House debates

Wednesday, 12 May 2021


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

10:25 am

Photo of Mark ButlerMark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | | Hansard source

I rise on behalf of the opposition to speak in relation to this bill, the Health Insurance Amendment (Prescribed Fees) Bill. I indicate that the opposition will be supporting the bill, but I foreshadow that I will be moving a second reading amendment at the end of my remarks.

This bill is a very modest one in its impact, to say the very least, but it is important. It highlights the difficulty that the health system in Australia is having with coming to grips with modern information management systems and digital technology, with what many other if not almost all other sectors of our economy and society have done in relation to grasping the opportunities of modern information technology. I well remember when former Prime Minister Tony Abbott was the health minister, close to two decades ago, and said that his No. 1 KPI as health minister was to introduce an e-health record. Yet still we struggle with having good digital systems that ensure that people are able to have confidence that their health records are stored digitally and are available, subject to their consent, obviously, by all of their clinicians—but I digress.

This bill deals with a particular challenge that is fairly extraordinary. I make no criticism of the government for the fact that we've found this challenge. It just reflects the slow transition of the health system to modern information systems. The challenge is that, under current legislation, once a medical practitioner gains fellowship with their specialist college—when a medical practitioner is admitted to the College of Surgeons or the College of Psychiatrists, for example—they are then able to charge higher Medicare rebates. The way they do that is by making an application to Services Australia, which in the ordinary course of events is approved. They are then able to charge the higher Medicare rebates. The current system as legislated requires that medical practitioner to pay a prescribed fee of $30 and to pay that fee by way of cheque or money order. I'm not sure whether they're required to fax through a copy of the money order or send it by telegram or carrier pigeon, but the system requires them to pay by cheque or money order. It is highly prescriptive. One could argue reasonably that this system was slightly outdated even before the COVID pandemic, but it became a particular challenge, obviously, during the pandemic. It became very difficult because of movement restrictions and suchlike that really made it very difficult for medical practitioners to move up through their specialist registration with their college and then be able to charge a higher Medicare rebate.

We're told that the government explored the option of implementing more-modern payment systems for these fees—one could ask why they weren't already in place—but the advice from government is that the cost of an upgrade to something slightly more modern than the payment of a fee by money order or cheque was assessed as being far greater than the loss in revenue from scrapping the fee. If there are younger people watching these proceedings, I wonder whether we'll have to explain to them what a cheque is. I've talked to members on our side—I'm sure it's the same on the other side—about when you bring a new staff member into your electorate office and pay a sponsorship to a local sporting club or suchlike by cheque. A number of us have stories where much younger members of staff have literally looked at this oddly sized piece of paper and asked, 'What is this?' Anyway, apparently the cost of moving to a more modern payment system was going to cost more than simply scrapping the $30 fee, so the government has taken the decision to remove the fee entirely, which is the decision this bill gives effect to. That seems a sensible approach to this rather peculiar information management challenge that the government has identified, and we will support it. What we want to see, obviously, is medical practitioners who have done all of that hard work to gain admission to their specialist college able to continue to practise as a specialist as soon as possible and, obviously, charge the higher Medicare rebates that go with that specialisation.

As I said at the beginning of my remarks, this particular challenge really does reinforce the ongoing challenge that our health system has in moving towards more modern information management systems. I know there are a couple of members in the House on both sides of this chamber—the member for Macarthur and the member for Higgins—who will be speaking on this bill who have much more direct experience of this than me. But I hark back to that KPI that former health minister Tony Abbott identified in 2004, almost two decades ago. His first KPI, his most important KPI, as he said then, was to transition the health system to one based around a functional, personally controlled electronic health record. We still grapple with these things today, as this bill has reminded us.

I want to give a couple of examples of some of the ongoing challenges in the health system—firstly, in relation to the use of new and sometimes not-so-new information technology, and that is in relation to telehealth; and, secondly, in relation to the broader workforce challenges that this bill, indirectly, is dealing with as well, in terms of medical practitioners moving to specialist colleges.

The issue of telehealth is one that the medical health system has been grappling with for some time. The use of telehealth has been in place for some time for a range of different assessments and therapies. But, as the pandemic really hit last year, the member for McMahon, when he was the shadow health minister, spent a lot of energy and time calling on the government to mainstream telehealth at a time when Australians were, to varying degrees around the country, locked down in their homes but still needed to be able to consult their treating doctors. To the government's credit, they heard those calls not just from the member for McMahon but from the health system and the community more broadly and introduced telehealth as a broad based MBS measure, albeit on a temporary basis.

The minister said in November, I think, that it was his intention to make telehealth a permanent measure, but all we've had since then is a rolling series of six-month by six-month extensions by the minister, which are good as far as they go but don't give that ongoing, permanent confidence to the community and, importantly, to the health workforce that this is a permanent transition in the way in which health services are delivered. A couple of weeks ago—I can't remember the exact date—the minister did make a decision to extend the telehealth measures that were due to expire on 30 June to the end of the 2021 calendar year. Again, it's better than nothing but a far cry from the permanency that the minister promised back in November.

Broadly, at first blush, although people want permanency and some sense of confidence about how this is going to operate, this was something welcomed to a degree by the community and by the health sector—until they read the finer detail. The finer detail was to abolish all but two of the MBS items allowing phone consults. That is a very serious set of decisions that very understandably have caused a great deal of concern in the broader community as they have become aware of it but particularly in the health sector. These phone items—particularly, for example, the long consult item—have been widely used through the pandemic since they were introduced. We were told that there have been 2.8 million items for level C phone consults and nearly 200,000 items for level D consults since the measures were introduced.

There had been some talk around Canberra that the department and the minister were concerned that maybe these phone consultations were being misused or weren't the clinically optimal way for GPs, particularly, to consult with their patients. But it was very vague; it was very vague what the actual concern was. I think that we, as members of parliament, all understand that there's quite a variety of levels of comfort with different technology. The government says, 'We want people consulting with their GP, if they're not face-to-face, over video consult.' That's fine, except where, first of all, patients aren't comfortable or don't have the technology quite yet to do video consultations, or, for that matter—and I'll come to this—where the doctor says: 'Actually, we're quite comfortable with doing a phone consult. We don't need to see a person for the particular purpose of the consult in question here.'

