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Wednesday, 13 October 1971
Page: 2265

Mr KENNEDY (Bendigo) - I wish to devote my speech to the health needs of the poor in Australia. I believe that the situation is so important that a committee of this House should be established to investigate the health needs of the poor and the under privileged groups in Australia and to make recommendations on how their needs should be met. I say this because of the evidence of the gross failure of the Commonwealth Government's subsidised medical scheme for low income families. Figures recently released indicate that there is a great and fundamental failing in this Government's provision for Australia's poor. Yet I believe that the collapse of the subsidised medical scheme is only the tip of the iceberg. Although this has been disastrous in itself nevertheless it exposes to the public only the financial side of the health care of low income families and groups in Australia.

Let us briefly review the facts. The figures show that only 25 per cent of eligible migrant families and individuals arriving in Australia last year fully protected themselves in the Government's scheme by registering with a private benefits organisation. Only 4 in every 10 of Commonwealth social service beneficiaries receiving unemployment, sickness and special benefits protected themselves by registering with a private benefits organisation. Some dispute has, of course, been manufactured by the

Government over the figures of those who are specifically low income families living under or slightly above the minimum wage. Suffice to say that even if we accept the dubious Government device of legislating 60,000 families out of the low income category so that today not 180,000 but 120,000 families are eligible for assistance, the simple fact is that this low income section of the community has been prevented by the over complexity and under publicity of the scheme from joining it. As at 30th June this year, just 18 months after the scheme came into operation, only 6,102 families in Australia earning less than $46.50 a week were registered with private benefits organisations and thereby protected against the costs of ill health. I repeat that as at 30th June this year, 18 months after the scheme came into operation, 6,102 families on incomes below $46.50 were registered with a private benefits organisation and properly covered by the Government's scheme.

The failure of the Government to enlist people into its medical scheme is only the tip of the iceberg. The nine-tenths of the iceberg that 1 am afraid will not be seen, and has not been seen in the past, represents the overall health needs of the poor. This is what I believe should . be investigated by a special select committee of this House. The danger is that this Government, having been acutely embarrassed by the failure of its scheme, will fall victim to 2 temptations. Firstly, it will see only the insurance problem and not the overall problem of health care and, secondly, it will resort to a few gimmicks of public relations to resuscitate artificially a scheme which requires not sticking plaster but major surgery. Let us look at these 2 problems- The only solutions the Government has to the failure of its scheme are firstly, spending more money on advertising; secondly, simplifying a few procedures; thirdly, making better use of social workers and hospitals, mainly owned or employed by the State governments, to enlist those eligible into the scheme.

Let me reiterate that the only means of including every citizen within a single insurance scheme is to have a single compulsory, universal insurance scheme that levies charges on the pay packet according to the ability to pay and with generous exemptions according to family size. Let us not forget the size of the problem that the Government's legislation should be dealing with but is not tackling. According to the Nimmo Committee's recommendations made 2 years ago. the means test should take account of family sizes to cover 250,000 low income families or 1 million people. There is no doubt that the Government is hostile to such a scheme. It is satisfied with claiming eligibility for only 120,000 families. Yet only by including the largest number of low income families can the scheme succeed. Here is the Govern* ment's paradox: If it does not include all these families, the whole scheme will not be effective; but if it does, there will be so much red tape and bureaucracy involved in coping with a multiplicity of means tests that, as Scotton and Deeble have pointed out. the costs could not be justified to the public. The Government would be in the position of having to justify not having a single compulsory health scheme. This is one of the reasons why the Canadian royal commission on health recommended that for a health scheme to be effective and economically to exempt low income families, it would have to be a single compulsory scheme, that is, a scheme along the lines proposed by the Labor Party.

How effective would attempts to revive the health scheme be? Firstly, in the case of migrants, only 1 in 4 of those arriving last year was registered in the Government scheme by fully, enrolling with a private benefits organisation. These are most likely to have been the migrants from English speaking countries who made up one half of migrants arriving in Australia in the June quarter. Regardless of the subsidised medical scheme, 1 estimate that probably 80 per cent of Greek, Italian and Turkish migrants arriving over the last 18 months have not been covered either in the subsidised scheme or in the benefits insurance scheme. The 1966 poverty survey in Melbourne showed that in Melbourne, 75 per cent of Greeks and Italians surveyed who arrived over the previous 5 years were not in a health benefits organisation. The surveyors also estimated that 98 per cent of the Greeks arriving in the last 18 months before the survey were not covered with insurance. Furthermore, Scotton and Deeble, reporting in a book entitled 'The

Health of a Metropolis', said that their survey of Prahran in the last few years showed that cultural factors were a massive influence alongside the family's low income status in preventing these migrants from protecting themselves. While it took United Kingdom settlers in Australia 10 years to reach the Australian average of 77 per cent of the community being covered, in 10 years only 53 per cent of Greeks and Italians were enrolled in a health insurance organisation. In a period of less than 4 years only 51 per cent of United Kingdom settlers were insured, while the percentage of Greeks and Italians was less than 37 per cent.

Thus any improvement for the 2 months eligibility of migrants - during which period they are probably healthiest of all - will be virtually of no significance as a means of enrolling certain groups of migrants in the benefits scheme and of protecting them. Yet even if we were able to include every newcomer into the health benefits system, we would still be faced with the fundamental question which demands investigation by no less important a body than a select committee of this House: that is, what sort of problems do the migrants arriving have, and how well are we meeting them? Just how vital this question is has been highlighted by the article in the 'National Times' on Monday entitled 'The Rising Migrant Health Scandal'. The article by Eric Walsh paints a grim picture of large scale neglect or ignorance of the health needs of migrants. It dramatically highlights the disastrous consequences for migrants in leaving the nation's health facilities and provisions unchanged despite the special and great needs of migrants. It lends support for my belief that under this Government the Department of Health has had its functions narrowly circumscribed within the ideological dogmas of the Government; that is, the Department does very little to examine and improve the health care of the nation, because it is preoccupied with making the Government's health insurance scheme stave off failure and because it is afraid of cutting across Liberal dogmas about State rights. The fundamental questions of the quality and availability of health care for the Australian people and, in particular, for such groups as migrants, have to be made subordinate to the question of the cost of care and the primary question here is the cost of insurance. Similarly, even supposing every low income family eligible for Government assistance was involved in the Government subsidised scheme, the fundamental questions would still remain: What sort of care do such families require, and are these needs being met?

The scheme of course will not succeed. For example, only a fraction of families led by male wage earners on the minimum wage is included in the scheme at present. Indeed, if we assumed that every family registered with a private benefits fund as at 30th June this year was led by a mother, we would see that only a fraction of all the uninsured deserted wives in Victoria are covered in the scheme.

According to the 1966 survey of poverty, while 17 per cent of intact families in Melbourne were not insured, the percentage of fatherless families not insured was 25 per cent. In 1966 there were about 15,000 such families in Victoria; so a quarter of these, or 3,750, would be uninsured. Yet no more than 2,373 families earning less than $46.50 or more were enrolled with the Government scheme in February this year, while 4 months later a total of only 658 families and individuals were registered with a private benefits organisation. As it happens, about 60 per cent of all the families registered under the category earning less than $4.50 were families led by women. Thus the scheme has massively discriminated against and excluded tens of thousands of low income families led by male wage earners and wives. The Government grasps at the straw of hope that tampering with the system will get all these people into it. It will not.

Of equal importance is this: How are the poor being catered for? What are their needs? We simply do not know well enough. What are we doing about the situation where the low income family is either prevented from attending a doctor because the father has fallen behind with his bills or because of a shortage of doctors in his district? Perhaps he is attracted to the outpatients clinic because of cheap pharmaceutical costs or out of habit, or, being uninsured for treatment by a general practitioner, finds the treatment at the outpatients clinic either free or cheap enough to go without medical insurance. Are we satisfied with this system? And what of the health needs and the health care of the aged and others who are either enrolled in the pensioner medical scheme or are excluded from it by the tapered means test? The scheme has numerous defects and the gap is growing between the services offered to one minority in the community and the superior and more extensive services offered for those enrolled in the voluntary health insurance scheme as a whole.

Those who are in the pensioner medical service are not covered for specialist treatment except at a public hospital, and basic services such as chiropody, physiotherapy, and optometrical services are not provided. The lack of fundamental requirements such as oxygen for aged people with, say, asthma is a vicious defect in the system. For example, only a few months ago one of my constituents complained to me that she was paying $31 a month, or almost a quarter of her and her husband's pension income per month, for a cylinder of oxygen. What would the husband's condition have been if he did not have the oxygen? Such is the system that even the doctors themselves have described it as being in many ways a second rate scheme. But perhaps the worst defect of the pensioner medical scheme is the uncertainty, doubt and worry about their future that members of the scheme have. Coupled with this is the feeling of charity and a handout being conceded rather than of a basic right being acknowledged. There is also the feeling among many pensioners, and among doctors who treat them and who sacrifice a portion of their income to do so, that the pensioners are a race apart. This causes suspicion and resentment among pensioners and gives rise to the fear of over-using the scheme.

The uncertainty among pensioners arises from the dissatisfaction of doctors with the scheme. Not all doctors will treat pensioners. In the city of Bendigo only 15 of the 25 general practitioners, according to figures given to me earlier this year, will treat pensioners. I believe this is not only a unique but also a disgraceful situation.

