10.1 Overview

This chapter provides a background to the Australian regulatory context for health occupations. It commences with a discussion of the broad policy context within which this Review of Traditional Chinese Medicine (TCM) is occurring. It then provides a discussion of what is meant by occupational regulation. An analysis of the risk factors in TCM in the context of the Australian regulatory environment is presented in Chapter 11 Chapter 11lso directly addresses the issues highlighted by theAHMAC criteria (see Appendix 1) and puts forward options for regulation.

10.2 Methodology

The Health Issues Centre (Victoria) was commissioned to prepare the analysis of the legal framework required for assessing and developing regulatory recommendations concerning the practice of TCM. Discussions were held with a wide range of government officers, professional representatives, and individual practitioners and educators in TCM. Government agencies approached included the Therapeutic Goods Administration, the Australian Quarantine Inspection Service, the Victorian Department of Human Services, the Western Australia Department of Health, the Victorian Department of Infrastructure and the Australia New Zealand Food Authority.

10.3 The Australian Policy Context

The review of TCM is occurring within a national policy context which delineates the scope of the potential regulatory options. Key components of this policy context include:

• the mutual recognition legislation for the registration of health professionals;
• the National Competition Policy; and
• the criteria for health practitioner registration adopted by the Australian Health Ministers' Conference and Advisory Council.

10.3.1 Mutual Recognition

The Mutual Recognition Agreement was reached between all State and Territory governments and the Commonwealth at a special Heads of Governments meeting in May 1992. It is designed to promote freedom of movement of goods and services, including service providers, in an integrated Australian market. It reflects the view that if requirements in one jurisdiction meet community expectations, then they should be acceptable in any other Australian jurisdiction.

The requirements of mutual recognition are detailed in the Commonwealth Mutual Recognition Act 1992, and each State has now passed legislation adopting the provisions of that Act.

Mutual recognition helps ensure that health practitioners registered in one State or Territory are automatically entitled to registration in any other that registers that occupation, but only to the extent to which local practitioners are registered in a particular State. This means conditions may be attached to registration to ensure equivalent standards. It is the individual practitioner's responsibility to comply with local requirements for practice regardless of where he or she originally qualified.

The principles of mutual recognition are also directed at reducing unnecessary regulation of occupations to achieve flexibility of the labour force. The Heads of Government sought to reduce existing occupational regulation unless there were compelling health and safety reasons, and the Australian Health Ministers agreed that this was a first step towards agreed national standards for each health occupation. This led to the repeal of several health practitioner registration Acts. It was agreed that no future action would be taken to regulate any further health occupation unless the need for doing so had been agreed by the Australian Health Ministers' Conference (via AHMAC). This is discussed further below.

10.3.2 National Competition Policy

On a broader level the Commonwealth, State and Territory Governments agreed to examine a national approach to competition policy in order to improve Australia's economic competitiveness within the global market. The first step taken was to commission the National Competition Policy Review, chaired by Professor Fred Hilmer. The Hilmer Report was presented in August, 1993. Its major finding was that the greatest impediment to enhanced competition in many sectors of the economy was regulatory measures imposed by government.

The report identified two forms of regulation which impact most directly on competition: regulation that restricts market entry, and regulation that restricts competitive conduct1.

While promoting the benefits of competition for consumers it was understood that competition may not always be consistent with social and health goals1:

Competition policy is not about the pursuit of competition for its own sake. Rather, it seeks to facilitate effective competition in the interests of economic efficiency while accommodating situations where competition does not achieve economic efficiency or conflicts with other social objectives. (p.xvi)

However, particular concern was expressed that regulatory regimes for professional and other groups may be more restrictive than necessary to protect the public interest objectives for which they were imposed and "that standards may be harmonised at the level of the most restrictive standard, rather than the most appropriate"¹. The report referred specifically to occupational licensing in its discussion of the need for scrutiny of restrictions on market entry which require service providers to meet prescribed standards or qualifications before they can practice in particular fields1. Recommending principles to promote regulatory reform, it argued that1:

Governments which choose to restrict consumers' ability to choose among rival suppliers...should demonstrate why this is necessary in the public interest. (p.212 Rec 9.2)

To monitor the implementation of the new competition policy, the Australian Competition and Consumer Commission has been established through the merger of the Trade Practices Commission and the Prices Surveillance Authority. The Competition Code, a slightly modified version of the competitive conduct rules contained in Part IV of the Trade Practices Act 1974 (Commonwealth), has been extended to all persons engaged in business, including health professionals, from 21 July 1997. Financial penalties for anti-competitive conduct will apply to offences by firms and individuals covered by the Competition Code.

