BILLS DIGEST NO. 98, 2014–15              8 May 2015

Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015 [and associated Health and Aged Care Bills]

Amanda Biggs and Alex Grove
Social Policy Section

Date introduced: 26 March 2015

House:  House of Representatives

Portfolio: Infrastructure

Commencement:  Schedule 1 from each Bill commences at the same time as Part 1 of Schedule 2 to the Norfolk Island Legislation Amendment Act 2015 commences, which is 1 July 2016.

Links: The links to the Bills, their Explanatory Memoranda and second reading speeches can be found on the Bills’ home pages for the Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015, the Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015, the Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015, the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015, and the Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015, or through the Australian Parliament website.

When Bills have been passed and have received Royal Assent, they become Acts, which can be found at the ComLaw website.

Nature of the Norfolk Island Bills package

The Bills which are the subject of this Bills Digest are part of a package of eight Bills (Norfolk Island Bills package) that propose reforms to the governance arrangements for Norfolk Island and propose to extend mainland social security, health (including Medicare), immigration and taxation arrangements to the Island.

Most of the substantive changes to governance, social security, health and immigration arrangements are made by the Norfolk Island Legislation Amendment Bill 2015.[1] However, individual Bills are required when a tax or levy is to be imposed.[2]

The Bills covered by this Bills Digest are:

•       the Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015[3]

•       the Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015[4]

•       the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015[5]

•       the Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015[6] and

•       the Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015.[7]

Together they make consequential amendments to extend tax and levy related measures to Norfolk Island.

Two related Bills will amend taxation arrangements, including by extending Medicare levy arrangements to Norfolk Island. These are:

•       the Tax and Superannuation Laws Amendment (Norfolk Island Reforms) Bill 2015[8] and

•       the A New Tax System (Medicare Levy Surcharge–Fringe Benefits) Amendment Bill 2015.[9]

Purpose of the Bills

Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015

The purpose of the Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015 (the Aged Care Levy Bill)[10] is to amend the Aged Care (Accommodation Payment Security) Levy Act 2006 to extend the provisions of that Act to the territory of Norfolk Island.[11]

Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015

The purpose of the Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015 (the Health Compensation Charges Bill)[12] is to amend the Health and Other Services (Compensation) Care Charges Act 1995 to extend the provisions of that Act to the territory of Norfolk Island.[13]

Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015

The purpose of the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015 (the Approved Pathology Centres Tax Bill)[14] is to amend the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000, to extend the provisions of that Act to the territory of Norfolk Island.[15]

Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015

The purpose of the Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015 (the Pathology Fees Bill)[16] is to amend the Health Insurance (Pathology) (Fees) Act 1991 to extend the provisions of that Act to the territory of Norfolk Island.[17]

Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015

The purpose of the Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015 (the Risk Equalisation Levy Bill)[18] is to amend the Private Health Insurance (Risk Equalisation Levy) Act 2003, to extend the provisions of that Act to the territory of Norfolk Island.[19]

Background

Health status of Norfolk Island residents

There is limited data on the health status of residents of Norfolk Island. A recent draft health plan provided a summary profile of some health indicators based on a number of sources. This included the following findings:

•       the age profile of the population is generally older on the Island compared to the mainland[20]

•       a majority of the adult population (75 per cent) reported more than one major risk factor for cardiovascular disease[21]

•       there was significant under-diagnosis of hypertension in the community[22]

•       there were a high number of undiagnosed and untreated cases of diabetes[23]

•       around 20 per cent of the population was considered obese[24]

•       income levels on the Island are generally lower than on the mainland[25] and

•       the most common reason cited for financial distress was high medical Bills.[26]

A more recent survey based on a sample of 335 respondents included the following additional findings:

•       a majority of the population (83 per cent) described their health as either good, very good or excellent[27]

•       63 per cent of the population reported being either overweight or obese[28]

•       in terms of physical activity, both men and women reported engaging in low, medium and high levels of physical activity that exceeded the Australian benchmarks for these categories[29]

