Monday, 29 July 2019
Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019; Second Reading
I rise to speak on the Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019. I indicate to the chamber today that Labor is supporting this legislation. The bill amends the Health Insurance Act 1973 to legislate for a new Bonded Medical Program. This program was announced more than a year ago in the 2018-2019 budget. Under the program, up to 850 medical students a year will be offered Commonwealth-supported places at Australian universities. This is in exchange for completing return-of-service obligations in currently under-serviced areas.
The new Bonded Medical Program will open in January 2020 and gradually replace the two existing bonded programs. We note on the Labor's side the government's assurances that, compared to the existing schemes, the new program is designed to streamline administrative arrangements with one statutory scheme to replace individual contracts and deeds with each participant under the current program; standardise return of service obligations with each participant to serve three years in an underserviced area within 18 years of completing their medical degree; standardise penalties for not completing return of service obligations with sanctions including repayment of Commonwealth support and nonpayment of Medicare benefits for six years; and be more responsive to changing workforce requirements with underserviced areas to be defined in new rules to be made under the act. This will allow governments to update eligible areas over time.
We note that the government is making separate but related reforms as to how underserviced areas are defined. The government has introduced a new Distribution Priority Area system, replacing the District of Workforce Shortage System for GPs. While Labor supports the reasons for the change, it was implemented with little notice to GPs and patients on July 2020, and its impacts on particular areas are still, we think, to be understood. So, we sought a briefing on this new system, including on whether it addresses workforce shortages in outer metropolitan areas as well as regional and remote and rural areas.
We welcome the fact that this bill includes transition provisions for participants in the existing programs. Some 10,000 participants are undertaking a medical degree training or return of service obligations under the current program and, with some exceptions, these participants will be able to opt into the new program from 1 January 2020.
We support this bill because it is intended to help address the shocking health inequalities in regional, remote, and rural Australia. As Labor's national platform recognises, Australians living in regional, rural and remote areas, typically, have poorer access to health services, poorer health outcomes and a lower life expectancy than those living in Australia's cities.
The Australian Institute of Health and Welfare figures show that rates of health risk factors are higher in outer regional and remote Australia, with 22 per cent smoking daily, compared to 13 per cent in cities; 68 per cent being overweight or obese, compared to 61 per cent in cities; 72 per cent doing low or no exercise, compared to 74 per cent in cities; and 24 per cent drinking at risky lifetime levels, compared to 16 per cent in our cities.
Access to health care is also poorer with lower rates of almost every health profession, including medical specialists, dentists and a range of allied health providers. I note that this also translates to the amount of Medicare rebate that's spent in Australia's rural and remote areas. As a result of these factors, the overall burden of disease is around 10 per cent higher in regional areas; 30 per cent higher in remote areas; and 70 per cent higher in very remote areas. Many of these deaths are preventable, with 2½ times as many potentially avoidable deaths in very remote areas than in Australia's cities.
So, while we welcome it, this bill is patently not a silver bullet for the issue of the health disparity between metropolitan, regional, rural and remote Australia. We call on the government to do much more on rural health in its third term than it's done in its first two terms. Labor stands ready to work with the government to improve the health of seven million Australians, or close to 30 per cent of all Australians, who live in rural, regional and remote Australia. Thank you.