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Monday, 12 November 1973
Page: 3148


Mr COATES (Denison) - I wish to devote my time in this debate to the Government's health insurance program and the question of privacy. More than 6 months public debate has taken place on the report of the Health Insurance Planning Committee. The White Paper spelling out the Government's intentions was tabled in this House last week. Later this month, legislation to implement the program will be introduced. Since the Planning Committee's recommendations were made, many false charges have been laid against the program by the Australian Medical Association, the General Practitioners Society in Australia, the larger private health insurance funds and by members of the Opposition. There have been blatant lies and misrepresentations galore, all designed to instil fear into the public. It has upset me to see many of the people whom this program will most help being unnecessarily worried by the propaganda of those who oppose the program for their own selfish reasons.

One of the most ridiculous accusations that has been made against the program is that it will involve an invasion of personal privacy. Not being able to argue rationally about the main issues of the program, its opponents have dragged in this red herring and, using just a whole lot of emotive words, have tried to discredit it. Mr Cade of the Medical Benefits Fund of Australia talks about 'a health dossier on every Australian' and 'doctors will be facilitating the accumulation of medical dossiers on their patients'.


Mr HOLTEN (INDI, VICTORIA) - Who is Mr Cade?


Mr COATES - He is the General Manager of the Medical Benefits Fund of Australia. In its propaganda to the public, the Medical Benefits Fund goes further. One of the little slips which it includes with its bills contains the following words:

If the Federal Government are allowed to force through their compulsory nationalised health insurance scheme, details of your personal and private life are no longer confidential.

As with all Federal Government bureaucracies, privacy goes to the wind, your private details become the property of Federal files.

What an insult to refer to Australian public servants in that manner. It continues:

Many Government Departments will have access to details of your private life.

Your private details are respected as confidential with your present scheme. Keep it that way . . .

What a load of rubbish that is. The Australian Medical Association in its more oily publicity used the following phrases:

The politicians say these personal records will he kept secret. We sincerely hope so. But we would feel a lot happier to have your records kept safely locked up in a doctor's filing cabinet and not rattling around inside a Government computer.

That is further rubbish. Let me allay all the rumours and put the facts straight once and for all. The facts regarding privacy are that this new program will guarantee privacy for the first time. In a moment, I shall give an outline of how the system will work and the guarantees that will be built into it to ensure privacy of records. Firstly, I wish to emphasise that the records which the Health Insurance Commission will maintain will be for statistical purposes only. In any case, they are not medical histories. No record of diagnosis or details of treatment are required. So there will bc required even less detail than is required by the private funds under the existing scheme. I refer to paragraph 1.22 in the Planning Committee's report. It states:

Complete confidentiality of information about individual patients and doctors is an essential feature of the plan. The Committee recommends that safeguards be written into the legislation along the lines of those in the Taxation and Social Services legislation. Statistics about the operation of the plan would be restricted to those which did not breach the privacy of individuals.

I seel: leave to incorporate in Hansard 5 paragraphs. Nos 2.1 to 2.5, from the White Paper on the Australian health insurance program. I obtained permission from the previous speaker, the honourable member for Herbert (Mr Bonnett), to incorporate this section of the White Paper.

The DEPUTY CHAIRMAN (Dr Jenkins)Order! Is leave granted? There being no oboection. leave is granted. (The document read as follows) -

ELIGIBILITY FOR BENEFITS

2.1 The benefits of the Health Insurance Program will be available to a-1! Australian residents. The entitlement to benefits will be accorded by the legislation and will not depend on registration or any form of action required of individuals. 2.2 For the convenience of beneficiaries of the Program, and as part of an efficient administrative system every adult in the community will be given a health insurance card. A card for the children in a family will be given to their mother or guardian. It will not bc necessary for a card to be produced to a doctor or hospital for a patient to receive medical or hospital services. It must be emphasised that the purpose of the card is simply to enable members of the public to obtain benefit payments as conveniently as possible. 2.3 It should be borne in mind that many existing health insurance funds require contributors to produce numbered membership cards or books to facilitate benefit claim processing. Indeed, one large fund is issuing to contributors membership cards similar to the health insurance cards proposed for the Program. 2.4 All people who can establish their identity as residents of Australia will be entitled to have their claims paid on presentation of these claims to the Health Insurance Commission. The simplest and most convenient way for a person to meet the Commission's identification needs is to record the number of his or her card on the claim form. The Government is confident that the vast majority of Australian people will co-operate in the simple processes involved in administering the Health Insurance Program on an economic and efficient basis. 2.5 During recent months there has been gross misrepresentation of the purpose of health insurance curds. It has been suggested that the issue of the cards will in some way be an invasion of individual privacy and even that they will 'depersonalise' medical services. These suggestions are completely unfounded. The legislation will contain provisions under which it will be an offence for any person or authority to require the production of health insurance cards as proof of identity other than for the. purposes of the Health Insurance Program. The Government will insist that complete confidentiality regarding individual patients and doctors is maintained by the Commission. The information required for the processing of claims will bc less than is now required by private health insurance funds. A special committee has been established by the Government to recommend steps necessary to guarantee the privacy of individuals. The committee includes a representative of the Australian Medical Association. The relevant measures decided on as a result of this study will be incorporated in the health insurance legislation at the appropriate time.