•       a majority (64 per cent) reported low levels of psychological distress, 23 per cent reported moderate levels of distress and 13 per cent high or very high, broadly in line with Australian benchmarks[30]

•       around 32 per cent reported alcohol consumption at moderate to high risk levels, but a majority (47 per cent) reported consumption at low risk levels[31] and

•       a majority (around 62 per cent) reported not smoking in the previous three months, while around ten per cent reported smoking on a daily basis.[32]

In addition, another recent report found that some 59 per cent of respondents reported cost was a barrier to them accessing health care.[33]

Healthcare on Norfolk Island

All health services on Norfolk Island are currently provided through the Norfolk Island Hospital Enterprise (NIHE). Medicare arrangements do not currently operate.

Established under the Norfolk Island Hospital Act 1985 (Norfolk Island) the NIHE currently has about 24 beds (including aged care beds) and is the only provider of health services for the whole of Norfolk Island.[34] Services include typical hospital services such as surgery and obstetrics, dispensary (pharmacy), laboratory and pathology services, x-rays, physiotherapy, dental services, primary care services and aged care. The hospital is currently undergoing a process to become accredited to Australian health standards.[35]

Unlike public hospitals in Australia, the NIHE is permitted to charge for its services, but the fees must be based on the ‘true economic cost of the services’ and requiring patients to pay for services up-front is prohibited.[36] In addition to this revenue, the NIHE also receives significant subsidies from the Administration of Norfolk Island with additional revenue provided by the Australian Government. In 2012–13, the Administration provided $1.83 million to the NIHE while the Australian Government provided $100,000. Revenue from fees totalled $1.33 million.[37]

Because the NIHE is required to provide health services regardless of whether a resident owes it money, it often carries a number of debts. It is estimated that some 43 per cent of hospital debts remain outstanding for 90 days or longer.[38] The latest financial statements show that the hospital operated with a deficit of $278,160 in the last financial year.[39]

Under the Healthcare Levy Act 1990 (Norfolk Island), most adult residents of Norfolk Island are required to pay an annual levy to the Island’s Healthcare Fund to help meet the cost of their health care.[40] The Healthcare Fund was established under the Healthcare Act 1989 (Norfolk Island) and is intended to help residents meet catastrophic medical costs and the cost of a medical evacuation if required.[41] However, only when their annual out of pocket health expenditure exceeds an annual threshold, are additional health costs met by the Healthcare Fund. Patients must incur charges of $2,000 before they become eligible to receive benefits from the Healthcare Fund.[42] As noted recently in a speech by the Assistant Minister for Infrastructure and Regional Development, Jamie Briggs, a family of four would need to spend almost $4,000 annually before the Island’s health insurance fund would start to assist them.[43]

Norfolk Island recently signed an agreement with South Eastern Sydney Local Health District (SESLHD) to provide patients with enhanced pathways to treatment, such as allowing Norfolk Island patients to access specialist health services remotely using Telehealth facilities.[44]

Medicare

Since 1989, residents of Norfolk Island have been ineligible for Medicare and the Pharmaceutical Benefits Scheme (PBS). When Medicare commenced in 1984, the definition of an Australian resident did not extend to residents of Norfolk Island.[45] However visitors who were eligible to stay in Australia for more than six months were granted eligibility for Medicare, meaning residents of Norfolk Island who visited the mainland still had access to Medicare whilst here (although not to hospital services).[46]

In 1988, extending free access to mainland hospital services for visiting Norfolk Islanders and giving Australian visitors to Norfolk Island free hospital treatment was under active consideration. However, Commonwealth health authorities advised against it and the proposal did not proceed.[47] Amendments to the Health Insurance Act 1973 later that year further restricted access to Medicare to persons with a legal entitlement to live in Australia, while also excluding Australian citizens who lived overseas and removing Medicare benefits for any services provided overseas, effectively excluding Medicare eligibility for Norfolk Islanders.[48]

