Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. The purpose of this bill is to implement changes arising from recommendations of the independent review of Medicare integrity and compliance undertaken by Dr Pradeep Philip, commissioned in November last year. The bill:

Amends the Health Insurance Act 1973 to: remove the requirement for the Australian Medical Association to agree to the appointment of the Director of the Professional Services Review (PSR); amend consultation requirements for appointing other statutory office holders of the PSR to enable consultation with relevant peak bodies directly; establish the statutory office of Associate Director of the PSR; remove the requirement for the Chief Executive Medicare to consult with stakeholder groups prior to issuing a notice to produce documents …

The Professional Services Review, or PSR, is an independent statutory agency responsible for maintaining the integrity of Australia's Medicare program through investigating and sanctioning inappropriate practice by health professionals. The coalition has a strong and long-held commitment to protecting the integrity and financial viability of Medicare.

Our Medicare system underpins our world-class health system and, importantly, it is there for all Australians. We are so in fortunate in Australia to have a health system that is accessible and available to every Australian, no matter where you live or how old you are. Protecting the viability of Medicare is key to this. Medicare, including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, continues to provide Australians with access to free hospital care and affordable health care and medicines. When we were in government, investment in the MBS and the PBS grew significantly under our leadership. That meant we were able to subsidise and list more than 2,900 new and amended drugs to allow more Australians more affordable access to potentially life-saving and life-changing medicines and treatments. The coalition have been stewards in ensuring the viability of Medicare and supporting access to affordable health care for all Australians, having introduced this legislation in the last parliament. In fact, we oversaw record investment in this area and we were committed to continuing that record through our commitment to investing $133 billion, over four years, in Medicare.

The coalition will always be committed to supporting the integrity and financial viability of Medicare to ensure all Australians have access to the critical support provided by Australia's healthcare system into the future. In fact, this bill continues the important reforms started by the former coalition government to strengthen the PSR's review mechanisms, particularly for claims relating to the MBS. We were glad to see the government pass the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022 in December. This was a coalition bill that we proudly introduced in the 46th Parliament to strengthen the compliance powers of the PSR and add a degree of flexibility to the PSR's ability to address any inappropriate practice. We understand that it is vital that there continues to be rigorous and effective health practitioner compliance to protect the financial integrity of Medicare.

We also have a strong track record of supporting our hardworking healthcare practitioners and peak bodies to correctly claim health payments, with a clear focus on education, engagement and consultation. Australians rightly expect their tax dollars to be used appropriately and effectively, particularly when they are being spent on our health system, which is facing increasing pressures. We need to support practitioners who are doing the right thing by the taxpayer and their patients but also to identify the healthcare practitioners who are not acting in good faith. So we acknowledge that this bill builds on the coalition's work to strength the PSR and protect the viability of Medicare through additional reforms; however, we do have concerns with the amount of consultation undertaken prior to the introduction of this bill, particularly in regard to the review on which these reforms are based. Dr Philip stated in his report:

Given the timeframes set for this Review, my formal consultation with stakeholders has been necessarily limited, supplemented by informal discussions with participants, and I have based most of my work on desktop analysis.

Considering the limited time frames set for the review resulted in Dr Philip having restricted time to undertake thorough consultation and being forced to run a largely desktop exercise, the opposition believe it is critical to ensure we gather more information from stakeholders on the impacts of these reforms. This bill contains some significant changes to longstanding arrangements, and it is important that we explore those changes thoroughly through proper consultation. Time and time again we are concerned by the government's refusal to allow for appropriate levels of consultation on their policies and to follow proper process.

The coalition will not stand in the way of good policy, but we need more information on this bill so that we can be certain it will uphold our record of protecting the integrity and viability of Medicare and our world-class healthcare system. The opposition will support the passage of this legislation through the House but we will take the time to explore these reforms properly in the Senate.

