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Wednesday, 10 June 1970

Mr Les Johnson (HUGHES, NEW SOUTH WALES) - I know the honourable member for Oxley (Mr Hayden) is anxious to say a few words in regard to these requests from the Senate. I understand that the requests before the Committee at the moment are 1 to 7.

Dr Forbes - Except 4.

Mr Les Johnson (HUGHES, NEW SOUTH WALES) - Firstly i would like to say that i am grateful for the acquiescence of the Minister for Health (Dr Forbes) in making available the copies of the statement about which there was discussion prior to dinner this evening. One of the matters which is before the Committee at the present time concerns the proposal to make available to all persons who are hospitalised the Commonwealth benefit of S2 per day. i know this matter would be to the gratification of honourable members who represent Queensland electorates. I think it is to the credit of those who have been responsible for these amendments that this anomaly which has been outstanding for such a long time has now, probably without the enthusiasm of the Government, been overcome. The fact of the matter is that for a long time in Queensland free hospitalisation has been available and as a result of this provision the Commonwealth has declined to make benefits available. As I understand it, if the request of the Senate is conceded - and I believe it is to be conceded though probably not in the precise form in which the request is made but in a general way - it is intended that all patients who undergo hospitalisation in that State will now receive this benefit. There is some speculation and I believe it is important for the Minister to clarify this point in connection with public hospitals in other States which under the provisions of a means test make free hospitalisation available to certain people. I know that honourable members from New South Wales will be aware of these provisions.

It is a provision which places very onerous financial obligations on the States concerned and the effect of it is that the States, in recognition of the fact that people who are not members of hospital funds but require hospitalisation and are unable to pay for it just have to be provided with hospitalisation. These people are admitted to hospitals and to public wards provided they measure up to a certain criterion as far as a means test is concerned. The general effect of the means test in New South Wales is to take the income of the person concerned and then, having deducted from it an amount which represents the payments on the person's home and making allowances for each dependant, in circumstances where there is an amount less than the basic wage remaining that person is admitted to a public hospital. It seems to me it is now beyond doubt that the Queensland public hospital system will be included in the provisions to which I have referred; that is to say, S2 per day will be made available to persons hospitalised in Queensland in all circumstances. But what I would be very anxious to know from the Minister is whether this provision is to apply to other States and especially to the hospitals to which I have referred.

This is an important breakthrough. One wonders what the total cost to the Queensland Government has been through the Commonwealth's failure to be more sympathetic about this matter over the years. It must amount to some millions of dollars. I understand that every person who goes into a public ward in Queensland will now benefit by way of a direct payment, to the hospital rather than to the patient, of $2 per day. Is the same provision to apply to other States where persons are admitted to public hospitals in consideration of their inadequate means? There are other provisions which are before the Committee at the present time. I confess I have not had the opportunity to go through them w:th care but I may possibly be able to speak again later.

One matter concerns the proposal that benefits should be made available for persons who receive treatment from ophthalmologists, particularly refraction treatment. I am given to understand it is not the intention of the Government to accept this amendment which was moved in this House, was subsequently supported in another place and has come back here by way of a message from another place. The Minister has said that if persons who avail themselves of the services of ophthalmologists are assisted in every way it would be to the disadvantage of optometrists who engage in a sim:lar practice, the practice of providing refraction treatment. It seems to me to be an alarming situation when patients over the country and doctors in many circumstances are contending that refraction treatment should be the subject of benefit by way of the national health scheme, when the Opposition has favoured this proposal as have some Government supporters in this House and when, in addition, a favourable response has come from senators in another place about the matter, that the Minister finally says 'No, we are not going to give effect to this suggestion because we have not yet contrived the means by which we give equal treatment to the 2 professions which engage in the provision of refraction treatment'.

I think one of the Minister's problems is that there is an inadequacy of legislative provisions in the various States. In fact, if my memory serves me correctly, he has made specific mention of those. In other words, because of the inadequacy of the Government in this matter and because it has failed to apply itself to the need to register people to demonstrate their capacity so that the public at large can be protected, and because there has been a lack of uniformity in training requirements and matters of this kind, the Government is now saying 'We are not prepared to include refraction treatment in the benefits system under the national health scheme'. There is little doubt that many people who go in the first place to general practitioners and who are then referred to ophthalmologists have a genuine and fundamental medical need and are involved in very considerable cost in undergoing this treatment. I believe it is to the discredit of the Government that it is not prepared to accept this proposal which has come from another place and which has the support of many honourable members here simply because it has been unable to contrive the means by which some kind of equitable treatment can be given to 2 sections of the profession. It is well known that the Opposition has for many years in this House supported proposals to give benefits to patients of ophthalmologists and optometrists. I believe it is now necessary for the Government to apply itself to this matter more earnestly than it has in the past in order to provide registration arrangements so that in the not too far distant future the message which has come from the Senate on this occasion can be given effect to and by this means the national health scheme can be made more effective in regard to optometrical and ophthalmological treatment.

