Considerations Statutory provision for a no balance billing fee Schemes can negotiate a lower fee
Remuneration determination Models –SA model –Belgium model –Australian model –Hybrid model
Advantages of statutory maximum fee Affordability Expansion of minimum mandatory benefit Rationalisation of plans Can include assessment of healthcare needs
Belgium model Bargaining council model If no agreement, Minister decides 7 year – no Ministers intervention Advantage –Agreed fee by all parties Disadvantage –Inefficiency may be entrenched
Australian model Coding centre Fees centre Federal Government MBS fees Disadvantage: coding development for National Health benefits
Hybrid model Sufficiently representative provider group Sufficiently representative funder group Centralised bargaining process Agreement? Consideration for Certification by MOH Certification criteria met? Ministerial determination Publication in Gazette of no balance-billing tariffs Appeal process (limited to subsequent process) Yes No Yes ICU
Certification criteria and statutory powers Statutory TOR Include budget impact, Inflation… Representivity Powers of the Minister …
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