Posted by: Chris Cole | December 31, 2013

South Australian Dept of Health illegally billing ED patients

SA Health is currently unethically and illegally charging rural patients for ED care.

Creatively, some political tosspot decided to dichotomise the ATS triage system such that Cat 1 & 2s are seen for free and Cat 3,4, & 5s are privately billed by the doctor providing the service and have to chase Medicare for partial reimbursement later.

This is in direct contravention of the National Healthcare Agreement, and represents a version of state/federal healthcare cost shifting not seen in any other Australian state or territory. (Snaps for boldly going where no other state health dept has, illegally, gone before, guys!).

In the spirit of laziness, rather than re-hashing it all over again, below is the body of a letter to Jack Snelling, Minister for Health in SA:


Dear Mr Snelling,

I am writing to bring to your attention an interesting and concerning
fact about the delivery of rural healthcare in South Australia that
has only recent come to my attention.

In contravention of the National Healthcare Agreement, and federal
legislation, SA Health has been insisting that rural GPs who provide
after-hours emergency medical services at state public hospitals
privately bill some patients for public hospital emergency department

Those patients deemed suitable by your department to be privately
billed comprise those who are not admitted as inpatients to the
hospital, and whose Australasian Triage Scale (ATS) category is
assessed as being 3, 4 or 5. These patients are being privately billed
by the GP providing the service, and must then seek partial
reimbursement via Medicare.

State public hospitals, including rural hospitals, are mandated,
required and expected to provide emergency medical and nursing care
for all Australians, with no cost to the patient at point of care
delivery. This has been the case for some decades now. Your
department's current policy and practice in forcing emergency
department patients to pay for emergency medical care that your
department is already funded to provide, is blatant state / federal
cost-shifting. It is also grossly unethical. It does not occur in any
other state or territory in Australia. In the context of the National
Healthcare Agreement, it could also be construed as illegal.

There is a provision in the National Healthcare Agreement (paragraph
G.21) which allows that: "Eligible patients may obtain non-admitted
patient services as private patients where they request treatment by
their own GP, either as part of continuing care or by prior
arrangement with the doctor”.

The salient point here is that the intent of this provision was to
facilitate obtaining care from one's own local GP in certain
circumstances. And then only if the patient specifically wants and
requests this mode of care provision. It was not intended to be
applied as a blanket billing model for a majority of emergency
department patients. Its utilisation as such by your department is
quite frankly an abuse of the system, and clearly not in keeping with
either the intent or, indeed, the specific and exact wording and
requirements of the agreement.

Furthermore, your department's ad hoc adoption of a dichotomous
application of the triage system to determine who should be billed
(category 3,4 and 5 patients) and who should be treated free of charge
(category 1 and 2 patients) has no basis in reality or evidence, and
belies a lack of understanding of the purpose and application of the
Australasian Triage System in the practice of emergency medicine. I
would refer you to the Australasian College for Emergency Medicine
( for a comprehensive definition, but in brief: a
patient's assigned ATS category (1 to 5) does NOT reflect whether or
not they require emergency department, high acuity, complex or
hospital-level care.


  1. Just found this. Did you ever get a reply? And what does ACEM say about this situation?

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