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STANDING COMMITTEE ON FINANCE AND PUBLIC ADMINISTRATION - 29/10/2008 - Item 16525 in part 3 of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007

Estimates & Committees
Sarah Hanson-Young 29 Oct 2008

Senator Hanson-Young -Mr Ryan, what is the department's view on the claims from various people who have given submissions and will be presenting throughout the next two days that practitioners are being liberal in interpreting the descriptions under this particular item?

Mr Kingdon -The department can only hold to the judgement of the practitioner. If someone were to draw to our attention what they felt were inappropriate practices then this would be referred to Medicare, who, in turn, if they felt there were a matter to be answered, would probably refer it to the PSR because that is the only body that can peer review.

Senator Hanson-Young -And that has not been the case?

Mr Kingdon -There has been no instance drawn to our attention.

Senator Hanson-Young -So throughout the country, regardless of the different states' jurisdictions and the different legalities of what is mid-term and late-term abortion in the different states, no-one has brought to the attention of the department practitioners being, in their view, quite relaxed with their definitions.

Mr Kingdon -No specific instances. People can make assertions about practitioners in general but that does not help us to pinpoint the-

Senator Hanson-Young -So no evidence has been presented to the department.

Mr Kingdon -No.

Senator Hanson-Young -My next two questions are in relation to what impact a disallowance of this item would have particularly on women in rural and remote areas and also on women who come from socioeconomically disadvantaged backgrounds. At the end of the day, if the only services that they are able to access are through the public sector, those are the people who are going to be most affected, I would imagine. Do we have any numbers?

Mr Kingdon -We have no numbers, and that is making assumptions about the socioeconomic status of essentially people who hold private health insurance. These items really only relate to out-of-public hospital services-they can occur in a public hospital but with the patient as a private patient-so we have not looked at that demographic.

Senator Hanson-Young -So you do not think disallowing this particular item you would have any effect on people in rural and remote areas above and beyond that on people in metropolitan Sydney, for example?

Mr Kingdon -No, I did not say that.

Senator Hanson-Young -This is what I am clarifying.

Mr Kingdon -You can only extrapolate in terms of the accessibility of services. If you are living in a rural or remote area, you usually have much more difficulty in accessing a service and getting an appointment. I would have thought that anything that interfered with the process of someone having their situation managed as soon as possible, any impact there, would probably be more difficult for a person in a rural or remote area, simply because it would be harder for them to find an alternative arrangement. And any delay, particularly if you are talking about second trimester pregnancy, is obviously going to be far more critical.

Senator Hanson-Young -Absolutely. If you are in outback South Australia and you have to organise somebody to come and look after your farm and your other kids or something, so you can make your way into Adelaide, that is going to add a few extra weeks to something that perhaps could have been managed earlier if you were already living in Adelaide.

Mr Kingdon -One can make that assumption, but we obviously have not modelled or looked at that specifically.

Senator Hanson-Young -Thank you.

Senator CAROL BROWN -I just want to ask a question about the private health insurance issue. Am I reading correctly from your submission that currently private health insurers are obligated to refund items claimed under 16525? Is that right?

Mr Ryan -Only where they offer that service within the private hospital.

Senator CAROL BROWN -You have said in here that they would not be obligated to pay benefits. Do you mean they are not currently obligated?

Mr Ryan -If they do not offer the service within their hospital.

Senator CAROL BROWN -I just wanted to clear that up. We have talked about the process in terms of reissuing different item numbers. I just want to ask two things. I take it that there was consultation carried out with the medical profession and that an agreement was reached about the current descriptors that are under this item.

Mr Ryan -Yes. Back from 1994-95.

Senator CAROL BROWN -That is a long time ago. Do you know how long that consultation took?

Mr Ryan -I believe it commenced in mid-1994 with the submission that we received from the medical profession. As I said, it was to review the whole of the obstetrics services within the Medicare Benefits Schedule. There was a series of meetings that went through late 1994 and early and mid-1995 and resulted in the final change in November 1995. So I would say it was probably about 18 months worth of consultation.

Senator CAROL BROWN -We have had suggestions that the descriptors should be changed. If that decision was taken, would you be following the same consultation process?

Mr Ryan -It is our preferred consultation process to work with the profession to come up with the most clinically relevant item descriptor, so that there is an understanding from the government side of things as well as the profession-so that it is agreed.

Senator CAROL BROWN -So that is the preferred consultation process that the profession likes to see?

Mr Ryan -Yes.

Senator CAROL BROWN -And I would like to take up an issue that Senator Ryan asked questions on: describing actual procedures in an item. Would that require the same sort of consultation procedure?

Mr Ryan -The item descriptor is, in a sense, part of a regulation, so any change to that item descriptor would require regulatory change.

Senator CAROL BROWN -But, if it were a more comprehensive descriptor-I think he was talking about describing procedures-basically it is the same consultation process that you have currently undertaken?

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