Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026

Senator McALLISTER (New South Wales—Minister for the National Disability Insurance Scheme) (12:18): I thank members for their contribution to the debate on the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026. Medicare represents the very best of Australia. It is a system that is literally the envy of the world, allowing Australians to receive high-quality health care regardless of their bank balance.

Our government is deeply committed to Medicare, deeply committed. We are strengthening Medicare because it is at the heart of universal health care. We are making it easier for Australians to see a GP for free.

This bill establishes for the first time a clear and enduring legislative framework for Commonwealth primary care incentive payment programs. These programs are a central part of how the government supports access, affordability and quality in Australia's primary healthcare system, including in rural and regional communities. Primary care incentive programs represent more than $1.4 billion of annual government investment.

Yet a number of quite significant programs operate without a dedicated legislative scheme that is tailored to establishment, administration, compliance and review. And so, the bill before the Senate at the moment addresses that gap. It inserts a new part into the Health Insurance Act 1973, creating a consistent statutory basis for incentive payment programs while allowing detailed program settings to be dealt with in rules.

That approach will give providers and government greater certainty, but it also preserves the flexibility that is necessary to keep program settings up to date as health system needs evolve. The bill establishes clear processes for participation, administration and decision-making, and that includes approval pathways, notification requirements, reconsideration rights and access to independent merits review through the Administrative Review Tribunal.

It strengthens the integrity of public expenditure by applying appropriate compliance, recordkeeping, information use, civil penalty and debt recovery arrangements to these programs. Importantly, the bill does not change the underlying policy settings of existing programs. It does not alter substantive eligibility criteria or payment amounts, and existing participants are intended to transition into the new framework without any requirement to reapply.

The bill also supports efficient high-volume administration by enabling specified administrative action to be undertaken with the assistance of computer programs. This is subject to oversight, transparency, substituted decision safeguards and review rights. And I do want to take some time to address the remarks made by my colleague Senator Steele-John, because we should approach this discussion carefully, and a blanket assertion that the use of computers in the administration of government is dangerous is an unhelpful way to approach this debate.

The government does now use and has for many years used computers to make high-volume decisions. These processes are already in place. These are essential tools of public administration, and they allow many thousands of transactions to be completed every day.

Raising fear about that process in the community and necessarily causing alarm about the use of computers in government is a foolish way to approach this debate. But of course we should be thoughtful about the safeguards that are necessary with any use of computers. Of course we should be careful.

And this bill establishes a regime of transparency around the use of computers. I want to talk a little bit about that. The bill's automated decision framework is strictly limited to the administration of incentive payment programs.

For example, it does not authorise and it cannot be used for any form of clinical decision making—any form whatsoever. So it can't be used in relation to a patient's diagnosis, their treatment or their health care. And so to come into the chamber and to imply that perhaps it can be used for these purposes is not helpful to an informed debate.

I think if we could agree on anything in this place it might be that, in 2026, what would be useful would be a debate based around fact rather than fear. And I think every senator in this place has an obligation to pursue debate on those terms. The approach that we propose is intended to support efficient, timely and consistent administration of high-volume programs, and it is expected to be used for objective administrative functions.

This might be assessing objective eligibility requirements and some payment calculations where the relevant criteria can be reliably applied by a computer program. For example, verifying GP practice accreditation or whether Medicare billing information indicates that a required service threshold has been met might be a way that you can reliably, predictably and safely use a computer to make a decision.

Importantly, any decision that is proposed for automation must be capable of being reduced to sufficiently objective criteria. Where a matter requires individual judgement, discretion or consideration of a person's particular circumstances, like a serious compliance action, like a banning order, it will remain subject to human decision-making. This is a sensible and proportionate application of a technology that is available to us, and I think it's incumbent on people in this chamber—we owe it to the Australian community—to have a sensible conversation about how we use these technologies in the public interest.

The bill includes strong safeguards to ensure that automation is used safely and appropriately. Only actions that are specified in rules may be automated. Importantly, automation does not displace review and reconsideration rights for providers.

I make these points because I do think that we are at risk of allowing this debate to descend into one based on fear and unfounded assertions rather than one based on facts. Today, I seek to put these facts on the public record in the hope that the debate may proceed in a slightly different direction from here on. I note that the bill also strengthens information sharing arrangements to support administration of program integrity while ensuring that those arrangements remain targeted, rules based and subject to appropriate protections for personal information.

Importantly, this bill provides stability. Patients can continue to benefit from the outcomes of these programs and from the strengthened access to primary care that they provide. A further important feature of the bill is the amendment to the short title of the Health Insurance Act 1973 to the 'Medicare Act'.

This includes a transition period to support the consequential amendments and systems changes required across Commonwealth, state and territory frameworks. This is a foundational reform that will strengthen the administration, integrity and sustainability of Medicare incentive programs and help ensure that the government investment in primary care is delivered effectively.

I note that a number of senators have circulated and moved second reading amendments, and I thought I might use the time remaining to address the substance of those amendments. I'll turn first to the second reading amendment circulated by Senator Steele-John. The government won't be supporting this amendment.

We do recognise the important role that telehealth plays, and that is especially true for vulnerable groups and for people in regional and remote Australia. There are currently more than 200 MBS items for telehealth services that are available nationally for eligible patients. They are available for consultation with a general practitioner, of course, but also with a nurse practitioner, a non-GP specialist, a consultant, a physician, an allied health provider and other providers.

In the last financial year, 2025-26, more than 11 million patients received more than 35 million MBS telehealth services from more than 92,000 providers. The total benefits that were paid out for these services were $1.88 billion. Current telehealth eligibility requirements reflect contemporary evidence and expert advice.

They balance this with the role that telehealth plays in supporting patient access to health care. Patients are eligible for telehealth from a GP or a nurse practitioner if they have had at least one face-to-face service, either with that provider or another provider at the same practice, in the last 12 months. This reflects the evidence that telehealth is best integrated with continuous care and a relationship with the provider that is established face to face.

Patients are also eligible if they are registered in MyMedicare at the practice they are receiving the service from or if they meet one of the exemptions for these requirements. The government acknowledges the very significant role that telehealth plays, but we do not support the approach suggested by Senator Steele-John in the second reading amendment that he has circulated.

I want to turn to the amendment circulated by Senator Ruston. The government is very proud of the record investments that we are making in Medicare and bulk-billing, and we note that, since commencing that investment and since commencing the payment incentives that we have put in place to encourage GPs to bulk-bill, we have seen very significant increases in bulk-billing across the country.

This is of course immensely important because bulk-billing and the ability to see a GP for free lies at the heart of the Medicare promise. It's why we did go to the Australian people promising to invest in Medicare and promising to deal with the collapse in bulk-billing that occurred because of the previous government's negligent approach to Medicare and their hostility to Medicare.

We're unapologetic about our continuing investments to drive bulk-billing so that you can see a doctor for free. We continue to invest in urgent care clinics for the same reasons. Pleasingly, we are seeing more and more Australians avail themselves of the services either of a bulk-billing GP or of an urgent care clinic.

We do see more and more Australians who are seeing a doctor for free. This matters. It matters because Australians should be able to access health care when they need it.

They shouldn't have to worry about the cost of health care, and it's why we continue to prioritise these investments in Australia's public healthcare system. We don't agree with the assertions in Senator Ruston's second reading amendment, and the government will not be supporting them. What we will do is we will continue to make investments in strengthening the Medicare system, including, as this bill does, strengthening the legislative framework that enables it.

I also table an addendum to the explanatory memorandum relating to the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026. The addendum responds to matters raised by the Standing Committee for the Scrutiny of Bills.