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Wednesday, 13 May 1970

Dr KLUGMAN (Prospect) - I refer to paragraph (b) (b) of clause 8 which seeks to amend the definition of professional service' in the principal Act to provide, among other things, for a prescribed medical service that is rendered in an operating theatre of an approved hospital by a legally qualified dentist or dental practitioner approved by the DirectorGeneral for the purposes of this definition. In some way this amendment indicates the complete lack of thought behind the legislation. Let us examine what it refers to. No doubt this arises out of the Nimmo Committee's report in which there is special reference to oral surgeons who carry out many of the procedures which medical practitioners also carry out.

If a person is a patient of a medical practitioner and the medical practitioner carries out the procedure the patient is entitled to a rebate from his fund, but if the procedure is carried out by an oral surgeon - and in many cases the patient has no choice - he is not entitled to a benefit. I think that this is wrong. Nowhere in the Act is it stated how these oral surgeons will be declared. Will every dentist be approved by the Director-General for the purposes of this definition? 1 am not sure what will happen. Will the person who receives treatment by an approved dentist or dental practitioner receive a rebate at the specialist rate or at the general practitioner rate? Many of the procedures appearing in the schedule come under 2 headings, specialist and general practitioner. 1 am sure that the Minister for Health has not thought about this, ls the dentist to be regarded as a specialist in this particular instance? For example, is the dentist who removes a foreign body from the mouth entitled to a higher rebate than a medical practitioner who performs the same service? Should he be treated as a specialist? I do not know, and I should like to hear what the Minister's thoughts are on this matter.

Over 100 of the items covered in the schedules are performed by oral surgeons, so I am informed by oral surgeons. In fact, there are only a limited number of oral surgeons in Australia. In New South Wales, for instance, there are 20 to 30 who are recognised as oral surgeons. Will they be the only ones recognised for the purposes of this legislation? I certainly have no objection to - indeed I welcome - the aspect of the legislation which encourages people who require an anaesthetic for a particular procedure to be admitted into a public hospital and for the procedure to be carried out in an operating theatre. Far too many procedures involving anaesthetics are carried out outside public hospitals and outside operating theatres and this increases the risk to the patient. But it is also obvious to those of us who know something about these procedures that many of them do not involve the use of a general anaesthetic. In many cases they may require the use of a local anaesthetic and, in some cases, no anaesthetic is necessary. Will it become necessary for people to be admitted into a public hospital and to have the procedures performed in the operating theatre just to get a refund? The Government has proposed this clause and it could result in cluttering up our public hospitals.

Let us consider a case where an oral surgeon is performing some particular procedure connected with a fracture of a mandible. If he has to take an X-ray - and as I understand it, unless the X-ray is taken inside the operating theatre the patient is not entitled to a refund - does he take the X-ray machine into the operating theatre? If he takes the X-ray outside the operating theatre - and it is the dentist rather than a medical practitioner who reads the X-ray - the patient is not entitled to a refund. I feel that the Minister and his officers in drafting this legislation have not thought clearly about the outcome of a literal application of this type of amendment

Amendment No. 4 on the Opposition's circulated list proposes a review of the schedule of fees. 1 would strongly support some fixed time of review. When I was in medical practice I objected to the adverse publicity that arose when medical fees were raised. One had difficulty in obtaining any sort of agreement with the funds or with the Government to increase their contributions. I am sure that this is one of the main worries facing medical practitioners at the present time. I think the same kind of thing applies in my new occupation. I strongly argue that there ought to be some fixed method of reviewing the Schedule as it applies to members of Parliament. 1 turn now to the proposed amendment referring to eligibility and whether members have to belong to a fund for 6 months or 2 months and so on. I think it important that the Minister look closely into this aspect. Many people are being discriminated against. I cannot ascertain from this legislation whether this is still likely to happen. As we all know a significant number of females in Australia conceive their first child outside marriage. Therefore they are at most members of a medical benefits fund contributing at the single rate. Many medical benefit funds have adopted the line that contributors are not entitled to the maternity benefit or the benefit for a confinement if they subscribe at a single rate, even though the husband also may be a member contributing at the single rate. I think this is obviously wrong. I hope the Minister will assure me that when he examines the rules of these funds he will make sure that rules of that sort are not applied and that a determination on matters of this kind is not simply left to the good graces of the people at the desk who are interviewing these poor girls. That is not the way this should be determined. It is nobody's business whether a girl was married or whether she contributed to a fund at the single rate at the time she conceived. She should not have to show that she was contributing to the fund at the family rate for 10 months before giving birth to a child. I have not had much time to deal with the large number of amendments proposed.

The CHAIRMAN (Mr Lucock)Order! The honourable member's time has expired.

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