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Thursday, 19 March 1987
Page: 1174

Mr BLANCHARD(5.49) —I support the National Health Amendment Bill 1987. Before I discuss the Bill I would like to comment on some of the remarks that have been made by honourable members opposite. It seems to me that very little time has been spent by them on reading it, and I can understand why. They have been far more interested in the machinations of their Party machines and in who will be leader of what faction and when. Of course, this means that affairs of state take a back seat. This is a shame because there should be a fair measure of support from both sides of the House on the health issue. Judging from honourable members' contributions, I feel they have a degree of support for a decent health service in this country. They may differ as to the means of achieving a good health system but, generally speaking, I will not condemn individual members.

The contributions from the Opposition so far in this debate have concentrated essentially on attacking bulk billing and the whole concept of Medicare. I cast back my mind to the pre-Hawke years, to the time when the Fraser Government ran this country and was responsible for its health. We had a succession of schemes, almost on a yearly basis, to try to work out what was the best form of health cover for the country at large. We must remember that eventually we finished up with more than two million people not being covered by the health system of that day.

The honourable member for Moreton (Mr Donald Cameron) in his ubiquitous manner spoke widely on general issues, but he did not once touch the substance of the Bill. This, I am afraid, is an example of what I was speaking of earlier. I want to look at a number of amendments in the Bill and, in particular, at the changes to the pharmaceutical benefits scheme. Before I do that, I will refer to two other matters contained in this Bill. The first extends the definition of `pensioner' for the purpose of the principal Act to include certain children of deceased veterans referred to in sub-section 86 (3) of the Veterans Entitlement Act 1986. When, as I anticipate, this amendment is agreed to by the Parliament, these children will be entitled, as they should be, to pharmaceutical benefits free of charge.

The second matter relates to an amendment which will enable persons contributing to private health funds to obtain cover for pathology services rendered while they were in-patients of a hospital or a day hospital facility. At present the definition of `basic private table' or `basic table' provides that one of the benefits to be included in the basic table in respect of registered health benefits organisations relates to professional services rendered to persons while they remain in-patients of a hospital or day hospital facility.

What must be realised is that professional services extend to include a range of pathology services that are required to be performed after the in-patient has been discharged. For example, pathology samples may be taken at the time the patient was in hospital but the actual testing of them may not be performed until after the date of discharge from hospital. At this point of time, under the present Act, a person who receives such pathology services is denied any benefit from a registered health benefit organisation. I think we would all agree that that is a most unsatisfactory state of affairs. This amendment will rectify this situation by deeming the pathology service which is required, to have been rendered to an in-patient of a hospital or day hospital facility

Let us examine the amendments which will affect the pharmaceutical benefits scheme. As honourable members know, this scheme makes a wide range of drugs and medicinal preparations available to the public on a subsidised basis. Drugs are included in the scheme on the basis of a comparison with other available drugs of their quality, safety, effectiveness and cost. It is a scheme which has helped to keep costs down to the consumer, particularly those on low incomes and social security beneficiaries who suffer from chronic illnesses or who have families with young children who are likely to be large users of prescription drugs. These people have all benefited from the pharmaceutical benefits scheme. The scheme is both responsible and equitable in the light of present budgetary restraints.

The scheme commenced on 1 November 1986 and from that date no family or individual was required to pay for more than 25 pharmaceutical benefit scheme prescription items in any one calendar year. After purchasing those 25 items, both general and concessional patients receive all future pharmaceutical benefit prescription items free for the remainder of that year. This so-called safety net provision was an overdue reform which increased protection for high volume users of drugs who previously could face massive bills.

It is interesting to observe the confusion which exists on the Opposition benches in respect of the safety net concept. This is another area in which the Opposition cannot get its act together. One doubts whether it ever will. It is doomed-from the Opposition's point of view, not the Government's point of view-to the Opposition benches for many years to come. The Opposition health spokesman, the honourable member for Barker (Mr Porter), wanted to claim credit for designing the safety net provisions. In his speech to the House on 24 September he had this to say:

I visited British Columbia to study its pharmaceutical benefits scheme and I was impressed with the safety net idea. I subsequently followed up my discussions with the Pharmacy Guild and, when I addressed the Pharmacy Guild annual general meeting last year, outlined my view that we would in government implement a similar scheme in Australia.

He continued:

I am glad that the Government has seen fit to pick up this proposal of mine as I believe that it is a more appropriate way to direct the available resources to those most in need.

