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Thursday, 6 December 1973
Page: 4412

Dr GUN (Kingston) - I congratulate the Minister for Social Security (Mr Hayden) on the excellent job he has done in bringing forward this great reform which will be of lasting benefit to all Australians. We are now at the culmination of a long campaign of both publicising the health insurance program and refining it to provide the best possible services in Australia.

Mr King - Mr Deputy Speaker, I wish to take a point of order. I have taken note, and for the last 15 minutes there has not been one Minister at the table or on the front bench.

Mr DEPUTY SPEAKER -Order! The Minister for Health is in the chamber.

Mr King - The Minister is sitting in one of the back benches taking notes. There should be somebody on the front bench.

Mr DEPUTY SPEAKER - Order! There is no substance for the point of order.

Dr GUN - I was saying that this marks the culmination of a long campaign on the part of the Government and its supporters. (Quorum formed). Unfortunately the present time marks the culmination of another campaign, a campaign mounted by certain well organised pressure groups with a vested interest in the present scheme. This minority has been able to mobilise vast amounts of money to run a propaganda campaign to try to win the support of the otherwise uncommitted people in the community. It is a pity that the low income earners and those who will be the main beneficiaries of our proposals cannot run a campaign themselves, but they unfortunately are not politically organised and of course they are in no position to finance an expensive radio and television campaign. It is a sad fact that this happens with any great social reform; the main beneficiaries are poorly organised. Thus the propaganda campaign by default is won by the well organised groups with a vested interest in the status quo. However, I believe that the Minister should take heart in the justice of his cause.

Every great social reform will by definition have a powerful campaign organised against it by vested interests. If this were not so it would not be a great social reform and would have occurred quite naturally long ago. What does sadden me is to see the political opposition in this Parliament not only lining up with these vested interests but also receiving riding instructions from them. Nowhere is this more obvious than in the present debate. Quite clearly the Opposition is not speaking for the Australian public; it is prostituting itself by acting as a front for certain pressure groups. I want to make some remarks about hospital services.

Mr Hurford - Chipp is running to his masters. You can see him going to the back of the chamber.

Dr GUN - I agree with the remarks of my friend, the honourable member for Adelaide. It is often said by opponents of the Government's proposals that private hospitalisation should be available for those who prefer to insure for it, but that for those who cannot afford it public hospital treatment should be available. What I object to about this proposition is that it implies two standards of service. It means private hospital treatment, which is allegedly better treatment, for those who can afford it and the allegedly inferior public hospitals for those who cannot. I think this is utterly iniquitous. It is wrong that the best hospital treatment should be available only for the better off. If private practice, fee for service, is the best type of hospital treatment it should be available to everybody, not just to those who can afford it. In fact, proper public hospital treatment is superior. In any case, it would be unacceptable to have every hospital patient in Australia a private patient. This proposition would mean an enormous cost and would divert expenditure of public money from more important areas of health care. The answer must be to provide adequate public hospital accommodation without charge and without means test for every Australian who wants it, and that should be a funda mental right. That is the objective of the Govvernment's proposals. These proposals, in addition to providing more public hospital accommodation will enable public hospitals to be upgraded so as to provide the best treatment possible for all Australians.

What this measure will mean will be the ready availability of public hospital accommodation free of charge and free of means test to everybody who wants it. That is precisely what has been provided in Queensland for many years. I am aware of statements that have been made that we would be unable to provide sufficient public hospital accommodation for everybody who wants it. The fact is that it is this present scheme which fails to provide adequate public hospital accommodation. In the past the Commonwealth has provided insufficient funds to have enough public hospital beds. The result has been, particularly in my own State of South Australia, a shortage of public hospital beds. I repeat that this is under the present scheme. Although there is no means test in South Australian public hospitals, most South Australians know that under the present scheme they have no hope of getting a public hospital bed except for emergency illnesses. The result is that most South Australians are forced to take private hospital insurance whether they want it or not and whether they can afford it or not.

The Government's proposals will change all this. It is fundamental to our proposals that sufficient finance will be provided to the State governments to enable them to provide free public hospital accommodation to everybody who wants it. Those who cannot afford private hospital treatment or have no special wish for private hospital treatment will no longer be forced to take out extra insurance to cover the cost of private hospital treatment. It is worth mentioning here, however, that the low income earners will now find it cheaper to take out that extra private hospital insurance, if they want it, than under the present scheme. Of course, it is obvious that with the relatively low number of public hospitals in South Australia we could not overnight provide all the required accommodation in public hospitals. But this does not stop arrangements being made with non-public hospitals such as the community hospitals and religious hospitals to provide the necessary hospital accommodation, and arrangements are being made to do precisely that. Furthermore, the extra money being provided for public hospitals will enable public hospital facilities not only to be extended but also to be improved. I am aware that many people choose private hospitalisation so they can choose the doctor who treats them. We recognise this wish on the part of many patients and substantial assistance will be provided towards private hospital treatment.

