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Thursday, 19 March 1987
Page: 1180

Dr BLEWETT (Minister for Health)(8.00) —in reply-Apparently the honourable member for Curtin (Mr Rocher), who was the last speaker on the Opposition side and who was only half-way through his speech on the National Health Amendment Bill, regarded his remarks as so unimportant as not to return to the House to complete them. In these circumstances I am happy to wind up this second reading debate. The first point I want to make is that, as usual with these health Bill debates, it is not the Bill that has been debated; we have listened to the usual collection of mendacities about Medicare, which as usual, has been blamed for all the faults in the health system. Today those accusations became quite laughable-Medicare, I understand, is somehow responsible for the generic drugs policy of this Government; Medicare is responsible for aspects of the Pharmpay system; and Medicare is responsible for hospital waiting lists. I wish to refute each of those charges which have been made by the Opposition in this debate.

The best point to start with is the assertion of the honourable member for Barker (Mr Porter) that we had an excellent health scheme in this country before Medicare. That sort of proposal has already been dealt with by most of my colleagues, who have treated it as the bunkum it is. I want to make a few points in relation to that. Of course, under Medicare there has been an increase in the total number of services provided to Australian people, simply because under the failed health schemes of the previous Government two million people did not have access to doctors. To give them that universal cover has meant, of course, that in toto there has been an increase in the number of people treated under the Medicare system.

It is simply nonsense and incorrect and wrong in fact, as are so many statements of the honourable member for Barker, as my colleague the honourable member for Bendigo (Mr Brumby) so eloquently pointed out, to claim that there has been an increase in overservicing under Medicare-that is, an increased number of services per patient, which is the basic characteristic of overservicing; that is, more and more services being delivered to particular patients. The figures simply confute that assertion by the honourable member for Barker. In the last year of the Liberal health scheme, 1983, there were 7.70 services per enrolled population; in 1986, which is the last year for which we have statistics, there were 7.68 per enrolled population. I will not claim that Medicare is leading to less servicing of patients, but there has been no change in the pattern of servicing of patients under Medicare. Of course, the kinds of alleged facts produced by the honourable member for Barker are then used to show that overservicing is going on, of which there is no evidence, as I have just pointed out.

That leads him to attack bulk billing. I point out that those figures show that bulk billing has not led to an increased number of services per patient. Opposition members talk about doing away with bulk billing in order to deal with the alleged problem of overservicing which their figures do not support. Let me point out that 70 per cent of those bulk billed are pensioners and the disadvantaged in this community; the great proportion of those bulk billed are the poor and the disadvantaged. The remaining 30 per cent who are bulk billed are mostly the less well off. As the survey of doctors in Sydney by the Australian Consumers Association quite clearly indicated, in Sydney the greatest amount of bulk billing is being done in the working class suburbs.

What we have mostly in this country is not doctors exploiting bulk billing but compassionate doctors using the bulk billing facility to treat pensioners, the disadvantaged and others who are not well off or who are in great need of medical services, which was always the intention. Again we had, as usual, this one-handed accountant, which is the only way we could describe the honourable member for Barker, making all these claims about an explosion in health costs. Of course, according to the figures there has been a significant increase on the expenditure side under Medicare, but that has been offset almost entirely by the levy and by the ending of the tax rebate system. Despite all the tales of the Opposition, there has not been an explosion in the net costs of health under this Government. Indeed, the increase in costs has been offset by the moneys coming in from the levy and by the ending of the tax rebate. We have to balance the two parts of the Budget, otherwise one simply becomes a one-handed accountant-the chief method of calculation used by the honourable member for Barker.

In his efforts to account for the costs of Medicare he bemoans the fact that last year it cost 96c to process each Medicare claim, and he said what a dreadful increase it was. I point out to him that that amount-96c per claim-is less than the cost of processing claims four years ago. Despite inflation and despite the increases in other costs, the processing cost of claims under Medicare is today less than it was under the Liberal system four years ago. As my colleague the honourable member for Canberra (Mrs Kelly) pointed out quite clearly, under the Liberal system the administration cost was 10 per cent; administration of the 67 health funds ate up 10 per cent of the moneys going into health. We have cut that to 4.6 per cent, which represents a saving over three years of $300m which we have been able to put into health and not waste on administration.

