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Australian Parliamentary Joint Committee on Human Rights |
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Purpose
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The Health Insurance (General Medical Services Table) Regulations 2021
implements annual Medicare indexation and recommendations from the MBS Review
Taskforce relating to general surgery and orthopaedic
services (the first
instrument)
The Health Insurance Legislation Amendment (2021 Measures No. 1)
Regulations 2021 amends cardiac services and indexes diagnostic imaging
services
and two items for the management of bulk-billing pathology services (the second
instrument)
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Portfolio
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Health and Aged Care
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Authorising legislation
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Last day to disallow
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15 sitting days after tabling (tabled in the House of Representatives on 3
June 2021 and the Senate 15 June 2021).
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Rights
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Health; social security
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2.73 The committee requested a response from the minister in relation to these legislative instruments in Report 8 of 2021.[2]
2.74 These two legislative instruments make changes to the Medicare Benefits Schedule (MBS), which is the list of health professional services that the Australian Government subsidises. Both apply an indexation rate of 0.9 per cent to relevant listed items. The first instrument makes a total of 752 amendments to the MBS in relation to general surgery and orthopaedic services by adding 202 items, amending 334 items, and deleting 216 items. The second instrument makes several amendments, including consolidating and removing some procedures related to cardiac services on the MBS.
2.75 By providing for a number of surgeries to be available to individuals at a subsidised rate (and applying an indexation of 0.9 per cent to those items), this measure appears to promote the rights to health and social security. The right to health refers to the right to enjoy the highest attainable standard of physical and mental health.[3] In particular, in relation to accessibility, the United Nations Economic, Social and Cultural Rights Committee has noted that 'health facilities, goods and services must be affordable for all...including socially disadvantaged groups'.[4] The right to social security recognises the importance of adequate social benefits in reducing the effects of poverty and plays an important role in realising many other economic, social and cultural rights, in particular the right to an adequate standard of living and the right to health.[5]
2.76 However, as these instruments make a significant number of detailed amendments to the MBS, questions arise as to whether they may have the effect of reducing access to existing subsidised healthcare services and/or reducing the rebate ultimately available to patients receiving relevant treatment. The first instrument makes a total of 752 amendments, including deleting 216 items and amending 334 items. The second instrument introduces new items and removes cardiac surgical procedures that are stated to no longer represent best practice.[6] The statements of compatibility for both instruments are brief and provide no detailed analysis of the effect of the instruments. They state only that the instruments maintain existing arrangements and the protection of human rights by ensuring access to publicly subsidised medical services which are clinically appropriate and reflective of modern clinical practice.[7]
2.77 The explanatory materials state that these amendments have been made in response to the findings of the MBS Review Taskforce relating to restructuring the MBS, incentivising best clinical practice and combining like procedures.[8] However, it is not clear whether this process of consolidation and amendment may have the effect that some procedures are ultimately more expensive for patients (for example, if a surgical procedure would previously have been covered by multiple MBS items, which will now be consolidated and provide the patient with a lower rebate than they currently receive), or if some procedures will no longer be subsidised at all, and no equivalent procedure is now subsidised. As such, it is not clear whether elements of this instrument may constitute a retrogressive measure with respect to the rights to health and social security, and if so, require justification.
2.78 Australia has obligations to progressively realise economic, social and cultural rights using the maximum of resources available,[9] and has a corresponding duty to refrain from taking retrogressive measures, or backwards steps with respect to their realisation.[10] Retrogressive measures, a type of limitation, may be permissible under international human rights law providing that they address a legitimate objective, are rationally connected to that objective and are a proportionate way to achieve that objective.
2.79 With respect to a legitimate objective, article 4 of the International Covenant on Economic, Social and Cultural Rights establishes that States Parties may limit economic, social and cultural rights only insofar as this may be compatible with the nature of those rights,[11] and 'solely for the purpose of promoting the general welfare in a democratic society'.[12] This means that the only legitimate objective in the context of the International Covenant on Economic, Social and Cultural Rights is a limitation for the 'promotion of general welfare'. The term 'general welfare' refers primarily to the economic and social well-being of the people and the community as a whole, meaning that a limitation on a right which disproportionality impacts a vulnerable group may not meet the definition of promoting 'general welfare'.[13] The United Nations Committee on Economic, Social and Cultural Rights has indicated that if any deliberately retrogressive measures are taken, the state has the burden of proving that they have been introduced after the most careful consideration of all alternatives and that they are fully justified by reference to the totality of the rights provided for in the Covenant and in the context of the full use of the State's maximum available resources.[14]
2.80 The statements of compatibility provide a brief descriptive outline of the requirements associated with a retrogressive measure, but do not analyse whether and in what manner those requirements are engaged by either instrument, nor an analysis of whether, if any of the measures are retrogressive, they are justified under international human rights law.