Proposed provisions in the Norfolk Island Legislation Amendment Bill 2015 extend Medicare benefit arrangements to Norfolk Island by including the Island in the definition of Australia.[49]

Private Health Insurance

The Norfolk Island Legislation Amendment Bill 2015 includes a number of provisions that propose to extend Australia's private health insurance arrangements to Norfolk Island.[50] Transitional arrangements are proposed for the calculation of a person’s liability for the Lifetime Health Cover loading, to allow a one year extension to the date a person’s lifetime health cover base day is determined.[51]

Aged Care

Currently, the Aged Care Act 1997 and related acts do not apply to Norfolk Island.[52]

Aged care services on Norfolk Island are provided by the NIHE. The 24 bed hospital includes 12 aged care beds, and the NIHE also provides home and community aged care services.[53] In practice, aged care services take the form of an aged care unit in the Norfolk Island hospital, hostel type accommodation in the hospital grounds, and a district nurse who visits aged people in their homes three times a week.[54]

Eligible residents in the aged care unit of the hospital qualify for a long-term care benefit, and are required to pay the fees for their care up to 80 per cent of their income.[55] The NIHE also receives an annual subsidy from the Administration of Norfolk Island to meet the costs of providing health care on the island. In 2013–14 the NIHE received $448,312 in aged care income, and a further $1.9 million subsidy from the Administration.[56]

Aged care service provision on the island is below the standard of mainland Australia. A 2001 report by the Joint Standing Committee on the National Capital and External Territories (Joint Standing Committee) noted that a lack of home support services and alternatives to nursing home care meant frail elderly residents had to choose between leaving the island to seek care or becoming long-term hospital patients.[57] The Joint Standing Committee heard that the aged care accommodation provided in former public wards of the hospital was in poor physical condition, lacked privacy and security, as was not able to accommodate married couples together.[58] The Joint Standing Committee recommended that the Aged Care Act be extended to cover Norfolk Island.[59]

In 2013, consultants engaged to draft a health services plan for the Island noted a striking lack of progress since the 2001 Joint Standing Committee report, with the situation still characterised by ‘an absence of appropriate aged care service options’,[60] and a ‘skewing of health services to acute care [that] is inconsistent with the needs of a population that is ageing’.[61]

In keeping with the 2001 recommendation of the Joint Standing Committee, the Australian Government is now seeking to extend the legislative provisions for subsidised aged care to Norfolk Island.

Accordingly, the Norfolk Island Legislation Amendment Bill 2015 amends the Aged Care Act, Aged Care (Transitional Provisions) Act 1997,[62] Australian Aged Care Quality Agency Act 2013[63] and the Aged Care (Accommodation Payment Security) Act to extend aged care arrangements to the island.[64]

Committee consideration

Selection of Bills Committee

At its meeting of 26 March 2015, the Selection of Bills Committee resolved to recommend that the Bills comprising the Norfolk Island Bills package not be referred to Committee for inquiry and report.[65]

Senate Standing Committee for the Scrutiny of Bills

At the time of writing this Bills Digest, the Senate Standing Committee for the Scrutiny of Bills had not published any comments in relation to the Bills in the Norfolk Island Bills package.

Parliamentary Joint Committee on Human Rights

At the time of writing this Bills Digest, the Parliamentary Joint Committee on Human Rights had not published any comments in relation to the Bills in the Norfolk Island Bills package.

Statement of Compatibility with Human Rights

As required under Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011 (Cth), the Government has assessed these Bills’ compatibility with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of that Act. The Government considers that these Bills are compatible.[66]

Policy position of non-government parties/independents

No statements by non-government parties in relation to the amendments contained in the Bills discussed in this Bills Digest have been identified. The Bills Digest for the Norfolk Island Legislation Amendment Bill 2015 contains information about the responses by government parties/independents to the proposed reforms contained in the Norfolk Island Bills package.[67]

Position of major interest groups

No stakeholder comments in relation to the amendments contained in the Bills discussed in this Bills Digest have been identified. The Bills Digest for the Norfolk Island Legislation Amendment Bill 2015 contains an overview of the positions of major interest groups to the broader reforms contained in the Norfolk Island Bills package.[68]

Financial implications

The total Norfolk Island reform package is estimated to cost the Commonwealth $136.2 million over the forward estimates, according to the Explanatory Memorandum.[69] However, potential revenue from the collection of levies and taxes is not separately identified.

