Mr. Chairman, during the Second Reading debate I gave notice that we in these benches would be putting forward an amendment to clause 2. I did in fact go through the basic reasons for our putting up an amendment, but would like to restate them briefly. We in these benches feel that there is a need for this account. We are in agreement that, in terms of the situation in which South Africa finds itself today, extraordinary measures are needed. If these extraordinary measures to some extent cut across the rights and privileges of Parliament, then, in the best interests of the country, we believe that this should happen.

We can well understand that the hon. the Minister might have cause to make funds available to other State departments for matters which he does not wish to disclose to the public. Of course, if such matters are disclosed here in Parliament in a debate they will be exposed to the Press and to the public. However, while granting all this, we feel that we should perhaps try to retain a measure of control, if not beforehand, then at least afterwards. We do of course have control over the total, globular sum of money that will be voted to this special account but we believe that Parliament should be able, at the end of the fiscal year concerned, to be informed as to where this money has gone. I want to assure the hon. the Minister that we do not want to know the fine detail of where the money should have gone. We do not, for instance, want to know, if the Minister has given the money to a particular department, what that department used the money for, in the finest detail. We do, however, believe that this Parliament should have knowledge, after the event, of which department this money has gone to. If we can be given particulars only of the globular amount, we accept that in the best interests of the country this is all the information that we can have, but at the same time we do believe that if, shall we say, R1 million is voted to this account, we should know where that R1 million has gone to. We should be able to know whether it has gone to the Department of Defence, to the Department of Foreign Affairs or to some other department, or whether a particular department received the lion’s share, or perhaps a smaller share. We should know if one of our departments of State is to be involved in secret services of this nature. We believe that this will be in the best interests of the country. We cannot see any reason why this should not be disclosed. We cannot see any reason why any information which is divulged in this matter should be harmful to South Africa. If the hon. the Minister can persuade us that in so divulging this information, that could be harmful to South Africa, we shall of course have to take that into consideration, but at this stage we cannot see that the divulgence of this information, after the event, will be harmful to the best interests of the country as a whole. Therefore, Mr. Chairman, I wish to move the following amendment standing in my name on the Order Paper—

Mr. Chairman, when the hon. member for Park-town spoke on behalf of this party during the Second Reading debate on this Bill, he pointed out very clearly that we accepted that there were circumstances under which it would be necessary for secret moneys to be made available to the Government and to be applied in very specific circumstances. We accepted that principle, but what we could not accept was the extent to which this Bill extends that principle, because it makes it possible for the means by which money can be made available for secret purposes, to be extended to all State departments. We could also not accept the manner in which that means of expenditure was to be made available to all State departments. We said that we had very serious reservations about clause 2(3) …

Where are your official speakers on this Bill?

Clause 2(3) deals with the manner in which, on a basis of consultation between the Minister of Finance and any other Minister, money can be appropriated from a central fund which is to be established, for any particular department for its use in a secret manner. We also expressed reservations about whether or not there would be an indication of what amounts of money went to what departments or of the extent to which there would be any auditing of such moneys. I should like to re-emphasize that we accept the principle that a country like South Africa, facing the difficulties and problems which it is facing, must have a certain amount of money available to be spent in ways which cannot be divulged to the public. We do want to emphasize, however, that that must always be restricted as far as possible. Obviously it must be a practice that must be exercised as responsibly as possible, and there should be effective control to prevent abuses in regard to the country concerned.

I should just like to point out that there are two considerations which apply here. The Government’s argument in motivating this particular legislation was that one did not want one’s enemies or detractors to know where one was spending secret funds, and to an extent, of course, that is so. It can be damaging to a country’s security if the purposes for which such funds are appropriated are always known to the public as a whole. One must always bear in mind, however, that to the extent to which one does not make the expenditure of funds public one also suffers from the disadvantage that one’s detractors and enemies can put the worst possible interpretation on the expenditure of such funds. If it is known that a country is spending a certain large sum of money for secret purposes, and there is no indication of where the money is being spent, one hands one’s detractors and enemies the possibility of placing the worst possible interpretation on what is being done with such money. I think that is one of the things the hon. the Minister should take into consideration.

There is also another point that he should, however, take into consideration. The larger the portion of a nation’s budget spent secretly, i.e. out of public view, the further one moves away from true democracy and the closer one moves to a dictatorship. I do not believe there are any democracies, however, which do not spend some money secretly, so we are entitled to do so ourselves, but one must guard against spending more and more money secretly because on that basis one moves along the spectrum from a democracy to a dictatorship and one finds one’s credibility in the West being reduced in proportion to the amount of money one may spend secretly. The less money one spends secretly, the higher is one’s credibility and the smaller the extent to which one can be criticized by one’s detractors and enemies.

We are going to support the amendment moved by the hon. member from the NRP because it does, to an extent, improve that section of clause 2 to which we have an objection. I should like to go just a little bit further, however, and refer to the fact that the hon. the Minister said that he could not give an assurance to Parliament that we would be informed about what amounts of money were being appropriated for what State departments. When a question was put to the hon. the Minister, he seemed to have a certain degree of difficulty in answering the question, and he created a certain degree of confusion. I should like to put this to the House in order to give the hon. the Minister an opportunity to clarify the point. I quote from the hon. the Minister’s Hansard of 16 March—

He also said he could not give an indication whether the departments concerned would be named and what the amounts were that would be appropriated for those departments. A little further on in the hon. the Minister’s reply, he said—

We have a problem here. A great deal of confusion is being created by two statements of the hon. the Minister in his reply, statements which are largely contradictory. In the first statement he said he did not think that we would be given any details whatsoever in regard to this appropriation, details of the departments that will be given money and of the amounts that will be given. Then, a little further on, he said not only that there would be an audit by the Auditor-General, but that the audit would go so far as to establish “the effectiveness of the expenditure”. Where the hon. the Minister said that the audit would go that far, he was indicating that the Auditor-General would have access to the full details of the expenditure of that money, because if the Auditor-General does not have full access to those details, he can obviously not establish to what extent that money was spent effectively. I think it is necessary for the hon. the Minister to clarify this issue. He should tell us whether in fact we will know what departments get money and what moneys will go to those departments and also to what extent the audit on the expenditure of those funds will be detailed and will establish the effectiveness of that expenditure. If the hon. the Minister’s statement that the effectiveness of the expenditure will be determined by the Auditor-General is allowed to stand, it simply means that the Minister has said to us that the Auditor-General will have access to all the details with regard to the expenditure of that money.

We also had the unedifying spectacle of the hon. member for Durban Point lumbering once again to the defence of the Government—and this is with regard to the same point.

Of my country, not of the Government.

The hon. member quoted clause 3(1), viz. that “the account shall be audited by the Auditor-General”, and then he gave his interpretation—and I quote his words—

He went on to say that the Official Opposition had not read the legislation, but he proceeded to indicate that in fact he had not read the legislation, because in the legislation the following words appear—

By no stretch of the imagination can the hon. member for Durban Point say that that means that the accounts will be fully audited.

Read subsection (1).

The audit is subject to a qualification. [Time expired.]