2.81 As such, in order to assess the compatibility of this measure with the rights to health and social security further information is required, and in particular:
(a) whether these instruments reduce the quantum of benefits available for any specific MBS items, that could adversely affect the rebate payable to patients;
(b) where these instruments remove MBS items entirely, whether any of those items are not covered by, or replaced with, alternative MBS items;
(c) whether these instruments have the effect of reducing the quantum of benefit for specific medical procedures, including those procedures which are currently covered by multiple MBS items and will now be covered by one item;
(d) what is the objective sought to be achieved by the instruments, and whether this constitutes a legitimate objective (being one which is solely for the purpose of promoting general welfare);
(e) whether and how the measures are rationally connected to (that is, effective to achieve) that objective; and
(f) whether and how the measures constitute a proportionate means by which to achieve the objective (having regard to whether the measures are accompanied by sufficient safeguards; whether any less rights restrictive alternatives could achieve the same objective; and the possibility of oversight and the availability of review).
2.82 The committee noted that having regard to the significant number of detailed changes to the MBS, and the complex nature of the surgeries and services involved, it is not clear whether these instruments may have the effect of either reducing access to subsidised surgical services, or reducing the rebate provided to patients receiving some services. If this were the case, this may constitute a retrogressive measure, a type of limitation under international human rights law. The committee considered further information was required to assess the human rights implications of the instruments, and as such sought the minister's advice as to the matters set out at paragraph [[15]].15
2.83 The full initial analysis is set out in Report 8 of 2021.
2.84 The minister advised:
Information on cardiac changes made in the Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021
(a) Whether this instrument reduces the quantum of benefits available for any specific MBS items, that could adversely affect the rebate payable to patients
A total of four cardiac items (38285, 38286, 38274 and 38358), which are for the primary procedural services, have had a schedule fee reduction, and therefore a reduced rebate payable to patients. These reductions on fees have been based on expert advice from the profession and clinical experts. A summary of the fee changes is as follows:
• The fee for item 38285 was reduced from $198.95 to $160.55.
• The fee for item 38286 was reduced from $179.20 to $144.60
• The fee for item 38274 was reduced from $940.80 to $777.60
• The fee for item 38358 was reduced from $2,957.65 to $2,089.00
The schedule fee has been reduced, based on clinical advice, for two procedural services for the insertion and removal of implanted loop recorders:
- the fee for item 38285 has been reduced from $198.95 to $160.55 (a reduction of 20 per cent)
- the fee for item 38286 has been reduced from $179.20 to $144.60 (a reduction of 20 per cent).
These changes reflect a reduction in the complexity for the insertion and removal of implanted loop recorders due to improvements in technology of the device. These procedures can also now be provided to patients in the outpatient setting, potentially reducing exposure to out-of-pocket cost related to a hospital admission.
Item 38274, which is for the transcatheter closure of ventricular septal defect, has been amended to remove the imaging component of the procedure (which is provided under item 55130). Although the schedule fee for item 38274 has been reduced from $940.80 to $777.60, if the provider is required to provide the imaging component, they are able to claim the imaging service under item 55130 (which has an indexed fee $174.10), as well as the fee for item 38274. Under this change, patients will still receive the same total rebate (plus the increase for indexation) prior to the 1 July 2021 changes.
Item 38358, which is for the extraction of chronically implanted leads, has been amended to clarify the service is to be performed by an appropriately trained provider. The fee has been amended, as this service is also provided with item 90300, which is for a standby cardiothoracic surgeon to ensure patient safety for this complex procedure. Under this change, patients will still receive the same total rebate (plus the increase for indexation) prior to the 1 July 2021 changes.
(b) Where this instrument removes MBS items entirely, whether any of those items are not covered by, or replaced with, alternative MBS items
As part of phase 2 of cardiac changes which were recommended by the MBS Review Taskforce, a total of 59 cardiac items were removed.
