David Leyonhjelm (NSW, Liberal Democratic Party) Share this | Link to this | Hansard source

I inform the Senate that at 8.30 am today, four proposals were received by the President in accordance with standing order 75. The question of which proposal would be submitted to the Senate was determined by lot. As a result, I inform the Senate that the following letter has been received from Senator Griff:

Dear Mr President,

Pursuant to standing order 75, I propose that the following matter of public importance be submitted to the Senate for discussion:

The need for Australia to have a more transparent and accountable health system that helps consumers make informed choices.

Is the proposal supported?

More than the number of senators required by the standing orders having risen in their places—

The ACTING DEPUTY PRESIDENT: I understand that informal arrangements have been made to allocate specific times to each of the speakers in today's debate. With the concurrence of the Senate, I shall ask the clerks to set the clock accordingly.

Stirling Griff (SA, Centre Alliance) Share this | Link to this | Hansard source

Anyone who knows me knows that I am particularly passionate about medical transparency. By that, I mean providing consumers, the public, with all the information that they need to make an informed choice about a surgeon or provider; information that allows them to judge up-front the costs and risks before going under the knife. For example, how much will the surgeon cost? Are there any hidden fees? How often does a surgeon perform a particular procedure? Most importantly, what are their revision or, in other words, error rates? What about the hospital or clinic? What is its record of medical errors and patient readmission rates, and how does this compare with other hospitals and clinics? At the moment, consumers have almost none of this information at their disposal, unless, of course, they know someone on the inside. They take it on trust that hospitals, clinics and medical specialists will provide a good service and charge fair fees.

As consumers, we are often embarrassed to ask a surgeon about their fees. We're embarrassed to quiz them about their abilities and how often they have done a particular operation. We don't want to offend them because we are putting our health, and sometimes our lives, in their hands. If we want this information, we have to ask for it ourselves, always at a time when we are the most vulnerable. This information needs to be publicly available; in fact, it is in a number of countries around the world, most notably the UK, where you can review every specialist right down to their different procedures. And guess what? When it's all on the public record, the bar is lifted for everyone. Everyone wins; the public and the medical professionals.

People should be able to sit at their home computer, when they have had a moment to think, and research their surgeon before going under the knife. They need to know all costs beforehand and not be shocked by a bill that could potentially run into many thousands of dollars. Most importantly, they shouldn't find out after the fact that they've been operated on by a novice. Our medical system operates very much as a closed shop. If you are referred to a specialist, you ultimately have no idea of whether you've got a star performer or a dud.

This is not just about consumer information; better medical transparency and accountability will also blow the lid off the otherwise secretive world where the profession protects its own. Imagine if disgraced surgeon Jayant Patel's performance data had been publicly available all those years ago?

Perhaps then it wouldn't have taken a brave whistleblower to come forward and expose this deadly doctor, and perhaps his tragic reign at Bundaberg Base Hospital would have come to an end much quicker.

That's the thing about transparency: there is nowhere for dodgy doctors and deadly hospitals and clinics to hide. The concept is not a new one. In Australia, private health insurer Medibank publishes an annual Surgical variance report in conjunction with the Royal Australian College of Surgeons, which details a number of key indicators, including the rates of hospital-acquired complications, average surgeon out-of-pocket costs plus average total costs for a procedure, and the percentage of patients readmitted within 30 days. But this report misses a key component: disclosure of individual surgeons. We know from answers to questions that I put at estimates that the government is, at a snail's pace, also working to collect better mortality and morbidity data from public hospitals to publish on the MyHospitals website. Transparency of information can really only be a good thing, as it forces outliers to lift their game or get out.

If you want to know what a good system for medical transparency could look like, go to the My NHS website in the UK. It's not perfect but it's pretty damn good. You can look up your procedure by either hospital or individual surgeon to see how both perform. It is easy to navigate and breaks the information down in ways that make it easy to understand and compare. For instance, each hospital will show how many times a particular procedure has been carried out and the average demographic of patients treated for the same condition, and it will show for each hospital what percentage of patients had a greater risk of problems before or after surgery. It provides context and comparison. For surgeons, the data changes with the procedure. For instance, for cardiac surgeons, it provides the two most important pieces of information that you want to know as a patient: how often the surgeon has performed cardiac surgery and their patients' in-hospital survival rate—down to two decimal points.

