Health Insurance Act 1973 - Declaration of Quality Assurance Activity under section 124X (QAA No. 3/2010)

EXPLANATORY STATEMENT

ISSUED BY THE AUTHORITY OF

THE MINISTER FOR HEALTH AND AGEING

HEALTH INSURANCE ACT 1973

DECLARATION OF QUALITY ASSURANCE ACTIVITY

UNDER SECTION 124X

QAA No. 3/2010

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, through Medicare benefits, the Pharmaceutical Benefits Scheme, Public Hospitals 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 described in the Declaration is a quality assurance activity to which Part VC applies.  Regulations 23C to 23G of the Health Insurance Regulations 1975 (the Regulations) set out the public interest criteria that must be met by quality assurance activities in order to be declared under the section 124X.

The Declaration is a legislative instrument for the purposes of the Legislative Instruments Act 2003.  This Declaration has effect from the day after registration on the Federal Register of Legislative Instruments.  Section 124X(4) of the Act prescribes that, unless sooner revoked, this determination ceases to be in force at the end of 5 years after the instrument of declaration was signed. 

This declaration under subsection 124X(1) applies Part VC of the Act to the following activity:

1. CareTrack Australia

An overview of the activity for which the Declaration pursuant to s124X is made is contained in the Attachment.

Before the Minister can make a declaration, certain requirements must be met.

Firstly, the Minister must be satisfied that the persons engaged in the activity are authorised to do so as described in paragraph 124X(3)(a) of the Act.

The activity meets the requirements of paragraph 124X (3)(a) in that the persons engaged in this activity are authorised to do so by the University of South Australia which is an educational institution and research body.

Secondly, paragraph 124X (3)(b) of the Act provides that the Minister must be satisfied that it is in the public interest to have Part VC of the Act apply to the activity. In doing so, the Minister must have regard to criteria prescribed by the Regulations. The criteria relevant to the activity are in regulations 23C and 23E.

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 service assessed, evaluated or studied. Information from the study will be published detailing the quality of healthcare provided as well as the factors affecting the quality of the service.
• Regulation 23D does not apply as the activity will be undertaken in more than one State or Territory.
• Regulation 23E applies because the Minister is satisfied that the Activity is of a kind that has not been engaged in previously in Australia. The Declaration is needed to make the Activity effective by encouraging full participation in the Activity by persons who provide health services by providing participants with a greater degree of confidence and security that their participation is solely to the benefit of establishing and improving quality assurance.
• Regulation 23F does not apply as the Activity has not previously been carried out in Australia.
• Regulation 23G does not apply as the activity does not include the assessment or evaluation by a person of the services, skill or performance of a health practitioner for the purpose of determining the health care practitioner’s clinical practicing rights.

CONSULTATION

Consultations regarding the applications for declaration were undertaken in May 2010. This included obtaining advice on the potential value of declaring the activity as a quality assurance activity for the purposes of the Act, the methodology used to conduct the activity, and whether the application met the criteria required for declaration, in particular those criteria relating to whether it is in the public interest to declare the activity.

Those consulted included:

• Members of the Qualified Privilege Advisory Group, which includes:

­       an external clinician; a legal expert, a quality manager working in the field of health care quality assurance; and

­       a consumer representative.

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 Legislative Instruments.

As provided by subsection 124X(4) a declaration ceases to be in force at the end of 5 years after the instrument of declaration is signed, unless revoked earlier.

The Declaration is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

QAA No. 3/2010

ATTACHMENT

OVERVIEW OF THE ACTIVITY

1. PURPOSE OF ACTIVITY

The CareTrack Australia activity seeks to provide a clearer understanding of who is receiving what healthcare from whom and how decisions about care are made by patients and healthcare providers for 50 common conditions.

Data obtained from the CareTrack Australia activity will provide a clearer understanding of the issues in choosing care practices, from a variety of perspectives (the patient and the healthcare provider) and will enable targeted interventions to be developed and evaluated. An important component of the activity is to examine the feasibility of applying the CareTrack Australia methodology, on an on-going basis, to track healthcare practice over time. This would enable the measurement and monitoring of safety and quality on a national scale and across a variety of healthcare practices and settings.

The objectives of the activity are:

• To determine the percentage of healthcare encounters at which Australians receive evidence based healthcare for 50 common conditions.
• To examine the drivers of healthcare practices from the perspective of patients and healthcare providers.
• To demonstrate the feasability of applying the CareTrack Australia methology on an on-going basis to 1000 patients per year so that changes in healthcare practice can be tracked over time. The tools and systems developed will provide a sustainable way to track improvements in healthcare.