Carers Queensland Inc. Submission to the Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care.

Transcription

1 Carers Queensland Inc. Submission to the Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care May 2014 Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 1

2 Submission Title: Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian healthcare Date: May 2014 Author: Approved by: Sarah Walbank, Policy and Research Officer Debra Cottrell, Chief Executive Officer Carers Queensland Inc. 15 Abbott Street Camp Hill 4152 Queensland Phone: (07) Website: ABN: Carers Queensland Inc Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 2

3 CARERS QUEENSLAND INC. Family carers provide unpaid care and support to family members and friends who have a disability, mental illness, chronic medical condition, terminal illness or are frail aged. The activity and impact of providing care is best understood in terms of its context; as a relationship between two or more individuals, rooted in family, friendship or community. Caring is a role rarely chosen by most, nor does it discriminate. Children and young people, people of working age and older people, people with a disability, people who identify as culturally and linguistically diverse, indigenous Australians and those living in rural and remote Queensland provide care to a family member or friends on a daily basis. For some caring is a short term commitment whilst for others, it is a role that literally lasts a lifetime. Carers Queensland Inc. is the peak body representing the diverse concerns, needs and interests of carers in Queensland. Carers Queensland believes that all carers regardless of their age, disability, gender identification, sexuality, religion, socioeconomic status, geographical location or their cultural and linguistic differences should have the same rights, choices and opportunities and be able to enjoy optimum health, social and economic wellbeing and participate in family and community life, employment and education like other citizens of the State. Carers Queensland s mission is to improve the quality of life of all carers throughout Queensland. We believe we are in a unique position to advocate on behalf of the 484,400 1 carers living in Queensland. We aspire to provide an independent platform from which to advance the issues and concerns of carers and believe our knowledge and expertise in carer issues means that we are able to provide the Government with relevant and trusted information that will ensure that the needs of carers will be recognised, respected and acted upon. Our ambition is to ensure that carers are recognised and included as active partners in the development of government health and social policy, legislation and service delivery practices. This submission reflects the concerns of Queensland s carers, those citizens who provide unpaid care and support to vulnerable family members and friends. This submission has been informed by consultation with Queensland s carers and Australian and international research. Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 3

4 CARER CONTEXT Social disadvantage is a pivotal determinant of poorer health in the general population. 2 Disadvantage, including social disadvantage, is a multi-dimensional concept; it is about penurious lives and lack of opportunities and includes such factors as poverty, deprivation and social exclusion. Understanding why people become and remain disadvantaged, and the consequences of disadvantage, is challenging. Many of the factors are interlinked, and when combined, can have a compounding effect. Those who experience deep disadvantage include single parents, Indigenous Australians, people with long term health problems and/or a disability, people with low educational attainment 3 and carers. Many carers, but particularly those who have been providing care for a very long time, those caring for more than one person or those with intensive caring responsibilities, are financially and socially disadvantaged and experience poorer health including diminished immune responses, susceptibility to physical illness and chronic injuries 4 and emotional problems including moderate and severe depression. 5 Research has shown that carers incur additional costs directly related to the disability, chronic illness or frailty of the person they care for and support. Such costs include additional energy consumption for heating and cooling, cleaning and laundry, personal hygiene including incontinence wear and appliances, specialist diets, specialist therapies and equipment, medications and treatment costs, communication and travel costs and costs associated with community support services such as respite care. Furthermore, many carers bear significant economic and social costs from lost educational and employment opportunities. 6 Their ability to pay for household essentials, to save money or generate a financial buffer are poor when compared with the general population. This perpetual financial struggle creates significant anxiety and eventually diminished health and emotional wellbeing. Carers Queensland s own research indicates that many carers are financially unfit, ineligible for mainstream credit and reliant on microfinance, payday lenders or other loan sources to make ends meet. Many struggle with the cost of living and have to delay one payment in order to make another payment or in order to get by. 7 Some carers in Queensland, particularly those who have been in full time caring role for two years or more, will constitute some of the 12.5% of citizens living below the poverty line. 8 ACOSS research (2012) indicates that in households where the main income earner is in receipt of the Carer Payment 24% live below the poverty line. 9 At the aggregate level carers have a higher rate of poverty and those carers caring for two years or more are more likely to be in persistent poverty 10 and disadvantage, which results in entrenched poverty and dependency on the state Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 4

