Guideline - Access to public health care for Medicare-ineligible victim-survivors of Domestic and Family Violence and/or Sexual Assault
Directive number: QH-HSDGDL-045-1
Effective date: 24 July 2024
Review date: 18 July 2027
Supersedes: Version 1.0
On this page:
- Purpose
- Scope
- Barriers for Medicare-ineligible victim-survivors of DFV and/or sexual assault
- Identifying individuals who are experiencing, or at risk of experiencing, DFV
- Identifying individuals who have experienced sexual assault
- Definitions
- Related documents
- Document approval details
Purpose
This guideline supports the implementation of a mandatory requirement under the Health Service Directive (HSD) Fees and charges for healthcare services (QH-HSD-045) for Hospital and Health Services (HHSs) to ensure that Medicare-ineligible victim-survivors of domestic and family violence (DFV) and/or sexual assault are provided access to public healthcare for assessment, diagnostic investigations, treatment, and other supportive care, relating to their experience without any costs to the individual.
Scope
All HHSs must comply with the new HSD requirement.
From 28 June 2024, Medicare-ineligible victim-survivors of DFV and/or sexual assault can access free health care in relation to an experience of DFV or sexual assault. Free health care means no costs charged directly to individuals. Where possible, costs can be indirectly recovered from a third party, such as private health insurers, travel insurers and/or asylum seeker support agencies. Free health care can be provided in a public hospital or other public health setting at the time of presentation when DFV and/or sexual assault is disclosed or identified.
The disclosure and associated care may be provided in an Emergency Department, in-patient or out-patient setting. See Appendix 1 for services and treatments that are in scope.
An example of a Patient Workflow for a Medicare-ineligible patient presenting to a HHS in response to an experience of DFV and/or sexual assault is provided at Appendix 2.
People covered under the Directive include anyone who is not eligible for Medicare, including (but may not be limited to):
- all genders and age groups, including children and young people;
- people on proposed marriage and partner visas, including children attached to these visas;
- people on Bridging Visas;
- international students, including scholarship students and their family members;
- people who are on temporary work visas, including seasonal workers and their family members in Queensland;
- people on Visitor Visas, including those who might be fleeing conflict or on a pathway to seeking asylum in Australia; and
- people whose visa status is uncertain or expired, but they are not considered to be seeking asylum.
People seeking asylum are already covered for public healthcare in Queensland under QH-HSD-045. For more information, visit the Queensland Health website on public healthcare access for asylum seekers.
Medicare-ineligible individuals who can access private health insurance for treatment (including Overseas Student Health Cover and Overseas Visitors Health Cover) should, where possible, have their treatment covered by their health insurance. However, care should be taken when applying this as for some people, their partner or employer might sponsor their health insurance or manage their policy, limiting their ability to access cover. Where there is a risk that using a victim-survivor’s health insurance for this purpose would compromise their safety or confidentiality, the health service should exercise due care and respect the patient’s concerns.
Individuals who are citizens of a country that has a reciprocal health agreement with Australia (i.e., United Kingdom, New Zealand, Sweden, Netherlands, Slovenia, Belgium, Finland, Republic of Ireland, Malta, Italy and Norway) are able to access medically necessary healthcare services while visiting Australia. Refer to Services Australia - Reciprocal Health Care Agreements for details relating to individual countries. In instances where the treatment for a DFV and/or sexual assault is not covered by the reciprocal health agreement, these individuals should not be charged for their treatment.
Barriers for Medicare-ineligible victim-survivors of DFV and/or sexual assault
People who are ineligible for Medicare, particularly those from culturally and linguistically diverse (CALD) backgrounds, can face complex challenges when trying to access health services as a victim-survivor of DFV and/or sexual assault. Barriers include but are not limited to:
- ineligibility for Medicare and other government services due to their visa type;
- dependence on another person, often a partner or employer who is a sponsor of their visa, particularly if the other person is the person using violence;
- inability to pay for healthcare or financial dependence, which could include dependence for transportation, housing, and ongoing sponsorship of their visa;
- ‘visa abuse’, where a person’s temporary or dependent visa status is used to control them or is intentionally exploited by a perpetrator;
- fear of engaging with government services and the impact this may have on their visa status or their partner’s visa status;
- differing attitudes and understanding of what domestic and family violence is and tolerance for violent behaviours;
- differing attitudes by health professionals in responding to CALD communities and women’s health generally;
- stigma and embarrassment; and
- language barriers.
It is important for frontline staff who are involved in patient administration and care to be aware of these complexities when engaging with Medicare-ineligible people, particularly those from CALD backgrounds. A DFV specialist health worker or social worker should be engaged in any situation involving suspected or disclosed abuse, violence or assault, as well as a credentialed interpreter if required.
For more information on when interpreters should be engaged, read the Working with Interpreters Guidelines.
Identifying individuals who are experiencing, or at risk of experiencing, DFV
There are existing Queensland Health procedures and guidelines that help health workers sensitively screen for DFV.
