Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise today to speak on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. This bill proposes to amend the Health Insurance Act to create an overarching framework for the establishment and operation of accreditation schemes for diagnostic imaging services. It is a very important bill, obviously, because it regulates such an important division of our health sector. Diagnostic imaging includes a range of diagnostic medical services, including ultrasounds, computer tomography, nuclear medicine, radiography, magnetic resonance imaging, positron emission tomography and bone densitometry.

The Australian government provides Medicare rebates for a number of diagnostic imaging services listed in the Diagnostic Imaging Services Table and a legislative framework is made up of the Health Insurance Act, which is being amended by this bill, the Health Insurance Regulations and the Health Insurance (Diagnostic Imaging Services Table) Regulations. Management of diagnostic imaging services under Medicare is undertaken cooperatively between the government, represented by the Department of Health and Ageing, and sector representatives, represented by the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association, through the radiology memorandum of understanding.

The radiology MOU is one of four collaborative agreements between the government and diagnostic imaging representative organisations made as part of the 2003-04 budget process for managing Medicare funded diagnostic imaging services. There are additional MOUs for cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasound. The radiology MOU is the largest of the diagnostic imaging MOUs and accounts for around 80 per cent of all the diagnostic imaging services under Medicare.

By way of background, for those who might be listening to this debate and who might not be aware of the extent of coverage of the issues we are debating today, approximately 12.6 million services were claimed under the radiology MOU in 2005-06, accounting for more than $1.3 billion in Medicare benefits for the services covered by the MOU. The point I am making is that this is not an insignificant part of the health sector; it accounts for around 10 per cent of the total Medicare budget. That is why it is so important that we ensure not only the quality of diagnostic imaging services provided to the millions of patients but also that the investment of Australian taxpayers in Medicare is well protected.

We also do not want to find ourselves in a repeat performance of late last year when the Minister for Health and Ageing was forced to provide $32.7 million in additional funding to Medicare for diagnostic imaging services because of a massive blow-out arising from changes in government policy. The blame for this blow-out lies fairly and squarely at the feet of Minister Abbott, who himself conceded that the original level of funding allocated by the government was not going to be adequate. Unfortunately, it is an all too familiar scenario for us with this minister, who is far more interested in short-term political fixes and abuse across the chamber than he is in long-term planning for Australia’s health system.

As I said earlier, the bill seeks to create an overarching framework within the Health Insurance Act for the establishment and operation of accreditation schemes for diagnostic imaging services as agreed by the government and the representatives of the sector as part of the negotiations for the current MOU. Under the scheme being implemented through this bill, all diagnostic imaging practices providing services under the MOU will need to be accredited by an approved accreditation provider in order for Medicare benefits to be payable for the services they provide. Obviously this is important for us, and we see it increasingly rolled out in the health sector that accreditation processes are the one way of ensuring that patients get quality services and ensuring that Medicare is being paid appropriately to those providers who are meeting set standards.

By allowing the minister to establish the rules and the operational details of the accreditation scheme through a legislative instrument, the bill has been designed to enable the introduction of accreditation schemes for other diagnostic imaging services in the future without further need to amend the act. Labor supports the legislation. We are disappointed that there is scant detail available as to how this accreditation process will actually work in practice, but we support the intention and the need to establish such a process.

We recognise that accreditation schemes are widely utilised within the health sector as a method for reviewing and improving systems of care and ensuring that consumers receive quality services irrespective of who provides the services or the facilities in which they are provided. Labor also knows how important it is to get the most out of the scarce health dollar. We support measures which will result, hopefully, in efficiencies under Medicare and in the health system more broadly.

Given that diagnostic imaging services account for such a chunk of Medicare benefits, we recognise that it is in the interests of the efficient working of Medicare and the broader health system that services are provided within a framework for continuous improvement in the delivery of safe and high-quality care. Just as past Labor governments built Medicare, we believe that we should retain, defend and strengthen it, and an accreditation system for providers of diagnostic imaging services will help to protect Medicare, which is the cornerstone of our health system.

I turn now to the provisions of the bill. The most significant changes are effected by items 5 and 11 of schedule 1. Item 5 inserts a new section 16EA to the Health Insurance Act 1973, which precludes the payment of Medicare benefits for diagnostic imaging services unless the procedures are carried out at premises that are accredited under a diagnostic imaging accreditation scheme to undertake the particular type of diagnostic imaging procedure. Where the images are captured off site—for example, by mobile services—they must be captured on equipment that is ordinarily located at a base for mobile diagnostic imaging equipment or diagnostic imaging premises accredited to undertake that procedure. So, obviously, the purpose is to make sure that using Medicare as the payment mechanism is actually the incentive. I would not say it is the ‘stick’, when you talk about carrots and sticks, but it is the way to ensure that all the providers will participate in this accreditation scheme.

