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Wednesday, 19 April 1961

Mr REYNOLDS (Barton) .- The honorable member for Isaacs (Mr. Haworth) is a more credulous person than I take him to be if he is convinced, on the flimsiest of evidence, that the Australian national health scheme is the best in the Commonwealth of

Nations. As a matter of fact, the honorable member has only to talk to any number of British immigrants who come to Australia and ask them how our health scheme compares with that in the United Kingdom and he will get rather a severe jolt. I have in my possession a report by the Minister for Health in New South Wales, Mr. W. F. Sheehan, who has only recently returned from the second Commonwealth and Empire Law Conference. Mr. Sheehan took the opportunity to examine public health schemes in Canada and the United States of America. While I do not intend to delve deeply into his report, it is worth noting that Mr. Sheehan stated at page 6 -

I have no hesitation in asserting that FederalState relations and co-operation in both the United States of America and Canada can be an object lesson to those in Australia.

On some other matters which are rather relevant to this debate, Mr. Sheehan said that in Canada, for example -

The Federal act prescribes that in order to participate, the province must make insured services available to all the residents of the province on equal terms and conditions. Thus there can be no exclusions on grounds of nationality, age, income- and I ask the Minister to note - or pre-existing condition.

All persons receive equal treatment. Another important passage which I ask the Minister and the honorable member for Isaacs to note is -

Length of time for which insured persons are entitled to receive insured services depends solely on medical necessity. No arbitrary limitation may be imposed in regard to entitlement in connexion with length of stay in hospital.

In other words there rs none of the business that we have in this country whereby benefits are reduced after a person has been in hospital for 84 days. The report continues -

On the other hand, where it is not considered medically necessary for an insured patient to have treatment in hospital his insurance entitlement does not apply.

The report of the Minister for Health in New South Wales also states that in Canada, 92 per cent, of the Canadian people are covered by the national health scheme compared with 73 per cent, in Australia, a figure to which the honorable member for Isaacs referred. Supporters of the Government proclaim ours to be a marvellous health scheme. I acknowledge that it is improving, but I remind the Government that the Australian national health scheme does not provide for such important health services as dental treatment It provides for a very limited optical treatment and there is no provision for such specialized services as physiotherapy. Nothing is provided for patients who have to go into mental hospitals. Even an age pensioner entering hospital is denied his pension, and the State Department of Health is deprived of the proportion of pension it normally attracts for persons who go into benevolent institutions.

Hospitals in every State of Australia are grossly overburdened. It has been said that pensioners under the pensioner medical service do not have to insure for hospital treatment. The simple fact is that most elderly persons find it almost impossible to gain admission to public hospitals anywhere and certainly in the metropolitan areas of Australia. They are legally entitled to free admission to a public ward, but in fact, most public hospitals will not take longterm patients and most of the elderly people who seek admission suffer from heart conditions or other long-term illnesses. Elderly people have recognized this fact as disclosed by the Minister for Health (Dr. Donald Cameron) in an answer to a question that was asked by the honorable member for Moreton (Mr. Killen). The honorable member asked -

How many contributors to medical or hospital benefit funds established under the National Health Act are contributors to the special accounts?

The Minister replied that at 31st December, 1960, the figures were medical, 16,757, and hospital, 288,495. That means just what I said - they can get medical treatment by presenting their card, but they cannot get free hospital treatment in the same way. The Minister for Health in New South Wales, and many other responsible authorities, have advised pensioners that even if they have a pensioner medical service card they will find it darned difficult to gain admission to any of the overcrowded public hospitals in any State for long-term treatment.

When this health scheme was introduced one of the things it was supposed to do was to provide adequate hospital facilities. It was lauded on that account; but in fact to-day the scheme does not provide anything like adequate hospital accommodation. I remind honorable members that while the Government has often given the impression to the public that it is a great benefactor through the pensioner medical service, the simple fact is that the Commonwealth provides in respect of the hospitalization of pensioners only an amount of 8s. a bed a day to public hospitals. I was told only last Saturday by the chairman of the board of the St. George District Hospital - one of the biggest public hospitals in Sydney - that the average cost of maintaining a bed in his hospital is £35 a week. About the same figure would probably apply in all other public hospitals in Sydney, and no doubt elsewhere in Australia. So, in other words, the Commonwealth contributes the basic amount of £2 16s. a week towards the hospitalization of each pensioner, compared with the average cost of maintaining a bed of £35 a week. Yet the Government and its supporters claim that this is the best national health scheme in the British Commonwealth.

