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Wednesday, 13 May 1970


The CHAIRMAN - At the moment the amendment has not been moved so there is no motion before the Chair.


Mr REYNOLDS - I wish to make a few preliminary remarks. First, I wish to voice my protest concerning the way the Government is treating this Chamber in the discussion of this very important Bill. National health was the subject of a great deal of debate up and down the country all through and preceding the last Federal election. The Government has seen fit now to curb the debate. Furthermore, one observes that the

Government is bringing the Bill on for debate, as it did last week at the second reading stage, when the proceedings of the House are not being broadcast.

I now move:

At the end of the clause add the following paragraph: "(c) by omitting from sub-section (4.) the words '.other than an attendance at which an examination of the patient's eyes is made in consequence of which spectacle lenses are prescribed'.".

I do so with the object of removing the discrimination against patients who use the services of an ophthalmologist where that service involves the prescription of spectacles. Under the Bill persons who seek the services provided by an ophthalmologist will attract certain Commonwealth benefits providing spectacles are not prescribed. If a patient is referred to an ophthalmologist, who is as we know an eye specialist and a highly trained medical man, by an optometrist or a general practitioner, as he is entitled to be, and if that eye specialist comes to the conclusion that part of the treatment required is the prescription of spectacles, no Commonwealth benefit will be paid to the patient.


The CHAIRMAN - Order! I point out to the honourable member for Barton that I have looked at the amendment moved by him and I find that the effect of it would be to increase the amount of appropriation required. Accordingly, I rule the amendment out of order.


Mr REYNOLDS - In that case I simply move:

That clause 5 be postponed.

I do that as an indication of my Party's unhappiness about this clause. I was indicating to the Committee the very unfair treatment meted out to patients who go to an eye specialist for an eye examination in the course of which examination, however thorough it may be, the ophthalmologist prescribes spectacles. In such a case no Commonwealth benefit will be paid. I do not know why the Government has this obsession. A patient who is referred to an eye specialist will have to pay $1.50 for the first consultation. Where a patient is referred and spectacles are prescribed as part of the consultation the patient will have to pay not $1.50 but $5.75. A patient who goes to an eye specialist without being referred will have to pay a total of $8.90. Honourable members are well aware of the Government's promise during the Federal election campaign last October that no patient seeking attention from either a general practitioner or a specialist would have to pay more than $5 for such a visit. Here we have a denial of the Government's promise. 1 understand that it could be possible for a patient to be asked to pay the full SIO of the common fee charged by ophthalmologists. This is not only a denial of the Government's promise but also, in my view, a denial of justice.

The Australian College of Ophthalmologists points out that the prescription of spectacles can be merely incidental to the medical examination. The medical examination could be a most exhaustive affair and could involve a full examination of the eye to see whether any kind of disease is present, lt could lead to surgery and after care treatment. In all those situations, providing that no speactacles are prescribed, the patient would be fully covered and would not have to pay more than $5 for all of those treatments. But if after all that kind of treatment is provided the doctor says: 'Look, besides having this examination and this other kind of treatment you will also have to wear glasses or have your glasses changed', the patient is prejudiced and will receive no Commonwealth benefits whatsoever. I am told by the College that the patient possibly will not even receive fund benefits. 1 would like the Minister to tell me whether that is correct.

I ask the Minister to tell the Committee why this provision is contained in the Bill and why there is this prejudice involving the provision of spectacles. There is not the same kind of prejudice against a doctor who prescribes drugs that are not on the list of pharmaceutical benefits. There is no such prejudice against a prosthetic surgeon who provides artificial limbs. I ask the Minister: What would be the position if the ophthalmologist had to provide an artificial eye? The patient will receive no Commonwealth benefit if the doctor prescribes glasses to see with but presumably if, in the course of his treatment, the patient is provided with an artificial eye then he will receive the whole benefit at no greater cost than $5. T am told that the elimination of this discrimination would not cost more than Sim.

The number of people estimated to be affected by this provision would amount to about half a million. About 500,000 services are involved annually. If the Bill goes through in its present form, those 500.000 services will not attract Commonwealth assistance. Obviously, the health of the community will suffer. Many people will not be able to afford to have the examination because the ophthalmologist may have to prescribe glasses and the patient will be denied any Commonwealth benefit. The Bill needs to be amended in the way suggested by the Labor Party to eliminate the discrimination where spectacles are prescribed and to provide encouragement, first of all, for the medical man. There are about 400 ophthalmologists in Australia today. There is a great need for more of them. The kind of discrimination and prejudice involved in this particular clause will not be an encouragement to them. Certainly it will not be an encouragement to the many patients who will require the services of an ophthalmologist. lt is said that many people can be saved from going blind by going at an early date to have their eyes examined fully by a specialist. This applies especially in the case of chronic glaucoma. There are many other eye diseases where early detection by a qual'fied man could preserve the patient's sight. The clause under discussion gives no encouragement to people who might be in fairly necessitous circumstances to go along and receive such eye treatment from highly qualified people. These doctors are medical men with at least 6 years of undergraduate training plus at least 4 years of postgraduate training. They are not quacks. We are talking about highly qualified medical services. The Government is denying these people the freedom to prescribe glasses without in some way deterring the patient.


The CHAIRMAN - Order! The honourable member's time has expired.







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