Thursday, 4 April 2019
Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019; Second Reading
That this bill be now read a second time.
Australia has one of the best health systems in the world; however, it's under intense pressure from an ageing population, increasing chronic disease, spiralling health costs, technological changes and rising consumer expectations. It is critical for the Australian government to tackle these pressures head on by reforming key parts of the system to build a long-term national health plan.
Essential to the success of a long-term health plan is ensuring Australians have the health workforce to deliver it: the right people with the right mix of skills providing quality services at the right time right around the country. The 2018-19 federal budget commits $550 million to the government's Stronger Rural Health Strategy. This strategy will help improve the health of people living in regional, rural and remote Australia through better training, recruitment and retention of health workforce.
The Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019 is one of the targeted strategic responses under the Stronger Rural Health Strategy which responds to national challenge of ensuring primary health care is accessible and available to all Australians no matter where they live. Under the strategy a total of $20.2 million was committed to reform the bonded medical program.
The bonded medical programs are long-term investments in the health workforce by the Australian government. These programs were introduced back in 2001 as the Medical Rural Bonded Scholarship Scheme and was expanded to include the Bonded Medical Places Scheme in 2004. These schemes are designed to address the doctor shortages across regional and remote Australia and in areas with workforce shortages. Participants receive a place in a medical course at an Australian university in return for commitment to work in unserviced areas.
This commitment to work in unserviced areas is referred to as return-of-service obligation, known as ROSO. Under current agreements the ROSO can be as much as six years of continuous service in a regional and rural/remote area and in areas with a workforce shortage after obtaining qualifications as a specialist medical practitioner. Each year, government provides up to 850 bonded Commonwealth support places in Australia—medical courses. As the program matures, increasing numbers of doctors are due to commence their return of service. Up to 700 doctors are expected to commence their return of service each year over the next five to seven years.
Today a total of 10,062 participants are actively participating in the bonded medical program, 9,452 participants are completing their medical degree or training and a further 610 are undertaking their ROSO by working in regional and remote locations, including areas of workforce shortage. It can take up to 22 years for a bonded doctor from a first-year medical student to complete their obligation to the Australian public under the bonded medical program. I commend and acknowledge the significant impact this value sector of the medical workforce is starting to have on reducing the gaps in medical services outside metropolitan areas.
The bill is part of a broader reform to the bonded medical programs. Reforms will create a modern, flexible administrative system with greater capacity for the programs to support and target voluntary, recognised, Australian-trained doctors to work and stay in regional and rural/remote areas of Australia. It will enable participants to enter, if not already, an existing participant to opt into a statutory scheme without the need for individuals to contract. It will make it easier, significantly, for the bonded doctors to complete their ROSO by reducing and streamlining administrative requirements, giving more options as to when, where and how ROSO can be completed and providing earlier and stronger links with professional support agencies for doctors.
These improvements will encourage doctors to stay working in places where they are undertaking their return-of-service obligations beyond their obligations. These improvements will help ensure more fully qualified Australian trained doctors work in regional, rural and remote Australia in areas of workforce shortage. More importantly, the reforms will also better target future bonded workforce locations of need as demographic and workforce demands change over time.
The bill introduces a statutory scheme known as the bonded medical program to come into effect as of 1 January 2020. The statutory regulation scheme consolidates the existing BMP and the MRBS schemes under a single legislative framework to progress government's long-term view to move towards a single bonded medical scheme. The statutory scheme is clearer about the conditions of sanctions applied under the program, including the application for a medical ban for breaches of conditions under the MRBS scheme. Participants of the statutory scheme continue to have the right of an internal review and they'll be able to seek review for administrative decisions through the Administrative Appeals Tribunal.
From 1 January 2020 new participants will enter the program under a new statutory scheme and existing participants will be able to opt in. Existing administrative arrangements are significantly onerous and outdated, with the different contractual provisions both within and across existing schemes. Contractual agreements are complex and unwieldy to administer and are unable to be modernised efficiently and effectively to ensure the program responds to the government's future workforce needs and offers modern and flexible arrangements are needed to support the future rural medical workforce.
The statutory arrangements will eventually replace the myriad and complex contractual arrangements currently in place with individual participants. Statutory provisions will ensure that existing participants and future participants will have access to the same suite of options and opportunities moving forward.
Managing obligations over the 20-year period can be frustrating at times and resource intensive. The statutory scheme will enable participants to flexibly self-manage these obligations through a program-specific web portal and phone application. Participants, no matter where they are, will be able to log on and update their information and be able to plan, track and record their RoSO.
The statutory scheme will enable collection of data for reporting and effective evaluation of programs. At this stage, it is too early to evaluate the program's success; However, it is critical that government and medical professionals in the Australian public have access to robust evaluation of the program outcomes to inform policy decisions into the future. It is the government's long-term view to rationalise the bonded medical program to a single bonded medical scheme once all the existing schemes have expired. It is envisaged that this will occur in around 2035 when all participants under the existing scheme have either completed their obligations under that program or have chosen to opt into the new statutory scheme. The government is committed to implementing progressive and responsive administrative arrangements which support both current and future bonded doctors keen to make substantial contributions to better access medical services across Australia.
Debate adjourned and the resumption of the debate made an order of the day for the next sitting.