Commonwealth Numbered Regulations - Explanatory Statements

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NATIONAL HEALTH REGULATIONS (AMENDMENT) 1997 NO. 353

EXPLANATORY STATEMENT

STATUTORY RULES 1997 No. 353

Issued by authority of the Minister for Health and Family Services

National Health Regulations (Amendment)

Section 140 of the National Health Act 1973 (the Act) provides that the Governor-General may mike Regulations for the purposes of' the Act.

Subsection 140(2) of the Act makes provision to preclude or modify, by National Health Regulation, certain benefit arrangements to permit pilot or demonstration schemes, which could lead to an enhancement of the health insurance industry.

Paragraph (ea) of Schedule 1 of the Act (Conditions of registration of health funds) specifies that where there is no Medical Purchaser Provider Agreement (MPPA) between a fund and a doctor, more than 25per cent of the Medicare Benefits Schedule (MBS) fee cannot be payable by the health fund. As a result, where doctors charge above the MBS fee, patients incur out-of-pocket expenses.

The purpose of the regulations is to allow an arrangement where the doctors are not covered by a MPPA, but can receive payment in addition to 25 per cent of the NBS foe from the health fund. A project has commenced under which in-hospital services will be provided without medical out-of-pocket costs for patients. This can be achieved by the two participating health funds paying amounts in excess of 25 per cent of the MBS fee Under certain' circumstances. These circumstances include where the hospital or doctor (or body representing doctors) has in place, arrangements for simplifying the payment of doctors' bills And Worming the patient that the cost of their treatment will be a prior to that treatment.

The effect of the regulations will be streamlining of the billing system for patients participating in the project. The project will meet two of the major concerns facing patients with private health insurance, being out-of-pocket medical costs and multiple bills.

The project commenced on the date the regulations came into effect and will run until such time as amendments to paragraph (ea) (such as those contained in the Health Legislation Amendment Bill (No.2) 1997) come into effect, or for twelve months, whichever comes first. It will be subject to ongoing monitoring and evaluation. The implementation of this project will provide the opportunity to evaluate alternative payment arrangements for inhospital services that appear to have considerable advantages over traditional health insurance arrangements, with a view to encompassing them into mainstream arrangements.

The regulations commenced upon Gazettal.