Emma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

I welcome the opposition's support for this important legislation, the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. In my role as Assistant Minister for Rural and Regional Health I visit towns and suburbs around Australia and have the great privilege of meeting with healthcare workers and the communities they care for. In the last few months I've been to Mildura, in north-west Victoria; Burnie, in Tasmania; Gordonvale, in Far North Queensland; and Coffs Harbour and Lismore, in New South Wales. Everywhere I go I hear the same thing. People cannot get the health care they need when they need it. Medicare is in the worst state it has been in in its 40-year history. That doesn't just happen; it's a result of a decade of cuts and neglect. But we're turning that around. We're doing what should have been done a decade ago: strengthening our healthcare system and Medicare. At the centre of Medicare is bulk-billing. As the health minister, Minister Butler, has said, bulk-billing is the beating heart of Medicare, but, after nine years of neglect, that beating heart needs more than a pacemaker. It needs a defibrillator.

Thankfully, our $6 billion investment in Medicare is just what the doctor ordered. We are strengthening Medicare so that Australians will have better access to care and a stronger healthcare workforce. In the budget, we announced that we are tripling the bulk-billing incentive. This is the largest increase in the incentive in the history of Medicare. We are also indexing the Medicare rebate. It is the largest increase of the Medicare rebate in 30 years—three decades. This will transform our healthcare system. In our major cities, it means a 30 per cent increase in investment, and, in rural and regional centres, it's a 50 per cent increase. And we're not stopping at bulk-billing. We announced a comprehensive package of measures to rebuild Medicare. This includes supporting health professionals to work at the top of their scope of practice, using all of their skills and training; expanding our essential nursing workforce, right around Australia; improving access to crucial after-hours care; providing flexible funding for team based care—the right kind of care; and investing in digital health, including initiatives to support the sharing of pathology and medical imaging across the entire health sector, so that vital information is at the fingertips of healthcare professionals when they need it most.

As I visited the outer suburbs and regional towns after the budget, I met with healthcare practitioners. This is what they has to say. In the Illawarra, I met with Dr Katherine Michelmore, a GP and the medical director of South Eastern NSW Primary Healthcare Network. She told me: 'It's perhaps the first time in a long time that we've had cause for optimism.' When I was in Lismore, I met Ken from the Lismore GP SuperClinic, who told me: 'What the government announced in the Medicare increase is exceptional. It is going to bring back bulk-billing. It is going to encourage those who have recently changed maybe to private billing to go back to bulk-billing, and I really think it's a step in the right direction.' When I was in the Hunter, I met with Dr Yasas, a fellow of the Royal Australian College of General Practitioners. He said: 'It has been a lifeline thrown at us with the budget because we've been struggling to continue bulk-billing patients, especially the vulnerable parts of our community, especially children and elderly and those people living with disabilities.' These measures are going to work.

The Australian Labor Party have a proud history with Medicare. After all, it was the Whitlam Labor government that founded Medibank in 1975, before it was axed by the Liberal coalition under Fraser. Thankfully for all of us, it was reinstated as Medicare in 1984 by the Hawke Labor government. It seems that it's the role of Labor governments to throw the lifeline to our universal healthcare system time and time again when it has been left to the perils of the Liberals. For those on this side of the House, health care isn't just what we do; it's who we are. The member for Higgins is an infectious disease specialist and general physician. The member for Newcastle is a former disability support worker. My good friend the member for Macarthur is a paediatrician. The member for Cooper trained as a nurse on the floor of the Mercy Hospital in Melbourne all those years ago. The member for Robertson is an emergency doctor in my community on the Central Coast of New South Wales. The member for Kingston is a psychologist. The member for Ballarat started her working life as a social worker in Victoria. The strength of our health care system is that it's universal—that no matter who you are or whatever your background, you can get the care you need when you need it.

This amendment, in practice, will remove the veto power of the Australian Medical Association in the appointment process of the Director of the Professional Services Review, also known as the PSR. As an independent statutory agency, the PSR is responsible for protecting the integrity of Medicare—our universal system of care—by investigating inappropriate practice. The PSR is critical to ensuring that patients are protected, as we all must be, in our clinical care and that dodgy conduct, when it occurs, is stamped out.

Integrity must underpin our universal system of care. The changes will remove potential conflicts of interest to enhance public perceptions of the PSR scheme and ensure the PSR process can operate with impartiality and independence. These measures are essential to maintaining public confidence and strengthening the integrity of Medicare. The amendment will make sure that our healthcare system remains public, by Australians for all Australians.

