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Tuesday, 16 October 1984
Page: 1791


Senator PETER BAUME(9.34) —The Senate is discussing in cognate debate two Bills. Senator Giles confined herself, as I will, to the Health Legislation Amendment Bill 1984 which deals, amongst other things, with the problems which are raised by the 35-day rule and to which previous speakers have directed some of their remarks. This 35-day rule applies to the rights of people who go to hospital with acute illnesses to continue to receive free hospital care. People who may have been Medicare levy payers and who think that entitles them to a free hospital bed should understand-and this Bill makes it clear-that there is no such entitlement and that what they are entitled to, if they are acutely ill, is a bed for 35 days only. That is what Medicare has offered. After that time the pensioners or the aged persons may well be faced with the withdrawal of a large part of their incomes or pensions because of the rules which have been introduced as part of the Medicare package and the way in which it is being administered. Senator Giles speech a moment ago was punitive, uncaring and displayed neither compassion nor understanding of the problems facing the aged, especially the people in hospitals. I indicate that the Opposition is dissatisfied with the approach the Government has taken in relation to this problem raised by the 35-day rule. Accordingly I move:

At end of motion, add ', but, in relation to the Health Legislation Amendment Bill 1984, the Senate-

(a) is of the opinion that the Bill does not deal adequately with the serious problems faced by the long term sick and elderly caused by the Medicare 35 day rule; and

(b) calls on the Government to withdraw the 35 day rule until proper arrangements have been made to care for patients affected by the rule'.

It is quite irrelevant for Senator Giles to regale the Senate with stories of people she has heard of who are wealthy and who walk out of nursing homes to take trips. We are talking about people who are admitted to hospital ill and who , at the end of 35 days, after an acute illness, suddenly find that they are faced with one of the gifts of the Australian Labor Party, that is, administrative procedures which may remove at a stroke their right to continue to receive the free hospitalisation which was promised to them as part of the Medicare package. They cannot continue to receive it.

That raises several problems. The first is that not enough nursing home beds are available when they are needed for people who might be classified as nursing home patients. That is a fact around Australia. Senator Giles and the Labor Party may not think more beds are needed. In fact, the Labor Party has oversighted the imposition of a virtual freeze on the establishment of more nursing home beds over the last 18 months, but aged Australians and their families know better. They know, and I know when I have gone to try to help them , that it is very difficult to find a nursing home bed. It may be fine in theory to say that at some stage after 35 days a bureaucrat may decide that someone is no longer sick enough for hospital and now requires a nursing home bed, but to put that scheme into effect is possible only if the nursing home beds are there for the patient.


Senator Crowley —Don't keep shouting. We know the truth.


Senator PETER BAUME —Senator Crowley knows as well as anyone that the fallacy of the scheme is that the nursing home beds are not available. Aged Australians are caught in a squeeze by bureaucratic procedures which say that no longer can they enjoy the benefits of an acute hospital and that, by the way, there is nowhere else for them to go and that is just bad luck. Senator Giles at least had the grace to admit that there are problems in some of the States with shortages of nursing home places. We are talking about people who have been acutely ill. We are talking about a situation where a person comes in having had a stroke or a cerebro-vascular accident for some reason and at the end of 35 days may have recovered partially but is not yet completely well and needs continuing rehabilitation and care in some unit. The patient may find that the doctor, because the guidelines are not well enough defined, may not know whether or not that certificate can be signed. So the first problem is that not enough nursing home beds are available to make this scheme operate properly. The Australian Labor Party has not made it easy for new nursing home beds to be established. Until they are, it is simply not right to move down this track of the 35-day rule with the hardship which it causes.

The second problem which goes with the 35-day rule is that of the certificates which must be signed by the doctors, which are known as section 3B certificates. Section 3B is a section of the Health Insurance Act 1973 which provides that a certificate shall be signed by a doctor if a patient is to continue receiving full acute care benefits in a private or a public hospital. If a person has been in an acute care bed in a hospital for 35 days, the doctor must sign a certificate under that section to certify that the patient should continue to require acute care. But under the arrangements that were in place before Medicare came into operation on 1 February there were more generous and more practical arrangements. The arrangements under the previous Government were different. A section 3B certificate-the one we have been talking about-could be issued under four circumstances, not one. The first circumstance was that the patient was in need of acute care. The second was that the patient may be in need of professional attention for an acute phase of his or her condition. The third was that there may be a need for active rehabilitation. The fourth was that there may be a need for continued management for medical reasons as an in- patient. Four reasons were provided under which patients could continue to qualify for benefits, but the Australian Labor Party has now restricted this to one reason-a continuing need for acute care. The Government has made it more difficult for certificates to be obtained as well as shortening the period before which a certificate is needed from the 60 days which operated when we were in government to 35 days. One hardship after another is being piled upon aged Australians and we are receiving case history after case history of patients, many of whom have had strokes, some of whom have died within a couple of weeks of being refused certificates--


Senator Chaney —What happens to these people?