Let us see what the honourable member for Petrie (Mr Hodges) had to say about the safety net idea which the honourable member for Barker so warmly embraced. In the same debate and on the same day the honourable member for Petrie-knowing the honourable member, I am sure he said this with great sincerity-stated:

Let me examine this prescription record form. I have one here. It is just typical of the bureaucratic nonsense that would come out of the Health Department.

He continued:

It will be a nightmare for chemists.

For once the honourable member for Barker was right. The scheme is a more appropriate way to direct the available resources to those most in need.

Mr Hodges —Have you talked to chemists?

Mr BLANCHARD —The honourable member should wait and listen. It must not be forgotten that this scheme was developed by the Government through consultation and close co-operation with the Pharmacy Guild of Australia.

Mr Hodges —So what?

Mr BLANCHARD —I think it is important. My friend would have a lot more to say if it were not, I can assure him. According to the figures I have, up to 17 March 53,000 people have been covered by the safety net scheme and obviously more will be covered over time. Furthermore, there has been no criticism of the scheme since it began. It has been well received by both the consumer and the pharmacy industry. In a Press release dated 24 September 1986, the Minister for Health (Dr Blewett) stated that the Health Department and the Pharmacy Guild of Australia would continue to monitor the impact of the new scheme upon the community to maximise its effectiveness and to ensure that there were no abuses of the new arrangements. The changes to the safety net provisions contained in this Bill illustrate the effectiveness of this monitoring. It has picked up abuses and it has picked up some faults in the operation of the scheme.

The amendments provide for two exceptions to the requirement that purchases of pharmaceutical benefits must be for determined quantities if the purchases are to satisfy criteria associated with the issue of pharmaceutical benefits entitlement cards. The safety net legislation does not allow a prescription for fractional quantities of pharmaceutical benefits to count towards the 25-prescription threshold. It was framed that way as a safeguard against doctors prescribing benefits in small quantities to accelerate the issue of an entitlement card.

Under the present legislation prescriptions can be counted towards the safety net only where the quantity ordered is the same as the maximum quantity at the date of supply. However, the maximum quantity can change between the date of prescribing and date of supply. It would be unfair if the prescriptions for a maximum quantity at the time of prescribing were not allowed to count towards the safety net threshold because of a change in the maximum quantity by the time of supply. The existing provisions also created an anomaly in the area of addictive and dangerous drugs where prescribing maximum quantities may be inappropriate to the treatment of short term conditions. The requirement that the maximum quantity be prescribed on each occasion contradicts the spirit of present drug initiatives.

Clause 5 of the Bill deals with the issue of pharmaceutical benefits entitlement cards. At present, approved pharmacists, medical practitioners and hospital authorities are required to retain for a period of 12 months application forms and accompanying documents which supported their issue of the corresponding entitlement card. The amendment provides a new requirement for such persons to forward those documents to the Secretary to the Department within one month of their issuing the corresponding entitlement card. The effect of this amendment will be that by the regular receipt of these documents the Department of Health will be able to monitor more effectively the safety net scheme. This will specifically assist the pharmacists who at the moment have to wait for payments. These payments to pharmacists will now be able to be made on a regular basis and should not be delayed because of non-receipt of documents.

In any new scheme teething problems are always likely to occur, and the pharmaceutical benefits scheme has been no exception to that rule. During the past two years there have been difficulties in the processing of pharmaceutical claims. To ensure that pharmacists continued to receive reimbursement for their claims for drugs dispensed under the scheme, the Department made advance payments based on statistical calculations of the value of the pharmacist's claim. Claims made in this manner were to be subject to full processing when resources became available in order to determine the correct entitlement due. Subsequent advice from the Attorney-General's Department indicated that the Department had no power under section 99 of the National Health Act to make advance payments and that such payments were invalid. The Department immediately ceased making those payments, as it was obliged to do-and rightly so. The Auditor-General was advised of this legal advice and will report to the Parliament on the matter. The proposed legislation will obviously correct that situation.

The Department aims to process pharmaceutical claims within a 30-day period. This will have the advantage of allowing pharmacists to receive payment prior to having to pay their drug companies' bills. It will thus help to prevent a financial burden being placed on pharmacists. The amendments contained in this Bill are all designed to improve the operation of the scheme and should be welcomed by both the consumer and the Pharmacy Guild. I support this Bill before the House.