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Wednesday, 14 September 1983
Page: 824


Mr FISHER(11.23) —Clauses 31 to 45 deal with the approval of private hospitals and their categorisation. I want to raise this categorisation factor tonight together with the very real concern of several thousand people in the electorate of Mallee and throughout Victoria who are serviced by the bush nursing hospital system. Medicare will, of course, have a disastrous effect on thousands of patients in my electorate and in other electorates throughout Victoria. Indeed, through all of rural Victoria we will see massive reductions in health care services. As the Minister for Health (Dr Blewett) knows, the Victorian Bush Nursing Association is a unique group. The Association was established to provide in rural areas of Victoria hospital and related services for the care and treatment of people in need of medical care. Currently there are 38 bush nursing hospitals in Victoria with a total bed capacity of 828. There are also 18 bush nursing centres. In my electorate of Mallee there are nine bush nursing hospitals and three bush nursing centres. These hospitals, which are unincorporated, are registered with the Health Commission of Victoria as private hospitals. The hospitals are administered by autonomous committees elected from the hospitals' members and the committee members act in an honorary capacity.

The organisation of these hospitals is very similar to that of ordinary small public hospitals, with one major difference. While public hospitals have full time qualified administrators, this is not the case with the bush nursing system . Several hospitals have full time salaried managers or secretaries and some have part time salaried secretaries. Others have secretaries operating in a purely honorary capacity. Like Bush Nursing Association centres, the hospitals in the main are located in small and relatively remote areas. Being private hospitals, the principal source of income is in-patient fees. Contrary to popular belief, bush nursing hospitals are not subsidised by the State Government. With the introduction of Medicare, all these hospitals will face severe financial difficulties because few people will be able to afford them.


Mr Leo McLeay —A point of order, Mr Deputy Chairman. I have been listening to what the honourable member has had to say. It does not sound all that relevant to the clauses before the Committee.


The DEPUTY CHAIRMAN (Mr Rocher) —Clauses 31 to 45 deal with private hospitals. I have been listening carefully and, as far as I can see at the moment, the comments are relevant.


Mr Leo McLeay —Mr Deputy Chairman--


The DEPUTY CHAIRMAN —Does the honourable member wish to take a further point of order?


Mr Leo McLeay —Yes. With due respect, Mr Deputy Chairman, my understanding of bush nursing hospitals is that they are public hospitals.


The DEPUTY CHAIRMAN —Order! There is no point of order.


Mr Leo McLeay —It is a quite relevant point of order.


The DEPUTY CHAIRMAN —Order! There is no point of order. I call the honourable member for Mallee.


Mr McVeigh —Mr Deputy Chairman, I raise a very brief point of order. I wonder whether the member from the Government side who raised the point of order was confused about loans for housing over lunches.


The DEPUTY CHAIRMAN —Order! There is no point of order. I call the honourable member for Mallee.


Mr FISHER —Thank you, Mr Deputy Chairman. I will not comment on the quite ignorant point of order raised by the honourable member for Grayndler (Mr Leo McLeay). I ask the Minister for Health: If it was the intention of the Australian Labor Party, as it stated in its pre-election policy, that all Australians would be guaranteed automatic entitlement to medical services without any direct charge, why are bush nursing hospitals being categorised under the private hospitals system? Over one-third of private hospitals in Victoria are bush nursing hospitals and they play a major role in health care services in remote areas. Yet no one-not pensioners and not even the 1 per cent levy payers-will be able to use the facilities of the bush nursing system without cost. People wanting to use a bush nursing hospital will have to take out private health insurance to cover themselves. It will clearly disadvantage thousands of people living in rural areas where the only hospital is a bush nursing one. I ask the Minister: Does he expect these people to travel unnecessary miles-in many cases in my electorate, hundreds of miles-in order to receive hospital care that they can afford? How many lives is the Government prepared to put at risk with this carelessly constructed policy? Is this how the Labor Government intends to look after the sick and the elderly or is this simply another attack on people who live in rural areas?

