EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 149
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 37) REGULATIONS
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides in part 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.
Schedule 1 to the Act contains a table of medical services and rules for the interpretation of the table. The table of medical services contains items which set out the description of each medical service, and the fee for the calculation of medicare benefit applicable in each State in respect of the service.
Section 4 of the Act provides that the table of medical services, items or rules of interpretation in Schedule 1 to the Act may be varied or replaced by
regulations, and that regulations replacing such a table may be amended by regulations. The Health Insurance (Variation of Fees and Medical Services) (No 36) Regulations, as amended by subsequent regulations, prescribed the previous table of medical services in pursuance of section 4 of the Act.
Section 9 of the Act provides that medicare benefit shall be calculated by reference to fees for medical services set out in the table of medical services in Schedule 1 to the Act. Medicare benefit is normally payable, in accordance with section 10 of the Act, at a rate of 85% of the relevant fee specified in the table of medical services. An additional amount of medicare benefit is payable where required to ensure that the difference between the benefit normally payable and the fee specified in the table of medical services does not exceed $10.00 in relation to a single professional service, or an aggregate of $150.00 per patient in a year in relation to multiple professional services.
The regulations repeal the regulations prescribing the previous table of medical services and prescribe, pursuant to section 4 of the Act, a replacement
table of medical services incorporating the following amendments of the present table:-
• increased fees for the calculation of medicare benefits in accordance with the determination of the 1985 Medical Fees Enquiry;
• revision of items in the table in accordance with recommendations of the Schedule Revision Committee and otherwise agreed to by the Minister for Health;
• inclusion of new items and other related amendments in respect of the performance of magnetic resonance imaging; and
• minor textual amendments.
The 1985 Medical Fees Enquiry, an independent public enquiry conducted by Mr Deputy President K.C. McKenzie of the Australian Conciliation and Arbitration Commission, determined increases in fees for medical benefits purposes to apply from 1 July 1985 to 30
April 1986. The Treasurer and the Ministers for Employment and Industrial Relations and Health, on behalf of the Government, had previously agreed to accept the determination of the Enquiry. The determined increases range between 3.42% for anaesthetic services and 3.87% for pathology services. The effect of the increases is, for example, to increase the fee specified in the table of medical services for a standard consultation with a general practitioner in New South Wales from $15.00 to $15.60 and the related medicare benefit from $12.75 to $13.30.
The amendments of the table, other than the increase to fees described above, affect 127 new or previous items and comprise the following:
• the amendment of the description of medical service in 72 items;
• the insertion of 32 new items;
• the deletion of 20 items;
• the amendment of the description of medical service and fee in 1 item; and
• the amendment of the fee in 2 items.
These amendments, which result principally from recommendations of the Schedule Revision Committee, are necessary to ensure that the items included in the table reflect developments in current medical practice. The Schedule Revision Committee is a body comprising 5 representatives of the Australian Medical Association and 5 Commonwealth Officers which advises the Minister for Health in relation to desirable amendments of the table of medical services.
The amendments relating to the performance of magnetic resonance imaging are directed to the control of Commonwealth financing of this expensive new diagnostic technique. To this end, two new items have been inserted into the table of medical services and an amendment made to rule 19 of the rules of interpretation in the table. The effect of this is that, inter alia, for medicare benefits to be payable, magnetic resonance imaging will have to be performed using the equipment of a public
hospital or a radiology unit operated by the Commonwealth, a State or an authority of a State, the Northern Territory, the Capital Territory Health Authority, or an Australian University.
The regulations came into operation on 1 July 1985.