Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill proposes to modify the operation of section 19AB of the Health Insurance Act 1973. This section 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 and section 19AB was one of the changes implemented. The change meant that overseas trained doctors who started work in Australia from 1 January 1997 and who wished to access Medicare benefits for their services needed to practise 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 a GP.

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 of the rural health workforce showed that this policy had made a difference to health services being provided in the bush. Many communities are reliant on these medical practitioners and would not have practising GPs without the action of the Howard government.

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 the commencement date of the 10-year moratorium on overseas trained doctors. It will also 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 by serving in the most remote locations. The coalition will be watching the impact of this measure very closely.

The coalition has long been concerned with ensuring the provision of medical services in regional and remote areas of Australia. The Howard government established essential 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 showed 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 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 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.

The current government, as much as it seeks to denigrate the former coalition government, will in fact reap the benefits of the forward-thinking policies of the Howard government. Generally across the health workforce increasing numbers of health professionals will be graduating 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.

Ursula Stephens (NSW, Australian Labor Party, Parliamentary Secretary for Social Inclusion and the Voluntary Sector) Share this | Link to this | Hansard source

In summing up the debate on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, I thank Senator Fierravanti-Wells and other speakers in the debate. I want to make some short points about this particular piece of legislation to remind those listening to the debate of what we are actually doing here under this bill. It does, as Senator Fierravanti-Wells so rightly said, actually have an impact on and give effect to some changes to the 10-year moratorium. The reasons for that are very clear. Ours is a government that is determined to ensure that we develop a more transparent and fairer and consistent health system. That includes all of those considerations that are given to our rural health workforce. Those who were affected by the 10-year moratorium, which was put in place in 1997, and have been restricted from providing professional services that attract Medicare benefits for that period of 10 years are now coming out of that cycle and so the government is considering how we can continue to manage this issue. That is what this bill is all about.

I do want to say, though, that the way in which the 10-year moratorium is currently counted actually excludes years of tenure as a temporary resident, so overseas trained doctors may be prevented from providing professional services which attract Medicare benefits for longer than 10 years, which hardly seems fair. So the amendments propose that the 10-year restriction will commence from the time that a medical practitioner is first registered as a medical practitioner in Australia and will cease after that 10 years, providing that the medical practitioner has gained Australian permanent residency or citizenship during that period. The 10-year moratorium will continue to be used, along with the other reforms that are being implemented under the Rural Health Workforce Strategy, to recruit GPs for and retain GPs in rural and remote Australia. But, as I said, the measures make sure that the system is much fairer and recognises the services to districts of workforce shortage. So, as part of our $134 million rural package in the 2009 budget, the 10-year moratorium will also be scaled so that the more remote you go the shorter the moratorium. From 1 July 2010 more than 3,600 overseas trained doctors who have restrictions on where they can practise now will be able to discharge their obligation sooner according to the remoteness of the locations in which they choose to work. This is the way in which we want to incentivise overseas trained doctors to actually come into some of the harder to service areas of our country. The 10-year moratorium therefore will not be as stringent as it has been since its introduction under the previous government in 1997.

The package of reforms to this section of the act completes the significant workforce reforms already underway, as I have said, and to date it has delivered the biggest investment in our workforce through a $1.6 billion Council of Australian Governments partnership that will help to deliver training for the huge increase in Australian-trained graduates, which will actually increase from 12,700 this year to 14,700 in 2013. That funding will also help support undergraduate clinical training for 13,800 medical students and, importantly, 38½ thousand nursing students and 18,000 allied health students in 2010. We are also providing $28 million to help train around 18,000 nurse supervisors, 5,000 allied health and VET supervisors and 7,000 medical supervisors. Along with this we are increasing the availability of specialist workforce places by boosting the total number of GP training places to more than 800 from 2011 onwards, a 33 per cent increase on the cap of 600 places imposed by the former government, and we are providing specialist training places outside of the traditional public hospital settings.

This year’s budget delivers more than $200 million to help tackle the shortage of doctors and health workers in rural and remote Australia and to improve the access to health and medical services of the seven million Australians who live in regional and remote Australia. At the same time we are streamlining the multiplicity of rural health programs to make it easier for doctors and, much more importantly, easier for communities to understand and access the initiatives that will help to build the rural health workforce of the future. New access to choices as to maternity services and nurse practitioner services will also be enabled through bills which are currently before the Senate. The commencement date for the provisions is 1 April 2010 or on royal assent, whichever is the later date. It is very pleasing to have this particular bill before the Senate today. It complements, as I have said, significant workforce reforms and commitments by this government. I commend the bill to the Senate.

Question agreed to.

Bill read a second time.