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Wednesday, 13 May 1970

Dr FORBES (Barker) (Minister for Health) - Mr Chairman-

Dr Gun - I raise a point of order. Is the Minister going to take all the time available?

The CHAIRMAN - Order! The honourable member for Kingston will resume his seat. The point of order is not valid.

Mr Hayden - I rise to order. There is limited time available. Under the guillotine arrangements we have only until S.45 p.m. to discuss these clauses. The Minister ought to give some of his own supporters an opportunity to speak now. The Opposition has co-operated.

The CHAIRMAN - Order! There is no valid point of order.

Mr Hayden - It is a matter of fair play. If the Minister is going to reply to every speaker-

The CHAIRMAN - Order! There Ls no valid point of order. The honourable member for Oxley pointed out that the time available is very limited. I call the Minister for Health.

Dr FORBES - I have already allowed 2 members of the Opposition to speak. I did not rise. I departed from the normal custom in the Committee stage of a Bill. The honourable member for Oxley (Mr Hayden) decided to move the remaining proposed amendments in this group at once. Some of them were accepted by you, Mr Chairman, as proposed amendments but others were not. I think it quite reasonable for me to speak on behalf of the Government and deal with those proposed amendments which were accepted in the same way as the honourable member leading for the Opposition did. In order not to use up the available time

I will confine myself to the proposed amendments that were accepted by you, Sir, and be as brief as possible. 1 shall deal first with proposed amendment No. 9 which was moved by the honourable member for Oxley and accepted by you. lt would have the effect of having the schedule of fees reviewed at least every 2 years. The Government can not accept this proposition and does not believe that it is necessary. I have already stated on behalf of the Government that it is desirable for an arrangement to be negotiated with the Australian Medical Association for a review of the common fees on which the medical benefits are based. The Government has given an undertaking that it will pursue this matter to the point where there is an agreed method of arriving at a review of fees at regular intervals. The Australian Medical Association has put a particular proposal to the Government as to the way in which this should be done. The Government has not yet made a decision on that proposal but hopes to do so shortly. After it has made its decision there will be, inevitably, quite a bit of negotiation with the Australian Medical Association. I have no doubt at all that there will be a satisfactory method of updating common fees agreed upon but we have not yet reached that point. Nor do I believe, as a matter of general principle, that it is appropriate that either that or the sort of provision moved by the Opposition should be incorporated in this legislation. Therefore the Government opposes this amendment.

Sir, thenext proposed amendments accepted by you were Nos 7 and 8. Both proposed amendments relate to clause 16. You accepted proposed amendment No. 7 in whole and proposed amendment No. 8 in part. These proposals refer to the power given for the Director-General to make a provisional payment of Commonwealth benefit in those cases where it is possible but not certain that there will be compensation paid in third party or workers' compensation cases and where the amount of compensation paid would reduce the Commonwealth medical benefit. If the compensation received is high enough to reduce the amount of Commonwealth benefit that should be paid below the amount actually paid provisionally, the difference is repayable by the contributor. The effect of the proposed amendment would be to force the payment of Commonwealth benefit in all possible compensation cases where the patient had not established entitlement. The present Act allows the Director-General to investigate and to make an assessment of the situation. It permits him to use his judgment as to whether payment of compensation is probable and as to tha amount that will be paid. This achieves much greater accuracy in the amount of benefit paid. If the Commonwealth benefit were paid in all cases, as proposed, there would be difficulty in recovering the amount over paid to the contributor, not to mention the inconvenience caused to the contributor.

Proposed amendment No. 8 refers to the power of the Minister to determine how much of a payment made in settlement of a claim under workers' compensation or third party is attributable to medical expenses. The amendment proposes an appeal to the court that either heard the case or would have heard the case if it had not been settled out of court. The practice of the courts varies in that in some cases the amount attributable to medical expenses is specified whereas in others a lump sum is awarded. In some cases there is a settlement out of court. The effect of this proposed amendment would be to force the courts indirectly to make an assessment of medical expenses in each case heard and, if the contributor desired it. also in those cases settled out of court. The proposed amendment would seem to serve little useful purpose as the court could use only the same criteria as the Minister would use in making his determination. For that reason I oppose it.

Having replied to the amendments which have been accepted, I would like to answer the question raised by the honourable member for Prospect (Dr Klugman) with respect to the proposal to provide benefits in the Government's plan for certain items which related to oral surgery. It is not intended to prescribe services of a kind which will normally be given in a dental practitioner's surgery. The remarks of the honourable member for Prospect w?re directed at the special situation which arises when a patient is given a procedure of a kind sometimes performed by a doctor and in other circumstances performed by an oral surgeon. The emphasis in this matter is on the question of what services are prescribed. We have not yet reached the point of actually prescribing these services. They are certainly not prescribed in the schedule. We have received from the Australian Dental Association only in the last few days details of the services which it suggests are appropriate within the context of the Government's intention. These suggestions went no further than to remove an anomaly in the existing Act in circumstances where services could bc done equally well by an oral surgeon and a medical practitioner. At present there is a working party of my Department and the Australian Dental Association examining this situation in detail.

There are a number of other matters', including that raised by the honourable member for Prospect in relation to the persons who will be recognised under the Act for these purposes, which have to be worked out by negotiation. Until that is done it seems appropriate for the Government to restrict this to the recommendation contained in the Nimmo Committee report, that it should be restricted to services performed in the operating theatre of an approved hospital. After all this is worked out that would appear to the Government to be the appropriate time to consider whether this restrictive provision recommended by the Nimmo Committee is unduly restrictive.

In relation to the point made by the honourable member for Prospect about unmarried mothers, it is the intention of the Government, as I indicated in a statement that I made originally on this matter, to introduce as a condition of registration of the funds uniform conditions of registration, which will cover the point that he made, for all funds in Australia. I think that will answer the point that the honourable member made.

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