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Wednesday, 13 October 1971
Page: 2258

Dr KLUGMAN (Prospect) - As seconder of the Opposition's amendment I wish not only to concentrate on the points that we make in our amendment but also to make some general criticism of the National Health Bill. One would have thought that when the Government had an opportunity, such as it has now, to amend the National Health Act- this Bill in fact is amending it - it would have gone much further than it has. I should like to commence by referring to the one positive contribution which the Government has made in this piece of legislation. This is the change which was made to the Bill which was introduced some 2 weeks ago. It relates to increased subsidies for nursing home patients. It was not mentioned in the previous Bill.

The proposed increase in the nursing home subsidy will add another $24m per annum to the Budget, and I am not com plaining about that. But I should like to re-emphasise the point which was made by the honourable member for Oxley (Mr Hayden) in the last minute of his speech. He did not have time to develop it. It is important to realise that this answer which was given last week by the former Minister for Health (Dr Forbes) was given after the Prime Minister (Mr McMahon) had made his announcement regarding the increase in the nursing home subsidy. The question referred to tables which had been submitted by the Government in 1967 - 4 years ago - as evidence to the Senate Select Committee on Medical and Hospital Costs and asked the Minister to update those tables according to the latest available information. What answer did we receive from the former Minister for Health? He said that the tables 3.25 and 3.27, which relate to fees charged for private nursing homes, have not been updated as projects have not been undertaken to obtain more recent information. This is a ridiculous proposition. The Government decides to spend $24m on providing subsidies for nursing homes but it does not even know what fees are charged by nursing homes. It has not obtained any information on that matter since 1967. I am not blaming the present Minister for Health (Senator Sir Kenneth Anderson) who probably knows very little about health or health administration. After all, the portfolio of Minister for Health had to be moved into the Senate and I feel that at least the present Minister for Health is basically a more decent and reasonable person than the last 2 Ministers for Health, Dr Forbes and Senator Greenwood who were completely hopeless and, in addition, in my opinion did not have any sort of humanity or sensitivity about them, which I think the present Minister for Health possesses.

Why has the number of nursing home beds increased from 33,000 to 47, 000 in the last 5 years? Let us look at this matter. One of the reasons for the increase is that the Government has not gone on to deal with a much bigger problem than nursing homes, and that is the question of psychiatric hospitals. In 1956 the Government decided to amend legislation which had been in existence under the Chifley Government which treated psychiatric hospitals in the same way as ordinary hospitals. There can be no earthly reason why this should not be done. But no, the Government does not subsidise psychiatric hospitals. It does not even pay pensions to pensioners who are inmates of psychiatric hospitals. What a fantastic proposition to put forward in 1971. One could see the sort of attitude which the Department of Social Services adopts in the answer which was given last week to a question concerning the payment of pensions to psychiatric hospital patients. The reply referred not to psychiatric hospital patients but to inmates of mental hospitals. This is the sort of attitude which is adopted by the Department of Social Services and, I suppose, the Department of Health.

What happens is that as soon as a patient is admitted into a State psychiatric hospital - and I am talking about the position in Sydney, but this position applies in the other States - he does not receive a subsidy from the Government. He does not receive his pension, he does not receive the $2 a day subsidy and he is not eligible for hospital benefits. What does the State government do? First, it charges the patient at the rate of approximately $70 a week, and that rate also applies to pensioners. The States do not take any active steps to recover the fees if the patients have not any money - and the vast majority of them do not have any money. All of the patient's assets go to the Master of Protective Custody, and when the patient and the patient's spouse die the Master of Protective Custody sells all their property in order to recover the amount of fees due, which amount to approximately $3,600 per year.

As we know, more than 78 per cent of patients in psychiatric hospitals are in fact long term patients; they are in hospital for more than one year. Therefore, for practical purposes they lose all their property. This is the ridiculous proposition which applies to patients who are admitted to psychiatric hospitals. I have some in areas surrounding my electorate. As soon as patients are admitted to psychiatric hospitals, the State government - and 1 do not blame it - tries to get rid of the patients because they cost too much money. As soon as patients have been sedated with Largactil, or whatever tranquiliser is the cheapest at the particular time, the govern ment transfers the patients to private hospitals or nursing homes. Then the patients become eligible to receive a subsidy of $2 a day. It will now become $3.50 a day or even $5 a day or $6.50 a day if they are intensive care patients.

Obviously the Government pushes the patients out of psychiatric hospitals because they can receive that kind of subsidy in nursing homes. In addition, patients become eligible to receive their pensions. But they receive no treatment in these nursing homes. Occasionally a doctor may call, but he does is write out another prescription for more Largactil or whatever is being given to the patient. The more Largactil that is given to patients the more sedated they become and the more they need intensive care. In this way, patients in these nursing homes are more likely to receive $6.50 a day instead of $3.50, or $5 a day instead of $2, depending on whether we are considering the position before or after the Act is amended. The Government does not concern itself with this matter. This is a disgrace. This is due to the fact that patients in psychiatric hospitals and their relatives do not kick up sufficient stink. Friendly societies mounted a campaign to have the previous Bill altered between the time when it was introduced 2 weeks ago and now and alterations have been made. I am not complaining about the alterations, but I am pointing out what happens if some sort of organisation puts pressure on the Government and what happens if pressure is not put on the Government.

I turn now to deal with the subsidised health benefits plan and the pharmaceutical benefits scheme. The Minister for National Development (Mr Swartz), who in this place represents the Minister for Health, in his second reading speech referred to the proposition that under the subsidised health benefits plan people are also eligible to receive pharmaceutical benefit concessions. The Minister said:

While the Government will assist these special groups of people to obtain their pharmaceutical benefits for a charge of only SOc, the onus to establish initial eligibility must rest with the persons concerned. It is essential therefore that persons who believe they are entitled to subsidised pharmaceutical benefits, should make application to the Department of Social Services or. in the case of migrants, to the Department of Health as soon as the changes become effective.

That proposition is quite ridiculous when already we have seen that the subsidised health benefit plan is- not working for the very reason that there is too much bureaucracy involved. The honourable member for Bendigo (Mr Kennedy) who conned the figures from the Minister for Health will no doubt deal with this point. The figures show that only a very small proportion- about 10 per cent- of people in what are called A, B and C categories apply and only about half of them go on to register after their applications have been granted. What happens is that the Government spends huge amounts of money on advertisements in foreign language newspapers, radio and television broadcasts telling new Australians about the necessity to register for national service but nothing is spent on advertising the subsidised medical services available to this group of people. Politically I do not mind because all that these advertisements do is confirm the fact - and it is a fact - that this Government is more concerned with conscripting young migrants than it is with helping the needy migrants. We think that the Government's spending on advertisements certainly confirms that fact.

Mr Graham - You really do not believe that.

Dr KLUGMAN - You should find out how much is spent on advertising for conscription purposes and how much is spent on advertising our subsidised medical benefits scheme in foreign language newspapers and foreign language advertisements. I want to deal briefly with the increase from 50c to $1 for prescriptions under the pharmaceutical benefits scheme. Before doing so I will deal quickly with the funds because the schedules refer to the increase in doctor's fees. There has been an increase in the common fees and this has been incorporated in the amended Bill. We know that there is an increase; yet the Minister has stated that medical incomes in New South Wales increased by 30.5 per cent between the December quarter of 1969 and the December quarter of 1970. Following this - I emphasise the words 'following this' - huge increase of 30.5 per cent in one year there was a further increase of 15 per cent for general practitioners which came into force on 1st July 1971.

In answer to a question on notice, question No. 2790, on 8th September 1971 the Minister gave the figures, giving a completely wrong impression, on the question of democracy in the health funds - what we call medical and hospital benefits organisations. He referred to the fact that 83 per cent of medical benefit organisations and 77 per cent of hospital benefit organisations have provision in their constitutions for the election of contributor representatives to their governing bodies. What he has ignored is the fact that the main funds, for example in New South Wales, the Medical Benefits Fund of Australia and the Hospital Contributions Fund of Australia have no such provision. There is no provision for contributor representation on the boards of directors of those funds. Those funds would cover well over 80 per cent of all people with medical and hospital insurance in New South Wales.

Even in funds in other States where this provision does exist contributor representatives have very little say. For example the Hospital Benefits Association in Victoria, which is the main health insurance organisation in that State, has only 4 elected contributor representatives out of 52 members. I suppose it is a step in the right direction but on the basis of representation it is certainly very unsatisfactory, as I think most people will agree. The cost of health insurance has gone up at a terriffic rate compared with the Commonwealth basic wage and the minimum wage in New South Wales. I would like to make the point that the percentage of subscriptions at the lowest possible cost to medical benefit and public ward hospital funds in New South Wales, as a percentage of the ruling Commonwealth basic wage in 1955 and the minimum basic wage in New South Wales in 1971, has increased from 1.03 per cent of the basic wage to 3.52 per cent of the basic wage. This is a huge increase in proportion - from 1.03 per cent to 3.52 per cent of the basic wage. I seek leave to incorporate in Hansard a table which sets out the minimum weekly family contributions to medical funds and family hospital contributions compared with the Commonwealth basic wage and the minimum wage. I checked earlier with the Minister who is in charge of this matter.

Mr DEPUTY SPEAKER (Mr Drury)Isleave granted? There being no objection leave is granted. (The document read as follows) -


I turn now to the pharmaceutical benefits scheme. There has been an increase in the cost per prescription from $2.18 in 1960-61 to $2.30 in 1970-71 but the number of prescriptions per person have gone up from 2.13 a year in 1960-61 to 4.46 per person in 1970-71. Let us look quickly at some of the reasons for these increases. The Minister gave some reasons and I accept some of them as being relevant but then he says: 'What other reasons.' We do not know what they are. Might I suggest a couple of reasons. The first is the poor doctor and patient education on the use of drugs. There is a proposition that patients expect to get some sort of prescription when they walk out of the surgery and there is an acceptance by doctors of the advertising by drug companies that their product will solve some particular problem, though this is true in only a very small percentage of cases. Secondly, there is a proposition - and this is something with which the Department of Health should certainly deal - that there is pressure on doctors to keep the costs of their prescriptions down.

I had been in practice until about 2 years ago. Some 6 or 8 years ago when I was in practice I had a visit from 2 gentlemen from the Department of Health who looked like detectives. Probably they were picked for their size. They were very pleasant. 1 have no particular complaint about them. They wanted to see me and it looked at though 1 was to be charged with something. Then they told me the terrible news that the average price of my prescriptions was - I am now being approximate - £2.6s compared with an average of £2.2s for the area. I had an argument with them because I hate bureaucracy interfering with me in that way. I think I adequately explained my position. When I asked other doctors what they did they told me that when they write a prescription for something very costly - it may cost £4 - and something which would bring up their average price they add a prescription for absorbic acid tablets which cost only about 4s, a prescription for asprins which cost only about 4s or for sleeping tablets which cost about 4s. The average of the 2 prescriptions, although the second was unnecessary, would be £2.2s instead of £4 for the first prescription only. The Government is only kidding itself if it believes that it is achieving anything by insisting on certain averages because it does not work out this way. People can get around such propositions. They can add a prescription for olive oil, cascara or other items. The Minister for Immigration (Dr Forbes), who usually represents the Minister for Health in this place, was, to my mind, obviously wrong in his estimates of the effect of the proposed increases in patient contributions on the total amount involved. He said that the increase from 50c to $1 will effect a reduction in the cost of the scheme to the Commonwealth in respect of general prescription benefits of $24.6m in a full year. I cannot accept that proposition because, as table 37 of the 1970-71 annual report of the Department of Health shows the patient contribution on general benefit prescriptions was $24.4m last year and the contribution rate has been doubled since then. Therefore that amount of $24.4m would be only the starting point. In the same speech he said that it is estimated that the rise in the cost of prescriptions will be 15 per cent and the rise in the number of prescriptions will be 6 per cent; yet the total increase will be only 1 per cent. Obviously those figures must be wrong. I would like to deal with some of the specific effects of the alterations in pharmaceutical benefits but, regrettably I do not have the time to do so at this stage. However, I shall try to do so in the Committee stage of the consideration of this legislation.

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