Emergency Ambulance Services

Adjourned debate on motion of Hon. R.A. Simms:

That this council—

1. Acknowledges that access to emergency ambulance services is a critical health service;

2. Notes that the cost of an emergency ambulance service is $1,171, plus a per kilometre fee of $6.70;

3. Recognises that the cost of an emergency ambulance service is more than the fortnightly rate for a single full age pension;

4. Acknowledges that South Australia is the only jurisdiction in the nation that does not provide free emergency ambulance services to people on the full age pension:

5. Notes that emergency ambulance services are free for all residents in Queensland and Tasmania;

6. Notes that COTA SA is calling on the state government to provide free emergency ambulance services for all older South Australians on a full age pension; and

7. Calls on the Malinauskas government to waive the cost of emergency ambulance services for all full age pensioners in their upcoming budget.

(Continued from 14 May 2025.)

The Hon. D.G.E. HOOD (17:24): On behalf of the opposition, I rise to speak in support of the Hon. Mr Simms' motion urging this council to acknowledge that access to emergency ambulance services is a critical health service; that the cost of an emergency ambulance service is more than the fortnightly rate for a single full age pension; that South Australia is the only jurisdiction in the nation that does not provide free emergency ambulance services to people on the full age pension, with emergency ambulance services free for all residents in Queensland and Tasmania; notes that the Council on the Ageing (COTA ) is calling on the state government to provide free emergency ambulance services for all older South Australians on a full age pension; and calls on the Malinauskas government to waive the cost of emergency ambulance services for full age pensioners in their upcoming budget, which of course will be delivered tomorrow.

The Council on the Ageing SA serves as the peak organisation for older individuals in South Australia and focuses on the promotion, improvement and protection of their wellbeing. As part of their state budget submission the peak body is calling on the state government to address the cost-of-living-pressures, issues around access to health and wellbeing, social connections and older South Australians living in regional South Australia as well by providing free ambulances for all full age pensioners in South Australia.

The cost of an emergency ambulance service is extraordinary. It is actually $1,171 in addition to a per kilometre fee of some $6.70. It does not take a mathematical genius to work out that this exceeds the fortnightly rate for a single individual receiving a full age pension—that is, one trip in an ambulance can exceed their full pension. South Australia remains the only state in Australia that does not offer free emergency ambulance services to individuals on the full age pension, in contrast to the provisions in Queensland and Tasmania where such services are provided at no cost to residents.

As the population ages many individuals face declining health and chronic conditions, leading to increased reliance on emergency medical services, so accessibility to ambulance services is increasingly imperative. In 2021-22, individuals aged 65 and over accounted for a significant proportion of hospitalisations and emergency department visits in Australia, and I am sure that is not surprising to any of us, but while the emergency treatment is free under Medicare at the ED, South Australia uniquely imposes substantial fees for ambulance services in order to get the patients to the ED. This financial burden disproportionately affects older residents, as they use the service more often, and many of these people live on fixed incomes and are struggling with the rise of the cost of living in our state, as are most of us.

A national survey by the Australian Bureau of Statistics revealed that a significant percentage of age pensioners either lack private health insurance or face financial constraints that deter them from seeking necessary emergency care, and of course this can deter them from seeking ambulance services when they need them as well. Indeed, research indicates that fear of ambulance costs leads some older individuals to forgo calling for help via an ambulance at all, thus potentially compromising their own health outcome. This is a risk that we should not be taking.

COTA SA is therefore calling on the state Labor government to provide free ambulance services for older South Australians, aligning with practices in other Australian states, to ensure equitable access to emergency medical care during the cost-of-living crisis that we are currently experiencing, but beyond that just as a sense and principle of equitable access to what is an essential service. So it is with some eagerness that the opposition supports this motion.

The Hon. R.P. WORTLEY (17:28): The government notes that ambulance fees can impact on all groups in our state. However, it is our view that a partial user-pays model is the fairest option for all residents. We also strongly believe that funding is better spent on preventative health programs, which help us limit ambulance usage in our community.

To understand ambulance fees, we need to take in a historical overview. Until 1993, ambulance services across the state were provided by private entities, notably the St John's Ambulance Brigade, with each provider establishing their own fees and subscription schemes independent of state government. In some cases these were operated with the funding assistance of local government.