I am proud to be part of Labor's healthcare team. It demonstrates Labor's investment and the priority of health care that we have five ministers and assistant ministers working in health care. I'm very proud to support the member for Cooper, who introduced this bill. As the member for Cooper said, Australians are rightly proud of Medicare and of the committed group of doctors and other health professionals who deliver Medicare services right around Australia. The member for Cooper has also said that bulk-billing is at the heart of Medicare. It is the beating heart of Medicare. We know, and I know from my visits to suburbs and towns around Australia, that it has never been harder or more expensive to see a GP. We as a government are investing in making Medicare stronger for all Australians, wherever they live and whatever their circumstances, and in delivering critical funding and investing in reform for the healthcare system of tomorrow.

The budget handed down in May delivered more than $6 billion in new investments to strengthen Medicare, as well as the indexation boost to Medicare rebates that I mentioned. The value of that is more than $1.5 billion, the biggest increase in 30 years. It is absolutely critical that all Australians, wherever they live and whatever their age, have access to care when and where they need it. That's why strengthening Medicare was the centrepiece of our budget.

This package is worth $3.5 billion. As I mentioned, it triples the bulk-billing incentives for GP visits, the largest ever investment in bulk billing incentives. In our major cities, it means a 30 per cent increase in the payments to a bulk-billing GP, and, in the many rural and regional parts of Australia where I have had the chance to visit and hear from healthcare professionals, it will mean an increase in bulk-billing of around 50 per cent. That will transform health care right around Australia, particularly in the most regional and remote parts of Australia. It will mean five million children and their families, and seven million pensioners and concession card holders, will all benefit from the increase in the bulk-billing incentive. This historic investment means three out of five visits to a GP will be bulk-billed. That is why this legislation today is absolutely critical, because every Australian must have confidence in our Medicare system, our universal system of care, and the legislation that we're discussing today is important in protecting the integrity of Medicare.

This bill makes several priority amendments in response to the recommendations from the review. As I mentioned, the measures in this bill will strengthen the operation of the Professional Services Review, known as the PSR, as well as improving the effectiveness of the current process for auditing payments relating to Medicare services. It means in essence that the bill removes the veto power of the Australian Medical Association, known as the AMA, in the appointment process for the director of the PSR; amends consultation requirements for appointments of other statutory office holders of the PSR, including deputy directors, panel members and members of the determining authority, to enable consultation with relevant peak bodies directly; enables the appointment of associate directors of the PSR; and removes the need for engagement with stakeholder groups as a prerequisite for issuing a notice to produce documents during an audit.

The PSR is an independent statutory agency responsible for protecting the integrity of the Medicare program by investigating whether a person has engaged in inappropriate practice. In doing so, the PSR protects patients and keeps us safe, and the community in general, safe from the risks associated with inappropriate practice, if and when it occurs. As a healthcare professional myself, I understand the importance of these measures—as, I'm sure, millions of people around Australia do as well. The PSR addresses the behaviour of a person who may have engaged in inappropriate practice through a review by the director or by committees made up of clinical professional peers.

Currently, the director of the PSR cannot be appointed without the agreement of the AMA. The government considers that this veto power isn't consistent. It's not aligned with public expectations and could undermine confidence in the independence of the PSR as a regulator. The veto power, it's important to note, has never been exercised, raising further questions of the need for this requirement. Given the potential conflict between the PSR's objective to safeguard Medicare and the AMA's role in representing the interests of medical professionals may be subject to the PSR review, it's appropriate for the veto power to be removed.

I am very pleased to support the member for Cooper and the legislation that we're putting through the House. As I mentioned earlier, it is absolutely critical that all Australians have confidence in Medicare, in our universal system of care. That's so they know they're receiving the right kind of care and that all health practitioners will conduct themselves professionally and behave in a way in accordance with the professional standards of their discipline and the community expectations of healthcare workers. So I'm very pleased today to be able to support this legislation.

