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Thursday, 26 November 2009
Page: 13157


Ms LIVERMORE (1:49 PM) —I too rise to support the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. As we have just heard from my colleague, the member for Isaacs, this bill contains some straightforward and very common-sense changes to the Health Insurance Act 1973. Specifically, these amendments will streamline the operation of sections 19AB and 19AC of the act and in so doing will remove some anomalies and confusing terms that have created particular problems for doctors from New Zealand who are practising in Australia.

Those of us in parts of Australia characterised as districts of workforce shortage—or where we think we should be recognised as a district of workforce shortage—are familiar with section 19AB of the Health Insurance Act. I am sure that you, Deputy Speaker Saffin, have been in that situation yourself, coming from a regional part of Australia. Under normal circumstances overseas trained doctors and former overseas medical students are subject to a moratorium of 10 years in terms of their access to a Medicare provider number. Those doctors cannot provide medical services that attract Medicare benefits for a period of 10 years from the date on which the person is both a medical practitioner and an Australian permanent resident or citizen.

That is where section 19AB of the Health Insurance Act comes in. That is the section that provides for an exemption to the restriction on overseas trained doctors providing services that attract Medicare benefits. Many of us have made representations on behalf of doctors or medical practices wishing to employ overseas trained doctors, and that always involves trying to make the case for an exemption under section 19AB on the basis that the practice is indeed serving a district of workforce shortage. These restrictions on the access of overseas trained doctors to Medicare provider numbers were introduced as a way of giving the government a direct means to encourage doctors to work in rural and remote areas. The 10-year moratorium, by restricting an overseas doctor’s right to practise, in one sense also creates an incentive for those doctors to provide services in rural and remote communities that would otherwise struggle to attract doctors. If you go bush you can avoid the moratorium and start providing Medicare rebateable services immediately.

Up until now New Zealand citizens and permanent resident doctors have also been caught up in these restrictions, with the 10-year moratorium being imposed on them. This is clearly not logical when New Zealand medical courses are accredited by the Australian Medical Council in exactly the same way that Australian courses are accredited. This bill, therefore, amends the Health Insurance Act to remove the anomaly relating to New Zealand doctors. People who are permanent residents or citizens of New Zealand and who obtained their primary medical education at an accredited Australian or New Zealand medical school will be removed from the classification of ‘overseas trained doctor’. This makes sense and will not change the strict standards that will apply to those New Zealand doctors practising in Australia. Because of the requirement that they must be a graduate of an Australian Medical Council accredited medical course, their qualifications, even when received from a New Zealand university, will be the equivalent of an Australian graduate.

The second amendment in this bill relates to the use of the term ‘former overseas medical student’ in the Health Insurance Act. Currently section 19AB of the act imposes the Medicare restrictions on those ‘former overseas medical students’, meaning someone who attended an Australian medical school for their primary medical degree but who was not an Australian citizen or permanent resident at the time they were enrolled. This has proved to be misunderstood and has caused confusion among the medical profession. Instead, the term to be used in the act will now be ‘foreign graduate of an accredited medical school’. This better reflects the situation of doctors whose nationality is foreign but whose education is Australian. The use of terms has been tidied up but the effect of the section in the original act is the same—the moratorium will apply to foreign graduates of accredited medical schools because of the requirement for the 10 years to run from the time you are both a permanent resident or citizen and a medical practitioner.

The third amendment in this bill will be welcomed by those doctors who are currently subject to the moratorium, because for some of those doctors the starting point of the 10-year period has been delayed by ignoring any period the doctor might have been working in the country as a temporary resident. The amendment removes the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. This overlooks the reality that most overseas trained doctors enter Australia as temporary skilled migrants, usually for a four-year stay. Many then apply during those four years to become permanent residents.

