Outcome 3 – Access to Medical Services

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Outcome Strategy

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the major activities and performance indicators published in the Outcome 3 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 3 was managed in 2010-11 by the Medical Benefits Division, the Acute Care Division and the Population Health Division.

Program Name	Program Objectives in 2010-11
Program 3.1: Medicare Services	Improve access to evidence-based, best practice medical services. Improve access to clinically relevant dental services.
Program 3.2: Alternate Funding for Health Service Provision	Support access to necessary medical services that may not be available through mainstream mechanisms or which may not be available in Australia.
Program 3.3: Diagnostic Imaging Services	Support access to high quality, safe, clinically relevant and cost effective diagnostic imaging services, including services performed using x-ray, computed tomography, ultrasound, magnetic resonance imaging, cardiac imaging, and nuclear medicine technologies, including positron emission tomography services.
Program 3.4: Pathology Services	Support access to high quality, safe, clinically relevant and cost-effective pathology services.
Program 3.5: Chronic Disease – Radiation Oncology	Complement the delivery of radiation oncology services under Medicare (Program 3.1) and the Regional Cancer Centres Initiative (Outcome 10) by improving access to, and quality of, appropriately staffed and equipped radiation oncology treatment facilities for Australians with cancer.
Program 3.6: Targeted Assistance – Medical	Provide targeted assistance to eligible people to access health care, currently not covered under existing programs, including breast prostheses reimbursements.

Major Achievements

• A new five year Pathology Funding Agreement between the Government and the pathology sector was signed in April 2011 that ensures patients can access quality, affordable pathology services and is expected to generate savings of more than $500 million over the five years.
• Improved access to specialist services for people in remote, regional and outer metropolitan areas and people in aged care homes and Aboriginal Medical Services by providing new rebates and incentives for specialist consultations provided by video conference.
• Implemented new Medicare arrangements for midwives and nurse practitioners to improve choice and access to maternity care for women and their families, and to increase access to primary care services.
• New radiation oncology facilities in Cairns (Queensland) and Orange (New South Wales) became operational in 2010-11, providing local access to cancer treatment for residents in those areas.

Challenges

• The emergence of potential irregularities in the administration of the Professional Services Review (PSR) Scheme. The PSR Advisory Committee, comprising the department, Australian Medical Association, Professional Services Review and Medicare Australia, is now working to help the PSR improve transparency and effectiveness of PSR processes.
• Maintaining the flow of applications to the Medical Services Advisory Committee while trialling new processes and documentation for submission based applications and agreed decision analytic protocols. This has been managed, in part, through the introduction of transition arrangements for applications for co-dependent technologies that require advice from more than one advisory committee.
• Delayed closure of the Medicare Chronic Disease Dental Scheme.

Program 3.1: Medicare Services

Improve Access to Evidence-Based Medical Services

The department developed the policy and regulatory framework to support the Government’s 2010 election commitment, ‘Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations’. This program funds video conference consultations with specialists for people in remote, regional and outer metropolitan areas of Australia. Video consultations with specialists are also funded for all care recipients in a residential care service and patients of an Aboriginal Medical Service or Aboriginal Community Controlled Health Service anywhere in Australia.

The department implemented the More Choice For Women – Expanding Medicare Support For Midwives Measure, which provides for Medicare rebateable services for midwifery care provided by appropriately qualified and experienced privately practising midwives working in collaborative arrangements with medical practitioners. The measure recognises that women should have a range of birthing options available to them and be supported in their choice of practitioner and their preference for continuity of care. Recognising midwives as primary maternity care providers under Medicare also assists in improving service delivery by enabling better use of the existing workforce and the development over time of new, more innovative models of care that can be tailored to meet local needs.

The department also implemented the Expansion of the Nurse Practitioner Workforce Measure, which allows eligible nurse practitioners working in collaborative arrangements with medical practitioners, to provide Medicare rebateable services within their scope of practice. This measure was designed to assist in improving the flexibility and capacity of the primary care health workforce. Both measures were implemented on 1 November 2010 following extensive stakeholder consultation through advisory and technical advisory groups. Eligible midwives and nurse practitioners can also request a range of diagnostic tests, refer patients to specialists and consultant physicians and prescribe certain medicines under the Pharmaceutical Benefits Scheme (PBS) within their scope of practice.

