Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to 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.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

I am pleased to rise in support of the Health Insurance Amendment (Provider Number Review) Bill 2007 and to commend this legislation to the House. The history of it is quite plain. When we came to government, we introduced major changes to the Medicare provider number system for new medical practitioners. We were keen for those who were newly graduated to seek postgraduate qualifications before they were able to access the right to work under the Medicare benefits scheme. We also knew there were doctors who would undertake further training and workforce experience once they had finished their university book learning.

The effect of these changes was very clear: it was about improving the quality of doctors by giving them a rounded series of experiences that would add to the quality, in a quite effective way, of those in the workforce. It meant that a lot of young doctors were encouraged—you may say coerced—to work towards a fellowship with a recognised medical college. It also included the recognition of general practice as a distinct medical discipline. We see the role of general practitioners in our community as an enormously noble task. I am sure that in Tasmania, where you come from, Mr Deputy Speaker Quick, you have your own doctor. We all have our own doctor, who we get to know and trust.

The doctor who my parents took me to from the age of about 11, Terry Russell, shocked us all a few years ago when he decided to move away from general practice, take no more names on the books and move into the specialisation of circumcision, which left us a bit high and dry as a family. It certainly left me high and dry; I had no need for his services from that point on. I was very happy to eventually find some other doctors. I was quite amazed at the time that the opposition was banging on about the lack of bulk-billing, because every doctor I was able to access in my electorate was a bulk-billing doctor. We have about a 90 per cent bulk-billing rate in my electorate. We have had a very successful increase in the number of general practitioners and medical specialists, bulk-billing and otherwise, in my electorate. It is excellent. We have a public hospital, the QEII, at Nathan and a great private hospital in the Sunnybank Private Hospital, where unfortunately my mother is sitting today. At the end of it, these are good and reliable medical facilities that are staffed by great doctors.

What a difference, though, the last 10 or 11 years have made to medical services across the south side of Brisbane and in the electorate of Moreton. I remember when I was the candidate for Moreton in 1995. Dr Wooldridge, who was the shadow minister for health, became a very good minister for health in the first couple of terms of the Howard government. Michael Wooldridge and I went to the QEII hospital at Nathan. Peter Beattie was the Queensland health minister at the time and refused to allow me as a mere candidate to go into the hospital on the political visit of the shadow minister for health.

Alan Griffin (Bruce, Australian Labor Party, Shadow Minister for Veterans' Affairs) Share this | Link to this | Hansard source

Mr Griffin interjecting

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

What is your seat again?

Alan Griffin (Bruce, Australian Labor Party, Shadow Minister for Veterans' Affairs) Share this | Link to this | Hansard source

Bruce.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

That is right. You are not Bruce from Griffin; you are Griffin from Bruce. Do not talk about infectious diseases with regard to what I am about to say. This is what the minister for health, Mr Abbott, has been saying in the chamber this week. When the Leader of the Opposition was the key adviser to Wayne Goss, Wayne Goss reluctantly appointed Peter Beattie to the ministry in the dying days of his 1989-96 government. Peter Beattie was the health minister at this time. So parlous was the circumstance at QEII hospital that when Dr Wooldridge went in—he still talks about it now; he has never forgotten this—he saw several floors completely empty of patients, and the member for Bruce will be amused to know that he went to the operating theatres and saw mannequins. Mannequins were in the operating theatres because they were never being used. Here we have a great public hospital in Queensland, and the administrative decisions of the Goss-Rudd government in Queensland delivered mannequins to the operating theatres of the No. 1 public hospital in my electorate. There was a mannequin lying on the operating table, a mannequin with a nurse’s uniform on and a mannequin with a surgical mask on. Why? So that those who happened to go to the hospital knew what it looked like to see something like a body in the operating theatre. They were the most extraordinary times.

Why did they do that? Because Wayne Goss and his sidekick, the current Leader of the Opposition, Mr Rudd, decided to pilfer all of QEII hospital’s resources. They decided to shoot them off to the Logan Hospital, which coincidentally was in Mr Goss’s electorate. These were the administrative decisions that we inherited; they are the reasons why we have to work on things such as the Medicare provider number and why we had to invest in building a stronger network of medical services across my part of Brisbane.

It is extraordinary to think that, worse still, what was being pilfered—stolen—was equipment that had been generated by the hard work of the QEII hospital auxiliary. They had raised at that stage about $1 million in various funds, mainly through the ground floor coffee shop where they sold to an ever-decreasing number of people in attendance at the QEII community hospital. They had shut down two of the four floors. They were selling cups of tea and biscuits, making sandwiches and so forth and the money that had been generated bought medical equipment. The Queensland government would not buy it; the hospital auxiliary bought it instead. The machines that went ping, if you like, as Monty Python’s Flying Circus would say. They had all of those things, but they were being pilfered and taken to the Logan Hospital. That was the sort of situation we had.

From 1992 to 1995, before I was the member for Moreton, I worked with the QEII hospital auxiliary to embarrass a change of circumstance for this hospital. I wanted Michael Wooldridge to see it for himself, and he maintains to me today that he has never seen a worse example anywhere in Australia of the betrayal of a local community when it comes to community general hospital policy than what he saw at QEII hospital the day he saw mannequins in the operating theatre. The hospital is a lot better than that these days, mainly due to the fact that the former coalition minister for health, Mike Horan, in the short-lived Borbidge-Sheldon government between 1996 and 1998, restored the status of QEII hospital.

