Sam Birrell (Nicholls, National Party, Shadow Assistant Minister for Regional Health) Share this | Hansard source

I too rise to speak on the Health Legislation Amendment (Miscellaneous Measures No. 1) Bill 2025. This bill, like so many other pieces of legislation introduced by the Albanese government, is like a scorpion. You start at the top and everything is fine. Then you get to the sting in the tail, not unlike the sting that many Australians are feeling when they need to pull out their credit card as well as their Medicare card. With that in mind, I'll start at the tail of this piece of legislation, and that refers to schedule 4, the Bonded Medical Program.

There simply is not enough detail in the bill, the explanatory memorandum or the assistant minister's second reading speech. The explanatory memorandum correctly explains that the Bonded Medical Program, first introduced in 2001, aims to address the shortage of medical professionals in regional, rural and remote areas, and, as shadow assistant minister for regional health, I am acutely aware of how important that scheme is. So we will be seeking further information and scrutiny on this bill through a Senate inquiry, particularly in relation to the implications of proposed changes to the Bonded Medical Program and the assignment of Medicare benefits for bulk-billing and signified billing arrangements. It is vital that these measures do not create unintended consequences or additional administrative burden for our hardworking health professionals.

Right now, it is undeniable that primary health care is in crisis under this government. While there have been several schemes over the decades, the fundamentals are the same: medical practitioners receive support from government in return for a commitment to work in regional settings. Under the current scheme, those who sign up receive a Commonwealth supported place, a CSP, in an Australian university medical course. In return, they make a commitment to work in eligible regional, rural or remote areas for a period of three years, or 156 weeks. This is referred to in the scheme as the return-of-service obligation, and participants have 18 years in which to complete this service obligation. The statutory Bonded Medical Program commenced in 2020 and replaced two legacy schemes. The Medical Rural Bonded Scholarship Scheme was from 2001 to 2015, and the Bonded Medical Places Scheme operated from 2004 to 2019. The legacy scheme participants are able to voluntarily opt into the Bonded Medical Program and receive a significant reduction in the return-of-service obligation and more flexible program conditions. In some cases, the length of time doctors are obligated to practise in areas of need in regional Australia is cut from six years to three years by opting into the current scheme. I can understand the reasons for wanting to streamline participation and administration to a single scheme, but we should also recognise the outcome is a significant cut to the amount of time those practitioners are required to practice in rural and regional areas to satisfy their return of service obligation.

I will remind everyone in this place that, still, doctors do not growing on trees. The bonded medical programs have played an important part for many years in delivering Australian-educated doctors to regional communities. The schemes have operated alongside similar schemes binding foreign-trained doctors to work in regional areas for a set period as part of their visa decisions. Schemes designed to address GP workforce challenges in regional and remote communities are already being undermined by changes that the Albanese government has made to Distribution Priority Areas. They've expanded the GP priority areas: 17 areas became more remote under the new Modified Monash Model classifications, but priority areas continue to extend into the fringes of capital cities; and 15 metropolitan areas gained DPA status, which allows for those areas to compete for overseas-trained doctors with the most remote and underserviced regions in Australia.

What we can't afford is further dilution of programs designed to get doctors into communities that most need them. Schedule 4 seeks to make changes to the Bonded Medical Program so that consequences for participants who withdraw from the program or fail to complete their return of service obligation—I emphasise that word 'obligation'—balanced the 'personal circumstances' of the bonded participant with the broader interests of the community. It is not clear from this bill, from the explanatory memorandum or the second reading speech, what that actually means in practice and what the implications are going to be for regional and remote Australia, who need these GPs. While a waiver is referenced, there's no detail to it. I can understand that, in some cases, there may be compassionate and compelling circumstances for a waiver to be applied, but the broader interests of the community are also very important, and these schemes can mean the difference between having or not having a local GP.