That's really why there has been such a strong reaction from doctors groups to this decision, which was subject to no consultation with them. It was a complete surprise after they read the fine print of the announcement by the minister that he was extending—again, on a temporary basis—the telehealth items that were introduced during the pandemic. The AMA president, Dr Omar Khorshid, said that the profession had been blindsided by the government's decision. He said: 'The permanent future of telehealth must include access for people who are disadvantaged, and that means, at this stage, telephone consults. The beneficiaries of telehealth are patients, not doctors.' He further went on to say, 'We believe that the quality of care provided over telephone consultation is excellent, so long as it's being done appropriately, and is no different to what is provided over video.'

Obviously, if they're doing a telehealth consult, there are circumstances where the doctor will want to see the patient; they will want to have a video consult to see the particular rash or have some other visual assessment of their patient. We should trust GPs to make that assessment; we should trust the clinical judgement of GPs to make a decision about whether, in a particular circumstance, a phone consult is acceptable and appropriate—particularly given that they, better than anyone, understand the circumstance of their patients. They, better than anyone, understand that there are some patients who are not, at least yet, comfortable and able to access video technology. Maybe the government would have understood that better if they had actually consulted with doctor groups about this decision—I do make that point. As I said, this particular bill does highlight again the challenges that the health system is having in coming to grips with modern technology. Frankly, this government is even having difficulty in coming to grips with the appropriate use of rather longstanding technology, like telephones.

As I close my contribution I will also make some remarks generally around workforce. The measures in this budget dealing with more general health, rather than aged care and mental health, are relatively modest. To the extent that there are measures, they're broadly measures that the opposition would support. But I want to talk about one particular measure that was—as almost every measure in the budget was—leaked to the media some days ago: the decision to boost bulk-bill rebates for rural and regional Australia. The opposition supports measures to increase bulk-billing and is very aware of the particular challenges, first of all in attracting sufficient numbers of health professionals, including GPs, to rural and regional Australia; that was something which we worked very hard on when we were last in government. I had the honour of working as the parliamentary secretary to the then Minister for Health, Nicola Roxon, at the time, and this is something that we broadly support. But I want to draw attention to these ongoing challenges that are presented by the application of the Modified Monash Model. Again, this is something that leaves a number of communities in Australia out in the cold with this latest decision.

When the decision to increase bulk-billing rebates for rural and regional Australia was announced, it was presented as something that would support communities and clinics outside the big cities. As I was going through the papers, it appeared to apply to Modified Monash Model areas 3 to 7, so it leaves out areas 1 and 2. Just last week, as I was travelling through the Hunter Valley with the member for Shortland and the member for Newcastle, and then when I spent time on the Central Coast with the member for Dobell, I met GP after GP who drew attention to the challenge those communities are having attracting and retaining GPs and keeping up bulk-billing rates because of the cuts to their incomes, on top of the Medicare rebate freeze that they dealt with, through the application of the Modified Monash Model system.

The roundtables that we had with the member for Dobell on the Central Coast really highlighted a region whose population, compared to the demographic average across the country, is older than average and has a range of more complex health conditions. It gets no support from this decision. Again, it is treated as if it's part of Sydney. There are parts of Sydney that are treated as what we used to call a district of workforce shortage, but the Central Coast is not one of them. If you actually go through the Central Coast and talk to GPs who have surgeries that have no GPs in them—surgeries that were built to deal with the enormous growth in population on the Central Coast, a growth in population that is weighted towards the older part of the population—the lack of any attention in this budget to these challenges around bulk billing and the availability of workforce in regions like the Central Coast and the Hunter Valley is particularly stark.

With those remarks, I move, as a second reading amendment:

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 urges the Government to implement policies to better protect Australians' health".

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

Is the amended seconded?

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

I second the amendment and reserve my right to speak.

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

The original question was that this bill be now read a second time. To this, the honourable member for Hindmarsh has moved an amendment that all words after 'That' be omitted with a view to substituting other words. If it suits the House, I will state the question in the form that the words proposed to be omitted stand part of the question.

10:42 am

Photo of Katie AllenKatie Allen (Higgins, Liberal Party) Share this | | Hansard source

The Morrison government always has a view to the future. Whenever there is an opportunity, no matter how small, to make an efficiency gain and improve the lives of hardworking everyday Australians, we take it. This legislation exemplifies this in a very small way. It removes a minor but impractical administrative measure that burdens medical practitioners and ultimately their patients. This is in line with the Morrison government's commitment to delivering an even better post-COVID-19 healthcare system. We should be ambitious for our healthcare system. That is why I served on the board of Cabrini hospital before coming to this place. The only hospital in Higgins, it is a not-for-profit Catholic-based private hospital. As I said in my first speech, our healthcare system is undoubtedly one of the best, if not the best, in the world. It is a unique and effective blend of public and private, where the private sector provides innovation and choice and the public sector provides a safety net for all.

This bill simplifies the administrative processes for recognition of specialist and consultant physicians for Medicare purposes under the Health Insurance Act 1973. I note the member for Macarthur in the chamber here today. I know he will welcome this small addition to the changes we're rolling out. It will remove the requirement to pay a $30 prescribed fee for specialist and consultant physicians for Medicare purposes. This benefits practitioners and also Services Australia, who are tasked with processing this fee. Ultimately, it helps patients.

Currently the pathway to be recognised as a specialist or consultant physician requires a medical practitioner to apply to Services Australia for access to higher Medicare rebates. This process requires a medical practitioner to pay a prescribed fee of $30 by a cheque or money order to have their application processed. The issue with this payment is that it is fundamentally outdated, an issue heightened by the COVID-19 pandemic. Movement restrictions and in-person services quotas meant that practitioners had trouble paying the fee, while Services Australia had trouble processing the fee. As a result, patients missed out on receiving higher Medicare rebates.

