EXPLANATORY STATEMENT
STATUTORY RULES No. 184 of 1988
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES (No. 49) 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 of medical services (the table) in Schedule 1 to the Act.
Section 4 of the Act provides, among other things, that the regulations may prescribe a table of medical services (other than pathology services) in accordance with the form of the table set out in Schedule 1 and that upon commencement of a regulation prescribing a table of medical services the table so prescribed has effect as if it were set out in Schedule 1 in the place of the table in that Schedule. The Health Insurance (Variation of Fees and Medical Services) Regulations prescribe such a table.
By virtue of sub-section 4(6) of the Act, the No. 47 Regulations automatically cease to be in force on 18 October 1988, ie the day next following the fifteenth sitting day of the House of Representatives 12 months after their notification in the Gazette. The No. 49 Regulations replace the Nos. 47 and 48 Regulations, both of which lapse within the next 12 months. Certain amendments are made to both the table and its rules for interpretation in order to implement agreements with the Australian Medical Association (AMA) and other professional bodies. The Minister for Community Services and Health agreed to the various recommendations and amendments, set out below, which amend the table of medical services and its rules for interpretation.
Based on representations from the New South Wales Government and after costing by this Department, the Minister agreed to an increase in the fee for item 2980 (magnetic resonance imaging) from $250 to $285 per service. This increase meets the need to ensure that private patients’ requirements continue to be met in public hospitals.
Following discussions with the AMA and the Royal Australian College of Obstetricians and Gynaecologists (RACOG), the Minister agreed to recommendations arising from deliberations by the Medicare Benefits Advisory Committee (MBAC). The Committee is a statutory body, comprising representatives of the AMA and the Commonwealth, which advises the Minister on revisions which are required to the table. The amendments and new items so approved by the Minister relate to the removal of warts and to laser therapy services in gynaecology.
The Minister also agreed to amendments to obstetric items in the table, increases in obstetric fees and new items concerning Caesarean section. These changes have satisfied AMA and RACOG concerns about the structure of the obstetrics part of the table.
After consultation between the AMA, relevant professional groups and this Department, the Minister agreed to new items and amendments covering diagnostic vascular investigations. These changes refer to matters which had been listed for consideration by the Medical Benefits Schedule Revision Committee prior to its cessation following the AMA’s decision in May 1987 not to attend its future meetings. The fees have been derived from detailed costing using accepted cost accounting principles and based on information obtained from the providers of the services, equipment suppliers and Medicare claims data. The profession considers, however, that the fees should be somewhat higher than those proposed by this Department.
The Minister also agreed to new funding arrangements for radiation oncology planning and treatment services. These incorporate Medicare benefits for non-capital components and Health Program Grants for capital components.
The Minister agreed to the inclusion of services in the table which are performed regularly enough to warrant such inclusion as new specific items. Their inclusion obviates the previous cumbersome mechanism of benefit payment for these items which, attracting benefit under ‘non-specific’ items as a result of MBAC recommendations, required examination by a skilled assessor or Medical Advisor. The inclusion of such services in the table results in administrative savings through the more efficient assessing of claims in the normal processing stream.
The Minister agreed to an overall Schedule fee increase of 4.50% from 1 August 1988 which is implemented as follows:
• GP consultations (and related items) increased by 5.40%,
• optometrical consultations increased by 4.50%; and
• all other services except Part 7 (Pathology) increased by 4.00%.
Certain other amendments have been made to the table in order to rectify various technical errors and omissions which occured[TWN T31] as a result of the 1987 reprint of these Regulations.
The proposed regulations also include additions and amendments to the Rules for Interpretation of the table. These are mostly consequential but do include some new rules which clarify the application of items to certain services. The opportunity has also been taken to improve the drafting style and simplify the language of the Rules.
Authority: Section 133 of the Health Insurance Act 1973
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