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Thursday, 26 November 2009
Page: 13136


Ms HALL (11:58 AM) —I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. The purpose of the bill is to streamline the operation of section 19AB of the Health Insurance Act 1973 and remove a number of anomalies. The act provides that overseas trained doctors and former overseas medical students are not able to provide professional services that attract Medicare benefits for a period of 10 years, and that is called the 10-year moratorium. The bill amends the class of persons subject to the restriction in section 19AB, and amends the start date of the moratorium period.

The bill relates to the removal of current restrictions applicable to doctors who are New Zealand permanent residents and citizens who have obtained their primary medical education at an accredited medical school in Australia or New Zealand. The change effectively removes these doctors from the classification of ‘overseas trained doctor’ and ‘former overseas medical student’. The removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have either Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium period to commence is an important provision of this bill. The bill also makes an amendment to section 19AC of the act, which provides a period in which medical practitioners can apply for a review of the decision to refuse to grant an exemption or to impose one.

The issue is that many New Zealanders elect to study in Australian universities and are treated no differently to Australians. A New Zealand student may enrol in a medical course before they discover that they are not an ‘Australian permanent resident’ under the meaning of the act. Eligibility is measured from the time a student commences their primary medical degree, so obtaining Australian citizenship or permanent residency once they have commenced their studies offers no relief.

Many Australian citizens elect to study at New Zealand medical schools. These medical schools are accredited by the Australian Medical Council to the same standards as Australian medical schools. However, as these Australians did not obtain their primary medical degree in Australia, they are also subject to section 19AB of the Health Insurance Act. The proposed amendment means that Australian and New Zealand students who attended schools accredited by the Australian Medical Council in New Zealand and Australia will be treated the same as students who studied in Australia. The amendment recognises the standards of primary medical degrees from New Zealand universities and will ensure that New Zealand citizens and permanent residents are treated similarly to Australian citizens and permanent residents.

This amendment also addresses the fact that, although New Zealand citizens are generally entitled to stay permanently in Australia on a special category visa, these visas are not permanent visas pursuant to the Migration Act 1958. Currently, New Zealand citizens who complete their medical qualifications at an Australian medical school come within the definition of ‘former overseas medical student’. The effect of this amendment will be that 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 attract Medicare benefits from the commencement date of the bill, and they will no longer be subject to that moratorium. That will be really good for our health system and good for those New Zealand doctors and former overseas medical students, including Australian citizens who trained and qualified in New Zealand.

This is a very important issue. I represent an electorate where there is a chronic shortage of GPs. This shortage has existed for a very long time and it is an issue that I have been raising in this parliament since 2000. The current minister for health has embraced the issue and acknowledged the fact that there is a shortage of doctors within the Shortland electorate and, for that matter, Australia wide. She has taken steps to address this shortage, and I would like to put on the record my thanks to her for the actions that she has taken.

As I have already mentioned, this is an issue that has existed for some time in Australia. In the mid-1990s it was proposed that there were sufficient medical practitioners in Australia to meet the health needs of Australians. The thinking behind the policy was that there was an oversupply of general practitioners in the city, metropolitan and large population areas, while the rural and remote areas could not attract doctors. It was thought that there was a maldistribution of general practitioners throughout Australia. Of course, because of our Constitution, it is impossible to force doctors to practise in certain areas. So the Howard government, following their election in 1996, introduced legislation and initiatives to address medical workforce maldistribution. Unfortunately they did not think it through properly because, instead of addressing the maldistribution, they created a chronic medical workforce shortage. The Howard government at all levels constantly ignored the fact that this was an issue that needed to be addressed, unlike the current Rudd government and unlike the current health minister.

In 2006 the Standing Committee on Health and Ageing of the parliament conducted an inquiry into health funding. Its report, called  The blame game: report on the inquiry into health funding, made some very critical findings about workforce shortage. It did identify the fact that, the further you are away from the heart of Sydney in New South Wales or the heart of Melbourne in Victoria, the harder it is for you to obtain a doctor or treatment from nurses and allied health professionals. It identified the fact that the workforce shortages were worse in outlying areas. It also identified that there was a skilled health workforce shortage throughout Australia in particular in relation to GPs. Some areas raised were that there was a constant, continuing, ongoing problem with a shortage of general practitioners and a failure of the government to address this. Part of the shortage of the health workforce was due to—and the report makes this point—the underinvestment in the number of training places. The maldistribution of health professionals across Australia with the shortage of GPs and most other health professionals in suburban, regional and rural areas was also identified as a big problem. Underlying everything was the underinvestment in the training of doctors that we needed.

