ADDRESS BY THE PRIME MINISTER, MR. E. G. WHITLAM, M, P.,
TO THE 46TH ANNUAL WESTERN AUSTRALIAN SUMMER SCHOOL
UNIVERSITY OF WESTERN AUSTRALIA FRIDAY 18 JANUARY 1974
A SOCIAL SERVICE APPROACH TO HEALTH
LAST MONDAY I WAS ABLE TO TELL A NATIONAL CONVENTION OF
TEACHERS OF MY SPECIAL SATISFACTION AT THE ACHIEVEMENTS OF THE
AUSTRALIAN GOVERNMENT IN THE FIELD OF EDUCATION IN THE LAST YEAR.
IDESCRIBED HOW IT HAD TAKEN AUSTRALIAN GOVERNMENTS NEARLY 100-YEARS
TO ESTABLISH THE PRINCIPLE THAT EDUCATION IS A NATIONAL RESPONSIBILITY.
I OUTLINED HOW THE RESULT OF THE FAILURE TO ACCEPT THIS PRINCIPLE
HAD BEEN " ITO ENTRENCH PRIVILEGE AND WIDEN STILL FURTHER THE
INEQUALITIES'IN THE EDUCATION SYSTEM" THE MAJOR BATTLE OVER THIS
ISSUE WAS WON LAST YEAR WITH THE CREATION OF A NEW CHARTER FOR THE
CHILDREN OF AUSTRALIA AND THE PROVISION OF THE ESSENTIAL FUNDS AND
MACHINERY TO IMPLEMENT IT.
THAT SPEECH COULD HAVE BEEN EASILY ENTITLED " A SOCIAL
SERVICE APPROACH To EDUCATION". FOR THE ESSENTIAL INGREDIENT OF A
SOCIAL SERVICE APPROACH TO ANY ASPECT OF OUR SOCIETY MUST BE TO
OFFSET PRIVILEGE AND MINIMISE INEQUALITIES. IT MUST BE TO IDENTIFY
AREAS OF DISADVANTAGE AND DISABILITY AND STRIVE TO IMPROVE AND
REMEDY THEM. I AM PROUD OF THE IRREVOCABLE FIRST STEPS WE HAVE TAKEN
TO ACHIEVE THESE GOALS IN EDUCATION. I AM CONFIDENT THAT WE CAN
PRESS ON SUCCESSFULLY WITH THE GREAT TASK THAT LIES AHEAD OF US.
v s e/ 2
-b V
UNHAPPILY I CAi4NOT SPEAK TO YOU TODAY( ABOUT AuSTRALIA0S
HEALTH SYSTEM WITH THE SAME DEGREE OF PRIDE AND CONFIDENCE. WE CAN
BE PLEASED WITH THE PROGRESS THAT HAS BEEN POSSIBLE IN THE LAST YEAR.
THE AUSTRALIAN GOVERNMENT HAS MADE THE FIRST MOVES TO IMPROVE OUR
HOSPITALS AND OTHER HEALTH-CARE FACILITIES; THE MINISTER FOR HEALTH.-
DR EVERINGHAM, TOLD YOU OF THESE ADVANCES ON WEDNESDAY. WE AHAVE1
HOWEVER, BEEN THWARTED IN OUR ATTEMPTS TO ACHIEVZE SOME OF OUR MOST
IMPORTANT OBJECTIVES.
THE RESULT IS THAT THE PROVISION OF HEALT H'CARE IN AUSTRALIA
IS STILL CHARACTERISED BY THE ENTRENCHMENT OF* PRIVILEGE AND BY
INEQUALITY. Too MANY AUSTRALIANS MORE THAN A MRLLIONI IN FACT -HAVE
NO FINANCIAL PROTECTION AGAINST THE HIGH COST OF ILLNESS AND INJURY.
Too MANY AUSTRALIANS PARTICULARLY THOSE WHO LIVE AWAY FROM THE
CENTRES OF OUR MAJOR CITIES -HAVE INADEQUATE ACCESS TO HIGH QUALITY
HOSPITALS AND MEDICAL SERVICES. Too MANY AUSTRALIANS SUFFER FROM
A SYSTEM WHICH MAKES IT CHEAPER FOR A WEALTHY MAN TO INSURE H= IMSELF
AGAINST MEDICAL CHARGES THAN IT IS FOR PEOPLE WHO ARE NOT WEALTHY.
