Outcome 3: Access to Medical Services > Part 1 Outcome Performance Report

Major Achievements

• Increased opportunities for radiation oncology workforce training in public and private facilities.
• Improved access to magnetic resonance imaging with the extension of Medicare eligibility to ten more locations. This brings the total number of Medicare-eligible magnetic resonance imaging units across Australia to 112.
• Streamlined processes to list new services and procedures on the Medicare Benefits Schedule.
• Improved access to medical services.
• Finalisation of the review of the Professional Services Review Scheme.Top of Page

Challenge

• Managing Medicare outlays that are uncapped within agreed capped funding under the Pathology and Diagnostic Imaging Memoranda of Understanding.Top of Page

Key Strategic Directions for 2006–07

Long Term Affordability and Sustainability of the Medicare Benefits Schedule

Amendments to the Medicare Benefits Schedule

The Department made 249 amendments and 27 deletions to the Medicare Benefits Schedule in 2006–07 to ensure that medical services supported through Medicare remain clinically relevant and financially sustainable for all Australians. Changes included items to fund antenatal checks by nurses, midwives and registered Aboriginal Health Workers on behalf of medical practitioners for patients living in rural and remote Australia; and single event multilevel surgery for cerebral palsy in paediatric patients.

Some of these amendments included the introduction of new items for the treatment of fractures in paediatric patients, and the placement of catheters for the administration of high dose rate brachytherapy to treat prostate cancer. Restrictions on locations where telepsychiatry services can be provided were removed, as were minimum requirements for face-to-face consultations. These restrictions had previously been identified as a barrier to accessing telepsychiatry services by a telepsychiatry working group comprising the Royal Australian and New Zealand College of Psychiatrists and the Department.

Review of the Professional Services Review Scheme

In 2006–07, the Department undertook a review of the Professional Services Review Scheme to enhance its ability to protect the integrity of the medical and pharmaceutical benefits schemes. Established in 1994, the Professional Services Review contributes to the provision of quality and cost effective health care through the assessment of health practitioners’ conduct within Medicare and the Pharmaceutical Benefits Scheme.
The review, carried out in collaboration with the Australian Medical Association, Medicare Australia and in consultation with the Professional Services Review, found that the scheme and its aims continue to have the support of key stakeholders. In 2007–08, the Department will establish a Professional Services Review Advisory Committee to maintain an overview of the scheme and provide broad policy advice. The Department will refine the scheme to enhance its effectiveness and expand it to allow peer review of the conduct of allied health practitioners. Consideration will also be given to reviewing services funded by the Department of Veterans’ Affairs.

Review of Technologies and Medical Procedures

The evidence-based review of new technologies and medical procedures for public funding largely ensures that the Medicare Benefits Schedule is sustainable and supports appropriate clinical care. The Medical Services Advisory Committee, which includes representatives from the Department, and whose Secretariat is located within the Department, provides independent expert advice to the Minister on new technologies and medical procedures and applies a clinical and consumer perspective to the evaluation of the evidence. The Medical Services Advisory Committee completed 14 assessments of technologies and medical procedures in 2006–07. Of the technologies and medical procedures assessed, eight were added to the Medicare Benefits Schedule. These included deep brain stimulation for the treatment of Parkinson’s disease and the minimally invasive treatment of endovascular coiling for intracranial aneurysms. Uterine artery embolisation for the treatment of symptomatic uterine fibroids and cardiac resynchronisation therapy for the treatment of heart failure were also added.Top of Page

Affordability for Patients

Medicare Safety Nets

Also during the year, the Department monitored and provided advice to the Minister on the operation of the Medicare safety nets. The Medicare safety nets provide a financial buffer to individuals and families who face high health care costs. In 2006, over 1.5 million people qualified for the Extended Medicare Safety Net, with 446,000 families and 65,000 singles receiving extra benefits, totalling $257.8 million. Top of Page

Improved Access to Services

Cancer and Mental Health

Work with the medical profession through the Medicare Benefits Consultative Committee continued throughout 2006–07 to improve access to and the affordability of medical services on the Medicare Benefits Schedule.

In November 2006, the Department introduced two new items for cancer case-conferencing as part of the Council of Australian Governments Australian Better Health Initiative. The items will encourage collaboration between relevant care givers such as specialists and general practitioners in planning for the management and treatment of people suffering from cancer. A case conference is a meeting of relevant health care and service providers to discuss the care needs of a patient. It involves practitioners from relevant specialties, for example an oncologist, a radiologist, a psychiatrist and a general practitioner, coming together to discuss and agree on a coordinated approach to the patient’s treatment. An important outcome of a case conference is a care plan for the patient. Medicare funding for these items covers costs associated with participation in, the coordination of a multidisciplinary case conference, and the preparation of a patient’s care plan.

As part of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative, the Department introduced new Medicare Benefits Schedule items to improve access to comprehensive mental health care and services for patients. The new items include higher schedule fees and rebates for patients seeing a psychiatrist for the first time. The fees for psychiatrists to provide general practitioner-referred assessment and management plans also increased substantially. Discussion on this initiative can also be found in the Outcome 5 and 11 chapters.

Improved Medicare Benefits Schedule Listing Procedures

New Medicare Benefits Schedule listing procedures commenced on 1 November 2006 as part of the Department’s drive to increase program efficiency and improve consumers’ access to services. The new procedures ensure services are now listed and made available to consumers shortly after negotiations with the medical profession and changes to legislation are finalised. This compares well to previous arrangements where new items were generally introduced on either 1 November or 1 May.

