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Outcome 3 - Access to Medical Services

Access to cost-effective medical, practice nursing, allied health services, including through Medicare subsidies for clinically relevant services.

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Outcome Summary

Outcome 3 aims to provide access, through Medicare, to high quality medical, dental and associated services to help people manage their health. The outcome also aims to improve access to these services by ensuring that they are safe, that they work and that they provide value for money. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 3 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 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 2009-10 by Medical Benefits Division, Acute Care Division and Mental Health and Chronic Disease Division. The department’s state and territory offices also contributed to the achievement of the outcome.

Programs Administered under Outcome 3 and 2009-10 Objectives

Program 3.1: Medicare Services

Improve access to a range of medical and associated services.
Provide greater access to bulk billed diagnostic imaging services.
Implement new evidence-based Medicare items.
Improve the range of maternity care options available to mothers in Australia.
Improve access to primary care services for all Australians by expanding the nurse practitioner’s role.
Offer preventative dental checks for teenagers.

Program 3.2: Alternative Funding for Health Service Provision

Support access to essential medical services that may not be available through mainstream mechanisms or which may not be available in Australia.

Program 3.3: Diagnostic Imaging Services

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

Program 3.4: Pathology Services

Promote quality and effective pathology services to ensure that people receive the services they need to manage their health.
Improve pathology services for Aboriginal and Torres Strait Islander people.

Program 3.5: Chronic Disease – Radiation Oncology

Promote better access to quality radiation therapy treatment for cancer patients by expanding the number of facilities available and developing the workforce.
Support capital infrastructure projects.
Increase the radiation oncology workforce.

Program 3.6: Targeted Assistance – Medical

Ensure that eligible people have access to health services that are not otherwise covered by existing programs.

Major Achievements

New radiation oncology facilities in Darwin (Northern Territory) and Lismore (New South Wales) became operational in 2009-10, providing local access to cancer treatment for patients serviced by those locations.
Signed a Memorandum of Understanding with the Australian Radiation Protection and Nuclear Safety Agency to establish and operate a national dosimetry service. This service will ensure that cancer patients receive a properly calibrated radiation dose while having radiation treatment.
Implemented the recommendations set out in the Medicare Benefits Schedule (MBS) Review, in May 2010, to simplify the primary care aspects of the MBS, remove ‘red tape’ and encourage preventative health care.
Extended Medicare Safety Net benefits for selected MBS services, such as obstetrics, Assisted Reproductive Technology and one type of varicose vein surgery item, were capped to discourage excessive fees. This will support the future sustainability of Medicare, which assists patients with their out of pocket costs for Medicare services.

Challenges

The implementation of the second component of the Increased MBS Compliance Audits Initiative did not occur in 2009-10 due to delays in passing legislation through the Senate.
Delayed closure of the Medicare Chronic Disease Dental Scheme. Closure of the old scheme is required to make funding available for a planned new scheme, the Commonwealth Dental Health Program.

Program 3.1: Medicare Services

Program 3.1 aims to improve access to a range of medical and associated services. This will be achieved through Medicare rebates for clinically relevant services that are generally accepted in the medical profession as being necessary for the appropriate treatment of patients – backed by evidence.

The program also aims to: provide greater access to bulk billed diagnostic imaging services; implement new evidence-based Medicare items; provide a range of maternity care options available to mothers in Australia; and offer preventative dental checks for teenagers.

Key Strategic Directions for 2009-10

The department’s strategies to achieve these aims were to:

improve access to clinically relevant medical, dental and associated services;
ensure the appropriateness and sustainability of the Medicare system; and
improve access for Australian mothers to a range of high quality maternity care services, with an expanded role for eligible midwives.

Major Activities

Improved Access to Clinically Relevant Services

Medical and Associated Services

In 2009-10, the department continued its commitment to improve health outcomes for all Australians by implementing a Quality Framework for the Medicare Benefits Schedule (MBS). This included introducing a new time-limited process for MBS items that were not assessed by the Medical Services Advisory Committee (MSAC). This process ensures that these new services are also aligned with contemporary clinical evidence, represent value for money and improve health outcomes.

A key component of the MBS Quality Framework is the implementation of a systematic approach to reviewing existing MBS items. The primary focus of the reviews is identifying and evaluating current
MBS services which are potentially unsafe, ineffective, or inappropriately used. In 2009-10 the department, with the involvement of relevant clinical groups, initiated four reviews which will be completed during 2010-11. The department also commenced work to strengthen arrangements for setting fees for new MBS services to improve transparency.

The department in 2009-10 commenced reviews of MBS funding for quality pathology and diagnostic services in consultation with stakeholders and relevant professional groups. Further development work and consultations with stakeholders will continue in 2010-11.

In May 2010, the department implemented the results of the MBS Review, as part of the Government’s agenda to create a patient-centred health system. The review addressed doctors’ concerns that the MBS was overly complex, encouraged shorter consultations and did not sufficiently encourage preventative care. Without limiting the services and benefits available to the community, MBS item numbers in the primary care part of the schedule were reduced from 85 to 33 – a reduction of 52 items. The explanatory notes were made clearer and shorter. Item descriptors were clarified to give GPs greater confidence and reward to spend more time with patients to deal with multiple health problems and provide valuable preventative care. Patients benefit from access to longer consultations that attract a higher rebate and are better supported to manage their chronic conditions and/or to stay healthy.

The MBS was amended to include an item for capsule endoscopy for the surveillance of Peutz-Jeghers syndrome<a href="#1"><sup>1</sup></a>, items for the implantation of a device for the management of faecal incontinence and items for Sacral Nerve Stimulation for urinary conditions. These changes demonstrate the department’s commitment to strengthen Medicare by ensuring that the MBS continues to reflect and encourage up-to-date medical practice.

As announced in the 2009-10 Budget, the department restructured and increased Medicare rebates for Assisted Reproductive Technologies for 15 obstetric services.

The department implemented MBS fee changes for a number of procedural items that can now be performed more quickly due to improvements in technology or where the service can be delivered as part of a standard consultation. This measure was revised in the 2010-11 Budget and will provide savings of $70.4 million over five years. These changes will help to ensure the long-term affordability and sustainability of Medicare for both taxpayers and the Government.

During 2009-10, the department worked with relevant public hospitals and private diagnostic imaging providers to increase the number of operational Medicare-eligible Magnetic Resonance Imaging (MRI) units across Australia. Six additional Medicare-eligible MRI units were established at: Bankstown in New South Wales; Cairns and Rockhampton in Queensland; Morphett Vale in South Australia; and Joondalup and Armadale in Western Australia. This brought the total number of eligible units to 125.

Nurse Practitioners

The department consulted extensively with medical, nursing and consumer groups regarding the MBS arrangements for nurse practitioners, including a potential MBS item structure, arrangements for referrals and requesting diagnostic services, and collaborative arrangements (refer to Outcome 12 – Health Workforce Capacity for further details).

