PAULINE HANSONS ONE NATION
States have the primary responsibility for the provision of health services; however decisions by the Federal Government, and allocation of tied grants, have a direct impact on Health issues.
During the last few years various governments have told Australians they will have to provide for their old age as the tax payer will be unable to provide pensions to adequately support them. They are not only being encouraged to take out superannuation but are being forced to do so. No such mention is made in regard to providing finance to pay for the medical services they will require as they grow older.
As Australians age they will place increasing demands on the health services eg. Joint replacements, coronary artery bypass, pacemakers etc. There will also be a greater demand for nursing home and hostel accommodation. According to the Institute of Health and Welfare the life time risk of a 65 year-old person requiring nursing home care is 24% for a male and 37% for a female. By the time the baby boomers reach this age it will increase to 35% for a male and 50% for a female. As technology is advancing with great rapidity new investigative and corrective procedures will arrive on the medical scene with a concomitant increase in costs. Advances in anaesthetics have enabled the frail and aged to undergo complicated and formerly risky procedures.
It is already apparent that the rise in costs of private medical insurance is causing many people to drop out of this kind of insurance, particularly the young and healthy, leaving an ever-increasing burden on those who remain.
This situation will become more acute in the next ten to twenty years when the baby boomers reach the age when they will fall into the category of heavy users of health resources. As the population ages the risk of cancer increases exponentially. The baby boomers will find that the health and welfare support enjoyed by the present retirees will not be available to them unless there is a very considerable increase in the present taxation burden of PAYE taxpayers, or there is a complete revamp of the taxation system and/or there is a shift to private health cover. Future generations will be better educated and much more aware of the latest advances in medicine and will be more demanding and critical than their parents were. It is going to be very difficult if not impossible to convince healthy young people to subsidise the health costs of the aged.
If the costs of health care cannot be met then rationing will have to occur resulting in long waiting lists in hospitals with many patients dying before gaining access to medical care. We are seeing evidence of this occurring at present.
The four major divisions of health are:
The more money, time and effort the Government puts into the first three division the less it will need to put into the last.
The Medicare levy will be retained.
Taxpayers who take out full private health cover will be exempt from the Medicare levy.
The increase in private health cover will translate into a lower cost for public health; the loss of revenue from the Medicare levy (that levy is approximately $1.3 billion) will be borne by reallocating funds from other areas.
We propose that emergency Medicare services will be available to visitors from countries with which we have reciprocal agreements subject to an analysis of any imbalance of visitor numbers disadvantaging Australia. Visitors from countries without reciprocal agreements and without health insurance will be informed that they will be responsible for any medical costs during their stay.
All Australians will be encouraged through incentives to obtain private health cover.
Private health insurance will be fully tax deductible; but the amount of tax deductibility will be less the amount a taxpayer saves by not paying the Medicare levy. The initial loss of revenue through allowing health insurance premiums as tax deductions will be borne by reallocating funds from other areas; however the long term effect of a shift to private health cover will be a net saving of expenditure on public health services.
There will be no monopoly on provision of health insurance.
The issue of gap insurance and capping of doctors fees will be subject to community debate and user and provider input before a decision is made.
The Commonwealth Dental Health Scheme and pensioner denture scheme will be available to all those disadvantaged through low income, including all welfare, unemployment benefit and aged pension recipients.
Public dental clinics will be upgraded and sufficient staff will be employed to provide the bulk of the allowable services in the scheme.
A scheme similar to the Remote Areas Dental Scheme (R.A.D.S) in NSW for areas not serviced by a public clinic will be funded through tied grants. This will enable country towns to be provided with good dental services through the existing private practitioners in the towns. The scope of this scheme is to be similar to that provided by the Veterans Affairs Dental Scheme, which will be retained and upgraded, with selected items of treatment eg. Cosmetic work, crowns, implants etc. being part paid for by a fee levied on the patient, depending on the item of service rendered.
All work done by the RADS scheme is to be monitored periodically by government employed dentists who will randomly inspect and regulate quality.
School Dental Health Clinics are now poorly utilised and the facilities lie wasted. The School Dental Health Scheme for primary school children will be upgraded to provide full staffing and facilities to enable the establishment of a comprehensive preventative program enabling primary school students to receive examinations and treatment on at least a yearly basis at no cost. Education and prevention of dental disease is the primary function.
