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Thursday, 6 December 1973
Page: 4454

Mr DEPUTY SPEAKER (Mr Scholes - Order! Is leave granted? There being no objection, leave is granted. (The document read as follows) -


Mr THORBURN - It is interesting to note what various speakers have said in this debate. The honourable member for Indi (Mr Holten) made a great song and dance about a woman who, under the proposed scheme, went to hospital to have a baby. He exhibited how much he knows about the White Paper and the Bill that is before the House at the moment. Apparently he is not aware that a woman who has elected to have her general practitioner attend to her during the prenatal period of her confinement can have the services of her own general practitioner when she is a public patient in hospital. Obviously the honourable member during this 6 months period did not have a look at this aspect of the health scheme. The Opposition has taken little opportunity to study this matter.

It is interesting to note some of the philosophies of member's opposite. The honourable member for Hotham (Mr Chipp), who led for the Opposition in this debate, made a number for points which I think require some comment. Firstly, he said that the Opposition accepted that the schedule of fees was not binding on all medical practitioners. But if any health scheme is to succeed the schedule of fees must be adhered to by a substantial majority of medical practitioners. Let us examine the record of the medical profession up to date? If we take the worst example of their record - that is, home visits by general practitioners - we find in my home State of New South Wales that in the quarter completed June 1972, 32 per cent of general practitioners were prepared to keep to the schedule of fees; for the quarter completed September 1972 the figure was 32 per cent; for the quarter completed December 1972, the figure was 31 per cent; and for the quarter completed March 1973, the figure was 29 per cent.

Let us also consider the performances of specialists and all other medical practitioners in the three major States on the basis of the whole schedule of fees. Only 58 per cent of medical practitioners and specialists in New South Wales adhered to the schedule of fees in the June 1972 quarter. In the following three quarters the figures were 65 per cent, 70 per cent and 71 per cent. It is interesting to note that in Victoria and Queensland they have started to go bad again. The percentages for June, September and December in Victoria were 69, 70 and 71. Then in the first quarter of this year the figure went back to 70 per cent. In Queensland it has gone from 73 per cent down to 72 per cent. So one can see that the Liberal Party, in keeping its existing scheme going and in trying to fortify the out of date and unrealistic scheme that exists at present, is making a number of assumptions that are totally incorrect. The fact is that the majority of doctors, as shown from the statistical records that have been supplied, are not keeping to the schedule of fees at all. If the Liberal Party is hanging its hat on these figures, obviously the scheme it is proposing as an alternative would not succeed right from the start.

I want to comment on the remarks of the honourable member for Chisholm about public wards. The first thing he said was that the public wards will be inundated with patients. One would suspect that not even he would think that suddenly everybody is going to get sick because a new health scheme is brought in. As far as the general practitioner is concerned there is absolutely no difference between the existing scheme and the scheme that the Government proposes. A person will elect to go to the doctor to whom he normally goes. It is interesting to note that most of the opposition that has come through this Parliament has concerned the right of a person to select his own doctor.

How free is this choice at present? I do not blame the general practitioners. I think it is an archaic type of arrangement that a general practitioner should be on call for 24 hours a day, 7 days a week. At present the position is that he engages some other service to look after his practice during his out of hours time. So the likelihood is that a person will not be able to get the doctor of his choice during the 10 hours possibly that he is not available during the day and during the weekend period. In fact, he wil not even know who the doctor will be, because these doctors are engaged on a salary basis by various agencies. When a person telephones for the doctor he gets a message telling him the number to call, and some doctor he has never seen before in his life, about whom he knows nothing at all, comes to attend him during the period he is sick if it happens to be out of hours for most doctors in most States. As I say, I do not blame the doctors for this. But it makes hollow the argument that we must have the doctor of our choice; it is almost impossible to get the doctor of our choice.