The current Queensland government are still trying to destroy the viability of the QEII hospital through a number of other practices they have undertaken. For instance, they have ordered competition for the coffee shop. They now have their own Queensland Health coffee shop which runs in competition to the hospital coffee shop. They have put in their own little health department coffee machines to try to detract from the effectiveness of the hospital auxiliary. But the hospital auxiliary continues to soldier on and has raised millions of dollars towards the work that is being done.

I raise all of this in concert with this particular piece of legislation because it is absolutely important for people to know that we want young doctors to go to great community general hospitals like the QEII to gain very full, on-the-job access to the realities encountered. We do not want to see, for instance, a repeat at QEII hospital of the closure of the accident and emergency section, which always seems to be so close to being threatened. There is a view prevalent in the Queensland health department that, if you pay for the public servants first and for the patient-caregiver part of the equation last, the hospital system is running well. They pay big dollars to people in town. In fact, they have people sitting at desks in the head office in town who are allocated on the books as staff at QEII but who do not actually provide any service at QEII hospital. Nevertheless, they push paper around and suck up some of the money that QEII hospital needs—and receive high rates of pay, it seems to me. They are saying to people in my electorate who go to QEII looking for accident and emergency care: ‘Hop on a bus that will take you to Princess Alexandra Hospital 10 minutes away.’

This is the sort of nonsense that is going on. The problem is that local GPs are then further taxed by these accident and emergency requests that should be met by the local community hospital. That is a great cost shift by the state government because the Commonwealth taxpayer pays for the Medicare access to the fantastic local GPs that we have. It is a very clever trick: restrict access to health services at a community general hospital, make patients work harder to gain access to those services, push them onto local GPs and let the Commonwealth taxpayer pay for it.

What are Queensland doing with their GST money? Why is every other state complaining that rivers of gold are flowing into the Queensland treasury coffers but things such as maintaining, improving and growing the status of a great community general hospital like QEII are not being done? What are they doing with the money? There are road infrastructure failures in Queensland. The Goss-Rudd administration failed to build the Wolffdene dam, so there is not enough water in south-east Queensland.

Harry Quick (Franklin, Independent) Share this | Link to this | Hansard source

Order! I would remind the member—

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

I am paraphrasing. I understand the admonition. Mr Rudd is the Leader of the Opposition, and I concede your point.

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

No. This is the Health Insurance Amendment (Provider Number Review) Bill 2007 and I ask the member to come back to the bill at hand.

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

I am very happy to do that. I am just finishing an illustration of a general point I am making about the pressure that is being applied to general practitioners, Medicare provider number holders, in my electorate by the sorts of difficulties that are being created by the bad decision making of the state government. The point is that on every core responsibility of state government—road infrastructure, water infrastructure, power infrastructure, rail infrastructure and medical infrastructure—the money is not being spent. So what are they spending it on? They are spending it on lots of TV ads telling people we live in a smart state, but not on ads that are being met by any sort of reality.

I pay tribute to the local general practitioners who operate under the Health Insurance Act. People now have a higher level of quality and a higher level of experience because of the deliberative measures of the federal government in 1996. Through the measures that we introduced in those years and the principled measures contained within the principal bill, we had put in place a biennial review. That is understandable because, when you change a system, you want the review process to occur less often once the system is operating better and with more experience than in the early days. This biennial review would be costing the taxpayers the best part of $200,000, take nine months to complete and take up the time of an enormous number of staff at the Department of Health and Ageing. The government has made the decision, after consultation, to change the biennial review to a five-year review. The member for Gellibrand was confused and amused but nevertheless supportive of the measure.

As to why the government would make these particular changes, it is simply that experience on this issue now counts and people understand what is required of them. Things are far better than they once were. We have made certain that all medical practitioners are now more appropriately skilled to enter into unsupervised general practice. In other words, we have created a system that is now working and, rather than constantly reviewing the review of the previous review and sucking up a couple of hundred thousand dollars every two years and taking a lot of departmental officers off other tasks, we are making it possible now for five-year reviews to occur. From my point of view, this is a very good, common-sense approach.

I will also say for the record that not only do we have more general practitioners with their Medicare provider numbers operating in my electorate than we have ever had before, and more of them bulk-billing than ever before; we have also got the effects of the innovations of this government now about to come on stream in a big way. The deliberate decision built around the efforts of the member for Herbert to create a school of tropical medicine means that doctors in training in Townsville will learn on the job in Townsville about tropical medicines and be more likely to stay in regional Australia. The fact that more medical places have been made available at institutions such as Griffith University, through its principal campus in my electorate and also its Gold Coast campus, means that more people are in training as well. The future, if you like, is not just simply about quality; it is about quantity.

Of course, the role of professionals coming from other countries is very important indeed. Of course, they are required to be adequately and properly trained and apply for Medicare provider numbers. Jayant Patel may have discredited the Queensland health system by his actions—the system failed to track his failings and too many people were hurt or killed as a result of that—but it is important to note that we should not target all doctors who have come from other parts of the world who may even look as though they are ethnically the same as Dr Patel. We need to understand that in gaining access to a Medicare provider number these people are people of quality. We demand that of them. State governments demand that of them. In my electorate, as a result of the very effective and community focused work of people like Dr Shabbir Hussein—he is a PhD, not a medical doctor, but his children are medical doctors—who came from southern Africa, a difference is being made. Dr Hussein is a Muslim man who is very proud to be in Australia. He has brought other doctors from that part of the world to also work in our local community.

We now have out-of-hours healthcare services based at Kuraby and Underwood—and I know that Dr Hussein has also put work into other places around the Gold Coast, 40 minutes south of me. Because of this man’s initiative, there are now Medicare provided services that operate until midnight most days of the week, and he is looking to set up 24-hour health care. These are the sorts of things that were only ever imagined years ago. As a result of the proactive and focused efforts of Minister Abbott and his department, we have been able to deliver that.