The cost of requiring a new modern system to take digital payments—and it is pretty hard to believe that we are talking about this in the 21st century—is far in excess of the $200,000 in revenue this payment generates over four years. Put simply, this is a prime example of red tape. It does not contribute significantly to government revenue, it doesn't help doctors and, with the COVID-19 pandemic, it is now unfairly hurting the hip pocket of patients. This bill corrects this issue. This small but important tweak is just one of the Morrison government's efforts to ensure a modern and efficient healthcare system post COVID-19.

The impact of COVID-19 means that we have been required to become more sophisticated and flexible in the use of technology and to think differently about how to solve problems that everyday Australians face. For the short term, we will have to continue to be agile and creative—and I welcome the fact that Australia has been very good at pivoting across many different aspects, including our healthcare sector. One of the great developments coming out of the COVID-19 pandemic, one of the great pivots of 2020, has been the rapid expansion of telehealth services. I welcome the comments from the member for Hindmarsh, but I have a point of difference with him about the rollout of telehealth services.

The uptake of new technology has been challenging for the best of us. However, as they so often do, our medical and healthcare practitioners have taken this in their stride. They should be congratulated for their adaptability and responsiveness. Due to the program's success in telehealth medicine, and in the interests of safety in protecting both our doctors and patients, this has now been extended to 30 June 2021. The government has consulted extensively with peak bodies and members of the medical and health profession to ensure the staged and proportionate integration of healthcare services.

Last year on 27 November the Minister for Health and Aged Care, Greg Hunt, flagged that telehealth in the long term will become a permanent addition to Australia's Medicare system. I look forward to this commitment being secured and I congratulate the Minister for Health and Aged Care, Greg Hunt, on the excellent work that he has done in initiating a very rapid rollout, in 10 weeks, of something that could have taken 10 years in a normal period of time to be rolled out. I understand that he is working very hard with the sector to make sure that the rollout goes smoothly and that it is sustainable in the long term. But certainly with 3.3 million video consultations and 41 million phone consultations provided last year it is clear patients and medical practitioners alike have taken up telehealth with enthusiasm.

While telehealth will never replace the more attentive and important care given in an in-person consultation, it fills a key gap in our health system. Whether you are travelling hundreds of kilometres, if not thousands of kilometres, across this wide continent to see your medical practitioner or in particular, your specialist, or whether you are sitting for hours in congested traffic in our major inner cities, telehealth provides an efficient and rapid way for patients to connect with doctors. We know this will improve the effectiveness. As a paediatrician, I know that parents sometimes have to take time off work in order to take their child to an appointment and to sit for hours in a medical practitioner's rooms—and, yes, I would say that I was responsible for some of that sitting as, even though you do try to be effective and efficient as a medical practitioner, sometimes the wait can be long. Telehealth provides the ability for people to be able to care for themselves and their families and to be able to do this in an efficient and effective way.

I do however think that it is important that we focus on telehealth utilising video technology. At the moment, telehealth is predominantly phone based, with 80 per cent of services being provided by phone. This is where my views differ from those of the member for Hindmarsh, in that I think that percentage should be 80 per cent videohealth. The reason for that is that we know many cues come from a video experience. By not allowing that to be the most important aspect of the telehealth services means that medical practitioners are potentially missing out on some important cues that they may receive via videoconference.

I do understand that older Australians may not be as technology savvy as some might believe, but I think that older Australians have been enthusiastic with their uptake of things like telehealth and that, once they have seen the light, so to speak, with regards to videohealth, they will enthusiastically embrace it. We need to make sure that this is transitioned carefully and that there is support to ensure that the videohealth links are secure and safe and that privacy is also maintained. But I do believe that these things can be addressed and certainly should be addressed.

Access to bulk-billed appointments via phone or video don't just benefit Australians in accessing their regular appointments in a pandemic but also help ensure that people, who perhaps have depression or are unwell, who do not wish to or cannot wish to leave their homes—particularly in cold winter months in Melbourne—are more likely to access health care. That is very important for early intervention and is very important for secondary prevention to prevent readmissions when people have been home from hospital. Too often Australians, particularly those living with chronic health disease or with disabilities, and especially those with fluctuating conditions, will face delays in accessing health care and that can potentially compound their conditions.

During COVID one of the reasons that telehealth facilities were rolled out was to protect health practitioners as well. It meant that, in that swift crisis that we all faced, we were able to ensure that, when we were facing difficulties with PPE and mask acquisition, we could keep our frontline workers as safe as possible. So the use of telehealth has had a myriad of uses throughout the COVID pandemic.

The use of telehealth is about protecting the most vulnerable members of our healthcare network. It is jointly about guaranteeing that vulnerable patients can receive continuity of care and advice. The expanded use of telehealth will undoubtedly be a positive legacy piece of the COVID-19 pandemic and one that all Australians should feel proud.

The government is also implementing the most significant reforms to private health insurance in over a decade, which is making private health insurance simpler and more affordable. From 1 April 2021 the government increased the maximum age of dependants for private health insurance policies from 24 to 31 years and removed the age limit for dependants with a disability. I cannot emphasise how important this will be to ensuring that young people maintain their private health cover, particularly if they've been part of their family's private health cover. This is part of the government's commitment to ensuring private health insurance is affordable and provides value for money for its consumers. This serves the additional purpose of encouraging young Australians to continue with private health insurance when they reach the age of 31—the age at which lifetime health cover commences.

My son is an example of this. He was on our family cover. He is a young man who has epilepsy. Unbeknownst to us he allowed his private health insurance to lapse. During that period of time he was trying to access a neurological appointment and took a long time to receive an appointment. In the meantime he was on the wrong dose of his antiepileptic medication. He suffered a seizure, a generalised convulsion, which can be quite dangerous. So because he allowed his PHI to lapse he actually put his own health and life at risk. I am delighted to say that he will now be able to be incorporated into our family health cover. And hopefully as a young man, who has only just commenced employment in the workforce, he may see the benefits of private health insurance going forward.