The current Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild of Australia will be retained.
Pharmacists will be given incentive to be Medicare agents in areas where there is not ready access to a Medicare office.
The Pharmaceutical Benefits Scheme will be retained as a basis of ensuring Australians have reasonable and timely access to efficient and cost effective pharmaceuticals. Concessional eligibility for the dispensing of PBS listed pharmaceuticals will be maintained for those who are eligible to receive pensions.
The approval processes for the listing of new pharmaceuticals are to be as responsive to community needs as possible, while ensuring that those medications have distinct cost and therapeutic benefits. Quality will be given more weight than cost when determining listing of new pharmaceuticals - the process will be quickened. The existing Isolated and Remote Pharmacy Allowances under the 1995-2000 Pharmacy Agreement will be continued to help pharmacists in financially marginal remote locations.
$70 million is being or has been cut from Home and Community Care programs in the last three years. Funds will be reinstated for Community Care programs such as Meals on Wheels, Home Maintenance Programs, community transport and home help services, which are essential to elderly and disabled people. This will allow elderly and disabled people to continue to live in their own homes with some support rather than being placed in nursing home care where there is not nearly the same quality of life. It will take considerable capital input to redress the years of neglect by previous governments to raise the level of the quality of hostel and nursing home facilities required to care for the increasing number of persons requiring aged care support. This will only be possible if the taxation system is overhauled. The concept of aging in place is supported strongly.
One Nation supports the concept of the government continuing to subsidise the cost of aged care and for persons being required to contribute to the cost of their residential care; provided that no person who is assessed as in need of residential care, is denied access to hostel or nursing home care on the grounds of inability to meet a portion of the cost appropriate to their means and ability to pay. A proportion of residential care places subsidised by government funding will be reserved for people receiving full or partial social services and veterans affairs benefits.
Funds are now being directed to paying for services to be supplied in residential environments for mentally and physically disadvantaged people. One Nation recognises many disabled people benefit from living in the community, but there are others who need centre based care.
The policy of shifting the emphasis away from centre based care of the mentally and physically disadvantaged will be reassessed.
The abuse of the system ie. "Doctor Shoppers" and drug addicts doing the rounds must be curtailed and a foolproof and cost effective method must be found to stop the trafficking of large quantities of prescription drugs for heroin etc. Patients may and often do visit several doctors to get further opinions for relatively trivial complaints. 21,000 Doctor shoppers cost the taxpayer approximately $31 million per year. Over four thousand patients see thirty different doctors per year.
Public hospitals are presently maintained, equipped and staffed as a State government responsibility. Fees for doctors working in these hospitals should be decided by negotiation.
Visiting Medical Officers (private doctors not employed by the government) should not be charged for the use of the facilities made available to them in recognition that they are on call for emergencies out of hours and that they teach medical and nursing students free of charge. It should also be noted that many specialists provide their own highly specialised equipment at no charge to the hospital.
One Nation supports the return of control of public hospitals to their own hospital boards. Reversion to hospital boards effectively restores control to local communities who can then take pride and an interest in their hospital.
Co-location of Private and Public Hospitals is not supported. Operating costs of Private hospitals should not be subsidised by government, but every encouragement will be given for the development of Private Hospitals.
Reintroduction of lotteries whose funds specifically support hospitals will be considered.
Vocational Registration (VR) was brought in by the Royal Australian College of General Practitioners (RACGP) in 1989 ostensibly to improve the standards of general practice.
The result of Vocational Registration is that patients attending general practitioners (GPs) who have not been stamped as Vocationally registered receive a lesser rebate, at present $4.00, and no rebate at all if they have not been given a provider number.
In 1989 Dr. Wooldridge, the current Coalition Health Minister said publicly [in Melbourne Age] "The VR was not concerned with standards of general practice. Thats rubbish, this is about the protection of their members interests. It is about limiting entry into general practice, keeping people out. They are protecting their own privileged position and not worrying about students and doctors in training. The RACGP was selling out younger doctors and medical students to solve the economic problems of general practice."