This is all a far cry from what is publicly available in Australia. It means that as a patient you're not going blindly into surgery with fingers crossed, hoping you've made the best choice. You can take some control at a time in your life when you feel you have very little of it. Out-of-pocket costs are also a well-known problem, and that is why Centre Alliance last year initiated the Senate inquiry into the value and affordability of private health insurance and out-of-pocket medical costs. We are still waiting for the government's response on that report, but we were at least happy to see that the health minister is listening to our concerns and those of consumers and is trying to make headway with out-of-pocket costs by appointing an advisory committee to work with industry to make this information more transparent.

IVF is another area that needs a very bright spotlight shone on it. At the moment, couples can fork out almost $10,000 for each round of IVF treatment, with only half of that recouped through Medicare. All that these would-be parents have to go on is reputation, rumours and what the clinics themselves choose to say about their success rates. There is no standard set of information that clinics need to provide, yet the results for each can vary widely. In 2014, live birth rates between clinics varied from nine per cent and 24 per cent for fresh cycles. Two years earlier, live birth rates were as low as four per cent and as high as 31 per cent, depending on the clinic. Some clinics won't disclose their live birth rates, choosing to instead publish their clinical pregnancy rates, which of course are much higher.

The lack of transparency also poses a significant cost to government. In 2015 Richard Henshaw, a senior fertility expert with the Monash group of IVF clinics, told the ABC's AM program that the worst-performing IVF clinics actually cost taxpayers more than the best performers. He said that clinics in the top 25th percentile cost Medicare around $2 million to produce 100 live births, whereas clinics in the bottom 25th percentile soak up around $6 million to produce the same result. Taxpayers, through Medicare rebates, as well as parents are paying up to three times as much as they really need to, simply because they've had the misfortune to select a poor-performing clinic for their treatment.

One couple underwent 12 cycles of IVF over five years and spent $100,000 to get there. They did 10 cycles at a clinic recommended by their GP—with no success. Then they switched clinics and finally had a child. It doesn't have to be this way. The US and UK both publish individual clinic success rates—that is, the chances of a live birth—vital information for making one of the most important decisions in an infertile couple's life. We have these great examples we can model ourselves on, but somehow in Australia it's just too hard. 'It can't be done here,' this self-serving industry says.

There is every reason to move to a more transparent and accountable health system, and I implore the federal government to work with the states to do just that. I imagine there will be resistance from some medical colleges, but, frankly, we shouldn't try to shield poor performers from the embarrassment or loss of income that might result from such a system. It is, in the end, about more consumer choice, better public safety, better use of taxpayer money and better health outcomes. Who could argue against that?

Jim Molan (NSW, Liberal Party) Share this | Link to this | Hansard source

A key part of the motion that Senator Griff has put forward—and it's a very good and logical motion—is to provide facts. As Senator Griff said, quite often people don't have access to facts or are reluctant to ask for the facts that they need. In a general sense, I'd like to state that the government supports greater transparency to assist patients. We are certainly keen to work with the states to develop mechanisms to ensure greater public disclosure in our healthcare systems.

Information is currently collected and published by the states. It varies and it generally focuses on matters such as admissions, emergency department wait times, elective surgery wait times, hospital acquired infections and patient experiences. The government will work with the states to harmonise the reporting of this information, which can be incredibly important for patients. We will also continue to work with the states and territories to progress a national approach to clinical quality registries, which should lead to relevant outcomes measures being reported through the new Australian Health Performance Framework. But when we consider a motion which speaks of 'the need for Australia to have a more transparent and accountable health system that helps consumers make informed choices' we immediately come up against scare campaigns, disinformation and intentional wrong information that quite often can overcome the well-intentioned information that people themselves may seek.

There is the need for Australia to have a more transparent and accountable healthcare system that helps consumers make more informed choices. There are no two ways about that. But what goes against this is, in particular, the approach that Labor takes to this key issue. I recently had experience of this in Eden-Monaro, the electorate in which I live. The problem is that disinformation provided by Labor, particularly the scare campaign about the health system that was run during the 2016 election campaign—a campaign that was tried again in Bennelong and failed—goes against what Senator Griff is trying to achieve. The member for Eden-Monaro, Mike Kelly MP, as part of that campaign, recently claimed that the government is cutting $2.2 million from Eden-Monaro's public health system. When this is broken down, he claims that certain amounts have been cut from the South East Regional Hospital, from Queanbeyan hospital and from Cooma, Tumut, Yass, Pambula, Braidwood, Bombala, Tumbarumba, Batlow-Adelong and Delegate hospitals. Mr Kelly said:

Access to health care should be determined by your Medicare card – not your credit card …

That's just a ridiculous statement. Mr Kelly claims:

… we will always fight to protect Medicare and we will fight Turnbull's $2.2 million cut to Eden-Monaro's hospitals.