Medicare Teen Dental Plan

In 2009-10, the department provided secretariat support for the legislated review of the Dental Benefits Act 2008 (the Act). In its report, the review committee found the Act and its associated rules provide an appropriate legislative and administrative framework for the payment of dental benefits and support the aims of the Medicare Teen Dental Plan.

Medicare Chronic Disease Dental Scheme

A challenge for the department this year was the delayed closure of the Medicare Chronic Disease Dental Scheme. The closure was to make funding available for the introduction of the new Commonwealth Dental Health Program (discussed in Outcome 13 – Acute Care).

Sustainability of the Medicare System

During the course of 2009-10, the department worked with Medicare Australia to draft the Health Insurance Amendment (Compliance) Bill, to protect the integrity of the Medicare system. The Bill establishes simple, cost-effective administrative mechanisms to deal with incorrect payments which constitute the highest risk to Medicare expenditure.

Medicare Safety Net

The Extended Medicare Safety Net provides an additional benefit for out-of-hospital Medicare services. This applies once annual thresholds in out-of-pocket costs, for out-of-hospital services, have been met. Once the threshold has been reached, patients are eligible for an additional benefit of 80 per cent of their out-of-pocket costs in addition to their standard Medicare rebate. However, from 1 January 2010, an upper limit or cap on Extended Medicare Safety Net benefits was applied for some Medicare services, such as obstetric services and Assisted Reproductive Technology services, such as in-vitro fertilisation (IVF). The safety net caps have been applied to items where an independent review showed that the Extended Medicare Safety Net led to increased fees charged to patients or where government benefits were flowing to providers rather than patients. Capping safety net benefits will contribute to the sustainability of the program, whilst continuing to provide some assistance for patients with high health costs.

During the year, the department amended the legislation to enable Extended Medicare Safety Net caps to be placed on MBS services. The department worked with the IVF profession to restructure the MBS items for IVF, which delivered a structure that provided higher standard MBS rebates for some IVF services, whilst achieving the savings set out in the Budget. The department will continue to monitor expenditure under the safety net in 2010-11 and prepare for the legislative review of capping benefits, which is expected to be tabled in Parliament during 2011.

Maternity Care

The department consulted extensively with medical, midwifery and consumer groups regarding the MBS arrangements for eligible midwives, including a potential MBS item structure, arrangements for referrals and requesting diagnostic services, and collaborative arrangements (refer to Outcome 5 – Primary Care).

¹ A genetic disease of the gastrointestinal tract and pigmentation of lips and oral mucosa.

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Performance Information for Outcome 3

Program 3.1: Deliverables

Qualitative Deliverables

Improved Access to Clinically Relevant Services
Qualitative Deliverable:	Regular stakeholder participation in program development through avenues such as regular consultative committees, conferences and stakeholder engagement forums. In addition: The department maintains and analyses comprehensive data on services, benefits, and costs to patients, as an aid to developing advice on the Program’s contribution to Government policy.
Result: Deliverable met.
The department maintains Medicare data for developing well researched policy, and costing the impact of policy. The department also invested in improving its analytical capabilities through the acquisition of technology as well as developing staff expertise and knowledge. This improves the department’s ability to develop policy and to provide advice to the Minister.
Qualitative Deliverable:	Results of completed health technology assessments are considered by the Medical Services Advisory Committee to inform its advice to the Minister to support evidence-based decision-making. The committee reports annually on timeframes and milestones for assessment and advice to Government and the outcome of Government decisions. Assessment reports are made available on the Medical Services Advisory Committee website.
Result: Deliverable met.
In 2009-10, 13 completed assessments were presented to the committee, resulting in 14 recommendations to Government; eight of which were in support of new or ongoing public funding.
Qualitative Deliverable:	Independent Review of the operation of the Dental Benefits Act 2008, under which the Medicare Teen Dental Plan operates, is required by legislation as soon as possible after 1 July 2009.
Result: Deliverable met.
An independent review of the Dental Benefits Act 2008 commenced on 29 September 2009. The Review Committee provided its report to the Minister on 23 December 2009 and this was tabled in both Houses of Parliament on 15 March 2010.
Sustainability of the Medicare System
Qualitative Deliverable:	To provide advice to Government on sustainable health care financing policy, the department assesses all available evidence to ensure that rebates for new services will be clinically appropriate and set at levels that achieve value-for-money.
Result: Deliverable met.
In 2009-10, new services considered by the Medical Services Advisory Committee continued to have their cost-effectiveness evaluated on the basis of available evidence. In addition, the new listing process implemented as part of the MBS Quality Framework initiative ensured that the department considered available evidence for any other new services considered for listing on the MBS. The department also commenced development of an input-based approach to setting MBS schedule fees, which will support consideration of value-for-money for all new services listed on the MBS. These approaches will ensure sustainable health financing through more consistent evaluation of the cost-effectiveness of new services.
Qualitative Deliverable:	Timely and accurate costing and analysis of Medicare data will allow the creation of more targeted and effective health programs.
Result: Deliverable met.
The department maintained Medicare data for the purposes of informing evidence-based policy and costing the impact of policy. Medicare analysis activity increased by approximately 30 per cent in 2009-10 compared with 2008-09. The department also invested in improving its costing and forecasting capabilities by acquiring more advanced software, and developing staff expertise, and knowledge.

Quantitative Deliverables

Improved Access to Clinically Relevant Services
Quantitative Deliverable:	Percentage variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.6%
Result: Deliverable not met.
The department’s estimates of MBS expenditure continued to provide an accurate guide for the Government and the community on future expenditure. Actual expenses for Outcome 3 were $15.450 billion compared with the estimated $15.7006 billion (which was a 1.59 per cent variance from budgeted expenses). The MBS is a demand driven program that fluctuates to meet the medical needs of the Australian public. Expenditure estimates take into consideration a range of factors, including new policy, annual indexation, population growth and ageing, as well as changes in the pattern of use of medical services.
Quantitative Deliverable:	Number of vouchers provided to eligible teenagers.
2009-10 Target:	1.3 million	2009-10 Actual:	1.3 million
Result: Deliverable met.
In 2009-10, 1,336,355 vouchers were provided to teenagers eligible for the Medicare Teen Dental Plan.

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Program 3.1: Key Performance Indicators

Quantitative Key Performance Indicators

Improved Access to Clinically Relevant Services
Quantitative Indicator:	Number of services delivered through Medicare by providing rebates for items listed on the Medicare Benefits Schedule.
2009-10 Target:	315 million	2009-10 Actual:	308 million
Result: Indicator substantially met.
Medicare rebates were provided for 308 million services, representing 14.0 services per capita. The services per capita are slightly lower than anticipated (14.3).
Improved Access to Clinically Relevant Services
Quantitative Indicator:	Uptake of preventative dental checks by eligible teenagers.
2009-10 Target:	60%	2009-10 Actual:	32%
Result: Indicator not met.
The Medicare Teen Dental Plan was implemented on 1 July 2008 and is a demand driven program. Future uptake targets will be estimated based on actual demand.

