Speaking On The Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2015

The bill before the House, the Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2015, is about the national joint replacement register. It is a bill that matters to all Australians but particularly those 100,000 Australians every year who have a joint implanted in their body.


The National Joint Replacement Registry collects data on the implantation of prosthetic joint replacement devices. It reports on the performance of those devices and any revisions that are required. The work of the registry improves the health outcomes for many Australians. The learning that we have gained from this important body has reduced the rate of revisions of transplanted prosthetic devices. Revisions, by the way, are procedures involving replacement or repairs—and I know that is a matter well known to you, Madam Deputy Speaker Burke. For some patients, revisions require a longer time in hospital for recovery. They are generally more expensive and more complex, largely because they involve, to use the vernacular, reopening old wounds. The registry assists in getting better outcomes by tracking and providing an analysis of the best devices to use in the unique circumstances of patients. By avoiding revisions, we get better outcomes for patients and better outcomes for the health finances of both the private sector and the public sector.

The registry provides invaluable post-market surveillance of joint replacement prostheses. Because of the registry, we know, for example, that there were 42,470 hips replacements registered in 2014, an increase on five years earlier, 2009, of well over 10,000. There were 53,624 knee replacements registered in 2014, an increase on five years earlier, 2009, of almost 10,000 again. Also, because of the registry we know that, for example, replacing the joint surface of the kneecap during a knee replacement lowers the rate of revisions. We know that what works for one class of patient may not work for another. For example, resurfacing the joints of patients with osteoarthritis works to reduce revision but does not appear to reduce the rate of revisions for those people with rheumatoid arthritis. We would not know this without the data available to us from the registry. The registry informs clinicians of the best and most appropriate procedure for particular uses. It ultimately saves the system a lot of money, but, more importantly, it improves the outcomes for patients, particularly by assisting in reducing the rates of revision and ensuring that an operation, once done, improves the quality of life of the patient.

The registry requires funding certainty to enable it to operate properly, which is why in 2009 the Labor government, with the support of the Liberal-National coalition, applied a levy on all device sponsors. This ended years of ad hoc funding arrangements with industry and government. The measures implemented in 2009 by Labor have meant that the registry has stable funding for the critical work it does and ensured that it can continue to provide data to improve patient outcomes. We are pleased to see the government's ongoing support for the registry and the levy which underpins it. The feedback we have received on this bill from stakeholders shows that it has broad support, so Labor is pleased to support the ongoing work of the registry and will support this amendment, which will see a change in the way the levy is calculated and applied to device sponsors. Device utilisation and the value of the prosthetic device will now place a greater and determining role on the way the levy is calculated. The changes as proposed by the government will result in increased activity. The levy will, therefore, raise an additional $600,000 over the next four years to facilitate this, commencing with $100,000 this year and $200,000 a year for the following two years.

Labor will, of course, watch with interest to see whether the government has got its settings correct. The levy must raise enough money for the Australian Orthopaedic Association to effectively run the registry, which supports improved quality of care for patients. We have legitimate reasons to raise doubts about the government's competence when it comes to matters of health policy. In less than two years, we have seen a system which has been studied and envied by countries all around the world driven into complete chaos. We saw over $57 billion worth of cuts to the health and hospital system in the previous budget, added to by an additional $2 billion worth of cuts from health services this year. We have seen four emanations of a GP tax by stealth. In its final emanation, we see the freezing of Medicare rebates, forcing doctors to pass the charge onto their patients. The Medical Journal of Australia estimates that this will cost patients in excess of $8 by 2018.

We have seen the cutting of funds that provide rehabilitation and treatment services for people who have drug addictions, at the very same time as we are spending $20 million on a campaign to raise awareness about the dangers of certain drugs. We have seen cuts of $160 million in Aboriginal and Torres Strait Islander health services and more than half a billion dollars cut from public dental programs. We have seen almost $400 million cut from preventive health programs and hundreds of millions of dollars cut from the health flexible funds that support vital services right across our health system. We have seen cuts to veterans dental and allied health programs and in the recent budget we have seen cuts to the Healthy Kids Check; cuts to the programs that will support the electronic health record; and cuts to the Pharmaceutical Benefits Scheme, including the proposal that is still before the Senate to increase the cost of medicines by $5 for all general patients and 80c for concessional patients as well as restricting access to the Pharmaceutical Benefits Safety Net. We have seen the axing of the Health Direct 24-hour health advice, which provides after-hours phone advice to patients in need. We have seen cuts to optometry programs and plans to make unfair changes to the Medicare Safety Net.

Labor will support sensible measures. This bill is a sensible measure to ensure that we have a fair way of levying the industry to ensure that the important work of this registry is maintained now and well into the future. But against the backdrop of the chaotic changes to our health system, members of the public would well understand, as all members on this side of the House understand, that we have deep reasons to be very skeptical about the government's competence to manage this important area of public policy.