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Tuesday, 21 August 1973
Page: 73

Major reformsare under way in the delivery and financing of health care in Australia. To this end, action is being taken to introduce a new health insurance program, to promote community-based health services and the modernisation and regionalisation of hospitals, to introduce a free dental scheme for school children and to improve the health of Aboriginals.

Some major initiatives in the field of health to be introduced in 1973-74 include: ° assistance for the establishment of community-based health services, including facilities for the treatment of mental illness, alcoholism and drug dependency; ° assistance to meet urgent needs for additional hospital facilities in Sydney, Melbourne and Brisbane; ° provision of free hospital and medical treatment for ex-servicemen of the Boer War and 1914-18 War for non-war caused disabilities; ° provision of free hospital and medical treatment for all ex-servicemen and women with theatre of war service suffering from malignant cancer, regardless of cause; ° introduction of a free dental scheme for school children; ° a new emphasis on health services for Aboriginals.

Direct outlays from the budget on health are estimated to rise from $783.2 million in 1972-73 to $978.9 million in 1973-74, an increase of 25.0 per cent. Estimated outlays on health are equivalent to 8.0 per cent of total estimated outlays in 1973-74.

The total cost of Government assistance in the healthfield includes revenue forgone from various taxation concessions. The cost of these concessions, in terms of revenue forgone, in the 1971-72 income year, the latest year for which data are available, is estimated at $220 million, made up as follows:

 

Details of actual outlays on health in the three years to 1972-73, together with estimated outlays in 1973-74, are shown in the following table:

 

Brief descriptions of the purposes of some of these expenditures follow.

Medical Services and Benefits

Medical Benefits - General

Under the present voluntary health insurance scheme, the Government provides benefits for medical services rendered to contributors to registered medical insurance funds and to their dependants. The rates of Government and fund benefits are related to the fees for medical services and are set out in the Schedules to the National Health Act.

In respect of some insured patients (known as 'Special Account' contributors) whose medical and hospital claims would otherwise be disallowed because of fund rules relating to pre-existing ailments, chronic illness or maximum benefits, the Australian Government reimburses the funds for any losses incurred in providing benefits.

To assist families with incomes of $60.50 a week or less, the Government, under the Subsidised Health Benefits Plan, meets the cost of medical insurance benefits and hospital insurance benefits to cover public ward treatment. This entitlement applies also to unemployment and sickness beneficiaries and to migrants for a period of two months after arrival in Australia. Graduated assistance is provided to families with incomes exceeding $60.50 a week but not exceeding $69.50 a week.

Expenditure on general medical benefits is expected to reach $178.0 million in 1973-74, an increase of $17.8 million on expenditure in 1972-73. The increase reflects, in the main, an increase in population, an increase in utilisation of medical services and greater use of higher cost services. The estimates make no provision for the cost of higher Government benefits which might be determined in the light of the recommendations of the Medical Fees Tribunal that, at the time of writing, was inquiring into medical fees.

Medical Benefits - Pensioners

The Government meets the cost of general practitioner surgery consultations and home visits for pensioners enrolled in the Pensioner Medical Service (and their dependants). These costs are expected to increase by $1.2 million in 1973-74 to $32.0 million as a result of an increase in membership of the scheme and a small increase in the number of services per member.

Treatment and Allowances for Ex-servicemen and Women

The Repatriation Commission meets the costs for eligible persons of specialist, local medical officer, paramedical and dental services, of providing and maintaining surgical aids (including spectacles) and of travelling expenses for the purpose of medical treatment.

The cost of providing these services is expected to. increase by $2.9 million in 1973-74 to $19.9 million. The increase reflects, in the main, new policies announced in the Budget Speech, namely the provision of free treatment for ex-servicemen of the Boer War and the 1914-18 War and for all ex-servicemen and women with theatre of war service suffering from malignant cancer. These measures are expected to cost $2.0 million in 1973-74 and $2.7 million in a full year.

Hospital Services and Benefits

Hospital Benefits - General

Under the voluntary health insurance scheme, the Government provides a benefit of $2 a day for in-patients insured against the cost of hospital treatment. Uninsured patients receive a Government benefit of 80 cents a day. In cases where no charge is made by a hospital, a benefit of $2 for each qualified in-patient day is naid direct to the hospital.

The cost of Government hospital benefits is expected to increase by $15.1 million in 1973-74 to $97.4 million. The increase reflects mainly a greater number of bed-days qualifying for Government benefits, an increase in the number of 'Special Account' contributors and increased membership of the Subsidised Health Benefits Plan.

Hospital Benefits - Pensioners

Under an arrangement with State Governments, pensioners enrolled in the Pensioner Medical Service are entitled to free public ward hospital treatment. The Government makes a payment of $5 for each pensioner bed-day towards the cost of this treatment.

