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Wednesday, 21 October 2009
Page: 10456

Ms ROXON (Minister for Health and Ageing) (9:03 AM) —I move:

That this bill be now read a second time.

The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 will amend the Health Insurance Act 1973 (the act).

The bill proposes to streamline the operation of section 19AB of the act. Section 19AB provides that Medicare benefits are not payable in respect of professional services provided by an overseas trained doctor or a former overseas medical student, except in certain circumstances.

Changes resulting from the bill

Overseas trained doctors and former overseas medical students who were first recognised after 1 January 1997 have generally been restricted from providing professional services that attract Medicare benefits for a period of 10 years.

This is commonly referred to as the ‘10-year moratorium’.

New Zealand citizens and permanent resident doctors practising in Australia are currently subject to this restriction.

Overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions. A primary consideration in granting such a section 19AB exemption is that an applicant must work in a district of workforce shortage.

Section 19AB of the act is therefore a key mechanism by which the government influences the distribution of the medical workforce in rural and remote areas of Australia, so that areas of workforce shortage have appropriate access to medical services.

The 10-year moratorium has proven to be an effective mechanism in ensuring that overseas trained doctors provide services to those communities in greatest need, which tend to be rural and remote.

The proportion of overseas trained doctors is significantly higher in rural and remote areas. In fact, 41 per cent of all doctors in these areas have trained overseas. This has been due in part to Medicare provider number restrictions imposed by the act.

Despite the recent increases in medical students and emerging increases in medical graduates, our communities continue to be reliant upon overseas trained doctors. In this respect, we are no different from other OECD countries. With Canada, the United Kingdom, New Zealand and the United States of America, the percentage of foreign-trained doctors has increased significantly.

There are four measures proposed in this bill.

Firstly, the bill proposes to remove the restrictions imposed by the act on New Zealand citizen and permanent resident doctors in relation to their access to the Medicare benefits arrangements.

The amendment will lift those restrictions so that New Zealand citizens and permanent resident doctors who obtain their primary medical degree from an Australian or New Zealand medical school will no longer belong to the category of ‘overseas trained doctor’ and ‘former overseas medical student’. Consequently, they will no longer be restricted by the 10-year moratorium imposed by the act.

It is important to note that New Zealand resident and citizen doctors will still be subject to the requirement that they have appropriate recognition of their qualifications in order to access the Medicare benefits system.

Secondly, the bill will rename the term ‘former overseas medical students’, which is defined in the act as students of Australian medical schools who were not an Australian citizen or permanent resident when they enrolled in their primary medical degree at an Australian medical school.

This term will be renamed ‘foreign graduate of an accredited medical school’ to more accurately reflect its meaning The current provision in the act that subjects this category of doctors to the 10-year moratorium remains unchanged.

Thirdly, the bill proposes to introduce a time limit for seeking a review of a decision to refuse an application for a section 19AB exemption or a decision to impose conditions on an exemption.

Currently, the act provides no time limit for applying for a review of a rejected exemption application. The amendment will insert a provision into the act which will allow applicants to apply for a review of a decision within 90 days of a refusal. The amendment will also include a 90-day period for a review of a decision to impose one or more conditions on a section 19AB exemption.

The bill also proposes to rectify an anomaly in the act which currently counts the 10-year moratorium from the time the overseas trained doctor achieves Australian permanent residency or citizenship.

Most overseas trained health professionals enter Australia through the temporary skilled visa categories for initial periods of up to four years. For example, the temporary medical practitioner visa subclass 422 was extended from two to four years in 2003. In addition, since 2005, medical practitioners have been able to access the business long stay visa subclass 457 which allows a visa holder to remain in Australia for up to four years.

During the four years some medical practitioners seek additional assessment and apply to migrate to Australia permanently following a positive assessment by the relevant professional body and/or registration board.

The way in which the 10-year moratorium is currently counted excludes the years of tenure as a temporary resident, so overseas trained doctors may be prevented from providing professional services which attract Medicare benefits for in excess of 10 years.

This amendment proposes that the 10-year restriction will commence from the time the medical practitioner is first registered as a medical practitioner in Australia, and will cease after 10 years, provided 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 reforms to be implemented under the Rural Health Workforce Strategy, to recruit and retain GPs in rural and remote Australia—however, these measures make sure the system is a fairer system that recognises the service to districts of workforce shortage.

As part of our $134 million rural package in the 2009 budget—this year’s budget—the 10-year moratorium will also be scaled, so that the more remote you go, the shorter the moratorium. From 1 July next year, more than 3,600 overseas trained doctors who have restrictions on where they can practise will be able to discharge their obligations sooner, the more remote the location in which they choose to work.

The 10-year moratorium, therefore, will no longer be as stringent as it has been since its introduction in 1997.

This package of reforms to this section of the act complements the significant workforce reforms already underway—making the system more transparent, fairer and consistent with government policy.

Workforce reform

Our workforce reform program has to date delivered the biggest ever investment in workforce through a $1.6 billion COAG partnership that will help to deliver training for the huge increase in Australian trained graduates which will increase from 12,700 this year to 14,700 in 2013.

This funding will help support undergraduate clinical training for 13,800 medical students, 38,500 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.

Alongside this, we are increasing the availability of specialty 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 providing more specialist training places outside the traditional public hospital settings.

This year’s federal budget also delivers more than $200 million to help tackle the shortage of doctors and health workers in rural and remote Australia, and to improve access to the health and medical services of seven million Australians who live in regional or remote areas.

At the same time, we are streamlining the multiplicity of rural programs to make it easier for doctors and easier for communities to understand and access the initiatives that will help to build the rural health workforce for the future.

New access to choice in maternity services and nurse practitioner services will also be enabled through bills which are currently before the Senate.

The commencement date for these provisions to take effect is 1 April 2010 or on royal assent, whichever is the later date.

Accordingly, I commend bill to the House.

Debate (on motion by Mr Haase) adjourned.