Key Strategic Directions for 2005-06
Provision of Free Public Hospital Services to Public Patients through the Australian Health Care Agreements
During 2005-06, the Department continued to administer the 2003-08 Australian Health Care Agreements (AHCAs). In signing the agreements, State and Territory governments committed to providing equitable access to free public hospital services on the basis of clinical need for all eligible patients, as well as matching the Australian Government’s annual cumulative rates of growth in hospital funding. All states and territories qualified for the full amount of funding in 2005-06.
The Department worked collaboratively with the states and territories during 2005-06 to implement a new standardised system for reporting recurrent health expenditure. The new system was agreed between the Australian Government and each state and territory before 30 June 2005, as required by clause 36 of the 2003-08 AHCAs. In 2005-06, the Department achieved bilateral agreement with each state and territory on specific methodologies in advance of the first reporting period, commencing 1 July 2006. The new system will enable a greater level of consistency, comparability and accountability of state and territory expenditure on public hospital services.
In 2006, the Department publicly released the third The State of our Public Hospitals
report. The report provides a picture of our public hospitals in 2004-05 and shows how services have changed since 1998-99. Key findings of the report were:
more people were admitted to Australian public hospitals in 2004-05 than in any previous year. Of the 4.3 million admissions to public hospitals, 86 per cent were treated as public patients;
in 2004-05, 82 per cent of elective surgery admissions were seen within the recommended time. This measure has been declining steadily since 1998-99, when it was 90 per cent; and
there were over 4 million presentations to public hospital emergency departments in 2004-05. Fifty per cent of people were seen within 25 minutes, but the time varied depending on location.
As well as promoting greater state and territory accountability for the funds provided through the AHCAs, the report aims to:
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- stimulate improvement in service performance and health outcomes;
- facilitate best practice service delivery; and
- increase community understanding of the performance of the public hospital sector, including areas of variation between states and territories.
Contribution to the National Blood Agreement
The National Blood Agreement sets out the primary policy objectives and secondary policy aims of all governments in relation to the Australian blood sector. In 2005-06, the Department contributed to these aims and objectives through:
- ongoing provision of 63 per cent of funding for the supply of blood and blood products and services;
- providing support to the Minister on blood matters via the Jurisdictional Blood Committee;
- reinforcing Australia's self-sufficiency policy of striving to source blood components and plasma from within Australia to meet appropriate clinical demand; and
- assisting in the development of evidence-based clinical practice guidelines to influence the appropriate use of blood products used to treat haemophilia and von Willebrand's disease.
Review of Australia’s Plasma Fractionation Arrangements
The Australian Government committed to review arrangements for fractionation of blood plasma collected in Australia, under the Australia-United States Free Trade Agreement. Plasma fractionation is the separation of blood plasma into a number of proteins for medical use. The review terms of reference and membership of the independent Review Committee were announced in February 2006. The Review Committee will report to the Australian Government by 1 January 2007.
During 2005-06, the Department provided administrative and secretariat support to the Review Committee. The Review Committee received 45 written submissions and undertook a national consultation process with stakeholders, including industry, patient and clinician groups and State and Territory governments. The Review Committee and secretariat also consulted with international industry stakeholders, overseas government policy agencies and regulators of plasma products in the conduct of the review.
Improving the Rate of Organ Donation in Australia
In 2005-06, the Department continued to implement a range of programs to improve the rate of organ and tissue donation in Australia. This included:
- work with Medicare Australia to increase the number of legally valid consent registrations on the Australian Organ Donor Register (AODR). The Medicare claim form was redesigned to include direct AODR registration by claimants. From July 2005 to May 2006 there were 783,000 new AODR registrations;
- the Flame for Life initiative was created for Australian Organ Donor Awareness Week 2006 and travelled around Australia to feature in symbolic ceremonies in each capital city; and
- the National Competition for Organ and Tissue Donation was opened to secondary and tertiary students to submit entries to three competitions on the theme of the gift of organ and tissue donation.
In spite of these initiatives, Australia’s rate of organ and tissue donation remains low compared to other Organisation for Economic Co-operation and Development countries. The number of Australian donors per million population (dpmp) in 2005 was 10.0, compared to the United Kingdom at 10.7 dpmp and Canada at 12.8 dpmp. This has been identified by health ministers as a challenge to be addressed as part of a national reform agenda for organ donation.