In conclusion, these changes I have mentioned will remove potential conflicts of interest, enhance public perception of the PSR scheme and ensure that the PSR process can operate with impartiality and independence so that Australians can have confidence in the impartiality and independence of the PSR. These measures are essential to maintaining public confidence, so that every Australian, wherever they live and wherever they're accessing care, will know that their healthcare professional is conducting themselves appropriately, meeting professional standards and meeting the community's expectations of them. The amendment will make sure that our healthcare system remains public, by Australians for Australians. Thank you.

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

Today I'm really pleased to speak about the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. This bill implements changes arising from the recommendations of the Philip review, an independent review of Medicare integrity and compliance conducted by Dr Pradeep Philip of Deloitte Access Economics.

The review was undertaken at the request of the current Minister for Health and Aged Care, with its purpose being to focus on the payment system of the Medicare Benefits Schedule, the MBS. The five terms of reference for the review of the MBS were, broadly, to look at high-level ways of reducing fraudulent behaviour; integrity risks around payment and claiming channels; non-compliant or overservicing risks; ways of improving the Practitioner Review Program and Professional Services Review functions; and a review of the Health Insurance Act to identify potential improvements to strengthen both compliance and penalties for fraud and inappropriate practice. Importantly and alarmingly, the Philip review concluded that, in relation to our current Medicare system, legislation, governance, systems, processes and tools are currently not fit for purpose, and that without significant attention they will result in significant levels of fraud. These governance failures are real and they are concerning. Unsurprisingly, the recommendations arising from Dr Philips's review were wide ranging, but they can be categorised into four broad areas: governance and structure; operational processes; modernising technology; and strengthening legislation. These are all very important recommendations, but today's bill addresses only a small fraction of them.

Firstly, this bill removes the requirement for the Australian Medical Association, the AMA, to agree to the appointment of the Director of Professional Services Review, the PSR. This recommendation was made on the basis that the current arrangement is inconsistent with public expectations regarding the independence of the Professional Services Review. The Philip review recommended removing this veto power because of the breadth of health professionals whose members are now potentially susceptible to review by the PSR. The fact is that a veto power from the AMA—a single professional body—no longer reflects the fact that there are a wide range of professionals who could potentially be referred to the PSR. The review described this veto as an anachronism which has never been exercised and considered that its removal could bring about a measurable enhancement to the perception of the PSR by the sector, and it could remove perceived conflicts of interest. I have to note that, recently, I met with the Consumers Health Forum of Australia, which noted that there's also no consumer representative on the PSR. Despite the clear advantages and documented impacts on health and on medical research, consumer involvement is often undercooked in our government administration structures. I believe the addition of a consumer representative to the PSR would add an additional, important voice. It would give comfort to patients and their families that the issues considered by the PSR include their perspectives, and that those perspectives inform the PSR's responses.

The bill also amends consultation requirements for appointing other statutory office holders of the PSR to enable consultation with relevant peak bodies directly, rather than via the AMA. That seems entirely appropriate. It makes no sense that an external advisory body—a peak body of medical professionals, of doctors—can exercise any other veto power or effect over other office holders of the PSR. The bill establishes a new statutory office of Associate Director of the PSR, who will assist with managing conflicts of interest and workload pressures. That associate director will have the same functions and powers as the director in reviewing inappropriate practice but will not have a role in administering the PSR agency. To streamline the audit process, the bill removes the requirement for the chief executive of Medicare to consult with relevant professional bodies prior to issuing a notice to provide documents. This will ensure clear and accountable natural justice to the regulated entity under investigation without the unnecessary involvement of a non-regulated entity.

It has to be said that these amendments to the bill, worthy though they are, are relatively confined. They're very modest when viewed in the context of the very wide-ranging recommendations set out in the Philip review. Indeed, Dr Philip sets out a 10-year plan for ongoing, continuous improvement initiatives and activities within the Medicare Benefits Schedule. Whilst we can look forward to this ambitious reform agenda being addressed in future policy development and legislation, rather than concentrating on each of those recommendations and the journey towards widespread Medicare reform, our focus should be on the broader conclusion drawn by Dr Philip: that the governance of Medicare, as the minister has said and as the member for Dobell has already told us, is out of date, and Medicare is in its worst shape in its 40-year history. Dr Philip said:

As the health system has evolved, governance … is now inadequate, running the risk of piecemeal approaches to compliance and fraud and no holistic understanding of major trends … in the nature of healthcare delivery.

