Bills Digest no. 61 2005–06
Health Legislation Amendment Bill
2005
WARNING:
This Digest was prepared for debate. It reflects the legislation as
introduced and does not canvass subsequent amendments. This Digest
does not have any official legal status. Other sources should be
consulted to determine the subsequent official status of the
Bill.
CONTENTS
Passage History
Purpose
Background
Main Provisions
Concluding Comments
Endnotes
Contact Officer & Copyright Details
Passage History
Health
Legislation Amendment Bill 2005
Date Introduced: 14 September 2005
House: House of Representatives
Portfolio: Health and Ageing
Commencement: Most
parts of the Bill commence on the day of or the day after Royal
Assent. Schedule 2, items 8 to 11 and 22 to 25 commence the day
after Royal Assent, or immediately after the commencement of
Schedule 1 of the National Health Amendment (Prostheses) Act
2005, whichever is the later
The purpose of the Bill is
threefold:
-
Schedule 1 proposes to amend the National Health Act
1953 to extend, until 30 June 2006, the existing arrangements
for approving pharmacists to provide medicines under the
Pharmaceutical Benefits Scheme (PBS)
-
Schedule 2 proposes to amend provisions within the National
Health Act relating to private health insurance which do not
include reference to dependants of private health contributors (and
thus which could result in contributors dependants not receiving
hospital benefits even where the dependant is included on the
contributor s policy)
-
Schedule 3 proposes two changes to provisions within the
Health Insurance Act 1973 relating to the conditions under
which Medicare benefits are payable. The first set of changes
proposes to clarify the scope of existing powers in the Health
Insurance Act to set conditions, limitations and restrictions on
particular items in the Medicare Tables (which set out the
circumstances in which benefits for certain medical, pathology and
diagnostic imaging benefits are payable). The second set of changes
proposes the insertion of a new power in the Health Insurance Act
to allow the Minister to determine that Medicare benefits are not
payable for certain services rendered in specified
circumstances.
Current arrangements for approving pharmacists to supply PBS
medicines were due to cease on 30 June 2005 but were extended to 31
December 2005 as a result of the Health Legislation Amendment
(Australian Community Pharmacy Authority) Act 2005
(passed in June this year).
This Bill proposes to make a further extension of these
arrangements until 30 June 2006.
In summary, current arrangements require that applications by
pharmacists to supply medicines subsidised through the PBS from
either new or relocated premises must be referred to the Australian
Community Pharmacy Authority (ACPA). The Secretary, Department of
Health and Ageing, may only grant permission to supply PBS
medicines following approval of an application by ACPA.
ACPA is required to consider all applications against
location-based criteria which must be satisfied in order for a
pharmacist to obtain approval to supply PBS medicines from
particular premises. These criteria are set out in what are known
as the Pharmacy Location Rules and include such things as the
minimum distance between pharmacies and whether there is a
community need for pharmaceutical services in a particular
location.(1) The Pharmacy Location Rules also prevent
pharmacies which are located within, adjacent to, or connected to,
a supermarket, and to which members of the public have direct
access from within the premises of the supermarket, from being
approved to supply pharmaceutical benefits.
