Private health insurance income thresholds

Published on Tue 1 June 2021 1:15pm

As far as public goods go, in my view, it’s what comes first. When you think of the great public goods like education, our environment and public health, I think most people would agree that health is what you need to achieve first and foremost. So you want the best quality of care, and Australians have a right to expect that.

Mr Wilson (1:15pm) I’m happy to make a contribution to this debate on the Private Health Insurance Amendment (Income Thresholds) Bill 2021 and to do so in support of the second reading amendment moved by the member for Hindmarsh. These are some relatively minor but welcome changes in relation to the indexations that are part of our private health system. Private health funds form part of our health system as a whole, which has always been a hybrid model. We have private and public health in this country, and together the public health system, at the foundation, and then the private health system on top of that seek to deliver three things to the Australian people. At the very top of that list is quality of care. I don’t think there’s any doubt that, in all of our lives, the building block of wellbeing, the foundation on which our ability to be at our best and to pursue our lives, our interests and achieve our potential, is good health. As far as public goods go, in my view, it’s what comes first. When you think of the great public goods like education, our environment and public health, I think most people would agree that health is what you need to achieve first and foremost. So you want the best quality of care, and Australians have a right to expect that.

It’s entirely reasonable that people have choice in their health care. In the most dire circumstances, emergencies, essentially the system takes care of you. If you have a bad accident, you will be collected in an ambulance, you will go to emergency and you will receive the kind of high-quality care that’s available in the Australian hospital system. You probably won’t know too much about it and you won’t have to make a choice. But there are other kinds of health care where choice is relevant, and people should be able to make some choices with respect to their health care. The private system does enable that. Then of course there’s the issue of cost management. It’s not just cost management for individuals, but cost management for the nation and the system as a whole. Someone, such as a primary school student when they first understand the health system and its public and private components, might be forgiven for thinking that the public part is the only part that draws on the public purse, and the private part is essentially paid for by the individual. That’s not the case. We support, with Commonwealth assistance, those who choose to have private health insurance in one form or another. The cost picture, the cost to Australia as a whole, is made up of and the costs are drawn from both the public and the private system.

It’s interesting to note that, again, someone might think that if you had a system with a higher private-to-public mix then that would draw a smaller amount from the public purse, but there’s actually evidence to the contrary. I think the United States is the best example of that. The United States has a significantly less universal form of public health than we have in Australia, and yet government expenditure on health in the United States is considerably more than it is here. So, I think there’s not much doubt that our health system, as it has evolved, is a comparatively strong one, and people who’ve travelled to other parts of the world may well have had some experience of that.

For it to remain strong, we need to keep tending to it. We need to keep looking at the various settings and costs and the way in which it changes over time, because health care is one of those areas of life that is changing all the time. There are new pharmaceutical treatments, new diagnostic treatments and new forms of surgery. It will come as no surprise when I say that most of them are at the cutting edge. The more innovative ones come with an appropriate price tag attached, and that’s something that needs to be managed.

The pandemic has allowed us to see various aspects of our life in Australia under the magnifying glass, as it were, and that includes our health system. When decisions were taken in March and April last year to prepare for and manage what could have occurred if the virus had really got off the leash in Australia, one of the decisions made was to stop certain kinds of hospital procedures, to essentially free up capacity in our health system and in our hospital system in particular for what might have been a more dire form of infectious spread in Australia. That meant cancelling elective surgery, and I think people understood the logic of that. For some private health providers, though, it put them in a very difficult position, because their model is dependent on providing services that are paid for by the people who go and have the elective procedures that are covered by their insurance. My understanding is that, in some cases, private hospitals not surprisingly gave indications that they might need to shut down a little bit more comprehensively than the health authorities were anticipating. Health authorities were hoping that everything would go dormant as far as ordinary healthcare activities were concerned and would be there ready and waiting for what might have happened if the virus had really spread throughout the Australian community. When the private health providers gave some indication to government that they might shut down a little bit more seriously than that, that was an issue. It was certainly true in Western Australia and I expect it was in other jurisdictions. But that was an issue that needed to be managed, and government had to find a way to encourage that private capacity to remain online. At that stage we were looking at ICU capacity and ventilators. I remember a conversation in WA when we were briefed about how many ventilators were available, and at that stage there were perhaps only a few hundred. They were trying to bring more online, because we know at the very acute part of the COVID-19 disease it is the provision of oxygen and a ventilator that can keep you alive.

