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Wednesday, 13 May 1970

Mr HAYDEN (Oxley) - lt seems to me that this is an opportunity to discuss the points which would have been made in the amendments proposed by the honourable members for Scullin (Dr Jenkins) and Barton (Mr Reynolds) in discussing the amendments. We feel it is wrong to impose on the public the provision that those people who are not in a medical benefits fund do not obtain the $2 a day hospital bed subsidy from the Commonwealth. The honourable member for Scullin commenced lo make the point that uninsured patients receive only 80c a day. As I represent Queensland, 1 feel some exasperation with this practice and wonder why the Government did not take the opportunity of upholding the Nimmo Committee's recommendation on this point in relation to Queensland. It was that those people in the non-paying public ward beds of the hospital system in that State should attract the S2 a day bed subsidy instead of 80c as at present. It has been frequently pointed out that this practice deprives Queensland of about SI. 5m each year, money which is sorely needed. Professor Saint, Dean of the Medical Faculty of the University of Queensland, recently announced publicly that unless something was done to provide more money for the hospital services in Queensland a critical situation would arise in which the facilities available just would not be capable of handling the demands placed upon them.

We feel - and I mentioned this principle earlier - that it is wrong for the Government to use public money for this purpose. The money is raised from taxpayers and paid into Consolidated Revenue, which is the source for Commonwealth subsidy. The Government says to the public after raising it from them - after extracting it from them, because they do not have any choice - 'We will refund it to you in the case of ill-health but only provided you join some of these health insurance schemes that we are propping up'. They are terribly inefficient schemes. Over 100 health insurance schemes operate in Australia today. I think I will take this opportunity, wilh the forbearance of the Minister for Health (Dr Forbes), to reply to a proposition made, but not fully, by the Minister in the closing stages of his second reading speech. He said the problem with the Opposition is that it speaks of a single large fund as though this inherently will be more efficient than the present multiplication of funds. He went on to say - this point was mentioned by the Nimmo Committee - that the experience of the Committee in its investigations was that some of the smaller funds were more efficient than the bigger funds. This is quite true. I am prepared to accept it but it would be a fallacy to compare the present practices with what we have in mind. lt is understandable that a small fund, under the present situation would most likely be the more efficient scheme because most of these are closed schemes and apply fairly stringent entry conditions. People are in fairly good health when they join these schemes. Because they are closed schemes they do not indulge in competition, do not pay commission rates for agencies, and do not have high expenditures involved in building up status symbols which are all pari and parcel of the big schemes. The larger open schemes operating in Australia are inefficient because they in fact do these things which we criticise, lt is inherent in their nature. They compete against one another; they have expensive radio sessions; they advertise extensively. This is all expenditure that has to be borne unnecessarily by the contributor. There is a fair bit of duplication. There is inefficient use of administrative facilities available; that is, there is a surplus capacity in the arrangement of the organisation. All in all there are fairly large diseconomies in the way they operate because of this general inefficiency which is part and parcel of the nature of the competition between these funds. Indeed, this was identified by the Nimmo Committee. It pointed out that the activities of the open schemes should be regionalised. The aim quite clearly was to try 10 eliminate some of. these unattractive practices which have to be borne at the contributors' expense. Our scheme is based on a universal contribution to a single health insurance system.

Before I divert from that on to the further points on the subsidy I would like to refer to statements made by the Minister in his second reading speech in the House in which he claimed there had been substantial cuts in the expenditure on health in Canada last year. Yes, indeed there were. The first thing he referred to was a 25% cut in the votes for emergency health and emergency welfare services which were effective during this financial year. What he forgot to mention was that total expenditure in these services is extremely small in relation to civil defence expenditures. He next referred to cuts in expenditure in general health gi ants. I do not know what he has in mind. 1 have done a fair bit of work to try to track down what he is referring to but it is a bit difficult to find exactly what he has in mind. I put it to the Minister that any cuts occurring in Government expenditure in Canada today are of a general nature and arc part of the austerity measures introduced by the Trudeau Government in that country. In spite of that - and the Minister will be well aware of this because I brought this point to his notice as a result of communications I had with the Minister for Health in Canada - the health services in Canada operate on a provincial basis and their nature varies from province to province. In fact there will not be a reduction in the expenditure on provincial health services and this is the essential nature of the point T was discussing.

The London Times' on 15th September 1969 pointed out that in spite of the austerity programme introduced by Mr Trudeau Government expenditure would continue to rise. It said:

This is due primarily to cost escalations beyond the control of the Federal Government such as statutory Federal contributions to spending programmes by the provinces

This covers health expenditure. The system in Canada is that there is a statutory commitment by the Federal Government to fund the health programmes operated by the provinces. This is a scheme which benefits the more efficiently operated schemes with the aim of giving an incentive to the less efficient ones to improve their efficiency.

In any event, the point I am making to the Minister is that what he pointed out the other day, while I am sure it was pointed out in good faith, did not fully investigate health expenditure in the provinces. What I am quoting now clearly explodes the assertions he made that the universal health system operating in Canada had failed. The provincial health schemes have not slashed their expenditure at all.

I will now revert to what I was talking about earlier. It is wrong in our opinion that a person should be compelled to join a private health insurance fund. These funds are expensive. Hospital funds have over $80m salted away in reserves and medical funds have over $40m salted away as dead money in reserves. The funds incur unnecessary expenditures in operaing. Of every $4 contributed to the schem $1 is dead money. It is diverted to administrative costs which are a high proportion of contributions or else it goes into reserves. By international standards and for example compared with the American scheme, which is similar to the Australian scheme, we have an inordinately high retention rate. This is public money that is raised from the public. It is extracted from the public and it ought to be available for all members of the public who go to hospital. If they want further protection they should be allowed to become members of a health insurance scheme - that is, while we have the system as the Government presently operates it.

I am certain it is clear to honourable members and the public that this is not the system the Labor Party would operate. But we are trying to make some improvement and provide some alleviation for the public under the present deficient scheme which the Liberal Government persists in imposing on the public. We propose that allowance of $1.50 for handicapped children should be $2. It is quite wrong for it to be less than this.

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