Bills Digest no. 123 2009–10
Health Insurance Amendment (Pathology Requests) Bill
2010
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
Financial implications
Main provisions
Concluding comments
Contact officer & copyright details
Passage history
Health Insurance
Amendment (Pathology Requests) Bill 2010
Date introduced: 10 February 2010
House: House
of Representatives
Portfolio: Health and Ageing
Commencement: Schedule 1 commences 1 July 2010
Links: The
relevant links to the Bill, Explanatory Memorandum and second
reading speech can be accessed via BillsNet, which is at http://www.aph.gov.au/bills/.
When Bills have been passed they can be found at ComLaw, which is
at http://www.comlaw.gov.au/.
The Health Insurance Amendment
(Pathology Requests) Bill 2010 (the Bill) proposes amendments to
the Health Insurance Act 1973 (the Act), that would remove
the requirement that a request for a Medicare eligible pathology
service be made to a particular pathology provider. This would
allow a patient to take their pathology request to a pathology
provider of their own choice.
Under Medicare arrangements, if a medical practitioner decides
that it is clinically necessary, she/he may refer a patient to an
approved provider for a diagnostic test. This referral normally
takes the form of a written request for a particular service.
The Act currently requires that in order for a Medicare benefit
to be payable, a designated pathology provider must be named in the
referral request.[1]
This means that a patient must take the request for service to the
pathology provider specified by their doctor. Many doctors use
pre-branded forms that include the company details of a particular
provider for this purpose.
In contrast, the requirement to nominate a particular provider
is not a condition of a referral request for a diagnostic imaging
service. Under diagnostic imaging arrangements, a patient can take
their request for service to any approved and accredited
provider.[2]
The proposed provisions in this Bill would remove the
requirement that a particular pathology provider be specified in
the request for referral. The proposed amendments would change the
wording to specify that a pathology provider be in receipt of a
referral in order for that request for service to be Medicare
rebatable.[3] This
would allow the patient to take the pathology request to any
approved and accredited pathology provider.
However, it is important to note that there is nothing in the
proposed provisions of this Bill which would prohibit a referring
doctor from recommending a particular provider to the patient.
Indeed, a discussion paper released by the Department of Health and
Ageing acknowledges that the practice of doctors discussing
possible providers with patients should be encouraged.[4]
The Government has indicated that it intends to amend
regulations to clarify that requests for pathology can be taken to
any approved provider. Specifically, the regulations will require
that any pre-branded forms used by doctors must include a statement
to this effect, although these regulations are not expected to come
into force until after July 2011. This is to allow the Government
time to consult with the sector on the wording of these
statements.[5]
The proposed changes to pathology referrals were announced as
part of the 2009–10 Budget. It is one of two reforms the
Government is proposing for pathology and diagnostic imaging
arrangements that together are intended to increase competition and
improve patient choice.[6] The other reform, which is yet to be implemented, would
allow pathology providers to operate an unlimited number of
collection centres. The total cost of these reforms is estimated to
be $3.4 million over four years.[7]
The Selection of Bills Committee (the Committee) recommended the
Bill be referred to the Community Affairs Legislation Committee for
inquiry and report by 12 May 2010. The Committee’s reasons
for referral and principle issues for consideration include:
- The onus being on the patient to choose the pathologist
- Examination of any possible problems arising between the
referring doctor and the pathology provider
- Examination of problems that may arise due to differences in
technical measurements adopted by different pathologists
- Examination of any impacts on arrangements between general
practitioners (GPs) and pathologists for emergency or out-of-hours
contacts.[8]
When the measure was announced in the Budget, some pathologists
expressed concern. The Royal College of Pathologists Australasia
claimed it is the ‘professional right’ of doctors to
determine to whom they refer their patients, and that removing this
right could affect quality of care.[9]
A discussion paper prepared by the Department of Health and
Ageing that invited interested stakeholders to make submissions by
no later than 22 February 2010 was recently released.[10] However, the fact that
the Bill was introduced prior to this deadline prompted some
surprise.[11]
Concerns have also been raised that if a patient is free to take
their referral to any pathologist, rather than the one usually
preferred by their GP, this could hinder communication between the
referring doctor and the pathologist or result in pathology results
being misinterpreted or missed.[12] However, as noted in the Minister’s second
reading speech, GPs will still be free to make
recommendations.[13]
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The specific measures proposed in this Bill are estimated to
cost $140 000 over two years. This will fund amendments to
pathology request forms and a communications strategy.[14]
Schedule 1 of the Bill contains proposed
amendments to the Act. As previously mentioned, these proposed
amendments would have the effect of removing the existing
requirement that a pathology request be made to a particular
approved pathology practitioner or authority, while retaining
the requirement that a written request for pathology services be
made by the treating practitioner.