Not even all pensioners are covered by the scheme. The Government in October, 1955, introduced a means test so that thenceforward large numbers of age pensioners in receipt of a full or part pension were debarred from benefit under the pensioner medical service, and from free hospital treatment, and from the right to free medicine under the pharmaceutical benefits scheme, simply because they received £2 a week or more in income, apart from their pensions. The result was that many of these poor souls are worse off now than are people who are receiving full pensions, which attract these other concessions. Yet honorable members opposite talk about the great virtues of this scheme.

In a few weeks probably a very high proportion of the membership of this Parliament, along with thousands of other members of the community, will be knocking on doors in connexion with a fund-raising campaign for the National Heart Foundation. They will be begging from door to door, one might say, in order to obtain funds that are not otherwise available to enable the carrying out of urgently needed research. Not .only is the amount of research being done at present inadequate, but it has not been co-ordinated so as to achieve efficiency and economy in the way the Commonwealth should co-ordinate it. My friend, the Minister for Health in New South Wales, has directed our attention to the good example set by Canada in this respect. The federal departmental head in Canada consults regularly with the heads of the departments of health in the various provinces, in order to be able to advise the Federal Minister frequently on the needs of Canada's health scheme. As a result, there is a happy, co-ordinated and co-operative joint scheme in Canada, operated between the federal and the provincial authorities, of a kind which seems to be missing in this country. The Minister should recommend to the Government that we try to emulate Canada's example.

While the matters to which I am referring are not strictly within the ambit of the bill, I think they are worth mentioning. We have heard a lot in the last year or so about hospital treatment in non-recognized hospitals. Those are hospitals which are not recognized for benefit under the Government's scheme. I find that about half of the people who have entered such hospitals for treatment have had their claims for benefit rejected. These rejections are the result of an amendment passed through this Parliament last year or the year before. I can quite understand how this happens, but I think that it is most unjust that these claims should be rejected in the cases to which I shall refer. The amendment provided that people who enter these nonrecognized hospitals for treatment will attract Commonwealth benefit only if they satisfy two conditions. First, they must be receiving treatment equivalent to the treatment they would receive if they were able to gain admission to a public hospital. Secondly, they must be suffering from a disability which would normally be treated in a public hospital. It is on that second condition that most people are debarred from benefit. A person suffering from a heart complaint, for instance, which needs more than home treatment or out-patient treatment, and calls for a lengthy stay in hospital, is usually told by the public hospital that there is no accommodation available because the treatment might last over months in the hospital, and there are no facilities for such lengthy treatment there. That person may then enter one of these private non-recognized hospitals for treatment. When the patient makes application for the benefit the claim is rejected because the patient was treated for a disability in regard to which the public hospital had refused admission. But the reason that the public hospital would not accept the patient was not the nature of the disability, but the lack of accommodation to enable long-term treatment. That is what is happening to many unfortunate people on the special account, who enter non-recognized hospitals for treatment. Incidentally, I hope that the Minister will be good enough to take notice of these points when he reads " Hansard " later.

There is also the unfortunate business regarding mental hospitals, to which I have referred before. Part of the problem which is making it so difficult for the State authorities to maintain their mental hospital services as adequately as required is that pensioners who enter these hospitals find that their pensioner medical card gives them no entitlement to treatment. The Commonwealth does provide something towards the capital cost of providing mental hospitals, but gives nothing towards their running costs. That is bad enough, but the fact is that many pensioners who should never be in mental hospitals are in such hospitals to-day simply because they cannot obtain treatment in public hospitals. All they are suffering from is senility or part-senility. The Director-General of Public Health in New South Wales - and I suppose this applies also in other States - has, year after year, referred to the fact that mental hospital facilities are being over-taxed simply because many pensioners who should not be in mental hospitals are there only because no public hospital facilities are available for them. The States have to carry that burden, and they receive no contribution from the Commonwealth to meeting the cost of upkeep of these hospitals. That is another reason why it is so ludicrous for the Government to tell us that its health scheme is the best in the world, or even in the British Commonwealth. I acknowledge that the scheme has its virtues, but let us not blind ourselves to the fact that we have a long way to go before we are providing anything like the ideal kind of health services that we should be providing to the people.

