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Wednesday, 14 September 1983
Page: 792


Mr MILTON(6.18) —In speaking in support of the Health Legislation Amendment Bill 1983 and related levy Bills I make one very important point at the outset; that is, we are a government which is committed to consultation. We do not make decisions in stealth, as did the previous Fraser Government. Rather we believe in open government. Because I have only a limited time to speak in this debate I want to confine my remarks to the aspects of the Bill which relate to hospitals.

Earlier this year I addressed a local meeting of the Australian Medical Association in relation to Medicare. At that time I was accused of giving a political speech despite the fact that I had been invited as a politician to address the AMA. What else did the local doctors expect? After all, I was supported by the Secretary of the Department of Health, Mr Laurie Willett, who gave full details of the technical aspects of Medicare and its practical application for medical practitioners. Of course, the AMA had hoped to embarrass me at the meeting in the hope that I would show my ignorance of health care needs. Instead, I was able to put before them the views of the people in my electorate of La Trobe who can no longer afford the exorbitant expense of health care which has been caused by seven years of Liberal-National Party Government. In that period of conservative Government five different health schemes were introduced. They were marked by the stealth of their introduction, with no consultation. They had an immediate effect on sick people who had no chance to learn to cope with the changes. Another thing about my meeting with the local AMA is that I was appalled at the irresponsibility of the Victorian President of the Association who advised the doctors present not to co-operate with the Government in the bulk billing aspects of Medicare. For such a negative attitude to be taken by a professional association towards a positive government initiative is probably unprecedented in recent years and will, in my view, mark the decline of the AMA as a professional body with any integrity or social responsibility.

Let me say at this point that I bear no ill will to the individual doctors in my electorate with whom I have talked about Medicare and who are also members of the AMA. I only hope that efforts will be made to get rid of the present conservative leadership of the AMA so that those doctors who care deeply for their patients are able to bring their views to the fore, and patients can once again have faith that their doctor is truly catering for their interests. Perhaps I am old fashioned, but I had always thought that doctors studied for the profession because they had a real desire to heal the sick rather than to gain a high salary and status. I have every sympathy with a doctor who has bought an expensive practice and is struggling to meet high capital costs. However, that is no excuse for imposing a high fee structure on sick patients who have no choice but to pay the piper.

Now I have those remarks off my chest I wish to talk about the aspects of Medicare which relate to hospitals. The first thing to point out is that if we were not introducing Medicare on 1 February next year the cost of a ward bed in public hospitals throughout Australia would be $130 a day and premiums would be rising even higher. For lower and middle income earners who take out health insurance the costs have become a great strain on the family budget. The arrangements for reimbursing the States will represent a fair reimbursement of the revenue that will be lost through the removal of public hospital charges. Medicare will provide the same entitlement to basic medical benefits and treatments in a public hospital by the hospital doctors to every Australian resident regardless of his or her income. In a society as comparatively wealthy as ours, no one should be deferring treatment because he or she cannot afford the medical bills.

Basic health care is the right of all Australians. I do not accept the view of the AMA and members of the Opposition who argue that providing cover to all Australians will encourage the overuse of health services. There is no reason to expect that the two million Australians without cover at present will use medical and hospital services more than will the rest of the community. Those people in the profession, and honourable members opposite such as the honourable member for Mackellar (Mr Carlton), who try to make invidious comparisons with the introduction of the health system in Britain, are distorting the facts. As a resident of Britain at the time of the introduction of the new national health system I can vouch, as a patient, for the success of that scheme.

Apart from the great need which all such people have for Medicare, the universality of cover is also most advantageous in terms of efficiency and reduced administrative costs. Doctors and hospitals will find that their bad debt problems disappear overnight. In public hospitals there will be no need to check for free treatment entitlement or for private fund membership; nor will there be any need to hound patients for the payment of bills if they do not fall into either of those categories. Medical benefits will be payable for medical services rendered to in-patients of public and private hospitals. Subject to agreements with each State and the Northern Territory, all persons eligible for Medicare benefits will also be entitled to public hospital in-patient accommodation and treatment without charge when that treatment is provided by a doctor appointed by the hospital. Out-patient treatment in public hospitals will also be provided without charge.

A matter which will require attention in the future is the need to cover motor vehicle third party and workers compensation services under Medicare. It is important, in my view, to simplify the administrative procedures in such cases. Possibly such simplification will reduce the high medical costs involved. People wishing to have private treatment in a public hospital or treatment in a private hospital will be able to insure for such treatment. There will be no need for anyone to take out hospital insurance if he or she is satisfied with the care provided in public hospitals by doctors employed on a salary or sessional basis.

