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Thursday, 28 March 1985
Page: 973

Senator LEWIS(3.13) —Today in the lunchtime debate on matters of public interest I referred to the salaried medical practitioners in the Australian Capital Territory employed in health care centres. I have previously referred to this matter in connection with the Capital Territory Health Commission report. I think I have clearly demonstrated that a number of salaried medical practitioners in the Australian Capital Territory are, in plain language, ripping the hell out of the system. On the other hand, I have to acknowledge that there are some paid medical practitioners in health care centres who are endeavouring to provide a good and proper service. I am not trying to attack all of them. Clearly they vary. However one of the great problems is that there is very little incentive for those who are giving proper attention to their duty to continue to do so when they look at the work patterns of their colleagues.

The real reason for using salaried doctors in the Australian Capital Territory has very little to do with patient care, although that is the rhetoric. An explanation of the real reason is set out in a document forwarded by the Chairman of the now defunct Capital Territory Health Commission, Dr Doust, to Senator Crowley and Mrs Joan Child, MP, in March 1984. This document acknowledges that the real philosophy in respect of the health care medical service in the Australian Capital Territory is 'the introduction of Medicare and the Labor Government's policies on community health, the pressure to control medical fraud and overservicing and the current oversupply of doctors' with an objective 'to provide a measure of competition sufficient to exert a controlling effect on the otherwise unregulated private sector'. I seek leave to table the document, Mr Deputy President.

Leave granted.

Senator LEWIS —This document is typical of the woolly thinking about medical care. One thing these doctors cannot be accused of is overservicing. A doctor who manages to cope with one patient per day is certainly not overservicing the community. Obviously if the government brings in more and more doctors-the document indicates that that is the intention-what will happen in the Australian Capital Territory is that some of the good doctors will leave. Their salaries will be affected so gravely that they will get out and some others in the private sector will overservice the private sector to make sure that they do get a reasonable salary. It is typical of the woolly thinking that goes on in this area. That is taking the situation from the medicos point of view.

If one looks at the situation from the patient's point of view one sees that some patients will shop around to see whether they can get totally free service under the Australian Capital Territory health service, which they can. They will look at Doctor A's service. If they do not like him they will try Doctor B and Doctor C because it will not cost them anything to do so. In effect people will shop around until they find a doctor who can provide them with the sort of service they want. That is not the concept of primary health care which this system was supposed to introduce. What do patients want? Do they want cheap medical service or do they want competent medical service? In the Australian Capital Territory this system has failed. The Government would do far better if it were to adopt on a larger scale the principle which it adopts with some health centres-that of having non-salaried private practitioners providing the service in a health care centre. Those doctors should be required to pay for the services that are provided to them. They should be required to pay a fair rent for the rooms they use and to pay for the nurse, the typist and the receptionist. Some of that money could be used to meet some of Canberra's needs.

There is a desperate need in Canberra for nursing homes for the aged. There have been no admissions to nursing homes in the Australian Capital Territory since last July and that is because there is not room for them. There is a need for a service for the intellectually handicapped and the chronically ill; there is a need for drug rehabilitation services; there is a desperate need for more nurses and more beds; and there is a need for a children's ward at the Woden Valley Hospital. The Government would do far better if it turned its attention to those areas of health care need in the Australian Capital Territory instead of carrying these doctors on the Government's back.