Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 1999 (NO. 1) 1999 NO. 48

STATUTORY RULES 1999 NO. 48

Issued by the authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance Amendment Regulations 1999 (No. 1)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

The purpose of the regulations is to allow Medicare benefits to be paid in respect of services provided by a medical practitioner in the course of work performed for an approved deputising service.

Section 19AA of the Act prevents a Medicare benefit from being paid in respect of a service rendered by a medical practitioner, where the practitioner first became a medical practitioner on or after 1 November 1996, and was not: recognised as a specialist, consultant physician or general practitioner; or listed on the Register of Approved Placements created under section 3GA; or a person to whom sections 3J(1)(c) or (d) of the Act applied.

Section 3GA of the Act provides for the creation of a Register of Approved Placements. Persons may be listed on the Register once they are enrolled or undertaking a course or program of a kind specified in the regulations. Once included on the Register, a person is eligible to provide services for which a Medicare benefit will be payable, when performed during the course or program. This ensures that only persons in properly supervised and recognised positions are able to provide services for which a Medicare benefit will be payable.

Paragraph 3GA(5)(a) of the Act requires a body to be specified in the regulations for the purpose of providing written notice that a person is enrolled in or undertaking a course or program specified in the regulations to the Managing Director of the Health Insurance Commission. Subparagraph 3GA(5)(a)(i) provides for the relevant course or training program to be prescribed in the regulations.

The new regulations add a new Item to Part 2 of Schedule 5 of the Health Insurance Regulations. Schedule 5 contains a list of programs and administering bodies specified for the purposes of section 3GA approved placements. The new Item adds a new administering body and a new program into Part 2 of Schedule 5. The new body is the Department of Health and Aged Care and the corresponding new program is the Approved Medical Deputising Service Program.

The Approved Medical Deputising Service Program is prescribed in Part 2 of Schedule 5 to address the difficulty experienced by medical practices that rely upon deputising services to provide care for their patients at times when the practice is closed. There is currently a shortage of medical practitioners willing to provide deputising services to medical practices.

The regulations permits the Department of Health and Aged Care to approve a deputising service, which would in turn allow medical practitioners working at the service to become listed on the Register of Approved Placements under section 3GA of the Act. A Medicare benefit would be payable in respect of services performed by such doctors.

Notes on clauses

Items 1 and 2 of Schedule 1 amend the name of the Commonwealth Department that provides the Health Insurance Commission with written notice under paragraph 3GA(5)(a) of the Act in respect of the relevant course or program.

Item 3 of Schedule 1 inserts a new program in Part 2 of Schedule 5 namely the "Approved Medical Deputising Service Program". The Commonwealth Department of Health and Aged Care is specified in Schedule 5 as required by paragraph 3GA(5)(a) of the Act.

The regulations commenced on Gazettal.

REGULATION IMPACT STATEMENT

Health Insurance Act 1973

Amendment to Health Insurance Regulations 1975

Background

Patients seeking medical services outside of normal business hours are commonly referred to a medical 'deputising' service. A medical deputising service engages medical practitioners to provide patient care for a medical practice in times when the practice is closed or unable to care for its patients.

Identification of problem

Medical deputising services currently experience difficulty in recruiting sufficient medical

practitioners to meet the demand for after hours and home visit services, especially in rural

areas. In many areas of Australia it is therefore increasingly difficult to access a medical

practitioner who is willing to provide 'home visit' ambulatory medical services outside of

normal business hours. Deputising services and doctors perceive the difficulty to be the

impact of a recent limitation placed upon the ability of new medical practitioners to provide

services that attract a Medicare benefit by the Health Insurance Amendment Act (No.2) 1996.

Newly graduated doctors were previously a major source for recruitment by deputising

services. Deputising services do not usually engage medical practitioners who are unable to

access Medicare benefits as this can result in a higher treatment cost to patients who are

unable to claim the benefit. In many cases temporary resident doctors are then imported to

undertake this work.

Where there is a shortage of doctors willing to provide deputising services there can be expected to be a resultant hardship for patients requiring after hours medical care, particularly those patients who have difficulty in seeking medical care outside their homes. The filling of vacancies with temporary resident doctors does not provide a long-term solution to the problem.

Objective

The objective of this regulatory change is to expand the pool of medical practitioners able to perform medical deputising work and specifically, to increase availability of after hours home visits, by increasing the number of medical practitioners who are able to attract a Medicare rebate for deputising work.

Items 1 and 2 of Schedule 1 to the proposed regulation are technical amendments designed to assist the public in identifying the body responsible for relevant programs.

Options

Several alternatives were considered to address the short supply of medical practitioners willing to provide deputising services. Option 1 was selected for implementation.

Option 1: promote deputising work, including after hours home visits, by means of an incentive scheme based on granting access to Medicare rebated services to medical practitioners who are otherwise ineligible to provide services that attract a Medicare benefit.

Option 1 would increase the pool of medical practitioners able to perform after hours home visits as part of their employment by a deputising service. It would involve approving deputising services to supervise medical practitioners in placements under section 3GA of the Health Insurance Act 19 73 (the Act), for the purpose of their performing deputising services. Such practitioners would be able to access the existing incentive available under section 3GA, a Medicare provider number, which would allow them to provide services that attract a Medicare benefit.

The regulation change required to achieve Option 1 would be minimal. It would involve a small addition to Schedule 5 of the Health Insurance Regulations to approve the Department of Health and Aged Care to administer a program named the Approved Medical Deputising Service Program. Details for the program could be contained in administrative guidelines and would be the subject of agreement between participating deputising services and the Department.

