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Wednesday, 27 September 1972
Page: 2020

Dr KLUGMAN (Prospect) - Before discussing the estimates for the

Department of Health I would first apologise for the absence of many of the doctors who sit on this side of the chamber. The reason they are not here is that we are continually receiving deputations from organisations.

Mr Giles - Sixty per cent of your doctors are here now.

Dr KLUGMAN - They have just come in. We have been talking to dentists and surgeons about what will happen next year and we will be speaking with the General Practitioners Society of Australia in a few minutes on the same subject, lt is interesting to note that their discussions with us show that they have no great confidence in the likely re-election of the present Government, and I cannot blame them for that. I would like to deal with some of the relative side issues that arise on the general question of health. One of the problems that is continually emphasised is that of over-usage. It is asked: 'What will happen under the Labor Party scheme if it does not cost the patients anything? There will be great over-usage'. The reason suggested for over-usage is that patients who feel they needed medical attention will just visit their doctor. But what is happening at the present time? At present we have overusage resulting from the suggestions of medical practitioners themselves. We have completely unethical behaviour on the part of medical practitioners who own private hospitals. They suggest to their patients that they have operations in these private hospitals, operations which are often not necessary, or suggest that patients be admitted into the private hospitals for examinations because, in addition to the normal profit they would make, they make a profit from owning those private hospitals.

Let us look at what used to be the position of the Australian Medical Association when I went through my medical course. I was sent a booklet entitled Handbook for Qualified Medical Practitioners' which includes a chapter on ethical considerations. There, in relation to chemists, it states that a doctor must not arrange with a chemist for the payment of a commission on business transacted, nor hold a financial interest in a chemist shop. It seems terribly reasonable to me that a doctor should not have any additional financial interest in ordering prescriptions or certain treatment for a patient. But this is peanuts compared to what is happening at the present time. The Labor Party health committee has received a deputation from the Federation of Private Hospital Proprietors. Of a total of 7 executive members of the Federation, 4 or 5 are medical practitioners. They own private hospitals. And it is suggested that they do not have a financial interest in putting people into hospital. It is quite fantastic behaviour on their part. The handbook in relation to the doctor and commercial undertakings states:

A general ethical principle is that a doctor should not associate himself with commerce in such a way as to let it influence, or appear to influence, bis attitude towards the treatment of his patients.

What more obvious commercial undertaking can a doctor engage in than the owning of a private hospital, which surely must at least appear to influence his attitude to the treatment of his patients, lt strikes me that this would be a corresponding situation to that of a crown prosecutor owning a private prison.

Mr Hayden - Or a judge.

Dr KLUGMAN - Or a judge owning a private prison, so that he could make a decision whether he wanted to make an additional profit from sending someone to gaol. It is quite fantastic. The AMA talks about the Labor Party interfering in the sacred relationship where the patient owes money to the doctor, but yet the Association does not interfere in respect of the present behaviour of some medical practitioners. I can put it quite fairly when I say that the majority of medical practitioners are as disturbed about this situation as I am. They think it is ridiculous for the AMA to behave in this way to protect the big boys in the profession who own these hospitals. We know that the doctor who is president of the Federation of Private Hospital Proprietors is the Liberal Party candidate for the seat of the Australian Capital Territory. Doctors and the health insurance funds participate in the attack on the Labor Party scheme, and often they overlap in that the same people are involved on behalf of both the doctors and the funds in the publication of such things as the 'AMA News', the 'AMA Gazette', the Health Care Finance' publications and the

Voluntary Health Insurance Council publication, which are front organisations for the Hospitals Contribution Fund of Australia and the Medical Benefits Fund of Australia and its allies respectively.

At present they are continually producing new booklets such as one entitled Doctors and Health Insurance', an attack on the Labor Party, and 'Labor Party's Health Scheme', another attack on the Labor Party. In many cases where the publication is a publication of the funds, contributors' money is being used, with the blessing of the Government, to attack the Labor Party. When I talk about 'the blessing of the Government' it is interesting to note that one of the people who has been most active in attacking the Labor Party is a Liberal Party member, Dr Lionel Wilson, from one of the Sydney suburbs. He is employed by the Hospitals Contribution Fund and its Health Care Finance organisation to publish one of its booklets called The Second Blessing'. The blessing is the Government's voluntary health insurance scheme. This gentleman is now the Treasurer of the AMA and is using AMA funds, but this is not so bad because AMA members at least have a vote in respect of the disposal of their funds. But in addition HCF funds are being used - and HCF members have no say in the disposal of their funds - to attack the Labor Party.

Let us look at the propositions that are being put up by medical practitioners. One is that medical practice would collapse under the Labor Party scheme because it is suggested there could be a 25 per cent increase in the work of medical practitioners. They suggest that this increase could not be handled because doctors already are working a 70-hour week. This is quite untrue. I was in medical practice for 20 years and know that if a doctor worked flat out for 70 hours a week he would not be much of a doctor and would be earning such fantastic sums that everybody would know about it. Let us look at what happens at present. On the basis of 6 patients an hour with 10 minutes being allocated to each patient - and I put it to the House that relatively few general practitioners average only 6 patients an hour - and at the present rate of $4 a visit, a doctor would earn $24 an hour or $960 gross in a 40-hour week. If he worked the 70-hour week the medical practitioners talk about his income would be $1,680. Now let us assume that all his patients are pensioners and that he gets $3 for each patient. It would still work out at $18 an hour or $720 in a 40-hour week. His expenses at the most would come to something like $200 a week. I have been generous in my allotment for expenses, allowing $120 for salaries, $30 for rent and $50 for private expenses such as car expenses. However, as this doctor is sitting in his surgery his car expenses would not be very high. If we take off the expenses, the doctor treating only pensioners in a 40-hour week would still have an income of $520 a week, or $1300 or $1400 for a 70-hour week. I put it to honourable members that I am quite sure that there are few doctors who in fact work such long hours. There are not enough patients for them to see. Doctors just do not see that many patients. 1 would like to take up many other points, especially concerning what is to my mind a lack of ability on the part of the Department to cost our scheme. I am not necessarily blaming the officers of the Department who seem to be reasonably well paid, judging from the estimates that we are asked to pass now. Perhaps pressure is being put on them by the Acting Minister. I was about to say the present Minister, but he has not been able to talk to the officers of his Department for some considerable time and he has not influenced them in any way. I realise that my time is up but I shall try to take the opportunity during this debate to raise more of these issues.

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