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Thursday, 19 March 1987
Page: 1163


Mr SNOW(4.36) —We now have two National parties in this House and two Liberal parties and, in the confusion, two Liberal views on the pharmaceutical benefits scheme. The attacks by the two honourable members opposite, the honourable member for Barker (Mr Porter) and the honourable member for Petrie (Mr Hodges), have one thing in common in respect of the pharmaceutical benefits scheme. They are both not very constructive. The honourable member for Barker has been claiming credit for the safety net provisions that have been put into the Government's legislation which we are now discussing-the National Health Amendment Bill-and acknowledging that the scheme is working quite well and even saying that it was his idea. Then we just had the honourable member for Petrie telling us that the system is a nightmare. The Opposition is absolutely and completely divided. One could almost divide the Opposition into the number of people that exist in it. The two honourable members have told us that there nothing wrong with removing items from the pharmaceutical benefits scheme to save expenditure; yet they-particularly the honourable member for Petrie who has just spoken-have criticised the Minister for Health (Dr Blewett) for doing just that. I am amazed that a member of this House would think that the Minister does not take into account the advice of the Pharmaceutical Benefits Advisory Committee, a committee of doctors and pharmacists which considers whether items should or should not be on the national health scheme, whether in the context of reducing expenditure or of putting other items on the list and keeping expenditure the same, as I believe happened in this case. I propose to touch on this matter again later in my speech, because it touches on what the whole philosophy of the pharmaceutical benefits scheme should be.

The attack on the scheme by the honourable member for Barker listed, for example, fast delivery of details of the new scheme to pharmacists. It was not based on any argument that the scheme was not working, because it patently is working. It was not based on any argument that the scheme was unfair. It patently is fair, allowing people with chronic illnesses throughout Australia-illnesses for which they can find no cure-to obtain free medication after 25 prescriptions have been dispensed in any one year. The Opposition's criticism was not based on any argument that the scheme was not working. It patently is working with both pharmacists and the patients co-operating. The Opposition's attack was based on quick delivery of data to pharmacists before the scheme commenced. It was based on criticisms of the program which was set up under the Fraser-Howard Budgets. Pharmpay, the system of payment to pharmacists, was a creature of the Fraser-Howard years; yet today we see the spokesperson for health matters and the honourable member for Petrie disparaging it. I might say that in South Australia there is a maximum delay in payment of 34 days under Pharmpay at the moment. Honourable members opposite based their attack on testing systems for medications which operated under their schemes. I commend the Minister for Health for now trying to upgrade the system to improve the testing procedure. Honourable members opposite were in office for 30 years. Why did they not do something about the system of payment to pharmacists? Why did they not do something about drug evaluation? The criticisms of honourable members opposite of these inheritances of previous governments contrasts with their silence on how well the new scheme is working. That it is working well has been attested to by a medical practitioner, Dr Steve Flecknoe-Brown of Middle Cove, who sums up the view that the pharmaceutical benefits scheme got away from its original intent to supply essential medication. I quote from his Letter to the Editor published in Medical Practice of December 1986-January 1987. He wrote:

I have never been an apologist for the points of view of the present Federal Government and Health Minister, but I do perhaps know a little more about the background of the new PBS than most, and against this background, the scheme looks very sensible to me . . .

It is clear now that the Department of Health has taken the decision that the original intent of the Pharmaceutical Benefits Scheme will be further upheld. Originally, medications which we now take for granted, (e.g. antibiotics) were very expensive and yet very necessary to the health of the community. Thus, a community underwriting scheme was devised and this was called the Pharmaceutical Benefits Scheme.

Twenty years later, most of the `old biologicals' are now relatively cheap and affordable on a cash basis, and so the public underwriting scheme is no longer needed for these substances. On the other hand, sophisticated new drugs, including the `new biologicals', are several orders of magnitude more expensive and again a scheme of public underwriting of the cost of these substances would seem desirable. Whilst I have never argued that such public underwriting should be the responsibility of government, clearly this government considers that it is. I would personally have preferred to see the private health funds take the initiative when it was available several years ago, but now the opportunity has gone.

As a result therefore, the new anti-cancer drugs, human recombinant insulin and several other expensive and innovative medications-

may I say that they came on to the pharmaceutical benefits scheme at approximately the same time as the items taken off by the honourable member for Petrie; they are very important drugs-

are now available on a $10.00 prescription (free for pensioners).

In a move showing extraordinary responsibility and restraint, the Department of Health decided that it had to meet its budgetary obligations, and so something had to be dropped from the . . . Scheme. The $1.00 or $2.00 cost of a packet of aspirin or paracetamol is unlikely to make a significant impact on the individual pensioner, whose pension is, after all indexed to take into account such items as the cost of beer and cigarettes.

Thus, I find myself supporting the principle of the `new' Pharmaceutical Benefits Scheme, in that it is once again doing what the Pharmaceutical Benefits Scheme was originally designed to do.

