Outcome 3 - Access to Medical Services

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

Major Achievements

• Increased the bulk billing incentive for Medicare eligible magnetic resonance imaging services from 95% to 100%.
• Improved access to specialist medical services through introduction of new Medicare Benefits Schedule (MBS) items for specialist video consultations for patients living in rural, regional and outer metropolitan areas.
• Improved the Medical Services Advisory Committee’s timeliness, transparency and effectiveness.
• Commenced 11 rapid reviews and two specialty reviews, to consider the safety, clinical effectiveness and cost-effectiveness of services as currently rebated through the MBS.

Challenges

• Embedding video consultation into normal practice where distance is a barrier for patients accessing private specialist services.
• Supporting the ongoing sustainability of Medicare expenditure.

Trends

In 2002-03, 221 million Medicare services were provided. Medicare services have grown steadily since 2002-03 with an annual average rate of 4.7 per cent up to 2010-11. In 2011-12, the number of Medicare services grew by 4.2 per cent, to around 332 million services in the financial year.

Figure 3.1: Medicare services 2002-03 to 2011-12 ⁶⁰

Text version of Figure 3.1

Figure 3.2: Medicare Benefits Schedule expenditure 2002-03 to 2011-12 ⁶¹

Text version of Figure 3.2

Figure 3.3: Proportion of Medicare Services bulk billed, 2002-03 to 2011-12 ⁶²

Text version of Figure 3.3

Extended Medicare Safety Net

The Extended Medicare Safety Net (EMSN) provides an additional Medicare benefit for families and singles who have out-of-pocket costs for Medicare eligible out-of-hospital services. Once an annual threshold in out-of-pocket costs for out-of-hospital services has been reached the EMSN pays 80 per cent of the families or singles out-of-pocket costs for out-of-hospital services for the remainder of the calendar year.

In 2011, EMSN expenditure increased by 8 per cent, from $342.2 million in 2010 to $369.0 million in 2011. This followed a decline in EMSN expenditure of 34 per cent between 2009 and 2010. This reduction in expenditure was due to the introduction of upper limits, or caps, on the benefits paid through the EMSN for selected items, such as obstetrics and assisted reproductive technology services. EMSN benefit capping does not limit the out-of-pocket expenses that accumulate towards the EMSN threshold. Some areas of the EMSN continue to grow at a significant rate, such as operations and anaesthetic services provided out-of-hospital.

Figure 3.4: Total expenditure through the Extended Medicare Safety Net by calendar year ⁶³

Text version of Figure 3.4

Note: EMSN thresholds increased significantly on 1 January 2006; EMSN benefit capping commenced on 1 January 2010.

Outcome strategy

Outcome 3, through the Medicare program, aims to provide access for eligible people to high quality and clinically relevant medical, dental and associated services and ensure that existing and new Medicare services are safe and cost-effective. The Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 3.1: Medicare Services

Program 3.1 aims to improve access to evidence-based, best practice medical services; improve access to specialist medical services through the use of telehealth; and improve access to clinically relevant dental services.

Medicare provides access to:

• free or subsidised treatment by health professionals such as doctors, specialists, optometrists, dentists and other allied health practitioners (in special circumstances only);
• free treatment and accommodation as a public (Medicare) patient in a public hospital; and
• 75 per cent of the Medicare Schedule fee for services and procedures if you are a private patient in a public or private hospital (does not include hospital accommodation and items such as theatre fees and medicines).

A total of $17.6 billion was paid in Medicare benefits in 2011-12, in respect of 332 million services. This represents approximately 15 services and $784 in benefits for every Australian.

Medicare rebates were provided for 332 million services, representing 15 services per capita.

Improve Access to Evidence-Based Medical Services

The Australian Government is committed to building a comprehensive management framework for the Medicare Benefits Schedule (MBS) to ensure the MBS supports cost-effective, evidence-based best practice care through independent expert advice from the Medical Services Advisory Committee (MSAC). MSAC’s role is to advise the Minister for Health on evidence relating to the safety, effectiveness and cost-effectiveness of new and existing medical technologies and procedures. This advice informs Government decisions about public funding for medical services.