This is deeply disturbing. A sound and well-functioning compliance and integrity system is critical for all Australians. We have to give Australians trust in the Medicare system and, by extension, our health system.

We also have to ask ourselves, 'What does integrity in our health system look like?' As we've seen in recent days, trust in the integrity of our governments and the system of our government is taking a battering, day by day, month by month. The report released last week by the Australian National Audit Office, the ANAO, into the $2 billion Community Health and Hospitals Program wasn't just scathing; it was utterly damning. The point of that ANAO audit was to assess the effectiveness of administration and compliance within the grants and rules of the CHHP. The audit found that executive oversight and risk and fraud management in that scheme were deeply deficient. Only two of 171 programs in the CHHP were highly suitable.

The health department was found to have repeatedly fallen short of ethical requirements and to have repeatedly and deliberately breached guidelines in disbursing taxpayers' funds. In some cases, the department administered grants that it first found out about from ministerial press releases. More than a billion dollars of taxpayers' money was allocated from what was essentially a ministerial slush fund. We only found out about it after the fact—five years later, after the money was gone. This is why I am deeply concerned about the Philip review's 10-year time line for administrative change. We need stronger mechanisms now. We need stronger legislative mechanisms to ensure that substandard funding allocations and deliberate breaches of the Medicare system are prevented, not identified five years after the fact. And, when those breaches do occur, as they inevitably will, they should be identified quickly and bad actors penalised accordingly.

The practices illuminated in the ANAO's report and, to a lesser but still concerning extent, in the Philip review have had the unfortunate effect of eroding public confidence in our healthcare system. Somewhere along the line, some people who work for our Commonwealth have forgotten that the Commonwealth must use and manage all of our public resources properly. 'Properly' in this context means efficient, effective, economic and ethical use of taxpayers' money. When we see that in this light, we have to ensure that the executive oversight, risk and forward management of our Medicare system does not fail as it clearly has for the CHHP grants program.

Trust in government is at an all-time low. We have to do what we can to restore it. Our Medicare system is world class. It supports the health of every Australian, but it needs world-class governance and oversight to keep it strong and to make sure that it is fit for purpose. Dr Philip makes the observation that the overwhelming majority of health practitioners are well-meaning and ethical people who are concerned primarily for the health and welfare of their patients. I could not agree more. But the system that they inhabit and in which they work is no longer fit for purpose. We have to have a system that's not reliant solely on the goodwill and altruism of health professionals to properly manage our public resources and meet the needs of the Australian people. Our Medicare system desperately needs to adapt to changing health needs and health services delivery. Australians deserve to be able to trust in Medicare. Our young and future generations have to be assured that it will be there for them.

Sunlight is the best medicine, and we need it now to ensure that our Medicare system and our health system more broadly remain an international exemplar for what modern health care should look like. I commend this bill to the House.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I would like to firstly thank the members for Cooper and Dobell, the assistant health ministers, for introducing the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. I thank the member for Dobell, in particular, for speaking so well on it. I also thank the member for Kooyong, who is a highly respected medical practitioner. Her contributions in health care and in this parliament have been fantastic, and I thank her for her speech.

I'm very proud of our nation's healthcare system and of Medicare in particular. I started my private practice on the same day that Medicare was introduced into Australia. I'm very proud of that. I saw the difference in what happened pre Medicare and post Medicare. I won't go into the history of it. Suffice it to say that the most common cause of bankruptcy prior to Medicare was medical costs. That changed dramatically with the introduction of Medicare. I know that people in my community who had previously not been able to access care by paediatricians such as myself and who were put on long waiting lists or missed out on care altogether for their children could see a paediatrician without a huge financial impost. Equitable access to health care became incredibly important for our community since that time.