The department worked with the independent Professional Services Review (PSR) agency, Medicare Australia and other key stakeholders, including the Australian Medical Association, to improve arrangements supporting the integrity of the Medicare program, by making PSR processes more transparent and effective.

The role of the Medical Services Advisory Committee (MSAC) was expanded to provide evidence-based advice to Government on all changes to and reviews of the Medicare Benefits Schedule. This will allow new items, amendments of existing items or reviews of major components of the Schedule to be undertaken with consistency in approach to allow independent expert advice on the best health outcomes for Australians. This activity is important in that it will deliver evidence-based advice on all aspects of public reimbursement through processes that allow greater community input.

Qualitative Deliverable:	Develop an MBS Quality Framework.
2010-11 Reference Point:	Timely consultation with stakeholders, including health consumers, and the establishment of three committees to inform the advice provided to Government.
Result: Deliverable substantially met.
The development of the MBS Quality Framework involved three key elements: introduction of a new evaluation and listing process for MBS items that utilise the Medical Services Advisory Committee for all items; strengthening arrangements for appropriately pricing and listing new MBS services; and establishing systematic MBS monitoring and review processes to inform appropriate amendment or removal of existing MBS items. The previous assessment of proposed new MBS items was formalised by developing a consistent and transparent process to determine eligibility for MBS listing informed by independent expert advice. To promote consistency of expert advice to Government on issues affecting the MBS, advice on outcomes from the work undertaken through the MBS Quality Framework is provided by the Medical Services Advisory Committee rather than listing MBS items assessed through the MBS Quality Framework on an interim basis as initially envisaged. Over the past two years the department has consulted widely with stakeholders through a large number of bilateral meetings with peak stakeholder organisations, as well as through public input to discussion papers and focus groups and in trials of new listing and review processes for MBS items in relation to the MBS Quality Framework. The department will continue to seek advice from these stakeholders as implementation of the Comprehensive Management Framework for the MBS progresses.
Qualitative Deliverable:	Evaluation plans developed for new MBS items that are not assessed by the Medical Services Advisory Committee.
2010-11 Reference Point:	All new MBS items have an evaluation plan developed in consultation with relevant stakeholders prior to listing on the MBS.
Result: Deliverable met.
An evaluation framework for new items was developed as part of the MBS Quality Framework. The department developed a new evidence-based approach to the assessment of services not previously evaluated by the Medical Services Advisory Committee (MSAC). Design and testing of the framework resulted in recognition that the approach would be best implemented through expansion of the role of MSAC. The Comprehensive Management Framework for the Medicare Benefits Schedule (MBS) was announced by the Government in the 2011-12 Budget and has subsumed the former MBS Quality Framework. The department will report back to the Government on progress under the Comprehensive Management Framework for the MBS in time to inform funding decisions as part of the 2013-14 Budget.

