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Wednesday, 14 September 1983
Page: 768

Mrs KELLY(3.48) —I listened with interest to the previous speaker in this debate, the honourable member for Warringah (Mr MacKellar), and took note of the various criticisms he made of the proposals which we are debating today. He criticised the proposed Medicare arrangements on the grounds that this was a socialist scheme being introduced by a socialist government. I see that the honourable member is nodding his head in agreement with what I say. In that the Medicare arrangement is universal, then indeed this scheme is a socialist scheme . In that it is based on a capacity to pay, again I believe that it is a socialist scheme and I am quite proud of that fact. There is no reason for us to apologise for that because those two fundamental issues are the basis of this Medicare proposal.

Mr MacKellar —Nothing about the quality of health care.

Mrs KELLY —Firstly, it is a universal scheme and, secondly, it is based on a capacity to pay. The honourable member for Warringah says that it is not based on the quality of health care. Indeed, the very aim of this scheme is to provide adequate health care for all Australians. That situation does not exist in this country today; nor did it exist under the previous Government and, in particular , the honourable member for Warringah when he was Minister for Health. So the whole basis of this proposal is to provide a health care system for all Australians.

The honourable member for Warringah argued that the alternative provided by his Government was the solution to all the problems. In fact, it was the cause of many of the problems we have in health care in Australia today. I will just quote one aspect where the honourable member stated that the policy of his Government was based on a 'sense of responsibility of providers'. If a sense of responsibility of providers caused the $100m that has been lost to the taxpayers through overservicing and fraud by providers, I have some queries and doubts about the health system that existed under the previous administration, in fact under the previous Minister's administration.

The other issue that was questioned by the honourable member was the problem of curbing costs and the costs of the new Medicare arrangements. I submit to this House that the legislation that we are introducing today-which is to come into effect on 1 February-is based on the assumption that there is a new attitude in the community today about health care costs and about efforts that should be made to curb health care costs. I believe that the investigation through the Joint Committee of Public Accounts of this Parliament into previous medical arrangements and the examination of health costs, overservicing and fraud have in fact led to a different attitude in the community about the costs of health services. I am quite sure that this House will see some major statements in the next few months about this whole issue of fraud and overservicing and how they can be detected.

Another issue that was raised by members of the Opposition was the confusion that exists in the community. Any confusion that exists in the community has arisen because of the large number of changes that have occurred to medical arrangements over the last few years. The previous Government was elected on a commitment that it keep Medibank Private. It then changed its arrangements on about five different occasions. So if the community is confused, the only people who are to blame for the confusion are the members of the Opposition. What the Government is doing with the Health Legislation Amendment Bill, the Medicare Levy Bill, the Income Tax Laws Amendment (Medicare Levy) Bill and the States ( Tax Sharing and Health Grants) Amendment Bill (No. 2) which are before us today, is simply to put into effect a promise given to the electorate at the last election. It should be no surprise to the members of the Opposition, nor to the community at large, that we are proceeding to implement an election promise. These health care arrangements we are bringing in are an essential part of the prices and incomes accord, on which we have reached agreement with the unions. We have entered into a definite commitment. It is a commitment we are following through, unlike the previous Government which chose to ignore most of the commitments and the promises it made to the electorate.

There has been some criticism about the administrative arrangements of Medicare . I believe that common sense indicates that we should administer Medicare through a single public fund aided by modern computer technology with all Australians being guaranteed medical and hospital insurance cover at the lowest possible cost. It is estimated that a single public fund will administer medical benefits payments for $30m less per annum than the current administrative costs of a large number of private funds that we have today. Both consumers and even doctors will benefit from the quicker payment of claims under Medicare. Doctors will be able to bulk bill and receive 85 per cent of the cost of consultations without incurring the expensive accounting and office overheads. I hope doctors will take full advantage of that system. This will be of benefit to patients who are pensioners, the disadvantaged and the chronically ill. It will provide a simplified and worry-free system for those patients.