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Program 3.2: Alternative Funding for Health Service Provision

Program 3.2 aims to support access to essential medical services not funded through mainstream mechanisms. This includes alternative funding for services where it would not be appropriate for Medicare support, and financial assistance for necessary medical procedures performed outside Australia.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

support access to necessary medical services that may not be available through mainstream mechanisms, or which may not be available in Australia.

Major Activities

Medical Services Not Available Through Mainstream Mechanisms

During 2009-10, the department worked to improve access to essential medical services not covered by Medicare or available to the target audience through mainstream mechanisms. Three program grants were provided to organisations that deliver primary health care services to the socially disadvantaged and homeless, and to visually impaired people, which either could not be funded through Medicare due to access barriers or could not be funded as efficiently through Medicare.

Services provided to these population groups included intervention counselling relating to addiction, lifestyle and social problems, mental health pathology, harm reduction and minimisation, and self care, optometric and orthoptic consultations, scientific aids, assisted technology, and adaptive living aids for targeted individuals requiring low vision and rehabilitation assistance.

The department provided financial assistance to 12 Australians with life-threatening conditions for life-saving medical treatment in a number of overseas countries. These treatments were not available in Australia.

Performance Information for Outcome 3

Program 3.2: Deliverables

Qualitative Deliverable

Qualitative Deliverable:	The department reviews information on services provided as an aid to developing advice on the Program’s contribution to Government policy.
Result: Deliverable met.
The department provided access to essential medical services that were either not funded through mainstream mechanisms or where it would not be appropriate for Medicare support. Financial assistance was also provided for necessary medical procedures performed outside Australia for 12 individuals.

Quantitative Deliverables

Medical Services not Available through Mainstream Mechanisms
Quantitative Deliverable:	Percentage variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	44.7%
Result: Deliverable not met.
Whilst the dollar value of this deliverable was not met, the objectives of the program were met through the timely administration of alternative funding programs. This program is demand driven and funds are provided on an approved needs basis.
Quantitative Deliverable:	Number of health services provided to Australian residents that could not be provided through Medicare due to patient access barriers.
2009-10 Target:	36,200	2009-10 Actual:	46,775
Result: Deliverable met.
This deliverable was exceeded through the timely administration of alternative funding programs.

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Program 3.2: Key Performance Indicators

Qualitative Key Performance Indicators

Qualitative Indicator:	Timely administration of alternative funding programs. Measured by applications and grants processed within agreed timelines.
Result: Indicator met.
Consistent with the previous three years, the department administered three program grants, according to the contractual schedule, to organisations that provided health services to socially disadvantaged, homeless, and visually impaired people which either could not be funded through Medicare due to access barriers or could not be funded as efficiently through Medicare. The department also provided financial assistance for necessary medical procedures performed outside Australia for 12 individuals.

Quantitative Key Performance Indicators

Medical Services not Available through Mainstream Mechanisms
Quantitative Indicator:	Percentage of applications and grants processed within agreed timelines.
2009-10 Target:	90%	2009-10 Actual:	90%
Result: Indicator met.
Consistent with the previous three years, applications and conditions of grants were processed within agreed timelines. The department provided timely administration of three program grants and financial assistance to 12 Australians with life threatening conditions to receive proven life-saving medical treatment overseas.

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Program 3.3: Diagnostic Imaging Services

Program 3.3 aims to support the quality and effectiveness of diagnostic imaging services by: improving accreditation systems; providing funding to secure access to high quality diagnostic imaging services; working with stakeholders to establish when diagnostic imaging services are clinically relevant and cost-effective; and funding Positron Emission Tomography (PET).

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

provide access to safe, cost-effective and clinically effective diagnostic imaging services, including services performed using X-ray, computed tomography, ultrasound, Magnetic Resonance Imaging (MRI), cardiac imaging, PET and nuclear medicines technologies.

Major Activities

Safe, Cost-effective and Clinically Effective Diagnostic Imaging and Pathology Services

Review of funding of Diagnostic Imaging Services

The Medicare Benefits Schedule (MBS) supports access for the Australian community to some of the most advanced imaging techniques and services. In 2009-10, the department commenced a detailed review of funding arrangements for diagnostic imaging services. The review aims to establish the appropriate Medicare fee relativities for imaging items, as well as to explore alternative funding mechanisms to determine their viability for diagnostic imaging. The review is also examining the impact and appropriateness of the current funding arrangements for MRI and PET. In conducting the review, a Diagnostic Imaging Review Consultation Committee was established as a forum to enable diagnostic imaging stakeholders to contribute to the review process. A wide range of stakeholders including consumers, clinicians, industry and other interested parties provided written submissions in response to a discussion paper released by the department.

In 2010-11, the department will continue the consultation process and draw upon stakeholder feedback, research and expertise from other sources to develop options for the future funding of diagnostic imaging services.

Bulk Billing Incentive for Diagnostic Imaging

On 1 November 2009, a bulk billing incentive for diagnostic imaging services was introduced to the MBS to promote industry viability and greater access for patients. From November 2009 to May 2010, approximately $90 million was paid in bulk billing incentives for diagnostic imaging services.

Encourage More Effective Use of Diagnostic Imaging

In 2009-10, the department established a contract with the National Prescribing Service to promote evidence-based requests for pathology and diagnostic imaging services. This is an important step towards ensuring that consumers are sent for the testing they need to assist with improving their health. During 2010-11, work with the National Prescribing Service will continue and the initial targeted intervention strategy will commence. Over the next three years, the National Prescribing Service will evaluate and report to the department on savings to the MBS as a result of these initiatives.

The department also funded the Royal Australian and New Zealand College of Radiologists to perform a number of quality projects in diagnostic imaging. These projects are intended to improve the quality of Medicare services.

Workforce Support for Diagnostic Imaging

The department in 2009-10 expanded its existing support for training, by entering into a funding agreement with the Royal Australian and New Zealand College of Radiologists to provide 19 radiology training positions. These additional trainees will provide an immediate workforce benefit, by providing services to patients during their training, as well as a longer term benefit by addressing workforce shortages faced in the radiology discipline.

Diagnostic Imaging Accreditation Scheme

In 2009-10, the department developed the second stage of the Diagnostic Imaging Accreditation Scheme to include from 1 July 2010, non radiology practices such as, cardiac ultrasound and angiography, obstetric and gynaecological ultrasound, and nuclear medicine imaging services.