In 2011-12, all applications for new MBS items, as well as amendments and reviews to existing items were referred to MSAC and its two new subcommittees. The Protocol Advisory Subcommittee determined the questions for public funding and facilitated public consultation, and the Evaluation Subcommittee assessed the strength of an application’s or review’s evidence for safety, effectiveness and cost-effectiveness.

The 2011–12 Budget included two years funding to implement the Comprehensive Management Framework for the MBS (CMFM) to supersede the Quality Framework.

The CMFM builds on the outcomes of the Review of Health Technology Assessment in Australia (December 2009) and provides the public, the health technology industry and health professionals a clear pathway for applying for new services to be listed on the MBS or to have existing items reviewed. These measures provide improved transparency, coordination and consistency for such stakeholders seeking expert advice on public funding of professional services.

In 2011-12, the Department commenced 11 rapid reviews and two specialty reviews of MBS items, and completed the Review of Ophthalmology Stage 1. As a result, more than 60 new and revised Medicare Benefits Schedule listings have been developed and agreed with the Royal Australian and New Zealand College of Ophthalmologists. Increased funding for paediatric ophthalmology consultation items was provided from 1 March 2012 and adjustments made to items for eye injections to better reflect contemporary practice. The ophthalmology review successfully tested new methodologies which will be used for other whole-of-specialty reviews in 2012-13.

Following the Minister for Health’s approval of 11 selected services for rapid review in December 2011, the Department commenced rapid reviews of MBS services for wrist ganglia, diagnostic knee arthroscopy, varicose veins, lipectomy, rhinoplasty, vulvoplasty, botulinum toxin, cardiac perfusion, carotid vessels, implantable cardioverter defibrillators and inguinal hernia.

The Department engaged health technology assessment consultants to provide protocols to guide each of the 11 rapid reviews. These protocols were prepared with extensive input from craft groups, clinicians, departmental officers and medical advisers before being presented to the MSAC’s Protocol Advisory Subcommittee for approval. The protocols will be published for public comment after July 2012. The final protocols, incorporating public comment where necessary, will be the blueprints to govern the second stage of the rapid reviews – evidence collection and review report – which will commence in 2012-13.

The Department commenced a specialty review of skin services in 2011-12, contracting a health technology assessment consultancy to prepare a protocol to guide the review into 2012-13. The protocol was drafted with advice from craft groups, clinicians, departmental officers, and departmental medical advisers.

The second stage of the ophthalmology review commenced in 2011-12. The review protocol was approved by the Protocol Advisory Subcommittee in December 2011, and a draft final report is being prepared for public consultation. The review is scheduled for MSAC consideration in 2012-13.

Reviews of existing MBS items were instituted under the Comprehensive Management Framework for the Medicare Benefits Schedule so that the MBS could be systematically evaluated for safety, quality and clinical effectiveness. While the 2011–12 rapid and speciality reviews have yet to recommend changes to the MBS, they were identified through consideration of their clinical relevance, quality, safety, utilisation, and the strength of evidence available on which to base a review. The rigorous processes governing their selection and execution form a solid framework on which to base effective, sound changes to the MBS. 

Improved Access to Specialist Medical Services through Telehealth

On 1 July 2011, the Department successfully introduced 34 new MBS items for telehealth and telehealth related services.

These new MBS items are intended to help address some of the barriers preventing access to specialist services for Australians in remote, regional and outer metropolitan areas. Through the use of online video consultations, patients in these areas will have access to a range of medical specialists sooner, and without the time and expense involved in travelling to inner metropolitan areas.

The Department is also funding training and support for practitioners to encourage them to provide services by video conference, where clinically appropriate, through Outcome 12. The Department is monitoring the use of online consultations and will evaluate their effectiveness.

The Department introduced 11 new MBS items on 1 July 2011 to enable specialists to provide consultations to patients via video conferencing. The Department also introduced 23 new MBS items on 1 July 2011 to enable eligible practitioners to assist at the patient end of the specialist video consultation. The first year of implementation has been successful in encouraging health professionals to conduct video consultations.

Funds were made available to support the provision of online consultations through incentives for medical practitioners. See Program 3.2 (improved access to specialist medical services through telehealth) for further details.

The first year of Medicare data for specialist video consultations shows that 13,856 patients located in rural, remote and outer metropolitan areas accessed MBS funded telehealth services.