These developments have been accompanied by complementary arrangements at the State and Territory level. All States and Territories have agreed to ensure that proposals for new legislation that restrict competition are accompanied by evidence that the legislation is consistent with the Guiding Legislative Principle of National Competition Policy. This incorporates a two-pronged `competition test'.

10.3.3 The Competition Test

The Victorian approach provides an example of the situation in other States and Territories. The Competition Policy Reform (Victoria) Act 1995 came into effect on the 21st July 1996, accompanied by complementary Guidelines for the Review of Existing Legislation and Guidelines for the Application of the Competition Test to New Legislative Proposals.

The `competition test' must be applied to all new regulatory measures including Acts of Parliament, ordinances, regulations and Ministerial Directives, but not to industry agreements or codes of practice made between members of an industry (or professional) association. It requires that any regulatory measure which might restrict competition be accompanied by documentation showing that:

• the benefits of the restriction to the community as a whole outweigh the costs; and
• the objectives of the legislation can only be achieved by restricting competition2.

Under the Guidelines, regulatory proposals such as occupational licensing that would limit the number of persons engaged in an occupation are deemed to be restrictions on competition unless proved otherwise2. Occupational regulation is also seen as tending to promote unwarranted rigidities in the workplace and segmentation in the labour market2 (Attachment 2).

When proposed legislation contains such a deemed restriction, then before the proposal can be lodged with Cabinet, the relevant Minister must obtain a certificate from the Premier to the effect that the restriction has been adequately justified. The Guidelines set out a five stage process to justify new statutes that contain deemed restrictions on competition:

1. Identify the restriction.
2. Clearly articulate the objective that Government seeks to achieve by the restriction in the context of the proposed legislation and to assess all practicable alternative means of achieving that objective. This assessment must include non-legislative strategies.
3. Assess the costs that the restriction would generate for the community generally. It is important to consider potential competition from prospective entrants (would be health care providers) in the market (the health industry), as well as competition from existing market participants (other health care providers). The Taskforce provides the following example2:

   A licensing scheme that limits the number of suppliers in a market would allow incumbent suppliers to set prices higher than would be possible in the face of price competition from new entrants to the market seeking to establish market share. (p.8)

4. Assess the community benefit including all private and public benefit that the restriction on competition would achieve. This is where the broader social goals, for example a reduction in the risk of accidents, are relevant. In this sense the assessment is much broader than just the effects on competition. However, factual evidence must be supplied that the purported community benefits are achievable, probable, and attributable directly to the restriction on competition.
5. Ensure that the benefits outweigh the costs, including economic, environmental and social costs, likely administrative and compliance costs, and any relevant government legislation and policies. Guidelines for this assessment are contained in the Regulatory Impact Statement Handbook `Better Regulation' issued by the Victorian Department of Business and Employment in July 1995.

Any occupational licensing proposals will thus be subject to close scrutiny. In line with this, the Victorian Department of Human Services plans to review all existing health practitioner registration Acts over the next three years.3

This approach, however, is not very different from existing policy in relation to occupational licensing adopted by the Australian Health Ministers' Advisory Council (AHMAC). Applications for registration of a health practitioner group must meet both the National Competition Policy and the AHMAC criteria.