The purpose of the Location Rules is twofold: first, to provide
widespread community access to pharmaceutical services, and second,
to ensure the continued viability of existing pharmacies. The
Location Rules have been somewhat controversial since their
introduction, with some commentators and interest groups suggesting
that they are a source of insufficient competition within the
pharmacy sector.(2) Negotiations over pharmacy locations
rules have taken on added significance as a result of further
efforts by the Woolworths retail chain to gain government
permission for the establishment of in-store
pharmacies.(3) For example, Woolworths has recently
proposed a trial of dedicated pharmaceutical dispensing areas
within the supermarkets, staffed by qualified
pharmacists.(4)
The Rules and their administration by ACPA are being reviewed as
part of negotiations between the government and the Pharmacy Guild
of Australia for the Fourth Community Pharmacy
Agreement.(5) According to a recent media report, a
draft report by Allen Consulting commissioned by the government and
the Pharmacy Guild to inform this review, proposed the abolition of
the current location rules and their replacement with an
arrangement whereby the government varies the dispensing fees paid
to pharmacists depending on the supply of pharmacies in a
particular location.(6) The media report also suggested
that, according to Allen Consulting, the current rules had allowed
pharmacies to increase their incomes without passing on the
benefits to consumers, and that competition between pharmacists,
including from within supermarkets, would lead to the delivery of
higher quality pharmacy services .(7)
The Pharmacy Guild responded by arguing that the Allen
Consulting report was incomplete, inaccurate and entirely at odds
with the term of reference [of the review into Pharmacy Location
Rules] . According to Guild National Vice-President, Bill Scott,
the draft report s comments on increasing pharmacy profitability
did not take into account that pharmacies had also increased both
the number of prescriptions dispensed and other services provided
over the previous decade.(8) He added that the
replacement system suggested by Allen Consulting would simply
replace one set of regulation with another .(9)
Comments earlier this year by the Prime Minister, John Howard,
and the Minister for Health and Ageing, Tony Abbott, suggest that
the government would not be seeking to make significant changes to
the Pharmacy Location Rules in the Fourth Agreement but would be
intending to achieve savings in the amount of dispensing fees paid
to pharmacists.(10)
According to recent media reports, the Fourth Agreement is close
to being finalised, and will include a relaxation of the existing
Location Rules to allow pharmacies to be established in all-night
medical centres and large shopping centres where an economic case
can be made . The ban on supermarket chains such as Woolworths and
Coles Myer operating in-house pharmacies will be maintained. The
recent media reports also suggest that the 10 per cent margin
pharmacists are currently allowed will be wound back (though it is
unclear to what extent).(11) This is in line with the
government s stated aim of achieving a reduction in the rate of
growth of payments to the pharmacy sector with the long-term aim of
limiting pharmacy sector revenue to 0.4 per cent of GDP in 2040
.(12) (Further, according to the recent media reports,
the new agreement will include a $150 million Community Service
Obligation, under which expensive, low-demand medicines will be
made available to rural and remote communities.)
Provisions for the Pharmacy Location Rules and ACPA will no
longer be in force after 31 December 2005. As noted above, these
provisions were due to cease on 30 June 2005 but extended to 31
December 2005 as a result of the Health Legislation Amendment
(Australian Community Pharmacy Authority) Act 2005.
According to the government, this extension was necessary in order
to allow further time to consider and make decisions in relation to
the findings and recommendations of the review of the Pharmacy
Location Rules and role of ACPA.(13)
The purpose of the Bill is to provide a further extension of
provisions relating to the Pharmacy Location Rules and ACPA from 31
December 2005 until 30 June 2006. According to the Parliamentary
Secretary for Health and Ageing, Christopher Pyne, this extension
is necessary in order to enable the government, in consultation
with the Pharmacy Guild of Australia, to carefully consider the
findings and recommendations of the review of these
provisions.(14)
While, as noted above, issues related to the Pharmacy Location
Rules have been somewhat controversial, the measures contained in
this Bill are relatively procedural and have not attracted
significant public commentary or analysis.
While the Labor Party supported the previous extension of
provisions for the Pharmacy Location Rules and ACPA from 30 June to
31 December 2005, it was critical of the government s role in
negotiations towards the Fourth Community Pharmacy Agreement. For
example, the Shadow Minister for Health and Ageing, Julia Gillard,
criticised the government for not concluding its review into the
location rules and ACPA in a timely way (that is, sufficiently
prior to the cessation of the Third Community Pharmacy Agreement on
30 June 2005).(15) It is likely that similar criticisms
may be made in relation to this Bill given that (a) it provides for
a further extension of time in which to conclude the
Location Rules review process and (b) despite indications from the
government that negotiations for the Fourth Community Pharmacy
Agreement would be concluded well before September 30 [2005]
.(16)
Schedule 1 is not expected to have a direct financial
impact.
The operation of private health insurance funds and the
provision of private health insurance products are regulated by the
National Health Act 1953. Various provisions within the
relevant sections of the National Health Act make reference to
contributors to health funds (that is, the persons who
take out a private health insurance policy), but do not include
references to the dependants of contributors even though
dependants of contributors may also be members of the health fund.
The absence of explicit references to dependants in the National
Health Act creates a technical loophole which could result in
dependants of contributors being excluded from private health
insurance cover, even where dependants are listed on a health
insurance policy and where the contributor has paid for them to be
covered.
