Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 proposes to alter the operation of section 19AB of the Health Insurance Act 1973. Section 19AB of the Health Insurance Act came into force through an amendment made to the act in 1996. In the early to mid-1990s the prevailing view within the Hawke-Keating government was that Australia produced enough medical graduates to meet the nation’s health needs. Indeed some, including the then health minister, Graham Richardson, thought that there were too many doctors when in fact shortages were emerging. When the Howard government came to power in 1996 it set out to correct those problems. Section 19AB was one of the changes implemented. Overseas training doctors who started to work in Australia from 1 January 1997, if they wished to access Medicare benefits for their services, needed to practice in rural and remote areas, areas of health workforce shortages, for a period of 10 years. It became known as the 10-year moratorium.

The purpose was, and remains, to influence distribution of the medical workforce in rural and remote areas of Australia, ensuring communities in remote locations have access to medical services. It is generally agreed that the requirements have been successful and have had significant and beneficial impacts on workforce outcomes. Indeed, overseas trained doctors have been fundamental to the continued delivery of healthcare services in many remote communities and have become valued members of those communities.

The government’s audit last year of the rural health workforce revealed that this policy had made a difference to health services being provided in the bush and the minister acknowledged, in introducing this bill, that it has proven to be an effective mechanism to providing services to communities with the greatest needs—so much so that 41 per cent of doctors in rural and remote Australia have been trained overseas. Many communities are reliant on these medical practitioners and would not have practising GPs without them.

The main provision of this bill will make it easier for New Zealand doctors to work in Australia. It will remove the 10-year moratorium restrictions on New Zealand citizen and permanent resident doctors trained at New Zealand or Australian medical schools. The change effectively removes these doctors from the classification of ‘overseas trained doctor’ and ‘former overseas medical student’ in section 19AB of the Health Insurance Act. The other significant change in this legislation is to alter the commencement date of the 10-year moratorium on overseas trained doctors. It will remove the requirement for overseas trained doctors to have both Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium period to commence. The changes will see the moratorium commence from the time a medical practitioner is first registered, to recognise that some overseas doctors work in Australia for several years on a visa before seeking residency or citizenship. The government makes these changes at the same time as it intends to scale back the moratorium, with 3,600 overseas trained doctors able to shorten the term of the moratorium from July next year by serving in the most remote locations. The coalition will watch the impact of that particular measure closely.

The coalition has long been concerned with ensuring provision of medical services in regional and remote areas of Australia. Apart from introducing section 19AB of the act, which this bill will amend, the Howard government established key and innovative programs to encourage medical professionals to train and establish practices in regional areas. Indeed, in the first budget of the Howard government in 1996-97, the then government established University Departments of Rural Health programs. They exist now in 11 regional locations and an evaluation carried out last year—10 years after their inception—found that they have made a significant contribution to rural health outcomes and influenced rural and remote practitioners to remain in practice.

The Rural Clinical Schools program followed in the year 2000 and 10 of these schools were established in that first year. Another four were launched in 2006-07. Clinical schools enable medical students to undertake extended blocks of training in regional areas. Again, the review of these programs commissioned by the Department of Health and Ageing last year found that the RCS program has delivered convincingly and with the University Rural Health program was contributing to enhancing the rural health workforce. The full worth of the RCS program will only start to become evident in the next few years as its early cohort start establishing themselves in medical practice. The rural health workforce will also be boosted by students assisted under the Bonded Medical Places scheme. Hundreds of medical students have been provided with financial help, which will see them work for six continuous years in rural and remote areas.

