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Wednesday, 11 November 1959

Mr MACKINNON (Corangamite) . - Mr. Speaker, the introduction of the national health scheme by the Government, through the auspices of the right honorable member for Cowper (Sir Earle Page), who was then Minister for Health, was a tremendous advance in social legislation in this country. No matter what honorable members may feel about the scheme, it has been universally acclaimed as a practical and, I believe, advantageous step towards solving a national problem.

It is safe to assume that the honorable member for Newcastle (Mr. Jones), who has just resumed his seat, will introduce the class-war angle into any arguments that he presents in this House. I was interested in his comparison between the amount of tax paid by some members of the community and the benefits received under the scheme. He cited the case of somebody on an income of £50,000 a year. Well, I do not know many such people. I think there are very few of them about. However, it is a good story - from the honorable member's point of view. But what he failed dismally to show to the House was that any health scheme must be supported by the taxpayer. What he failed to present was this very pertinent point, that the people paying large amounts in income tax are making a direct contribution to this scheme and whether they get some slight recompense out of the fact that the scheme is adjusted on a universal basis is, I think, completely beside the point.

Mr Uren - Why should they get a benefit from the scheme if they do riot need it?

Mr MACKINNON - If the honorable member will be patient I will answer him. This bill is a further step towards adjusting the scheme to our national requirements and changing conditions. The bill falls naturally into three divisions. The first section deals with alterations in the scale of medical benefits and provides for increased Commonwealth and fund benefits to be paid for certain operations and certain costly medical treatment. I believe that every honorable member will approve that aspect of the bill. I believe, too, that honorable members on both sides of the House will approve the second portion of the bill, which adjusts certain anomalies in the eligibility of institutions to obtain Commonwealth and fund benefits for inmates of those institutions under the special account scheme introduced last year.

The third portion of the bill is, to my mind, the most contentious portion. That is the portion dealing with proposals for changes in the pharmaceutical benefits element of the scheme. This portion was designed to introduce two major changes, with which I propose to occupy my time to-night. The changes are, first, a widening of the general list of drugs obtainable free of charge to include the same comprehensive range of drugs as is at present included in the list of drugs available free under the pensioner medical scheme. Secondly, the bill introduces a charge of 5s. for drugs prescribed from this expanded general list. When the pharmaceutical benefits section of the act was first introduced it was restricted to a free list of relatively few - approximately 40 - so-called life-saving drugs. In the first year of operation the pharmaceutical benefits scheme involved an expenditure of £7,500,000. The list of drugs has grown as the result of the requirements of the medical profession and as a result of discovery of advanced drugs until it now embraces some 170 items on the ordinary free list, plus some 70 items that are free when prescribed for certain ailments. In other words, the list has grown from some 40 prescribed drugs to approximately 240. The anticipated expenditure this year on the pharmaceutical benefits scheme is £24,000,000 - an increase of approximately £9,000,000 in the last two years.

These figures provide serious food for thought and I believe they also present a problem with respect to anticipated further equivalent increases and their impact on revenue and on the taxpayer. I was very impressed by the remarks of my colleague, the honorable member for Paterson (Mr. Fairhall), last night. He touched on the nub of this problem as to how much the public will be prepared to pay for health benefits and for health schemes generally. He quoted freely from a well-known book that was produced in the United Kingdom in 1952 dealing with this very problem. The actual point of his argument was that when you get into the philosophical side of health benefits and when you approach them from a political point of view also, you cannot deny the vast expense involved. We must remember that the original plan embraced a limited list of what are called life-saving drugs.

The bill before the House involves a much wider scheme. It involves obviously much greater expenditure. It takes in the whole of what is recognized as a fairly general pharmacopoeia. Also I believe that in the face of pressures from the public generally that we should make available the best medical treatment and the best drugs, we must accept responsibility for a vastly increasing expenditure in those items.

The pensioner medical scheme embraces the generally accepted list of drugs necessary for the treatment of diseases but that list- did not apply to the original national health scheme and this bill proposes to amend the list of drugs that shall apply to the national health scheme. With the idea of introducing some restraint in the prescribing of expensive drugs, and also to assist to finance this vast expenditure, the Government conceived the idea of introducing the 5s. charge for prescriptions, with some exemptions for a limited number of repeat prescriptions. It is believed that this charge may restrain frivolous abuse of the scheme. The analogy has been taken of the ls. charge introduced in the United Kingdom, which is purported to have had an influence towards restraining expenditure. However, I think the remarks of the right honorable member for Cowper last night indicate that the charge for prescriptions in the United Kingdom has not had the effect on the expenditure of the scheme that we would hope for in this case.

