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Wednesday, 27 September 1972
Page: 2038

Dr CASS (Maribyrnong) - I would like to hark back to some of the comments of the Minister for Housing (Mr Kevin Cairns) when he referred to the views of the honourable member for Oxley (Mr Hayden) on the medical profession and, more specifically, his suggestion that the folksy general practitioner no longer exists.

Mr Kevin Cairns (LILLEY, QUEENSLAND) - I indicated his lack of regard.

Dr CASS - His lack of regard for the folksy general practitioner. If that is what the Minister said, I still wish to make the same sort of remarks. I regret to say that the folksy general practitioner does no longer exist, through no fault of the Labor Party nor, would I suggest, through any fault of the Liberal Party. The reason he no longer exists is that the nature of medical practice has changed. I admit that there are certain aspects of the folksy general practitioner which we sadly miss today, but with increasing technology and the increasing demands we make on general practitioners, he can no longer be the leisurely folksy general practitioner he once was.

The problem is so serious that, quite apart from the Government's views on the Labor Party's scheme, our thoughts on general practitioners and the suggestion that general practice clinics might help to reestablish the standing of the general practitioner is in accord with the views expressed - and I trust that the Minister can find time to read them when he has finished speaking to the Minister for Immigration (Dr Forbes) at the table- by the Australian Medical Association study group on general practice in its pamphlet entitled General Practice and Its Future in Australia'. The basic point about the suggestion made in this publication is that with the establishment of general practice clinics, with the use of ancillary medical personnel, it may be possible to re-establish some of this intimate relationship people once had with general practitioners. It may allow general practitioners to regain the status they once had.

I deal now with the question raised by the Minister for Housing about the dreadful tax we are going to impose and with his implication that this will represent an enormous increase in cost to everybody. I made a speech on this matter once before and I will not repeat the whole of it for the sake of the Minister. My only comment is that he is misunderstanding the whole point. If we raise more funds by way of taxation it will be only so that people need pay less money to voluntary health insurance funds and less money directly to doctors. We are not suggesting that the doctors will receive more than they are getting under the present system. So where is the extra money that the minister talks about to go? It will not go to the doctors. It will not go to the hospitals. It will not go to the nursing staff. It will not go into his or my pocket as parliamentarians, that is for certain. So what is he talking about? He is bluffing, surely.

Mr Kevin Cairns (LILLEY, QUEENSLAND) - Your rate of tax increases.

Dr CASS - The rate of taxation will be simply enough to raise the same amount now raised in payments to benefit funds and fees paid by patients who suffer illness and thereby need medical treatment. The present system victimises people who are ill because in addition to suffering illness and suffering medical treatment they have to suffer the pain of paying the medical fees. Our proposal simply recognises that we should pay to maintain hospital services while we are well so that if the need arises any one of us will have free access to the services, the determinant being our medical need and not our capacity to pay. It is a simple proposition.

One cannot argue about the quality of medical care in this country. It is always said by honourable members on the other side of the House that the standards in Australia are higher than they are anywhere else in the world. I do not know on what they base that because on the few parameters that one can examine there is no justification for that claim whatsoever. Our infant mortality rate and our pre-natal mortality rate is no better than in countries with what one would call 'socialist medical services'. It is not necessarily much worse either. There is not very much difference in standards. The only differences one can perceive :re in unnecessary surgical procedures performed on patients, but there is good statistical evidence to show that when doctors are paid a fee for service they tend to provide more medical services than they need to for the best care of their patients.

Several studies have been conducted into this matter, and I have talked about it before. My remarks are in Hansard and I will not bore honourable members with it. I will simply add a little more evidence to my case, this time from someone arguing the case for fee for service as against a capitation fee. I join with the view that the capitation fee is not a good one. That is the problem with the British health scheme. I would not be in favour of a capitation fee, but nonetheless, even in this argument I find confirmation of my claims. The report which I have states that when the system of payment changes from capitation fee to fee for service, all in all, it is concluded that a 17 per cent increase in the utilisation of physicians services will occur. The report states that there has not been any appreciable change in the utilisation of clinics. I take it that that refers to hospitals and not to private physicians. So the increase in physicians' services has not been offset by a decrease in utilisation of the clinics. The reason I mention this is that it was claimed that if the doctors saw the patients more readily, presumably because they are getting more pay, there would be less need for the patients to utilise the services of hospitals. The report to which I am referring was produced from the Baltimore experiment. It is not to do with surgery; it is to do with overall physician caTe. In fact, the increased medical services did not reduce the call for the patients to use hospital services. It was found also that when the doctors were paid on a fee for service basis the prescription rate rose quite astronomically. The increase in the number of prescriptions provided to patients was 32 per cent.

I come now to the question of where the Australian Medical Association stands in relation to Labor Party policy and the claim made that last night on television the

AMA conceded something about Labor Party policy. I cannot be sure what the honourable member for Oxley (Mr Hayden) meant by his comment but I certainly do not think that he meant that the Australian Medical Association, to a man, will now vote for the Labor Party because it supports our policy on this matter. Obviously that is nonsense. The point is that for the first time publicly on television a spokesman for the AMA conceded-

Sir John Cramer - He did nothing of the sort.

Dr CASS - How about listening to what I think he did? He conceded that if some doctors choose to work for a salary - the Minister mentioned this in the quote he has just given - they still will be OK as doctors as far as the AMA is concerned. This is a concession, because up until now we have been fed to the gills with the claim that doctors who are forced to work or who elect to work on salaries somehow or other are inferior doctors - that the only decent relationship between a doctor and patient depends upon the fee for service. The conclusion one draws from the admission last night is that the AMA concedes the point that the doctor-patient relationship does not depend upon a fee passing from the patient to the doctor, and that is the fundamental point that we have tried to make all along.

Of course, the reality is that when a patient enters a doctor's consulting room the doctor does not size the patient up in terms of what he can pay or whether he will pay the bill. I do not believe that for a minute. I have more faith in doctors than that. The doctor assesses the patient in terms of his medical need. Whether or not the patient can pay is irrelevant to the quality of medical care the doctor should and does give to the patient.

It does not make the slightest difference whether the doctor is paid a salary or whether he is paid a fee for service; the doctor will still give reasonable service to the patient, based on medical needs. The problem as far as doctors are concerned is that they are frightened that if they are on a salary they will not be paid enough. That is purely an administrative problem; it has nothing to do with the basic philosophy of the Labor Party. Of course, the answer is that a Labor government will, I trust, give a reasonable reward to doctors in the same way as, we hope, socialised lawyers get a reasonable reward from the community when they become judges.

Proposed expenditure agreed to.

Dr Forbes - I suggest that the order for the consideration of the proposed expenditures agreed to by the Committee on 31st August be varied by postponing the consideration of the proposed expenditure for the Department of Housing.

The DEPUTY CHAIRMAN (Mr Luchetti) - Order! Is the suggestion of the Minister agreed to? There being no objection, that course will be followed.

Department of Immigration

Proposed expenditure, $68,024,000.

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