Medicare Benefits Schedule Online

The Department made wide-ranging improvements to the online version of the Medicare Benefits Schedule, available at www.health.gov.au/mbsonline, to include a free email subscription service, and enhance search functionality and download options. Navigation has also been improved. Over 1,400 people have signed up to receive email information about changes to the Medicare program and there have been over 415,000 downloads of the November 2006 Medicare Benefits Schedule book since its introduction.

New Surgical Services

Following the release of the Independent Review of Assisted Reproductive Technology and the Government’s response in November 2006, the Department listed new items to cover surgical sperm retrieval and intracytoplasmic sperm injection services on the Medicare Benefits Schedule in May 2007. This followed positive recommendations for funding by the Medical Services Advisory Committee. Male infertility is a significant factor in couples undergoing assisted reproductive services and the introduction of these items provides an important treatment option for couples who may not otherwise be able to achieve a pregnancy.

Reciprocal Health Treaties

During 2006–07, the Department continued to progress its program of reciprocal health treaties. At the beginning of the year, Australia had reciprocal health arrangements with Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the Republic of Ireland, Sweden and the United Kingdom. This meant that Australians travelling to these countries could access the health care system in the same way as local residents, and vice versa. The Department is expanding the arrangements to include Belgium and continued negotiations for reciprocal arrangements with Slovenia and Denmark. Agreements with these countries are expected to come into force in 2008.Top of Page

The Medicare Benefits Schedule Reflects and Encourages Appropriate Clinical Practice

Skin Cancer Identification and Treatment

Throughout 2006–07, the Department worked collaboratively with the medical profession, including the Australian Society of Plastic Surgeons, the Australasian College of Dermatologists, the Royal Australian College of General Practitioners and the Australian Medical Association through the Medicare Benefits Consultative Committee, to ensure best medical practice in skin cancer identification and treatment. A number of items associated with skin flap and skin graft surgery were amended in response to concerns expressed by some members of the medical profession around suggested inappropriateness in skin clinics. The amendments clarify appropriate clinical practice in the treatment of skin cancer and are in line with advice from the medical profession regarding the management of cancerous lesions.

Anaesthetic Consultations

The Department introduced a new fee structure for anaesthetic consultations on 1 November 2006, based on the time spent with patients for pre-anaesthesia and referred anaesthesia consultations. The new time-based fee structure supports consultations provided in-rooms, particularly long consultations for patients with complex medical conditions. Improvements in anaesthesia have enabled older, sicker patients to have surgical treatment. Enhanced efficiencies in practice management and surgical procedures mean that these patients increasingly undergo day surgery or are admitted on the day of surgery for an extended period. Ensuring that best practise standards in preoperative planning and post-operative recovery are maintained requires the need for pre‑anaesthetic work-up to be undertaken prior to the patient being admitted. The new fee structure supports this approach and also provides a mechanism for informed financial consent by patients.

Neurosurgery Consultations

A new neurosurgery consultation fee structure, introduced by the Department on 1 November 2006, recognises that neurosurgery consultations are invariably longer and are significantly more complex than for many other types of consultation and may include discussions with other family members. The new structure includes an initial consultation item and four time-tiered subsequent attendance items reflecting increasingly complex clinical consultations. The changes to the items reflect the needs of both patients and clinicians more appropriately. Top of Page

Improved Access to Pathology and Diagnostic Services and Increased Radiotherapy Workforce Numbers

Pathology and Diagnostic Services

In 2006–07, the Department worked to increase the community’s access to diagnostic services through a three year trial of mobile magnetic resonance imaging services. The trial will evaluate the efficacy of mobile magnetic resonance imaging in rural Australia. The Department will support an evaluation over the three years of the trial. The trial commenced during November 2006 for Gippsland in Victoria and south eastern New South Wales. The mobile magnetic resonance imaging units provided services with no out-of-pocket expenses for all Medicare-eligible services. The Department also worked with medical imaging providers to implement the Government’s decision to extend Medicare-eligibility to magnetic resonance imaging units in a further ten locations, including two units in rural Australia. In 2006–07, the number of magnetic resonance imaging machines grew to a total of 112.

The clinical trial funded by the Department to investigate point-of-care pathology testing in general practice clinics continued during 2006–07. Data on outcomes of the trial, which will be received in 2007–08, are expected to provide important information to guide the future role of point-of-care testing in providing access to pathology services.

The Department was involved in work throughout 2006–07 to estimate the effect of government policy introduced in 2004 and 2005 on diagnostic imaging and pathology services. This helped to establish appropriate levels of Medicare funding under the Memoranda of Understanding with the respective professional and industry groups.

Radiation Oncology Workforce

The Department continued to work with the relevant health professions, the jurisdictions and radiation oncology providers to increase the number of training places for radiation therapists and medical physicists by providing a funding contribution to the salaries of 57 radiation therapy and seven medical physics trainees. Initiatives to facilitate clinical placements for university students and to provide clinical preceptors for radiation therapy and medical physics students and trainees continued. These initiatives to expand the radiotherapy workforce have allowed three new radiation oncology units to open in 2006–07 (in Traralgon, Toowoomba and Coffs Harbour), bringing the total number of facilities nationally to 50 and increasing access to radiation oncology for cancer patients in regional centres. Top of Page