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Thursday, 11 November 1971
Page: 3356


Mr LLOYD (Murray) - Animal quarantine is a responsibility of the Department of Health, and it is this part of the Department's work to which I wish to address my remarks. Recent developments in animal quarantine in several overseas countries are enabling these countries to leave Australia far behind in animal breeding improvement techniques. The Australian cattle, sheep and goat industries need infusions of new genetic material, and a quarantine station which will allow these breeds and strains to be imported is the only effective way to achieve this. We urgently require such a maximum security quarantine station and diagnostic laboratory established on an off-shore island. The diagnostic laboratory section is as necessary as the quarantine facility. The Australian livestock industries arc the backbone of our agriculture and our exports.

Although Australia is one of the most important livestock countries, it possesses fewer disease testing facilities than other advanced agricultural countries. For example, any transmission testing for blue tongue has to be conducted in South Africa. Already unnecessarily large profits are being reaped by the United Kingdom and New Zealand interests because of our policy. With the exception of New Zealand for the last 2 years, no bovine3 have been allowed into Australia since 1958. Since 1969 the importation of cattle semen has been permitted from New Zealand and the United Kingdom. Improved testing and quarantine procedures developed since the 1950s have been reflected in the quarantine stations now established or about to be established in several countries, and in our own rapidly changing semen import regulations.

From a position of no semen imports from the United Kingdom we have moved to one where we allow imports after 2 years quarantine of the semen after certain health tests on the donor bull before semen is taken from him, and, since September of this year, imports are allowed after 12 months quarantine following health tests. Approximately 150,000 doses of semen valued at about $1.5m have entered Australia from the United Kingdom in 2 years, and the flood of expensive semen from this source has just begun. Charolais has been the major breed, but after May of next year simmental will probably surpass it. New Zealand semen from imported United Kingdom bulls was subject to 12 months quarantine before its entry was allowed into Australia, but as of last Friday this period has been reduced to the bull's 6 months residence at an artificial insemination station after a satisfactory blue tongue test. This blue tongue test is to be conducted at Somes Island, which is the new quarantine station in Wellington Harbour. In other words. New Zealand can do it but we cannot.

In September we also altered our import regulations for live animals from New Zealand, so that New Zealand can now import cattle from France without jeopardising her booming trade of exporting to Australia the progeny of imported United Kingdom bulls. This trade is only beginning, but already over 1,000 charolaiscross cattle have been sold at exorbitant prices to Australians. Thousands of doses of unnecessarily expensive charolais semen also are being sold to Australia by New Zealand. Before long simmental and limousin-cross cattle will also be exported to Australia. I understand that the Animal Production Committee of the Standing Committee on Agriculture is investigating this question of exotic breeds of sheep, cattle and goats which would be of value to Australia. A quarantine station would be required to allow their entry into Australia. I have been encouraged by the report in the Queensland 'Country Life' of 28th October last of a speech by Mr R. W. Gee, the Assistant Director-General (Animal Quarantine) of the Department of Health, which he made to the University of Queensland Veterinary Students Association. He said:

If Australia is to maintain a leading position in the production of meat and animal fibres, we must retain access to all genetic material available in the world, so long as our country is not exposed to the risk of importing exotic diseases.

Techniques have now been developed that will permit the importation into Australia of exotic animals from most countries of the world, provided facilities are available that will allow the close segregation of such animals in a high security quarantine station, the testing of them for exotic diseases in the country of origin first and again through a high security laboratory in this country after their arrival.

Dr HelenNewton Turner of the Division of Animal Genetics of the Commonwealth Scientific and Industrial Research Organisation, and possibly the leading sheep geneticist in Australia, is another distinguished and enthusiastic supporter of the need for importing exotic sheep breeds into Australia. She mentioned several of these heat tolerant carpet wool types and wool-less sheep breeds in an article entitled 'Exotic Sheep Breeds of Value in North Australia', which was published .n the July issue of Wool Technology and Sheep Breeding'. If we had some of these carpet wool types of sheep in Australia at the present time we might not be hearing the argument which we hear in this chamber about the imports of wool from New Zealand.