However, on the question of choice of doctor I would like to digress briefly. It is quite obvious in these days when many doctors practice in the one clinic that the choice of doctor by the patient is illusionary. As often as not that choice is made by someone other than the patient. In the case of choice of specialist this decision is rarely made by the patient; it is nearly always made by the referring doctor. But I do not think this matters very much. Let us remember that repatriation patients do not have a choice of specialist when they go into the repatriation hospital. Yet how often has anyone ever heard a repatriation patient complain about this? I certainly never have. I cannot, in my experience as a medical practitioner or a member of Parliament, recall a repatriation patient ever saying that he did not like the repatriation system because there was no choice of specialist in repatriation hospitals. I think perhaps Opposition members could ask the Returned Services League what it would think about making any alteration to the system now operating in repatriation hospitals.

Personally I would strongly rebut the basic premise which is made by many Opposition spokesmen, and even some spokesmen for the medical profession, that the personal doctor-patient relationship is the most important thing in medical practice. This is no longer true. Important it may be, but there are more important considerations. I know that many patients feel they obtain a subjective benefit from a close relationship with their doctor, but there is no objective evidence that this has any significant influence on a patient's well-being. The aims of the health service are to prevent and to cure illness. I would go so far as to say that many of the traditions in medical practice run quite counter to community health. For example, excessive attention to the doctor-patient relationship has led, I believe, to treatment of problems which may be psycho-social rather than medical, such treatment being by completely inappropriate means by doctors who do not have training in social welfare counselling. As I have said in this House before, one result of this has been excessive recourse to drug therapy, especially the anti-depressive drugs and tranquillisers. What is needed is an integrated health care program by a health team with adequate facilities and adequate recording systems. To put the choice of doctor above these priorities is to turn the clock back.

To return to the measures before the House, we acknowledge nevertheless that some patients like to choose the doctor who will treat them in hospital. One of the measures the Government is taking in this direction is to expand the range of choice for public patients. This will be especially so in midwifery cases. What we propose is that a woman will be able to attend her general practitioner at his surgery during pregnancy and be attended, if she wishes, by the same doctor as a public patient during confinement. In other words, the scheme will provide for full cover for women who want their own general practitioner to attend them in hospital. For those patients who still want private hospital treatment, we will be providing considerable financial assistance in 3 forms - firstly, a daily bed subsidy of $16; secondly, coverage of medical costs; and thirdly, tax deductibility of private insurance charges.

Finally, I would like to mention the great benefits which pensioners will receive from the Government's proposals. As all pensioners know, their pensioner medical service card entitles them to free treatment from their general practitioner but not from specialists. From now on under the Government's proposals the pensioner will be eligible to receive treatment not only from the general practitioner but also from a specialist. In other words, if the general practitioner refers pensioners to a specialist for consultation, for management, for a cardiogram or for any other investigation such as an X-ray, a blood test or a urine test, they will be covered in the same way as insured patients are already covered.

Furthermore, there will be great benefits in the provision of hospital services for pensioners. Under the present scheme pensioners are entitled only to free treatment by public hospitals. However, because of the shortage of public hospital beds many pensioners take out extra private hospital insurance because they fear that if they have a non-urgent illness they will never get into a public hospital. Because we propose to provide sufficient public hospital accommodation for those who want it, pensioners will no longer have to take out that private hospital insurance. This again brings up the question of those pensioners who still want treatment from a particular doctor in hospital. If in spite of the extra public hospital accommodation available pensioners still prefer to have private hospital treatment it will be much easier for them from now on. For one thing they will be covered for specialist treatment in private hospital, whereas under the present scheme the pensoiner medical service voucher is only for a visit by a general practitioner.

The next important feature of this service is that pensioners who are now eligible for fringe benefits will not only get all the extended benefits I have mentioned but they will also get them without having to contribute anything at all. Let me summarise the benefits of the new pensioner medical service. Pensioners will be covered for treatment by a general practitioner or a private specialist. They will be eligible for public hospital treatment which will in the future be freely available. They will be eligible for specialist or general practitioner treatment in a private hospital, again without having to make any health insurance contribution whatsover. Therefore, if a pensioner wants to take insurance to provide full private hospital cover he will only need to insure himself for about $15 a day. As pensioners will have to contribute nothing in order to obtain all the other benefits, this small amount of insurance will be their only outlay. In money terms this would mean that a single pensioner would receive all the rights of public hospital treatment and specialist treatment for nothing and he would receive all the rights of private treatment in hospital and outside for an insurance contribution of about 65c a week. I have much pleasure in supporting the legislation.

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