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Wednesday, 11 November 1959

Mr BIRD (Batman) .- One incontrovertible fact emerges from the discussion of the bill, and that is that Australia's socalled national health scheme is urgently in need of drastic amendment and widespread alteration. I join issue with those who claim that it is a national health scheme. It is nothing of the kind. A national health scheme, of course, embraces everybody in the nation, but, although many hundreds of thousands of people participate in this scheme - I am told by the honorable member for Barton (Mr. Reynolds) that the figure is 67 per cent. - one-third of the community is not yet in the scheme. That means that 33 per cent, of the population is precluded from receiving any government benefits, although these people as taxpayers contribute for them. That is essentially a basic fault in the scheme. This may be called a health scheme, but it is certainly not a national health scheme when only two-thirds of the people are able to enjoy benefits, not for which they pay completely but for part of which the taxpayers as a whole pay.

Anybody who has made the slightest examination of the scheme, free from party bias, must admit that it has many weaknesses. It had many weaknesses in 1953, and the subsequent trivial amendments have not in any way strengthened it. That being so, it is most unfortunate that on this occasion, when the Government has seen fit to make several fairly substantial alterations, it has not seized the opportunity to remedy the anomalies and the obvious faults. The alterations, which I shall discuss soon, are not far-reaching enough and, in some respects, the problems have only been trifled with. The Government has gone only a very short way towards developing the scope of benefits which, in the opinion of very many people, are totally inadequate. The health scheme as we know it - I refuse to call it a national scheme - depends for its success on public participation and is based on the principle of selfhelp. But it must be made sufficiently attractive to maintain public support, and we know that a section of the public has not seen fit to join the scheme. Unfortunately, the proportion of medical and hospital fees met by the scheme has been falling at a regular rate since 1953 because of the diminishing value of the £1. Instead of covering nearly 90 per cent, of the average medical fees, as was originally intended, it covers at best 60 per cent. The honorable member for Fawkner (Mr. Howson) last night said that the figure was 80 per cent. I corrected him by interjection and said that it was 90 per cent., but he replied that I was wrong. Later in the evening the honorable member for Werriwa (Mr. Whitlam) referred to a statement that had been made by the British Medical Association to the effect that in the early days the scheme covered 90 per cent, of the average medical fees. I thank the honorable member for Werriwa for proving that my interjection was correct.

This bill in some very small way seeks to stem the downward trend in the relative value of the health scheme benefits, but the suggested new rates by no means adequately make up all the leeway. In fact, the Government is only playing with the problem. There is a particular need for a review of payments in relation to surgical treatment. The bill makes a very feeble effort in that direction - those are the only words that I can use to describe it - because the present maximum payment for various kinds of surgery bears little relationship to the cost of an operation. By its very nature, illness requiring major surgery frequently involves prolonged heavy expenditure in addition to the cost of the operation. This casts a very heavy burden upon the average family. Recently I underwent a major operation. In my ward in the hospital were men receiving only very ordinary wages who were concerned as to how they were going to meet their obligations because they had to pay the total cost of their operations. The amount that they will receive from the hospital benefit societies under the present scheme will by no means recompense them, and the additional £30 for a major operation does not bring these payments within cooee of what an operation costs to-day. I have personal knowledge of that.

There is the greatest need for adequate insurance to meet the cost of major surgery, but the amounts that are payable under the present scheme, and the additional amounts that are contemplated under the proposal now before us, are both very low and rigidly limited. Many people have found to their dismay that the total cost of an operation is far in excess of what they will receive from the benefit societies. I hope that nobody in the community kids himself that the additional amount that he will receive when this bill becomes law will make it any easier for him to meet the cost of a major operation. I shall prove my statement in a moment.