I will also mention Dr Madonna Abdella, a psychiatrist from the Philippines, and the creation of the Healthcare for All project, which is based at Acacia Ridge, just across the railway line from my electorate. They are providing an enormous amount of good for our community through the recruitment of overseas trained doctors to be employed as GPs in bulk-billing medical facilities throughout Queensland. I see that the member for Kennedy is here. He will be very interested to know what Dr Abdella is doing with this project. It involves the rotation of recruited overseas trained doctors through remote and regional areas, initially in Cunnamulla and Cape York—I am sure, Member for Kennedy, they are coming your way. Dr Abdella wants to rotate them through those far-flung parts of Queensland and then bring them back into the city to keep them well and truly trained and up to date.

This is the sort of initiative that is very much at the heart of why the government made the changes it did in 1996 and what this bill is about. These overseas trained doctors, employed in bulk-billing medical centres at Acacia Ridge, Toowong and other places, will also be providing 24-hour GP services in selected localities. This is going to make a difference when it comes to Aboriginal health. It is going to make a difference when it comes to general practice training programs—all funded by the Australian government.

I praise the work of Healthcare for All. It is a joint initiative of the Migrant and Workers Resource Centre and the Toowong Community Medical Centre, and I say well done to them. These things happen because we now have the acquisition of Medicare provider numbers on a far stronger and more stable footing. The quality is assured and the quantity is growing, and for those sorts of reasons the work of the government has been very important. But the work has not finished, and we are very determined to make sure that we continue to grow what we have already achieved to date. I thank the House, and I commend this bill to this place.

Bob Katter (Kennedy, Independent) Share this | Link to this | Hansard source

I pay tribute to the previous speaker, the member for Moreton. I think he does an excellent job in his portfolio and an excellent job as a member of parliament representing his area. He is one of the very few pleasant and intelligent people that we encounter in our daily dealings with government. I wish there were more like him. I avail myself of the opportunity to say a few words on the Health Insurance Amendment (Provider Number Review) Bill 2007, not because in itself it is of importance; it is purely obviating the necessity for a review every two years and saving a tiny bit of taxpayers’ money. The issue of provider numbers and the qualifying period is an appalling imposition upon rural Australia.

Previously we would get first-year doctors. All of western Queensland was manned by first-year doctors. They may not have been the best doctors in the world—heavens, it was just their first year in practice and they were thrown out on their own resources—but they were better than nothing. A lot of the doctors that go out there, and God bless them, have enormous difficulties with English. Their culture is so enormously different from ours that they have enormous difficulties in fitting in. But at the present moment we are making do with these doctors as opposed to the doctors we had previously.

The two-year qualifying period is appallingly bad. It took six years of fighting, arguing and battling from the time I formed the original committee to secure the Townsville medical school till the time it started—I think it was in its seventh year. We had our first graduates last year, so we are talking about a program that has most certainly put a big hole—about 12 years—in my life. The reason all that time and effort was put in was that we people in North Queensland, and there are a million of us up there, require 1,000 doctors. It may be that 1,500 or 2,000 doctors are needed, depending on what set of figures you want to use. In fact it is 3,000 doctors—that would meet the average for Australia.

Where are we going to get them from? Our young men and women go down to Brisbane and they are trained in Brisbane. They marry a Brisbane girl or a Brisbane man, and they do not return to North Queensland, which is 2,000 kilometres away. They have lived in Brisbane for six years. They are not suddenly going to up stakes, roll their swag and go back up to a small town from whence they came—and they do not. Hence the fact that the last time I reviewed the 21 doctors practising in the mid-west and Mount Isa only nine were Australian. All the rest had come from overseas. That is a lot of drawbacks for us.

Of course, if you introduce a two-year qualifying period we will get nobody at all. Some of the blokes who went there for one year stayed for five, six or seven years; some of them stayed all their lives in the northern and western towns—but I am talking specifically about North Queensland. If you say that they have to work in a big hospital for two years, that means we do not get them. Once they have qualified in a big hospital for two years, they are not going to gallop off to the bush. Previously they had to do that. If they wanted a job with Queensland Health, almost invariably they were sent there. But if we are required to provide a qualifying period, that just means we will not get those doctors. The first graduates came out of James Cook University. There were about 60 or 70 graduates last year, and it will effectively be another two years before we get them on the ground. When the students for this year graduate, it will be another two years before we can get any of those people on the ground.

If they are young and inexperienced, to some degree they are forced to take their own initiative when they are by themselves in these communities. If they are really worried, there should be a superintendent in Mount Isa or Townsville—it should really be Charters Towers, but we will say Townsville—who they can ring and ask: ‘I have a difficulty here. Could you please advise me?’ Surely the government can pay some specialists in Townsville to provide advice to the doctors in these outlying centres, or a superintendent from a hospital in Mount Isa, Charters Towers or Townsville, but the government has not done that.

I want to praise Minister Abbott very fulsomely because he has lifted the number of graduates—which was reduced to about 65, for reasons I do not want to go into. He has taken that number up to 160 graduates a year. We thank Minister Abbott very sincerely for what is a very great achievement. Michael Wooldridge was the ‘angel of the bush’, as I have described him in this House on many occasions. We got the first new medical school in 40-odd years—I think it has been 44 years since we built the last medical school. There are no extra graduates coming out. Now half of the graduates are women—and God bless them, but they tend to become mothers and not practise medicine on a full-time basis. I have said that they become 30 per cent or 50 per cent doctors. I was corrected the other day when I was told the number is lower than that. I do not know whether it is or not. But this new phenomenon of 50 per cent of the faculty being female has dramatically reduced the number of doctor hours that we have in Queensland.

