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Wednesday, 13 October 1971
Page: 2254

Mr BUCHANAN (McMillan) - The amendment moved by the Opposition is couched in the sort of language to which we have grown accustomed. While not opposing the Bill the Opposition is making some sort of criticism of it. This approach is quite unacceptable for a lot of reasons, but mostly because it is obscured. The amendment claims that the Commonwealth nursing home policy is unsatisfactory because of its cost to the patients. I presume the Opposition would like this to be something that is free. The amendment refers also to the inadequate provision of alternative forms of accommodation. The Opposition does not give any explanation of what that means. Then to say that the system of voluntary insurance for medical services is on the point of collapse is just plain ridiculous. So we reject the amendment. But let us not go into that.

I would like to say a few words about the Bill itself. The honourable member for Oxley (Mr Hayden) did not say very much about it and T hope that other speakers will talk about the Bill and not about health services in general, which could cover a very wide field because to do so would waste a lot of everybody's time. The Minister for National Development (Mr Swartz) has introduced a proposal that we should increase to $1 the 50c patient contribution for prescriptions. I find that this is a rather large increase to be made in one shot. When I come to examine the position, having had the benefit of making a fair study of this whole subject through the House of Representatives Select Committee on Pharmaceutical Benefits, I can only come to the conculsion that the Treasury has asked (hat the amount of $160m which the Commonwealth is contributing to pharmaceutical benefits should be reduced. It has picked out an easy figure and just doubled the patient contribution. The saving works out at between $24m and $25m over a whole year. It will save perhaps $16m for the remainder of this year.

What basis is there for increasing the patient contribution from 50c to $1? I know that some doctors have been recommending that this should be done but I have not been able to find out why they have done so. Originally when this 50c contribution was introduced the Minister spoke about it being a deterrent. The word deterrent' is not used in the second reading speech relating to this Bill. I presume from this that there has been a change in attitude. Anyhow, it is ridiculous to talk about a deterrent to the patient. The patient does not know what the doctor will prescribe. The deterrent should be applied to the doctor. As I have said several times over the years this national health scheme, which was introduced by Sir Earle Page a long time ago, was introduced purely and simply for the benefit of the doctors so that the doctor's bill would be paid and he would be protected all along the line.

When we come to examine what has actually happened in the pharmaceutical area we find that this is what has happened. The doctor can prescribe as much as he likes. Very often a mother will bring along to the doctor a child with a bit of a cold, sore throat and bad chest, and the doctor will say: 'We will have an antibiotic'. He knows it will not do any good. There is no bacteriological testing to see whether an antibiotic is required but on spec, because it does not cost the doctor anything, he orders an antibiotic. He then prescribes a linctus because the mother will expect little Willie to be given some sort of medicine. This will not do him any good either. It may soothe the throat a little, but no linctus has been invented yet which will cure a cough. Because there has been a growing use of anti-depressants and a tendency to give everybody tranquillisers or pep pills the doctor may say: 'Let him have a little bit of some anti-depressant'. So the mother goes along to the chemist with 3 items on the script, and these will now cost her $3. 1 cannot for the life of me see how we can justify this unless we go back in our thinking to 1964 when the 50c patient contribution was proposed.

Dr Klugman - Your figure goes back further than 1964.

Mr BUCHANAN - I only want to go back to that time at this moment. I do not need any comment. I have been associated with the subject for a very long time. At the moment I only want to go back to 1964 when we introduced this 50c. At that time the friendly societies, as friendly societies had done for generations, made medicines available at very low cost. There was a great argument then, and I freely admit that at that time I was against the friendly societies being allowed to benefit from the scheme because it was obvious that, compared with the chemists, they were to be given a greater advantage for their members. I still think that they have an unfair advantage in a lot of ways. But now we have reached the stage where the friendly societies are to be allowed to refund to their members anything up to $1 on the cost of a prescription. At the present time members are making a contribution of 5c a week for a family and this enables them to get their prescriptions at a saving of 40c. I daresay there will have to be an alteration in rates, but that is unimportant. If they want to, they will be able to recoup the whole Si.

My thinking moves from 1964 to the present, and I find that the only way out of the impasse that has arisen would be if we allowed the friendly societies and anyone else who wants to - the pharmacy guilds or the medical benefits funds - to provide pharmaceutical rebates. I remind the House that the La Trobe Valley Health Services provide limited pharmaceutical benefits as do the friendly societies, and there is no reason why this practice cannot be extended so that the rest of the community can take advantage of it. The patient now has to find 40 per cent of the average cost of pharmaceutical prescriptions. In other words, it is becoming a little bit unbearable, and mothers who have to put down $3 on the counter for medicines should be allowed to take out some insurance against the cost as should the whole of the community. No mention of this idea appears in the Bill. If this is no longer a deterrent - and no mention is made in the second reading speech of a deterrent - I submit that we ought to take this action. Actually, it will not cost the Commonwealth Government anything. The insurance funds, presumably on an actuarial basis, will enable people to protect themselves against the cost, as they should be able to do. If people wish to be able to insure against these things, they should be allowed to do so.

I take one little exception to the description of this facet as the most expensive component of the Government's overall health benefits plan. The honourable member for Oxley pointed this out. lt may be the most expensive of the Commonwealth's contributions, but the Commonwealth has chosen to bear the burden of the cost of medicines over the years and, consequently, it is paying out too much. One of the reasons why it is paying out too much is that over-prescribing is taking place. To penalise patients for what is mostly the fault of doctors is not fair.

