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Wednesday, 17 September 1958


Dr DONALD CAMERON (OXLEY, QUEENSLAND) - The honorable gentleman asks a very searching question, but it is not one that can be answered in very simple terms. Before I answer it, I would like to say, as I said yesterday in another context, that it is a mistake to believe that there is any single national health scheme which can be applied without change in all countries. Each country requires a scheme suited to its own conditions and its own character, so I would not like what I say to be regarded as criticizing the operations of the scheme in Britain.

In brief, the answer to the honorable gentleman's question is that in Australia we have always based the provision of ordinary medical services chiefly on domiciliary medicine and general practice, and anything which disturbs that particular set of circumstances will, I believe, have very adverse consequences on the rest of our arrangements in Australia. In Britain, general practice is based on what I may call a complete capitation system. That is to say, the doctor is paid for the number of people on his panel and not for the services that he renders. A complete capitation system in Australia would inevitably have the result of separating general practice from specialist practice and segregating specialist practice into some other category, presumably based on hospitals or something of that sort. It would remove from the general practitioners not only financial incentive but also professional incentive, and it would not be a very long time before the general practitioner came to feel that he really did not have a job to do. The inevitable result of that, of course, would be a decline in the standards of general practice.

Our national health scheme is based on providing facilities for the patient to pay for the actual services rendered to him in domiciliary and general practice as well as in specialist practice. The effect of this, of course, is that a great deal of practice is conducted - and conducted, I may say, at a very high level - in the patient's home and not in hospitals, with a consequent saving of a great many hospital beds. Anything which tends to upset this relationship, such as the substitution of a full capitation scheme would, I believe, have the most disastrous consequences for Australia.







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