A significant finding from the review of cardiac services items was the need to modernise the cardiac services section of the MBS to reflect contemporary clinical practice, clarify appropriate use of the items, differentiate clinical indications and ensure patients receive procedures in line with current best practice.
The MBS Review Taskforce made 65 recommendations to improve the appropriate use and criteria under which cardiac services are delivered. The items marked for deletion are intended to provide for the following scenarios, either independently or in combination in the revised schedule:
• Combine similar surgical procedures
• lncentivise advanced techniques
• Remove procedures that no longer represent best practice or are unsafe
• Reduce low value interventions
Therefore, deleted items are captured either in new items or amended items, or are being removed because they no longer reflect current evidence-based practice.
(c) Whether this instrument has the effect of reducing the quantum of benefit for specific medical procedures, including those procedures which are currently covered by multiple MBS items and will now be covered by one item
Apart from the four items which have had an amended fee (items 38285, 38286, 38274 and 38358), the changes to cardiac services, which include the bundling of multiple items into a single item, provide rebates that have been calculated in either a cost neutral way (with the net rebate remaining the same), or an increase to the schedule fee to reflect complexity (and therefore an increase to the patient rebate).
(d) What is the objective sought to be achieved by the instrument and whether this constitutes a legitimate objective (being one which is solely for the purpose of promoting general welfare)
The following changes to cardiac services aim to promote patient welfare:
• Combining similar surgical procedures: this improve the consistency of billing between providers and therefore the consistency of rebates for patients.
• lncentivising advanced techniques: higher fees (and therefore rebates) will be provided to encourage providers to employ advanced surgical techniques that improve patient outcomes and reduce complications.
• Removing procedures that no longer represent best practice or are unsafe: Patients will more likely receive improved interventions and no longer be exposed to outdated techniques that are no longer supported by evidence.
• Reduction in low value interventions: Patients are much less likely to undergo procedures that are not required or may be better provided for by another service.
Furthermore, in many instances, service providers will be able to receive rebates for procedures that will now be aligned with Australian and international best practice clinical guidelines.
(e) Whether and how the measures are rationally connected to (that is, effective to achieve) that objective
The majority of the cardiac items from 1 July 2021 will align with the latest Australian and international best practice clinical guidelines.
The new cardiac changes made in the regulation amendment sees a change to cardiac procedural services where providers will be required to practice in alignment with the latest evidence-based guidelines that reduce procedural complications, reduce recovery time and improve long-term health outcomes. These changes are supported by the representative stakeholder groups relevant to cardiac service provision.
(f) Whether and how the measures constitute a proportionate means by which to achieve the objective (having regard to whether the measures are accompanied by sufficient safeguards; whether any less rights restrictive alternatives could achieve the same objective; and the possibility of oversight and the availability of review)
The cardiac changes made in the regulation amendment will achieve the objective of providing high-value, evidence-based medicine to the Australian public. These changes are accompanied by sufficient safeguards that allow for revision procedures when required and clear alignment with best practice.
The Department of Health will monitor the changes and will conduct a standard post implementation review in the appropriate timeframes.
Information on general surgery changes made in the Health Insurance (General Medical Services Table) Regulations 2021
(a) Whether this instrument reduces the quantum of benefits available for any specific MBS items, that could adversely affect the rebate payable to patients
Fee changes arising from implementation of the Government's response to the MBS Review Taskforce (the Taskforce) for general surgery services aim to better reflect the relative complexity of performing the medical procedures provided by the items. Fees were determined based on expert advice from the medical profession, clinical experts and consumer representatives.
Five general surgery items (amended items 30388, 30574 and 30443, and new items 30791 and 31585) which provided for laparotomy, appendicectomy, subsequent necrosectomy, cholecystectomy and removal of gastric band have reduced fees in recognition of being simpler procedures relative to existing MBS services. A summary of the fee changes is as follows:
• The fee for item 30388 reduced from $1,647.45 to $1,108.20.
• The fee for item 30574 reduced from $127.10 to $64.10.
• The fee for item 30443 reduced from $762.45 to $668.45.
• The fee for new item 30791 is $453.35. This item is for a subsequent necrosectomy, which used to be billed under item 30577, which has a current fee of $1,133.30.
• The fee for new item 31585 has a fee of $865.85. This item is for the removal of adjustable gastric band, which used to be billed under item 31584 that has a current fee of $1,601.50.
Savings generated through the reduced fees for these items have been reinvested into other more complex general surgery items.
