Can the Government bypass the Parliament over the GP co-payment?

Parliament house flag post
Senate chamber

Can the Government bypass the Parliament over the GP co-payment?

Posted 18/07/2014 by Amanda Biggs

Recently, ABC news online reported that based on advice provided to the Greens from the Parliamentary Library, the Government could bypass the Senate to introduce elements of its GP co-payment proposal. The news story goes on to suggest that the Government could use its regulatory powers to implement at least one element of the proposal—a $5 reduction in the Medicare rebate paid to doctors—without the need for legislation. This Flagpost explains how this might occur.

The Medicare rebate is calculated as a proportion of the Medicare Schedule Fee, which is listed in the Medicare Benefits Schedule. For most out of hospital services, the rebate is calculated at 85% of the Schedule Fee, but for GPs it is calculated at 100% of the Schedule Fee. The requirement to calculate the rebate in this manner is enshrined in the Health Insurance Act 1973.

So how could the Government reduce the rebate without changing the Act?

The fees for medical services are described in the General Medical Services Table (GMST) in the Medicare Benefits Schedule, which also details the types of medical services for which a rebate is payable. The amount of the Schedule Fee for each medical service is specified in the GMST—literally thousands of services with their fees are listed. Because services may need to be added, amended or deleted to reflect current medical practice, the GMST needs to be in a form which can be updated easily. The GMST must also allow for regular indexation of fees due cost increases. Hence, the Act specifies that the Minister can make regulations to alter the services and benefits listed in the GMST without needing to amend the principal Act.

Amendments to the GMST are made frequently. When the GMST needs to be updated this is done by an amendment to the GMST regulation, which is then registered on the Federal Register of Legislative Instruments and tabled in Parliament. The GMST regulation is also a disallowable legislative instrument, meaning that either Parliamentary chamber can vote to disallow (but not amend) the regulation. A motion to disallow a legislative instrument must be made within 15 sitting days of the legislative instrument being tabled.

Most recently, the GMST regulation was amended to increase GP fees by two per cent (indexation of other services will be paused for two years, under a budget savings measure). The increase in GP fees was done in part to provide some compensation to GPs for the effect of the proposed reduced rebate. It should be noted that GPs are free to charge patients a fee higher than the Schedule Fee—but the effect of specifying a Schedule Fee is widely regarded as having a moderating effect on doctors’ fees.

If the Government wishes to reduce the level of rebate paid to GPs it could simply issue a new regulation specifying a reduced Schedule Fee for these services. Because the GP rebate is set at 100 per cent of the Schedule Fee, a reduction in the Schedule Fee would have the effect of reducing the rebate due to the doctor (if they bulk bill) or the patient (if they don’t) by the same amount. Being a legislative instrument, the regulation would also be subject to Parliamentary disallowance.

On the other hand, trying to reduce the rebate paid to doctors without reducing the Schedule Fee would not be possible without changes to the Act. This is because section 10AA of the Act specifies that the rebate (or benefit) must be calculated as a direct proportion of the Schedule Fee. Amending the Act to remove this requirement would require successful passage through the Senate, where a majority of Senators have previously indicated opposition to the GP co-payment proposal.

The other component of the budget measure is a $7 co-payment to be imposed by doctors on patients who are bulk billed. The government intends that the doctor would keep the $7, presumably to partially offset the $5 reduction in their rebate. Currently, the Act prohibits any additional charge on a patient who is bulk billed. To permit bulk billed patients to be charged a co-payment would require an amendment to section 20A of the Act.

Regardless of whether the Government chooses to pursue a regulatory or legislative approach to try to meet its objective of reducing the rebate paid to GPs and impose a patient co-payment, Parliamentary approval will be needed.

Thank you for your comment. If it does not require moderation, it will appear shortly.
Facebook LinkedIn Twitter Add | Email Print


Flagpost is a blog on current issues of interest to members of the Australian Parliament

