Craig Thomson (Dobell, Australian Labor Party) Share this | Hansard source

I rise to support the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. The purpose of the bill is to streamline the operation of a section of the Health Insurance Act 1973 and remove a number of anomalies. Section 19AB of the Health Insurance Act restricts overseas trained doctors and former overseas medical students from providing professional services which attract Medicare benefits for a period of 10 years from the date on which the person is both a medical practitioner and an Australian permanent resident or citizen. This is commonly referred to as the 10-year moratorium. Overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions if they work in a district of workforce shortage located in a rural, remote or outer metropolitan area.

This bill will amend sections 19AB and 19AC of the act. There are five amendments proposed in this bill. The first amendment will remove persons who are permanent residents or citizens of New Zealand and who obtained their primary medical education at an accredited Australian or New Zealand medical school from the classification of ‘overseas trained doctor’. Previously, a person was considered to be an overseas trained doctor if they obtained their primary medical degree from a medical school outside Australia.

The second amendment will rename the term ‘former overseas medical students’ to ‘foreign graduate of an accredited medical school’ to more accurately reflect the meaning of the term. This will address issues arising from New Zealand citizens who are able to stay permanently in Australia on a special category visa but who are not considered to be Australian permanent residents being restricted by the 10-year moratorium after they obtain their medical qualifications from an Australian medical school.

The third amendment will rectify an anomaly in section 19AB of the act which currently operates, in relation to a person who becomes a medical practitioner prior to becoming an Australian permanent resident or citizen, to count the 10-year moratorium from when the person achieves Australian permanent residency or citizenship. The amendment proposes that the 10-year restriction will commence from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided the medical practitioner has gained permanent residency during that period.

Finally, section 19AC of the act will be amended to insert a time limit of 90 days during which an applicant can seek a review of a decision to refuse an application for a section 19AB exemption or a decision to impose one or more conditions on a section 19AB exemption. These provisions will take effect from 1 April 2010 or when the legislation has received royal assent, whichever is the later date.

The Rudd government are strengthening our health system after years of neglect and buck-passing by the former Howard government. Let us have a look at some of the programs that the government have put in place in terms of hospitals. The government, through the COAG program, will invest $64 billion in hospitals and the health system across the country over the next five years. That is a 50 per cent increase on the previous agreement of the former government. We have invested $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 and delivered more than 41,000 procedures. Under stage 2, more than 150 hospitals will receive funding right across Australia. We have invested $750 million in taking pressure off emergency departments. More than 30 hospitals will benefit from this particular program.

Labor are now undertaking historic investment in nation-building health infrastructure. We are investing $3.2 million in 36 major projects across our hospital and medical research institutes, including $1.2 billion in world-class cancer centres, and we are providing $275 million to construct 34 GP superclinics across the country. One of those, at Warnervale, is a temporary one. A couple of months ago I had the pleasure of opening the temporary facility. Warnervale is in a fast-growing area of the Central Coast. Many of the other speakers on this bill have identified doctor shortages as being an issue. The areas of Warnervale and Hamlyn Terrace are new suburbs with new people moving in, but we do not have the doctors. By the end of 2010 this temporary GP superclinic will be permanent and will go a long way to assisting the doctor shortage in that area. This has happened with the absolute cooperation of the Central Coast Division of General Practice, which is a very enlightened division of general practice. It has worked with the government on almost all of the initiatives that the government have put forward on improving health.

I would like to commend Dr Phil Godden, who is the Chairperson of the Central Coast Division of General Practice, and Mr Bill Parker, the CEO, for the very cooperative and constructive approach that they have taken to both this GP superclinic and primary healthcare issues right across the Central Coast. In fact, they started from a position of having some scepticism about a GP superclinic and have moved to a position of absolute support. They are proposing to me ways in which the type of model that is set up for the GP superclinic can be expanded to many more GP practices on the Central Coast. This is a terrific initiative—$275 million has been provided to construct these GP superclinics across the country. As I said, we in Dobell are lucky enough to have one that not only provides those services but is inspiring other GP clinics in the area to look at adopting a similar model of delivery of service, and that is a terrific thing.

The Rudd government has also made available $500 million for subacute care to help older people leave hospital earlier and free up beds. As we know, one of the real problems with our hospital system is what is called bed blockage, whereby we do not have the type of transitional care that is required to get people out of public hospitals—they do not want to be stuck there, but they are not well enough to go home. This $500 million for subacute care provides the sort of assistance that gives people some dignity, gets them out of the hospitals and frees up those beds so that the hospitals can deal with the acute care issues that they are designed to deal with.

In terms of workforce, the Rudd government will invest $1.1 billion in training more doctors, nurses and other health professionals. This is the single biggest investment in the health workforce ever made by the Australian government. It will see 812 additional ongoing GP places from 2011 onwards—a 35 per cent increase on the cap of 600 places imposed in 2004 by the former Liberal government. Little wonder that our health system is experiencing these workforce shortages, given the previous government’s chronic lack of investment in training for doctors, nurses and allied health professionals in general right across the board. It is because the former government did not put the money into making sure that the health workforce was being properly trained that we are seeing these shortages right across our health system today. This government is determined to make sure we train enough doctors, enough nurses and enough allied health professionals so that when people need health care they can get the sort of health care they deserve and people will be available to provide that care.

This government will also deliver $134.4 million to better target existing incentives and provide additional non-financial support to rural doctors. The reform introduces incentives based on the principle that the more remote you go the greater the reward. Under this initiative, 2,400 more doctors in 500 communities around Australia will become newly eligible for rural incentive payments. We will deliver $122.7 million in a package of measures to improve choice and access to maternity services for pregnant women and new mothers by providing MBS and PBS benefits for services provided by midwives. This is a very important initiative and one that I know many people on this side of the House have spoken about before, but it is particularly important to the people of the Central Coast. Because of a lack of obstetricians, it was proposed that Wyong Hospital’s maternity ward would have to close. With initiatives like this the maternity ward has changed to being midwifery led. There are midwives there who are delivering two or three babies a day in this area because of the freedom that has been provided to them under this sort of package, which enables midwives to step in and provide that sort of service.

This government is providing access to the MBS and the PBS for nurse practitioners at a cost of $59.7 million. The government will also provide 20 nurse practitioner scholarships, 1,134 new annual Commonwealth-supported higher education places in national priority areas of nursing and a new incentive of $6,000 for eligible nurses who return to a hospital or aged care setting. These are practical steps for addressing the workforce shortages that this government inherited after the inaction of the previous government. They are very important measures to make sure that people are able to receive the sorts of health care that they should be able to get access to in a country like Australia.

Prevention is better than cure. This government is also recognising that fact and has invested a record $872 million—the largest, single investment ever in preventative health—to keep people fit, healthy and out of hospitals. We are providing child health checks for four-year-olds to promote early detection of chronic disease risk factors and funding of $12.8 million to 190 schools around the country to construct either a kitchen or a garden under the Stephanie Alexander kitchen garden program. In dental care, we have committed a total of $650 million to two new dental programs. The Teen Dental Plan commenced last year and provided a $150 million annual payment to eligible families. To the end of December, 258,203 teenagers will have received a dental check-up under this program with 7,598 dentists providing these services.

Unfortunately, due to the position that the opposition have taken in the Senate—not just on this issue but on many issues affecting families—the Commonwealth Dental Health Program that will provide up to one million consultations has been unable to commence. I take this opportunity to urge those opposite to get on with it, to make sure that those who have the greatest difficulty in paying for their dental care are able to access the Commonwealth dental health scheme which we have proposed. This scheme should not be held up in the other place. This is a measure for people who have chronic dental problems and it is being blocked by those opposite for the sake of some ideological position. This should be passed to ensure that there is better dental health care for older Australians and for those who cannot afford dental health care.

The government, along with the states and territories, will invest $1.6 billion through a number of partnerships to target chronic disease among Indigenous Australians. Chronic disease is the single largest contributor to the life expectancy gap. This government is determined to have a better approach to reducing the gap in life expectancy of Indigenous Australians. The enormous gap is shameful for all of us. This government is out there ensuring that we make those types of investments which go some way to reducing the life expectancy gap.

We have committed funding of over $44 billion over the next four years on age and community care. No government in the history of the Commonwealth has committed more. This is a record amount of money being spent on age and community care with more allocation of community places, as well as residential places. We are rolling out an additional 2,000 transitional care beds at a cost of $293.20 million. As I said earlier, this will help reduce pressure on hospitals.

Construction work is already underway on the government’s commitment of $300 million zero real interest loans to create more than 1,300 new beds in aged care. This year will provide $192 million for the National Respite for Carers Program, which funds a national network of more than 600 community based respite care services. Since being elected, we have improved and strengthened quality measures by increasing announced and unannounced visits to homes by 3,000 a year and by investing more than $127 million in the aged-care workforce.

For the future, the government has embarked on a path to build the health and hospital system that Australia needs for the 21st century. Last week the Minister for Health and Ageing hosted a consultation here at Parliament House with private health insurers and private hospitals to discuss the National Health and Hospitals Reform Commission’s final report. It was the 76th consultation around the country to road-test the commission’s proposed reforms. Promoting personal wellness and combating chronic disease are priorities for the Rudd government.

The social and economic burden of chronic disease is unacceptably high. The government encourages private health insurance providers to continue to extend their products by including positive preventative health treatments such as those to quit smoking, to lose weight or to manage stress. Figures released just two weeks ago show that private health insurance membership continues to rise as Australians increasingly seek to improve their health, to stay well and to adopt preventive measures in their lifestyle.

At the most recent consultation the minister outlined the commission’s recommendations and discussed with the private health sector their priorities to improve the nation’s health system, including proposed modifications to Medicare that the commission called Denticare and Medicare Select. Denticare proposes that all Australians have universal access to preventative and restorative dental care and dentures, regardless of their ability to pay. People would have their choice of either a public or private insurer and in both cases Denticare would meet the costs incurred. Dental services are a large and growing part of private health insurance. This is an issue that is very close to my heart, and I spent many years in my former job campaigning to try to get governments to properly address dental care. We have had Medicare now for well over 26 years but, for some bizarre reason, when it comes to discussing dental care the mouth seems not to be part of the rest of the body. The proposal for Denticare firmly puts this issue right at the front and centre of some of the reforms that this government will look at and consider for the future of Australians’ health. It is one that I would urge us to look at very carefully and closely because of the health and lifestyle issues that people suffer from when they cannot afford to go to the dentist and illness occurs because their teeth are in such a chronic state. This is a very good recommendation that we should spend a considerable amount of time looking at with a view to adopting.

Consultations have been held in my electorate of Dobell, where the Minister for Health and Ageing visited Wyong Hospital. We consulted with front-line health professionals there about the ways in which the Rudd government can address the challenges in the health system. Wyong Hospital has benefited from the recent injection of $792,000 to improve elective surgery performance. The funding is part of stage 2 of the Australian government’s elective surgery waiting list reduction program. It has allowed the hospital to purchase additional surgical equipment to reduce the waiting times for elective surgery. Under stage 2 of the elective surgery plan the Rudd government provides funds to support the construction of new operating theatres, to upgrade existing elective surgery facilities and to purchase new surgical equipment to reduce waiting lists.

The visit was also part of the government’s national consultation program following the release of the National Health and Hospitals Reform Commission report that I have been talking about. This is part of the Rudd government’s conversation with the nation to road-test the commission’s proposed reforms. It involves hearing first-hand what doctors, nurses and other health professionals think of the recommendations that will help shape the future of health and aged care in this country. We have already taken concrete steps to improve Australia’s health and hospital system, after 12 years of neglect by the previous government, under the first stage of the plan, which provided $150 million to Australian hospitals to increase the number of elective surgeries being carried out, and the other programs I have gone through in my contribution in this debate. This legislation in relation to New Zealand doctors is a small part of that, but an important part of the narrative of improving our health system, something that this government is very committed to. I commend the bill to the House.

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