Treatment for Ex-servicemen and Women

Hospitals and clinics are maintained in each State for the treatment of eligible exservicemen and women and dependants. Use is also made of State public hospitals where appropriate.

The cost of this treatment (including capital outlay) is expected to increase by $1 1 .8 million in 1973-74 to $68.7 million. The main component in the cost of treatment is salaries and allowances which is expected to increase by $6.2 million to $40.9 million in 1973-74, largely because of the full-year effect of determinations in 1972-73. Capital expenditure on Repatriation institutions is expected to increase by $3.4 million to $11.0 million in 1973-74.

Free hospital treatment will be given to ex-servicemen of the Boer War and 1914-18 War and ex-servicemen and women with theatre of war service suffering from malignant cancer. The estimated cost of these measures in 1973-74 is $0.7 million and the full-year cost is $1.2 million. The estimated expenditure in 1973-74 also reflects the Government's decision to provide, free of charge, through the Repatriation Artificial Limb and Appliance Centres either directly or through commercial limb makers, artificial limbs to all persons who need them. This is estimated to result in current expenditure of $0.2 million in 1973-74 and $0.5 million in a full-year. Capital expenditure is estimated at $0.5 million in 1973-74.

Mental Health Facilities

Since 1955 the Government has reimbursed State Governments one third of the capital costs of new mental health institutions. The most recent Act under which this assistance has been provided terminated on 30 June 1973 but the Government has still to reimburse the States $1 .75 million in 1973-74 for approved expenditures incurred before 30 June 1973 and an amount has been included in the budget figures for this purpose.

Proposed new arrangements for mental health assistance are described under the heading, Community Health Facilities and Services.

Other expenditures under this item include an annual payment to the New South Wales State Government for the cost of maintaining residents of the Australian Capital Territory who are receiving psychiatric treatment and the cost of medical care and treatment for eligible ex-servicemen and women at State mental hospitals.

Hospitals in the Territories

The Canberra Hospital Management Board operates two hospitals in the Australian Capital Territory and the Department of Health operates five hospitals and a leprosarium in the Northern Territory.

The net cost of hospital services in the Territories is expected to increase by $5.2 million in 1973-74 to $33.3 million. The increase is largely attributable to the construction and operation of the Woden Valley Hospital in the Australian Capital Territory, the expansion of Northern Territory hospitals and to the full year effect of award increases granted to hospital staff during 1972-73.

Capital Cities Hospital Development

As announced in the Budget Speech, grants totalling $4.5 million will be made in 1973-74 to New South Wales, Victoria and Queensland towards the planning and construction of a hospital at Westmead in Sydney and towards site acquisition and planning of a major hospital in both Melbourne and Brisbane. The Interim Committee of the Hospitals and Health Services Commission has identified areas in these cities urgently needing additional hospital facilities and will continue its examination of hospital needs in other areas of Australia. Of the total funds, $4.0 million will be made available to New South Wales and 0.25 million to each of the other two States.

Pharmaceutical Services and Benefits

Pharmaceutical Benefits - General and Pensioners

Except for a flat charge per prescription which is payable by patients, the Government meets the cost of a range of drugs and medicinal preparations supplied on a doctor's prescription to any person in the community. The patient contribution is $1 per prescription except for persons eligible to receive assistance under the Subsidised Health Benefits Plan where the contribution is 50 cents, and for persons enrolled in the Pensioner Medical Service, and their dependants, where no contribution is payable.

Expenditure on pharmaceutical benefits for the general population is estimated to increase by $27.8 million in 1973-74 to $147.3 million. Of the increase, $6.7 million reflects increases in dispensing fees for chemists, including retrospective payments (the full-year cost is $4.6 million). Increases in population and utilisation, and changes in prescribing patterns account for the remainder.

Expenditure on pharmaceutical benefits for eligible pensioners is estimated to increase by $8.3 million in 1973-74 to $66.4 million. The additional outlay results from increases in chemists' dispensing fees, including retrospective payments, amounting to $3.3 million (the full-year cost is $2.2 million) and increases in numbers and utilisation.

Pharmaceutical Benefits - Ex-servicemen and Women

Pharmaceutical benefits are provided free of charge by the Repatriation Commission to eligible ex-servicemen and women and dependants.

The cost of these benefits is estimated to increase by $4.3 million in 1973-74 to $24.3 million. The main element in the increase is the extension of free treatment to ex-servicemen of the Boer War and 1914-18 War and to ex-servicemen and women with theatre of war service suffering from malignant cancer. The estimated cost of these measures in 1973-74 is $2.1 million and $2.8 million in a full year.

Nursing Home and Domiciuary Care Services and Benefits

Nursing Home Benefits

A benefit of $3.50 a day is payable to all patients in nursing homes. An additional benefit of $3.00 a day is payable to those patients requiring intensive care. As from 1 January 1973 a fund benefit (related to fees in each State) became payable to insured patients. For pensioners enrolled in the Pensioner Medical Service, the Government pays an additional benefit equivalent to the relevant fund benefit in each State.