There is a third element here that's not addressed: the integrity of the scheme itself. Currently, breaches may be liable for financial penalties, such as repayment of the scholarship or CSP fees, and, in addition, former medical rural bonded scheme participants can receive a six-year Medicare ban. Without additional information gleaned through an inquiry—that's why we want to send it to a Senate inquiry—it's difficult to determine the impact of these changes. I'm a bit wary of any change that undermines the scheme and makes it easier for participants to on one hand receive the benefits but then not deliver the obligation under which they were given the benefits in the first place. We need doctors in the regions. You can wave your Medicare card as much as you want, even if you're the Prime Minister, but you won't be able to use it if there's not a doctor available.

There are alternatives are out there that I've seen work very successfully in getting medical professionals into regional areas. Initiatives of the previous coalition government are a great example of this. In my electorate of Nicholls the Murray-Darling Medical School Network—which moves Commonwealth supported places out to regional universities and regional campuses—school of rural health at the Shepparton campus of the University of Melbourne is a great example of this. The way the program works is that students will do a Bachelor of Biomedical Science—there are 15 places set aside at La Trobe University in this particular scheme, and 15 places from any other appropriate pre-requisite undergraduate course—and then the participants will go into the four-year Doctor of Medicine, which will be exclusively at the school of rural health in Shepparton, which is over the road from the hospital.

The students spend four years in a regional setting. The first graduates will come out at the end of this year, in 2025, and I'm really looking forward to the moment when they graduate. I know those students personally. They've already set themselves up in regional areas. Most of them were country kids in the first place. The reason the scheme was so attractive to them is that they were kids who, if they had to go to a university in Melbourne or Sydney to study medicine, they just wouldn't have studied medicine. They studied medicine because there was an opportunity to do it in a regional setting, close to their families, in an affordable way. So we have all of these kids who are going to be doctors who wouldn't have otherwise been. They are going to study in a regional location. They are going to be there for four years. They are going to put down roots. They've met people. In some cases, they have started families. In some cases, they are close to their existing families. I think, in some cases, people have already put down a deposit on a house. They are going to stay and practice in regional areas.

The Murray-Darling medical school is an example of really creative thinking by the then coalition government, saying, 'The evidence shows us that, if you train people in regions, they're likely to practice in regions.' We're about to yield in all regional areas, not just Shepparton but across the areas where the Murray-Darling medical school runs, the benefits of having those young people graduate and work in these regions. I think that we should look at expanding the Murray-Darling medical school beyond the Murray-Darling to other parts of regional Australia and to make sure that we contribute to that population balance by not just focusing a lot of our university courses in major metropolitan cities but moving them out to regional cities so that they grow and so that we grow Australia in an even way.

The Murray-Darling medical school, along with the bonded medical scheme and the programs that have required overseas doctors to practice in regional areas as part of their visa requirements, is an example of the government being creative and filling that need for medical professionals in regional areas. But, if you start watering down these schemes, as this bill may do—again, it's not clear—in relation to the bonded medical scheme, you are going to not only water down the scheme but water down the ability of regional communities to have access to GPs.

The other schedules in this bill seek to address regulatory and administrative issues. The coalition acknowledges the intent of this bill. It contains a number of technical amendments to improve the efficiency of several important elements of our health system. Schedule 1, for example, is on the automation of Medicare provider numbers. In my own electorate, my office has had to assist general practitioners facing extended delays on the issuing of a Medicare provider number. Schedule 2 refers to the private health insurance rebate premiums reduction scheme and schedule 3 the modernising assignment of Medicare benefits for bulk-billing and simplified billing.

Every government comes in and has a look at how things have worked. I think things worked well under the previous coalition government, but there's always room for improvement. If a new government comes in and finds ways to streamline because of new technology or new ideas then that's a good thing. I'm very supportive of that. But, once again, we are presented with a bill that has many reasonable elements but where we are concerned about one aspect. We need further explanation, further information and a Senate inquiry to interrogate those changes and make sure we don't end up with unintended consequences that leave regional and remote Australians even worse off than they are currently in relation to a trained, efficient and available medical workforce.

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