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Wednesday, 31 August 1994
Page: 698

Senator LEES (Deputy Leader of the Australian Democrats) (3.56 p.m.) —Senator Woods made a comment about looking at quality rather than just talking about economics. I believe that Australia has one of the most accessible and equitable health services in the world. I think if we, unfortunately, take out of that the health statistics of our Aboriginal community and just look at the life expectancy of the rest of Australians, infant mortality rates et cetera, we will see that we certainly have a health system that gives us one of the highest levels of care anywhere in the world. If we look then at the economic side of it, we spend some 8.6 per cent of our gross domestic product. While that is slightly above the OECD average, it is nowhere near the high expenditure rates in some other Western countries.

  Looking at the specific question that we have before us today on whether or not we have a crisis in health funding in Australia, I would like to take it one part at a time. Firstly, I will answer some of Senator Wood's comments as to the crisis in private health insurance and to answer those, what I believe to be spurious remarks, I think we just need to look at the statistics.

  There is no crisis in private health insurance. When we take the period between 1984-85 and 1992-93 and actually look at the contributions that have gone into the coffers, we see that there has been a 171 per cent increase in the actual income that the funds have received. If we look over that period at the increased amount of money they have spent on management, we see that it has gone up 126 per cent. If we take one final figure, and that is the total reserves, we see that they have increased over that period by 132 per cent. They have gone from total reserves of $520 million in 1984-85 up to $1.205 billion in reserves for the private health insurance industry as a whole. So I would argue that, far from being in crisis, they are doing very nicely thank you. The only problem they have is that many Australians are voting with their feet. They are actually looking at what they get for their dollar and they are deciding that it really is not worth it.

  If we try to find another crisis, the next place we can look is in the private hospital system. Again, we have a great deal of trouble finding any sign of a crisis because they are, in fact, increasing the number of beds that they are providing. Surely no-one is going to go into business providing hospital beds if they think that they are going to make a loss. If we actually look at the number of people that are choosing to use private hospital beds, we see that there has been an increase. It has gone up to about 29 per cent of the total patient admissions, compared with before Medicare when only about 23 per cent of total admissions were into the private hospital system. So there is no sign of a crisis there.

  However, we then move on to the public hospital system. I will argue here that, while we do not have a crisis, we certainly have some problems. If we want to look at Medicare as a whole, we see that a big crack is appearing in the public hospital system and we have to stand back and look at why.

  Certainly one of the problems revolves around the fact that we have the highest hospitalisation rate in the western world, give or take Iceland. It depends how one counts where we are, but we are certainly way up there with the top few countries. We have to ask why.

  As I move around and visit hospitals, particularly in my home state of South Australia, I come back again to the lack of other services: the lack of mental health services; the lack of aged care services; and the lack of drug and alcohol counselling. There is a lack of allied services such as appropriate accommodation for people awaiting admission to nursing homes. There is lack of services for people suffering from a drug-related illness—people who, simply because there is nowhere else to go, are sent to a hospital, often by a kind policeman who decides not to lock them up in police cells. Unfortunately, after being detoxed or treated for the night they often go back onto the streets, only to find themselves back in hospital again in a few days time, using up one of the most expensive services in this country.

  The Democrats suggest that if we put more money into the next level of services, into community services, we would in fact save money. To save money in this country we will initially have to spend some money to provide that level of services, the cheaper option services. The money will not just go into what we might call the traditional health areas; it will also be spread across into housing. We need to have other facilities for people rather than the very expensive option of a public hospital bed.

  In the time available to me, I would like to look at a few of the other problems in the public hospital system. We see the cost shifting that is going on, thanks to the state governments. Victoria has taken out some $370 million at the same time as the federal government has tried to pump in some $270 million. I have to agree here with the minister that several state governments are now cost shifting at such a rate that they are undermining the very system they are supposedly supporting and preserving for their constituents.

  My home state of South Australia will also be using casemix funding, not as an approved system of administration but simply as a means of freeing up money to be used for purposes other than those within the health system. We note the high administrative costs of having various levels of state and federal administration. We also note the duplication and overlapping of services, and the very poor coordination and integration of services.

  We ask the federal government to consider whether it wants to just sit back and look at the public hospital systems in many states being run down to the point where they will be closed or privatised, as is happening in many rural areas, particularly in Victoria. Does it want public hospital services shifted to aged care areas with the communities losing a range of other services, particularly some of their crisis care services?

  I am not sure that we can call the situation regarding waiting lists in our public hospitals a crisis. Certainly there is a problem in some parts of Australia. The base problem is that we do not have any sort of state-wide computerised system of adequate lists to tell us where the wait is or what it is for. If we could get those systems in place we could surely start to look at the availability of specialists rather than shift patients from the north of Sydney to the south, or from the east of Adelaide to the west or whatever. Until we have those waiting lists, which will have to be compiled by state governments, we cannot continue to claim that we have a problem of huge waiting lists. A lot of this is anecdotal, and in my home state a lot of the problems could be solved by suggesting that people talk to their doctors and look again at perhaps moving to other hospitals.

  Casemix funding, which I have touched on very briefly, will give us the opportunity actually to spend some of the dollars in a range of other community services. Instead of that, at least three state governments are using this simply as a cost saving measure. Instead of taking that money out of health, if we could spend it in areas such as rehabilitation, adequate discharge planning and community nursing and, as I said before, for specific programs such as aged people with dementia and for those with alcohol related illnesses, we would see fewer people actually needing our public hospital system.

  We cannot get away from the issue of the inequitable distribution of services. This is the only area in respect of which I will agree with Senator Bob Woods that we have a crisis. In particular, I wish to highlight the crisis in funding for Aboriginal health. This is an area in which the government's words do not meet its actions. In this year's budget we were told that there was to be an additional $500 million for Aboriginal health. But when one looks at the papers, at the figures and at the sums, one sees that the vast bulk of that money was in fact ongoing funding to maintain the 90-odd community health services at the existing inadequate levels. There is only just over $5 million per year of extra money to be spread around those 90-odd Aboriginal community health services. Bearing in mind that there is already a crisis in that last year many of these health services were not able to get through to even the end of the year before running out of money, one wonders how that very small amount of money spread across so many services will go anywhere near solving those problems.

  Another poor area is the area of mental health. Again we see several crises there due to a lack of adequate funding, particularly in rural areas. The government has done very little about the general area of preventive medicine. We can see huge potential problems in this area unless we again tackle the whole question of primary health care services and prevention.

  Some of the potential problems that I do not have time to cover in this speech include the increasing range of litigation and the cost of litigation. We have to look at the cost of new drugs and new procedures. We need to look at the way in which we will have to come to terms with some form of rationing of services and some way of distributing services equitably as we move towards the year 2000.