Thursday, 14 November 2019
Medical and Midwife Indemnity Legislation Amendment Bill 2019; Second Reading
The Labor Party will be supporting the Medical and Midwife Indemnity Legislation Amendment Bill 2019, which seeks to improve the operation of indemnity insurance following a first principles review. Medical indemnity insurance covers doctors, midwives and other health professionals and providers for the large compensation that may be payable to patients after provider errors. Since a major market failure in 2002, the Commonwealth has provided substantial support for the medical indemnity insurance market—around $83 million in 2018-19. This bill amends the Medical Indemnity Act 2002 and related legislation to improve the operation of the Commonwealth support. In particular, this bill introduces a requirement that all indemnity insurers must provide cover to all providers. At present this universal coverage obligation only applies to the four insurers who have contracts with the Commonwealth. This is a sensible and helpful extension.
Unfortunately, this legislation fails to fix the significant gaps in indemnity insurance for Australia's midwives. In fact, this legislation does not even attempt to deal with those. In particular, it fails to address the lack of cover for homebirths and the lack of competition and choice in other midwifery cover. Currently we do not have indemnity insurance for all homebirths. The current exemption for holding that insurance is set to expire, putting midwives in a position of uncertainty. Unless the minister addresses this issue, it could jeopardise the ability of midwives to attend homebirths. On the issue of competition, there's only one provider of indemnity insurance for midwives.
This is not an easy situation to resolve, but we call on the government to consider options to address it. The Labor Party is concerned about these issues because we believe midwives perform an incredibly important role in our health system. The last Labor government added midwives to the National Registration and Accreditation Scheme and gave midwives access to a range of Medicare and PBS items for the first time. We call on the government to give midwives the support and attention they deserve.
I'm grateful for the opportunity to speak on this bill. Growing up on a family farm just outside of Chinchilla, where my mum was the local midwife, today, as a senator for Queensland, I have a very special interest in medical and midwifery services for regional Australia, especially in Queensland. As I noted in my maiden speech, these essential services are contracting away from many towns and small communities in regional centres around Queensland. While Chinchilla has a hospital, it's a hospital without any reliable maternity services. So much for better access to essential services in my home town! How can this work? How can families plan for what should be a joyous time? I'm grateful for the leadership of the Prime Minister and for the coalition government's determination to lead the fight for rural and regional Australians to ensure that they receive their fair share of government funding, services and support.
Improving essential services in the bush starts with this bill, the Medical and Midwife Indemnity Legislation Amendment Bill 2019. As a responsible Commonwealth government, we must do all that we can to enable privately practising doctors, health professionals and midwives to take up the slack in neglected communities, and that means nationwide access to affordable professional indemnity insurance. Currently, under the Health Practitioner Regulation National Law Act, midwives are required to hold appropriate professional indemnity insurance in order to be registered. At the present time, an exemption to this requirement applies to privately practising midwives who provide labour and delivery services for homebirths up until December 2019. According to the Australian College of Midwives, most midwives will be covered by their employer. However, self-employed midwives will need to arrange their own insurance.
A recent submission from the Australian College of Midwives to the First Principles Reviews of the Medical Indemnity Insurance Fund concluded that indemnity insurance was a barrier for privately practising midwives and has resulted in the loss of a number of excellent privately practising midwives from the profession. Stepping up to the plate on this issue, the Australian government has agreed to work with indemnity insurers, representative peak bodies and practitioners to improve Commonwealth support for medical indemnity arrangements. Taken collectively, the initiatives in this bill will aim to: simplify the legislative structure that supports effective and affordable medical indemnity insurance; ensure universal cover to medical practitioners; expand government support for high-cost and exceptional claims made against healthcare professionals; clarify eligibility for run-off cover schemes; streamline reporting obligations; and monitor capacity. This is an impressive list of reforms. These reforms should support the long-term stability and sustainability of a sector that is so vital to improving equality of access to reliable maternity care in regional communities.
The World Health Organization has announced 2020 as the year of the nurse and the midwife. I trust that the Senate will support this bill and, in doing so, provide for the long-term stability and affordability of medical indemnity premiums for our midwives and medical practitioners around Australia to help ensure better equality of health care and patient safety, irrespective of postcode. I commend the bill to the Senate.
I acknowledge I'm not on the speakers list, but I wish to make a very short statement. I want to rise to associate the Greens with the comments made by Senator Carol Brown in relation to midwives and to flag that, whilst I unfortunately don't have my documents with me, we endorse the sentiment and contents expressed therein.
I thank all senators for their contributions and in particular Senator Rennick for his personal reflections relating to elements of this bill. This bill, as has been outlined by a number of others, amends the Medical Indemnity Act 2002 and related legislation to reduce and simplify the legislation underpinning the medical indemnity schemes through consolidation and repeal of redundant legislation. The new legislation will continue to ensure medical indemnity insurance products are both available and affordable for medical and allied health practitioners. Improvements have been made to the provision of universal cover for doctors who may otherwise be uninsurable. While there is a risk that poor-performing doctors benefit from universal cover, the reason it exists is to protect doctors with a significant claims history from being denied cover where the claims history relates to their specialty, location or patient cohort. This risk is being mitigated by increasing the risk loading which insurers can apply and by enabling insurers to refuse cover in exceptional circumstances.
Only four of the six participating insurers have a contract with the Commonwealth. The effect of this has been that the two insurers outside of these contractual arrangements cannot be compelled to provide cover and there is no mechanism to enforce universal cover. The effect of the contractual arrangements has, therefore, been unevenly distributed.
Insurers will continue to be able to impose risk management conditions on high-risk doctors and refuse insurance in exceptional circumstances. These new arrangements will reduce administrative requirements, and insurers will no longer need to contract with the Commonwealth, removing inequities between contracted and non-contracted parties. This will reduce the burdensome and duplicate reporting and ensure there is an open market.
The government will also be maintaining support for high-cost claims and exceptional claims made in respect of health practitioners who are insured by insurers presently participating in the schemes. These practitioners will need to be practising in professions accredited by the Australian Health Practitioner Regulation Agency. The government will be establishing a separate high-cost claims and exceptional claims scheme for allied health professions, including employed privately practising midwives. The allied health schemes will mirror the existing high-cost claims and exceptional claims schemes to include midwives and close an inequitable gap. This means all registered midwives not covered under the Midwife Professional Indemnity (Commonwealth Contribution) Scheme are covered under the allied health high-cost claim scheme. Claims made under these schemes will apply regardless of whether it is made against a practitioner covered by an insurance contract between the individual practitioner and insurer or an insurance contract between the practitioner's employer and insurer. However, the claim must be against the individual practitioner. The amendments in this bill will ensure parity arrangements for doctors, allied health professionals and midwives.
In summary, these legislative changes support the recommendations of both the first principles and thematic reviews while addressing recommendations made by the Australian National Audit Office. The government will continue to ensure improvements are made in the monitoring and performance of the indemnity insurance fund against its objectives of delivery of the independent actuarial evaluation to be tabled in parliament in 2021. I commend the bill to the Senate.
Question agreed to.
Bill read a second time.