Medical Rural Bonded Scholarship Scheme
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The Medical Rural Bonded Scholarship Scheme is a program intended to increase the number of doctors practising in rural and remote regions of Australia. It is a contract linked with legislation (s19ABA Health Insurance Act 1973 (Cth)) introduced by the Australian federal government in 2000 which provides a scholarship of over $20000 a year at the cost of prohibiting access to Medicare provider numbers unless medical practitioners serve in rural and remote areas for 6 consecutive years. The Federal Government retains the right to define what a rural area is at any time. New medical school applicants offered a Medical Rural Bonded Scholarship must sign up to contracts of service before they are allowed to become medical students.
If the contract (signed before the doctor began their study of medicine) is breached by the contracting doctor, as well as repaying scholarship monies, that doctor will not be able to receive Medicare rebates, meaning that patients will not be able to use their Medicare card to obtain treatment with them, for a period of typically 12 years by operation of section 19ABA of the amended Health Insurance Act (1973) Cth.[1] This restriction may apply to an estimated 10% - 20% of all medical students who are in some form of bonding, including other schemes such as the Bonded Medical Places Scheme, which allows practitioners to practice in areas of need, which may include outer metropolitan areas.
A flow on effect of the scheme is that Australian citizens who are not party to the bonded medical practitioner's decisions will also lose the ability to access Medicare with these medical practitioners.[1]
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[edit] Application
Typically the MRBS scheme offers scholarships to medical school applicants who did not receive adequate marks in the interview part of the medical entrance exam to gain a ‘standard’ place. These applicants (not yet students) are offered a ‘MRBS’ place if they sign a contract stipulating they can only study medicine on the condition that they agree to work in a rural community for six years once they have completed their basic medical training and GP or other specialist fellowship. This selection criterion indicates that rural areas are receiving Medical Practitioners who are less 'suitable'.[citation needed]
All students who are in the MRBS scheme are enrolled under HECS, or as they are now Commonwealth Supported places.
[edit] Parliamentary debate
Members of the Australian parliament have raised concerns over the constitutionality of the scheme, as section 51(xxxiiiA) of the Australian Constitution prohibits legislation introducing any form of civil conscription for medical services.[2] Speaking in the House of Representatives, Michelle O'Byrne said
On 10 September 1998, in a press release, the minister stated: The scholarships are probably unconstitutional due to the limitation in section 51 preventing civil conscription of doctors."[2]
Countering the view that the scheme constitutes civil conscription is the argument that the scheme is entered into voluntarily. Government minister Ian Macfarlane said,
If the people who are considering taking these scholarships are not prepared to take the conditions, the answer is simple: don't sign them. This is not a compulsory scheme; this is a voluntary scheme."[3]
A conscription argument is that refusing qualified doctors (and the Australian public) access to rebates because the Practitioners have defaulted on their contracts effectively renders them unable to make a living as medical practitioners. Mr Dick Adams (Lyons) said about the bill
As I said, this bill is really about bashing people to achieve a goal. It sets out conscription on people which might be a contractual arrangement for 17 years and then you take away the Medicare ticket so they cannot get payment. Therefore, working as a doctor would be pretty difficult because you would probably work for nothing. I do not think that is the solution. ...[this is] a bill to bash people about the head with and make them stay somewhere where they probably do not want to be.'[4]
[edit] See also
[edit] References
[edit] External links
- Action group/resources against bonding[5]