(b) Where this instrument removes MBS items entirely, whether any of those items are not covered by, or replaced with, alternative MBS items
The services covered by the removed general surgery items have either been combined into new; considered to be provided more appropriately under other existing items; or determined to be obsolete as they no longer reflect modern clinical practice.
(c) Whether this instrument has the effect of reducing the quantum of benefit for specific medical procedures, including those procedures which are currently covered by multiple MBS items and will now be covered by one item
The MBS Review aimed to simplify the Medicare Benefits Schedule (MBS) by developing items that represent complete medical services (through the consolidation of similar items). In these cases, fees were determined based on the weighted average of the component services.
(d) What is the objective sought to be achieved by the instrument and whether this constitutes a legitimate objective (being one which is solely for the purpose of promoting general welfare)
The changes to the general surgery items implement the Government's response to the recommendations of the MBS Review Taskforce for general surgery services. The changes promote patient welfare through:
• updating services to support evidence-based practice;
• providing greater flexibility in procedure approach which will support surgeons to provide best practice treatment tailored to individual patient needs;
• combining services that are similar procedures separated by means of access to simplify the MBS and improve billing transparency for patients; or
• removing services that no longer represent best practice.
(e) Whether and how the measures are rationally connected to (that is, effective to achieve) that objective
The measure implements the recommendations made by the clinician-led MBS Review Taskforce.
(f) Whether and how the measures constitute a proportionate means by which to achieve the objective (having regard to whether the measures are accompanied by sufficient safeguards; whether any less rights restrictive alternatives could achieve the same objective; and the possibility of oversight and the availability of review)
The implemented recommendations of the Taskforce for general surgery services will contribute to the Government's objective of providing
high-value, evidence-based medical services to the Australian public. Consultation with relevant clinical bodies and consumer representatives during implementation provides assurance that the measure is proportionate to the recommendations of the Taskforce.
The Department will closely monitor the impact of the changes on patients, in consultation with the sector, through a post implementation review process.
Information on orthopaedic changes made in the Health Insurance (General Medical Services Table) Regulations 2021
(a) Whether this instrument reduces the quantum of benefits available for any specific MBS items, that could adversely affect the rebate payable to patients
Fee changes to items for orthopaedic surgery arising from the implementation of the Government's response to recommendations of the MBS Review Taskforce (the Taskforce) aim to better reflect the relative complexity of performing the relevant medical services. Fees were determined based on expert advice from the medical profession, clinical experts and consumer representatives.
One orthopaedic surgery item (49527) has a reduced fee from $1,650.65 to $1,371.25, to better reflect the intended purpose of the item descriptor for the provision of minor revision knee replacement procedures. The fee has been reduced because the described procedure is now less complex, relative to the more complex revision knee replacement (49533). This reduction of this fee was based on expert advice from the profession and clinical experts.
Savings generated through this fee reduction have been reinvested into item 49533.
(b) Where this instrument removes MBS items entirely, whether any of those items are not covered by, or replaced with, alternative MBS items
The services covered by the removed orthopaedic items have either been combined into new items; considered to be provided more appropriately under other existing items; or determined to be obsolete as they no longer reflect modern clinical practice.
(c) Whether this instrument has the effect of reducing the quantum of benefit for specific medical procedures, including those procedures which are currently covered by multiple MBS items and will now be covered by one item
The MBS Review aimed to simplify the Medicare Benefits Schedule (MBS) by developing items that represent complete medical services (through the consolidation of similar items).in these cases, fees were determined based on the weighted average of the component services.
(d) What is the objective sought to be achieved by the instrument and whether this constitutes a legitimate objective (being one which is solely for the purpose of promoting general welfare)
The changes to the orthopaedic items implement the Government's response to the recommendations of the MBS Review Taskforce for orthopaedic services. The changes promote patient welfare through:
• updating services to support evidence-based practice;
• providing greater flexibility in procedure approach which will support surgeons to provide best practice treatment tailored to individual patient needs;
• combining services that are similar procedures separated by means of access to simplify the MBS and improve billing transparency for patients; or
• removing services that no longer represent best practice.
(e) Whether and how the measures are rationally connected to (that is, effective to achieve) that objective
The measure implements the recommendations made by the clinician-led MBS Review Taskforce.