Item 1 proposes to amend subparagraph
(d)(ii) of the definition of ‘professional
service’ in subsection 3(1) of the
Act by omitting the words ‘to whom the treating practitioner
has made a request for the service’ to simply ‘who
received a request for the service made by the treating
practitioner’.
Amendments, with similar effect, are proposed to section
16A of the Act (Medical benefits in relation to pathology
services) by items 2–9.
Item 10 proposes to repeal subsection
16A(8) of the Act. Subsection 16A(8)
currently has the effect of deeming a pathologist to be the
proprietor of a laboratory in certain circumstances. This provision
would no longer be relevant under the proposed new pathology
request arrangements.
Items 11–13 propose to amend
section 23DK of the Act, which provides for
request and confirmation forms. These proposed amendments are
similar to those proposed in items 1–9
above.
As in item 10 above, item 14 proposes
to repeal subsection 23DK(11) of the Act, because it would
no longer be relevant under the proposed new pathology request
arrangements. Currently, subsection 23DK(11)
provides that references made, in section 23DK, to approved
pathology practitioners include references to requests
deemed, under section 16A, to have been made to those
approved pathology practitioners.
Concluding comments
The Bill proposes amendments which would remove requirements
that a designated pathology provider be specified in a referral for
pathology, allowing patients to take their pathology referral to
any approved provider. This would align pathology referral
requirements with those of diagnostic imaging. However, regulations
requiring wording on pathology referral forms to be amended to
reflect this change will not be promulgated until July 2011,
allowing for a consultation process to occur.
While the Government argues the measure will improve patient
choice, some have argued that communications between pathology
providers and referring doctors could be undermined and hence
affect the quality of patient care.
The referral to a Senate Committee for examination may delay the
passage of the Bill.
[1].
Health Insurance Act 1973
subsection 16A(3).
[2]. See
Medicare Benefits Schedule Book, p. 551,
http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/2C3B0FAC365E1877CA25767200168230/$File/201001-MBS.pdf
[3].
With the exception of a
pathologist-determinable service, which is covered under a separate
section 16A(6).
[4].
Department of Health and Ageing ‘Removal of restrictions on
pathology request forms’ web page, viewed 17 February 2010,
http://www.nhhrc.org.au/internet/main/publishing.nsf/Content/patholology-leg-reqfrms
[5]. N
Roxon, ‘Second reading speech: Health Insurance Amendment
(Pathology Requests) Bill 2009’, House of Representatives,
Debates, p. 7, 10 February 2010,
http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22chamber%2Fhansardr%2F2010-02-10%2F0021%22.
The consultation process is currently underway.
[6]. N
Roxon (Minister for Health and Ageing), L Tanner (Minister for
Finance and Deregulation), Increasing competition in pathology
and diagnostic imaging, media release, 12 May 2009, viewed 17
February 2010,
http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2009-hmedia15.htm
[7].
Australian Government, Budget
measures: budget paper no. 2: 2009–10, Commonwealth of
Australia, Canberra, 2009, p. 292.
[8].
Selection of Bills Committee, Report no. 2 of 2010, the
Committee, 24 February 2010, viewed 25 February 2010,
http://www.aph.gov.au/Senate/committee/selectionbills_ctte/reports/2010/rep0210.pdf
[9]. Royal
College of Pathologists Australasia, ‘Budget cuts a health
risk’, media release, 13 May 2009, viewed 17 February 2010,
http://www.rcpa.edu.au//static/File/Asset%20library/public%20documents/Media%20Releases/2009/Budget_Cuts_Health_Risk.pdf
[10].
Department of Health and Ageing, Removal of
restrictions on pathology request forms: discussion paper,
Department of Health and Ageing, Canberra, 2010, viewed 26 February
2010,
http://www.nhhrc.org.au/internet/main/publishing.nsf/Content/9CFD18C4089721F1CA2576A80081F055/$File/Disc%20Ppr%20-%20Path%20Req%20Forms.pdf
[11]. M Metherell,
‘Pathology change ‘increases risks’’,
The Age, 11 February 2010, p. 8, viewed 17 February 2010,
http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22media%2Fpressclp%2FE5VV6%22
[12].
Ibid.
[13].
N Roxon, ‘Second reading speech’,
op. cit., p. 7.
[14].
Explanatory memorandum, Health Insurance
Amendment (Pathology Requests) Bill 2010, p. 1.
Amanda Biggs
1 March 2010
Bills Digest Service
Parliamentary Library
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