Additional comments by Coalition senators
Health
Insurance Amendment (Extended Medicare Safety Net) Bill 2009
1.1 The Coalition introduced
the Extended Medicare Safety Net (EMSN) in 2004 to assist with the
out-of-pocket expenses of all Australians. The legislation allowed the
Minister to initiate an independent review of the 'operation, effectiveness and
implications' of the Act. The former Health Minister engaged the Centre for
Health Economics Research and Evaluation (CHERE) at the University of
Technology Sydney in 2007 to complete a review. This Bill is largely a result
of the review's findings.
1.2 The Coalition
welcomes the review and Government consideration of how to address some of its
concerns. However, Coalition Senators believe that a number of submissions
raised legitimate concerns with the direction taken by the Government to
address the review and the consequences on certain Australians accessing
medical services. These concerns relate to a lack of industry consultation by
the Department in designing this Bill, and the discrimination against patients
receiving the medical services targeted by this Bill. Better consultation would
have allowed the Government to investigate the consequences of the measures.
Lack of Industry
Consultation
2.1 The Australian
Society of Ophthalmologists noted in its submission that the Government made
"no consultation with health care providers or consumers prior to the
announcement of this (Bill)...the result is that a decision has been taken with a
number of adverse consequences for the community."[1] The Australian
Medical Association submitted that it would be better practice "...for the
Government to consult the medical profession when it is developing policy on
Medicare rebates so that there can be proper scrutiny of the practical effect
of the measures in the Bill and the draft Ministerial determination."[2]
2.2 The Chair's
report contends that the Committee is satisfied that the "Department has
adequately responded to the concerns put to the committee by various
stakeholders." Coalition Senators do not believe that the concerns of
industry groups have been adequately considered by the Government. Despite the
claims by the Department of constant consultation, it appears that the
potential consequences to certain patients has not been adequately considered.
Better consultation with the profession would have allowed a fairer assessment
of the impact upon these patients.
2.3 Proper
consultation with the industry leading to a Ministerial Determination on the
level of a particular cap will be essential to the operation of this Bill.
Coalition Senators recognise the undertaking by the Department to continue
working with the profession "leading up to the implementation of this
measure."[3]
Discrimination of
Certain Medical Services
3.1 The Bill will allow a
restriction on the rebate for costs incurred for outside-of-hospital Medicare
services on certain items. These items include: all obstetric services
including some pregnancy related ultrasounds; all Assisted Reproductive
Technology services (IVF treatments); a type of cataract surgery; and, a type
of varicose vein surgery. Coalition Senators recognise the need to monitor
costs relating to the operation of the EMSN and understand that some providers
have increased costs to absorb the Medicare rebate provided. However, Coalition
Senators wish to raise concerns of submissions made contending that the Bill
will increase the costs of medical services provided to certain groups of
Australians and the effect is discriminatory in nature.
3.2 The Australian
Medical Association (AMA) submits that "it is inevitable that patients
will incur greater out-of-pocket costs for these services as a consequence of
this measure". The increases are despite the Government promising before
the 2007 Federal Election that "with about one million people each year
receiving some cost relief from the safety net, Federal Labor will not put more
pressure on family budgets by taking that assistance away."[4] The disturbing
pattern of the Government breaking its election promises is a concern.
3.2 Coalition Senators
are particularly concerned at the potential cost increases for families and
rural Australians. The AMA's analysis of the draft Ministerial Determination is
that costs for normal obstetric deliveries will increase "by around $466
for patients who are charged fees in the bottom quartile, and around $1,706 for
patients who are charged fees in the top quartile."[5] The Australian
Society of Ophthalmologists submit that "the economic viability of the
delivery of eye care to rural and remote communities will be destroyed".[6] This will lead
to more patients moving to the public hospital system, more congestion and
increased costs to both insured and uninsured patients.
3.3 The Chair's report
contends that, whilst capping these items will have "the desired effect of
curtailing public expenditure on the extended safety net", the actual
causes for cost increases have not been determined. The report recognises:
"...the difficulty of establishing
a causal link between an increase in average fees for medical services and the
range of factors that may have contributed to higher costs. Indeed it is highly
likely that the recent increase in average fees for the services that the
government proposes to cap is the result of several factors."
3.4 Coalition Senators
are concerned that the Government does not have a clear idea as to why the
costs of obstetric, IVF and cataract services have increased and that it
proposes to increase out-of-pocket costs in order to save public finances. For
example, Access Australia submits that the factors relating to rising costs for
Assisted Reproductive Technology must be determined by consulting with the
particular doctors accused of overcharging.[7]
It is unfair to require certain Australians, such as families and those living
in rural areas, to pay higher costs, without addressing the range of factors
contributing to the higher costs of these services.
Conclusion
4.1 Coalition Senators
believe that better consultation with the profession would have resulted in a
better understanding of the factors placing upward pressure on the cost of
certain medical services. The operation of the EMSN will require continued
reviewing in order to ensure that the out-of-pocket costs to those Australians
receiving these services does not increase unfairly and that these services
continue to be available.
Sue Boyce
Senator for Queensland
Mathias
Cormann
Senator
for Western Australia
Judith Adams
Senator for Western Australia
John
Williams
Senator
for New South Wales
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