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Thursday, 26 November 2009
Page: 13128


Ms SAFFIN (11:22 AM) —I welcome the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. It has been a long time coming; it is a long time overdue. It is welcomed universally by the community and the medical profession. I would like to thank the Minister for Health and Ageing for her responsiveness on this matter. The matter has sat inert for some years. It was in the too-hard basket, there was lack of interest or it was overlooked, but the fact is it is before us today and deserves support across the board in this place. This bill corrects the problem that excludes New Zealand citizens and New Zealand permanent residents who are doctors from accessing Medicare benefits for a period of 10 years after first being recognised to practise as a medical doctor after 1 January 1997, which was the operative date. It is known colloquially as the 10-year moratorium. It is to do with provider number restrictions. The current system is that overseas trained doctors and former overseas medical students may be granted an exemption from the provider number restrictions et cetera. It is said that the primary consideration—and, from my perspective, it is the primary consideration—in granting this exemption is that an applicant must work in a district of workforce shortage, or area of need, as we call it.

The operative part of the Health Insurance Act is section 19AB. Section 19AB provides that Medicare benefits are not payable to an overseas trained doctor or a former overseas medical student except in certain circumstances—and generally, as I referred to, in a district of workforce shortage. I noted the comments by the member for Herbert in relation to the particular problems he has with workforce shortage in his area. In 2007, when Labor came into government, I had a look at the figures that were used to assess the areas of need. They were still using data from the 1991 census, which is a bit outdated to determine an area of need. There were some other factors implying that that needed to be changed, and that whole system has been reviewed. Also, in general, the mechanism I am referring to has been used to assist rural and remote communities where Australian doctors do not practise so that the public can get access to well-trained doctors—because that is what we need. It follows then that there are more overseas trained doctors in some rural and remote areas. For a whole range of reasons, some doctors do not want to go to rural and remote areas. Sometimes it is because of the changing nature of medical practice. Sometimes it is about wanting to get a balance between family and work. Sometimes it is about wanting to work with other doctors so that you can actually do that.

In her second reading speech the minister said that 41 per cent of all doctors in communities of greatest need are in rural and remote areas. The government has also created more places for medical students. Part of the policy approach is that they will be in rural and remote areas, but this will take some time to kick in because of the time it takes to train our doctors. It seems to take a long time, but I know it is essential that they have that long training.

I welcome the extra student placements in country areas. There are some in my area, where we have the university’s department of rural health, and quite an influx of rural medical students and allied health students as well. It is great, because they work under a collaborative model but they are effectively under the university’s department of rural health. Dr Sue Page, a very active health advocate in our area, has said that what is also encouraging about getting them into these areas is that the longer they are there the longer they stay. They sometimes form relationships and get married, so they are more likely to stay in the area. That is one of the factors.

The main change that this bill will effect is the removal of the current restrictions on New Zealand permanent resident and citizen doctors who obtained their medical qualifications at an accredited medical school in Australia or New Zealand. Section 19AB of the Health Insurance Act, which classifies them as ‘overseas trained doctors’ and ‘former overseas medical student’, will no longer apply to them. There has also been confusion about the classification of ‘former overseas medical student’. It actually means a foreign person who graduates from an Australian medical school, but hardly anyone got that upon the first, second or even third reading. It does cause confusion. A ‘former overseas medical student’ will now be known as a ‘foreign graduate of an accredited medical school’. This is a better classification than ‘former overseas medical student’, but in my view it could have been made a little bit better. But it is certainly better and removes the confusion of the other title.

The current requirement for the operative date of the 10-year moratorium made it mandatory for the doctor to have Australian citizenship or permanent residency. If they were here for, say, two to five years practising and then acquired either status, the 10-year rule would then start to kick in. Therefore it could be up to 15 years in all before they could access a Medicare provider number in general. That seemed an inordinately long time. It seemed to be an unintended consequence of the way that that section of the act worked. This bill, sensibly and fairly, changes this so that the 10 years start when the medical practitioner is first registered as a medical practitioner in Australia and becomes a permanent Australian, as it will be known, at least in that 10-year period. The definition of ‘permanent resident’ will be repealed and the ‘permanent Australian’ definition will be amended to replace ‘permanent resident’ with ‘a holder of a permanent visa’, thus making ‘permanent resident’ redundant.

The new definition accords with definitional consistency with the Migration Act 1958. New Zealand citizens are entitled to take up what is called a special category visa that enables them to stay permanently in Australia, but this category of visa is not a permanent visa in the sense that I have just been talking about—so that it falls within the definitions of the Migration Act 1958. So that anomaly will be overcome. The good part of this bill is that from 1 April 2010 or on royal assent, whichever is the later date, the New Zealanders who obtained their primary medical degree from an Australian or New Zealand medical school and were previously subjected to the 10-year moratorium or a section 19AB(3) Health Insurance Act exemption will attract the Medicare benefits—that is, a provider number. The moratorium periods of section 19AB and any section 19AB(3) exemptions will no longer have any effect—so, finito.

Another key development is that, when medical practitioners appeal against a decision to refuse to grant them an exemption or a decision to impose conditions on an exemption made pursuant to sections 19AB(3) and 19AB(4) respectively of the Health Insurance Act, there will be a 90-day maximum period within which the medical practitioner must appeal. It is section 19AB(3) that covers exemptions in general and it is section 19AB(4) that covers the conditions on such exemptions. The upshot is that, if a medical practitioner applies for a review of a deemed refusal, such an application has to be made within the 90-day period. That 90-day period begins, so I am advised, on the day after the end of the 28-day period referred to in section 19AC(2). Medical practitioners who have received a decision refusing an exemption or a decision to impose conditions prior to the commencement of the bill will have 90 days from the commencement to make a review application.

It is a welcome change, particularly for my Northern Rivers area, where it did have a dire consequence for a very able and very well regarded general practitioner. I would also like to say thank you to the people who advocated in my area, such as Dr Sue Page and Dr Chris Mitchell, President of the Royal Australasian College of General Practitioners, who also lives in the Northern Rivers area. In something that is sent out to all the GPs he thanked me for my advocacy. The result of that was that I got some feedback from general practitioners around Australia, including from some who are not New Zealand citizens but who have had some ideas about ways of moving forward, particularly on how we can continue to attract doctors to rural and remote areas and other areas in need. It was most welcome. It is something I am reading through now and am in discussions with doctors about.

The member for Herbert prompted my memory on one other thing I wanted to say. Some years back when I was a member of the New South Wales Legislative Council we did not have this system, but there were a lot of doctors who were overseas trained, were trying to practise in Australia and lived in Australia as either permanent residents or Australian citizens. Understandably, there were restrictions on their right to practise, but some of them were without foundation. Those doctors belonged to an association, and some of them went on a hunger strike outside the parliament building. That was quite distressing to some people. The doctors were on that hunger strike for quite some time. I profess to not quite understanding hunger strikes, but I know that when people are desperate they undertake such missions.

I had quite an engagement with those doctors and with the health minister at the time, Dr Andrew Refshauge, and we had some negotiations. Then Stepan Kerkyasharian was commissioned to do a review. He did a review and came up with 28 good recommendations, a lot of which were taken up nationally at the state level—at the intersection of state and national governments, working together to cover these areas. I remember very well what some of those recommendations were. They were taken on board by the AMA and by other associations. When we are dealing with these issues, there is a point at which any government has to make a decision and provide leadership, but there have to be negotiations and consideration, and it is necessary to work hand in glove with the profession. I am sure that in the future we will see some other changes, but this is one that was ridiculous in its application and made a ridiculous differentiation, and that will be corrected. I am very pleased to be able to support this bill.