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Wednesday, 10 June 1970

Dr FORBES (Barker) (Minister for Health) - by leave - Mr Speaker, I wish to make a statement concerning the National Health Bill before it is considered again in Committee. In particular, I desire to make some general comments regarding the 7 requests by the Senate for amendments to the Bill and the 12 amendments to the Bill made by the Senate. As honourable members are well aware, the parliamentary procedures for dealing with requests and amendments made by the Senate to a single Bill - as is the case with the National Health Bill - provide for the requests only to be dealt with by this House as a first step. The decisions of the House on the requests are then conveyed to the Senate which considers the decisions made by the House, before it refers the amendments to the Bill to this chamber for consideration. Because of this procedure, which prevents the requests and the amendments being dealt with in the one stage, it is important, I feel, for me to advise at this point of time of the attitude overall of the Government to the total of 19 requests and amendments that we have to consider.

The first point I wish to stress is the need to have these requests and amendments viewed in their proper perspective. It could be inferred that the relatively large number involved is a reflection of the unacceptability of the Bill - and therefore the new health benefits plan - to the Senate. However this is by no means the case. Firstly, the basic principles of the health benefits plan as framed by the Government and as contained in the Bill have remained unchanged. These include the legislative provisions for the common fee approach as a means of ensuring adequate benefit returns to patients, the proposals for differential benefits as between specialist and general practitioner services and the major changes in the Commonwealth's relationship to the insurance organisations. No amendments have been proposed by the Senate in these areas. This must be taken as an indication that these fundamental principles are regarded as being sound and of course the Government is gratified to find that this is so.

The second point I wish to make regarding the requests and amendments is that only 7 of the total number of 19 are directed to the Bill itself. The remaining 12 - and I repeat 12 out of 19 - are directed not to the Bill but to the principal Act. One of the most important requests made by the Senate is for an amendment to the Act to provide the Commonwealth benefit of $2 a day for all patients, whether or not the individual patient is insured. As honourable members are aware, the Bill is aimed basically at authorising the new medical benefits plan and touches on hospital benefits in only a consequential way. As I advised the House on 4th March last, the recommendations of the Nimmo Committee regarding hospital benefits had implications of such a far reaching nature that the Government is not in a position to make decisions on them at this stage and will not be able to until the States' attitudes have been clarified. I advised at that time that negotiations with the States would be actively pursued. Despite the vigorous pursuit of these negotiations, they have not reached a stage where the Government can formulate and bring forward its proposals in the hospital benefits area. Notwithstanding this, the Government is agreeable to dealing with the matter which is the subject of the amendment to which I have referred - to pay the commonwealth hospital benefit of $2 a day for all patients - in advance of a number of related matters.

Briefly the Senate request No. 5 in the schedule of requests is to substitute the word 'person' for the word 'contributor' in section 46 of the principal Act with the intention of making every patient in hospital automatically eligible for the Commonwealth hospital benefit of $2 a day. Membership of a hospital benefits fund would no longer be a requirement. Speakers to this amendment in the Senate directed their comments mainly to the situation in Queensland where no charge is made on public ward patients. It was claimed that Queensland is disadvantaged as compared with other States due to its adherence over the years to a policy of free public hospitalisation. The Government is sympathetic to this argument and has been ever since the Nimmo Committee submitted its view that Queensland's policy gives full effect to the Commonwealth objective of affording the community adequate financial protection against the cost of hospital treatment. This view was strongly endorsed by the Wedgewood Committee.

The specific terms of the amendment requested by the Senate were clearly directed to the Queensland situation but the amendment went further and proposed the payment of the Commonwealth $2 a day benefit irrespective of whether the patient was insured and irrespective of whether a hospital charge was made. The Government is not prepared to accept an amendment in the wide terms requested by the Senate. However the Government is prepared to sponsor a further amendment to the Bill to provide for the payment of the Commonwealth benefit of $2 a day to hospitals in ali cases in which no charge is made to patients. Under this amended proposal the benefit would be payable in respect of each such patient, irrespective of whether or not the patient is insured, lt is proposed that this benefit will replace, where relevant,, the present Commonwealth benefits paid in respect of such patients. At present these patients are eligible for the Commonwealth $2 a day benefit if insured - and there will be no increased payment for these patients - or the 80c a day benefit if uninsured. The proposal is that in future the patients will not be classified separately in this way but will all attract the Commonwealth hospital benefit of $2 a day for patients where no charge is made.

The Commonwealth benefit of $5 a day paid to hospitals on behalf of pensioner patients where no charge is made would not be affected under the proposal. The mechanics of the payment of the new benefit will be that it is paid direct to the hospitals concerned in the same manner as the 80c benefit is paid now and not through hospital benefit funds. The proposed arrangement will apply of course in respect of any hospital in any State, for example, an infectious diseases hospital, which follows a practice of treating patients without charge. The procedures of the Parliament do not permit a motion for this amendment being moved in this House and arrangements are being made for a request for an amendment along the lines 1 have mentioned to be moved when the Bill is returned to the Senate.

I wish to return now to the other requests for amendments and amendments made to the Bill by the Senate. Generally, these are directed to particular questions and do not involve wide ramifications. The objectives of the amendments are beyond question and my one regret is that each is being brought forward in isolation and not as part of a complete review of the legislative provisions contained in the Act with which the Government will be perservering.

The Government is prepared to accept request for amendment No. 4 relating, to the provisional payment of Commonwealth medical benefit in third party and workers' compensation cases and amendments I, 3, 4 and S relating to the specialist recognition advisory committees, No. 6 relating to the agreement with the Australian Medical Association for the pensioner medical service and No. 9 relating to the furnishing of information by applicant medical and hospital benefits organisations. No. 8, which is connected with request No. 5 dealing with eligibility for hospital benefits, is acceptable in a modified form, as is No. 10 relating to the registration of insurance organisations. In addition, the Government is prepared partially to accept amendments numbered II and 12 dealing respectively with the annual returns of insurance organisations and the pharmaceutical benefits advisory committee. The remaining requests for amendments and amendments are not acceptable to the Government.

In summary, the Government is prepared to accept 9 of the 19 requests and amendments in the form presented by the Senate or in a modified form, lt will present an alternative proposal for I of them and is prepared partially to accept a further 2. The Government is unable to agree to 7 of the amendments. The decisions of the Government are evidence of its determination to improve the health benefits plan in all its aspects as well as its wish to have this Bill passed speedily and given royal assent so that needless delay does not occur before increased benefits are payable to those in the community who incur expenses on medical treatment. As I emphasised earlier, none of the amendments is directed to the new basic principles of the medical benefits plan and I ask the House to give speedy passage to the Bill. I will be speaking to the detail of various requests for amendments and amendments as they arise in Committee.

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