With the advent of Medicare the private health funds will inevitably expand the range and level of the ancillary cover for dental and paramedical services. People will be able to obtain cover for services such as physiotherapy, chiropractic, chiropody, dentistry and home nursing and the cost of aids and appliances. I have been contacted by a number of constituents in relation to the need for Medicare to cover these ancillary services, but to include such cover at this time would inevitably increase the cost of Medicare substantially and mean a consequent rise in the levy. I can only say that it was important to introduce the basic medical and hospital cover under Medicare and the ancillary services must be left to the next stage of Medicare. We must not move too far too fast without adequate consultation and review of the services supported by Medicare in its first year of operation.

With the introduction of Medicare it will be necessary to cover the costs of public hospitals in relation to the removal of all in-patient and out-patient fees for patients who elect to be treated free as public patients and the reduction of fees for private patients in public hospitals. Reimbursement to the States must also be necessary for the payments they must make to private hospitals for daily bed subsidies from the anticipated date of 1 July 1985. Additional grants will be made to the States for the community health centres and the escalation in the cost of the grants. The agreements between the States and the Northern Territory and the Commonwealth Government contained in the Schedule to the Health Legislation Amendment Bill will, amongst others, include the requirement that public hospital admissions be made solely on the basis of medical need without regard to health insurance status. There will be peer review and hospital audits with an expansion of hospitalisation and certificates of need for high technology equipment. Health costs in public hospitals have been escalating over the past few decades. The arrangements contained in this legislation will ensure that the Commonwealth Government plays an important role in the national policy and planning aspects of the medical services provided by public hospitals.

The right of private practice for salaried doctors in public hospitals has been a matter of concern to me for some time. I welcome, therefore, the provisions of this legislation which ensure that Commonwealth medical benefits will be payable for diagnostic services provided to in-patients and out-patients of public hospitals only if the service is provided in the form of a contract between the medical practitioner and the hospital and which is acceptable to the Minister. The medical practitioner will be able to draw up to 25 per cent of a full time specialist's salary from charges received under the contract, the residue being used on the basis of State government guidelines. I anticipate that visiting diagnostic specialists will be required to receive comparable remuneration for the services they provide. As the Minister for Health (Dr Blewett) has indicated , this provision will remove the present defective double payment for services offered and introduce some accountability into the right of private practice. It is not, as some commentators have attempted to assert, an attempt to abolish the right of private practice.

I wish now to discuss the categorisation of private hospitals which will take effect under the Health Legislation Amendment Bill. Private hospitals cover a wide range, with major surgical hospitals at one end of the range and, at the other, bush nursing hospitals, some of which provide services similar to that provided by nursing homes. Despite the large difference in the cost structures as a result of the different level of care provided, the level of fees is the same and substantial profits can be made by the nursing hospitals while the major hospitals are just able to survive. Thus the Bill proposes a three tiered structure: Category A hospitals will receive $120 per day in basic benefit and $ 40 per day in Commonwealth bed subsidy; category B hospitals will receive $100 per day basic and $30 per day bed subsidy; and category C hospitals will receive $80 per day basic and $20 per day bed subsidy. Each category will respectively therefore receive $160, $130 and $100 per day. From 1 February 1984 these benefits will reflect reasonable cost levels rather than the inflated levels involved in some present private hospital charges. Regulations will lay down the principles of categorisation under the Health Insurance Act and will have regard for the actual services provided in a hospital, subject to the opinion of the State Minister of Health with regard to the relevant category. Appeals against the categorisation can be made to the Minister and to the Administrative Appeals Tribunal.

I do not accept the recent newspaper reports that bush hospitals will suffer financial problems as a result of Medicare. As a result of the increased bed subsidies, a total of $113.2m will be paid to private hospitals in 1983-84, representing an increase of more than 50 per cent on the previous allocation for bed day subsidies. As from 1 February 1984, insured patients in a private hospital who are classified as nursing home type patients will be paid $80 per day, less the patient contribution. This amount will be frozen at that level until it is equal to the standard nursing home benefit plus the patient contribution. If the nursing home type patient elects to be treated as a private patient the present arrangements will still apply. There will be no charge for public patients but the patient contribution will still be payable.

Having given my own rundown of the provisions of the legislation which will affect the hospital system I indicate again my strong support for the introduction of Medicare. As a result of successive conservative, Liberal-led governments in Victoria and Canberra, Victorian hospitals have severe problems. There have been years of neglect and the State Labor Government has inherited a public hospital system which is in rapid decline. The introduction of the new health Bills in this Parliament is the beginning of a new era for the hospital system. In particular, the consultative process between Commonwealth and State governments will help to streamline and make more efficient hospitals' financial and operational procedures. Audits, peer review and the monitoring of the introduction of high technologies such as nuclear medicine, ultrasound, coronary by-pass grafts and computerised axial tomogram scanners will reduce the escalating costs of modern medicine. These improvements will not occur overnight . I commend these Bills to the House.

Sitting suspended from 6.30 to 8 p.m.