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Thursday, 19 March 1987
Page: 1103


Mr McARTHUR(11.10) —Along with the honourable member for Barker (Mr Porter) and the honourable member for Warringah (Mr MacKellar), I support the Opposition's view that the Australian Institute of Health does not need to be a statutory authority. This is at a time when Medicare costs have blown out. The levy raises about $1.6 billion and the total cost of health care in Australia is about $8.9 billion, which gives the lie to the fact that we have efficiency and equity in the health care system, as suggested by the honourable member for Scullin (Mr Jenkins). In fact, health care costs have blown out considerably since the present Minister for Health (Dr Blewett) has been in charge and the present Medicare arrangements have been in place.

For many years there has been a growing awareness of the need for careful study of health needs as a means of improving the health of Australians. In 1979 the Senate Standing Committee on Social Welfare identified the need for Australian health services to be evaluated, the setting of goals and objectives, the establishment of standards and the collection of appropriate data. The report said that it was imperative that proper evaluation occur in order to provide information essential to the proper planning of health and welfare systems and to the efficient and effective operation of these agencies. Similarly, in 1980 the Commission of Inquiry into the Efficiency and Administration of Hospitals, chaired Mr Jim Jamison, gave support to the recommendation of the Commonwealth Parliamentary Joint Committee of Public Accounts that a bureau of health economics be established. It was envisaged that the bureau would undertake identification of internal and external factors influencing the efficiency in hospitals and other health institutions. It also recommended that the bureau would collate comparative statistics and financial data on a national basis.

These calls were largely answered in September 1984 with the introduction of the Australian Institute of Health, under the auspices of the Department of Health, established along lines similar to the Bureau of Agricultural Economics in the Department of Primary Industry and having the principal functions of reporting on priorities and progress and conducting or supporting research into the use of health services and the health status of the Australian population, with particular emphasis on health economics, health statistics and health services planning. In addition, the Institute is required to develop, collate and publish national health statistics in conjunction with other relevant bodies, and service the national committee on health and vital statistics. The Institute also provides advice and research support to the Australian Health Services Council, and other Commonwealth and State bodies, as well as collaborating with international health agencies in meeting the needs for health development, research and training.

I refer the House to the cost of setting up this body as a statutory authority. It would make the Institute a growth department and would provide a more complex arrangement. I have no doubt that the organisation would have to find another building and would have to employ more public servants. Finally, it would not be fully accountable to the Minister. It would lack the co-ordinating element in terms of the Health Department which it now has. Personally, I accept the need for some statistics for the health restoration of Australians and for the prevention of illnesses in men and women in the States around the Commonwealth.

I refer honourable members to the Better Health Commission reports. I commend the Minister for setting up the Better Health Commission which has provided the data included in its three reports. Indeed, in the statistics area, the Australian Institute of Health Bill emerges from comments made in those reports. In a country such as Australia, with 25 per cent of the work force involved in the Public Service, it is interesting to note that the Better Health Commission takes the view that some of our statistical collections leave something to be desired. I would have thought that the large number of public servants that we have at Federal, State and local levels would be able to collect these statistics. The report suggests that health surveys are in about the middle range compared to other countries in identifying people's health status. In the vital statistics area, where State governments collect data on births, deaths and marriages, there is an obvious lack of co-operation at the national level. However, it would be hard to identify areas where the establishment of a statutory Institute of Health would help to overcome these difficulties. For those people who have been associated with hospital administration, there seems to be no lack of statistics and information about patients required by government agencies, both State and Federal. I find it difficult to come to any conclusion as to how a statutory authority would improve this process.

It would appear that an improvement in the data collection process and procedures would be a much more important feature than a Federal statutory authority enforcing the statistical collection. Hospitals deliver health care at the State level, either through publicly funded State hospitals or through privately funded operations. The base statistics are collected at the hospital door and interferences by Federal authorities will not assist.

