Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Hansard source

The incorporated speech read as follows—

I rise today to speak to the Health Insurance Amendment (Provider Number Review) Bill 2007.

This Bill proposes that the biennial review process contained in section 19AD(1)—which reviews the operation of the Medicare provider number legislation—be replaced with a review process every five years, with the next review to commence in 2010.

The Health Insurance Act 1973 is the key legislative instrument providing for payments by way of Medical Benefits and payments for Hospital Services. Sections 19AA, 3GA and 3GC of the Act are collectively known as the Medicare provider number legislation. The sections were inserted by the Health Insurance Amendment Act (No. 2) 1996 in December 1996.

Section 19AA requires that medical practitioners who first obtained registration in Australia after 1 November 1996 have to satisfy minimum proficiency requirements, having either obtained a fellowship as a specialist, a consultant physician or a general practitioner, or registering on the Register of Approved Placements, before being eligible to access Medicare benefits. This covers both Australian and overseas trained doctors. Previously, new medical graduates had been able to apply for a Medicare provider number upon receiving their basic medical registration.

Section 3GA provides for a Register of Approved Placements, where doctors subject to section 19AA who are undertaking training towards Fellowship can provide professional services in approved placements.

Section 3GC provides for a Medical Training Review Panel whose functions are to compile information on the numbers of medical practitioners who are enrolled in, or undertaking, courses and programs, and the type and availability of such training. The Medical Training Review Panel also may establish and maintain a register of employment opportunities for medical practitioners, in such a form and containing such information as the Minister determines.

When Minister Wooldridge gave his Second Reading Speech on the Health Insurance Amendment Act (No. 2) 1996 he outlined the Government’s policy rationale underpinning the introduction of the sections outlined above:

Firstly, he argued then that the changes would increase the quality of health care available to the Australian Community by making sure that, in future, all general practitioners were properly trained and recognised the reality that a basic medical degree was no longer adequate for a doctor to practise unsupervised in the community.

Secondly, he argued that the new provisions would help correct some of the distribution problems with the medical workforce, noting the absurd situation of having to import more than 500 overseas trained doctors on temporary visas each year to work in our public hospital system, even though we had something like 4000 more doctors than our population would require.

Finally, the then-Minister Wooldridge argued that the measures would reduce one of the major growth pressures on Medicare, making it more sustainable in the longer term.

In 1996 Labor was wary of these changes. And while there has been some progress—the requirements of section 19AA continue to ensure that Australia’s GP workforce is well trained, and the restrictions on provider numbers have served to curb one of the growth pressures on Medicare—there is more to do.

Australia remains beset with problems concerning the distribution of our medical workforce. In 1996, when the provider number legislation was first introduced, there was a recognised oversupply of general practitioners with an undersupply of GPs in rural and remote areas. Since then the situation has changed to an across the board undersupply of GPs, with shortages most acute in rural and remote areas and now also in many outer metropolitan areas.

We’re seeing this sort of problem across the country, where insufficient planning by the Howard government has resulted in doctor, dentist and nurse shortages impacting on the health of communities.

This is particularly so in regional, rural and remote Australia.

But the overall undersupply of GPs is all of this Government’s making.

Health workforce planning has been limited and ineffective in the life of the Howard Government.

Whilst health workforce planning is a complex task but we all know that it takes at least 10 years to train a GP. We also know that the increase in the number of female GPs resulted in overall less hours of practice. This is in no way a criticism of those women doctors. Their more family friendly work practices are to be commended and are also being adopted by their male counterparts.

It takes 10 years to train a doctor.

There are more women training and practicing as GPs. We know the ratio of GPs to potential patients by region. We know the number of specialists who are being trained.

There can be no excuse for the dire undersupply of GPs.

This undersupply can be sheeted directly home to poor planning by the Howard Government.

The introduction of section 19AA in 1996 was met with widespread concern among the profession that the new provision may adversely affect the future employment prospects of medical students and interns who were already in the system.