Expenditure on nursing home benefits is expected to increase by $28.0 million in 1973-74 to $120.8 million. The increase reflects an increase in the number of patient bed-days and the full-year effect of the additional benefit for eligible pensioners which was introduced on 1 January 1973.

Domiciliary Care Benefits

Subject to certain criteria being met, the Government pays a benefit of $2 a day to persons who arrange for the provision of nursing care for elderly relatives at home. The benefit was introduced on 1 March 1973. Expenditure amounting to an estimated $7.0 million in 1973-74 represents the cost of the benefit in its first full year.

Nursing Home and Domiciliary Care for Ex-servicemen and Women

Nursing home accommodation is provided, free of charge, to those ex-servicemen and women whose war-related disabilities involve constant care and management. Special and intermediate rate war pensioners, 1914-18 War nurses and chronically ill war widows are assisted with the cost of their nursing home accommodation on the same basis as nursing home patients who are enrolled in the Pensioner Medical Service. Free domiciliary care services are provided as required.

Expenditure on nursing home and domiciliary care for eligible persons is expected to increase by $6.0 million in 1973-74 to $10.0 million. The greater part of the increase results from the full-year effect of the additional benefits for repatriation nursing home patients which became effective from 1 January 1973. The extension of free treatment to ex-servicemen of the Boer War and 1914-18 War and to ex-servicemen and women with theatre of war service suffering from malignant cancer is expected to cost $0.9 million in 1973-74 and $1.2 million in a full year.

Other

This item includes grants to the States to assist in providing nursing home accommodation for aged persons of limited means and subsidies to non-profit organisations that provide home nursing services. The estimated increase of $1.1 million in these expenditures includes the cost in 1973-74- $155,000 - of the increase in subsidies paid to home nursing services announced in the Budget Speech.

Community Health Facilities and Services

It is proposed to provide assistance mainly to the States for the provision of comprehensive community-based health services, such as community health centres. In 1973-74 the Government will meet both capital and operating costs of approved facilities and $10 million has been provided for this purpose.

It is also proposed to introduce legislation to authorise grants to the States and local authorities for the development of facilities - other than in-patient facilities - for treating mental illness, alcoholism and drug dependency. The grants will meet the capital costs of approved facilities, including non-residential and hostel facilities and the maintenance costs of approved non-residential services, including expenditure on preventive programs, research and evaluation. The proposed legislation would also authorise, on the recommendations of the States, grants towards the capital and maintenance expenditure of voluntary organisations involved in the fields of alcoholism and drug dependency. For1973-74 an amount of $7.5 million has been provided for this program.

Treatment and Prevention of Tuberculosis

Under the Tuberculosis Act 1948, the Government reimburses the States for capital expenditures on facilities for the treatment of tuberculosis and for maintenance expenditure on the diagnosis and treatment of tuberculosis to the extent that the maintenance expenditure is in excess of the States' maintenance expenditure in 1947-48.

The Government also extends allowances to persons suffering from tuberculosis and their dependants. These allowances will be increased in line with social service pensions and benefits.

Expenditure on the treatment and prevention of tuberculosis is estimated to increase by $0.9 million in 1973-74 to $13.4 million.

Health Schemes for School Children

Under agreements with the States the Government has reimbursed them for the cost of supplying one-third of a pint of milk each day of the school year to children under 13 years of age. As announced in the Budget Speech, it is proposed to enter into discussions with the States with a view to modifying the scheme as from 1 January 1974 or as soon as possible thereafter.

The Government is establishing, in co-operation with the States, an Australia-wide school dental scheme. The aim is to provide a free dental service to all pre-school and primary school children by 1980 and, subsequently, to secondary school children under15 years of age. The Government will meet the capital and running costs of training facilities as well as the capital costs and 75 per cent of the running costs of clinics.

Total expenditure on health schemes for school children is expected to increase by $4.3 million in 1973-74 to $16.1 million. Expenditure on the free supply of milk to school children is expected to decline by $3.5 million, but this will be more than offset by the estimated expenditure of $7.9 million on the school dental scheme.

Health Services in the Territories

In the Australian Capital Territory and the Northern Territory the Australian Government provides health services of the type provided elsewhere in Australia by State and local government authorities. These services include public health activities, ambulance services and community health centres. The cost of these services is estimated to increase by $2.8 million in 1973-74 to $10.5 million.

Health Services for Aboriginals

The main item under this heading is grants to the States for Aboriginal health services. These grants, which are estimated to increase by $6.3 million in 1973-74 to $9.1 million, will provide additional hospital facilities, clinics, health centres, doctors and nurses in areas of higher Aboriginal population. Provision is also made for the development of programs of health education and preventive medicine.