This gap between 24 and 31 years of age is often the time that young people are going out into the workforce. They have a lot of additional expenses. They are saving, hopefully, for their first home—as a member of Goldstein would be very pleased to hear—and they also have difficulties with job security. So PHI or private health insurance is often not their No. 1 expense. I think this extension is a very welcome extension. I think it will be a benefit, ensuring that people who wish or choose to invest in private health insurance will continue that coverage from their family coverage onwards.

The Morrison government has worked hard to ensure the vitality of our healthcare system before, during and now after the COVID-19 pandemic; although, I note we're still not out of the woods yet. This minor but worthwhile amendment to prescribed fees is a welcome change, which will abolish this administrative imposition on medical practitioners. This is great news for our healthcare system, its practitioners and ultimately for patients. I commend the bill to the House. Thank you.

10:54 am

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

First of all I would like to acknowledge the contribution by the Member for Higgins. I would also like to acknowledge the Member for Lyne as being, with myself and the Member for Higgins, one of three people who have direct knowledge of this particular amendment. I would like to commend the shadow minister for health, Mark Butler, for his deep understanding of our healthcare system and knowledge of this particular amendment. As with many things that this government does, we support the amendment but understand that this is tinkering at the edges of a healthcare system that is under increasing stress.

It is good as a specialist to receive your specialist acknowledgement by achieving the fellowship of your royal college, be it the college of physicians or the college of surgeons or psychiatrists or whatever specialty. That's very important and a great part of our joy in receiving specialist recognition. But part of that also is the time when you can get specialist recognition for payment through Medicare. I remember in 1983 having to get either a bank cheque or a money order rather than a personal cheque to pay my contribution for this. Every specialist really waits for that moment and it is a really important time. The fact that we are now allowing it to happen in a much more ordered and modern way is really correcting an anachronism that should be long past, as the shadow minister commented. However, it is tinkering at the edges of what is a very significant problem in our healthcare system, and that is access to higher level specialist care.

Across the board we see in Australia a degradation in life expectancy from inner-city and metropolitan to outer metropolitan, rural, regional and remote areas. Life expectancy gradually decreases along that line. Access to higher level care increasingly is restricted to people living in inner metropolitan areas. We see that in a whole range of mortality and morbidity figures. With the advent of modern health care, we are seeing increasingly complex procedures available. For things like for coronary artery disease, urgent stent insertion is now the treatment of choice and has contributed markedly to a reduction in mortality and, indeed, a reduction in morbidity in our major capital cities. This is less and less available the farther we move from the inner city of all our major capital cities. These treatments mean that people live longer and are able to return to the workforce following a heart attack much more quickly and with much less disability. We see those available increasingly in our capital cities, but it's still a major difficulty in our rural and regional areas and also in our outer metropolitan areas. There are new treatments—for the management of stroke, for example, with clot retrieval—which are essentially available only in our inner cities on a regular basis, and little effort is being made by the government to try to provide these higher level medical services to outer metropolitan, rural and regional areas. There seems to be little acknowledgement from the government of the difficulties in getting these procedures made available to all Australians.

One issue that the government has spoken about is the increases in Medicare payments to GPs living in rural and regional areas. Yet, for the last five years, I have been writing to the minister for health, explaining to him how difficult it is to recruit GPs to our outer metropolitan areas. More recently, the changes to the area-of-need classifications for the outer metropolitan areas, as the shadow minister for health spoke about, are making it very, very difficult to recruit general practitioners to our outer metropolitan areas.

In my electorate of Macarthur, one of the fastest-growing electorates in the country, I have general practices contacting me every week saying they can't recruit GPs to work in their already overburdened clinics, which puts enormous pressure not only on our patients but also on our public hospitals, which are now being used as general practices by many people because they can't access general practice care. This is a failure of the government to understand that their responsibility is to deliver the best health care they can to all Australians, not just some. This is, again, a failure of understanding the importance of health care to everyone.

There are other issues that the government is also failing on. The member for Higgins mentioned private health insurance. Some of the changes that the government recently made to private health insurance, in particular in the area of disability, allowing people with disability to remain on their parents' health insurance indefinitely, have been very important changes. But it is too little, too late. The numbers in private health insurance are dropping, which is putting more and more pressure on our public health system, which the government seems to be quite happy to let happen, without any real move to improve the viability of private health insurance for all Australians.

In terms of technology, the government's idea of how My Health Record is working is deeply flawed, yet there is little commitment from the government to try and improve our electronic healthcare records. This is very poor. This is the future of health data, and how we store and use that data is increasingly going to impact on all our health care as the future evolves. Yet the government has done nothing to improve My Health Record, to the point where the whole system needs to be redesigned and re-established because the majority of Australians are not using electronic healthcare records. This is increasingly important as we develop an understanding of the genetic nature of disease and how we apply that to health management across a whole range of fields, from cardiovascular disease to obesity and diabetes, to cancer therapy and cancer management.

In this budget—this is another piecemeal measure—the government has put in some funding to provide support for breast cancer genetic screening. That's very important but it's only part of the answer. There is no commitment from the government to an overall picture of gene and cell management. We need to be doing this as a whole-of-health approach, not just as a piecemeal approach all the time. That's what we get from this government.

Unfortunately, it's not just in electronic health records and other technology; little is being done to support the telehealth and telemedicine regime. The recent changes were announced by the minister without consultation and without any proper engagement with the healthcare workforce, yet this is going to be a very important part of our health future. This should have entailed consultation with a whole range of health providers—not just doctors and general practitioners but specialists, nursing staff, allied health staff, physiotherapists and occupational therapists. A whole range of options could be made available to try and improve our telehealth system, futureproofing it and enabling the expansion of services for the benefit of all patients.