10.3.4 AHMAC Criteria

The lack of a coherent approach to occupational regulation in Australia is long-standing and in 1981, the Standing Committee of the Conference of Australian Health Ministers concluded that registration of health practitioners was granted too readily.4 At State level:

• The Victorian Regulation Reform Unit noted that there was no system of occupational regulation either in health or any other area and that controls were developed in response to ad hoc pressures5. Following a Review of Registration for Health Practitioners (1987,1990)6, Health Department Victoria identified the need to standardise its approach to regulation of health occupations by applying a consistent and `least restrictive' model that focussed on risk of harm and evaluation of alternatives to regulation.
• The Western Australian Health Department Review of the Status of Unregistered Health Occupation Groups (1989) asserted the need for pre-registration evaluation using consistent criteria7 that required groups seeking registration to demonstrate firstly, that if the group's activities were left unregulated, they could cause actual physical or mental harm; and secondly, an assessment of alternatives to registration that might have the same beneficial effects7.
• Queensland Health has undertaken a similar Review of Health Practitioner Registration Acts (1994) as part of its business regulation review program, under which "all legislation is being examined with the intention of reducing any negative impact of regulations on business and the public, unless the regulations are in the public interest"8.

In 1992 this approach was adopted at the national level. AHMAC accepted the recommendations of its working party that occupational regulation by government of several health practitioner groups was unnecessary, taking into account the benefits of continued regulation and the risks of deregulation, and a number of groups were deregulated in Australian jurisdictions, including naturopaths, speech pathologists and social workers in the Northern Territory.

In 1995, six criteria for assessing the regulatory requirements of unregulated health occupations were adopted by AHMAC (see Figure 10.1 and Appendix 1). In line with the Hilmer approach and the earlier State-based inquiries into regulation of health occupations, the criteria essentially direct government to ask:

• 1. Is registration the most direct, effective and least restrictive way of dealing with a significant risk of harm to public health and safety?

  2. Do the benefits clearly outweigh the potential negatives of regulation?

Criterion 1

Is it appropriate for Health Ministers to exercise responsibility for regulating the occupation in question, or does the occupation more appropriately fall within the domain of another Ministry?

Criterion 2

Do the activities of the occupation pose a significant risk of harm to the health and safety of the public?

Criterion 3

Do existing regulatory or other mechanisms fail to address health and safety issues?

Criterion 4

Is regulation possible to implement for the occupation in question?

Criterion 5

Is regulation practical to implement for the occupation in question?

Criterion 6

Do the benefits to the public of regulation clearly outweigh the potential negative impact of such regulation?

Figure 10.1: The AHMAC Criteria

AHMAC already had before it applications for occupational regulation from practitioners of acupuncture and TCM. The working party that developed the criteria was reconvened to evaluate those applications against the criteria, in order to promote a national approach. All groups making submissions to AHMAC were to be encouraged to make a single submission addressing the criteria, and acupuncture and Chinese herbal medicine were to be considered part of the occupation of TCM for the purposes of evaluation. Before final recommendations are made to AHMAC the working party must also receive the findings of this TCM Review commissioned by the Victorian Department of Human Services.9

10.4 Occupational Regulation

10.4.1 Introduction

The regulatory framework that will be appropriate will depend on the nature of the problems identified as arising from the practice of TCM. In the context of this review, `government regulation' refers to any instrument of the state that imposes controls on health care practice. This can include ordinances, subordinate legislation (often called Regulations), statutes or Acts of Parliament, administrative decrees, proclamations, guidelines and procedural statements.

Occupational regulation imposes controls over entry into and conduct within particular occupational groups5.

In the health sector legislative registration is often seen as according recognition to a health occupation that has `come of age' as a profession.10 However, under the National Competition Policy, recognition of professional status or contribution is not considered an appropriate purpose of government regulation. Because regulation imposes restrictions on a particular group, it must be justified by a public purpose.

The lack of common definitions in discussions of occupational regulation tends to confuse assessment of relevant options. The following is intended to clarify the use of terms and throw some light on the limitations of each model.