I referred before to the inadequate provision of specialized services such as dental services. Dentists say that it is a most worrying thing when parents come to their surgeries to have two or three children treated. Perhaps the parents themselves need treatment, and the dentists know that they cannot afford it. They feel bad about having to send such people a bill for treatment, when they know that no assistance will come from the Government in the in the payment of the bill. Of course, the costs of dentistry, along with other costs, have zoomed in recent times, and this places a tremendous financial burden on those concerned. The Australian Labour Party, in each of its most recent election programmes, has shown its desire to provide health schemes to cover these specialist services. Many people are referred by doctors for physiotherapy treatment, which is intimately connected with their medical treatment; yet for some reason physiotherapy is not included in the services covered by the scheme.

I should like to touch on another aspect and that is the registration of hospitals under the Commonwealth scheme. The present position has created a problem for some hospitals, which have tried to obtain registration under the scheme. People who cannot obtain admission to a public hospital must enter a private hospital. This is commonplace when minor surgical operations are required. Cases of tonsillectomies, particularly for children, and other minor surgery are referred by doctors to these private hospitals, which are quite efficient, apparently. Many doctors operate on patients there. Admittedly, the hospitals do not provide a full-time service. They do not provide night treatment, but they do provide all the necessary facilities for operations. As T have said, the patients are referred by many doctors to these hospitals. The State Department of Health registers the hospitals for its purposes, but the Commonwealth will not register them under the scheme and will not provide benefits for those who make use of them.

The point at issue, surely, is whether the institutions provide a desirable standard of service. If they provide the service, though it may be only part of the total service required, and if they relieve our over-taxed public hospitals, why not register them, even if it is only registration of a limited nature, and why not provide benefits for the many people who are compelled to make use of these hospitals? The hospitals have the approval of the medical fraternity. I understand that some members of the medical fraternity are part-owners or have some proprietary interest in these institutions. This is not always so, but it does happen in some instances.

I turn now to another matter and this relates to the pharmaceutical benefits scheme. Like the honorable member for Eden-Monaro (Mr. Allan Fraser) and others who have spoken in this place, I believe that the formulary does on occasions inflict injustices. The Minister may by now have received a letter from me in which I refer to a desperate young man in my electorate. This rs not an isolated matter; this happens on many occasions. This young man, who has had a skin complaint almost since birth, has been treated by many doctors and has been given various forms of treatment. Now a skin specialist, I think at Royal Prince Alfred Hospital in Sydney, has hit on something that not only appears to be relieving this poor unfortunate fellow of pain but indeed seems to be curing him of the complaint. The doctor says that nothing on the formulary looks as if it would effect a cure. This young man is 24 or 25 years of age. He now must pay the specialist and the local doctor who treats him three times a week to apply the treatment. He must also pay for the very expensive medicines used and in one period of three weeks these cost him £18. Here is a young, ordinary man - he is a shop hand, if I may call him that - and he must pay a good portion of his wages year after year for medical treatment. 1 thought the health scheme was designed to relieve sick people of worry and insecurity. I believe that, whatever may be said of a socialist scheme-

Sitting suspended from 6 to 8 p.m.

Mr REYNOLDS - Prior to the suspension of the sitting, I had made some critical observations about the national health scheme, and as the sitting was suspended I was discussing in particular what I regard as deficiencies in the pharmaceutical benefits aspect of the scheme. I had mentioned a case in which specialist advice was that the medicines provided by the formulary did not meet the requirements of the patient. This one particular case could be multiplied many times in the experience of many members of the Parliament in their dealings with their constituents.

I suggest that the pharmaceutical benefits scheme is rather lacking in flexibility. I am aware of the existence of the Pharmaceutical Benefits Advisory Committee, which is mentioned in the bill. That is an expert committee which advises the Minister for Health. But there are many medical authorities of eminent standing in the community who, nevertheless, are not happy with the formulary. Their pragmatic experience in these matters has convinced them that there are medicines other than those in the formulary that will relieve pain or effect cures. The great problem, of course, is that many of these medicines that are not included in the formulary are very costly. As a result, many ordinary working people like the man I mentioned just before the suspension of the sitting are in difficulty because they have to spend a large proportion of their weekly income on specialist treatment and on drugs and medicines. In the case which I mentioned, about £18 was spent on medicines in three weeks. I visited my own local general medical practitioner last Friday for a check, and he made out three prescriptions for me. One was for a medicine which was on the free list and the other two were for medicines which were not on the list.

Mr Chaney - It is just as well the honorable member was not ill.

Mr REYNOLDS - The honorable member can see that I am all the better for those medicines. These days, getting prescriptions is a bit like taking tickets in lotteries. A person is lucky to find that one prescription out of three is for a drug which is on the free list.

