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Wednesday, 11 November 1959

Mr BUCHANAN (McMillan) . - Mr. Speaker, the purpose of this bill is to bring our national health scheme up to date in respect of its three sections - medical, hospital and pharmaceutical benefits. There has been a very gratifying response by the public to the purely voluntary scheme which this Government introduced in respect of medical and hospital benefits. Two years ago, I was informed that 62 per cent of the population was covered by it. I understand that the proportion at the present time is 67 per cent. However, about 10 per cent, of our population is composed of pensioners, servicemen, and inmates of mental institutions and similar places. I think that it would be fair to suggest that another 10 per cent, of the people, probably, are unwilling to join in a scheme such as this. Therefore, more like 80 per cent, of those who could come within the scope of the scheme are probably covered. This indicates to me a very ready and very satisfactory acceptance of the principle of self-help and government assistance.

However, all along, there has been one very obvious defect in the medical benefits side of the national health scheme. The benefit refunded in respect of major surgical operations, the administration of anaesthetics, and investigatory operations and services has been quite inadequate. Only very minor changes in the benefits have been made since 1953, and there have been quite large increases in medical costs since that year. The refund of 12s. - in some instances, it may even be 13s. 6d. - in respect of each fee of 17s. 6d. charged for surgery consultations is quite adequate, and this benefit does not call for any change.

I understand that there is a move afoot to charge an additional 6d. a week by way of contributions in order to allow funds to increase this benefit, the fund to pay 10s. and the Commonwealth to pay 6s. I sincerely hope that this proposal will not be proceeded with. It seems to me that it would be an open invitation to the British Medical Association to increase the consulting fee to 25s. I hope we can prevent that. This move would mean, in addition to an unnecessary increase in contributions, that fund members would have to pay out of their own pockets more than they do now. It must be remembered, too, that there is a limit to the weekly subscriptions that people can afford to pay. If these subscriptions get above the economic level in relation to the daily life of fund members, we face loss of fund membership and the breaking down of the whole scheme. I suggest that once these subscriptions reach 6s. or 7s. a week we have gone as far as it is possible to go.

More than 11,000,000 of the 15,000,000 services provided under this scheme in 1957 came under the heading of benefits in respect of consultations with general practitioners. I have not the actual figures for later years, but I understand that there has been no change in the very large percentage of the total that this class of claims represents - about 74 per cent. It appears to me that the normal family requirements in respect of visits to the family doctor are quite adequately covered. But the benefit paid in respect of what may be regarded as a catastrophe - the Commonwealth benefit is no more than £11 5s. for a major operation or £3 15s. for a normal confinement - is quite inadequate. The Government has now decided to increase the benefits it pays and thereby bring the total benefit nearer to reality. Fund benefits, too, will be very materially increased. If some of the funds have to increase their contributions by as much as 6d. a week, that will be unfortunate.

The new rates of benefit announced in respect of some 140 items under this bill have been arrived at, evidently, after consultation with the British Medical Association and by agreement with it. The Minister for Health (Dr. Donald Cameron) indicated that the Commonwealth benefit for major operations will be increased from £11 5s. to £22 10s. and that the benefits in respect of some less serious operations will be appropriately increased. I have carefully looked through the list of proposed increases, and I find that for only seventeen of the 73 items in respect of which the present benefit of £11 5s. is being increased is the benefit actually to be doubled. The increased rates in respect of the remainder of these 73 items range from £15 to £18 15s. The benefits in respect of 59 of the items at present subject to a benefit of £11 5s. are not being increased at all. It would be interesting to know why these items were regarded as meriting the maximum benefit when the scheme was introduced and are not so regarded now. I hope that the Minister has these items, also, under review and that the benefits in respect of them will be increased as soon as possible.

The figures indicate that approximately 50 per cent. of the money expended on this scheme is spent on the payment of benefit for the first item - consultations with general practitioners. A reasonable objective, if we are to make this scheme attractive to the public and maintain its present coverage, or possibly increase the coverage to more than 80 per cent. of those who could benefit, would be for the Commonwealth to double the whole range of its benefits for operations. This would probably involve an additional cost of £4,000,000, and perhaps even up to £5,000,000, but it would bring the scheme much closer to satisfying the claim made by the right honorable member for Cowper (Sir Earle Page), when introducing the national health scheme, that it was intended to meet the costs of 90 per cent. of medical services for all those who were willing to come into it.

The proposed alteration of hospital benefits does not concern me greatly. Since the inauguration of this scheme, the Government has very substantially increased the benefits which it provides, and the present amendment in this respect is really only to re-define the conditions attaching to the special account procedures. I take it that this means that the patients in homes which are not recognized under the act as hospitals will be entitled to benefit if they are suffering from any illness or injury requiring treatment of the kind usually associated with public hospitals, provided that the treatment conforms to the standard of that given in public hospitals. I believe that all honorable members will be in accord with this.

However, I find cause for concern over the proposed drastic changes in pharmaceutical benefits. The Minister has told us that the cost of these benefits has risen so high that it must be controlled if it is not to dominate our national health service and leave correspondingly less room for improvements in other benefits. He said, also, that the national health service is not something that is static and fixed, that it does not need to remain in the form in which it began, and that it must be capable of modification and improvement from time to time as circumstances demand. He said that these modifications and improvements must be made in a way which is financially responsible and properly correlated to the rest of the great structure of social services which the Government has built up. He also spoke, at the beginning of his speech, of the benefits flowing directly to patients. He stated -

There is no doubt whatsoever that a contributory health benefits scheme on a voluntary basis is the one most appropriate to Australian needs and conditions and that the future of this scheme is now assured.

With this I could not agree more. But why did the Minister not remain consistent in his thinking and apply this same contributory idea on a voluntary basis to the pharmaceutical benefits as well as to medical and hospital benefits? I was delighted to hear the honorable member for Cowper (Sir Earle Page) advise the Minister that we should adopt this procedure. All honorable members who have not done so should study that speech most carefully. Several other members also have brought this proposal forward and I want to associate myself closely with it.

I compliment the Minister on his patience in sitting through the whole of this debate. He has set a precedent for other Ministers to follow when bills concerning their departments are under consideration. He has taken terrific punishment and I warmly congratulate him on having sat through to this very late hour listening to members putting forward their ideas. But as it is such a late hour I would like to suggest to you, Mr. Speaker, that perhaps the Minister would consider this a suitable time to adjourn the debate. I ask for leave to continue my remarks at a later date.

Leave granted; debate adjourned.

Thursday, 12 November 1959

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