Accreditation is one way to ensure that patients receive access to quality diagnostic imaging services. From 1 July 2010, Stage I of the scheme will be broadened, and all practices providing diagnostic imaging services will need to be accredited in order to be eligible for Medicare benefits for those services.

Stage II of the scheme will introduce a two-step incremental approach to accreditation against a comprehensive suite of accreditation standards developed by the department in 2009-10 in consultation with professional bodies representing the industry.

man using diagnostic imaging equipment

In 2010-11, department will evaluate the impact of implementing the accreditation scheme and the efficiency of the scheme.

Diagnostic Imaging QualityPractice Program

The two-year Diagnostic Imaging Quality Practice Program was implemented by the department in two phases. Both phases of the program were designed to improve the quality of diagnostic imaging services in Australia, through grant funding investments in information technology systems, capital infrastructure, investments in facilities and in developing the workforce, assisting with accreditation and compliance costs, and assisting with meeting the digital imaging and archiving guidelines.

Phase I of the program provided grant funding directly to 638 practices in 2009-10.

Phase I – Diagnostic Imaging Quality Practice Program (GST excl)

Number of funding applications received (2008-09 and 2009-10) 919
Number of practices seeking funding 2,306
Total amount of grants paid (2008-09 and 2009-10) $19,685,600
Amount of grants paid (2009-10) $8,234,850

Phase II, the digital imaging and archiving project, was administered by the Australian Diagnostic Imaging Association. A set of digital imaging and archiving guidelines was developed and practices that demonstrate that they meet these guidelines were eligible to apply for an incentive payment through the association.

Phase II – Digital Imaging and Archive Guidelines Project Funding (GST excl)

Total project value $1,600,000
Funds for the development of guidelines and administration of the program $266,600
Funds to be distributed to eligible practices $1,334,000

Positron Emission Tomography Program

Positron Emission Tomography (PET) is a nuclear medicine imaging modality funded under Medicare and used predominantly for cancer management.

A major achievement for the department in 2009-10, was the expansion of the range of clinical applications for which PET is supported through the Medicare Benefits Schedule. Following advice from the Medical Services Advisory Committee that PET is clinically effective and cost-effective for the expanded applications, the department made items available to all eligible PET facilities for oesophageal, gastric and head and neck cancers. The department expects to respond to further advice from the committee on the technology’s effectiveness for other clinical indications in 2010-11.

The department also worked with the states and territories to increase the number of PET facilities in Australia. This involved funding NSW Health to expand access to services at the Calvary Mater Newcastle Hospital and the Royal North Shore Hospital in Sydney, the Tasmanian Government to support a PET facility at the Royal Hobart Hospital and Austin Health to support a new facility in Geelong, Victoria.

Funding was also provided to Austin Health in Victoria, and Westmead Hospital in New South Wales in 2009-10, for PET services and research. This work is expected to continue in 2010-11.

There are seven PET facilities around Australia that can access an extended range of PET items under Medicare for data collection purposes. This data is being used to inform applications to the Medical Services Advisory Committee for the purpose of making these items generally available on the Medicare Benefits Schedule. This process will continue in 2010-11.

At the end of 2009-10, there were a total of 21 PET scanners operating in 18 locations around the nation.
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Performance Information for Outcome 3

Program 3.3: Deliverables

Qualitative Deliverables

Safe, Cost-effective and Clinically Effective Diagnostic Imaging and Pathology Services
Qualitative Deliverable:	Regular stakeholder participation in program development through avenues such as regular consultative committees, conferences and stakeholder engagement forums.
Result: Deliverable met.
The diagnostic imaging industry was invited to participate in a Diagnostic Imaging Quality Workshop, held in December 2009.
Qualitative Deliverable:	Development of second edition Diagnostic Imaging Practice Accreditation Standards by 15 February 2010.
Result: Deliverable met.
The second edition of the Diagnostic Imaging Accreditation Standards was developed in consultation with professional bodies representing the industry.
Qualitative Deliverable:	Management of the framework for the provision of PET services across Australia through the continued funding of PET services on eligible PET scanners through Medicare, currently 20 scanners in operation in 18 locations.
Result: Deliverable met.
Capital funding for PET facilities at Royal North Shore Hospital and Calvary Mater Newcastle Hospital (for a replacement machine) increased the number of operational PET scanners from 20 in 2008-09 to 21 in 2009-10, with two funding agreements signed in 2009-10 for two additional PET machines to be operational in 2010-11.

Quantitative Deliverables

Safe, Cost-effective and Clinically Effective Diagnostic Imaging and Pathology Services
Quantitative Deliverable:	Percentage variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-5.2%
Result: Deliverable not met.
Not all funding was expended under the Diagnostic Imaging Quality Practice Program.
Quantitative Deliverable:	Funds provided to the Diagnostic Imaging Quality Practice program for quality improvement activities. All funds in the program will be finalised in 2009-10.
2009-10 Target:	$10.0 million	2009-10 Actual:	$10.0 million
Result: Deliverable met.
Under Phase I, not all diagnostic imaging practices accepted the department’s offer of funding. Then some of the remaining funds were allocated to Phase II of the program, to manage the digital imaging and archiving program.

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Program 3.3: Key Performance Indicators

Quantitative Key Performance Indicator

Safe, Cost-effective and Clinically Effective Diagnostic Imaging and Pathology Services
Quantitative Indicator:	Number of practices participating in the Diagnostic Imaging Accreditation Scheme.
2009-10 Target:	3,000	2009-10 Actual:	2,860
Result: Indicator substantially met.
The 2,860 practices accredited under the Diagnostic Imaging Accreditation Scheme provided 15,139,124 diagnostic imaging services and $1,639,530,890 in Medicare benefits in 2009-10. Trend data is not available for this indicator, as practices are progressively being accredited.

Program 3.4: Pathology Services

Program 3.4 aims to support the quality and effectiveness of pathology services and ensure that people receive the services they need to manage their health. This is complemented by the new bulk billing incentives introduced in 2009 for pathology, which will further enhance patient access to affordable pathology services.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

align pathology services with evidence-based best clinical practice to ensure efficient use of testing for the possible health outcome.

Major Activities

Pathology Services

Review of Funding of Pathology Services

The Medicare Benefits Schedule (MBS) supports access for Australians to a wide range of high quality pathology services. In 2009-10, the Government requested that the department undertake a detailed review of pathology funding arrangements to ensure continuing access for patients to quality pathology services. The review aims to establish appropriate fees for MBS items for different pathology disciplines; to identify groups of pathology tests that might be appropriate for different funding arrangements; and to provide options for implementing tendering for selected pathology services.

An extensive consultation process commenced in 2009-10, with a Pathology Review Consultation Committee established as the main avenue for stakeholders to have input into the review. Feedback from a wide range of interested consumers was also solicited in response to a discussion paper released in January 2010.

