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Health Insurance Amendment Bill 1996



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D E P A R T M E N T O F T H E P A R L I A M E N T A R Y L I B R A R Y

Parliamentary

Research

Service

Health Insurance Amendment Bill 1996

Bills Digest No.94 1995-96

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ISSN 1323-9031

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Except to the extent of the uses permitted under the Copyright Act 1968, no part of this publication may be reproduced or transmitted in any form or by any means including information storage and retrieval systems, without the prior written consent of the Department of the Parliamentary Library, other than by Senators and Members of the Australian Parliament in the course of their official duties.

Published by the Department of the Parliamentary Library, 2018

Warning:

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This Digest was prepared for debate and reflects the legislation as introduced but does not canvass subsequent amendments.

This Digest was available on PDBS, and on the Internet, from 4 June 1996.

Health Insurance Amendment Bill 1996

Date Introduced: 8 May 1995 House: Senate Portfolio: Health and Family Services Commencement: The amendments contained in the Bill will commence on a day fixed by Proclamation or, if such a day has not been Proclaimed within 6 months of the Bill receiving the Royal Assent, on the first day after the end of that period.

Purpose

To incorporate provisions dealing with the Australian Childhood Immunisation Register (ACIR) into the Health Insurance Act 1973 (the Principal Act) and to allow information from ACIR to be provided to others in restricted circumstances.

Background Immunisation against specific diseases has been in use in Australia since the 1920s. The process of immunisation involves administering a vaccine to a person to allow their own immune system to develop anti-bodies to a disease (the process was pioneered by Edward Jenner approximately 200 years ago). Current Australian immunisation programs relate to rubella, measles, pertussis (whooping cough), a variety of meningitis (Hib), diphtheria and tetanus.

The potential of immunisation campaigns to lessen the frequency of a disease is best illustrated by the World Health Organisations successful campaign to eradicate smallpox. The campaign was launched in 1958 and, by 1977, had eradicated smallpox except in research institutions. In more developed countries, including Australia, poliomyelitis has also been eradicated. In 1988 the WHO introduced a program aimed at the global eradication of this disease.

While immunisation campaigns have been in use for a long time, there are few reliable statistics available on the frequency of diseases that could be prevented by immunisation

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or the proportion of people who are immunised. In a 1993 paper, titled National Immunisation Study, the National Health and Medical Research Council (NHMRC) states:

Moreover, the data [on preventable diseases] probably understate the incidence, by up to 90% for some diseases, because notification procedures are not uniform across Australia and cases of measles, mumps, rubella and whooping cough are often undiagnosed or unnotified.1

Having noted potential problems with the statistics available, the Department of Human Services and Health compiled the following figures for the occurrence of vaccine preventable diseases, with the 1994 data relating to cases reported to mid-April 1994 and not being full year figures.2

Disease 1992 1993 1994

Rubella 3747 3623 411

Measles 1400 4339 830

Pertussis 725 3826 1210

Hib 501 393 44

Diphtheria no data no data 5

Tetanus no data no data 2

The Australian Medical Association and the Australian College of Paediatricians have claimed that whooping cough and measles killed 457 Australian children between 1980 and 1990.3

A survey by the Australian Bureau of Statistics published in 1992 deals with the coverage of immunisation for children aged between 0 and 6 in 1989-90. Findings of the survey include:

• only 52.9% of such children were fully immunised, with 29.5% partly covered;

• 3.6% had no vaccination and 14% were unsure;

• the rate of vaccination varied between diseases, with rates high for diphtheria and tetanus and lower rates for whooping cough and polio;

• ACT had the highest rate of immunisation while the Northern Territory had the lowest rate; and

• in addition to variations across States/Territories, there were differing rates of immunisation between regions, with urban areas tending to have higher rates.4

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A number of reasons have been suggested for the above figures, including:

• children from economically disadvantaged families and areas have lower immunisation rates;

• lower rates of immunisation are also found in Aboriginal children, children of recent immigrants and children of Arabic and Asian, other than Chinese, background;

• if a child has two or more siblings, or an older sibling who is not fully immunised, they are more likely to not be fully immunised;

• many children are not fully immunised because of parents fear of side effects of the vaccine, particularly for whooping cough;

• refusal to have children immunised is rare and is concentrated in relatively highly educated groups that prefer 'natural' methods (although there is no scientific evidence on the effectiveness of such methods);

• many parents do not have children vaccinated against diseases perceived to have been eradicated (the main case is for poliomyelitis which, while it no longer exists in Australia, can be found in many areas of the world);

• booster shots can be forgotten so that a child is not fully immunised; and

• immunisation services are fragmented with little co-ordination so that follow-up reminders often do not occur.5