MBS rebates for video consultations first became available on 1 July 2011. Expenditure on MBS rebates has been lower than provided for in the forward estimates as most providers started providing services towards the end of the financial year. Take-up of MBS telehealth items is expected to increase in 2012-13 as there are now more than 5,000 doctors providing telehealth services. 

Improve Access to Clinically Relevant Dental Services

In 2011-12, the Department worked with the Department of Human Services to ensure access to preventative dental services for teenagers aged 12-17 years old, under the Medicare Teen Dental Plan.

A challenge for the Department this year was the continued delayed closure of the Medicare Chronic Disease Dental Scheme. The Government attempted to close the Scheme in 2008 but the necessary legislative instrument was disallowed by the Senate. The closure was to make funding available for the introduction of a new Commonwealth Dental Health Program (discussed in Outcome 13 – Acute Care). It remains Government policy to close the Scheme.

The National Advisory Council on Dental Health provided its Final Report to the Government in February 2012. This report provided a range of options for dental services for children and adults for consideration in the context of the 2012-13 Budget.

In 2012, 1.2 million vouchers were posted 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.

The Medicare Teen Dental Plan is a demand driven, calendar year program. As eligibility for benefits spans the full calendar year, vouchers issued in 2011 and 2012 can be used for services outside the 2011-12 reporting period. Claims for benefits may also be made for several years after the date of service. 

Whole of Program Performance Information

In 2011-12, the review of MBS services including colonoscopy, ophthalmology, obesity and pulmonary artery catheterisation, made recommendations on the quality and safety of services and aligned their use to evidence-based cost effective best clinical practice.

In 2011-12, stakeholders were invited to comment on the four evidence-based MBS reviews and 22 Medical Services Advisory Committee (MSAC) Consultation Decision Analytical Protocols through targeted invitations and public consultations to inform the development of reports and participated on consultative review committees for the MBS reviews.

Program 3.1 is primarily driven by demand driven programs to meet the medical needs of the Australian public.

Program 3.2: Targeted Assistance – Medical

Program 3.2 aims to provide targeted assistance to eligible people to access health care, currently not covered under existing programs (including reimbursements for external breast prostheses), and support access to necessary medical services that may not be available through mainstream mechanisms or which may not be available in Australia. Program 3.2 also aims to improve access to specialist medical services through the use of telehealth.

Targeted Assistance

The Department manages several programs designed to help people access necessary medical services in times of greatest need.

Reciprocal Health Care Agreements

Reciprocal Health Care Agreements provide access to public health services for Australian residents visiting certain countries, and for residents of those countries visiting Australia. This supports a safer environment for Australian residents travelling overseas for tourism or business purposes. In 2011-12, the Department managed agreements with 11 countries. In 2011-12, visitors to Australia from reciprocal countries accessed 134,954 MBS services with total benefits paid of $8.04 million.

These funds were available, but were not spent. They relate to the Reciprocal Health Care Agreement with Italy, 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.

Disaster Health Care Assistance Schemes

Through the Disaster Health Care Assistance Schemes, the Department provides ex-gratia payments to eligible victims and their families to cover out-of-pocket expenses for health care delivered in Australia for ill health or injury which has arisen as a result of specific international disasters. The six schemes cover incidents arising from acts of terrorism, civil disturbances or natural disasters. In recent years, these have included events such as the Bali bombings and

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.

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 2011-12, the Department of Human Services paid 2,270 claims on the Department’s behalf.

National External Breast Prostheses Reimbursement Program

The Department provided reimbursement of up to $400 for new and replacement external breast prostheses for women who have had a mastectomy as a result of breast cancer, through the National External Breast Prostheses Reimbursement Program. An independent evaluation, released in May 2011, found the Program to be easily accessible, efficient and sensitive to the needs of women accessing the service.

During 2011-12, 14,447 reimbursements were processed under this program. Of the 14,447 eligible claims made, 99.8% were processed within 10 days of lodgement.

Medical Services Not Available through Mainstream Mechanisms

During 2011-12, the Department worked to improve access to necessary medical services which are not available through mainstream mechanisms, such as Medicare, or which are not available in Australia.