Expenditure in the Northern Territory on Aboriginal health services is also expected to increase significantly.

Other Health Services

Medical Research Grants

Through the medical research program of the National Health and Medical Research Council, the Australian Government assists the medical research activities of Australian and State Government departments, universities and institutions, and of individual research workers and the training of medical research workers. The increase of $0 . 5 million in 1973- 74 to $4.3 million reflects the first full-year cost of the Council's 1973-75 triennial program.

Commonwealth Serum Laboratories Commission

The main functions of the Commonwealth Serum Laboratories Commission are to produce and sell biological products, undertake research into the production of therapeutic biological products and hold stocks of biological products. The total provision of $3.2 million for 1973-74 is $0.4 million higher than for 1972-73.

The Government has announced its intention to establish a separate Australian Pharmaceutical Commission, alongside the Commonwealth Serum Laboratories Commission, to acquire a non-biological production unit with a view to the later amalgamation of the two Commissions. No funds have been provided for this purpose in the Budget.

Health Laboratories

This item covers the running costs of the Australian Government Health Laboratories, the Acoustic Laboratories, the Radiation Laboratory and the National Biological Standards Laboratory.

The Health Laboratories make available a free clinical pathology service to hospitals and medical practitioners.

The Acoustic Laboratories supply hearing aids to children, ex-servicemen and eligible pensioners and their dependants and conduct research. As announced in the Budget Speech, it is proposed to amend the National Health Act to abolish the $10 charge currently paid by eligible pensioners and their dependants who are supplied with hearing aids. The amendment will also entitle these persons to receive free hearing aid batteries from the Acoustic Laboratories. The estimated cost of these measures in 1973-74 is $75,000 and the estimated fullyear cost is $150,000.

Standards for the measurement of ionising radiations and radioactive substances are maintained by the Radiation Laboratory. The Laboratory is also responsible for procuring and distributing all radio-isotopes used in Australia and for the surveillance of the level of radioactivity in the Australian environment.

The National Biological Standards Laboratory is responsible for testing therapeutic products recommended for listing as pharmaceutical benefits. The Laboratory is also involved in setting standards for goods which come within the provisions of the Therapeutic Goods Act.

Expenditure by Health Laboratories is expected to increase by $2.5 million in 1973-74 to $11.7 million.

Educational Campaigns

The Government sponsors two educational campaigns in the health field - the National Drug Education Program and the Anti-Smoking Campaign.

Since 1970-71 the Australian Government has provided funds to support State and National projects of drug education; $750,000 has been allocated for the program in 1973-74.

The National Education Campaign on Smoking was launched in 1972. Under this program, up to $500,000 for each of the three years to 1974-75 has been allocated for the purposes of disseminating information on the health hazards of smoking. To reinforce this educational campaign, the Government has decided that advertising of cigarettes and cigarette tobacco on television and radio will be phased out over three years.

Blood Transfusion Service and Products

The Australian Government meets 30 per cent of the annual operating cost of the Red Cross Society's Blood Transfusion Service in the States and 90 per cent in its Territories.

Blood collected by the Society's Transfusion Service is processed into blood fractions, plasma and serum by the Commonwealth Serum Laboratories Commission. The blood products are supplied, free of charge, to hospitals and approved pathologists for use in medical diagnosis and treatment. The Australian Government reimburses the Commission for the cost of processing the blood.

The Government's contributions are estimated to increase by 80.6 million in 1973-74 to $3.0 million.

Quarantine Services

Human, animal and plant quarantine measures are enforced mainly to prevent the introduction of exotic diseases into Australia. By arrangement, the States administer animal and plant quarantine with costs being reimbursed by the Australian Government. Human quarantine is administered by the Australian Government.

To encourage" the safe disposal of overseas ships' garbage, the Australian Government has met the whole cost of providing incinerators and ancillary structures at selected ports and has shared with the States half the cost of access roads.

Quarantine services in 1973-74 are expected to cost $4.6 million, about the same as in 1972-73.

Other

This item includes the cost of the Australian Government's annual subsidy to the Royal Flying Doctor Service (currently $485,000 a year), subsidies towards the cost of certain international health conferences and administrative expenditures related to public health and the administration of the Therapeutic Goods Act.

General Administration

This item comprises the general administrative and capital expenses of the Department of Health and the Department of Social Security (in respect of health insurance). The estimated increase in administrative expenses of $15.6 million in 1973-74 to $29.7 million, includes the full-year effect of salary and other cost increases in 1972-73 and expenditure of $8.0 million for a computer that the Department of Social Security will use for the proposed new health insurance program.

Recoveries

Recoveries include miscellaneous charges imposed by the Australian Capital Territory and the Northern Territory Health Services and charges met by certain countries for treatment given to their ex-servicemen through Repatriation facilities.







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