy is this? The government penalises individual medical practitioners for inappropriate prescribing practices but not the corporates for whom they work. There is no indication that the Howard government understands the realities of the commercial world of medical services provision in Australia, which the government is effectively funding through Medicare. While the corporates are drawing huge revenues from Medicare, the government’s surveillance of the integrity of the Medicare scheme and of the interests of the taxpayer is concentrated on individual doctors.

The result of this action is that the corporates who employ the radiologists have managed to disappear off the government’s Medicare surveillance radar. The government has apparently no idea of the amount of Medicare funding that flows to the large corporate medical services providers. This situation has occurred because the AMA has bludgeoned the government into establishing a professional services review scheme that is completely inadequate. You would not believe it if you read it in the tabloids, but it is a reality in Australia that corporate medicine is insulated from proper accountability in respect of its use of Medicare as a cash cow. It could easily be construed that AMA self-interest has effectively emasculated the PSR.

Why the Howard government constantly allows the medical profession to mangle its regulatory responsibilities is beyond belief. On top of that, in 2005-06 the PSR—let us remember that it is the Medicare scheme watchdog—only managed to claw back approximately $1.3 million in inappropriate payments made by Medicare. On the other hand, the cost of running the PSR in 2005-06 was no less than $5.4 million. You would have to wonder what this is all about. The government’s Medicare watchdog runs at a massive loss while corporate medicine reaps huge financial returns from the Medicare scheme.

So what does this all mean for the bill we are considering? Given the four-year delay in finalising the diagnostic accreditation model, how can we be assured that the radiology practice accreditation scheme will not be watered down to the detriment of patients? When the radiology practice accreditation scheme finally comes into operation, Australian consumers will need to be able to have confidence in it. It is about time that this government lived up to its responsibility to the Australian people and to Medicare. (Quorum formed)

Brett Mason (Queensland, Liberal Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

I would like to thank Senator McLucas and Senator Sterle for their contributions to this debate. On behalf of the government, I acknowledge the opposition’s support for the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. This bill establishes a framework under Medicare for the introduction of an accreditation scheme for practices providing diagnostic imaging services covered by the Radiology Quality and Outlays Memorandum of Understanding. Patients should have timely access to high-quality radiology services. From 1 July next year, accreditation against objective and realistic standards will become a condition for facilities providing Medicare eligible diagnostic imaging services. The impetus for accreditation is not a reflection on the quality of services now being provided. However, accreditation provides government and the community with extra assurance that the 12 million or so diagnostic imaging services supported by Medicare, at a cost of $1.2 billion annually, are provided by organisations that are able to meet specified standards. The presence of many senators in this chamber signifies the importance that the government attaches to this bill.

The government is working closely with the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association, the relevant industry body, to develop a scheme that is practical and workable and that will minimise the cost to each practice. We are seeking expert advice on the standards through our extensive consultation with a wide range of bodies and a wide range of groups. The transitional arrangements in the bill will ensure that these practices will have ample time to prepare for the accreditation process. The bill also includes a mechanism to ensure that any adverse decision regarding a practice’s accreditation status will be the subject of an independent review, and so no-one will lose access to Medicare without a full and a fair process. The government is aware that there are robust discussions going on between the college and the industry on the development of the regime. We appreciate their commitment and trust that they will be able to work in collaboration with relevant professional medical groups to reach an agreement on the nature and structure of the accreditation regime. On behalf of the government and the Minister for Health and Ageing, I restate our willingness to assist the college and industry to meet the 1 July 2008 commencement date. Early agreement on the accreditation regime will ensure the necessary planning and implementation arrangements are completed in good time. I commend the bill to the Senate.

Question agreed to.

Bill read a second time.