Of course, the relationship between the member for Eden-Monaro and the Labor leadership is something we have to remember.

The Department of Health go to the point that Senator Griff was making, in that they put out the truth. The truth is that, in contrast to Labor's last year in government, this year the coalition has delivered nearly $2 billion more to New South Wales hospitals. The truth is that funding is increasing by $9 billion more under the new hospital funding agreement for New South Wales hospitals. That is a fact. In 2012-13 Labor delivered only $43 million for the Southern NSW Local Health District, the district within Eden-Monaro, compared to $100 million from the coalition in 2016-17. If we want transparency, we must have truth, and you cannot have truth when these facts are being misrepresented. The coalition delivered an increase over 2012-13 of 131 per cent. The coalition delivered $13.8 billion in 2012-14 and increased this to a record $22.7 billion by 2021—an increase of 64 per cent. This is not a cut.

When we were faced with these claims we actually responded, and the response has to be considered. I will take this opportunity to quote what I said in response to the member for Eden-Monaro and his claims that we are cutting in Eden-Monaro. I stated: 'I would not go so far as to say that one of my parliamentary colleagues is lying, but this is scaremongering at its worst. It targets vulnerable patients.' I said: 'The truth is that federal funding for public hospital services under the coalition has increased from $13.8 billion in 2013-14, to a record of $2.7 billion in 2021'—that's a 64 per cent increase—and that 'in New South Wales the coalition is delivering nearly $2 billion more to New South Wales hospitals, compared to what Labor funded in their last year in government.' In 2012-13, Labor only provided $43 million for the Southern NSW Local Health District, which compares to almost $100 million the coalition funded in 2016-17—as I said before, a 131 per cent increase. I said: 'It's deeply disappointing that Mike Kelly and Labor will say and do anything to try to trick patients with patently false statements. Thankfully the real figures show the truth.'

I think that it's a very good idea to go to the reaction of locals, people who live in, work in and administer the health system within Eden-Monaro. I would like to quote from the Bega District News of 11 April. The article reads:

The head of the Southern NSW Local Health District says there is no issue with funding for the region’s hospitals, allaying concerns raised in recent days.

Andrew Newton is the CEO of the Southern NSW Local Health District. The article continues:

While the federal parties bicker over public hospital funding allocations, Andrew Newton, Southern NSW Local Health District CEO, said there was no issue for the 'very robust' budget arrangement across his region.

'I’ve had no indication that we’re getting anything other than what we asked for,' Mr Newton told Fairfax Media on Wednesday.

If we're going to have transparency on the issue of health, we must tell the truth; the truth must be available. The article goes on to say that Mr Andrew Newton, the CEO, said:

'I’m the one who allocates the funding to hospitals anyway [not the federal government].'

The article continues:

Mr Newton said a national partnership agreement is from where federal funding for health comes, with the state’s health districts putting forward their case based on capital needs and activities at LHD level.

'We look at a district level, remoteness of hospitals and the activities undertaken—it's a very objective process, not emotive,' he said.

'We get a fair allocation for our 12 hospitals and there’s been no reason to believe we’re getting anything different.'

I make the point that if we're going to have transparency and accountability in any aspect of a health system, it is absolutely critical that we encourage people to ask questions of their doctors—to go on websites and check to see what is written about the health organisations they're going to. They also must ask political parties—in this case, the Labor Party—to produce the truth. It is of utmost importance that we look back, at least a little bit, to see that Labor's $2.8 billion better hospitals fund simply rehashes an old policy from 2010. This policy failed to meaningfully reduce wait times in emergency departments or for the elective surgeries that Senator Griff spoke about. It is critical that we get transparency. Transparency is based on truth.

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

One of the more exciting things in the health system over the last 20 years has been the rise of consumer focused health. We have a great deal to be grateful for. There are some active, dedicated and very brave consumers who have consistently put information and personal experience into the public realm to ensure that consumers have a genuine say in the health systems of this country.