10.4.2 Self Regulation

The Report of the AHMAC Working Group Advising on Regulatory Requirements for Unregulated Health Occupations noted that:

The fact that an occupation is not registered does not preclude practitioners of an occupation undertaking self regulation by:

• setting their own standards of practice supported by codes of ethics;
• encouraging membership of a professional association;
• ensuring there is a recognised and accredited body of knowledge.9

The certification regime of the Chartered Professional Accountants is a highly successful example of the use of self regulation to promote community confidence in a profession. Certification or accreditation systems provide a way of identifying those who have obtained certain qualifications. They do not prevent uncertified practitioners from undertaking the relevant occupation, but do limit the use of identified titles to certified practitioners. The regulatory controls imposed by an association on certified practitioners may be as stringent as those imposed by any government regulation7.

Self regulation does not preclude recognition of unregistered professions. For example, the Queensland Skin Penetration Regulations officially acknowledge the Australian Acupuncture Association Ltd by adopting the Association's Code of Practice. On a national level, the Therapeutic Goods Regulations, as well as exempting a range of registered practitioners from restric tions on advertising of therapeutic goods, also exempts members of a number of TCM and other complementary medicine practitioner associations.

10.4.2.1 Strategies for Self Regulation - An Example

Following government determination that registration was not necessary for social workers, the Australian Association of Social Work (AASW) has developed a model for action to maximise the effectiveness of self regulation12

Steps to ensure public accountability were considered essential, and the AASW established a certification system in conjunction with a public education program to increase awareness of the role of the profession, the Association and the accountability of AASW members. The certification system is founded on a continuing education program, with AASW practising certificates denoting Accredited Social Workers who undertake regular continuing education activities to help assure their competence. Over time this will become known as a condition of ongoing AASW membership. The Association is working with educational institutions, employer bodies and government to ensure maximum recognition of the continuing education program and association practice standards.

Training in ethics will be a core requirement of the continuing education program. Complementing this, revised complaints and ethics review mechanisms are being developed, with consideration given to appointing members of other professional groups as observers at disciplinary hearings to promote external accountability.

The Association considers that this shift to systematised self regulation will benefit both the general community and the profession. It will promote community access to competent and ethical social work practitioners and ensure that accredited social workers have a competitive position in the labour market.

The recent merger of the Australian Acupuncture Association Ltd (AAcA) and the Acupuncture Ethics and Standards Organisation (AESO) provides an accreditation and disciplinary function independent of the administrative functions of the professional association and seeks to utilise similar strategies to promote self regulation of TCM practitioners.13

10.4.3 Co-Regulation

What is co-regulation?

Co-regulation is a system of government regulation in which the relevant occupation is involved to a greater or lesser degree in the administration of the regulatory scheme5. It can apply to various levels of regulation from certification to licensing. It is not to be confused with self regulation. While a registration board with members primarily drawn from the relevant practitioner group does involve a limited delegation of power by government to the peer group to regulate its own, registration boards are increasingly tending to include people drawn from outside the relevant practitioner group.

More importantly, however, this delegation of power is within a framework that emphasises the public interest and public accountability, and provides legislatively based sanctions for non-compliance. Unlike self regulation, the purpose and functions of the registration system are set down in legislation, subject to public scrutiny, and are not determined by the health practitioner group alone.

Problems with co-regulation

Co-regulation continues to attract criticism because of the tendency of registration boards to confuse their role with self regulation. For example, a recent edition of Nexus, the newsletter of the Nurses Board of Victoria, carries a description of the Mission, Values and Guiding Principles of the Board.`Self-Regulatory' is the term heading the list of key values guiding the Board and `Maintenance of self-regulation and professional integrity,' is the first of the guiding principles14.

The British General Medical Council (GMC) is the model on which most Australian health practitioner registration boards were originally based. A recent review of the GMC noted that, in the public eye, the GMC remains indistinguishable from the British Medical Association. It concluded that it is dubious whether such a body could satisfactorily guard the public's interest15:

The GMC's best intentions tend to be obstructed by the more conservative elements of the medical profession...Everything it wishes to do requires several rounds of consultation with the many arms of the profession; it feels it can only act when there is general agreement. (p14)

The absence on many registration boards of adequate representation of consumers, overseas trained professionals, and health practitioners from other disciplines has also attracted criticism. The best health care is that practised as a co-operative effort between practitioner and patient and in many cases between several professions as well15. "(The) broader public interest may not be as effectively served where membership of boards consists solely of members of the relevant profession"16.

