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Thursday, 26 November 2009
Page: 13130


Mr SYMON (11:37 AM) —It is a pleasure to follow on from Ms Saffin, the member for Page. I, too, speak in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill amends the Health Insurance Act 1973, with the purpose of streamlining the operation of section 19AB of that act and removing some of the anomalies in its operation. Section 19AB of the Health Insurance Act was introduced in 1996 and dictates that Medicare benefits are not payable in respect of professional services provided by or on behalf of an overseas trained doctor, except in certain circumstances. The change was made as part of a package of reforms designed to help address shortages in the medical workforce in rural and remote areas.

Under the legislation there is a 10-year moratorium on overseas trained doctors accessing Medicare benefits, unless they are working in an area where there is a workforce shortage. The main provision in this bill removes the current restrictions applicable to New Zealand permanent residents and citizens who are doctors and who have obtained their primary medical education at an accredited medical school in Australia or New Zealand. This change will effectively remove New Zealand permanent residents and citizens from the classification of overseas trained doctor and former overseas medical student under the Health Insurance Act. Under these proposals, the term ‘former overseas medical student’ will be changed to ‘foreign graduate of an accredited medical school’ to more accurately reflect its meaning. A time limit will also be introduced for seeking review of a decision to refuse an application for a section 19AB exemption or a decision to impose conditions on an exemption.

Finally, there will be a change to the way in which the 10-year moratorium is counted. Currently, the moratorium starts from the time an overseas trained doctor achieves Australian permanent residency or citizenship. Most overseas trained doctors, however, come to Australia through the temporary skilled visa category; hence, the 10-year moratorium could, in effect, last for up to 14 years. Under this amendment the period will commence from the time that a medical practitioner is first registered as a medical practitioner in Australia. It will continue to operate for 10 years and then cease, provided that the medical practitioner has gained Australian permanent residency or citizenship during that period.

The moratorium has been effective in helping meet demand in rural and remote areas for medical services, but of course there is still much more to be done. It will continue to be used in order to bring GPs into rural and remote areas, in addition to the measures announced in this year’s budget as part of the government’s $134 million Rural Health Workforce Strategy. The focus of the strategy is to improve access to health services for people in rural, regional and remote areas of the country. To encourage more medical professionals to practise in remote areas, the government is targeting incentives under the banner ‘The more remote you go, the greater the reward’. The 10-year moratorium will be scaled so that, the more remote the area where a doctor practises, the shorter the moratorium.

Financial incentives are also in place, such as a $120,000 grant for a doctor relocating to a very remote area. Under these reforms almost 500 communities around Australia will, for the first time, become eligible for rural incentive payments. As the Minister for Health and Ageing stated, ‘Australia’s increasing reliance on overseas trained doctors is not unique, with other OECD countries experiencing similar trends.’ I believe that, in the longer term, we actually have to address our own shortages and train more local doctors. It is something that we cannot escape. We as a developed nation cannot continue to go on taking doctors from other overseas countries where they have greater shortages than we do.

There is also an impact of not having enough doctors locally. My electorate is most certainly neither rural nor remote—it is very urban—but we have shortages of doctors in that urban setting. We have general practices that are closed down and not replaced. We have waiting lists to see a GP. It is not a simple thing. In many cases, people may have to wait one, two and sometimes even three days for an appointment with their local GP. We do have bulk-billing clinics. There are a few of those around but, even then, there can be long waits and I represent a very populated part of Melbourne. It being hard to find an available doctor is certainly not an isolated incident.

One of the references I always like to use when I talk about health issues is produced by the Australian Institute of Health and Welfare. Their publication Australia’s health 2008 is particularly good when it comes to facts and figures on anything to do with the health system. In the 2008 report they referred to a report put out by the Australian Medical Workforce Advisory Committee in 2005 which looked at the supply and requirements of the general practice workforce in Australia through to 2013. That report, even at that time, estimated that there was a shortage of between 800 and 1,300 general practitioners. Obviously, as our population grows, that figure will become even greater.

The changes in this bill to the classification of doctors trained in New Zealand are a reflection of the close relationship that our two countries enjoy. Australia’s relationship with New Zealand is probably better developed and more extensive than our relationship with any other country. This relationship brings enormous benefits to both countries. I think we see those every day. Dr Ashton Calvert, former Secretary of the Department of Foreign Affairs and Trade, stated:

… the partnership with New Zealand is of first-order importance.

The historical, economic, social, cultural and political foundations of Australia-New Zealand relations run deep, and will always inform what we do together.

The common background of our two countries, the long history of cooperation both bilaterally and on the wider international plane, and the values we share are all part of the strong base on which the contemporary relationship is built.

Of course, New Zealand citizens enjoy many benefits in Australia. The Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with many benefits and citizenship rights through its provisions, such as permanent residency rights without the requirement of obtaining a permanent residency visa.

Contrary to this, the Health Insurance Act requires the department to use the Migration Act 1958 to determine residency status. This act considers New Zealand citizens to be temporary residents of Australia. Thus, New Zealand citizen doctors are considered to be overseas trained doctors if they registered as a medical practitioner after 1 January 1997.

Many New Zealanders—or Kiwis, as most of us would call them—choose to study at Australian universities. When they do so, they are treated the same as Australian students. They may not be aware that, under the Health Insurance Act, they will not be considered to be a permanent resident. Eligibility is measured from the time a student commences their primary medical degree, so obtaining permanent residency or citizenship after this offers no relief.

Similarly, many Australians elect to study in New Zealand. I know they have many fine universities over there; I have visited them on many occasions. Although these New Zealand medical schools are accredited to the same standards as Australian medical schools, Australian citizens who obtain their degrees at them will fall within section 19AB of the act as they did not gain their primary medical degree in Australia.

The effect of this bill is to remedy these anomalies. Professional services provided by New Zealand residents or citizens who obtained their primary medical degree from an Australian or New Zealand medical school and who had previously been subject to the 10-year moratorium will now attract Medicare benefits from the commencement date—that is, such people will no longer be subject to the moratorium.

This bill does not intend to extend these benefits to medical practitioners whose primary medical education was obtained outside New Zealand or Australia. Former overseas medical students are to be renamed ‘foreign graduates of an accredited medical school’, as I mentioned earlier. This will continue to include people who were not Australian or New Zealand permanent residents or citizens at the time they enrolled in an accredited Australian or New Zealand medical school.

The proposals in this bill clear up a few outstanding anomalies and recognise the standard of primary medical degrees from New Zealand. New Zealand permanent residents and citizens will be treated similarly to Australian citizens and permanent residents for the purpose of section 19AB of the act. This bill also makes some other changes to tighten up the operation of the Health Insurance Act, as I touched upon earlier. I commend this bill to the House.