Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Hansard source

Australians deserve a healthcare system they can trust. They deserve to know that when they go to see their GP or access any form of medical service those delivering the service are operating with the utmost integrity. This government and this Minister for Health, Mr Butler, are serious about delivering a radical improvement to our country's health system. It is well and truly needed after nine long years of cuts and neglect from those opposite, those opposite who can't help themselves but undermine the health system that Australians hold so dear to their hearts. That's why we're getting on with strengthening the Medicare system that Australians value so highly. Strengthening Medicare also means safeguarding the taxpayer funds that underpin it, and this government is committed to that task.

This Health Insurance Amendment (Professional Services Review Scheme) Bill 2023 responds to the Independent review of Medicare integrity and compliance undertaken by Dr Pradeep Philip. The provisions within the bill will bolster confidence in Medicare integrity and remove a potential for undue influence over the professional review process. In short, the bill removes the veto power of the Australian Medical Association, the AMA, over the appointment of the director of the professional services review, known as the PSR. It amends consultation requirements for appointments of other statutory office holders of the PSR, including deputy directors, panel members and members of the determining authority, to enable direct consultation with peak bodies rather than this being coordinated through the AMA. It enables the appointment of associate directors of the PSR, and it removes the need for engagement with stakeholder groups as a prerequisite for issuing a notice to produce documents during an audit.

The PSR is a peer review scheme established to investigate and sanction against inappropriate practice by health professionals under Medicare. The PSR's objective, to safeguard the integrity of Medicare, may conflict with the AMA's objective to represent the interests of medical practitioners who are subject to the PSR review. The removal of the AMA's veto power is appropriate, as it is not consistent with public expectations and it undermines confidence in the independence of the PSR as a regulator. I note my colleague the member for Macarthur commented that the AMA has never used that veto, and I'd like to stress that this is in no way a criticism of the AMA.

The bill will enable direct consultation with peak bodies on the appointments of the deputy directors and panel members of the PSR, rather than making arrangements through the AMA as an intermediary for other professional groups as is currently the requirement under legislation. Similarly, the bill removes the requirement to consult with the AMA on the appointment of the chair and other members of the determining authority. Instead, the minister is to consult directly with the relevant peak bodies on appointments of medical practitioner members of the determining authority, which is consistent with the current requirements for other non-medical health practitioners. These changes remove any perceptions of inappropriate influence over the operation of the PSR scheme and ensure the PSR process can operate with impartiality and independence.

The bill also enables the appointment of associate directors of the PSR, who will be able to make decisions and exercise the same powers as the director in reviewing inappropriate practice. This is necessary to assist in managing conflicts of interest, unexpected absences and workload pressures as, currently, the director is the sole decision-maker, and there are no fallbacks if the director, for some reason, cannot make decisions due to a conflict of interest or unavailability. Associate directors will not have a role in the administration of the PSR agency. The director remains the sole statutory agency head and the accountable authority under the Public Governance, Performance and Accountability Act 2013.

Finally, the bill removes the need for engagement with stakeholder groups about documents relevant to substantiating Medicare payments as a prerequisite for issuing a notice to produce documents during an audit. This amendment will strengthen Medicare compliance powers without limiting the types of documents a person may provide during an audit of payments. It will also speed up these processes. There will be no impact on procedural fairness protections for a person being audited; they will continue to have the opportunity to make submissions about the compliance matter, and to provide any information or documents they consider relevant to their matter. The measures in this bill will strengthen the operation of the PSR, as well as improving the current process for the auditing of Medicare payments.

Australians are rightly proud of Medicare and of the committed work of doctors and other health professionals who deliver Medicare services. They know that the overwhelming bulk of Australia's doctors and health professionals are honest and hard working, and comply with Medicare rules. Before entering this place, I worked in the health sector for many years, including as a member of the Medical Board of Australia. In this role, we dealt with matters of registration and of complaints made against medical practitioners across Australia. From time to time we made referrals to the PSR, when allegations fell into their jurisdiction. I took this role very seriously.

