Page 1819 - Week 06 - Wednesday, 4 May 2005

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improvement of services and to assess the best way to use available resources (human, financial and infrastructure) to meet client needs.

Ms Porter just said Mr Abbott ought to butt out because he does not know anything about medicine; he is not a doctor. Perhaps Mr Corbell, by that same token, has to butt out of his plan to introduce clinical streaming, because he is not a doctor either.

The opposition supports the use of clinical streaming as a funding model. We do not have an argument with that. We are surprised that the government would adopt such a rationalist approach. Perhaps there is some hope for our beleaguered health system after all. The point here is that the clinical streaming approach explicitly requires a deep analysis of the cost and efficacy of services in health. It is in this context, no matter how emotive it is, that a discussion about the cost and effectiveness of IVF and ART must be had.

But it will not be alone. All streams should be addressed in this way—cancer, for instance. Some people in this debate have tended—in my view, wrongly—to focus on the success rates of IVF and ART without putting them in a clinical context. For example, cancer treatment is hellishly expensive. We all know that. The results vary with different cancers. But it is well accepted that, 20 years ago, the survival rate for leukaemia was very marginal. But the treatments were persisted with and the survival rates are now in the 90th percentile. No-one in this place, I am sure, is suggesting that we do not persist with cancer treatments.

The application of the cost versus the results of IVF and ART, outside the clinical setting, does not help this debate. But that is not to say that we should not see and not debate the clinical data in the context of the clinical streaming model. That is a valid debate, and it is one that we should have.

Having made these general comments, let us look at Ms Porter’s motion seriatim. I note with interest that she again goes back to the Labor hobbyhorse: the Liberal Party is going to get rid of Medicare or is going to ruin Medicare, or it is just not what it used to be or the thing has changed. After 30 years of supposedly getting rid of it, the thing is still there. It is receiving extra funding all the time. I believe it is being reinforced and strengthened by the federal Liberal government to a position where it can actually survive into the future, unlike the unsustainable models of previous Labor governments.

Part one of Ms Porter’s motion says that this Assembly “recognises the importance to the ACT community of maintaining accessibility to Medicare-funded treatments and services based on objective merit rather than subjective value judgments”. We happily support that. Indeed, as I have already noted, the adoption of a clinical streaming model will allow us to ensure that accessibility to publicly funded treatment or services will be based on objective clinical merit.

Let us look at part 2. Part 2 “notes the negative implications associated with restricting Medicare subsidisation for in vitro fertilisation treatments on an arbitrary basis”. I would also agree that restricting Medicare subsidisation for IVF and ART treatments on an arbitrary basis should be opposed. Restricting them on a clinical basis is another matter. If the evidence shows that there should be restrictions, then that is something that should

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