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Thursday, 26 November 2009
Page: 13161


Mr ZAPPIA (2:09 PM) —I take this opportunity to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. As others have already said, the purpose of this bill is to amend the Health Insurance Act 1973 to, firstly, remove restrictions which apply to New Zealand permanent resident and citizen medical practitioners who have obtained their primary medical education at an accredited medical school in Australia or New Zealand and, secondly, remove the specification in the act that the period of 10 years during which overseas trained doctors are restricted from accessing Medicare benefits must commence from the time doctors become permanent Australians, even if they become medical practitioners prior to gaining that residency status. The bill also introduces a time period in which medical practitioners can appeal against the refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption which has been granted.

In essence, this bill not only removes unnecessary barriers to New Zealand medical practitioners but also eliminates the discrimination that currently applies between New Zealand medical practitioners and other New Zealand professionals who work in Australia. For years this country has had a special immigration arrangement with New Zealand whereby New Zealanders and Australians can travel and work much more freely between the two countries than can people of other nationalities. But, because of the specific requirements relating to doctors working in this country, that same freedom relating to New Zealanders does not apply to medical practitioners. This bill seeks to remove that aspect of the medical requirements to ensure that New Zealanders, regardless of whether they are medical practitioners or related professionals, have the same ability to work freely in this country as their other professional counterparts.

The government is also responding to the health needs of the nation and the inadequate level of services available in many parts of the country. These services have deteriorated over the last decade because of the neglect and buck-passing by the previous Howard government, which cut a billion dollars from the states under the last health agreement. Specifically, in relation to this bill, the Howard government failed to invest in sufficient university medical training places. Not surprisingly, we are now faced with a shortage of medical practitioners around the country and particularly in regional and remote communities. It was not just in the number of medical practitioners that fell. Using the latest international comparisons, in 2006-07 Australia spent 8.7 per cent of its gross domestic product on health. That was less than the OECD median expenditure of nine per cent of GDP and considerably less than the weighted average of 11.2 per cent of GDP across the 29 OECD countries that we were compared with. It might only be a couple of per cent but as we all know a couple of per cent in terms of real budgets equates to billions of dollars.

The Rudd government takes seriously its health obligations and the commitments it has made to the Australian people. Since coming to office, the Rudd government has invested $64 billion in the nation’s hospital and health system over the next five years. That is a 50 per cent increase on the previous agreement between the former government and the states. The Rudd government has invested $600 million in the elective surgery program and $750 million in taking pressure off more than 30 hospital emergency departments. The Rudd government is also now undertaking historic investment in nation-building health infrastructure by investing $3.2 billion in 36 major projects across our hospital and medical research initiatives, including $1.2 billion in world-class cancer centres.

The Rudd government has also committed $275 million for some 36 GP super clinics across the country, and $500 million has been approved for sub-acute care to help older people leave hospital and free up hospital beds. The Rudd government will also invest $1.1 billion in training more doctors, nurses and other health professionals. This is the single biggest investment in the health workforce ever made by an Australian government. The commitment will see an additional 812 ongoing GP training places from 2011 onwards, which represents a 35 per cent increase on the cap of 600 places imposed since 2004 by the previous coalition government.

One area of particular concern to the people I represent in Makin, and I expect of concern to people across Australia, is dental health care. I understand some 650,000 Australians are currently on public dental waiting lists. The Rudd government when it came to office committed a total of $650 million for two dental programs. One is the teen dental program, which provides a $150 annual payment to eligible families. It commenced last year and, to the end of December, 258,203 teenagers had received a dental check-up under the program, with 7,598 dentists providing services. Regrettably and unfortunately, due to the Liberals standing in our way in the Senate, the Commonwealth Dental Health Program, which would provide up to a million consultations, has not been able to commence.

The Rudd government also commissioned and is now considering the recommendations of the comprehensive report of the National Health and Hospitals Reform Commission, led by Dr Christine Bennett. That report is the product of 16 months of consultations, research and deliberations by the commission. It provided the government with 123 recommendations, which the government, through its consultations across the country right now, is in the process of considering. I want to quote from page 3 of the executive summary of that report, because it effectively summarises the state of our health system in Australia. It says:

The case for health reform is compelling.

The health of our people is critical to our national economy, our national security and, arguably, our national identity. Our own health and the health of our families are key determinants of our wellbeing. Health is one of the most important issues for the Australian people, and it is an issue upon which they rightly expect strong leadership from governments.