Accordingly, the purpose of the amendments proposed by Schedule
2 is to insert references to dependants of contributors in the
relevant sections of the National Health Act, so as make clear that
the relevant provisions within the Act apply to contributors
and their dependants.
Thus, the amendments proposed by Schedule 2 do not represent any
change to existing policy, but rather seek to close existing
technical loopholes which could be used to exclude dependants of
contributors to private health insurance funds from receiving the
cover to which they are entitled.
Schedule 2 is not expected to have a direct financial
impact.
Schedule 3 proposes two changes to provisions within the
Health Insurance Act 1973 relating to the conditions under
which Medicare benefits are payable. The first set of proposed
changes would clarify the scope of existing powers in the Health
Insurance Act to specify particular conditions under which benefits
for certain medical, pathology and diagnostic imaging benefits are
payable.
The second set of changes included in Schedule 3 (contained in
item 5) propose the insertion of a new power in the Health
Insurance Act to allow the Minister to determine, by legislative
instrument, that Medicare benefits are not payable for certain
services provided in specified circumstances. The changes proposed
by item 5 of Schedule 3 have been highly controversial.
Subsequently, the Health Minister, Tony Abbott, indicated recently
that these changes would not be pursued when the Bill is debated in
the parliament. Notwithstanding this decision by the government,
this Digest discusses the nature of the changes proposed by the
Bill as introduced and the issues raised by them.
Currently, Medicare benefits are payable for medical or
professional services set out in the Medicare tables : the general
medical services table, the diagnostic imaging services table, and
the pathology services table.(17) The Medicare tables
set out items of services, the relevant fees for each item, and
rules for interpreting the items and the table.(18)
According to the Explanatory Memorandum, it has been a long
standing practice to specify the circumstances in which items of
medical, diagnostic imaging and pathology services will apply by
including conditions, restrictions and limitations in the Medicare
Tables . Examples include restrictions on the number of times
particular items may be claimed in specified periods, requiring
practitioners to have particular qualifications to perform
particular services, and requiring that particular services only be
provided to patients who meet certain criteria.(19)
The Health Insurance Act currently allows for the regulations
under which the Medicare tables are made to set out rules for the
interpretation of the tables. The amendments proposed by items 1 to
4 of Schedule 3 will amend the Health Insurance Act to make it
clear that the rules of interpretation can include conditions,
limitations and restrictions on services provided under particular
items. Thus, the amendments proposed by items 1 to 4 do not
represent any change to existing practice (but rather seek to
codify the validity of current arrangements), and as such are
likely to be uncontroversial.
As far as the Parliamentary Library is aware, the changes
proposed by items 1 to 4 of Schedule 3 are not affected by Minister
Abbott s decision not to pursue the controversial elements of
Schedule 3.
As noted above, the proposal contained in Schedule 3, item 5 has
been highly controversial since the Bill was introduced. Health
Minister Abbott has subsequently indicated that the changes
proposed by this section of the Bill will not be pursued.
Currently, the Health Insurance Act permits the making of
regulations to prescribe certain circumstances in which Medicare
benefits for certain professional services are not
payable.(20) However, the Explanatory Memorandum points
out that the existing provisions cannot be utilised in most
circumstances , because regulations cannot be made under these
provisions unless they are made in accordance with a recommendation
of the Medicare Benefits Advisory Committee (MBAC), and MBAC is no
longer in existence .(21) (The Medicare Benefits
Advisory Committee and its replacement body, the Medical Services
Advisory Committee, are discussed below.)
Accordingly, Schedule 3, item 5 proposed a new power through
which the Minister will be able to determine that Medicare benefits
are not payable for certain services or services provided in
certain circumstances.
