CHECK AGAINST DELIVERY EMBARGOED UNTIL DELIVERY
SPEECH BY THE PRIME MINISTER
14TH CONGRESS OF THE CONFEDERATION OF MEDICAL
ASSOCIATIONS IN ASIA/ OCEANIA
SYDNEY 12 NOVEMBER 1985
Dr Lindsay Thompson
Distinguished Guests
At the outset I should like to thank the Chairman of the
Organising Committee of the 14th Congress of the
Confederation of Medical Associations of Asia and
Oceania, Dr Lindsay Thompson, for the kind invitation to
address your official dinner this evening. I should
also like to congratulate Lindsay on his appointment as
President of the Confederation an office to which he
will bring great expertise and dignity. I
May I also welcome overseas visitors to Australia. The
Congress is another example of the growing recognition
of the importance of co-operation between countries in
the Asia/ Oceania region in areas where the exchange of
information and expertise can offer significant benefits
to the populations of the participating countries.
Only last Friday I was privileged to be at the opening
of the new building for the Walter and Eliza Hall
Institute of Medical Research in Melbourne. That
Institute, and others like it in Australia, are
developing a growing relationship with researchers in
Asia and Oceania. The Institute's work on developing a
malaria vaccine, for instance, is of tremendous
significance for Asia and Oceania.
During this century there have been impressive advances
in medical science. In 1979 smallpox was officially
declared to be eradicated on a worldwide basis.
Poliomyelitis, tuberculosis, typhoid, all killers or
causes of substantial suffering, irreversible
disability, grief and social stigma have been pushed
into the background. Inevitable childhood diseases such
as measles, mumps and rubella are effectively
preventable nowadays with the elimination of such
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dreaded complications as encephalitis, deafness and
congenital deformations. Birth control has been made
highly effective and relatively safe resulting in a
substantial reduction in the physical and psychological
burden of unwanted pregnancy. Pregnancy itself, birth
and parenthood are no longer so clouded with the nagging
prospects of losing either the child or the mother or
both. On the other hand, success in eradicating the diseases
of childhood or childbirth seems to have produced a
transferance of the health problem to those who now
survive through to adulthood.
In most of the advanced countries newborns of both sexes
can now look forward to an average lifespan of more than
years. In many countries concern is now being
expressed at the impact of ageing of the population on
health care costs and the nature of health care
services. The quality of life of these senior citizens
has been enhanced through control of painful or
disabling conditions ranging from dental care and hip
replacement to cardiac pacemakers.
It is one of the ironies of life that this impressive
record of performance and the expectations about things
to come is accompanied by growing apprehension about the
alarming rate at which health care costs keep rising.
This apprehension is compounded by misgivings about an
emphasis on technological capabilities at the cost of
human dignity. Questions and doubts about the real
impact of health care on health status and on life
expectancy are increasingly being voiced and echoed
through the media and in the public arena. Some argue
with the uncritical support of many that health care
resources could be spent more effectively on other
social endeavours.
It is important to point out, however, that a
fundamental principle of my Government's health care
policy is that no Australian is denied access to medical
treatment in the community and public hospital services.
The Medicare health insurance program which we
established is a simple, fair, and affordable health
insurance system that provides basic health cover to all
Australians. I believe that Medicare is one of my Government's most
significant social reforms. Medicare's universal health
insurance coverage has brought to an end the
unacceptable situation where under the previous
Government two million poor and disadvantaged
Australians were without health insurance.
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My Government's initiatives in community health have, to
date, been based on the Medicare arrangements. It was
Medicare which laid the foundation of an expansion of
community health programs for which an additional
was provided in 1984/ 85. This funding has been
continued. Priority now needs to be given to closing
gaps between existing programs and extending existing
community health activities, particularly in the area of
allied health professionals to support the already well
established network of general practitioner services.
Through increased Federal Government funding and
involvement there is the opportunity to influence the
direction of the provision of community health.
Medicare is founded in a mixed system of health care
provision. Private medical practice continues in public
hospitals, and private hospitals provide about 20% of
total hospital bed days in Australia. The Government
believes that the private sector has an important and
continuing role to play in the co-ordinated delivery of
health care services and is endeavouring to remove
unnecessary regulation. As a part of the package to
resolve the recent NSW Doctors Dispute, for example,
detailed negotiations are underway to achieve
deregulation of private hospitals at the Commonwealth
level. It must not be assumed that there are no significant
problems remaining. The recent report by the Federal
Parliamentary Public Accounts Committee, and subsequent
hearings, exposed serious concern about the provision of
pathology services under the fee for service system.
These concerns, I should hasten to add, were expressed
by the major Australian medical associations, the Royal
College of Pathologists, patients and others. The
Government does not believe that the criticisms and the
significant costs of such services can be ignored.
The Government is committed to the operation of an
efficient, high standard health care system through
Medicare at a cost that is affordable to the Australian
people. It is important that increases in health costs
be restrained particularly in those areas where serious
problems have been identified. The Minister for Health,
Dr Blewett, has already given notice that the Government
intends to address problems in the pathology industry.
Many of the problems facing Government stem from
technological advances that promise to save and extend
lives, but are very costly. As this technology moves
from the experimental stage to adoption in the
mainstream of medicine, it will pose some difficult
social dilemmas. Should, for example, care be provided
in cases where expected costs may appear
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disproportionately high. Should the latest technology
be introduced before it has been fully evaluated for
efficacy and cost effectiveness against existing
technology.
A recent report on " Into the Twenty First Century: The
Development of Social Security" by the International
Labour Office points out that:
" It would be undesirable to-limit medical progress
or to restrict access to the benefits of medical
technology which can demonstrably improve the
quality of life. As our societies become richer,
it is in this area that we are convinced that
people want to see more money spent particularly
on improvements in the quality of care given to the
aged and the dying as well as in the life prospects
of children."
The ILO report further observes that, while there have
been clear breakthroughs in improving the quality of
life for many groups of patients in the past 30 years,
the extent of the improvement should not be exaggerated.
The report argues that the vast increase in health
spending has not accelerated the decline in mortality
rates ( relative to the previous 30 years) and that there
is no clear link between spending on curative services
and better health.
Some other problems which I believe need to be addressed
by Australia and other countries include:
Wi the current bias towards care in institutional
settings relative to care in outpatient
settings;
( ii) the bias towards short-term acute and curative
medicine and the inadequate attention to the
prevention of illness and health promotion;
( iii) the lack of interest in the role of volunteer or
other helpers who could supplement public
programs in addressing need; and
( iv) for some of the countries represented at this
Congress, improvement in the status of public
health is important and it must both anticipate
and respond to the needs of specific
populations.
Progress in resolving some of these important policy
issues will depend on the development of new approaches
to the delivery of cost effective health care services.
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Globally Governments are restricted in the resources
they can make available for medical efforts to save
lives. I hope that the forthcoming Reagan/ Gorbachev
Summit will result in decisions regarding arms control
which could make available more resources devoted to
saving human life.
I am aware that some of these health policy issues will
be touched on in the scientific program of the Congress.
I hope that limits to the availability of public
resources in the field of health care are recognised and
that attention will be directed to identifying the most
effective ways in which these resources can be used.
Again I would like to thank you for your kind invitation
to speak to you tonight. I wish the Congress every
success and hope that Congress delegates who are
visiting Australia find their stay professionally and
personally rewarding.
Thank you.