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The Medical Rural Bonded Scholarship Scheme is a description given to a series of arrangements by the Australian Department of Health and Aging (hereafter DHA) and requests. The DHA's propaganda is the scheme is to increase the number of doctors practising in rural and remote regions of Australia.
However the legislation passed by the Commonwealth Parliament s19ABA Health Insurance Act 1973 Cth, only functions to cut back access to provider numbers and their dependant rebates for health services. Further the legislation does not mention any scheme, but contracts.
The scheme operates as a series of arrangements to pay Universities with on the basis they get persons to sign up to certain contracts and to terminate students who will not be part of the contract from their medical studies.
Universities in a bid to get this money often hold out to persons that they must sign the Commonwealth contract before they can be students students. However the Contract with the Commonwealth requires the person to be eligible for HECS or CPS before they sign. Hence an eligible student.
In fact persons are not part of the 'scheme' as their rights and penalties entirely rise from contract with the Commonwealth and legislation. The usage of the term 'scheme' applies to the arrangements between the University and the Commonwealth in relation to student enrollment.
The scheme also appropriates the term 'scholarship' but in fact persons are as stated before in contracts executed as deeds. The contract provides payments under that contract of repayable on breach indexed $20000 a year. Further if the contract is breached s19ABA makes the person prohibiting access to Medicare provider numbers for up to 12 years 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.
This is an important distinction as the Australian constitution requires that all Australians are fee from any form of civil conscription in relation to medical services (s51 xxiiia). The High Court ruled that persons has to absolutely free in relation to the decision to be part a Commonwealth scheme. In practice this mean a Commonwealth contract cannot be asked to be signed before a person can deliver medical services, i.e a person must be student before they can sign a contract of medical services with the Commonwealth.
If the contract is breached as well as repaying monies remitted in the contract to the person, that person 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 breach is that Australian citizens will also lose the ability to access Medicare with these medical practitioners.[1]
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
On10 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]
This is true only where the contact has been entered into after a person is a student. Where a person has be required to enter into a commonwealth contract or scheme before they deliver or partake of medical services at any time is a form of civil conscription 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]