I've been fortunate enough over many years now to work with a number of consumer groups. They include the Consumers Health Forum of Australia and the National Mental Health Consumer and Carer Forum. These two groups have lived and breathed the focus of Senator Griff's motion. What they talk and engage with their community about is ensuring there is transparency and accountability in our health system. As Senator Griff said, 'The voices of consumers will be active in policy development and, most particularly, they will be reinforcing the need for consumers to make informed decisions about what treatments, what services, what processes they want to follow for their health.'

It's not been easy to have this voice heard. Consistently, there have been attempts to push back, to ensure that there's not a view that only professionals in some way have the necessary knowledge, the necessary experience and the necessary probity to determine health practices. I suppose it's not that much different from legal services of any other profession. But I really want to acknowledge in this motion, this afternoon, the fact that consumer organisations have been at the forefront in ensuring that we have the development of effective policies. They also have a very strong role in the coordination—bringing around the table—of people with shared experiences and knowledge so that we can talk through issues around health services and ensure that there is a width of knowledge and experience available.

A Four Corners program recently filmed about out-of-pocket expenses in the Australian health system has caused a lot of questions in the wider community. I think this was one basis for Senator Griff's motion. We did a Senate community affairs inquiry a couple of years ago that looked specifically at the issue of out-of-pocket expenses in our health system. Naturally, the consumers were strong advocates and provided very strong evidence to that inquiry.

This particular Senate inquiry is available in Hansard, as are all public hearings and submissions, and made very confronting reading. I think it was two-and-a-half or three years ago. It was particularly confronting for someone like me. I sat through that evidence and looked at what was happening to the concept of informed choice in our medical process. We made recommendations, and promises were given by government about how they would be able to respond to the issues. We saw, only very recently, more up-to-date filming and experiences in hospitals across this country, which put the fact that changes had not been made. The absolutely solid principle in medical practice in Australia of informed consent does not seem to have the solid basis that one would expect across some areas of medical practice.

I want to put a couple of points on record this afternoon. We were deeply concerned during the Senate inquiry that informed consent seemed to have various definitions, depending on where you were and which practitioner you were dealing with. It seemed to me that if there is one thing that should have a fairly clear definition, it should be informed consent. What we also found was that giving someone a piece of paper and thinking that is the beginning and the end of your responsibility in getting them to sign, saying that they understand all that's above, is not the best and most effective mechanism to fulfil the expectation that the patient and their families understand fully what they've signed up for and what they're going to enter into.

That is not just for financial informed consent. One of the focuses of this particular motion is the financial out-of-pocket expenses, the enormous costs and the variation in costs that seems to be available across the system for exactly the same service, depending on where you live, which hospital you attend and which other services you have. It's also about the absolute knowledge of the process that you're going to face—the different things that you're going to experience once you take that very important step into the medical system.

We've heard that a number of people are just not able to understand the complexities and the variations that are before them once they step into sometimes quite confronting medical experiences. That's perfectly understandable, particularly at a time when you're unwell, or in pain or deeply concerned about a family member who has a serious illness or a need for emergency surgery of some type. We talked at length during our inquiry about which wraparound services should be provided in the medical space to ensure that if people don't have that understanding there'd be services around them that would work with them, so that if anything happened they would have timely intervention to ensure that they are supported through the various issues that could happen and could go wrong.

One of the gentlemen we had evidence from in one of our regional centres claimed that the impact on his health caused by the receipt of the medical bills after his surgery possibly had more impact on his health than anything that led up to the original surgery. He was very open about that. He said that the shock that he received when he received the bill for the other services around what he was in hospital for caused him such immediate distress that he genuinely thought that he was going to need more medical treatment. That was not unusual, except that he had a particularly amusing way of putting it into expression when he came to our inquiry.

The role of the national consumer groups is to ensure that the messages, the understandings, are made public and shared and that they provide another source of reinforcement if people are unsure about where they stand in a certain situation or where they could get support. The national consumer health services often provide helplines, through either the internet or the phone, that can link you to services that can provide the absolutely necessary support that you have to have.