As is currently drafted, the Health Insurance Act provides for the 10-year moratorium period to start from the time a person is both a permanent resident and a medical practitioner. Under the current arrangements, those doctors who move from temporary residency to permanent residency, and who have been working in a district of workforce shortage in order to obtain the exemption under section 19AB effectively have the 10-year moratorium extended by a matter of some years. This bill will mean that the 10-year moratorium period starts from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided that the practitioner has gained permanent residency or citizenship during that period. This is much more in line with the original intent of the moratorium and is fairer to overseas trained doctors and foreign graduates.

Finally, the bill contains an amendment that will place a time limit on appeals against a decision made pursuant to section 19AB. Those practitioners or medical practices that wish to appeal against a decision by the minister to refuse an exemption sought under 19AB will now have to appeal within 90 days of that decision. This is a commonsense amendment to ensure that there have not been substantial changes in circumstances between the time of the original determination and the subsequent reconsideration by the minister.

The debate on this bill gives us the chance as well to talk about medical workforce issues more generally, and I am sure that most people in the debate have taken that opportunity. It particularly allows me to recognise the role of overseas trained doctors and other health professionals in keeping services going in many parts of my electorate. We should acknowledge their contribution while at the same time recognise that we need to address the underlying factors that have caused us to rely so heavily on the skills of overseas trained health professionals. For the time I have been in parliament, there have been significant problems with workforce shortages across the health system. Whether it is nurses, doctors, specialists or those working in aged care, a lot of the issues we have faced in Central Queensland have come back to the difficulty in recruiting and retaining staff. As a fairly new government, we are still dealing with the legacy of the previous government’s failure to properly plan for our health workforce needs. That was exemplified by one of the Howard government’s earliest decisions to cut the number of GP training places. In contrast, I am pleased to say that one of the first things this government did was to increase the number of GP training places. Those places will jump from 600 in 2004 to more than 800 in 2011. That represents something like a 35 per cent increase in GP training places.

We know that for most people it is the wait to see a GP, or being told that GPs in their town are not taking new places, that is the clearest sign that our workforce is not keeping up with demand and also that our health workforce is not effectively distributed—and that hits us hardest in rural and regional Australia. That is why the federal government has moved to prioritise rural health and rural health workforce needs. The 2009-10 federal budget included a significant measure, the Rural Health Workforce Strategy, which encompasses a number of initiatives that aim to better target workforce incentives to communities in greatest need. One of the components of that package is the introduction of the Australian Standard Geographic Classification Remoteness Area system as a measure of eligibility for a number of workforce programs. This new system will replace the previous Rural, Remote and Metropolitan Areas system. One of the things that the Australian Standard Geographic Classification Remoteness Area system looks at is how to scale or allocate incentives when it comes to trying to attract and retain health professionals in rural and regional areas. It means that the use of this new classification system will result in an estimated 2,400 doctors in rural communities across Australia being able to access incentives for the first time. Almost 500 communities around Australia will become eligible for rural incentive payments.

I am pleased to say that Rockhampton, which is the major town in my electorate, is one of those communities eligible for rural incentive payments under this new classification system. I would hope to see those incentive payments being taken up by health professionals, and a subsequent increase in the number of health professionals choosing to set up practice and join practices in Rockhampton.

The other thing that the government is doing is continuing the National Rural and Remote Health Infrastructure Program that was available under the previous government, and I am happy to see that it has been continued by this Labor government. There was recently an announcement, which was very welcome in my electorate, of about $43,000 being paid to the Central Queensland Physio Group to provide additional services in the community of Yeppoon. Yeppoon is a beautiful seaside town, about 30 kilometres east of Rockhampton. It is a very fast-growing community and one of those places where demand for medical services and allied health services is very quickly outstripping supply. It used to be the case, when I first started in this House, that it was quite acceptable and the people in Yeppoon thought it was reasonable to travel into Rockhampton for services. But Yeppoon has really come of age. It is one of the fastest growing places in Queensland and it is really not the case any more that people in Yeppoon should have to travel outside of their community to access basic health and allied health services.

