EXPLANATORY STATEMENT
STATUTORY RULES 1987 No 309
ISSUED BY AUTHORITY OF THE MINISTER FOR COMMUNITY SERVICES AND HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (No 48) REGULATIONS
Section 133 of the Health Insurance Act 1973 (“the Act”) provides in part that the Governor-General may make regulations, not inconsistent with the Act, 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.
Section 9 of the Act provides in effect that medicare benefits shall be calculated by reference to the fees for medical services set out in the table. The table is defined to mean the table consisting of the general medical services table and the pathology services table. The general medical services table is set out in Schedule 1 to the Act and contains items setting out the description of each medical service, the fee for the calculation of medicare benefit applicable in each State and rules for the interpretation of the table.
Section 4 of the Act provides among other things that the table of general medical services may be varied or replaced by regulations. The Health Insurance (Variation of Fees and
Medical Services) (No 47) Regulations (Statutory Rules 1987 No 160) prescribe the present table of general medical services pursuant to section 4 of the Act.
In that table, there are two sets of associated items: items 110, 116 and 118 and items 122, 128 and 130. The items provide for a professional attendance by a consultant physician in the practice of the physician’s specialty (not being psychiatry) where the patient is referred by a medical practitioner, and where the attendance takes place at one of the locations specified in each of the items. The items are linked sequentially, so that -
• the first item (item 110 or 122) provides for the initial attendance in a single course of treatment;
• the second item (item 116 or 128) provides, at a lesser fee, for the second or third attendance in a single course of treatment; and
• the third item (item 118 or 130) provides, at a lesser fee again, for the fourth or subsequent attendance in a single course of treatment.
This sequential linking does not permit a distinction to be made between attendances of a complex nature and attendances requiring less involvement on the part of the consultant physician.
The Minister for Community Services and Health has agreed to rectify this anomaly. The Health Insurance (Variation of Fees and Medical Services) (No 48) Regulations give effect to the Minister’s decision by omitting items 116, 118, 128 and 130 and inserting new items 116, 119, 128 and 131.
The new items still provide for a professional attendance by a consultant physician in the practice of the physician’s specialty (not being psychiatry) where the patient is referred by a medical practitioner, and where the attendance takes place at one of the locations specified in each of the items. The new items then distinguish between an attendance of a minor nature and an attendance which is not of a minor nature.
The regulations also insert a new rule of interpretation to define an attendance of a minor nature as a second or subsequent attendance in a single course of treatment at which it is not necessary to carry out a physical examination of the patient, and which does not result in any substantial alteration to the treatment of the patient.
The regulations have been prepared in consultation with the Australian Association of Consultant Physicians.