Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I move:

That this bill be now read a second time.

Australians are rightly proud of Medicare and of the committed group of doctors and other health professionals who deliver Medicare services.

Bulk billing is the beating heart of Medicare and after nine years of cuts and neglect by the former government, we know it's never been harder or more expensive to see a GP.

The government is making Medicare stronger for all Australians, delivering critical funding, and investing in reform for the healthcare system of tomorrow.

This budget delivers more than $6 billion in new investments to strengthen Medicare, as well as an indexation boost to Medicare rebates of more than $1.5 billion—delivering the biggest increase in 30 years.

The centrepiece of our Strengthening Medicare package is $3.5 billion to triple the bulk-billing incentives for GP visits—the largest ever investment in bulk-billing incentives.

In our major cities, it means a 30 per cent increase in the payments to a bulk-billing GP.

In rural areas and regional centres like Cessnock, the increase to bulk-billing GPs will be around 50 per cent more.

Families and pensioners will all get free trips to the GP because of this record investment in bulk billing.

Five million children and their families and seven million pensioners and concession card holders will all benefit from the increase to bulk-billing incentives.

This historic investment means three out of five visits to the GP will be bulk billed.

Only a Labor government strengthens Medicare. And Strengthening Medicare also means safeguarding the taxpayer funds that underpin it and this government is committed to that task.

The Health Insurance Amendment (Professional Services Review Scheme) Bill 2023 responds to the Independent Review of Medicare Integrity and Compliance undertaken by Dr Pradeep Philip, known as the Philip review. The Philip review was commissioned by the government last November to respond to concerns about the operation of the Medicare system.

While the Philip review found that most health professionals are well meaning and protective of the health system, it also noted that changes are needed to modernise the compliance system underpinning Medicare to ensure it remains rigorous and effective.

The government is committed to protecting the integrity of Medicare. This bill makes several priority amendments in response to recommendations from the review.

The measures in this bill will strengthen the operation of the Professional Services Review, known as the PSR, as well as improving the effectiveness of the current process for auditing payments relating to Medicare services.

In essence, the bill:

The PSR is an independent statutory agency responsible for protecting the integrity of the Medicare program by investigating whether a person has engaged in inappropriate practice. In doing so, the PSR protects patients and the community in general from the risks associated with inappropriate practice.

The PSR addresses the behaviour of a person who may have engaged in inappropriate practice through a review by the director or by committees made up of clinical professional peers.

Currently, the director of the PSR cannot be appointed without the agreement of the AMA. The government considers that this veto power is not consistent with public expectations and undermines confidence in the independence of the PSR as a regulator. This veto power has also never been exercised, raising further questions of the need for this requirement. Given the potential conflict between the PSR's objective to safeguard Medicare and the AMA's role in representing the interests of medical practitioners who may be subject to PSR review, it is appropriate for the veto power to be removed. The bill will also enable direct consultation with relevant medical peak bodies regarding appointments of deputy directors and panel members of the PSR, instead of making arrangements for the AMA to coordinate and provide advice, as is the current requirement.

Similarly, the bill removes the requirement to consult with the AMA on the appointment of the chair and other members of the determining authority. Instead, the minister is to consult directly with relevant peak bodies on appointments of medical practitioner members of the determining authority, which is consistent with current requirements for other health practitioners subject to the PSR arrangements.

These changes will remove potential conflicts of interest to enhance public perceptions of the PSR Scheme and ensure the PSR process can operate with impartiality and independence.

Allowing for associate directors to be appointed will also improve the PSR process by managing conflicts of interest, unexpected absences, and high case volumes. The director of the PSR is currently the sole decision-maker for most aspects of the PSR Scheme. There is no contingency in place if the director is unable to make decisions on a particular matter due to a conflict of interest or if they are otherwise unavailable. To address the risk that a case may lapse if a statutory time limit passes while the director is unavailable to make a decision, the bill makes provisions for a new statutory office of associate director.

The bill will provide for multiple associate directors to be appointed on a full or part-time basis which will allow for the recruitment of more wide-ranging medical expertise. An associate director would be able to review inappropriate practice in the same way as the director and make relevant decisions such as whether to enter into a written agreement with a person under review or to refer them to a committee of their peers.

Associate directors will not have any functions relating to the administration of the PSR. The director will remain the sole statutory agency head and the accountable authority under the Public Governance, Performance and Accountability Act 2013.

Finally, the bill will remove the need for engagement with stakeholder groups about documents relevant to substantiating Medicare payments, as a prerequisite for issuing a notice to produce documents during an audit. This amendment will strengthen and speed up Medicare compliance functions, without limiting the types of documents a person may provide during an audit of payments.

Importantly, this change will not have any impact on procedural fairness requirements for a person being audited. There will continue to be an opportunity for the person to make submissions about their compliance matter and to provide any information or documents they consider relevant.

Robust structures to identify and address noncompliance and inappropriate practice are essential to ensure that Commonwealth resources are directed to necessary health services and to ensure that Medicare remains sustainable. By supporting the integrity of Medicare, this bill will ultimately benefit all Australians.

The former government was given five separate reviews, including from the Australian National Audit Office, that told them billions of dollars in taxpayer money was being lost each year. They failed to act to protect Medicare.

Australians know that the overwhelming majority of our doctors and health professionals are honest, hardworking and comply with Medicare rules.

But they also understand that, at a time of great pressure on household and government budgets, every dollar in Medicare is precious and must be spent directly on patient care.

Strengthening Medicare means safeguarding the taxpayer funds that underpin it and this government is committed to that task.

Debate adjourned.