Central Queensland Physio Group have recognised this and have set up practice in Yeppoon, but this additional money will allow them to expand the services they can provide out of their new building. It will mean they can have room for more physiotherapists than they originally anticipated and will also be able to provide equipment and room for services like podiatry. That is going to be great for those people living on the Capricorn Coast. It is a recognition that the Capricorn Coast, and Yeppoon in particular, is really coming of age and that these basic health services should be provided right there in that community and not require people to travel into Rockhampton, which has traditionally been the major centre for these kinds of medical services.

I want to congratulate the principals of CQ Physio Group, Jim Griggs and Ben McGuire. They provide a terrific service to Central Queensland, not just Rockhampton but also the Capricorn Coast, and also out to the mining towns. They really play a strong role in training up-and-coming physios and training physio students and those who are just starting out in the profession. They also play a very active role in the community, encouraging people to stay fit and active and to take responsibility for their own health. Congratulations to Ben and Jim and to the team at CQ Physio Group. It was a great pleasure to be able to tell them a few weeks ago that they were successful in their bid for funding under the National Rural and Remote Health Infrastructure Program.

The support for health services in Central Queensland from this government goes well beyond $43,000 for the CQ Physio Group. Earlier this year it was announced in the budget that the Rockhampton Base Hospital would be the recipient of $76 million for a major upgrade of facilities there. That is on top of the $75 million that the state government has already contributed towards the upgrade of the hospital. We are seeing some really exciting things happening at the base hospital, which will create the facilities and capacity to boost the services available. I think there have been cranes and work crews up at the Rockhampton Base Hospital for as long as anyone in Rockhampton can remember, but it is all going towards building us a health service that will see us well into the new century by recognising the growth and development that is going on in Central Queensland and by making sure that those essential services keep up with the demands of a growing population that is being attracted by the booming economy.

While that building program is still going on, one thing that is already up and running as part of those new facilities is the long awaited, full-time MRI machine in Rockhampton. This is something that goes back quite a few years. I think I was lobbying and campaigning for this in the lead-up to the 2004 election. It was still an issue in the 2007 election and I secured a commitment from Nicola Roxon, who is now the Minister for Health and Ageing, that the Rockhampton Base Hospital would be given an MRI licence. The state government has purchased the MRI machine and is providing for its operation, but the federal government, through granting that licence, is effectively picking up the tab for the services provided by that MRI machine. Up until now, we have had a part-time machine in Rockhampton. We had a situation where the MRI machine was operated by a private company. It was located in a very large truck and was driven up and down the coast between Rockhampton, Gladstone and Bundaberg. But it has been recognised for some time that a hospital the size of the Rockhampton Base Hospital that provides the level of services it does needs a permanent MRI machine. That was something that I campaigned very hard on in the lead-up to the 2007 election because I saw it as a facility that was really essential in providing world-class health care in my electorate.

The next thing to work on is the Rockhampton Base Hospital’s bid to be considered as one of the regional cancer centres. The health minister announced that applications for the regional cancer centres program opened up a couple of weeks ago and I think, with the development that is already happening at the Rockhampton Base Hospital, there would be great scope to really increase the bang for the buck if it were successful in a bid to be a region cancer centre. The building that is going on right now is creating additional capacity at the hospital and it would dovetail very nicely if we were to secure additional funding for a regional cancer centre and fully integrate that into the development that is already going on. I am right behind that application by Queensland Health and I hope the case can be successfully made to secure funding to again increase the level of service available in Rockhampton.

If we ever get out of this place, I am looking forward to having a consultation with representatives from the health sector on Wednesday and looking at the recommendations from the National Health and Hospitals Reform Commission. Hopefully I can get out of here on Wednesday but, until then, I stand here and commend the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 to the House.


The DEPUTY SPEAKER (Ms AE Burke)—I thank the member for Capricornia, and I am sure we all share her sentiments about getting out of this place at some stage.