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Thursday, 6 December 1973
Page: 4440

Mr SPEAKER - Order! The honourable gentleman will resume his seat. As soon as the honourable member for Lilley has finished his speech, the honourable member for Darling

Downs may make a personal explanation. If I were to allow personal explanations during a speech it would rob the member who is speaking of his time.

Mr DOYLE - I thought perhaps when the honourable member rose that he may have been going to draw the attention of the House to the fact that since this debate commenced at 8 p.m. there have been at the most 2 members of the Liberal Opposition in this chamber. Returning to the submission that I am making, these implications will mean in effect a much wider choice of private medical care. (Quorum formed). Even that effort brought in only about two more Liberal members; that is how interested they are in this important debate. I was saying that these implications will mean in effect a much wider choice of private medical care and a considerable upgrading of the Queensland public and private hospital systems.

The Australian Government's health insurance program has been the subject of intense debate which has featured attempts to mislead and confuse and to blur the essential features of the plan. The philosophical base of the program is that all Australians, irrespective of their means, should have access to a high standard of health care. This care should be available on the basis of medical need and not on the financial capacity of the individual to buy health services. 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. The program provides for the establishment of the Health Insurance Commission which will provide insurance cover for all Australians, both for medical services and for hospital treatment. The program also provides Australian Government support for both public and private hospitals.

Queensland, of course, is in a different situation from most other States because already it operates a public hospital system which provides both in-patient and out-patient services free of charge.

Mr Hansen - Who brought that in?

Mr DOYLE - This of course was introduced by an Australian Labor Party government, and it was introduced in the teeth of opposition from the Conservatives in the State House of Queensland. When I listened this afternoon to some of the comments of honourable members opposite I thought that they might have been re-echoing some of the opposition that the then Conservatives put forward to Labor's plan at that time. It is significant that the system in Queensland was introduced in 1946 by an Australian Labor government as part of a national program which received full co-operation through reciprocal legislation in all States. This early system was restricted to in-patient services in all States except Queensland, which extended the program to cover out-patient services. Some years later the Commonwealth withdrew from the scheme, and Queensland decided to continue to provide both free in-patient and free out-patient facilities.

Mr Hansen - Those benefits were provided by a Labor government, were they not?

Mr DOYLE - Yes, and it was the Menzies Government which instigated the Commonwealth's withdrawal from the scheme. Unfortunately this enlightened and humane attitude towards the rights of citizens to free public ward care has been available only at a cost to the Queensland Government and Queensland people.

When the Liberal-Country Party Government withdrew from the full system it penalised Queensland for providing free hospital care. It subtracted a sum from Queensland equivalent to the income Queensland would have received if it had charged for those services. Queensland's share from the Grants Commission has been subsequently reduced in a discriminatory fashion by an amount approximately equivalent to the finance that would be raised if charges were applied for free hospital services. This is the reason why Queensland stands to make up for this neglect and Commonwealth bias. The $35m extra we will receive will go a long way towards making up for years of financial stringency and tight budgeting in Queensland state hospitals.

I was somewhat alarmed this afternoon to hear the honourable member for Darling Downs refer to the additional $35m to be injected into the Queensland scheme as being almost nothing. This hopefully will lead to an end to the need for charity in our state hospital system. In 1972-73 the Golden Casket distributed $3.2m to hospitals out of a total hospital expenditure of $100m. I mention this because many people have the wrong idea that the hospitals in Queensland are fully financed through the medium of the Golden Casket. It is the State's responsibility - not the responsi bility of charity - to provide for hospital care. Under State Labor governments Queensland's free hospital scheme was soundly conducted and something to be proud of. However, because of the maladministration of the scheme by Country-Liberal Party governments in Queensland the standard of Queensland's hospitals has declined, and most of us who are from Queensland know it.

Mr Donald Cameron (GRIFFITH, QUEENSLAND) - Rubbish.

Mr DOYLE - The honourable member for Griffith says 'rubbish'. I will quote the remarks of one of his colleagues from the Queensland Parliament - a Liberal - and the honourable member can tell him it is rubbish if he chooses to do so. The centralised bureaucratic administration and the lack of funds from the State and the Commonwealth have combined with a deliberate State policy to make Queensland's free system look as unattractive as possible.