Failure to implement universal immunisation can cause diseases that were thought to have been eradicated from a region to reoccur. An article in the Medical Journal of Australia reports two such cases. The first related to the reintroduction of paralytic poliomyelitis. It is reported that twice within 15 years a religious group in Holland that refused immunisation were responsible for outbreaks of the disease in that country and that the disease was also spread to the United States and Canada on both occasions by visiting members of the group. At the time of the visits poliomyelitis was considered to have been eradicated in the latter countries. The article also reports that following adverse publicity regarding the effects of whooping cough vaccine in the 1970s, which were later proved to be incorrect, the rate of vaccination in the U.K. fell from approximately 80% to 40% and that there were two subsequent outbreaks of the disease (1977-79 and 1981-82) in which more than 100 000 cases of the disease were reported and 27 people died.6

It was announced in the 1995-96 Budget that funds would be allocated to establish ACIR which would monitor immunisation coverage and provide a central register to enable parents to determine the immunisation status of their child regardless of where the immunisation service was provided. ACIR commenced operation on 1 January 1996. According to the second reading speech for the Bill, approximately 450 000 immunisations had been registered by 1 April 1996.

ACIR was originally funded for two years, after which the scheme would be evaluated to determine whether it should be continued. This included funding for preparatory work on the scheme during the period 1 July 1995 until its commencement on 1 January 1996 so that funding for the ACIR would end after 18 months of its operation on 30 June 1997. In the second reading speech to the Bill the Minister states that:

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Under this government funding for the Register will be continued beyond this 18 month period.

The explanatory memorandum to the Bill provides a financial impact statement which states that ACIR will cost $3.18 million in 1995-96 and $3.30 million for 1996-97. There is no estimate of costs beyond 1 July 1997.

ACIR is currently established under regulations made under the Principal Act. However, those regulations do not provide for information sharing, which prevents ACIR being used to share information with those who provide immunisation services and State/Territory immunisation bodies. This also prevents 'reminder notices' being sent to those on ACIR when their next immunisation is due.

Main Provisions

Item 1 of Schedule 1 of the Bill will insert a new Part IVA into the Principal Act that deals with the ACIR.

Proposed section 46B deals with the Health Insurance Commission's (HIC) responsibilities in respect of ACIR. HIC is to:

• establish and keep ACIR;

• record on ACIR all immunisation encounters that are notified to the HIC;

• make payments in respect of the administrative costs incurred by those providing information; and

• provide information in respect of immunisation (see below).

The information that may be provided from ACIR is dealt with in proposed section 46E which allows the Managing Director of HIC to:

• give information about the immunisation of children that will not identify the individuals involved to: a recognised immunisation provider for a purpose relating to the immunisation or health of the child (as individuals are not to be identified such information could, amongst other matters, relate to the incidence of a disease in an area); a prescribed body; an officer of the Department; or an officer of a Department, authority of a State or Territory that has requested the information;

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• provide information about a particular child where that is requested by an immunisation provider and a (not both) parent or guardian of the child agrees to the provision of the information; and

• post information to a parent or guardian of a child relating to the immunisation of the child (which will allow 'reminder notices' to be sent).

Item 2 will save the ACIR kept under regulation 3 of the HIC regulations and provide that it is to be taken to have been kept under proposed Part IVA (NB. Regulation 375 of 1995 provides for ACIR to be kept under regulation 3Q rather than regulation 3 as referred to in the Bill).

Section 130 of the Principal Act contains a number of provisions to make it an offence for officers of the HIC to disclose information received due to their duties except in restricted circumstances. Item 3 of the Bill will amend section 130 to extend restrictions to those who receive information under proposed section 46E. Such information may only be used for the purposes for which it was provided, and is not to divulged to another unless necessary for the performance of that person's functions as a provider of immunisation. The information may also be divulged by an officer of an authority or department to which it has been provided under proposed section 46E for the performance of their duties in relation to immunisation.

Endnotes

1 NHMRC, National Immunisation Strategy, April 1993, p. vii. 2 Department of Human Services and Health, Childhood Immunisation, August 1994, p. 4 (this work provides a review of the literature on immunisation in Australia). 3

Ibid.

4 Ibid., p. 5.

5 Ibid.

6 The Medical Journal of Australia, Vol 160 , 18 April 1994, pp. 459 & 460.

Chris Field Ph. 06 277 2439

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Bills Digest Service 29 May 1996

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.

Except to the extent of the uses permitted under the Copyright Act 1968, no part of this publication may be reproduced or transmitted in any form or by any means, including information storage and retrieval systems, without the prior written consent of the Parliamentary Library, other than by Members of the Australian Parliament in the course of their official duties.

Published by the Department of the Parliamentary Library, 1996.