The Health workforce DFV training guideline, which applies to all health service employees, outlines the recommended resources and training programs available to promote best practice, particularly for those employees in clinical areas who are more likely to interact with DFV victim-survivors and/or persons using violence.
The Queensland Health DFV Toolkit of resources has been developed to help health workers use sensitive inquiry to safely and appropriately recognise, respond, and refer to suspicions and disclosures of DFV.
Staff and nurses who work in admin and triage in the course of their normal duties, as well as those staff in the revenue and billing parts of the HHSs should complete, at a minimum, the Understanding Domestic and Family Violence online module and be familiar with the contents of these guidelines.
Under the Health workforce DFV training guideline, it is also recommended that health professionals who work in the following clinical areas complete the Clinical response to Domestic and Family Violence learning package within six months of commencing their role and refresh the training every three years:
- maternity services;
- emergency departments;
- community child health;
- paediatrics;
- allied health;
- mental health, alcohol and other drug services;
- sexual health;
- Aboriginal and Torres Strait Islander health; and
- multicultural health services.
Identifying individuals who have experienced sexual assault
The Caring for people disclosing sexual assault Health Service Directive (QH-HSD-051) outlines the responsibilities of HHSs in caring for any person who discloses that they are a victim of sexual assault, and the separate requirements for reporting suspected sexual offences against children to police and to child safety under the Criminal Code and Child Protection Act 1999.
Definitions
| Term | Definition / Explanation / Details |
|---|---|
Culturally and linguistically diverse (CALD) | Culturally and linguistically diverse communities are those whose members identify as having non-mainstream cultural or linguistic affiliations by virtue of their place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. |
Disclosure | Any occasion when an adult or child who has experienced or perpetrated DFV informs a health employee or any other third party. |
Domestic and Family Violence (DFV) | DFV includes behaviour, or a pattern of behaviour, that is physically, sexually, emotionally, psychologically or economically abusive, threatening, coercive or aimed at controlling or dominating another person through fear within a relevant relationship. A relevant relationship includes an intimate personal relationship, a family relationship or an informal care relationship. |
Health professional | The Hospital and Health Boards Act 2011 defines a health professional as -
|
Medicare-ineligible | Patients who are not eligible for Medicare, including overseas visitors who:
|
Person using violence | A person who is being violent, abusive or controlling towards the victim-survivor. The term recognises a person’s ability to undergo personal development, be accountable for their actions, and stop their harmful behaviours. |
Sexual assault | Sexual assault and sexual violence are two terms that are sometimes used interchangeably and refer to sexual activity that happens where consent is not freely given or obtained, is withdrawn or the person is unable to consent due to their age and other factors. It occurs any time a person is forced, coerced, or manipulated into any sexual activity. |
Victim-survivor | A person who experiences DFV and/or sexual assault, including children and young people. |
Related documents
- Fees and charges for health care services Health Service Directive [QH-HSD-045]
- Caring for people disclosing sexual assault Health Service Directive [QH-HSD-051]
Document approval details
Document custodian
Executive Director, System Policy Branch, Strategy, Policy and Reform Division
Approval officer
A/Deputy Director-General, Strategy, Policy and Reform Division
Approval date: 18 July 2024
Version control
| Version | Date | Comments |
|---|---|---|
| 1.0 | 18 July 2024 | New approved HSD guideline |
Appendix 1
In-scope treatment and services
Healthcare services provided by HHSs in Emergency Departments, in-patient or out-patient settings for the purposes of assessment, diagnostic investigations, treatment (including the provision of medications) and other supportive care in relation to a DFV and/or sexual assault-related experience, including (but may not be limited to):
- Clinical care and forensic medical examinations for people disclosing sexual assault;
- Physical injury assessments and associated clinically indicated investigations (including radiological investigations);
- Treatment of any physical injuries;
- Psychosocial support and other necessary allied health services relating to the experience;
- Testing and prophylaxis for sexually transmissible infections, including post-exposure prophylaxis;
- Pregnancy testing;
- Emergency contraception;
- Termination of pregnancy as a result of DFV and/or sexual assault; and
- Interpreter services.
Where appropriate, HHSs can continue to recover costs from third parties, such as private health insurers, travel insurers or asylum seeker support agencies.
Scope to be determined on a case-by-case basis
The HHS may use its discretion, on a case-by-case basis, to determine what treatments are required to be provided at no cost to a Medicare-ineligible individual in complex circumstances. This discretionary power may be exercised by a senior or executive level officer at the relevant hospital/HHS through advocacy from a treating physician, specialist DFV health worker or social worker. Services that may be out of scope generally but could be considered include:
- Ongoing medications not related to prophylactic treatments of sexually transmissible infections;
- Ongoing allied health support; and
- Antenatal and maternity services.
Appendix 2
Example - Patient Workflow
Please follow the link to Appendix 2: Example - Patient Workflow