I had brought to my notice recently the case of a man who earns £22 a week and who underwent an operation which cost him £221, which included hospital fees. Under the present scheme he receives £76 but. when this bill becomes law, he will receive only an additional £30, so that, in all, he will receive benefits amounting to £106 to meet an account for £221, There is a vast difference between the two amounts, and I should have thought that the Government, knowing the gross injustice that is being suffered by most people in the middle income group who are unfortunate enough to have to undergo a major operation, would have grasped the nettle and provided a worthwhile amount to assist a person to meet the cost of an operation. After all, £60 for a major surgical operation is mere chicken feed. A good number of major operations require the services of not one but two Collins-street surgeons, and £60 will hardly meet the cost of their spare time, let alone the cost of the operation itself. Of course, it is highly debatable whether, when the proposed £30 is added to the present benefit, the surgeons' fees will remain unchanged. As the honorable member for Eden-Monaro (Mr. Allan Fraser) said last night, it is extremely likely that the surgeons' fees will rise. But even if they remain unchanged, £60 is nowhere near enough when an operation costs in the vicinity of £140 or £150.

In 1953 we were told that the scheme would offset the crippling financial obligations that might be incurred by ill health. Even the new list of benefits does not go that far. I am very disappointed that the Minister did not do a first-class job and bring the benefits to somewhere within reasonable distance of the cost of major operations to-day, particularly those in which two Collins-street surgeons may be concerned.

The health scheme does not give a member of a benefit society any right of appeal against the amount that the society allows him. A man sends his claim to the society and the cheque that he receives may not measure up to the amount that he has worked out for himself according to the table that he received when he became a member of the society, but there is no authority to which he may appeal against what he considers to be the small payment that he has received. After all, a murderer has a right of appeal to a higher authority; a man who commits a grave assault upon another person has a right of appeal to a higher authority if he is convicted, but a participant in this scheme has to take what the hospital benefit society gives him without having the right of appeal to any higher authority. It is true that the Minister, in reply to a question that I directed to him some time ago, said that if he had the particulars of a case that he would look into it, but every person is not prepared to write to the Minister to have his case investigated. In the first place, with due deference to the Minister, a person may not know who the Minister is, and secondly, he may not go to the trouble of writing because he may feel that the Minister is so busy that he will not take any notice of his representations. This legislation should contain a clause which will give a person the right of appeal to some authority if he thinks that he has not been paid enough.

Another serious weakness in the scheme, of which hundreds of thousands of people have had experience, is the failure to recognize dental treatment as a medical service attracting the payment of benefits. After all, dental health is an important factor in the maintenance of general health, and for most people it is a costly item. For the life of me, I cannot understand why dental treatment is not included in the scheme. Why is not physiotherapy also included in the scheme? After all, physiotherapy frequently follows the direct instruction of a doctor when the doctor feels that he cannot do any more for the patient. I had that experience myself. I went to a doctor who treated me on two or three visits and then told me that in his opinion I would receive the best treatment from a physiotherapist. I went to a physiotherapist on about five occasions and I was cured completely. The treatment that I received from him was just as important - perhaps more important in this instance because it cured me - than the treatment I had received from the doctor. But I received no benefit to meet the cost of the physiotherapy treatment. If a person attends a doctor he receives 12s. towards meeting the doctor's fee of 17s. 6d. The scheme shows a remarkable omission in relation to physiotherapy treatment, and the position should be rectified as early as possible.

Why must subscribers to a society wait such a long period to receive their payment? After all, a patient has to pay the hospital before he leaves. In fact, progress accounts are usually submitted to the patients each Friday or Monday while they are in hospital. Doctors and surgeons expect payment as soon as their accounts are submitted, but when the account is sent to the benefit society - I have in mind particularly the Hospital Benefits Association of Victoria, of which I have some knowledge - weeks elapse before the inadequate amount to which a member is entitled is sent to him. The delay did not affect me to any great extent because I was able to finance the lag out of mv salary, but I can name to this House any number of people in my electorate who are in financial difficulties because of the delay in receiving their society benefits. The man to whom I have referred who had to meet a bill of £221, had to borrow £100 to pay the account, but he will have to wait six, eight or ten weeks before he receives his money from the hospital benefits association. The whole thing is wrong. The matter has been brought to the notice of the Minister on numerous occasions but nothing has been done because members still have to wait an interminable period before they receive the payment from the societies. Something must be done to speed up these payments, because often people are placed in embarrassing circumstances when they have to borrow money to pay their medical fees.