I was checking the table on health professionals and there is a comparison in the The blame game report between general practitioner numbers per 100,000 head of population in Australia. In 2000 there were 191.5 GPs to 100,000 head of population. In 2005, under the hand of the Howard government, that had dropped to 178.6 GPs per 100,000 head of population. I think that in itself is a comment on the way the Howard government under the leadership of the health minister, Tony Abbott, managed to ensure that people throughout Australia actually could go and see a GP when they needed to.

Shortland electorate is an older electorate. It is the 11th oldest electorate in Australia. We do have a chronic shortage of GPs as I mentioned earlier in my contribution to this debate. As at August 2009, there were 310 GPs working on the Central Coast. At the Wyong end of the Central Coast there were 131 doctors. Shortland electorate fits into the Wyong end of the Central Coast and the northern part of the Wyong Shire Council falls within Shortland electorate. That is the area where there is an incredible shortage of GPs and has been for a very long time.

The average age of GPs in the area is 54.5 years. As that workforce continues to age, that is going to have a further impact on the shortage of GPs in the area. I believe that it is vitally important that this issue is addressed. I see the legislation that we are debating here in the parliament today as providing some relief to the people not only of the Central Coast part of my electorate but the Lake Macquarie part of my electorate as well.

It is interesting to note that the socioeconomic status of the Central Coast population is lower than the average for New South Wales and Australia. People there experience poorer health, have higher mortality rates and have higher rates of behavioural health risks such as smoking and obesity. Poor access to GPs and primary health care further exacerbate the issue. The majority of the area’s Aboriginal and Torres Strait Islander populations in the northern Sydney and Central Coast area health catchment reside on the Central Coast, and a significant number reside within the Shortland electorate.

I mentioned that Shortland electorate is an older electorate. In the Central Coast part of the electorate, the population is proportionally older and younger and those people have a greater need to access medical services because of the need for support at both the older and younger ends of the health spectrum. Smoking levels among Central Coast residents are approximately one in four males and one in five females, which is well above the average. Risky drinking behaviour is above the average and mental health, drug and alcohol related conditions are increasingly prevalent on the Central Coast. The burden of chronic disease and avoidable acute conditions is increasing across the region.

With figures like that attached to the area, rather than having fewer GPs we need to have an increase in GPs. At this particular point, I thank the minister for the initiatives that she has already introduced to increase the number of GPs that are available. In the Hunter part of the electorate, we will receive an additional four GP allocated places this year, with this continuing to increase over the coming years.

We should not be in the position we are in now. If the former Minister for Health and Ageing, Mr Abbott, the member for Warringah, had acknowledged early in the piece that there was a problem with doctor shortage and if the 12 years of poor workforce planning by the former Howard government had not happened, we would not be in a position where we have this chronic shortage of GPs across the country. As I mentioned, there has been an increase in the number of training places for GPs this year. The number will increase further in 2010-11 as part of the government’s $86 million commitment to providing 212 additional ongoing GP training places from 2011. As I have already mentioned, our region—the Hunter part of the electorate—has four new GP allocated places for this year.

I have talked about the Central Coast part of the Shortland electorate. I would now like to turn to the Lake Macquarie area of the Shortland electorate. It has been an area that, over time, has fared a lot better in relation to GPs, but in the dying days of the Howard government the shortage became much more apparent. One of the GPs in an area of the electorate where there are a lot of elderly residents decided that he just could no longer practise. He was about 78 years of age and had a medical practice where he worked full-time. He tried to attract doctors to work in the area, and one person that was very keen to come and work in the area was a person that was trained in New Zealand. He had lived in Australia for about three or four years but, unfortunately, this person was affected by the moratorium that is referred to in this legislation and was unable to take up that position. The result was that the practice closed. The result was that all those elderly people that relied on that GP for treatment and support were without a GP.

I raised the issue with the former Minister for Health and Ageing and got no satisfaction whatsoever. Mr Abbott was not receptive to doing anything to address this chronic doctor shortage within the Shortland electorate. That is why a situation has now arisen where people have to wait not three to four weeks, as I have mentioned in speeches over the last few years, but up to a month or six weeks for an appointment with their doctor. Action has been taken but, unfortunately, the action has been taken when there is a crisis, not at the time it should have taken place. The Howard government and Mr Abbott should have looked at taking some decisions in planning for the future and addressing the chronic workforce shortage that existed—but no, they ignored it. We had to wait until the current Minister for Health and Ageing and the Rudd government came to power to address these issues.

We have legislation before us today that is going to amend the classification of overseas medical students. It will remove the requirement for overseas trained doctors and foreign graduates of an accredited school to have both permanent residency and medical registration, for a moratorium of ten years, and will remove the requirement for persons who are permanent residents of New Zealand to obtain primary medical education at an accredited school in Australia. I commend the legislation to the House. (Time expired)