According to Health Parliamentary Secretary Christopher Pyne s
second reading speech, a power of the kind proposed by Schedule 3,
item 5 was required to allow swift action to be taken to prevent
medical practitioners claiming existing Medicare Benefits Schedule
items for services which they were never intended to cover or which
the Government does not wish to fund through Medicare
.(22)
The Explanatory Memorandum explains that there are occasions in
which the Government decides it is not appropriate for certain
services to be funded under Medicare . The existing regulation
making powers in the Health Insurance Act (section 19A) have been
used in the past to specify that Medicare benefits are not payable
for certain services. The Explanatory Memorandum to the Bill gives
the example of services rendered in relation to the removal of
tattoos.(23) The Explanatory Notes to the Medicare
Benefits Schedule provide other examples of restrictions on
services that have been enacted under section 19A of the Health
Insurance Act in the past, including:
-
professional services rendered in association with the injection
of human chorionic gonadotrophin (a hormone produced by the
placenta during pregnancy(24)) in the management of
obesity
-
professional services rendered in relation to the use of
hyperbaric oxygen therapy (a medical treatment in which oxygen
under high pressure is inhaled(25)) in the treatment of
multiple sclerosis, and
-
professional services rendered for the purposes of, or in
relation to, the removal from a cadaver of kidneys for
transplantation.(26)
-
Because of the existing requirement that regulations of this
nature be made in accordance with a recommendation of the MBAC
which no longer exists, the government argued that an amendment to
the Health Insurance Act was required to allow the existing
provisions to continue to be used to make determinations along
these lines.(27)
The Explanatory Memorandum also explained that:
some medical practitioners utilise existing
[Medicare Benefits Schedule] items for services the items were
never intended to cover. This issue most commonly arises in
relation to new medical technologies. Practitioners sometimes claim
benefits for new technologies under existing items, before the
Government is satisfied that the new technology is safe, or
represents value for money.(28)
A press release issued by the Health Minister, Tony Abbott in
response to concerns about the changes (see below) cited the cases
of vertebroplasty, a technique used for treating spinal fractures,
and uterine artery embolisation, used in the treatment of fibroids,
as examples of techniques which have not yet been proven to be
safe, effective and cost effective and should not be claimed by
doctors under Medicare (though both techniques are currently being
assessed by the Medical Services Advisory Committee(MSAC) see below
for more information about the role of the
MSAC).(29)
The Explanatory Memorandum also explained that rapid advances in
medical technology mean that the practice of billing Medicare for
technologies and procedures which have not been approved for
Medicare benefits has the potential to drive up the costs of
Medicare and also impact on the broader health system through, for
example, increased private health insurance premiums
.(30) This point was underscored recently by the release
of the Productivity Commission s report on the impacts of advances
in medical technology in Australia, which found that advances in
medical technology may have driven up to one-third of the growth in
real health spending over the past decade. The Commission also
found that while future technological advances are likely to
support further dramatic improvements in healthcare , they are also
likely to raise expenditure significantly .(31) Hence,
the government argued that in order to contain expenditure on new
technologies which have not been approved for Medicare benefits,
there was a need for the Minister to have power to respond quickly
when instances of Medicare being billed for unapproved procedures
became apparent.(32)
The powers proposed by Schedule 3, item 5 of the Bill would not
have changed the existing process for adding new items to the
Medicare tables, or for reviewing existing items.
Currently, new items for new medical technologies and procedures
are added to the Medicare tables on the advice of the MSAC. MSAC
advises the Minister for Health and Ageing on evidence relating to
the safety, effectiveness and cost effectiveness of new medical
technologies, and the circumstances under which new medical
technologies should be funded through Medicare.(33)
Prior to the establishment of MSAC (after the 1997 98 Budget), new
items were added to the Medicare tables on the advice of the MBAC.
MBAC was superseded by MSAC.
Reviews of existing items in the general medical services table
are currently overseen by the Medicare Benefits Consultative
Committee (MBCC). (There are separate arrangements for the
diagnostic imaging and pathology services tables.) The MBCC reviews
particular services or groups of services within the general
medical services table to ensure that the Schedule reflects and
encourages appropriate clinical practice . It also has a role in
advising the Minister on appropriate fee (and consequently,
Medicare rebate) levels.(34)
Thus, the new powers proposed by Schedule 3, item 5 would not
have given the Minister any new discretionary power to add new
items to the Medicare tables or withdraw existing items. Rather,
they would have given the Minister the power to prescribe certain
procedures for which Medicare benefits would not be payable (such
as new and untested procedures), or prescribe conditions under
which Medicare benefits are payable for existing
items.(35)
While the amendments to the Health Insurance Act proposed by
Schedule 3, item 5 would not have represented a major change to
existing processes for listing new items on the Medicare tables or
reviewing existing items, the proposed amendments nonetheless
raised several important issues.