With the establishment of Medicare by the federal government 41 years ago, it was decided that ambulance services, like dental services, would not be covered. In 1993, the then Arnold Labor government established what is now the South Australian Ambulance Service (SAAS), then known as the South Australian St John's Ambulance Service, a private entity co-owned by the Minister for Health, Family and Community Services and the Priory of St John in Australia. From this point onwards, fees have been set by the responsible minister, currently the Minister for Health and Wellbeing.

The obligation for SAAS to charge fees has been legislated and legislation will be required to change this. Fees are set each financial year and published in the Government Gazette. Concessions are provided to holders of a Services Australia Pension Concession Card. Services Australia indicates that all age pensioners are eligible for this card. This makes the fees 50 per cent cheaper than the $1,171 as stated by the Council on the Ageing (COTA). It is important to note that consumers do not actually pay the full cost of the ambulance service they have received. The fee represents less than 50 per cent of the total cost of the service. The vast majority is funded by the government.

We acknowledge the financial burden that ambulance fees can place on individuals, especially older South Australians. While SAAS is required by the Health Care Act 2008 and respective Treasurer's Instructions to charge a fee for services rendered, there are policies in place to assess eligibility for special consideration due to financial hardship. SAAS has recently reviewed its hardship policy to align with government best practices, simplifying processes and paperwork for consumers.

SAAS also provides the community with a range of services which are provided free of charge to the consumer if clinically appropriate, such as telehealth services which can provide care over the phone or refer the patient to a more appropriate health service. Another is SAAS's Community Paramedics program, which provides primary care services in some communities. I know that the government is expanding this program to the Yorke Peninsula later this year.

Further, SAAS offers a low-cost ambulance cover membership subscription scheme, which is open to all South Australians, including the 59.7 per cent who already have private health coverage for ambulance services. For the annual cost of approximately $60 per person, a pension concession card holder can receive an unlimited number of emergency ambulance services within South Australia at no further cost. There is a clear correlation between ambulance usage and a cost of service.

COTA SA raises the example of Tasmania and Queensland as two jurisdictions which do not charge residents at all. However, according to the federal Productivity Commission's annual Report on Government Services, those two states have over the last 10 financial years seen a combined increase of ambulance usage of 42.4 per cent compared to a combined 19.7 per cent in other states and territories. This correlation has been supported by academic research over a number of years. According to the last census, people aged 65 and upwards accounted for 20.1 per cent of South Australian residents; however, those aged 67 or older accounted for 47 per cent of SAAS's workload last financial year.

In three years, the Malinauskas government has added an additional $7.1 billion to the health budget. This additional funding is enabling us to add more clinical staff and more hospital beds. The latest Report on Government Services released earlier this year also shows that South Australia has experienced the most significant improvements of any jurisdiction in ambulance response times in a year. Response times improved by 22 per cent in our first year of government, with SAAS responding to 90 per cent of all incidents within 55.6 minutes in metropolitan Adelaide.

The most recent report showed a further 38 per cent improvement in our second year, with 90 per cent of all incidents responded to within 34.3 minutes, a more than 21-minute improvement, and the biggest improvement in the nation. This is a marked improvement on ambulance response times compared to under the former Liberal government, when incidents were responded to within a whopping 71.3 minutes in 2021-22.

South Australia recorded its best April priority 2 lights and sirens ambulance response times in five years, with 2,511 more South Australians reached on time in April 2025 compared to March 2022 when we took office. In April 2025, ambulances reached 67.7 per cent of all P2 emergencies within the target time of 16 minutes, the best April P2 response times since 2020 and also a significant improvement on last month, which was 63.8 per cent.

The Malinauskas government has increased investment in SAAS, with over $109 million in additional government funding in 2022-23. This compares to the previous government, which cut funding to SAAS by $13 million in its first two years. Our government's investment in ambulance services includes 350 more ambos across the state, with 51 based in regional locations. Since being elected in 2022, our government has now delivered:

more than 300 extra ambos to improve response times and help fix the ramping crisis;

36 additional ambulance vehicles, with 27 already on the road;

the building and upgrading of 24 ambulance stations, including new stations already open at Norwood, Woodville, Edwardstown, Mount Barker, Victor Harbor and Golden Grove;

a new team of 20 specialised ambulance officers now supporting the transfer of medically stable, low acuity patients requiring ambulance transport out of our public hospitals, getting them home sooner and freeing up beds for others; and

$120 million for a new ambulance headquarters, which will include a new city ambulance station and garage, a two-storey ambulance emergency operations centre and a state health coordination centre, due to be completed later this year.