In trying to monitor health risks there is a grey area of statistical analysis and interpretation. The Better Health Commission agrees that those private groups have been better able to interpret these monitoring areas than government agencies. The Commission refers particularly to the Victorian Anti-Cancer Council and the way in which it has provided data on the risk factor for those who indulge in smoking or other potential cancer-forming habits. It also refers to the National Heart Foundation, a privately funded operation which has been successful in monitoring the heart disease risk potential of Australians.

Medicare is delivered at the State level and a similar problem is emerging in Victoria where it has been suggested by the Government that administrative arrangements be increased. In Victoria there are 34,000 patients in hospital queues awaiting treatment, and the position there is not improving. In recent days the nurses have been on strike and elective surgical operations have been banned, thus increasing the problems of patients in that State seeking treatment. In Victoria the shadow Minister for Health, the Hon. Mark Birrell, has researched these matters in some detail. He is on record as indicating the disastrous performance of the Victorian Health Commission. The State has reduced by 2.4 per cent in real terms funds for up-front hospital care-that is, hospital facilities and the availability of services to patients have been reduced. On the other hand, there has been a 10 per cent increase in funds for the administration of the Health Department. Those people seeking treatment are getting less money, but the bureaucrats in the Department are getting more money to administer a disastrous health system in that State. I refer to the subject of capital projects to demonstrate the problem that Victorians are facing. A sum of $21m has been spent on a new 10-storey wing in the eye, ear, nose and throat hospital in East Melbourne, but that new wing has been empty since July 1986 and I understand that it could have served 100,000 out- patients if it had been in operation. That is the state of Medicare in Victoria-more administration such as is suggested in this Bill, but less delivery of patient care.

The philosophy of Medicare, as the honourable member for Warringah indicated, is the perception that the Government will provide a free health system. The Prime Minister (Mr Hawke) in launching Medicare claimed that it would be cheaper, fairer and better, and, of course, we know that that is not the case. The attitude now prevalent in the community is that the Government will look after the health of all Australians. We now find that Australians are taking out private health insurance to make sure that they overcome the difficulties of Medicare. In fact, 50 per cent of Australians have taken out private health insurance. Half the population have voted with their feet and taken the view that Medicare is neither free nor adequate. In fact they are paying twice: They are paying the levy and they are paying their own private health insurance, for two basic reasons. The first is to make sure that they get a doctor of their choice, and the second to make sure that they can get into a hospital when they want to.

I turn to the reports of the Better Health Commission. I commended the Minister for Health on setting up the Commission, and I also commend the members of the Commission for providing these three reports. I notice that the honourable member for Perth (Dr Charlesworth) is in the House, and I commend him as a member of the Commission on these excellent reports. They have put forward an alternative point of view to the attitude and perceptions that Medicare has brought about in health care in this country. The reports suggest a change from the approach of curing those who are ill to a preventive medicine approach. Volume 1 of the first report, which I have read with great interest, sets out the sort of approach that the Better Health Commission is trying to bring about in Australia in order to change the attitudes of administrators, patients and medical practitioners. Its approach aims to make Australians healthier, fitter and more able to look after themselves. Of course, in the long term that will save the Australian taxpayers money.

I turn to the goals and strategies of the Better Health Commission's three task forces. I draw the attention of the House to the details of the first volume, in which the three task forces set out the areas of their approach to improving the health of Australians. The task force on cardiovascular disease has some very practical and sensible approaches to heart disease in Australians up to the year 2000. It hopes to reduce the number of smokers to 15 per cent of the population. It hopes to increase the number of adults with a lower percentage of cholesterol in the blood and to reduce to less than 5 per cent the number of adults in the population who have high blood pressure. It also hopes to increase to 60 per cent the proportion of adults participating in sufficient activity to achieve and maintain physical fitness and health.