Another reason for our objection to the bill is the peculiar treatment that has been meted out to the chemists. I cannot understand why they have been treated in such a cavalier fashion in this legislation. " Cavalier " is the only word that I think describes the position. In the first place, chemists are placed at a serious disadvantage when the relevant standing committee considers features of the health scheme that affect the chemists and the Government. The standing committee at the moment consists of two members from the Department of Health, two from the Treasury and four representing chemists The chairman of the committee, I understand, is the Director of Pharmaceutical Services of the Commonwealth. A man does not have to be a mental genius to appreciate what happens when the four government nominees clash with the four chemists. A casting vote has to be given by the chairman, who is a government servant. It would be an extraordinary occasion when he differed from the other government nominees. I understand that that has never yet happened. Surely in the interests of fair play and justice the chairman of that committee should be a man drawn from outside, a man of independent thought and outlook not tied in with the chemists or with the Commonwealth health service. Why should an apparently highly paid Commonwealth public servant be the arbiter in any dispute between the four persons on one side and the four persons on the other side in that standing committee?

For the life of me I cannot understand why this position is perpetuated. At the earliest possible opportunity the Government should remove this grave injustice which is being handed out to the members of the Pharmaceutical Guild of Australia. When, from time to time, the guild has made applications for increases in dispensing fees it has always been told that the scheme is already too costly. For example, it has made many approaches to the Department of Health for improved rates of payment - I shall deal later in a brief fashion with how the rates are fixed - and has consistently had its applications rejected on the ground that chemists are making excessive profits. That is very problematical indeed, because figures supplied to me by reputable chemists in my electorate, by no means members of the political party to which I give allegiance, provide an absolute contradiction to that claim.

It is safe to say that the average chemist to-day is getting a reasonably comfortable living. Most chemists are, of course, cooperating in the health scheme, and most of them would make not more than £3,000 a year according to the actuarial figures supplied to me, which I accept unreservedly, because I respect the men who gave them to me. That being so, I think that the chemists should not be penalized just because the scheme is too costly. I know why the scheme is too costly. The honorable member for Eden-Monaro told us last night why it is costly.

I shall give one example of how the cost of the scheme is inflated. Recently, I went to see a constituent of mine, and arrived at his home while the doctor was there. The doctor told him that he would have to write a prescription for some tablets for him. As the man's wife was out, I offered to take the prescription to the chemist, pick up the tablets and pay for them. When I asked the chemist how much the tablets were to cost, he said to me, "You are lucky you do not have to pay for them. They cost £4 10s., but they come under the free medicine scheme."

The doctor had prescribed 100 tablets for the patient. I took that bottle of tablets back to my constituent, and a few days later I called and asked him how he was getting on with the medicine. He told me that he had had to discontinue taking the tablets after he had taken only three, because they produced an allergy. So 97 of these tablets prescribed by the doctor at a cost of £4 10s. to the taxpayer were completely wasted. The doctor could easily have prescribed ten or twenty tablets at the start until he saw the patient's reaction to them. In this way the taxpayer would be saved a considerable amount of money in cases where a particular type of medicine did not agree with the patient. Since then I have discovered that this is not an isolated case, and that doctors prescribe 50 or 100 tablets for patients, which are free under the scheme, without their having any cer tainty that the patient is able to take without any deleterious effect the tablets prescribed.

The honorable member for Eden-Monaro was correct in the explanation he gave last night of why the scheme is too costly. But the costliness of the scheme is no reason for expecting chemists to do dispensing on the cheap because somebody else is falling down on the job. A chemist normally charges 6s. for an ordinary prescription, but under the Commonwealth scheme he can charge only 3s. for dispensing a prescription for a pensioner.

Mr MALCOLM FRASER (WANNON, VICTORIA) - That is for a compound prescription.

