GARY ADSHEAD, HOST: Now you might not have heard about this just yet because it is certainly a developing story but if you're a Bupa private health insurance policyholder, for example, you've got a problem. The company behind the Mount Private Hospital in Perth will be terminating its contract with Bupa after months of fighting about a fair funding deal. Now, in summary, Healthscope, which runs the Mount in this state, and dozens of other private hospitals around the country, accuses Bupa and other insurance operators represented by the Australian Health Services Alliance of short changing them and making it tougher for them to keep the hospital doors open. The escalation means about 6 million Australians will lose their cover and therefore choice of medical treatment and care at private hospitals around the country. That's if they are, as I said, a Bupa customer or a number of other private health insurer funds. Now, first up, I'm going to be talking to the Health minister, Mark Butler, and then I'll be joined by Greg Horan, who is from Healthscope which operates the Mount Hospital. But first up, the Minister. Thanks very much for your time
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: My pleasure, Gary.
ADSHEAD: Just first up, obviously, the fight between private health insurers Bupa and of course private hospital operators, Healthscope. They've got the Mount Hospital here in WA that has deepened, you must be concerned?
BUTLER: Yeah, I'm very concerned. I'm concerned for patients, for private health insurance members. I'm very much of the view that these two big companies, it's the second biggest hospital operator and the second biggest insurer in the country, they're not small players, they're big, sophisticated commercial players have got to sit down and sort this out. I get that there's always a pretty strong commercial tension between insurers and hospital operators. That's how the system has operated for decades. But at the end of the day, they've got to do a deal here.
ADSHEAD: Are you involved in that? Because given there's something like 38 private hospitals around the country so that's now minimising the choice that these that people will have depending on their insurance company. It's severe isn't it?
BUTLER: Yeah it is. This isn't the first time there has been a very difficult negotiation over the past 12 months. Private hospitals are doing it tough. We've been working with insurers and hospital operators as well as clinicians and patient groups, obviously, to work through that pretty, deeply over the last several months. The reality is with these two, it's in no one's interest to have a hospital go out of contract. It's not in the hospital's interest. It's not in the insurance interests. It's certainly not in patients' interests. This brinkmanship has got to end. Yes, they've got a job to look after their own commercial interests but at the end of the day, they receive a lot of taxpayer money and obviously a lot of money from their members to do the right thing by patients. I expect them to sit down and do a deal.
ADSHEAD: Okay, who's telling us the truth here? Because, you know, you've got one side saying that they're involved in gouging, and then you've got the other side saying that they're paying a fair share. Who's telling us the truth?
BUTLER: None of this is ever black and white. Obviously both have to wash their face. They both have to make sure that their operations continue to be viable and profitable so that they can keep delivering services to their members and the patients. It's always shades of grey in this, Gary, as you know but at the end of the day, the private health insurance and hospital sector has always, or at least for many decades, operated on the basis that the operators who get the benefit of being a big part of our health system have to come to a deal. They can't just sort of vacate the field and leave patients and insurance members who've been paying their hard earned money year after year, high and dry. Now, this isn't the first time this has happened this year, including between big operators, including between the big insurers and the big hospitals. I urge and will be privately urging these two players to get back to the table and to fix this.
ADSHEAD: So will you intervene in terms of calling them together yourself, or how does this work?
BUTLER: I'm talking to them now via you, Gary, and obviously my office, our department is in close contact with these players. We do not involve ourselves in commercial negotiations. We do not use taxpayer funds to bail out one side or the other because they think they need more money. The reason why these two operators, whether they're insurers or hospital operators, get to be in a very privileged position of delivering health services, significantly underpinned by taxpayer contributions, is at the end of the day, they're expected to come to a deal in the patient's interests, and that's the case here as well.
ADSHEAD: Can I ask you in all seriousness, obviously you've moved against vaping, you've outlawed it, but have you actually created a very, very viable black market?
BUTLER: It was there already, Gary. These things were flooding into the country in quite remarkable numbers and since I put an import ban in place on the 1st of January and resourced the Border Force and the Therapeutic Goods Administration we've seized almost 7 million vapes. That's about five times as many vapes as were seized in the previous several years. We've really lifted that. We know vapes are harder to get. High school principals are telling us they're seeing less of it in their high schools. The vape stores are starting to shut down. In my electorate, for example, every single one has been shut down. The stores that were set up just to sell vapes, nine out of ten them set up down the road from schools The problem we've got, though, is there is still this black market. Organised crime is involved in it and convenience stores, tobacconists are continuing to sell these things under the counter, in spite of the fact that it's clearly illegal. Now we pass very serious penalties in the Parliament a few months ago, fines of up to $2.2 million and jail time of up to seven years. We've conducted hundreds of operations in partnership with state authorities, including here in WA. At some point soon, I want authorities to start prosecuting these people. I'm deadly serious about shutting down this public health menace, but I'm I've also been very honest with the Australian people since I started this debate a couple of years ago, when you're fighting big tobacco and now also fighting organised crime, that is making a huge amount of money out of this market, which they use to bankroll their sex trafficking, their drug trafficking and their other criminal activities. You can't win overnight, but you've got to keep fighting.
ADSHEAD: Minister, in your opinion, though, whose responsibility is it if a vaping shop, they call it something else, a smoke shop, whatever the case may be, suddenly pops up in a country town. Who do you think should be policing that?
