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

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

The member for Grey raised several very valid points. One of the points he raised, however, for which there is very little evidence, is that there is, at least in part, an epidemic of overservicing in city areas. That is fundamentally not the case; there is no evidence for that. The problem is, of course, access to proper medical care in outer metropolitan, rural and regional areas. That's why, by whatever measure you care to take, health outcomes in outer metropolitan, rural and regional areas are much worse than in the cities. Whether you take rates of bowel and lung cancer, rates of smoking and cardiovascular disease, death rates or age of death, male or female, they're all much worse in outer metropolitan, rural and regional areas. The further people move from access to medical care the worse those statistics are. So what the member for Grey was saying—that overservicing in the cities is affecting servicing in rural and regional areas—is not true.

We need the appropriate number of doctors and you need more. I don't particularly want to be distracted with this argument. I'm happy to have it later on. But, if the member for Grey is making these statements, he should be able to produce the evidence, and there is no evidence for that.

I've discussed the Bonded Medical Program many times because I've had to deal with medical students who signed up to this program when they were 17 or 18 and in full flight of getting a good HSC mark and getting into medicine. They signed up for something that may have looked good, but, as the member for Grey and others have pointed out, as their circumstances changed, their priorities changed. I've had to act for a number of people trying to get out of these bonded programs because their lives had changed, because of partners, children et cetera. They haven't worked. They haven't really made much difference to the medical workforce in rural and regional areas. They don't affect the outer metropolitan areas, which also have huge difficulties in attracting general practitioners. I'll just explain to you why that's the case.

If you work in disadvantaged areas—in outer metropolitan areas and in rural, regional and even remote areas—the work is very hard. If you're a doctor working in these situations, you're expected to deal with everything from an obstetric emergency to an acute cardiovascular event, a stroke or a severe seizure disorder. Our standards of medical care have improved a lot over the years and expectations have risen. Providing care in an outer metropolitan hospital, which may not have access to specialist care, may not have access to a range of interventions, like MRI scanning and cardiac catheterisation, and may not have access to the range of specialists that could support you in an inner city hospital, makes the work far more difficult, far more time-consuming—because the work is generally put on the one practitioner only—and much more stressful. If you happen to be on call in these communities, the work is far more difficult than if you were a general practitioner working in an inner city practice with multiple doctors with multiple cover, either not on call at all or only on call one in 10 or one in 14. So the work is much more difficult in these areas and it has proven to be much more difficult to attract people to these areas.

For those reasons and others it's difficult to get ongoing education, even though there are some programs that support rural and regional education. It's more difficult to access specialists and subspecialists in rural and regional areas. As the member for Grey has pointed out, there have been multiple schemes and multiple programs put in place to try to support doctors in rural and regional areas. There has been very little in outer metropolitan areas, like my electorate, but in rural and regional areas there have been lots of schemes put in place. To date they have not been successful in stimulating an influx of medical professionals to the rural and regional areas, and neither have the bonded scholarships, as we've mentioned. I think the financial rewards are not so great as to compensate for the lifestyle and the hours required when working in these practices.

I have approached the health minister on a number of occasions to make sure that they can review these areas of workforce need, the distribution priority area classifications. That has had very little effect, in spite of me approaching the minister on a number of occasions. It's not an issue that's new to the government. I've certainly been doing it since I've been in parliament—for six years. Countless times, I've written to the minister and I've spoken in this chamber about this very thing.

In my own electorate, which is an outer-metropolitan electorate, some of our general practices are having trouble recruiting and retaining quality local medical people. These are the very family practices that we've relied on and that have been on the front line of the pandemic. They play a vital role in our national immunisation program, yet the government has ignored their concerns. Because they've had trouble recruiting general practitioners, it has put far more pressure on our public hospital, which is already overstretched because of the pandemic.

On countless occasions, on behalf of these medical practices from not only my electorate but also the rest of the state, some of whose principals have contacted me, I've urged the government to review its distribution priority area classifications. I have been fobbed off by the government using the bureaucracy as a shield, without any meaningful change. It's not the same trying to access a general practitioner in my electorate as it is in the eastern suburbs or on the North Shore of Sydney. Many of my patients have huge difficulty getting access to a general practitioner. They tend to use the public hospital as their general practitioner, and that puts added pressure on an already-stretched system. I suggest that the junior coalition partner also listen very carefully to what's happening in their electorates, because their constituents have similar problems to mine with access to primary care through a general practitioner.