In 2010-11, the department will continue the consultation process and draw upon stakeholder feedback, research and expertise from other sources to develop options for the future funding of pathology services.

Encourage More Effective Use of Pathology Services

In 2009-10, the department established a contract with the National Prescribing Service, to deliver evidence-based interventions to practitioners and consumers, to optimise the use of pathology services. This is an important step towards ensuring consumers are sent for the testing they need to assist with improving their health. Work with the service will continue in 2010-11 and the initial targeted intervention strategy will commence during this period. Over the next three years, the National Prescribing Service will evaluate and report to the department on savings to the MBS as a result of these initiatives.

Bulk Billing Incentives for Pathology

On 1 November 2009, the department implemented new bulk billing incentives to improve patient access to affordable pathology services. These incentives are payable per patient episode, ranging from $1.35 to $3.40, and are paid in addition to the standard Medicare rebate.

Pathology Accreditation Scheme

The department worked closely with the National Pathology Accreditation Advisory Council in 2009-10 to refine the requirements of the national pathology accreditation framework. This ensures focus is on the most effective quality assurance strategies that address the areas of greatest risk to patient safety in pathology service delivery. This focus on risk minimisation was also carried through to the investment strategies initiated under the Quality Use of Pathology Program. A major consumer consultation project was undertaken to collect information on consumers’ experiences of pathology testing and suggestions for improvement. This information now forms a valuable resource for future policy development and potential areas of future investment.

A national workshop was held in December 2009, to reflect on the most successful best practice requesting strategies explored under the Quality Use of Pathology Program over the past 10 years, and to consider what that program could do in future to complement the work of the National Prescribing Service in this area. The workshop resulted in a publicly available list of priority issues and potential strategies for future consideration by pathology and requester peak organisations, the Quality Use of Pathology Program and the National Prescribing Service to promote best practice pathology requesting.
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Performance Information for Outcome 3

Program 3.4: Deliverables

Qualitative Deliverables

Pathology Services
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as the Quality Use of Pathology Committee, the National Pathology Accreditation Advisory Council, annual pathology quality and safety workshops, and conduct of specific-issue consultations in priority areas.
Result: Deliverable met.
During 2009-10, the department held biannual meetings of both the Quality Use of Pathology Committee and the National Pathology Accreditation Advisory Council, as well as a large number of issue-specific meetings of professional and consumer stakeholders to address high priority program objectives, such as consumer perspectives on pathology testing, identification of areas of unmitigated safety risk to patients and the role of e-health in supporting the delivery of high quality pathology services.
Qualitative Deliverable:	Encouraging pathology service requesting patterns towards identified priority areas by engaging the National Prescribing Service to work with stakeholders (pathologists, general practitioners, specialists and consumers) to focus requesting patterns on agreed best clinical practice that makes best use of pathology testing.
Result: Deliverable met.
The National Prescribing Service has an established track record of working with healthcare professionals and consumers to facilitate better selection and use of pharmaceuticals. The department has engaged them to encourage better use of pathology.

Quantitative Deliverables

Pathology Services
Quantitative Deliverable:	Percentage variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-12.9%
Result: Deliverable not met.
In 2009-10, the department’s priority for new expenditure under the Quality Use of Pathology Program was to partner with key stakeholder groups to explore a series of complex quality related and sector capacity reform issues. Delays were experienced while relevant stakeholder groups gained agreement within their constituencies for the proposed implementation strategies and while funding agreements were negotiated with the department. By the end of 2009-10, all anticipated projects were either underway or about to commence but it was not possible at that stage to put alternative funding strategies in place to use the remaining 2009-10 funds. By the end of June 2010, the 2010-11 program appropriation had been fully committed. Project plans have been prepared to support the development and finalisation of the remaining unallocated funds and existing projects will be carefully managed to ensure that planned expenditure occurs as scheduled.
Quantitative Deliverable:	Provide funding for the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services program.
2009-10 Target:	$801,000	2009-10 Actual:	$801,000
Result: Deliverable met.
Four-year funding agreements were put in place to support the continued operation of the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services program during 2009-10. This program is managed by Flinders University and the Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd. Each sponsoring organisation met the requirements of their respective funding agreements (which included a requirement for the organisations to work together on key elements of the program) and all funding was disbursed on schedule.
Quantitative Deliverable:	Number of new and/or revised national accreditation standards produced for pathology laboratories.
2009-10 Target:	4	2009-10 Actual:	4
Result: Deliverable met.
Four revised accreditation requirement documents were finalised and introduced into the relevant subordinate legislation, associated with the Health Insurance Act 1973 that governs eligibility for Medicare funding. The revised standards covered safety and quality issues related to the operation of mortuaries, Human Immunodeficiency Virus (HIV) and Hepatitis C testing. The standards also cover the requirements that must be met by laboratories in terms of the retention of test samples and records, as well as mandatory participation in approved external assessment processes to ensure the quality and comparability of the testing they perform. In 2009-10, an additional 11 pathology accreditation standards were at varying stages of review, and were being considered by the relevant experts and consumer representatives, to ensure they cover all known key risk areas and conform to government requirements for minimum regulation to ensure patient safety.

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Program 3.4: Key Performance Indicators

Qualitative Key Performance Indicators

Pathology Services
Qualitative Indicator:	All Medicare-eligible pathology laboratories are capable of meeting national pathology accreditation standards. This is measured by a laboratory’s assessed capability of meeting the standards set by the National Pathology Accreditation Advisory Council and which form the basis of the national pathology accreditation program.
Result: Indicator met.
The mandatory requirement for pathology laboratories, to attain accreditation status against the standards set by the National Pathology Accreditation Advisory Council, continued to ensure that no Medicare funding was provided to laboratories that are unable to meet minimum quality and safety requirements that are designed to protect patients from harm. The department managed the ongoing review and refinement of the accreditation framework to ensure that key safety issues were addressed by the standards and that the standards were achievable. This involved significant consultation with pathology experts and consumers and the pathology sector more broadly. This indicator has consistently been met in previous years.
Qualitative Indicator:	The Quality Assurance in Aboriginal and Torres Strait Islander Medical Services program continues to receive endorsement by key Indigenous stakeholder groups, such as the National Aboriginal Community Controlled Health Organisation, for its cultural appropriateness. This can be measured by the increased number of health sites enrolled in the voluntary program.
Result: Indicator met.
The announcement of ongoing funding for the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services (QAAMS) program in the 2009-10 Budget was met with support from member health care organisations of the National Aboriginal Community Controlled Health Organisation – that have received support under the QAAMS program to date. Existing QAAMS participation was retained and there was a steady growth in the number of new participating sites in 2009-10. The improved health outcomes for Indigenous consumers, as a result of the testing supported by the QAAMS program, has also prompted Queensland Health to invest in infrastructure to support eligible Queensland health care services to apply for participation in the program. The department ensured that the QAAMS program management arrangements incorporated ongoing opportunities for local Indigenous representatives to provide feedback on the acceptability of the program and also organised a specific national consultation meeting for QAAMS participants to provide feedback directly to the department. This is a consistent approach with previous years of this program.