IHAVE JUST MENTIONED THAT MORE THAN ONE MILLION AUSTRALIANS
ARE UNPROTECTED AGAINST HOSPITAL AND MEDICAL CHARGES. OUR OPPONENTS
HAVE FREQUENTLY TRIED TO DENY THAT ESTIMATE. THEY HAVE MADE THEIR
DENIALS SO THAT THEY CAN PRETEND. THAT IT IS POSSIBLE TO OVERCOME THE
DEFICIENCIES OF OUR PRESENT HEALTH SYSTEM BY MINOR IMPROVEMENTS@
ON THE 8TH JANUARY THE AUSTRALIAm BUREAU OF STATISTICS A BODY WHOSE
OBJECTIVITY I PRESUME WOULD NOT BE CHALLENGED PUBLISHED A REPORT
ON A SURVEY WHICH GIVES THE LIE 1* O OUR OPPONENTS'I ASSERTIONS. a e3
-3-
-THE BUREAU CONDUCTED A SURVEY WHICH COVERED ABOUT 30,000 DWELLINGS
IN ALL STATES, THE NORTHERN TERRITORY AND THE AUSTRALIAN CAPITAL
TERRITORY TO DETERMINE HOW MANY PEOPLE AGED 15 AND OVER WERE COVERED
BY HOSPITAL AND MEDICAL EXPENDITURE ASSISTANCE SCHEMES THAT IS
PEOPLE COVERED EITHER BY CONTRIBUTQRY HEALTH FUNDS OR B. Y NONCONTRIBUTORY
SCHEMES, INCLUDING THE PENSIONER MEDICAL SERVICE, FREE
COVER OF PERSONS ON UNEMPLOYMENT OR SICKNESS BENEFITS AND THE LIKE.
THE SURVEY DID NOT INCLUDE SERVICEMEN BECAUSE OF THE FREE HEALTH
SERVICES THAT ARE PROVIDED'FOR-THEM.
THE REPORT SHOWED THAT ONLY 86.5 PER CENT OF THE PEOPLE
SURVEYED WERE COVERED BY AN ASSISTANCE SCHEME. IN OTHER* WORDSi.
13.5 PER CENT OF THESE AUSTRALIANS WERE UNPROTECTED. EVEN ALLOWI1NG
FOR THE PARTIAL PROTECTION AFFORDED TO QUEENSLANDERS BY THE FREE
PUBLIC HOSPITAL SYSTEM IN THAT STATE, MORE THAN 10 PER CENT OF THESE
AUSTRALIANS WERE DEVOID OF HEALTH PAYMENT COVERAGE. To USE OBSOLUTE
FIGURES, THE REPORT ESTIMATES THAT 1.225,000 AUSTRALIANS AGED
AND OVER WERE NOT PROTECTED. IF WE BEAR IN MIND THAT NEARLY
PER CENT OF AUSTRALIANS ARE AGED UNDER 15, WE-CAN CONFIDENTLY
ESTIMATE THAT WELL OVER 1h MILLION AUSTRALIANS ARE NOT COVERED FOR
THE COST OF HOSPITAL AND MEDICAL TREATMENT.
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WHO ARE THESE PEOPLE? THE BUREAU'S REPORT CONTAINS FIGURES
WHICH THROW UP SOME INTERESTING ANSWERS TO THIS QUESTION, MIGRANTS
HAVE LESS PROTECTION THAN PEOPLE BORN IN AUSTRALIA, AND AMONG
MIGRANTS, THE WORST OFF ARE THOSE WHO HAVE NOT * BEEN IN AUSTRALIA
FOR VERY LONG; AND SOME MIGRANT GROUPS FARE LESS WELL THAN OTHERS,
THE FIGURES ALSO INDICATE A DISPARITY BETWEEN INCOME GROUPS; LOW
INCOME EARNERS ARE LESS LIKELY TO BE PROTECTED THAN THE WEALTHY,
IN OTHER WORDS, THE CLASSIC PATTERN OF INEQUALITY AND. ENTRENCHEMENT
OF PRIVILEGE WHICH ANY SOCIAL SECURITY APPROACH MUST CONTEND WITH
IS TO BE FOUND IN OUR HEALTH SYSTEM,
SOME OF THE FIGURES THAT INDICATE THESE CONCLUSIONS ARE
WORTH QUOTING. ONLY 83,3 PER CENT OF PEOPLE BORN OUTSIDE AUSTRALIA
WERE COVERED, COMAPRED WITH 87,6 PER CENT OF THOSE BORN IN
AUSTRALIA, OF PEOPLE WHO ARRIVED IN AUSTRALIA BETWEEN JANUARY 1971
AND AUGUST 1972, WHEN THE SURVEY WAS CONDUCTED, ONLY 68 PER CENT
WERE COVERED, OF THOSE WHO ARRIVED BETWEEN 1967 AND 1970 THE FIGURE
IS 77,2 PER CENT, MORE THAN 53,000 GREEK MIGRANTS OR 37.5 PER CENT
WERE UNPROTECTED: ABOUT 52,000 ITALIAN MIGRANTS OR 19.1 PER CENT
WERE WITHOUT COVERAGE, IF A GREEK MIGRANT ARRIVED IN AUSTRALIA
BETWEEN 1967 AND 1970 THERE WAS ONLY A 1O PER CENT CHANCE THAT HE
HAD BENEFITED FROM HEALTH EXPENDITURE ASSISTANCE SCHEME,
NOW LET US TURN TO THE DISADVANTAGES BETWEEN VA-,, 6US ! NCOME
GROUPS. THE REPORT ESTIMATES THAT 92.4 PER CENT OF PROFESSIONAL,
TECHNICAL AND RELATED WORKERS AND 91.5 PER CENT. OF ADMINISTRATIVEO
EXECUTIVE AND MANAGERIAL WORKERS BENEFITED FROM ASSISTANCE SCHEMES.
