Online version of the 2012-13 Department of Health and Ageing Annual Report
- Around 400,000 patients will have better access to public dental services following the establishment of the National Partnership Agreement on Treating More Public Dental Patients, which will provide $344 million to states and territories over three years.
- Public hospitals will be funded for the services they actually deliver under a new national system of Activity Based Funding for public hospital services, which started on 1 July 2012. The Department provided national leadership for implementation of national health reform. Commonwealth payments for public hospital services of over $13 billion were made through the National Health Funding Pool to Local Hospital Networks and states and territories.
- Tasmanians will get improved health care under new palliative care and elective surgery measures.
- Enable more people to get life-saving and life-transforming organ and tissue transplants by working with states and territories to develop a nationally consistent policy for the special release of cord blood units for purposes other than bone marrow reconstitution.
0% SUBSTANTIALLY MET
10.5% NOT MET
|Period||Met||Substantially met||Not met|
Programs contributing to Outcome 13
- Program 13.1: Blood and organ donation services
- Program 13.2: Medical indemnity
- Program 13.3: Public hospitals and information
Outcome 13 aims to improve access to and the efficiency of public hospitals and acute and subacute care services. In 2012-13, the Department worked to achieve this Outcome by managing initiatives under the programs outlined below.
Program 13.1: Blood and organ donation services
Program 13.1 aims to improve Australians’ access to organ and tissue transplants, and support access to blood and blood products.
Improve Australians’ access to organ and tissue transplants
In 2012-13, the Department continued to help implement organ and tissue transplant reforms by providing advice and governance support to the Australian Organ and Tissue Donation and Transplantation Authority. The reforms aim to achieve a significant increase in the number of life-saving and life-transforming transplants for Australians by introducing nationally consistent donation processes and systems in hospitals. This will be supported by dedicated donation specialists, together with a nationally coordinated approach to community and professional awareness and education. The Department also implemented the Supporting Leave for Living Organ Donors initiative to help alleviate the financial stress of living organ donation.
The Department continued to fund the Australian Bone Marrow Donor Registry (ABMDR) to maximise the chance of a suitable donor match, either in Australia or overseas, for a patient needing a bone marrow, cord blood or peripheral blood stem cell transplant. In 2012-13, the ABMDR undertook 638 donor searches on behalf of Australian patients, with 288 Australian patients with leukaemia or other life-threatening haematological or immune system diseases receiving a bone marrow, peripheral blood or cord blood transplant. Of these, 116 Australians accessed treatment through the ABMDR and 172 Australians accessed treatment through international registries. Australia provided 77 bone marrow, cord blood or peripheral blood stem cell donations to overseas recipients. Through the Bone Marrow Transplant Program, the Department approved financial assistance for 285 patients in Australia, for the costs of obtaining and transporting bone marrow or stem cells from international donors.
The Department also funded the National Cord Blood Collection Network to collect, process, bank and release high quality umbilical cord blood stem cell units to Australian and international transplant centres for patients needing a transplant. In 2012-13, 44 Australian patients received single or double cord blood unit transplants. The network used 27 cord blood units from the Australian inventory and imported 31 cord blood units from international registries for patients for whom a suitably matched unit was not available from within the Australian inventory. In addition, 49 units were exported to international patients.
Scientific developments in the cord blood sector required collaboration between the Department and state and territory governments to consider the medical, ethical, financial and legal implications for the release of cord blood units for purposes other than bone marrow reconstitution. Work will continue in 2013-14 to develop a robust national policy to guide future operations of the network.
Deliverable: Support the Australian Bone Marrow Donor Register and the National Cord Blood Collection Network to identify matched donors and stem cells for transplant
2012-13 Reference Point: Increase diversity of tissue types of donors and cord blood units available for transplant
- The ABMDR started developing recruitment and collection strategies targeting donors from ethnically diverse populations to improve the prospects of finding a match for an Australian patient within the Australian donor pool or cord blood inventory, and reducing the reliance on overseas donors of cord blood.
Genetic diversity of the cord blood inventory increased from 48% to 52% of cord blood units donated from parents who identify as not from North-West European ancestry in 2012-13 (baseline target is 45%).