Mr. Chairman, I appreciate the attitude hon. members of the NRP adopted yesterday when they supported the principle of the Bill and therefore I should have liked to have met them half-way today with regard to the amendment which the hon. member for East London North has moved. That would, however, mean that I should have to commit myself now by saying that the separate amounts transferred from this new account to the departments will necessarily be divulged, be it in advance or afterwards. In the wording of the amendment this would naturally happen after the audit had been done. That would mean that I would be committing myself, and I cannot do that at the moment because it is very clear that it might not be in the national interest. It depends on the circumstances. I have to request the hon. member to take my position in that regard into account. I can agree with much of what he said, but at the moment I do not want to commit myself to such an extent, because I can imagine that circumstances may arise where it would not be in the interests of the country to divulge such information. It is therefore impossible for me to accept the amendment. That is in fact the crux of the matter.

†The hon. member for Bryanston made a most remarkable statement a few moments ago when he referred to the “unedifying” spectacle of the hon. member for Durban Point supporting the Government on this measure. He said that it was “unedifying for the hon. member for Durban Point to have supported the principle of the Bill. I want to suggest that the hon. member for Durban Point showed an infinitely greater understanding of the present-day problems confronting this country than the hon. member for Bryanston will ever do. The hon. member for Bryanston made great play of the fact that I allegedly caused confusion about the auditing of this account. I do not think I did anything of the kind, Mr. Chairman, and I stand completely by the statements I made yesterday. If the hon. member will look at the Bill, he will see that as far as the new account is concerned, the Bill clearly provides in clause 3(1) that the account shall be audited by the Auditor-General. What could be clearer than that? The Auditor-General will obviously have all the powers at his disposal to audit the account, and that is the end of that matter.

What do you mean by “the effectiveness of this expenditure”?

Why does the hon. member not read the contents of the Exchequer and Audit Act? If he does, he will see what is stated there on that point.

What do you mean by …

It is not what I mean, but what the Act means, what is stipulated in the Act. That was discussed at length in this House not very long ago when I myself moved amendments to the Act. The hon. member must therefore not ask me what I mean; the hon. member must rather ask what the Act means. It is a question for the Auditor-General to carry out his responsibilities in that regard and he is very well capable of doing it.

Secondly, clause 3(2) provides—

I don’t see, Mr. Chairman, how I can possibly add to that. I said yesterday, in reply to a point raised by the hon. member for Durban Point, that those consultations would obviously take place. It depends on the hon. Minister concerned, whoever he may be. If the need should arise to transfer an amount out of the new fund to be created into the accounts of a specific department, obviously the Minister of Finance must consult with the Minister concerned and the Auditor-General as to the audit of that particular transaction and how that money is spent.

As I tried to indicate yesterday, Mr. Chairman, whatever may be thought of the Minister of Finance and other hon. Ministers, the fact remains that the Auditor-General is squarely concerned here. The Auditor-General has a very responsible position and he has to carry out his auditing duties at a very high level indeed. I think the House need have no qualms on that issue whatsoever.

Mr. Chairman, there is not much I can add except once more to say that for practical reasons I regret that I am not in a position to accept this amendment.

Mr. Chairman, I want to raise another matter in the same clause with the hon. the Minister. I want to refer to the phrase “being in the national interest” which appears in line 34. Hon. members will recall that during the Second Reading debate we mentioned the fact that all moneys appropriated by Parliament were presumably spent in the national interest. I think the hon. the Minister would agree with that. I think there are two matters which are common cause in the discussion of this legislation. In the first instance it has been acknowledged by all parties in the House that there are secret funds made available to certain departments and that there is no objection to that. There was also no objection thereto when the original legislation was introduced. In the second instance I think it is also common cause that it is conceded that under normal circumstances this legislation would not be necessary.

When one looks at the actual wording here, the question arises whether the hon. the Minister would consider a slight rewording of that phrase. Actually, I am not going to move an amendment; I should like, however, the hon. the Minister to give this his attention and should he feel that there is anything of substance in my suggestion to improve the wording, he should consider it before the legislation goes to the Other Place. I should like the words “in the national interest” to be substituted with “in the interests of the security of the State”. I think such a phrase will make it much clearer and I think this is how the hon. the Minister himself has argued earlier. If he is prepared to accept such a suggestion—I shall first wait for his reply—I shall be more than ready to move an amendment. I should, however, like to hear his comments on it first.

If one looks at section 2 of the Foreign Affairs Special Account Act, No. 38 of 1967, one sees that the words “in the national interest” are used, but they are used specifically in connection with the Minister of Foreign Affairs and they have a bearing on matters of a confidential nature. There is a direct qualification which I think is reasonable and good. If one looks at section 2 of the Security Services Special Account Act, No. 81 of 1969, one finds there, too, that although the words “in the national interest” are used, the phrase is connected with the Bureau of State Security in the words “as the Prime Minister from time to time …”. Finally, the Defence Special Account Act, No. 6 of 1974, refers specifically to matters of defence where it deals with the utilization of moneys in the account.

Therefore, I think it would be an improvement and I should like to hear the hon. the Minister’s comments on this. I remind him again that all we are asking for is that the words “in the national interest” be replaced by “in the interests of the security of the State”.

Mr. Chairman, this particular proposal by the hon. member for Pinelands does, of course, restrict the meaning of the clause as it stands at the moment. I would say “in the national interest” has a wider context than simply “in the interests of the security of the State”. It seems to me that one would be restricting the uses to which that money might be put and that, I think, might be undesirable simply because we are dealing here with uncertainties as to the future. We do not particularly know what might be the type of onslaught on us and it may be necessary to take counteraction which we do not particularly want to disclose to our enemies or to those who are hostile to us, but at the same time there might be some doubt as to whether it is strictly in the interests of the security of the State. However, there might very well be a very wide consensus that it was in the national interest.

I am simply reacting immediately to the hon. member’s proposal. It did not sound unreasonable to me, but I am reluctant to commit myself on the spur of the moment to what seems to me would be a restriction on the use of such funds. What I am prepared to do is to discuss this aspect further with my advisers. I do not want to give the impression that I feel I could accept the proposal. I am merely prepared to take the matter up with my advisers.

Mr. Speaker, I thank the hon. the Minister for his reply and for his willingness to look at this aspect before it goes to the Other Place. May I just elaborate for a moment. I think it is true that when one has a Government and an Opposition there obviously may well be differences of interpretation as to what is in the national interest and what is not.

Yes.

The hon. member for Bellville’s ideas are, of course, very close. He is coming right. However, there are still some gaps. [Interjections.] The hon. the Minister and the hon. member for Mossel Bay specifically referred to the security of the State which is involved and, therefore, I think it would be an improvement…

Are you not concerned about the security of the State?

Very much so. That is why I am worried about that hon. member. He really worries me considerably … [Interjections.] I will let the matter rest at that. I am glad and grateful that the hon. the Minister will give this some further thought.

Mr. Speaker, I move—

In view of the fact that this Bill and the Medical, Dental and Supplementary Health Service Professions Amendment Bill in certain respects concern related matters, I shall now elucidate all of those matters fully in order that no repetition may be necessary in the debate on that Bill.

One of the most important aspects of the Medical Schemes Act is the determination of tariffs for services rendered to members of medical schemes and their dependants. Since the passing of that Act, this matter has always caused dissatisfaction. In 1975 we made an attempt to obtain a more satisfactory solution by giving the representative associations of the professions concerned, the authority themselves to determine the relative values of the services involved, and we merely placed the onus on the Remuneration Committee to attach a monetary value to the unit value of the services. As is now well known after the report of the Remuneration Commission which was appointed at the beginning of last year, this system has also not given satisfaction either.

