Annual Report - Outcome 3 – Access to Medical Services

Table of contents

Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 3 aims to provide Australians with access to the cost-effective and high quality medical services they need to manage their health. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 3 (Program Objectives in 2008–09)

Program 3.1 – Medicare Services

Support access to a range of medical services listed in the Medicare Benefits Schedule. This includes funding medical services and payments made under the Medicare safety nets and bulk-billing incentives, and enabling the delivery of optometric services in remote areas.
Maintain and analyse comprehensive data on services, benefits and costs to patients, as an aid to developing advice on the program’s contribution to government policy.

Program 3.2 – Alternative Funding for Health Service Provision

Help people access essential medical services that may not be available through mainstream mechanisms, such as for homeless people and those requiring life-saving medical treatment overseas.

Program 3.3 – Diagnostic Imaging Services

Promote the quality and effectiveness of diagnostic imaging services to ensure people receive the services they need to manage their health.

Program 3.4 – Pathology Services

Promote the quality and effectiveness of pathology services to ensure that people receive the services they need to manage their health.

Program 3.5 – Chronic Disease – Radiation Oncology

Promote better access to radiation therapy treatment for cancer patients, by reimbursing the costs of major capital equipment and expanding the number of facilities.
Support the development of the radiation oncology workforce, and research in radiation oncology.

Program 3.6 – Targeted Assistance – Medical

Support a number of diverse areas of Australian Government health care assistance that is not covered by other programs.

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 3 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 3 was managed in 2008–09 by the Medical Benefits Division. The Acute Care Division and the Mental Health and Chronic Disease Division also contributed to this outcome.
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Major Achievements for the Outcome:

Increased the availability of Medicare benefits for positron emission tomography by expanding items to all eligible positron emission tomography facilities for colorectal cancer, ovarian cancer and melanoma (see Improved Access to Radiation Oncology, Magnetic Resonance Imaging and Positron Emission Tomography);
Expanded accessibility and affordability of high technology diagnostic imaging services by increasing the number of Medicare-eligible magnetic resonance imaging units from 113 to 120 (see Improved Access to Radiation Oncology, Magnetic Resonance Imaging and Positron Emission Tomography);
Protected the future of the Medicare scheme by supporting the Australian Government Solicitor in defending a High Court challenge to the constitutional validity of the Professional Services Review Scheme (see Protecting the Integrity of Medicare through Enhanced and Increased Compliance Activity);
Introduced the Medicare Teen Dental Plan voucher system from 1 July 2008 to allow the payment of benefits for preventative dental checks for eligible teenagers (see Improving Access to Dental Services); and
Ensured the delivery of high quality diagnostic imaging Medicare services by engaging with around 2,800 diagnostic imaging practices to participate in the new Diagnostic Imaging Accreditation Scheme (see Performance Information for Outcome 3 Administered Programs).

Challenges for the Outcome:

The planned closure of the Medicare Chronic Disease Dental Scheme did not proceed due to disallowance in the Senate of subordinate legislation to effect the closure (see Improving Access to Dental Services);
Failure to implement the second component of the Increased Medicare Benefits Schedule Compliance Audits Initiative due to delays in finalising legislation (see Protecting the Integrity of Medicare through Enhanced and Increased Compliance Activity); and
The planned introduction of streamlined Medical Services Advisory Committee assessment processes was deferred pending the outcomes of the review of Commonwealth health technology assessment processes (see Using the Medicare Benefits Schedule to Encourage Appropriate Clinical Practice).

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Key Strategic Directions for 2008–09 – Major Activities

Improved Access to Radiation Oncology, Magnetic Resonance Imaging and Positron Emission Tomography

Expanded Radiation Oncology Services

Radiation oncology (radiotherapy) is one of the important ways in which people with cancer are treated, along with surgery and chemotherapy. It involves the use of ionising radiation to destroy tumour cells. As a curative or palliative method, it may be the primary technique, or as a therapy used in conjunction with other treatment such as surgery.

In 2008–09, the Department improved access to radiation oncology by supporting the purchase of expensive equipment and infrastructure. This included contributing funding towards the establishment of new radiation oncology facilities in towns around the country including: Lismore and Orange in New South Wales (due for completion in June 2010 and January 2011, respectively); Cairns, Queensland (to be completed by July 2012); and Bunbury, Western Australia (due for completion in April 2011). Funding was also provided for new facilities in Darwin in the Northern Territory (in March 2010), and expanded services in Launceston, Tasmania. These facilities will improve access to radiation oncology services for cancer patients in those areas and surrounding regions.

The Department also managed the Radiation Oncology Health Program Grant scheme to assist with the high cost of radiation oncology equipment, providing grants to 53 radiation oncology facilities and approving funding for three proposed new facilities. The Department will continue to provide grants under the scheme in 2009–10, to ensure cancer patients have access to the treatment they need.

Priorities in 2009–10 will also include working with educational institutions, professional bodies, treatment centres, and the State and Territory Governments, to coordinate and provide financial assistance to increase the radiation oncology workforce; and developing a quality framework for the radiation oncology sector. The Department will also promote appropriate access to radiation oncology facilities for people requiring treatment in regional areas, by replacing equipment and ensuring that patients are treated with relevant and up-to-date techniques.
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Positron Emission Tomography/Computed Tomography Scanning Services

Positron emission tomography is a nuclear medicine imaging modality funded under Medicare mainly for cancer management.

A major achievement for the Department in 2008–09, was the expansion of the range of clinical indications for which positron emission tomography is supported through the Medicare Benefits Schedule. Following advice from the Medical Services Advisory Committee that they represent clinically and cost effective services, the Department made items available to all eligible positron emission tomography facilities for colorectal cancer, ovarian cancer and melanoma. The Department expects to respond to further advice from the committee on the technology’s effectiveness for other clinical indications in 2009–10.

In addition, the Department worked with the states to implement the increase of positron emission tomography facilities in Australia. This involved providing funding to NSW Health to expand access to services at the Calvary Mater Newcastle Hospital and the Royal North Shore Hospital in Sydney; and engaging with the Tasmanian Government to support a positron emission tomography facility at the Royal Hobart Hospital. At the end of 2008–09, there was a total of 18 positron emission tomography facilities operating out of 15 locations around the nation. This compares with 17 facilities operating out of 14 locations in 2007–08.
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New Magnetic Resonance Imaging Locations

Magnetic resonance imaging uses strong magnetic fields and radio frequency pulses to generate sectional images of the body, and is especially useful in soft tissue examinations. However it is also an expensive technology. Another major achievement for the Department during the year, was the establishment of an additional seven Medicare-eligible magnetic resonance imaging units across Australia, in locations at: Sutherland Shire, and the Hunter region in New South Wales; Bundaberg in Queensland; Clayton-Oakleigh and Inner Melbourne in Victoria; Joondalup in Western Australia; and Launceston in Tasmania. This brought the total number of units nationwide from 113 to 120.

The Department will continue in 2009–10, to work with relevant public hospitals and private diagnostic imaging providers to ensure that a further six units become operational. It will also start reviewing funding arrangements for magnetic resonance imaging, with a focus on restrictions around Medicare-eligible/ineligible units.

Funding for the above activities was sourced from Programs 3.1 – Medicare Services, 3.3 – Diagnostic Imaging Services and 3.5 – Chronic Disease – Radiation Oncology.

Improving Access to Dental Services

Medicare Teen Dental Plan

Access to annual dental check-ups is important for teenagers to develop good oral health habits. In 2008–09, the Department helped improve access to dental services through implementation of the Medicare Teen Dental Plan. Commencing on 1 July 2008, the plan enables eligible teenagers to access a voucher system that provides up to $153.45 towards the cost of an annual preventative dental check consisting of an oral examination and, if required, other services such as x-rays, a scale and clean, fluoride treatment and oral hygiene instruction.

In 2008–09, the Department completed the development of a voucher system in conjunction with Medicare Australia and Centrelink, to enable the payment of Medicare benefits for the preventative dental services provided. In 2008, 1.3 million vouchers were sent to eligible teenagers or their families. The Department estimates that another 1.3 million vouchers will be distributed during 2009. In addition, the Department and the Australian Taxation Office worked with the states and territories to assist them to use Medicare Teen Dental Plan vouchers in the public dental system, which will provide broader access to dental providers under the program.
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Key Facts for 2008–09: Who is eligible for a Preventative Dental Check under the Medicare Teen Dental Plan?

Teenagers aged between 12 and 17 years who receive Abstudy, Carer Payment, Disability Support Pension, Parenting Payment, Special Benefit, or Youth Allowance.
Teenagers whose family/carer/guardian receives either Family Tax Benefit Part A, Parenting Payment, or the Double Orphan Pension in respect of the teenager.
Teenagers with partners who receive Family Tax Benefit Part A or Parenting Payment.
Teenagers receiving financial assistance under the Veterans’ Children Education Scheme or the Military Rehabilitation and Compensation Act Education and Training Scheme and cannot be included as a dependent child for the purposes of Family Tax Benefit because they are 16 years or older.

Medicare Chronic Disease Dental Scheme

A challenge for the Department this year was closing the previous government’s Medicare Chronic Disease Dental Scheme. The planned closure was to make funding available for the introduction of the Commonwealth Dental Health Program (discussed in the Outcome 13 Acute Care chapter) and the Medicare Teen Dental Plan (discussed above). The Department developed the subordinate legislation required to close the scheme; however it was disallowed in the Senate.

Funding for the above activities was sourced from Program 3.1 – Medicare Services.
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Protecting the Integrity of Medicare through Enhanced and Increased Compliance Activity

Increased Medicare Benefits Schedule Compliance Audits

Another challenge for the Department in 2008–09, was the delayed introduction of legislation to improve practitioners’ compliance with Medicare Benefits Schedule requirements. Under current arrangements, practitioners are not legally required during a compliance audit to provide verifying documents to Medicare Australia to substantiate a Medicare benefit. Through implementation of the Increased Medicare Benefits Schedule Compliance Audits initiative, the Department worked with Medicare Australia to address stakeholder concerns with legislation and protect the integrity of the scheme by establishing a simple, cost effective administrative mechanism to deal with incorrect payments, which constitute the highest risk to Medicare expenditure.

Activities included drafting the Health Insurance Amendment (Compliance) Bill 2009 to mandate the requirement to verify documents to substantiate Medicare benefits during a compliance audit, and introduce a financial penalty for practitioners who were unable to substantiate the service they provided. The Department also developed a Privacy Impact Assessment which incorporated feedback from stakeholders, including the Consumers’ Health Forum and the Office of the Privacy Commissioner. The Bill is currently scheduled for introduction into the spring 2009 Parliamentary sitting to enable time for the Government to consider the recommendations of the report.

Stakeholder Consultation on Changes to the Compliance Program

As indicated above, the Department and Medicare Australia consulted with key organisations to discuss the effect of the Increased Medicare Benefits Schedule Compliance Audits initiative on Medicare providers. Discussions focused on the draft legislative amendments to the Health Insurance Act 1973 and the flow on effects to practitioners. These consultations resulted in a number of submissions from organisations representing providers, consumers and privacy groups, which were used during the development of the Health Insurance Amendment (Compliance) Bill 2009. The Medicare Australia Stakeholder Consultative Group also considered the initiative.

Stakeholder feedback was predominantly supportive with main concerns relating to privacy and confidentiality. The Department worked closely with Medicare Australia to ensure that stringent safeguards are in place to protect the privacy of both the patient and the Medicare provider.

Key Fact for 2008–09: High Court Challenge to Medicare and the Professional Services Review Scheme

A major achievement for the Department this year was supporting the Australian Government Solicitor to successfully defend a High Court challenge contending that Medicare and parts of the Professional Services Review Scheme amounted to civil conscription contrary to section 51(xxiiiA) of the Constitution. In a 6–1 majority, the court found that the Health Insurance Act 1973 allowed doctors the freedom to choose where and when they practised while requiring them to conduct their practices with the care and skill that would be acceptable to the general body of medical practitioners. The decision protects the future of Medicare for the Australian community; allows a number of other matters relating to the Professional Services Review Scheme to proceed and provides certainty to the community that they will be protected against inappropriate practice by Medicare-eligible practitioners.

The Department is currently drafting amendments to the Health Insurance Act 1973 to increase the efficiency and effectiveness of the Professional Services Review Scheme in response to adverse findings by the Federal Court, and recommendations from the 2006 Review of the Professional Services Review Scheme.

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Using the Medicare Benefits Schedule to Encourage Appropriate Clinical Practice

Policies that Meet the Needs of the Community

During 2008–09, the Department consulted closely with professional medical, nursing, allied health and consumer groups to frame advice to the Government on ways to streamline and simplify the primary care elements of the Medicare Benefits Schedule. Consultations identified opportunities to effect change that will provide a simpler and clearer schedule of health services for patients and doctors to interpret, and more efficient access for patients to medical services.

The Department commissioned the Australian Safety and Efficacy Register of New Interventional Procedures – Surgical, a program of the Royal Australasian College of Surgeons, to undertake a pilot process for identifying and reviewing surgical items currently listed on the Medicare Benefits Schedule that may be of questionable clinical benefit. This initiative revealed a lack of comprehensive contemporary clinical practice guidelines for Australian surgeons, and the need for formal processes to identify and evaluate medical services that may be unsafe, unnecessary or ineffective. In 2009–10, the Department will move to develop a quality framework for Medicare, to better align medical services to evidence-based best practice guidelines.

Reversal of Sterilisation Procedures

Under the Medicare Funding for Reversal of Sterilisations Initiative, the Department reinstated Medicare benefits for reversal of sterilisation procedures from 1 July 2008. This provided people with access to four items for reversal of sterilisation procedures in order to restore fertility, ensuring more affordable options, and improving access to safe and appropriate treatments for couples who may otherwise not be able to achieve a pregnancy.

Improving Maternity Services

In 2008–09, the Department focused on improving maternity services so women have a greater choice in the type of care they may receive when having a baby. As part of this work, the Commonwealth Chief Nurse and Midwifery Officer led the Review of Maternity Services in Australia, which looked at a range of issues including antenatal services, birthing options and postnatal services up to six weeks after birth (refer to the Outcome 5 Primary Care and Outcome 12 Health Workforce Capacity chapters for further details).

Following the review, the Department examined relevant Medicare items, in the process of developing advice to the Government on how to improve women’s choices, increase access to safe, high quality maternity services, and to make better use of the maternity workforce. This contributed to a package of reforms in the 2009–10 Budget, which includes access to Medicare for certain antenatal, birthing and postnatal services provided by eligible midwives working in collaboration with obstetricians, general practice obstetricians and other health professionals. The Department will work to introduce underpinning legislation in 2009–10, with the aim of making the new Medicare items available for eligible midwives from November 2010.

Further discussion relating to maternity services can be found in the Outcome 5 Primary Care and Outcome 8 Indigenous Health chapters.
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Refined Medical Services Advisory Committee Processes

The Australian Government relies on timely and quality advice from the Medical Services Advisory Committee to ensure that new medical technologies are safe, and clinically and cost effective. In 2008–09, the Department worked with the committee to improve its consultation with professional and consumer organisations, to better support its deliberation process. It also worked to help streamline the committee’s current assessment processes which had in some instances led to lengthy delays in the completion of assessments. A comprehensive review of Commonwealth health technology assessment processes was announced in December 2008 as a Better Regulation Ministerial Partnership between the Minister for Health and Ageing and the Minister for Finance and Deregulation. The Medical Services Advisory Committee’s processes will be reviewed in light of any recommendations from the Health Technology Assessment Review that are accepted by Government.

The Department also worked with the committee to make its deliberations more publicly accessible. As a result, a public summary of the rationale for the Medical Services Advisory Committee’s advice to the Minister for Health and Ageing will be published at www.msac.gov.au following consideration of that advice by the Minister. Publication of this material complements the technical evaluation documentation that summarises the available evidence about the safety, clinical effectiveness and cost-effectiveness which was considered by the committee as part of its considerations in formulating its advice.

Funding for the above activities was sourced from Program 3.1 – Medicare Services.

Key Fact for 2008–09: Changes to the Medicare Benefits Schedule

From 1 January 2009, same-sex couples and their children were able to register as a family for Medicare Safety Net purposes and receive the same entitlements as opposite-sex couples and their children.

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Performance Information for Outcome 3 Administered Programs

Program 3.1 – Medicare Services
Indicator:	Number of Medicare rebates provided.
Reference Point/Target:	Medicare rebates will be provided for an estimated 294 million services, representing approximately 13.7 services per capita.
Note: The figures in this indicator were amended from ‘288 million’ and ‘13.5’ to ‘294 million’ and ‘13.7’ respectively in the 2008–09 Health and Ageing Portfolio Additional Estimates, to reflect the inclusion of additional initiatives, including the continuation of the Chronic Disease Dental program to the end of the 2008 calendar year.
Result: Indicator met.
Medicare rebates were provided for 294 million services, representing 13.6 services per capita. This compares with 279 million services (13.1 per capita) in 2007–08 and 258 million (12.3 per capita)in 2006–07.
Indicator:	Effective communication to providers and patients to maximise utilisation of the Medicare Teen Dental Plan.
Reference Point/Target:	1.1 million vouchers to be provided to eligible children and teenagers annually and program information provided to approximately 9,000 dentists. Utilisation will be measured by the uptake of the preventative dental check by patients and providers.
Result: Indicator met.
The Department, working with Medicare Australia, provided 1.3 million vouchers to eligible children and teenagers for a preventative dental check in 2008. The provision of vouchers for the 2009 annual preventative dental check began in January 2009 and will continue throughout the year. As at 30 June 2009, 459,691 vouchers had been utilised. The Department also provided information about the Medicare Teen Dental Plan to the dental profession by direct mail-out to 8,653 dentists and through the Department’s website via factsheets and an electronic schedule.

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Program 3.2 – Alternative Funding for Health Service Provision
Indicator:	Timely administration of alternative funding programs.
Reference Point/Target:	Applications and conditions of grants are processed within agreed timelines.
Result: Indicator met.
The Department administered three program grants according to the contractual schedule, to organisations that provide primary health care services to the disadvantaged and homeless, and services to visually impaired people which either could not be funded through Medicare due to patient access barriers or could not be funded as efficiently through Medicare. The Department also provided financial assistance to ten Australians with life threatening medical conditions to receive proven life-saving medical treatment overseas.

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Program 3.3 – Diagnostic Imaging Services
Indicator:	Funding of high quality, relevant diagnostic imaging services.
Reference Point/Target:	Medicare rebates will be provided for an estimated 17 million diagnostic imaging services representing approximately 0.8 services per capita.
Note: The figures in this indicator were amended from ‘12 million’ and ‘0.6’ to ‘17 million’ and ‘0.8’ respectively in the 2008–09 Health and Ageing Portfolio Additional Estimates, to reflect updated statistics and data.
Result: Indicator met.
Medicare rebates were provided for around 17.3 million diagnostic imaging services representing approximately 0.8 services per capita. This compares with 16.5 million services in 2007–08, and 15.7 million in 2006–07. A major achievement for this year was the implementation of Stage 1 of the Diagnostic Imaging Accreditation Scheme. Under Stage 1, which concludes on 30 June 2010, practices providing radiology services are required to provide documentary evidence demonstrating compliance with entry level standards. These standards will ensure that patients receive a high quality, safe and effective service regardless of who provides the service or where the service is provided. There are around 2,800 practices participating in the scheme.
Indicator:	Expansion of Medicare-eligible magnetic resonance imaging services throughout Australia.
Reference Point/Target:	Up to 127 Medicare-eligible magnetic resonance imaging units in 2008–09.
Result: Indicator substantially met.
The number of Medicare-eligible magnetic resonance imaging units operating across Australia rose from 113 to 120 in 2008–09. The Department’s Invitation to Apply process was unable to find a suitable applicant to provide a viable service in north-west Tasmania. The selection process was closed and the funds redirected to three health projects benefiting the residents of north-west Tasmania. One process is still underway and the remaining five magnetic resonance imaging units are expected to be in place in 2009–10.

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Program 3.4 – Pathology Services
Indicator:	All Medicare-eligible pathology laboratories are capable of meeting national pathology accreditation standards.
Reference Point/Target:	100% of Medicare-eligible laboratories meet national pathology accreditation standards.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates, to include reference to ‘Medicare-eligible’ pathology laboratories. This was to ensure that when disconnected from relevant text, the indicator is specific in its focus.
Result: Indicator met.
No laboratories were identified by Medicare Australia during 2008–09 as being unable to satisfy the quality requirements of the national pathology accreditation scheme. All laboratories therefore retained their eligibility for access to Medicare benefits.

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Program 3.5 – Chronic Disease – Radiation Oncology
Indicator:	Radiation oncology initiatives are developed to increase workforce capacity to support capital expansions.
Reference Point/Target:	Workforce research and capital projects are progressed in consultation with the radiation oncology sector. Applications and conditions of grant are processed in line with program guidelines.
Result: Indicator met.
A national workforce planning exercise of the three main radiation oncology professions (radiation oncologists, radiation therapists and medical physicists) commenced in 2008–09. The Department also: contributed to funding 54 radiation therapy and 22 radiation oncology medical physics trainee positions and a number of continuing professional development activities; funded universities to streamline the coordination of clinical training and support undergraduate radiation therapy clinical placements; in consultation with the radiation oncology sector, commenced planning for additional projects to support workforce expansion during 2009–10; and applications and grants were managed in accordance with program guidelines.

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Program 3.6 – Targeted Assistance – Medical
Indicator:	Quality, relevant and timely advice to Medicare Australia on eligibility of claims for assistance.
Reference Point/Target:	Stakeholder satisfaction.
Result: Indicator met.
All requests for advice on the payment of claims for assistance under the program were responded to in a timely and appropriate manner, to enable Medicare Australia to respond to claimants. Medicare Australia indicated satisfaction with the quality, relevance and timeliness of the Department’s advice through regular informal feedback, including email correspondence and face-to-face meetings.

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Performance Information for Outcome 3 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 evidence-based policy research as required. This included the provision of policy advice to the Minister regarding the review of the Medicare Benefits Schedule and Commonwealth Health Technology Assessment processes. In addition, nine Medical Services Advisory Committee Submissions were completed during 2008–09. The Department also completed an open tender process and managed the contract for the independent review of the extended Medicare safety net, and arranged for the publication and the tabling of this report in Parliament.

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Output Group 2 - Program Management
Indicator:	Administered budget predications are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Indicator:
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator met.
The actual Administered expenses for Outcome 3 were 0.4% more than budgeted expenses. This variance is primarily due to a higher than anticipated demand within the Medicare Benefits Schedule.
Indicator:	Stakeholders participate in program development through a range of forums.
Reference Point/Target:	Stakeholders participated in program development through regular consultative committees, conferences and stakeholder engagement forums.
Result: Indicator met.
Stakeholders met with the Department and were consulted through the Medicare Benefits Consultative Committee. Stakeholders were also involved during reviews throughout 2008–09, including the Strategic Review of Future Funding Arrangements for Diagnostic Imaging and Pathology, the Review of the Medicare Benefits Schedule and the Health Technology Assessment Review.

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Outcome 3 – 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 3.1: Medicare Services
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	-	-	-	957
Special appropriations
Dental Benefits Act 2008	92,787	58,102	(34,685)	104,142
Health Insurance Act 1973	14,026,985	14,142,051	115,066	14,897,926
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	22,174	21,991	(183)	26,379
Revenues from other sources	517	599	82	399
Subtotal for Program 3.1	14,142,463	14,222,743	80,280	15,029,803
Program 3.2: Alternative Funding for Health Service Provision
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	4,269	4,437	168	3,461
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	274	271	(3)	325
Revenues from other sources	6	7	1	7
Subtotal for Program 3.2	4,549	4,715	166	3,793
Program 3.3: Diagnostic Imaging Services
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	18,985	18,342	(643)	21,980
Annual Appropriation Bill 2 (Other Services)	1,500	1,500	-	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,470	3,441	(29)	4,127
Revenues from other sources	81	94	13	151
Subtotal for Program 3.3	24,036	23,377	(659)	26,258
Program 3.4: Pathology Services
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,915	2,955	(960)	4,450
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,144	3,118	(26)	3,740
Revenues from other sources	73	85	12	69
Subtotal for Program 3.4	7,132	6,158	(974)	8,259
Program 3.5: Chronic Disease - Radiation Oncology
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	94,209	91,510	(2,699)	86,119
Annual Appropriation Bill 2 (Other Services)	11	-	(11)	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	2,380	2,361	(19)	2,832
Revenues from other sources	56	64	8	52
Subtotal for Program 3.5	96,656	93,935	(2,721)	89,003
Program 3.6: Targeted Assistance - Medical
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	44,302	28,895	(15,407)	18,634
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	2,428	2,407	(21)	2,888
Revenues from other sources	57	66	9	53
Subtotal for Program 3.6	46,787	31,368	(15,419)	21,575
Total Resources for Outcome 3	14,321,623	14,382,296	60,673	15,178,691
Outcome 3 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	22,941	22,741	(200)	27,036
Output Group 2: Program Management	11,719	11,763	44	13,985
Total Departmental Resources	34,660	34,504	(156)	41,021
Average Staffing Level (Number)	214	211	(3)	247

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