Telehealth is not just very important in rural and regional areas; it's very important in electorates like mine, which have a high level of disadvantaged patients, a high level of Indigenous patients and a high level of people with disability. Access to telehealth is very important and should have been expanded by the minister, with support given to practices to establish more telehealth facilities. The ability to conference telehealth and engage other practitioners for case conferences et cetera should have been expanded. As a paediatrician I found access to case conferences vitally important for my patients, often those with multiple disabilities. A process should have been put in place by the minister to allow this to happen rather than restricting access to telehealth practices.

Again, whilst this amendment gets agreement from both sides of the parliament, it's piecemeal, it doesn't look at the overall health picture and it could have been done a whole lot better with a philosophy of improving health care for all Australians. If you live in the inner city it may well be that you get good access to a whole range of health services, but, in outer metropolitan, rural and regional areas, access to high-level specialist care is increasingly being rationed, and the health outcomes in terms of both mortality and morbidity are being paid for by some of the most disadvantaged groups in our country.

This change is a very small change. Whilst I welcome it, I want the government to look at putting in more processes that enable high-level specialist care to be given to people living in rural, remote and isolated areas. It can be done. Teaching-hospital-level health care should be available to everyone in Australia. There are ways of doing this. The health cardiology bus that is used in remote and regional areas of Queensland to provide high-level cardiac care to the teaching-hospital level should be available across the country. Our most remote Indigenous families should have access to high-level eye care, high-level ENT care and high-level cardiovascular and diabetes care. We know that can be done with a commitment from a government that philosophically understands the importance of universal access to the best health care possible.

The government has approached the whole health issue in a piecemeal and very political way, without a philosophy of providing the best care to everyone. We've seen rollouts of some innovative health policies occurring in very advantaged communities and not in disadvantaged communities. Once again, the health workforce is not being evenly supported across the country. In my own area, the electorate of Macarthur, we have had major problems recruiting GPs to work in our GP clinics, major difficulties recruiting specialists to work in our hospitals and major difficulties providing tertiary-level health services in the outer metropolitan area. There are ways of doing this much, much better.

Whilst we support this amendment, the government needs to do more to support health care for all Australians. In particular, we need to look to the future and we need to futureproof our health care for everyone. That means a commitment to electronic healthcare records for everyone, a commitment to supporting telehealth, a commitment to supporting the most disadvantaged and, overall, a commitment to supporting our workforce that has supported us so well throughout the pandemic.

One of the reasons Australia has done so well in the pandemic is our health workforce. I don't just mean the epidemiologists and the infectious-diseases consultants; I mean the nursing staff, the contact tracers and the IT specialists—the people who work on the ground to make sure we are all protected. I really thank them so much for this, but we need more from the government for overall health care as we emerge from the pandemic so that there is justice for all within our health system. I thank the House. I thank the shadow minister for his amendment, and I reiterate our approval of it.

11:08 am

Photo of Fiona MartinFiona Martin (Reid, Liberal Party) Share this | | Hansard source

I rise to speak in support of the Health Insurance Amendment (Prescribed Fees) Bill 2021. The bill amends the Health Insurance Act 1973 to remove the requirement for new specialists and consultant physicians to pay a prescribed fee when applying for recognition for higher Medicare rebates. It reaffirms the Morrison government's commitment to cutting red tape and ensuring better access to health services for all Australians.

This amendment is a small amendment, but the changes will ease the bureaucratic process for recognition as a new specialist or consultant physician for Medicare purposes under the Health Insurance Act 1973. It does this by removing the requirement to pay a $30 fee to gain access to higher Medicare rebates. As it stands at the moment, the current pathway to recognise a specialist or a consultant physician requires a medical practitioner who has gained fellowship with a specialist medical college to supply to Services Australia for access to higher Medicare rebates. As part of this process, the medical practitioner must pay the prescribed fee, $30, via money order or cheque. Only then can the application be processed.

This simple amendment will reduce the cost and processing times for new specialists and consultant physicians to be recognised for Medicare purposes, therefore providing more efficient patient access to higher Medicare rebates. During the COVID crisis, it became apparent that this method of payment was impacting specialist and consultant physician recognition for the purposes of Medicare. This was mainly because neither method of payment was efficient or practical during movement restrictions and in-person service closures. As a result, patients of new specialists or consultant physicians may not have been able to receive higher Medicare rebates when they were entitled to.

These changes will not only remove costs for physicians and provide better access for patients; they will also make it easier for Services Australia to more efficiently process applications from new specialists and consultant physicians, ensuring earlier access for patients to higher rebates. If this change is not made, patients of new specialists and consultants may not be able to receive higher medical rebates during any future movement restrictions and/or reductions in in-person service availability. In the past, this requirement has delayed access to higher Medicare rebates.

The government has done a lot to assist with patients access to better health care. More Australians are now seeing their doctor without having to pay. Nearly nine out of 10 visits are free. The GP bulk-billing rate was 89.3 per cent in 2020, compared to 81.9 per cent in 2012-13, Labor's last year in government. In total, there were 440 million Medicare services last year, with $25.9 billion in total benefits paid. During the COVID-19 pandemic, we have extended Medicare subsidised telehealth services, enabling more than 50 million consultations since the crisis began.

In summary, this amendment, which is a rather simple and small amendment, will reduce red tape and improve efficiency so patients have better access to health care. We don't want our doctors consumed with paperwork. We want them to treat patients. I support the changes.

11:12 am

Photo of Pat ConroyPat Conroy (Shortland, Australian Labor Party, Shadow Minister for International Development and the Pacific) Share this | | Hansard source

This bill, the Health Insurance Amendment (Prescribed Fees) Bill 2021, goes to the future of the healthcare system in this country. I thank the speakers, on both sides, for their contributions about the impact of this on modernising payment schemes. In particular, I find it incredible that we're still asking people to pay by cheques or money order. I'm 42 years old. I don't think I've ever used a money order in my life.