Further problems are also being experienced with the present system. It is required, namely, that a judge or an advocate of at least five years’ standing should be chairman of the Remuneration Commission. Since the beginning of last year there have been three remuneration commissions, i.e., for doctors, for physiotherapists and for dentists. The hon. the Minister of Justice has advised me that it will no longer be possible to second a judge for this purpose and that he will unfortunately not be able to make a state advocate available to perform the task either. If it is taken into account that there are almost 28 supplementary health service professions of which the fees can be determined in this manner, and if an advocate in private practice has to be appointed for this purpose, this will give some idea of the extent of the costs if the present system is continued with.

Apart from this, the Dental Society has already indicated in advance that it can no longer afford to participate in the present Remuneration Commission system. In spite of that, this Association requested at the end of last year that a commission should be appointed with a view to the introduction of a tariff whereby patients may obtain more substantial benefits. This ultimately cost the association more than R20 000.

Hon. members are also aware of the fact that the Medical Association has indicated that it is no longer prepared to participate in the activities of a Remuneration Commission.

For the reasons mentioned, section 30 of the Act, in terms of which tariffs are determined, has now become unenforcable and it is in the interests of the members of medical schemes that another system be established.

As far as the professions of doctor, dentist and supplementary health services are concerned, the matter will be dealt with in the Bill relating to those professions. Clause 9 of this Bill deals solely with the determination of tariffs in respect of services rendered to members of medical schemes by private hospitals and independent theatre units. In terms of these provisions, the Representative Association of Medical Schemes and the Association of Private Hospitals must agree on a tariff, and the tariff so agreed upon shall be the prevailing tariff. If agreement cannot be reached, the tariffs must be determined by a committee of the Central Council of Medical Schemes, consisting of the chairman of the council acting as chairman of the committee, a member of the council with knowledge of medical schemes designated by the council, a member of the council with knowledge of private hospitals and unattached operating-theatre units, a member of the council with knowledge of hospital and clinic services and a member of the council with knowledge of financial and business techniques.

I think this is a well balanced body which should be able to see justice done to all the interested parties.

Together with the aforementioned, (i) section 29 is being amended by clause 8 to provide for contracting out of persons other than those registered under the Medical, Dental and Pharmacy Act, in order to achieve uniformity; (ii) section 32 is being amended by clause 10 to provide for direct payments to such institutions which are contracted in; and (iii) amendments are being effected to certain definitions, and others are being deleted.

The question of the elimination of contracting out has been a major talking-point recently. This was due to a draft Bill which the department had published for information and comment. Although it was very clearly stated in the Government Gazette that this Bill had been published solely for information and comment, and although the Secretary for Health, with my knowledge, pointed out forcefully to doctors and dentists at numerous meetings that the Cabinet had not yet taken any final decision on any principle contained in the Bill, this did not stop people from trying to make political capital out of the situation before the election.

The simple facts are the following. As I have already indicated, serious dissatisfaction with the present system arose. The scrapping of the provision for contracting out was one aspect of a possible solution to the problem. There was already a stigma attached to that. Because previously there had not been a survey of public opinion on the matter, it was decided to do so by way of the publication of the draft Bill. The closing date for comment was 30 November 1977, as was clearly stated in the Government Gazette in question. Before all the comments could be processed, the Cabinet adjourned for the December holidays. I could only attend to the matter towards the middle of January 1978. The comment was overwhelmingly against the scrapping, and on the basis of the evidence before me, and after consultation with the Medical Association, the Dental Association and the Representative Association of Medical Schemes, I submitted the matter to the Cabinet for consideration on 28 February 1978.

A newspaper made the allegation that the proposals had led to an immediate clash between the Government and the Medical Association. In this connection I might mention the following: The first time that I interviewed representatives of this Association since the publication of the Bills, was in February 1978.

The Government’s approach is to serve the interests of the total community of South Africa, and in connection with health matters we strive to establish the most practical and feasible measures in the interests of everyone in South Africa. The facts as they emerge from the comments were considered in this light, and in view of the fact that the commentary was overwhelmingly opposed to the scrapping of the provision in question, the Bill has been adapted accordingly.

Having touched on that, I wish to point out that all parties in Parliament agree that health should be outside politics. I therefore find it deplorable that there are elements that are attempting to drag this subject into politics and to make political capital out of it.

Hon. members will note that the definition of “a member of a medical scheme” is being amended to include holders of certain insurance policies. At present there is only one company which falls into this category. Medical schemes have made urgent representations for this amendment, because under present circumstances the policies concerned cannot be controlled by law and there are opportunities for all sorts of irregular practices. If the amendment is not introduced, the result will be that existing medical schemes will be converted into insurance companies, and if that happens, we might as well repeal the Act.

By means of clause 2 the composition of the Central Council for Medical Schemes is adjusted. In view of the fact that this council will be less involved in professional matters, the adjustment has been effected with the idea that the council should devote its attention specifically to matters affecting medical schemes. In view thereof, the number of doctors has been reduced from two to one, and the number of persons with a special knowledge of medical aid schemes has been increased from one to four. The provision made for a member with a knowledge of schemes which came into existence under the Industrial Conciliation Act and which have been exempted from the provisions of this Act, was originally inserted in an effort to bring those schemes under the provisions of this Act. Up till now, this effort has not succeeded and in the circumstances, the continued existence of that section is no longer considered necessary. In lieu thereof, provision has been made for someone with a special knowledge of private hospitals and unattached operating-theatre units. Expertise of this nature in the council is essential in view of the council’s involvement with the determination of tariffs for those institutions. As a balancing factor, provision is made for someone with a special knowledge of hospitals and clinic services. It is the special function of the council to guard the interests of members of medical schemes. In view of that, provision has been made that two members of medical schemes can be appointed as members of the council.

The other amendments which have been introduced, are obviously essential and I do not think it is necessary to go into them further now. I have already referred to them, but I should like to put it by way of summary that the published Bill was adapted in the light of the commentary received and I really trust that it will be more satisfactory than the existing provisions. As far as the patient and his relatives are concerned, illness is a subject charged with emotion. It therefore behoves us, the other interested parties, to regard matters affecting the patient less emotionally and to act more objectively, and so to ensure that the interests of the patient are served properly and to the best of our ability.

Mr. Speaker, if one looks at the record of legislation which has been introduced by the hon. the Minister of Health over the past few years, it is immediately noticeable that the hon. the Minister and his department have obviously gone about introducing a comprehensive programme of new and amended legislation in order to up-date and to modernize South Africa’s health legislation. This became necessary because of the rapidly changing circumstances in the field of health services and in the medical profession. It also became necessary in order to remove the large number of anomalies which had accumulated over the previous decades.

In the past I have already had the privilege of congratulating the hon. the Minister and his department on the quality of the legislation brought before the House. Although from time to time one obviously had reservations concerning certain aspects of the legislation introduced, this is again one of the occasions on which it is clear that the legislation which has just been introduced by the hon. the Minister is necessary and will receive the support of the medical profession as such.

