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Wednesday, 11 November 1959

Mr TURNBULL (Mallee) .- As is usual when I rise to participate in a debate, I wish to make some references at the outset to statements that have been made by certain honorable members. The honorable member for Eden-Monaro (Mr. Allan Fraser) has said that all hospital patients will have to pay 5s. for each prescription that is written for them. Of course, it would appear that " all " means " every one ". But in the hospitals there are many pensioners. If the honorable gentleman had said that all hospital patients with the exception of pensioners would pay the 5s., he might have been right, but I do not think hospital patients will have to pay. Anyway, he was in a way veiling the real issue and not letting people know exactly what was happening.

I do not want to go over all the points in the scheme that have been mentioned. I want to deal with the scheme as it affects four different sections - the Government, the public, the doctors and the chemists. First, let me deal with the public. The pensioners will not be affected by this legislation.

Mr Thompson - Those who have medical cards.

Mr TURNBULL - The honorable member for Port Adelaide has interjected that only the pensioners with medical cards will not be affected. That is quite correct. But if a pensioner has not a medical card, that means that he is receiving only a part pension, because he has some other means. The general public, apart from pensioners, therefore, will now become entitled to a much wider range of drugs at a cost of 5s. per prescription. It appears to me that that will greatly assist in keeping up the high standard of health of this nation, because for a long time doctors have been restricted as to the drugs they may prescribe under the scheme.

Some honorable members claim that doctors have been prescribing too liberally. The honorable member for Eden-Monaro said -

Nowhere in the bill is a curb placed on the medical profession.

The honorable member for St. George (Mr. Clay) advocated some curb on doctors in this respect. In his second-reading speech the Minister said that the Government could see that there would be a greater charge on it when the scheme came into operation, and that the Government was not at all anxious to have, nor did it think it could have, such a scheme on the cheap. In fact, the Minister said -

It is from this very wide range of drugs and medicines to which I have referred that doctors will have a choice of what to prescribe for their patients, and within it a doctor will not be hampered in his medical discretion by any consideration of the cost of the prescription to the patient.

That is practically the opposite of what the Opposition is saying. The Opposition contends that there must be some restriction on doctors' prescriptions; the Minister has said that the range should be as wide as possible so that the doctor can prescribe the appropriate drug for the ailment from which the patient is suffering. Of course, the Government could not possibly hope that with the wider range of drugs to be provided the scheme would cost less. The Government realizes that it will cost more; but the charge of 5s. is to be imposed so that the public might have a realization that they are getting something valuable. When you get something for nothing, after a while you take it as a matter of course and do not appreciate it. By paying even 5s. the public will realize that it is getting something that is valuable, although people will be paying only a small percentage of its real worth. That is really why the Government decided to impose this charge of 5s. per prescription. Of course, the charge will cut the cost to the Government to some extent, but this saving will be offset by the increased cost arising from the extension of the range of drugs. Honorable members on both sides of the House have pointed this out, so it appears that every one realizes that that will be the case.

It is my considered opinion that only a few doctors are prescribing drugs more or less lavishly. I believe that when a doctor examines a patient he generally endeavours to prescribe the best possible medicine or drug for the ailment. This bill merely widens the prescribing range, and therefore helps the doctor to bring back health to his patients. If we were to restrict the doctor in writing prescriptions, that restriction might occur in a case like that mentioned by the honorable member for St. George, where the necessary treatment or drug could not be given because the drug was not available on the pharmaceutical benefits list. The results that he talked about could follow, in many cases, in such circumstances.

The next, and the most important thing as far as I am concerned, is the position of the chemists. I believe that chemists are getting perhaps the rawest deal. The charge of 5s. has to be collected by the chemists. I have met a number of chemists in my electorate. I am pleased to hear honorable members on both sides refer to the high standard of the chemists in business and in their profession. Every chemist I know or have known is or has been a man of very high standing.

A certain proportion of a chemist's business is concerned with free medicine for pensioners, a certain proportion is concerned with free medicine for the general public, and then there is the normal business of the chemist. With the extension of free medicine benefits, as they apply to the general public, to cover the range available to pensioners at present, the normal business of the chemist will be restricted tremendously. The chemist will have to collect the 5s. prescription fee. He will not be collecting it for the Government, as has been said by some honorable members, but will be collecting it for himself, because for every prescription the Government will pay 5s. less than heretofore.