IN CONTRAST, THESE BENEFITS APPLY-' TO ONLY 68.7 PER CENT OF SOME
GROUPS OF LABOURERS, 78.7 PER CENT OF OTHER GROUPS OF LABOURERS1
TRADESMEN, AND PRODUCTION PROCESS WORKERS, 7717 PER CENT Or-CONSTRUCTION
WORKERS AND 81.5 PER CENT OF MINERS, QUARRYMEN AND RELATED WORKERSI
PEOPLE IN RURAL INDUSTRIES ALSO SUFFER BY COMPARISON WITH OTHER
AUSTRALIANS; ONLY 82.9 PER CENT OF FARMERS, FISHERMEN, TIMBER
GETTERS AND THE LIKE ARE PROTECTED.
IT IS ABSURD THAT IN A COUNTRY AS WEALTHY AS OURS
DISCRIMINATION OF THIS KIND.-AGAINST NEW ARRIVALS'AND LOW INCOME
EARNERS SHOULD EXIST. THOMAS JEFFERSON SAID IN 1787 THAT " WITHOUT
HEALTH THERE IS NO HAPPINESS. AN ATTENTION TO HEAL-7H, THEN, SHOULD
TAKE THE PLACE OF EVERY OTHER PROJECT" IT SEEMS THAT AUSTRALIAN
GOVERNMENTS HAVE BEEN PREPARED TO CONDONE A GREATER MEASURE OF
UNHAPPINESS AMONG OUR DISADVANTAGED THAN AMONG THOSE WHO DERIVE* SO
MANY OTHER BENEFITS FROM OUR SOCIETY$
AUSTRALIA'S PRESENT PRIVATE HEALTH INSURANCE SYSTEM IS
CLEARLY TO BLAME FOR THIS SITUATION. DISADVANTAGED PEOPLE ARE
DISCOURAGED FROM BELONGING TO PRIVATE HEALTH FUNDS BECAUSE
CONTRIBUTIONS TO THEM ARE IN NO WAY RELATED TO A PERSON IS ABILITY
TO PAY; CONTRIBUTIONS INVOLVE FLAT RATES OF PAYMENT. IN FACT, THERE
IS DISCRIMINATION IN REVERSE BECAUSE OF OUR SYSTEM OF TAX DEDUCTIONS$
9 t s/ 6
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A TAX DEDUCTION IS WORTH MORE TO A HIGH-INCOME EARNER THAN TO
SOMEONE ON A LOWER INCOME. THUS, WHEN THE HIGH-INCOME EARNER CLAIMS
A TAX DEDUCTION FOR A HEALTH FUND CONTRIBUTION HE GAINS MORE FROM IT
THAN DOES A POORER MAN. THIS MEANS HIS HEALTH INSURANCE ENDS UP
BEING CHEAPER. FOR EXAMPLE, IN NEW SOUTH WALES A MAN WITH A WIFE
AND TWO CHILDREN ON ABOUT $ 70 A WEEK PAYS $ 81-A YEAR IN PUBLIC WARD
HOSPITAL COVERAGE AND MEDICAL INSURANCE AFTER TAX CONCESSIONS.
HOWEVE~ R, A MAN WITH THE SAME NUMBER OF DEPENDANTS ON $ 400 A WEEK
ONLY PAYS $ 54I FOR MEDICAL INSURANCE AND ER. LYAIE WARD COVERAGE AFTER
HE HAS GAINED HIS TAX CONCESSIONS0 AND TO REPEAT A. POINT I HAVE
OFTEN MADE IN THIS CONTEXT, IPAY LESS FOR HEALTH INSURANCE THAN
DOES MY CAR DRIVER.