Certainly, my own experience from working in the mental health space and with mental health consumers is that their activities and their knowledge are so valuable in the development of policies in this space and have consistently ensured the concept of wellness. This is that individuals will have the space to have their wellness as the No. 1 focus of the process, rather than medical definition and diagnosis. I think that is one of the most important elements in mental health change in the last 10 years. I will be forever grateful to the patients and for the resilience of the people in the national consumer groups that, despite the many times when they must have despaired about whether their voices would be heard, they continue to be actively engaged in the process.

Senator Griff, your motion remains more real than ever. I think at this stage people across the chamber would understand that the absolute importance of transparency and accountability in our health system must be paramount in the development of any policy and, in particular, when we're looking at the policies around our health and our wellbeing.

In that process, I think it's important that no matter what we do in the development of policy—and no matter what we do in the discussion about how we should have changes or where focus should be on resourcing—we should always put at the very centre of any discussion the role of people who have had the lived experience of illness, of hospital services and of the very personal ways that the whole range of things take place once you take that step onto the medical journey. All of those should be able to be identified and the consequent impact of them should be part of the development of policy. Otherwise, we're going to be consistently just putting things on top of discussion rather than engaging fully. I think that's something that we can benefit from in the development of our health policy.

It is important that this is part of an open discussion. It's sometimes seen as an afterthought and something that can be done after the really important stuff of putting the research dollars—or putting the emergency dollars—into equipment or resources in hospitals. All of those are important, but those things will not be as effective as they could be if we don't maintain that absolute focus on consumers in the situation.

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

When you consider what we're elected to do in this place, and when you consider what the role of government is, there is nothing more important than ensuring that we provide a health system that looks after people. Election after election, people tell us they want their governments to invest in health care. They want their governments to ensure that there is a health system that they know will look after them if they're sick and will look after their loved ones if they become unwell. Of course, Medicare and our public hospital system are the fundamental pillars of our health system. They are absolutely critical if we're to ensure that people are looked after.

We know that Australians value decent health care. We know that Australians, when asked the questions, 'Would you prefer to have a tax cut?' versus: 'Or would you prefer to have a greater investment in Medicare, ensuring that you and your children aren't faced with big out-of-pocket costs? Would you prefer to have Medicare funded dental care?' always tell us: 'We want to see a better health system. We want to see schools that are well funded.' And that's why I'm glad that Centre Alliance have put this issue on the agenda.

It was just last week that they sided with the government to lock in $140 billion worth of tax cuts—tax cuts that will go disproportionately to people on high incomes and tax cuts that will ensure that bankers, CEOs and politicians get an extra $11,000 in their back pocket while a few hundred dollars in scraps are given to people on lower incomes. The consequence of that decision is that we have less funding available for all manner of public services, with our health system chief among them. You can't rip $144 billion from the health system and expect it to be able to function in a way that you want.

We have a very good health system, but we can do better. Compared to spending right across similar countries, we spend about average; it's approaching 10 per cent of GDP on health care. When you look at what the US spend, it's something like 17 per cent of their GDP on health—with much worse health outcomes. So we've got a pretty good system, but there are challenges.

A PwC report last year for Australian Unity showed that by 2040 we're going to need an additional $57 billion in capital costs and an additional $30 billion in annual operating costs for both aged care and hospitals. There needs to be a much greater investment over the next few decades. Yet when you see the $144 billion in tax cuts—and now we have a debate this week around cuts to the company tax rate—it's hard to see how we're going to be able to find the revenue to invest in those things. What's the consequence? The consequence is that people on public waiting lists, waiting to have their hips done, are going to have to wait longer. A family with a sick child at midnight in an emergency department is going to have to wait longer before their child is seen.

There are already huge pressures on our hospital system. When you consider what the Abbott government did in scrapping the National Health Agreement when they were the first elected, it ripped billions out of our hospital system. There are huge challenges. We continue to give $6½ billion—and growing—in a wasteful subsidy to the private health insurance industry. And of course when we talk about transparency in our health system, that is one area where people tell us that they are sick and tired of the big up-front, out-of-pocket costs they face when they get health care within a private hospital. We know there are a few rogue operators; we know that, and we welcome some of the measures addressed to make sure that there is transparency around the costs that some rogue doctors are charging. But the problem's a systemic one. We can't predict whether there's going to be a complication. We can't predict what the course of treatment might look like for each individual person. Therefore, it's very hard to say to somebody, 'Well, here are the out-of-pocket costs you're facing if you utilise the system through a private provider.' You simply can't do that.

