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Wednesday, 27 September 1972
Page: 2026

Dr GUN (Kingston) - There are many reasons why the present health insurance system is unsatisfactory and why it must be completely scrapped and replaced by a universal health insurance scheme, as is the programme of the Australian Labor Party. I wish to deal with just one aspect of the present system to show why it is so unsatisfactory, namely, the inefficient use and the misappropriation of contributors' money by so-called voluntary health funds. Under the Labor plan money collected from contributors will be used to finance both private practitioners working on a fee for service basis and salaried doctors. Thus, there will be a salaried system working in parallel with private practitioners. If doctors and patients prefer a salaried service, finance will be available for such a service, but no-one will be forced into it.

Under the present system, however, a salaried service is positively discouraged. For example, if a public hospital wishes to pay sessional fees or salaries to its consultant staff no assistance is given by the Commonwealth. I believe that a salaried service is incomparably better from a public health viewpoint. But even if this Government disagrees with this surely it should allow people a choice between the 2 systems.

Recently an example of this type of discrimination was brought to my attention by the Family Planning Association of South Australia, which runs a clinic in an Adelaide suburb. A representative of the Association told me that, because the doctor working at the clinic was not in private practice and did not send out accounts to the patients in his own name, no medical benefits could be paid for services at that clinic. I wrote to the Minister for Health (Senator Sir Kenneth Anderson) about this matter. I received a reply from the Acting Minister for Health (Dr Forbes). Part of the reply which I received on 22nd June of this year reads:

I have had this matter examined and I would advise that the Commonwealth Director of Health, Adelaide, has advised the Assocaition that Commonwealth benefits are payable for medical services given by or on behalf of a medical practitioner at their Clinic but that payment of fund medical benefit was subject to the rules of the individual medical organisations.

I understand that the South Australian medical benefits organisations have recommended that they do not pay amounts of fund benefit because the charges are raised by the Family Planning Association and not by medical practitioners in private practice.

As this recommendation is in conformity with the rules of the funds, patients who contribute to organisations with this particular rule, will receive payment of the amounts of Commonwealth benefits only.

The Government might say that this is not its concern as long as it pays the Commonwealth benefit and that whether the fund pays the benefit is up to the fund itself. This argument and the Minister's reply are completely unacceptable. It should be remembered that people are really forced into these funds because if they do not join the Government denies them Commonwealth benefits. The funds operate under the National Health Act. It is the Commonwealth's responsibility to ensure that the contributors' money is not unreasonably denied to them.

Why should a contributor be denied payment just because the doctor is not in private practice? The funds seem to be a law unto themselves, with a vested interest in private enterprise medicine. I fail to see how anyone can possibly justify a contributor being denied the choice of going to a non-private practice clinic if he so wishes. It is not without significance that these funds have doctors on their boards of directors. In fact, I had the greatest difficulty some 3 years ago in finding out who actually were the directors of one fund - the Mutual Hospital Association. I eventually got the answer by putting a question on the notice paper. The answer which I received from the Acting Minister for Health revealed that on 30th June 1970 the board of directors of that fund included 2 doctors, one of whom is a past president of the Australian Medical Association. It is worth recalling the attitude of that body to a salaried medical service. It is small wonder then that this medical fund denies the use of contributors' money to pay benefits for services provided by doctors who are not in private practice.

It is also of passing interest that as at 30th June 1970 the chairman of the board of directors of the Mutual Hospital Association was Mr Ian MacLachlan, who is the current President of the Liberal-Country League in South Australia. It is small wonder that the Acting Minister for Health was so vigorous in defending such organisations earlier today. I wonder how many contributors realise that their money is being held in these circumstances. How many contributors to health funds realise that their money is being used for political purposes, by such bodies as the so-called Voluntary Health Insurance Council which is a political lobby trying to retain the present system and opposing Labor policies? How many people realise that part of the money that they contribute to purchase health care is being used for political purposes? It might be asked: What redress does the contributor have? Can he change the rules of the fund? At least in the case of the fund I mentioned the contributors have no say at all in framing the policies of the fund. Perhaps a contributor can do what the Acting Minister suggested this morning at question time. He said: 'If he is unhappy let him change funds.' But that makes no difference because, as is clearly shown in the letter from the Minister which I have quoted, all the funds, or at least those in South Australia, are the same; they all refuse to pay benefits to a doctor who is not in private practice.

The only form of redress to the contributor is to change the Government which allows and even encourages this absurd system. It is imperative that a truly public, universal health insurance commission be set up which will be fully accountable and fully answerable to the public. I conclude what I wanted to say by making reference to something which was raised by the honourable member for Angas (Mr Giles) who said the Australian medical system was the best in the world. I do not know on what basis he made that claim, but I think what we must really go on is the quality of health care and the standard of health in the community. As far as I can see we have no firm means of measuring the standard of health care in Australia. This is one of the big criticisms: We have not taken enough trouble to try to carry out an audit of the health care that is available in Australia. I seek leave to incorporate in Hansard paragraph 61 of the report called 'General practice and its future in Australia', which is the first report of the AMA study group on medical planning.

The DEPUTY CHAIRMAN (Mr Drury) - Is leave granted? There being no objection, leave is granted. (The document read as follows) -

61.   ... we make a comparison between figures for each decade from Australia, England and Wales, Sweden and the U.S.A. for the year 1966. Differences in infant mortality are apparent with Sweden lowest and the U.S.A. highest of the four countries. It is noticeable that between the ages of 5 and 45 Australia and the U.S.A. have age specific rates (per 100,000) considerably in excess of Sweden and the United Kingdom. After the age of 45, the rates in England approximate to those of Australia due to rises in deaths from heart and lung diseases, which are not seen in Sweden. Eventually all the countries come together by age 75+. Noticeable also is the absence of the peak age 15-24 in Sweden and the U.K. compared with U.SA. and Australia due to much higher deaths due to accidents in the latter two countries. These age specific rates indicate striking differences which do not justify any complacency about our health care system in Australia. It is, of course, true that Sweden has a homogeneous population, it is a compact small country, and it has an advanced comprehensive health and social security system. All these factors play a part in its low mortality rate - Sweden does provide a challenge to younger countries like Australia to emulate its health standards by an aggressive programme of prevention of major public health problems such as accidents, heart and lung disease, as well as an improved system of health care.

Dr GUN - I thank the Committee. This paragraph sets out that there is quite a big leeway for improvement in the quality of health care for the people of Australia. One further point on this matter has been raised in the recent statement by the President of the Australian Medical Association. He referred to the assertion by the Commonwealth Department of Health that if patients did not have to pay for medical services there would be an impossible increase in the utilisation of the medical services. I point out that the figures in the annual report of the Commonwealth Department of Health show that in the last 2 years there has been, as the Acting Minister for Health pointed out during question time this morning, a reduction in the proportion of medical fees paid by the patient from about 36 per cent to about 19 per cent. One would have expected, on the basis of AMA reasoning, that the utilisation of services would have increased; yet an examination of the annual report of the Commonwealth Department of Health will show that the number of services per person covered in that period increased by only just over 4 per cent, whereas there has been a much greater decrease in the absolute amount which has had to be paid by the patient.

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