Qualitative Deliverable:	Results of completed health technology assessments are considered by the Medical Services Advisory Committee to provide advice to the Minister to support evidence-based decision-making.
2010-11 Reference Point:	Results of health technology assessments are relevant and appropriate, and are provided to the Medical Services Advisory Committee in a timely manner.
Result: Deliverable substantially met.
In 2010-11, the department established new committee arrangements to apply from 1 January 2011 to facilitate the delivery of health technology assessments under expanded terms of reference for the Medical Services Advisory Committee. These arrangements included the establishment of a Protocol Advisory Subcommittee, an Evaluation Subcommittee and a Medical Services Advisory Committee Expert Standing Panel. The introduction of a standing panel of experts available to assist with development of protocols will reduce the time previously taken to recruit experts to Advisory Panels. Introduction of increased applicant, stakeholder and consumer input requirements into the Protocol Advisory Committee has impacted slightly on the timeliness of commencement of assessment reports. The new process will however deliver a more widely consulted protocol and a greater degree of certainty prior to commencement of assessment reports and allow more active community engagement.
Qualitative KPI:	Advice is provided to Government on a strategic, evidence-based framework for managing the MBS into the future.
2010-11 Reference Point:	Advice available for consideration in the 2011‑12 Budget.
Result: Indicator met.
In 2010-11 advice was provided to Government based on the outcomes of the MBS Quality Framework initiative and recent reforms to the Medical Services Advisory Committee. In the 2011-12 Budget a further two years of funding to implement a Comprehensive Framework for Managing the MBS was introduced. This framework builds on the work of the MBS Quality Framework and will provide the public, the health technology industry and health care professionals with a clear pathway for applying for new services to be listed on the MBS or to have existing items reviewed. There will be improved transparency and consistency in obtaining expert advice on the public funding of professional services and improved coordination.
Quantitative KPI:	Number of services delivered through Medicare by providing rebates for items listed on the MBS.
2010-11 Target:	334m		2010-11 Actual:	319m
Result: Deliverable substantially met.
Medicare rebates were provided for 319 million services, representing 14.3 services per capita.
Qualitative Deliverable:	Methodologies for reviewing MBS items are developed and trialled.
2010-11 Reference Point:	Stakeholders collaborate in reviews spanning various aspects of the MBS, such as single items, groups of items and clinical pathways.
Result: Deliverable met.
The department established four demonstration reviews – surgical interventions for the treatment of obesity; pulmonary artery catheterisation; colonoscopy; and a whole of specialty review of ophthalmology – in order to develop and trial methods of reviewing MBS items. The reviews were supported by external consultants experienced in health service evaluation who took a mixed-methods approach to evidence including fit-for-purpose health technology assessments, concordance with clinical practice guidelines, data analysis, and consumer engagement. Each review was undertaken in an open and cohesive way with relevant stakeholders such as the medical craft groups and the Consumers Health Forum. Additionally, reviews were informed by clinical expert advice through Clinical Working Groups. Under new arrangements introduced from 1 January 2011 the Medical Services Advisory Committee will provide advice to Government on the outcomes of these reviews.
Qualitative Deliverable:		Develop a cohesive, strategic health technology assessments framework.
2010-11 Reference Point:		Commonwealth health technology assessments processes progressively aligned within the strategic policy framework proposed by the Review of Health Technology Assessment in Australia (December 2009).
Result: Deliverable substantially met.
The department is implementing recommendations from the Review of Health Technology Assessment in Australia within the recommended strategic policy framework in a phased approach. This is intended to reduce the impact on ‘business as usual’ (as some recommendations are reliant on the completion of others) and to permit ongoing refinement as the other recommendations are addressed. Deliverables due in 2010 were delivered on time and substantial progress has been made towards ensuring recommendations due in 2011, which relate to improving procedural fairness and transparency and providing for greater consistency across Commonwealth health technology assessment processes, will meet forecast timeframes. The review of Health Technology Assessment Review implementation activity which is due in 2013 will further assist in guiding any necessary alignment.

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Improve Access to Clinically Relevant Dental Services

As announced in the 2011-12 Budget, the department will work to establish a National Advisory Council on Dental Health to provide advice to the Minister for Health and Ageing on options to address identified priority areas for dental health (discussed in Outcome 13 – Acute Care).

Quantitative Deliverable:	Number of vouchers provided to eligible teenagers.
2010-11 Target:	1.3m		2010-11 Actual:	1.2m
Result: Deliverable substantially met.
In 2010-11, 1,226,534 vouchers were provided to teenagers eligible for the Medicare Teen Dental Plan. A reduction in vouchers sent reflects a reduction in the number of eligible teenagers over the period.
Quantitative KPI:	Percentage uptake of preventative dental checks by eligible teenagers.
2010-11 Target:	33%	2010-11 Actual:			30%
Result: Indicator substantially met.
The Medicare Teen Dental Plan is a demand driven, calendar year program. As eligibility for benefits spans the full calendar year, vouchers issued in 2010 and 2011 can be used for services outside of the 2010-11 reporting period. Claims for benefits may also be made for several years after the date of service.

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Whole of Program Performance Information

Program 3.2: Alternative Funding for Health Service Provision

Medical Services Not Available Through Mainstream Mechanisms

Program grants were provided to three organisations that deliver primary health care services to the homeless, the disadvantaged and the visually impaired who have difficulty accessing such services through the mainstream mechanisms. Services provided to these population groups included intervention counselling relating to addiction, lifestyle and social problems, mental health pathology, harm reduction and minimisation, self care, optometric and orthoptic consultations, scientific aids, assisted technology, and adaptive living aids for targeted individuals requiring low vision and rehabilitation assistance.