Key provisions

Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015

The Aged Care (Accommodation Payment Security) Act 2006 guarantees the refund of accommodation payment (bond) balances to aged care residents if their approved provider becomes insolvent.[70] If the provider does not refund all of the balance, the Commonwealth pays the outstanding amount to the resident.[71] The Commonwealth can then recoup its costs by imposing a levy on other approved providers by regulation under the Aged Care (Accommodation Payment Security) Levy Act 2006.[72]

As previously noted, the Aged Care (Accommodation Payment Security) Act is amended by the Norfolk Island Legislation Amendment Bill 2015.[73]

Schedule 1 of the Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015 amends subsection 3(2) of the Aged Care (Accommodation Payment Security) Levy Act to insert the words ‘Norfolk Island’. This extends the application of that Act to Norfolk Island.

Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015

The Health and Other Services (Compensation) Act 1995 provides that the Commonwealth does not pay a Medicare benefit, nursing home benefit, or residential care subsidy for a person who is in receipt of injury compensation payments.[74] However, the Commonwealth may recover such benefits or subsidies where they have already been paid—but only to the extent that the recovery charge does not constitute a tax.[75] In order to ensure that the benefits can be recovered, the Health and Other Services (Compensation) Care Charges Act provides for the recovery of benefits where they may be determined to be a tax.[76]

The Health and Other Services (Compensation) Act is amended by the Norfolk Island Legislation Amendment Bill 2015.[77]

Schedule 1 of the Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015 inserts proposed section 3A into the Health and Other Services (Compensation) Care Charges Act so that it extends to Norfolk Island.

According to the Assistant Minister for Infrastructure and Regional Development, Jamie Briggs, this ‘ensures that Medicare benefits, nursing home benefits or residential care subsidies are recoverable from persons on Norfolk Island who receive compensation or damages through a judgement or settlement.’[78]

Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015

Pathology broadly covers blood and tissue testing which is used to determine the cause and progression of disease.

As stated above, all health services on Norfolk Island including pathology are currently provided through the NIHE. There are no independent pathology providers outside of the hospital. In 2012, the NIHE performed 8,592 pathology tests, a slight increase on the previous year.[79]

In order to provide approved Medicare rebatable services in future, a pathology provider needs to comply with the requirements for the provision of pathology services as prescribed in the Health Insurance Act 1973 (HIA).[80] The HIA places certain conditions on those seeking to obtain approval as providers of pathology services and to operate as specimen collection centres, including the payment of certain fees and taxes.

The Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000 requires that a tax must be paid before the Minister can grant an approval to an approved pathology authority to become an eligible collection centre.[81] For an approval that is granted for one year, the tax is set at $1,000. For an approval of less than one year, the tax is calculated according to a pro-rata formula specified in the Act.[82] Grants of approval for collection centres located on the same premises as a category GX or GY accredited pathology laboratory are exempt from paying the tax. GX and GY laboratories are normally located in recognised public hospitals.[83]

Item 1 of Schedule 1 of the Bill inserts the words ‘Norfolk Island’ as proposed paragraph 4(aa) of the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act, in order to extend the operation of that Act to Norfolk Island.

Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015

The HIA specifies the approval requirements for applicants seeking to become an approved pathology provider or authority.

