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Wednesday, 26 March 2003
Page: 10246


Senator PATTERSON (Minister for Health and Ageing) (5:18 PM) —I move:

That this bill be now read a second time.

I seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

The speech read as follows—

This Bill makes a number of amendments to the Health Insurance Act 1973 in relation to the payment of Medicare benefits for diagnostic imaging and radiation oncology services.

The amount of Medicare benefits paid to patients for diagnostic imaging and radiation oncology services is substantial—in the order of $1.3 billion annually or about 16% of total Medicare outlays. The Government needs to therefore ensure accountability for expenditure in this area while giving patients access to these services whenever they need them.

The Bill contains three measures that are designed to continue to facilitate accountability for the cost-effective provision of diagnostic imaging and radiation oncology services for all Australians.

The first measure establishes a scheme for the registration of practice sites that undertake diagnostic imaging procedures. These procedures include diagnostic radiology, ultrasound, computed tomography, magnetic resonance imaging and nuclear medicine. Registration also applies to practice sites that render radiation oncology services. These sites will need to be registered in order for Medicare benefits to be payable.

The registration system will provide a mechanism for the Commonwealth Government to collect further information about the rendering of diagnostic imaging and radiation oncology services.

Two of the key pieces of information to be collected from a registered practice will be the numbers and type of equipment located at the site and proprietorship details of the site and practice.

This will allow the Commonwealth, in association with the medical profession, to monitor the nature of services provided by a number of different factors, such as practice type, size and structure. For example, we will be able to look at whether a practice is a stand-alone practice; co-located with a primary care practice, a public hospital, or a mobile service.

There is a perception that the changing ownership structure in medical practice may lead to pressures on practitioners to adopt methods that favour corporate profits to the detriment of access to, and quality of care. These pressures may encourage, for example, high throughput of patients, unnecessary return consultations, and/or excessive ordering of diagnostic imaging services.

The information collected through the registration of practices will enable the Commonwealth to monitor activity in this area to ensure that patient access and high quality care are maintained.

The information will also help to address overservicing, claiming errors and inappropriate practice in general. It will also enable the assessment of compliance for benefits by ensuring that the equipment used in relation to a Medicare claim meets the eligibility requirements.

The monetary savings made in addressing these issues can be then re-directed back into the Medicare program to improve access.

Information collected under the new system will therefore help the Government to plan and develop programs to maintain the key objectives of Medicare. These objectives are of course to:

· make health care affordable for all Australians

· give all Australians access to health care services with priority according to clinical need, and

· provide a high quality of care.

The need to introduce a means of identifying physical practices in diagnostic imaging was identified as part of the collaborative agreement between the Commonwealth and the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. This agreement allows the Commonwealth to manage Medicare expenditure in diagnostic imaging in collaboration with the diagnostic imaging industry. Other groups of medical practitioners who regularly provide diagnostic imaging services were consulted with in the development of this measure as well.

A similar registration and information collection system already exists under Commonwealth Health Program Grant requirements for radiation oncology, however, these apply to private radiation oncology practice site only.

While this provides comprehensive information on those sites, there is very little data available on public radiation oncology facilities, which form the majority of service providers. This restricts the ability of providers and government to adequately plan and provide appropriate access to these services.

The introduction of LSPNs for radiation oncology practice sites was recommended by the Radiation Oncology Inquiry Committee in its report of 8 June 2002. This will bring public and private facilities under the one umbrella to help address planning, service provision, workforce, age of equipment and other issues identified in the report.

Once registered, all that practice sites will need to do is advise of changes to the information on the register. It is envisaged that practices will also be annually sent details of the information on the register for the practice to confirm or change details on a periodical basis. The impact of this measure on practices will therefore be minimal.

The second measure in this Bill implements recommendations of a review commissioned by the Government in July 2000 in relation to the referral arrangements for diagnostic imaging services. The review committee included representatives from the Royal Australian and New Zealand College of Radiologists, the Committee of Presidents of Medical Colleges, the Australian and New Zealand Association of Physicians in Nuclear Medicine and the Royal Australian College of General Practitioners.

The committee's recommendations being addressed in this Bill are:

· allowing a provider to substitute a more appropriate imaging service where the provider feels that the patient has been referred for an inappropriate service;

· requiring a further referral where a service provider deems additional services to those specified in the original referral are necessary and those services are of the type that would have otherwise required a referral by specialist; and

· making it unlawful for all diagnostic imaging service providers to station diagnostic imaging equipment or employees at the premise of another practitioner. This measure currently applies to specialist radiologists only.

So that patients are not disadvantaged by this last recommendation, exemptions to this provision will be provided in identified areas of need, for example, in remote areas.

These new arrangements will streamline referral arrangements in diagnostic imaging, making it easier for patients to access, and the provider to deliver, the most appropriate services.

The final measure seeks to redress an anomaly relating to the referring arrangements for osteopaths.

Under the current legislation, practitioners registered as chiropractors under State or Territory registration laws can request specified diagnostic imaging services under the Medicare arrangements. Osteopaths registered as chiropractors under those laws are also able to participate.

However, some States now have separate legislation governing the registration of chiropractors and osteopaths which means that osteopaths in those States are unable to access the referring arrangements for diagnostic imaging services.

The amendments will restore the rights of affected osteopaths. They will also allow State or Territory registered osteopaths who were not previously registered as chiropractors under State or Territory legislation to request these services.

Debate (on motion by Senator Crossin) adjourned.