EXPLANATORY STATEMENT
ISSUED BY THE AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
DECLARATION OF QUALITY ASSURANCE ACTIVITY UNDER SECTION 124X OF THE HEALTH INSURANANCE ACT 1973 - QAA 5/2017
Part VC of the Health Insurance Act 1973 (the Act) creates a scheme to encourage efficient quality assurance activities. Those activities help to ensure the quality of health services that are funded by the Government, including through Medicare benefits, the Pharmaceutical Benefits Scheme, and/or Health Program Grants. The scheme encourages participation in such activities by protecting certain information from disclosure, and also by providing some protection from civil liability to certain persons engaged in those activities in good faith, in respect of those activities.
In order for Part VC to apply to an activity, the Minister must make a declaration pursuant to section 124X of the Act that the activity is a quality assurance activity to which Part VC applies.
The Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act 1973 – QAA 5/2017 (the Declaration) has effect from the day after registration on the Federal Register of Legislation.
The Declaration applies Part VC of the Act to the following activity:
- Practice Visits: A Peer Review Activity for Specialist Obstetricians and Gynaecologists in Australia.
An overview of the activity is contained in Attachment A.
Before making a declaration under section 124X, the Minister must be satisfied that the persons engaging in the activity are authorised to do so in one of the ways set out in paragraph 124X(3)(a) of the Act. The persons engaged in activity are authorised to do so by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) which is an educational institution and an association of health professionals (see subparagraphs 124X(3)(a)(iv) and 124X(3)(a)(vi) of the Act).
Paragraph 124X (3)(b) of the Act provides that the Minister must be satisfied that it is in the public interest that Part VC of the Act apply to the activity. In doing so, the Minister must have regard to criteria prescribed by regulation. The criteria are set out in regulations 23C to 23G of the Health Insurance Regulations 1975.
The activity meets the criteria as follows:
- As required by regulation 23C, the activity includes the disclosure of non-identifying information that concerns the quality of the service assessed, evaluated or studied. De-identified reports on the processes and outcomes of the activity will be published in the Australian and New Zealand Journal of Obstetrics and Gynaecology and/or the RANZCOG O&G Magazine.
- Regulation 23D does not apply as the activity will be undertaken in more than one State or Territory.
- Regulation 23E does not apply as the activity has previously been engaged in Australia.
- Regulation 23F applies as quality assurance activities of this kind have previously been engaged in in Australia.
- As required by subregulation 23F(2) , the Minister’s delegate is satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in the activity by persons who provide health care services, to a greater extent than the participation in the previous activities of the same kind. RANZCOG Fellows are persons who provide health care services, and application of Part VC to the activity encourages their greater participation in the activity by providing an activity that gives Fellows the confidence to participate in open discussions about their performance and clinical decision making without fear of litigation.
- As required by subregulation 23F(3), the Minister’s delegate is satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging acceptance and implementation of recommendations by persons who provide health services, to a greater extent than the previous activities of the same kind. The activity does this by ensuring the recommendations are relevant to the practicing Fellows clinical practice. Recommendations are based on the key performance indicators and confidential interviews with the Fellows colleagues.
- As required by subregulation 23F(4), the Minister’s delegate is satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in monitoring the implementation of recommendations. The RANZCOG Steering Committee reviews all reports on the Fellows performance and monitors the implementation of recommendations with a follow-up questionnaire twelve months after the practice visit to determine if the recommendations were implemented.
- Regulation 23G does not apply as the activity will not include the assessment or evaluation by a person of the services, skill or performance of a health care practitioner for the purpose of determining the health care practitioner’s clinical practicing rights.
CONSULTATION
Practice Visits: A Peer Review Activity for Specialist Obstetricians and Gynaecologists in Australia was previously declared a quality assurance activity under section 124X of the Act in 2012 (Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act (QAA 1/2012)). The RANZCOG applied to continue the declaration of the activity as a quality assurance activity to which Part VC of the Act applies.
The RANZCOG was consulted in relation to the final design and content of the declaration. Wider consultation was not considered necessary as the quality assurance activity only relates to the RANZCOG’s Practice Visits activity.
The RANZCOG is a specialist medial college responsible for training and accrediting doctors in Australia and New Zealand in the specialties of obstetrics and gynaecology. Participation in the practice visits activity is carried out via a co-contribution funding model, with the RANZCOG Steering Committee overseeing the activity. It was therefore not considered necessary to seek wider consultation.
The declaration of this activity will not result in any direct or substantial indirect effect on business.
The Declaration comes into operation on the day after registration on the Federal Register of Legislation.
Subsection 124X(4) of the Act provides that, unless sooner revoked, a declaration ceases to be in force at the end of 5 years after it was signed. Accordingly, the Declaration provides that it is repealed at the end of 5 years after it is signed.
The Declaration is a legislative instrument for the purposes of the Legislation Act 2003.
ATTACHMENT A
OVERVIEW OF THE ACTIVITY
The Practice Visits: A Peer Review Activity for Specialist Obstetricians and Gynaecologists in Australia is a work-based peer review of obstetric and gynaecological specialists. Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) voluntarily participate in the activity. A practice review of an individual Fellow is comprised of a surgical logbook, patient satisfaction questionnaires following patient appointments, and a practice profile questionnaire completed by the Fellow. This is followed by a peer visit by two independent RANZCOG Fellows who assess and evaluate the practice and competence of the Fellow based on key performance indicators, observations of major and minor surgery, and interviews with the Fellow’s colleagues. The visitors provide the Fellow with feedback at the end of the visit outlining positive aspects of work and areas of vulnerability from a risk management perspective, and prepare a report on the Fellow’s performance, including recommendations about the provision of services. Where changes to practice or a program of training are recommended, the visitors may follow up with the Fellow as part of the activity.
The RANZCOG Steering Committee will evaluate the outcomes of the activity, and publish the outcomes in the RANZCOG’s O&G Magazine, and present at the Provincial Fellows Annual Scientific Meeting or the RANZCOG Annual Scientific Meeting.
The objectives of the activity are to provide:
- individual Fellows with recommendations in improving the quality and risk management of their practice; and
- peer support and feedback from Fellows working in similar circumstances.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Declaration of Quality Assurance Activity under section 124X of the
Health Insurance Act 1973 - QAA 5/2017
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the
Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
The Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act 1973 – QAA 5/2017 (the Declaration) declares the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ Practice Visits: A Peer Review Activity for Specialist Obstetricians and Gynaecologists in Australia to be a quality assurance activity to which Part VC of the Health Insurance Act 1973 (the Act) applies. Information known solely as the result of the activity, or documents created solely for the purposes of the activity, will be covered by qualified privilege.
Human rights implications
This Declaration engages the right to health as set out in Article 12 of the International Covenant on Economic, Social and Cultural Right by assisting with the progressive realisation by all appropriate means of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
The Qualified Privilege Scheme established by Part VC of the Act is aimed at encouraging participation in quality assurance activities that help ensure the highest possible health care standards are maintained. The quality assurance activity described in this Declaration will provide participants with a greater degree of confidence and security that their participation is solely for the benefit of establishing and improving outcomes of the community health care.
Conclusion
This Declaration is compatible with human rights as it promotes the right to health.