The HIA requires an applicant to give a signed undertaking to the Minister in relation to fulfilling certain administrative and quality-related obligations. The Minister can either accept or reject their undertaking.[84] The Health Insurance (Pathology) (Fees) Act specifies the payment of a fee from the approved pathology provider to the Commonwealth when acceptance of their undertaking is given. The fee is $500 for the acceptance of an undertaking from an approved pathology practitioner and $1,500 from an approved pathology authority.[85]

When a premises is approved as an accredited pathology laboratory the Health Insurance (Pathology) (Fees) Act specifies certain fees are payable, depending on the accreditation level of the laboratory. There are four accreditation levels with a scale of fees. The highest accreditation requires payment of a $2,500 fee; the second highest requires payment of $2,000; the third highest requires payment of $1,500 and the lowest level accreditation requires payment of $750.[86]

Item 1 of Schedule 1 of the Bill inserts the words ‘Norfolk Island’ as proposed paragraph 4(aa) of the Health Insurance (Pathology) (Fees) Act, in order to extend the operation of that Act to Norfolk Island.

Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015

Private health insurers in Australia operate under a regulatory regime specified in the Private Health Insurance Act 2007, and related legislation and regulations.[87] Under this regime, private health insurers are liable for a number of levies.

One of these, the Risk Equalisation Levy is an amount each insurer must pay into the Risk Equalisation Trust Fund (RETF). The RETF is a pool of funds which allows for the sharing of risk across insurers—effectively a form of reinsurance. It is a fundamental component underpinning Australia's community rating system which prohibits insurers from charging different premiums on the basis of health, age (other than at entry), gender or claims history.[88]

Item 1 of Schedule 1 of the Bill inserts the words ‘Norfolk Island’ after ‘extends to’ in section 4 of the Private Health Insurance (Risk Equalisation Levy) Act, in order to extend the operation of that Act to Norfolk Island.

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[1].              Parliament of Australia, ‘Norfolk Island Legislation Amendment Bill 2015 homepage’, Australian Parliament website, accessed 7 May 2015

[2].              General drafting practice is that Bills imposing a tax or levy are stand-alone Bills. This is because section 55 of the Commonwealth of Australia Constitution Act (Constitution) stipulates that ‘Laws imposing taxation shall deal only with the imposition of taxation, and any provision therein dealing with any other matter shall be of no effect’. Constitution, accessed 5 May 2015.

[3].              Parliament of Australia, ‘Aged Care (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[4].              Parliament of Australia, ‘Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[5].              Parliament of Australia, ‘Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[6].              Parliament of Australia, ‘Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[7].              Parliament of Australia, ‘Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[8].              Parliament of Australia, ‘Tax and Superannuation Laws Amendment (Norfolk Island Reforms) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[9].              Parliament of Australia, ‘A New Tax System (Medicare Levy Surcharge–Fringe Benefits) Amendment Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[10].              Parliament of Australia, ‘Aged Care Health (Accommodation Payment Security) Levy Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[11].              Aged Care (Accommodation Payment Security) Levy Act 2006, accessed 5 May 2015.

[12].              Parliament of Australia, ‘Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 5 May 2015.

[13].              Health and Other Services (Compensation) Care Charges Act 1995, accessed 5 May 2015.

[14].              Parliament of Australia, ‘Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 6 May 2015.

[15].              Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000, accessed 5 May 2015.

[16].              Australian Parliament, ‘Health Insurance (Pathology) (Fees) Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 6 May 2015.

[17].              Health Insurance (Pathology) (Fees) Act 1991, accessed 5 May 2015.

[18].              Parliament of Australia, ‘Private Health Insurance (Risk Equalisation Levy) Amendment (Norfolk Island) Bill 2015 homepage’, Australian Parliament website, accessed 6 May 2015.

[19].              Private Health Insurance (Risk Equalisation Levy) Act 2003, accessed 5 May 2015.

[20].              Nexus Management Consulting (NMC), Norfolk Island - Draft Health Services Plan, NMC, October 2013, p. 8, accessed 14 April 2015.

[21].              Ibid., p. 9.

[22].              Ibid., p. 10.

[23].              Ibid.

[24].              Ibid.

[25].              Ibid., pp. 11–12.

[26].              Ibid., p. 11.

