1Professional Services Review Scheme - Directions as to Sampling (No. 2)

Health Insurance Act 1973

Professional Services Review Scheme –

Directions as to Sampling (No. 2)

I, CARMEN MARY LAWRENCE, Minister for Human Services and Health, acting under section 106K of the Health Insurance Act 1973, issue the following Directions, being directions that are in accordance with advice received from the Australian Bureau of Statistics, for the purposes of sections 106H and 106J of that Act.

Dated 31 January 1995

CARMEN LAWRENCE

Minister for Human Services and Health

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PART 1 – PRELIMARY

1.1 This Direction may be cited as Professional Services Review Scheme – Directions as to Sampling (No. 2).

1.2 This Direction sets out procedures in regard to samples of services for the purposes of Subdivision C (Findings based on statistical sampling) of Division 4 of Part VAA of the Health Insurance Act 1973 (the Act).

1.3 Terms used in this Direction that are defined in Part VAA of the Act have the same meanings in this Direction as in that Part.

1.4 Part 2 of this Direction sets out the procedure for producing and using a sample for the purposes of subsection 106H(1) of the Act. Part 3 sets out the procedure for increasing the size of a sample if the practitioner under review so requests under subsection 106J(2) of the Act.

Professional Services Review Scheme – Directions as to Sampling

1.5 A sample produced for any purpose referred to in these Directions must be randomly selected in accordance with proper statistical sampling practice unless the contrary is specifically stated.

PART 2 – SAMPLING

2.1 If a referral to the Director relates to services of a class specified in the referral (“the specified class”) that may be the subject of findings under Division 4 of Part VAA of the Act, the Commission may supply a sample (“preliminary random sample “) drawn from the services included in the referral. The preliminary random sample must contain twice the number of services worked out by reading from Table 1 the number at the intersections of:

(a) the row containing in its leftmost column (the column headed “class size”) the number of services of the specified class included in the referral; and

(b) the column headed “50%”.

2.2 If the Committee proposes to make a finding based on statistical sampling, the Committee must examine a sample of 30 services (“exploratory sample”) from the preliminary random sample and determine whether each of those services constitutes inappropriate practice or not. The Committee must then calculate the percentage of services in the exploratory sample that constitute inappropriate practice and round down the result to the next lower multiple of 5%.