This repressive piece of legislation will put at risk the viability of several hospitals in Victoria, including several rural hospitals. I have spoken to two bush nursing hospitals today. The one at Birchip advises me that it will be losing $1,000 a week under these arrangements and the hospital at Nyah will lose some $2,500 a week. Clearly this cannot be tolerated. Not only are the hospitals threatened with closure but also cleaners, cooking staff, nurses and doctors will also certainly have to leave these country regions. The closure of local bush hospitals will put the medical staff out of work and force them to move elsewhere to look for work. It will also have a serious effect on the unskilled work force. In turn, this downturn in the number of people living in the towns and coming into the towns for medical care will affect small business.

The most astonishing aspect of this legislation is that in the drafting of it little consideration was given to discussing the implications of Medicare arrangements, and the categorisation of hospitals such as those which belong to the Victorian Bush Nursing Association. As recently as 31 August the Department of Health was claiming that it had lost the submission sent by the Association to the Minister for his consideration. Despite the fact that the executives of the Association advised on several occasions that they were prepared to meet with the Minister, such a meeting, unfortunately, has not taken place. In fact, although the Department received considerable correspondence from the Association, it was asking what the group was as late as early August.

What an admission from the Department of Health to a group which represents over 33 per cent of private hospitals in Victoria, which provides 900 hospital beds and which employs hundreds of staff-a group that, with the introduction of Medicare, will move from profitable, sound growth to possible extinction. I plead with the Minister to review this legislation carefully to ensure that this outstanding and efficient Victorian health care delivery service is protected. Under this legislation people served by and who must attend a bush nursing hospital will have to take out health insurance and will also be compelled to pay the tax levy. They will have absolutely no choice and will pay twice for the privilege. This is an act of gross discrimination. I thought tonight that members of the Australian Labor Party might be prepared to speak on this issue.

As we are discussing the very serious issue of the categorisation of private hospitals, I wish to mention those in Victoria that will be affected. In my electorate of Mallee there are nine hospitals-the hospitals of Beulah, Birchip, Charlton, Hopetoun, Murrayville, Natimuk, Nyah, Rainbow and Sea Lake. In the electorate of my colleague the honourable member for Murray, Mr Lloyd, we have the hospitals of Murchison, Nagambie, Pyramid Hill and Tongala. In the electorate of the honourable member for Gippsland, Mr McGauran, we have the hospitals of Heyfield, Mirboo North and Toora. The electorate of my colleague the honourable member for Indi, Mr Ewan Cameron, has the hospitals of Chiltern, Euroa, Violet Town, Walwa and Yackandandah. The honourable member for Wannon, Mr Hawker, has in his electorate the Merino hospital. The honourable member for Corangamite, Mr Street, has Cobden hospital. The honourable member for Bendigo, Mr Brumby has Wedderburn hospital. The honourable member for Isaacs, Mr Charles, has the Chelsea hospital. The honourable member for Flinders, Mr Chynoweth, has the hospitals of Hastings and Mornington, and the honourable member for McMillan , Mr Cunningham, has the hospitals of Neerim, Pakenham, Upper Yarra and Cowes. The Minister for Communications, Mr Duffy, has in his electorate the Berwick hospital. The honourable member for Ballarat, Mr Mildren, has the hospitals of Avoca, Ballan and Trentham. The honourable member for Casey, Mr Steedman, has the Lilydale hospital and the honourable member for Burke, Dr Theophanous, has the hospitals of Gisborne and Lancefield.

I mention these hospitals to indicate the very real and serious problem that will be faced in Victoria if these hospitals are forced to close or in any way to reduce their services as a result of the decisions being taken. There is an option. The recommendation is that an additional daily bed subsidy be paid to bush nursing hospitals for each in-patient day for eligible pensioners and persons designated by the Department of Social Security as disadvantaged; and that such a subsidy be not less than the average daily bed cost as reported annually by hospitals to the Victorian Bush Nursing Association, less the standard daily bed subsidy of $30 per day payable to private hospitals, and not more than an approved charge for treatment for a private patient in shared accommodation in a public hospital, which is $80 per day. I ask the Minister to look urgently at this problem in the interests of the secure and safe delivery of medical services in the country areas of Victoria.