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Thursday, 6 December 1973
Page: 2553

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

The Bill before the Senate is the second National Health Bill for 1973. It contains provisions already announced by the Treasurer (Mr Crean) in his Budget Speech of 21 August, a number of amendments which are of an administrative nature and other amendments relating to eligibility of pensioner medical service entitlements. Honourable senators will recall that on 2 1 August the Treasurer announced this Government's proposal to abolish the $10 charge presently applied to eligible pensioners and their dependents who are supplied with hearing aids from the Commonwealth Acoustic Laboratories. Also, that these persons should be supplied with hearing aid batteries free of charge. The Bill provides for the implementation of both of these decisions.

At that time, the Treasurer also announced that the handicapped children's benefit would be doubled. This benefit is payable to the proprietor of an approved handicapped persons home for each day on which the handicapped child receives handicapped person care in that home. The Bill provides for the rate of this benefit to be increased from $1.50 a day to $3 a day, with effect from 1 January 1974. This measure is expected to cost the Australian Government $0.2m for the remainder of this financial year and $0.5m in a full year. The Bill includes a number of amendments which are of an administrative nature. The first of these is to provide for the transfer of administration of certain parts of the Act from the Department of Health to the Department of Social Security. This Government has always held the view that the administration of social welfare schemes has been too fragmented and that their operation should be controlled by the one department. Provisions in the Bill give effect to the transfer of Parts III to VI of the Act, and other parts relating to matters arising in connection with these Parts, to the Department of Social Security. These Parts relate to the operation of the medical and hospital benefits schemes and the operation of the pensioner medical service. The amendments are in accordance with the administrative arrangements ordered by His Excellency the GovernorGeneral on 19 December 1972.

The second administrative amendment to the Bill is to widen the regulation making power contained in section 13A. This section enables alterations to be made to the tables of medical benefits contained in the Schedules to the Act. However, the existing provisions permit amendments only of the items and benefits in the tables of the Schedules. Honourable senators will be aware that at present a Medical Fees Tribunal is examining a list of fees submitted by the Australian Medical Association. Decisions have already been handed down on parts of that list. It is apparent that these and future decisions will significantly alter the structure of the medical benefits schedules and the benefits for services. The amendments proposed in the Bill will allow more substantial changes of the schedules by permitting the replacement of tables in the Schedules to the Act by regulations, the amendment of the rules of interpretation of the table in the First Schedule, and schedules, by regulations and, finally, the amendment of those regulations by other regulations. The existing provision in the Act- that amendments to the tables in the Schedules made by regulation must be incorporated into the Act within one year plus 15 sitting days of the House- still remains. In accordance with this provision, the opportunity has been taken in this Bill to incorporate into the Act amendments to the tables of benefits which have been made since March 1973.

A further amendment of an administrative nature relates to proposals made by the Australian Society of Anaesthetists and the AMA to the Medical Fees Tribunal. If these proposals are accepted in total or in part an amendment of the Act is needed to cover anaesthetics administered when there is a number of services performed at the same time. The provisions in the Bill are similar to section 16A of the Act, which provides for a reduction of the benefits to half for the second operation on the one occasion and to one quarter for any further operations on the same occasion. More substantial reductions of the anaesthetic benefits have been proposed by the Australian Society of Anaesthetists, and it is expected that the Tribunal will indicate the reductions appropriate in its view. Until then the reductions cannot be specified in the body of the Act and this provision in the Bill allows these to be made by regulations.

As honourable senators will know, the pensioner medical service is one of a number of fringe benefits available to pensioners who satisfy the 1967 social services means test. Its principal objective is to provide a basic range of medical services to persons whom it could reasonably be expected are unable to afford health insurance coverage. Increases in the rates of pension have caused more persons to become eligible for the benefits of the pensioner medical service. As the Minister for Social Security (Mr Hayden) announced in another place on 1 1 September during the introduction of the Social Services Bill (No. 4) 1973, the 1967 means test will continue for fringe benefit eligibility purposes but future increases in the rates of pension will not extend eligibility for fringe benefits, including pensioner medical service entitlement, to persons whose means are outside the new limits proposed. These limits will be those applying after the recent increases granted in the Budget. For a single pensioner the disqualifying limits of means as assessed', by application of the relevant provisions of the Social Services Act, will be $33 a week, and for a married pensioner couple $57.50 a week, before fringe benefit eligibility ceases. 'Means as assessed' refers to the provisions in the Social Services Act relating to means testing including the formula for deeming certain property to have a notional 'income' equivalent. This means that the weekly income of a single pensioner, including pension, could be $49.50 before eligibility for pensioner medical service entitlement ceases. The corresponding combined income figure for a married pensioner couple is $86.50.

The provisions in the Bill fix the eligibility for pensioner medical service entitlement at the levels I have just outlined. Clearly, any extension of these limits arising from further increases in the rates of pensioner benefits would create situations of inequity between such pensioners and the many non-pensioner families in the community who have weekly incomes less than these amounts but who are required to take out health insurance coverage. Honourable senators will be aware that these provisions will apply only until the introduction of the Government's universal health insurance plan. This plan will not limit pensioners' entitlements to the restricted range of services available under the present pensioner medical service, and will, therefore, represent a tremendous improvement in the entitlements of pensioners as it will, indeed, in the entitlements of everyone in the community.

Perhaps I ought to state at this point that under the Australian Government's health insurance program, legislation for which was introduced in another place on 29 November, medical services obtained by pensioners from a private medical practitioner will be fully covered. This will refer not only to consultation at home or in a doctor's private surgery but also to procedural items which currently are excluded from medical benefit cover under the private health insurance arrangements. But the program will go further than that. Pensions, as will be the case with everyone in the community- that is, there will be no distinction, no second rate citizenry- will be able to obtain the services of a specialist of their choosing, no doubt with the assistance of a general practitioner, and medical services in the private surgery of that specialist and have those services fully covered by the Australian Government's new health insurance program. I commend the Bill to honourable senators.

Debate (on motion by Senator Rae) adjourned.

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