Senator PETER BAUME —These people go into some sort of limbo. They are not able to continue to receive the benefits of being in an acute care bed in a public hospital and sometimes they cannot find a nursing home bed. That is what we are objecting to. The doctor used to have four circumstances under which he could sign a section 3B certificate. Of course he did not have to sign the certificate until the sixtieth day of hospitalisation and, as honourable senators will realise, not a lot of patients needed 60 days in hospital. However, the only ground on which a 3B certificate can now be signed, under Labor, is when the doctor is willing to certify that the patient is in need of acute care. The other conditions which were previously available have been removed, to the detriment of aged Australians and to the detriment of their right to care. This puts pressure on patients and their families and on the already inadequate system of nursing home provision. There is real hardship there and it is quite clear now that Medicare does not provide what the people were led to expect that it would provide. It does not provide a right to a free bed in a public hospital as that right has now been limited to 35 days of care-a right to 35 days only. If Senator Giles wants to say that in her view the welfare of the patient is paramount, she and the Australian Labor Party are choosing strange ways to show that concern or that care.

There is great pressure on doctors now because since Medicare came in one of the things which Labor has done is to make a doctor who might be judged as making a false statement in relation to these certificates liable to a fine of $ 10,000 or five years in gaol. I do not for one moment countenance any false certification. If any of the stories which Senator Giles told were correct and if there were cases of false certification I would want those people punished appropriately because certificates have to be able to stand. But the severe penalties which have been imposed and the limitation of the conditions under which doctors can sign have now made many doctors uncertain about what they should do about those patients who come into the grey areas in relation to this question of continuing need for acute care.

There are two other problems with the way section 3B certificates operate currently. Firstly, they can be revoked retrospectively. This is an interesting contrast to the fact that they cannot be given retrospectively. They must be postdated from between nought and seven days and, if this legislation is passed, between nought and 14 days before they come into effect. Secondly, problems do arise where a doctor or a hospital is unsure whether a patient genuinely needs a section 3B certificate or continued hospital treatment. As I have said, with the more restrictive conditions this uncertainty is greater than it used to be. If the doctor is faced with that situation either the patient may be deprived of the care to which he should be entitled or the doctor may be submitting herself or himself to the risks of very great penalty.

We find that a patient has the right to only 35 days of hospital benefits whether he is a Medicare levy payer or whether he carries private health insurance. That is a lesser right than that which existed under the Fraser Government when a full 60 days of hospital benefits were available. The 35-day limit applies unless the 3B certificate is issued and that, as I have said, can be done-if this legislation takes effect-14 days in advance.

We have had several changes to this provision. We have had the change from 60 to 35 days of hospital benefits and we now have fewer reasons for a doctor to sign a 3B certificate. I ask the Senate: What happens on the thirty-sixth day? What happens to the patient who has had a stroke, who is not well, who cannot go home and look after himself, who cannot find a nursing home bed, for whom the doctor cannot certify he needs continuing acute care but for whom he would have been able to certify this had he been in one of the other circumstances for which the Fraser Government provided? What happens on the thirty-sixth day in hospital? A pensioner may find that he is being charged $12.40 each day that he remains in a public hospital. He may find, having thought he was covered under Medicare, that at the end of 35 days, on the thirty-sixth day, 87 1/2 per cent of his pension is withdrawn. Alternatively, if the patient is in a private hospital on the thirty-sixth day there may be charges of anything up to $50 a day or whatever it might cost. I think Senator Giles gave us some figures which indicated the variation from State to State. The patient will have to find very large amounts of money from his own pocket.

In this legislation and in the changes which the Labor party has brought in we have seen a diminution of the rights which aged Australians have enjoyed. We have seen a diminution in their rights to hospital care when they become ill. We have seen diminution in their right to continuing hospital care until they are well and all of this is taking place at a time when the Labor Government has made it more difficult for alternative accommodation for nursing homes to be established. Many aged Australians understand what has happened. They are very angry. They are aware of what has been going on. We urge the Government, in the interests of humanity, to make sure that enough nursing home beds are available. Until they are available we urge the Government, in the terms of our amendment, to restore some humanity to government and to get rid of the 35-day rule until it can be administered without hardship or harm to the very people who are most vulnerable and most in need of help.