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.

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.

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.

Strengthening Medicare means safeguarding the taxpayer funds that underpin it, and this government is committed to improving the compliance framework that ensures the integrity of Medicare.

The Health Insurance Amendment (Professional Services Review Scheme No. 2) Bill 2023 builds on the Health Insurance Amendment (Professional Services Review Scheme) Act 2023, which implemented priority amendments in response 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 in November 2022 to respond to concerns about the operation of the Medicare system.

While the Philip review found that the majority of health professionals are well meaning and protective of the health system, it recommended a comprehensive review of legislation relating to Medicare to ensure it is fit for purpose, including amending legislation that hinders the effectiveness of compliance activities.

This bill will strengthen the operation of the Professional Services Review, known as the PSR, by addressing ambiguities and issues in the legislation, which will protect the integrity of Medicare.

The PSR is an independent agency established under the Health Insurance Act 1973 and is responsible for protecting the integrity of Medicare 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 and protects the Commonwealth from having to meet the cost of services provided as a result of inappropriate practice.

The PSR investigates inappropriate practice through review undertaken by the director of the PSR and in some cases by a PSR committee made up of health professional peers of the person under review.

A key amendment in this bill relates to the requirements for qualifications of committee members. The legislation was intended to ensure that members of a committee would be peers of the person under review and have the appropriate skills and experience to assess their provision of services. However, current requirements are too strict to account for a practitioner with an unusual combination of specialties where there may be fewer than ten practitioners in Australia with the exact same qualifications. In such cases, it has been very challenging to establish a committee with similarly qualified members who do not have any conflicts of interest.

Further, the current requirement for committee members to have the same qualifications as the practitioner has led to incongruous outcomes if the practitioner is providing services in a different field from their formal specialist qualifications. This is also inconsistent with the purpose of the definition of inappropriate practice, which requires consideration of whether a practitioner's conduct in providing services as one kind of practitioner would be considered unacceptable to the general body of that kind of practitioner.

To resolve both issues, the bill will amend the requirements for committees to better align with the definition of inappropriate practice, that is, if a practitioner was providing services as one kind of practitioner, the members of the committee must also be that kind of practitioner. The bill will also clarify that the requirements are met for a person providing services as more than one kind of practitioner if each committee member is at least one of the relevant kinds of practitioner and the committee members are, in combination, practitioners of each of the relevant kinds. For example, if a person was providing services as both a cardiologist and a paediatrician, one committee member could be a cardiologist and the other a paediatrician, or both committee members could be dual-qualified as both cardiologists and paediatricians.

A related change will also clarify how to apply the definition of inappropriate practice, that is, if a practitioner was providing services as more than one kind of practitioner, the test for inappropriate practice is whether their conduct would be unacceptable to the general bodies of each kind of practitioner.

The bill also makes several other amendments to clarify and improve administration of the PSR Scheme, including to:

Clarifying these matters will ensure that a person under review is clearly aware of how the PSR Scheme should apply to them, and enable the PSR to perform its role more effectively. The PSR must be able to work efficiently to achieve its objective to protect patients, the community and the Commonwealth from the risks and costs of inappropriate practice. This is 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.

A stronger Medicare means stronger safeguards that protect Medicare and the taxpayer funds that underpin it and the Albanese government is committed to that task.

Debate adjourned.