Coupled with that is the fact that the population of Queensland has risen from under two million to four million in a 30-year period, and there has been virtually no increase in the number of graduates in Queensland. Most certainly that has left us in North Queensland—where the population had gone from about 200,000 or 300,000 to nearly one million—in very desperate straits. The old situation was that these people were employed by the state government and the state government insisted upon them going to country centres to receive their qualifications. Just the opposite occurs now. The state government said, ‘We’ve got you for two years because you’ve got to do two years to qualify, and we’re going to send you out to Cloncurry, Julia Creek or Cunnamulla.’ They had to go; otherwise they would not get any qualifications. Now just the opposite is true: if they go, they cannot become qualified. So we are not at all happy about the new situation that has arisen. We are very hostile towards it and I suppose, to some degree, I should be arguing that we review it again so that we can go back to the old system where a doctor went out to rural areas.

People would say: ‘They weren’t properly trained.’ They were better than nothing. That is the choice that we have really been left with. We have a hodgepodge system where someone arrives from overseas, they have very great difficulties with the language and they are in training. We have seen the terrible case in Bundaberg, but unfortunately that is not a Lone Ranger case in the state of Queensland, nor in other parts of Australia—but I refer particularly to North Queensland. So we have been left with a vastly substandard situation to what we had all the way up to the late eighties, and it has been exacerbated dramatically by the two-year qualifying period in a training hospital. The difference between a small town in North Queensland and a place like Townsville, Cairns, Mount Isa or Mackay is that most of the smaller centres do not have training hospitals. Most of them have single-doctor operations and there is no training, so they cannot get a provider number. That is the problem. We would present this firmly before the government, saying: ‘Do something about this.’

The Australian Medical Association trade union—and heaven knows they are the most powerful in Australia—stopped many doctors from coming into the country and stopped any new medical schools from opening. I might add that, thanks to the wonderful work by Michael Wooldridge and particularly Ian Ronski, Lady Logan and Mary Jane Streeton—they were most actively involved; there are many others whom I should thank—the first medical school was opened and in four years time an extra 160 doctors will come into the marketplace in North Queensland. We now have nearly 100 coming into the marketplace each year, but it will go up to 160. We most sincerely thank the government, Minister Wooldridge and Minister Abbott, who increased that number to 160.

But there is a huge problem out there that is not being addressed—that is, this two-year qualification period, which we are discussing today. It works in completely the opposite way that it should work. Instead of it ensuring that we get good and highly qualified doctors, it absolutely ensures that we never get good and highly qualified doctors, because they have to go to the big centres to get their qualifications. They cannot go to country centres to get their qualifications, so we lose them. This is a serious matter and it needs the attention of the government. People will die, as they have, as a result of government inaction on this matter. It requires standing up to the AMA, I think. That is not an easy task for any minister, but I am quite sure that the minister has the ability to manoeuvre through these waters. We need to get back to the situation where doctors in all those towns are linked in with a superintendent in a big hospital in, say, Innisfail, Mount Isa, Cairns, Townsville or Mackay—wherever the big hospital is—and are able to ring up if they have any difficulties. If they are working in a ward, they cannot go running up the ward every five seconds to ask another doctor for assistance. Really, in this time of great telecommunications, we can do this just as well in a small town where the doctor is linked to a big hospital as we can where the doctor is working in a ward in a hospital. There is no necessity for this imposition. We plead with the government to review the situation.

Ken Ticehurst (Dobell, Liberal Party) Share this | Link to this | Hansard source

The Health Insurance Amendment (Provider Number Review) Bill 2007 proposes an amendment to the Health Insurance Act 1973, relating to arrangements for reviewing the operations of sections 19AA, 3GA and 3GC of the act, collectively known as the Medicare provider number legislation. This amendment is the result of comments submitted to and deliberations undertaken at the most recent biennial review process in 2005. The amendment aims to change the frequency of the review from two to five years, with the next review to commence in 2010. The biennial review undertaken in 2005 reported that there continued to be overwhelming agreement with the objective of the legislation and reported it was agreed that the legislation was having, in particular, a positive impact on raising the quality of general practice services to the community. There was also broad agreement that the operation of section 19AA of the act has not exacerbated any medical workforce shortages. The bill is therefore a relatively straightforward proposal to retain the review process but change the review interval from two to five years, with the next review report to be tabled in parliament no later than 31 December 2010.

To provide some background on the issue, in 1996 the Australian government introduced major changes to accessing Medicare provider numbers for new medical practitioners. Under section 19AA of the act, newly graduated doctors were required to obtain postgraduate qualifications before they were able to access the Medicare Benefits Schedule. Exceptions were made for those doctors who were enrolled in approved training or workforce schemes. These changes had the effect of encouraging young doctors to work towards fellowship of a recognised medical college, including recognition of general practice as a distinct medical discipline. For general practitioners, the intention of limiting Medicare provider numbers to only those doctors who have received vocational training was to ensure that all medical practitioners are appropriately skilled to enter into unsupervised general practice.

At the time the legislation was introduced, there was a view in the medical workforce and by the doctors in training that it would significantly restrict access to training places by junior doctors. There were strong concerns that junior doctors would be forced to spend years working in salaried positions in hospitals or that, due to the lack of training positions, large numbers of doctors would be unemployed. But this has not occurred. The concern that the legislation would negatively impact on the availability of training places has not eventuated.

