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Thursday, 19 March 1987
Page: 1168

Mrs KELLY(5.14) —I was absolutely fascinated by the speech of the honourable member for Moreton (Mr Donald Cameron), not by any comments that he made about the National Health Amendment Bill, because he really did not get on to that at all, but rather by the comments he made which obviously give us some indication of the future policy of the Opposition in relation to health matters.

Mr Porter —Don't you worry about that.

Mrs KELLY —I think the people of Australia will be a bit worried about that, particularly as the Opposition has revealed to them all its arm's length servicing of the patients. The honourable member for Moreton referred to the way in which nurses would have to take on the role of doctors in hospitals. I suppose that he would have the doctors working from their yachts on the Brisbane River and getting the nurses to do the work. Who would we pay? Would we pay the nurse or the doctor? It will be fascinating to see the Opposition's policies, if ever they emerge.

I have listened to the contributions by the honourable member for Moreton and other speakers. I have seen crocodile tears being shed for those people who are waiting for elective surgery. I have a lot of sympathy for people who are waiting for elective surgery. I particularly have sympathy for people waiting for elective surgery in this city. Why is that? Because the doctors are on strike here. They refuse to service Medicare patients. Why? Because the Government has offered them only a 21.5 per cent increase in their fees. Is that not dreadful? I would like any member of this House or any member of the community to indicate that he or she has received a 21 per cent increase in income in the last few years. No one in this House has, and very few people in my electorate or the electorates of other members of this House have. That is not good enough for the doctors in Canberra. No, they have to demand more. First of all, we negotiated with them on a fee for service basis. Why is that? It is because that is what they said they always wanted. When they did not get what they wanted there they said: `All that negotiation is over. That is not good enough for us. The 21.5 per cent is not good enough for us. We want new negotiations, this time on a sessional basis'. Then they dictate their own terms in relation to that. This Government will not stand for that.

The people caught in the middle of this are Medicare patients who have been admitted to hospitals. I believe a lot of doctors in Canberra are responsible, and they say that they will service people in emergencies. I hope that we have a very broad definition of emergencies. Regardless of that, this situation cannot continue because in Canberra over 50 per cent of all patients admitted to hospital are Medicare patients. Until those doctors fulfil their obligations to those patients the lives of those people are at risk. No trade union in this country has ever put the lives of people at risk as the doctors in Canberra are doing at this very minute. At this minute people are being admitted to hospitals who are not being serviced because the doctors are on strike, because they refuse to take a 21.5 per cent increase. We cannot even sit down and discuss the issue with them. They say: `No, a 21 per cent increase is not good enough'. I am sorry to show emotion in this issue, but people's lives are at risk. My constituents' lives are at risk. It is a very emotional issue to me and to the people whom I represent.

Mr Porter —What about those who can't get into hospitals?

Mr White —What about the others who can't get in at all?

Mr DEPUTY SPEAKER (Mr Ruddock) —Order! If all honourable members interject at once nobody can be heard. I think it is better to keep a little decorum.

Mrs KELLY —In light of the message from the Deputy Speaker, I would like to make some comments now in relation to the Bill. I would like to explain some of the misunderstandings-I think some of the deliberate misunderstandings-about this Bill. This is really only a minor Bill, but we would never believe that from the debate going on today.

Mr Porter —It is a major issue.

Mrs KELLY —It is true; it is a major issue, and the pharmaceutical benefits scheme is a major issue. It also takes a great deal of taxpayers' money. The interesting thing is that the costs that we are talking about in relation to this scheme are $687m this year; so it is a lot of money. It is important that we understand the nature of the scheme and the effects that these amendments would have. There has been considerable discussion in this debate about the role that the Minister for Health (Dr Blewett) takes. Let us make very clear who decides what items are and what items are not covered by the pharmaceutical benefits scheme. Basically that decision is not made by the Minister for Health. It is made by the Pharmaceutical Benefits Advisory Committee. That consists of nine members, six of whom, by the way, are nominated by the Australian Medical Association. They do not make the decisions on financial grounds; they make them on medical grounds. They are not influenced by the Minister at all in relation to this. It is true that some drugs have recently been deleted from the list, but it is also true that some have been added. Since March 1983 over 100 new drugs have been added and 70 have been removed. Now there are about 2,000 formulations on the list.

There has been enormous growth in the use of these drugs, particularly in the pension area. Last year the growth was more than 20 per cent. I would like to draw attention to one fact that is very interesting and bears consideration-probably nothing more than that at this stage. However, it is something that we as members of the Parliament should take into consideration. Pensioners in Australia consume at least twice as many drugs per capita as their counterparts in the United States of America. I do not know why that is the case. We cannot blame the pensioners. They do not even know what most of the drugs are. They just go along, tell the doctor their symptoms and get a whole pile of drugs. So we cannot blame them. We cannot blame the demographics. There is no doubt that our population is aging, but so too is the American population. However, our population is not aging so quickly that we get a 20 per cent increase in one year. There is no particular reason why our pensioners should be less healthy than American pensioners or why our pensioners were less healthy last year than they were the year before.