We have also launched a life-saving smart app, GoodSAM, to help people with cardiac arrest access cardiopulmonary resuscitation sooner, potentially sending aid within seconds of a 000 call. We have invested $23.5 million to enable SA Ambulance Service to introduce an electronic patient care records system to streamline workflows and communication between ambulance and hospital staff. We delivered $10.7 million for SA Ambulance Service to expand one of its key hospital avoidance teams: a clinical telephone assessment service staffed by 15 highly skilled paramedic telehealth clinicians.

At the last state election, this government committed to taking preventive health seriously. Preventive health done well is, after all, the best way to keep our society healthy and not needing ambulance services. This is why we established Preventive Health SA as an agency in its own right with landmark legislation last year. Through Preventive Health SA, we are funding a range of evidence-based campaigns, including a statewide smoking and vaping cessation campaign that has shown effectiveness in reducing prevalence.

Members interjecting:

The Hon. R.P. WORTLEY: Mr President, please. The Hon. Mr Hunter here would love to hear what I am saying, but he cannot.

The PRESIDENT: Order, the Hon. Ms Lensink and the Hon. Mr Simms!

The Hon. R.P. WORTLEY: These are the people who cut the living daylights out of our health services and opposed the new Royal Adelaide Hospital—they were prepared to give a paint job to the old Royal Adelaide Hospital—and you dare criticise the great work that the Malinauskas government has done to help this state.

We are funding the Get2It bowel screening campaign with the Cancer Council of South Australia and the Every Moment Matters alcohol in pregnancy campaign with the Foundation for Alcohol Research and Education. We are also providing more than $9 million in grant funding to community-based organisations to facilitate prevention and health promotion efforts.

The Malinauskas government is taking health very seriously. We have committed billions of dollars to making sure the people of South Australia are healthy. I know that those opposite do not like hearing this because of their abject failure when they were in government for four years, but the health system in this state under the Malinauskas government is on the way up.

The Hon. J.S. LEE (17:38): I rise today to support the Hon. Robert Simms' motion calling on the Malinauskas Labor government to waive the cost of emergency ambulance services for all full age pensioners in the 2025-26 budget. As someone with ageing family members who have underlying health issues, I understand the stress and anxiety that so many members of our community feel when they consider what might happen if they ever need to call for an ambulance in an emergency.

For too many South Australians, the cost of an emergency ambulance service makes them pause and weigh up whether they can afford to make that call when they need emergency medical attention. For older South Australians, who are more likely to require urgent medical attention and are also greatly impacted by ever-increasing cost-of-living pressures, the financial burden of paying for ambulance insurance or ambulance services is often simply too much.

I am grateful that my family members have private health insurance that covers ambulance services, but many of the most vulnerable people in our community are not in that position. Rising energy costs over the last decade, and the latest cost-of-living burden, escalating insurance premiums for home and car, all leave age pensioners on a fixed income with very little left over in their household budget.

Making ends meet on a fixed age pension is hard enough as it is, and an unexpected bill for an ambulance call-out that costs more than the fortnightly rate for a single full age pension would tip many over the edge into financial distress. It should not be this way. I note that other jurisdictions such as Queensland and Tasmania provide free emergency ambulance services for all residents, but in South Australia we have the second highest fees in the country and we are the only state that does not provide free emergency ambulance services for those on a full age pension.

Only yesterday, as was reported in The Advertiser, Reeva Brice, an 84-year-old age pensioner, had to pay a $1,200 bill for a three-kilometre ambo ride after fainting. It demonstrated a real-life scenario of why this motion should be supported. I want to thank COTA SA for their strong advocacy on this issue and for highlighting the significant impact that free access to critical health services would have on vulnerable older South Australians.

The Malinauskas Labor government has the opportunity to make substantial difference in the lives and wellbeing of vulnerable older South Australians by waiving the cost of emergency ambulance services for all South Australians on a full age pension in line with the other Australian jurisdictions. I thank the honourable member for moving this motion and I fully commend it to the chamber.

The Hon. J.M.A. LENSINK (17:41): I was not listed to speak, but I just wish to make a brief contribution in favour of this motion. I am not going to rebut all the silly things that were said by the government about smoking cessation programs and a whole range of things that are completely irrelevant to this. Just to speak to personal experience, I will say at the outset that my parents are not pensioners; they are self-funded retirees who have full private health cover.

