N.S.W. Medicare war zone

Press, 21 June 1984, Page 8

N.S.W. Medicare war zone

By CHRIS PETERS, NZPA Sydney Most of the 5000 doctors working in New South Wales hospitals went out on strike yesterday in the latest round in their fight against the introduction of a national health system.

The row has reached a new pitch of emotionalism after the state’s Premier, Mr Neville Wran, applied the torch with punitive regulations pushed through Parliament last week. In a carrot-and-stick exercise he has held off implementing the new laws — which among other things ban erring doctors from public hospitals for seven years — if the doctors will withdraw resignations submitted in the dispute. Since he took over the running from his Health Minister, Mr Ron Mulock, the stakes in the dispute have been raised by each side in rapid succession, culminating in yesterday’s crisis. Only emergency cases will be dealt with in the hospitals throughout Australia’s most populous state, and the doctors insist that they will stay out until not only Mr Wran’s seven-year ban threat is withdrawn, but original grievances over Medicare are resolved, too.

New South Wales has become the national battleground in the row over Medicare. Doctors throughout the country are sitting on the sidelines with the Federal Government in Canberra. The doctors, have got their most militant and prosperous members who stand to gain or lose the most in the row fighting for what they believe is a cause against the eventual nationalisation of Australia’s medical system. The country’s Labour Government is acknowledged even by the doctors to have an electoral mandate to introduce a national health system and it has put its case into the safe hands of Mr Wran, probably the toughest political streetfighter in the country. For Mr Wran, a Labour traditionalist from the Sydney working-class suburb of Balmain, the fight with the doctors is seen in simple terms — the whole dispute comes down to money and an attack on the fledgling Medicare system. For the doctors it is a case of principle — the Medicare regulations give the Federal and state governments power to alter their contracts of employment limits how much they

can charge their private patients if they treat them in public hospitals, and changes a system that they say has worked well for years. Twice already doctors have gone out on strike — in March nationally for 24 hours, then in New South Wales for two days in April. One of the central issues is the system whereby visiting specialists treated public patients in hospitals for nothing and in return were given free use of hospital facilities when treating their own patients. That worked well before the introduction of Medicare, when the ratio of private patients to public they treated was 70:30.

Since February 1 that ratio has practically reversed and the specialists have seen their incomes cut.

Medicare provides the specialists with sAusts2 an hour for treating public patients and charges them for the use of facilities for the shrinking number of private patients, but the doctors say that they are losing both ways. Since late last year the doctors, specialists, and surgeons working in the state hospital systems throughout Australia have been bridling against the regulations

drawn up in the country’s second crack at setting up a national health scheme. Their first bone of contention was the provison for the Federal Health Minister to overrule terms of contracts between public hospitals and visiting doctors — particularly diagnostic specialists such as radiologists.

The relevant section set a limit of how much such specialists could earn from working in public hospitals. After they reached that, set initially at sAust62,soo a year, they had to start paying a portion to the hospital.

Out of that row came an agreement for a special inquiry into doctors’ grievances — the Pennington inquiry — which has still to report back to the Government.

In April a new dimension was added to the row when the New South Wales Government, along with the three other state Labour governments, introduced rules governing visiting specialists’ use of public hospitals. It ruled that doctors using public hospitals to treat their private patients would not be allowed to charge more than the scheduled fee, and it forbade doctors from trying to convince

their patients to join private health funds.

On April 9 state doctors went on strike for a week, but returned to work after two days after a “truce” was arranged. That was when the resignations began to flow — or, more correctly, notice of intention to resign — and Mr Wran stepped in.

Last week he recalled the state Parliament and pushed through his tough measures, deeming that all doctors who resigned were taking industrial action and would be banned from public hospitals for seven years.

Once the law is implemented all resignations will be declared null and void and will have to be resubmitted.

The state Government says that only a handful of specialists have said they will quit often from only one of several appointments, and their stand is emotional huff and puff. The surgeons say, “wait and see.”

But now both sides have made their final bids, and the doctors and the government must now turn up the cards to see who has the stronger hand.