Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Professional Services Review Scheme No. 2) Bill 2023. The purpose of this bill is to improve the ability of the Professional Services Review to investigate potentially inappropriate practice by health professionals by addressing issues and ambiguities in the Health Insurance Act 1973. The Professional Services Review, or PSR, is an independent statutory agency responsible for maintaining the integrity of Australia's Medicare program through investigating and sanctioning inappropriate practice by health professionals. The bill builds on the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023, which was passed in September this year. That bill continued the reform to the PSR that was commenced under the former coalition government to strengthen the review mechanisms that were primarily for claims of MBS items. The bill also continues to implement changes arising from recommendations of the Independent Review of Medicare Integrity and Compliance, which was undertaken by Dr Pradeep Philip.

The bill amends the Health Insurance Act 1973 to clarify and improve administration of the PSR scheme, including to better align the requirements for qualifications of committee members to the definition of inappropriate practice and to clarify how these requirements should apply; to ensure the committees can be properly established for practitioners who hold a rare combination of specialities or are practising in a different field to their formal specialist qualifications; to make it clear, where appropriate, that a reference to a practitioner includes a practitioner who is not currently registered, such as a deregistered or suspended practitioner, in order to ensure the PSR scheme applies consistently; to clarify the requirements for a person under review notifying a committee that they are unable to attend a hearing due to medical reasons, including that the person must provide a medical certificate supporting this evidence; and to provide the director with the power to extend the statutory time frame of 12 months for deciding a matter if the person under review leaves Australia or if there are ongoing court proceedings in relation to the matter.

The coalition is supportive of this bill as it contains sensible changes in line with our strong and long-held commitment to protecting the integrity and financial viability of Medicare. Australia's Medicare system underpins our world-class health system and, importantly, is there for all Australians. We are so fortunate to have a health system in Australia that is accessible and available to every Australian no matter where you live or how old you are, and protecting the ongoing viability of Medicare is key to this. Medicare, which includes the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme, continues to provide Australians access to free hospital care and more affordable health care and medicines.

When the coalition was in government, investment in the MBS and PBS grew significantly under our leadership. In fact, we oversaw record investment in this area, and we were committed to continuing that record through our commitment to invest $133 billion over the four years into Medicare. Our approach to Medicare saw the highest bulk-billing rates on record. That is why it has been extremely disappointing to see that, since Labor came into government, bulk-billing rates have been dropping consecutively every single month. The latest annual data shows a total Medicare bulk-billing rate of 77 per cent, and 80.2 per cent for non-referred GP appointments, in the 12 months to June this year. These are the lowest bulk-billing rates since 2013. This is in stark contrast to the 12 months to June 2021, which saw rates at an all-time high of 88.8 per cent under the coalition. The Albanese government is overseeing plummeting bulk-billing rates at a time when Australians are struggling to pay the bills, let alone cough up for an unexpected GP appointment. And we know that the cost of seeing a GP could rise to over $100 per consultation. So this government was elected with a promise to strengthen Medicare, yet all of the data is pointing in the exact opposite direction. In fact, it has only become harder and more expensive to see a doctor since Labor were elected, despite all their headline promises.

The Health of the nation report released by the RACGP this week has confirmed the increasing unaffordability of primary care under Labor. The number of GPs who bulk-bill all their patients has halved in one year, and the cost of seeing a doctor has increased by, on average, $11 per visit. That's $11 straight out of the pockets of Australians who are facing a cost-of-living crisis. Bulk-billing rates are falling, and the cost of seeing a GP is increasing, creating an unacceptable barrier for Australians in need of critical health care. This proves how important it is to ensure the viability of Medicare is safeguarded into the future, because right now it is clear that Medicare has been weakened from every angle, and Australians cannot afford for this concerning trend to continue. That is why the coalition will always be committed to supporting the integrity and financial viability of Medicare to ensure that all Australians have access to the critical support provided by Australia's healthcare system into the future.

We were glad to see the government pass the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill in December 2022. This was a coalition bill that we proudly introduced into the 46th Parliament to strengthen the compliance powers of the PSR and add a degree of flexibility to their ability to address any inappropriate practice. We understand how vital it is that there continues to be rigorous and effective health practitioner compliance to protect the financial integrity of Medicare. We also have a strong track record of supporting our hardworking healthcare practitioners and peak bodies to correctly claim health payments, with a clear focus on education, engagement and consultation.

Australians rightly expect their tax dollars are being used appropriately and effectively, particularly when they are being spent on a health system which is facing increasing pressures. We need to support practitioners who are doing the right thing by the taxpayers and by their patients but also identify the health practitioners who are not acting in good faith. However, we do have concerns with the amount of consultation that was undertaken prior to the introduction of this bill, particularly in regard to the review on which these reforms are based. Time and time again, we are concerned by this government's refusal to allow appropriate levels of consultation on their policies and to follow proper process. Dr Philip stated in his report:

Given the timeframes set for this Review, my formal consultation with stakeholders has been necessarily limited, supplemented by informal discussions with participants, and I have based most of my work on desktop analysis.

This is simply not good enough. Once again, we put our disappointment on the record for the way that the limited time frames set for this review acted as a significant barrier for Dr Philip's ability to undertake thorough consultation. This is now a well-entrenched theme from Labor. They do not take the consultation process seriously, and any consultation that is performed by this government seems to be merely a political exercise, often after the decisions have been made. Their focus continues to be all on the headlines and never on the details or the delivery.

But, once again, the coalition will support this bill and its proposed changes, in the interests of improving the Professional Services Review scheme. We acknowledge that this bill builds on the coalition's work to strengthen the PSR, and we are committed to supporting sensible reforms that protect the viability of the Medicare system into the future.

Anthony Chisholm (Queensland, Australian Labor Party, Assistant Minister for Education) Share this | Link to this | Hansard source

Australia's universal healthcare system, Medicare, provides free and subsidised access for all Australians to most healthcare services. The government is committed to strengthening Medicare by 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 act 2023, which implemented priority amendments in response to the Independent Review of Medicare Integrity and Compliance undertaken by Mr Pradeep Phillip, known as the Phillip review. The Phillip review was commissioned by the government in November 2023 to respond to concerns about the operation of the Medicare system. The Phillip review recommended a comprehensive review of legislation relating to Medicare to ensure it is fit for purpose.

This bill will strengthen the operation of the Professional Services Review, known as the PSR, 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 the Medicare program by investigating whether a person is engaged in appropriate practice. The investigation occurs by review undertaken by the director or by committees made up of health professional peers of the person under review. The bill will align requirements for the qualifications of committee members with a definition of 'inappropriate practice' and will clarify how these requirements should be applied. This will ensure that committees can be properly established for a practitioner with an unusual combination of specialities or where the practitioner is providing services in a different field from their formal specialist qualifications.

The bill will also make several other amendments to clarify and improve the administration of the PSR scheme. Reducing ambiguity will ensure that a person under review is aware of how the PSR scheme should apply as well as 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. I acknowledge senators for their contribution to debate on this bill.

Question agreed to.

Bill read a second time.