The absurdities that we heard today went even farther. We got to the Pharmpay system. Somehow the honourable member for Barker said that Pharmpay-the system of paying pharmacists-could be described as unworkable. I ask: Who designed Pharmpay? The answer is that it was designed by the Fraser Government. A working party under the honourable member for Warringah (Mr MacKellar), who was the Minister in those days, designed Pharmpay. Which Cabinet approved the Pharmpay system? It was the Cabinet of the Fraser Government when the honourable member for Warringah was Minister for Health. Who began the implementation of Pharmpay? Again it was the Fraser Government. The tenders were called in 1982. Insofar as there were flaws in the Pharmpay system, it was very much designed, decided on and implemented by the previous Government.

By the time we came to power this juggernaut was very well down the road. Its being a new system, this Government was hit with the obvious problems that one has with a new and massive processing system. To deal with this, payments were based on an average sample of scripts. As the honourable member for Curtin was trying to point out, it was discovered that this was an illegal way of making these payments. That sort of payment has been made since 1974 whenever there has been a crisis in the pharmacy paying system. If it were illegal in the last two years-as has been pointed out, the procedure has been in place since 1974-each time we have had a crisis in the pharmacy paying system this illegal system has been used. At least this Government has recognised that problem, and has dealt with it in this legislation.

Even more, we are trying to make the Pharmpay system work to clean up the problems that we inherited from the previous regime. For instance, we now have a settlement which will deal with that whole problem of backlog-a settlement negotiated with the Pharmacy Guild of Australia. This is a result of the co-operation existing between this Government and the Pharmacy Guild. We are trying to streamline the procedures which again had been passed on to us in relation to this Pharmpay juggernaut. We are developing very quickly the claims transmission system; that is, having a computerised system of putting in claims. Indeed, I can now say that, as a result of the further actions we have taken, today claims are being processed and paid in all States in under 30 days. However, let me say, like so many of the messes that we have had in the health area, they come very much from what we inherited from the previous Government.

The theory was advanced again today by the honourable member for Barker that the problem we have had with generic drugs is the result of this Government's determination to offset Medicare costs by trying to process generic drugs very quickly. Let me point out again that the policies we have pursued in this area are simply the policies that we inherited from the previous Government. Insofar as there has been a so-called fast track process whereby a priority approval for some generic drugs was in place, it has been in place for the last decade or more. So I would suggest that the honourable member for Barker go ask his mates about the system which was introduced under them. This Government has given no instruction whatsoever in relation to this so-called fast track system. It accepted the system which had been passed on from the preceding government. Indeed, we have not been operating this system for the past two years. That is, for most of the Medicare period the so-called fast track program has not been operated by this Government.

Again, the honourable member tried to smear the Government with the claim of the release of a generic drug on to the market before all tests had been concluded on that drug. Again I suggest he go ask his mates about that drug because one such incident occurred in 1979-80 and it appears to have been the one referred to in that recent newspaper report. So, again, alleged problems that this Government has had are very much the result of the policy developed under the previous Government.

The honourable member then went on to refer to 33 generic drugs about which issues have been raised in relation to the Gestalt data. Around half of those 33 drugs were approved under the previous Government. Again, I make the point that this whole supposed fast track procedure, or alleged fast track procedure, has been one which has been in operation for a number of years, which was devised and developed before this Government came to power. Again, contrary to the claims that the honourable member repeats in this House in relation to the problems with the Gestalt data-he never listens to any argument or to any fact but just simply goes on repeating his claims and he knows that in this case what he has said is wrong. He knows that they were only brought to my attention last October and that the Hall report was only brought to my notice at that time, as I have made clear quite precisely in this House.

