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Annual Report - Performance Indicators
Outcome Performance ReportMajor AchievementsOutcome SummaryPerformance IndicatorsFinancial Resources Summary

PERFORMANCE INDICATORS (EFFECTIVENESS INDICATORS)


Indicator 1. Affordability of private health care

Target:

a. Trends in private health insurance membership and coverage.
b. Proportion of in-hospital services covered by no/known gap arrangements.
c. Trends in age profile of people with private health insurance.

Information source/reporting frequency:

a. The Private Health Insurance Administration Council (PHIAC) Quarterly Report A.
b. PHIAC Quarterly Report on gap arrangements.
c. PHIAC Quarterly Report A.


The Department supports the Australian Government’s objective of giving Australians a choice in health services through improving affordability, access and quality in private health care.

The 2004-05 year has again seen continued stability in the rates of participation in private health insurance. At 30 June 2005, 8.7 million people or 42.8 per cent of the Australian population were covered by private health insurance. This is comparable with 30 June 2004 where 8.6 million Australians had private health insurance cover, or 42.9 per cent of the population.

At 30 June 2005, 70.9 per cent of insured in-hospital episodes were covered by a no or known gap arrangement, up from 70.6 per cent at 30 June 2004 and 1 per cent at 30 June 1998.

The number of people over the age of 65 with private health insurance was 1.1 million in June 2005 compared with 1.05 million in June 2004.

Indicator 2. Choice for consumers between private and public health care

Target:

a. Consumer awareness of private health care services.
b. Proportion of in-hospital episodes delivered to private patients in public and private hospitals.

Information source/reporting frequency:

a. Surveys published by the Australian Bureau of Statistics and others.
b. Australian Hospital Statistics.
c. Private hospital administrative data.


Private health services complement publicly funded services, and the partnership between the public and private sectors is a key feature of the Australian health system. Almost half the population chose private health insurance in addition to the security offered by the Medicare system of universal health insurance. The Department supports consumer awareness through improving consumer access to information regarding private health care services.

The proportion of in-hospital episodes delivered to private patients has increased from 32.8 per cent in 2001-02 to 33.3 per cent in 2002-03 to 34.0 per cent in 2003-04.

Indicator 3. Complaints regarding access to appropriate private health care services

Target:
Fall in proportion of member complaints to PHIO that proceed to ‘dispute’ level.

Information source/reporting frequency:
Private Health Insurance Ombudsman Annual Report.


The number of complaints received by the PHIO in 2004-05 was 2,485, a decrease of approximately 12.7 per cent from the 2,845 complaints in 2003-04.

PART 2: PERFORMANCE INFORMATION


Performance Information for Administered Items


Administered Item 1. Federal Government 30% Rebate:

Target: Quantity: Percentage of in-hospital episodes (both in private and public hospitals) delivered to private patients Percentage change from last financial year.

Result: No target percentage specified in 2004-05 PBS

34.0% in 2003-04, an increase of approximately 0.7% from 33.3% in 2002-03.

Target: Quantity: Number of private health insurance policies. Percentage change from previous financial year.
Result: No target percentage specified in 2004-05 PBS. 4.12 million in 2004-05, an increase of approximately 1.1% from 4.07 million in 2003-04.
Target: Quantity: Number of people covered by private health insurance. Percentage change from previous financial year.
Result: No target percentage
specified in 2004-05 PBS.
8.70 million in 2004-05, an increase of approximately 0.8% from 8.62 million in 2003-04.
Target: Quantity: Proportion of the population covered by private health insurance. Percentage change from previous financial year.
Result: No target percentage
specified in 2004-05 PBS.
42.8% in 2004-05, a decrease of approximately 0.1% from 42.9% in 2003-04.


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Performance Information for Departmental Outputs


Output Group 1. Policy advice regarding health industry and related hospital issues, including:
  • development of policy initiatives to make private health insurance more attractive to consumers and thereby support the ongoing viability of the private health industry sector.

Target: Quality: A high level of satisfaction of the Ministers, Parliamentary Secretary and Ministers' Offices with the relevance, quality and timeliness of policy advice.

Result: Target met.

The Minister and Minister’s Office were satisfied with the relevance, quality and timeliness of policy advice, Question Time Briefs, Parliamentary Questions on Notice and briefings.

Target: Quality: Timely production of evidence-based policy research.
Result: Target met. The Department continued to provide, within requested timeframes, high quality and timely evidence-based research and analysis to inform the Australian Government, and to use in consultation with stakeholders.
Target: Quality: Opportunity for stakeholders to participate in policy and program development.
Result: Target met.

Health funds, private hospitals, day facilities and consumer representatives have indicated their satisfaction with the quality and timeliness of Departmental inputs to a range of policy and program environments.

The Department regularly seeks input and feedback from key stakeholders through formal consultation, committee and working group processes as well as informally through day to day liaison.



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Output Group 2. Program management, including:
  • managing the Federal Government 30% Rebate estimates;
  • making payments to the Australian Taxation Office (ATO) under the Service Level Agreement;
  • financial management and reporting on Outcome 8;
  • successful implementation of regulation review and Budget initiatives;
  • developing and implementing strategies to improve quality and cost-effectiveness of care
  • in the private sector;
  • implementing more effective arrangements for rehabilitation care in the private sector;

Target: Quality: A high level of stakeholder satisfaction with the timely development and implementation of national strategies.

