The claim

Prime Minister Scott Morrison and members of his Government are warning that Australians face being kicked off hospital waiting lists by an influx of asylum seekers and refugees seeking medical treatment in Australia under the so-called medevac legislation.

Minister for Home Affairs Peter Dutton told reporters in Brisbane that "people who'd need medical services in Australia are going to be displaced from those services because if you bring hundreds and hundreds of people from Nauru and Manus [Island] down to our country they are going to go to the health network".

Mr Morrison repeated this claim, telling ABC Radio: "It's just a simple fact. If we've got to treat more people in Australia then obviously they're going to take the place of people who were getting that treatment anyway. It's just simple math."

Mathias Cormann, the Minister for Finance and the Public Service, also made the same claim, telling Sky News it was "a statement of fact" that "if more people come to Australia they will displace services that otherwise would be available for Australians".

Following Mr Dutton's claim, St Vincent's Health Australia tweeted: "This is a baseless claim. Public hospitals can accommodate the health needs of asylum seekers without disadvantaging anyone. St Vincent's is happy to make its hospitals available to provide care to asylum seekers without affecting waiting lists."

The Australian Healthcare and Hospitals Association, a national body that represents public hospitals, also used Twitter to say: "Australia's health system has enough capacity to cope with the small number of additional patients likely to require treatment under the medivac arrangements."

Would Australians be displaced from hospital waiting lists if refugees and asylum seekers came to Australia for medical treatment under the new legislation?

RMIT ABC Fact Check investigates.



The verdict

The claims made by Mr Morrison, Mr Dutton and Senator Cormann are baseless.

Australia's healthcare system is structured to allow for fluctuations in demand for hospital services.

Experts consulted by RMIT ABC Fact Check said even if all the refugees and asylum seekers on Manus Island and Nauru were to come to Australia for medical treatment, they could be accommodated without any material impact on hospital waiting lists.

Assuming the refugees and asylum seekers were treated as public patients, said the experts, they would be prioritised in the same manner as Australian citizens, and would attract Commonwealth funding that is provided to hospitals to manage extra patients.

Accordingly, emergency patients would be triaged and given immediate medical treatment. Patients requiring non-emergency medical treatment would be categorised according to need and placed on waiting lists.

All hospitals need to accommodate emergency and non-emergency patients. ( Unsplash: Natanael Melchor )

How many refugees and asylum seekers require medical treatment?

There are a total of 1015 detainees on Nauru and Manus Island, 787 of whom are classified as refugees.

It is unclear how many are sick, or how many might apply to be transferred elsewhere for medical treatment.

Known as the medevac legislation, the new laws govern the transfer of people from offshore processing countries for medical or psychiatric "treatment or assessment".

The legislation applies specifically to detainees currently on Nauru and Manus Island.

Immigration Minister David Coleman has said he expects all those in offshore facilities will ultimately come to Australia as a result of the legislation.

Jana Favero of the Asylum Seeker Resource Centre, which is part of a coalition of NGOs managing the cases of those who wish to apply for a transfer, told Fact Check she expects about three to five applications this month.

However, there remains uncertainty about whether detainees would, in fact, be sent to Australia.

The Government has also indicated that refugees and asylum seekers requesting transfers for medical treatment would be sent to Christmas Island, the Australian territory more than 2,600 kilometres north-west of Perth.

How public hospitals accommodate fluctuations in demand

State and territory governments largely own and manage public hospitals in Australia through what are known as Local Hospital Networks, set up to co-ordinate hospital services and funding in defined areas.

There are 136 of these networks in Australia; they oversee 701 public hospitals and 61,000 hospital beds.

Governments enter into what are known as service level agreements with each of the Local Hospital Networks, setting out the type and volume of services they must provide.

Hospitals normally schedule patients evenly over the course of the year in accordance with these agreements and funding, factoring in anticipated peaks and troughs in patient demand.

Services are provided free through Medicare, but because of the volume of patients, waiting lists regulate the demand for non-emergency — or elective — surgery.

Through a combination of triage and flexible funding, public hospitals "flex up" or "flex down" to accommodate varying levels of demand for hospital services.

The latest available data shows that in 2016-17 there were more than 11 million admissions to hospitals, 6.6 million of which were admissions to public hospitals.

A supplied image of police entering the Manus Island detention centre in late 2017. ( AAP/Supplied )

Hospital waiting lists

All hospitals need to accommodate emergency and non-emergency patients. The former are dealt with urgently.

