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Wednesday, 13 October 1971
Page: 2288


Mr BERINSON (Perth) - I oppose these clauses which give effect to the Government's decision .to increase the patients' contribution with respect to pharmaceutical benefit prescriptions to $1. Apart from the principle involved in this proposal, the Bill as a whole is open to 2 serious objections in relation to the timing of its discussion. In the first place, the revised Bill that we now have before us was introduced only yesterday, so that we have had far too little time to give considered study to the new clauses in it. The only excuse for the rush that I have heard advanced is that the need for increased nursing home benefits is now urgent. However, as the homes and their patients have now gone for 2i years without an increase in the intensive care benefit and Si years without an increase in the ordinary benefit, it is hard to take that sort of explanation seriously.

The second instance of bad timing relates directly to the increased prescription charge. This increase comes after the appointment of a select committee which is now in the process of considering all aspects of the pharmaceutical benefits scheme including the prescription charge itself. I know that there are differing views in this place on the subject of committees. Some honourable members are for them and some are against them. But I am quite sure that the worst possible compromise on the question of committees is that We should have committees but just ignore or by-pass them when they are in operation. That is exactly what we seem to be doing in this case.

Now why should we double the prescription charge and, indeed, why should we have a prescription charge at all? There are 2 possible justifications. Firstly and simply, we could have a charge to minimise Government expenditure in this area. Secondly, we could have a charge to act as a possible deterrent on excessive and unnecessary - that is, by definition, undesirable - drug taking. It is disappointing in this respect to see that the Government has looked at the increased charge solely in revenue raising terms. This financial year, so we are told, the charge of $1 will save the Commonwealth $16m. In a full year it will save the Commonwealth $24. 6m. If, as is to be clearly inferred by the Minister's speech in introducing this Bill, the Government's only interest is to find $24m, there is hardly a worse way of doing it than by this charge on illness.

Moreover, the extent of the increased charge is not justified even by the Minister's own figures. As he points out, the relationship of patient contributions to the total cost of the scheme has fallen from 23.1 per cent in 1960-61 to 21.7 per cent this year. Even on his estimate of the average prescription cost for next year, however, the new $1 charge will not merely restore the position of the 1960-61 .figure of 23.1 per cent but will increase that figure to 38 per cent. Why? What justification can there be for an increase, for any increase, and certainly for an increase of this magnitude? The Government does not explain anything by constant reference to the increased cost of the scheme as a whole. Of course its costs have increased over the years. But so has its scope, . so has its usefulness and so has its contribution to economies in other sections of our national health scheme.

Where the costs have increased, the increases are both explicable and justifiable. For example, the Minister indicated that the cost of the scheme increased by $24m last year. The annual report of the DirectorGeneral for Health for 1970-71 clearly indicates how this situation arises. Referring to page 35 of the Director-General's report, we find that $13. 6m of the increase was due to the relaxation in restrictions on drugs already listed and that $5.9m was attributable to items recently added to the list of benefits. In other words, of the whole increase of $24m, we find that $19. 5m was added as the result of new or relaxed benefits. That leaves less than S5m, and a large proportion of that amount can be attributed simply to increased population. The remaining amount, if the Government wished to meet it in this way, could be met amply by an increase of the prescription fee from 50c to 55c or 60c as a maximum. Certainly nothing of the order of $1 is warranted.

On the other hand, to discuss an aspect of this question which has been entirely neglected by the Government, I believe that it is conceivable that an argument could be raised for some sort of prescription fee and even an increased prescription fee on the basis of the need to deter unnecessary drug taking. It was quite clear that this was the view of the Department of Health as it was presented to the House of Representatives Select Committee on Pharmaceutical Benefits. I do not say that their view was substantiated but the Department did produce some figures and propositions which at least deserve consideration. For example, the Department pointed out that the average consumption of national health scheme drugs by non-pensioners is 4.5 per year and by pensioners approximately 18 per year. The Department was able to refer the Committee to the British experience where on 3 occasions when drug charges have been either introduced or increased drug usage has fallen by approximately 9 per cent to 12 per cent, at least in the short term. I am well aware that those figures on their own prove nothing. I am very well aware of the fact that there are many other factors which one has to take into consideration before arriving at some conclusion as to what those figures mean. But at least they are worthy of consideration and one would have expected the Government to consider and to comment on them when making such a radical change in the prescription charge position, as it has now done. For the moment I am prepared to say that in the absence of concrete, let alone conclusive, evidence to the contrary, I prefer the attitude of the Labor Party suggesting that there should be no prescription charge to that of the Government which says that the prescription charge should be doubled without making an attempt to justify the increase. la the very short time at my disposal 1 will say only 2 other things very briefly. These relate firstly to the inflationary effect of the proposed prescription charge. I. also want to make a brief comment on the 50c concession which is being offered to 'those eligible to receive assistance under the subsidised health benefits scheme. Firstly, I want to deal with the inflationary effect to which I have referred. An increase from 50c to $1 has the effect that all items at present on the list under a total cost of $1 - and it has been estimated in the absence of a concrete aswer from the Department that there will be up to 800 of those items - will come off the list for non-pensioners. They must then be obtained as private prescriptions at private rates of profit margin and dispensing fee. In round figures I have estimated that a prescription now costing $1, including the 50c patient payment, will then cost approximately $1.40, which is an increase of 40 per cent. A prescription now costing 70c will cost $1.05, which is also an increase of over 40 per cent. The difference does not arise because pharmacists suddenly become rapacious or altruistic as prescriptions come off and on the scheme. The fact is that the total cost of prescriptions under the scheme is lower for 2 reasons: Firstly, because it is . practical and inevitable to charge less to a bulk customer, which the Commonwealth is; secondly, because the Government presumably working on the basis that it should deal hardest with its weakest opponents, has kept pharmacists' dispensing fees to a rise of only 2c, or 6 per cent, over a 10-year period when dispensers' salaries alone have increased by more than 50 per cent. Whatever the reason, the overall effect on the community will be inflationary in the sort of area in which inflation should not be permitted, let alone created by Government action.

Finally, in the one minute left to me, let me say something about this 50c concession which applies to people eligible to receive assistance under the subsidised medical scheme. The submission regarding prescription fees which the Pharmacy Guild put to the House of Representatives Select Committee on Pharmaceutical Benefits was to the effect that people under the subsidised scheme shoud get their pharmaceutical benefit prescriptions for nothing. One sees the strength of that proposition when one considers who is eligible to receive subsidised assistance. They include people on sickness and unemployment benefits of $10 a week and whole families whose income is $49 a week or less. How can people on that level of income be expected to spend lc, let alone $1 or even . 50c - this magnificent concessionon prescriptions? The should obviously be placed on the same basis as full rate pensioners and receive their . prescriptions free.

The DEPUTY CHAIRMAN (Mr Hallett) - Order! The honourable member's time has expired.







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