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STANDING COMMITTEE ON FINANCE AND PUBLIC ADMINISTRATION - 30/10/2008 - Item 16525 in part 3 of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007

Estimates & Committees
Sarah Hanson-Young 30 Oct 2008

Senator Hanson-Young -This is a question to all three of you. Do you agree with previous witnesses who have suggested that disallowing this particular Medicare item would not necessarily stop people from going through the procedure but in some cases prolong the pregnancy and push those weeks even further out so that a woman would have a termination even later than perhaps she would have beforehand?

Dr Mould -It is a possibility. It is a hypothesis. I have seen no data to show that that is what happens. I am sorry, but I have no anecdotal evidence that I can call on to provide you with any assistance there.

Dr Cockburn -This came up in the Victorian debate, and I think it was around whether there should be a 24- or a 20-week cut-off in the Victorian law. I think that what was raised was-and, again, I have no evidence of this, but this was the theory-that often it is the 18-week ultrasound where they may get the first serious evidence of a foetal abnormality.

Senator Hanson-Young -Some people do not have that until 20 weeks.

Dr Cockburn -That is right. And then they may need to go on and have an amniocentesis, which can sort of push it out. I think that is where that came from. I think there was some, again, anecdotal talk about whether women in Western Australia at that point might try to avoid going to the panel, if you will, and come to Victoria-or not even come to Victoria-and have the termination before the 20-week mark to avoid having to go to the panel. As I say, that was the sort of discussion that was being had. I have no evidence of it.

Senator Hanson-Young -Ms Coleman, do you have anything to add?

Ms Coleman -I was just going to say that the people who may hypothetically be having this procedure or who may hypothetically be travelling from Western Australia to Victoria are clearly not the people who are in the greatest financial need. That is just a by the bye.

Senator Hanson-Young -What effect do you think that disallowing this particular Medicare item might have on women in rural or remote areas?

Ms Coleman -Women in rural and remote areas are already quite frequently disadvantaged in terms of their access to specialist services. The various state governments try all sorts of innovative ways to enhance women's access to consultants when they live in the bush, but I think anything that makes it more difficult for a resident woman, man or child in a remote area to get access to expert treatment is just an extra burden. There is a shortage of GPs in the bush. There is a shortage of specialists in the bush. I think removing this item as well is probably just going to be an extra burden, but that is a hypothetical statement.

Dr Cockburn -My concern-and I also used a hypothetical example in my submission-would be the woman who has a private obstetrician gynaecologist, let us say, in a rural centre and she only has access to a private hospital. Let us say that her finances are such that this is the tipping point. She may then have to travel to a public hospital in the city where she no longer has her choice of obstetrician, she no longer has her choice of hospital and she has to move away from her family. It is hypothetical, but $200 could be the tipping point for her. That is one thing that I think counts.

Senator Hanson-Young -We have heard from a number of witnesses-and I must say that there have been those both advocating for the disallowance and those opposing the disallowance-and from people who have made submissions that this will mean women will use the public hospital services more. What kind of an impact do you think that is going to have on those services? A woman who has had a child in a public hospital is on a waiting list anyway.

Dr Mould -There are a number of issues there. The first is access in a geographical sense. Secondly, there is access in a timely sense and, regrettably, the pressure on the public hospital system is such that waiting times are very long despite the best efforts of the various state governments to improve them. So there are two issues. First of all they have to find or get a referral to a public hospital and, secondly, they then have to access what are at times rather meagre services at that public hospital and the resources that are at that public hospital

Dr Cockburn -It would be very important that that particular public hospital did provide the service, because there are places that are already serviced by public hospitals that may not provide that service. Adding to that, some people have said that the disallowance of this item number would send a message to the Australian people that second trimester termination under these circumstances was not appropriate. The thing is that the message would not get very far because, if these procedures are going to be shifted to the public hospital, I think that the state governments would realise that these are being underfunded and they would probably, through the Commonwealth health services agreements, be applying to the Commonwealth to get more money to pay for these procedures. So it would end up that the Commonwealth potentially would be paying more and spending more taxpayers' money for these procedures if this item number were disallowed.

Senator Hanson-Young -On another topic, there has been a lot of debate over the last day and a half about whether partial birth abortion is taking place in Australia or not and in particular practices or not. People who have said that they are taking place have not named any places. In your profession and in the work that you do, are you aware of this practice happening?

Dr Cockburn -My understanding is that it is not a recognised medical term. I was not taught this in medical school. I do not know anybody who does it. I have asked some of my colleagues and everybody I have spoken to has said that they do not know anybody who does this procedure. I have no evidence. I have not seen any evidence that it is being done in Australia. I find the description of the practice abhorrent in the sense that, if a baby were to be born partially and then murdered, that is terrible. I would assume that that is horrible and, to the best of my knowledge, I do not believe that it is being done.

Dr Mould -I have no knowledge at all. I am sorry, Senator.

Senator Hanson-Young -From the National Foundation for Australian Women's perspective, if it were happening, do you think that you would be aware of it?

Ms Coleman -To the extent that I would assume that some of my colleagues who are in the medical profession might be aware of it and might draw it to my attention, yes, I guess we would probably hear of it in that way. But, as you can hear, we are not hearing about it. There are people who talk about it, but that is a separate issue. That is not the same as saying that we have heard that it is actually a practice. That we do not know about. I know that there are people who talk about it but I am not quite sure whether they have evidence.

Dr Cockburn -There have been people talking about practices that are clearly illegal or clearly not under this item number. I would say that if people are making these claims, why don't they refer those doctors to the relevant authorities? I do not understand, if these procedures are illegal and not under the item number, why the authorities are not dealing with them.

Senator Hanson-Young -I must point out that the department clearly said yesterday that they had not received any complaints about these types of practices or practitioners using the item number liberally.

My final question is to clarify. A number of people who are supporting this particular disallowance are citing moral objections and I would say moral objections to abortion overall. Putting that aside, can you see any clinical evidence as to why this particular item should be disallowed?

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