KPI: Targeted collection strategies to increase the diversity of tissue type and cord blood units
2012-13 Reference Point: Reporting demonstrates ongoing implementation of agreed targeted collection strategies
- During 2012-13, targeted collection strategies were implemented as planned. The ABMDR updated their online donor information and provided promotional material. Brochures and posters were given to bone marrow donor centres to encourage ethnically diverse and younger people to join the registry. In 2013-14, additional efforts will focus on engaging dedicated education officers to communicate with ethnically diverse communities and align cord blood unit testing and banking procedures with expected regulatory changes.
Deliverable: Number of banked cord blood units
2012-13 Target: Total 2,379
2012-13 Actual: 523
Result: Not met
2012-13 Target: Indigenous 129
2012-13 Actual: 64
Result: Not met
- In 2012-13, a total of 1,398 cord units were collected, of which 875 remain subject to regulatory clearance before they can be banked. The number of cord units collected overall, including from Indigenous donors, was below target. This was in part due to delays in processing times which occurred due to delays in recruitment of cord blood bank staff and delayed implementation of anticipated regulatory changes. Additionally, transplant outcome data has informed changes in clinical practice for a preference for selecting high value cord blood units with higher total nucleated cell counts. This is in line with global trends. Cord blood transplant outcomes correlate with a high degree of matching and the total nucleated cell count of a cord blood unit.
The Clinical Services Plan was developed in 2010-11 and the recommended collection and banking strategies continued to be implemented in 2012-13. This included targeting donations from ethnically diverse populations and units with a high total nucleated cell count, which improves the likelihood of the unit being selected for transplant. Given this, collection targets will be reviewed to align with clinical practice and to improve the value of the inventory, in light of emerging evidence in relation to ethnically diverse units, quality and size of the total nucleated cell count.
Historically, reaching the target for Indigenous donors has been challenging. In 2012-13, collection strategies targeted donations from Indigenous mothers at all network centres and provided culturally appropriate education activities to raise awareness and participation of Northern Territory Indigenous donors.
KPI: Percentage of eligible Australians in need of a bone marrow, cord blood or peripheral stem cell transplant who are able to access appropriate treatment
2012-13 Target: 100%
2012-13 Actual: 100%
- To be eligible for appropriate treatment, Australians in need of a bone marrow, cord blood or peripheral stem cell transplant will require a suitably matched donor. Where a suitably matched donor was found, all eligible Australians were able to receive treatment.
Support access to blood and blood products
The Department ensured access to affordable and quality blood supply by providing governance support to the National Blood Authority (NBA) and delivering the Commonwealth’s contribution of funding to the blood sector. In addition, the Department chaired the Jurisdictional Blood Committee (JBC) and continued to support the development of strategies that support appropriate blood use, a reduction in inventory wastage, and better forecasting and demand management across jurisdictions.
The Department also contributed to the Hepatitis C Litigation Settlement Scheme, which provides a contribution to the out-of-court settlement costs for eligible individuals who contracted hepatitis C as a result of a blood transfusion in Australia between 1985 and 1991.
Deliverable: Effective planning of the annual blood supply through the National Supply Plan and Budget
2012-13 Reference Point: The 2013-14 National Supply Plan and Budget agreed by all Health Ministers in 2012-13
- Health Ministers agreed to the 2013-14 National Supply Plan and Budget on 14 June 2013. The Commonwealth’s contribution in 2013-14, based on the national cost-sharing arrangements, is expected to be up to $715 million. This funding will ensure Australians have access to blood and blood products that they require for treatment of numerous medical conditions. These include cancer, heart, stomach, bowel, liver and kidney diseases, during and after surgery, treatment of traumatic injury or burns and for treatment of chronic conditions including bleeding disorders (eg haemophilia) and immunodeficiency conditions.
Deliverable: Percentage of the total contribution, made by the Australian Government, to the approved National Supply Plan and Budget
2012-13 Target: 63%
2012-13 Actual: 63%
- The Australian Government contributed 63% of the approved National Supply Plan and Budget, with state and territory governments providing the remaining 37%.
KPI: Improved evidence based policy on funded blood products and services
2012-13 Reference Point: Number of applications for assessment of new blood products submitted to Medical Services Advisory Committee (MSAC)
- In 2012-13, the Department continued to work with the states and territories through the JBC, the NBA, and the MSAC to implement the health technology assessment framework for blood and blood products. This ensures that patients get access to blood products that have been proven to be safe, effective and cost-effective. One application, subcutaneous immunoglobulin (SCIg)88 was referred to the MSAC by the JBC for consideration.