During the consultation process, noting the wide acceptance of the legislation by relevant national health organisations, the frequency of the review process was discussed with a view to extending the period between reviews. The review process takes nine months to complete and requires significant staffing resources from the Department of Health and Ageing. With continuing wide acceptance of the legislation, the need to conduct a review on a biennial basis is no longer critical.

My electorate of Dobell on the Central Coast is classified as an area of workforce shortage. Access to quality health care is so important to the Central Coast community that I am always working to attract more doctors to our region. By working with the community over the last 12 to 18 months, we have been able to secure 13 new doctors for Dobell. The Australian government is committed to improving access to GPs in regional areas like the Central Coast.

The 2006-07 federal budget contained some important measures to address this aim, including $241 million to train more doctors and nurses in our system. With the Central Coast rapidly growing in population, this sort of commitment is vital. It is creating 400 new places for medical students and 1,000 extra higher education places for nurses each year. Essentially, this means that more students are having the opportunity to get into medicine if they spend part of their training period in a regional area, and it may encourage them to continue in a regional practice.

Hundreds of patients visiting GPs in Dobell are benefiting from higher bulk-billing incentives. There are higher rebates for GPs in eligible areas who bulk-bill Commonwealth concession card holders and children under 16 years. This initiative has been welcomed by families with children under 16 and many of the Central Coast’s seniors. The Australian government’s Medicare initiatives are attracting more and more doctors to the Central Coast. In fact, the bulk-billing rate in Dobell has increased by around seven per cent to just under 80 per cent.

The opening of two medical centres in the northern area of the Central Coast in the last two years is greatly improving the level of health care available in the rapidly growing area of Warnervale. I secured $523,000 toward the establishment of the North Wyong Primary Health Care Centre. It is a fantastic initiative that is working towards attracting more GPs to the area, especially those with a strong interest in research. I am now working with the Central Coast Division of General Practice to secure additional funding for the centre in recognition of the innovative model of health care that the new centre is trialling and the urgent need in the Wyong community for primary health care services. The Minister for Health and Ageing, Tony Abbott, visited the centre and met with several Central Coast doctors and definitely understands the medical needs of our area.

To conclude, this is a very straightforward bill that will not have any impact on any other act or on access to medical training placements. As I mentioned earlier, all previous reviews have found the legislation to be well accepted. The government recognises the need to maintain a monitoring process but does not see a need for a review to take place every two years.

I reiterate that the Howard government is committed to improving and strengthening Medicare and the medical workforce to ensure that all Australians, including the people of the Central Coast, have access to quality, affordable medical care. Sadly, thanks to a New South Wales Labor government that is out of touch with the needs of our local community, the situation in our local hospitals leaves a lot to be desired. Of course, the operation and management of these hospitals is a state government responsibility.

These comments are no reflection on the fantastic, skilled, though underresourced, staff that I have the pleasure of working with on many occasions. Figures for December 2006 show that, of all hospitals in New South Wales, Gosford Hospital had the second highest number of people waiting for surgery, behind Newcastle’s John Hunter Hospital, and that 19 per cent of patients who went through the Wyong Hospital emergency department triage system in December 2006 waited much longer than they should have for treatment. People stuck in emergency departments included very sick patients who needed to be admitted to hospital, and I know that the staff in the emergency department would have done all they could to help them.

The problem is not that we do not have qualified people in New South Wales but that the Labor government, unlike the Howard government, simply does not understand the needs of local communities. Despite the record funding New South Wales receives under the GST, it is failing to provide the necessary funding to assist these dedicated professionals to do their jobs as they would prefer to do them.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

I support the legislation, the Health Insurance Amendment (Provider Number Review) Bill 2007,before the House. I was doing a quick run-through of some of the issues in this legislation and recalled that the first question I asked when I came into this parliament was in relation to Medicare provider numbers, in particular to the possibility of the geographical allocation of Medicare provider numbers. I note with interest that in the 2004 election, even though the government had rejected the concept of using the allocation of Medicare provider numbers on a population or geographical basis, the access of doctors to public funds through Medicare was driven by the need of the population for the doctors rather than the need for the doctors to locate in places they particularly liked to be.

I note that the government, on rejecting that concept, actually introduced it into the major western urban areas, particularly of Sydney and Melbourne but also of Brisbane, to encourage specialists and other medical people to locate in those areas. So the concept of geographical allocation of provider numbers is not alien to the government; it is just that the government has tended to use it as a political tool rather than one for delivering equity to patients across the nation. Those of us involved in politics realise that the decisive seats in a federal election, particularly the last one, are in those geographical locations—for instance, the importance of Western Sydney in maintaining government.

It is an issue that has interested me for some years. I believe that from a number of perspectives we should have a closer look at the use of Medicare provider numbers as a way of getting services to the people rather than, as I said earlier, doctors accessing a provider number in an area where there is an oversupply of doctors on a population basis. I am sure others have been through the number of patients per doctor in country areas compared to the number of patients per doctor in city areas. But most doctors have one thing in common. Most of them have access to Medicare, which is access to the public purse. Given the ballooning of health costs, whether they be state or federal, at some stage we have to have a closer look at the way we allocate medical operatives in terms of their access to public funding.