Program grants were provided to three organisations to provide primary health care services to the homeless, disadvantaged and visually impaired who have difficulty accessing these services through mainstream mechanisms. Services provided under the health program grants include primary health care; intervention counselling; optometry and orthoptic consultations; and scientific aids, assisted technology and adaptive living aids for low vision and rehabilitation.

The Department regularly reviews reports from funding recipients to assess whether the needs of the target audience are being met through the program.

38,739 health services were provided to eligible Australian residents in the reporting period, exceeding the 2011-12 target.

90% of health program grants were processed within agreed timelines.

The Department also provided financial assistance to ten Australians with life-threatening conditions to receive necessary medical treatments which were not available in Australia.

Twenty applications (of the 24 applications received in 2011-12) for financial assistance under the Medical Treatment Overseas Program were processed within the minimum assessment time frame of 6 weeks in accordance with the Program guidelines. Timely assessment is dependent upon the availability of independent expert advice about the applicant’s condition and treatment options in Australia and overseas. The Department efficiently administered approved financial assistance to 10 Australians, including 6 ongoing eligible funding recipients.

Improved Access to Specialist Medical Services through Telehealth

On 1 July 2011, the Department introduced a range of non-MBS financial incentives linked to the telehealth MBS items to encourage and support the initial and ongoing provision of telehealth services to eligible patients by practitioners. The financial incentives have been highly successful in encouraging specialists to provide video consultations funded under Medicare. The 2011-12 target of 2.7 per cent of specialists was reached in March 2012 and the 2012-13 target of 4.5 per cent was achieved in June 2012.

Figure 3.5 Percentage of specialists providing video consultations funded under Medicare

Text version of Figure 3.5

The Department of Human Services has administered the payment of financial incentives to eligible telehealth practitioners and eligible facilities to coincide with the payment of MBS rebates.

The financial incentives have been highly successful in encouraging practitioners to start providing telehealth services to patients for whom distance is a barrier to accessing specialist services. In 2011-12, 5,173 practitioners [33% specialists and 67% patient-end providers] and 54 facilities participated in specialist telehealth consultations.

In 2011-12, 7% of specialists, including psychiatrists and consultant physicians, provided a telehealth service. This significantly exceeded the target rate of 2.7% for the year.

Whole of Program Performance Information

The Department commissioned an evidence-based, rapid response policy on the use of telehealth in primary care to research and inform evaluation of telehealth initiatives.

Telehealth Advisory Group continues to be the primary avenue for consultation on telehealth program implementation and evaluation. The Department has also maintained stakeholder relationships and consultation regarding telehealth policy and programs through the Australian College of Rural and Remote Medicine and the Telehealth Advisory Committee, and direct consultation with medical colleges and other groups.

The variance is due to the success of Telehealth incentive payments which exceeded expectations.

Program 3.3: Diagnostic Imaging Services

Program 3.3 aims to provide access to safe, efficient and clinically effective diagnostic imaging services.

Safe, Cost-Effective, Clinically Relevant Diagnostic Imaging Services

The Program aims to provide access to safe, efficient and clinically effective diagnostic imaging services, including services performed using x-ray, computed tomography, ultrasound, magnetic resonance imaging, cardiac imaging, positron emission tomography and nuclear medicine technologies.

The Diagnostic Imaging Reform Package aims to improve the quality and value of diagnostic imaging services. Implementation of this package commenced on 1 July 2011, with full implementation anticipated by 30 June 2016. As part of the Package the incentive for the bulk-billing of Magnetic Resonance Imaging (MRI) services was increased from 95 per cent to 100 per cent of the MBS fee from 1 May 2012. This is anticipated to improve the affordability of this important imaging service for patients by encouraging providers to bulk bill. The Package includes the following key elements:

• addressing fee relativities and incentives;
• ensuring appropriate requesting of diagnostic imaging;
• enhancing the role of radiologists in appropriate imaging;
• enhancing the Diagnostic Imaging Accreditation Scheme;
• expanding patient access to MRI; and
• increasing access to MRI services for primary care patients.

The funding agreements for the 1st round were released in July 2012. The delay was due to the need to change the assessment process to manage conflict of interest risks and the need to prioritise other activities. Given this, the Department will reconsider the approach to future funding rounds.

