Minority
Report by Senator Nick Xenophon
1.1
These
comments are confined to the likely effects of the proposed cap on the public
subsidy for out-of-hospital Medicare services under the Extended Medicare
Safety Net (EMSN).
1.2
As outlined
in the majority report, the Health Insurance Amendment (Extended Medicare
Safety Net) Bill 2009 restricts the rebate for costs incurred for
out-of-hospital Medicare services by introducing a cap on a variety of items
described in the Budget Papers as incurring ‘excessive’ fees.[1] These
items include, amongst other things, all obstetric services including some
pregnancy related ultrasounds, all Assisted Reproductive Technology services
and one type of cataract surgery. These measures which are due to take effect
from 1 January 2010 are expected to provide savings of $257.9 million over four
years.[2]
However, there is concern that in seeking to achieve these savings the
Government may unleash unintended consequences, which will be counterproductive,
lead to adverse health outcomes and subsume the projected savings.
1.3
Evidence from
AccessAustralia over the proposed changes and the impact on IVF services states
that ‘if this Bill is passed, it will deny many hardworking Australian families
their last chance to have a child.’[3]
1.4
AccessAustralia’s
submission and evidence that the changes will adversely affect the one in six
who need medical help with infertility[4]
indicates the potential extent of the impact of these changes (with many
couples not realising they may have a fertility problem until they decide to
have children).
1.5
A key
underlying premise of the Government’s rationale for these changes is:
There is evidence that
the Extended Medicare Safety Net has enabled some doctors to charge excessive
fees resulting in windfalls being paid by taxpayers through Medicare. The cap
will encourage patients whose doctors charge excessive fees to seek other
providers who charge more reasonable fees.[5]
However,
evidence from Dr Richard Henshaw indicates when the costs for a cycle are
increased there is increased pressure for multiple embryos to be used, which
increases the chance of medical complications, multiple births and neonatal
intensive care.[6]
AccessAustralia
points out that:
More
than 40,000 individuals were able to access IVF services with the support of
the Medicare Safety Net in 2008 and nearly 11,000 babies are born each year as
a result. Based on estimates reported in The Australian newspaper (2/4/09),
the $42 million spent on IVF in the Safety Net equates to approximately $4,500
for each of these IVF children born last year. IVF therefore is a
cost-effective, valuable investment given the significant return each of these
children, as productive Australians, will bring their families and this country
of ours.[7]
1.6
Similar
concerns about the unintended consequences the proposed changes could have on
ophthalmology services have also been expressed, in terms of increased
out-of-pocket expenses for patients, greater congestion in the public hospital
system and reduced access for rural and remote settings (including indigenous
communities), among others.[8]
‘A greater risk of falls (x2), hip fractures (x8) in elderly Australians as a
consequence of poor vision’[9]
has been cited as another factor.
1.7
Dr Hillary
Joyce set out the concerns of obstetricians and gynaecologists on behalf of the
National Association of Specialist Obstetricians and Gynaecologists. Dr Joyce
highlighted that ‘the Medicare Safety Net has provided hundreds of thousands of
Australians with the security of affordable service access when they need it,
particularly those faced with high-cost services or recurrent medical expense.’[10]
1.8
In addition
to the issues raised with respect to IVF treatment, Dr Joyce pointed out that:
Thirty
per cent of women have their children under care of private obstetricians, and
if there is less choice to do so because of reduced affordability then there
will also be an impact on the public system, which is already overloaded, if
those women turn to the public system to help them out of their predicament.
Certainly, for the future mothers we do see reduced choice, reduced access, and
reduced affordability.[11]
1.9
The rationale
for these changes, namely excessive fees and overcharging, could be tackled by
alternative means including:
1.9 There
appears to have been a lack of analysis and modelling by the Government over
the potential unintended consequences (and additional costs) of the proposed
changes, particularly in relation to IVF.
Recommendations
Recommendation
1
That the Bill not be passed in its current form until adequate
assessment of the costs and implications of the proposed measures has been
undertaken.
Recommendation 2
That the Government ought to pursue alternative approaches to deal
with concerns of excessive charging including informed financial consent for
patients.
NICK XENOPHON
Independent Senator for South Australia
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