This last aim is succeeding, because of the first two faults. There was a powerful investigation of the sorry plight of our hospitals, outlined in a hard hitting series in the local edition of the 'Australian' newspaper by Jim Briggushaw. He showed that maladministration had reduced Queensland's free hospital system to a total wreck, according to many doctors working under the system. The heavy hand of hospital controllers and the lack of independence have led to high staff resignations and staff going south. It has been claimed that delays have been caused in the treatment of people with minor illnesses to encourage them to go to a private doctor rather than to use the public hospitals' casualty and outpatients departments. In fact here the 'free' system of hospital care for some becomes very expensive because of money lost through people being off work for a longer time.

The dead hand of Queensland bureaucracy works in all areas. Doctors have to fight for every piece of equipment they need, even when it is lifesaving equipment. Often it takes 5 years to plan for and obtain equipment through the complex committee systems which govern every aspect of hospital life, down to the number of swabs allocated to each ward. Then, when the application has run the gauntlet of the hospital boards, it can be vetoed by the Queensland 'Department of Health. This is no fault of the people who staff the hospitals, the nurses and the other medical people. They are doing a sterling job under very adverse conditions due to the maladministration of the

Queensland hospital system under conservative governments.

What's wrong with our hospital system in Queensland is money - 'the lack of it. Only vast transfusions of cash can save it. In case honourable members think this is just a biased remark I can quote an impeccable source - a Liberal member of Parliament, and a doctor to boot. Dr Arthur Crawford, the member for Wavell, said 3 years ago that Queensland needed an additional $30m to make its health expenditure comparable with that spent in the southern States. Strangely enough this is the very amount - in fact it is more now due to cost increases - that Queensland is promised under the Australian Government's health insurance program. As I said, Queensland will receive $35m out of an extra $80m offered to the States for hospital services.

This perhaps explains the strange silence of Mr Tooth, our Health Minister, and Premier Bjelke-Petersen who would have been expected to oppose the so-called socialist plan of the centralist Government in Canberra. They do not oppose it because they know that the plan is a godsend for our hospitals. Mr Tooth does not know what he will do without this massive and much needed financial injection. I suggest that Queenslanders, when this money is made available from the Federal Labor Government, must be vigilant. They must agitate to ensure that the extra cash does go into our hospital system. Unfortunately already there are disturbing signs that this might not happen. The 'Courier-Mail' as we know appears to have a close working relationship with the present State Government. In fact its previous medical roundsman, Peter McColl, now works for the Health Minister, Mr Tooth. The latest medical reporter wrote on 7 November that the Australian Government's bed subsidy proposals meant more than $20m to our hospitals. In referring to the amount that will be made available the Courier-Mail' was not charitable enough to express the full amount. The correspondent wrote:

But it is unlikely that this money would be injected straight into public hospital budgets. Probably it would be shuffled into State Treasury bookkeeping and hospitals will continue to receive about the same amount as they do at present.

This is disturbing news, given the grim picture I have painted of conditions in our hospitals. We must press the Government to use the financial bonanza it receives to improve the conditions and facilities, the number of staff and by their action, the morale of our hospital workers. They deserve it and so do the people of Queensland.

It is also interesting to note that the Queensland Branch of the Australian Medical Association has supported the principles of the Queensland scheme and at the same time has attacked these principles in our national program.

Mr Cooke - Because it would be the end of the Queensland scheme.

Mr DOYLE - If that is a legal opinion I will not accept it. There are certain people in the honourable member's profession about whom it is said that they hang their mistakes about 6 feet above the ground. I would not take any advice from the honourable member. It is true to say that the hospital side of our program provides for the improvement and extension of the Queensland scheme to the rest of Australia. This fact has led some Queenslanders to believe that they will now have to pay, through the universal levy, for something which they had previously been able to obtain free.

Mr Donald Cameron (GRIFFITH, QUEENSLAND) - Hear, hear!