These included consultation and decision-making processes and
the adequacy of existing powers.
The Explanatory Memorandum and supporting documentation did not
make clear what kinds of decision-making processes would have
preceded a determination made under the new power proposed by
Schedule 3, item 5.
As noted above, according to the Explanatory Memorandum there
are occasions in which the Government decides it is not appropriate
for certain services to be funded under Medicare . However, it was
not clear from the EM or other associated documentation
how the government comes to such decisions, for example,
how the government is alerted to instances of Medicare being billed
for procedures or technologies it has not approved.
The Legislative Instruments Act 2003 requires that
rule-makers consult before making a legislative instrument, so
presumably there would have been some consultation process before
any enactment of the new powers.(36) According to the
Health Minister, Mr Abbott, protocols to be used in determining
whether benefits should be payable in respect of a particular
procedure would have included consultation with the AMA prior to a
decision being made .(37) Beyond this, however, no
details of the protocols to which the Minister referred, nor any
other details about what kind of consultation process may have
preceded a determination being made under the new powers, were made
available. Further, there did not appear to be any role (at least
not formally) for MSAC in providing advice on determinations made
under the proposed new powers.
As explained briefly above, the Health Insurance Act already
provides for regulations along the lines of those envisaged by the
government under the amendments proposed by Schedule 3, item 5 to
be made. However, as the Explanatory Memorandum explains, these are
effectively defunct because they can only be used in accordance
with a recommendation from the MBAC which no longer exists.
However, it is not clear why the existing regulation making
powers could not have been modified, instead of creating a new
(apparently more discretionary) power in the Health Insurance
Act.
For example, the reference to MBAC in the relevant part of the
Health Insurance Act (subsection 19A(2)) could be replaced with a
reference to MSAC (or a more general reference to a committee
established to advise the Minister on medical services benefits,
since MSAC is not mentioned anywhere else in the Health Insurance
Act).
While this would be more cumbersome than the system mooted by
Schedule 3, item 5 (in that the process for making regulations is
more complex and time consuming than the process for making
Ministerial determinations by legislative instrument), it would
alleviate the problems that the Explanatory Memorandum points to
with existing regulation making powers (that is, that they make
reference to a committee which no longer exists) and would also
ensure that any determinations made under the proposed new powers
are made on the basis of expert advice.
Various doctors groups expressed concern about the amendments to
the Health Insurance Act proposed by Schedule 3, item 5. For
example, the Australian Medical Association (AMA) President Mukesh
Haikerwal has said that he feared the new power could be used to
reduce Medicare rebates for particular procedures as a means of
making budget savings: It could be used to say if you are over 90,
you can t have a hip replacement It may go to other ethical issues
just as sinister. This is a huge sledgehammer that will have
collateral damage problems .(38)
Doctors Reform Society president Tim Woodruff questioned whether
the proposed new powers would have been used by the Minister to
prevent Medicare funding for abortion. According to Dr Woodruff,
legislative changes which allow the Health Minister to decide
himself what operations and procedures should be rebateable under
Medicare strikes at the very heart of the universality of Medicare
. Further, Dr Woodruff said that Australia already has an
independent assessment process for determining what operations and
procedures should be covered by Medicare (this is the MSAC process
discussed above): If its too slow, speed it up by all means, but
not by giving a politician with no medical knowledge the power to
decide on the basis of moral beliefs .(39)
In response to these concerns, Health Minister Tony Abbott said
that the claims of sinister intentions behind the amendments to the
Health Insurance Act proposed by Schedule 3, item 5 had no
foundation .(40)
Opposition parties expressed concerns similar to those raised by
doctors groups about the amendments to the Health Insurance Act
proposed by Schedule 3, item 5. Australian Democrats leader Lyn
Allison expressed her reservations as follows: Access to health
care should always be made on the basis of the best available
evidence not the religious views of particular politicians If this
is about stopping Medicare funding for abortion, the Minister must
be up front with his colleagues and the vast majority of
Australians who disapprove of changes to the status quo on abortion
.(41) Similarly, Labor Health spokeswoman Julia Gillard
said that she was highly suspicious about the proposed powers, and
that her antennae [were] raised .(42)
Schedule 3 was not expected to have a direct financial impact
(though it is aimed at providing a means through which to contain
future costs).