I think all members of the community, whether they be the doctors prescribing the drugs or the patients, have to be very responsible in looking at these drugs because they cost a lot of money and someone has to pay for them. The taxpayers, the Government, pay for these 2,000 items. This is why it is absolutely critical and essential that only critical drugs be placed on the free list of items which are made freely available to pensioners and are subsidised in respect of the rest of the community. It is obvious that as developments occur in technology and science it is important that the list adjusts to changing circumstances.

Various examples have been given of new drugs and experimental drugs that come on to the market. These drugs cost a lot of money-some cost $40 or $50. Such drugs are subsidised. But other drugs are now available over the counter very cheaply. One can go to one's local pharmacist-I would prefer that one did not go into Woolworths, and I will refer to that later-and buy something like paracetamol for about $2. But what would it cost the Government to provide that drug to the pensioner for nothing? It would cost the Government much more. First of all, that drug would have to be prescribed by a doctor. Therefore, the Government would have to subsidise that medical consultation which would cost $13.30. Then when the prescription is taken to the pharmacist, the Government would pay a dispensary fee of $2.40. The cost of the drug itself is about $1.70 to the Government. So it would cost taxpayers, who ultimately pay the bill through the Government, over $17 for something that one could get across the counter at one's pharmacy for $2. So at times it is necessary to readjust the scale and that is what is being done through the changes to the pharmaceutical benefits scheme.

I also want to refer briefly to the safety net provisions in this legislation. I think it is important that we congratulate the Government on this safety net scheme. As the mother of a couple of children I can tell honourable members that when one has a sick child one's other children also get sick very quickly and it is very easy to build up 25 scripts. I think it is important that we have this safety net provision. I understand that as of 17 March about 53,000 people are covered by the safety net provisions.

Mr Reith —What about a safety net for the pensioners who cannot get into hospital?

Mrs KELLY —The truth of the matter is that there is a big safety net in this proposal because the pensioners of Australia can get over 2,000 prescription items free. What is the Opposition's policy? What is it going to do about it? We have not heard what the policy of honourable members opposite is. They get up and condemn our legislation. But I would like to know what they are going to do. How are they going to pay for some of their crazy policies? God help the pensioners of Australia if the Opposition ever gets into government.

At this stage I would like to make reference to some other points, particularly those raised by the honourable member for Barker (Mr Porter) about the cost of Medicare. I have always taken a great interest in the cost of government administration. The Committee of Public Accounts, of which I am a member, made a report on pathology. We closely examined and made a lot of recommendations about the administration of health, particularly the new Medicare administrative arrangements. I need to make some points because a lot of untruths have been issued in this debate. First of all, let us have a look at the figures. Medicare is a very efficient system. The average claim processing time is three days for cheques and direct billed claims. Doctors who direct bill often receive their payments within a week of making their claim. This reduction in administration and fast cash flow is no doubt a major reason why 51 per cent of all medical services are being directly billed, thereby allowing patients to receive their medical services at no direct cost. In Canberra about 50 per cent of people are Medicare patients. I do not have all the details of the number of people who are directly billed, but it is important that the doctors receive their payments very quickly and efficiently. There is a huge network of 264 Medicare branches. I inform the Minister for Health, who is in the chamber, that although I have not managed to get the few more branches in my electorate that I have asked for, I am still working on it. Obviously this is a vastly more superior system than having a huge number of private funds.

Mr Porter —Why?

Mrs KELLY —Because it is more efficient. There are economics of scale.

Mr Porter —It is not.

Mrs KELLY —Of course it is. We have got the facts, we know.

Mr Porter —Have a look at their costs.

Mrs KELLY —Prior to the introduction of Medicare, 10 per cent of the total medical benefits bill was spent on administration costs. Under Medicare those costs have been halved to only 4.6 per cent. In the last financial year, the administration and processing of Medicare claims through the Health Insurance Commission cost $123m. If the previous system, of which the honourable member for Barker is so proud, had continued, administrative costs in the last financial year would have been about $250m. That point needs to be made. The overheads are not very substantial. In fact, there has been a reduction. There are great economies of scale in this very efficient Medicare system because it delivers a quick service both to the patients in terms of bulk billing and to the doctors who we paid after a turnaround time of about a week. It is important that these issues be brought to the fore.

Finally, I would like to congratulate the Minister for his consultation with the pharmacists in the build-up of the pharmaceutical benefits scheme. Before I conclude, I would like to give a special note of thanks to the Minister for Territories (Mr Scholes). A number of pharmacists who came to see me were very concerned about proposals they had read about in the newspaper that there were going to be amendments to the local ordinance which would allow pharmacies to operate in big supermarket chains. I totally oppose that proposal and I told the pharmacists that when they came to see me. I then wrote to the Minister for Territories to ask him for his view and whether he could give me any guarantee that the pharmacy ordinance would not be amended to allow this to happen. He said:

It would seem to me inappropriate for Territory's legislation to be amended to allow pharmacies to be owned and operated by the retail supermarket chains.

Mr Porter —Will you table the letter.

Mrs KELLY —I am sure that all of my pharmacists are very pleased about this view. It is not necessary to table it as I have sent it to every pharmacist in the Australian Capital Territory. On behalf of all of them I would like to thank the Minister for his reassurance.