Given the long lead times in producing medical graduates, it is only in this current financial year that the first of these doctors will commence their return of service obligation in rural areas. The current government, as much as it seeks to denigrate the former coalition, will in fact reap the benefits of the forward-thinking policies of the former government. Generally across the health workforce increasing numbers of health professionals will be graduated from the nation’s medical schools over the next few years. All of these students will have begun their career path under the coalition government. It is hoped that significant numbers of them will consider practising in regional Australia and thus contribute to alleviating the uneven distribution of the health workforce, which unfortunately disadvantages those living outside major centres. This bill has wide support across medical representative bodies. The coalition supports these changes to the legislation.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Until the mid-1990s, it was commonly the perception amongst the Australian public that we could produce our own doctors in sufficient numbers to ensure that our population, as we continued to grow in the seventies, eighties, nineties and beyond, could cope—that we produced enough graduates. Then in the 1990s and beyond we decided to make it more difficult and more restrictive for people to train as general practitioners and specialists. We often insisted on primary degrees before medical degrees could be undertaken. In regional and remote areas, particularly places in my area of South-East Queensland such as Somerset, Fassifern and the Lockyer Valley, it was clear that there were increasing problems getting doctors into those areas.

I served on the health community council for the Ipswich and West Moreton area for the best part of 10 years. During that time I chaired the Esk health reference committee and visited all those regional hospitals at Boonah, Laidley, Gatton—subsequently when I was a candidate, in respect of Gatton—and also the Esk hospital on numerous occasions as well as Ipswich General Hospital and other facilities. It became very obvious to me and to many people in South-East Queensland outside of the Brisbane metropolitan area that we simply did not have enough doctors. There were not enough doctors and not enough doctors with the right to practise. It was increasingly difficult no matter what we did in terms of expanding the remuneration packages and whether or not we could give a right to private practice if they were linked to that hospital to bring doctors and their families to those areas. This is a real problem for rural and regional Australia, particularly for areas outside of Ipswich, in places that are between Ipswich and Toowoomba, up through the South Burnett as well, up in the Kingaroy and Nanango areas.

Legislation and funding which enables greater accessibility and more doctors to be brought to those areas is good legislation and worthy of support. Both sides of politics were a little short sighted when it came to looking at doctor training. Certainly I do not share the member for Dickson’s appreciation and belief that the Howard government was strongly committed to the health system. That was not the evidence of the Institute of Health and Welfare before the last federal election in October 2007 when effectively it said very clearly and categorically that the Howard government had failed with respect to the health and hospital system and that the states, territories and private providers had to take up the slack where the Howard government had failed.

But there is a disproportionate response in terms of the practice of doctors throughout the country. More doctors can be found in Sydney, Melbourne and Brisbane than there should be. There should be more doctors in places like Kingaroy, Nanango, Laidley, Esk and Gatton. The people in those areas deserve just the same kind of health care and hospital accessibility as people who live in our major capital cities. This legislation, which effectively opens up the right to practise and effectively allows it to be easier for New Zealand residents who are medical practitioners to practise and to get a right to practise in Australia, is worthy of support.

About four years ago the local division of general practice in my area, along with the University of Adelaide, commissioned a report looking at doctor numbers and the needs of the Ipswich and West Moreton community. Bear in mind that Queensland, according to the latest Australian Bureau of Statistics data, grew by 2.6 per cent and the Ipswich area grew by 4.1 per cent in the last 12 months. It goes to show that in the very fast growing area of South-East Queensland we need more and more health services, more and more doctors, more and more nurses and more and more allied health professionals. Four years ago that study found that we had one GP for every 1,609 people living in the Ipswich and West Moreton area. That is simply not good enough, particularly as it found that in the next five to 10 years about one-third of the GP workforce would retire. We have seen numbers increase in the areas west of Brisbane, but it is simply not good enough. Legislation here that will go towards increasing the number of doctors, particularly New Zealand doctors, able to practise is warmly welcomed.

Most overseas trained doctors come to Australia through a temporary skilled visa category for an initial period of up to about four years. We saw that in the category of visa called the temporary medical practitioner visa subclass 422. It was extended from two years to four years in 2003, and since 2005 doctors have entered Australia via the subclass known as the 457 visa. In fact, the New South Wales health department for a long time has been one of the biggest users of 457 visas in the country.

