Annual Report - Outcome 13

Table of contents

Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 13 aims to provide all Australians with access to cost-effective and high quality acute care services. The outcome also aims to ensure a safe supply of blood and blood-related products; increase the rate of organ and tissue donation in Australia; and support doctors who provide private medical services. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 13 (Program Objectives in 2008–09)

Program 13.1 – Blood and Organ Donation Services

Provide funding to the National Blood Authority to ensure demand for blood and blood products is met.
Support Australian patients under the Bone Marrow Transplant Program.
Fund non-government organisations in the blood and organ donation sectors.
Fund State and Territory Governments under the Hepatitis C Litigation Settlement Scheme.

Program 13.2 – Medical Indemnity

Ensure doctors have access to fair, affordable and secure medical indemnity insurance.

Program 13.3 – Public Hospitals and Information

Support the provision of free public hospital services to public patients through the Australian Health Care Agreements.
Fund the development of national classification systems for patients, their treatment and associated costs.
Provide funding to State and Territory Governments to help improve access to public dental treatment.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 13 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 13 was managed in 2008–09 by the Acute Care Division and the Regulatory Policy and Governance Division.

Major Achievements for the Outcome:

More sustainable public hospital services into the future, achieved through the provision of an additional $500 million in base health care funding for states and territories (see Supporting Improvements in the Efficiency of, and Access to, Public Hospitals and Health Services);
Worked with the states and territories to develop an outcome-focused National Healthcare Agreement to provide timely and quality health care services to all Australians (see Supporting Improvements in the Efficiency of, and Access to, Public Hospitals and Health Services);
Worked with the states and territories to deliver elective surgery to an additional 41,584 patients by implementing stage one of the Elective Surgery Waiting List Reduction Plan (see Improving Elective Surgery and Reducing the Waiting List); and
Worked to increase the number of life-saving and life-transforming transplants for Australians by establishing the new Australian Organ and Tissue Donation and Transplantation Authority to implement the national reform package (see Reforming National Efforts to Lift Organ and Tissue Donation Rates).

Challenges for the Outcome:

Delayed reduction of waiting lists for public dental services, due to the postponed implementation of the Commonwealth Dental Health Program (see Improved Access to Commonwealth Dental Health Services); and
Activation of the National Blood Supply Contingency Plan due to a shortage of red cells nationally (see Ensuring the Safe Supply of Blood and Blood-related Products).

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Key Strategic Directions for 2008–09 – Major Activities

Long Term, Sustainable Health Reform through the National Health and Hospitals Reform Commission

To ensure sustainable improvements in health outcomes, the Department worked to address a range of challenges faced by the health and hospital system, such as the burden of chronic disease, an ageing population, rising health costs, and pressures such as increased demand for services. This involved supporting the National Health and Hospitals Reform Commission to develop and oversee a long-term health reform plan for Australia.

The Department did this, in addition to the provision of funding, by informing the community about the Commission’s role and encouraging people to contribute to the reform process through submissions. The Commission subsequently received over 500 initial submissions which helped inform a series of discussion papers on possible reform areas, and an interim report, which was released in December 2008 (available at www.nhhrc.org.au). The interim report emphasised four strategic reform directions and contributed to the process through: promoting individual and collective action to take responsibility for good health and wellbeing; establishing connections in services so that patients receive comprehensive care throughout their life; recognising and addressing health inequities; and improved use of people, resources and knowledge. The Commission received feedback from almost 700 individuals and organisations on its interim report.

The Commission released the final report in July 2009. In 2009–10, the Department will assist the Government in the community consultation process, and provide advice to the Government on the final report.

Funding for the above activities was sourced from Program 13.3 – Public Hospitals and Information.

Supporting Improvements in the Efficiency of, and Access to, Public Hospitals and Health Services

The Department administers funding to assist the states and territories to deliver free public hospital services to the community and to support improvements in the access, efficiency and care available through the public health system. During 2008–09, provision of this assistance involved the conclusion of funding under the Health Care (Appropriation) Act 1998 and the introduction of transitional arrangements to prepare for the new Council of Australian Governments’ federal financial framework.

In 2008–09, the Department administered $10.257 billion under the Ministerial Determination, to extend the terms of the 2003–08 Australian Health Care Agreements by one year. The provision of an additional $500 million base health care funding to the states and territories, and more generous indexation provisions under the new Health Specific Purpose Payments, contributed to better relationships with the Australian, State and Territory Governments, and put public hospital services on a more sustainable footing for the future.