People with chronic illnesses, families with young children and others who use large numbers of prescription drugs have benefited from the new pharmaceutical benefits scheme. From 1 November last year no individual or family has had to pay for more than 25 pharmaceutical benefits scheme prescriptions in any calendar year. Already, as at 17 March 1987, 53,000 people-possibly 26,000 families-have been covered by that new safety net provision introduced by this Government. After purchasing their first 25 items, both general and concessional patients receive all future pharmaceutical benefit items free for the remainder of that year. The safety net provision was a long overdue reform which will increase protection for high volume users of drugs who previously could face massive bills. I appreciate the fact that the honourable member for Barker recognised that point. I deplore the fact that the honourable member for Petrie did not.

The new scheme was developed by the Government through consultation and close co- operation with the Pharmacy Guild of Australia. That co-operation was obviously essential because pharmacists are assisting in its operation by issuing entitlement cards and they are recording pharmaceutical purchases. I believe that the honourable member for Petrie did the Pharmacy Guild and pharmacists in general a disservice by claiming that the scheme is not working. They were heavily involved in discussions. I was involved in discussions, as a member of the relevant committee and convenor of the working group on the Industries Assistance Commission report on pharmaceutical products. I worked with them constantly.


Mr Blanchard —A very good chairman, too.


Mr SNOW —I thank my colleague for his compliment. When the matter was introduced the Minister for Health said that it was not anticipated that the administrative work load on individual pharmacists would be significant. I believe that that has proven to be the case. Agreement had been reached on payments to pharmacists for their role in the scheme.

The Minister, the Department and the Pharmacy Guild are continuing to monitor the impact of the new scheme on the community to maximise its effectiveness and to ensure that there are no abuses of the new arrangements. That is why we are doing what we are doing today. It is part of that monitoring. I believe that the alternative being offered by the Opposition as its health policy is little more than a rehash of the 1976 Fraser scheme which really began the dismantling of Medibank. The failure of that scheme was demonstrated by the fact that it lasted only two years and it was followed by four more messy and more confusing health schemes. A decade later, it is obvious that the Opposition has not learned anything from its past mistakes. In fact, not long before we came to government, the previous Government introduced a complex form. The honourable member for Petrie talked about the shambles under the present system. Why did he not tell us about the shambles of the four, five or six health schemes under the Fraser-Howard Budgets? Why did he not tell us about the shambles of six years of illegal payments to pharmacists under the previous Government, which is being rectified by this legislation? Why did he not tell us about the shambles of the long-winded statement that had to be signed by patients under the last Carlton-inspired adjustments to the pharmaceutical benefits scheme under the previous Fraser-Howard Government? It is obvious that the Opposition has learned nothing from its mistakes.

I quote from the November 1986 editorial of the Australian Journal of Pharmacy:

As pharmacy has demonstrated before in the past decade, its strategic position, with members evenly spread geographically in shopping centres throughout the nation, makes its members a potentially formidable lobby.

What Mr Hodges has overlooked--

that is, the honourable member for Petrie, who spoke before me-

is that when his party was in power during the Fraser Government years, the Guild twice found itself in total confrontation with the government-situations in which trust and communication broke down completely.

Another part of the editorial states:

It is not even certain that Mr Porter would become Health Minister.

Certainly, it is not certain in the present leadership struggle. It continues:

After all, the Guild's first confrontation with the Fraser Government was after Mr Ralph Hunt, now deputy leader of the National Party, had been appointed Health Minister instead of the previous so-called `shadow Minister'.

Mr Hunt lost that confrontation. After saying that he would not give up his Ministerial prerogative (to unilaterally determine the level of pharmacists' NHS dispensing fees), he capitulated under threat of a Guild High Court writ. He appointed an independent chairman to the then existing fees negotiation committee.

. . .

The goodwill that initially created was undermined, however, when the Fraser Government (with Mr Carlton as Health Minister) outrageously suspended the Tribunal's operations, making a mockery of its statutory basis, during the 1982-83 wage freeze. That government ignored the fact that pharmacists are not members of the public service-rather, they dispense NHS scripts by agreement with the government.

With this historical background, it can be seen why the Guild is pleased with its new agreement with the federal government, despite the drawbacks to which it has freely admitted, and on which critics have pounced.

I conclude by saying that over the past 38 years, since the first Menzies Government came to power, we have had approximately 7 years of Labor government. I believe that the pharmacy industry has had good and reasonable relations with those Federal Labor governments. When Dr Everingham was Minister for Health, good relations were developed. I believe that they have deepened with the present Minister for Health. Certainly, there are strong criticisms by the Pharmacy Guild-important criticisms which ought to be listened to. As well, there has been constant contact between the Guild and the Government at both a policy making and a ministerial level. I have been pleased to have been involved in those contacts with the pharmacy profession and with other professions, including the veterinary and optometry professions, in developing policies which result from consultation. After all, that was part of the reason for this Government coming into power. I have great pleasure in supporting the Bill. (Quorum formed)