It is quite clear that the machinery that has existed up to date for the establishing of tariffs was unsatisfactory. That created a great deal of unhappiness and opposition from the medical profession. It was quite clear, too, that, sooner or later, the hon. the Minister and his department would have to do something about this matter. A great deal of thinking has gone into the drafting of the legislation which is before the House today. Unfortunately there was some confusion. The hon. the Minister has also, at length, drawn the attention of the House to the confusion that existed, confusion that arose at the time when this particular legislation was published in draft form. The hon. the Minister has indicated that he feels there was an over-reaction. Be that as it may, it is nevertheless unfortunate that when the impression was created by the publication of the draft legislation that doctors would be prevented by law from contracting out of medical schemes, widespread consternation arose in the medical profession, consternation which resulted in the contracting out, within only a few months, of some 1 600 medical practitioners. We now have the position, as the hon. the Minister indicated in reply to a question earlier today, that something like 3 900 medical practitioners out of a total of about 14 000 medical practitioners in South Africa are contracted out at the present time. It is unfortunate that that happened. It is unfortunate that that anxiety and unhappiness should have been caused, but I think that the department responded favourably to the mass of objections to this provision. They have now very wisely decided not to go ahead with that particular provision. I think the medical profession as a whole will thank the Minister for having seen his way clear to decide not to proceed with that particular provision. Undoubtedly it would have caused uncertainty and anxiety in the medical profession. It would have caused many more doctors to contract out.

The doctors have indicated the reasons why they were opposed to the previous system and the previous machinery in terms of which the tariffs were established. Apart from the fact that they found that the tariffs were unsatisfactory and did not meet their requirements, they felt very strongly about not being involved in the controversy surrounding the establishment of tariffs. They feel that this affects the basis on which they provide medical services to the public. They have indicated that there are many special circumstances surrounding the intimate and personal service which a doctor provides, and that it is unfortunate if, in relation to these services, there should be a controversy about the tariffs to be charged. There are, for example, doctors who prefer to give extended periods of attention to their patients. Instead of giving 10 or 15 minutes of his time to a patient, a doctor may feel that he wants to give as much as an hour to a patient. If, however, he is restricted to a production-line type of tariff, he obviously cannot afford to do so. The doctors felt that this was a matter which should not be handled in the way in which it was previously handled. I believe that this new dispensation will meet most of these objections, particularly since doctors are now entitled to contract out if they feel that the tariffs which are laid down do not meet their particular requirements.

The responsibility which rests on the hon. the Minister and his department in this regard is in the first place to ensure that the highest possible standards of medical service are available to the entire population of the country at the lowest possible tariffs. One of the considerations to be borne in mind when one deals with the benefits to be derived from medical schemes, is continuity of membership. Unfortunately it is so that as a result of the fact that people move from one form of employment to another, that they become unemployed, that they retire, or for any other reason, there are many thousands of people who find that they do not have the benefit or the support of a medical scheme. This creates a great deal of hardship and suffering for many people. It is often found that these people cannot obtain the standard of service to which they are entitled. One of the most important requirements is therefore to provide for the continuity of benefits to be derived from medical schemes. To a certain extent, although to a limited extent only, this legislation does provide for that.

Another positive aspect of the legislation is that it provides for a restriction on the administrative costs charged by medical schemes. The position is that medical schemes are in fact not supposed to be profitmaking organizations. They are supposed to exist in order to serve the public. One of the favourable results of a restriction on administrative costs will be to ensure that that principle is carried out. But having said all this, the Minister and his department must nevertheless continue to be vigilant in the sphere of what is coming to be known as “over-doctoring”. This term refers to the practice which sometimes takes place, that more medicine is dispensed than is necessary for maintaining peoples’ health. In many cases the public are receiving more medical attention and more doctoring than is in fact good for them. That is one of the aspects which should also be mentioned in this regard. This Bill is setting up new machinery, to a large extent, for the establishment of tariffs. I think the machinery will be more efficient and I think that the representations of the various interested parties about this machinery for setting up tariffs are adequate, and I believe that it will meet the requirements of the various parties concerned. I believe that the medical profession, the medical schemes and all other interested parties should find the new machinery acceptable, adequate and effective for establishing fair and equitable tariffs for the provision of medical services. The Minister has also pointed out that provision is also made for the establishment of tariffs with regard to hospitals, clinics, etc., and in this particular case it will be on the basis of consensus or agreement between the medical schemes represented by the representative association of medical schemes on the one side and the approved association representing the hospitals and clinics on the other, and only if agreement cannot be reached will the Council for Medical Schemes then, by way of a tariff committee, intervene and establish tariffs for the services concerned. I also think that the composition of the committee to be established in that regard is such that both parties are adequately represented, and one can expect the tariffs at all times to be fair.

In conclusion let me say that I believe that if the provisions of this legislation are carried out in the spirit in which the legislation was drawn up, this would lead to satisfaction on all sides. I should just like to say that I do believe that the hon. the Minister and his department will nevertheless have to be vigilant enough to see to it that none of the parties involved attempts to abuse, in any way, the new machinery which is being provided for the establishment of tariffs and for the conducting of these affairs.

Mr. Speaker, in the nature of things, we on this side of the House are, of course, pleased to know from the hon. member for Bryanston that this measure has their support.

*One appreciates the fact that the hon. member has noticed that the Department of Health has been occupied in the past few years in modernizing and consolidating its legislation. We particularly appreciate the fact that health legislation has enjoyed so much attention in the last few years that our health legislation can probably be considered among the most modern in the world. That achievement definitely does not go unnoticed, and the people who are entrusted with this deserve our sincere thanks.

In order to see the Bill which is before the House in its right perspective, we would do well to go back a little to the original legislation which was before this House in 1967, viz. the principal Act, the Medical Schemes Act. That Act added a totally new dimension to the whole health set-up of private medical practice in the Republic of South Africa and actually created a triangular relationship consisting of the doctor and patient on the one side and the medical aid scheme on the other. Unfortunately, as is the case with any new dispensation, problems arose even then because the medical practitioners and the patients had formerly been accustomed to think in one dimension, viz. the dimension of the medical practitioner/ patient relationship, a very important element and an element which definitely retains its importance, even in this new dispensation which has already been in operation for 11 years. However, even at that time, problems arose as to who should determine the fees which should be paid to those who provide the services to patients.

Of course, there were also other problems which I shall come to a little later on, but most of those problems were settled by means of compromise. However, as I have already intimated, it is a pity that in the 11 years that this legislation has been on the Statute Book, it has not yet been possible to fined a modus vivendi to eliminate all the problems and all the doubts which existed about this legislation at that time. The first solution which was suggested, and which was contained in the original legislation as well, was the establishment of an arbitration committee which would be entrusted with establishing fees. It must be borne in mind that prior to this, the Medical Association, the medical practitioners as such, had been the founders of a good number of medical aid schemes in the country. In fact, the Medical Association can rightfully claim that they were the ones who actually took the initiative in the establishment of medical schemes in the country in an attempt to enable a certain category of people to pay for their medical services. That is why, in 1967, the Medical Association rightfully laid claim to the established right which they had had up to that time to determine their own fees. They also found it very difficult to give up that right which they claimed for themselves as a professional body to make their own assessment of their services. It has always been the principle that a profession should have the right to determine its own fees. However, since the medical aid schemes provided for a very important need, it was absolutely essential for the determination of fees not to be left exclusively to the medical profession and measures had unfortunately to be taken to deal with the question of the determination of fees. Then, of course, an arbitration committee was proposed as a solution. Since the Government had a responsibility in respect of the increasing number of medical aid schemes which were being established, the Government also had to have a share in the determination of fees. No matter how unfortunate this may be, modern times and circumstances have required the interests of these people, to be taken care of, and they must be seen to be taken care of. The Government cannot afford to be accused of allowing the medical profession to push up its fees in an arbitrary way and of having no control over it. The Government has also consistently refused to exercise control to the extent of having the State itself determine those fees. When it was ultimately established that the arbitration committee could not work it all, there was a change-over to a system of a remuneration commission as indicated by the hon. the Minister in his Second Reading speech.