A major achievement for the Department during the year was completing negotiations with the states and territories to develop a new National Healthcare Agreement. The agreement aims to shape the health system around the health needs of patients, their families and communities; and focus on disease prevention and injury management; not simply the treatment of illness. The agreement also supports an integrated approach to the promotion of healthy lifestyles, and diagnosis and treatment of illness across the continuum of care; and provides people with timely access to quality health services based on their needs, not ability to pay.

In addition, the Government provided $1.286 billion in 2008–09 for activity based funding, subacute care and Taking Pressure off Public Hospitals (Emergency Department) Council of Australian Governments reforms, which are part of the National Partnership Agreement on Hospital and Health Workforce Reform. The Department worked with the states and territories on the implementation of these initiatives. A National Framework and Implementation Plan for activity based funding was finalised and jurisdictions commenced development of state-level implementation plans for delivery in August 2009. The Department also worked closely with the states and territories on the development of implementation plans for the subacute care and Taking Pressure off Public Hospitals elements, to enable approval of the plans in 2008–09.

In 2009–10, the Department will monitor the implementation of the National Healthcare Agreement and National Partnerships through a range of mechanisms such as regular meetings with the states and territories, to ensure that the new outcomes-focused approach delivers improved performance in health care.

Funding for the above activities was sourced from Program 13.3 – Public Hospitals and Information.

Improved Access to Commonwealth Dental Health Services

Under the Commonwealth Dental Health Program, the Australian Government intends to provide $290 million to the State and Territory Governments to fund around one million additional public dental visits over three years. Planned closure of the previous government’s Medicare Chronic Disease Dental Scheme did not proceed in 2009–10 with the consequence that the Commonwealth Dental Health Program has not been implemented. The Senate did not support the closure and the Government was unable to put in place the necessary subordinate legislation to close the scheme, with the consequence that funding for the program is not presently available.

Improving Elective Surgery and Reducing the Waiting List

A key focus during the year was to reduce the number of people waiting longer than clinically recommended for elective surgery. The Department aimed to do this by implementing a waiting list reduction plan by boosting elective surgery and expanding the capacity of hospitals, for example through additional equipment and operating theatres.
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Waiting Lists

In 2008–09, the Department worked with the states and territories to implement the Elective Surgery Waiting List Reduction Plan, which aims to ensure sustainable improvements in the delivery of elective surgery.

The Department began implementing the plan in three distinct stages. Under the first stage, which ended on 31 December 2008, the Department administered funding to jurisdictions to reduce the number of patients waiting longer than clinically recommended for surgery. A national target of 25,278 additional procedures was set for 2008, which was exceeded by 64 per cent. An additional 41,584 patients received elective surgery in 2008 than in 2007. As at 31 December 2008, 22,615 patients were waiting longer than recommended, which compares favourably with the 33,654 patients overdue for an operation as at 30 September 2007. Reporting for this performance of the plan was provided quarterly and published on the internet at www.health.gov.au following Australian Health Ministers’ Conference endorsement.

During 2009–10, the Department will provide additional funding to the states and territories to support elective surgery system improvements and reward those jurisdictions that meet reduction targets.

Increased Public Hospital Capacity

Increasing the capacity of hospitals will make surgery more efficient and reduce waiting lists. During 2008–09, the Department began the second stage of the Elective Surgery Waiting List Reduction Plan, to build public hospitals’ capacity to improve elective surgery performance. Projects supported included: the construction of additional operating theatres in places such as the Geelong and Frankston hospitals, a number of facilities in South Australia and the Royal Darwin and Alice Springs hospitals; and the purchase of new surgical equipment and improved elective surgery management in hospitals such as the Children’s Westmead Hospital in New South Wales.

Funding for the above activities was sourced from Program 13.3 – Public Hospitals and Information.

Ensuring the Safe Supply of Blood and Blood-related Products

Australia needs about 20,000 donations of blood every week to meet current demand. The ability for patients to have blood products when they need them is called ‘supply security’. If supply security is adequate, it means there are always products available to meet clinical demand regardless of a range of adverse events. In 2008–09, the Department worked to ensure supply security of blood and blood-related products by supporting quality and safety improvements; and increasing blood and plasma donation rates.