Mr Cooke - Hear, hear!

Mr DOYLE - That shows that the honourable members have not read the proposal we are putting forward.

Mr Donald Cameron (GRIFFITH, QUEENSLAND) - You are a con man.

Mr DOYLE - It is therefore important to stress to Queenslanders that there are some very real and tangible benefits for them under the Australian health insurance program.

Mr SPEAKER - Order! The honourable member for Griffith will withdraw that epithet. If there is any further such occurrence I will not ask for apologies; I will immediately name the honourable member.

Mr Donald Cameron (GRIFFITH, QUEENSLAND) - He is not a con man. I withdraw the remark.

Mr DOYLE - I was referring to the benefits to Queenslanders. The first of these is that the program will give Queenslanders a much wider freedom of choice in doctors' services available to them. This will result from the fact that everybody will be insured for medical benefits. At present only about half of Queensland's population is covered by private medical insurance. Every Queenslander will be able, when the program is introduced, to have access to the same medical services and a complete choice of family doctor. irrespective of the misleading and incorrect statements that are made by honourable members opposite. Furthermore, the family doctor will be paid for his services to these patients in the same way as he is with patients who are now privately insured. He will not be asked to provide his services, skills and treatment as a charity.

As I have pointed out already, the second important implication of the Australian health insurance program for the people of Queensland is that it will lead to a very significant upgrading of hospital staffing and facilities. Under the present scheme, which is the scheme that was operating under the previous Government, the Australian Government would pay in 1974-75 some $20m towards the cost of operating public hospitals. The Queensland Government would pay about $90m. Under the Australian Government's proposal, Federal contribution would be raised by $35m to $55m. If members of the Opposition who come from Queensland believe that this kind of additional finance should not be made available to their home State, I submit they are not worthy to represent that State.

This massive injection of funds into the public hospital system must inevitably lead to substantial improvements in the services and facilities available to the people of Queensland. In Queensland, as in other States, the public hospital system is supported by a private hospital system which includes some large establishments providing a full range of medical services. Some of the big religious and charitable hospitals, notably the Mater Misericordiae public hospital, treat patients for nothing on the same basis as the Government-run public hospitals. The private sector also includes establishments which, while called private hospitals, would more accurately be described as nursing homes or geriatric homes. Some of these are run by religious, charitable and community organisations, and some are run by private enterprise for profit.

The White Paper on the Australian health insurance program deals in some detail with the support that the Government will provide for private hospitals. The White Paper makes clear the fact that the substantial financial assistance to be provided to private hospitals and their patients will not involve interference in management of the hospitals. Hospital benefits for patients in private hospitals will be equal to the daily bed payments to be made directly to public hospitals from the health insurance fund. The basic rate of benefit for patients in private hospitals in 1974-75 will be $16 a day. The patients in private hospitals may be charged for all medical services, including diagnostic services, on a fee for service basis. These charges will attract medical benefits under the program.

It is important to note that at present the Australian Government benefit now paid to patients in private hospitals is $2 a day. This compares with $16 a day under the new program. Fees for private patients in public hospitals, as distinct from public patients in private hospitals, will be $15 a day in intermediate wards and $22 a day in private wards. The Government intends to ensure that private insurance tables to cover these fees are available for patients in both public and private hospitals in Queensland. Together with the $16 a day under the health insurance program, these tables will provide cover for fees of $31 per day and $38 per day respectively. These arrangements will provide substantial cover for the average fees of private hospitals throughout Queensland in 1974-75. The White Paper states:

If the present system were to continue, patients seeking coverage for private hospital treatment would be required to take insurance cover for at least $14 per day more than that proposed under the new program. After allowing for the effect of tax deductions, this cost would be greater for most people than the combined cost of community rated contributions for the additional private hospital charge above the bedday subsidy and the 1.3S per cent levy under the new program.

The Australian Government has recognised the important role played by religious, charitable and community run hospitals. This role is especially important because such hospitals provide an opportunity for freedom of choice by patients and for the expression of high vocational motivations by those who work in and for them-

Mr SPEAKER - Order! The honourable gentleman's time has expired.

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