TO ADD TO THIS INJUSTICE, A PERSON WHO CANNOT AFFORD
HEALTH INSURANCE OR WHO DOES NOT QUALIFY FOR ANY ASSISTANCE SCHEME
SUFFERS A FURTHER PENALTY. FOR THE COMMONWEALTH SUBSIDIES FOR MEDI. CAL
CHARGES ARE ONLY PAID TO PEOPLE WHO ARE INSURED AND, IF THE UNINSURlED
PERSON GOES INTO HOSPITAL, HE ATTRACTS A PALTRY SUBSIDY OF 80 CENTS
A DAY FOR HIS ACCOMMODATION. CLEARLY, PAST GOVERNMENT PRACTICE HAS
BEEN TO TRY TO FORCE PEOPLE INTO JOINING PRIVATE THE SO-CALLED
/ IVOLUNTARY" 1 HEALTH INSURANCE FUNDS WHETHER THEY FIND THE RATES
EXCESSIVE OR NOT. 17
I THE PRESENT HEALTH SCHEME HAS OTHER SUBSTANTIAL DEFICIENCIES
APART FROM INJUSTICE AND INEQUALITY, IT HAS ONLY BEEN SAVED FROM
SERIOUS FINANCIAL TROUBLE BY MASSIVE GOVERNMENT SUBSIDIES. SUBSIDIES
FOR MEDICAL AND HOSPITAL BENEFITS ROSE FROM $ 80,000,000 IN 1969 TO
$ 200,000,000 IN 1972, IF WE LOOK AT TOTAL AUSTRALIAN MEDICAL COSTS,
WE FIND THAT THE AUSTRALIAN GOVERNMENT PAID FOR ABOUT 54 PER CENT
DIRECTLY AND INDIRECTLY ( THROUGH TAXATION) IN 1969, IN 1972-73 THE
GOVERNMENT CONTRIBUTED 68 PER CENT. ABOUT $ 203,000,000 WAS PAID
BY DIRECT SUBSIDY AND $ 61,000,000 AS TAXATION CONCESSIONS, THIS MEANS
THAT TWO DOLLARS IN EVERY THREE EARNED BY DOCTORS. COMES FROM THE
AUSTRALIAN GOVERNMENT,
THE PRESENT SCHEME HAS ALSO BECOME UNNECESSARILY EXPENSIVE
AND WASTEFUL, LARGE SUMS OF MONEY ARE KEPT USELESSLY IDLE IN THE
RESERVE HOLDINGS OF THE PRIVATE FUNDS; IN 1971-72 THEY AMOUNTED TO
$ 124,000,000 OR THE EQUIVALENT OF 42 PER CENT OF THAT YEAR'S
CONTRIBUTIONS, THERE IS UNNECESSARY DUPLICATION OF SERVICES BECAUSE
OF THE EXISTENCE OF 81 MEDICAL AND' 90 HOSPITAL INSURANCE ORGANISATIONS
OPERATING THROUGHOUT AUSTRALIA, COMPETITION FOR MEMBERS, WASTEFUL
ADVERTISING AND COMMISSION RATES ALL CONTRIBUTE TO UNDULY HIGH
OPERATING COSTS FOR THESE FUNDS, AT PRESENT THESE COSTS ACCOUNT FOR
AN AVERAGE OF ABOUT 11 PER CENT OF CONTRIBUTIONS FOR ALL FUNDS AND
AN AVERAGE OF 15 PER CENT FOR MEDICAL FUNDS,
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THE FAILINGS OF AUSTRALIA' S HEALTH SYSTEM ARE NOT, OF COURSE,
CONFINED TO INSURANCE. GRAVE INADEQUACIES HAVE DEVELOPED IN THE
PROVISION OF HEALTH SERVICES. AGAIN WE FIND THE SPECTRE OF
INEQUALITY ARISES, FACILITIES HAVE NOT KEPT PACE WITH CHANGES IN
THE NATURE OF OUR SOCIETY, HOSPITALS, DOCTORS AND OTHER SERVICES
ARE SPREAD UNEVENLY AND UNFAIRLY, THERE IS * A TENDENCY FOR DOCTORS
TO LIVE IN MORE AFFLUENT SUBURBS BECAUSE OF THEIR FINANCIAL ABILITY
TO DO so, AND THERE HAS BEEN A TENDENCY FOR HOSPITALS TO BE
LOCATED NEAR WHERE DOCTORS LIVE AND PRACTICE. MY COLLEAGUE THE
MINISTER FOR SOCIAL SECURITY MR BILL HAYDEN, HAS POINTED OUT THAT
IN SYDNEY, FOR EXAMPLE, THE CITY'S SEVEN TEACHING HOSPITALS ARE
LOCATED WITHIN AN EIGHT-MILE RADIUS OF THE G. P. O. AND FIVE OF THEM
ARE WITHIN A FOUR-MILE RADIUS. YET THE GREAT MAJORITY OF SYDNEY'S
POPULATION LIVES A CONSIDERABLE DISTANCE OUTSIDE THESE PARAMETERS.
IT IS OBVI-OUSLY WRONG TO DEPRIVE MOST OF A CITY'S POPULATION OF
READY ACCESS TO THE BEST HOSPITAL FACILITIES.
THE MAJOR PROBLEM, HOWEVER, WHICH CONFRONTS US IN THIS
FIELD IS THE GROWING COST OF HEALTH SERVICES. AT PRESENT THEY COST
AUSTRALIA MORE THAN $ 2,000,000,000 OR ABOUT 5.3 PER CENT OF GROSS
DOMESTIC PRODUCT. BUT THEIR COST IS INCREASING DRAMATICALLY WHEN
COMPARED WITH THE COST OF OTHER SERVICES. HEALTH SERVICES ARE
ENORMOUSLY DEMANDING IN TERMS OF MANPOWER. THE SORT OF LABOUR~ SAVINGS
THAT HAVE BEEN POSSIBLE IN OTHER INDUSTRIES HAVE NOT BEEN ATTAINED.
