Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2026

Ms AMBIHAIPAHAR (Barton) (17:05): I rise to speak on the Private Health Insurance (National Joint Replacement Registrar Levy) Amendment Bill 2026. Before I was a lawyer, long before I was a member in this place, I worked in anatomy. I spent many days and years in a lab at the University of Sydney preparing human specimens for teaching.

My work was not only teaching anatomy but also embalming people who donated their whole body to science through the University of Sydney's program. It's not the most common opening line you'd have at a dinner party, for sure! It might clear a room, but it also might strike up a really good conversation with someone who might be curious about the work that I was doing.

But I want to say something sincere about this work because it shaped how I see this bill. Every specimen I prepared had once been a person, someone who was a family member, who had a favourite chair or music and who chose to give their body to science for strangers to learn from. I never stopped being grateful to the many people who donate their bodies to science, and I never will.

Some of my favourite work was particularly working with trainee surgeons. Through the courses run by the Royal Australasian College of Surgeons, I helped prepare human specimens for doctors specialising in orthopaedics. Let me tell you, trainee orthopaedic surgeons are a particular breed.

They're wonderfully skilled and focused, with an enthusiasm for power tools that would probably put most weekend renovators to shame. I used to watch them work out the angle of a cut, the feel of the bone under their hands and how a joint is actually meant to sit and move in the human body. I thought: 'Somewhere out there is a stranger who doesn't know yet that they'll need a new joint.

One day they'll be lying on a table trusting that the person holding that scalpel knows exactly what they're doing and that the device is going to work well and also be safe.' Let me tell you what the National Joint Replacement Registry is, because it is vital. The Australian Orthopaedic Association runs it. It collects information from hospitals across the country to really improve the quality of care for people having joint replacements.

Think of it as the most patient record keeper in the world. It follows these devices for years, for decades. If one starts performing worse than it should, the registry is how we find out.

But even the most dedicated registry has to pay its bills. The cost of running it is funded under a Commonwealth grant agreement, and that cost is recovered through a levy on the medical device companies that supply the devices used in joint replacement surgery, which makes sense. If you profit from supplying those devices, you chip in to keep that system honest.

That is fair to say. Here's where we hit a bit of an issue. Under the Private Health Insurance (National Joint Replacement Register Levy) Act 2009, the levy is capped at $5,000 per device per financial year.

Our cap sounds perfectly reasonable—it's got that tidy vibe to it—but, in practice, it has produced a result that is not balanced. Picture two companies. One is a big supplier shifting enormous volumes of devices.

The other is a smaller medium-sized business supplying much fewer. Under the cap, the big supplier hits that ceiling pretty quickly. From then on, every additional device is effectively free of levy.

Meanwhile, the smaller company is paying close to the full amount on each device it sells. So the company moving the most product pays the least in proportion, and the smaller players carry more than their fair share. If you were designing a system from scratch, I don't think anyone would sketch it that particular way.

I spent about a decade, after working at Sydney uni, as an employment industrial relations lawyer, representing workers as well as employers and big and small businesses. One thing I learnt in that time is that a cost feels very different depending on where you're standing—so for a large company an unfair levy is a line in some sort of spreadsheet, but for a small or medium-sized business it can be the difference between hiring additional staff, backing the next innovation and staying in the market or not.

Fairness in how a cost is shared isn't some abstract principle or thought; it is a practical one. Here's the fix, and it's quite simple. This bill amends the 2009 act to remove the cap of $5,000 per device per financial year.

Once it's gone, the levy will be allocated in proportion to the actual volume of devices each company supplies. Supply more, contribute more; supply less, contribute less—fairer, simpler and exactly what we promised in the 2025-26 budget. I want to be clear about what this is not: it's not a new tax.

It doesn't change what the registry does or how it does it. It simply changes how a cost that already exists is shared out, so the load sits where it should. Let me bring this in a more practical way to my electorate of Barton, because this is where it gets real—especially for me; I played too much tennis as a kid, and trying to play squash these days in the courts downstairs and also doorknocking in my community takes a toll on my knees.

But when you walk through my electorate, in Hurstville, Rockdale, Kingsgrove, Bexley and Carlton, you'll meet people whose lives have been changed by a joint replacement. A grandfather in Hurstville who spent 40 years on his feet in the kitchen can finally go to the park with his grandkids. A nonna in Earlwood who swore she'd never see the garden in spring is now bossing around tomatoes and probably scaling those prickly pear bushes as well—and that's a reflection of my childhood, growing up with the Italian family that raised me.

There is the bricklayer in Kingsgrove whose knees clocked out long ago. And it's not only our older residents; it's also sporting people. It's the netballer on the courts of West Botany Street who has done her knee for the second time and is already asking whether she can get back out there.

It's the weekend footballer who has been playing since he was six and whose body is now sending him a very detailed invoice on the system. These are people who fill our clubs, our halls and our sidelines. They are the heartbeat of the electorate of Barton, and when their joints let them down they deserve a health system that gets them moving again.

Here's the thing, though: nobody is thinking about a registrar or a levy when they're on the operating table. Why would they? They're thinking about whether it will hurt, how long the recovery is going to take and whether they'll be dancing with their daughter at her wedding next year.

But they are relying on this system all the same. They're relying on the fact that somebody is going to be keeping track. A database somewhere is watching how these devices perform over 10, 15 or 20 years.

If something goes wrong, someone will notice and the surgeons will know. That's the quiet assurance of the registry. A registry only keeps its assurance if it's properly and sustainably funded by a system that the industry itself can see is fair.

A levy that squeezes little guys while the big ones coast doesn't build confidence. It really is a levy that treats everyone proportionately. Let's not forget about the businesses themselves, because Australia has small- and medium-sized medical device companies doing really clever, innovative work—some right in my electorate of Barton; we have a large health precinct in the St George area—and we want them here.

We want them competing, inventing and giving Australian surgeons and patients more choice. An unfair cost structure is a very much a quiet barrier to all of that, so fixing it is good for business, but it's even better for patients.