The best investment we have is ensuring that every cent is invested in our public hospitals, in Medicare, in all the foundations that we know lead to better health outcomes and a better use of the taxpayer dollar. If we did this right we could have Medicare funded dental care. If we didn't give tax cuts to people who don't need them, if we didn't give tax cuts to some of the wealthiest companies, every person in this country would be able to access a dentist and have it funded through Medicare. We need to do much better, and the way to do that is to ensure that we've got the revenue base to invest in our health system.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I'm pleased to enter into this MPI debate—which I thought was about health but, from hearing the previous speaker, it seems that I must have read the wrong Red. It seems that it's a re-debate about last week's taxation decisions and the taxation decisions the Senate will be called upon to talk about and decide upon into the future. Of course, I can't let Senator Di Natale's misinformation about the tax system pass unchallenged. Senator Di Natale was part of a Labor-Greens alliance that ran this country for six hard, dark years. Senator Di Natale says that because we give tax cuts and because we encourage investment into Australia we're not going to have money for education and for the thing that this debate is about, health.

Senator Di Natale may have been a good doctor, but I'm afraid his economics is sadly lacking. You see, Senator Di Natale, one of the reasons we want to encourage investment in Australia is so that we can create jobs, so that we can create profitable companies employing people, both of which pay tax. When you have more taxpayers paying tax, you're able to first of all pay off Labor's debt—and we've started that long process, down from over $100 billion when we took office; we've got it down this year I think to around 25 in this year's budget, down to 16 and next year 11, and the following year we're back to the Howard government type surpluses. It was very small at the start—a $2½ billion surplus the year after next—but is projected to go upwards. Contrast that to the Labor Party. Every year they were in power the deficit went up.

Senator Di Natale says that because we're giving tax cuts there won't be money for health. Well, the contrary is the fact. If you encourage investment into Australia, if you encourage this multinational investor who wants to build widgets—and he's going to make X million dollars profit, but he can do that in Australia or he can do it in France or he can do it in the United States—where do you think he's going to go if he can invest his money and still make $100 million profit? Is he going to go to the place that charges him 30 per cent company tax? Or is he going to go to the one that charges him 25 or 20 or 15? You don't have to be a Rhodes scholar to work that out. If he doesn't invest in Australia to build his widgets, that will mean the cost of the work provided in building the widget factory will not go to Australian workers but to United States' workers or to French workers. The people that will man the widget factory when it's built will not be paying tax in Australia. They will not be providing jobs for Australians; they will provide jobs for citizens of the United States or of France, and they will pay tax to those countries.

By keeping our corporate tax rate competitive with the rest of the world, we create investments, we create jobs and we create tax. So Senator Di Natale's comment that because of the tax cuts we won't be able to invest in the health system is just absolute foolishness, misinformation and part of the Labor-Greens mantra. I would remind Senator Di Natale that when he and the Labor Party ran this country for six dark years, health funding actually went down, and what was spent wasn't money that the government had; they had to borrow it all from overseas lenders just to keep the health system going. Now, fortunately, under the coalition government, that no longer applies and we are able to pay our way and start paying off the Labor-Greens debt of those six dark years.

I don't know that the Greens were part of this, but Labor's major contribution to the health debate in recent years was that outrageous lie that the government was intending to sell Medicare. Everybody knew beforehand, they knew on election day and they know now that was nothing more than an unmitigated lie, a fabrication made up by the Labor Party's propaganda machine, and yet it worked. It convinced a lot of people to vote for the Labor Party at the last election. That was an unmitigated lie. What this government has shown is that it is intending to move ahead with the health debate.

I digress slightly to think of the system in Queensland. It was only 2½ years ago that the Newman government was in power and, in that time, it stopped the waiting lists in the public hospitals. They got rid of a lot of people, a lot of those Labor apparatchiks who were employed in the middle level in the hospital area. They weren't doctors or nurses; they were just the normal sort of mid-level clerical people that the Labor Party are so fond of finding jobs for, because they are mainly Labor Party branch members. Lawrence Springborg, to his very great credit, had a hospital system in Queensland that was actually working. There was a dental system that provided private practitioners around the state with the money to look after the teeth of all and everybody, even those who couldn't afford it. It was, for a short period of time, a wonderful health system in Queensland, and that's similar to what the coalition does with health at a federal level.