The partial schemes that have been put in place have been put in place without much evidence and without much forethought about how this is going to work and how we're going to keep general practitioners in these rural, regional and outer-metropolitan areas. The health outcomes demonstrate the difficulties in accessing medical care in outer-metropolitan, rural and regional areas. The bonded medical scholarships have not changed it. Neither has setting up rural medical schools, and neither have some of the supports put in place through medical education.

I believe that people are forgoing medical treatment through the pandemic, and this has become much, much worse in outer-metropolitan, rural and regional areas. Lack of access to general practitioners is the primary problem. My personal view is that we need to engage better with the departments of health of all the states to make sure our teaching hospitals have more of a role in providing medical workforces to outer-metropolitan, rural and regional areas. That will require a total rethink of how health care is managed in previously disadvantaged areas. But it is important that we do that; otherwise health care in outer-metropolitan, rural and regional areas will fall further and further behind the inner suburbs of our wealthy capital cities.

We already see different advances in the medical management of, for example, coronary artery disease and heart attacks, with acute intervention which can be life saving and lifestyle saving. Stroke management is changing dramatically, with acute clot retrieval through neuroradiological techniques. There have been huge changes in medical care, and our provision of medical care to these outer-metropolitan, rural and regional areas has not kept pace with those changes in medical care. This bonded medical scholarship scheme will do little to redress those needs. The gap is widening, and the increasing cost of health care is only perpetuating the inequality that is occurring.

Australia's spend on its health budget is much less than many other countries in the developed world, such as the Scandinavian countries, the United States of America, Great Britain et cetera. Where we spend around 10 per cent of our GDP on medical costs, they're spending 12 per cent, 14 per cent or 16 per cent. We need to fund our health care better. We're now approaching a time similar to the time of the advent of the Whitlam government, when healthcare costs were out of the reach of average Australians. We need to rethink our access to medical care for those disadvantaged areas. We need to rethink Medicare on that basis, we need to fund Medicare properly and we need to make sure that our major teaching hospitals that provide the highest level of care can provide that level of care throughout the country. We need to rethink how we engage with them.

I think it's very unfair that someone who lives in, for example, North Sydney, should get far better care than someone who lives in Campbelltown, Minto, or Airds; someone who lives in Temora; someone who lives in Armidale; or someone who lives in Broken Hill. I think we need to look at a more equitable approach to health care.

I think that the government needs not just to pay lip service to these complaints; there needs to be a real review of how we provide health care in Australia. I welcome the recent announcement that a new appeals process will be installed to existing DPA classifications—I think that's very important—but there's a lot of work from making that possible to getting it right and allowing our practices to recruit medical practitioners on a DPA basis. It's not a new issue, as I've said.

I want to thank my friend and colleague the member for Dobell, who has worked very hard on similar issues on the Central Coast. The member for Chifley also has worked hard to get GP recruitment in his outer metropolitan electorate. I know the member for Macquarie has worked very hard in her electorate to see what can be done to get better GP recruitment in her electorate. Labor has consistently been trying to get the government to address the GP shortages. These shortages have made the pandemic problems even worse in disadvantaged electorates, and it's time the government actually took notice and did something about it. This small change to the bonded medical scholarships will not make much difference at all, I'm afraid, and we really do need to see meaningful action from a government that's been prepared to sit on its hands for far too long.

I am constantly being contacted by general practitioners in my electorate and others around the country to see what can be done to improve recruitment of general practitioners, because primary care is the basis of all good medical care. If you can't get your primary care right, you will not have good health care. This is across a whole range of issues, be it paediatrics, obstetrics, immunisation programs, public health campaigns and even dental health and other preventative health measures. Unless we can get our primary care right, we will not get decent primary health care across the country.

What's happening is very inequitable. This is a government that for eight years has sat on its hands, and it's time we had a consistent program from the government to improve the whole system.