George Campbell (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to incorporate Senator McLucas’s speech.

Leave granted.

Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Link to this | Hansard source

The incorporated speech read as follows—

I rise today to speak to the Health Insurance Amendment (Provider Number Review) Bill 2007.

This Bill proposes that the biennial review process contained in section 19AD(1)—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 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 by the Health Insurance Amendment Act (No. 2) 1996 in December 1996.

Section 19AA requires that medical practitioners who first obtained registration in Australia after 1 November 1996 have to satisfy minimum proficiency requirements, having either obtained a fellowship as a specialist, a consultant physician or a general practitioner, or registering 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 functions are to compile information on the numbers of medical practitioners who are enrolled in, or undertaking, courses and programs, and 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 Minister Wooldridge gave his Second Reading Speech on the Health Insurance Amendment Act (No. 2) 1996 he outlined the Government’s policy rationale underpinning the introduction of the sections outlined above:

Firstly, he argued then 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 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 4000 more doctors than our population would require.

Finally, the then-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. And 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 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 with an undersupply of GPs in rural and remote areas. Since then the situation has changed to an across the board undersupply of GPs, with shortages most acute in rural and remote areas and now also in many outer metropolitan areas.

We’re seeing this sort of problem across the country, where insufficient planning by the Howard government has resulted in doctor, dentist and nurse shortages impacting on the health of communities.

This is particularly so in regional, rural and remote Australia.

But the overall undersupply of GPs is all of this Government’s making.

Health workforce planning has been limited and ineffective in the life of the Howard Government.

Whilst health workforce planning is a complex task but we all know that it takes at least 10 years to train a GP. We also know that the increase in the number of female GPs resulted in overall less hours of practice. This is in no way a criticism of those women doctors. Their more family friendly work practices are to be commended and are also being adopted by their male counterparts.

It takes 10 years to train a doctor.

There are more women training and practicing as GPs. We know the ratio of GPs to potential patients by region. We know the number of specialists who are being trained.

There can be no excuse for the dire undersupply of GPs.

This undersupply can be sheeted directly home to poor planning by the Howard Government.

The introduction of section 19AA in 1996 was met with widespread concern among the profession that the new provision may adversely affect the future employment prospects of medical students and interns who were already in the system.

To address these concerns, and as a result of amendments in this Chamber, 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 requires that the impact of sections 19AA, 3GA and 3GC of the Act to be reviewed on a biennial basis, with a report 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 sections 19AA, 3GA and 3GC of the Health Insurance Act. 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. This 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 the Parliament by the Minister no later than 31 December 2010.

So the major change is the period of review.

It is significant to note the 2005 review, for the first time, commented on the level of support for the review process itself. Notably, the review found “unanimous support for the continuation of the Biennial Review process” which was seen as “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 1973”.

The review noted that some stakeholders considered that the reviews were too close together—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.

Notably, the report stated that “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. Such a proposal was neither flagged nor recommended by the 2005 Review process.

We have heard speculation from some stakeholders that these changes to the review process will in due course be followed by amendments to the operation and mandate of the Medical Training Review Panel which operates under section 3GC. Perhaps that speculation provides some explanation for the options that the government is pursuing. Typical of this government, it has not been forthcoming with this information.

Having said that, there is evidently support amongst some stakeholders for a longer interval between reviews, and the Government’s assertion that the legislation is less contentious than it once was appears from recent reviews to be legitimate.

The Explanatory Memorandum to this Bill states that the review process takes nine months to complete and requires significant Departmental staffing resources. The 2005 review process cost the Department $80,000 (including an independent reviewer, transport and accommodation costs) and required the full-time secondment of two full-time senior Departmental officers for approximately nine months for secretariat duties. According to the Minister’s second reading speech “In total, the 2005 biennial review process exceeded $180,000.”

With the changes proposed in this Bill the Government contends that “this financial impact will be incurred every five year rather than every two years”, a modest saving that Labor supports.

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.

George Campbell (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to incorporate Senator Sterle’s speech.

Leave granted.

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

The incorporated speech read as follows—

I rise to speak to this Bill which proposes that the two year review process of the Medicare provider number legislation, contained in section 19AD(1) of the Health Insurance Act 1973, be replaced with a review process every five years.

Before I go on to outline my concerns about this Bill, I would like to draw the attention of Senators to the Government’s response to a number of facts and figures I presented when I spoke last week, on a package of private health insurance bills being moved by the Government.

To illustrate my points, I relied on officially published statistics from the Australian Institute of Health and Welfare, as I intend to do again today.

Upon the conclusion of my speech Senator Brandis labelled my contribution as “silly”.

When confronted with the facts, the best Senator Brandis could do was to try to gloss over them with nothing other than petty school boy taunts.