The health minister is already involving himself in the substantial reform of private health insurance, and some of my colleagues in this debate would have spoken about it. I want to, particularly in the short time left to me, talk about private health insurance reforms and discounts for 18- to 29-year-olds. Insurers in Australia will be making private health insurance more affordable for young Australians, and that's what every young Australian aspires to—I shouldn't use the 'aspiration' word; people opposite me won't know what I'm talking about. From 1 April next year, insurers will be able to offer discounted private hospital cover to people aged 18 to 29. Legislation currently prevents insurers from offering premium discounts to people on the basis of their age. But insurers will be able to offer that premium discount to offer hospital cover of up to two per cent for each year that a person is under 30 to a maximum of 10 per cent for 18- to 25-year-olds, and these discounts will be gradually phased out once the policy holder turns 40. This is important, because private health insurance cover provides consumers with greater choice in the provision of treatment, access to shorter waiting times and coverage for some services that are not funded by Medicare.

Younger Australians, particularly those under the age of 30, have far lower rates of private health insurance participation than most other age groups. This means that young people are currently missing out on the benefits of private health insurance, which I'd suggest everyone in this chamber take advantage of. The viability and sustainability of private health insurance relies upon a broad membership base. Encouraging more young people to take out private health insurance will, therefore, benefit everyone. This will really improve the affordability of private health insurance for young Australians, increasing their access to private hospital services. The lower premiums will encourage more young Australians to purchase private health insurance. With lower premiums, taxpayers will save $16 million over four years on private health insurance rebates, and these premiums for hospital cover, for young Australians, will be up to 10 per cent cheaper. That's just one of many reforms that this government, and our wonderful health minister, Mr Hunt, is looking at, again, to improve Australia's health system. I think it's uncontested that Australia has the best health system of anywhere in the world, and we in the coalition government intend to make it even better in a sustainable—that is, a paid for—way.

Murray Watt (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the motion that has been proposed here; that there is a need for Australia 'to have a more transparent and accountable health system that helps consumers make informed choices'. The need for greater transparency and accountability in our health system is something that the Labor opposition has supported for some time now. As I'll mention in the course of my contribution, there are a number of either policies or commitments that we've already made, and a number of other things that we have asked the government to act on, that would improve transparency and accountability, which, unfortunately, the government has yet to act on.

I think all of us understand that ensuring that Australians have good quality health care and are able to enjoy a decent standard of health themselves is one of the most important things that we can ask of our federal government. It's really good that over a number of years, due to improvements to the way health care has been provided in this country and to advances in medical technology, more and more Australians are living longer, healthier lives. Despite that, we know that there remain pockets of health disadvantage throughout our community, particularly if we're looking at preventable diseases. That is particularly where we need to see greater action on the part of governments.

In terms of transparency and accountability, though, I don't think anyone can deny that it's important for governments to ensure that health consumers, citizens of Australia, have access to as much information as possible about the availability of health care and the likely cost of that health care if they get problems fixed, whether in hospitals, by GPs or in other environments. Giving patients access to more information about the fees and out-of-pocket costs that they are likely to incur in the health system is absolutely critical for consumers to be able to make informed choices about the kind of health care that they need.

All of us who come to this place as political representatives have heard the horror stories from constituents of the cost of health care that they end up incurring which goes well beyond what they expected that they would incur when they made a decision to have a particular operation or procedure performed. Unfortunately, because health care is expensive to provide, it's not as if people get a bill for just another $20 or another $10—which, for many people, is still a lot of money. Too often, what we see in the health system is people agreeing to have procedures conducted, thinking they are going to be fully covered either by the public system or the private system—if they have private health insurance—only to find out, once they've had those procedures undertaken, that they are left with a bill of several hundred dollars or, even worse in some cases, several thousand dollars. That's not something that anyone should be faced with in this country with a universal health system of the kind that we have.