Qualitative Deliverable:		Services accessible to those in need.
2010-11 Reference Point:		Services delivered in accordance with program criteria and guidelines.
Result: Deliverable met.
The department administered three program grants, in accordance with the contracted schedule, to organisations that provided health services to socially disadvantaged, homeless and visually impaired people which could either 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 13 individuals.
Quantitative Deliverable:		Number of health services provided to eligible Australian residents, that could not be provided through Medicare, due to patient access barriers.
2010-11 Target:		36,400		2010-11 Actual:	47,856
Result: Deliverable met.
This figure was exceeded through the timely administration of relevant funding programs.
Quantitative KPI:	Percentage of applications and grants processed within agreed timelines.
2010-11 Target:	90%		2010-11 Actual:		90%
Result: Indicator met.
90% of applications and conditions of grants were processed within agreed timelines.

Qualitative Deliverable:		Provision of health services through the Medical Treatment Overseas Program.
2010-11 Reference Point:		Eligible Australians with life-threatening conditions are provided with support through the Program.
Result: Deliverable met.
The department provided financial support to 13 eligible Australians with life-threatening conditions for life-saving medical treatment in overseas countries.
Quantitative KPI:		Percentage of applications for financial assistance under the Medical Treatment Overseas Program processed within agreed timelines.
2010-11 Target:		90%	2010-11 Actual:	90%
Result: Indicator met.
Twenty-one applications for financial assistance under the Medical Treatment Overseas Program were processed within the minimum assessment timeframe of six weeks in accordance with the program guidelines. Timely assessment is dependent upon the availability of expert advice about the applicant’s condition and treatment options in Australia and overseas. The department efficiently administered approved financial assistance to 13 Australians including five ongoing eligible funding recipients.
Qualitative Deliverable:	Regular review of gaps in service provision to ensure program objectives are met.
2010-11 Reference Point:	Timely and responsive review process.
Result: Deliverable met.
The department regularly reviews reports from funding recipients to assess whether the needs of the target audience are being met through the program.

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Whole of Program Performance Information

Program 3.3: Diagnostic Imaging Services

Safe, Cost-effective, Clinically Relevant Diagnostic Imaging Services

Review of Funding of Diagnostic Imaging Services

Encourage more Effective use of Diagnostic Imaging Services

Diagnostic Imaging Accreditation Scheme

Qualitative Deliverable:	Introduction of Stage II of the Diagnostic Imaging Accreditation Scheme.
2010-11 Reference Point:	Stage II implemented by 1 July 2011.
Result: Deliverable met.
From 1 July 2011, radiology and non-radiology practices eligible to claim Medicare benefits are required to participate in the Scheme in order to claim Medicare benefits. Non-radiology practices have until 30 June 2011 to gain entry level accreditation which involves a practice meeting three reasonably basic standards.
Quantitative KPI:	Number of practices participating in the Diagnostic Imaging Accreditation Scheme.
2010-11 Target:	4,000	2010-11 Actual:	4,092
Result: Indicator met.
With radiology and non-radiology practices choosing to participate in the Scheme, the numbers have stabilised at 4,000 – 4,100.

Positron Emission Tomography

Whole of Program Performance Information

Program 3.4: Pathology Services

Review of Pathology Funding Arrangements

While the agreement is primarily a mechanism to manage pathology outlays, it also allows for a number of additional key components, including:

• maintaining the Government’s competition reforms to ensure that big and small players alike
  can open new pathology collection centres;
• a commitment to improve transparency for setting and reviewing pathology fees, including a new role for the Medical Services Advisory Committee to assess the cost-effectiveness of new pathology tests;
• a commitment to develop a National Pathology Framework covering issues like workforce development and laboratory accreditation;
• the integration of pathology results within eHealth records;
• the engagement with GP stakeholder groups to investigate ways to improve support services to GPs to better request pathology services; and
• the establishment of a working party to develop an approach for genetic services.