Item 1 proposes to amend subsection 90 (3C) of
the National Health Act 1953 so that subsections relating
to the role of APCA in approving applications to supply
pharmaceutical benefits will continue in force until the end of 30
June 2006 unless sooner repealed.
Item 2 proposes to amend section 99Y to provide
that provisions relating to the establishment, membership and
functions of the ACPA, and the requirement for the Minister to
determine the rules with which ACPA must comply in making its
recommendations, will continue in force until the end of 30 June
2006.
Schedule 2 proposes a series of amendments to the National
Health Act 1953 to include references to dependants of
contributors:
-
items 1 and 2 amend relevant definitions (in
sections 4(1) and 73AAI(2))
-
items 3 to 7 amend provisions within the
section of the Act pertaining to hospital purchaser-provider
agreements (section 73BD)
-
items 8 to 11 amend provisions
within the (new) section of the Act pertaining to gap and no-gap
prostheses (section 73BDAAA)
-
items 12 to 15 amend provisions within the Act
(in section 73BDAA) pertaining to practitioner agreements
-
items 16 to 20 amend provisions within the Act
pertaining to medical-purchaser provider agreements (in section
73BDA)
-
item 21 amends a provision within the section
of the Act which pertains to gap cover schemes (section 73BDB)
-
items 22 to 33 amend relevant provisions within
Schedule 1 of the Act, which pertain to the conditions of
registration of private health funds.
Items 1 to 4 relate to the first set of changes
to the Health Insurance Act 1973 proposed by Schedule 3
those clarifying the scope of existing powers to specify particular
conditions in the Medicare tables under which benefits for certain
medical, pathology and diagnostic imaging benefits are payable:
-
items 1 to 3 add references to the new
subsection proposed by item 4 in the sections pertaining to the
Medicare tables elsewhere in the Health Insurance Act
-
item 4 inserts a new section in the
Health Insurance Act (4BAA) which clarifies that the Medicare
tables may set conditions, limitations or restrictions on services
provided under items in the Medicare tables
Item 5 pertained to the second set of changes
proposed by Schedule 3 as discussed above (which the Minister has
indicated he will not pursue). It proposed the insertion of new
subsections (19A(3) and 19A(4)) to the Health Insurance Act which
would have allowed the Minister to determine, by legislative
instrument, that Medicare benefits are not payable in respect of
professional services rendered in specified circumstances. In
accordance with the Legislative Instruments Act, any determinations
made under the powers proposed by item 5 would have been
disallowable.
As noted above, as part of negotiations for the Fourth Community
Pharmacy Agreement, the government and the Pharmacy Guild undertook
a joint review of the Pharmacy Location rules and the role of ACPA
in their administration. Through this Bill, the government is
seeking to extend existing arrangements in order to allow it, in
consultation with the Guild, more time to consider the findings of
the review. Given the controversy surrounding these rules and the
protracted nature of negotiations between the government and the
Pharmacy Guild, the outcome of the review will be eagerly
anticipated by the various stakeholders in the pharmacy sector.
Nevertheless, the measures contained in the Bill to extend the
arrangements for approving pharmacists to supply PBS medicines have
not attracted significant public commentary or analysis. The fact
that the relevant measures in this Bill represent the second
attempt by the government to extend the time available to consider
the findings of the review of Pharmacy Location rules is likely to
attract some criticism from the Opposition.
As discussed above, the amendments proposed by Schedule 2 are
aimed at amending loopholes within the National Health Act which
might be used to exclude dependants of contributors to private
health funds from receiving benefits (even where the contributor
has paid for them to be covered). Thus, the amendments proposed by
Schedule 2 do not represent any change to government policy and are
likely be to uncontroversial.
Schedule 3 proposes two sets of amendments to provisions within
the Health Insurance Act pertaining to the Medicare tables. The
first set of amendments clarifying the provisions within the Health
Insurance Act to set conditions, limitations and restrictions on
services within the Medicare tables simply codify existing practice
and are likely to be uncontroversial.