Mr BIRD - That is correct. I should like to know whether this 3s. less received by the chemist goes to help this enlarged scheme proposed by the Government. If so, why are the chemists not given an opportunity to have more representation on this at present lop-sided standing committee? They did not have a chance to put a reasonable case for themselves in regard to this payment for dispensing prescriptions under the pensioner medical scheme. They just have to accept the 3s., and there it is! On the other hand, the British Medical Association gets preferential treatment, and the Minister should explain at the earliest opportunity the mystery of why such unfair treament is meted out to the chemists.

Chemists do a lot of work other than dispensing prescriptions. Although they do this work under the national health scheme they get no recompense for doing it. Reputable chemists in my electorate, whose statements I accept unreservedly, have told me that the paper work that a chemist has to do under the scheme amounts to about five hours a month. It is quite probable that the further obligations which this bill will impose on chemists will increase the time that they will have to spend on paper work to six or seven hours a month, but they will still get no recompense from the Government for doing it. Not a brass farthing! It is hard to understand why the Government is treating the chemists in such a beggarly fashion.

In addition, the chemists have not received fair treatment in relation to other fees. For example, since 1947, there has been a ls. 6d. dispensing fee for tablets dispensed under the Government's scheme, and despite substantial cost of living increases received by just about everybody else who provides services to the community, no increase in this fee has been given to the chemists. They get the same old rate although other costs, such as rail fares, tram fares, wages and the cost of materials and many other things have increased substantially.

I appeal to the Government to cease treating the chemists as outcasts and pariahs in regard to this scheme. The chemists play an integral and very important role in the scheme, but all the Government has done is antagonize them unnecessarily. The chemists claim that they were never properly consulted about the Government's proposal to impose a prescription charge of 5s. They were not asked for their views. The Minister said in answer to a question that they were asked, but they claim they were not. I do not know who is right, but apparently the chemists did not receive the consideration to which they are justly entitled. This is a fact which ought to be greatly deplored.

There is another aspect of the difficulties of the work of chemists that I wish to mention. Patients often bring to the chemist, for filling, prescriptions which have been wrongly written in that they are not in accordance with the regulations governing the scheme. The wrong prescription must be rectified; but the chemist cannot keep a pensioner waiting while he has the prescription adjusted, so he fills the prescription and then sets about having it corrected. He has to do this because he cannot claim under the scheme until the correction has been made. So the chemist is up for the cost of telephone calls to the doctor and letters to the department, and for delay and everything else. Having the prescription corrected will cost him lOd. in postage alone. Why should the chemist have to meet these expenses because of a doctor's error? Why should this also be heaped onto the back of the chemist? What have chemists done to incur all this injustice?

I think that at the earliest possible opportunity the Government should give an explanation of this peculiar treatment of chemists. In addition it should make out, if it can, a case explaining why chemists should be called upon to act as unpaid tax collectors for the Government in relation" to the proposed 5s. charge for prescriptions. Why should the chemists be singled out to collect this charge? After all, they are not to receive any commission on the amounts collected by them. In those circumstances, it is definitely unfair that they should be expected to do these things in an unpaid capacity. The Government has plenty of money, so why should it expect a body of men who have given very patriotic services to the community for many years, for a very nominal return, to work free for it. After all, the average income of £3,000 a year received by chemists is not high in view of the fact that these men have to go through a long course of study to enable them to earn that income. They are specialists, and it is not fair to ask them to work for the Government in an unpaid capacity.

I should like now to have something to say about the proposed charge of 5s. per prescription. This is distinctly a retrograde step. When the community is awaiting a positive step forward on the part of the Government in meeting its responsibility for the health of the individual, this shackle of 5s. per prescription is imposed on it.

