Wednesday, 11 September 2019
Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019; Second Reading
I present the explanatory memorandum to this bill and move:
That this bill be now read a second time.
In particular, I want to thank all of those present for their joint work on this bill. This bill is about ensuring that we have fairness and equity across all of the different medical students and, in particular, a better deal for the regions. I commend the bill to the House.
The opposition will be supporting this bill. The bill amends the Health Insurance Act to legislate for a new Bonded Medical Program. It was announced more than a year ago in the 2018-19 budget. Of course there are already existing bonded medical programs. This bill makes what I think can be fairly described as largely uncontroversial changes. The new Bonded Medical Program will open on 1 January 2020 and gradually replace the two existing bonded programs. Labor notes the government's assurances that, compared to the existing scheme, the new program will: streamline administrative arrangements, with one statutory scheme to replace individual contracts to each participant under the current programs; standardise return-of-service obligations so that they're clear and easily understood by all involved, with each participant to serve three years in an underserviced area within 18 years of completing their medical degree; standardise penalties for not completing the return-of-service obligations, with sanctions including repayment of the Commonwealth support and non-payment of Medicare benefits for six years; and be more responsive to changing workforce requirements, with underserviced areas to be defined in new rules to be made under the act. This, quite correctly, will allow governments to update eligible areas over time.
We welcome the fact that this bill includes transitional arrangements for participants in existing programs. Around 10,000 participants are undertaking a medical degree, training or return-of-service obligations under the existing programs. With some exceptions, these participants will be able to opt into the new program from 1 July 2020.
This is a very important piece of policy more broadly. I'm not talking about the amendments in particular, which the opposition finds unobjectionable and in many cases sensible. But, more broadly, we face ongoing health inequities in Australia. People who live in rural and regional Australia have worse health outcomes than people in metropolitan Australia, and people who live in rural Australia have a lot of difficulty compared to metropolitan Australia getting access to medical treatment. It's not just about GPs; it's about specialists, where the shortages are acute. Importantly, a related matter, not directed affected by the bill, concerns allied health professionals. It's very important to have good access to allied health professionals in rural and regional Australia. This has been a focus of ours since the election. My early travels as the shadow minister for health have taken me to remote Northern Territory, to rural and remote New South Wales, to Bourke, Brewarrina, Walgett and Broken Hill. This will continue to be a focus for us in our policy development on this side of the House, because we think it's important that Australians, regardless of where they live, have access to very good health care. Of course we have to make our objectives reasonable; nobody is going to suggest that you can have a major teaching hospital in every country town. But people who live in rural and regional Australia deserve access to the very best health care that is possible and practical.
It's not just about workforce or social determinants of health. There are broader issues at play, but workforce is key. We intend to continue to prioritise this area. Many honourable members may have seen, but some may not have seen yet, a very disturbing Four Corners episode this week about rural health outcomes. Again, these are issues which shouldn't necessarily be traversed in this bill, but they underline the scale of the challenge for rural and regional Australia to ensure that we are getting professionals into workplaces in rural Australia. I do want to acknowledge that some universities are doing good work. I would particularly note the University of Newcastle, James Cook University and Charles Darwin University, with a focus on both rural and regional medicos and medicos of Indigenous background who, in particular, go and work in Indigenous communities. All the evidence tells us that if you come from a rural background to start with and then go to medical school, you're much more likely to work in a rural region when you have become a qualified medico. So this is a very important area. We probably don't focus on it enough in this parliament. We will certainly be focusing on it on this side of the House.
In the meantime, we're happy to lend our bipartisan support to the legislation the minister has introduced, but I will move a second reading amendment, which I believe has been circulated in my name. I move:
That all words after "That" be omitted with a view to substituting the following words:
"whilst not declining to give the bill a second reading, the House criticises the Government for its cuts to and neglect of health care, which have made health care more expensive and less accessible for people in regional, rural and remote Australia".
In summary, 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 the challenge of ensuring primary health care is accessible and available to all Australians no matter where they live. Only last week I was on the Eyre Peninsula and the Yorke Peninsula talking with local communities about access to doctors, and I realise how fundamentally important this is. This bill is part of a program to ensure that more Australians have access to medical services no matter where they are.
Under the strategy, a total of $20.2 million was committed to reform the bonded medical programs. The bonded medical programs are a long-term investment in the health workforce by the Australian government. These schemes are designed to address the doctor shortage across regional, rural and remote Australia and in areas of workforce shortage. Participants receive a place in a medical course at an Australian university in return for a commitment to work in underserviced areas.
The bill introduces a statutory scheme, known as the Bonded Medical Program, to come into effect from 1 January 2020. The statutory scheme consolidates the existing Bonded Medical Places and Bonded Medical Rural Scholarship schemes. It brings these schemes under a single legislative framework to progress the government's long-term view to move towards a single bonded medical scheme—simple, elegant, understandable. The statutory scheme is clearer about the conditions applied under the program and provides greater flexibility for participants to complete their return-of-service obligation. Participants in the statutory scheme will continue to have right of internal review and now will be able to seek review of administrative decisions by the AAT. From 1 January 2020, new participants will enter the program under the new statutory scheme and existing participants will be able to opt in.
The statutory arrangements will eventually replace the myriad complex contractual arrangements currently in place with individual participants. In effect, it is an administrative archaeological dig which is being replaced with a single statutory scheme. Statutory provisions will ensure that existing and future participants have access to the same suite of options and opportunities going forward.
These improvements to the program will encourage doctors to stay working in the community where they are undertaking their return-of-service obligations beyond their obligations and ensure that that there are more fully qualified Australian-trained doctors working in regional, remote and rural Australia and in areas of workforce shortage. Perhaps just as importantly, the reforms will better target the future bonded workforce to locations of need as demographic and workforce demands change over time.
The scheme will enable collection of data for reporting and effective evaluation of the program. At this stage it is too early to evaluate the program's success; however, it is critical that the government, the medical profession and the Australian public have access to robust evaluation of the program outcomes to inform policy decisions into the future. Without these changes, the program will become increasingly outdated, with growing frustration experienced by participants and the key stakeholder groups that support them. Therefore, steps to modernise the program are required.
It's the government's long-term view to rationalise the Bonded Medical Program to a single bonded medical scheme once all existing schemes have expired. It is envisaged that this will occur around 2035, when all participants under the existing schemes have completed their obligations under the program.
I thank members for their contributions to the debate on this bill. I note the presence in the House of the member for Macarthur, and I would be happy, if he wishes to speak, to make an exception to allow that to occur.
I'm very relaxed. I think that's appropriate. He's had a long and distinguished medical career and, if he wishes to do that, it's reasonable for the House to make such an accommodation.
The government is committed to implementing progressive and responsive administrative arrangements which support both current and future bonded doctors keen to make a substantial contribution to better access to medical services across Australia. I want to thank the opposition for their support and I thank the AMA, the College of GPs and the College of Rural and Remote Medicine. I particularly want to thank the Australian Medical Students Association as well as the collective medical college deans around the country. I commend the bill to the House.