The base line report for phase one of the evaluation of stage 1 was submitted to the Department in December 2011. Phase two of the evaluation commenced in July 2012. The third and final phase of the evaluation will be completed in December 2013.

The number of practices currently participating in the Scheme is slightly lower than anticipated, but it continues to increase.

Implementation of Capital Sensitivity commenced on 1 July 2011, arrangements were refined from 1 July 2012. Timelines for implementation to date have been met.

The Capital Sensitivity measure is intended to improve the quality of diagnostic imaging services by encouraging providers delivering services under Medicare to upgrade and replace aged equipment as appropriate. The measure includes reduced rebates for diagnostic imaging services provided on aged equipment.

Bulk-billing rates have increased from 73% in 2010-11 to 74% in 2011-12.

 Whole of Program Performance Information

The report of the 2010-11 review of the Diagnostic Imaging Quality Practice Program was received in 2011-12.

The report of the review of the Diagnostic Imaging Quality Program, provided an analysis of the outcomes of the grant program, based on the quality initiatives implemented by practices which received a grant.

During 2011-12, the Department managed Program 3.3 funds effectively and achieved a variance of -0.6%.

Program 3.4: Pathology Services

Program 3.4 aims to align pathology services with best clinical practice to ensure access to and efficient use of testing.

Access to Pathology Services

On 1 July 2011, the new Pathology Funding Agreement commenced. It is a five year Agreement between the Australian Government and key stakeholders in the pathology sector. The Agreement provides a mechanism to manage pathology outlays as well as a framework to enable the Government and the sector to work cooperatively on a number of issues.

During 2011-12, the Department has established a number of committees and working parties, which include representation from a range of stakeholders. The work of these committees and working groups will help ensure that the aims of the Agreement are achieved: that patients have access to quality, affordable pathology services and the cost to the taxpayer is contained. Through cooperation with key stakeholders, the effectiveness of the Agreement can be monitored and emerging issues can be addressed. Information about the committees and working parties, together with minutes of the meetings, are published on the Department’s website.

The Department established an expert stakeholder committee that has commenced the development of a national pathology framework that is specified in the Pathology Funding Agreement. This is expected to be completed during 2012-13.

The Genetics Working Party was established and includes representatives from a wide range of organisations with an interest in genetic testing. During 2011-12, the review was commenced, with a report anticipated in December 2012.

The Department also worked with the pathology sector to facilitate the inclusion of pathology services into the broader eHealth agenda.

Instead of a requirement for the inclusion of patient healthcare identifiers into pathology records by July 2012, it was determined that the integration of pathology services into the broader eHealth agenda was more appropriately met by development of a framework for ensuring that pathology data could be accommodated within specifications of the Personally Controlled Electronic Health Record. This activity continues to be progressed with key stakeholders.

During 2011-12, the Department continued to work closely with the National Pathology Accreditation Advisory Council (NPAAC) to refine the national quality standards to ensure patients have access to high quality pathology services. NPAAC has worked to streamline accreditation materials to improve the comprehensiveness of the documents and to align them with the Australian Commission on Safety and Quality in Health Care’s National Safety and Quality Health Service Standards, where appropriate.

Four revised accreditation standards were completed in 2011-12, and there are five other standards documents under active review. The NPAAC has also continued with its streamlining initiative of the pathology accreditation standards framework. This was to improve transparency and align it to the relevant Australian Commission on Safety and Quality in Health Care national standards for safety and quality.

The Department contracted Ernst & Young to undertake development of a transparent MBS fee setting approach for pathology items. Ernst & Young has engaged in discussions with the pathology sector about cost drivers and data. Over a two year time frame, there will be further development of a detailed definition of pathology cost drivers and a rigorous process for collecting cost data from providers, resulting in a comprehensive fee setting mechanism.

The Quality Use of Pathology Program has supported a range of pathology initiatives focused on improving the quality assurance development activities in emerging fields such as genetics, consumer awareness of risks and benefits of pathology testing, and providing better guidance for requesters of pathology services on the appropriate use of pathology testing.

Under the administrative arrangements established by the Department to support the effective operation of the relevant aspects of the Health Insurance Act 1973, the Department of Human Services 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.

Although expenditure relating to the bulk-billing incentive payments was lower than estimated, the percentage of pathology services that were bulk-billed was over the target.