[27].              R & S Muller Enterprise, Health services survey report, Norfolk Island Hospital Enterprise, 3 February 2015, p. 9, accessed 9 April 2015.

[28].              Ibid., p. 11.

[29].              Ibid., p. 16.

[30].              Ibid., p. 26.

[31].              Ibid., p.39.

[32].              Ibid., p 35. Out of 335 respondents, 207 reported not smoking over the period and 33 reported smoking daily.

[33].              R & S Muller Enterprise, Response to the Draft Health Services Plan, Norfolk Island Hospital Enterprise, 3 February 2015, p. 32, accessed 9 April 2015.

[34].              Norfolk Island Hospital Act 1985 (Norfolk Island), accessed 5 May 2015.

[35].              R Adams (Minister for Cultural Heritage and Community Services), Norfolk Island Hospital Enterprise update on accreditation process, media release, 21 March 2014, accessed 9 April 2015.

[36].              Norfolk Island Hospital Act 1985 (Norfolk Island), paragraph 8(1)(a) and subsection 25(2). Fees for most services were recently raised by 3.5%. See R Adams (Minister for Cultural Heritage and Community Services), Increase in Norfolk Island health service charges, media release, 15 January 2014, accessed 9 April 2015.

[37].              Department of Infrastructure and Regional Development, ‘Financial statements—Administration 2012–13: Norfolk Island Hospital Enterprise’, Note 4G, p. 63 accessed 6 May 2015.

[38].              Nexus Management Consulting (NMC), op. cit., p. 11.

[39].              Ibid., p. 49.

[40].              Section 7 of the Healthcare Levy Act 1990 (Norfolk Island) accessed 8 April 2015. Exemptions apply for certain low income persons and veterans. The levy is payable quarterly. The healthcare levy was recently raised to $220 a quarter and the evacuation levy to $80. R Adams (Minister for Cultural Heritage and Community Services), Increase in healthcare and medical evacuation levy proposed amendments to healthcare legislation, media release, 21 February 2014, accessed 9 April 2015.

[41].              Section 7 of the Healthcare Act 1989 (Norfolk Island), accessed 13 April 2015.

[42].              Originally the threshold of expenditure was set at $2,500. See section 19(1A) of the Healthcare Act 1989 (Norfolk Island). However, in June 2012 the threshold was dropped to $2,000. Exemptions apply to low income earners. T Sheridan (Minister for Community Services), Healthcare levy and healthcare fund relief, media release, 11 May 2012, accessed 9 April 2015.

[43].              J Briggs (Assistant Minister for Infrastructure and Regional Development), Statement on Norfolk Island, speech, 27 March 2014, accessed 13 April 2015.

[44].              T Sheridan (Minister for Community Services), Signing of MOU between South East Sydney Local Health Services and Norfolk Island Hospital Enterprise , media release, 22 February 2013, and Patients to have immediate access to health services in New South Wales following the finalisation of discussions between the Norfolk Island Hospital Enterprise and South East Sydney Local Health District, media release, 18 February 2012, both accessed 9 April 2015.

[45].              Eligibility for Medicare is a requirement for eligibility for the PBS.

[46].              This historical overview is drawn from Joint Standing Committee on the National Capital and External Territories, In the pink or in the red? Inquiry into the provision of health services on Norfolk Island, Canberra, July 2001, pp. 133–134, accessed 9 April 2015.

[47].              In March 1988, ‘Commonwealth health authorities advised that an agreement for reciprocal health care could only be contemplated where there were negligible costs to the Budget, comparability of health care systems and equality of access’. Ibid., p. 134.

[48].              Ibid., p. 134. The relevant legislation is the Community Services and Health Legislation Amendment Act (No. 2) 1988, accessed 6 May 2015.

[49].              Items 214–220 of Schedule 2 of the Norfolk Island Legislation Amendment Bill 2015, accessed 7 May 2015.