The legislation of 1960 was chiefly aimed at keeping the costs of medical services and medicines as low as possible. Secondly, it was aimed at bringing order and organization of power into the new situation, the dynamics of the establishment of medical aid schemes, and to maintain this. Thirdly, it was aimed at protecting patients and medical practitioners against exploitation, not only by one another, but by outside bodies as well. One important facet of that legislation which may easily be overlooked is that that Medical Schemes Act actually militated against the establishment of a Government health service. Sir, you will remember that some time ago, especially after the findings of the Snyman and Reinach Commissions were published, some people said that we would have to socialize the practice of medicine in this country in order to prevent an escalation in the bosts of medical services and medicines. The relevant law actually silenced those voices and that demand. If that law had not appeared on the Statute Book, we would have been placed under even greater pressure to establish a Government health service here, as is the case in Britain, and this is an undesirable system that no one in this country wants anything to do with. This important effect of the Medical Schemes Act is often overlooked. As I say, a Government health service is totally undesirable. Let me state this categorically once again because I am convinced that I am reflecting the policy of the Government in this regard. There is no one in this House, including the Government side, who wants to introduce any form of Government health service. Anyone who makes such an allegation or wants to read it into measures which are being taken is being mischievous and is not doing this country a favour. A Government health service does not give any satisfaction, neither to the medical practitioners nor to the patients. As is the case in Britain, a service like this costs an enormous amount, and unfortunately it is true that it is abused by both patients and medical practitioners. That is why I want to state categorically that if people are reading into these measures which are being taken that we want to introduce a Government health service, they are being mischievous and are doing the country a disservice. We do not want such a service, and the Government, the hon. the Minister and the department have so often taken a stand against a service of this kind, that it is practically inconceivable that there could ever be a change in this point of view.

I want to return to the point with which I began. I said that when the legislation was placed on the Statute Book in 1967, the most important point in dispute concerned the question of who should determine the fees. I went into the question of what measure had already been put to the test by the Government to combat this problem. This function is now being transferred to the Medical Council, and I think it is a particularly fortunate choice. I remember that when we discussed the legislation at the time, the council was mentioned as an alternative when the question of who should determine the fees for the various schemes was discussed. The name of the Medical Council was mentioned at the time, but at that time it was still believed that this was not the task or the function of the Medical Council, an opinion with which I could never quite agree, because the council has since its inception been the body which has disciplined medical practitioners when it received a complaint that a medical practitioner had charged too much for services rendered to a patient. The Medical Council therefore has the knowledge and the necessary status. The council consists of people who are esteemed in their profession and whose decision will be accepted if that decision is made after thorough consideration and is based on knowledge. That is why I feel it is a good idea, and a very good solution, for this function to be transferred to the Medical Council.

Due to the nature of the task which was entrusted to the Remuneration Commissions, it was doubtful from the very start whether the commission would succeed in carrying out its purpose. The reason that it is a clumsy system, that it is a very expensive system and that in addition it is complicated because of the unit figure evaluation which had to be made. However, I feel that tariffs should be determined by the body which is functionally involved in this matter.

I should just like to exchange a few ideas about the right which medical practitioners will have in future to contract in or out. I am very sorry that emotions were inflamed about the original draft Bill which was published by the department. It is such a pity that some parties created the impression that the draft Bill would be the law of the Medes and Persians in future. Surely it was stated clearly that the draft was being presented for comment and that comment was being awaited from all interested parties concerning the clauses which were contained in the draft. I find it a great pity that the Medical Association in particular reacted publicly to the legislation in what I feel was a totally premature and unsuitable way. I can declare categorically today that the squabble which took place and the unsavoury publicity which was given to the so-called standpoint of the department and to the published standpoint of the Medical Association has not done anything to promote the image of medical practitioners in our country.

People forget that medical practitioners are also human beings who have to keep body and soul together and therefore must have a means of exchange which necessarily takes the form of money. The medical practitioner cannot do his work for nothing; he must also be able to make a living. However, when his fees are discussed, the general public is only too inclined to think that the medical practitioner does his work for money alone. This is the type of publicity which was elicited by the badly timed, premature reaction which followed the publication of the draft Bill.

I am very pleased that the hon. the Minister and his department kept to a principle which I feel is very important and which was published in a letter from Dr. Frank Counihan of Port Elizabeth in the S.A. Medical Journal of 5 October 1974. In his letter he refers to the following statement which was made by a well-known British lawyer—

In the same letter reference is also made to a statement by Mr. Justice J. P. Kotzé in which he stated—

The desired condition, as expressed by the two lawyers, is now being made possible by the Bill and any medical practitioner is free either to enter into a contract with a medical aid scheme or to tell the medical aid scheme that he is no longer prepared to provide his services on the conditions concerned.

The most important task of the medical practitioner remains the care of the interests of his patients and I trust that the legislation will now make it possible for the medical practitioner to continue this specific task unhindered and without interference.

Mr. Speaker, medical aid schemes as such are well known for the fact that they are supposed to be all things to all men. The medical aid schemes are one of the sort of hybrids which have arisen out of an attempt to combine a free enterprise/free professional system with the kind of social security benefits which people expect in an area of very great concern to them, namely their health and that of their dependents.

I should like to congratulate the hon. the Minister and his department on having satisfactorily come to terms with the problems of the medical profession, the medical aid schemes and the patients as such. In regard to the guarantee which will now be required to be given by medical aid schemes, I should like to say that we would probably be seeing the last of the adventurers in this direction.

I refer specifically to organizations which attempt to make profit out of health and health services.

Furthermore I would like to add the congratulations of this party to the hon. the Minister and his department on having successfully come to terms with this vexed question of fees and the right of the medical profession to contract out from medical schemes. At the same time I would like to indicate to the hon. the Minister that I think one of the most important benefits which will result from this Bill, is the restoration of confidence in the hon. the Minister’s department. The Bill will also allay the fears, that the Government may have aroused in certain individuals, and expectations that the Government is contemplating the possibility of a nationalized health service with all the detriments that entails to the profession and to the patients. I would like to say that this confidence was also evidenced when the hon. the Minister’s department enacted the Medical, Dental and Supplementary Health Services Act, No. 56 of 1974. I do not think it is very often that this House has the opportunity to hear of positive benefits to the country flowing from enactments. The psychologist profession in South Africa is deeply grateful for the enactment of Act 56 of 1974, the effect of which was to bring about the professionalization of psychology and to bring it into its correct perspective. However, the Medical, Dental and Supplementary Health Services Act, which is referred to in the Bill, will produce certain difficulties when the amendment in the Bill is enacted. These difficulties relate to the definition of “psychologist”, a factor which we may be able to discuss in the Committee Stage rather than at present. One aspect for which the psychologists are certainly going to be extremely grateful is that it appears now—I trust that my interpretation is correct—that the clinical psychologists will now be able to exercise a profession, and that the patient who benefits from the exercise of that profession will now be able to claim a refund of fees charged by clinical psychologists. This was not possible before and that has had a very detrimental effect on the clinical psychologists’ profession in South Africa.