It has been said to me that perhaps a small boy will come along with a prescription for his mother, who is very ill, but without having with him the money to pay for it Is the chemist to tell the boy to go back home and get the 5s. before he will give him the prescription? No! His professional ethics would not allow him to do that, because it is a matter of urgency that the prescription be filled. So he gives the lad the prescription, and still has to collect the 5s. In the town where I live, a prescription may be ordered by telephone and the chemist asked to send it three or four stations along the line. He may not see the patient for whom the prescription has been written for quite a long time, and he still has to collect the 5s. Some one has said to me that if there were no free medicine scheme, the chemist would still have to collect all the money for the prescription in such a case. That sounds all right at first, but the real point is that if there were no free medicine scheme the chemist would be carrying on his normal business, charging a higher rate for prescriptions than the Government is paying, and, like any other businessman, would be making some sort of provision for bad debts. But when the Government is paying what is considered generally by the pharmacy profession to be a low rate at present, and with the range of drugs under the scheme being extended - which will result in a restriction of the normal business of the chemist - there is no chance of the chemist making provision for bad debts. So, from the very start of the negotiations with the Minister, and at the meetings that we have had in party rooms, I have advocated that the basis of this is the pricing, the cost, and what the Government is prepared to pay to the chemists.

On two occasions, I have asked the Minister whether he considered that these negotiations could be brought to a successful conclusion in order that the chemists might be satisfied with the amount they receive for making up these medicines under the scheme. On each occasion, the Minister has replied, " Yes, I am perfectly satisfied that we can make satisfactory arrangements". The present negotiations have been going on for some time. I would have been much more pleased if they had been finished before this bill went through the Parliament. We should then have known just where we stood, whether the negotiations bad been successful and whether the chemists throughout Australia were satisfied with the deal that the Government was prepared to give them. However, the negotiations are still going on, and I have complete faith in the Minister. I think that, when the Federated Pharmaceutical Service Guild has set out what the chemists desire - and perhaps after further negotiations - the Minister will come to an agreement pleasing to both the Government and the chemists. That is the main basis of the scheme, and I strongly urge the Minister to reach agreement with the guild.

I recently visited a chemist's shop and went to the room where medicines were dispensed, in order to see what was happening. I learned that there is considerable wastage of drugs. The chemist pointed out to me rather a large jar, and indicated that its contents had cost twelve guineas. He said that the doctors had been prescribing the drug in tablet form, but had ceased to write prescriptions for it. As a result, he was left with what remained on his hands. He pointed out other drug containers the contents of which he still held. He said, " There is a great deal of waste. Unless the doctors in our town start writing prescriptions for these drugs, I shall be left with them. That will cause me a big loss. " All these things must be taken into consideration. Also, a chemist whose business is too big to be run by himself, and who has to employ staff, finds that his expenses are as high as, or even higher than, those of any profession or business on a similar scale anywhere in Australia. Every one knows that you have to pay big money in order to get a man with the necessary qualifications. In view of these circumstances, I am particularly anxious that the Government look to the pricing and the allowances made to chemists for the making up of these prescriptions. The payment to the chemists should be adequate and satisfactory, because chemists play such an important part in maintaining the health of the people of Australia.

My attention has been directed to several other matters. The honorable member for Port Adelaide (Mr. Thompson) objected to a patient having to go to an ordinary general practitioner to be referred to a specialist. I think that is quite proper.

If every one went straight to a specialist without being referred by a general practitioner, people would probably be going to doctors who were not specialists in the ailment involved. Secondly, these people would be cluttering up the consulting rooms of specialists and preventing them from treating other people suffering from the diseases in which they specialize. If, on the other hand, a patient goes first to a general practitioner, the general practitioner finds out what is wrong with him and sends him to the appropriate specialist. Time, money and trouble are saved. The skill of the specialist is made available to many more people who need it.

