Chris Bowen (McMahon, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

The opposition will be supporting this bill. The bill amends the Health Insurance Act to legislate for a new Bonded Medical Program. It was announced more than a year ago in the 2018-19 budget. Of course there are already existing bonded medical programs. This bill makes what I think can be fairly described as largely uncontroversial changes. The new Bonded Medical Program will open on 1 January 2020 and gradually replace the two existing bonded programs. Labor notes the government's assurances that, compared to the existing scheme, the new program will: streamline administrative arrangements, with one statutory scheme to replace individual contracts to each participant under the current programs; standardise return-of-service obligations so that they're clear and easily understood by all involved, with each participant to serve three years in an underserviced area within 18 years of completing their medical degree; standardise penalties for not completing the return-of-service obligations, with sanctions including repayment of the Commonwealth support and non-payment 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, quite correctly, will allow governments to update eligible areas over time.

We welcome the fact that this bill includes transitional arrangements for participants in existing programs. Around 10,000 participants are undertaking a medical degree, training or return-of-service obligations under the existing programs. With some exceptions, these participants will be able to opt into the new program from 1 July 2020.

This is a very important piece of policy more broadly. I'm not talking about the amendments in particular, which the opposition finds unobjectionable and in many cases sensible. But, more broadly, we face ongoing health inequities in Australia. People who live in rural and regional Australia have worse health outcomes than people in metropolitan Australia, and people who live in rural Australia have a lot of difficulty compared to metropolitan Australia getting access to medical treatment. It's not just about GPs; it's about specialists, where the shortages are acute. Importantly, a related matter, not directed affected by the bill, concerns allied health professionals. It's very important to have good access to allied health professionals in rural and regional Australia. This has been a focus of ours since the election. My early travels as the shadow minister for health have taken me to remote Northern Territory, to rural and remote New South Wales, to Bourke, Brewarrina, Walgett and Broken Hill. This will continue to be a focus for us in our policy development on this side of the House, because we think it's important that Australians, regardless of where they live, have access to very good health care. Of course we have to make our objectives reasonable; nobody is going to suggest that you can have a major teaching hospital in every country town. But people who live in rural and regional Australia deserve access to the very best health care that is possible and practical.

It's not just about workforce or social determinants of health. There are broader issues at play, but workforce is key. We intend to continue to prioritise this area. Many honourable members may have seen, but some may not have seen yet, a very disturbing Four Corners episode this week about rural health outcomes. Again, these are issues which shouldn't necessarily be traversed in this bill, but they underline the scale of the challenge for rural and regional Australia to ensure that we are getting professionals into workplaces in rural Australia. I do want to acknowledge that some universities are doing good work. I would particularly note the University of Newcastle, James Cook University and Charles Darwin University, with a focus on both rural and regional medicos and medicos of Indigenous background who, in particular, go and work in Indigenous communities. All the evidence tells us that if you come from a rural background to start with and then go to medical school, you're much more likely to work in a rural region when you have become a qualified medico. So this is a very important area. We probably don't focus on it enough in this parliament. We will certainly be focusing on it on this side of the House.

In the meantime, we're happy to lend our bipartisan support to the legislation the minister has introduced, but I will move a second reading amendment, which I believe has been circulated in my name. I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House criticises the Government for its cuts to and neglect of health care, which have made health care more expensive and less accessible for people in regional, rural and remote Australia".

See this speech in context