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Wednesday, 25 November 2009
Page: 12832


Mr DUTTON (1:33 PM) —The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 proposes to alter the operation of section 19AB of the Health Insurance Act 1973. Section 19AB 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. Section 19AB was one of the changes implemented. Overseas training doctors who started to work in Australia from 1 January 1997, if they wished to access Medicare benefits for their services, needed to practice 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 medical services. 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 last year of the rural health workforce revealed that this policy had made a difference to health services being provided in the bush and the minister acknowledged, in introducing this bill, that it has proven to be an effective mechanism to providing services to communities with the greatest needs—so much so that 41 per cent of doctors in rural and remote Australia have been trained overseas. Many communities are reliant on these medical practitioners and would not have practising GPs without them.

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 alter the commencement date of the 10-year moratorium on overseas trained doctors. It will 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 next year by serving in the most remote locations. The coalition will watch the impact of that particular measure closely.

The coalition has long been concerned with ensuring provision of medical services in regional and remote areas of Australia. Apart from introducing section 19AB of the act, which this bill will amend, the Howard government established key 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 carried out last year—10 years after their inception—found 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 the year 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 last year 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.

Given the long lead times in producing medical graduates, it is only in this current financial year that the first of these doctors will commence their return of service obligation in rural areas. The current government, as much as it seeks to denigrate the former coalition, will in fact reap the benefits of the forward-thinking policies of the former government. Generally across the health workforce increasing numbers of health professionals will be graduated 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.