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Thursday, 25 March 1999
Page: 4393


Dr THEOPHANOUS (11:55 AM) —My friend the member for Mitchell was full of a lot of bombast in his comments, but I did not notice much in his contribution by way of any new ideas or suggestions in this very difficult area. Let me say, first of all, that I agree with the comments of the shadow minister that we have 19 pages of amendments in the Health Legislation Amendment Bill (No. 3) 1999 because of the fact that the government rushed the previous legislation through and did not think about a number of key issues in relation to it.

Since we are essentially discussing questions about the funding of health and the role of the private health insurance industry, I say to the member for Mitchell that he is completely incorrect when he says that the Labor Party did not do sufficient thinking on this in the past. I can tell you that between 1993 and 1996, when I was parliamentary secretary for health under Ministers Graham Richardson and Carmen Lawrence, there was a lot of thought and discussion put into these issues. In fact, the matter was discussed not only at the ministerial level but also at the level of the Labor Party caucus. Indeed, there was even an inquiry by the Labor Party caucus in relation to these issues. So to suggest that the Labor Party did not consider this matter is false.

In addition to that, we should also have a warning here. No system in the Western world is perfect when it comes to the issues of health funding. It is very important that we try to learn from the experience of other Western countries that are struggling with these issues rather than pretending, as the member for Mitchell does, that the Minister for Health and Aged Care has now got the system absolutely right and that he has done a fabulous job. I think that what the minister has done is actually a stab in the dark. He has basically brought in the $1.5 billion support for the private health insurance industry in the hope that it is going to fix up our problems.

But, before I address this question of whether that is going to do anything very much for our problems, I want to say some thing about this whole question of private and public health, because of the way the terms private and public are being used. The member for Mitchell talked about socialised medicine. I do not know that there are many countries in the world nowadays talking about socialised medicine, but I assume he is referring to the British system. The model of funding whereby the government actually pays doctors a certain salary for so many patients—which is the British system—is not one that is generally used by most Western countries. If that is what he meant by socialised medicine—namely, that GPs dealing with people and also doctors in hospitals and specialists are all paid a fixed salary—that system is now pretty rarely seen around the world. If that is what is meant by socialised medicine, it has never been the position in Australia, with the exception, of course, of some areas in our public hospital system.

When we are talking about the funding of hospitals, that is one of four possible categories of ways in which to fund hospitals and health services. The one that is most interesting from the point of view of Australia, and the one that we have generally pursued, is the Medicare system, which does not pay doctors a salary but pays them on the basis of a fee. It does allow people to choose doctors and it does allow doctors to have a number of patients—provided, of course, that they do not go overboard and completely overservice and overcharge. That is a matter which is critical in certain respects with a system such as the Medicare system, and a matter which the minister has failed to address seriously since he became the minister. I give him credit for some of the initiatives that he has carried out, but on the issue of overservicing and overcharging he has not done very much at all, and I think he ought to look at that.

The Australian system also has a third category. The third category is where doctors are paid, especially in private hospitals, through this business of the private health insurance funds. Even the word `private' in relation to these health insurance funds is interesting—especially now. We call them private health insurance funds but, especially with the government's latest initiative, the taxpayer actually contributes very significant amounts towards those funds. So in what sense are they private? There is obviously a public component. The public component is the contribution which the taxpayer makes towards the sustenance of those funds—the $1.5 billion which was recently added by the minister in order to prop up the private funds.

One of the issues that has been raised by the opposition is: if these funds are intended to help people pay for hospital treatment, why not boost the hospital system directly with these funds rather than doing it indirectly by paying through the health funds and then getting the health funds to sponsor private hospitals and other services? That is the question.

The minister, in trying to deal with this question, has said over and over again, `This is an ideological issue; the Labor Party simply has an ideological commitment to public hospitals.' But that is not the issue. The issue would apply even if we were to say that there were a number of hospitals that were privately owned. This question would still arise.

One of the questions that has not been thought about in the health debate, which was thought about for a while during the time of Minister Graham Richardson, was the matter of making private hospital beds accessible to public patients and, indeed, to people who are being subsidised by the taxpayer. So rather than having this roundabout system, the minister might care to think about a more direct way of supporting the private hospital system, if he wants to support it, by allowing more public patients to be able to go into the private hospital system, rather than having this indirect and highly expensive approach of boosting the private health insurance funds, which are then supposed to support the private hospitals. Why does it have to be done in that way? The minister has not answered these questions.

