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Wednesday, 14 September 1983
Page: 830


Mr NEWMAN(12.02 a.m.) —I make a general observation. One of the threads that have come through Government members' argument in this debate has been that in talking and promoting Medicare they have all told us how this is the most detailed policy that has ever been put into a Bill and presented to this Parliament and how it has remained a central plank of the Australian Labor Party 's platform for years and years. Yet the honourable member for Grayndler (Mr Leo McLeay) took points of order, obviously out of total ignorance of what the legislation is all about. So much for the knowledge of one honourable member about a Bill which is supposed to have been formulated over so many years. The honourable member for McMillan (Mr Cunningham) tried to excuse his delinquency in his electorate by admitting that after all these years of preparation he had finally got around to dealing with one problem in his electorate last Wednesday. He should hang his head in shame.

I return to the clauses that we are talking about. Whilst I appreciate the arguments that the honourable member for Capricornia (Dr Everingham) made, I do not think he understands that categorisation is causing a great deal of concern in the electorate. Whilst there may be provisions for appeal, there is still a great number of questions being asked about the criteria which will be applied to private hospitals in finally geting their certification. I hark back to what I began with. If this is such a well-formulated and well-planned scheme I would have thought that these things would have been a little more clear than they are now.

I come to another problem of categorisation that the Minister for Health (Dr Blewett) might be able to deal with. It relates to those hospitals which have a mix of acute beds and long term beds. I pose a problem of a hospital which has, say, 80 beds, of which 30 are long term. If it is a normal, run of the mill, private hospital, the long term beds will have a very high occupancy rate. Those beds will represent about 37 or 38 per cent of total bed space available in the hospital. The remaining, say, 63 per cent will be acute care beds and will have a much lower occupancy rate. The overall effect of this will be that perhaps the long term beds will take up, say, 50 per cent of the bed days in that hospital. I am sure that the Minister would readily appreciate that that would mean that that hospital would have a great deal of trouble qualifying as a category B hospital under the criteria which such hospitals understand now apply. The point I am trying to make is: Would the Minister, when looking at that sort of problem , which is not unusual, take into consideration the separation between long term beds and the acute beds in the hospital and make a determination accordingly? In other words, there would be flexibility within a hospital situation to decide the categories which the Minister would apply to them. That is one problem about categorisation.

Another problem which goes very much to the heart of the arguments that have been put by many honourable members on this side of the chamber during the debate is the question of competition. I go back to a point that I made in the general debate. Let us take a category B hospital. As I understand it, the rate which would apply to that hospital would be $30. If we take a case which I think is typical of a category B hospital, it would charge, say $130 for a shared private ward. If a patient is insured he would get back $100 from the insurance scheme from the basic cover. The Commonwealth would offer $28 and so the patient would be left with the basic fee being paid but the additional cost of $16 for a medical bed or $28 for a surgical bed would not be paid. So the patient would be up for $30 a day. The officials advising the Minister are all scratching their heads. The Minister can indicate whether I am right or wrong. But that is a situation that has been posed to me. If it is not a real situation then that is the Government's fault because that is the position private hospitals believe will prevail. I will be glad if the Minister can clear up that point because a number of private hospitals in my electorate would be very pleased to have the matter clarified. I come back to the point again: If a person has basic cover and if the contribution by the Commonwealth is taken into consideration, the fee a patient will have to pay in addition to his medical insurance will be of the order of $18 to $30 a day.

The other point I make again concerns the question of just how much patients will have to pay for basic health cover. The Minister said it would cost $5 but, as has been said now on several occasions, it could be raised to $7 or $8. I come back to the point of all this which is the question of competition between private hospitals and public hospitals. If there is to be a shift to the public hospital sector-if the sorts of figures that I have now queried and which the honourable member for Mackellar (Mr Carlton) has put forward in the case of bush hospitals are correct-the competition between public hospitals and private hospitals would be such that the drift to the public hospital area will be quite extreme. In my electorate the various assessments being made indicate that it could go as high as 30 per cent. The whole point is that even if there were a small shift private hospitals would find that they would have a drift away from them which would make them quite uneconomical. Worse that that, the public hospital sector would find that it would be deluged with patients which would absolutely choke their services. I would like a clarification of those points by the Minister.

I summarise the points that I have made. The first point I raised concerned the confusion that now seems to prevail in relation to the categorisation of hospitals. Secondly, I hope there is some flexibility in the Minister's determinations which will allow for the sort of situation I described where there is a mix of acute and long term beds. Thirdly, and perhaps most importantly, there is the question of the patient meeting the cost of going into a private hospital whilst on basic cover and the fact that unless that is very carefully assessed it will be found that there will be a drift away from private hospitals. That drift would make many of those private hospitals uneconomical but, worse than that, it would choke the public hospital sector.