I am not opposed to the use of semen for the introduction of new breeds and new genetic material. I am a director of the Victorian Artificial Breeders Cooperative Bull Farm Bacchus Marsh Ltd, the largest artificial breeding establishment in Australia. It produces about half of the cattle semen produced in Australia. So I hope that I am a constructive supporter of artificial insemination in cattle. But sheep semen techniques are not very reliable, and very few countries from which we would want to obtain sheep would have the technical capability to produce viable, diseasefree semen. The latter is also true of cattle and goats. Furthermore, the development of a new breed by artificial insemination by crossing with an existing breed takes about 20 years, and even then the genetic pool available for the breed is too limited. A total of 240 santa gertrudis cattle were imported from the United States in the early 1950s, and the successful and rapid establishment of this breed indicates that about 200 head of a breed are required. One of the desirable heat tolerant beef breeds, the afrikander, is having difficulty in being successfully established here because less than 10 were imported.

The type of quarantine station at Some Island in New Zealand or Gross Isle in Canada, while suitable for receiving cattle from advanced temperate countries, would not be sufficient for Australia's needs. Because of the midges and other insect carriers in our climate, a station would have to be located on an island about 50 miles off-shore and be capable of holding 200 to 300 animals at a time. It would have to provide security for animals from countries in Africa and the Middle East, with their diseases, as well as to safeguard against the introduction of the foot and mouth problems of northern Europe. I am told that this is technically possible, and Mr Gee's statement, which I quoted, confirms this. I was pleased to read in the annual report of the Department of Health that a veterinarian from New South Wales visited Gross Isle in Canada last year. But such a quarantine station would be expensive to maintain, and people importing animals would have to pay the cost of the quarantine. Canada is importing hundreds of cattle a year, and 1 believe that the cost of the service to the importer is about $2,000 per head. There is no doubt that our demand would be as great. Briefly, some of the types of livestock that would be of value to us are heat and tick tolerant beef cattle varieties and also beef and dual purpose cattle breeds from Europe. In sheep there are the heat tolerant carpet wool varieties, heat tolerant woolless vanties, temperate carpet wool types and temperate woolless mutton types. In goats there are the improved mohair types. In addition to the saving to Australia from the United Kingdom and New Zealand profiteers - this saving would be very considerable - such an island would be of immense value to Australia and its livestock industries in the future.

Dr CASS(Maribyrnong) (5.36>- With the increase in technological changes in medical practice the costs inevitably are soaring and this holds for any country whether it has our particular brand of national health scheme or the American variety, which is supposedly wedded to the fee for service private enterprise system or the system in the United Kingdom and other European countries which has a tendency towards salaried service. But when the Australian Labor Party proposes, in order to cope with our problems here, that we might achieve greater efficiency in the hospital service and at the same time employ the specialists in the hospitals on a salary, that we might reduce the cost of medical care if for no other reason than that we might eliminate some unnecessary surgical procedures, there are usually loud laughs from those who disagree with that policy and suggestions that it is all nonsense. They suggest that we all know that if people get something for nothing they will over-use the system. The suggestion implied in this is if one can get an operation for nothing one is more likely to have it; surely an idiotic suggestion because I do not think anyone would suggest that having an operation is fun. People only have them because they need them. ( would like to quote some facts and figures to confirm the suggestion that we are making that a salaried service, far from increasing the rate of usage of medical services, would tend to reduce it and would certainly reduce the cost to the community. Firstly I would like to quote from what was said by the late Professor John Read when discussing this problem of a fee for service. He said: a decision, conscientiously made, not to operate on a patient, may bring the doctor a fee of $5-20.

This depends on whether he is a general practitioner or a specialist. He continued:

A decision, equally conscientiously made, to operate on the same patient, may bring the doctor an additional fee of $20-$250. Provided the fee concerned in each case is 'the most common fee' on the Commonwealth list, and the patient is insured against medical costs, the direct cost to the patient will be $5 or less.