People who already endure much pain and suffering, to say nothing of mental distress, are subjected to great financial hardship by the inadequacy and inflexibility of the pharmaceutical benefits formulary.

I suggest that there ought to be a little more flexibility and that there should be provision for some appeal tribunal which could consider individual cases. A patient may be able to submit substantial medical evidence that although his treatment is not the kind that would ordinarily be prescribed for the complaint from which he suffers, it is the best and most effective treatment for him. We all know how individuals vary, not only in their psychological and personality make-up, but also in their physical constitutions, and flexibility should be provided in the pharmaceutical benefits scheme in order to allow for these variations. I suggest that there should be provision for appeals by individuals who require costly medicines which apparently are suited to them but which are not in the formulary. The practitioners who prescribe these medicines are not just quacks who have set themselves up in business here and there. They are people of extremely high standing. Indeed, I suggest that many of them are of a standing equivalent to that of the members of the Pharmaceutical Benefits Advisory Committee. All that I am asking is that respect be shown for the professional status of eminent doctors and specialists who prescribe costly drugs not in the formulary and who believe that the formulary is not adequate to meet the needs of particular patients.

As I have said, many of these drugs and medicines which are not listed in the formulary are very costly. Many doctors of my acquaintance have suggested that they all are too costly and that there is gross profiteering in the production of drugs and, more particularly, in their distribution. Only the other day, a local practitioner pointed out to me that many of these drugs are imported and that the Commonwealth levies customs duties on them, thereby increasing the cost. In many instances, this increases the cost to the Commonwealth in the long run of imported drugs which are provided free under the pharmaceutical benefits scheme.

I make a positive suggestion the adoption of which would help to solve this problem. I imagine that the operations of the Commonwealth Serum Laboratories could be very greatly extended in order that these costly drugs may be produced in Australia. I am sure that these laboratories could pro duce drugs at a cost much lower than that at which they are obtained from other sources, and particularly from overseas. Only to-day, I read in a newspaper that an officer of the Commonwealth Serum Laboratories had made a statement about the long delay in providing for the enlargement of the facilities of the laboratories in order to permit much more research to be undertaken. The officers of the laboratories recognize that a lot of necessary research remains to be done and that greater financial provision is required if the research needs of this country are to be met. I think that the Minister for Health ought to give a good deal of attention to this matter.

I have only a few minutes left, and I have time to mention only one other matter in this rather quick survey of the national health scheme. This is a matter to which I and other honorable members have directed attention on previous occasions. At the outset of my remarks, I referred to the many deficiencies in the national health scheme with respect to the lack of provision for dental treatment, optical treatment and specialist services such as physiotherapy. I also mentioned the anomalies in the special account procedure and the new means test introduced by the Government in respect of the pensioner medical service. I want to deal now with optical services. The strange anomaly in this respect is that if a person is to attract Commonwealth benefit and fund benefit for optical treatment, not including spectacles, he must be treated by an eye specialist or an ophthalmologist. If he is to attract full benefits, he has to be referred to the specialist or ophthalmologist by a suitable person, just as a patient who goes to any other specialist will attract the full Commonwealth and fund benefits only if he first goes to his general practitioner and is referred by the general practitioner to the specialist. There is a parallel between the two classes of treatment.

With respect to optical treatment, a person attracts full Commonwealth and fund benefits if he is referred by a general practitioner but not if he is referred by an optometrist. I am well aware of the very solid training that optometrists have to undertake. These days, they have to get the equivalent of a Bachelor of Science degree and they undertake intensive study in a highly specialized field. I suggest, with all due respect to my colleagues in the ranks of the general medical practitioners, that optometrists are infinitely better qualified to diagnose eye troubles than are general practitioners, and optometrists would be just as well fitted to refer people to ophthalmologists and specialists as are general practitioners. The fact is, of course, that about three-quarters of the people who seek treatment for eye troubles go to optometrists or opticians, and more particularly to optometrists. But if an optometrist refers a patient to an ophthalmologist, the patient will not receive full Commonwealth and fund benefits. However, if a general medical practitioner, who probably knows very little about eye troubles, refers the patient, full benefits are paid.

The optometrists suspect that this restriction is merely a way of diverting patients from optometrists into the hands of the local general medical practitioners, and they are therefore very ' suspicious of this aspect of the national health scheme. I think that very recently the Minister has been made well aware of the criticisms of the scheme that are made by the optometrists, and I am hopeful that in the very near future he will remedy what I regard as a serious anomaly that affects both the optometrists and the thousands of people in the community who seek treatment from them.

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