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Thursday, 12 November 1959

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) (Monaro) . - I direct the attention of the Minister for Health (Dr. Donald Cameron) and the committee to the practice adopted by some doctors of refusing to abide by the rules of the national health scheme under which payment of patients' accounts may be made direct from the fund, and the concurrent practice of these doctors of refusing to submit an itemized account until the account has been paid. By doing this, they make it impossible for the fund to pay benefit for the patient, because the fund cannot authorize payment until it has seen a detailed, itemized account. This matter has been brought officially to the notice of the Minister by the Latrobe Valley Hospitals and Health Services Association. The first extract that I would like to read to the committee comes from the national health booklet issued in 1953. The question asked is -

How will the benefits be paid?

The answer is -

Approved organizations will be free to decide for themselves whether the benefits, including the Commonwealth subsidy, will be paid directly to the member when he produces the receipted account from the doctor or directly to the doctor on the authority of the member who presents an unpaid account.

That procedure is authorized by the national health scheme. But these doctors are making their own rules and are defying the rules of the national health scheme. In doing so, they claim to have the support of the British Medical Association. Since the matter has been brought officially to the notice of the Minister in writing by the Latrobe Valley Hospitals and Health Services Association, I ask him what action is he taking to ensure that these doctors abide by the rules of the national health scheme. I have here a copy of an account for £10 17s. 6d. rendered to a patient in Traralgon by a group of doctors. No details are given, but at the bottom of the account is stated -

An itemized account will be issued on request on settlement of this account.

In other words, the patient must pay the account before he is allowed to know what he is paying for, and that is done solely, I gather, to ensure that the fund is not able to make the payment but that the patient must somehow find the money, pay the account and then obtain a refund from the society. This matter was taken up by the Latrobe Valley Hospitals and Health Services Association with the doctors concerned, and this very illuminating answer was received -

The British Medical Association has instructed all Doctors in the Latrobe Valley to refrain from itemising accounts, and to issue itemised accounts only upon request when the account has been paid.

By what authority does the British Medical Association make rules which are in direct conflict with the rules of the national health scheme? How does it come about that the Minister to whom this matter has been referred has failed to take any action to uphold his own scheme? I hope he has taken action, but if he has, I am unaware of it. The doctors go on -

I trust you will understand that there is nothing personal in this request, as we are acting purely under the directive of the B.M.A.

That is one case which bears on the point that I bring to the attention of the Minister. Here is another letter written on behalf of a firm of doctors, dealing with exactly this point of the refusal of doctors to render itemized accounts until after payment has been made, and their refusal to abide by the rule of the national health scheme which allows the fund to make payment to the doctors on behalf of the patient. The firm writing on behalf of the group of doctors says -

The provisions of this act in relation to members' rights, particularly in regard to payment to a doctor where the account is unpaid, are now being investigated by the B.M.A. with a view to having the legislation amended, so as to prohibit : such payments unless a " Hardship " form is completed.

I would like the Minister to inform the House whether he proposed to amend the act at the behest of the B.M.A., and if so, why. I ask the Minister to state also, if the act is not to be amended, why he is not ensuring that members of the B.M.A. abide by the rules of his own scheme. The letter goes on -

We are prepared to help members--

That is, members of funds - in any way possible, within reason, but we must also abide by any decision of the B.M.A. in regard to these matters.

The second matter to which I direct the attention of the Minister is the increasing concern being expressed in various parts of Australia at the prospect of rates of contribution for hospital and medical benefits being increased, the injury that this will inflict upon family budgets, and the necessity for some clearer statement than the Minister has so far given us. Concern is also felt at the prospect that increased medical benefits will be followed immediately by increased medical fees, since apparently no assurance has been given by the B.M.A. that fees will not be increased, and, apparently, the Government is not willing to take action to protect the rights of patients and contributors in these matters.

I direct the attention of the Minister particularly to a resolution of the Australian Society of Engineers - a very important and highly respected trade union - expressing its great concern at the indication that contributions to medical benefit funds and societies will have to be increased to meet increased costs, and also its concern at the likelihood that increased fees will now be charged for medical services. The society points out that under the present scheme a rebate of 12s. 6d. is available for an ordinary visit to a doctor's surgery, for which the fee is 17s. 6d., and that it appears likely that the rebate will be increased to 1 3s. 6d. This is an increase of one shilling, but the cost of a visit to a doctor is likely to be increased to £1 or 22s. 6d. This would leave the member of the society very much worse off than he is now.

What information the union has of the intentions of the medical profession, I do not know, but I direct the attention of the Minister to this matter because statements on the likelihood of medical fees being increased in the new year are now being very widely made. During the secondreading debate, I quoted a statement appearing on a doctor's account that from 1st

January the fees for visits and consultations would be increased. I bring these matters to the attention of the Minister, and hope that he will be able to give me assurances on them now.

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