I congratulate the government on its initiative of the new medical schools that will be started up across Australia, in particular the one to be based in Armidale in my electorate. I believe the concept is a good one and it is based on the successful concept of the university departments of rural health. I particularly congratulate Associate Professor Peter Jones on the work that he has done. Peter Jones is from Newcastle, but he has been resident in Tamworth for some years. In my view, he and his team have driven the concept of the university departments of rural health. He brought this concept of medical training from Newcastle, located it in Tamworth and developed an infrastructure. Now that infrastructure is going to be converted into a full-blown medical school based in Armidale at the University of New England. There will be training of doctors and nurses—there are nurses being trained there now—and training at the major training hospital of Tamworth, which is a major base hospital for the north of the state.

I think Peter Jones has done an outstanding job and I am sure that the Minister for Health and Ageing, Tony Abbott, would concur. The minister was in Tamworth for the launch of the new facility for the Newcastle University Department of Rural Health and I hope he will revisit Tamworth when the medical school is formally opened. It is a medical school that is going to embrace the existing infrastructure of Newcastle and the courses that are being delivered there.

Newcastle university also deserves congratulations because it has been providing services particularly to country students. And, as the previous speaker pointed out, if you educate a country student in medicine, or in an associated faculty, in the country, the likelihood of them forming their relationships et cetera in the country and actually working there as a medico are heightened. I think the government has recognised that. It is going to take some time to come through, of course, because there is a lack of doctors in Australia at the moment, but at least there is movement in the right direction. I think Peter Jones, with his relationship with Newcastle university and his capacity to develop a relationship with the University of New England, has been the main driver behind the establishment of the new medical school, and it is a great credit to him.

I also congratulate the state government. The states, having custodianship over the hospitals, have a valuable role to play in this process of moving towards a medical school located in the country. Working with the Commonwealth they have been able to achieve an outcome where New South Wales has actually given a guarantee to upgrade a number of hospitals, particularly Armidale and Tamworth, to teaching status. Obviously, you cannot teach new doctors in facilities that are not set up to embrace their education. So Tamworth, Armidale and, I believe, the Manning Base Hospital—and I think there is one other that I cannot recall for the moment—will be upgraded at a state level so that that teaching can take place.

Obviously, that will have a spin-off for people within those regions in terms of the specialists who might be encouraged to move to those regions. I think that will be a very important step forward for medicine in that part of the world but also, most importantly, for educating medical students in a country environment.

The state government has recently announced that it will be allocating $48 million over four years in recurrent funding for the allowance for the teaching component at those hospitals, plus upgrade funding of, I think, about $8 million. And only in the last 10 days there has been a commitment given to fully rebuild the Tamworth Base Hospital, at a cost of about $130 million.

All these things augur well, but it is no good having facilities if you do not have doctors, and I think the most important ingredient of all, in what I have just talked about, is the fact that the government has taken the initiative to set up medical schools in country locations. I think it will have a positive effect, over time. Too often we look for short-term fixes in this place, and I think this is one instance where we are actually trying to address a long-term problem. The outcome, regrettably, is going to take some time to achieve, but at least progress is being made.

Another issue related to the lack of professional people in country communities is the dental issue. From time to time we hear being thrown around in this place the question of whose fault the state of dental care is and who is responsible for funding arrangements. It is often said dental care is essentially a state responsibility. Most people would remember—I was not in this place at the time; in fact I was in the New South Wales parliament—Prime Minister Keating introducing some arrangements where the Commonwealth put money into the provision of dental care and the Howard government removing that. Who should be paying for the provision of dental care has been a continual political football.

One thing should be very clear and that is that oral health should be included under the Medicare arrangements—and that is a Commonwealth responsibility. There should not be a distinction based on who funded dental care, whether it was state or Commonwealth; that distinction should not run over into the Medicare arrangements. And, for the life of me, I cannot understand why oral health is treated differently to bodily health. We had one particular circumstance in my own electorate in recent months where a lady removed a tooth with a pair of pliers—and I think that lady was in this parliament only in the last few days—because she could not get access to a dentist.

There are two problems. The first is that there are not enough dentists. That leads to another issue: the training of dentists and the allocation of student places for the training of dentists, and, of those who are being trained, the numbers who are either going into research or going overseas. The retention rate of new dentists who are available to go into the Australian marketplace is quite small. We have had the foresight to look at the doctor problem and come up with ways and means of trying to address that, and now we have to look very closely at what we are doing on the dental issue.

One thing that should be done immediately, to alleviate the cost to many Australians, is that oral health—not cosmetic oral health, but oral health—should be included under the Medicare arrangements. Currently, if a patient can show that if they do not attend at a dentist it will lead to other bodily health problems, they can gain access to some Medicare funding. Now that seems extraordinarily counterproductive; it is placing policy before the needs of people when you actually wait for someone to get ill before you look after their teeth. I think, in the long term, if that was our attitude to health problems generally, the saving of money would be outweighed by the long-term cost. So I would encourage the government to revisit that issue. And I think this may well be the year that that issue is revisited, partly because of the political dimension to the issue that seems to be developing in this place and partly because of the demands by many hundreds of thousands of Australians to have some form of access to dental care at an affordable price.

We keep being told by both sides of parliament—and I agree—that we are a nation enjoying a degree of prosperity not seen before. If we cannot as a society look after our elderly and those who need their teeth fixed so that they can eat their food and survive and be productive members of the community, it really raises a number of questions irrespective of who historically is responsible for the delivery of those services. We have seen a whole range of activities, some of which I agree with and some of which I do not, where the Commonwealth has moved on the states to take away some of their responsibilities. Perhaps this is one of those areas, particularly in relation to Medicare access.