I want to assure the hon. the Minister that he certainly has the unstinted support and congratulations, on production of this document from this party. I would like to ask the hon. the Minister a final question. Hon. members are probably aware that the S.A. Medical and Dental Council is at present busy with the examination and registration of certain ladies of society who will have to register with that council as the 29th supplementary health service. I would like to ask the hon. the Minister whether the registration of these ladies, who are sometimes of ill repute, means that certain members of society will now be able to claim massage parlour fees from their medical aid funds.

Mr. Speaker, it may perhaps be necessary for me just to emphasize a few points which have already been mentioned. It is nevertheless interesting to know that the first medical scheme in South Africa was established in 1889 by the De Beers Consolidated Group and that the first legislation on medical aid schemes was only introduced in 1967. I think the Bill is a great step forward towards ironing out the problems which have existed for many years. For instance, many of the matters that were points of conflict in 1967, still are today, and therefore it was clear that there had to be new legislation to rectify these matters.

The then Minister of Health appointed a Select Committee in 1967. There was a great deal of unanimity in that Select Committee, but in spite of that the problems were not solved. The first point of conflict, as was rightly singled out by the hon. member for Cradock, concerns the right of a profession to determine its own tariffs. Indeed, I think it is an inherent right where there is a contractual bond between a patient and a doctor or professional man. I believe that this Bill, in terms of which the Medical and Dental Council will now determine the fees, will in fact satisfy the medical profession to a large extent too. As regards the points of conflict in the past, the question arises whether it is really essential for the Government to have control over medical schemes. I believe it is essential. That is why it is also necessary to give the medical profession certain built-in guarantees by means of this Bill.

I am of the opinion that the Medical Schemes Amendment Bill which is before the House at the moment, affords the medical profession more protection against socialization. There is just one point I want to remark on in respect of this aspect. The hon. member for Cradock discussed it thoroughly. I had the privilege of working under the National Health in London for a year. Experience has taught me how much irregularity and dissatisfaction this system gives rise to, not only in the case of the patient, but in the case of the doctor too. A medical practitioner who works for a salary, is deprived of his initiative. Moreover, the patient must go through a great deal of red tape before he can receive the necessary treatment. I think we in South Africa have succeeded in creating a model alternative. I believe that many of the problems will be eliminated by this Bill. We can no longer allow the situation to exist here in South Africa where a non-professional body actually has a say in the tariffs of medical practitioners. That is why I think that the Medical and Dental Council, which in any event has been able to apply certain disciplinary measures over the years in the question of excessive fees charged by medical practitioners, is now being placed in a position to establish guidelines for the determination of medical tariffs.

The last matter which I should like to raise, is that this Bill also provides for the elimination of malpractices in the administration of medical schemes. Firstly, it is the function of a scheme to provide a service and not to make money. Clause 6 makes provision for these malpractices to be eliminated. I believe that the Bill is effective in this regard.

Although the requirements in clause 4, which amends section 15, are essential for the protection of the members of a scheme, they must, nevertheless be implemented with the greatest circumspection, because the words “(to)… ensure the financial stability of the scheme” can be a very relative concept. Too strict criteria can limit the establishment of new schemes and criteria which are too lax can be to the disadvantage of the members. We must also have some leeway in respect of the question of working costs in the implementation of this legislation. Otherwise the smooth functioning of the schemes may be inhibited. However, I want to assure the medical schemes and the medical profession that I will be the first person to point out any failings in the function of this legislation to the hon. the Minister and his department in the future. I hope that the Bill will eliminate all the mistrust which exists, and I request everyone concerned with the administration of the legislation to give it a chance in the interests of better health services in South Africa. I think the smooth functioning of a scheme is very much dependent on the attitude with which both the medical schemes and the profession approach the legislation.

Mr. Speaker, I should like to say thank you very much to all hon. members who participated in the debate for their constructive commentary, remarks and contributions. Firstly, I want to thank the hon. member for Bryanston for the words of appreciation which he expressed of the department for the special attempt which they made, in the five-year programme, to revise our health legislation almost completely. Several short laws still remain, but for the rest I think we have achieved the objective which we set ourselves five years ago. We find it encouraging that there are people who appreciate it. I want to compliment him on having ignored politics and looked at what really took place, and as such I appreciate it. I have little fault to find with the rest of what the hon. member said. He raised certain aspects which also emerged in other contributions to the debate, for instance the profession’s over-reaction, a reaction which was taken up as if the issue concerned only one single clause of the draft Bill, but which in reality concerned a whole number of aspects which they did not feel happy about and in respect of which they then overreacted. They were too hasty. I do not know whether there was suspicion or fear. I said that disease was an emotional subject, but one will be very sorry if, whenever one talks about fees and has to take a decision on a tariff, one does not bear in mind that one has to think of the general interests as well and that it is not socialism when one has to reach an agreement with a body or patient on fees. This is precisely what is being envisaged here. There was so much flexibility in those proposals that all this was possible.

There were in fact amendments to the proposals, but when it generated emotion of the kind which was in fact generated—and this happened while the election was in progress—one was unfortunately forced to conclude that the election was being used by members of the medical profession and especially by the leaders of the medical profession. I am not saying that they used the election on purpose. I am just mentioning it. However, they chose the time in which it happened very badly. They were supposed to present their commentary or objections by 30 November. They reached decisions as early as 11 November. Agitations were also started which gave rise to the fact that we had a squabble—as someone expressed it here— and that we had to take note far and wide of objections, commentary and emotions, while it was not relevant at all. I personally told one of the people who came to see me that comments on the relevant document had to be submitted before 30 November. I was requested to withdraw the document. In the meantime the document had already been published. I can hardly imagine a greater lack of understanding for the way in which these things work. As I have already said, I pointed out that comments on the document had to be submitted before 30 November. After that, I said, my door would be open for whoever wanted to talk to me about it. However, I did not prevent leading figures in the medical profession from taking this drastic step, a step which I feel does not really testify to strong confidence. As far as I am concerned, it is actually a great pity. However, the die has been cast. As hon. members themselves have heard, 3 941 medical practitioners have contracted out. Prior to that, there were already 2 000, of a total of 14 000 medical practitioners, who had contracted out.

The fact that the vast majority in the medical profession remained calm, gives me a great deal of confidence in the profession as such. I am delighted to be able to state that the majority—in spite of the tremendous rowdiness of the minority—did not allow themselves to be led along a path which, I feel, would not really have been a credit to the dignity of a profession for which I have a tremendous regard. When I talk about my respect for the medical profession, I am talking chiefly about my respect for the dignity of the profession, as well as for the excellent leadership material which the profession usually produces.

So far, I have commented in general on what hon. members said in their speeches. Mention was also made of the fact that it is a good thing that the Remuneration Commission no longer exists. I do not want to make any further commentary on this. Reference was also made to continuity and doubt was expressed about the question of whether the continuity which is necessary, really exists. However, I want to refer hon. members to section 20 of the present Act. Provision is made for a considerable degree of continuity in this Act, with reference to people who change from one medical scheme to another.

As to the argument that too many kinds of medicines are being used, I do not want to express any further opinions on this matter now. It is a subject which actually belongs to another debate. Of course, this does not mean to say that this is not something which my department and I are also concerned about. We are always giving attention to this matter.