However, Medicare was designed a long time ago, as were many of the regulatory mechanisms involved in making sure it works correctly. It's very important to note that two people I know very well—Dr Tony Webber, who was head of the Professional Services Review, and Professor Julie Quinlivan, who also was head of the PSR—were very critical of the role that the PSR has played in reducing medical fraud and mismanagement over the last 30 years. They both had some very significant things to say, as reported recently in the Fairfax press and on TV by the ABC on Four Corners. They were very critical of the lack of ability to prosecute poor practice and medical fraud in this country.

I should point out that Dr Webber was a very well respected GP. In fact, he used to refer to me many years ago. I respect him as a doctor but also in his previous role as head of the PSR. Professor Julie Quinlivan is a well respected obstetrician and gynaecologist who has worked for women's health for many years. She now has a university appointment as a professor of obstetrics and gynaecology and is highly respected. She also brought up many issues involved with the PSR.

The Philip review, which was introduced by Mark Butler, the Minister for Health and Aged Care, found that there was need for a review of the integrity and compliance processes in the PSR, and this bill is the result of that review. Dr Philip found that changes were needed to ensure the compliance system that underpins Medicare is modernised, effective and rigorous, and that certainly has not been the case. I relied on Medicare for my income for almost four decades. In that time, I was approached by a number of colleagues to provide character references for them when they were being reviewed by the PSR. In every case that I was involved in giving a character reference for, the review was appropriate and the action taken also was appropriate, but there is a view in the profession that these reviews are too infrequent and do not look at the overall practices that have crept into medical practice over a number of years since the corporatisation of medicine and since access to care has become increasingly difficult in the last 10 or 15 years.

I must stress that the vast majority of medical professionals that I've worked with in my career were honest and always did the right thing, but it was quite clear to me that there were some people who were outliers who could have been better regulated by the PSR and should have been better regulated by the PSR, and I think most medical professionals would say that. This bill makes several priority amendments in response to the Philip review and its recommendations, and I applaud it, as I applaud the health policy analysis and developments made by the present health minister in response to 10 years of neglect by the previous government.

This bill specifically removes the veto power of the Australian Medical Association, the AMA, over the appointment of the Director of Professional Services Review. Surely no-one in this day and age could argue with that. I have been a member of the AMA for 45 years, and I think none of my colleagues who are members of the AMA disagree with this fundamental change in the PSR. The PSR will now have oversight of a whole range of different professionals providing health care and support for health care in our community. It's not appropriate that the AMA continues to have a veto power, a veto power, I might add, that it has never used. It does seem a little silly that it is still there. The bill also amends the consultation requirements for the appointment of other statutory office holders of the PSR, including deputy directors, panel members and members of the determining authority, to enable direct consultation with peak bodies rather than just being coordinated through the AMA. This is, of course, appropriate, and it is appropriate that this bill has been introduced by this government, a government committed to Medicare and committed to equitable access to health care for all Australians.

Concerns have been raised that the objective of the PSR, which is to safeguard the integrity of Medicare, may conflict with the AMA's objective to represent the interests of medical practitioners subject to the PSR. I know my colleagues want our system to be as rigorous as it possibly can be, so I don't think these concerns are well placed. I know that the AMA has done an enormous amount of work to ensure the compliance and transparency of medical care in this country and will continue to do so. The AMA will be one of the bodies consulted before any other major changes are made, and it will also be consulted when medical practitioners are subject to review. The removal of the AMA's veto powers is appropriate. It has previously not been consistent with public expectation and undermines confidence in the independence of the PSR as a regulator if the AMA has veto power.

Last year, at the same time our government commissioned the Philip review, I spoke in parliament on the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill that amended the PSR arrangements to manage and review the practice of corporations and not just single practitioners. I think that is vitally important if our system is going to be fit for purpose. This bill is part of our government's work to strengthen Medicare and to ensure there is equitable access to health care for all Australians. At the moment, because of ten years of difficult behaviour by the previous government, equitable access to health care has been allowed to fall away, particularly in rural and regional areas but also in outer metropolitan areas.

