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One Voice: Remuneration

One of the Parliamentary Committee’s primary interests was doctors’ remuneration. In its final report, it agreed with the NHMRC in opposing the 1938 health insurance legislation. Its cover was restricted, the Committee said, the benefits that it proposed were limited, and there were inherent disadvantages in the proposed method of payment. But it came down against both fee-for-service and capitation.

The Committee said that its investigations had been helped by advice from leading doctors. It had had the help of advice from a medical planning committee that had included distinguished members of the medical profession as well as politicians. Throughout its investigations, the Committee had had the cooperation of the profession, it said, and good relations with the BMA at federal and branch levels. Even if it were well-founded, this sunny frame of mind would not long survive. From the individual member level upwards, there was a flurry of debate within the BMA as a response to the proposals of the NHMRC and Joint Committee reports, not only as they concerned doctors’ remuneration but also over their potential constitutional limitations.

The Committee’s proposal for a salaried medical service had found favour with some doctors in Victoria who had already canvassed the idea beforehand. Debate in the Queensland branch is reported to have produced support for three suggested remuneration schemes. Capitation had been supported by two members of the Federal Council in giving evidence to the Committee.

The Council was thought to be only implicitly supporting a fee-for-service system by at first rejecting just capitation and salaried service. Later, however, it made its support for a fee-for-service system explicit by adopting the position that it was the only acceptable one for medical services. It also canvassed ideas for a statutory body containing BMA representatives and reporting to the Department of Health to operate the health system, rather than the Health Commission envisaged by the Committee.