BUTLER: Well, we passed the laws through the Parliament. I've talked with health ministers, the Attorney General talked with police ministers. It was a very, very concerted discussion between the Commonwealth and states and territories that we would pass the law through the Parliament, we would police the border, and then we would work with state governments to do the policing on the ground. When I say policing, I don't actually mean, you know, police officers. These things are usually enforced by health departments, by consumer affairs departments, it's different from state to state. At the end of the day, we work with state authorities. We conduct joint operations where retail premises are doing something contrary to the law. In this case selling vapes. There's many other things that obviously are enforced at a local level as well.
ADSHEAD: And are you getting updates on that? Because the evidence here is that you said it, no one's being prosecuted and also the fact that these shops are popping up at the moment. I mean, they're emerging, particularly in country towns. I've had reports in country towns where they just pop up. All of a sudden they're next to the local Chinese restaurant, and it's pretty obvious what's going on but no one other than if the police see something really untoward are going through the door and proving that they're selling vapes and shutting them down. It doesn't seem to be happening?
BUTLER: Yeah, we've got a very clear protocol agreed between police authorities and health authorities. Police only really get involved if there's suspicion of an organised crime element. The enforcement of the vaping is really the job of health departments or consumer affairs departments. There is clear evidence that vaping has started for the first time in several years to drop away. We've seen that through Roy Morgan Research. After skyrocketing year upon year, after the last, five years, there is less vaping. As I said, we're getting anecdotal feedback from high schools that there's less vaping at high schools, which was my primary focus but we do have to lift our activity here. These laws have only been in place for a few months. In a couple of weeks, I'll be meeting again with all of the state and territory and Commonwealth authorities at a forum that's been pulled together by the Border Force. We do have to continue to lift our activity here. I never pretended this would all be gone on the 2nd of July, with the new laws coming into effect on the 1st of July. This is going to take a while and take concerted effort, but I'm confident we're heading in the right direction.
ADSHEAD: Now, I know you've been here in relation to the RACGP, the Royal Australian College of GPS, can I just ask you, did you get to meet with a lady by the name of Bec yesterday? In relation to mastectomies and the systems that are in place for people that find out they've got the BRCA1 gene mutation and the speed with which it, well, the slowness of which it takes to actually get something done about it?
BUTLER: I don't remember whether I met with Bec. I was at a forum in the Parliament House about inherited cancers, particularly inherited breast cancer and the systems around preventative mastectomies. We were addressed by a fantastic patient, Linda, who'd been through that experience herself - a gruelling experience. She's got three daughters who are now considering their position around this because there is obviously an inherited aspect to the BRCA1, BRCA2 genetic mutations, which are such a driver of breast cancer risk. I met with them, with the surgeons, with the patient groups around breast cancer yesterday, and it was an incredibly valuable meeting. I see it's been covered in some of the newspapers this morning.
ADSHEAD: Do you accept that being told that once you have been, you know, told you've got the BRCA1 gene mutation, you could be waiting 2 to 4 years for a prophylactic mastectomy, as in the case of Bec?
BUTLER: This was really confronting. First of all, just for your listeners, if they're not familiar with it, if you do have this genetic mutation one of the options for patients is to get a preventative mastectomy. This will cut your risk of developing breast cancer by somewhere between 90 and 95 per cent, so highly effective. Obviously, a very painful decision, distressing decision, but highly effective and what we found from this report that the breast cancer group has put together is there is a huge variability across the country about how these procedures are treated and the level of urgency attached to them. Every surgery is given a category: a hip replacement, a knee replacement, a preventative mastectomy is categorised one, two, three or four and according to that category you have to wait different periods of time. What we were called upon to do was to get much better uniformity around the categorisation of this surgery. Much more clarity about how genetic testing takes place, how the genetic testing data is treated. We're currently in the Parliament dealing with some of the issues that people are concerned about, that if they get these genetic tests done, is that going to affect their insurance, for example? We're passing laws to protect people against that as well. It's a complex picture. It was a really valuable discussion I had yesterday I talked only after it with the Head of Cancer Australia, the national body responsible for all of this stuff, about how we can progress this with states and territories.
ADSHEAD: Have you got a report card yet on how the rollout of Medicare Urgent Care Clinics is going?
BUTLER: They're going really well, Gary. We started opening them mid-last year and already 900,000 patients have gone through them. About 1 in 3 of them are kids under 15. You know, your kid falls of their skateboard, or they get injured at Saturday afternoon sport and break their wrist, if they can't get into their GP immediately up until now, the only real option has been to go and sit in an emergency department for hours and hours. These Urgent Care Clinics we now have 78 open, I promised 50 at the election, we've now got 78 open. They're open seven days a week. They're available for walk ins and importantly, they're fully bulk billed. The feedback we're getting from patients, particularly parents, when their kid gets injured or very sick and needs attention, but not necessarily hospital attention. It’s gone down very, very well. We're also starting to see I'm really pleased that the presentation numbers for those less urgent or less serious emergencies in our public hospitals is starting to taper off as well. We're seeing fewer presentations for those minor emergencies in our hospitals, which are overcrowded, very pressured with the life-threatening emergencies that are coming through their front door.
ADSHEAD: Minister, I really appreciate you joining us and giving us your time this morning.
BUTLER: Thanks, Gary.
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