I see that the member for Riverina is arcing up a little, but it is quite true; there is a huge difficulty in accessing equitable health care in rural and regional areas. We, as a government, are committed to making sure that equitable access is available to all Australians. Our 2023 budget was very important in the improvement of access to equitable health care; the indexation boost to Medicare rebates, costing over $1.5 billion; and the tripling of bulk-billing incentives for many practices in outer metropolitan and rural areas. For many doctors, this will make the difference between staying in practice and leaving those practices.

The centrepiece of our strengthening Medicare package is $3.5 billion to triple the bulk-billing incentive for GP visits. I can't emphasise how important that is. The government is also looking at ways of trying to improve the want of medical students to go into general practice rather than specialty practice. I've always seen general practice as the hardest of the medical specialities. It's important that we continue our Medicare review process because there is much more to be done, and, as Dr Philip said of the PSR, there's still much more to be done. But we need to do it in a methodical and organised manner. We need to bring the professions with us. We need to make sure that Australians can access equitable care around the country so that it's not just in the inner cities where people can get access to the best care. We know that statistically mortality rates increase the further you go from the centre of our major cities. This is certainly true for people in rural and regional areas, but it's also true for people in outer metropolitan areas. It is imperative that vigorous arrangements to identify and address poor compliance in the medical field and inappropriate practice are seen as essential to the ongoing commitment to improving Medicare.

This bill will benefit all Australians by supporting the integrity of Medicare. It is very important that we, as politicians, understand the importance of making sure that Medicare remains the centrepiece of our healthcare system in Australia. We've had it now for a long period of time—40 years—but it is very important that we see that Medicare has underpinned Australians having some of the best health care in the developed world, and we don't want access to care to deteriorate the way it did under the previous government. It's very important. Medicare is the centrepiece of our healthcare system and must remain so.

I commend this bill to the House, I thank the minister for moving it and I look forward to health reforms, in the future, that will improve equitable access to health care for all Australians.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andrew Charlton (Parramatta, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. This is a classic Labor bill. It's a classic Labor bill because it seeks to strengthen Medicare, which every year enables millions of Australians to access our country's world-class health care. And it's a classic Labor bill because it seeks to improve integrity and trust in our public institutions. This bill will do that by enabling direct consultation with peak bodies when it comes to the appointment of statutory office holders of the PSR, rather than consulting through the AMA. It does that by creating the position of associate directors to make the director of the PSR more accountable. And it does that by removing the veto power of the Australian Medical Association over the appointment of the Director of Professional Services Review. In short, it means more accountability and more transparency through more independence.

This bill and the changes within come in the aftermath of the Philip review. Commissioned by the Albanese government and conducted by independent expert health economist Dr Pradeep Philip, the review was tasked with looking at the integrity of Medicare and its compliance mechanisms. When the Philip review was released, one journalist said of its findings:

The report … does not pull any punches about the train wreck Medicare has become after decades of Band-Aid solutions and a lack of scrutiny …

We're a Labor government. That means we're serious about protecting Australia's health care and we're serious about protecting Medicare. The report found that the legislation governance systems, processes and tools are currently not fit for purpose, leaving the door wide open for significant levels of noncompliance, fraud and billing errors. Dr Philip found that this noncompliance currently costs up to $3 billion. At a time when the cost of living is hitting households hard across the country, and in my electorate of Paramatta, Australians simply can't afford that, and the government can't afford to continue the pattern of neglect.

When this report was released, in April of this year, the Minister for Health and Aged Care, Mark Butler, said: 'We are determined to act on this as soon as we appropriately can. We're not going to let the grass grow under our feet in responding to this report.' This bill does just that. It signals the end of that pattern of neglect set in place by the former coalition government. It begins the process of closing loopholes and doors for fraud and noncompliance in our healthcare system. Importantly, it continues the work of bringing back integrity into government.

It's important to know that this bill also comes at a critical time in our nation's history. It comes at a time when trust in our medical professionals, our doctors and nurses in particular, faces a decline. Roy Morgan research between 2017 and 2021 showed a decline in trust in our health professionals and our health system, with doctors down seven per cent and the health system down more broadly. It won't come as a surprise that faith in public institutions and government suffered crippling blows over a decade of neglect and abuse of authority in the previous government. Trust in government reached an all-time low in 2019 and has only risen since the election of the Albanese Labor government. This bill has been described as making a small change to the Professional Services Review, but it's the neglect of risks over time—small weaknesses, lack of integrity—that now represents one of the biggest risks to accountability and transparency in government. This bill takes a step to end that.