Many boards lack the legislative capacity to respond adequately to patient complaints and grievances, especially where complaints relate to substandard practice as opposed to matters of ethical behaviour. Where an independent complaints body exists, such complaints can sometimes be subjected to investigation by that agency, but in some States (for example South Australia), these agencies can only deal with complaints concerning practitioners in the public sector.

Even on ethical matters statutory boards can be found wanting. A United States review of boards regulating TCM practitioners found a lack of disciplinary action meant that the burden of policing ethics still fell mainly to the professional associations17.

Self funding by the profession of statutory boards charged with occupational regulation also reinforces the perception that the major stakeholder in the activities of any board is the regulated profession. In reality, all health practitioners, patients, potential patients, their families and of course, governments all have a vital interest.

10.4.4 Certification

Certification provides a means of identifying practitioners who have achieved the qualifications thought desirable for practice in a given field5,8. A certification system can be self regulatory or imposed by government. A simple certification scheme would not involve any scheme for monitoring standards of conduct post certification, such as disciplinary procedures. Such a system does not prevent anyone who is not certified from practising the given occupation, but can offer the public a way of differentiating between competing service providers. A person who is not certified but holds themselves out to be so may be subject to criminal prosecution for offences related to fraudulent misrepresentation.

10.4.5 Registration

While registration may be no more than the listing of people on a register, with no additional government intrusion beyond payment of a fee and no implication of special qualifications5, in the Australian health sector, registration has come to be identified with the establishment of registration boards having significant powers over the registered practitioners.

Registration can prohibit unregistered people from practising under a statutory `protection of practice' model. Most statutes imposing registration on health practitioners, however, only prevent unregistered people from using the title associated with the registered group. This is conventionally known as `protection of title'. Unregistered people can still undertake practices associated with the registered occupation, but if they use the protected title they may be prosecuted, under the registration Act.

Registration enables the public to identify those practitioners who have achieved certain levels of training considered necessary for safe practice. It cannot prevent incompetence or wrongdoing. However, modern registration Acts should provide some assurance of investigation and sanction if a practitioner offers treatments that are beyond his or her competence, or practices in a substandard way.

Statutory registration does not imply government endorsement of the efficacy of the type of health care offered by registered health practitioners. For instance, medical practitioners, physiotherapists, osteopaths and chiropractors, all registered professionals, are direct competitors and the philosophies of health care underlying their fields of practice are quite different6a.

Some registration models, like the Council of Allied Health Practitioners in the United Kingdom or the Alberta Health Disciplines Board in Canada, enable the registration of more than one health practitioner group under the one regulatory structure. If applied to different kinds of TCM practitioners, registration based on this model might involve one board and one register for all TCM practitioners. The register could be endorsed as to whether the practitioner is entitled to use certain titles associated with different TCM disciplines, for example `acupuncturist', `Chinese herbalist' or `acupuncturist and Chinese herbalist' depending on the qualifications held by the practitioner seeking registration.

Even under a registration model, self regulation of a profession has an important role to play. Continued self regulatory activities are directed at constantly enhancing the qualifications, the integrity, social standing and ethical position of the profession. This too has a `preventive' impact, through promoting good practice. Both self-regulation and registration are complementary.18 They differ in emphasis but both recognise that standards are critical to both the public and the practitioner group.

10.4.5.1 A Typical Registration Act

A fairly typical example of a registration Act for protection of title is found in the Victorian Medical Practice Act 1994. This Act followed the Review of the Victorian Medical Practitioners Act 197018, which proposed revision of the Act in line with the principles of the Victorian Review of Registration for Health Practitioners. As noted above, similar principles were also adopted by AHMAC.

The Medical Practice Act 1994 (Vic) explicitly states that the main purposes of the Act include:

to protect the public by providing for the registration of medical practitioners, investigations into the professional conduct and fitness to practise of registered medical practitioners, (Section 1(a)).

