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Wednesday, 14 September 1983
Page: 804


Dr BLEWETT (Minister for Health)(9.09) —I move:

(1) Clause 12, page 7, lines 8 to 22, omit the clause, substitute the following clause:

''12. Section 10 of the Principal Act is repealed and the following section is substituted:

Entitlement to medicare benefit

'10. (1) Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with sub-section (2) is payable, subject to and in accordance with this Act, in respect of that professional service.

'(2) A medicare benefit under sub-section (1) in respect of a professional service is an amount equal to-

(a) 85% of the fee specified in respect of the service in the table in relation to the State in which the service is rendered; or

(b) if the amount calculated under paragraph (a) is less by more than $10 than the fee from which it is calculated-an amount that is less by $10 than that fee.

'(3) Subject to this Act, where-

(a) a claim (in this sub-section referred to as the ''threshold claim'') for medicare benefit is made by a claimant in respect of a professional service-

(i) which was rendered to a person, being either the claimant or another person (in this sub-section referred to as the ''patient''); and

(ii) in respect of which the medical expenses are incurred by the claimant in a year,

and the claim is accepted for payment by the Commission;

(b) the claimant has, or another claimant or other claimants has or have, made other claims (in this sub-section referred to as the ''prior claims'') for medicare benefit in respect of professional services-

(i) which were rendered to the patient; and

(ii) in respect of which the medical expenses were incurred by the relevant claimant in that year,

and the prior claims were accepted for payment by the Commission before the time when the threshold claim is accepted for payment (in this sub-section referred to as the ''relevant time''); and

(c) the Commission is satisfied at the relevant time that-

(i) the first-mentioned claimant has paid the medical expenses in respect of the professional service to which the threshold claim relates:

(ii) a claimant has, or claimants have, paid the medical expenses in respect of professional services to which some or all of the prior claims accepted by the Commission for payment before the relevant time relate;

(iii) the sum of the patient contributions in respect of the prior claims referred to in sub-paragraph (ii) is less than the relevant amount for that year ; and

(iv) the sum of the patient contribution in respect of the threshold claim and the patient contributions in respect of the prior claims referred to in sub- paragraph (ii) is equal to or exceeds the relevant amount for that year,

the medicare benefit payable-

(d) in respect of the professional service to which the threshold claim relates -shall be increased by the amount of the excess (if any) referred to in sub- paragraph (c) (iv);

(e) in respect of a professional service-

(i) to which a prior claim accepted for payment by the Commission before the relevant time relates; and

(ii) in relation to which the commission becomes satisfied, after the relevant time, that the claimant has paid the medical expenses,

shall be increased by an amount equal to the patient contribution in respect of that claim; and

(f) in respect of a professional service-

(i) to which a claim for medicare benefit that is accepted for payment by the Commission after the relevant time relates;

(ii) which was rendered to the patient; and

(iii) in respect of which the medical expenses are incurred by the claimant in that year,

shall be increased by an amount equal to the patient contribution in respect of that claim.

'(4) Where an amount calculated in accordance with sub-section (2) is not a multiple of 5 cents, the amount of cents shall be increased to the nearest higher amount that is a multiple of 5 cents.

'(5) For the purposes of sub-sections (3) and (6), but without prejudice to the meaning of an expression in any other provision of this Act-

(a) where a person to whom medicare benefit is payable in respect of a professional service is given or sent a cheque under sub-section 20 (2) for the amount of the medicare benefit, the person shall be taken to have paid so much of the medical expenses in respect of that service as is represented by the amount of the medicare benefit;

(b) the question when medical expenses are incurred in respect of professional services relating to prescribed items shall, notwithstanding anything in this Act, be determined in accordance with the regulations; and

(c) a reference to a professional service is a reference to a professional service (including a medical service rendered outside Australia)-

(i) in respect of which medicare benefit is payable; and

(ii) the medical expenses in respect of which exceed the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service.

'(6) In this section-

''patient contribution'', in relation to a claim for medicare benefit in respect of a professional service, means an amount equal to the difference between-

(a) the fee specified in respect of the service in the table in relation to the State in which the service is rendered or, if the medical expenses in respect of the service are less than that fee, those medical expenses; and

(b) the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service;

''relevant amount'' means-

(a) in relation to a year, being the period of 5 months commencing on 1 February 1984-$62.50 or, if a higher amount is prescribed for the purposes of this paragraph, that higher amount; or

(b) in relation to the year commencing on 1 July 1984 or a subsequent year-$150 , or if a higher amount is prescribed for the purposes of this paragraph in respect of that year, that higher amount;

''year'' means-

(a) the period of 5 months commencing on 1 February 1984;

(b) the year commencing on 1 July 1984; or

(c) a subsequent year commencing on a 1 July.'.''.