The second set of proposed amendments inserting a new power
within the Health Insurance Act to allow the Minister to determine,
by legislative instrument, that Medicare benefits are not payable
for services delivered in certain circumstances have attracted
commentary and criticism from doctors groups and opposition
parties. The key issue raised by the proposed amendments is the
basis on which decisions will be made to restrict Medicare funding
for particular services under the new powers: for example, what
kind of consultation process will precede any determination being
made, and the extent to which the Minister will receive expert
advice before making a determination under the new powers. However,
since the Bill was introduced into the Parliament, Health Minister
Tony Abbott has indicated that the controversial changes proposed
by Schedule 3 will not be pursued.
-
A consolidated version of the Pharmacy Location Rules can be
accessed from the Australian Community Pharmacy Authority website
at:
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pbs-general-pharmacy-acpa-consdeterm.htm
(accessed 22 May 2005).
-
See, for example, P. Kerin, High price of anti-competition ,
Business Review Weekly, 30 June 2005, p. 34; N. Ballenden,
The pharmacy: why it can t stay a closed shop , Consuming
Interest, Winter 2005, pp. 18-20; M. Metherell, Pharmacy
profits hit a nerve , Sydney Morning Herald, 16 May 2005;
B. Glasson, Getting tough on turf , Australian Doctor, 18
February, 2005; A. Fels and F. Brenchley, Dispense some competition
to the pharmacies , Sydney Morning Herald, 8 April 2004;
J. Albrechtsen, Strip these white coats of subsidies ,
Australian, 1 September 2004.
-
See for example, C. Jimenez and K. Murphy, Woolies in pharmacy
trial furore , Australian, 10 May 2005; M. Polimeni,
Woolies in fresh pharmacy assault , Canberra Times, 7 May
2005.
-
AAP, Woolworths touts pharmacy trial , Australian, 9
May 2005.
-
Hon. Tony Abbott, Minister for Health and Ageing, Fourth
Community Pharmacy Agreement , Media release, 18 April
2005, see
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-mediarel-yr2005-ta-abb036.htm
(accessed 11 October 2005).
-
M. Metherell, Pharmacy profits hit a nerve , op. cit.
See also D. Gibson, Pharmacists defend competition curbs , West
Australian, 17 May 2005.
-
ibid.
-
Pharmacy Guild of Australia, Pharmacy draft report incomplete
and inaccurate , Media release, 16 May 2005, see
http://www.guild.org.au/public/currentissues/media_location_report_160505.pdf.
-
ibid.
-
See, for example, M. Davis, Pharmacists stick to script ,
Australian Financial Review, 25 June 2005; Pharmacy
Guild opposes plans by Woolworths for in-store pharmacies ,
7.30 Report, ABC television, 19 July 2005.
-
S. Lewis, Chemists win deal on drugs for bush , The
Australian, 24 October 2005, p. 1. See also M. Polimeni, No
fund deal yet: chemists , Canberra Times, 25 October 2005,
p. 6.
-
Abbott, Fourth Community Pharmacy Agreement , op. cit.
-
Explanatory Memorandum, p. 1. According to the government, the
purpose of the review was [T]o evaluate the net public benefit of
the [Pharmacy Location] Rules in terms of achieving their policy
objectives, identify any significant anomalies in their application
and administration and report on alternatives to remedy any such
deficiencies and anomalies . See Explanatory Memorandum, op.
cit.
-
Hon. Christopher Pyne, Parliamentary Secretary to the Minister
for Health and Ageing, Health Legislation Amendment Bill 2005
Second Reading Speech , House of Representatives, Debates,
14 September 2005, p. 2.
-
Julia Gillard, Shadow Minister for Health, Health Legislation
Amendment (Australian Community Pharmacy Authority) Bill 2005
Second Reading Speech , House of Representatives, Debates,
25 May 2005, p. 2.
-
Hon. Tony Abbott, Minister for Health and Ageing, Fourth
Community Pharmacy Agreement wholesale distribution of PBS
medicines , Media release, 9 August 2005.
-
Explanatory Memorandum, p. 9; Health Insurance Act
1973, sections 4, 4AA, 4A.