Item 11 inserts a new division into part IIB of the act, which sets out the framework for the establishment and operation of diagnostic imaging accreditation schemes. New section 23DZZIAA allows the minister to establish, via legislative instruments, the accreditation schemes and to approve persons who will be accreditors—able to accredit practices for the purposes of the scheme. Under the section, the legislative instrument can specify the conditions for accreditation and provide for any matters needed to create and administer the scheme. If the legislative instrument establishing a scheme confers a power or function on the minister in administering the scheme, the minister will be allowed to delegate those powers or functions to an officer as already defined in section 131 of the act, to the department, to a person performing the duties within the department, to the CEO of Medicare Australia or to an employee of Medicare Australia.

That accreditation status of accredited practices for Medicare benefits will be recorded on the diagnostic imaging register or the location specific practice number—commonly known as LSPN—register. The type of information that will be recorded will be prescribed by the regulations when the regulations for the scheme are made. Obviously, again, the purpose of the accreditation process is for governments to be able to play a role in ensuring that appropriate standards are met, but making this information available will also be of use to consumers and other health providers.

The bill requires that the regulation should include full and proper review mechanisms for reconsideration of any accreditation decision. I note that the new section 23DZZIAD sets out the reconsideration mechanism by the minister of accreditation decisions. This applies where an accreditation provider does not grant accreditation to a service, will not renew the accreditation, or revokes or varies accreditation such that there would be a reduction of Medicare benefits entitlements. According to the explanatory memorandum, the minister’s decision following a reconsideration of that accreditation decision will not be reviewable by the Administrative Appeal Tribunal ‘because the minister’s decision is a review of a decision of an approved accreditation provider, which itself will be required to have a full and proper review mechanism in place’. We will, of course, be keeping our eye on the process that is established in the regulations to make sure that adequate and appropriate review processes are in place. Obviously the decisions to provide accreditation or not will be very serious ones for the industry. It is a little frustrating to deal with overarching legislation that is giving power to the regulatory process when we have not seen the regulations. We are asked to understand that the things that will go in the legislation will be okay because there will be other guarantees in the regulations which we have not seen. Obviously we will keep our eye on it to ensure that the government does live up to the commitment that it has made.

Importantly, the new section 23DZZIAE makes it clear that the proprietor of an unaccredited premises or base must notify their patients that Medicare benefits are not payable before the patient undertakes any diagnostic imaging procedure. The proprietor must also advise the patient that the reason no Medicare benefits are payable is that the premises are not accredited for the procedure that the patient is having. The offence for unaccredited sites is a strict liability offence, carrying a fine of 10 penalty units for an individual and 30 penalty units, being $3,300, for a corporation. Obviously these are very important things. It is very important that the consumers are told beforehand. They might otherwise be expecting or understanding that there is a Medicare benefit payable to them when that will not in fact be the case. We have in this place also just debated a related bill changing the offences regarding inappropriate practices relating to requesters and providers of radiology services. These will no doubt tie in with those so that the two, when looked at together, will ensure that high-quality standards and the cutting out of any inappropriate practices can go hand in hand.

New section 23DZZIAF provides that, where the proprietor failed to provide that notification of the accreditation status that no Medicare benefit was payable to a patient, the amount of the Medicare benefit paid to a patient in respect of that service is recoverable from the proprietor of the diagnostic imaging premises. This debt will be in addition to any fine that can be imposed on the proprietor and is obviously aiming to ensure that there is a clear disincentive to this approach. Not only should the consumer be protected but the government also should be protected in being able to reclaim this money if it has been inappropriately claimed. These are the substantial changes proposed by this bill. The introduction of an accreditation scheme via legislative instrument for radiologists is clearly aimed at improving standards within the sector and making proprietors liable if correct procedures are not followed. These are worthy objectives. Obviously these accountability measures will also enhance the service experienced by consumers as well.

Subject to the passage of the legislation, the government has indicated the commencement date for the proposed scheme to be 1 July 2008. This will presumably coincide with the commencement of the new memorandum of understanding between the Commonwealth and the diagnostic imaging sector, as the current MOU runs out on 30 June 2008. Among the current MOU principles and objectives are those to promote access to quality, affordable radiology services and to improve the quality and delivery of radiology services—very worthy objectives that we support. Labor considers that these objectives would be even better served by a greater investment and emphasis in e-health broadly and in teleradiology in particular.

In March this year my colleague Senator Conroy announced Labor’s broadband policy, an area where the government has buried its head in the sand and continues to do so. As announced in March, federal Labor will revolutionise Australia’s internet infrastructure by creating a new national broadband network that will connect 98 per cent of Australians to high-speed broadband internet services at speeds over 40 times faster than most current speeds. ‘Why is this relevant here?’ you might ask, Mr Deputy Speaker.

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