Mr COATES - I shall outline now the method by which the operation of the Health Insurance Commission will work so far as records are concerned. When a bill is sent to the Commission a record of it will be filed on a computer, but the computer record will be in terms only of a number allotted for the type of service covered by the bill. It will not involve a detailed diagnosis code. Thus, in the case of a consultation with a general practitioner the number allotted will identify the service simply as a consultation. It will not reveal the nature of the consultation. So, the details of services rendered will be limited in the computer record.

There is another major protection. Data held by the Health Insurance Commission will relate only to the Department of Social Security card numbers and not to the names of patients. Patients' names will not be available in these records. They will be available on a separate registration index only. Thus, even if an individual's record was extracted from the computer it would not reveal the patient's identity. The only way in which the patient could be identified would be for the inquirer to have access to the registration index at the same time. Such complete access will be denied to all but a handful of doctors employed by the Commission to check on any possible fraudulent abuse of the insurance system by private practitioners. Even they, as I have indicated, would still get only the barest details of services rendered to patients. Barriers to access by other persons will be built into the computers. This is a feasible and necessary safeguard. In addition to this, records will be kept for about a year only, so there is no possible way in which anyone could check up on the long term record of a patient.

Let me make a comparison with the existing system. Under the existing system of health insurance, patient histories are held by the private funds in manual files for the most part, although there is a notable trend towards computerisation of claim processing. Some funds have been using computers for some time. This indicates that already there is a move towards the storage of records on computers. Also, under the existing system of health insurance, data is available to a wide range of private fund employees. Fund employees who currently have access to patient histories are not subject to any legislation concerning the privacy of history data, whereas all Commission employees under the new scheme will be subject to strict security provisions enforceable by law. So much for the feigned concern of the Opposition, the Australian Medical Association and the funds about secrecy. It was the present Opposition which presided over the so-called voluntary scheme and its lack of secrecy and protection.

The Commission's health insurance number, which will aid data security, has been carefully designed to ensure that it cannot be manually assembled from personal details and that these details cannot be derived from an examination of the number. It is understood that one fund, the Hospital Benefits Association of Victoria, will shortly replace membership books with plasticised personal identification cards for each member. Presumably the member's number will also be used as an aid to data security and for computer processing. Although the Australian Medical Association is extremely critical of the Government's proposals to supply such membership cards under the universal health insurance program, it has mtaintained a continuous silence when a private fund does exactly this. Safeguards will be included in the legislation to the effect that the use of health insurance cards will be restricted to programs administered by the Department of Social Security. It will be illegal for any person to ask another to identify himself for any other purpose by producing his health insurance card or by quoting his health insurance number.

In addition, the Attorney-General (Senator Murphy) already is establishing a group to advise him on the general question of the protection of individual privacy. The group will consist of experts in the relevant fields of law, computing and civil rights. Its first task will be to make recommendations on the manner in which unwarranted invasions of privacy, which at present exist or for which there is potential in large scale administrative operations such as health insurance, may be guarded against. In order that the interests of the patient be represented, the Minister for Social Security has arranged for a representative from the Medical Consumers Association to be a member of the study group. The Australian Medical Association is represented as well. The appointment of a special committee by the Attorney-General shows clearly that the Government has a firm commitment to the principle of the right of privacy. The Government agrees with the principle set out in Article 17 of the International Covenant on Civil and Political Rights that 'no one shall be subjected to arbitrary or unlawful interference with his privacy'.

Clearly, the collection and storage of data concerning individuals by both public and private bodies is, in this computer age, a vital aspect of this issue. In its February issue of the 'Australian Computer Journal', the Australian Computer Society stated that it was the Society's belief that provided proper safeguards are incorporated in them, computer based data banks should pose less of a threat to privacy than manual or other noncomputer systems. That is exactly the aim that we are pursuing for the Health Insurance Commission. It will indeed be safer than the present collection and storage of medical information by private health funds which operate without any legal limitations in this regard.







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