A Director of a Victorian medical centre wrote:

Ambulance Victoria  ( AV ) advised private registered Day Procedure Centres and Private Hospitals in Victoria by letter on about 26 June 2014 that from 1st July 2014 there would be significant changes in billing guidelines for AV patient transport services in Vic. Specifically, such PRIVATE HEALTH CARE facilities would

“ …. become responsible for the costs associated with all emergency and non-emergency transports from a private healthcare facility for a Community Service Obligation patient. …..  “

CSO patients are, briefly, pensioners who have always been said in all relevant discussions and literature to have an entitlement to “free” ambulance transportation when clinically justifiable, under government funded CSO arrangements.

How can it be Legal for a Victorian Department of Health Minister suddenly to make private entities become responsible for the costs of such government funded CSO services to patients, with no negotiation or contract?

Is this a question within your area of interest? It certainly is in the interest of many pensioner patients in Victoria, who have had a portion of their “entitlements” reduced without notification.

The power of the Ambulance Service to charge fees is set out in the Ambulance Services Act 1986 (Vic) ss 10 and 16.  Pursuant to s 16

… An ambulance service may—

(a) charge reasonable fees for services rendered;

(b) operate or participate in a subscriber scheme;

(c) provide services to members of, or contributors to, a health fund under an agreement with a health fund;

The Secretary of the Department of Health “… may by instrument, give directions to an ambulance service relating to— (a) the fees that the service may charge …” (s 10(5)).  An ambulance service must comply with the Secretary’s direction (s 10(6)).

The Secretary has issued such a direction – see Patient transport charging guidelines for Victoria.  The current guidelines took effect on 1 July 2014.  The guidelines on Table 3 say that for ‘Private patients in private healthcare facilities’ the sending private healthcare facility is responsible for ambulance charges.

The Government of Victoria (and all the state governments) appear to have imposed community service obligations upon the state ambulance services to provide free transport for pensioners and others, but I can’t see where there is any legal obligation to do so.  There does not appear to be a COAG agreement requiring states to provide ambulance as a community service obligation (as there is for Pharmacy Wholesalers), there is no mention of ambulance services for pensioners and others in the National Healthcare Agreement 2012 nor do these community service obligations get a mention in either the Health Insurance Act 1973 (Cth) or the National Health Act 1953 (Cth) or their regulations.

Even so:

There has been a long tradition in Australia on governments imposing special requirements on Government Trading Enterprises (GTEs) which extend beyond the commercial operations of the business.  Governments have often required GTEs to … provide concessions to particular users… These requirements are usually termed ‘community service obligations (CSOs).’

(Steering Committee on National Performance Monitoring of Government Trading Enterprises, Community Service Obligations: Some Definitional, costing and funding issues (Canberra, 1994), p iii; see also Industry Commission, Community Service Obligations: Policies and Practices of Australian Governments (Canberra, 1977)).

The Commonwealth does not claim to impose an obligation on the states to provide ambulance services.  The Department of Human Services says:

In addition to Medicare services, concession cards can give you, your partner and dependants other concessions from state and local government authorities and private businesses.

Contact the state government health agency in your state for information on concessions available in your state or territory.

If we look to the Victorian Department of Human Services, they say ‘Concession cardholders are eligible for free ambulance and air ambulance travel anywhere in Australia in an emergency or on the recommendation of a doctor’ (http://www.dhs.vic.gov.au/for-individuals/financial-support/concessions/health/ambulance-travel).  All that persuades me that whatever level of agreement there is between the states there is no binding legal obligation to provide free ambulance service.

So where does that leave us?  The Secretary can set ambulance fees which ambulance services must comply with. That has been done and the Secretary has determined that the sending health service, on the basis presumably that it is that service that is arranging the ambulance and requesting the service, is liable to pay the fees.   How is that legal?  It’s because s 10 of the Ambulance Services Act 1986 (Vic) says that the determination can be made and I can’t find any other law that would say this obligation is improper or illegal.

It is however, problematic to make a third party liable, if I call an ambulance for someone I’m not liable to pay the fee just because I rang the ambulance, so why is the private facility?  This could turn on many things all based in contract law – what’s the contract between the provider and the patient? What services does the provider agree to pay for? What’s the relevant law regulating the private health provider? Who is requesting the service?  These are all issues beyond ‘emergency law’ and any provider who wanted to question them would need to obtain independent legal advice.