EXPLANATORY STATEMENT
STATUTORY RULES 1983 NO. 106
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Issued by Authority of the Minister for Health
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides that the Governor-General may make regulations prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Sub-section 130(1) of the Act provides that a person shall not, directly or indirectly, except in the performance of his duties, or in the exercise of his powers or functions, under the Act, and while he is, or after he ceases to be, an officer, make a record of, divulge or communicate to any person, any information with respect to the affairs of another person acquired by him in the performance of his duties, or in the exercise of his powers or functions, under the Act. An “officer” is, by virtue of sub-section 130(14) of the Act, a person performing duties, or exercising powers or functions, under, or in relation to, the Act.
By virtue of paragraph 130(3)(b) of the Act, the Permanent Head may divulge information to which sub-section 130(1) of the Act relates, notwithstanding the provisions of that sub-section, to any prescribed authority or person. Sub-section 130(4) of the Act, however, prohibits information so divulged from being further divulged by the recipient authority or person, and by any person or employee under the control of that person or authority.
Regulation 9B of the Health Insurance Regulations (‘the Regulations’) provides that each of the authorities specified in Schedule 3 to the Regulations is a prescribed authority for the purposes of paragraph 130(3)(b) of the Act. The authorities specified in Schedule 3 are the authorities established in each State or Territory responsible for the registration or licensing of medical practitioners. One of these authorities is the New South Wales Medical Board, established under the Medical Practitioners Act, 19 38 of New South Wales (‘the State Act’).
In addition to the New South Wales Medical Board, there are separately constituted under the State Act an investigating committee, a disciplinary tribunal and the
Medical Practitioners Charges Committee. The New South Wales Medical Board is prevented by sub-section 130(4) of the Act from further divulging information received under paragraph 130(3)(b) of the Act to members of these separately constituted bodies. This information would normally relate to abuses in connection with the payment of medical benefits under the Act. Such information is available to members of bodies with similar functions in other States or Territories which are not so separately constituted from the authority prescribed for the purposes of paragraph 130(3)(b). The statutory rules remove this anomaly by amending Regulation 9B of the Regulations to prescribe, as persons prescribed for the purposes of paragraph 130(3)(b), members of the investigation committee, the disciplinary tribunal, and the Medical Practitioners Charges Committee constituted under the State Act.
The draft statutory rules came into operation on the date of their notification in the Commonwealth of Australia Gazette.
Overview
The Health Insurance Act 1973 was enacted by the Commonwealth Parliament to establish a system of health insurance in Australia, aiming to provide equitable access to healthcare services. The Act addresses the problem of ensuring that healthcare costs are shared among the population, thus preventing individuals from facing prohibitive costs for medical services. The Act empowers the Governor-General to create regulations necessary for its implementation, including provisions on confidentiality and information sharing. The explanatory statement details amendments to the Health Insurance Regulations to align with the structure of medical practitioner regulation in New South Wales, ensuring that relevant authorities involved in investigating and disciplining medical practitioners can access necessary information while maintaining confidentiality protocols. This amendment removes inconsistencies in the ability of different authorities to share information within the regulatory framework, thus facilitating more effective oversight and regulation of medical practitioners.
Scope and Application
The Health Insurance Regulations (Amendment) under the Health Insurance Act 1973 apply to officers of the Commonwealth who are involved in the administration and enforcement of the Act. This includes individuals or entities performing duties or exercising powers or functions under the Act, such as the Department of Health and other relevant authorities. The regulations also pertain to prescribed authorities or persons who are authorised to receive information regarding the affairs of another person acquired by an officer in the course of their duties, with specific provisions to prevent further disclosure of such information. Geographically, these regulations have a national reach, affecting all states and territories within the Commonwealth of Australia. The Act does not explicitly state any exclusions, exemptions, or thresholds, but the regulations provide detailed specifications on which authorities are authorised to receive sensitive information. Subordinate instruments, such as amendments to the regulations, extend or restrict the application of the Act as necessary to align with policy changes or administrative requirements.
Key Provisions
The key provisions of the Health Insurance Regulations (Amendment) centre around the disclosure of information under the Health Insurance Act 1973. Regulation 9B, as amended, now specifies the authorities that are permitted to receive information under certain circumstances, despite the general confidentiality requirements set out in section 133 of the Act. Specifically, this amendment updates the list of prescribed authorities to include not only the New South Wales Medical Board, but also the investigating committee, the disciplinary tribunal, and the Medical Practitioners Charges Committee. These bodies are established under the Medical Practitioners Act 1938 of New South Wales and are responsible for the registration and licensing of medical practitioners.
The obligations imposed by this amendment are primarily concerned with ensuring that sensitive information related to the payment of medical benefits is appropriately shared between the relevant authorities. Under section 130(1) of the Act, officers of the Commonwealth must not divulge any information they acquire in the course of their duties unless they are acting within the scope of those duties or under specific provisions of the Act. However, section 130(3)(b) allows for the disclosure of such information to prescribed authorities, such as the ones now listed in amended Regulation 9B. Moreover, section 130(4) ensures that any information received by these authorities cannot be further divulged, maintaining a level of confidentiality even as the information is shared for specific regulatory purposes.
The consequences for breaching these provisions can be significant. If an officer or authority fails to comply with the confidentiality requirements set out in section 130(1), or if a prescribed authority further divulges the information in contravention of section 130(4), they could face legal action. The Act does not specify maximum penalties for these breaches, but such actions could result in civil or criminal penalties depending on the severity and intent of the breach. The seriousness of these potential consequences underscores the importance of adhering to the provisions designed to protect the privacy and integrity of health insurance-related information.