Sometimes people will assume that all of the ambulance fees are covered if you have private health insurance. You still do need an emergency transport to submit that. My experience dealing with rebates and the interaction between the private health system and the South Australian Ambulance Service is pretty unsatisfactory in that I had to go to a lot of trouble because I had made the mistake of assuming that we should pay for it up-front and then rebate it from our private health.

That is a bad idea, because all the health funds know that the South Australian Ambulance Service is notoriously slow and that you should submit it straight to your private health insurer and they will cover the emergency fee. However, they will not cover the transport back from the hospital to, in my parents' case, the aged-care facility because my parents are not mobile at all and therefore they have to return home via ambulance. I think the cost for that is some $250 or $300, so if that has to be borne by pensioners that is clearly a significant out-of-pocket cost.

We learnt our lesson early, so we have actually taken out the private health insurance cover, which I think is $25 or $30. A lot of people will get caught in that trap without realising it. But the SAAS—and I am very grateful to the staff who have attended to my parents in a timely manner, and for their professionalism—financial system is from I do not know what year. It certainly does not seem to have been dealt with in recent years and it needs a rocket. With those comments, I commend this motion.

The Hon. C. BONAROS (17:44): I was not listed to speak either, but I want to indicate my support for this and echo the sentiments that have just been expressed, because they were the points that I was also going to raise, particularly in relation to this. I know it is easy for us to say that you can get ambulance cover, but that will not cover the sorts of scenarios the Hon. Ms Lensink has just outlined. I have just pulled up the list: family cover $198; single cover $99.50; pensioner $118; and pensioner concession single $59.50. That might not seem like much to us, but for the cohort of people that we are speaking to and for many more it is a lot of money and they cannot find the money to be able to afford this.

When people let things go because they cannot afford them, it is these sorts of things they usually let go first. It is also the same group who are more likely to need the ambulance and end up with one of those hefty $1,170-odd bills that you get when you have called out the ambulance. I got one of those last week for my son. Thankfully, I can afford private cover and I can deal with it, but I can tell you it smacks you in the face when you get it. I do not know how on earth you deal with that when you fall within the cohort that COTA is advocating for in the Hon. Rob Simms' motion. Whether it is $59, $118 or $198, it is not sitting in your bank account and you cannot afford it. So it is with those words that I indicate my full support for the motion.

The Hon. R.A. SIMMS (17:46): I thank all members for their contributions: the Hon. Dennis Hood, the Hon. Jing Lee, the Hon. Michelle Lensink, the Hon. Connie Bonaros and the Hon. Russell Wortley. I thank crossbenchers and the Liberal opposition for their support of this sensible proposal. It is a modest proposal, but it is something that I think would deliver some tangible benefits for South Australians who are struggling, when every other state is able to provide free emergency ambulance services to people receiving the full age pension—every other state than South Australia.

I want to reflect momentarily on the Hon. Russell Wortley's contribution, which I found extraordinary for many reasons. One of the things I found quite shocking in the Labor Party's talking points that he read from was the suggestion that the Labor Party supports a user-pays model when it comes to accessing an ambulance in our state. We have just come off the back of a federal election campaign where the Prime Minister made much of the need for Medicare to be protected and spent a lot of time brandishing his Medicare card, moving around the country.

Yet now it seems that in the state of South Australia the Malinauskas government is saying that when you turn up at an emergency department you need to bring your credit card with you. I do not think most South Australians will support the idea that accessing an ambulance should be based on your capacity to pay and that a user-pays model is appropriate when it comes to emergency services. I do not think most South Australians will support that.

Let us reflect on some of the costs associated with this. For a single emergency ambulance trip in South Australia an individual will pay $1,171, plus a per kilometre fee of $6.70. This is a charge that exceeds the fortnightly rate of the full age pension. It is bad enough that older South Australians are too scared to call an ambulance because they live in fear that they will be ramped for hours and hours, but now we have South Australians who are too scared to call an ambulance because we know they are going to be slugged with a bill of over $1,000. It is not acceptable, in the middle of a cost-of-living crisis, to see the Malinauskas government taking this position. I urge them in tomorrow's budget to send those talking points to the bin and instead show some leadership on this issue.

This is the third budget in a row when the Greens have argued for some action on this. The Council on the Ageing has been steadfast in arguing for this over many, many years. I think it will be a key issue for the Malinauskas government heading into the next state election. This is the last budget they are handing down before the state election and I urge them to show some leadership on this. User-pays is not the South Australian way when it comes to accessing emergency services.

Motion carried.