I can tell you that having toughed it out with the best of them at Thornlie Senior High School in the 1970s, getting inane comments thrown at you from the likes of Senator Brandis is like a touch up with a scented silk handkerchief. All Senator Brandis proved is that Government Senators have nothing of substance to say when presented with the facts about how they have failed Australians in the last 11 years.

The Bill I rise to speak on today is about doing even less. And hasn’t this been a trademark of the Howard Government.

As far as medical services are concerned, this Government has spent more and done less. So if it wants to do less about monitoring the provision of medical practitioner provider numbers it will be simply following the pattern of the last 11 years.

When the Howard Government came into office it started on its course of trashing the things that are so important to the lives of Australians, young and old.

Let me tell you—and the Australian people need to know this—that under this Government, Australia’s GP workforce has gone into free fall. It is critically ill and this is easily illustrated.

At the risk of more schoolyard taunts from some of the sillier Senators opposite, and that’s a risk I am more than prepared to take—I refer Senators to the Howard Government’s own statistics, which show that in 1995/96 20% of Australia’s GP workforce were over the age of 54 years.

In the 2005/06 Government statistics this figure is shown to have risen to 32%. If this pattern continues almost a third of Australia’s GPs can be expected to leave the workforce within the next 10 years. Who is going to replace these doctors? The fact is, we don’t know. Over the past 10 years there hasn’t been enough young doctors entering the GP workforce to replace those who will leave.

In 1995/96 17% of the GP workforce was under the age of 35 years. In 2005/06 this figure had fallen to 7%.

This is a disaster.

Over the next 10 years, somewhere in the order of 5000 experienced GPs can be expected to leave the profession yet they will be replaced by fewer than 1000 experienced doctors, who by that time will be in the 35-44 year age bracket.

Under this Government, the only thing that is certain is that we are losing more experienced doctors than we are gaining.

The Government knows full well it takes from nine to 13 years for a doctor to be fully educated and trained.

Spending a decade pursuing a culture of “she’ll be right mate” and letting the number of doctors dwindle, is not something that can be fixed in one or two years or on the eve of an election.

A whole generation of potential new doctors has been lost through the inaction of a Government with a simplistic ideology that private health care is the answer to all health care.

To illustrate just how much this Government has been asleep at the wheel on the issue of medical practitioner training over the past 11 years, there are now less Australian trained GPs in the GP workforce than there were in 1996—when Labor was in Government.

What a testament to abject policy failure by this worn out, tired Howard Government.

How a Government that is responsible for medical training policy and funding can manage in 11 years to reduce the number of Australian trained GPs in the workforce is beyond comprehension.

In 1995/96 the number of overseas trained GPs was 24% of the GP workforce. By 2005/06 this figure had increased to almost 31% of the GP workforce.

At this rate, within another 10 years or so, more than half of Australia’s GP workforce will not come out of Australian universities but from overseas universities.

Australians deserve much better than this.

Australians are now realising that the remedy will only come from a change of Federal Government.

Because of the Howard Government’s health policy failure, Australia is going to have to depend on an increasingly high proportion of overseas trained doctors for decades to come.

But Australians are used to this from the Howard Government.

It’s the same Government who has been at the wheel while Australia has plunged head first into a massive skills shortage in other key trades and professions. While sufficient numbers of Australians were not given the opportunity to be trained in the required skills, the supply has had to come from beyond our shores.

Where is this deepening doctor supply crisis hitting worst?

I can tell you—in Australia’s rural and remote areas, like the Federal Electorate of Kalgoorlie.

That electorate takes in the booming areas of the North West. Rich in iron ore and other minerals as well as natural gas, there is a screaming demand for workers—they can’t get enough.

But there is also a screaming demand for GPs to service the health needs of that growing population.

It is hard enough to get the workers in those areas, and the Howard Government’s failure to fund the training of enough doctors makes it even harder—families won’t go to areas if they think the health services are not adequate and there are not enough doctors.

In 1995/96 33% of GPs in rural and remote areas were overseas trained. By 2005/06 this figure had risen to 58%.

There is no doubt that a high proportion of overseas trained doctors provide high quality medical care.

Nonetheless, from the numerous events in recent years, the growing dependence by rural and remote communities on overseas trained doctors has resulted in far too many instances of very serious harm to patients.

The Howard Government has to take responsibility for this situation. It is the Commonwealth that funds medical practitioner training places.

It is the Commonwealth that runs the medical fee for service system.

It is the Commonwealth that issues Medicare provider numbers.

And it is the Commonwealth that controls the strategic policy and funding levers as far as medical services are concerned in Australia.

I particularly want to point out the mess the Howard Government has made of GP services in my home state of Western Australia.

