House debates

Wednesday, 12 May 2021


Health Insurance Amendment (Prescribed Fees) Bill 2021; Second Reading

11:39 am

Photo of David GillespieDavid Gillespie (Lyne, National Party) Share this | Hansard source

I rise in support of this very practical bill, the Health Insurance Amendment (Prescribed Fees) Bill 2021. This bill reforms the requirement that an emerging, soon-to-be-registered specialist medical practitioner or consultant physician has to pay a $30 fee. Having gone through 10 years of advanced training, being approved by the relevant college, being approved by the specialist advisory committee in that subspecialty and applying to AHPRA—going through all those checks, balances and quality assurance mechanisms—there is a $30 fee at the end of all that.

The department which administers the Health Insurance Act has realised that the digital transfer cost to bring this into the digital age, for each emerging specialist—and there are only so many of them each year—would far outweigh any administrative benefit, given all those other checks and balances. So, hallelujah! A bit of common sense is being applied; they're going to waive this fee. I don't think anyone will object to that, because we have a very good regulatory system—just like we have a very good health budget that was announced last night. It's mind-boggling how much money the coalition government has put into the health budget since we were given the responsibility of governing the nation in 2013.

During the COVID crisis the response has been exemplary; around the world, people are looking on in envy at how we responded and how we have avoided the crises other nations are involved in now. Over the last few months, we have had 81 days with no transmissions. That's an amazing percentage. Obviously, there will be transmissions every now and again, but we are increasingly back to near-normal life and that's because we have managed the health crisis well. That's with public health measures, border measures and contact tracing—all of those things.

As I said, the response is just mind-boggling. We have funded respiratory centres, and private hospital systems have been engaged to cope with any overflow from public hospital systems in the COVID crisis period. Obviously, in this budget we're continuing all these services—all the respiratory clinics, helping with the vaccination rollout, and engaging with the state health systems for them to do their part as well. All this requires an awful lot of taxpayer funds but the coalition government and this health ministry have been right ahead of the curve. The more detail I see, the more practical and clinically beneficial it will be. We have a generational step change in how the federal government intervenes to help with mental health and suicide prevention.

We have a plan—a macro plan and micro details—and now we have money attached. All these plans are great, but if they're not funded they don't deliver the full benefit. I note with great relief that we're going to expand the headspace service, with 54 more places. We're going to expand support for the Head to Health initiative for kids and for adults. All the links to digital support for mental health services are being supported: Lifeline, beyondblue and the Butterfly Foundation. All these issues are really important. Eating disorders are getting much more fiscal support out of this budget—all the services that help people with eating disorders will be really pleased. I recall that, when I was in practice, there were very few services on the whole North Coast that could look after specialised eating disorder patients. There were a couple of very effective units in major centres, mainly in Sydney, but now that we've got all these other allied services in this space it will be so much better.

Unfortunately in mental health, the apogee of it all and the sad bit is when people take their own life or attempt to take their own life because their mental health is disordered and to them it seems like that's the logical way out. But fortunately we do save people from failed attempts. Post discharge, the care after one leaves a place where they've been an inpatient and cared for is a very risky period. The aftercare of people who've gone through a suicide attempt is now addressed in this budget. There will be an aftercare system.

We're looking at new and innovative treatments, including transcranial magnetic stimulation for refractory depression. This is evidence of the logical plan, as I said. It's all been thought through. We've had three ministers involved in this, including the Minister for Health and Aged Care and Assistant Minister Coleman. It's obviously been a really well thought through plan. We're looking at improving mental health workforce and workplace support, as well as mental health governance of all these arms that we are putting funds into. Also, there are some sections of our country that are at higher risk because things get lost in translation or the services aren't that thick on the ground, particularly in some multicultural groups and in the Indigenous space, so there are extra funds allocated for that.