16/ 9
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* FOR EXAMPLE, THE SELLING OF GROCERIES AND ALLIED COMMODITIES HAS
BEEN REVOLUTIONISED IN RECENT YEARS BY THE DEVELOPMENT OF SUPERMARKETS,
WHICH OVERALL ARE LESS DEMANDING OF LABOUR THAN THE TYPE OF STORES
THAT THEY HAVE TO A GREAT EXTENT REPLACED. THAT SORT OF MANPOWER
RATIONALISATION HAS NOT BEEN POSSIBLE WITH HEALTH SERVICES,
PARTICULARLY AS COMMUNITY EXPECTATIONS HAVE RISEN AND AS NEW AND
MORE COMPLICATED MEDICAL PROCEDURES HAVE BEEN DEVELOPED. THE RESULT
IS THAT IT HAS BEEN ESTIMATED THAT, AT THE PRESENT RATE, HEALTH
COSTS WILL DOUBLE EVERY FIVE OR SIX YEARS IN AUSTRALIA, ACCORDING
TO THIS ESTIMATE, OUR EXPENDITURE ON HEALTH SERVICES COULD BE MORE
THAN 12 PER CENT OF GROSS DOMESTIC PRODUCT BY THE YE* AR 2000 ONLY
26 YEARS FROM NOW. THAT IS, IF NOTHING IS DONE TO ENSURE GREATER
EFFICIENCY IN OUR HEALTH SPENDING.
ICAN DEMONSTRATE THE PROBLEM THAT CONFRONTS GOVERNMENTS
AND CITIZENS ALIKE BY ANALYSING THE CURRENT PLIGHT OF PUBLIC
HOSPITALS HERE IN WESTERN AUSTRALIA. THE OPERATING COSTS OF PUBLIC
HOSPITALS IN THIS STATE IN 1974-75 ARE EXPECTED TO BE MORE THAN
DOUBLE THE COSTS IN 1970-71 WHEN THE LAST INCREASE IN FEES OCCURRED;
THEY ARE EXPECTED TO RISE FROM $ 46 MILLION TO NEARLY $ 95 MILLION.
THE SHARE OF THE COSTS THAT COMES FROM STATE GOVERNMENT SUBSIDIES IS
EXPECTED TO RISE IN THE SAME PERIOD FROM 59 PER CENT To 67 PER CENT.
THIS TREND CAN ONLY BE ARRESTED BY A LARGE INCREASE IN PUBLIC
HOSPITAL FEES OR BY GREATER ASSISTANCE FROM THE AUSTRALIAN GOVERNMENT,
SIGNIFICANTLY GREATER ASSISTANCE FROM THE AUSTRALIAN GOVERNMENT WOULD
FLOW FROM THE FINANCING ARRANGEMENTS UNDER OUR PROPOSED HEALTH
INSURANCE PROGRAM. OUR OPPONENTS IN THE SENATE, HOWEVER, WERE ABLE
TO USE THEIR NUMBERS IN DECEMBER TO HINDER THIS HAPPENING.
THERE CAN BE NO QUESTION THAT TWO THINGS NEED TO HAPPEN
TO CONTROL THESE TRENDS AND ACHIEVE THE GREATER EFFICIENCY AND GREATER
EQUALITY THAT ARE NEEDED IN THE PROVISION OF HEALTH SERVICES IN
AUSTRALI'A. WE MUST ACCEPT THE NEED FOR NATIONAL RESPONSIBILITY FOR
HEALTH, AS IN EDUCATION, AND WE -MUST OVERHAUL OUR HEALTH INSURANCE
SCHEME. THE HISTORY OF MOVES TOWARDS NATI'ONAL RESPONSIBILITY IN
HEALTH IS A RECENT ONE. AN AMENDMENT TO THE CONSTITUTION, CARRIED
BY REFERENDUM IN 1946, GAVE THE AUSTRALIAN GOVERNMENT THE POWER TO
PROVIDE FOR / IPHARMACEUTICAL, SICKNESS AND HOSPITAL BENEFITS, ( AND)
MEDICAL AND DENTAL SERVICES . HOWEVER, SINCE THEN THE BENEFITS OF
COMMONWEALTH INVOLVEMENT HAVE LARGELY BEEN FELT IN THE AREA OF MEDICAL
AND PHARMACEUTICAL COSTS. THE MEDICAL BENEFIT SCHEME STARTED IN
19C53 AND I HAVE ALREADY POINTED OUT HOW COMMONWEALTH SUBSIDIES
UNDER IT HAVE GROWN DRAMATICALLY, IN NO SMALL PART DUE TO ITS
INEFFICIENCIES. A PHARMACEUTICAL BENEFITS ACT WAS PASSED BY THE
NATIONAL PARLIAMENT IN 1947. THIS ACT HAD LITTLE SUCCESS AND WAS
SUBSEQUENTLY AMENDED UNTIL THE INTRODUCTION OF THE PRESENT FORM OF
THE PHARMACEUTICAL BENEFITS SCHEME UNDER THE NATIONAL HEALTH ACT
IN 1959. THE TOTAL COST OF PROVIDING BENEFITS UNDER THIS SCHEME,
INCLUDING PATIENT CONTRIBUTIONS ON PRESCRIPTIONS, WAS $ 226.3 MILLION
IN 1972-73. THE AUSTRALIAN GOVERNMENT HAS INDEED ACCEPTED A NATIONAL
RESPONSIBILITY IN BOTH THE MEDICAL AND PHARMACEUTICAL AREA ALTHOUGH
WHETHER ITS MONEY HAS BEEN WELL SPENT IS ANOTHER MATTER. / 11
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THE HISTORY OF AUSTRALIAN GOVERNMENT INVOLVEMENT IN HOSPITALS
IS IN SHARP CONTRAST WITH THE EXPERIENCE IN OTHER AREAS. THE LABOR
GOVERNMENT INTRODUCED THE HOSPITALS BENEFITS ACT IN 19145 AND THIS
PROVIDED A BENEFIT OF 60 CENTS A DAY FOR ALL HOSPITAL PATIENTS.