The nutrition task force has similar objectives which are fairly simple, straightforward and practical. By the year 2000 it hopes to reduce the prevalence of overweight and obesity from 38 per cent to 25 per cent of the population. It also hopes to reduce the fat contribution to the Australian diet from 38 per cent to 33 per cent and to reduce the contribution of refined sugars and the intake of salt and alcoholic beverages. It aims to increase breastfeeding of babies to the age of three months and to increase the fibre content of the Australian diet.

The third approach of the Commission is the establishment of the injury task force which, by the year 2000, aims to reduce the number of road traffic injuries, both fatal and non-fatal, by 20 per cent. It also aims to reduce the number of alcohol related crashes by 15 per cent, to reduce the number of pool drownings of children under the age of 12 years by 95 per cent-I commend the Commission for looking at this particular problem-and to reduce the number of drownings of children under the age of two years by 90 per cent. The task force also hopes to reduce by 50 per cent the number of playground accidents involving children and requiring hospital treatment. Lastly, in the injury area, it hopes to reduce by 50 per cent the number of hospital admissions of children suffering accidental poisoning from drugs and household poisons. I commend the Commission, which was chaired by Dr Llewellyn-Jones. Members of the Commission are widely based and their approach in talking to community groups and those persons interested in health care and research was commendable.

For the information of honourable members I think it is wise to look at the second and third volumes of the report in which the Commission has carried on its very good work. In the second volume it has gone into considerable detail in the chapter entitled `Cardiovascular disease: preventing an unnecessary way of death'. That is a matter which is very close to all Australians-the possibility of a heart attack. Some of the details, research and practical suggestions about the way in which Australians should look after their own health are to be commended. Another chapter is entitled `Better nutrition for Australians'. Again, some of the details incorporated in the second volume are practical, sensible and not full of scientific data which the average Australian cannot understand. In another chapter entitled `The injury task force' a number of positive suggestions are made. The fourth chapter is entitled `Cancer in Australia: prospects for prevention and control'. In this chapter the Commission comes up with some observations and suggestions. It also looks at the problem of mental health in a chapter entitled `Mental ill-health in Australia'.

In volume 3 some of these areas have been pursued further. Some of the chapter headings indicate the trust and thinking which is so commendable compared with the attitude that Medicare engenders in the Australian population. One of the chapters is entitled `Prevention of disability', while `Promoting health in older people' is another. Honourable members will notice the emphasis on a positive attitude. Another is entitled `Youth health: it's everybody's concern'. Other chapters are entitled `Financial incentives for the promotion of health' and `Health and the media in Australia: an uneasy relationship'. Again I stress the ability of members of the House and members of the media to promote the positive attitude that health is not just a financial concern but is one that can be controlled by individuals. Individuals can improve their own health status. A further chapter is entitled `Preventive medicine in undergraduate education'-again a new initiative, a new tack in changing the attitudes of the medical profession to health care in Australia. Yet another chapter is entitled `The future of public health research in Australia'. I commend the Commission and the sorts of attitudes that emanate from those three volumes.

I also commend those private practitioners who have taken up this sort of view, particularly Dr Andre Kretsch, of Melbourne, who runs a preventative medicine clinic. He is actually putting into practice the sort of programs that the Better Health Commission is suggesting, by educating his patients, by monitoring their health on a yearly basis, by encouraging them to stick to a particular fitness regime and by keeping individual patients fit and out of the public health system over a period. I commend Dr Kretsch and others who are setting up preventative health clinics rather than concentrating on curative measures, which has been the traditional way in which medical practices have been run.

Finally, I point out that the implementation of the Australian Institute of Health as a statutory authority is really contrary to the sort of approach that the Better Health Commission has been suggesting. We need a health department that collects the statistics in a co-operative manner and that can put them together to help the sort of research that the Better Health Commission has advocated. We need fewer taxes and charges in the health system. We need less health costs and we must encourage happier, fitter Australians to take the general attitude of preventative medicine and preventative health programs. We do not want bigger and growing statutory authorities spending more money and getting fewer results for the personal health needs of individuals and the health of future generations of young Australians.