Access to Pathology Services

Qualitative Deliverable:	Implementation of bulk-billing incentives announced in 2009-10 Budget.
2010-11 Reference Point:	Incentives implemented by 1 November 2010.
Result: Deliverable met.
Bulk-billed pathology episode incentive items were listed on the Pathology Services Table of the Medicare Benefits Schedule effective 1 November 2010.
Qualitative Deliverable:	Promote open competition through increasing patient choice of pathology provider.
2010-11 Reference Point:	Removal of legislative barriers to allow patient choice.
Result: Deliverable met.
Changes to the Health Insurance Act 1973 came into effect on 11 December 2010.
Qualitative KPI:	The Quality Assurance in Aboriginal and Torres Strait Islander Medical Services program continues to receive endorsement by key Indigenous stakeholder groups.
2010-11 Reference Point:	Increased number of health sites enrolled in the voluntary program.
Result: Indicator met.
The number of sites increased from 133 at 30 June 2010 to 152 sites enrolled in the program at 30 June 2011.
Quantitative KPI:	Number of health services supported by the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services Program.
2010-11 Target:	150	2010-11 Actual:		152
Result: Indicator met.
The department undertook consultations in 2010-11 with both Quality Assurance in Aboriginal and Torres Strait Islander Medical Service program participants and with the National Aboriginal Community Controlled Health Organisation. There was strong endorsement of the model of service provision and support provided by this program to Indigenous health services throughout Australia (including in many rural and remote communities). The number of sites enrolled in the program continued to increase over the financial year and the target number of 150 enrolled sites was exceeded.
Quantitative KPI:	Percentage of Medicare-eligible laboratories meeting pathology accreditation standards.
2010-11 Target:	100%	2010-11 Actual:		100%
Result: Indicator met.
Under the administrative arrangements set up by the department to support the effective operation of the relevant aspects of the Health Insurance Act 1973, Medicare Australia has liaised effectively with the approved accreditation assessment agency to ensure that Medicare eligibility is only available to those laboratories that meet the requirements of the national pathology accreditation standards.
Quantitative KPI:	Value of bulk-billing incentive payments for pathology services.
2010-11 Target:	$91.6m		2010-11 Actual:	$82.2m
Result: Indicator substantially met.
Although expenditure relating to the bulk-billing incentive payments was lower than estimated, a high percentage of pathology services were bulk-billed in 2010-11.
Quantitative KPI:	Percentage of pathology services that are bulk‑billed.
2010-11 Target:	86%	2010-11 Actual:		87%
Result: Indicator met.
A high bulk-billing rate for pathology services was maintained during 2010-11.
Quantitative KPI:	Percentage of patients who can exercise choice between available pathology providers.
2010-11 Target:	100%		2010-11 Actual:	100%
Result: Indicator met.
An amendment to the Health Insurance Act 1973, effective 11 December 2010, enabled patients to take their pathology request forms to the pathology provider of their choice.

Whole of Program Performance Information

Program 3.5: Chronic Disease – Radiation Oncology

Access to Radiation Oncology Services

During 2010-11, the department provided funding towards the establishment of new and expanded radiation oncology facilities in: New South Wales (Orange, which commenced treating patients in May 2011); Queensland (Cairns, which commenced treating patients in June 2011); and Tasmania (Launceston, where expanded services became operational in May 2011). These new or expanded facilities will improve access to radiation oncology services for cancer patients in these areas and surrounding regions.

Quantitative KPI:	The number of sites delivering radiation oncology.
2010-11 Target:	61	2010-11 Actual:	61
Result: Indicator met.
By the end of 2010-11, 61 sites were delivering radiation oncology services. New facilities commenced operations in New South Wales, Queensland and Tasmania. The target indicator has consistently been increasing and met for the number of sites over the past three years delivering radiation oncology.

The department continued to support access to radiation oncology services through the Radiation Oncology Health Program Grants Scheme. The Scheme funds high cost equipment used in radiation oncology treatment with 61 radiation oncology facilities receiving funding under this Scheme in 2010-11. The department also continued to fund workforce related activities, including training places for radiation therapists and radiation oncology medical physicists.

Quantitative Deliverable:	Number of approved radiation oncology medical physics intern positions funded.
2010-11 Target:	25	2010-11 Actual:	15
Result: Deliverable not met.
In 2010-11, 15 radiation oncology medical physics registrars commenced their first year of training. Registrars require clinical preceptor support (qualified tutors) throughout their training. Limited numbers of available clinical preceptors resulted in facilities unable to recruit to projected positions.
Quantitative Deliverable:	Number of approved radiation therapy training positions.
2010-11 Target:	36	2010-11 Actual:	29
Result: Deliverable substantially met.
In 2010-11, there were 29 radiation therapy training positions in place. Facilities were unable to successfully recruit to projected positions. Ongoing liaison will be undertaken with the sector regarding recruitment strategies.

In 2010-11, the department continued to work with the sector to develop and implement a quality framework for radiation oncology, including the finalisation of a suite of radiation oncology practice standards. The focus in 2011-12 will be on options for the longer term assessment of the standards.