Section 62 prohibits a non-registered person from representing themselves as a registered practitioner of medicine. However, the Act does not prohibit an unregistered person practising medicine per se. It is provisions in other legislation that restrict to legally qualified medical practitioners the right, for instance, to prescribe various medications, issue various medical certificates, recommend involuntary admission to psychiatric facilities, and receive reimbursement for Medicare services under the Commonwealth Health Insurance Act 1973.

The registration of medical practitioners is based only on their achievement of qualifications considered to indicate competence to practise. The registration board's role in ensuring that practitioners maintain standards is enforced only in the breach through the disciplinary process18. Ensuring that practitioners maintain annually certified levels of competence is left up other mechanisms such as the activities of the professional colleges. Maintaining theoretical and practical standards is thus the task of continuing medical education, peer review and quality assurance activities. However, this approach is complemented by expanded disciplinary capacities. For example, the board has the capacity to make orders requiring participation in such activities as an outcome of a disciplinary hearing.

This type of co-regulation thus does not obviate the need for complementary self regulatory activities by professional groups.

10.4.6 Licensing

Some occupational regulation Acts prohibit people other than those licensed under the relevant Act from carrying out particular activities. This is the most restrictive form of occupational regulation and is sometimes described as `protection of practice'. The legislation sets out the scope of practice for the occupational group, and any activities falling within the scope of practice cannot legally be performed by anyone else. For example, only licensed dentists may practise dentistry (except in certain specified circumstances).

Somewhat confusingly in Australia, the term `licensing' is sometimes applied to simpler forms of registration, such as the licensing of dental technicians in Victoria through the Dental Techni cians Licensing Committee. The licensing of dental technicians does not however, prohibit anyone else from undertaking the tasks of a dental technician.

Sometimes occupational regulation Acts involve a mix of protection of title and limited protection of practice. Common provisions are that only a registered practitioner may6a:

• charge fees for treatment, or recover unpaid fees in a court of law;
• hold an appointment as a practitioner in any public hospital or institution;
• advertise therapeutic use of certain tests or methods of treatment (p.12).

Whether more extensive protection of practice provides the public with significantly greater protection than protection of title is debatable7. Certification or registration can provide the information needed by consumers to make their own judgements about practitioners and helps avoid increased service costs that can result from protection of practice. Thus schemes aimed primarily at restriction of the use of title are preferable to schemes which aim to restrict practice.

10.4.6.1 Targeted Licensing

Licensing legislation that defines the scope of practice of one group means that other groups may no longer exercise their skills. Given that many health practitioner groups have areas of overlapping skills and expertise, this can create unnecessary segmentation of health care, reducing consumer choice.

Negative licensing attempts a `more targeted and less restrictive approach'8 by setting out certain activities that are not permitted within an occupation. Thus, any person can practice but those who undertake the prohibited activity may be penalised, including possible prohibition from practising in the given occupation.

For example, advanced dental technicians in Victoria are permitted to carry out any dental work as long as it is in accordance with the Dental Technicians Act 1972 (Vic). This prohibits them from performing certain activities restricted to licensed dentists.

Similarly in the Ontario model, implemented in Canada at the end of 1993, potentially harmful acts and procedures associated with health care are prescribed in one major piece of legislation, the Regulated Health Professions Act 1991 (Ontario)19. Only registered health practitioners can undertake these `licensed acts'. Health practitioners are registered under separate Acts which complement the main Act and each specific Act protects the relevant title and sets out which of the licensed activities the registered group is allowed to carry out. Each licensed activity may appear in one or more than one of the Acts.

The advantage of this approach is that the focus is on the activities associated with major risks to the public. In this way the anti-competitive effects of broad scope-of-practice restrictions are avoided and, because it is procedures rather than broad practice that are defined, unregistered practitioner groups are clearer about what they cannot do (8:19-21). For example, licensed acts include diagnosis, procedures on tissue beyond the dermis, administering substances by injection or inhalation, and moving the spinal joints beyond an individual's usual range of motion using a fast low-amplitude technique.

The recent Queensland Department of Health draft policy paper Review of Medical and Health Practitioner Acts proposes a similar model to the Ontario legislation20.