[50].              Items 306–310 of Schedule 2 of the Norfolk Island Legislation Amendment Bill 2015 extend the provisions of the Private Health Insurance Act 2007 to Norfolk Island.

[51].              Lifetime Health Cover is a 2% loading on the cost of private health insurance premiums, which is incurred when a person delays taking out private health insurance after they turn 31.

[52].              Aged Care Act 1997 subsection 4-1(2), accessed 5 May 2015.

[53].              Norfolk Island Government, Community budget update 2014–15, 19 December 2014, p. 8, accessed 8 April 2015.

[54].              Norfolk Island Living Library, ‘The Norfolk Island Hospital’, Norfolk Island Living Library website, accessed 8 April 2015.

[55].              Section 28A of the Social Services Act 1980 (Norfolk Island), accessed 5 May 2015.

[56].              Norfolk Island Government, Community budget update 2014–15, op. cit.

[57].              Joint Standing Committee on the National Capital and External Territories, In the pink or in the red? Inquiry into the provision of health services on Norfolk Island, op. cit., pp. 83–86.

[58].              Ibid.

[59].              Ibid., p. 95.

[60].              Nexus Management Consulting (NMC), Norfolk Island - Draft Health Services Plan, op. cit., p. 22, accessed 14 April 2015.

[61].              Ibid., p. 23.

[62].              Aged Care (Transitional Provisions) Act 1997, accessed 5 May 2015.

[63].              Australian Aged Care Quality Agency Act 2013, accessed 6 May 2015.

[64].              Items 35–43 and 63–64 of Schedule 2 of the Norfolk Island Legislation Amendment Bill 2015. Norfolk Island will be considered a region of New South Wales for the purposes of allocation of places, extra service places and residential care subsidies.

[65].              Selection of Bills Committee, Report No. 4 of 2015, Senate, Canberra, 26 March 2015, accessed 6 May 2015.

[66].              The Statement of Compatibility with Human Rights can be found on page 9 of the Explanatory Memorandum to the Norfolk Island Legislation Amendment Bill 2015 et al.

[67].              The Bills Digest is available at the Bill homepage – see Parliament of Australia, ‘Norfolk Island Legislation Amendment Bill 2015 homepage’, Australian Parliament website, accessed 7 May 2015.

[68]              Ibid.

[69].              Explanatory Memorandum, Norfolk Island Legislation Amendment Bill 2015 et al., p. 8, accessed 7 May 2015.

[70].              Aged Care (Accommodation Payment Security) Act 2006, accessed 6 May 2015.

[71].              Aged Care (Accommodation Payment Security) Act, section 16.

[72].              Aged Care (Accommodation Payment Security) Levy Act 2006, accessed 7 May 2015.

[73].              Items 35-36 of Schedule 2 of the Norfolk Island Legislation Amendment Bill 2015.

[74].              Health and Other Services (Compensation) Act 1995, accessed 6 May 2015.

[75].              Health and Other Services (Compensation) Act, sections 7–10.

[76].              Health and Other Services (Compensation) Care Charges Act 1995, accessed 5 May 2015.

[77].              Items 211-212 of Schedule 2 of the Norfolk Island Legislation Amendment Bill 2015.

[78].              J Briggs (Assistant Minister for Infrastructure and Regional Development), ‘Second reading speech: Health and Other Services (Compensation) Care Charges Amendment (Norfolk Island) Bill 2015’, House of Representatives, Debates, 26 March 2015, p. 3562, accessed 9 April 2015.

[79].              Nexus Management Consulting (NMC), Norfolk Island - Draft Health Services Plan, op. cit., p. 18.

[80].              Provisions around pathology are specified in Part IIA of the Health Insurance Act 1973, accessed 7 May 2015.

[81].              Section 5(1) of the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000, accessed 13 April 2015.

[82].              Section 5(3) of the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000, accessed 13 April 2015.

[83].              Section 3 of the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000, accessed 13 April 2015.

[84].              Section 23DC of the Health Insurance Act 1973, accessed 7 May 2015.

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