Qualitative Deliverable:	Continued development of a framework to improve patient safety and clinical outcomes during radiation treatment.
2010-11 Reference Point:	Framework developed and implemented in a timely manner.
Result: Deliverable substantially met.
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 operate the Australian Clinical Dosimetry Service (ACDS). The ACDS commenced auditing radiation oncology facilities in January 2011. An independent evaluation will be conducted in 2013 to determine future arrangements. The department assisted the Tripartite Committee, comprising the Royal Australian and New Zealand College of Radiologists (RANZCR), the Australian Institute of Radiography (AIR) and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) to finalise a suite of radiation oncology practice standards.
Qualitative Deliverable:	Complete a trial of the draft radiation oncology standards, to be used as part of a quality framework for the sector.
2010-11 Reference Point:	Trial of standards, including advice and input from the profession, completed September 2010. Proposals for ongoing arrangements to be developed by June 2011.
Result: Deliverable substantially met.
A report on the trial of the radiation oncology practice standards, funded by the department, was finalised in May 2011. The outcomes of the trial informed the finalisation of the standards in June 2011. The trial demonstrated that the standards are usable and a practical guide to good clinical practice. The department is funding the Tripartite Committee to publish and disseminate the standards to radiation oncology facilities. The department worked with the Radiation Oncology Reform Implementation Committee (RORIC) to develop an options paper on the longer term approach to assessing a radiation oncology facility’s conformance with the standards.
Qualitative KPI:	Radiation oncology standards reduce adverse outcomes for patients.
2010-11 Reference Point:	Trial of radiation oncology standards indicate that the standards are effective.
Result: Indicator met.
The outcomes of the trial indicate the standards represent good clinical practice, are not onerous and are a sound guide for the provision of safe, quality radiation oncology services. The standards are strongly supported by the sector.

Qualitative KPI:	Radiation oncology initiatives are developed to increase workforce capacity to support capital expansions.
2010-11 Reference Point:	Workforce research and capital projects are progressed in consultation with the radiation oncology sector to increase the capacity of the sector.
Result: Indicator met.
In 2010-11, the department continued to fund radiation therapy interns to undertake their national professional development program (intern year), radiation oncology medical physics registrar positions and clinical preceptor (tutors) positions for radiation therapy interns and radiation oncology medical physics registrars, to increase workforce capacity to support service delivery. In consultation with the radiation oncology sector, the department developed, progressed and funded: cancer research projects with Cancer Australia through the Priority-driven Collaborative Cancer Research Scheme; the introduction of virtual environment radiotherapy training systems into radiation therapy teaching universities; a pilot national training network for radiation oncologists; and a symposium on lessons learned from previous oncology related capital works programs. The department continued to assess Radiation Oncology Health Program Grants in accordance with program guidelines and progressed the review of the program guidelines.

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Whole of Program Performance Information

Qualitative Deliverable:	Produce relevant and timely evidence-based policy research.
2010-11 Reference Point:	Relevant evidence-based policy research produced in a timely manner.
Result: Deliverable met.
Significant progress was made in collaboration with stakeholders and technical experts to improve service planning data. A range of reform initiatives that are expected to deliver improvements in quality standards and workforce capacity of radiation oncology services have also been informed by specialist technical advice from recognised leaders in the field who participate on the Radiation Oncology Reform Implementation Committee and its working groups.
Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
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 2010-11 and also provided quarterly reports to the Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council. Each of the working groups met at least three times.
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:	-0.7%
Result: Deliverable substantially met.
The variance can be attributed to less than predicted Radiation Oncology Health Program Grant expenditure, which is demand driven, and the inability of radiation oncology facilities to successfully recruit to the projected number of approved radiation therapy and radiation oncology medical physics training positions for which funding would have been provided.

Program 3.6: Targeted Assistance - Medical

Targeted Assistance

During 2010-11, the department managed Reciprocal Health Care Agreements with 10 countries for reciprocal access to health services while Australian residents are visiting those countries and for residents of those countries while visiting Australia. This supports a safer environment for Australian residents travelling overseas for tourism or business purposes. A new Reciprocal Health Care Agreement with Slovenia was negotiated and came into operation on 1 July 2011. In 2010-11, a total of 38,547 visitors to Australia from reciprocal countries accessed 127,267 MBS services with total benefits paid of $7.3 million.

Through the six Disaster Health Care Assistance Schemes, the department pays out-of-pocket expenses for health care required 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.

