Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise to talk on the Health Insurance Amendment (Provider Number Review) Bill 2007. This bill proposes that the biennial review process contained in section 19AD(1) of the Health Insurance Act 1973, 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, as many in this House would know, 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 in December 1996 by the Health Insurance Amendment Act (No. 2) 1996.

Section 19AA requires that medical practitioners who first obtained registration in Australia after 1 November 1996 have to satisfy minimum proficiency requirements—either obtain a fellowship as a specialist, consultant physician or general practitioner, or register 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 function is to compile information on the number of medical practitioners enrolled in or undertaking courses and programs and on 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 the then health minister Michael Wooldridge gave his second reading speech on the Health Insurance Amendment Act (No. 2) in 1996, he outlined the government’s policy rationale underpinning the introduction of the sections outlined above. Firstly, he argued 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 that they 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 4,000 more doctors than our population required. Finally, 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. 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 still much 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 but an undersupply of GPs in rural and remote areas. Since then, the situation has changed to an across the board undersupply of GPs, with the shortages being most acute in rural and remote areas and now also in many outer metropolitan areas.

In January, I visited Russell Island, in the federal seat of Bowman, with Labor’s candidate, Jason Young, to discuss the islanders’ healthcare problems. I learnt that the Bay Islands community in Queensland, with a population of nearly 4,000, has only one doctor. Those 4,000 people, I might add, are spread across a number of islands, so transport between islands, for either patient or doctor, is a bit of a challenge. With insufficient GP services on the islands, bulk-billing has been in decline and many local residents are deterred from seeking help, or unable to seek help, when they need it. This is just one example, and there are many more examples I could speak about today. We are seeing this sort of problem across the country. Insufficient planning by the Howard government is resulting in doctor, dentist and nurse shortages which are having a severe impact on the health of communities like that of the Bay Islands.

The introduction in 1996 of section 19AA was meant, as promised by the then minister, to actually tackle some of these problems. When it was introduced, it was met with widespread concern among the profession that the new provisions may adversely affect the future employment prospects of the medical students and interns who were already in the system. To address these concerns, and as a result of amendments in the Senate, 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 the impact of those Medicare provider number sections be reviewed on a biennial basis, with a report to 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 those three sections of the Health Insurance Act that I have mentioned. 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. The 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 parliament by the minister no later than 31 December 2010. So the major change is the period of review.

It is significant to note, though, that the 2005 review commented, for the first time, on the level of support for the review process itself. Notably, the review found that there was ‘unanimous support for the continuation of the biennial review process’, which was seen as a ‘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’. The review noted that some stakeholders considered that the reviews were too close together, so 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.

I must admit that I have been struggling to understand how the review found unanimous support for the biennial review process yet also expressed the two contradictory views that the stakeholders held. It seems that the government has opted to take up the views of some of the stakeholders who thought the reviews were too close together and so, accordingly, is proposing this five-year time frame, which Labor is prepared to support. It is, however, a little bit perplexing that the government has decided to go down this path without a clear explanation about the contradictory views that have been expressed within the review. For example, the report stated:

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, particularly as the proposal was neither flagged nor recommended by the 2005 process. However, we have heard speculation from some stakeholders that the changes to the review process that are in this bill will in due course be followed by amendments to the operation and mandate of the Medical Training Review Panel, which operates under section 3GC. That might hold some of the answers to this curiosity depending on the options that the government is pursuing, but, typical of this government, it has not been forthcoming with this information.

Having said that, it is clear, as I have indicated, that there is support amongst some stakeholders for a longer interval between reviews, and the government does assert that the legislation is less contentious than it once was. That certainly appears to be a legitimate view from the recent reviews that have been conducted. It is also clear, from the explanatory memorandum to the bill, that this review process, which takes nine months to complete, requires significant departmental staffing resources that could perhaps be used in a more constructive way. It was made clear that the cost of the 2005 review process to the department—in addition to the staffing resources, as I understand it—was $80,000 and required the full-time secondment of two full-time senior departmental officers for approximately nine months. According to the minister’s second reading speech, in total the cost of this biennial review was $180,000. Clearly, that is money that we do not want to spend unnecessarily.

With the changes, that financial impact will be incurred every five years rather than every two years, which is a modest saving that Labor is prepared to support. 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. I commend the bill to the House.

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