While the Australian health system has many strengths, it is a system under growing pressure, particularly as the health needs of our population change. We face significant challenges, including large increases in demand for and expenditure on health care, unacceptable inequities in health outcomes and access to services, growing concerns about safety and quality, workforce shortages, and inefficiency.

Further, we have a fragmented health system with a complex division of funding responsibilities and performance accountabilities between different levels of government. It is ill-equipped to respond to these challenges.

That is part of the executive summary of the Bennett inquiry. I suspect that very few of us in this place would disagree with those comments.

I mentioned earlier that, amongst the Rudd government’s commitments, $275 million had been allocated towards the provision of GP superclinics across the country. I particularly note and welcome that one of those GP superclinics will be established in the Makin electorate, which I represent. This particular clinic has a special status in that it will be established in partnership with the Rann state Labor government, which has also committed a matching amount of $12.5 million towards the clinic, so that it will be a $25 million GP superclinic. That collaboration has enabled us not only to carefully plan for and identify the location of the GP superclinic but, more importantly, to very carefully and methodically work through the range of services that will be made available from the clinic.

I understand that work on all of that is progressing and that the first services are expected to be provided from the clinic in the second part of 2010. The concept being supported is one whereby there will be a new facility established on Smart Road in Modbury, close to the Modbury hospital, and a range of medical and allied services will be provided from that facility. I also understand that a support facility is intended to be established on North East Road at Hillcrest, a few kilometres away, that will be linked to the Modbury GP superclinic and will form, in essence, an outreach centre of that superclinic.

I know from my discussions with people, including many of the medical people, out in the community that there are shortages and we could do much better in the delivery of health services to the people in Makin. I also know that there has been an incredible amount of pressure on the Modbury hospital outpatients department over recent years as a result of insufficient medical services being available. I look forward to the establishment of the GP superclinic in Modbury because I know that it will not only deliver much-needed services to the people I represent but also take pressure off the Modbury hospital and allow it to get on with providing the hospital services that it was established to provide.

I am grateful to Minister Nicola Roxon and to the South Australian state government Minister for Health, John Hill, for the cooperation and support I have seen from them in working through this complex problem. The funds have been committed. We want to see those funds being used in the most cost-effective way. And that is exactly what has been happening. To those who might say that it has taken us two years to deliver on this election commitment, I say: it is a process that we committed to, but we also committed to the necessary consultation that has taken place over recent months and the necessary planning to ensure that we deliver the best possible service when the doors to the new superclinic open.

I mentioned earlier the concern about the lack of funding for sufficient training places for medical practitioners in our universities over recent years and how that has resulted in a shortage of medical practitioners right across the country. I note that regional and remote parts of Australia in particular have been hit by those shortages because, not surprisingly, any medical graduate or medical professional who comes into this country would much prefer, in most cases, to work in one of the urban or city areas. It is not surprising that they do not particularly want to go out and work in remote and regional areas of Australia, and the government recognises that and has tried to provide additional incentives for them to do so.

But the shortages do not only apply in regional and remote areas; they also occur in metropolitan areas of our major capital cities. Certainly I am aware that we have had and still have shortages in parts of the Adelaide metropolitan area. I do not recall the exact figures but I do recall very clearly that the ratio of doctors to the community out in the northern suburbs of Adelaide was much lower than in other parts of Adelaide. Not surprisingly, when I was elected to this place I was made aware of the difficulty that people were having in securing appointments with their local GPs within a reasonable time. I can well recall one person ringing me up, quite frustrated and concerned that she was unable to get her daughter in to see her local GP for some three weeks; her daughter needed medical attention much earlier than that for an urgent issue. Having rung a number of GP service providers in the area, she had been unable to secure an appointment. That is the sort of thing that we need to overcome. It should not occur in Australia. Yet it did occur, because we were not training enough doctors in this country.

It would take some years for us to correct that shortage if we were to rely simply on medical students graduating from our universities. Clearly, therefore, the answer lies in attracting medical professionals to this country from overseas. That is what has been happening in recent years and it will continue to happen until we do have more medical graduates coming out of our own universities. In the interim, we need to change the regulations relating to those medical graduates who come from overseas—whether from New Zealand or any other country—to make it much easier for them to get on with providing the medical services that they are quite properly qualified and trained to do, because the sooner we can do that the sooner the Australian community will be the beneficiaries of the services they are calling out for.

I believe this bill is a critical step towards doing that. Yes, it addresses very specifically the case of medical practitioners who come from New Zealand, but it also deals with other matters that relate to some of the barriers in place against overseas-trained medical professionals. The sooner we can break down those barriers the better off the Australian community will be. For those reasons, I commend the bill to the House.