The Health Requirement
People who want to migrate permanently, or stay in Australia temporarily for various periods and intentions, must undergo comprehensive examinations to ensure they meet Australia's health standards.
Background
The health requirement is defined in Australia's Migration Regulations. It is set by the Department of Immigration and Citizenship (DIAC) on advice from the Department of Health and Ageing.
It is designed to:
- minimise risks to public health in the Australian community are minimised
- contain public expenditure on health and community services is contained, and
- protect access by Australians to health and other community services.
In line with Australia's global non-discriminatory immigration policy, the health requirement applies equally to all applicants from all countries, although the extent of testing will vary with circumstances.
Immediate family members of any permanent migration applicant, including dependent family members who do not intend to migrate, must be assessed against the health requirement.
If an applicant cannot meet the health requirement, the visa application must be refused under the Migration Regulations. People applying for visas to stay temporarily for short periods may also be required to undergo a medical, and/or X-rays, if their health is of special significance to their work or lifestyle, or if there is a very high risk of tuberculosis rating in the country where they have been staying.
A chest-x-ray and physical examination may also be required if a temporary entrant intends going into any health-care environments such as hospitals, nursing homes, creches and pre-school centres, or where there are indications that the temporary entrant may not meet the health requirement.
Blood tests may also be required in certain occupations or circumstances.
The decision process
Generally, the DIAC processing officer will ensure that the applicant has first met other relevant entry criteria, before asking the applicant to start their health assessment, but will encourage early health assessment where possible.
In some instances (particularly for applications made in Australia), applicants may or must undertake health processing before lodging an application.
An application cannot be finalised until the results of the health assessment are received at the DIAC processing office. Results may have been referred to a Medical Officer of the Commonwealth (MOC) in Australia for formal opinion.
The processing officer is required by law to accept the MOC's opinion on whether an applicant meets the health requirement.
The MOC's opinion is based on the results of medical and radiological examinations, which include an applicant's medical history, age, period of intended stay in Australia and other relevant considerations.
Provided the applicant does not pose a public health or safety risk, MOC decisions are based on the potential cost and impact on the Australian community resulting from the possible use of medical and related services for any health condition detected.
In assessing cost, the MOC takes into account the applicant's likely need for medical, pharmaceutical and community services, including assisted accommodation, home and community care, special education and income support such as Special Benefit, Disability Support Pension and Carer's Pension.
These costs can amount to more than $2 million for one person.
Although a person may not intend to make use of these benefits, the MOC cannot by law take such an intention into account. This is because of the legal inability to withhold entitlements common to all Australians. The MOC's opinion on the estimated costs must also by law be taken as correct.
No condition, with the exception of tuberculosis, automatically precludes the grant of a visa. All other conditions are investigated individually for estimated costs and resource use impact on the Australian community.
Australia's comprehensive medical system, Medicare, applies to all Australian citizens and residents in need and it is not possible to 'opt out' of Medicare.
Specific diseases
Tuberculosis
Tuberculosis (TB) is an emergency and a public health risk and is occurring in epidemic levels globally, according to the World Health Organization.
All permanent and some temporary entry applicants must have a radiological examination to test for TB. Children under 11 are generally exempt but have a medical examination in lieu of an X-ray, or may be requested to undergo X-ray if the MOC considers it warranted.
Before the health requirement can be met, people found to have active or untreated TB must undergo a course of treatment, followed by further tests to confirm that the disease has been adequately treated.
DIAC does not recommend that pregnant women undergo X-ray. Health requirements and finalisation of the visa application are to be completed after the birth of the baby.
Applicants whose TB has been treated, as well as those with previous but now non-active TB, are required to make a formal Health Undertaking.
In doing so, they agree to contact the Health Undertaking Service on a free-call number on arrival in Australia, and to report to the State or Territory health authority to which they have been referred for follow-up monitoring.
Hepatitis
Although the risk of Hepatitis transmission from newly arrived migrants is considered by health authorities to be low, screening for Hepatitis B is mandatory where the applicant is:
- pregnant
- a child for adoption, or
- an unaccompanied minor refugee child.
For other applicants, examining doctors may seek a test for Hepatitis after observations.
Applicants who test positive for Hepatitis do not automatically fail the health criterion, but in most cases are asked to report to the Health Undertaking Service for referral to State or Territory health authorities on their arrival in Australia.
Applicants who have an occupation or history that may have resulted in blood contact (medicine, nursing, and dentistry) may be subject to Hepatitis testing, even for a temporary stay.
HIV/AIDS
HIV/AIDS testing was introduced in 1989 for all migrants aged 15 or older.
Applicants under 15 years old must also be tested if they are being adopted, have a history of blood transfusions, or have other clinical indications.
Applicants who have an occupation or history that may have resulted in blood contact (medicine nursing, dentistry) may be subject to HIV testing, even for a temporary stay. Applicants diagnosed as positive for HIV/AIDS are not automatically refused a visa. The condition will be investigated to estimate potential costs.
Other tests
Any other tests may be requested at any time by a MOC.
Waivers
The Migration Regulations allow the Minister's delegate processing officer to consider waiving the health requirement for some close family members or for humanitarian applicants (such as refugees) where the applicant does not represent a risk to public health or safety in Australia.
The waiver consideration is based on whether the applicant is likely to present an undue cost to the Australian community or prejudice the access of Australians to medical and related services. Special circumstances are taken into account.
Waivers are only considered after the MOC assessment. Waiver is possible in some temporary subclasses.
