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Wednesday, 14 September 1983
Page: 811

Dr BLEWETT (Minister for Health)(9.48) —I just make a few brief comments about the contributions to this discussion. First of all, I am very grateful to the honourable member for Mackellar (Mr Carlton) for having torpedoed much of the argument of his Party in the second reading debate. The Committee will remember that Opposition members were busily arguing that the levy will account for only roughly $1,000m of the $8 billion health bill but the honourable member for Mackellar, in his argument, showed quite clearly that exactly the same is true of health insurance. The present health insurance system does not cover anywhere near the total bill of this country. We have never pretended that the levy will cover the total health bill of this country, just as this Opposition, when it has been honest, has never pretended that the health insurance provisions covered the whole health bill of this country. That point quite satisfactorily deals with one of the major arguments of the Opposition during the second reading debate. As the honourable member for Mackellar rightly pointed out, the Government already pays half the medical bill of this country. When we allow for the 30 per cent Commonwealth cover for everybody and the full cover for pensioner and health care services, we see that already 50 per cent of the bill is paid. All we are doing in this legislation is extending that payment to 85 per cent and funding it in a much fairer way by means of an income related levy.

The second point made by the honourable member for Mackellar was his kind of satire on the 'substantial' concessions made to the Australian Democrats. All he talked about was this one concession-and he mentioned the post box; I give him that-and he did so as though that constituted the understandings we made with the Democrats. But, unlike the Opposition, the Democrats have been willing for months to talk with the Government about the problems of this measure. Of course , many of the earlier concessions are already in the Bill; that is, that we should deregulate the private funds considerably to meet many of their demands and place restrictions on the competitive ability of Medibank Private so that it did not piggyback on Medicare. All of those arrangements are part of a much broader set of concessions and agreements that has been made with the Democrats. So, to come here and sneer because there is only this one amendment ignores utterly the agreements and understandings and the quite sensible arguments produced on a range of issues with the Democrats.

Let me now deal with the three questions raised by the honourable member for North Sydney (Mr Spender). We define 'chronic' in terms of people reaching that threshold. We have found it impossible to define chronic illnesses as such, and therefore we have a used a threshold basis; that is, a number of gaps. When it reaches $150, this will certainly cover people with chronic illnesses, and people who may have major surgery, or major accidents. We can do nothing about doctors who charge in excess of the schedule fee, just as the present health insurance system can do nothing about them. We are talking only about the gap between 85 per cent and the schedule fee. The approximate cost of the concession is $8m in a full year.

The other point raised by the Opposition on this clause is the question of overservicing. No doubt that issue will arise again. I make one general point about overservicing-particularly for the honourable member for Bass (Mr Newman). Overservicing is, in essence, a problem of an insurance system, and not a problem of either a public or a private insurance system. All the evidence is that it occurs under any form of insurance system. It does not seem to make much difference whether it is public or private; we have much the same problems. For instance, one of the disadvantages of the present system is that gap insurance is a way of encouraging overservicing, because if the doctor charges the schedule fee, the patient has nothing to pay in that situation. I accept this problem as a serious problem but not a problem particularly related to a public insurance system as against a private insurance system, because of the problems that have existed under the present system, with its private insurance system.

Mr Newman —Except that you reduce their income, if you succeed.

Dr BLEWETT —I shall come to the reduction of income shortly. The Joint Committee of Public Accounts drew attention to the fact that the only statistical analysis that had been carried out on bulk billing showed that there was no greater use of services where doctors bulk billed as compared with patient billing; that is, where doctors were already bulk billing-about 30 per cent to 40 per cent of all services are already bulk billed-those doctors did not feel, because they were bulk billing, an inclination or desire to overservice their patients. This means again that doctors exaggerate the kinds of cuts that might be produced in their income by these proposals, because even if they all bulk billed it would not be 15 per cent over their present situation, because their present situation already involves a large amount of bulk billing.

Mr Newman —But for someone bulk billing 70 per cent, the calculation is that they would be down about 8 per cent.

Dr BLEWETT —Right; then there would be the possibility that it would be done in that way. On the other hand, we know that because there are about two million people in the community who are uninsured, there is a considerable amount of sickness being untreated. In the estimates of costs we have made for next year we expect some increase because those people fearful now of visiting their doctor will come in. So in that sense the doctors benefit; they benefit, of course, in the ending of all bad bills, bad debts. So I doubt whether there will be any serious repercussions for doctors' incomes, for doctors who will charge a majority of their services by direct billing. That does not mean that, just as under the present system, we shall have the same problem of overservicing under the future system. I shall be making a major statement to the Parliament next month about proposals concerning overservicing-for many of which I would be perfectly prepared to give credit to the honourable member for Mackellar (Mr Carlton), who laid many of the foundations of the actions which we are taking, although he does not seem to be so keen on the policies that we here help to initiate.

Question put:

That the amendment (Dr Blewett's) be agreed to.