Quality and Safety Improvements

The ongoing quality and safety of Australia’s blood supply is dependent on ensuring that the Australian Red Cross Blood Service has access to high quality blood manufacturing infrastructure, as supply shortages most commonly occur when there is a problem in the manufacture of a blood product. To this end, in 2008–09, the Department worked closely with the National Blood Authority and the Australian Red Cross Blood Service to secure funding for the redevelopment of the principal blood manufacturing sites in Sydney and Melbourne. Final funding approval for the Sydney development was provided on 18 April 2009. Work will continue in 2009–10 to finalise the funding arrangements for the development in Melbourne.

The Department also worked to accelerate the introduction of universal leucodepletion (where white cells are removed from blood products), testing of platelets for bacterial contamination as part of the manufacturing process, and to increase monitoring of adverse transfusion reactions.
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Blood and Plasma Donation

The Department provided funding to the Australian Red Cross Blood Service to support initiatives during 2008–09 (the ‘Year of the Blood Donor’), to: celebrate blood donors; enhance community awareness of the value of, and need for, blood and plasma donors; and to help recruit new donors to meet growing need. As at 26 May 2009, the Australian Red Cross Blood Service reported that more than 17,000 Australians had visited the Year of the Blood Donor travelling exhibition, during which more than 9,000 blood typing tests were conducted and test recipients had pledged to donate blood.

A major challenge for the year occurred on 4 September 2008, when the National Blood Authority activated the National Blood Supply Contingency Plan due to low Group O blood stocks nationally. The authority activated the lowest level of the plan (White Alert), which aims to increase collection and production to build stock levels while meeting demand for emergency services and the majority of other clinical requirements. During the alert, the Department coordinated national media advice on the blood supply level and coordinated the jurisdictional analysis of the public health impact of the shortage. The alert continued until 23 October 2008 when the National Blood Authority in conjunction with the Jurisdictional Blood Committee and the Australian Red Cross Blood Service agreed that blood stocks and donation trends were sufficiently robust.

Funding for the above activities was sourced from Program 13.1 – Blood and Organ Donation Services.

Reforming National Efforts to Lift Organ and Tissue Donation Rates

In 2008, there were 259 deceased donors who enabled life-saving kidney, heart, lung, liver and pancreas transplants for 1,000 Australians; as at 1 January 2009, 1,625 patients were on waiting lists for organ transplants. This year, the Department worked to address this imbalance through a new national approach to organ and tissue donations and transplantation, and support for the National Cord Blood Collection Network.

National Reforms

A major achievement for the Department in 2008–09, was the establishment of the Australian Organ and Tissue Donation and Transplantation Authority as an independent legal entity within the Health and Ageing portfolio on 1 January 2009, which will provide leadership and drive implementation of Government reforms to lift donation and transplantation rates. The Department was responsible for creating the statutory office and functions of the Chief Executive Officer and the Authority’s governance structure.

The Department led the development of the transitional framework for moving the responsibility of the reform package from the Department to the Australian Organ and Tissue Donation and Transplantation Authority. It also provided the Authority with high level support to build its operational infrastructure.

National Cord Blood Collection Network

Cord blood is the blood left behind in the placenta and umbilical cord. While it is usually discarded after childbirth, cord blood is rich in blood-forming (haemopoietic) stem cells which can be transplanted into a patient to produce different types of blood cells after the patient’s own cells have been destroyed through treatments such as chemotherapy and irradiation. In 2008–09, the Department in conjunction with the states and territories, helped ensure a sufficient cord blood supply, by supporting the National Cord Blood Collection network. The network collects, banks and stores umbilical and placental cord blood. It also provides a coordinated approach delivering matched unrelated umbilical cord blood to patients requiring haemopoietic stem cell transplantation.

Funding for the above activities was sourced from Program 13.1 – Blood and Organ Donation Services.
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Implementation of Australian Health Care Classification Systems

In 2008–09, the Department worked closely with the Australian Institute of Health and Welfare to manage the annual collection, validation and reporting of national health care data submitted by states and territories as part of their reporting obligations under the Australian Health Care Agreements.

In August 2008, the Department published the Round 11 (2006–07) National Hospital Cost Data Collection. The National Hospital Cost Data Collection produces national average costs and costs weights for acute patients in the public and private hospital sectors. Cost data for private hospitals was published for the first time in four years and comprised 59 per cent of all private hospital acute separations. The private same-day National Hospital Cost Data Collection was initiated in Round 11 for the first time, however due to low levels of participation, the collection was not published. The Department worked closely with industry in 2008–09 to overcome the low levels of participation for day hospitals. This has resulted in a private same day costing collection being able to be published with all results in the Round 12 (2007–08) collection in August 2009.

In January 2009, the Department commissioned a review of the Australian Refined Diagnosis Related Group system’s management. The Australian Refined Diagnosis Related Group provides the basis of national admitted hospital patient information in Australia. This review sought to examine the operation of the refinement of the system (including the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification, (ICD-10-AM)) and provided recommendations based on stakeholder consultation for improvements.

Along with this, the Department published the Australian Refined Diagnosis Related Group version 6.0 in November 2008. This major review followed on from the release of the ICD-10-AM version 6.0 in July 2008. Work on ICD-10-AM version 7.0 began in July 2008.

A priority for the Department in 2009–10 will be to implement recommendations arising from a review of state and territory based information on diagnoses and procedures, aimed at ensuring that Australia remains an international leader in the field of health care information.

Funding for the above activities was sourced from Program 13.3 – Public Hospitals and Information.
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Safe and Sustainable Service at Mersey Community Hospital

On 7 March 2008, the Department commenced a two stage tender process to identify a suitably qualified and experienced organisation to operate the Mersey Community Hospital. The successful organisation would have been responsible for improving the health care services for people in the north-west region of Tasmania. However, the tender process did not result in a concluding bid.

The Department subsequently signed a Heads of Agreement with the Tasmanian Government for the Tasmanian Department of Health and Human Services to operate and manage the Mersey Community Hospital from 1 September 2008 to 30 June 2011. The agreement provides funding of up to $180 million over three years to be used solely at the Mersey Community Hospital. This arrangement ensures that the Mersey Community Hospital is integrated within the Tasmanian health care system, and will allow the hospital to continue to provide the current range of services and to identify any potential to enhance hospital services, for the benefit of the Mersey and surrounding communities. The funding also provides for capital works and improvements at the hospital. The Department closely monitored the services and finances of the hospital, through quarterly and annual reporting.

Funding for the above activities was sourced from Program 13.3 – Public Hospitals and Information.

Key Facts for 2008–09: Highlights from the State of Our Public Hospitals June 2009 Report

In 2008–09, there were:
- 4.7 million admissions to public hospitals; and
- 3.1 million admissions to private hospitals.
Fifty per cent of patients admitted to public hospitals and 66 per cent of patients admitted to private hospitals were discharged on the same day.
Of all public patients admitted, 67 per cent received acute medical care, 18 per cent surgery, six per cent medical procedures, six per cent maternity and three per cent sub-acute services.
Of all private patients admitted, 34 per cent received acute medical care, 38 per cent surgery, 20 per cent medical procedures, three per cent maternity, and four per cent sub-acute services.
A total of 565,501 patients underwent some form of elective surgery as public patients, with a median waiting time of 34 days. Of these, 84 per cent were seen within the time recommended.
There were over 7.1 million presentations to emergency departments in public hospitals.
Sixty-nine per cent of people were seen within the time recommended for their triage category. Half of all patients were seen within 24 minutes.
Twenty-eight per cent of people who presented to an emergency department were admitted to hospital or referred for treatment.

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Performance Information for Outcome 13 Administered Programs

Program 13.1 – Blood and Organ Donation Services
Indicator:	Increased rates of organ donations.
Reference Point/Target:	Implement measures to achieve a long-term, sustainable increase in Australia’s organ donation rate.
Result: Indicator substantially met.
In 2008, there were 259 organ donations in Australia, a rate of 12.1 donors per million population. This is an increase on the previous year of 198 deceased donations, a rate of 9.4 donors per million population. The Department worked collaboratively with the Australian Organ and Tissue Donation and Transplantation Authority, and the states and territories to implement the national organ and tissue reform package to improve donation rates. The authority assumed full responsibility of all elements of the reform package from the Department on 6 March 2009, three months ahead of schedule.

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Program 13.2 – Medical Indemnity
Indicator:	Reduction in the number of doctors requiring support under the Premium Support Scheme.
Reference Point/Target:	Reduction in the number of participating doctors.
Result: Indicator met.
The number of doctors requiring support under the Premium Support Scheme has fallen as medical indemnity premiums have become more affordable relative to the gross medical income of eligible doctors. This indicator was not met in 2007–08, where 3,611 doctors required support, an increase from the 3,533 requiring support in 2006–07, and 3,573 in 2005–06. In 2008–09, 2,607 doctors required support under the Premium Support Scheme.

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Program 13.3 – Public Hospitals and Information

Indicator:

Improve access to public dental services.

Reference Point/Target:

Reduction in state and territory public dental waiting lists for priority groups assisted.

Result: Indicator not met.

The Department was unable to meet this indicator due to delays in implementing the Commonwealth Dental Health Program.

Indicator:

Access to free public hospital emergency services. Measured by the number of public emergency department patients per 1,000 weighted population.

Reference Point/Target:

The same or increase on previous year.

Result: Indicator met.

In 2007–08, 7.1 million emergency presentations/occasions of service were provided to Australians. This equates to 321 presentations to accident and emergency departments of hospitals per 1,000 weighted population, an increase of 10 presentations per 1,000 weighted population since 2006–07. ‘Per 1,000 weighted population’ is a methodology applied by the Department to standardise the population on an age cohort basis across states and territories to make comparisons meaningful.

Table 2.3.13.1: Number of Accident and Emergency Presentations, Public Hospitals, 2006–07 and 2007–08

Australia	2006-07		2007-08
	Number	Number per 1,000 Weighted Population	Number	Number per 1,000 Weighted Population
	6,741,304	311	7.100,618	320.6

Source: State of Our Public Hospitals 2008 and 2009 reports.

Figures for 2008–09 will be available by June 2010, as required under the extended conditions of the Australian Health Care Agreements.

Indicator:

Timely treatment of public emergency department patients. Measured by the proportion of patients seen within the recommended timeframe.

Reference Point/Target:

Increased proportion seen within the recommended time across each state and territory.Australia

Result: Indicator not met.

In 2007–08, around 69% of patients at emergency departments of hospitals were seen within the clinically recommended timeframe, a reduction of 1% from 2006–07. However, emergency departments treated more patients, with the total volume of people seen within the recommended timeframe increasing by around 130,000 in 2007–08. Half of all emergency department patients were seen within 24 minutes in 2007–08, the same as in 2006–07.

Source: Australian Hospital Statistics 2006–07 and 2007–08 reports.

Table 2.3.13.2: Emergency Departments – Median Waiting Times for all Patients and Number Seen Within Recommended Time, 2006–07 and 2007–08

Australia	2006-07		2007-08
	Minutes	% Seen Within Recommended Time	Minutes	% Seen Within Recommended Time
	24	70	24	69

Indicator:

Timely public admission of people for elective surgery. Measured by the proportion of public patients admitted within the clinically appropriate timeframe.

Reference Point/Target:

Increased proportion across each state and territory.

Result: Indicator not met (note the proportion remained stable across years).

In 2007–08, 84% of patients were admitted for elective surgery within the recommended time. This is unchanged from 2006–07. Figures for 2008–09 will be available by June 2010, as required under the extended conditions of the Australian Health Care Agreements.

Indicator:

Additional patients receiving elective surgery.

Reference Point/Target:

An additional 25,278 patients on waiting lists treated under the Elective Surgery Waiting List Reduction Plan by December 2008.

Result: Indicator exceeded.

States and territories reported that 41,584 more patients received elective surgery in 2008 compared with 2007, which is 64% above the plan target of an additional 25,278 patients treated.

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Figure 2.3.13.1: Elective Surgery Proportion of Patients Admitted to Public Hospitals within the Clinically Appropriate Time, by Clinical Urgency Category

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Source: Elective Surgery Waiting Times (additions and removals) National Minimum Data Set.

Indicator:	Accurate costing and reporting of hospital activity and healthcare services through national healthcare classification, service costing and performance monitoring.
Reference Point/Target:	National Hospital Cost Data Collection round 11 reported by August 2008. Release of Australian Refined Diagnosis Related Groups v6.0 by 1 September 2008. Implementation of the National Hospital Cost Data Collection Review recommendations. Agreement on a new broader hospitals classification and performance framework and development program.
Result: Indicator substantially met.
The Department released the National Hospital Cost Data Collection Round 11 report in August 2008 for public and private hospitals and began work on Round 12 in November 2008; Version 6.0 of the Australian Refined Diagnosis Related Groups was released in November 2008. The development work on broader hospitals classification and performance work was deferred during 2008–09 while the Council of Australian Governments considered broader hospital reform. In May 2008, the review of the National Health Cost Data Collection was completed, however the Department delayed the implementation of the review’s recommendations following the Council of Australian Governments’ development of the broader health reform agenda, in particular the Activity Based Funding initiative possessive.
Indicator:	Enhanced, safe and sustainable hospital services for the people in the north-west region of Tasmania.
Reference Point/Target:	Implementation of effective governance arrangements for the Mersey Community Hospital which will enable safe and sustainable hospital services to be delivered to the north-west region of Tasmania.
Result: Indicator met.
The Department signed a Heads of Agreement with the Tasmanian Government on 27 August 2008 for the Tasmanian Government to operate and manage the Mersey Community Hospital and integrate the hospital into the Tasmanian health care system, implementing effective governance arrangements.

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Performance Information for Outcome 13 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
The Department provided a range of high quality and timely evidence-based research and analysis to inform the Government within the timeframes required. The Department undertook a number of research related projects to assist with policy development and measuring the cost of health care services. A review of the management of the Australian Refined Diagnosis Related Group classification system is informing improvements in the management of processes supporting national clinical coding practices for diagnoses and procedures that produce quality health care information about hospital patients. In addition, the investigation and collection of hospital costs and activity data; the development of patient-level data for outpatient services to assist in the development of a long term strategy for outpatient services information development; and the development of comprehensive indicators to capture rehabilitation services performance all contributed towards the evidence-base required for policy development. The Department engaged the Australian Institute of Health and Welfare to undertake oral health research and the reports produced informed policy development and advice.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator met.
The actual Administered expenses for Outcome 13 were 0.4% greater than budgeted expenses.
Indicator:	Stakeholders participate in program development through a range of avenues, such as conferences and regular meetings.
Reference Point/Target:	Stakeholders participated in program development.
Result: Indicator met.
The Department worked with consumers, industry and all State and Territory Governments towards improving the provision of acute care hospital services by ensuring that policy directions reflect, where appropriate, the broader concerns of the health sector. Consultation was achieved through the: annual Australian Health Care Agreement Data Meeting; quarterly Hospital Casemix Protocol Fund Data Working Group; quarterly Private Hospital Data Working Group; monthly Elective Surgery Waiting List Reduction Plan Working Group; and regular National Partnership Agreement Implementation Steering Committee and its working groups – the Emergency Department/Activity Based Funding and Sub Acute Care Measurement Working Groups.

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Outcome 13 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 13.1: Blood and Organ Donation Services
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	13,222	12,104	(1,118)	11,134
Annual Appropriation Bill 2 (Other Services)	639	98	(541)	-
Special appropriations
National Health Act 1953 - Blood Fractionation, Products and Blood Related Products - to National Blood Authority	523,808	523,808	-	564,386
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	7,689	7,063	(626)	9,573
Revenues from other sources	428	374	(54)	436
Subtotal for Program 13.1	545,786	543,447	(2,339)	585,529
Program 13.2: Medical Indemnity
Administered Items
Special appropriations
Medical Indemnity Act 2002	91,600	43,269	(48,331)	125,993
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	1,310	1,203	(107)	1,631
Revenues from other sources	73	64	(9)	74
Subtotal for Program 13.2	92,983	44,536	(48,447)	127,698
Program 13.3: Public Hospitals and Information
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	70,846	68,677	(2,169)	72,361
Annual Appropriation Bill 2 (Other Services)	197,900	197,900	-	-
Special appropriations
Health Care (Appropriation) Act 1998 - Australian Health Care Agreements - Provision of Designated Health (p)	10,263,233	10,261,485	(1,748)	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	14,991	13,769	(1,222)	18,664
Revenues from other sources	834	729	(105)	848
Subtotal for Program 13.3	10,547,804	10,542,560	(5,244)	91,873
Total Resources for Outcome 13	11,186,573	11,130,543	(56,030)	805,100
Outcome 13 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	15,716	14,454	(1,262)	19,453
Output Group 2: Program Management	9,609	8,748	(861)	11,773
Total Departmental Resources	25,325	23,202	(2,123)	31,226
Average Staffing Level (Number)	161	157	(4)	192

(p) = part.
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