The other thing I like about this budget, that's been very well received, is the focus on rural and regional health. You might have seen that in the days leading up to the budget we had some preliminary information. The increase in the bulk-billing incentive in a progressive fashion—currently it's at 150 per cent in difficult metropolitan areas. But, in aligning the population size to an increase in incentive, the more remote and regional you go the bigger the incentive. In an area that might have 50,000 people—a sizeable regional town—that would be a modified Monash 3. A big metropolitan centre is Monash 1. A very remote place is a Monash 7. Once you get into a modified Monash 3 it goes to 160 per cent. And then step wise up through three, four, five, six and seven it goes up to 190 per cent extra on the bulk-billing incentive, which will make medical practice much more sustainable in those more remote areas.

Everything is usually more complex there. People tend to get sicker. They have more comorbidities. There is much more responsibility without all the associated support mechanisms that people take for granted when you are in a metropolitan centre: you might have three specialists that you could reach to for help and there's probably a hospital, an accident and an emergency. But when you're in regional and remote Australia all of that falls onto the practice. In many cases they are often a de facto emergency centre. They're an after-hours centre. They have to look after really sick people until they can get evacuated after road trauma or after serious illness that is beyond the capability of a regional or a small, country district hospital.

There is also extra care in the workforce planning and the workforce incentives. As you know, there are some scholarships that we have supported for many years. One of the best ones to get young students training in their basic medical degree is called the John Flynn scholarship, after the fellow who started the Royal Flying Doctor Service. In a sequential way, during their training these students revisit and spend time in the same practice. They get longitudinal exposure to rural and regional practice, because the health workforce in the regional space is probably the biggest challenge. It is a complex area to fill. It's the same issue as for a lot of the other professional services. Trying to get pharmacists and physios in the regions is a lot harder than in a metropolitan place. It's the same with dentists and in other professions for that matter. But in the medical space we have a metrocentric distribution of services.

One of the best markers of a quality health system is easy access to those entry-level primary care services. That's why it is so important that we keep supporting all these rural initiatives. We've got extra funds to have more specialist, non-GP training in regional areas. We have grants to keep regional doctors all doing stuff up to date. They can go and do upskilling courses. It is a continuous and relentless responsibility if you are working as a professional medical operator; you need to keep up to speed. There's support for those doctors to go off and do upskilling. There is the practice incentive program and the Rural Procedural Grants Program.

There is assistance for rural diagnostic imaging. I went on a trip down the Darling River checking out things, and there are some amazing services in these remote areas of my home state. But to have some up-to-date equipment or the latest technology sometimes is not economic, because the volume of activity in these areas isn't as great. There is a one-off funding pool to assist rural and remote medical imaging, which is generally not government run. It's private providers who do it because they love the country, they live there, they want to be part of the community and they want people in regional Australia to get the same things they would get if they went over to the Canberra Hospital at Woden. So we are trying to correct this disconnect in access to services.

We have also done so much work in this budget over the digital health space, as well as the My Health Record. Having access to health data in a remote area is always very important if you are travelling or moving around for work.

We have a long-term health plan. As I mentioned, there are initiatives for women's health. On the Pharmaceutical Benefits Scheme, there are great announcements—new treatments for osteoporosis, asthma, lung cancer and breast cancer. There's the initiative for funding a trial for triple-negative breast cancer. Tick, tick, tick—they are all really good, practical things that will make a material difference to the outcomes for many people who suffer from very serious diseases.

As I said, this original bill is a very practical, commonsense administrative initiative which I don't think anyone in this building will object to. It's common sense. I am so pleased that, in the 2021 budget, health is right at the top. To put things in perspective, we've done amazing things. There is a generational step change in aged care as well. That is also in the health portfolio. That is $17.7 billion extra over the next four years that will be going into aged care—$10 a day per resident in a high-care centre will really turn the economics of that around for a lot of long-term, very efficient, longstanding aged-care providers in regional Australia who have been challenged because the economics have changed so much. It's really impressive. There's $2.3 billion in the mental health space. That's $2.3 billion in new initiatives on mental health and for adult, youth and children's treatment centres.

On Medicare itself, we always guarantee that every budget. But there is also the initiative of telehealth, which has been fantastic for regional Australia. That's been supported with continuing funds. Wherever you go in the health budget, just about everything that people would think is great is there. There are obviously other things, but we have to manage it and get the best value for money for the Australian taxpayer. But overall our health system has been keeping Australians— (Time expired)


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