At first sight, the introduction of the 5s. charge seemed fairly simple, but on closer examination it contains many possibilities of anomalies and its effect on the pharmacy profession is what really worries me. Under the system proposed, it will be the responsibility of individual chemists to collect the charge from the customer. Speaking now for chemists in our country areas - and I believe I have some responsibility towards them - I wish to say that I have been assured that a high percentage - as high as 30 per cent. - of their customers are not directly contacted. In other words, the chemists provide prescriptions under doctors' instructions for customers whom they do not see and therefore this charge must be carried on credit. I personally cannot visualize men of the ethical standards of the pharmacy profession refusing to supply drugs from the new general list because the 5s. is not paid directly or at the time of ordering the prescription. In those cases the chemists must wait for payment. I am told that it is not uncommon at the present time for long delays to occur before the chemist receives a script, after the doctor has given instructions to the chemist by telephone, and that until the script is received the chemists are unable to make claims for drugs already supplied.

I hope it will be possible, as a result of the discussions that are now proceeding, to make generous provision for this kind of contingency, so that the members of the pharmacy profession will be adequately covered and will not be out of pocket on such transactions. It does appear at the moment that some of the costs of the scheme must eventually be borne by these 4,000 chemists, who cannot in any way be held responsible for the huge increase in expenditure on the free medicine scheme. Furthermore, the virtual abolition of private dispensing, which the widening of the pharmacopoeia must involve, will remove one of the normally remunerative sections of a chemist's practice.

It has been suggested that the 5s. charge for prescriptions will tend to check or restrain expensive prescribing. If there is any real substance in the allegation that there has been over-prescribing or unnecessary prescribing by members of the medical profession, then surely, with a wider availability of drugs and the knowledge that a charge of 5s. is to be imposed, a doctor with some consideration for his patient will decide on the slightly better or more expensive drug as against that which has a lower list price, because the cost to the patient will be the same in any case, if both drugs are on the general list.

I believe that members of the guild are quite justified in their claim that all dispensing of drugs within the list should attract the 5s. charge; in other words, that the charge should be levied on dispensaries and on doctors doing their own dispensing, as well as on chemists. The chemists have a strong claim that they should not be placed at a commercial disadvantage as compared with their competitors. If it is found that the proposed provisions react against chemists, then they must be altered.

I also believe that consideration should be given to the principle involved in section 99 of the act with regard to agreement on the scale of charges. While I realize that it is impractical for representatives of the guild to fix charges, I believe that their views should be given greater consideration by the standing committee. Chemists are responsible people who are providing a most valuable service to the community, and their part in the scheme involves them in a vast amount of paper work, most of which is very exacting. This office work has increased as the scope of the scheme has widened, and it seems certain that these new amendments will add further burdens of office work.

My attention has also been directed to clause 21 of the bill before us, dealing with the stocktaking required by the Director-General. It is considered by members of the profession that some form of qualification should be introduced to restrict this requirement, subject to agreement of the guild or committee of inquiry.

What the results of this legislation will be is difficult to forecast at present, but it does appear that there are strong reasons for a re-examination of that section of the bill relating to pharmaceutical benefits. The more I consider various methods of overcoming the rising costs, the more I am led to the belief that eventually we must evolve some contributory insurance scheme, such as has been suggested by the right honorable member for Cowper (Sir Earle Page), and has also been referred to by the honorable member for Chisholm (Sir Wilfrid Kent Hughes) and certain other honorable members. I believe this is a basic necessity in the future conduct of the pharmaceutical benefits section of the national health scheme.

Tn conclusion I would like to say that if this scheme is to progress, and if it is to remain within our economic capacity, there must be a great deal of restraint, both by the medical profession and by a section of the community which has hardly been mentioned. I refer to the manufacturers of the ethical proprietary lines of drugs which are now accepted as basic in the general pharmaceutical benefits scheme. I feel that there is an obligation on those two sections of the community to make sure that the scheme does not fall down under the weight of its own over-expenditure.

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