To address these concerns, and as a result of amendments in this Chamber, a sunset clause was attached to section 19AA, which was to expire on 1 January 2002. The sunset clause acted as a safeguard to ensure that the legislation would be revoked automatically unless it was demonstrated to Parliament that there were no significant adverse impacts on doctors affected by the changes.

The Senate also required a review of the operation of the legislation to be undertaken by the end of 1999. The mid-term review undertaken in 1999 recommended, among other points, that the sunset clause be removed so as to end the uncertainty faced by junior doctors and medical students.

In 2001 the Act was amended by the Health Legislation Amendment (Medical Practitioners’ Qualifications and Other Measures) Bill 2001, removing the sunset clause in section 19AA, and inserting a requirement in section 19AD(1) that requires that the impact of sections 19AA, 3GA and 3GC of the Act to be reviewed on a biennial basis, with a report be presented to Parliament by 31 December of the review year. Under these arrangements, biennial reviews were completed in 2003 and 2005.

Undertaken by a consultant appointed by the Minister for Health and Ageing—the review process has been well supported by stakeholders. The first mid-term review in 1999 received 15 written submissions, the 2003 review received 41 submissions, and the 2005 review received 24 submissions. On each occasion the review found continuing support for the operation of the Medicare provider number legislation as contained in sections 19AA, 3GA and 3GC of the Health Insurance Act. Each review made a series of wide-ranging recommendations concerning vital workforce issues, some of which have been adopted and implemented by the Government.

That is the background to this Bill. This Bill’s objective is now to replace the biennial review process in section 19AD(1) with a review process every five years, with the next review to commence in 2010.

Schedule 1 Item 1 specifies a five year review period, with the report for the next review due to be laid before the Parliament by the Minister no later than 31 December 2010.

So the major change is the period of review.

It is significant to note the 2005 review, for the first time, commented on the level of support for the review process itself. Notably, the review found “unanimous support for the continuation of the Biennial Review process” which was seen as “useful means of monitoring the operation and impact of the Medicare provider number legislation and a significant forum for advancing the quality objectives of section 19AA of the Health Insurance Act 1973”.

The review noted that some stakeholders considered that the reviews were too close together—not allowing enough time between reviews for recommendations to be implemented or evaluated—while other stakeholders considered that a longer period of time between reviews would effectively act as a brake on the implementation of recommendations arising from the review process.

Notably, the report stated that “All agreed that with the projected increase in medical graduates from 2008, the Biennial Review would become even more relevant in 2007 and 2009.”

Given these findings in the 2005 review it is curious, to say the least, that this proposal for a five year interval has been put forward by the Government. Such a proposal was neither flagged nor recommended by the 2005 Review process.

We have heard speculation from some stakeholders that these changes to the review process will in due course be followed by amendments to the operation and mandate of the Medical Training Review Panel which operates under section 3GC. Perhaps that speculation provides some explanation for the options that the government is pursuing. Typical of this government, it has not been forthcoming with this information.

Having said that, there is evidently support amongst some stakeholders for a longer interval between reviews, and the Government’s assertion that the legislation is less contentious than it once was appears from recent reviews to be legitimate.

The Explanatory Memorandum to this Bill states that the review process takes nine months to complete and requires significant Departmental staffing resources. The 2005 review process cost the Department $80,000 (including an independent reviewer, transport and accommodation costs) and required the full-time secondment of two full-time senior Departmental officers for approximately nine months for secretariat duties. According to the Minister’s second reading speech “In total, the 2005 biennial review process exceeded $180,000.”

With the changes proposed in this Bill the Government contends that “this financial impact will be incurred every five year rather than every two years”, a modest saving that Labor supports.

Accordingly, we are prepared to support the Bill. But we do note some wariness in doing so, given the review recommendations, given the changing number of professionals that will be coming into the sector and given our concerns that the issues of workforce shortages and, in particular, distribution have still not been solved. They were not solved by the original introduction of these provisions and they will not be in any way further improved by this bill.