(f) Whether and how the measures constitute a proportionate means by which to achieve the objective (having regard to whether the measures are accompanied by sufficient safeguards; whether any less rights restrictive alternatives could achieve the same objective; and the possibility of oversight and the availability of review)
The implemented recommendations of the Taskforce for orthopaedic services will contribute to the Government's objective of providing high-value, evidence-based medical services to the Australian public. Consultation with relevant clinical bodies and consumer representatives during implementation provides assurance that the measure is proportionate to the recommendations of the Taskforce.
The Department will closely monitor the impact of the changes on patients, in consultation with the sector, through a post implementation review process. In addition, given the scale and complexity of the changes made to the orthopaedic items, the post-implementation review process will be expedited to ensure there are no unintended consequences or service gaps for patients.
2.85 With respect to the Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021, the minister advised that Medicare benefits have been reduced with respect to four relevant procedures based on advances in technology, and the possibility for some procedures to be performed on an outpatient basis (rather than hospital admission), which may have the effect of reducing out-of-pocket expenses for patients. The minister also advised that the instrument removes 59 items, stating that these changes are intended to provide for combined procedures, incentivise the use of different procedures, remove outdated procedures, and reduce rates of low-value interventions. The minister stated that the instrument will not, otherwise, reduce the quantum of benefits payable for relevant procedures.
2.86 With respect to the Health Insurance (General Medical Services Table) Regulations 2021, the minister advised that 216 deleted items had either been combined into new items, considered to be provided more appropriately under other existing items, or determined to be obsolete as they no longer reflect modern clinical practice. He stated that fees had been reduced with respect to six items, because of simplified procedures associated with those items, and noted that the savings from those reductions were being re-invested into more complex surgery items. As to whether this instrument has the effect of reducing the quantum of benefit for specific medical procedures, (including those procedures which were covered by multiple MBS items and will now be covered by one item), the minister stated that the MBS Review aimed to simplify the MBS by developing items that represent complete medical services (through the consolidation of similar items), and that in these cases, fees were determined based on the weighted average of the component services.
2.87 Insofar as these changes mean a patient has reduced access to a specific subsidised surgical service, or receives a lower rebate for some services, it would appear that there is some risk that, for some patients, these amendments may constitute a retrogressive measure with respect to the right to health and social security. Being a type of limitation under international human rights law, a retrogressive measure may be permissible where it seeks to achieve a legitimate objective, is rationally connected to (that is, effective to achieve) the objective, and constitutes a proportionate means by which to achieve the objective.
2.88 The minister advised that the objective behind these amendments is to promote patient welfare by: combining similar surgical procedures (to improve billing consistency); incentivise the use of advanced techniques; remove procedures that no longer represent best practice (or are unsafe); and reduce low value interventions. Improving general health outcomes, and the provision of advanced healthcare services, is likely to constitute a legitimate objective for the purposes of international human rights law, and it would appear that these amendments may be rationally connected to those objectives.
2.89 With respect to proportionality, the minister stated that consultation with relevant clinical bodies and consumer representatives during the implementation of these amendments provides assurance that the measures are proportionate to the recommendations of the MBS Taskforce, and stated that the department will monitor the impact of the changes through a post implementation review process. These two processes have the capacity to serve as important safeguards. However, it is noted that it is not clear if individual patients, who in some instances may now have to pay a higher gap fee payment, can apply to pay a reduced rate based on their financial circumstances.
2.90 In general, by providing for a number of surgeries to be available to individuals at a subsidised rate (and applying an indexation of 0.9 per cent to those items), this measure appears to promote the rights to health and social security. However, as noted, for some patients, the reduction (or removal) of Medicare item benefits for specific procedures may have the effect of reducing their access to subsidised medical services, or otherwise reducing the subsidy payable to them. Given the breadth and complexity of the amendments made by these two legislative instruments, it is difficult to determine the extent of any such cohort. Much will depend on how the amendments operate in practice, and monitoring and review of these changes will be important to ensure any reduction in social security benefits remains proportionate to the objectives sought to be achieved.
2.91 The committee thanks the minister for this response. The committee notes that these two legislative instruments make a significant number of amendments to the Medicare Benefits Schedule (MBS) in relation to general surgery, orthopaedic services and cardiac services, and apply an indexation of 0.9 per cent to those services.