KPI: Percentage of applications for funding of new blood products that have undergone a cycle one assessment, with those requiring a detailed assessment submitted to MSAC
2012-13 Target: 90%
2012-13 Actual: 100%
- In July 2012, MSAC began consideration of an application of subcutaneous immunoglobulin (SCIg) that had been referred by JBC. In November 2012, MSAC provided advice to the JBC in relation to the safety, efficacy and cost-effectiveness of the SCIg application. Based on advice from JBC, SCIg was approved by the JBC for inclusion on the 2013-14 National Product and Services List for funded supply by Health Ministers.
Program 13.2: Medical indemnity
Program 13.2 aims to ensure the stability of the medical indemnity insurance industry so that insurance products for medical professionals are available and affordable.
Ensure the stability of the medical indemnity insurance industry
Medical indemnity insurance is a specialised form of professional indemnity cover that provides surety to medical practitioners and their patients in the event of an adverse outcome arising from medical negligence. Affordable and stable medical indemnity insurance allows the medical workforce to focus on the delivery of high quality medical services.
By subsidising high cost claims and providing a guarantee to cover exceptional claims, the Government ensures that the medical indemnity insurance industry continues to remain stable and secure.
Deliverable: Continued participation in the Medical Indemnity National Collection through the Medical Indemnity National Collection Coordinating Committee and the Medical Indemnity Data Working Group
2012-13 Reference Point: Reports published by the Australian Institute of Health and Welfare
- The Department worked closely with the Australian Institute of Health and Welfare and other Medical Indemnity Data Working Group and Medical Indemnity National Collection Coordinating Committee stakeholders to assist in the publication of two reports on medical indemnity claims. The reports present data on both public and private sector medical indemnity claims and an analysis of claim trends over time.
Ensure that insurance products are affordable for doctors
The Department administers a number of schemes – such as the Premium Support Scheme and the Run-off Cover Scheme – designed to maintain and improve premium affordability for medical practitioners.
Deliverable: Percentage of eligible applicants receiving a premium subsidy through the Premium Support Scheme
2012-13 Target: 100%
2012-13 Actual: 100%
- All eligible doctors who applied received a premium subsidy.
KPI: Number of doctors who receive a premium subsidy support through the Premium Support Scheme89
2012-13 Target: 2,300
2012-13 Actual: 1,84790
- In 2012-13, 1,847 doctors received a premium subsidy. This is a reduction from the 1,944 doctors in 2011-12. This is a positive result – it indicates that medical indemnity premiums are affordable.
KPI: Percentage of medical indemnity insurers that have a Premium Support Scheme contract with the Commonwealth that meet the Australian Prudential Regulation Authority’s Minimum Capital Requirement
2012-13 Target: 100%
2012-13 Actual: 100%
- All medical indemnity insurers that have a Premium Support Scheme contract with the Commonwealth meet or exceed the Australian Prudential Regulation Authority’s Minimum Capital Requirement.
Ensure availability of professional indemnity insurance for eligible midwives
Privately practising midwives need insurance to meet the requirements of the Government’s National Registration and Accreditation Scheme. Indemnity insurers are reluctant to offer professional indemnity insurance to midwives, as the small potential premium pool and potentially high risk exposure means it is not commercially viable. The Australian Government contracted an insurer, Medical Insurance Group Australia (MIGA), to provide professional indemnity insurance to eligible midwives, to ensure that women and their families can access midwifery care.
Deliverable: Percentage of eligible midwife applicants covered by the Midwife Professional Indemnity Scheme
2012-13 Target: 100%
2012-13 Actual: 100%
- All eligible privately practising midwives who applied for Commonwealth-supported professional indemnity insurance through Medical Insurance Group Australia were offered cover.
KPI: The continued availability of professional indemnity insurance for eligible midwives
2012-13 Reference Point: Maintain contract with Medical Insurance Group Australia to provide professional indemnity insurance to eligible midwives
- Eligible privately practising midwives were able to purchase Commonwealth supported professional indemnity insurance from MIGA. The Commonwealth has recently extended the contract with MIGA for a further two years, expiring 30 June 2015.