In other words, the patient has no financial incentive to have or not to have the operation. It still costs him $5 because the bulk of the fee is met from benefit funds and the Commonwealth. So the doctor weighing the issue up is faced with the prospect of using his judgment to decide whether to operate on a patient with a painful tummy. It might be an appendix but he might wait till the morning to see whether it settles down. With some anxiety and after waiting through the night to ensure that nothing goes wrong with the patient, he will get the glorious fee, if he is a specialist, of $20. On the other hand, if he decides to take out what might be a lily white appendix the problem is solved in an hour and he can go home to bed and rest content with the thought that nothing is likely to go wrong and collects a fee of $200. I am not sure what the fee for an appendicectomy is. The point is that he collects the fee and the patient has had an operation which may well have been unnecessary. This is often the case for when the specimen removed on operation is sent to the pathologist the pathologist's report comes back with the remark 'normal tissue'. This is not an uncommon occurrence.

To try to give another example of the influence of fees on the way doctors treat patients, quite by accident I came across an article which purports to show the results of changing from what is in essence a salaried service - a capitation fee where a doctor does not get a fee for every service he provides but a set rate no matter how often he sees the patient - to one where the doctor is paid a fee for every service, amongst patients who pay nothing anyway. This was in Baltimore and service was being provided to indigent patients who did not pay. The interesting finding is that in a group of people, although one would expect getting a service for nothing that these patients would use the opportunities to the maximum - I do not necessarily agree with that view but it is the commonly held view - it was found in 1961 and 1962 when the physicians were paid on a salary basis that the visits per person per year were 2.7 and 2.6 respectively. After changing to a fee for service system straight away the figures shot up to 3 and 3.2. Prescriptions per patient before the change when the doctors were only treating them on a salary basis numbered 5.5 in 1961 and 5.1 in 1962. But when they changed to the system where the doctor got a fee for prescribing, the number of prescriptions per patient jumped to 6.2 and 6.5. In percentage terms there was a 17 per cent increase in the utilisation of physicians' services when they changed from a salaried system to a fee for service system. So let us not be fooled by this claim that if people get something for nothing they will over-use the service.

The next point I would like to raise refers to the hospital situation. I have suggested before that by employing specialists on salaries we would increase efficiency and overcome many of the objections people now have to the large public hospital system. One knows that one has to go along and join long queues. One gets an appointment to see the specialist at one o'clock but turns up at 12 o'clock to get at the head of the queue. However, so does everybody else and one finishes up waiting till 3 or 4 o'clock anyway because the specialist is not there. This is not because he is playing truant but because he is quite legitimately busy treating a private patient somewhere. After all, he has to earn his living and he has a right to look after his private patients. So with the pressures on him and the need to earn a living he is busy treating a private patient and turns up late for his clinic. One hospital in Australia recently experimented with a change from the fee for service system or, as it is known in the large public hospitals, the honorary system - the system whereby specialists provide their services for nothing. The Perth Hospital in 1968 changed to a sessional payment system. The surgeons and physicians are paid a sessional payment for being at the hospital on time to look after their clinic and it is interesting to note what happened at the Perth Hospital.

Before the changeover the monthly admissions to the hospital were 1,600 patients. After the change, in a couple of years it had risen to 2,200 patients a month but at the same time the average bed stay fell by 2 days. In other words, the average admission period for patients fell by 2 days. This can save a lot of money if the average was somewhere about 12 days before the change-over and it then dropped to 10 days. This is quite a considerable saving. Professor Joske gives these figures and he calculated what they were equivalent to in terms of the number of beds required. This was a 600-bed hospital and there wa an increase of 225 beds at that hospital but this was achieved without increasing the number of beds by one. In capital expenditure terms it represented a saving of over $5±m, which is the cost of erecting a 225 bed hospital. In other words, over a year they were able to treat 7,000 more patients without increasing their resident staff or the nursing staff. No increase at all occurred in the number of doctors. The cost in terms of salary for the visting physicians was a mere $50,000 a year.

Let us stop talking nonsense about the sacrosanct doctor-patient relationship depending on a fee for service. That implies that the surgeon or the physician sums up a patient on the basis of whether the patient can or cannot pay for the service before the surgeon or physician treats the patient. That, in my mind, is an insult to the medical profession. Whether a patient can or cannot pay is irrelevant. Members of the medical profession treat patients irrespective of this fact. We must accept the fact that doctors conscientiously want to treat patients. We would get far more efficient service if the doctors were paid a salary instead of a fee for their service. Then we would eliminate this incentive to overtreatment on the part of doctors. It is not a conscious incentive. It is an unconscious one but it is still inevitably there.







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