Another matter which has been brought to my attention concerns clause 21, which provides for the insertion in the principal act of proposed section 104a. This proposed section empowers the DirectorGeneral of Health to require a chemist to supply particulars of his stock on hand at any time. The chemist must comply with the demand within a time which may be specified by the Director-General. I do not think that the Director-General will use this power to any great extent. I have been asked to protest against this provision, but it is my considered opinion that there is no need to worry about it. Surely we have enough faith in the Director-General of Health to know that he will not demand that chemists supply particulars of their stocks every few weeks. He will ask for this information only when it is absolutely necessary. Although I have been asked to protest against this provision, I am not prepared to do so, because I have enough faith in the Director-General to know that he will not harass chemists by asking them to make reports every few weeks concerning the stocks of drugs that they have on hand. If any chemist was harassed in this way and he brought the matter to the notice of myself or, I think, of any other member on either side of this House, the case would soon be aired in this chamber and we should soon get it straightened out. The harassing of chemists in the way that is envisaged is unthinkable, and, therefore, I do not consider that the protest against clause 21 warrants my support.

My attention has been directed, also, to the fact that the rates of payment to chemists may be varied by the Minister.

Proposed sub-section (1.) of section 99 of the principal act, in clause 18, provides -

The Minister may, after consultation with the Federated Pharmaceutical Service Guild of Australia, determine -

(a)   the rates by reference to which, and the manner in which, the Commonwealth price of a pharmaceutical benefit is to be ascertained . . .

I have been asked to support a suggestion that this sub-section should read -

The Minister may, after consultation and agreement with the Federated Pharmaceutical Service Guild of Australia . . .

I think that would be very nice. However, one possible objection occurs to me. If the Minister could not reach agreement, there would be a deadlock. Therefore, I do not support this suggestion, although I think that consultation with the guild is necessary.

Perhaps the chemists have a legitimate complaint in respect of the standing committee, on which there are four members of the guild, three members who are really employees of the Department of Health, and one member who is a Treasury official - a total of eight members. One of the employees of the Department of Health is chairman. Most chemists would prefer an independent chairman. But the real point is that the Government will not allow any of its instrumentalities throughout Australia to take control out of the Government's hands. On any board that one cares to name - an agricultural board, a wheat board or any other kind of board - the responsible Minister has the final say. The chairman represents the Minister. I put it to the Minister that, in this instance, it would be quite reasonable if the chairman were some one other than an employee at the Department of Health. He could still represent the Government. I think that would be a workable arrangement and that it would be a great advantage. I make this suggestion with the best of goodwill, in the hope that the Government will take some notice of it.

I should like to sum up by saying that I have dealt with four parties to the national health scheme - the public, the doctors, the chemists and the Government. First of all, I believe that the Government is doing the best it can to give the people of Australia better medical benefits. Let me deal, secondly, with the doctors. I believe that very few doctors in Australia are prescribing more or less at random and trying to heap great expense on the Government. I suggest that those who are doing this are only a small minority. The standard of the profession is so high that this sort of thing would not be done to any great extent. Some one has said in this debate, " Any doctor will tell you of his colleagues who are prescribing much more than is necessary ". I cannot believe that. It does not seem to me to ring true. I am sure that no doctor would talk about what his colleagues were doing. On the whole, I think that we should be mighty proud of the doctors of this country.

Mr Cope - There are good and bad everywhere.

Mr TURNBULL - I believe that is correct. But I believe that everywhere the bad are in the minority - and a very small minority.

The main point that I want to make on behalf of the chemists is that the Minister for Health must see that they receive adequate pay for their work for the Government. They must keep their work on a high standard. That cannot be done in this country with its rising costs unless the chemists get enough money. These men have shops and businesses and are working for the Government. Their normal business is being restricted and they will have bad debts in respect of the 5s. fee. They cannot provide for their bad debts at the present time and the Government must see that the money that it pays to them makes provision for bad debts.

I think that members of the general public are receiving the best deal that they have ever had. Opposition members have stated that they do not think that this voluntary contributory scheme is good. Probably, it has many faults. But I can say to the Opposition, to the Government, and to the people of Australia that it is the best health scheme that we have had in this country and that this bill will improve it. Taking all in all, the main point that I want to make to the Minister is that the price paid to the chemist must be adequate. I ask him to concentrate on that and to do all that he can to bring to a successful conclusion the negotiations that have been going on for some time.

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