A high bulk-billing rate was maintained during 2011-12.

An amendment to the Health Insurance Act 1973, effective 11 December 2010, enables patients to take their pathology request forms to the pathology provider of their choice.

Whole of Program Performance Information

All policy research activities were delivered within expected timeframes.

Relevant key stakeholders, including pathology professionals, scientific organisations, professional organisations and consumer groups were consulted, both formally and informally, on a range of issues through committees, conferences, public consultations and meetings.

The variance reflects a number of factors that affected expenditure in 2011-12. These include the delay in a planned redevelopment of a pathology database and fewer committee meetings that required expenditure on venue hire, catering, accommodation and committee travel costs.

Program 3.5: Chronic Disease – Radiation Oncology

Program 3.5 aims to complement the delivery of radiation oncology services under Medicare and the Regional Cancer Centres Initiative (Outcome 10) by improving access to, and the quality of, appropriately equipped radiation oncology treatment facilities for Australians with cancer.

Access to Quality Radiation Oncology Services

Access to appropriate radiation oncology services is vital in the treatment of cancer patients. The Department supports access to these services through the provision of funding for facilities, equipment and staff.

In 2011-12, the Department provided funding towards the construction and establishment of a new radiation oncology facility in Bunbury, Western Australia. This facility commenced operations in August 2011 and is capable of treating over 800 cancer patients per year. It means that most cancer patients in the region will no longer need to travel away from home for treatment.

To increase the radiation oncology workforce a grant funding round for innovative workforce related projects was conducted. Fourteen projects were approved for funding to the value of $7.2 million over three years. The types of activities being funded include workforce planning, reducing barriers to training and attracting staff to regional areas. For example, one project will focus on career opportunities within the professional groups providing this important treatment.

Funding was provided to 64 facilities to contribute to the cost of approved radiotherapy equipment, through the Radiation Oncology Health Program Grants Scheme.

Of the 65 private facilities that were approved for funding, one did not proceed to construction.

The Australian Clinical Dosimetry Service, being operated on a trial basis by the Australian Radiation Protection and Nuclear Safety Agency, continues to undertake equipment audits at radiation oncology facilities to check that the doses of radiation delivered to patients are accurate.

The Australian Clinical Dosimetry Service is in its second year of operation and is offering a three-level audit program. Audit results indicate the standard of dosimetric practice in Australia is good. An independent evaluation of this service will be conducted in 2013 to consider future arrangements.

The Department assisted the Tripartite Committee, which represents the three radiation oncology professional bodies, to promote and disseminate the Radiation Oncology Practice Standards. The standards are now available to all facilities as a guide to good radiotherapy practice.

By the end of 2011-12, 63 radiation oncology sites were providing services to patients. A site, which was predicted to commence operations this financial year, is now expected to commence treating patients later in 2012. A further site proposed to be established in 2011-12 did not proceed to construction. 

Whole of Program Performance Information

A number of projects and initiatives around workforce, research and service planning aimed at improving access to quality radiation oncology services were conducted or commenced in 2011-12. The advice of relevant professional groups and other technical experts was enlisted in these projects.

The main consultative mechanism to provide advice to the Department regarding strategies to ensure improved access to radiation oncology services was the Radiation Oncology Reform Implementation Committee (RORIC) and its working groups. RORIC and its working groups met at least twice during 2011-12. In addition, the Department conducted a symposium to launch the Radiation Oncology Practice Standards.

The variation can largely be attributed to less than budgeted expenditure under the Radiation Oncology Health Program Grants Scheme (which is a demand driven program), unforeseen delays in the performance of a small number of funded projects and some radiation oncology facilities not being able to recruit radiation therapists and medical physicists to the number of projected training positions.

Outcome 3 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

60. Medicare Financing and Listing Branch, forecast model. Services do not include Teen Dental (MBS Group B1).
61. Source: Medicare Financing and Listing Branch, forecast model.
62. Source: MedicareWiz.
63. Table data is based on the date the Medicare data was processed.
64. The Medicare Teen Dental Plan operates on a calendar year basis. As such, estimates are for vouchers provided in the relevant calendar year.
65. The Medicare Teen Dental Plan operates on a calendar year basis. As such, estimates are for vouchers provided in the relevant calendar year.

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