THE REVIEW OF THE HEALTH LEGISLATION
(PRIVATE HEALTH INSURANCE REFORM) AMENDMENT ACT 1995
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RECOMMENDATIONS
Chapter 2
Recommendation 1:
| The Committee recommends that it continue to monitor
the operation of the Health Legislation (Private Health Insurance
Reform) Amendment Act 1995 and report to the Senate on
or before 1 July 1998. |
Chapter 3
Recommendation 2:
| The Committee recommends that the provisions relating
to the implementation of medical purchaser-provider agreements under
the Health Legislation (Private Health Insurance Reform) Amendment
Act 1995 proceed, subject to the recognition of the right of the
medical profession to treat patients according to their clinical needs,
the right of the profession to collectively negotiate contracts, subject
to authorisation by the ACCC, and the right to public scrutiny of
contracts as provided for in later recommendations. |
Recommendation 3:
| The Committee recommends that contracts entered into
between medical practitioners and health funds or hospitals at all
times clearly uphold the professional duty of practitioners to treat
patients according to their clinical needs. |
Recommendation 4:
| The Committee recommends that groups of doctors or organisations
representing the medical profession negotiate medical agreements with
health funds or private hospitals by seeking authorisation for joint
negotiations as provided for under the Trade Practices Act 1974.
|
Recommendation 5:
| The Committee recommends that the National Health
Act 1953 be amended to provide for the public scrutiny of purchaser-provider
agreements by consumers, except for those parts of contracts dealing
with the price arrangements entered into between the parties. |
Recommendation 6:
| The Committee recommends that the Purchaser-Provider
Panel be convened and that the sunset clause which limits the life
of the Panel to 30 June 1997 be deleted. |
Recommendation 7:
| The Committee recommends that the Purchaser-Provider
Panel be provided with access to purchaser-provider agreements as
part of its monitoring role relating to contractual arrangements entered
into between the relevant parties. |
Recommendation 8:
| The Committee recommends that in the interests of continuing
certainty in the contracting process, and recognising that contributors
should not be totally disadvantaged, if in an emergency they are treated
in a non-contracted hospital, an appropriate default benefit should
continue in place after 1 July 1997. |
Recommendation 9:
| The Committee recommends that private hospitals negotiate
hospital agreements with health funds by seeking authorisation for
joint negotiations as provided for under the Trade Practices Act
1974. |
Recommendation 10:
| The Committee recommends that the Commonwealth Government
take available options to conclude the Relative Value Study of the
MBS on an accelerated timetable. |
Chapter 4
Recommendation 11:
| The Committee recommends that the Aggregate Billing Advisory
Committee be convened as provided for in the Reform Act. |
Recommendation 12:
| The Committee recommends that the proposal contained
in the industry paper provided by the AMA/APHA, including the amendment
of the Health Insurance Act to enable patients to assign benefits
to third parties for private in-patient episodes of care and the relaxation
of restrictions on the payment of Medicare benefits, be the basis
of further investigation and debate by the Aggregate Billing Advisory
Committee. However, the consideration of reform by the Billing Committee
should not be restricted only to the ideas in the AMA/APHA proposal.
|
Recommendation 13:
| The Committee recommends that a re-assessment of the
functions, powers and funding arrangements of the Private Health Insurance
Complaints Commissioner be part of the ongoing monitoring of the operation
of the Health Legislation (Private Health Insurance Reform) Amendment
Act 1995 to be undertaken by the Committee in accordance with
recommendation 1. |
Recommendation 14:
| The Committee recommends that the Private Patients' Hospital
Charter be revised to include reference to the disclosure of patient
information pursuant to section 73G of the National Health Act
1953 and ensure that the Charter does not contain information
or advice which may be inconsistent with the provisions of section
73G. |
Recommendation 15:
| The Committee recommends that insurance funds, medical
providers, hospitals and consumer-oriented organisations accept greater
responsibility in the production of information for consumers, the
format of this information and in the availability and distribution
of this consumer information. |
Recommendation 16:
| The Committee recommends that documents such as the Private
Patients' Hospital Charter and the PHIAC booklet Insure? Not Sure?
be given a wider distribution and that it be a requirement to
give these documents prominence when displayed in `shopfronts'. |
Recommendation 17:
| The Committee recommends that these and other consumer
information brochures be made available in languages other than English
and that areas with large NESB communities be identified and targeted
with the distribution of consumer information in the relevant language.
|
Recommendation 18:
| The Committee recommends that PHIAC should, as part of
its statutory function of collecting and disseminating information,
publish comparative details (including cost) of major insurance products
on a regular basis. |
Recommendation 19:
| The Committee recommends that the Government investigate
the constitutional basis and feasibility of legislation to require
informed financial consent for medical and hospital services, irrespective
of whether or not a purchaser-provider agreement exists. |
Recommendation 20:
| The Committee recommends that funds be required to include
information relating to the Complaints Commissioner in their published
material and to draw their customers' attention to the role and functions
of the Complaints Commissioner. |
Recommendation 21:
| The Committee recommends that the Private Hospital Data
Bureau be funded to operate on an interim basis until the end of 1998,
and be operational from 1 January 1997. During this period consideration
should be given to the Bureau's role, functions and funding base.
The Bureau should aim to become self-funding, though with tight security
guidelines to ensure privacy breaches in the `selling' of data do
not occur. A combination of industry funding, particularly by the
private hospitals in an arrangement similar to that operating with
the funds and the Complaints Commissioner, should be considered. |
Recommendation 22:
| The Committee recommends that a review of data collection
at Federal and State levels be undertaken by the National Health Information
Management Group to ensure any duplication of effort and resources
is prevented. This review should consider the role of the Private
Hospital Data Bureau in the future collection and dissemination of
data. |
Recommendation 23:
| The Committee recommends that the disclosure of data
under section 73G of the National Health Act 1953 be the subject
of community and industry consultation and debate as to what are acceptable
secondary uses for personal health information and what are appropriate
safeguards to be applied in using such information at this wider level.
|
Recommendation 24:
| The Committee recommends that the relevant privacy guidelines
be revised to ensure that situations such as that which led to the
disclosure of private patient information do not recur and that the
use of data collected under the HCP is appropriately covered by such
guidelines. |
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