I do note that in what may have been phase 2 or phase 3—it’s hard to keep track, really—at some point around April or May, all of us were dealing with the issue of cruise ships and shipping-based infection. It seems like a long time ago now, but we had the Artania in Western Australia, a ship that had a significant infection issue for both passengers and crew. I think it was the Joondalup private health facility that was essentially put aside to deal with that, to be the dedicated facility for the passengers and crew who needed to be treated who were coming off the Artania. That whole healthcare exercise was seen through with an extraordinary degree of success. It was controlled. There was no infection outside of the hospital. I don’t think that any of the healthcare workers were infected, and all of the people who needed care were provided with care. Many of them, I think, German and Italian citizens, were ultimately able to fly home, and the crew were able to in some cases fly back to the Philippines and in some cases be returned to the ship. That was an instance where our private health facilities or capacity was marshalled and drawn upon in a sensible and well-organised way to deal with that particular aspect of the pandemic. It’s those kinds of things that we’re likely to need to draw more on in the future. As we’re seeing right now with the circumstances in Victoria, nobody can be sanguine about the progress of this pandemic, its future, how it will develop and what other challenges we will see.

What has been clear is that when we think of health care it’s not just the high-end medical expertise that is crucial; there are a lot of things involved in delivering health care that are in that practical or logistical category that probably aren’t that different from many other areas of life. It’s about anticipating what may occur, stocktaking the resources that you have—human capital, equipment and, in the case of hospitals, obviously beds, ventilators, oxygen machines, PPE, pharmaceuticals, all of these kinds of things—and then there’s the scheduling and administrative side of it. We are seeing at the moment some aspects of that administration being examined because they haven’t delivered what we may have expected, and we cannot have a situation where we’re not able to say how many people have been vaccinated within a particular cohort. We must be more effectively proactive in reaching out to ensure that vulnerable cohorts are vaccinated, and certainly we must be able to have, pretty much at the tips of our fingers, the details as to how effective those programs have been. We can’t have a situation where, as I understand, the responsible minister in Senate estimates today just simply isn’t able to give some numbers about people in certain categories of aged care, whether it’s aged-care residents or aged-care workers or people in residential disability care. If you’re not on top of that kind of detail, it speaks to the administrative competence or the administrative solidity that is underneath our vaccine program.

We need to be able to, using all the resources that we have—our public system, our private system, doctors and nurses, public servants in the relevant health departments—to identify what should be occurring. Obviously frontline workers should be vaccinated. People in residential aged care should be vaccinated. Their carers should’ve been vaccinated. That should’ve occurred already in almost all of those categories. We’re discovering now that it isn’t the case, and we’re seeing some of the consequences.

The numbers today are encouraging. I think we all saw 11 infections yesterday and some of the statements made by Victorian Health with a lot of compassion and concern and trepidation about what might be ahead, so to hear today that it’s only three gives us some hope. And we can take hope from the way the Australian community has responded through the 17 outbreaks and lockdowns to date, because, however difficult they have been, we have managed to get to the other side. But we should learn the lessons when these things occur. This has shone a bright spotlight on some things that I think have surprised all of us. We expected that you wouldn’t have aged-care workers working across multiple sites last year. That apparently changed, and then it apparently changed back, and it’s very hard to understand why that’s the case, not least because we know the consequences of that. And it’s not on the aged-care workers; the only reason aged-care workers do that is because they’re paid a pittance. They’re not properly supported and remunerated in the vital work that they do, and they have no choice other than to work in multiple centres.

This bill makes some minor but important changes to our health system as a whole—obviously the private health aspect of it, particularly in relation to the indexation of certain income thresholds, and we support it on that basis. Obviously I support the second reading amendment that’s been moved by the member for Hindmarsh.

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