Another aspect of the Bill is the new prescription fee of $1 per item. I would have thought that a number of items in the list of pharmaceutical benefits would be eliminated because I note that certain items cost 80c or 90c each in respect of which the patient contributes 50c at the moment and the Commonwealth reimburses the chemist by 30c or 40c as the case may be. The cost of these items if removed from the benefits list will be approximately SI. 20 each. They will come under a different formula. Once they are taken out of the pharmaceutical benefits area they will go on to a higher scale of prescribing and will cost the patient more.

I wonder whether the Minister can explain to me what will be done, for example, about digoxin? This is one of the most popular lines. At the moment it is available as a pharmaceutical benefit. If someone orders digoxin that person will have to pay a higher price for it because, under the rules in relation to this scheme, any item costing under $1 will not be included. I am told on excellent authority - I have no confirmation of this - that the prices of various items are being raised to take the cost of them just over SI each so that those items will come within the scheme. The Government, instead of paying out 30c or 40c on each item, will have to pay out lc to 2c only. The contribution by the patient will be $1. If this is so, I regard it as completely unfair. The only extenuating circumstance could be that we would be allowed to have some method of insurance to cover those items.

I turn now to the other part of the Bill that is of importance. After all, the part of the Bill that deals with the medical side is only tidying up some of the things that we all know have been done. I refer now to nursing homes. I would like to have quite a long time in which to talk on this matter. The subject of nursing homes is one of the really bad spots in our whole health scheme. Everyone of us has examples of constituents who are in grave difficulty because they have a relative in a nursing home. These people must meet the gap that exists between the cost of staying at that nursing home and the benefits payable with respect to the patient. That money must be paid by that person before he or she can spend any money on his or her immediate family.

I take Victoria as an example. In that State 83 per cent of the patients in nursing homes run by charitable institutions are base rate pensioners. A further 10 per cent are part pensioners. The cost of operating each bed in a nursing home in that State is said to be $63 per week. A single pensioner in such a nursing home is supported by the Commonwealth to the extent of $17.25 per week and almost certainly a supplementary pensioner allowance of $2 per week is paid. The nursing home subsidy is currently $14 per week. It will now be increased to $24.50 per week. That still leaves approximately $20 per week that somebody has to find. I have a great many figures here but the example that I have given is a fair example of them. With respect to ambulatory patients - here we note the difference between this class and the intensive care class with respect to benefit - between $25 and $30 is the gap which must be made up each week by somebody.

In this Bill the Government has made some sort of move towards alleviating the present situation. An increase of $1.50 a day is provided in respect of each patient in a nursing home. This increase covers a wide area and will cost quite a lot of money. But it will not settle the problem. In any community the position of the frail aged or just the aged, if honourable members like, must be considered in relation to the excellent homes for the aged system which the Commonwealth has subsidised very heavily. This scheme works admirably. Some marvellous homes for the aged where people live in nice surroundings and can spend their latter years looking after themselves are available. But these people reach the stage where they need a little supervision. Hostel accommodation with meals may be available for them or they may need to go into an ambulatory nursing home or to an institution where a little more than supervision - that is, nursing care - is provided. At the end of this scale are the people who have reached the stage where they need intensive care. This is not intensive care in the sense that the term is used with respect to hospitals. These are people who really need nursing care every day of their lives. They may require injections. They may need to be fed or to be dressed. They may not be able to walk around.

One of the answers to this problem must be separate units provided at the government level in association with hospitals. Nursing care should be provided from the hospitals at the required level if necessary. I find that one of the big troubles in nursing homes where intensive care services are required is the very high cost of nursing. One matron, who is facing the prospect of going bankrupt because people cannot afford to pay the fees, is herself paying out at this time in excess of $5,000 a year to a nurse for night duty on 4 nights a week. This is the sort of expense which cannot be carried by an ordinary nursing home. I ask whether the Government could make available units attached to hospitals for the care of these people so that nursing aides would be available in the home and the home would be able to call for nurses if actual nursing care was required.

I know that the Commonwealth Government has made $5m available over 5 years to the States for this purpose. But this sum of money has not been taken up. Victoria has accepted it only quite recently. It will be some time before Victoria achieves anything with that money. The other solution to the problem is to bring the cost of this accommodation within the scope of health insurance in the same way as I have suggested pharmaceutical benefits should come within the scope of health insurance. At the present time, hospital benefit contributions have been streamlined quite rightly on the basis of the recommendations of the Committee of Inquiry into Health Insurance, commonly known as the Nimmo Committee. One of the very good things that that committee did was to propose the categories of standard, intermediate and private wards. There is an anomaly in the whole costing of hospitals in that the cost per bed is obtained by taking the total expenses of the hospital - the cost of stamps and everything else that is bought during the year - and dividing it by the number of beds. That is called the cost per bed.

The cost of a bed in city hospitals is about $28 to $30 a day. The patients contribute only $15 towards the cost of a bed in a public ward. Funnily enough, at the West Gippsland Hospital the cost is only $22 a day. One could rationalise this out and introduce another table, besides the standard, intermediate and private ward tables, for those people who require nursing home care. From the figures that I have been able to obtain - and they would require a lot of checking, but I put them forward for consideration by honourable members - the injection of an extra 10c a week per contributor into hospital contribution funds would provide $5 a day in health insurance benefits for nursing homes, and that would cover the present gap which exists between charges and the combined benefit. Unfortunately, we cannot do any of these things without getting money from somewhere. The people who run these nursing homes must make a profit, but they are not making any fortunes. I do not have time to go into all the details of my proposal, but its adoption would go a long way towards overcoming the present problem.

Mr DEPUTY SPEAKER (Mr Hallett - Order! The honourable member's time has expired.

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