2.92 The committee considers that applying an indexation to MBS services, and providing for a number of surgeries to be made available to individuals at a subsidised rate, promotes the rights to health and social security. The committee also notes that where these instruments reduce access to subsidised surgical services, or reduce the rebate provided to patients receiving some services, this may constitute a retrogressive measure (or backwards step) with respect to those rights. The committee notes that a retrogressive measure may be permissible where it seeks to achieve a legitimate objective, is rationally connected to (that is, effective to achieve) the objective, and constitutes a proportionate means by which to achieve the objective.
2.93 The committee notes that these amendments are intended to promote patient welfare by combining similar surgical procedures (to improve billing consistency) and incentivise the use of advanced techniques. The committee considers that these are legitimate objectives, and that these instruments are rationally connected to them. With respect to proportionality, the committee considers that the extent to which the amendments may have the effect of reducing access to subsidised surgical services, or reducing the rebate provided to patients receiving some services, will depend on how they operate in practice. In this regard, the committee welcomes the minister's advice that these amendments, and their effects on patients, will be monitored and reviewed.
2.94 The committee considers that it would be of great assistances to its scrutiny of legislative instruments which make complex changes to medical benefits if the explanatory materials accompanying these instruments included the type of detailed information provided in this response.
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Suggested action
2.95 The committee recommends that the statement of compatibility with
human rights be updated to include the information provided
in this
response.
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[1] This entry can be cited as: Parliamentary Joint Committee on Human Rights, Health Insurance (General Medical Services Table) Regulations 2021 [F2021L00678] and Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021 [F2021L00681], Report 10 of 2021; [2021] AUPJCHR 103.
[2] Parliamentary Joint Committee on Human Rights, Report 8 of 2020 (23 2021), pp. 21-26.
[3] International Covenant on Economic, Social and Cultural Rights, article 12(1).
[4] UN Economic, Social and Cultural Rights Committee, General Comment No. 14: The Right to the Highest Attainable Standard of Health (2000) [12].
[5] International Covenant on Economic, Social and Cultural Rights, article 9. See also, UN Economic, Social and Cultural Rights Committee, General Comment No. 19: The Right to Social Security (2008).
[6] Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021, explanatory statement, p. 32.
[7] Health Insurance (General Medical Services Table) Regulations 2021 [F2021L00678], statement of compatibility, p. 29; and Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021 [F2021L00681], statement of compatibility, p. 33.
[8] See, Health Insurance (General Medical Services Table) Regulations 2021 [F2021L00678], statement of compatibility, p. 28. Information about the review can be found here: https://www.health.gov.au/initiatives-and-programs/mbs-review?utm_source=health.gov. au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation [Accessed
17 June 2021].
[9] UN Committee on Economic, Social and Cultural Rights, General Comment No. 3: The nature of States parties obligations (Art. 2, par. 1) (1990) [9]. The obligation to progressively realise the rights recognised in the ICESCR imposes an obligation on States to move 'as expeditiously and effectively as possible' towards the goal of fully realising those rights.
[10] International Covenant on Economic, Social and Cultural Rights, article 2.
[11] That is, the measure would not constitute a non-fulfilment of the minimum core obligations associated with economic, social and cultural rights. See, CESCR, General Comment No. 3: the nature of states parties' obligations (14 December 1990) E/1991/23(Supp) [10]. See also Amrei Muller, 'Limitations to and derogations from economic, social and cultural rights', Human Rights Law Review vol. 9, no. 4, 2009, pp. 580–581.
[12] Article 4.
[13] Limburg Principles on the Implementation of the ICESCR, June 1986 [52]. See also, Amrei Muller, 'Limitations to and derogations from economic, social and cultural rights', Human Rights Law Review vol. 9, no. 4, 2009, p. 573; Erica-Irene A Daes, The Individual's Duties to the Community and the Limitations on Human Rights and Freedoms under Article 29 of the Universal Declaration of Human Rights, Study of the Special Rapporteur of the Sub-Commission on the Prevention of Discrimination and Protection of Minorities, E/CN.4/Sub.2/432/Rev.2 (1983), pp. 123–4.
[14] UN Committee on Economic, Social and Cultural Rights, General Comment 13: the Right to education (1999) [45].
[15] The committee's expectations as to the content of statements of compatibility are set out in its Guidance Note 1. See, https://www.aph.gov.au/Parliamentary_Business/Committees/ Joint/Human_Rights/Guidance_Notes_and_Resources.
[16] The minister's response to the committee's inquiries was received on 3 August 2021. This is an extract of the response. The response is available in full on the committee's website at: https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/Human_Rights/Scrutiny_reports.
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