Impact of Option 1

Option 1 would be beneficial to medical deputising businesses, doctors and their patients, and should reduce the burden on hospital emergency services.

Increasing the number of medical practitioners who are able to attract a Medicare rebate for deputising work may assist the deputising services in recruiting staff. The Approved Medical Deputising Service program would expand the pool of Australian citizen and permanent resident medical practitioners able to perform deputising services that attract a Medicare rebate.

This would have an impact on the patient consumers of the services, in that the after hours services would be more readily available. Ultimately, the Approved Medical Deputising Service program would assist Australia's health care system to better meet patient needs and reduce inappropriate use of hospital emergency departments. The program would provide an employment alternative for medical practitioners who, because they are affected by section 19AA of the Act, are currently unable to provide Medicare rebated services. Such medical practitioners are able to access a Medicare provider number for a limited period if they undertake an approved placement in a course or program prescribed under section 30A of the Act. Places in the Approved Medical Deputising Service program would be approved placements for the purpose of section 3GA of the Act.

Option 1 would allow non-specialist citizen and permanent resident doctors to access a Medicare provider number in respect of professional services rendered in the course of specified duties for an approved deputising service. This would address the perception that temporary resident doctors are treated favourably at the expense of permanent resident and citizen medical practitioners.

The increased availability of permanent resident and citizen medical practitioners for positions in deputising services would lead to a reduction in the number of temporary resident doctors brought in to Australia to perform deputising services. It is preferable to utilise

Australian medical practitioners rather than to import temporary resident doctors on a short tern basis. This may result in a saving, comprised of lower recruitment, staff turnover and associated costs, for deputising services.

Temporary resident doctors are only permitted to access a Medicare provider number for a limited period, usually 12 months or less, and so there would be no impact on those temporary residents currently working in deputising agencies. Allowing medical practitioners currently covered by section 19AA of the Act to compete for these positions will reduce their perception of inequity.

Cost of Option 1

The proposed regulation would add to the cost of the administration of the health system if it resulted in more doctors being able to access Medicare benefits in respect of the services that they provide (approximately $120 000 per annum average per doctor). It is anticipated that the scheme will initially be cost neutral as citizen and permanent resident doctors will take up vacant positions that have previously been occupied by temporary resident doctors. Deputising services may make a saving as they will be able to reduce recruitment of temporary resident doctors from overseas. An offset may also occur as patients able to get timely treatment after hours will not need to present to a practice the following day. This cost neutral aspect of the scheme is reinforced by the fact that after hours services provided by deputising services (excluding emergency consultations) are only charged to Medicare as standard items. It should be noted that any greater than expected cost to Medicare would reflect a previously unmet medical practice and patient need for deputising services.

Administration of the program would be cost-neutral given that self-funded medical deputising services already exist. Their role as employment agencies means that mechanisms for appropriate supervision of doctors on the program are already in place. Administrative guidelines on the operation of the program would ensure that deputising services and the medical practitioners engaged to provide the services gain a clear understanding of the policy behind the program and an awareness of the need to confine professional services to those permitted under the program. Any professional services provided by a practitioner outside the scope of the program would not attract a Medicare benefit.

Option 2: take no action.

Impact of Option 2

Option would result in the maintenance of the status quo for the problem described above as market demands for deputising services are not being met. Industry mechanisms such as practice rosters may be appropriate in some circumstances, but are not available to or able to cope with the needs of all practices. Statistics indicate that up to 44 per cent of general practices rely from time to time upon a deputising service to ' meet some or all of their after hours care needs. Continued deputising service shortages could be expected to adversely affect such practices. The patients of these practices may also suffer serious adverse effects from the lack of availability of a medical practitioner, and may be forced to rely upon a hospital emergency service to provide both necessary and non-emergency care.

The use of temporary resident doctors to fill vacancies in deputising services does not provide a longterm solution to the problem. This short term solution is costly to deputising services due to the high rate of turnover of such doctors. The continued use of temporary resident doctors by deputising services is perceived as inequitable by citizen and permanent resident medical practitioners who are subject to the requirement for postgraduate training under section 19AA of the Health Insurance Act 1973 (the Act). Medical practitioners affected by section 19AA of the Act are unable to provide services that attract a Medicare benefit.

Cost of Option 2

Status quo, including the cost of unnecessary treatments administered by hospital emergency departments.

Option : economic incentives to all general practitioners have been investigated in the past, however, they are not feasible as a stand-alone measure. Such incentives do not target the particular issue of staff shortages experienced by deputising services and do not directly assist in increasing the availability of those services.

Cost of Option 3

Option 3 would be the most costly option because the payments would be generally available incentive payments not linked directly to the provision of deputising services.

Consultation

The proposed amendment would establish a voluntary framework for participation in the Approved Medical Deputising Service program and for that reason consultation is not necessary prior to the making of the amendment. The form of the proposed amendment has been influenced by previous consultations undertaken with deputising agencies about restrictions on medical practitioners' ability to provide services that attract Medicare benefits. Adopting Option 2 would address these concerns.

Deputising services would be consulted as to the content of any administrative guidelines for the program.

Review

In the event that consultation reveals that an approved deputising service no longer wishes to participate in the program, the voluntary nature of the scheme makes it possible for a service to cease participation, subject to any contractual arrangements in place.

Section 19AD of the Act provides that the Minister must report on the details of operation of section 3GA of the Act before 31 December 1999. This would facilitate a review of the operation of the program.

Section 19AA of the Act contains a sunset clause that contains an expiry date of January 1, 2002. At the time when section 19AA as a whole is reviewed, it would be appropriate to examine the operation of the program in the context of the wider scheme of provider number control.