In the past, the greatest contribution to the community's health has been made by government at all levels by means of what are known as environmental health services. Pure water supplies, sanitation, drainage, supervised food production, street cleaning and a protected standard of living have played the major part in defeating the plagues and pestilence of the past. Care of the individual in Australia has been left largely outside the sphere of government concern. Collective responsibilities like the provision of pure water supplies and of the other services that I have mentioned have been, very rightly, the concern of governments, and these responsibilities have been very successfully discharged. But governments have not been so consistent when it comes to the care of the health of the individual in the community. This matter is left to the individual himself, except for this totally inadequate and misnamed health scheme.

The provision of free life-saving drugs was a step in the right direction, and we acclaimed the Government for it. This

Government now proposes to take a step backwards by introducing this scheme under which a 5s. charge for the dispensing of each prescription will be imposed. I want to deal at length with the Government's relations with the chemists in respect of this proposal, because I think those relations show that this Government has played a very paradoxical role in its treatment of the chemists and of doctors. Section 99 of the National Health Act provides -

The Minister may, after consultation with the Federated Pharmaceutical Service Guild of Australia, determine the rates at which, and the conditions subject to which, payments shall be made in respect of the supply of pharmaceutical benefits.

In other words, the Minister has the right to determine the rates. He fixes them. The pharmaceutical guild has the right to make submissions, but the rates are fixed, ultimately, at the whim or caprice of the Minister.

When we look at the position of the British Medical Association in Australia, we see that it receives much more preferential treatment Section 32 of the act states -

The Minister may, on behalf of the Commonwealth, enter into an agreement with the Federal Council of the British Medical Association in Australia for and in respect of the provision by medical practitioners of medical services for pensioners and their dependants.

The doctors have the right to enter into an agreement. Naturally, any such agreement would be approved by both parties. But the Federated Pharmaceutical Service Guild is denied a similar right.

Originally, there was a document setting out the terms of agreement accepted by both the chemists and the Government. This included clauses which automatically varied, in accordance with changes in wages, rents and so on, the dispensing fee paid. After this agreement had been in operation for some time, the Department of Health refused to apply increases in these cost-of-living factors to the chemists' charges, and, in September, 1953, a new agreement was made. Victorian private dispensing fees less 10 per cent, discount were adopted. This scale of charges remained unchanged until the guild sought increases in the compounding fees some time in 1957. However, the parties failed to reach agreement and the Minister, in

April, 1958, determined a flat rate of 3s., which came into operation on 1st July, 1958.

This places the chemists in an impossible position. Terms applicable to them can be determined without their agreement, whereas terms applicable to doctors are determined by agreement with the British Medical Association. When that body reaches amicable agreement with the Government, the terms of the agreement are drawn up and duly certified in the proper way. The chemists are denied a similar right. I understand that the Minister has been treating with the chemists for months in this matter, and I suggest that, at the earliest possible opportunity, he should reach friendly agreement with them in order that they shall no longer be an aggrieved section of the community. And aggrieved they certainly are to-day!

I do not often agree with the honorable member for Maribyrnong (Mr Stokes), but I agree with him now. He took umbrage, and I certainly take umbrage, at clause 21 of this bill, which provides for the insertion in the principal act of proposed section 104a. The proposed section provides that the Director-General of Health may require a chemist to take stock of his drugs and medicinal preparations within a time specified by the Director-General. This provision is too wide. A chemist could be requested very frequently to make lengthy and costly stock returns. As I have already pointed out, chemists are at present expected to spend five hours of their valuable time every month preparing and despatching returns to the Government, and proposed section 104a will increase the burden on them. After all, this provision is a blank cheque, as it were. It could make chemists liable to submit returns weekly, monthly, six-monthly or yearly. This is a matter on which the Minister should reach agreement with the Federated Pharmaceutical Service Guild. There should be an agreement specifying the intervals at which stock shall be taken. In the proposed section, no period is specified, and this will operate entirely against the interests of the chemists.

The Minister for Health said in his second-reading speech that the guild had some apprehensions about the bill - that it was concerned about unfair competition by the friendly society dispensaries and about the fee to be paid by the Government for the dispensing of prescriptions under the pharmaceutical benefits scheme. The Minister said that he had been engaged in discussions with representatives of both parties.

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