-
Explanatory Memorandum, p. 9. Doctors are not obliged to charge
the fee set out in the Medicare tables, however these fees are
relevant to determining the level of Medicare rebate for
particular services (as the amount of the rebate is tied to the fee
set out in the Medicare tables).
-
Explanatory Memorandum, pp. 9, 10.
-
Health Insurance Act 1973, s. 19A.
-
Explanatory Memorandum, p. 11. See Health Insurance Act
1973, ss. 19A(2).
-
Pyne, Second Reading: Health Legislation Amendment Bill 2005 ,
op. cit.
-
Explanatory Memorandum, p. 11.
-
Human chorionic gonadotrophin n. , A
Dictionary of Nursing, Oxford University Press, 2003. Accessed
via Oxford Reference Online, Oxford University Press, Dept
of the Parliamentary Library, 28 September 2005: see
http://www.oxfordreference.com/views/ENTRY.html?subview=Main&entry=t62.e4108.
-
Hyperbaric oxygen therapy , Food and Fitness: A
Dictionary of Diet and Exercise, Michael Kent, Oxford
University Press, 1997. Accessed via Oxford Reference
Online, Oxford University Press, Dept of the
Parliamentary Library, 28 September 2005:
see http://www.oxfordreference.com/views/ENTRY.html?subview=Main&entry=t38.e890.
-
Department of Health and Ageing, Medicare Benefits
Schedule, 1 November 2004 edition, p. 21. These determinations
are contained in regulation 14 of the Health Insurance
Regulations 1975 (made pursuant to section 19A and 133 of the
HIA). Regulation 14 was added in 1985, and various amendments were
made between 1985 and 1995. Presumably these determinations were
sanctioned by MBAC, or were of the kind not requiring such sanction
(if not, they would be invalid).
-
Explanatory Memorandum, p. 11.
-
ibid.
-
Tony Abbott, Minister for Health and Ageing, Government tightens
up Health Insurance Act , Media release, 21 September
2005, see
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2005-ta-abb112.htm?OpenDocument&yr=2005&mth=9
(accessed 11 October 2005).
-
Explanatory Memorandum, p. 11.
-
Productivity Commission, Impacts of Advances in Medical
Technology in Australia , Media release, 20 September
2005. See:
http://www.pc.gov.au/study/medicaltechnology/finalreport/mediarelease.html
(accessed 5 October 2005).
-
Pyne, Second Reading: Health Legislation Amendment Bill 2005 ,
op. cit.; Abbott, Government tightens up Health Insurance Act , op.
cit.
-
MSAC website, see http://www.msac.gov.au/terms.htm
and http://www.msac.gov.au/bckgrd.htm
(Accessed 11 October 2005).
-
Department of Health and Ageing website: MBCC Guidelines. See:
http://www.seniors.gov.au./internet/wcms/publishing.nsf/Content/health-medicarebenefits-mbccguidelines,
accessed 7 October 2005.
-
Pyne, Second Reading: Health Legislation Amendment Bill 2005 ,
op. cit.; Abbott, Government tightens up Health Insurance Act , op.
cit.
-
Legislative Instruments Act 2003, section 17. According
to subsection 17(3), such consultation could involve notification,
either directly or by advertisement, of bodies that, or of
organisations representative of persons who, are likely to be
affected by the proposed instrument. Such notification could invite
submissions to be made by a specified date or might invite
participation in public hearings to be held concerning the proposed
instrument .
-
Abbott, Government tightens up Health Insurance Act , Media
release, op. cit.
-
S. Dunlevy, Medicare under the knife Abbott wants to ban
benefits for some surgery , Daily Telegraph, 21 September
2005, p. 9.
-
AAP, Doctors warn Medicare bill aimed at stopping abortions ,
AAP, 21 September 2005. See also Doctors Reform Society,
Doctors predict Health Minister Abbott could ban abortion ,
Media release, 21 September 2005.
-
Abbott, Government tightens up Health Insurance Act , Media
release, op. cit.
-
AAP, Doctors warn Medicare bill aimed at stopping abortions ,
AAP, 21 September 2005.
-
Dunlevy, Medicare under the knife Abbott wants to ban benefits
for some surgery , op. cit.
Angela Pratt and Luke Buckmaster
1 November 2005
Bills Digest Service
Information and Research Services
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