An honourable member: You don't look a day over 21.

Thank you. There's a lot of kindness in the room today. I attribute it to the budget hangover.

Photo of Andrew WallaceAndrew Wallace (Fisher, Liberal Party) Share this | | Hansard source

There'll be enough of that.

Photo of Pat ConroyPat Conroy (Shortland, Australian Labor Party, Shadow Minister for International Development and the Pacific) Share this | | Hansard source

The modernisation of payment systems is really important, particularly in COVID, when we need to upgrade our payment systems to make them as contactless as possible. I think that's very important. In his contribution, particularly in his second reading amendment, the shadow minister for health went to the broader issues that surround doctor training and workforce development. I'm going to take this opportunity to make a contribution on those broader issues, which are canvassed in the second reading amendment.

The changes to the Modified Monash Model for how we pay GPs is a disgrace. The fact that they have changed the classification of regions like mine has had a huge impact on bulk-billing rates. The cut to the bulk-billing incentive has had a direct impact on my electorate. For example, I had a roundtable discussion last week with GPs. They reported that it has cut payments to GPs salaries by $9,000 a year. That's on top of the fact that GPs have had a pay freeze for many years under this government. This government is continuing to diminish the value of GPs and, by attacking their remuneration, is making it a lot less attractive to GPs to train and go through the long process of becoming a GP. So we're seeing that cut impacting on the workforce.

On top of that, the implication for GPs is that, if they want to stay in business, they're going to have to increase the number of patients that pay a gap. In fact, GPs reported to me that, before the cut to the GP bulk-billing incentive, they were running at about 80 per cent bulk-billing and 20 per cent non-bulk-billing. That's reversed. They are now only bulk-billing 20 per cent for their patients. To quote one GP, this payment cut was 'the straw that broke the camel's back' in terms of their focus and commitment to bulk-bill. That's incredibly tragic. It's undermining the entire Medicare system and it's incredibly counterproductive.

Medicare is based on access to health care being based on need, not financial ability. We canvassed this issue when this government launched another attack on Medicare, which was the attempted introduction of the $7 co-payment charge. In testimony to a Senate inquiry into that, the Department of Health quantified the cost savings from it. They quantified that it would avoid four million visits to GPs per year. It was able to quantify that, if just one in 50 of those people who avoided visiting the GP presented to a hospital emergency department, the savings would be wiped out. The tricky bit is that the savings would accrue to the federal government, while the cost increases for EDs would be borne by the state government.

We are seeing an attack on preventive health and an attack on primary care under this government. That's having a huge impact on the Medicare system, and that's why the second reading amendment from the shadow minister is so important.

Another part of what GPs raised with me last week was the issue of the lack of ability to see specialists through the public system. These GPs said to me that they've basically given up on referring their patients through the public system to specialists because the wait can be up to four or five years. That's catastrophic. The most tragic case I heard was of a five-year-old boy who has been on the waiting list to see an ear, nose and throat specialist for two years. He's got constant ear infections, which are impacting on his hearing, impacting on his ability to learn and leading him to be further and further behind his classmates. He's been on the waiting list for two years. This is something that has an easy fix. While I'm not a doctor, I understand that grommets are probably the preferred course of treatment. Having had grommets, I can say that they did help with my particular issue. I try not to be too personal or to give false advice, but this GP said that grommets would provide an easy fix to this poor boy's situation. But he's been on the waiting list for two years and is likely to have to wait another two years to get the grommets. During that time he will be falling further and further behind his classmates. His potential to make the greatest contribution he can to our society is being diminished because of this. Ultimately, I would submit, the economic cost of the loss of potential of that young boy's life, from a purely economic point of view, outweighs any cost savings from this government's continued attack on the ability of people to see specialists through the public health system. That was another issue that was raised in this particular forum.

The third issue—and I'll finish on the third one—is the issue of bonded doctors. A number of doctors have come to see me concerned about the incompetence displayed by the Minister for Health and Aged Care and the Department of Health in managing the transition of the bonded doctors system. These doctors said to me that a couple of years ago they received notification from the Department of Health that the way doctors were bonded was changing. Instead of having to provide six or seven years of service as bonded doctors going to rural and remote areas they only had to do three. Therefore, they received a certificate saying that they had acquitted their service. Now the Department of Health has come back to them and said: 'We made a mistake. We're changing back to that. And, by the way, for the two years that you weren't doing your rural or remote service, because we told you didn't need to, we're now going to go you and you're possibly going to lose your Medicare provider number,' and a whole lot of other catastrophic things that would mean that these GPs and other doctors wouldn't be able to practise for 12 years. This is symptomatic of a government that can't manage the healthcare system. They can't manage primary healthcare, they can't manage the ability to make sure that people can see a doctor when they need to and not have to wait till when they can afford to. I'll end my contribution there. I commend the bill, with the second reading amendment, to the House. It covers some important areas of the health system.

11:20 am

Photo of Peta MurphyPeta Murphy (Dunkley, Australian Labor Party) Share this | | Hansard source

I thank my colleague, the member for Shortland, for speaking earlier than perhaps he thought he might on this bill because I was a little late into the chamber. I rise to speak on this bill, the Health Insurance Amendment (Prescribed Fees) Bill 2021. As those speaking before me have said, Labor supports this bill. There is a second reading amendment which talks about GPs, and I want to take the opportunity to speak on the legislation because there are a number of issues relating to GPs and health services in my electorate of Dunkley that I am incredibly eager for the government to take up and either support or fix.

The first relates to something that my colleague who was speaking just before me, the member for Shortland, was speaking about, and that is lack of access to GPs. In particular, this is an issue in outer suburban areas. My seat of Dunkley is an outer suburban seat. I have spoken before about the GP clinics that are finding it just impossible to get Australian trained GPs to come and work at their clinics. They have been relying on GPs from other countries and are now finding themselves in quite dire straits because they cannot keep GPs employed. As I have raised with the Minister for Health and Aged Care and have spoken about in this chamber before, the main issues are that, as an outer suburban area, we're not classified as a distribution priority area; that the removal of Medicare incentive payment 10981 causes financial difficulties and is a disincentive for doctors staying in bulk billing clinics, as opposed to going into private practice; and that clinics would like to see options for sponsoring doctors from overseas, because they can't hire locally—this was difficult before the pandemic and is even more difficult now.

