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Wednesday, 14 September 1983
Page: 815

Mr CONNOLLY(10.15) —Clause 18 of the Health Legislation Amendment Bill is very significant because it demonstrates the concern, which is to a large degree legitimate, that any government has to face in relation to technology in the medical profession. Having said that, however, I agree entirely with my colleagues in emphasising the fact that specialists in the fields of pathology, radiology, radiotherapy and nuclear medicine have every reason to feel that the provisions included in the Act under clause 18 may unfairly discriminate against them. Notwithstanding that, there is a problem that if doctors, who are either in full or part time service with a hospital and who also in relation to their contract of service have opportunities to take private patients using the facilities of the hospital some recompense must be made to the hospital for those facilities. Of that there is no doubt.

The problem rests on the question of whether hospitals have in the past had sufficient incentive to apply a more disciplinary approach to the doctors in their employ to see that the financial structutes upon which hospitals have been providing the very expensive technology which has been used by the doctors for their private patients does bring back to the hospital a reasonable return. It has been pointed out that under present arrangements States do set the paramaters for Commonwealth benefits. Because of this one could argue that the hospitals have never had the incentive to encourage doctors to meet cost requirements which ultimately benefit the Commonwealth because it keeps costs down. Nevertheless, the schedule fees obviously can be adapted from time to time to take this matter into account. The Opposition fears that in the draconian approach which the Government has taken it has not looked at some of these alternatives which need to be considered.

The other question raised is in relation to the specifics of the contract which has been proposed by the Government. One could ask whether this contract will meet the requirements for the provision of specialist services, especially in country areas. I note in the second reading speech of the Minister for Health ( Dr Blewett) that he made the point that conditions for visiting diagnostic specialists could be made more equitable when compared with those proposed for salaried staff. I trust that he has the situation of country hospitals in mind.

Quite clearly an agreement or a contract of services which may apply to a large metropolitan hospital could well not apply to circumstances outside metropolitan areas. Consequently, while the whole question of diagnostic services being provided under private practice contracts by full time specialists is an issue and one which the Opposition agrees needs to be given some consideration, we do not believe that it should be taken out of the context of the relationship which rightly should exist between a doctor and his patient, on the one hand, and at the same time the fiduciary relationship which should exist between the doctor and his employer, which in most cases is the hospital.