Program 13.3: Public hospitals and information
Program 13.3 aims to increase efficiency and capacity in public hospitals through National Health Reform, improved access to public dental services, and increase support for health services for the Torres Strait.
Increase efficiency and capacity in public hospitals
The Council of Australian Governments’ National Health Reform Agreement introduced nationally consistent Activity Based Funding (ABF) for public hospital services aimed at improving the efficiency of Australia’s public hospital system. Under ABF, Local Hospital Networks receive Commonwealth payments based on the actual number and type of services they provide.
In 2012-13, the Department made submissions to the Independent Hospital Pricing Authority (IHPA) to help develop the 2013-14 Pricing Framework, National Efficient Price (NEP) and National Efficient Cost Determinations. These determinations have applied to Commonwealth public hospital payments since 1 July 2013.
Deliverable: Provide financial contribution to states and territories to support the delivery of initiatives
2012-13 Reference Point: Payments to states and territories are made in a timely manner
- In accordance with the National Health Reform Agreement, Commonwealth funding for public hospital services has been provided on an activity basis calculated using the NEP, wherever practicable, since 1 July 2012. The Administrator of the National Health Funding Pool has been making payments to Local Hospital Networks since July 2012.
The National Partnership Agreement on Improving Public Hospital Services commits up to $3.4 billion to states and territories over eight years between 2010 and 2018. These funds will help to improve emergency department treatment times, reduce the length of elective surgery waiting lists and increase subacute care services.
All jurisdictions will get improved access to emergency departments, elective surgery and sub-acute care through investment under the National Partnership Agreement on Improving Public Hospital Services. This includes projects such as $61 million for the state wide Surgery Connect Program in Queensland, $3.9 million for new emergency department treatment spaces at The Canberra Hospital in the ACT and $17.59 million of subacute care funding to develop a 20 bed rehabilitation unit at the Moruya Hospital, in New South Wales.
Funding of $572 million was allocated during 2012-13 to support the delivery of initiatives with all allocations paid to states and territories on satisfactory reporting of progress.
KPI: Enhanced provision and improved mix of subacute care services in hospital and community settings
2012-13 Reference Point: States and territories reporting consistently demonstrates enhanced provision and improved mix of services
- States and territories have continued to report every six months on progress against subacute bed targets and the mix of services delivered. In 2012-13, states and territories remained on track to exceed the national target of 1,316 new subacute beds over four years from 2010-11 to 2013-14. Each jurisdiction has planned the delivery of subacute beds based on identified needs including rehabilitation, palliative care, psychogeriatric care, subacute mental health care and geriatric evaluation and management.
Elective surgery is surgery that, in the opinion of the treating clinician, is not an emergency and can be delayed for at least 24 hours. The National Partnership Agreement on Improving Public Hospital Services rewards those states and territories that achieve their National Elective Surgery Target (NEST). This increases the percentage of patients who receive their elective surgery within clinically recommended times (NEST Part 1) and at the same time reduces the number of patients who have already waited longer than the clinically recommended time (NEST Part 2). Measurement of the NEST began on 1 January 2012 with the Department monitoring state and territory calendar year progress towards achieving the targets.
KPI: Percentage of elective surgery patients seen within the clinically recommended times
2012-13 Target: 85%
2012-13 Actual: Cannot be reported91
Result: Cannot be reported
- The percentage of elective surgery patients seen within the clinically recommended times is no longer reported for financial years. During 2012-13, there was an increase in the volume of surgery for all jurisdictions except Victoria and Tasmania. For NEST Part 1, the ACT and the NT achieved their 2012 interim targets in all three categories. NSW, Queensland and SA exceeded their baseline performance. Victoria, WA and Tasmania performed below the 2010 baseline in at least one urgency category. For NEST Part 2, only the ACT achieved its target in all three urgency categories.
The National Partnership Agreement on Improving Public Hospital Services rewards states and territories that achieve their National Emergency Access Target (NEAT), requiring by 2015 that 90% of patients leave the emergency department within four hours of presentation, either by admission, transfer to another hospital or discharge. Measurement of the NEAT began on 1 January 2012 with the Department monitoring state and territory calendar year progress towards achieving the targets.
