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Wednesday, 11 November 1959


Mr DEPUTY SPEAKER (Mr Bowden (GIPPSLAND, VICTORIA) - Order! I will be responsible for abolishing something else. There is too much noise in the chamber.


Mr TURNER - Clause 10 (b) reads-

Section eighty-two E of the Principal Act is amended - by adding at the end thereof the following sub-section: - " (2.) For- the purposes of paragraph (h) of the last preceding sub-section -

(a)   the Director-General shall recognize, for special account purposes, an institution that is a public hospital or an approved private hospital unless it is, or is in his opinion in the nature of, a benevolent home, convalescent home, home for aged persons or rest home;

With the general purport of that provision I have no fault to find. Its effect is that full hospital benefits will go to patients in those institutions which are, in effect, hospitals and shall not go to those institutions which are, in effect, benevolent homes. The reason is quite clear. A hospital must provide a great deal of skilled service, and is therefore faced with expenses that are not incurred in a benevolent home. So the cost of running such a hospital is much higher than the cost of running a benevolent home, and the higher benefit should therefore go to the hospital.

However, I am rather doubtful whether the Director-General should be the final arbiter in this matter. What criteria is he going to apply? I suggest that the kinds of criteria he would use would be these: Where there is consistent medical attention such as injections and dressing of wounds and use of drainage tubes, &c, you have medical attention of the kind associated with a hospital. Again, where patients are bed-ridden you have circumstances that are familiar in hospitals. These are the kinds of criteria which I presume the Director-General would use in coming to the conclusion that an institution ought to be recognized as, in effect, a hospital, so that patients may receive the full hospital benefit. I feel, however, that there should be provision for an appeal to the Ministry in those cases where applications for benefit are rejected. It is most important that those whose applications are rejected should feel that they have the right of appeal, that these matters are sorted out, that the criteria are applied, so that if ultimately their applications are again rejected they may come away satisfied that justice has been done. Inclusion of a provision for the right of appeal to the Minister ought not to overburden the Minister, because the number of institutions involved would not be large.

I turn now to the provisions regarding pharmaceutical benefits. The present high and growing cost of pharmaceutical benefits has brought about the Government's present proposals regarding them. Will the proposals in this bill serve the purpose that is intended? Why has there been this great increase in the cost of providing pharmaceutical services? First of all, there has, of course, been the invention of quite a large number of new and expensive drugs. Secondly, people are living longer and enjoying the benefit of less ill health. Thirdly, there is the problem of wasteful prescribing.

Wasteful prescribing may take one of two forms - either an expensive drug is prescribed when a less expensive one would do, or too great a quantity is prescribed and a large part of it is wasted. Now, I ask again: Is the proposed remedy likely to be successful? Will it really impose a brake on wasteful prescribing? I doubt very much whether it will, because when the list of drugs which will be available under the scheme is greatly extended there will be imported into the whole scheme the possibility of a much greater wastage, in a secondary sense, with the prescription of the greater quantities of drugs.

Now, as regards prescribing cheaper drugs rather than the more expensive ones, I think that the people, having become accustomed to the present scheme and the provision of the more expensive drugs, will put pressure on medical men to continue to prescribe the more expensive drugs, even if a cheaper one is available at a nominal charge of 5s.

I found myself greatly attracted to the proposal put forward by the right honorable member for Cowper (Sir Earle Page). There is nobody in this House with greater experience in those matters. If we were to institute a pharmaceutical insurance scheme the pharmacists, who come in close contact with the wastages in prescribing, and who are closer to the patients and perhaps know better what goes on, are likely to put pressure on the medical profession to ensure that prescriptions are not wasteful, because they will have an interest in making their insurance scheme pay. If this should not happen, then obviously the cost of drugs will become so high that the contributions that would be required from those who contribute to the pharmaceutical insurance scheme would also become so high that contributions would fall off, and the scheme would crash of its own weight. In those circumstances the pharmacists would suffer. It is important that we should have people who have an interest in keeping down the cost of the scheme bringing their influence to bear upon the medical profession in regard to prescriptions.

In conclusion, I would say that I am even more enamoured of the right honorable gentleman's suggested scheme because, on referring to the report of the Hinchcliffe Committee on the Cost of Prescribing, published by Her Majesty's Stationery Office in 1959, I find that that committee came to the conclusion that the charge for prescriptions in the United Kingdom has not served its purpose. The right honorable member for Cowper added that the increased charge that had been made recently there is still proving ineffective. So I suggest that the proclamation of the part of the bill dealing with the prescription charge be held up while the Minister explores with the pharmacists the possibility of their instituting an insurance scheme along the lines proposed by the right honorable member for Cowper, However, I do not wish to say anything that would derogate from my original support of the measure that the Minister has brought forward. I think that the rest of the bill is excellent. There is a doubt as to the wisdom of the proposal with regard to pharmacists. The bill in general will bring about a real improvement in the national health scheme which, as I said at the outset is, I believe, one that gives the best value for the money that the people pay for it. Having regard to the many claims on the public purse and the many purposes which must be served by this Parliament I think it is a reasonable contribution to the health of the nation.







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