According to Australian Institute of Health and Welfare published statistics, the number of employed medical practitioners to population in Western Australia, has fallen dramatically below the national average in the last 11 years.

In 1995/96 the number of doctors per head of population in Western Australia was 9% below the national average.

On the latest figures, the number of doctors per head of population in Western Australia is now 16% below the national average.

This is a telling indicator of the ineffectiveness of WA coalition members of parliament, in representing the essential interests of Western Australians.

It is also a telling indicator of the effectiveness—or lack of it—of the Federal Health Minister, who used some comments of mine to the Senate last week on private health insurance to suggest Labor is against the private health insurance rebate.

Let me tell Senators opposite and the Health minister that Labor is not against the private health system as a compliment to a strong public health system—so, as far as that goes, Labor agrees with the very same comment made in the other place by the Health Minister.

But what this Howard Government—and its Health Minister have failed to do is ensure that the public health system remains strong.

They should hang their heads in shame.

They have been total non-achievers in carrying out their obligations and duties to the community who rely on them.

This Government is always quick to blame the States and Territories when there is any problem with Australia’s health services.

But the Howard Government’s claim that their private health insurance policies have taken pressure off public hospitals doesn’t stack up.

It is most instructive to note that in the period 2000/2001 to 2004/05, because of the absolute failure of the Howard Government’s private health insurance changes to relieve pressure on public hospitals, public hospitals have had to increase their medical practitioner workforce by 24% in just four years.

Since the introduction of the Howard Government’s much crowed about private health insurance changes, public hospitals have had to embark on a massive exercise to increase medical practitioner numbers to cope with service demand growth.

What a piece of policy brilliance!

The Federal Government pours billions into the private hospital sector while the private hospital sector neatly cost shifts to the public hospital sector.

From 1995/96 - 2005/06 the cost of Medicare benefits for GP services increased by, wait for it ... over $1.8 billion.

Over the same period there was no actual increase in the number of services provided by GPs despite the fact that the nation’s population grew by around 11%.

In other words in the ten years to 2005/06 the Government almost doubled the cost of its GP services bill and got no additional services for this extra expenditure.

How is this situation expected to take the pressure off public hospital emergency departments? We all know that it doesn’t so why won’t the Howard Government fess up?

If a private or public company was run like this, the clown at the top would get a multi-million dollar payout and be sent packing; while there would be a clean-out of the board.

The longer this Government is in power the more secretive it has become. It has developed and earned a reputation for treating members of the Australian community like mushrooms. Just keep feeding them the proverbial and keep them in the dark. The Australian public only gets information from this Government after it has been heavily filtered or is so out of date as to be almost useless.

Senators would be interested to note that back in 2001 the Federal Government had some very insightful things to say about medical workforce planning.

A report prepared by the Department of Health and Aged Care, titled “The Australian Medical Workforce”, says and I quote:

“Governments plan and intervene in medical workforce matters with the objective of ensuring access by the whole community to quality medical services. This objective is central to our health care system and enjoys consistent community support”

The report goes on to say:

“Universal access (to medical services) requires:

• A medical workforce which matches population need—that is, enough doctors of the right kinds in the right places”

I’d like to see that in Western Australia, enough doctors in the right places!

Back to the report and the requirements of universal access, it also says:

• The best expenditure of finite public resources—applying the rationing principle that services are accessible on the basis of individual need rather than ability to pay; and
• Medical services which are safe, of high quality and culturally appropriate.

And later in the report and I quote:

Without intervention by governments and other bodies these outcomes cannot be assured.

So there we have it. The Government department responsible for Australia’s health care system had, back in 2001, no misunderstanding about the principles of universal access to health care and the philosophy behind the Medicare scheme.

We know that, because they published a very considered paper on it.

However, it’s not words that count—and Senator Brandis should take particular notice of this—it’s actions that count.

And what action has the Howard Government taken?

The answer is very simple - the progressive dismantling of the Medicare principles and universal access to health care.

Here we are, six years after the publication of a departmental report on Australia’s medical workforce and what does Australia have?

• The medical workforce does not match the population need;
• Access to government subsidised medical care does not match the objective of individual need over the ability to pay; and
• The safety, quality and appropriateness of medical services in many parts of the country have been compromised.

On this side of the Chamber we are not going to let the Government get away with endlessly snowing the electorate.

We are going to continue to expose this Government and make them accountable.

The Howard Government has torn up their accountability contract with the Australian people and it’s time for the writ to be served.

As the Shadow Minister for Health, the Member for Gellibrand, said in the other place, Labor is prepared to support this Bill but in doing so we note that concerns about medical workforce shortages and in particular, distribution, remain unsolved.

Question agreed to.

Bill read a second time.