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Wednesday, 13 May 1970

Dr CASS (Maribyrnong) - I will begin by partly answering the last challenge because it will help me to explain what I want to say about the pensioner medical scheme. Of course, our view is that the whole concept of fee for service is the most expensive way of providing a medical service. I think there is no doubt that upon studying the results of the fee for service and salaried medical services in a countrysuch as the United States of America, one will find proof of that point. So much for that. Let me now come-

Dr Forbes - Does that mean you are going to introduce salaried services?

Dr CASS - That is my inclination. I would go further. I also think one would find in hospitals proof of my contention. What is more, the medical profession will work under those conditions. For instance, nearly 40% of doctors in this country are working for salaries of one sort or another, not on a fee for service basis. The figure is well above that in America where the most popular schemes are tending to be those where doctors are paid a salary. These schemes are the cheapest whilst at the same time being the most efficient in terms of quality. 1 want to speak of the quality of medical care provided for pensioners. I am here accepting the Governments' proposition that it shall be provided on a fee for sei vice basis: 1 am not now putting my view in relation to salaried services. Let us accept the proposition, because that is what we have here, that it should be on a fee for service basis.

In terms of our amendment, the concept of reviewing the agreement, I would take it further than our proposal does. I suggest that the fee paid for medical services to a pensioner should have a definite and constant relationship to whatever the fee might be for a non-pensioner. There should not be a discrepancy. It does not have to be identical. I am not saying that either, because I concede that the Government in paying the doctor for the pensioner service eliminates the need for a lot of his administrative cares and so on. He has no bad debts. I acknowledge that the fee the doctor receives can be less, but it should have a definite relationship. So far as the doctor is concerned the differential should be between the value of providing a service for a private patient, and what he gets for that, and what he gets from a pensioner patient. It should not be based on the possible proposition that a medical service provided to a pensioner is somehow an inferior service to the same service provided to a nonpensioner.

The next part of the amendment deals with the problem of doctors who overtreat pensioners because it is easy money. A doctor goes into a pensioner's home and looks at somebody else in the family and gets the pensioner to sign a little chit. He gets money for that visit too. I have heard of those cases, and I may be prepared to concede that that occasionally occurs. But what worries me in relation to the majority of pensioners treated honestly by the majority of general practitioners who give them the same standard of medical care is that those doctors are paid less than the fee they would receive from an ordinary private patient who has received the same service. Tn other words, they are in a sense subsidising. I am not making a cry for doctors to earn more money. That is not the point either. What I am trying to suggest is that in terms of quality there should not be a differential. If there are some doctors who make a lot of money out of overtreating patients and so on. that is a different problem and techniques must be devised to overcome it. The honest doctor and the honest pensioner patient should not be victimised for the sharp practices of a few on either side.

I am also aware that some pensioners quite happily go along and pester doctors more than they should because they have no social life anyway. That raises another question. It is humorous but sad that often doctors are asked to visit pensioners because pensioners are lonely. I am putting a serious case for looking into the whole aspect of pensioner medical care in the broad sense. There is a strong case, in my view, for providing pensioners with home visits of some sort so that in fact doctors do not have to fulfil that sort of requirement. This is something they do now because they need to do so medically. It is the only way of keeping these poor people sane.I hope honourable members appreciate the point I am trying to make. I hope honourable members opposite do not feel that I am getting at them politically as a member from this side of the House. That is not the point I am trying to make at all. The point is that we must guard against any feeling by either the pensioners or the doctors that the medical services provided for pensioners are somehow second rate. For that reason I think there should be a definite relationship established between the fees for pensioner medical services and the fees for ordinary medical services so that there is no possible feeling that anyone is being victimised or underpaid.

Proposed new clause negatived.

Proposed new clause 19b.

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