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Thursday, 26 November 2009
Page: 13133


Mr RAGUSE (11:47 AM) —I acknowledge the comments of the member for Deakin and his firm understanding of some of the issues that face our health system in this country. I rise today to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This is a bill that will make working in Australia easier for medical practitioners from New Zealand and improve administrative processes surrounding overseas sourced medical practitioners in general.

The bill has three main components. The first component is to resolve problems New Zealand doctors can face working in Australia. Current arrangements do not reflect the close relationship between Australia and New Zealand. Under the Trans-Tasman Travel Arrangement, people who are citizens of Australia or New Zealand can travel to the other country to visit, live or work without needing to apply for a visa. However, doctors currently fall under the significant restrictions placed on all overseas doctors.

Within the Health Insurance Act 1973, section 19AB is used in effect to place individual overseas doctors in a district of workplace shortage. By restricting eligibility for Medicare benefits, this system makes overseas doctors spend their first 10 years practising in areas of need. This system has been used since 1997 to manage doctor shortages, particularly in rural and regional areas. While effective, it is not reasonable for doctors from New Zealand to face these restrictions.

Importantly, these conditions are faced not just by doctors moving from New Zealand to Australia but also by people from New Zealand who train to become a doctor in Australia. This is because the term ‘former overseas medical student’ in the existing legislation is ambiguous and problematic to implement.

The bill proposes to replace the term ‘former overseas medical student’ with ‘foreign graduate of an accredited medical school’. The bill text reads:

foreign graduate of an accredited medical school means a person:

(a)   whose primary medical qualification was obtained from an accredited medical school; and

(b)   who was not …

(i)   a permanent Australian;

(ii)   a New Zealand citizen;

(iii)   a permanent resident of New Zealand.

When he or she is first enrolled in an accredited medical school. In turn the bill describes an accredited medical school as:

… a medical school that is:

(a)   accredited by the Australian Medical Council; and

(b)   located in Australia or New Zealand.

The consequence of these relatively small amendments is that doctors from New Zealand, educated in an accredited medical school either in Australia or in New Zealand, can be exempt from section 19AB restrictions.

The Health Insurance Act 1973 currently has no application time limits for review of section 19AB exemption decisions. These review requests are made to the minister or to the minister’s delegate and can apply to a decision or conditions of a decision. The second amendment plans to limit the time frame within which a review of a section 19AB decision can be requested. This will be set in a time frame of 90 days, which provides a reasonable amount of time while achieving process efficiency.

As previously noted, section 19AB of the Health Insurance Act 1973 is used to restrict where an overseas doctor can work during their first 10 years in Australia. However, the current condition is that these 10 years start when an overseas doctor becomes a permanent resident. Often, an overseas doctor may not become a permanent resident until some years after they begin practising in Australia, so individuals may, therefore, work under restrictions for far longer than the planned 10 years. The third main change proposed in this bill aims to fix that anomaly.

It is proposed to change the term ‘permanent resident’, within section 19AB, to that of ‘a holder of a permanent visa’ within the meaning of the Migration Act 1958. It is proposed that the time spent as a permanent resident working as a medical practitioner in Australia contribute towards the 10-year restriction. Doctors from overseas will be able to start their 10 years on restrictions from when they are first registered as a medical practitioner in Australia, as long as they gain permanent residency or citizenship during those 10 years. In the long term, we must move away from our reliance on overseas doctors. Not only do we have people with sufficient training who are capable of doing these jobs, but other countries need their own doctors. We cannot, therefore, take doctors from other countries where they are also needed.

In the second reading speech by the Minister for Health and Ageing, the bill was placed within the context of a broader health workplace reform. The Rudd government is working through a $1.6 billion COAG partnership to boost Australian trained graduates from 12,700 this year to 14,700 by 2013. We will help to fund undergraduate clinical training for 13,800 medical students, 38,500 nursing students and 18,000 allied health students in 2010. Part of this boost is an increase in the total number of general practitioner places from 600 under the former government to more than 800 from 2011 onwards. These are critical increases needed to manage an ageing population and ageing healthcare workforce.

Many times in this chamber I have spoken about issues within my electorate of Forde. It is an electorate diverse in nature in South-East Queensland with a mixture of rural and urban populations. Many times we have faced issues about the Beaudesert Hospital, which was built over a number of years and which has maintained a certain level of service. But some years ago the obstetrics unit was removed from the hospital. At the time, as a community that often will see certain services change, the hospital’s being downgraded was seen very much as a threat to the community. Essentially, the problem related directly to trained professionals. Even in South-East Queensland, in a region that is much better serviced than other areas—and certainly areas that you represent, Mr Deputy Speaker Scott—the fact is that the number of trained doctors available is rather weak.

I have for many years, and certainly prior to becoming the federal member for Forde, advocated the need to continually improve and increase the number of trained health professionals. I must say that the people of the township of Beaudesert in particular have certainly felt the effects of the shortage of trained staff. In fact, there have been a number of schemes over the years to attract other people and trained professionals to the region. When we talk about districts with workplace shortages, quite often if they are less than 100 kilometres from a major city they are probably worse affected by shortages. The importance of providing more trained people for our system and being able to train more people in our own system is very important. In the relationship and the treaties that we have with New Zealand it is very important that we recognise under our own system, and certainly in this bill, the importance of New Zealand training and the doctors or trainees that come from that system.

It is a very good time for this government and for our nation to consider how we deal with training issues in our medical professions. The government has put forward a view in the Bennett report, which is now in circulation, about the major reforms that we need to consider for the future of our hospital system and the entire health system in this country. It is always a problem when you have cyclical issues concerning services, appropriate assets, appropriate training and being able to attract the appropriate people to a system. The health system, by its nature, needs highly professional people. The reality is that we need not only bricks and mortar to provide good services to the communities of Australia but also appropriately trained people. While we recognise that many people from other countries who have trained in their systems are very appropriate for our system, the reality is that we cannot continue to take people and source people from countries that may have a whole range of issues around the availability and supply of their own medically trained people.

I mentioned the Beaudesert Hospital as an example of a hospital that most people in the region always complain about. They argue that it is only a case of putting one or two extra doctors into a hospital to make something work—in this case, obstetrics. The reality is that any service we provide within our medical system is part of an overall model that includes many other professionals that support and supplement any medical procedures that take place. For instance, to deliver obstetrics services within a hospital you have to have all of those other levels of professionals available.

This bill recognises the training of New Zealand doctors and encourages those doctors to move into the system. It will certainly make it much easier for us as a government to provide those 800 training places and have sufficient people taking up those opportunities. It is important that, through this bill and through the health reforms that the Rudd government intends to make, we work together collectively to ensure that we take care of all of these problems that have resulted from legislation that has almost penalised those people who have come to our country in good faith to train and work.

The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 puts forward a number of improvements to arrangements for overseas doctors in Australia. Our close relationship with New Zealand is reflected by our no longer applying section 19AB to doctors originally from New Zealand. The fair new arrangements in this bill better reflect the enduring friendship and good will between our countries. Improvements have also been made to the review processes and residency requirements within section 19AB. The improvements provide valuable administrative clarity and fairness for all overseas doctors. I therefore commend this bill to the House.