The Federal Government appears to be using the RACGP to control costs of GP services and this has adversely affected GP standards and service distribution. The RACGP appears to have four mutually exclusive responsibilities:
One Nation recognises that on-going education of medical practitioners is a worthy goal but will act to reverse the RACGP control measures which impact adversely on general practitioners.
While there is an oversupply of GPs and specialists of both medical and dental practitioners in the capital cities the rural areas continue to be starved of adequate care.
Reasons for this include:
To rectify this One Nation will:
University Medical and Dental schools will be encouraged to select students more by an assessment of aptitude and maturity rather than academically focussed selection alone. Selection criteria will ensure greater access of country students to medical and dental programmes provided there is not a lowering of academic standards.
ADEQUATE MEDICAL EXAMINATIONS FOR INTENDING MIGRANTS
During the last twenty years there has been a dramatic increase in a number of diseases viz. T.B., hepatitis B and A.I.D.s. Migrants suffering from these complaints have been admitted to our country due to inadequate screening, particularly abroad. One Nation will act to have tighter screening.
Australians travelling overseas will be made aware of diseases that are endemic in the country to which they are travelling and advised to take adequate precautions.
Australians have the right of free choice in the selection of their therapeutic treatments.
Practitioners of non-mainstream treatments have the same duties to the public as conventional medical practitioners with respect to:
Just as chiropractic, acupuncture and hypnosis have now been accepted as mainstream treatments, the Commonwealth through the Department of Employment Education and Training and the Department of Health and Human Services should accredit other alternative treatments after appropriate training and qualification standards have been established and met and the effectiveness of the treatment has been proven.
One Nation policy is for all Australians to be treated equally. Medical, dental and surgical services will be made available on the basis of need and not on the basis of race. $131.3 million has been allocated to Aboriginal and Torres Strait Islander Health Services together with $17.5 million for substance abuse services. Removal of dual administration of health services will generate significant savings.
Medical Insurance Premiums are escalating because current health policies have skewed health services away from GPs towards specialists. This has resulted in specialists doing work that could well be done by GPs. It is not necessary to have a Fellowship in
Surgery to remove a toenail.
30 Years ago there was a shift in the philosophy of medical schools towards producing "Undifferentiated doctors" instead of fully trained procedural GPs. Then as GP remuneration was reduced and specialist remuneration was increased, doctors switched from GP to specialist practice and lately we have seen the emergence of super specialists. Many of the procedures being carried out by specialists could be competently carried out by properly trained GPs.
There has been a trend lately to place emphasis on social awareness and empathy in the training of GPs. GPs are not social workers and should be trained to treat sickness, accident and disease. Once doctors are trained along the correct lines and qualified they will either acquire these social skills or starve.
Litigation has now reached epidemic proportions. The incidence of litigation in Australia has almost doubled during the last seven years compared with a 40% increase worldwide. The average cost of settling Australian claims has increased by 2 ½ times compared to the annual worldwide increase of 15%.
The Bolam principle (see Rogers v Whitacre) should be applied.
Introducing a no fault system such as operates in New Zealand will be considered. In childbirth when a baby is delivered and is found to have cerebral palsy, 1.4% of litigation against the medical profession is successful. A child or an adult sustaining brain damage whether acquired in childbirth or in a car accident has the same needs and this should be met by a no fault type insurance.
One Nation supports the concept of the delivery of health services on a national regional basis appropriate to the particular needs of each national health region. State governments should have the responsibility for the provision of all health services within the regions, including health services for the aged. Until now aged care was administered by the Commonwealth Department of Health and Family Services (DHFS) under the National Health Act. We believe that with appropriate funding, care of the aged should be a state responsibility. This will enable aged care services to be fully integrated with state hospital and community care services. One Nation would continue to support the concept of hospital and community aid packages currently provided through DHFS.
One Nation supports a policy of a non-political distribution of the available funds according to demographic need based on the health index of each state and territory and approved health programs. Rural and regional Australia will be afforded special treatment in recognition of the impact of geographical isolation.
Funding will be on the basis of block grants to each State and Territory justified according to each State and Territorys approved health care plan showing the aggregate amount to be spent on the various health care programs in the budget plan.
Accountability will be on the basis of program budgeting principles showing the heads of receipts and expenditure in relation to program inputs and outcomes and the unit costs of services and population served.