5 CONTEXT AND RECOMMENDATIONS Carers Queensland welcomes the opportunity to present the concerns and anxieties of those 484,000 Queensland citizens who provide unpaid care and support to vulnerable and frail members of our society with regard to the impact of out-ofpocket healthcare costs. As evidenced in the following section, Data From Carer Survey, accessing good quality health and allied healthcare in a timely manner is out of reach of many carers. This is particularly so for those carers who provide care and support for more than one person, provide intensive support, is a lone parent carer or grandparent carer, reliant on statutory income support or lives in rural or remote Queensland. There are 2.6m citizens in Australia who provide, in an unpaid capacity, care and support to another individual who is requires assistance because of a disability, chronic illness or frailty. Informal family care remains one of the lowest subsidised forms of care in Australia, the replacement value of which has been estimated at $40.9 billion per annum, or the equivalent to 60% of other formal health care cost. 13 On one hand carers are applauded by government for their contribution to their family and community and for their contribution to the $40.9 billion in saved taxpayer money. On the other hand, carers and particularly carers of people with severe disabilities and complex medical problems, resent the implication that they are a burden on the healthcare system, and are fearful of many of the proposed charges, particularly mandatory co-payments to see a GP. As one carer said: While a $6 co-payment is currently being considered, it concerns me that this figure may increase and also that pensions won't keep pace with inflation and at some future point a co-payment - on top of all the other health costs - would make consulting the GP an imposition, such that needed consultations would not be undertaken because of cost. The imposition of additional out-of-pocket costs, no matter how it is argued, will result in a further reduction of access to what was once promoted as a fair and affordable healthcare system. Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 5

6 RECOMMENDATIONS Carers Queensland respectfully makes the following recommendations for consideration: GP, Pathology and Diagnostic Imagery Co-payments a. Carers Queensland recommends that holders of Commonwealth Health Care Concession cards are exempt from mandatory GP, pathology and diagnostic imagery co-payments. b. If mandatory co-payment charges are implemented across the board Carers Queensland recommends the introduction of a robust safety net arrangement by which Commonwealth Health Care Concession card holders are afforded a reduction in the co-payment charge and a waiver of cost once the threshold is exceeded. Pharmaceutical Benefits Scheme a. Carers Queensland supports the maintenance of the existing safety net for Commonwealth Health Care Concession card holders Greater Collaboration with Industry Associations The vast majority of health care providers in Australia are for-profit companies whose priority is to maximise market share and shareholder profits. Carers Queensland believes that significant gains for all health consumers can be made through greater collaboration and agreement with various industry associations to address certain practices. a. Australian Medical Association to address the practice of GPs requiring patients to visit surgeries for repeat prescriptions and pathology requests and no other purpose. b. Insurance Council to investigate the viability of developing a suite of low cost, no-frills health insurance policies for lower or low income earners. Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 6

7 DATA FROM CARER SURVEY A recent survey of carers conducted by Carers Queensland highlighted the dependency of many carers on subsidised health and allied health care. 14 Accessing a GP: 64.1% of respondents indicated that they had chosen or would choose a GP or health clinic because they offered bulk billing. 81.6% of respondents use a medical practice that offers bulk billing. Impact of co-payments: 46.39% of respondents indicated that they had foregone medical treatment and 42.66% had abandoned allied health treatments because of the cost. Nearly one-third had chosen not to fill a prescription due to an inability to pay. In the words of two carers Carers are already under a lot of financial pressure because caring is often a full time job and leaves little time for earning an income. Added financial burdens, no matter how small, are accumulative and I for one would be more likely to put off my own health concerns in favour of putting money towards my child's needs who I care for. My husband s doctor does not bulk bill and there has been more than one occasion when we have had to pay a doctors bill and not purchase groceries. Accessing allied health: For many people, achieving and maintaining good health and thereby maximising social inclusion is dependent upon accessing a number of allied health interventions such as physiotherapy, occupational therapy, speech pathology and therapy, dietetics, and podiatry to name but a few. The efficacy of early interventions such as speech therapy, particularly for children with developmental disabilities and by extension their families, is well documented in research. 15 Notwithstanding, there are many children and adults with disabilities including carers with chronic injuries sustained through their caring responsibilities, who would benefit from timely allied health interventions but who do not have the money to pay for such care. Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 7

