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Portfolio: Health and Community Services
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Purpose
The Bill contains a number of minor amendments to health and community services legislation, including changing the definition of a patient, changing the name of the head of the Health Insurance Commission (HIC) to the Managing Director and allowing the cancellation of approval for pharmacists and medical practitioners when they cease to practice.
Background
Day surgery is increasingly used where an operation or other surgical procedure can be performed and the patient sufficiently recovered to return to their own home within the one day. This not only saves the need, and cost, of having a patient remain in hospital when it is not necessary but also allows people to recuperate in more familiar surroundings. The later point is seen as particularly important for children, where the trauma associated with a stay in hospital may outweigh that associated with the surgical procedure. Day surgery is seen as particularly relevant for procedures such as eye, ear, nose, throat, bowel, knee and some plastic surgery. However, the main criteria for the adoption of day surgery is the likely need of the patient and those without adequate home support, such as those who live alone or the elderly, are generally not seen as appropriate for the full range of day surgery.
Compared with international practices, Australia has a relatively low rate of day surgery. In the U.S. and Canada, it is estimated that between 40% and 50% of all surgical procedures are performed in day surgery. In Australia the estimated rate is around 25%. 1
The first day surgery facility opened in Australia in 1982 and was a private establishment. There are currently 73 such facilities and all are privately owned. 2 Under the Medicare Incentives Package, the government has financed 130 programs aimed at establishing day surgery facilities in public hospitals, with the aim of increasing the percentage of operations performed as day surgery.
While encouraging the growth of day surgery to replace overnight stays, due to cost savings, the government has been wary of the possibility of procedures currently being performed in doctors surgeries being transformed into day surgery procedures and therefore attracting higher benefits. When day surgery benefits were introduced in 1989, an exclusion list operated to exclude procedures normally performed at doctors surgeries from the day care benefit, which was only available where the doctor certified that the patient required admission for the day. Recently, the National Day Surgery Committee, which represents 19 surgical bodies, has recommended an increase in the benefit payable for day surgery to increase the use of this procedure. 3
Main Provisions
Amendments to the Health Insurance Act 1973
Clause 4 will amend section 3 of this Act to remove references to `in- patient' and substitute references to `patient'. Under the current definition of `in- patient' in this Act, a patient is required to occupy a bed and `private patient' is defined by reference to being an `in- patient'. The amendments will therefore allow the range of people covered by the term `private patient' to be extended to those who do not occupy a bed (e.g. those subject to day surgery). The amendment will also insert a definition of `patient' into this Act, which will be defined to exclude members of staff receiving treatment in their own quarters and, in most cases, newly- born children whose mother also occupies a bed in the hospital.
Section 16A of this Act provides that benefits will not be payable in respect of pathology services unless certain conditions are met, including that the specimen was collected by a person in one of the classes listed in sub- section 16A(5AA). To the classes of people who may collect specimens will be added employees of approved pathology authorities which are rendering the service, rather than collecting the specimen. This will cover the situation where a specimen is collected on behalf of one approved pathology provider but the specimen is subsequently collected by the employee of another which actually renders the service.
Section 61 of this Act provides for committees to recommend that practitioners be recognised as consultant physicians or specialists. Amendments contained in clause 9 will allow such recommendations to contain a recommendation as to the date the Ministers determination should have effect from and to provide that if no date is mentioned in such a determination, it will have effect from the date of the determination.
Amendments to the Health Insurance Commission Act 1973
The majority of the amendments to this Act will change the name of the General Manager to Managing Director. The main function of the position will remain the same, i.e. to manage the affairs of the HIC (clause 19). Clause 24 provides that the person currently occupying the position of General manager will become the Managing Director on the same terms and conditions and for the same period of tenure.
As well, clause 17 will repeal section 8D of this Act which was inserted in 1991 and allows the HIC to maintain dedicated computer equipment to provide certain information to various authorities.
Amendments to the Hearing Services Act 1991
Clause 32 will insert a definition of Australian permanent resident into this Act. Such a person will be one whose period of presence in Australia is not restricted by law.
The range of people eligible for assistance under this Act will be restricted by clause 33 which will amend section 5 of this Act to provide that to be eligible, people must be an Australian citizen or an Australia permanent resident.
Amendments to the National Health Act 1953
Clause 36 will amend section 4 of this Act to substitute a new definition of patient. The new definition will include people who attend day hospital facilities.
A person is entitled to a refund of the difference between the normal price payable for pharmaceuticals and the concession price where they were charged the full price because they could not prove that they were eligible for a concession and they can subsequently prove that they were entitled to the concession (section 87A of this Act). Clause 40 will amend this provision to provide that the Secretary will need to be satisfied that the person was entitled to the concession before the refund becomes payable. This provision will be deemed to have commenced from 1 July 1992 (sub- clause 2(3)).
Section 90 of this Act provides for the approval of pharmacists. Clause 41 will amend this section to provide that the reference to pharmacists includes a reference to a person who owns, or is about to own, a business that supplies pharmaceutical benefits.
The Secretary may cancel the approval of a pharmacist or a medical practitioner where they have not practiced for six months or more. Clause 44 will amend this provision to provide that approval may be cancelled where the person is not carrying on the business of a pharmacist or has ceased to practice as a medical practitioner. Clause 48 will amend section 98AA of this Act to perform a similar function in relation to the cancellation of a hospitals approval.
References
1. Address by the Minister for Health, Housing and Community Services to the National Day Surgery Seminar, 11 may 1992.
2. Ibid.
3. The Australian 12 May 1992.
Bills Digest Service 27 July 1992
Parliamentary Research Service
This Digest does not have any official legal status. Other sources should be consulted to determine the subsequent official status of the Bill.
Commonwealth of Australia 1992
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Published by the Department of the Parliamentary Library, 1992.