The Department's preferred position is that20:

...a new statutory method, involving regulation of `core restricted practices' be used to protect the public. (p56)

The model proposes that certain core practices that present risks to public safety be restricted to specified professions, in lieu of using a statutory definition to restrict the broad scope of practice.

10.4.6.2 Departmental Licensing

Licensing may be administered by the relevant government department. This occurs in the licensing of persons qualified "to operate or use radiation apparatus or radioactive substances" under the Victorian Health Act 1958. The licensing scheme broadens the range of practitioners authorised to practise radiography. Radiographers themselves must be registered by the Radiographers and Radiation Technologists Board of Victoria.

The Health Act 1958 also provides for a Radiation Advisory Committee in section 108AF. This Committee makes recommendations to the department for the licensing of other persons with the qualifications and expertise to operate or use radiation apparatus. In general, these licenses are issued for a limited scope of practice. Dentists can only perform radiography of the dento-maxillary facial region. Chiropractors and osteopaths will usually only be licensed to undertake plain radiography of the vertebral column and pelvis.

References

1. Hilmer F (Chair). National Competition Policy Review. Commonwealth of Australia. 1993:191-212.

2. Competition Policy Taskforce (Victoria). National Competition Policy Implementation: Guidelines for the Application of the Competition Test to New Legislative Proposals. December 1995:2-12.

3. Victorian Department of Health & Community Services. Competition Policy Task Force Proposed Schedule for Review. December 1995.

4. Standing Committee of the Health Ministers' Conference. Report on the Registration of Health Professionals. October, 1981.

5. Department of Small Business. Regulation Reform. Principles for Occupational Regulation: Victorian Government Policy. 1992:2-4.

6. Victorian Department of Health. Review of Registration for Health Practitioners. 6a:Interim Report 1987; 6b:Final Report 1990.

7. Western Australia Department of Health, Legislation Review & Development Branch. Review of the Status of Unregistered Health Occupations. Health Dept WA. 1989:3-5.

8. Queensland Department of Health. Review of Health Practitioner Registration Acts: Discussion Paper. Qld Health, September, 1994:16-21.

9. Australian Health Ministers' Advisory Council. Working Group advising on criteria and processes for assessment of regulatory requirements for unregulated health occupations. Interim Report 1996.

10. Naturopathic Physicians Association of Australia Inc. Submission to Victorian Minister for Health and Community Services May 1995.

12. Australian Association of Social Work. Draft Policy Manual - Continuing Professional Education. July, 1996.

13. Australian Acupuncture Association Ltd. AHMAC Submission. May 1995.

14. Nurses Board of Victoria. Nexus Newsletter. May 1996 2(1):1.

15. Stacey M. Operating in the Public Interest? Health Matters 1991(9):12-14.

16. Health Issues Centre. Protection for Health Care Consumers: Where to Next? Melbourne. 1991:7.

17. Mitchell B. Acupuncture and Oriental Medicine Laws. National Acupuncture Foundation 1995:144.

18. Siggins I (Chair). Review of the Victorian Medical Practitioners' Act 1970. Health Department Victoria, 1992:14.

19. An Act respecting the regulation of Health Professions and other matters concerning Health Professions. Chapter 18, Statutes of Ontario, 1991.

20. Queensland Department of Health. Review of Medical and Health Practitioner Acts. Draft policy paper, September 1991.

Chapter 10: The Australian Regulatory Context

Summary of Findings

The context for regulation of TCM in Australia includes:

• the Mutual Recognition legislation for the registration of health professionals;

• the National Competition Policy along with the state based competition test; and

• the criteria for health practitioner registration adopted by the Australian Health Ministers' Conference and Advisory Council.

These policies directly impact on any recommendations to do with the regulation of the TCM practice.

• Regulation involves the imposition of restrictions on a particular group. For government to engage in occupational regulation, this imposition must be justified by a public purpose, namely a significant reduction in the risk to public safety. The type of regulatory framework deemed appropriate for TCM will thus depend on the nature of the problems arising from the practice of TCM.

• Recognition of professional status or contribution is not considered an appropriate purpose for government regulation.