BILLS - Health Insurance Amendment (Professional Services Review Scheme) Bill 2023 - Second Reading

13 June 2023

I would like to firstly thank the members for Cooper and Dobell, the assistant health ministers, for introducing the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023. I thank the member for Dobell, in particular, for speaking so well on it. I also thank the member for Kooyong, who is a highly respected medical practitioner. Her contributions in health care and in this parliament have been fantastic, and I thank her for her speech.

I'm very proud of our nation's healthcare system and of Medicare in particular. I started my private practice on the same day that Medicare was introduced into Australia. I'm very proud of that. I saw the difference in what happened pre Medicare and post Medicare. I won't go into the history of it. Suffice it to say that the most common cause of bankruptcy prior to Medicare was medical costs. That changed dramatically with the introduction of Medicare. I know that people in my community who had previously not been able to access care by paediatricians such as myself and who were put on long waiting lists or missed out on care altogether for their children could see a paediatrician without a huge financial impost. Equitable access to health care became incredibly important for our community since that time.

However, Medicare was designed a long time ago, as were many of the regulatory mechanisms involved in making sure it works correctly. It's very important to note that two people I know very well—Dr Tony Webber, who was head of the Professional Services Review, and Professor Julie Quinlivan, who also was head of the PSR—were very critical of the role that the PSR has played in reducing medical fraud and mismanagement over the last 30 years. They both had some very significant things to say, as reported recently in the Fairfax press and on TV by the ABC on Four Corners. They were very critical of the lack of ability to prosecute poor practice and medical fraud in this country.

I should point out that Dr Webber was a very well respected GP. In fact, he used to refer to me many years ago. I respect him as a doctor but also in his previous role as head of the PSR. Professor Julie Quinlivan is a well respected obstetrician and gynaecologist who has worked for women's health for many years. She now has a university appointment as a professor of obstetrics and gynaecology and is highly respected. She also brought up many issues involved with the PSR.

The Philip review, which was introduced by Mark Butler, the Minister for Health and Aged Care, found that there was need for a review of the integrity and compliance processes in the PSR, and this bill is the result of that review. Dr Philip found that changes were needed to ensure the compliance system that underpins Medicare is modernised, effective and rigorous, and that certainly has not been the case. I relied on Medicare for my income for almost four decades. In that time, I was approached by a number of colleagues to provide character references for them when they were being reviewed by the PSR. In every case that I was involved in giving a character reference for, the review was appropriate and the action taken also was appropriate, but there is a view in the profession that these reviews are too infrequent and do not look at the overall practices that have crept into medical practice over a number of years since the corporatisation of medicine and since access to care has become increasingly difficult in the last 10 or 15 years.

I must stress that the vast majority of medical professionals that I've worked with in my career were honest and always did the right thing, but it was quite clear to me that there were some people who were outliers who could have been better regulated by the PSR and should have been better regulated by the PSR, and I think most medical professionals would say that. This bill makes several priority amendments in response to the Philip review and its recommendations, and I applaud it, as I applaud the health policy analysis and developments made by the present health minister in response to 10 years of neglect by the previous government.

This bill specifically removes the veto power of the Australian Medical Association, the AMA, over the appointment of the Director of Professional Services Review. Surely no-one in this day and age could argue with that. I have been a member of the AMA for 45 years, and I think none of my colleagues who are members of the AMA disagree with this fundamental change in the PSR. The PSR will now have oversight of a whole range of different professionals providing health care and support for health care in our community. It's not appropriate that the AMA continues to have a veto power, a veto power, I might add, that it has never used. It does seem a little silly that it is still there. The bill also amends the consultation requirements for the appointment of other statutory office holders of the PSR, including deputy directors, panel members and members of the determining authority, to enable direct consultation with peak bodies rather than just being coordinated through the AMA. This is, of course, appropriate, and it is appropriate that this bill has been introduced by this government, a government committed to Medicare and committed to equitable access to health care for all Australians.

Concerns have been raised that the objective of the PSR, which is to safeguard the integrity of Medicare, may conflict with the AMA's objective to represent the interests of medical practitioners subject to the PSR. I know my colleagues want our system to be as rigorous as it possibly can be, so I don't think these concerns are well placed. I know that the AMA has done an enormous amount of work to ensure the compliance and transparency of medical care in this country and will continue to do so. The AMA will be one of the bodies consulted before any other major changes are made, and it will also be consulted when medical practitioners are subject to review. The removal of the AMA's veto powers is appropriate. It has previously not been consistent with public expectation and undermines confidence in the independence of the PSR as a regulator if the AMA has veto power.

Last year, at the same time our government commissioned the Philip review, I spoke in parliament on the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill that amended the PSR arrangements to manage and review the practice of corporations and not just single practitioners. I think that is vitally important if our system is going to be fit for purpose. This bill is part of our government's work to strengthen Medicare and to ensure there is equitable access to health care for all Australians. At the moment, because of ten years of difficult behaviour by the previous government, equitable access to health care has been allowed to fall away, particularly in rural and regional areas but also in outer metropolitan areas.

Mr McCormack interjecting—

Dr FREELANDER: I see that the member for Riverina is arcing up a little, but it is quite true; there is a huge difficulty in accessing equitable health care in rural and regional areas. We, as a government, are committed to making sure that equitable access is available to all Australians. Our 2023 budget was very important in the improvement of access to equitable health care; the indexation boost to Medicare rebates, costing over $1.5 billion; and the tripling of bulk-billing incentives for many practices in outer metropolitan and rural areas. For many doctors, this will make the difference between staying in practice and leaving those practices.

The centrepiece of our strengthening Medicare package is $3.5 billion to triple the bulk-billing incentive for GP visits. I can't emphasise how important that is. The government is also looking at ways of trying to improve the want of medical students to go into general practice rather than specialty practice. I've always seen general practice as the hardest of the medical specialities. It's important that we continue our Medicare review process because there is much more to be done, and, as Dr Philip said of the PSR, there's still much more to be done. But we need to do it in a methodical and organised manner. We need to bring the professions with us. We need to make sure that Australians can access equitable care around the country so that it's not just in the inner cities where people can get access to the best care. We know that statistically mortality rates increase the further you go from the centre of our major cities. This is certainly true for people in rural and regional areas, but it's also true for people in outer metropolitan areas. It is imperative that vigorous arrangements to identify and address poor compliance in the medical field and inappropriate practice are seen as essential to the ongoing commitment to improving Medicare.

This bill will benefit all Australians by supporting the integrity of Medicare. It is very important that we, as politicians, understand the importance of making sure that Medicare remains the centrepiece of our healthcare system in Australia. We've had it now for a long period of time—40 years—but it is very important that we see that Medicare has underpinned Australians having some of the best health care in the developed world, and we don't want access to care to deteriorate the way it did under the previous government. It's very important. Medicare is the centrepiece of our healthcare system and must remain so.

I commend this bill to the House, I thank the minister for moving it and I look forward to health reforms, in the future, that will improve equitable access to health care for all Australians.