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Wednesday, 1 April 1987
Page: 1597


Senator COLSTON —My question to the Minister representing the Minister for Health relates to invoices issued by a particular pathology firm in Queensland. These invoices state in large print that the Commonwealth does not fully rebate pathology services. Is this assertion correct, or would it be more accurate to say that the pathology firm charges more than the schedule fee? If so, are there any figures which indicate the extent to which pathology firms charge above the schedule fee for services rendered?


Senator TATE —I have a brief available from the Minister for Health which informs me that Medicare benefits are payable at 85 per cent of the schedule fee, or the schedule fee less $20, whichever is the greater. Where a medical practitioner, including a pathologist, direct bills for the service, the Medicare benefit must be accepted as full payment for the service. Where a practitioner bills the patient there is no such restriction. The amount billed may be below, at or above-it is normally above-the schedule fee. Therefore, except when the patient is direct billed or charged at the benefit level, it is correct to say that the Commonwealth does not fully rebate the cost of pathology services. However, some pathologists, including some Queensland pathology firms, charge at levels above the schedule fee.

Figures produced from Medicare claims processed in the December quarter last year show that about 51 per cent of pathology services in Queensland were direct billed while 32 per cent were billed to the patient at a fee in excess of the schedule fee. The figures for a year earlier were about 56 per cent direct billed and only one per cent charged over the schedule fee. So there has been a considerable change there. In August 1986 the Government reduced the schedule fees for 18 pathology tests. This was partly in response to abuses identified by the Public Accounts Committee in its report on fraud and overservicing in pathology. Those 18 tests were mainly automated, generally involved minimum specialist input and were highly profitable because fees had not been adjusted although the technology involved had become more efficient. It is clear from the figures that some pathologists in Queensland have not reduced the fees they charge, thereby increasing the cost burden to patients. This is not confined to Queensland, but obviously Senator Colston has knowledge of a particular instance. Of the four largest pathology firms in Queensland, two direct bill almost all services and one direct bills some services but issues bills to patients for a substantial number of other services. The fourth firm charges patients rather than direct billing. The statistics show that both firms charge above the schedule fee.