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Wednesday, 9 May 1984
Page: 1792


Senator PETER BAUME(10.11) —I move:

That the Medical Services (Fees) Ordinance 1984, as contained in the Australian Capital Territory Ordinance No. 7 of 1984 and made under the Seat of Government (Administration) Act 1910, be disallowed.

Notices of motion Nos 1 and 2 are in my name, Mr President. They both deal with essentially the same subject. I therefore suggest that we have a cognate debate on the two disallowance motions, and I seek leave accordingly.


Senator Gareth Evans —I accept the sense of that arrangement.

Leave granted.


Senator PETER BAUME —Notice of motion No. 1 concerns the Medical Services (Fees) Ordinance 1984, which seeks to control prices of medical services in some Australian Capital Territory hospitals. I will foreshadow the other matter which is the subject of this cognate debate. It concerns some Health Insurance Regulations which prescribe the services for which fees are to be so controlled. In this debate I shall talk about both aspects of this matter, although I understand that we shall vote separately on the two motions at the appropriate time.

The ordinance and the statutory rules seek to fix medical fees that may be charged to private patients in public hospitals in the Australian Capital Territory for certain medical diagnostic services. These services are prescribed under section 17(1)(a) of the Health Insurance Act. So far, the prescribed services which are identified in the Health Insurance Regulations amendment are restricted to diagnostic pathology services and to radiology, although the Minister for Health (Dr Blewett) has made it clear that he may well move to extend the range of services at a later date.

The Opposition believes that the ordinance and the rules are both unnecessary, in that, firstly, the problem they seek to address does not exist; there is no problem. Secondly, the Opposition believes that this constitutes price fixing, with all the defects that that brings about. Worse than that, because it is unnecessary, because there is no problem, it extends the mistrust and it illustrates the contempt in which the Australian Labor Party holds the medical profession, and it signals an intention to limit private medical practice in Australia by restricting the fees which may be charged. We believe that this is a prelude to a move against other independent professions, one after the other. Our interest in this matter is for the consumers of medical services; it is for the people who visit doctors, and for whom the services are performed. We believe that the arrangements proposed under this ordinance and under the statutory rules will be bad for consumers. The fact is that there is no problem. Universally the prescribed diagnostic services in the public hospitals have been charged at or below the prescribed schedule fee. There is no example of hospital specialists charging more than the schedule fee for the services, in either radiology or pathology. Above all other fees-apart from those for medical specialists, surgical specialists, gynaecologists or orthopaedic surgeons-these diagnostic fees are the ones that have always been charged at or below the schedule.

Within the Australian Capital Territory, indeed across Australia, the Government has failed to produce even one example of doctors charging more than the schedule fee. In the Australian Capital Territory, which is the subject of this ordinance and these regulations, there is no problem; there is no example; there is no practice of doctors charging more for these diagnostic and radiology services. There certainly is no general problem requiring resolution and, therefore, it cannot be for the correction of some anomaly that these rules have been promulgated or this ordinance has been brought down. It is of course to achieve some hidden agenda, and it is this which concerns us.

More than that, patients are able today, and have been able for the last few months, to have all the hospital treatment, all the investigations, all the radiology and all the pathology they want or need at no cost at all to themselves, because the Medicare arrangements make it clear that everyone has the right, because they pay their Medicare levy, to go to a hospital, to take advantage of the services and not to be charged a penny. No one need be charged a single penny. Furthermore, if they decide to go as a private patient and get charged a fee in relation to whatever services they need-today we are discussing radiology and pathology-the charge to the Government, the charge to the public purse, the charge by way of payment of Medicare benefits, will be the same, irrespective of the fee charged. So the Government cannot be acting in some way to limit its own outgoings. Because there is not a problem of the radiologists or pathologists charging more than the schedule fee, what has happened and what has been happening can have no effect on the public revenue or upon patients.