Parliamentary Library Logo showing Information Analysis & Advice




refugees asylum immigration Australian foreign policy Parliament climate change elections women social security Indigenous Australians Australian Bureau of Statistics Employment Sport illicit drugs people trafficking taxation Medicare welfare reform Australian Defence Force higher education welfare policy United Nations Asia income management Middle East criminal law disability Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget health financing gambling school education forced labour aid statistics Australian Electoral Commission WADA emissions trading Australia in the Asian Century steroids detention Private health insurance OECD ASADA labour force transport Law Enforcement Australian Federal Police Industrial Relations people smuggling dental health National Disability Insurance Scheme Australian Crime Commission slavery Senate election results Papua New Guinea Australian Public Service International Women's Day corruption Afghanistan Fair Work Act child protection debt federal election 2013 parliamentary procedure poker machines ALP New Zealand Newstart Parenting Payment 43rd Parliament political parties Census constitution High Court skilled migration voting Federal Court terrorist groups Higher Education Loan Program HECS youth paid parental leave Aviation environment foreign debt gross debt net debt defence capability customs doping health crime health risks multiculturalism aged care Gonski Review of Funding for Schooling sex slavery sea farers Special Rapporteur leadership United Kingdom UK Parliament Electoral reform politics banking firearms public policy violence against women domestic violence mental health China ADRV terrorism social media pensions welfare ASIO intelligence community Australian Security Intelligence Organisation governance public service reform Carbon Pricing Mechanism carbon tax mining military history employer employee fishing by-election European Union same sex relationships international relations coal seam gas family assistance planning United Nations Security Council Australian economy food vocational education and training Drugs Indonesia children codes of conduct terrorist financing money laundering Productivity asylum seekers early childhood education Canada Population Financial sector national security fuel disability employment Tasmania integrity science research and development Australian Secret Intelligence Service sexual abuse federal state relations World Trade Organization Australia accountability housing affordability bulk billing water renewable energy children's health health policy Governor-General US economy export liquefied natural gas foreign bribery question time speaker superannuation expertise Senators and Members climate Intergovernmental Panel on Climate Change Department of Agriculture Fisheries and Forestry food labelling Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets health reform Indigenous constitutional recognition of local government local government consumer laws PISA royal commission US politics language education baby bonus Leaders of the Opposition Parliamentary remuneration health system Australia Greens servitude Trafficking Protocol energy forced marriage rural and regional Northern Territory Emergency Response ministries social citizenship human rights citizenship Defence High Court; Indigenous; Indigenous Australians; Native Title ACT Indigenous education Norfolk Island External Territories emissions reduction fund; climate change child care funding refugees immigration asylum procurement Indigenous health e-voting internet voting nsw state elections 44th Parliament 2015 ABS Age Pension Death penalty capital punishment execution Bali nine Bali bombings Trade EU China soft power education Fiji India Disability Support Pension Antarctica Diplomacy by-elections state and territories workers Bills anti-corruption fraud bribery transparency corporate ownership whistleblower G20 economic reform innovation standards NATO Members of Parliament Scottish referendum Middle East; national security; terrorism social services Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 online grooming sexual assault of minors ACT Assembly public health smoking plain packaging tobacco cigarettes Asia; Japan; international relations Work Health and Safety Migration; asylum seekers; regional processing China; United States; international relations fiscal policy Racial Discrimination Act; social policy; human rights; indigenous Australians Foreign policy Southeast Asia Israel Palestine regional unemployment asylum refugees immigration political finance donations foreign aid Economics efficiency human rights; Racial Discrimination Act employment law bullying Animal law; food copyright Australian Law Reform Commission industry peace keeping contracts workplace policies trade unions same-sex marriage disorderly conduct retirement Parliament House standing orders public housing prime ministers election timetable sitting days First speech defence budget submarines Somalia GDP forestry world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission regulation limitation period universities Ireland cancer gene patents genetic testing suspension of standing and sessional orders animal health live exports welfare systems infant mortality middle class welfare honorary citizen railways disciplinary tribunals standard of proof World Health Organisation arts international students skilled graduate visas temporary employment visas apologies roads Italy national heritage NHMRC nutrition anti-dumping Constitutional reform referendum Rent Assistance competition policy pharmaceutical benefits scheme obesity evidence law sacrament of confession US presidential election international days DFAT UN General Assembly deregulation Regulation Impact Statements administrative law small business Breaker Morant homelessness regional engagement social determinants of health abortion Youth Allowance Members suspension citizen engagement policymaking federal election 2010 workplace health and safety Trafficking in Persons Report marine reserves hearing TAFE Victoria astronomy resources sector YMCA youth parliament alcohol Korea rebate Australian Greens presidential nomination Racial Discrimination Act entitlements political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing Hung Parliament political education social inclusion Social Inclusion Board maritime early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin Iran sanctions Norway hospitals

Show all
Show less
Back to top