THIS FIGURE MIGHT SEEM LAUGHABLE NOW, BUT AT THE TIME THE AVERAGE
WE COST IN AUSTRALIA WAS ONLY $ 1.40 A DAY. THUS THIS INITIAL
COMMITMENT AMOUNJTED To 43 PER CENT OF DAILY OPERATING COSTS IN
HOSPITALS. THE LIBERAL/ COUNTRY PARTY GOVERNMENT REPLACED THE LABOR
SCHEME WITH THE PRESENT HOSPITAL BENEFIT SCHEME IN 1952. THIS
PROVIDED A COMMONWEALTH SUBSIDY OF 80 CENTS A, DAY PLUS 140 CENTS A
DAY FOR INSURED PATIENTS. STILL, IN THE CONTEXT OF THE TIME., THIS
WAS A SUBSTANTIAL SUBSIDY.
CONTRARY TO WHAT ONE MIGHT EXPECT, THE AUSTRALIAN
GOVERNMENT' S INVOLVEMENT IN PAYING FOR THE RUNNING OF HOSPITALS
HAS SUBSTANTIALLY DECLINED SINCE THEN. IT NOW PAYS A SUBSIDY OF
ONLY $ 2 A DAY FOR HOSPITAL PATIENTS, ALTHOUGH THERE ARE NATURALLY
PTHER BENEFITS WHICH DERIVE FROM TAXATION CONCESSIONS. IT IS
ESTIMATED THAT IN 19714-75 THE AUSTRALIAN GOVERNMENT WILL HAVE TO
PAY ONLY $ 165 MILLION TOWARDS THE OPERATING COSTS OF PUBLIC HOSPITALS.
THIS COMPARES WITH AN ESTIMATED EXPENDITURE OF $ 5140 MILLION BY
STATE GOVERNMENTS AND $ 2140 MILLION BY INSURED AND UNINSURED PATIENTS.
IT IS NO WONDER THAT SO MANY OF OUR HOSPITALS ARE INADEQUATE. i / 12
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IT IS TIME THAT THE AUSTRALIAN GOVERNMENT ASSUMED A MUCH
GREATER ROLE IN THE FINANCING OF HEALTH SERVICES, IT IS NO LONGER
POSSIBLE FOR THESE SERVICES TO BE FINANCED IN THE FRAGMENTED MANNER
WHICH HAS APPLIED UNTIL NOW. No ONE WOULD EXPECT THAT ANY MAN,
HOWEVER WEALTHY, COULD AFFORD TO PAY BY HIMSELF FOR ALL THE EQUIPMENT
AND MANPOWER NECESSARY FOR HIM TO RECEIVE PROPER TREATMENT FOR A
MAJOR ILLNESS, NO ONE WOULD EXPECT ANY DOCTOR, HOWEVER WEALTHY, TO
BE ABLE TO PROVIDE BY HIMSELF ALL THE'FACILITIES AND STAFF NEEDED
TO TREAT THE RANGE OF ILLNESSES AND INJURIES HE WOULD ENCOUNTER
TODAY. WE ARE ALL DEPENDENT ON THE AVAILABILITY OF COMMUNITY
FACILITIES. I THINK I HAVE DEMONSTRATED THAT THESE FACILITIES ARE
INADEQUATE AND ARE UNEQUALLY AVAILABLE AT PRESENT. IT IS ONLY BY
THE ASSUMPTION OF A NATIONAL RESPONSIBILITY IN HEALTH THAT WE CAN
OVERCOME THESE INADEQUACIES,
DR EVERINGHAM TOLD YOU ON WEDNESDAY OF THE DEVELOPMENTS
THAT HAVE TAKEN PLACE IN THE AREA NOW COVERED BY THE HOSPITAL AND
HEALTH SERVICES COMMISSION. AS HE TOLD YOU, ITS AIM IS THE
" PROVISION OF HIGH QUALITY, READILY ACCESSIBLE, REASONABLY
COMPREHENSIVE, CO-ORDINATED AND EFFICIENT HEALTH AND RELATED WELFARE
SERVICES AT LOCAL, REGIONAL, STATE AND NATIONAL LEVELS", WE HAVE
ALREADY ALLOCATED $ 4.5 MILLION FOR 1973-74 TO MEET URGENT NEEDS
FOR ADDITIONAL HOSPITALS IN SYDNEY, MELBOURNE, BRISBANE. SIGNIFICANTLY,
$ 4 MILLION OF THIS HAS BEEN ALLOCATED TOWARDS THE COST OF PLANNING
AND COMMENCEMENT OF CONSTRUCTION OF A MAJOR HOSPITAL AT WESTMEAD
IN THE WESTERN SUBURBS OF SYDNEY MUCH MORE A CENTRE OF POPULATION
FOR THAT CITY THAN THE G. P. O. WE HAVE ALSO ALLOCATED $ 10 MILLION