The Government does not support gap insurance for medical care. I support this view very strongly because I believe, like the honourable member for Prospect ( Dr Klugman) who spoke earlier in this debate, that gap insurance could well further encourage medical overservicing. However, as the Joint Committee of Public Accounts pointed out, there is a potential for abuse in bulk billing. In the progress report of the Public Accounts Committee, the Committee recommended that greater discipline needed to be applied to ensure better scrutiny of bulk billing procedures. I, therefore, welcome the insertion of proposed new section 127 (1) which, for the interest of honourable members, requires a practitioner, when agreeing to accept the assignment of Medicare benefits, to complete the assignment form before it is signed by the patient and to give a copy of the form to the patient as soon as is practicable. A contravention of this is punishable by a fine not exceeding $1,000 or a period not exceeding three months . This puts the onus on the doctor and allows for immediate action if this proposed new section is contravened entailing a substantial fine. I think that will be of great benefit to the cost containment that we are so concerned about as a Government in introducing this scheme.

Another positive response to the recommendations of the Public Accounts Committee-I think this goes hand in hand with introducing the new Medicare arrangements-is that a whole new emphasis is being put on looking at overservicing and medical fraud. It has been particularly pleasing to see the build-up of staff in the Department of Health to deal with the problems that were outlined in the interim report of the Public Accounts Committee. I understand an additional 80 staff have been appointed at State and Federal levels through the Department of Health, as well as a task force, to deal with the backlog and complex cases in fraud and overservicing. There is also much greater co-ordination now between the Attorney-General's Department and the Department of Administrative Services with the creation of a central co- ordinating committee at both Federal and State levels to co-ordinate the three departments in relation to fraud and overservicing.

These measures will not stop medical fraud and overservicing, but they do demonstrate a new determination and a will to come to grips with this massive problem, not only at the political level, but also at the administrative level. The Government, like the Public Accounts Committee, is very concerned about the need for cost containment. To contain costs we need a national cost control program with adequate statistics for evaluation, planning and control, and the co-operation of health providers-that is the States, the health institutions and the health professions with the public-to understand and work together for cost containment. I believe that over the years we have now got a different attitude in the community which is serious about cost containment. As a result of the medifraud inquiry, the Public Accounts Committee has made a large number of valuable recommendations which I believe the Government will follow-up.

From the detailed inquiries of the Public Accounts Committee it is apparent that the user plays very little part in determining health costs. The typical, and usually the only contribution made by the user, is the decision to make an initial visit to the general practitioner or the local hospital outpatients department. The critical and potentially expensive decisions are the pattern of treatment, the referral to a specialist, the recommendation to a laboratory and x-ray examination, the admission to hospital and the prescription of medication. These decisions are made by general practitioners, specialists and hospital administrators. The suppliers, not the users, are the critical determiners of cost in the health area. They should be the prime objectives of cost containment policies. No doubt, if governments made user charges high enough they would have some effect on usage of health services but it would be very much at the expense of the poor, the aged and the chronically ill. The only significant effect of such a policy would be to limit the use of health services by those who need them most.

In order to maintain efficient administrative controls over the delivery of health services, it is essential that all payment data is channelled through the one fund; that is, the national Medicare office. Without this control there would be no possibility of monitoring and checking fraud and overservicing which , it is estimated, has already cost the Australian community at least $100m a year. I am very pleased to see that the Public Accounts Committee has extended its terms of reference in the medifraud hearing. I hope that the inquiry goes alongside the further developments in the Medicare proposals. The proposal, for example, to revise the medical benefits schedule will ensure that cost containment is paramount in the implementation of the new Medicare arrangements.

In conclusion, I believe that there is now a new awareness of the need to monitor spending on health services. In the long term this will ensure the introduction of more efficient administrative measures and a more equitable and universal system of health insurance. Until now ordinary families on average weekly earnings have paid up to $500 a year in health insurance. Now, under Medicare those families will pay approximately half that, or $4.50 a week, in the form of the one per cent levy. That is very good news for ordinary Australians. I believe it introduces a much more equitable health system into Australia, a health system which is available to all.