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Increased Number of Medicare-eligible Magnetic Resonance Imaging Units
The Department’s activities continued to support improved access to Medicare-eligible MRI units in rural and metropolitan areas. MRI units are highly sophisticated diagnostic tools used for a range of medical-diagnostic purposes. They provide clear, state-of-the-art images of soft tissues such as internal organs, thereby increasing the ability of doctors to diagnose patients and plan treatments.
In 2005-06, an extra 14 Medicare-eligible MRI units became operational in under-serviced communities and hospitals, bringing the total number of Medicare-eligible MRI units across Australia to 100. This includes MRI units for Bendigo, Toowoomba and Bunbury. All providers have committed to ensuring that there are no out-of-pocket costs for pensioners and healthcare cardholders.
In addition, over the last year the Department sought providers for a Medicare-eligible MRI unit in Dubbo and for the trial of a mobile MRI service in Gippsland, Victoria and South Eastern New South Wales. These services were anticipated to become operational in 2005-06, but were delayed due to complicated negotiations between the Department and service providers. These services are expected to begin by the end of 2006.
Accreditation in Radiology Practices
The Department considered ways to implement an accreditation scheme called for under the terms of the 2003-2008 Quality and Outlays Memorandum of Understanding between the Australian Government (as represented by the Department), the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Diagnostic Imaging Association (ADIA). The purpose of an accreditation scheme is to ensure that Medicare benefits are only paid for quality services.
During 2005-06, the Department consulted with the RANZCR and ADIA about the best way to progress the introduction of the scheme. The Department continued to fund the RANZCR to maintain a voluntary accreditation scheme, until such time as a mandatory accreditation scheme is implemented.
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Providing Better Access to Radiation Oncology
During 2005-06, the Department implemented several initiatives aimed at increasing radiation oncology workforce numbers, which will ensure the long term sustainability of these services. The Department funded state, territory and private radiation oncology providers to subsidise the salary costs of employing 41 Radiation Therapist Professional Development Year positions and eight Medical Physics Registrar positions which commenced at the beginning of 2006 calendar year.
The Department also provided funding to the Queensland University of Technology; the Royal Melbourne Institute of Technology; the University of Newcastle; the University of South Australia; and the University of Sydney to support the travel expenses of radiation therapy students undertaking clinical placements at radiation oncology facilities. This practical experience is an integral component of the undergraduate course.
In addition, the Department contributed to continuing professional development activities by funding public and private radiation oncology providers to purchase various items, including library resources, presentation equipment, training courses, and computer hardware and software. The Department also provided funding to the professional bodies representing radiation therapists and medical physicists to support individuals continuing professional development. Activities include attendance at local and overseas conferences, seminars and workshops that individual radiation therapists and medical physicists would not normally be able to attend.
Further Development of National Minimum Data Sets
In 2005-06, the Department implemented a new outpatient national minimum data set which will collate data from states and territories on an expanded set of specialist outpatient clinics in public hospitals.
Work to extend the scope of this collection and to better specify information to be collected for services provided to patients attending specialist outpatient clinics continues under implementation of the Australian Health Care Agreements. Services include allied health and ancillary services – pathology, pharmacy and radiology and organ imaging, rehabilitation and geriatric evaluation and management.
These new developments will allow better monitoring of the performance of non-admitted services so that as the average length of stay for an episode of acute care decreases and patients are discharged from hospital, they will have timely and appropriate access to services for their recovery.
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Implementation of Medical Indemnity Measures
The Department’s ongoing work in implementing the Australian Government’s package of medical indemnity measures was a major achievement for 2005-06. The work conducted provided fair and affordable medical indemnity insurance cover for doctors within an industry framework which is significantly more stable and secure.
After introducing two new medical indemnity schemes in 2004-05 – the Run-off Cover Scheme (ROCS) and the Premium Support Scheme – the Department continued to improve and refine administrative and operational aspects of the schemes in responding to issues raised in the Department’s regular consultations with medical indemnity insurers. For example, the Department implemented a protocol to allow insurers to be paid for their costs in administering the ROCS.
In bringing about an improved competitive basis for the medical indemnity industry (as recommended by the Rogers Report), the Department worked with other Australian Government agencies to put in place measures to address United Medical Protection’s competitive advantage that it gained under the Incurred But Not Reported (IBNR) Scheme.