Wendy Askew (Tasmania, Liberal Party) Share this | Hansard source

I rise again to continue my contribution on the Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019, which will amend the Health Insurance Act 1973 by introducing a statutory scheme to administer the reformed bonded medical programs from 1 January 2020.

There are currently 9,406 program participants studying at medical schools or in prevocational training under the older programs—the Bonded Medical Places Scheme and the Medical Rural Bonded Scholarship Scheme—with a further 623 participants undertaking their return-of-service obligations. These participants will have the option to opt in to the new arrangements from 1 January 2020, and those who choose to stay under the existing arrangements will also be able to do so.

As the program matures, up to 700 doctors are expected to commence their return-of-service obligations in rural, remote and regional Australia each year over the next five to seven years. To be eligible to participate in the reformed bonded medical programs, a person must have accepted a bonded Commonwealth-funded place in a course of study in medicine at an Australian university. They must be an Australian citizen or permanent visa holder and agree to participate in the program using a web portal maintained by the department.

Under the new statutory scheme, participants will be required to work as a medical practitioner in eligible locations for a total period of three years. The three-year return-of-service obligation is half of the six years required under the previous Medical Rural Bonded Scholarship Scheme and a reduction of between one and three years for previous bonded medical programs scheme participants who entered the scheme in 2015 or earlier. Participants in the bonded medical programs scheme who entered the scheme in the years 2016 to 2019 agreed to a 12-month return-of-service obligation. These participants will retain their 12-month return-of-service obligation under the new statutory scheme should they voluntarily opt in.

Under the new scheme, the return-of-service obligations must be completed within 18 years from when the participant completes their course of study in medicine at an Australian university, but they may be completed by a series of periods. The period of 18 years to complete the return-of-service obligation may be extended in limited circumstances only where a participant or a family member has a medical condition that prevents that participant from completing their return-of-service obligation within the time frame. A participant will be subject to a number of conditions, including that they must complete their course of study in medicine at an Australian university. The return-of-service obligation must be completed in accordance with the rules, and the participant must give their information or documents to the department in particular circumstances. These are necessary safeguards to protect our investments in these participants.

Should a participant withdraw from their course of study in medicine after the census date for the second year of study, that participant will be liable to pay the Commonwealth the cost of the participant's course of study for the year or part year—semester—of study undertaken, plus interest. Where a participant does not complete their return-of-service within 18 years from completion of their course of study or an extended period, that person will be liable to pay the Commonwealth the cost of the person's course of study that was funded by the Commonwealth, less a pro rata proportion of the return-of-service completed.

Under the new statutory scheme, medical benefits will not be payable to an MRBS participant who becomes a participant under the new statutory scheme and does not complete their return-of-service within 18 years. Medical benefits will not be payable for six years from the day that breach occurs. Further, under the new statutory scheme a participant may be liable for an administrative penalty of $10,000 if the person fails to comply with the condition to provide the department with information or documents. This administrative penalty is considered to be a debt due to the Commonwealth and may be recovered, if needed, by the Commonwealth.

A participant will be able to withdraw from the bonded medical programs at any time by notifying the department using the web portal maintained by the department.

As I said earlier, these are necessary safeguards to protect our investment into these doctors, and they will protect the integrity of the scheme. However, the changes being made to the bonded medical programs are welcome. They will encourage young people interested in a career in medicine to work in more remote, rural and regional areas of our beautiful country. It will expose them to a different kind of medical practice and give them valuable experience for wherever their career may take them.

Doctors in rural and regional areas often become integral members of their communities, particularly in those small towns, often many kilometres from the nearest hospitals. Their families live in the community. Their children go to the school in the local area, and they go to the local church. They are members of the local sporting teams. They get involved in their community. Their days are not just nine to five working days; they work long hours and they're always on call. They can be exposed to situations where their patients are suffering serious life-threatening conditions and it may be some time before emergency service personnel can assist them. They are often the unsung heroes of their town. In the small regional and rural towns in my home state of Tasmania—Deloraine, Westbury, Bicheno, Smithton, Ross, Strahan, Wynyard; the list goes on—they understand this and they truly appreciate and value their local GPs.

Through the return-of-service obligations, this bill will provide doctors with exposure to a regional, rural and remote location. My hope—and I am sure the intent behind this bill—is that these doctors will settle into their community and find a love for their community. The ultimate outcome may well be that they will understand and enjoy the value they bring to the people within the community and will then decide to stay and put some roots down for many years to come.

I referenced Senator Brockman's contribution earlier in my contribution last night, and I note his comment:

In Western Australia alone there are just over 300 medical vacancies, 115 of them being GP positions, in regional areas.

This situation is reflected across the country, with similar statistics in most states and territories. He also acknowledged:

GPs in those country towns are of absolutely vital importance. They're such a central part of a small town's life and existence. In the city it is easy to ignore or forget or not realise what a central component to life in the bush those GPs are.

I cannot agree more with Senator Brockman's sentiments. Those of us who are fortunate enough to be able to pick up the phone and ring the doctor's surgery and get an appointment that day and feel a huge sense of disappointment if we can't get in for a couple of days should reflect on the experiences those in the rural and regional areas of this country experience.

The coalition government has clearly demonstrated its support for the rural and regional communities of this country, particularly those in drought and flood affected regions. As I mentioned yesterday, the public health system in Tasmania is struggling under the increasing demand and increasing cost of delivering medical services. The coalition government is clearly working hard to make sure that we are helping people in the rural and regional communities of this country, and the changes to the bonded medical programs reform is a great initiative. I strongly urge all senators in this chamber to support this bill.