Australians are justifiably proud of our health system, and our health practitioners are world class; the majority of health practitioners do the right thing by their patients and by the system. But there are those few who do not. In order for Australians to maintain their confidence in our health system, we need to have places where notifications can be made and investigated. Australians need to have the confidence that these regulatory bodies are not subject to undue influence. Health practitioners, those who are actually subject to the review, also need to have confidence that the regulatory bodies are not influenced and that they will do the right thing. And that is at the heart of what this bill is about. Our regulatory bodies not only need to be robust and fair but also, clearly, need to be seen to be so.

Labor is the party of Medicare, and this government has no higher priority than strengthening Medicare. It is why a centrepiece of this month's budget was the Strengthening Medicare package, the $3.5 billion to triple the bulk-billing incentives for GP visits—the largest-ever investment in bulk-billing. When I speak to people in Boothby about the healthcare system, what I most often hear about—apart from hospital ramping—is bulk-billing, and also being able to get in to see a doctor and able to afford to see that doctor. In Boothby I think we have about 25 per cent of doctors providing bulk-billing. Once you get out into rural areas, of course, it's much lower. Bulk-billing is the beating heart of Medicare, and after nine years of cuts and neglect by the former government we know it has never been harder or more expensive to see a GP. So this government is making Medicare stronger for all Australians, delivering critical funding and investing in reform for the healthcare system of tomorrow. The May 2023 budget delivers more than $5.7 billion in new investments to strengthen Medicare, as well as an indexation boost to Medicare rebates of more than $1.5 billion, delivering the biggest increase in 30 years.

But that's not all we've done. We've reduced the costs of prescriptions by $12.50; we've reduced the PBS safety net thresholds so that more people are able to access cheaper medications; we've cut the price of more than 2,000 medicines; and we've added more medicines to the PBS. We've given more self-funded retirees access to the Commonwealth seniors healthcare card so that they can access cheaper medicines themselves and we've committed to 50 bulk-billing urgent care clinics across Australia to relieve the stress on hospital emergency departments and to enable Australians to get urgent but non-emergency care quickly. I'm looking forward to one opening in Boothby before the end of this year to support the Flinders Medical Centre, which is our major tertiary hospital for the southern suburbs of Adelaide and southern regional areas. This government is committed to building back our health system after a decade of neglect by those opposite, and this bill is part of that. This bill contributes to the government's work in strengthening our healthcare system in the interest of patients and also in the interests of health practitioners.

I know that being subject to an audit, a review or a complaint is an extremely stressful experience for a practitioner to go through, whether they think they've done something wrong or not. It is important for them to have confidence in that system, confidence that the system is unbiased and not subject to undue influence by any particular body. So this is something that's not just good for Australians; it is good for our health system, it is good for our health practitioners and it adds to the other things that we are doing to support Medicare, to build back our health system and to build back the system that we have been so justifiably proud of since it was set up initially by Whitlam and then, of course, reformed and re-established by the Hawke government.

It is one of the things that I spoke about in my first speech; it's something that I've worked on for a long time. I worked in the health sector for close on two decades, both on boards and also in running non-clinical projects. The health system that we have in Australia is world class, in both its accessibility and its affordability. Those are very important things to Australians. This is part of people having confidence in their health practitioners, confidence in the system and confidence that our taxpayer money is going where it needs to go, which is to delivery of those services that we need.

The PSR, I know, has come under a bit of criticism for some of the estimates of Medicare fraud that have come out. I repeat: we know that most health practitioners do the right thing. But it is important that we can identify those who don't, because we need our health dollar to go as far as possible. We are an ageing population and we have increasing chronic disease; we need to ensure that we have health services that are accessible and affordable for all Australians, wherever they live, and this is part of that. I commend the bill.

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