Overseas trained doctors and former overseas medical students who were first recognised after 1 January 1997 have been restricted from providing professional services that attract Medicare benefits for a period of 10 years. As the shadow minister correctly noted, it is commonly called the 10-year moratorium. New Zealand citizens and permanent resident doctors practising in Australia are likewise subject to that restriction. A bit of history is important because a lot of people think that with Australia and New Zealand it is easy to enter one country or stay in the other, but in fact it was in 1973, under the trans-Tasman travel arrangement, that New Zealand and Australian citizens were first entitled to rights to visit, live and work in each other’s countries without the need to apply for any authority to do so. Changes in the Migration Act 1958 in September 1994 required all noncitizens lawfully in Australian to hold visas; however, this led to the introduction of a special visa category which is known in Australia as the Australian special category visa.

So, when a New Zealand citizen comes to, say, the Brisbane international airport and goes to line up, there is a sign which says ‘Australian and New Zealand citizens’. They waltz in there, present their passport at immigration and it is considered that they have made application for a visa. There is examination of their status in terms of health and character considerations, but automatically they receive that visa. Of course, there is a check to see if they are subject to criminal sanctions, prosecution or arrest or whether there is anything to be considered in relation to, say, the Hague convention on child abduction. It is not necessary for a New Zealand citizen who holds that special category visa to apply for or be granted permanent residency in Australia, because they are accepted.

We have hundreds of thousands of New Zealand citizens in Australia and they enrich our lives, our communities and our country. We see the benefit of New Zealand citizens in this country who contribute to our economy and pay taxes and participate in our community lives, in our sporting clubs, in our charitable institutions, in our churches and in other institutions in our community. We accept them as our brothers and sisters from across the Tasman. Perhaps it is only in circumstances when we play sport against them, particularly when they wear black shirts and are known as the All Blacks, that we are particularly aggressive and vociferous concerning our sisters and brothers from across the Tasman who are living in Australia. Sometimes I wonder whether we should cease to play Rugby Union tests in Melbourne, because they do not know anymore that, in fact, they are home games for us!

Getting back to the legislation before the House, it looks to streamline the operation of section 19AB of the Health Insurance Act and remove some irregularities which are there. I will go through those. The main provisions in this bill relate to removing restrictions applicable to doctors who are New Zealand permanent residents and citizens and who obtain their primary medical education at an accredited medical school in New Zealand or Australia, such as, for example, the University of Queensland St Lucia campus in Brisbane or over in Dunedin, Christchurch or Auckland. The change effectively removes these New Zealand citizens and permanent residents from the classification which we call an overseas trained doctor—or, indeed, a former overseas medical student—whom we are henceforth going to call a foreign graduate of an accredited medical school. That change will be reflected in section 19AB of the act.

This is being done because there is a lack of correlation between the Australian Citizenship Act 1948 and the Migration Act. The Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with so many of the benefits and rights of Australian citizenship. As I said before, they can live here without the need to obtain a permanent residency visa. However, the Health Insurance Act requires the Department of Health and Ageing to refer to the Migration Act 1958, which is the authority for determining status concerning residency. Regrettably, the Migration Act categorises New Zealand citizens and permanent residents to be temporary residents of Australia and, correspondingly, New Zealand doctors are considered to be overseas trained doctors if they were first recognised as medical practitioners, as so many of them were, after 1 January 1997.

What we are doing here is changing that. The bill will change the eligibility for New Zealand residents, but it is also going to help Australian doctors who are trained here in Australia. Schools which are accredited by the Australian Medical Council will be considered as having the same standards as the Australian medical schools. It is going to benefit Australian doctors across the Tasman and it is also going to benefit New Zealand doctors in Australia.

That is a good thing because it effectively means that they can easily get access to the rights to a medical practice and can practise and operate in those rural communities. Indeed, I simply do not know how we can provide adequate services, particularly in rural and regional Queensland, without the benefit of overseas trained doctors, as the shadow minister also said. If we can add more medical practitioners to those areas by allowing New Zealanders, citizens and permanent residents, to practise in those areas, it will benefit the health needs of those rural and regional communities.