This represents a 40 per cent no-confidence vote in the Government's scheme of pensioner medical care. Even of those 15 doctors treating pensioners, some are treating them in only small numbers, and in some cases the pensioners are old patients treated before they become pensioners. Those who are treating pensioners have warned that they cannot treat any more than they are already treating. Others will not treat pensioners at all. Considerable heartbreak and distress is caused when the patient, on reaching retirement and pension age, is pushed off to the outpatients clinic or, alternatively, is advised that his pensioner medical service is not adequate and that to ensure the full services of a doctor he should enrol in a benefits fund. There was recently a case where one general practitioner was called out to a patient at night. Upon arriving and discovering that the patient was a pensioner he said: 'I would not have come if I had known you were a pensioner.' There are also some doctors who treat patients for simple problems but pass them on to the outpatients clinic for more complex treatment.

There is no doubt that this is an unjust and discriminatory system which forces doctors to subsidise the Commonwealth Government and which offers pensioners frequently a second class service. The problem in Bendigo is made more difficult because the city has an unusually large percentage of pensioners in its population. It is also short of at least 8 general practitioners, like most country areas and also like some inner suburban areas. Similarly, it regularly faces the difficulty faced by most country areas of attracting sufficient doctors not only for private practice but also for the base hospital. As a consequence of all these factors, a very large number of low income families and pensioners attend not a general practitioner but the outpatient clinic of the base hospital.

One could talk at length about the health needs of the aged, the low income families, migrants and the Aborigines, yet of all these groups it is difficult to speak effectively. It is difficult, if not impossible, to discuss the problem of the health care of the poor in Australia. The research has simply not been done. Indeed, there is hardly any research being done in Aus tralia on the social aspects of medical care. There is an appalling ignorance, both among the community at large and in the Government itself, of the health needs of the poor. The collapse of the Government's subsidised scheme shows clearly that its interest was not in the welfare of the poor but in the continuation of its health insurance scheme. Similarly, the Department of Health is allowed to show little interest in health care outside the programmes of public health and the battle to prop up the Government's health insurance scheme. The Government sees its Department of Health largely as a disburser of moneys to the States. So we know that as an initiator of forward looking plans of comprehensive health care for the community the Government has failed dismally.

The poor are unseen and neglected. As a result, we know very little about the following: Firstly, the distribution and accessibility of general practitioners in poorer areas; secondly, the extent to which the poor are forced to use outpatients departments of public hospitals which are not designed to meet such needs; thirdly, the efficiency and economy of the use of outpatients departments by the poor; fourthly, the incidence of illness among the poor and the nature of this illness, especially chronic illness; fifthly, the connection between the ill health of the poor and the general pattern of their life style such as diet, hygiene, social and psychiatric problems and their promptness in seeking medical care; and, sixthly, the need to link health, education and social welfare services. By comparison with our appalling ignorance here, overseas - especially in the United States - the problem of the health care of the poor has received a tremendous amount of attention from governments and medical personnel. By comparison with the indolent apathy of the Australian Government, the United States Government has taken an active role in providing for the poor through substantial grants to States and to institutions for the care of the poor.

American observers and medical people claim that the traditional pattern of medical practice does not serve the poor well, and that the use of outpatient clinics is an unsatisfactory means of meeting their needs. In particular they have recommended the establishment of special community health centres in poor areas containing not only general practitioners but also social workers, psychiatric social workers, home nurses, health educationists, community liaison officers and so on to provide not only care but also prevention and education. The theory behind these centres is that they concern themselves with general social problems of the poor which have a direct bearing on their health. Such centres, hopefully, will attract the poor to them so that they will have a more positive attitude towards their health problems and will seek care as early as possible rather than leaving it till later when the situation is worse.

Thus not only do we need research on the subjects mentioned earlier. I am trying to track down some information on the subject. I was amazed at just how little research information there is in Australia on this subject. An extremely important part of such research would be to establish experimental community health centres, especially in poor areas, so that overseas theory and practice can be tested in Australia. In this regard, it is to be hoped that university departments of social and preventive medicine will sponsor such centres through the public hospitals with which they are associated. This has become common in the United States, and the Federal Government there makes special grants for foundations to set up community health centres.

I strongly urge the Government therefore to give all the financial support necessary to the venture by the Department of Social and Preventive Medicine of Monash University in co-operation with the University of Melbourne to establish a community health centre in Prahran. The centre will co-ordinate and integrate community health and social services. Doctors, social scientists, representatives of the Royal Prince Alfred Hospital and of the Mental Hygiene Authority will co-operate in this experiment. I strongly urge the Commonwealth not to allow financial obstacles to obstruct this project.

Finally, to reiterate, there is an appalling ignorance of the health needs of the poor in Australia and of other underprivileged

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groups. We do not know how these needs are being met. Accordingly, because I regard this matter as being of such importance, I move:

That so much of the Standing Orders be suspended as would prevent the honourable member for Bendigo from moving:

That this House is of the opinion that a select committee should be set up immediately to investigate and recommend on health care needs of underprivileged groups in Australia.

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