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IN THIS FINANCIAL YEAR TO ASSIST STATES AND ELIGIBLE ORGANISATIONS
TO MEET THE CAPITAL AND OPERATING COSTS OF REGIONALLY ORGANISED,
COMMUNITY-BASED HEALTH SERVICES, COMMUNITY HEALTH FACILITIES,
PROVIDED AT CENTRES AND THROUGH DOMICILIARY SERVICES, OFFER A GREAT
OPPORTUNITY FOR COMBATING THE UNEVEN DISTRIBUTION OF DOCTORS AND
OTHER HEALTH WORKERS IN OUR COMMUNITY, IN ADDITION, WE HAVE PROVIDED
MILLION TO ASSIST STATES TO DEVELOP COMMUNITY-BASED MENTAL
HEALTH, ALCOHOLIC AND DRUG-DEPENDENCY SERVICES,
OUR MAJOR FRUSTRATION IN THE LAST YEAR HAS BEEN IN OUR
ATTEMPTS TO OVERHAUL THE PRESENT HEALTH INSURANCE SYSTEM AND THE
FINANCING ARRANGEMENTS THAT FLOW FROM IT, IF OPPOSITION TO OUR
HEALTH INSURANCE PROGRAM CONTINUES TO PREVENT ITS IMPLEMENTATION
THIS WILL BE VIEWED BY FUTURE GENERATIONS AS A TRAGEDY OF GREAT
PROPORTIONS, THE PROGRAM WOULD OVERCOME THE SERIOUS PROBLEMS THAT
EXIST UNDER THE PRESENT SYSTEM, FOR A START, IT WOULD AUTOMATICALLY
COVER EVERYONE IN AUSTRALIA, IRRESPECTIVE OF THEIR MEANS OR THEIR
BACKGROUND. FOR MIGRANTS, THIS WOULD MEAN THAT, VIRTUALLY FROM THE
MOMENT THEY STEPPED OFF THE BOAT OR THE AIRCRAFT THAT BROUGHT THEM
TO AUSTRALIA, THEY WOULD BE PROTECTED AGAINST HEALTH COSTS, IT
WOULD BE FINANCED IN THE MOST EQUITABLE MANNER AS THE PAYMENTS TO
BE MET BY INDIVIDUALS WOULD BE BASED ON THEIR-CAPACITY TO PAY, THE
PROPOSED LEVY OF 1.35 PER CENT ON TAXABLE INCOME WOULD PROVE CHEAPER
FOR THE GREAT MAJORITY OF AUSTRALIANS, ,/ 14
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FOR THEIR CONTRIBUTIONS, AUSTRALIANS WOULD RECEIVE A
COMPREHENSIVE RANGE OF MEDICAL AND HOSPITAL TREATMENT, IF A DOCTOR
SENDS HIS BILL DIRECT TO THE PROPOSED HEALTH INSURANCE COMMISSION,
HIS PATIENT WILL NOT HAVE TO PAY ANYTHING FOR MEDICAL TREATMENT,
EVEN IF THE DOCTOR SENDS HIS BILL TO HIS PATIENT, THE COMMISSION
WILL PAY AT LEAST 85 PER CENT OF THE SCHEDULED FEE, AND IN NO CASE,
WHERE THE SCHEDULED FEE IS CHARGEDI WOULD THE PATIENT HAVE TO PAY
MORE THAN $ 5 FOR ANY MEDICAL SERVICES, To DISMISS IMMEDIATELY ONE
PHONY ISSUE THAT HAS BEEN RAISED BY OUR OPPONENTS, THESE ARRANGEMENTS
WOULD APPLY TO SERVICES PROVIDED BY ANY DOCTOR THAT ANY PATIENT
CHOSE TO CONSULT, FOR HOSPITAL TREATMENTI EVERYONE WOULD BE
ENTITLED TO FREE STANDARD WARD TREATMENT; ADMISSION TO THIESE WARDS
WOULD NOT BE RESTRICTED TO PEOPLE WHO SATISFY THE SAVAGE MEANS
TESTS WHICH APPLY IN SOME STATES AT PRESENT, THE PROGRAM WOULD
ACHIEVE THIS GOAL WITHOUT DESTROYING THE VIABILITY AND INDEPENDENCE
OF RELIGIOUS, CHARITABLE AND COMMUNITY HOSPITALS, PATIENTS IN
PRIVATE WARDS OF PUBLIC HOSPITALS OR IN PRIVATE HOSPITALS WOULD
ATTRACT A BED SUBSIDY OF $ 16 A DAY FROM THE AUSTRALIAN GOVERNMENT,
A CONSIDERABLE IMPROVEMENT ON THE $ 2 A DAY WHICH IS CURRENTLY PAID.