Quantitative Key Performance Indicators

Pathology Services
Quantitative Indicator:	Number of health services supported by the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services program.
2009-10 Target:	140	2009-10 Actual:	133
Result: Indicator substantially met.
Participation in the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services (QAAMS) program continued to grow in 2009-10, despite intermittent fluctuations in the number of participating Aboriginal and Torres Strait Islander health care sites, due to staff turnover (particularly in rural and remote areas) and the need for new staff to be trained in QAAMS quality assurance processes. A special funding initiative by Queensland Health to fund the purchase of new data-enabled testing devices for all 25 existing Queensland QAAMS sites and up to an additional 15 eligible sites over the next two years has been agreed. The QAAMS program does not provide funding for the purchase of devices, therefore overcoming the potential barrier to participation by interested health care services in Queensland. This is a consistent increase from the 110 sites in 2007-08 and the 120 sites in 2008-09.
Quantitative Indicator:	Percentage of Medicare-eligible laboratories meeting pathology accreditation standards.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
Due to the legislative and administrative arrangements that are in place under the Health Insurance Act 1973 and the Medicare Australia Act 1973, Medicare benefits were not paid to any laboratory that did not have a current accreditation approval in place. This indicator has been met for the past three years.

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Program 3.5: Chronic Disease – Radiation Oncology

Program 3.5 aims to promote better access to quality radiation therapy treatment for cancer patients by expanding the number of facilities available and developing the workforce. To achieve this, the program provides support for capital infrastructure projects, works with stakeholders to increase the radiation oncology workforce, and develops guidelines and standards to ensure the quality of services.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

improve access to, and quality of, radiation oncology treatment through an expansion of services and the development of a national quality framework.

Major Activities

Radiation Oncology

Radiotherapy is one of the key treatments for people with cancer. Cancer is more prevalent in older people, and an increased capacity for cancer services is required as the population ages. The equipment and infrastructure associated with radiation oncology services are expensive, and there is a shortage of trained healthcare professionals needed to operate this highly specialised equipment.

During the year, the department provided funding towards the establishment of new radiation oncology facilities in: New South Wales (Lismore, which commenced taking patients in May 2010 and Orange, which is due for completion in December 2010); Queensland (Cairns, which is due for completion in July 2011); Western Australia (Bunbury, due for completion in June 2011); the Northern Territory (Darwin, which commenced treating patients in March 2010); and Tasmania (Launceston, where expanded services should become operational in January 2011). These new or expanded facilities will improve access to radiation oncology services for cancer patients in these areas and surrounding regions.

The department continued to support access to radiation oncology services through the Radiation Oncology Health Program Grants Scheme. This scheme funds high cost equipment used in radiation oncology treatment with 57 radiation oncology facilities receiving funding under this scheme in 2009-10. The department also continued to fund workforce related activities, including training places for radiation therapists and radiation oncology medical physicists.

In 2010-11, the department will focus on ensuring that cancer patients have access to the treatment they need, will continue to provide grants under the Radiation Oncology Health Program Grants scheme and will work with educational institutions, professional bodies, treatment centres, and state and territory governments to coordinate and provide financial assistance to increase the radiation oncology workforce.

In 2009-10, the department continued to work with the sector to develop and test a quality framework for radiation oncology, and significantly progressed the standards and quality assurance streams. The focus in 2010-11 will be on exploring options for implementing the quality framework across the radiotherapy sector.

Performance Information for Outcome 3

Program 3.5: Deliverables

Qualitative Deliverables

Radiation Oncology
Qualitative Deliverable:	Regular stakeholder participation in program development is facilitated through the Radiation Oncology Reform Implementation Committee, which is overseen by the Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council to which it reports annually. The Committee is the key forum for engaging stakeholders in the radiation oncology sector and has working groups on workforce, quality and access, and incorporates all of the medical colleges, professional bodies, private providers, state and territory governments and consumers in the development of policy and coordination across the sector.
Result: Deliverable met.
The Radiation Oncology Reform Implementation Committee continued to support and facilitate the planning and implementation of strategies to ensure improved radiotherapy service outcomes for patients. It met twice in 2009-10 and also provided quarterly reports to the Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council. The working groups met at least three times each.
Qualitative Deliverable:	Radiation oncology initiatives are developed to increase workforce capacity to support capital expansions. Workforce research and capital projects are progressed in consultation with the radiation oncology sector. Applications and conditions of grants are processed in line with program guidelines. Fifty-four Government assisted radiation therapists are expected to complete their internships and 25 Government assisted radiation oncology medical physics interns will complete their second year of training.
Result: Deliverable substantially met.
In 2009-10, the department continued to fund radiation therapy interns to undertake their professional development years and fund radiation oncology medical physics registrar positions to increase workforce capacity to support service delivery (see quantitative deliverables for results). In consultation with the radiation oncology sector, the department developed, progressed and funded: a workforce planning review; an ‘areas of needs’ analysis; a research project into new technologies through the Trans-Tasman Radiation Oncology Group; and cancer research projects with Cancer Australia and partners through the Priority-driven Collaborative Cancer Research Scheme. The department continued to assess Radiation Oncology Health Program Grants in accordance with program guidelines, and also commenced a review of the program guidelines.
Qualitative Deliverable:	The development of a framework to improve patient safety and clinical outcomes during radiation treatment will be progressed. The department will work with the sector to prepare options for the establishment of a national dosimetry centre (to ensure that patients receive a properly calibrated radiation dose), which will be presented to Australian Health Ministers’ Advisory Council for consideration before June 2010. A 12-15 month trial of the draft radiation oncology standards will commence in July 2009 with 15 treatment facilities participating.
Result: Deliverable met.
The department worked with the sector to develop options for the establishment of a national dosimetry service, presenting a business case through the Clinical, Technical and Ethical Principal Committee to the Australian Health Ministers’ Advisory Council in March 2010. On behalf of the Australian Government and state and territory governments, the department is funding the Australian Radiation Protection and Nuclear Safety Agency for three years to establish and operate the Australian Clinical Dosimetry Service. An independent evaluation of the Australian Clinical Dosimetry Service will be conducted in the third year. The department also commissioned the National Association of Testing Authorities Australia, in July 2009, to conduct the trial of the radiation oncology standards with 14 participating radiation facilities. The trial is expected to be completed in the second quarter of 2010-11.