It may well be that officers in my Department were remiss in not bringing that information before the Minister before that date. But as soon as it came before me-as soon as it came before the Minister-we took immediate actions. I appointed outside consultants to review the questionable data. We held a special meeting of the Australian Drug Evaluation Committee-ADEC-and this Government accepted immediately all of its recommendations. We then decided, following up those recommendations, to appoint an inquiry under the auspices of the Public Service Board. I just point out that this committee of inquiry will be oversighted by a group consisting of Mr Chris Geckeler, First Assistant Commissioner of the Public Service Board, Dr Ron Wells, Director of the Australian Institute of Health, and Dr Robert Parfitt, Principal of the Canberra College of Advanced Education and soon to take up a position as Deputy Vice-Chancellor of the University of Western Australia. That Committee will draw upon overseas advice. As soon as these problems were brought to our notice, unlike a government which did nothing about it, which introduced these policies but made no effective effort to monitor them, these actions were taken immediately. All of the decisions flow from the information which was brought to my attention in October about the problems we had with the Gestalt data.

I just want briefly to deal with what is the only argument which in any way honourable members have been able to sustain in relation to Medicare, and that is hospital waiting lists. I do not intend to go at length through this problem again as I have explained it to the House. But as every report on hospital waiting lists in the States have made clear, it is not a Medicare problem. We reached the absurdity today where it was suggested that nurses somehow lent out instruments because of Medicare and the bitter battle that Victorian nurses had about their wages and conditions was essentially to do with Medicare. It was due to the fact that for many years their claims in many cases had been ignored by administrations and by previous governments.

Mr Kerin —Eclipses of the moon, too.

Dr BLEWETT —I agree with my colleague that anything will be linked with Medicare. The main causes, as some honourable members mentioned, have been clearly identified as staff shortages, mainly nurses, and the associated bed closures. The problem has also been caused by industrial problems in hospitals. There is no doubt that when doctors go on strike in Canberra or somewhere else the waiting lists are added to. If nurses take industrial action again one adds to the waiting lists. Major technological changes have increased demands for operations. These are the issues at the heart of the waiting list problem and these are the issues that need to be specifically addressed.

These issues are being taken up by the States. Victoria has recruited nurses from overseas so that it can open up its extra beds. It is arranging contracts with private hospitals and has expanded home care services to cater for nursing home-type patients. There has been an expanded use of operating theatres in South Australia to enable these facilities to operate on Saturday mornings. Increased day surgery is being developed in public hospitals. These are the specific actions that have been taken in relation to the specific problems and not in relation to the vague ideology and cliches produced by the Opposition.

Let me deal with a couple of issues that directly relate to the Bill because most of the things that were said by members of the Opposition had nothing to do with the legislation. The honourable member for Petrie (Mr Hodges) is one of the few pharmacists in this country who has been critical of the new pharmaceutical benefits scheme. Let me point out that the new pharmaceutical benefits scheme, which has been widely supported both by the public and pharmacists in this country, is the most massive change in the pharmaceutical benefits scheme in a generation. Yet it has been accomplished with remarkably little problems. I am not saying that when one introduces a new scheme such as this one does not have some administrative problems. But, in fact, the scheme has worked remarkably smoothly, given the preparatory time we have had and given the massive changes involved. I am very glad to say that this scheme was designed to benefit those in the community who needed medicines most. Already 28,000 cards have been issued entitling such people to free pharmaceutical benefits. That means that something like 68,000 people have already benefited; that is, people most in need of medicines under this new scheme. Despite the comments made by Opposition members-again they are incorrect-we are roughly on target. The estimated number of cards is roughly what we expected at this point of time.

Members of the Opposition may make their critical comments. But members of the public know that the scheme is working. They know that in difficult times we have designed a scheme which protects pensioners and also provides new protections for those most in need of medicine, meaning that the rest of us have to pay a bit more. But the people in need, either on medical grounds or on the grounds of disadvantage or pensioner status, receive their drugs free.

I think they are the major points that I wanted to make in relation to this debate. Insofar as Opposition members discussed the Bill itself, I have given specific responses. I believe that this Government's Medicare scheme, despite the criticisms that have been made, mostly, as I have said on no factual basis whatsoever-and there has been no effort to answer the argument produced on this side-will continue as the health scheme of this country. As compared with the things that the Opposition is talking about offering, Medicare will remain a major electoral asset for this Government in the coming election.

Question resolved in the affirmative.

Bill read a second time.

Message from the Governor-General re- commending appropriation announced.