8 In the words of a carer Paying $150 an hour for our undiagnosed autistic son to see an OT created stress for our family. Now we have a diagnosis and funding we don't have to worry and he is getting more therapy than before. His and our future is brighter! In our recent survey: 81.6% of respondents indicated that they or the person they care for and support use allied health services. Most allied health providers charge the scheduled price or higher, making it unaffordable to some. Health insurance: Health insurance is for many carers a luxury, well outside of their limited budget. In our recent survey: 14.9% of respondents had relinquished their health insurance because of the rising premiums 3.5% were ineligible to purchase insurance because of the nature of the disability or medical condition of the person they care for and support 32% had not purchased health insurance (unspecified reasons) Of those who had purchased health insurance the vast majority had purchased Extras cover and slightly less had hospital cover. Impact of the proposed $6.00 co-contribution: When asked of the impact of the proposed $6.00 co-payment at the time of visiting a GP: 44.7% of respondents indicated that they would delay visiting the GP 15.5% of respondents indicated that they would not be able to afford the consultation and would attend the hospital accident and emergency department instead. In the words of two carers Our son is immune-suppressed, meaning that he can become unwell very quickly and he may need many appointments regarding just one illness. With the costs of between 3-4 appointments per illness, the cost of multiple courses of antibiotics Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 8

9 and then the fact that this can happen multiple times per year would definitely mean more trips to hospital emergency over issues that the GP can manage. When you have a child with multiple health issues, you want to get to know and trust your GP very well and not have cost enter into making decisions about how many visits you can afford per year. I have on almost all occasions had to re book appointments to go to the doctors once a month just to have scripts refilled. To me this seems like an expensive practice considering that the government is bulk billed at the same price as consultation prices. I myself would go to the doctors no more than once a year for personal illness and find this monthly practice not only time consuming (waiting for more than 1/2hr each time} but a blight on the state health care system. REFERENCES 1 Australian Bureau of Statistics. (2012). Survey of Disability, Ageing and Carers: Summary of findings. No Canberra: Australian Bureau of Statistics. 2 Australian Institute of Health and Welfare. (2012). Australia s Health. Canberra: Author 3 McLachlan, R., Gilfillan, G. and Gordon, J. (2013). Deep and Persistent Disadvantage in Australia. Productivity Commission Staff Working Paper. Canberra: McLachlan, Gilfillan, Gordon. 4 Hirst, M. (2004). Hearts and minds: the health effects of caring. Social Policy Research Unit. York: Hirst. 5 Beyond blue. (2012). beyond blue guide for carers. Downloaded from 6 Cummins, R., Hughes, J., Tomyn, A., Gibson, A., Woerner., and Lai, L. (2007). The wellbeing of Australians Carer health and wellbeing report. Report No Deakin University: Melbourne. 7 Carers Queensland Carer Consultation Program Data. Unpublished data. 8 Queensland Council of Social Services (2012). Cost of living Report. Can low income households afford a basic standard of Living? Issue # Downloaded from 9 ACOSS. (2012). Poverty in Australia ACOSS Paper 194. Strawberry Hills: Australian Council of Social Services. Retrieved from 10 Hill, T., Thomson, C., Cass, B. (2011). Social Policy Research Paper No. 43. The costs of caring and the living standards of carers. Social Policy Research Centre: University of New South Wales. Downloaded from 11 Australian Bureau of Statistics. (2012) Survey of Disability, Ageing and Carers, Australia DO003. Canberra: Australian Bureau of Statistics 12 Hill, T., Thomson, C., Cass, B. (2011). Social Policy Research Paper No. 43. The costs of caring and the living standards of carers. Social Policy Research Centre: University of New South Wales. Downloaded from 13 Access Economics. (2010). The economic value of informal care in Report for Carers Australia, October. Canberra: Author 14 Carer Consultation Program Survey 10. April Unpublished data. 15 KPMG. (2011). Reviewing the evidence on the effectiveness of early childhood intervention. Report to the Department of Families, Housing, Community Services and Indigenous Affairs. Canberra: KPMG. Senate Community Affairs Committee inquiry into out-of-pocket costs in Australian health care 9