Clause 12 of the Health Legislation Amendment Bill sets out the rate of Medicare benefits which will be 85 per cent of the schedule fee, with a maximum patient payment of $10 for any one item where the schedule fee is charged. The same level of benefit will be payable for all types of patients and replaces the present confusing arrangements which provide for different levels of Commonwealth benefits according to type of patient and method of billing by providers. This essential component of Medicare will provide for equity, simplicity and efficiency.

The move to a single level of Medicare benefit for all will mean a reduction in benefits presently payable for pensioner services and disadvantaged persons' services, with an increase in the maximum gap from $5 to $10. However, this will not affect benefits payable for most general practitioner consultations and the effect on other benefits is only marginal. Medicare benefits cover the full range of medical services, including treatment by specialists, surgery and diagnostic services--


Mr Carlton —Mr Deputy Chairman, I raise a point of order. The Minister has referred to an amendment circulated in his name. I am not aware of the amendment having been circulated.


Dr BLEWETT —We had to rewrite clause 12.


The DEPUTY CHAIRMAN (Mr Rocher) —I understand that the amendments were circulated in this chamber at about 11.10 this morning.


Mr Carlton —With respect, if honourable members currently in the chamber do not have copies of the amendment before them, they can hardly debate the matter suitably. I have not been given the amendment during the time that I have been in the chamber.


The DEPUTY CHAIRMAN —I am assured that copies were circulated and that they were provided in the chamber.


Mr Carlton —May I suggest that copies be made available to those honourable members currently in the chamber so they will be able to debate this matter. Some honourable members may not have been in the chamber at the particular hour at which the amendment was circulated.


The DEPUTY CHAIRMAN —I draw the honourable member's attention to the amendments placed at the end of the table, which are available for the use of members.


Dr BLEWETT —As I was saying, Medicare benefits cover the full range of medical services, including treatment by specialists, surgery, and diagnostic services such as radiology and pathology. They are also payable for medical benefits rendered to in-patients of public and private hospitals, for certain surgical and orthodontic procedures rendered by approved dental surgeons, and consultation services rendered by participating optometrists. The amendment I have moved makes no change to the provisions currently set out in the Bill. However, the Australian Democrats in another place drew attention to the fact that the original clause 12 of the Bill could impose some financial hardship on individuals who suffered from chronic illness or disabilities. Such hardships would come about because of their requirement for regular medical treatment involving on each occasion the payment of a patient contribution of a maximum amount of $10 for each medical service where the schedule fee was charged. While we believe it is more appropriate for doctors to direct bill Medicare for chronically ill people who run up large medical bills and accept that payment in full settlement, we recognise that not all doctors would do this.

The Government, in considering the Democrats' proposal, also recognised that, in addition to those with chronic illness, there are occasions when individuals may suffer catastrophic illness which may involve a large number of medical services during the acute phase of the illness. The Government considers that such individuals should also receive protection against the financial burden imposed by such an illness. The proposed amendment would provide protection for each Australian against any substantial medical costs which must be met by patients in excess of the Medicare medical benefit at 85 per cent, with a maximum of $10 for each service. The amendment proposes that where a person by way of patient contributions is required in any one year to meet aggregate patient contributions of more than $150, being made up of differences between the Medicare medical benefits and the fee charged by the medical practitioners, where these fees are equal to the schedule fee or less, the Medicare medical benefit in respect of medical expenses incurred in that year will be payable by the Health Insurance Commission at the rate of the full medical benefit schedule fee. This means that after the patient has paid an aggregate amount so that the $150 threshold in any one year has been reached, a person will not be required to meet the difference between the Medicare medical benefit and the schedule fee for the remainder of the year.

This difference will be paid as an additional Medicare benefit so that each service received will attract a medical benefit of 100 per cent of the schedule fee. This will also apply to Australian residents who have medical services rendered to them overseas. It would not apply to assigned medical benefits accepted in full payment by the practitioner for the service rendered, since there is no patient contribution in such circumstances. In respect of the period from 1 February 1984 to 30 June 1984, that is, the transition period, the full year amount of $150 will be adjusted on a pro rata basis to ensure that individuals are not disadvantaged in the first five months operation of Medicare .

The Government considers that the proposed amendment provides substantial protection against episodes of substantial medical costs for all Australians and , in particular, those unfortunate Australians who, because of chronic illness, require regular medical treatment. I commend the amendment to the House.