My electorate of Parramatta is home to thousands of stellar professionals who make our community a world-class destination for health care. I recently visited the Good Street Medical Centre in Westmead, a suburb of Parramatta, and met Asha Kandiban, the practice manager. Asha told me about her experiences in running the practice. It's a fully bulk-billed clinic and helps to make up part of the world-class medical precinct of Westmead, alongside the Children's Hospital at Westmead, Westmead Hospital and the fantastic Westmead Institute for Medical Research.

Bulk-billing is the beating heart Medicare, and after nine years of cuts and neglect by the former government we know it's never been harder or more expensive to see a GP. Asha has been caring for local residents at Good Street for years and throughout the COVID pandemic. Asha's dedication to her community is not only inspiring but reflective of the thousands of medical practitioners and healthcare workers across Australia who comply with Medicare and health regulations. Australians are rightly proud of Medicare and the committed group of doctors and other health professionals who deliver Medicare services. Australians know that the overwhelming bulk of Australia's doctors and health professionals are honest, hardworking and comply with Medicare rules. But the neglect of compliance measures is a disservice to those healthcare professionals and frontline workers who do their best for Australia every day. I'm proud to see the Albanese government putting an end to that pattern.

More broadly, this is another step in our work to create a better future for Australians, which will yield dividends for those in my electorate of Parramatta. In this year's budget we acted to strengthen Australia's healthcare system. We invested a historic $6.1 billion into Medicare, including $3.5 billion to triple the Medicare bulk-billing incentive, benefiting the 84,537 locals who already bulk-bill across the 64 local GP clinics in Parramatta. We've also halved the cost of medicines for more than six million Australians. In January we delivered cheaper medicines, and Australians can now pay up to 30 per cent less for prescription medicines on the Pharmaceutical Benefits Scheme, with the maximum co-payment dropping significantly. Finally, I'm proud to be delivering a bulk-billed Medicare urgent care clinic to Westmead, helping locals access emergency health care quicker and reducing waiting times in existing emergency rooms locally.

The government is making Medicare stronger for all Australians, delivering critical funding and investing in reform for the healthcare system of tomorrow. I commend this bill.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I would like to thank everybody for their contribution to this important bill, the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. We need to make sure that our Medicare program is modern and fit for service and that it meets the needs of our communities, and I recognise the passion that everybody has spoken with. Thank you very much, everybody.

The Medicare program provides universal access for all Australians to most healthcare services. The Health Insurance Amendment (Professional Services Review Scheme) Bill 2023 is a timely and appropriate response to issues raised in the independent review of Medicare integrity and compliance. The bill removes the veto power of the Australian Medical Association over the appointment of the Director of Professional Services Review, known as the PSR. The bill also amends consultation requirements for appointing other statutory office holders of the PSR, enabling direct consultation with relevant peak bodies. This will ensure the regulator can operate with impartiality and independence and will improve public perceptions of the fairness and integrity of Medicare. The bill also allows for the appointment of associate directors of the PSR, which will provide for the alternative decision-makers to manage conflicts of interest, unexpected absences and workload pressures for the director. This will allow PSR matters to be finalised more quickly in some cases. One of the key issues identified in the review of Medicare integrity and compliance was the length of time the compliance processes currently take. Both practitioners under review in the community will benefit from faster resolution of compliance issues.

Finally, the bill will remove the need for engagement with stakeholder groups before requesting documents, which will improve processes used to audit payments relating to Medicare services. This will also strengthen and speed up Medicare compliance functions without limiting the types of documents a person may provide during an audit. The person being audited will continue to have an opportunity to make submissions about the compliance matter and provide any relevant information or documents.

The measures in this bill will strengthen the regulatory framework, supporting the integrity of Medicare to ensure that all Australians can continue to receive necessary health services. I thank the members for their contributions to the debate on this bill.

Question agreed to.

Bill read a second time.

Message from the Administrator recommending appropriation announced.