BILLS (Second Reading): Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021

18 October 2021

I rise to speak on the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021, and I foreshadow that I will move a second reading amendment. The purpose of the bill is to amend the Health Insurance Act 1973 to improve the implementation of the bonded medical program and the administration of the medical rural bonded scholarships contracts under section 19 of the act.

The program is designed to address the doctor shortage across regional, rural and remote areas, a shortage that has grown worse and worse under the Morrison government. Participants of the programs receive a Commonwealth supported place in a medical course at an Australian university in return for completion of a return-service commitment to work in regional, rural and remote areas and areas of workforce shortage.

The bill allows participants in two legacy schemes, the Medical Rural Bonded Scholarship Scheme and the Bonded Medical Places Scheme, to voluntarily opt in to the program, and if the secretary agrees to their participation they also become bonded participants. The program offers a number of advantages to bonded participants, compared with the two legacy schemes, including a shorter, three-year return-service obligation, rather than up to six years. It assures more flexibility in completing the return-service obligation as well. These changes are welcome, but this bill will not address the difficulties Australians in outer-metro, regional and rural areas are having in accessing health care, including seeing a GP.

The Morrison government's decision to remove areas like Newcastle and the Hunter region from the new distribution priority area classification means doctors in the Bonded Medical Program cannot meet their return-service obligations in these areas, making local GP shortages worse. Tightening access to regional bulk-billing incentives, as the government has done, is another policy from the Morrison government that has made regional GP shortages worse. And, of course, there is also the impact of the government's six-year freeze on Medicare rebates and its decision back in 2014 to abolish Health Workforce Australia. At a time when the government should be investing in Medicare and delivering more services to regional Australia, this government is doing the opposite.

I know the government likes to trumpet its rural health strategy, but this is just another announcement from this government that has failed to deliver an end to the regional GP crisis. A lack of doctors and other medical professionals in regional and rural communities across Australia is not a new problem, but it is an even more pressing problem in the context of the COVID pandemic. That's why Labor has established a Senate Community Affairs Reference Committee inquiry into outer-metro, rural and regional GPs and other healthcare services, which will consider the performance of programs such as the Bonded Medical Program. The inquiry will explore the GP crisis in outer-metropolitan, rural and regional areas, including an assessment of government policies such as the rural health strategy, the reforms to the distribution priority areas and the Modified Monash Model geographical classification system. It will also look at GP training reforms and the impact of the coalition's Medicare rebate freeze.

The inquiry has taken off. It has already heard from so many stakeholders confirming there is indeed a regional and rural healthcare crisis and that this crisis also extends to outer-metro areas. So far 43 submissions have been received from stakeholders, including local councils, medical colleges, health organisations and MPs from this place. These stakeholders and outer-metro, regional and rural MPs all acknowledge the challenges to delivering sufficient, high-quality health care to all Australians. These challenges are real, and their impact is only getting worse. Labor wants the inquiry to seek practical, positive solutions to make sure that Australians have access to quality health care regardless of where they live. I encourage all Australians and all MPs to engage with this inquiry.

General practitioners are the backbone of the vaccine rollout across Australia, yet there are regions in which it is near impossible to get a GP appointment. This has obvious implications for vaccination rates, with regional vaccination rates lagging 20 to 30 per cent behind those in cities, and this does nothing but place regional Australians at greater risk from the pandemic.

As the member for Macarthur makes clear in his submission to the Senate inquiry, a lack of regional GP access also increases pressure on regional hospitals, as Australians who can't get medical treatment through a local GP are forced to present to regional hospital emergency departments. Of course the same can be said of city hospital emergency departments, which are equally under pressure when people from outer-metro regions simply cannot access a GP. They head into the city based hospital system.

There are other things that regional, rural and outer-metro people are struggling to access when it comes to the healthcare system—for example, obstetrics. Pregnant women can find it very difficult to get the specialist care that they need. They very rarely can access GP shared programs or even midwifery services in outer-metro, regional and rural areas. We were all shocked that the Prime Minister's response to this problem was: the government builds roads, and women use roads. As someone whose daughter had to drive two hours from her regional home to get to the nearest hospital to have her baby, I can tell you that that is no comfort at all.

An area like aged care, where we know that GP access is very short and hard to come by in the cities, is even more desperate in outer-metro, rural and regional areas. Our elderly are not well served by the health system. If there is a shortage of GPs for young people and families, imagine how acute it might be for people in residential aged care or for isolated older people in their homes. They are desperate for good health care from good local GPs, and there just aren't any.

We know that the issue of mental health care is absolutely acute in rural and regional areas, where accessing mental health care is pretty much impossible. Imagine if we had a government that was dedicated and actually put in the time, the energy and the commitment to make sure that people out on farms and living in rural cities and in regional cities could access the mental health care they need: the suicide crisis, particularly amongst our young people, may just be alleviated. We know that some resources are scarce enough, even in the cities, but access is far worse in outer-metro, regional and rural areas.

One policy to support regional and rural access to crucial medical services is to boost the use of telehealth items so that patients can see a doctor regardless of the vast distances that characterise so much of our beautiful country. Everyone, from the medical profession to public health experts and patients themselves, accepts that telehealth is a crucial part of our Medicare system moving forward, but after almost two years of a global pandemic the Morrison government still hasn't made telehealth a permanent feature of Medicare. Some of my constituents who live in the city have told me what a life-changing thing it is to be able to access telehealth, including people with chronic fatigue syndrome, who find it incredibly difficult to leave their home. Trans people, who find it very difficult to access specific health care, have found telehealth to be a saviour. People who, for whatever reason, are finding it hard to get out of their homes and into healthcare services find telehealth to be absolutely revolutionising for their health care. So why is there a delay? Why can't this government simply get on with the job and make telehealth a permanent part of our Medicare system?

Millions of Australians living in outer-metro, regional and rural Australia deserve and are crying out for the same access to medical services as their cousins in the big cities, yet after eight long years of government the Prime Minister has failed to deliver it and has in fact made it worse. Labor will always fight to defend and strengthen Medicare and to make sure that all Australians have access to a GP and to other healthcare professionals. The rural and remote doctors, who I speak with quite a lot in my role as the shadow assistant for health care, have told us that there are many models of healthcare delivery that could be explored and added into the health system to make sure that people in rural and regional areas get good health care. We should be listening to these stakeholders.

We should be trialling new models of care that use our entire health force to their full capacity, like midwives, like nurse practitioners, like our allied healthcare practitioners, like physios and like pharmacists who would move to regional areas and who would boost the healthcare workforce. All of this can be looked at, all of this can be added to strengthening Medicare to make sure that all Australians, no matter where they live, can get the health care they deserve. I move the amendment circulated in my name:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House urges the Government to do more to address outer-metro, regional, and rural barriers to medical services including GP access for all Australians."