Quantitative Deliverables

Radiation Oncology
Quantitative Deliverable:	Percentage between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	3.0%
Result: Deliverable not met.
The variation in program expenditure relates to the Radiation Oncology Health Program Grants Scheme, which is a demand driven program. In the 2009-10 financial year, the demand for equipment funding increased.
Quantitative Deliverable:	Number of Radiation Oncology Health program grants provided to eligible public and private providers.
2009-10 Target:	56	2009-10 Actual:	57
Result: Deliverable met.
Fifty-seven radiation oncology facilities were funded through Radiation Oncology Health Program Grants including for new facilities in New South Wales, Victoria, South Australia and the Northern Territory.
Quantitative Deliverable:	Number of approved radiation oncology medical physics intern positions funded.
2009-10 Target:	25	2009-10 Actual:	22
Result: Deliverable substantially met.
In 2009-10, 22 radiation oncology medical physics registrars undertook their second year of training. A further three registrars will commence their first year in 2010-11.
Quantitative Deliverable:	Number of approved radiation therapy training positions (current funding agreements are for 2008-09 and 2009-10 only).
2009-10 Target:	54	2009-10 Actual:	47
Result: Deliverable substantially met.
In 2009-10, there were 47 radiation therapy training positions in place. Facilities were unable to successfully recruit to projected positions. The department will assist a further 43 radiation therapy training positions in 2010-11.

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Program 3.5: Key Performance Indicators

Qualitative Key Performance Indicators

Radiation Oncology
Qualitative Indicator:	A trial of the draft radiation oncology standards will commence in July 2009, with 15 treatment facilities participating.
Result: Indicator met.
The department engaged the National Association of Testing Authorities Australia in June 2009, to conduct a trial of the draft radiation oncology practice standards. This involved collecting feedback on the process of standard implementation using a representative sample of 15 radiation oncology facilities. The trial formally commenced in January 2010 and data are being collected via an on-line questionnaire, follow up site visits and a focus group meeting. The trial will conclude in the last quarter of 2010. The results from the trial will be used to establish baseline data on compliance and to assess the costs of compliance to inform the ongoing implementation of the standards.
Qualitative Indicator:	Options for the national dosimetry centre will be presented to the Australian Health Ministers’ Advisory Council for consideration by June 2010.
Result: Indicator met.
The Australian Health Ministers’ Advisory Council considered recommendations for the establishment of a national dosimetry service in March 2010. The department has engaged the Australian Radiation Protection and Nuclear Safety Agency for three years to operate the dosimetry service on a trial basis. The trial period is expected to begin in January 2011.

Quantitative Key Performance Indicator

Radiation Oncology
Quantitative Indicator:	The number of sites delivering radiation oncology.
2009-10 Target:	56	2009-10 Actual:	57
Result: Indicator met.
Fifty-seven sites were delivering radiation oncology services by the end of 2009-10. New facilities commenced operations in New South Wales, Victoria, South Australia and the Northern Territory. The target indicator has consistently been increasing and met for the number of sites over the past three years delivering radiation oncology.

Program 3.6: Targeted Assistance – Medical

Program 3.6 aims to ensure that eligible people have access to health services that are not otherwise covered by existing programs. To achieve this, the Government provides additional health care assistance to people who meet the different requirements for funding under various components of this program. These health care services are in addition to health care covered under existing programs and include health care assistance to eligible people affected by disasters, people who travel overseas and visitors to Australia covered under a Reciprocal Health Care Agreement, as well as providing incentives for the uptake of electronic Medicare claiming.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

provide eligible people with access to health care assistance not currently covered by existing programs.

Major Activities

Targeted Assistance

The Targeted Assistance Program provides assistance to eligible people for health and medical services not covered by existing programs.

Through the six Disaster Health Care Assistance Schemes, the department pays out-of-pocket expenses for health care required by ill health or injury incurred by eligible victims of specific international disasters, and their families. The schemes cover incidents arising from acts of terrorism, such as the Bali bombings, civil disturbances, or natural disasters, such as the Asian Tsunami. Out of pocket costs are those expenses which are not covered by Medicare, other government programs (including those provided by states and territories) or private travel or health insurance. Under most schemes, assistance is provided for the lifetime of the client.

During 2009-10, the department managed Reciprocal Health Care Agreements with a number of countries for reciprocal access to public health facilities for residents. This supports a safer environment for Australian residents travelling overseas on tourism or business. A new agreement with Belgium came into effect on 1 September 2009. The department continued to establish links with potentially suitable new countries, to extend the network of reciprocal health agreements.
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Performance Information for Outcome 3

Program 3.6: Deliverables

Qualitative Deliverables

Targeted Assistance
Qualitative Deliverable:	Regular stakeholder participation in program development, through avenues such as regular consultative committees, conferences and stakeholder engagement forums.
Result: Deliverable met.
Regular meetings are held with Medicare Australia who facilitates engagement with a range of stakeholders.
Qualitative Deliverable:	Establishment of disaster health care assistance framework to facilitate payments by Medicare Australia.
Result: Deliverable met.
In 2009-10, the department provided financial assistance to victims of specific international acts of terrorism or natural disasters. This assistance covered out-of-pocket expenses for health care delivered in Australia for ill health or injury. Six Disaster Health Care Assistance Schemes were established to provide financial assistance to victims and their families as a result of the following incidents: 2002 and 2005 Bali Bombings; 2004 Asian Tsunami; 2005 London Bombings; 2006 Egypt Bombings; and 2008 Mumbai Terrorist Attacks. Out-of-pocket costs are expenses which are not covered by Medicare, other government programs (including those provided by states and territories) or private travel or health insurance. Guidelines have been implemented to facilitate payments to eligible persons through Medicare Australia on the department’s behalf.
Qualitative Deliverable:	Reciprocal Health Care Agreements provide Australians travelling overseas with access to necessary health care where a reciprocal health care agreement exists.
Result: Deliverable met.
The department maintains Reciprocal Health Care Agreements with ten countries - New Zealand, the United Kingdom, Ireland, Belgium, the Netherlands, Sweden, Finland, Norway, Italy and Malta for access to public health facilities for more than 3.5 million travellers. On 1 September 2009, a new agreement with Belgium became effective. Under the reciprocal health agreement with Italy, the department must hold funds for the purpose of reconciling annual differences in medical expenditure with the Italian government.
Qualitative Deliverable:	Assistance for 141 approved pathologist authorities making the transition from Mediclaims to other electronic claiming channels.
Result: Deliverable met.
The Mediclaims claiming channel was closed in 2009-10. The majority of pathology claims are now transmitted through Medicare Online.