People with non-life threatening medical complaints, meanwhile, are placed on waiting lists.

These elective surgery patients are categorised according to their clinical needs using a triage system which classifies them in order of urgency.

Treating doctors refer to the standards set in the National Elective Surgery Urgency Categorisation guidelines to help them assign patients to one of three elective surgery categories.

These are as follows:

Category 1: surgery is recommended within 30 days

Category 1: surgery is recommended within 30 days Category 2: surgery is recommended within 90 days

Category 2: surgery is recommended within 90 days Category 3: surgery is recommended within one year.

The purpose of categorising elective surgery patients is to manage patient access equitably, so that priority is given to those who are assessed as having the greatest need.



The time periods recommended for surgery in each category are broad targets that hospitals aim to meet within their allocated budgets.

How refugees and asylum seekers would be managed in Australia's hospital system

Dr Stephen Duckett, the Grattan Institute's health program director, told Fact Check the refugees and asylum seekers on Nauru and PNG were so few in number that their impact on Australian waiting lists would be negligible.

"Even if every one of them was admitted, it's not going to make a material difference," he said.

"If there were 1000 extra admissions on top of the 6.6 million that we had in 2016-17, you would not be able to measure it, it's too small."

He said assuming that medical transferees who came to Australia for treatment were managed as public patients, they would be categorised using the same procedures used to categorise Australian citizens.

So, if they were admitted to hospital as emergency patients they would be seen immediately and the hospital could create extra capacity by discharging early those patients who were already very close to being discharged, he said.

"That, in a sense, even with no more beds, even with no more staff, creates an ability to admit someone to the emergency department and it does not directly affect the waiting lists," he said.

If the transferees presented as elective patients they would be categorised according to the urgency of their medical need and would join the waiting lists, just as Australian citizens would.

"So, they might go down the bottom of the list if that's what their priority is, or they might go to the top of the list if that's what their priority is," he said.

The acting chief executive of the Australian Healthcare and Hospitals Association, Dr Linc Thurecht, agreed with Dr Duckett, telling Fact Check public hospitals were accustomed to dealing with increases in demand and an influx of 1000 transferees could be accommodated without Australians being displaced from hospital waiting lists.

"If [detainees] all turned up at one hospital, then the hospital would go into a normal triage type situation," he said.

"But I think it's more reasonable to say, whatever numbers do find a need for emergency transfer, they will be spread out over time, and indeed, we'll be able to spread it out across the health system where there is capacity.

"Given our understanding of the way the Australian healthcare system and public hospitals are set up, we are not aware of any evidence that would support [Mr Dutton's] claim."

The detention centre on Christmas Island, pictured here in 2011. The Government has indicated that refugees and asylum seekers in offshore detention who request transfers for medical treatment would be sent to Christmas Island. ( AAP: Lloyd Jones )

The last piece of the jigsaw: hospital funding

To understand how public hospitals "flex up" or "flex down" to accommodate variable demand, it's important to understand not only how waiting lists work, but also how the extra patients are funded.

Under the National Health Reform Agreement, signed in 2011, public hospital funding is based on patient volume and the complexity of treatments.

This is known as Activity Based Funding and ensures hospitals are paid for the number and mix of patients they treat: if a hospital treats more patients, it receives more funding.

Activity Based Funding uses a nationally consistent approach, where payments are based on the same price for the same service provided across hospitals.

Hospital activities or services are priced according to their complexity and the resources required to perform them.

A national body distributes pooled Commonwealth and state and territory contributions to hospitals, based on these funding arrangements.

Under the current funding arrangement (2017-2020), the Commonwealth funds 45 per cent of the "efficient growth of activity based services", capped at 6.5 per cent a year.

Essentially, this means the Federal Government pays 45 per cent of the cost of the growth in the number of public hospital patients.

This allows the hospital to meet the cost of taking on extra patients, assuming the hospital is working within the parameters set out in the service level agreement between the Local Hospital Network and the state or territory government.

Or, as Dr Duckett, explained: "If the patient brings extra money with them [that is, Commonwealth funding], this allows the hospital to employ extra staff or meet the extra cost of treating them.

"That's what’s called "flexing up"; that is, if you've got additional revenue that goes along with the patients, you can afford to admit them."

Principal researcher: Sushi Das, chief of staff

Sources