Qualitative Deliverable:	Assistance provided to eligible people who have incurred an injury or ill health as a result of a specific international disaster.
2010-11 Reference Point:	Appropriate assistance provided in a timely manner.
Result: Deliverable met.
In 2010-11, 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 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. Guidelines are in place to facilitate payments to eligible persons through Medicare Australia on the department’s behalf.
Quantitative Deliverable:	Funds available for additional health care assistance to eligible people affected by specific international disasters.
2010-11 Target:	$780,000		2010-11 Actual:	$322,574
Result: Deliverable 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 2010-11, Medicare Australia paid 2,910 claims on the department’s behalf.
Quantitative Deliverable:	Funds available for health care assistance to people under Reciprocal Health Care Agreements.
2010-11 Target:	$50,000	2010-11 Actual:			$0
Result: Deliverable met.
Whilst these funds were not spent, they relate to the Italian reciprocal agreement, which is the only agreement with a financial adjustment provision, set out in the agreement’s administrative arrangements. While the identification of costs to be reimbursed does not occur on a regular basis, funds must be available to meet this obligation on an annual basis.

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National External Breast Prostheses Reimbursement Program

Qualitative Deliverable:	Reimbursement for breast prostheses provided to eligible women.
2010-11 Reference Point:	Appropriate assistance provided in a timely manner.
Result: Deliverable met.
An independent evaluation found the program was easily accessible, efficient and sensitive to the needs of women accessing the service.
Quantitative KPI:	Percentage of claims by eligible women under the National External Breast Prostheses Reimbursement Program processed within ten days of lodgement.
2010-11 Target:	90%	2010-11 Actual:	99%
Result: Indicator met.
During 2010-11, 14,910 reimbursements were processed under this program. Of the 13,483 eligible claims made, 13,443 were processed within ten days of lodgement.

Whole of Program Performance Information

Outcome 3 – Financial Resources Summary

	(A) Budget Estimate1 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 3.1: Medicare Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,997	1,672	(325)
Special appropriations
Dental Benefits Act 2008	68,523	57,509	(11,014)
Health Insurance Act 1973	16,392,466	16,266,209	(126,257)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	32,445	32,579	134
Revenues from other sources (s31)	1,423	1,402	(21)
Unfunded depreciation expense	741	953	212
Operating loss / (surplus)	-	2	2
Total for Program 3.1	16,497,595	16,360,326	(137,269)
Program 3.2: Alternative Funding to Health Services Protection
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	6,643	7,626	983
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	522	524	2
Revenues from other sources (s31)	23	23	-
Unfunded depreciation expense	12	15	3
Operating loss / (surplus)	-	-	-
Total for Program 3.2	7,200	8,188	988
Program 3.3: Diagnostic Imaging Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	5,550	5,730	180
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,241	2,250	9
Revenues from other sources (s31)	98	97	(1)
Unfunded depreciation expense	51	66	15
Operating loss / (surplus)	-	-	-
Total for Program 3.3	7,940	8,143	203
Program 3.4: Pathology Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,700	4,207	(493)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,631	2,642	11
Revenues from other sources (s31)	115	114	(1)
Unfunded depreciation expense	60	77	17
Operating loss / (surplus)	-	-	-
Total for Program 3.4	7,506	7,040	(466)
Program 3.5: Chronic Disease - Radiation Oncology
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	80,669	80,091	(578)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,529	2,540	11
Revenues from other sources (s31)	111	109	(2)
Unfunded depreciation expense	58	74	16
Operating loss / (surplus)	-	-	-
Total for Program 3.5	83,367	82,814	(553)
Program 3.6: Targeted Assistance - Medical
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	6,808	5,731	(1,077)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,150	1,154	4
Revenues from other sources (s31)	50	50	-
Unfunded depreciation expense	26	34	8
Operating loss / (surplus)	-	-	-
Total for Program 3.6	8,034	6,969	(1,065)
Outcome 3 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	106,367	105,057	(1,310)
Special appropriations	16,460,989	16,323,718	(137,271)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	41,518	41,689	171
Revenues from other sources (s31)	1,820	1,795	(25)
Unfunded depreciation expense	948	1,219	271
Operating loss / (surplus)	-	2	2
Total expenses for Outcome 3	16,611,642	16,473,480	(138,162)
Average Staffing Level (Number)	273	265	(8)
1 Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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³⁶ Available at: www.health.gov.au/internet/main/publishing.nsf/content/cancer-pubs-evprosth

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