There are a number of other changes and I will go through those briefly. We are amending, as I said before, the term ‘former overseas medical student’. The term ‘former overseas medical student’ is sometimes misunderstood and is not clear to many people. It is a strange term. It has been renamed ‘foreign graduate of an accredited medical school’, which I think is beneficial and certainly removes the confusion. The other thing that the bill does, which I think is beneficial, is amend section 19AC of the act. It introduces a period in which medical practitioners can apply for a review of a decision to refuse or grant an exemption or impose conditions under section 19AB. At the moment, there is no such time limit, so the whole thing can drag out for an endless period of time. Certainty and specificity is important.

This legislation is helpful, both nationally and to my community. I had the privilege of hosting, with the University of Queensland, Ipswich campus, a health forum in my area where these issues were discussed. I want to pay tribute to Professor Helen Chenery, the Deputy Executive Dean, Academic, at the University of Queensland in the Faculty of Health Sciences, for assisting me in putting on that forum. Issues such as the need for more doctors in our area were discussed. The need for equity and the need for access to better health care were topics of much discussion at that forum, as was the need for empowerment of consumers. If you get more doctors who are willing to practise and want to work in particular areas, you will improve health care and you will make consumers of health services feel that they are more important. You will make them feel that they are accepted and not put away. Seven million Australians live in regional and rural areas—that is, nearly a third of all Australians live outside the metropolitan area. We cannot afford to forget them. They need the kind of health care that all of us should enjoy. I think Australians believe that, when it comes to access to health care, everyone should get a fair go. What we need to think about seriously is the regions in which these kinds of doctors that we are talking about can go to, where there can be greater innovation, and access the right to practise and also the ability to collaborate with other allied health professionals.

I mentioned the University of Queensland, Ipswich campus, and the health forum. I mentioned how people discussed the need for more doctors to come to our area and how this legislation will impact and help. That site will be the location of the GP superclinic—a fulfilment of the Rudd Labor government’s election commitment made by the then shadow health spokesperson, Nicola Roxon, now Minister for Health and Ageing. Nicola Roxon came to Ipswich during the last federal campaign and made a commitment that we would deliver a GP superclinic. We estimate that can deliver somewhere between 12 and 14 doctors. I imagine there will be New Zealand doctors who will work at that particular clinic. That clinic will have a very strong focus on obesity, which is a chronic problem in my area, as well as type 2 diabetes, which is an increasing challenge for electorates across the country. We need doctors. Having more New Zealand trained doctors would be beneficial in my area as well as having more overseas trained doctors who are fluent in English and have sufficient proficiency and qualifications to practise as doctors in regional and rural Queensland.

The legislation that we have before us today, which we are examining and I hope will pass, is part of the matrix of what the Rudd Labor government wants to do with respect to health care reform. I commend the government for what it has done with respect to the National Health and Hospitals Reform Commission. The health forum in Ipswich that I mentioned was just one of dozens which have been undertaken across the country by the Minister for Health and Ageing and, indeed, the Prime Minister, who has gone to many. The final report of the National Health and Hospitals Reform Commission says that our health system has many strengths, but it has many weaknesses as well. We need to alleviate the increasing pressure on the health system with additional funding and changes of governance and structure. As our population grows, and it is growing rapidly, we will face greater health needs. In this country we are facing a demographic tsunami as our population grows older. We will have many challenges. We will have challenges to cope with, with an ageing population, but we will also see an increase in our birth rate. We are seeing that in my area. Bringing doctors from across the Tasman into my area will benefit the people in my community. Anything that we can do to assist in primary health care, with a greater emphasis on acute care and preventative care, is important. Spending less than two per cent of our health expenditure on preventative health is simply not good enough. In the future we need to make sure that our doctors, whether they come from New Zealand or overseas or whether they are trained locally, have a greater emphasis on preventative health care as part of their primary education. That should be a focus. I commend this legislation to the House. (Time expired)

Harry Jenkins (Speaker) Share this | Link to this | Hansard source

Order! It being 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour.