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Thursday, 26 November 2009
Page: 13178


Mrs D’ATH (3:25 PM) —I rise to speak in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill will make four amendments to the Health Insurance Act 1973. Before I go to the detail of the amendments, I wish to comment on the context in which this bill arises. Many speakers, if not every speaker, during the debate on this bill have spoken about the shortage of general practitioners in their local communities. The electorate of Petrie is no different in that respect. I have been given anecdotal evidence over the past two years by local doctors about our ageing GPs and the concerns about the future of medical services in the local area. In an area with a significantly large elderly population, it is of great concern that people throughout my community will continue to experience difficulties in getting access to timely medical assistance. Of course, we know the risk if people are unable to visit their local GP: these people end up in our emergency wards.

The Rudd government has recognised that shortage of doctors in Australia is one of the more significant problems in our health system along with the shortage of other health and allied health professionals. On 22 September 2008, the Minister for Health and Ageing, the Hon. Nicola Roxon, announced that the federal government would boost training for junior doctors in general practice. This commitment is taken in an effort to increase the number of GPs across Australia. Throughout 2009 $20 million was announced to fund approximately 80 additional places in a program which enables junior doctors to undertake short-term supervised training placements in general practices, bringing the total to 360. This program increases training capacity in the early years of a doctor’s postgraduate training by providing opportunities for junior doctors to gain clinical training experience in primary care. Of course, the range of initiatives announced by the Rudd government and the minister for health to lift the number of trained doctors in Australia will not result in additional doctors in our communities and in our hospitals overnight. Training as a doctor in Australia takes many years and Australia is proud of its training to produce high-quality doctors that will service our communities well into the future.

It is fair to say that Australia still needs to rely on a number of doctors from overseas. I understand that overseas trained doctors have caused concern in recent years. People want to make sure that our system of registration of doctors from overseas is vigorous and robust to ensure that foreign doctors are, at the least, equally qualified to those who train within Australia. This is extremely important. I support the need for a thorough process to ensure that the proper checks on qualifications are made and the history of the doctor is considered by the relevant medical authorities in Australia prior to registration being granted.

That brings me to the proposed amendments in the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill provides more access to certain trained doctors to provide professional services that attract Medicare benefits. It does not make it easier for foreign doctors to practise in Australia. It is important that those doctors who are given registration to practise in Australia are given fair access to Medicare benefits for the professional services that they provide, where they meet the relevant requirements.

The Health Insurance Act 1973 does not, it can be argued, provide fair access for doctors who have in fact been providing a professional service in Australia for some time or for persons who are not Australian residents but have attended a medical school in Australia. Equally unfair exclusion applies to Australian citizens who have attained their medical qualifications in New Zealand. The proposed amendments in the bill before the House address this inequity. Section 19AB of the Health Insurance Act 1973 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, known as the 10-year moratorium. This bill amends the class of person subject to the restrictions in section 19AB and amends the start date of the moratorium period.

The first amendment removes from the classification of overseas trained doctor persons who are permanent residents or citizens of New Zealand and who obtain their primary medical education at an accredited Australian or New Zealand medical school. As New Zealand citizens are categorised under the Migration Act 1958 as temporary residents of Australia, they currently fall outside the definition of overseas trained doctor. Despite this status under the Migration Act, New Zealand citizens, as we know, have been afforded many rights in Australia, including being afforded permanent residency rights under the Australian Citizenship Act.

In addition to the general status of New Zealand citizens who choose to reside in Australia, New Zealand doctors who have trained in New Zealand are in fact undertaking studies that are accredited by the Australian Medical Council. These students are accredited to the same standards as students of Australian medical schools. The proposed amendment will provide some equity in the way New Zealand trained doctors are able to provide professional services within Australia. Of course, it is only reasonable to then apply the same equity to New Zealand citizens who have studied at an Australian medical school and who seek to practise here. This amendment provides equity with Australian doctors by ensuring that New Zealand doctors are not defined as overseas trained doctors and as such are not required to comply with the 10-year moratorium. This amendment will also rectify another anomaly wherein an Australian citizen could elect to study at a New Zealand medical school. As these Australians did not gain their primary medical degree in Australia, they are also subject to section 19AB of the Health Insurance Act.

The second amendment changes the category ‘former overseas medical student’ to ‘foreign graduate of an accredited medical school’. This amendment seeks to remove the confusion that caused among some doctors by the term former overseas medical student. This category, which attracts restrictions under section 19AB, is meant to refer to foreign persons who graduate from an Australian medical school. Altering the name of the category is aimed at removing this confusion.

The third amendment removes the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. Currently, doctors who are trained overseas or who are non-citizens of Australia who completed their medical studies in Australia can find themselves being excluded from providing professional services that attract Medicare benefits for a period much longer than the 10-year moratorium. The reason this can occur is that the current framing of the Health Insurance Act requires that the 10-year moratorium does not commence until the person becomes both an Australian permanent resident or citizen and a medical practitioner.

Australia has a migration policy that requires individuals who seek to obtain permanent residency to go through an application process. This process has a number of steps and can take some time. In the meantime, if granted by the Department of Immigration and Citizenship a person is able to reside in Australia on a visa while their application is being considered. This individual may actually be a doctor who has received registration and is providing services within Australia. If, for any reason, the immigration process takes, for example, five years then it is only at the point of the application for permanent residency being granted that the 10-year moratorium period commences.

In setting time frames, it is not the intention of the legislators to establish a process that enables the time frame to be much greater than that prescribed. That is, however, what the current act does. The amendment in this bill will ensure that the act will better reflect what the intent of the section is. The bill will break the mandatory nexus between registration and residency or citizenship so that the 10 years can commence immediately upon registration. The bill, however, continues to ensure that the doctor’s professional services do not attract medical benefits unless the person is an Australian resident or Australian citizen by ensuring that the moratorium will cease after 10 years if the medical practitioner has gained residency or citizenship during that 10-year period. This requirement is much more reflective of the realities of gaining such migration status while ensuring that these benefits are only extended to doctors who have become Australian residents or citizens.

The last amendment is to introduce a maximum period of 90 days in which medical practitioners can appeal against a decision to refuse to grant an exemption or a decision to impose conditions on an exemption pursuant to sections 19AB(3) and 19AB(4) of the act. It is important that those doctors who are refused an exemption, or where a decision to impose conditions on an exemption has been made, have the right of appeal and that right of appeal is considered within a timely manner. It is also important that certainty exist to ensure that appeal processes do not continue indefinitely.

To ensure that proper consideration is given to decisions under appeal, it is important that the review of such decisions occur within a time frame that ensures that the materials are relevant and current at the time of such consideration. Under the Health Insurance Act 2009, there is no time limit for seeking a review under section 19AC. It is a common aspect of legal systems, tribunals and other bodies of review throughout Australia to set time limitations on the filing of claims. This right of appeal or review under section 19AC of the Health Insurance Act 2009 should not be exempt in this regard. The 90-day time limit proposed in this bill before the House is reasonable, considering the circumstances and the nature of the appeal or review sought. This will ensure that any decision to overturn the original decision can be made in a timely manner on the basis of current information.

Overall the amendments put forward in this bill address a number of anomalies that exist in the current act and will provide reasonable access to New Zealand doctors and Australian doctors trained in New Zealand to provide professional services that attract Medicare benefits. This bill will also ensure that overseas trained doctors and foreign graduates of an accredited medical school are not required to wait beyond the 10-year moratorium, where residency or citizenship is obtained. Lastly, this bill provides an improved process for the effective management of appeals and reviews.