I appreciate that these are not simple issues to resolve but, in the end, the clinics that I'm talking about are in places like Carrum Downs and Frankston and look after people who rely on bulk billing. They look after some of the most socioeconomically disadvantaged people in the broader Melbourne area. We know that, in the community of Frankston, we are just so far below the rest of Melbourne, the rest of Victoria and the rest of the country in regard to a lot of the health measures and in terms of life expectancy. There are issues with alcohol and other drug addictions. Diabetes is a significant issue. I could go on and on. We need good GPs and really good GP clinics that bulk bill. It's an issue that I've been raising for way more than 12 months now, and I'll continue to raise it. It's an ongoing and serious issue in my community.

The other issue that we have in my community that is not being addressed by the federal government and that charities, the not-for-profits, have had to step in and address—it has been raised with the minister of health, because it's also operating in his electorate of Flinders, but I'm yet to see any government support for it—is access to paediatricians for children from disadvantaged areas. There is a real problem with children from lower socioeconomic areas not getting in to see paediatricians. I can't even believe I have to say that sentence out loud in the federal parliament. That just should not be the case. The Menzies organisation, as a charity—with an amazing local man named Kevin Johnson, who is part of it—is providing paediatricians in schools. They are now servicing 22 schools with paediatricians in the broader Mornington Peninsula, including the Frankston area. From 27 January year until 1 April of this year alone, in term 1, there were 323 appointments for children to see paediatricians, including appointments for 85 new patients, often, particularly for those 85 new patients, for the first time—the first time ever that they had seen a paediatrician in their young lives.

In my electorate, the Paediatricians in Schools Outreach Program is out of Mahogany Rise Primary School, which also services Aldercourt, Seaford Park, Kananook and Monterey Secondary College; and out of Karingal Primary School, which services Frankston East, Ballam Park, Karingal Heights and Kingsley Park. This is a program that is providing essential care for children who need it now. It also provides that crucial preventative health care that not only enriches the lives of the children but also has so many benefits for the community and for the bottom line of health budgets. This is done by Menzies in conjunction with Peninsula Health through donations alone. As I said, it is not supported by government funding. I'm hopeful, because I've lobbied for it, that when we have the opportunity to go through the detail of the measures in the health budget that I will find some money in there for this essential and amazing program, but certainly it hasn't been announced. My serious concern is that the Minister for Health and Aged Care, whose electorate this program operates in, hasn't seen fit to support it. That's why I wanted to speak on this legislation. It's a terrific program and I really urge the government to support basic health care for young children who otherwise would not get it in my community and in the electorate of Flinders.

11:27 am

Photo of Ged KearneyGed Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | | Hansard source

The Health Insurance Amendment (Prescribed Fees) Bill 2021 simplifies the administrative processes for the recognition of specialists and consultant physicians by Medicare under the Health Insurance Act. It does this by removing the prescribed fee of $30. As the member for Hindmarsh and other speakers have noted, the current pathway in the act to recognise a specialist or a consultant physician requires a medical practitioner who has gained fellowship with a specialist medical college to apply to Services Australia for access to higher Medicare rebates. As part of this process, a medical practitioner is required to pay a prescribed fee of $30 via cheque or money order. One wonders how we got so out of date that this is still the process. Rather than just being out of date, this method of payment became difficult during the COVID-19 crisis and in particular during movement restrictions. This had a massive impact on specialist and consultant physician recognition for the purpose of Medicare.

The government explored the option of implementing more modern payment methods for these fees but the costs of such an upgrade were assessed as far greater than the loss in revenue from scrapping the fee. As a result, the government has elected to remove the fee entirely, which this bill gives effect to. Labor supports this measure as it will remove a barrier to better building the specialist medical workforce that Australia needs. But, again, how tiny a tweak is this. After eight long years of Liberal government, this, unfortunately, is the type of reform that we get.

Let's be clear, the government have failed on their two jobs with regard to health care this year. The first was the speedy, effective rollout of the vaccine; and the second was a safe, national quarantine system to protect returning Australians during the vaccine rollout. This government and this Prime Minister are failing on both measures. The Prime Minister has said that the vaccine rollout, in his words, 'is not a race'. Well, I disagree. It actually is the race of our lives. You cannot have a first-rate economic recovery with a third-rate vaccine rollout. This government has missed every target it has set. The Prime Minister promised four million Australians would be vaccinated by the end of March. After failing that target, the government's next target was six million Australians vaccinated by 10 May. With only just over 2.5 million vaccinations completed, 1.7 million of which have been delivered by the federal government, Scott Morrison has again utterly failed in achieving his own target. Frontline healthcare workers, aged-care workers and disability residents—all in the government's 1a rollout—were all supposed to be vaccinated by Easter; yet so many of them are still to receive their jabs.

At 400,000 doses per week, it will take two years for everyone to be protected from the virus—two years! The Prime Minister has been saying for weeks now that the vaccination program was ramping up. Well, it had better ramp up a mighty steep ramp, because he has no record of delivering on anything that he says he will. It's heartbreaking for so many people in our economy who need our borders open and who are relying on the rollout of the vaccine for their businesses to survive. It is heartbreaking for people who fear another lockdown and the pressure that that puts on their livelihoods and on the economy. It is negligent.

We know that this virus is already mutating. There are variants spreading right through the world now that will probably require populations to receive a booster shot. But, in order to get the booster shot, we have to first be vaccinated. I grant you that, but countries like the UK are preparing for booster shots as early as September and October. I'm already being asked by doctors and other people in my electorate what the plan is for booster shots. Have we bought booster shots? Are we yet negotiating with companies to have them onshore, ready when they need to be given, or are we going to be left at the back of the queue again just as we were with the vaccines? I note, significantly, that it appears that there was no money allocated for boosters in the budget.