The medical profession is an honourable profession and the practitioners of radiology and pathology in the Australian Capital Territory, as elsewhere, have a great sense of public duty and fair play. That is one of the reasons there has been no problem. They have worked within the rules, and they have done so assiduously and continuously. So, what is the problem to which the solution is addressed? The answer is that there is no problem. The Government has decided to move to impose this control, an action with no effect on its outgoings, to correct a problem which does not exist and which does not affect any of the Government's financial obligations. We are forced to conclude that a political agenda is being followed-a political agenda to do with an anti-doctor move. Either the Government does not trust the medical profession, the specialists in the hospitals, the radiologists, the pathologists-and I think I hear by way of interjection Senator Primmer agreeing with me that the Government does not--


Senator Primmer —I never said a word.


Senator PETER BAUME —I am sorry.


The PRESIDENT —Senator Primmer is not in his right place.


Senator PETER BAUME —Neither he is, Mr President.


Senator Bolkus —I take a point of order, Mr President. The point we were making was that Senator Baume should declare his interests, not that we were agreeing with him. As a general practitioner he should make it clear to the people listening to the debate that he has a vested interest in this matter.


The PRESIDENT —There is no point of order.


Senator PETER BAUME —I take up the intervention. I am interested in the comments of Senator Bolkus, who is a lawyer, and I will come back to them in a moment. I am not in practice; I have no vested interest in the matter. Of course I am a member of the medical profession. I happen not to be a general practitioner, although that is an honourable part of the profession.


Senator Grimes —Hear, hear!


Senator PETER BAUME —I notice my colleague Senator Grimes agreeing with that. I think Senator Bolkus does not really know what he is talking about. Maybe the Government is worried about some form of what may be called fee ambush. What do I mean by fee ambush? The Government may be worried that a person may decide to go to a doctor as a private patient unaware of the fact that that doctor will charge more than the schedule fee and that the person may become aware later that the bill he receives exceeds the schedule fee.

Let us consider this question of a fee ambush because that would be a problem. I have spoken to specialists in the Australian Capital Territory and some of them have told me that they as a matter of policy believe that fee ambush is wrong, that as a matter of practice they always discuss in advance what the fees will be and that they would see some move to prevent fee ambush as being appropriate and proper. Further, I am aware that in the Canadian province of Ontario regulatory action has been taken to prevent fee ambush. The rule in Ontario is very simple. Overbilling-that is, charging more than the schedule fee -is permissible but only if the patient is advised of that fact in advance. If patients are not so advised the rules in Ontario say that the fee must be limited to the schedule fee.

I have had discussions over the last day with representatives of the medical profession in the Australian Capital Territory who have told me that they consider that kind of provision to be a reasonable one and a far more reasonable attempt to resolve the problems which the Government may imagine it might be facing than to put down a blanket price control, as it is attempting to do. Doctors in the Australian Capital Territory, and indeed doctors across Australia , do not believe in ambushing the patient. They do not practise it. They believe in consumer sovereignty but they also believe in professional freedom and want to maintain it. If the Government came back to them and asked them whether they would look at the Ontario situation, which is as I have just described it a moment ago, I believe that the Government would receive from the medical profession a reasonable and positive response to that kind of proposal.

I take the opportunity of this debate to say that the Government has got itself into a bit of a bind in terms of its own drafting. The argument is complex but it is worth putting and I hope the Minister for Social Security, Senator Grimes, will follow it. I understand that section 17(1)(a) of the Health Insurance Act provides that no Medicare benefit is payable if a fee is payable to a public hospital. That has been a long-standing arrangement. However, I understand that in 1983 we added to the Act to provide that an approved agreement was needed between the doctor and the hospital before fees would be payable. Also I believe we declared that a Medicare benefit would be payable in a case where there was an approved agreement even if it would not otherwise be payable under section 17 (1)(a). That is the situation I think we got to under the legislation of last year: First, no fee is payable under section 17(1)(a) if it is payable to a public hospital; secondly, if there were an agreement in place the fee would be payable even if section 17(1)(a) stated it was not payable.

Let us consider the situation we have got to. Doctors across Australia have refused to sign agreements. There are no agreements between doctors and the hospitals for the hospitals to send out bills. I think it is quite possible that section 17(1)(a) applies. In fact, in the absence of those agreements, no Medicare benefits are payable in this situation. I mention that matter because it is probably worth making sure that it does not require further attention.