The final issue that I raise, and I have raised it before—and here again I congratulate the government, as I have before on this issue—is the multipurpose service issue, the provision of what most of us still think of as hospital services, which are traditionally funded by the state, and aged-care services, which are funded by the Commonwealth. I think this is a very good example of where both levels of government have worked well together to put in place a service delivery mechanism which is reasonably cost-effective in smaller and medium sized communities and delivers a service into those communities that was formerly under threat.

There is no doubt that in smaller communities like Emmaville, Guyra, Bingara, Bundarra, Tingha and Walcha—all of which are in my electorate—and communities such as Boggabri and others, with 500 to 2,000 people, there were pressures developing for the idea of a centralised healthcare mechanism that would provide a better way of treating those people because it saved money. The development of the MBS arrangement actually went back the other way.

I pay great credit to some people in the electorate of New England. Prior to me being the member, in the community of Emmaville a lady called Ellie Seagrave and other ladies in that community made a significant difference, not only to their particular community—and they have a great MBS at the moment—but also in terms of health policy and the delivery to other smaller and medium sized communities. The government, to its credit—and the state governments, to their credit—have embraced this policy. It is a very good example where, through working together, the objectives of health care and aged care have been achieved at reasonable cost to the budget bottom line. I pay great credit to all of those people that have been involved in structuring those processes. I think that most Australians would suggest that that particular policy decision has probably done a lot to maintain the integrity of some of those smaller communities which were very much at risk under a centralised arrangement where aged and sick people would go somewhere else because there was no local facility.

I have often been quoted as saying that if you apply a centralist approach, which is, in theory at least, the most cost-effective way to deliver the greatest number of services to the highest number of people at the lowest possible cost, you put them in a feedlot—in theory. I think that is what we have tended to do in our major urban areas. But this policy initiative reversed that, and there is a whole range of other social consequences for those smaller communities that evolved from that change in policy. I think the government should have a look at that model and start applying it in a number of other service provision areas as well. There is no doubt that it has had a positive impact on the structure and integrity of those communities by allowing the maintenance of the aged in the community that they have made a contribution to and allowing the capacity for people with low-level illness to be looked after within the community from which they come.

Luke Hartsuyker (Cowper, National Party) Share this | Link to this | Hansard source

I welcome the opportunity to speak on the Health Insurance Amendment (Provider Number Review) Bill 2007 because it gives me a chance to reflect on the importance of health in our community and how we enjoy the benefits of a wonderful health system. Many of us take good health for granted, but unfortunately some do not enjoy the blessing that is good health and are not able to lead an active life and participate fully in the community.

Last Saturday I attended a function to raise money for research into motor neurone disease. It was a very successful function attended by over 200 people. At that function they succeeded in raising in the order of $10,000, which is to be matched by the Rotary Medical Research Fund. This is going to mean a substantial boost to the funding that is being allocated to the research for motor neurone disease. I would like to compliment the Rotary clubs of Coffs Harbour, in particular Coffs Harbour Daybreak and Coffs Harbour Rotary club, for putting on this fabulous evening.

The catalyst for this function was a local Coffs Harbour resident, Steve Buckley. He is a local Rotarian, a small business man, a father and a very fine citizen. Steve, through no fault of his own, has been struck down by this terrible disease. Steve is in his mid-40s, like many of us in the parliament, and he is a fine father and a great citizen. He certainly did not deserve to be struck down by this disease. He and his devoted wife, Sharon, and their kids are showing great courage in dealing with this disease. It is a disease that we need to learn more about; it is very much a mystery.

We are very much conditioned to the thought that when we go to the doctor we will receive a prescription and whatever ailment that we have will be miraculously cured by the services of our fine medical professionals. Unfortunately that is not always the case. Motor neurone disease is a very dreadful example of just that. Steve will not see his kids grow up and he will not be enjoying life as we know it for all that much longer. He is currently dependent on a feeding tube to survive. This is indeed a great tragedy for a very energetic young man who was a musician in the local swing band and a very active contributor to the Rotary movement.

In addition to those types of diseases that we do not know enough about and that we are unable to tackle, there are a wide range of problems that we do know a lot about and for which we do have the answers, yet we ignore the signals that are being sent out. Obesity, smoking, alcohol abuse and lack of exercise are the sorts of areas in which we can make great strides with very little effort. They are areas in which, through lifestyle change, we can achieve huge improvements in health outcomes at minimal cost.

I was interested to see a report by Access Economics with regard to diabetes in Australia in which it put a price on the cost of obesity in Australia in 2005. That cost is $21 billion, and that is nearly 44 per cent of the government’s total spending on health care in the current financial year. The costs of obesity are spread across a number of portfolios, of course, but I would suggest that that is a really shocking comparison. That figure, $21 billion, is twice the Medicare funding for 2005-06 and it covers productivity losses, health costs, carer costs, lost tax revenue, welfare payments and the cost of lost wellbeing. But, broadly speaking, obesity is a problem that we could solve relatively quickly and it is a problem that, if solved, would yield huge benefits for the community.

There are great arguments to be put forward for prevention in this area. Estimates show that 20 to 25 per cent of Australian children are overweight or obese. These children are not getting the message of good food. We are making some good strides in this area, and certainly initiatives such as healthy food in canteens are very welcome ones. But it is regrettable that, despite these sorts of efforts, some of our children are slipping through the cracks. Some of our children are very influenced by the never-ending avalanche of advertising in the fast-food area that puts forward notions of fatty foods, high-sugar foods and all those foods that children like to eat but that are not necessarily good for them if eaten to excess. While the types of fast foods that are advertised on the television may be reasonable in moderation, unfortunately too many of our children are eating those types of foods to excess.