With regard to the vaccine rollout in aged care, it's been nothing short of a disaster. Families and residents have been constantly asking me when their residential aged-care facilities will receive the vaccine. I have had heartbreaking phone calls from people who have seen the state publicly run facility in a regional town get all their doses for the staff to be vaccinated and for the families to be happy and content that their residents are safe, while a privately run facility down the road that is in the purview of the federal government has no idea when the vaccines will be rolled out there. The public health networks are in the dark as much as we are. It's pretty crook when aged-care providers are ringing me and other local members to find out when their facilities will be getting their vaccinations. They can't find out that information from the federal government.

We are hearing stories of nursing homes being all set up, the residents all primed, the families all informed and the staff all ready to roll out the vaccinations, but no-one turns up. One aged-care facility told me recently that they went through the whole process. They lined everybody up—they had 160 residents—and everybody was getting a vaccination, until there were about eight residents left and they ran out. That facility had to tell those eight residents and their families that they had to miss out, with no plan to come back and no plan to make sure that those residents actually got the vaccination in the end. It was reported on the ABC that one aged-care facility, TLC—which actually have a facility in my electorate—decided to take the vaccination of their residents and their staff into their own hands. Their CEO, Lou Pascuzzi, said:

We really didn't want our residents, staff or contractors to endure another winter with the nervousness and trepidation that they have endured over the last 16 months.

We've got immunisation capabilities and primary care capabilities.

We decided to approach the government … and ask for permission to administer phase 1a ourselves.

That says a hell of a lot about the government's ability to roll out the vaccine to our aged-care facilities.

The other job the federal government had was to provide a safe national quarantine system, a responsibility that has been the Commonwealth's for more than a century. The hotel quarantine system that was put in place last year is not a long-term solution. What the Prime Minister needs to do is build a network of dedicated facilities around the country that are fit for purpose. This is a government which only acts when it has its back to the wall.

Even after all the horrors of the Royal Commission into Aged Care Quality and Safety, the Prime Minister still hasn't acknowledged that it was his cuts to the aged-care sector that have led to the crisis. The Prime Minister expects us to congratulate him for last night's budget announcements, but the truth is the package handed down last night still has huge gaps that leave our residents in aged care wanting. As someone who has spent a long time campaigning for aged care, I don't believe this budget package is the generational reform that the royal commission wanted and that the system so desperately needs. It seems to me to be more untied funding for providers that lacks proper wage increases for new nurses and carers. The Prime Minister must explain why he has refused to accept recommendations that require a registered nurse to be on duty at all times in nursing homes, why the government have refused to act to help increase the wages of nurses and carers, why they have failed to implement a registration program for carers and why the Prime Minister has not committed to implementing a comprehensive workforce plan.

Critically, there is no plan to ensure real accountability and transparency of taxpayers' money. There is nothing that seriously reforms the system to see exactly where the money goes, no change to the auditing requirements to stop money being funnelled away to Maseratis and offshore tax havens or secret family trusts, when residents are not being fed properly or are in soiled clothing and can't get access to proper care. As for the promises of staffing guarantees—two years down the track, mind you—and other promises made for aged care, given the huge gap between this Prime Minister's announcements and delivery, why should older Australians and their families trust him to follow through and fix his broken system?

On another point, I am a nurse, and I have been thinking a lot recently about preventive and primary health care, because that seems to be a term that this government rarely uses. There was practically nothing in the budget for preventive health care. As a nurse I was trained to consider the social determinants of health. That means your economic circumstances play a major role in your health outcomes and need to be dealt with if we are to have a healthy nation. Study after study shows that investing in primary health care and preventive health is far cheaper and more effective than waiting for people to end up in hospital, in our tertiary care system, which is resource intensive, overrun and very much more expensive. It is literally the old 'fence at the top of the cliff rather than the ambulance at the bottom of the cliff' argument. It is a no-brainer.

We need bolder thinking. We need healthcare reform. We need better and longer access to general practitioners, where there is a crisis of shortages. We need more access to nurse-practitioner led care, where appropriate, to improve reach and health outcomes. We need easier access to allied health practitioners, healthier kids with wraparound services attached to schools, more community led health care, with community health centres, and investment in Aboriginal health community care. We need so much more from a government when it comes to our nation's health. We need to bolster the health of the nation. And on this day, International Nurses Day, I would like to say a great big thankyou to all the nurses in Australia, who worked so hard to keep us safe during the COVID crisis and who work hard every day to keep the health of our nation in a better state.

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)

11:54 am

Photo of Ken WyattKen Wyatt (Hasluck, Liberal Party, Minister for Indigenous Australians) Share this | | Hansard source

The Health Insurance Amendment (Prescribed Fees) Bill 2021 simplifies Medicare administrative processes for recognition as a new specialist or consultant physician for Medicare purposes under the Health Insurance Act 1973 by removing the payment of a prescribed fee on the application. During the COVID-19 crisis, it became more evident that the outdated method of payment of the prescribed fee by cheque or money order was impacting specialist and consultant physician recognition for the purposes of Medicare, as neither method of payment was efficient or practical during movement restrictions and in-person service closures. As a result, patients of new specialists or consultant physicians may not have been able to receive higher Medicare rebates when they were entitled to them. Implementation of the bill means a prescribed fee will no longer be required to accompany an application form for higher Medicare rebates for new specialists and consultant physicians. This removes the cost to specialists and consultant physicians, and the administrative burden on Services Australia of processing the fee.

I thank members for their contributions to the debate on this bill.

Photo of Tony SmithTony Smith (Speaker) Share this | | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Hindmarsh has moved as an amendment that all words after 'That' be omitted with a view to substituting other words. The immediate question before the House is that the words proposed to be omitted stand part of the question.