KPI: Percentage of emergency department patients admitted, referred or discharged within 4 hours
2012-13 Target: 70%
2012-13 Actual: Cannot be reported92
Result: Cannot be reported
- Performance against the NEAT saw every jurisdiction record an increase in the number of emergency department presentations. Most jurisdictions demonstrated improvements on the previous year’s performance. WA was the only jurisdiction to meet or exceed its NEAT target in 2012. Queensland, SA, Tasmania and the ACT performed above their baselines, while NSW, Victoria and the NT performed at a level below their baseline.
Improve access to public dental services
The 2012-13 Budget included $344 million over three years for states and territories to provide public dental services to around 400,000 patients waiting for public dental services. States and territories will use this funding to provide a range of dental services including preventive and restorative services and dentures by expanding the workforce; extending opening hours; purchasing specialist services; engaging the private sector; and building infrastructure.
The Department also continued to provide funding for mobile Indigenous dental pilot projects that use transportable equipment and mobile staff in rural and regional areas.
KPI: Number of additional public dental patients treated by the states and territories above agreed baseline
2012-13 Target: 80,00093
2012-13 Actual: Cannot be reported
Result: Cannot be reported
- The National Partnership Agreement on Treating More Public Dental Patients has now been signed by all states and territories. Only three jurisdictions that have reported so far have achieved at least the minimum target threshold of 65 per cent and will be paid accordingly for the associated performance period. The funds and targets under this NPA are cumulative. Therefore, any target unmet, and funds unattained, will roll over into the next period, allowing individual jurisdictions to make up their unachieved target.
Not all reports have been received from the states and territories, therefore, the final figures are not yet known.
Deliverable: Implement the Mobile Indigenous Dental Pilot projects
2012-13 Reference Point: Mobile Indigenous Dental Pilot projects commence and program evaluation completed in a timely manner
- Seven pilot project sites for 2012-13 have been implemented and program evaluation completed.
KPI: Improve access to dental services for Aboriginal and Torres Strait Islander communities in rural and regional Australia
2012-13 Reference Point: Overall evaluation of the pilot program will identify the most effective models for future service delivery
- The final evaluation report was received before 30 June 2013.
(A) Budget Estimate 2012-13
(B) Actual 2012-13
Variation (Column B minus Column A)
|Program 13.1: Blood and Organ Donation Services1|
|Ordinary Annual Services (Annual Appropriation Bill 1)||14,600||14,114||( 486)|
|National Health Act 1953 - Blood Fractionation, Products and Blood Related Products - to National Blood Authority||674,348||674,348||-|
|Departmental Appropriation 2||3,492||3,222||( 270)|
|Expenses not requiring appropriation in the current year 3||90||159||69|
|Total for Program 13.1||692,530||691,843||( 687)|
|Program 13.2: Medical Indemnity|
|Ordinary Annual Services (Annual Appropriation Bill 1)||175||174||( 1)|
|Medical Indemnity Act 2002||96,589||-||( 96,589)|
|Midwife Professional Indemnity|
|(Commonwealth Contribution) Scheme Act 2010||334||-||( 334)|
|Departmental Appropriation 2||489||450||( 39)|
|Expenses not requiring appropriation in the current year 3||13||21||8|
|Total for Program 13.2||97,600||645||( 96,955)|
|Program 13.3: Public Hospitals and Information|
|Ordinary Annual Services (Annual Appropriation Bill 1)||207,203||197,533||( 9,670)|
|to Local Hospital Network Special Account||( 107,000)||( 107,000)||-|
|Local Hospital Network Special Account||107,000||105,739||( 1,261)|
|Departmental Appropriation 2||49,894||48,856||( 1,038)|
|Expenses not requiring appropriation in the current year 3||1,013||16,333||15,320|
|Total for Program 13.3||258,110||261,461||3,351|
|Outcome 13 Totals by appropriation type|
|Ordinary Annual Services (Annual Appropriation Bill 1)||221,978||211,821||( 10,157)|
|to Special Accounts||( 107,000)||( 107,000)||-|
|Special appropriations||771,271||674,348||( 96,923)|
|Special Account||107,000||105,739||( 1,261)|
|Departmental Appropriation 2||53,875||52,528||( 1,347)|
|Expenses not requiring appropriation in the current year 3||1,116||16,513||15,397|
|Total expenses for Outcome 13||1,048,240||953,949||( 94,291)|
|Average Staffing Level (Number)||211||210||( 1)|
- This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework.
- Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
- 'Expenses not requiring appropriation in the budget 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.