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Wednesday, 14 September 1983
Page: 813


Mr CARLTON(10.03) —In relation to clause 18 the Minister for Health (Dr Blewett) in his second reading speech drew attention to the concern expressed by the Government about the private practice arrangements of medical practitioners in hospitals, which of course are part of the State delivery systems. The Minister said:

The concerns about the operations of private practice rights particularly relate to diagnostic services and some therapeutic services-pathology, radiology , radiotherapy and nuclear medicine-where there is not usually any direct doctor -patient contact, where there is substantial scope for generating additional revenue, and where there is a significant technical content to the service which is provided by the hospital rather than the doctor.

On those grounds the Minister suggests that the medical benefits will not be paid by Medicare unless the Commonwealth Minister has approved the contract in each individual case entered into by the hospital with the doctor. This can apply to contracts written before the time of this Bill. The Opposition understands quite well that there may be a capacity, in certain situations such as this, for an excessive draw to be made on Commonwealth benefits. That may well be a concern, but the Opposition is very much concerned that the Federal Government should be returning once again to interfere directly in the delivery practices of the State governments and their hospitals and that it should be up to the Federal Minister, advised by the Commonwealth Department of Health, to pass these contracts between doctors and hospitals.

I think the Opposition's concerns about this would not be quite so great if the Minister had not demonstrated such an extraordinary view of the doctor-patient relationship in certain of these specialities. It is quite understandable that in pathology there may well not be such a close relationship between the practitioner and the patient. The specimens are sent to a laboratory, the pathologist in charge has various technicians in the laboratory, and there may well, in most cases be no contact with the patient, although in a hospital there is more likelihood of there being that kind of contact. We are talking about hospital pathologists. But to say that there is very little relationship in radiology, radiotherapy and nuclear medicine displays a very peculiar view of the doctor-patient relationship.

Anybody who has visited the major hospitals and seen the oncology units, the operation of computerised axial tomogram scanners, and the professionals in these areas making their professional judgments about and dealing with patients I think would be amazed at the statement made by the Minister in his second reading speech. Also I think those in the professions who read the second reading speech of the Minister would be gravely concerned, particularly if they were radiologists, radiotherapists and nuclear medicine practitioners operating in hospitals, that it has been suggested that they have little contact with the patient. The Minister says that there is a significant technical content to the service provided by the hospital rather than the doctor. Certainly in the last three cases the significant technical content is in the nature of the high capital cost machinery which is involved in these services. However, if the person who has the skills is being relegated to a mere servant of those machines , that person would have very grave cause for affront.

We are concerned about this and also about the fact that in clause 18 (1) (b), proposed new sub-section (4) (c) seems to be a requirement that the guidelines formulated by the Minister in this case should be published in the Commonwealth of Australia Gazette, but we see no reference to any capacity for parliamentary disallowance of those guidelines. I seek the Minister's information on this matter. Is it the intention in the provisions contained in clause 18 (1) (b), proposed new sub-section (4) (c), to have any capacity for parliamentary disallowance of those guidelines? If the Federal Department is to intervene in the local situation to this extent, at the very least the Federal Parliament ought to be able to oversee that process, particularly since it would have some concern about the Minister's rather peculiar view of at least three of the four specialities.

Also, it is not clear to me-perhaps the Minister can also advise about this- whether this provision could be extended to cover visiting specialists, not just the staff specialists within the hospital. That is an important point I would like to have clarified because it is not absolutely clear to me whether visiting specialists are excluded. Mere statements of good intention would not be enough. I would like to be assured that this matter is covered within the provisions of this clause and that it does not relate to visiting specialists. There would be very serious problems with visiting specialists, particularly in country areas, if a provision of this nature were to appear. As the provision stands, we have grave concerns about this clause. We seek assurances about some of it, but I am not certain at all that even those assurances would be sufficient for us to concur with it.