This bill is a positive piece of legislation for Australia’s health system. It will not result in an influx of overseas trained doctors, but it will provide more fairness in the system and may encourage overseas trained doctors or foreign persons trained within Australia to remain in Australia long-term and assist in addressing the shortage of doctors throughout Australia.

It is pleasing to hear those on the opposition side supporting this bill. It is certainly a bill worthy of support. However, it would be remiss of me not to take the opportunity to highlight some of the less than beneficial actions by those on the other side of this chamber in relation to addressing the genuine health issues in this country. While the Rudd government has been undertaking the most significant review of the health and hospital system in Australia, the opposition has been belligerent in its conduct. The Rudd government is tackling national issues such as: the lack of health expenditure on preventative health; one-third of Australians presenting to public hospital emergency departments are not being seen within a clinically recommended time; one out of every six Australians on a waiting list for elective surgery are not being seen within the clinically recommended time; it is estimated that there are some 650,000 Australians on public dental waiting lists, with an average wait of two years for essential dental treatment; and about two-thirds of people who need mental health care go untreated. In addition, health costs are rising rapidly: from $84 billion in 2003 to $246 billion in 2033, or about nine per cent of GDP now to 12.4 per cent of GDP in 2033. These are the challenges identified in the National Health and Hospitals Reform Commission report released on 27 July 2009.

The opposition has been blocking important legislation which aims to assist in the reform of health and hospitals in Australia. An example is the National Health Amendment (Pharmaceutical and Other Benefits—Cost Recovery) Bill 2008, which sought to provide authority for the cost recovery of services provided by the Commonwealth in relation to the exercise of powers for listing medicines, vaccines and other products or services on the Pharmaceutical Benefits Scheme and designation of vaccines for the National Immunisation Program. The Liberal Party delayed this bill for 12 months, costing the government at least $9.4 million expected in 2008-09. That is revenue that could have been redirected to support improvements in the health sector.

We all know of the delays and confusion from the opposition on the excise and customs bills, better known as the alcopops bills. Then there was the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-Off Cover Support Payment) Bill 2009. The Liberal backbenchers supported these bills in their submissions to this chamber. However, the shadow health minister could not bring himself to say anything positive about the new initiatives. More recently we have had the Australian National Preventive Health Agency Bill 2009, which is now sitting in limbo in the Senate. The Rudd government is not standing still on our health reforms, with the health minister reintroducing the Fairer Private Health Insurance Incentives Bill 2009 after the Liberal Party in the Senate rejected this bill earlier this year.

Whether it is child health, hospitals, aged care, Indigenous health, rural and remote health, mental health or dental health this government is committed to tackling the needs of Australians now and into the future. The Rudd government has already committed to investing $64 billion in the hospital and health system across the country over the next five years—a 50 per cent increase on the previous agreement by the Liberals. We have invested $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 but delivered more than 41,000 procedures. In stage 2 more than 150 hospitals will receive funding across Australia and we have invested $750 million in taking pressure off emergency departments.

The Rudd government has also invested in new health infrastructure, in investing in our health workforce and in preventive health measures. The government has committed to a total of $650 million for two dental programs and will invest $1.6 billion to improve Indigenous health. Additional funding has also gone into aged cared. For the future, the government has embarked upon a path to build the health and hospital system that Australia needs for the 21st century. The government has committed to an overhaul of the health system to ensure that it can cope with future challenges, including an ageing population and rising healthcare costs.

The government has already undertaken many more measures to deal with the critical issue of health services. In an electorate such as Petrie, we do not take the health system for granted. We know more needs to be done; we know that the federal government through the national health and hospitals reform process is serious about finding solutions for the future—solutions that plan for the long term. Already my area has seen the commitment of the federal government in announcing a GP super clinic. This clinic will be known as the Moreton Bay Integrated Care Centre and will have a strong focus on preventive health. These centres around the country will complement any future initiatives that the government implements to improve the health services for our communities. I support this bill before the House today and look forward to supporting many more health reform initiatives by the Rudd government.