Quantitative Deliverables

Targeted Assistance
Quantitative Deliverable:	Percentage variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-2.0%
Result: Deliverable not met.
The funding for this program is demand driven. The take up rate of electronic claiming was not as high as anticipated and is indicated in the underspend.
Quantitative Deliverable:	Total level of payments provided as incentives for medical practitioners to use electronic claiming (funding ended in December 2009).
2009-10 Target:	$15.830 million	2009-10 Actual:	$11.254 million
Result: Deliverable substantially met.
This program is demand driven, dependent on decisions taken by individual medical practitioners and practices. The underspend reflects a slower than expected use of electronic claiming by doctors for services that are not bulk billed.
Quantitative Deliverable:	Funds available for additional health care assistance to eligible people affected by disasters.
2009-10 Target:	$780,000	2009-10 Actual:	$436,654
Result: Deliverable substantially met.
The Disaster Health Care Assistance Schemes are demand driven programs. Eligible people receive reimbursement for all ‘out-of-pocket’ health care costs related to any injury or illness which has resulted from one of the incidents covered by the schemes. In 2009-10, Medicare Australia paid 2,900 claims on the department’s behalf. The schemes are ongoing programs as they provide lifetime assistance to the people covered under them.
Quantitative Deliverable:	Funds available for health care assistance to people under Reciprocal Health Care Agreements.
2009-10 Target:	$50,000	2009-10 Actual:	$878
Result: Deliverable substantially met.
Under the terms of the Australia-Italy Reciprocal Health Care Agreement, Australia is obliged to reconcile any differences in health expenditure through annual payments to the Italian Government. Funds must be available to meet this international obligation annually. This program is demand driven and whilst all funding was not expended for this deliverable in 2009-10, all Reciprocal Health Care requirements were met.

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Program 3.6: Key Performance Indicators

Qualitative Key Performance Indicators

Targeted Assistance
Qualitative Indicator:	Quality, relevant and timely advice to Medicare Australia on eligibility of claims for assistance, as measured by stakeholder satisfaction.
Result: Indicator met.
The department responded to all Medicare Australia’s request for advice on the payment of claims for disaster assistance under the program in a timely and appropriate manner. Medicare Australia indicated satisfaction with the quality, relevance and timelines of the department’s advice through regular informal feedback, including email correspondence and face-to-face meetings.
Qualitative Indicator:	Increased acceptance and use of Medicare Online and Medicare Easyclaim electronic claiming channels by general practitioners and specialists.
Result: Indicator met.
The use of electronic claiming by general practitioners and specialists increased significantly in 2009-10. Although the payment of financial incentives to use electronic claiming ceased on 31 December 2009, there has been no significant change in the proportion of claims submitted electronically, indicating that many practices have become accustomed to using this technology.

Quantitative Key Performance Indicators

Targeted Assistance
Quantitative Indicator:	Number of Medicare claims transmitted electronically and eligible for transition support (funding ends in December 2009).
2009-10 Target:	75.6 million	2009-10 Actual:	72.2 million
Result: Indicator substantially met.
This program is demand driven, dependent on claiming decisions of medical practices and providers, and their patterns of service use. For bulk billed services provided by general practitioners, the percentage of claims transmitted electronically via Medicare Online or Medicare Easyclaim reached over 90 per cent by June 2010. This is an increase from 89 per cent in June 2009 and from approximately 77 per cent in June 2008. For specialist bulk bill claims, the percentage transmitted electronically also reached approximately 90 per cent by June 2010. This compares with approximately 58 per cent in June 2008 and 85 per cent in June 2009. However, for services that are not bulk billed, there has been a slower increase in the use of electronic claiming than anticipated. Between June 2009 and June 2010, the percentage of GP patient claims submitted electronically increased from around 36 per cent to 47 per cent. This is an increase from 23 per cent in June 2008. For specialist services these figures increased from six per cent in June 2008 to 11 per cent in June 2009 and 15 per cent in June 2010.
Quantitative Indicator:	Number of general practices receiving support for claiming electronically (funding ends in December 2009).
2009-10 Target:	2,701	2009-10 Actual:	1,227
Result: Indicator not met.
A lower than expected number of general practices applied for up-front incentives to commence or extend their use of electronic claiming during 2009-10. Since the Transitional Support Package was introduced in the 2007-08 financial year, over 5,500 practices have received a lump sum incentive payment for using electronic claiming.

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Outcome 3 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 3.1: Medicare Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	957	-	( 957)	2,597
Special appropriations
Dental Benefits Act 2008	63,121	63,819	698	68,523
Health Insurance Act 1973	15,635,669	15,386,543	( 249,126)	16,171,456
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	29,909	29,159	( 750)	29,585
Revenues from other sources	799	654	( 145)	821
Unfunded depreciation expense¹	-	-	-	581
Operating loss / (surplus)	-	14	14	-
Total for Program 3.1	15,730,455	15,480,189	( 250,266)	16,273,563
Program 3.2: Alternative Funding to Health Services Protection
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	5,253	7,603	2,350	3,491
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	850	812	( 38)	841
Revenues from other sources	23	18	( 5)	23
Unfunded depreciation expense¹	-	-	-	17
Operating loss / (surplus)	-	-	-	-
Total for Program 3.2	6,126	8,433	2,307	4,372
Program 3.3: Diagnostic Imaging Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	19,981	18,946	( 1,035)	6,296
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,855	2,472	( 383)	2,824
Revenues from other sources	76	56	( 20)	78
Unfunded depreciation expense¹	-	-	-	55
Operating loss / (surplus)	-	1	1	-
Total for Program 3.3	22,912	21,475	( 1,437)	9,253
Program 3.4: Pathology Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,050	3,527	( 523)	4,697
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	3,234	2,809	( 425)	3,199
Revenues from other sources	86	63	( 23)	89
Unfunded depreciation expense¹	-	-	-	63
Operating loss / (surplus)	-	1	1	-
Total for Program 3.4	7,370	6,400	( 970)	8,048
Program 3.5: Chronic Disease – Radiation Oncology
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	88,193	90,868	2,675	82,653
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,000	3,821	( 179)	3,956
Revenues from other sources	107	86	( 21)	110
Unfunded depreciation expense¹	-	-	-	78
Operating loss / (surplus)	-	2	2	-
Total for Program 3.5	92,300	94,777	2,477	86,797
Program 3.6: Targeted Assistance – Medical
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	17,176	16,836	( 340)	7,308
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,026	919	( 107)	1,015
Revenues from other sources	28	21	( 7)	28
Unfunded depreciation expense¹	-	-	-	20
Operating loss / (surplus)	-	1	1	-
Total for Program 3.6	18,230	17,777	( 453)	8,371
Outcome 3 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	135,610	137,780	2,170	107,042
Special appropriations	15,698,790	15,450,362	( 248,428)	16,239,979
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	41,874	39,992	( 1,882)	41,420
Revenues from other sources	1,119	898	( 221)	1,149
Unfunded depreciation expense¹	-	-	-	814
Operating loss / (surplus)	-	19	19	-
Total Expenses for Outcome 3	15,877,393	15,629,051	( 248,342)	16,390,404
Average Staffing Level (Number)	266	252	( 14)	247

1 Reflects the change to net cash appropriation framework implemented from 2010-11.

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