Another area of great concern is the fight against cancer. Professor Hill, the President-elect of the International Union Against Cancer, has pointed out that 40 per cent of the 88,000 cancers diagnosed every year in Australia could have been prevented by healthy lifestyles established in early life. I acknowledge and welcome the $116 million Healthy and Active Australia initiative. We need to recognise that we are up against some real challenges in this area, including the sort of advertising that is putting forward notions of high-sugar and high-fat foods. We are up against lifestyle factors, in that we all lead very busy lives and it can be difficult to find time to have enough exercise and to eat as well as we should.

Tobacco use is another area of concern. The cost of tobacco use in Australia has been estimated at $21 billion, remarkably similar to the cost of obesity. And, again, this is a health problem which is readily preventable. I know there are many people who are attempting to reduce or to give up smoking. I think the important element there is that the benefits of giving up smoking commence from the first day. As soon as someone is able to kick the habit they are immediately receiving the benefits of withdrawing from that smoking habit. Smoking has been responsible for a range of problems in our community: heart disease, lung cancer, irritation of the eyes and nose, sudden infant death syndrome, lower birth weight in babies, bronchitis, pneumonia, lung and airway infections, asthma exacerbation, middle ear disease and respiratory symptoms—a whole range of illnesses which are contributed to by smoking. I see in the chamber now the Minister for Ageing, who is a keen advocate in the fight to reduce the rate of smoking in order to achieve improved health outcomes.

I have had relayed to me the story of a heavy smoker who, as a result of smoking, had undergone intensive heart surgery. Of course he had been advised to stop smoking. He was receiving physiotherapy in the weeks after the surgery but then he confessed to his physiotherapist that he was smoking again, and heavily. This gentleman had undergone some very invasive surgery, he had received very intensive medical treatment at cost to the taxpayers and yet he was not helping himself. It is a real concern that people are unable to break these habits and take responsibility for themselves and their own health outcomes and, in doing so, are costing the community a lot of money and reducing their possible health outcomes. It is a real problem. We certainly need to do a lot more in this area. How would the physiotherapist have felt as a medical professional trying to help this person only to find that he had again taken up smoking—the very cause of the problem for which he was being treated? I think our community should expect a degree of self-help from people who are enjoying the benefit of the very good services that our medical professionals can provide. It is absolutely futile if people can continue such a habit. It is hard to comprehend that when someone had endured that sort of invasive surgery there would not be a lesson in it for them and that they would not be able to quit of their own accord far more easily. So it is a matter of great concern.

Alcohol abuse is another problem, and not only in the health area. Alcohol is a major contributing factor in traffic accidents and in areas such as domestic violence. Abuse of alcohol not only has direct health concerns associated with it; it also produces a whole range of other social problems. So there are some lessons in this for us as a community. We really need to try much harder in the area of prevention. It is an adage that ‘prevention is better than cure’, but I think we can make some really great gains if we put a lot more effort at the preventative end. We can make some really great gains by helping people to combat obesity, to reduce or eliminate smoking and to deal with the issue of alcohol in a responsible way.

We should certainly be pursuing those goals much more actively. That is not to say that the state and federal governments have been inactive but I believe we can do a lot more. We can leap further in this regard. We can certainly, quickly and effectively, start to reduce our hospital waiting lists—not necessarily by putting more resources into acute treatment in our hospital wards but by having more effective preventive methods in place, by having much more effective preventive strategies which will stop people being admitted to hospital in the first place. That is something on which we should be working much harder.

If we look at the area of cardiovascular disease, the facts are really quite astounding. The problem of cardiovascular disease is really quite staggering, the causes of which are well documented. I would like to reflect on a few for a moment. An Australian dies every 10 minutes from cardiovascular disease. Thirty-eight per cent of all deaths from stroke and heart failure have cardiovascular disease as a major contributing factor. Of the 50,292 people who died in 2004, 60 per cent had not reached average life expectancy, which was itself largely driven by cardiovascular disease mortality. We know what the factors are, but for some reason we seem to be ignoring the warnings. As I said, prevention is better than cure. We need to work much harder in the area of preventive medicine. We need to be very much focused on adjusting lifestyle, getting people to take responsibility for their actions, making sure that they take the steps they need to take to ensure the right health outcomes. Probably the most effective health practitioners for many people in the community are themselves. Rather than depending on our health professionals to cure the ills, it is very much up to the individual to take the lead on this.

I welcome the opportunity to speak on this bill. The issue of preventive medicine is very important, and it is one on which we need to work a lot harder.

Christopher Pyne (Sturt, Liberal Party, Minister for Ageing) Share this | Link to this | Hansard source

I thank the members of the House who have participated in this debate—the members for Gellibrand, New England and Kennedy, and the members for Moreton, Dobell and Cowper. I am here on behalf of the Minister for Health and Ageing in order to sum up the second reading debate on the Health Insurance Amendment (Provider Number Review) Bill 2007.

This bill proposes an amendment to the Health Insurance Act 1973 relating to the arrangements for reviewing the operation of sections 19AA, 3GA and 3GC of the act, collectively known as the Medicare provider number legislation. The Medicare provider number legislation contained within section 19AA of the act was introduced in 1996. While it was initially considered to be contentious legislation at the time of introduction, all subsequent formal reviews of the legislation have found that the legislation continues to be well accepted and is raising the quality of general practice services to the community. There is also broad agreement that the operation of section 19AA of the act has not exacerbated any medical workforce shortages. The bill proposes to retain the review process but to change the review interval from two to five years, with the next review report to be tabled in parliament no later than 31 December 2010.

Question agreed to.

Bill read a second time.