Lyn Allison (Victoria, Australian Democrats) Share this | Link to this | Hansard source

I rise to speak about the necessity for health reforms in this country. We all know that the Rudd Labor government and its successors will face major challenges in the funding and delivery of health care in the coming years and well into the future. Health is an enormously complex area and the issues that face the system are enormously varied, as indeed are the strategies needed to reform them. The government’s promised National Health and Hospital Reform Commission is a welcome and long overdue response to the many calls for fundamental reform of our health system. This reform is urgently needed if we are to meet the needs of a progressively ageing population and the concomitant increasing burden of chronic disease. But a commission will be of very limited use if it focuses too narrowly on issues such as waiting times for elective surgery, which is what the government has done so far.

It is true that waiting times are easily talked about, but the way that they are constructed and managed is very complex and they are not good measures of health outcomes in any case. Elective surgery waiting lists are affected by many, many factors. They are easily manipulated and they are tied into the health system’s bias towards procedural medicine. We do need to reduce the number of people who are waiting longer than is clinically appropriate for surgery—there is no question about that. But simply increasing the number of people who undergo surgical procedures will make very little long-term difference to the quality of the health system and its capacity to provide equitable health care. As the Australian Healthcare and Hospitals Association has pointed out, if the funding goes to achieving simplistic targets for increasing activities then we may see more straightforward operations done at the expense of the more complex and difficult operations. And of course there is the problem of finding staff to perform the necessary surgery and care for the patients, given the chronic medical workforce shortages that hospitals are already facing. These workforce shortages are across the public and private sectors, limiting the ability of private hospitals to help prune waiting lists. Buying services from private hospitals, if it is not managed carefully, also risks increasing health costs to individuals, to the government and across the board.

It is true that we need to transform the relationship between the public and private health sectors. The Democrats have been arguing for a long time that direct government funding of private hospital operators would be a much more efficient mechanism than the current expensive, inequitable and inefficient private health insurance rebate. It is disappointing that the new government has ruled out a review of the private health insurance rebate. The appointment of the chief medical officer of a private health fund as chair of the national health and hospital reform commission also rings alarm bells with us. We have long opposed the private health insurance rebate but we do acknowledge that it is now entrenched and just getting rid of the rebate without putting other measures in place is not a realistic option. Purchasing services from private hospitals to reduce the elective surgery waiting times does, however, present an opportunity to start down the road of direct government funding to the private sector.

But it is vital that the model used does not exacerbate the existing problems in our health system. Without an increase in the medical workforce, simply directing patients to the private sector will increase caseloads and drive up the fees that those working in private hospitals will charge—leaving patients with even higher out-of-pocket expenses or leaving the government to pick up the tab at an ever increasing cost to the public purse. In 1996-97 the average patient out-of-pocket cost associated with specialist consultations was $16.88. By 2006-07 that had risen to $37.18. Out-of-pocket costs for obstetricians rose from $11.64 to $69.65 across the same time span. If doctors in private sectors can charge even higher fees, this in turn could exacerbate the exodus of staff from public hospitals, meaning more pressure on waiting lists in public hospitals rather then less.

The best solution is for specialists’ fees to be covered within the agreement between the government and the hospital operator. This would give private hospitals some power to negotiate and manage the billing practices of doctors—something that will save patients and the government money. Chest beating and threatening to take over public hospitals ignores the problems that exist within the private sector. Private hospitals now account for almost 40 per cent of all hospital separations and will no doubt remain strong providers of services into the future, but it is obvious that private health insurance funds are an inefficient way of funding health care and they hugely distort the way resources are spread across the health system. The private health insurance rebate is very expensive, it is inflationary and inefficient, and ultimately it is unsustainable. But for as long at the government subsidises the private health insurance industry through this rebate, it must regulate for greater efficiency, access and quality of care in the private sector.

There are many other areas within health that also need to be tackled. The new health minister has spoken favourably of hospital report cards, but there has been a deafening silence around the issue of national electronic health records. That is despite the fact that there is widespread agreement that electronic patient records that go with the individual would be safer and more efficient. They would cut huge amounts of duplication, save time on collecting basic information, cut down on repeating tests as people move from one doctor to another and results get lost or are not shared in a timely fashion, and they would improve medication adherence. A national system of shared electronic health records that protects patient privacy would not only support better clinical decision making and avoid waste in equipment, supplies and resources but also cut down on medical errors.

The needs of Australia’s health workforce also can no longer be ignored. The government’s election promise of more nurses for hospitals is welcome, but, as we know, it is not enough to build a workforce for the 21st century. By current estimates, Australia will be short 800 to 1,300 general practitioners by 2013. The Department of Immigration and Citizenship figures obtained by the Australian newspaper show there are currently 4,500 overseas trained doctors working in Australia on temporary visas and rural health services are increasingly dependent on these doctors. From 1995-96 to 2003-04 there was an 80 per cent increase in overseas trained GPs in rural and regional areas. We will need at least 470 extra registered nurses a year by 2010 and 1,500 dental health providers, mostly dentists, by 2010. There is already a nationwide shortage of about 2,000 midwives and figures from 2003 suggest that a quarter of Australia’s obstetricians were aged 60 or more.

This is obviously not sustainable. We are heading for a very serious problem in the health sector. We need national leadership prepared to take on vested professional interests that are more concerned with protecting their turf than working collaboratively to provide the best patient care. We need to reform our health workforce structures to remove the demarcations and the restrictive workforce barriers which stop current healthcare workers from expanding their roles and stop the creation of new types of workers. Updating the Medicare benefits schedule and the PBS arrangements to allow more professionals access to test ordering and prescribing authority as well as increasing the range of items which do not have to be provided by doctors is long overdue. And we need to make good on the COAG promises for national registration schemes for health professionals. These would go a long way to ensuring national standards, reducing red tape and making it easier for health professionals to work across state boundaries. These are some of the many reforms that need to be considered by the new government. I am very pleased to see Senator McLucas here; I am sure she has lots of influence over our health minister and that these issues will be taken up in the not-too-distant future by the government.