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Monday, 12 November 1973
Page: 3141


Mr REYNOLDS (Barton) - Tonight I would like to discuss a very important field of health care which has administrative and financial implications for 3 departments, the Departments of Health, Social Security and Repatriation. I refer to our hospital system, both public and private. There are over 1,000 approved hospitals, both public and private, in Australia today, excluding Repatriation hospitals, with over 80,000 beds. Their running costs are enormous, even in the public sector alone. The States now spend over $320m a year directly on hospital services. Even the Commonwealth spends more than $44m on Repatriation hospitals, plus a further huge amount in indirect payments to the States and in the form of subsidies to private hospitals. The Australian Government recognises the importance of hospital care within its total health plan. It has appointed the Hospitals and Health Services Commission, headed by Dr Sidney Sax, to recommend increased capital expenditure on hospitals, both new and established, and also alternative forms of health care which may serve to keep people out of these high cost, capital and labour intensive institutions, and to use more appropriate forms of medical care. This is well worth lengthy discussion itself, but I intend to examine mainly the impact of the Government's White Paper on health insurance, and see how it will affect the present structure of hospital services in Australia today.

First of all, the Government's attitude is summed up well in the White Paper's opening lines. They are:

The level of a person's income should not be a barrier to receiving whatever hospital or medical service he or she may need . . . Similarly in a country as wealthy as ours no one should be subject to the indignity of a prying means test to determine his or her eligibility for various forms of health care. The freedom of people to choose the type of hospital care they want, and their right to the ready availability of medical services are fundamental principles of Government policy.

While the Australian Government plans a great reform in the provision of availability of treatment in, and financial assistance to, State public hospitals, it recognises that private hospitals controlled by religious, charitable and community organisations play an important role within the nation's health services. They provide an opportunity for freedom of choice by patients and also for the expression of high vocational motivations by those who work for them. Personally I cannot help but think of Calvary Hospital in my electorate of Barton in New South Wales, where, with loving humanity, many patients, mostly unfortunate terminal patients, are attended to irrespective of religious faith by the kind sisters of the Little Company of Mary, who also provide services at Lewisham Hospital.

The Government endorses and will generously support the continuance of the dual public-private hospital system and will provide financial support for private hospitals and the patients they treat, so as not to restrict the autonomy of these hospitals or the services they provide. We will ensure the freedom of these hospitals. Religious, charitable and community hospitals will be able to set and control their own policies without unnecessary Government interference. I hope that will be noted. Now back to the details of how the scheme will work for patients needing hospital care. Again I quote from the White Paper. It states:

Patients entering public hospitals will have the right of free accommodation and treatment as hospital patients . . . irrespective of their incomes. They will also be able, if they prefer, to be treated as private patients (patients who elect to receive medical treatment in hospital from their private doctors, and who will have preference in the allocation of any intermediate or private wzrd accommodation.) Private insurance funds may offer insurance tables to cover the extra costs of 'preferred' hospital accommodation. Doctors treating private patients in public or private hospitals will continue to charge on a fec-for-service basis. Their fees will be eligible for medical benefits from the Health Insurance Commission. Special arrangements to cover the costs of most types of treatment and accommodation in religious, charitable and community non-public hospitals, and which at the same time guaranteee the autonomy of these hospitals are also included in the Program.

I continue the quote from the White Paper. It reads:

These arrangements will give patients entering hospital a greater range of choice than they have at present.

Yet we hear all this talk of restriction of choice. I quote again from the White Paper:

For all other medical services anyone will be entitled to attend a doctor of his or her own choice at little or no cost. Payments will be on a feeforservice basis except in any cases where doctors voluntarily choose some other method of medical practice such as contract practice.

This is a further quote from the White Paper:

A central objective of the Program is to ensure that medical and hospital services are financed for the whole population in the fairest and most efficient way. For this reason the contribution of individuals to the Program will take the form of a levy of 1.35 per cent on taxable incomes. For the majority, of Australians this will mean smaller contributions than they would have to make if the existing health insurance scheme were to continue.

The Government recognises that in Australia there is a strong desire by patients to make their own choice of doctor and, in particular, of their doctor of first contact. It must be stressed that preservation of this right has always been central to the Government's proposals, was central to the Planning Committee recommendations, and continues to be a central objective of the program set out in this paper.

The Government has always recognised that many people prefer to pay extra for particular types of hospital accommodation and treatment and that some people may wish to insure for the full costs of any medical services they receive ....

The primary intention of the Program is to provide complete insurance coverage against the costs of standard ward hospital treatment and an appropriate and predictable level of coverage against medical costs. This is in no way incompatible with opportunities for members of the public to purchase preferred and optional hospital and medical services. In addition to provisions for private hospital insurance there will be opportunities for people who wish to do so to take out supplementary private insurance against the portion of medical fees not covered under the Program and the costs of ancillary and allied health services.

There is no intention to enforce uniformity on the overall hospital system, and indeed it is acknowledged that hospital services geared to locally recognised needs are desirable.

The agreements which will be made with State Governments and non-public hospitals for hospital insurance and the payments for medical services performed in hospitals will recognise these facts.

The new system should have great appeal to the States for it marks the acceptance of a continuing commitment by the Australian Government to finance 50 per cent of their hospitals running costs. Under the new scheme they will receive an extra $80m a year. I seek leave to incorporate in Hansard a table from page 42 of the White Paper which shows how each of the States will be treated.


The CHAIRMAN (Mr Scholes - Is leave granted? There being no objection, leave is granted. (The document read as follows) -

 


Mr REYNOLDS - I thank the Committee. The scheme will also be of great benefit to Australians. For the first time they will all have access to completely free hospital care and treatment, and will also have a generous portion - $16 a day- of their hospital costs paid if they choose private ward accommodation, or private hospital care. Here I might point out that if they do choose this form of treatment the charges made by their own doctor will be covered under the medical benefits schedule. The extra charges for their preferred private treatment can be covered by private hospital insurance, the rates for which will, through Government regulations, be comparable to present private rates. I compare that $16 a day with the $2 a day paid by the previous Government towards hospitalisation in our various State hospitals. There is much more I would have liked to have said about this scheme, Mr Chairman. It will be a great scheme.


The CHAIRMAN - Order! The honourable member's time has expired.







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