THE GOVERNMENT AIMS TO ENSURE THAT PRIVATE INSURANCE IS AVAILABLE
AT REASONABLE COST TO COVER ANY EXTRA CHARGES FACED BY PRIVATE
PATIENTS,
ONE OF THE GREAT AND CONTINUING BENEFITS THAT WOULD FLOW
FROM THE HEALTH INSURANCE PROGRAM WOULD BE IN THE FINANCING OF PUBLIC
HOSPITALS. UNDER BILATERAL. AGREEMENTS WITH EACH STATE, THE AUSTRALIAN
GOVERNMENT WOULD BE PREPARED TO MEET 50 PER CENT OF THE NET OPERATING
COSTS OF PUBLIC HOSPITALS. PUBLIC HOSPITALS IN ALL STATES WOULD
BENEFIT FROM THESE ARRANGEMENTS. THE TOTAL GAIN TO STATE GOVERNMENTS
IN 1974-75 WOULD BE $ 80 MILLION. IN WESTERN AUSTRALIA, TO REFER
TO MY EARLIER EXAMPLE, THE STATE WOULD GAIN AN EXTRA $ 9 MILLION
FROM THE AUSTRALIAN GOVERNMENT.
THE HEALTH INSURANCE PROGRAM, COMBINED WITH THE WORK OF
THE HOSPITALS AND HEALTH SERVICES COMMISSION, WOULD PROVIDE THE
MACHINERY TO ENABLE A CLOSER SCRUTINY OF THE USE OF OUR RESOURCES
FOR HEALTH SERVICES AND GREATER EFFICIENCY. TO GIVE A MINOR EXAMPLE,
THE OPERATING COSTS OF THE HEALTH INSURANCE COMMISSION WOULD BE ONLY
ABOUT 6 PER CENT OF CONTRIBUTIONS COMPARED TO THE 11 PER CENT
CURRENTLY SPENT BY PRIVATE HEALTH FUNDS.
SOME OF YOU MAY HAVE WONDERED WHY, IN AN ADDRESS " A SOCIAL
SERVICE APPROACH To HEALTH", I HAVE MENTIONED SO FREQUENTLY. THE
WORD EFFICIENCY. THE REASON IS SIMPLE. WE CANNOT ALLOW HEALTH
COSTS IN AUSTRALIA TO RISE UNCONTROLLABLY. AT THE SAME TIME WE
ARE DETERMINED TO PROVIDE ADEQUATE HEALTH SERVICES FOR ALL AUSTRALIANS.
WE MUST THEREFORE ENSURE THAT EVERY DOLLAR WE SPEND IS SPENT WISELY.
WE MUST ENSURE THAT WASTEFUL EXPENDITURE IS AVOIDED IN AREAS OF
PLENTY SO THAT THE MONEY SAVED CAN BE DEVOTED TO AREAS OF NEED. / 116
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As I ASSUME YOU ALL KNOW, OUR PLANS HAVE FOUNDERED, AT
LEAST TEMPORARILY, ON THE ROCK OF THE SENATE, THE GOVERNMENT IS
NOW CONSIDERING ITS POSITION IN RELATION TO THE HEALTH INSURANCE
PROGRAM. M HAYDEN IS LEAVING AUSTRALIA IN JUST OVE( A WELK
EXAMINE HEALTH SYSTEMS OVERSEAS, PARTICULARLY THE CANADIAN AND
AMERICAN FEDERATIONS. THIS DOES NOT MEAN THAT WE HAVE ABANDONED
OUR LEGISLATION. BUT WE MUST LOOK AT ALTERNATIVE SYSTEMS OF
FINANCING HEALTH SERVICES, PARTICULARLY PUBLIC HOSPITALS, TO ENSURE
THAT WE MEET OUR NATIONAL RESPONSIBILITY. SINCE THE 1946 REFERENDUM
THE NATIONAL GOVERNMENT HAS HAD THE RIGHT AND DUTY TO PROVIDE
MEDICAL SERVICES, UNLESS THE AUSTRALIAN GOVERNMENT THE PRESENT
GOVERNMENT AND FUTURE GOVERNMENTS ACCEPT THIS RESPONSIBILITY,
WE WILL NEVER SATISFY THE OBJECTIVES OF A SOCIAL SERVICE APPROACH
TO HEALTH IN THIS COUNTRY. UNLESS WE ACCEPT OUR NATIONAL
RESPONSIBILITY, INEQUALITY, PRIVILEGE AND INADEQUACIES WILL CONTINUE
TO CHARACTERISE OUR HEALTH SYSTEM.