The need for greater transparency was highlighted by an ABC investigation into out-of-pocket costs last month. I think it aired on Four Corners. That was a very revealing investigation. It showed there are still too many instances where Australians face the dilemma of having to make a decision about whether they are going to have a health procedure undertaken on the basis of what the costs are going to be—and sometimes those costs are going to be higher than they should be because of cutbacks to the health system that we've seen by this government. But, even having weighed up the costs and benefits and decided to go and have a procedure performed, the ABC investigation revealed that there are a number of Australians who are facing huge bills when they come out of hospital, or wherever they've had a procedure done, which they hadn't planned for and, had they known about them, may have resulted in them making different decisions. In some cases they would still have gone ahead and had a procedure done. Obviously if it's a life-threatening procedure then someone is much more likely to make that kind of decision and somehow come up with the money needed to do so. But if people are having procedures done in the belief that something is going to cost a certain amount, only to find out that it's going to cost several thousand dollars more, that is an outrage that we should be taking action to prevent.

The ABC report showed that, while we continue to have every confidence that most Australian surgeons are going to do the right thing by their patients and are going to properly inform people about the likely cost of a procedure, there are rogues out there, as there are in any industry, who don't have the best interests of their patients at heart and are doing the wrong thing by their patients by not fully informing them of the likely cost of a procedure. The Four Corners investigation made clear that, tragically, there are some unscrupulous profiteers in the medical profession who do need to be brought into line, and that's what the purpose of this motion is. It is to emphasise the need for action by the government.

One troubling aspect of the Four Corners report was that there are some surgeons in Australia who are charging patients unexpected out-of-pocket booking fees of up to $6,000. That's something that many citizens of our country aren't necessarily providing for or thinking they are going to incur when they're making decisions about the health care that they will receive. This sort of behaviour can add significant stress to patients at a very vulnerable time. If someone is trying to make a decision about whether to get a procedure performed or not, that's a stressful time for people. Obviously when someone has had a procedure performed and they're discharged from hospital, or whatever health environment they've had that procedure performed in, they're hardly in a good position to be making a decision about whether they'll pay some out-of-pocket costs. In some cases, they are under far too much pressure to pay up to be able to think through the consequences.

Labor has called for an urgent ACCC investigation to look into this predatory and unethical practice from what is hopefully a small percentage of the profession, and it's disappointing that the government has not heeded our request. Perhaps the debate today and putting this issue on the radar will be enough to convince the government that this is a very serious issue that is affecting too many Australians and that no Australian should be left in a position where they have a health procedure undertaken only to find out that they are left owing thousands of dollars that they didn't provide for.

An ACCC investigation is urgently needed to try and crackdown on this practice. Of course there are also instances where we have some specialists simply charging exorbitant fees for their services, which means that there are enormous gaps between the amount someone is insured for and what they end up having to pay in the form of out-of-pocket costs. That's also wrong, and that's why it is so urgent that we get better transparency of fees for people so they can make much more informed choices before undergoing procedures. There needs to be a lot more accountability built into the system for surgeons who do the wrong thing by their patients and overcharge people.

Labor are very concerned that, despite the number of times that we've called for action on out-of-pocket costs, in terms of transparency, accountability and just taking action to keep those out-of-pocket costs down—despite all of that—we've seen no action on the part of this government and the current Minister for Health, Mr Hunt.

Instead of tackling the issue as part of their private health insurance package last year, they simply shunted it off to a committee and that's the last that we've heard of it. I know that this is something that we've been exploring at Senate estimates hearings, and we'd really like to know more from the government about what they are doing to try to bring out-of-pocket costs under control.

One of the key factors that is driving this increase in out-of-pocket costs in the Australian health system is the refusal of this government to do anything about the Medicare rebate freeze. We've seen the Medicare rebate just kept at the same level for far too long, and we understand that—even though there are many doctors who want to do the right thing and aren't seeking to overcharge their clients and their patients—the reality is that the cost of providing medical treatment is going up. Despite that, the government has held the Medicare rebate at such a low level for so many years that that has increased out-of-pocket costs that Australians are facing.

Across the entire country, Australians are now paying up to nearly $47 out of their own pocket to see a GP because the Medicare rebate just has not kept pace with the increasing cost of health care. Out-of-pocket fees to see specialists have soared even higher, up to almost $88 for Australians; they are having to pay another $88 out of their own pocket to see a specialist because of this government's refusal to fund the health system properly. As we're going to see this week, in another debate about company tax cuts, the government is happy to ship lots of money off to big business to give them a tax cut that the country can't afford, but out-of-pocket costs is another area that the government should be putting proper funding into.

Sue Lines (WA, Deputy-President) Share this | Link to this | Hansard source

Thank you, Senator Watt. The time for this debate has expired.