Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Hansard source

I too rise to speak on the Health Insurance (National Rural Health Commissioner) Amendment Bill and I do so because I feel very strongly, as all of us do on this side, about the adequate provision of health care for all Australians, regardless of where they live. This bill, as we heard, amends the Health Insurance Act 1973 to enable the appointment of a National Rural Health Commissioner. We heard earlier from the member for Makin that Labor will not be opposing this legislation, because we recognise the absolute need to address the problem of attracting and retaining doctors in areas where they are needed. Of course, those areas are the regions and rural areas.

An ABC article in January of this year discussed the possibility of a number of rural and remote communities risk being wiped out unless the shortage of basic medical facilities is addressed. It is only natural that people want services when they are living in a particular area, or if they are contemplating moving to a regional or rural area, and one of those basic services is health. The Rural Doctors Association of Australia president, Ewen McPhee, said that unless there was a renewed focus on the basic needs of smaller rural communities across Australia there would be dire consequences.

I do support the concerns raised by the member for Makin. One of those is that the position of the National Rural Health Commissioner terminates on 1 July 2020. There is absolutely no provision in the bill to extend that position. Another concern is that there are no review provisions of the commissioner's position within the legislation. The scope of the commissioner's role is primarily focused on the establishment of a national rural generalist pathway, and the bill appears to ignore other issues in rural health. Further, there is no advisory body proposed to assist the National Rural Health Commissioner with his or her work.

We know that Australians who live in regional and remote areas are getting sicker more often and waiting longer to see a doctor than their city counterparts. The contrast of this is starkest for those in remote areas, where, for example, average lifespans of women and men are respectively two years and 3.4 years lower than city dwellers. That is a stark difference. Suicide rates, for example, are twice as high in rural and regional areas. Chronic disease levels, including diabetes, coronary heart disease, lung disease, eye diseases and chronic obstructive lung diseases are considerably higher; yet, despite much poorer health, the average yearly Medicare benefits schedule spend per individual in remote areas is $536, compared with $910 in major cities. For Indigenous people the situation is even more dire, with men living two years less in regional areas and seven years less in very remote regions.

I suppose it is the nature of Australia, with its scattered rural and remote populations, that providing essential services to these communities is costly. But it is also absolutely necessary, regardless of the cost. It highlights the dangers of privatising certain aspects of these essential services. This is why we must be vigilant. We know that the ratio of health professionals, particularly in specialised sectors, is much lower in rural Australia than in the city areas. This means that, while the health of Australians is improving in many areas around the nation, there is still a big gap based on where you live. About one in three people living outside the cities and CBD areas reported longer than acceptable waiting times to see a general practitioner. The reasons for these gaps are many.

Personal safety is a high priority issue for rural and remote health workers, as well. This is certainly an area that must be addressed to remove some of the barriers to recruiting more workers to rural areas, especially health workers, GPs and medical professionals. According to the Rural Doctors Association of Australia, incentives to get doctors to move to remote areas are inadequate. The Australian Institute of Health and Welfare's 2008 report, for example, found that the number of medical practitioners was rising, but not in the right places. At the time of the report there were 335 doctors per 100,000 people in the big cities, compared with just 135 in remote Australia. The situation has certainly got worse since this report came out in 2008. Small town doctors often act in several capacities. They need separate skills to those of city doctors. They act as the local GP, the hospital's visiting medical officer and the after-hours responder in many cases. This is a very demanding job.

What has the coalition done to address rural and remote health care availability in the past? The establishment of the National Rural Health Commissioner is certainly a step in the right direction. The question is whether it will be enough to address those inadequacies that exist in rural areas. Importantly, will this compensate for past bad decisions? For example, one of the first health cuts made by this government was abolishing Health Workforce Australia. Abolishing Health Workforce Australia disproportionately impacts directly on the rural and remote health workforce, because that is where the largest imbalances exist.

So let us not forget that this is a government that has failed rural health in multiple ways. Some of those ways where they have failed rural health are through the Medicare benefits schedule freeze, the increases in the cost of medicines, cuts to pathology bulk-billing incentive payments and cuts to health workforce scholarships.

With this in mind, as we heard earlier, the Labor opposition will be moving amendments in the Senate that we believe will make this better legislation and which we ask the government to support. The amendments will be to broaden the scope of the commissioner's role, review rather than cease the commissioner's role on 1 July 2020 and establish an unpaid advisory board to support the commissioner with good, adequate advice. This will go some way to address the shortcomings contained in this particular bill. The commissioner will be appointed by the minister on either a full-time or part-time basis for a period of up to two years, and is only eligible if they have experience in rural health. The commissioner must provide a report each year to the minister for presentation to the parliament about the commissioner's activity, and the commissioner will have a number of tasks, including providing advice to the minister on matters relating to rural health reform upon request, defining what it means to be a rural generalist and developing a national rural generalist pathway. A rural generalist pathway provides postgraduate medical students with training and development to become a rural generalist, although it would be the role of the commissioner to define what it means to be a rural generalist.

The question remains about whether this is slightly superfluous, given that there is already an existing definition based on the Cairns Consensus from the 2014 World Summit on Rural Generalist Medicine. There is no doubt that the commissioner appears to be given a very narrow role. Whilst the development of the national rural generalist pathway is welcome, it is quite unclear that the commissioner will have much more of a role than that. The government had the opportunity to establish a commissioner's office with real political support and clout, which could put rural and remote health on the agenda, bringing those levels back up to the level of what we have in the cities, or close to it.

What does it mean exactly to give the commissioner a life span only until 1 July 2020, without any knowledge of the future after 2020? At that point the commissioner will cease to exist. That is only around three years. It is not really long enough to address these complex problems. I must say that the idea is not really original, either. Labor had already committed to appointing a rural health commissioner in the lead up to the federal election. We also announced that we would establish a health reform commission, whose job it would be to deal with rural and regional health workforce matters.

Now we know, from the reaction to Labor's announcement prior to the elections, that such measures as are contained in this bill would be largely welcomed by the main stakeholders. However, I believe that what stakeholders, practitioners and patients want is a clear commitment to the provision of adequate health care in rural areas. The reason there is a level of insecurity around whether this government actually has the commitment is its track record of turning its back on our universal healthcare system.

When Labor introduced the Medicare system in 1986, it had been met with strong opposition by the coalition from 1983, when the Hawke government first began it. It was only after the coalition's fifth successive defeat, in the 1993 federal election, that John Howard committed the coalition to retaining Medicare because he accepted the reality that the Australian public valued Medicare.

Moves towards privatising elements of health care currently covered by Medicare, as we have seen the coalition government do, are a stealth strategy of incremental cuts to reform Medicare as a safety net for the poor. They have adopted strategies of incremental cuts, by tinkering with Medicare, that are designed to gradually erode the broader public's confidence in, commitment to and support for Medicare. We must stand up and fight these moves, or the tipping point will be reached and Medicare will be recast as merely a welfare program for the poor. I therefore support the amendments that will be moved in respect of this bill in the upper house and urge the House to support them.

See this speech in context