There is also a fourth category of funding—where the individuals pay directly for their fees. One of the problems in the private health insurance area—and, as the minister knows, probably the major reason why so many people have not joined private health insurance funds—is that people know that, even when they join a private health insurance fund and pay all of that money for private health insurance, they go into a private hospital and find, at the end of the process, that many of their fees are not covered. The private insurance does not cover the totality of the fees for their procedures, operations and the specialists who use those private hospitals.

Many people have effectively said, `I'm going to end up paying anyway.' Some individuals have refused to take out private health insurance, not because they will not go into a private hospital but because they have worked out that, in the event that they do go into a private hospital, it is probably in their financial interest to pay the hospital directly. If they have private insurance, they will end up having to pay both the private insurance and the additional fees.

Why is this happening? It is happening because the minister has done nothing to control the charges imposed by private hospitals and private health institutions. The minister has done nothing on that point. In other words, a private hospital can virtually charge whatever they like. If people have to go to that private hospital, even if they have got private health insurance, they then have to pay that gap, that difference.

What about addressing this very serious problem, Minister? This is a key problem in health funding. The minister prefers to boost the health insurance funds, to give them support, so that they can make money out of the process. At the same time, it does very little in relation to the issue of the costs imposed by private hospitals for procedures and, indeed, it does little in relation to the costs for the procedures imposed by the specialists working in private hospitals.

I must correct the member for Mitchell: the suggestion that there ought to be a package did not come from the minister; it originated in the Labor Party in discussions held at the time Graham Richardson was minister. At that time there was discussion—and it was followed up by Carmen Lawrence when she was minister—as to whether arrangements could be made between private health funds and specific private hospitals so that the cost could be kept down and the coverage for people could be more comprehensive. The minister has finally decided to have a go at this after having been minister for all this time. But when are we going to see serious action on this matter? When are we going to see comprehensive coverage? When are we going to be able to say to the private health funds, `What have you done? Why don't you get into serious discussions with the private hospitals and the specialists about the costs of health care?'

This is the core of the whole funding issue. Funding for the provision of health services is not merely a private matter; it is a matter of concern to the whole of the community. As such, it is something which the whole of the community should have an input into. It is something which the whole of the community should be discussing. It is something which needs to be solved by the participation of the community. That means sacrifices. If we are going to continue to have a good health care system in this country, then, given that the overall costs of health care, especially the technical costs, are growing substantially, we have to ask ourselves how we are going to fund that health care system and how we as a community are going to be able to afford it.

Those who are most involved in the system have a responsibility. Our health care professionals, generally speaking, work hard, are very dedicated, perform excellently and in the majority of cases are not rewarded with very high salaries. This is especially true of nurses and non-doctor professionals. But there are some areas which are now beyond a joke, where greed is the principle rather than responsible service to the community. This is particularly the case with specialist technical services, such as pathology services, screening services, X-ray services and the like, where the costs are blowing out substantially. The minister says he talks to these associations and tries to get some responses from them in terms of controlling costs. But that is not what is happening. Far too many unnecessary procedures are still carried out as a result of these tests and the costs of those procedures relative to the cost of providing the technical assistance are far too high. This area is going to catch up with us, Minister, if we do not do more about it.

So when we talk about health care funding, health insurance and making the system operate well we also have to look at the responsibility the health care professionals have. They are making a good living, but some of them are now too greedy. They are ripping off the system, ripping off the Australian people and not behaving in accordance with their Hippocratic oath.

This is not only true of the ancillary services but also true of some specialist doctors. Nobody wants to say that if a specialist doctor has spent so many years at university and has had all this training he should not be very handsomely rewarded. But is it reasonable that some of these people are earning five to six times the salary of the Prime Minister of Australia? Is this reasonable, given the costs they are imposing on the health area through their private practices, especially through private hospitals? I think not.

While fair recompense, even generous recompense, is justified, we are now reaching a point where the costs of these excesses are affecting the whole community. If we could save in the areas of pathology services, X-ray services and specialist services, just think what we could do for our public hospitals, what we could do for our emergency services in hospitals and what we could do to help our ordinary GPs. While the health care professionals at this end are boosting themselves more and more, many of our ordinary GPs are in a difficult situation.

The minister struggled to get ordinary GPs to work in the country areas. The fact is that we do not offer them sufficient incentives, yet we offer these other people huge incentives. In fact we allow them to provide whatever charge they wish. When we talk about health funding, we need to think about those four categories I mentioned. We need to ask ourselves: what is the best balance that is to be achieved? The minister, in giving $1.5 billion to the health funds, has not achieved the best balance, unless he has also got a lot more money for other areas, which I doubt. But what is more disturbing is that, even if you accept that he is going to proceed with this approach, he has done very little to reduce the costs in this area. (Time expired)