I come back to the motion before the Senate concerning the intrusion by the Government, by way of this ordinance and by way of these regulations which I believe are unnecessary, into private medical practice. It will threaten the quality of health care available in public hospitals. It will do this if it results in even one highly qualified pathologist or radiologist determining to leave the public hospitals-if he or she stops giving service in public hospitals and takes himself or herself off into private practice. If even one of these highly qualified people leaves to go into the private sector it will be the public hospital system that will be the loser and it will be the patients who are the losers. If the doctors I know left it would not be because their incomes would be reduced. I have already pointed this out. They are not charging above the schedule fee. They would leave because many of them are determined, as a matter of principle, to maintain themselves as independent operators and not to submit to price control. In fact, if there was price control in the hospital system and none outside it they would move as a matter of principle. I think the members of the public would be the losers.

It is also a matter of fact in Australia that there are not enough radiologists or trained pathologists available to replace the very many private practitioners who at present keep the system operating as well as it does. I think the exodus of doctors from hospital service to private practice will continue if the Government continues to interfere and to restrict the way in which doctors operate and their sense of professional freedom. It will continue if the Government proceeds to limit the relationship between the provider of services and the user of services. I think if that happens, far from ensuring a universal system of health care, Labor, by introducing ordinances and statutory rules of this kind is laying the foundation for a dual system of health care-it is not a universal system as the Government thinks. The Government is moving to make more likely a dual system under which those practitioners, even if they do not earn a penny more-the actual quantum of money is not at issue-will move in order to get the freedom which they believe is theirs and which they want to maintain. I do not believe that will be in the best interests of the consumers.

I think this approach is a recipe for mediocrity. It does not allow for distinction between practitioners in the market and, of course, the market place will soon determine the practitioners it values. If in fact the Government extends, by way of further statutory rules-the health insurance regulations-the services to which this price control will apply, and if it comes to include, for example, the busy surgeon, the market knows which surgeons it values and prefers and in the end, I regret to say, the market will seek to find ways to overcome this kind of price control. I think in the end the patients will be the losers. Doctors fear that governments having tied the fees to the schedule will then not play fair at the next step. They believe the Government will then freeze the schedule and will move to let inflation reduce the real value of the fees they charge. I see no reason for doctors not to believe that that is a well founded fear. It is a problem with any aggressive and unsympathetic government. The statements by many members of this Government give no confidence that the Government is not unsympathetic and not aggressive when it comes to the medical profession.

This fee control is the first attempt by this Government to control the fees of any of the great independent professions of Australia. It will not be the last. This is not an issue for doctors alone. It is an issue which should apply also to lawyers and to the legal profession, to the accountancy profession, to architects, and to many other professions. Who will be next as this Government attempts to control their charges and their fees?

Senator Bolkus found it desirable to intervene and interject a little while ago . I ask him and many of the other lawyers around: Will they accept the same limitation on fees for their profession? How far would they extend that? As it stands, fee control is to be applied only to the medical profession. It is a discriminatory measure and it represents the feeling of this Government towards a group which has always commanded the highest respect in the community. It is a move which is motivated, we think, by the deeply felt beliefs of the Labor Government, but it is not a proposal which is in the best interests of consumers or in the best interests of the community. I must say that the Australian Labor Party has made no secret of its contempt for the medical profession. The Hansard has been replete with terms such as 'elitist' and 'greedy' in the last few months.

The only other thing I wish to say is that the Australian Democrats will have to indicate where they stand on this non-issue. I remind the Democrats again that there is no example of specialists in the Australian Capital Territory exceeding the fees. They have, as a matter of honour, worked within the schedule . This is merely an attempt, in ideological terms, to impose price control. I ask the Democrats: What is the position of their Party on price control? If they wish to impose price control, the medical profession in this case is merely a model. It is merely the first profession on which the price control is to be imposed. The providers of services in many professions want to know what the Democrats' position is. As the Democrats vote on this matter, so the lawyers, the accountants, the architects, the surveyors, the dentists and the many other individual entrepreneurs, will read the vote in terms of their own future. The negatives in the ordinance and the regulations are considerable. Having moved the motion relating to the ordinance, I urge the Senate to reject the ordinance. When I move that the regulations be disallowed, I urge the Senate to give support to that motion too.