I certainly echo some of the comments already made by the shadow minister for health and now by the member for Higgins. Of course, I fully agree to support this bill, the Private Health Insurance Legislation Amendment (Age of Dependants) Bill 2021, which is a very, very important one. One can only ask why it has taken the government eight years to bring this measure in. We know that rates of private health insurance have been falling over the term of the present government and that we are seeing the development of a very fractured health system.

Even though we have coped well so far in preventing the types of pandemic problems that have occurred in other areas, we are seeing increasing healthcare costs, more people dropping out of private health insurance, growing gap costs for out-of-hospital visits and, in New South Wales, the collapse of the public hospital outpatient system. So it's not all roses, and this measure will play a small part in trying to reverse the trend. We need to ask ourselves why it's taken so long for this legislation to be brought in and what we can do to try and make the system even better.

This legislation, as has already been mentioned, will increase the age that dependants can be covered by family private health insurance, up to the age of 31. Most importantly it will allow people with disability, as defined by eligibility for the NDIS, to get lifetime private health insurance cover from their family, which is a very important change for many of the families I have cared for and continue to care for in my electorate of Macarthur.

We do need to ask ourselves several questions about this legislation. The first is: why do we need to do this? This is a pretty dramatic change, compared to health insurance previously. When we were growing up, we could only remain on our parents' private health insurance billing until the age of 18, until we left school. It has gradually been increased to age 25, and now this legislation will increase it to 31. For anyone with a disability, the same definitions apply. So this has been a really dramatic change. We need to do this for several reasons. Firstly, younger people are needing to stay at home for much longer because housing affordability has deteriorated so much.

It is very important that we try and improve measures to make affordable housing available to those on modest incomes. At present that is not the case. People are needing to stay at home longer because they can't afford to buy or rent accommodation, particularly in our capital cities, and little has been done to change that. In fact, it has been getting worse over the eight-year period of the present government. That's one thing.

Secondly, younger people in education are accruing much higher debt than previously. With the increases in HECS payments required for many university degrees, many people are accruing HECS debts equivalent to the debts that we used to accrue for mortgages. It's a double whammy—housing affordability is poor and HECS debts are increasing. We know that, in the last five years, young people's HECS debts have increased by significant amounts around the country. So the affordability of housing and education has become much worse in the eight years of this government. Young people have been leaving private health insurance in droves. This legislation may do a little bit to change that trend, but it's taken the government eight years to bring it in.

Why are 31-year-olds still to be seen as dependants? It's because of housing affordability, HECS debts and the fact that the jobs that young people are getting are often relatively low paid, and growth in wages, under this government, is worse than it has been for many decades. These three reasons are causing young people to need to stay at home for longer and be dependent on their parents for longer, and they have less ability to pay for private health insurance.

Why is private health insurance so important? It is so important because private health cover and private health insurers provide access to volume based medical services very efficiently. Interventional treatments, ENT surgery, ophthalmology and gastroenterology are done very efficiently in the private system. We are lucky in Australia that we live in a system balanced between private health care and public health care.

I believe that private health insurance is very important for people who can afford it, because private health insurance provides access to volume based care in a much more efficient way than does the public system, while the public system does chronic and complex care much better than the private system. So we need to keep this balance of health care if we are going to continue to have a healthcare system that is amongst the best in the world. This government has done very little to promote private health insurance. This is a small measure, but it's taken them eight years to do it. It's very important that we continue this balance of both systems.

As a paediatrician, I have also seen the difficulties people with disabilities, particularly adolescents and young adults, have in accessing interventional care. I've been a paediatrician now for 40 years, and in those 40 years we've seen dramatic changes in the way that people with disabilities have been cared for. People are surviving longer. Their quality of life is improving. With the advent of Julia Gillard's NDIS, we've had really dramatic changes in people's quality of life and access to services.

The one difficulty has been getting interventional services for people over the age of 18 with disabilities. For example, people with cerebral palsy have access to injections of botulinum toxin, or botox, which has proved very useful in managing spasticity and mobility issues for people with cerebral palsy.

However, once someone turns 18, access to these services is very limited. People will now be able, if they stay on their parents' private health insurance billing, to get access as adults to botox and also to the orthopaedic surgery that they may require to maintain mobility. That has been very important in trying to get those sorts of services. We know, for example, that children with autism have a higher risk of mental health disorders. If they remain on their parents' private health list, they will be able to access mental health services in a much more timely manner than if they have to go on public waiting lists.

This will be very important for some of the people I have cared for over many, many years and will really lift a great and dramatic weight from their parents' shoulders. So these are very important measures. They will be very important for children with neurological disorders, such as spina bifida, who throughout their lives may require ongoing neurosurgery and orthopaedic surgery to maintain their health and their mobility. So these are very important issues.

One has to ask: why has it taken the government so long to bring this in? There are many challenges in our public hospital system for people with disabilities once they turn 18, and there's been an ongoing difficulty in transitioning care from the paediatric age group to the adult age group. It's been very difficult and has been limited by access to services. This will actually make quite a dramatic change to many of those kids and I thoroughly welcome it. Whilst I do congratulate the government on bringing this legislation in, I wonder about why it has taken so long. We know during the pandemic that there have been difficulties in accessing the public hospital system for elective and semi-elective surgery.

Once again, these private health insurance changes will make dramatic differences to young people with disabilities accessing the private health system and the interventional and procedural type health care that the private health system does very well. I welcome the fact that this may well increase the number of young people staying in private health insurance and transitioning into their own private health insurance once they turn 31.

I certainly know that I welcome it in terms of my own children, who are under 31, and getting them access to private health insurance. I welcome it on behalf of my many patients with disabilities, and I think it's something that we now need to be very actively exploring for those kids and their access to care.

I support the legislation and I do thank the government for bringing it in, but I think we need to look at the reasons why it is so important and the fact that for many people in our economy, we are working at a two-tiered level. Some people are doing very well, and some people, particularly young people, are really struggling in a whole range of areas, including housing, education and work. In conclusion, I welcome the legislation, but I do think we need to look at why this legislation is necessary and the reasons why young people are finding it so difficult, even at ages that might seem quite old, to get into the housing market, to get adequate jobs and to provide for themselves.