MrREYNOLDS (Barton) [8.10J- 1 would like to say a few words about the requests numbered 1 and 7 received from the Senate in respect to services rendered by optometrists and ophthalmologists. First of all, I do not go back at all on anything that I said in the debate on the second reading when 1 accused the Government of being guilty of a clear breach of faith in depriving patients of protection from high fees by a particular group of specialists. The specialists I refer to are the ophthalmologists. I understand that the cost in New South Wales - and it is much the same in other States - of a first and second consultation adds up to about $15. This means that the Government's promise that where a common fee is charged no medical service will cost a patient more than $5 is not going to be adhered to in this sphere. 1 was sorry to hear that the reason given for this breach of faith was because of the relationship with optometrists and the like service which they provide as far as refraction tests are concerned. The optometrist service has been described as an ancillary service and apparently the Government is not at this stage prepared to bring in a comprehensive coverage of such service within the national health scheme.

In describing the optometrist service as an ancillary service I remind the Minister for Health and the Government that even in this Bill the services of an optometrist are given professional recognition. For the first time the optometrist will receive under this legislation the right of referral. That right carries with it the implication that the Government recognises that optometrists, apart from measuring eyesight, are professionally capable of detecting diseases of the eye. Optometrists have never made the claim that they are capable of treating diseases of the eye. They have always regarded it as their professional responsibility to refer such persons to ophthalmologists or, as some people may call them, eye specialists who. because of their medical training, are capable of carrying out proper treatment. Ophthalmologists have reminded us on several occasions that besides securing a medical degree which incurred 6 years of university training they have also had to undergo 4 years of post-graduate training to fit them for their task. I do not want anything that I say to be construed as a suggestion that patients attending ophthalmologists ought not to be getting the protection of the national health scheme. But I see no reason whatsoever why the Government should use this business of the relationhip of optometrists to ophthalmologists as the reason for depriving many thousands of patients of the benefits promised by this Government during the last election campaign.

Besides the recognition of the right of referral given in this Bill to optometrists there are other indicators of the professional status of optometrists, and there is no reason why they should not have been included in this scheme. The health schemes in overseas countries do give widespread recognition to the services rendered by optometrists. This is so in the United Kingdom where up to 90% of persons receiving eye care ultimately receive that care from an optometrist. In the United States of America, Canada and in various parts of Europe, optometrists have professional service to render under the health care schemes operating in those countries. A further point I want to make is that in every State of Australia the services of optometrists are recognised in State Acts. In at least 3 States optometrists receive university training. This training is recognised by many universities. In New South Wales there is recognition in the Faculty of Optometry which involves a professional course of 4 years training. In Victoria the training covers a period of 5 years.

A point which will interest every patient who seeks eye care is that 60% of the Australian public still go to optometrists to receive treatment for eyes. Therefore, by debarring patients who attend either the ophthalmologist or optometrist we are in fact depriving many thousands of people of Commonwealth benefits in respect to a very important service. I think that none of us needs to be reminded just how important eye care is. If any of us here contemplates what it would be like to lose the sense of sight he will have a very strong appreciation of the importance of eye care and eye protection. As I said before, this service is professionally offered by 2 groups of people - the ophthalmologists and the optometrists. I think it is a poor show on the part of the Government to use the difference of professional regard in respect to these 2 groups of people to debar Australians of the benefit of their services.

The Minister in his speech did say - and I particularly draw his attention to this - that one of the reasons why the Government was not prepared to grant this benefit was that to accept the 2 relevant amendments as requested by the Senate would be to the financial disadvantage of the patients who attend optometrists. This may simply be because the amendments had to be constructed in somewhat of a hurry. In my view the whole circumstances in which this Bill was originally discussed in this chamber was a downright shame. Honourable members will recall that a guillotine was imposed and we had to try to discuss the amendments in a very limited time, so limited in fact that some amendments were not even moved. I think that this is a standing disgrace to the operation of the parliamentary procedures of this House. It had to be left to the Senate to deal in an extensive way with the various amendments which the Australian Labor Party wanted to move.

Coming back to the pointI was making, I want to suggest to the Minister that he has not taken into account our intention in moving those amendments, and that was that we expected that the patients attending optometrists would attract the benefits in respect of 2 professional services, namely refraction tests and the prescription of spectacles. In that regard I suggest that optometrists charging about $8.50 for the 2 services would not, if they attracted benefits for both attendances, be disadvantaged. In fact it may be that patients of optometrists will in the overall picture be charged 20c less for the services that they receive. I will not argue that point to any length but I challenge the Minister on his estimate of the relative cost to the patient in the 2 different professional groups.

Another important point which we should realise is that even though the Government has denied Commonwealth benefits to the patients of either ophthalmologists or optometrists there is still operating a discrimination against optometrists, particularly in New South Wales. This discrimination does not exist in every State but in New South Wales the major open funds, the Hospitals Contribution Fund of Australia and the Medical Benefits Fund of Australia, do provide fund benefits to patients of ophthalmologists but not to patients of optometrists. I think it is unfair. After all, these funds operate within the province of the National health scheme. I do not think they have any right to make this discrimination. It particularly penalises patients in outback areas. They have no access to ophthalmologists even if they choose to attend such persons. Therefore the ophthalmologists are discriminated against too. It is not a case of discrimination against one profession or another; it is a case of discrimination against one patient who chooses freely to go to an ophthalmologist rather than to an optometrist. Time is running out on me. I might take time later, if it is afforded me, to speak on the other matter 1 am concerned about which is the $2 Commonwealth benefit in respect of hospitalisation.

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