Result: Target met.

Health funds, private hospitals, day facilities and consumer representatives expressed their satisfaction through informal feedback with respect to their involvement with the Department in the development and implementation of a range of private health insurance strategies, including changes to prostheses and reinsurance, the portability industry consultations and the loyalty bonus review.

Target: Quality: Budget predictions are met and actual expenses vary less than 5% from
budgeted expenses.
Result: Target met. Budget predictions and actual cash flows varied by less than 0.5%.
Target: Quality: 100% of payments are made accurately and in accordance with negotiated service standards.
Result: Target met.

All payments were made accurately, on time and within agreed service standards.

Target: Quality: A high level of stakeholder satisfaction with relevance, quality and timeliness of information and education services.

Result: Target met. Through informal feedback, stakeholders indicated a high level of support and satisfaction with the timeliness, quality and relevance of information and education services, including changes to prostheses and reinsurance, the portability industry consultations and the loyalty bonus review.

Target: Quality: A high level of stakeholder participation in system-wide improvement activities.

Result: Target met. Stakeholders participated in formal and informal processes to improve several areas of private health, including changes to prostheses and reinsurance, the portability industry consultations and the loyalty bonus review.

Target: Quality: Increased standardisation of data collections between public and private sectors.

Result: Target met. The management of private and public acute care data collections has been centralised supporting standardisation shown on various data collections, including in the annual reporting of data.
  • recognition of hospital and day hospital facilities and special care nurseries for payment of health insurance benefits; and

Target: Quality: Timely recognition of hospital, day hospital and special care nurseries for payment benefits.

Result: Target met. During 2004-05, the Private Sector Outreach Services Working Party considered 16 new and 23 renewal outreach services applications covering 53 hospital facilities nationally. The approval process for these services takes about three to four weeks from the time the Private Sector Outreach Services Working Party meets to assess and make recommendations to the Minister’s Delegate for approval, or otherwise, of the applications.
  • regulation of the default table and prostheses list for benefits payable by funds to public and private hospitals and day hospital facilities.

Target: Quality: Decisions made within legislated timeframes.

Result: Target met.

Health funds submitted notification for premium increases in January 2005. These increases were scrutinised in conjunction with the Private Health Insurance Administration Council and advice was within the required timeframe.

Target: Quality: Public and industry inquiries on the administration of Acts dealt with promptly. Possible breaches of the Acts investigated and appropriate action taken.
Result: Target met. All public and industry inquiries in relation to the administration of the Acts were dealt with as soon as possible. All alleged breaches of the National Health Act 1953 were investigated and have either been resolved to the satisfaction of the Department or are currently being actioned.
Target: Quality: Timely amendments to the default table and prostheses list.
Result: Target met.

Updates for the basic default table were performed in a timely manner as required. Prostheses list updates occurred in August 2004 and February 2005.

Target: Quantity: 25-30 applications for recognition of facilities for health insurance business processed per year.

Result: Target not met. 10 applications for private day hospital facilities, 2 applications for private hospitals and 1 public hospital were processed for health insurance benefit purposes. In addition, 21 Special Care Nurseries in public and private hospitals were processed for payment of health insurance benefit purpose.

Target: Quantity: 10-20 contracts administered.

Result: Target met. 10 contracts were administered during 2004-05.


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Output Group 3. Agency specific service delivery, including:
  • make payments to the Health Insurance Commission (HIC) and the ATO for the administration of the Federal Government 30% Rebate on private health insurance; and
  • ensure that participants have effective and efficient access to the 30% Rebate scheme through appropriate monitoring of HIC’s and ATO’s legislated service delivery functions in accordance with agreed protocols.
Target: Quality: High level of client satisfaction with services provided by the HIC and the ATO as reported by each agency against their respective standards.
Result: Target met. The HIC has advised that feedback received from health funds indicates clients were pleased with the services provided by HIC. The ATO advised that the taxpayers’ Charter standards for taxpayer enquiries were achieved. This, combined with an analysis of reporting mechanisms for disputed tax assessments, indicates that claimants of the 30% Rebate through the tax system are satisfied.
Target: Quality: Accurate and prompt processing of claims as reported by the HIC and the ATO against each agency’s respective standards.
Result: Target met.

The HIC advised that it has processed all payments for the Federal Government 30% Rebate in the legislated time frames. The ATO advised that it aims to process 95% of electronic claims within 14 days and 90% of paper claims within 42 days as stated in the taxpayers’ Charter. The ATO processed 97% of electronic claims within 14 days and 94% of paper claims within 42 days.

Target: Quantity: 4.5 to 5 million policy holders claim the Rebate either as a direct payment or as a premium reduction.

Result: Target met. In 2004-05, 4.5 million policy holders claimed the 30% Rebate as a premium reduction or a direct payment.

Target: Quantity: The number of policy holders that claim the Rebate through the taxation system.

Result: Target met. In 2004-05, the ATO processed 297,981 claims relating to the year ended 30 June 2004.


Produced by the Portfolio Strategies Division, Australian Government Department of Health and Ageing.
URL: http://www.health.gov.au/internet/annrpt/publishing.nsf/Content/performance-indicators-8
If you would like to know more or give us your comments contact: annrep@health.gov.au