The hon. member for Cradock furnished an interesting historical survey of the course of medical legislation, as far as the determining of medical fees was concerned. I want to associate myself with the hon. member’s specific reference to the spectre of a State Health Service. I want us please to banish that spectre once and for all now. I have said this before and I say it again now. A proposal that people can agree on a fee for a specific medical service—and note that the certainty is being given to both the public and the medical practitioners that there will not be a continual bickering about specific fees—is definitely not socialism as I know it. That is why I ask hon. members to accept today that the Government and the Department of Health definitely do not envisage anything like this. We maintain our old conviction, viz. that a State medical health service will not work in South Africa.

I appreciate the other comments hon. members made. The hon. member for Durban North expressed his appreciation for the fact that we must intervene in cases where the profit motive—no matter on how small a scale—resulted in people making money, not so much from health, but from disease. We are not talking about a reasonable profit only now; the danger of exorbitant profits did exist. In fact, this is the best example to indicate that we are talking all the aspects in this regard into consideration and that we always place the interest of the public first.

Medical schemes are also a form of medical insurance. It is a form of insurance which gives one’s community a measure of security particularly to the middleman who is finding this an ever increasing burden. He is given the assurance that his full account will be paid. All these schemes were attempts to provide that security and at the same time assure the medical practitioner of guaranteed payment. Surely this is not socialism. But, Sir, we cannot allow excessive profits either, because this jeopardizes the entire capitalist system, the whole system of free enterprise. It would also cast a great deal of suspicion on the system of free enterprise if we were to allow it. The hon. member need not fear that confidence will not be restored. There will be a restoration of confidence, if that confidence was shaken in any way. Indeed, it is already taking place. Several medical practitioners who contracted out, are contracting in again. We have the figures which indicate this.

The last question which the hon. member asked, was, I feel, asked with some mischievousness. Unfortunately, I myself am not thoroughly acquainted with the factual aspects of the matter which he raised. Therefore, in this case, with the permission of the House, I want to owe him a reply.

The hon. member for Newcastle also made a very interesting contribution. I definitely believe that we must give attention to the requests which he made to the profession and to the department. I am sure that his requests will not fall on deaf ears. He may be very sure of that. His contributions are always particularly valuable.

Finally, I want to say that my attention was drawn to a report which appeared in The Daily News of Wednesday, 15 March. I am not going to read the whole report, but the heading reads “Doctors win as Minister backpedals”. This does not affect me personally at all, but this type of report, which presents matters out of context and in such a distorted way, does nothing but create ill-feeling amongst people. Of course, a journalist must try to get reports published in his newspaper which draws attention, but I have already asked these people to keep their tendency—I almost want to call it a pathological tendency—to drag politics into any form of Government action, out of health affairs. Health services and medicines do not draw any colour or class distinctions. If there are minor differences, we have the maturity to resolve these differences here. We have in fact resolved them here, and now that they have been resolved, one finds reports of this kind. A report like this is then brought to me so that I can react to it. I shall not react to reports like this. I do not think it behoves me to do so. However, I am certain that such reports also appeared in other newspapers. I do not have time to go into this. I just hope, Sir, that you will realize that it may have been necessary for me to say that this is the type of report for which I really cannot have any appreciation.

Mr. Speaker, I move—

As I have indicated in the debate on the Medical Schemes Amendment Bill, the provisions in regard to the determination of fees by a remuneration commission for services rendered to members of medical schemes, have become impracticable. The medical profession, especially, has grave objections to a body in which the majority of members are lay persons determining such fees.

The only statutory body in South Africa which has been established to protect and to promote the interests of the public in general, in regard to matters pertaining to health professions, is the South African Medical and Dental Council, and in my opinion the council is the most competent body to perform the function of determining such fees. This matter has been discussed with all the interested parties, and nobody could offer an acceptable alternative. Provision has therefore been made in clause 10 for the determination of such fees by the council.

In order to ensure that due cognizance is taken by the council of the facts characteristic of private practice, provision has also been made in clause 3 for the appointment, by the council, of a tariff committee for each profession with the object of investigating and reporting to the council on the determination of fees. A member of the council shall be the chairman of a committee so established, and the members shall be an even number of persons, at least half of whom being in private practice and being appointed after consultation with the representative association of the profession concerned. Half of the members so appointed, after consultation with the representative organization concerned, shall be persons who are contracted-in in terms of the Medical Schemes Act. This will ensure that the interests of all private practitioners are considered.

Since the council will be burdened with the additional function of the determination of fees, it will be necessary to modify the constitution of the council in order to accommodate the council to the new situation. This amendment is embodied in clause 2.

The council obtains its funds from the persons registered in terms of the Act. The determination of tariffs of fees, in respect of services rendered to members of medical schemes and their dependants, is an aspect which is to the benefit of such members and to the benefit of medical practitioners. It would be unfair to expect that registered persons alone should carry the financial burden. Provision has therefore been made in clauses 4 and 5 for the council not to have to defray from its funds any expenses incurred in this regard, and for the State to make an annual contribution to the council for the purpose of defraying such expenses.

Clauses 6 and 7 will empower the council to conduct examinations for the purpose of determining whether persons who hold qualifications, which do not entitle them to registration, possess an adequate professional knowledge and skill for unlimited registration. Provision is also made for exemption, for persons who pass such examinations, from any further examinations. Provision is also embodied in clause 8 to empower the council to conduct examinations in order to ascertain whether a medical practitioner, dentist or psychologist who fails to comply with the requirements laid down in the regulations with regard to the registration of specialities, possesses an adequate professional knowledge and skill for registration as a specialist.

Subsection 53(3) empowers the council, on the application of a patient, to determine the amount which in the opinion of the council should be charged in respect of services to which the account rendered by a registered person relates. In terms of section 53(5) the council may also take disciplinary steps against such a registered person in regard to such an account. At present a registered person or a patient has no knowledge of the standards applied by the council in the determination of such amounts. The amendment embodied in clause 9 will enable the council to determine and publish fees, used by the council as norms to deal with applications of this nature by patients, for the guidance of practitioners as well as patients.

Clause 11 is similar to section 40(2) of the Nursing Act passed recently by this hon. House and has been included after receiving a recommendation from the S.A. Medical and Dental Council that measures should be taken in this regard. The clause provides for the prohibition of a strike or go-slow strike by persons registered in terms of the Act where such a strike is intended to disrupt any health services rendered by the State, a provincial council or a local authority—it does not concern private practitioners. I am of the opinion that such a provision is necessary in the times we are living in at present.

I sincerely hope that it will never be necessary to apply the provision in South Africa and I wish to state unequivocally that I have no doubt whatsoever about the ethical behaviour of our medical practitioners towards their patients. However, we are living in dangerous times and at present nothing prevents the enemies of our people from disrupting our health services or endeavouring to disrupt such services by instigating or inciting registered persons to take part in, or to continue with a strike or go-slow strike by which our health service can be paralysed. I have therefore no hesitation in supporting the council in this matter.

Mr. Speaker, a draft Bill pertaining to these matters was also published for information and comment and it has been adapted after considering the comments received and after discussions were held with representatives of the Medical Association, the Dental Association and the Representative Association of Medical Schemes.

Mr. Speaker, as was the case with the previous Bill, so too this Bill meets a specific requirement It makes provision for the establishing of tariffs as far as registered members of the Medical and Dental Council are concerned. There is a small difference between the mechanism that is applied to establish tariffs in respect of practitioners and the mechanism that is applied where hospitals and clinics are involved. In the case of the previous Bill we were dealing with a system which was in the first place based on an agreement between the representative bodies of the service on the one side and the representative bodies of the medical schemes on the other side. In respect of that Bill I said that we approved of the mechanism decided upon in both cases. It could possibly have been an improvement if also in this case an attempt had in the first place been made to establish tariffs on a basis of agreement and, only if no agreement was reached, to proceed with tariffs committees in order to decide on tariffs. However, I do not think that that is terribly important. I just think that it might have been an improvement on the system that has now been decided upon. It is quite clear, however, that the system that has been decided upon is a marked improvement on the system that applied before. I believe that, if it is given time to be put into operation and to prove itself, it will achieve the support and co-operation of all parties involved.

It is not necessary for me to comment on the other matters contained in the Bill, with the exception of the provision contained in clause 11. The hon. the Minister in his Second Reading speech dealt with this provision and gave the assurance that the appearance of this clause in the Bill is in no way intended to cast any reflection whatsoever on the ethical standards or sense of responsibility of the medical profession, but that it is only introduced in order to provide for the very dangerous and difficult circumstances in which South Africa finds itself. I should like to express myself in accord with those views of the hon. the Minister. I sincerely hope that this clause will be applied in that spirit and that it will at no time be used to interfere in any way with the individual or corporate rights of the profession to express their views on matters which affect the conscience of the people of South Africa as a whole; in other words, that it will be applied specifically and exclusively in the interests of the people of South Africa in terms of the services rendered by these professions in local, provincial and Government institutions, and only in so far as strikes or go-slow strikes are concerned and not in any way in respect of any other activity in which the profession may wish to participate. If that assurance is given by the hon. the Minister—I accept that he did give that assurance in his Second Reading speech—we are happy also to support the Second Reading of this Bill.

Mr. Speaker, since in its wisdom this House, by accepting the previous Bill, has already decided that the Compensation Commission which was established under the Medical Schemes Act is to be done away with, there is of course a vacuum which must now be filled. The issue is now: What is the best way of filling this vacuum? The issue of how these fees are to be determined, also arises. Two matters which we must adopt as our point of departure are in my opinion indisputable, and the Bill makes provision for them.

In the first place, medical schemes, and the advantages to the public of such schemes, have come to stay. Such schemes have come to stay, not only because they afford sickness benefits to the public but also because an industry with an annual turnover of R250 million can no longer be eliminated in this country. The point of departure, therefore, is that those schemes exist and must be developed further. The schemes must remain because they serve a special purpose.

The second thing which, to me, cannot be denied is that a medical practitioner is free, and fully entitled, to decide whether he wants to work at a specific tariff, viz. whether he wants to contract out or not. Therefore a tariff must now be determined which, if possible, satisfies both the public—viz. the schemes— and the medical practitioners who have to render the services—and when I refer to medical practitioners I refer, too, to the dentists and other supplementary professions. However, the question arises as to who is most fitted to determine those fees. As was clear when the previous Bill was being discussed, various types of compensation commissions have been considered, but all gave rise to difficulties. Therefore compensation commissions have been done away with and now, through this legislation, we are coming forward with a new proposal, namely that the Medical and Dental Council is the body which is to determine the tariff. Why that council, Mr. Speaker? Because in terms of section 53 of the Act which established it, that council already has the power to determine fees when they are requested to do so. Consequently the council already has that power and they are not being granted a new power. Furthermore, the chairman of the Medical Association, whom the hon. the Minister called the leader of the medical practitioners, had the following to say in a letter he wrote to the S.A. Medical Journal—

That is how the medical practitioners see the matter. The Medical Council already possesses the power to determine fees and what the only essential change effected by the legislation amounts to is that the council determines the fees and is subsequently directed to publish the fees as the fixed tariff. That is the only difference. I do not think it is a material difference. It could entail more work for them, and I accept that it will in fact entail more work. The hon. member for Bryanston said that it would be a very good thing if, as provided in the previous Act, the Medical Association on the one hand and the association which represents the medical schemes on the other could negotiate with each other and agree on their tariffs. Such a system could indeed work well; I accept this. However there is nothing in this Bill to prevent it. If the Medical Council wishes to act wisely in this regard it will request the medical schemes and the Medical Association to come together and determine to what extent they are able to agree with each other. The Medical Council must then be prepared to declare the result of this agreement to be the official tariff of medical schemes. The matter is open, and I sincerely hope that the Medical Association and the Medical Council will adopt this procedure because it would be satisfactory to all. I also believe that it will have the effect that the absolute minimum of medical practitioners will contract out in this instance. This is the essence of the matter which the House must agree to today. I think that everyone will be in agreement on this score and I believe that this will be the happy solution for which everyone has been searching up to now.

However there are also other minor matters which crop up in this connection. The question can therefore arise as to whether the medical schemes and the doctors are not able to negotiate with each other in an effort to reach agreement. I do not believe one can allow a matter of such far-reaching importance to be dealt with in so haphazard a fashion. One cannot simply say: “See whether you can agree, because then we do not need an Act.” I believe that we are dealing with responsible people in this regard, because the Medical Association and the medical schemes are run by responsible people. I believe that they will be able to reach agreement with each other, but they are all independent. The time may come when they will be unable to agree. Then it will be necessary for an arbitrator to decide what the tariff is to be.

Another important aspect relating to the Bill is that there is no provision relating to time. These people can discuss matters with each other whenever they want to. This has been an long-standing problem under the previous legislation, and everyone complained about it At first the period for which the Minister had to wait before he could appoint a remuneration commission was three years, and then it became two years. However, these people may now negotiate with each other in respect of every item concerning which any of them are dissatisfied. In fact, the medical schemes, and also the Medical Association, can both appoint standing committees to negotiate with each other. Once they have agreed, the Medical Council can proclaim the official tariff. However, one has to accept that the Medical Council will have more work to do as a result. Because they will have more work to do, the number of members of the Medical Council is being increased by the provisions of this legislation in such a way that the registered medical practitioners will enjoy increased representation on this council.

Hear, hear!

I am pleased that that hon. member says “Hear, hear!” because one should always give decent representation to good people; as is the case with the NP in this House. Since the council is going to have more work, it also deserves to have more members. They will then be able to appoint the tariffs committee and this is important in this regard. It is important that as the hon. the Minister announced here, half of the people who will serve on the tariffs committee must be appointed by the Medical Council in co-operation with the Medical Association. However, what is more important is that half of those people will be in private practice and moreover, half of the people in private practice must be contracted in. In other words, they must already be co-operating with the medical scheme. Therefore this legislation creates the best possible opportunity for the new system to be able to work and to bear fruit in the interests of all. Furthermore, no one will be affected by the fact that the medical practitioners will have to pay higher registration fees, because in that regard, too, provision is being made that amounts may be paid to the Medical Council annually in order to alleviate the burden of this expense.

For these reasons it is a privilege for me to support the Bill and I have every confidence that the measure will be crowned with success.

Mr. Speaker, the NRP has pleasure in supporting the principle of the Bill before the House. We note with interest some of the comments that have been raised in the debate thus far. We will also be putting some comments in the course of the debate, but with an eye on the clock I move—

Mr. Speaker, I move—