The Government's scheme does not alter the existing scheme in that if a person is referred to a specialist for consultation he can still go to the specialist of his choice. But it is very interesting to note that, in the discussions that the committee had with the various medical organisations - this has been stated freely by a number of people who have written papers and letters on this subject - it was revealed that about 80 per cent of people who go to a general practitioner accept the advice of that practitioner as to the specialist that they will attend. So again that makes hollow the argument about selection of the doctor of one's choice. The position of a patient going to a hospital has not yet been fully determined. These are matters that will have to be discussed both with the State governments and with the boards of the various hospitals as to how the -medical staff in those particular hospitals will be structured.

Let me just make some criticism of the existing scheme. If there is a deficiency in the existing scheme it is that the majority of the money is going into the private sector of medical care and there is an absolute lack of money in the public sector. One can see this because the former Minister for Health in the previous Government will freely admit that over a period of time he was inundated with requests from the States for some special consideration in relation to hospitals where there were grave deficiencies. The Government has allocated some $4m in the coming year to the hospital complex at Westmead in Sydney. In my own electorate, which has a modern hospital because it is a new area, there is a bed ratio of 2.2 per thousand of population, which is one of the lowest ratios in Australia. In other words, we are gravely deficient of public beds in our area. That is common in many of the fast growing areas of New South Wales. If one goes to some of the country areas in which previously there were fairly large populations one will find a great abundance of beds. Recently one of the parliamentary committees visited a country town in New South Wales in which there were 29 maternity beds and only one of them was occupied. Taking the overall figure for New South Wales, the bed population ratio looks reasonable, but comparing the distribution of those beds with the population the position is entirely different.

This week I handed certain reports to the Minister for Health (Dr Everingham) and asked him whether he would look at the position in my electorate in order to ascertain whether something could be done in next year's allocation about making available some special grants to try to overcome the critical problem that is developing there in the public hospital sector. That is where the money has been taken away from. The same situation exists in Queensland. The people of Queensland are looking anxiously to the $30m that they are to get for the upgrading of their public hospitals. Because Queensland has expended its money over a period of years on health care, to the detriment of the buildings, it has been able to provide for its people. Labor's scheme proposes to make available to people money where it should be applied and where it is not being applied at present.

The Opposition must be terribly disconcerted by the success of the medical centres that have been established in Canberra by the Minister for Health, who is now sitting at the table. All sorts of dire predictions were made as to what would happen when this proposition was first put forward. It was said that no doctors would apply for any of the jobs. Of course the opposite has been the case. A number of specialists have consulted with us and said: 'If you can offer me a position at a salary which is commensurate with my experience and capabilities and you can offer me superannuation, annual leave, sabbatical leave and the other things to which I would normally be entitled, I will be delighted to work on a salary. I would be delighted to be able to apply myself full time to the health care of the people'. The health centres that have been established in Canberra have been an outstanding success. They have provided doctors with the opportunity of getting on with the job of providing medical care to the people of Canberra. They have also provided social workers to take away from the doctors the unnecessary task that most general practitioners have to face up to in their practice of dealing not only with the medical problems of their patients but also the social and other problems that exist. Of course, the Government has not had any shortage of people wanting to work in these centres. There has been a great response from people who want to devote themselves full time to the medical care of people. I am quite convinced that this will be the same with the Government's scheme.

As I have said, the arrangements that will have to be made with the States are still open to negotiation, but I am quite sure that a majority of the States will be able to negotiate with the medical people who are currently operating in their districts to serve in their hospitals in a full time or sessional capacity. I am quite sure that we will be able to provide to the people who go to those hospitals the very best medical care, which is what the people are interested in. They are not interested in the personality of the doctor. They are interested in getting the very best of medical care that can be made available to them. It will be made available through this scheme.

The Opposition's token opposition in the debate tonight has shown the shallowness of its proposals. The Opposition knows full well that this is a scheme which the people of Australia want, that a great number of medical people are in favour of it and that the only opposition is coming from those sectional interests who have some pecuniary position to defend.

Debate interrupted.

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