Online version of the 2012-13 Department of Health and Ageing Annual Report
- Enabled more patients to access magnetic resonance imaging (MRI) scans under Medicare.
- Supported telehealth services to give patients better access to specialist medical services where distance is a barrier.
- Promoted patient safety by implementing the removal of out-of-hospital benefits for complex and unsafe procedures.
- Ensured patients can continue to access affordable medical services by improving the management and governance of the Medical Benefits Schedule through implementing the Comprehensive Management Framework for the Medicare Benefits Schedule.
- Continue to engage key stakeholders of the Medical Services Advisory Committee and reviews processes. This is fundamental to ensure credibility of the processes and support for an evidence-based approach.
- Support long term sustainability of Medicare expenditure.
- Continue to work co-operatively with the non-Government signatories to the Pathology Funding Agreement in order to achieve the objectives of the terms of the Agreement and the key outcomes of access to high quality and affordable Pathology Services.
25.0% SUBSTANTIALLY MET
8.3% NOT MET
|Period||Met||Substantially met||Not met|
Programs contributing to Outcome 3
- Program 3.1: Medicare services
- Program 3.2: Targeted assistance – medical
- Program 3.3: Diagnostic imaging services
- Program 3.4: Pathology services
- Program 3.5: Chronic disease – radiation oncology
Figure 3.1: Steady increase of specialists providing telehealth services funded under Medicare
Outcome 3 aims to provide access for eligible people to high quality and clinically relevant medical, dental and associated services. In 2012-13, 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 and specialist medical services.
Improve access to evidence-based, best practice medical services
The Department aims to ensure all Australians have access to free or low-cost medical, optometry and hospital care and, in special circumstances, allied health services.
KPI: Number of services delivered through Medicare by providing rebates for items listed on the MBS
2012-13 Target: 336m
2012-13 Actual: 343.6m
- Medicare rebates were provided for 343.6 million services. This is an average of 14.8 services per capita. It compares with 332.2 million services in 2011-12 and 318.8 services in 2010-11.
To ensure the Medicare Benefits Schedule (MBS) supports cost-effective, evidence-based best practice care, the Department is progressing a number of reviews with the advice of the independent expert Medical Services Advisory Committee (MSAC). MSAC’s role is to advise the Minister 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.
Deliverable: Number of reviews of existing MBS items commenced:
2012-13 Target: rapid reviews 0
2012-13 Actual: 3
2012-13 Target: speciality reviews 2
2012-13 Actual: 2
- The Department began two specialty reviews for surgical paediatric services and ear, nose and throat services as well as an additional three reviews for vitamin D, vitamin B12 and folate testing. The draft scope and protocol reports have been released for public consultation and are being considered by expert working groups. The review reports will then be considered by the MSAC which will provide advice to the Minister.
Deliverable: Number of appraisals of new items, or amendments to items, commenced
2012-13 Target: 32
2012-13 Actual: 32
- In 2012-13, 32 appraisals of new items, or amendments to existing items, began.
Improve access to specialist medical services through the use of telehealth
The Department has introduced six new telehealth MBS items for short specialist consultations and made a range of adjustments to telehealth services funded under the MBS.
Deliverable: MBS rebates paid for specialist telehealth consultations
2012-13 Target: $58.2m
2012-13 Actual: $10m
Result: Not met
- MBS rebates continued to be available for private specialist telehealth consultations in 2012-13, with six new MBS items introduced for specialist video consultation which are 10 minutes or less. These MBS rebates have helped more than 40,000 patients in telehealth-eligible areas to access specialist medical services by video consultation.
Medicare is a demand-driven program and deliverables are impacted by patient and provider behaviour.
In 2012-13, the Department of Human Services processed claims for 71,000 telehealth services – an increase from 26,000 telehealth services in the previous financial year.
Using the Internet to Bring Health Services to Rural Patients
For patients who live outside the major cities, seeing a medical specialist can often involve a lot of travel, time and expense.
Many patients in rural and remote Australia are now able to access health care by ‘seeing’ a specialist in their home, GPs’ surgery, Aboriginal Medical Service or Residential Aged Care Facility.
Patients in areas such as Central and North West Queensland, the Eyre Peninsula of South Australia, and the Pilbara and Kimberley regions of Western Australia have obtained the specialist medical advice they needed by video consultation.
Specialists providing these video consultations have included ophthalmologists, cancer specialists and psychiatrists.
In 2012-13, the Medicare Benefits Schedule for telehealth consultations was adjusted to target the use of video consultations in rural, remote and very remote areas.
Improve access to clinically relevant dental services
The Department is focused on improving the dental health of Australian teenagers by promoting preventative dental checks. In 2012-13, the Department worked with the Department of Human Services to provide vouchers to ensure access to preventative dental services for teenagers aged 12-17 years under the Medicare Teen Dental Plan.
The Government closed the Medicare Chronic Disease Dental Scheme to all patients from 1 December 2012. The Department, along with the Department of Human Services, managed patient and provider access during the transition to the scheme closing.
Deliverable: Number of vouchers provided to eligible teenagers52
2013 Target: 1.2m
2013 Actual: 1.2m
- In 2012-13, 1.2 million vouchers were posted to all teenagers eligible for the Medicare Teen Dental Plan.
KPI: Percentage uptake of preventative dental checks by eligible teenagers53
2013 Target: 39%
2013 Actual: 31%
Result: Substantially met
- The Medicare Teen Dental Plan is a demand-driven, calendar year program. As eligibility for benefits spans the full calendar year, vouchers issued in 2012 and 2013 can be used for services outside the 2012-13 reporting period. Claims for benefits may also be made for several years after the date of service.
Program 3.2: Targeted assistance – medical
Program 3.2 aims to provide medical assistance to Australians overseas and support access to necessary medical services not available through mainstream mechanisms.
Provide medical assistance to Australians overseas
The Australian Government continued to facilitate the provision of essential medical treatment for Australian residents travelling in certain countries through Reciprocal Health Care Agreements.54 In 2012-13, the Department took a lead role in managing agreements with 11 countries,55 in collaboration with the Department of Foreign Affairs and Trade. In 2012-13, visitors to Australia from reciprocal countries accessed 144,223 MBS services with a total of $8.95 million paid in benefits.
Through the Disaster Health Care Assistance Schemes, the Department provides ex-gratia payments to eligible victims and their families to cover out-of-pocket expenses56 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.
In 2012-13, the Department of Human Services paid more than $414,000 for 3,041 claims on the Department’s behalf.
Deliverable: Provide health care assistance to eligible Australians overseas in the event of overseas disasters
2012-13 Reference Point: Assistance is provided in a timely manner
- The Disaster Health Care Assistance Schemes are demand-driven programs. Eligible people receive reimbursement for ‘out-of-pocket’ health care expenses related to any injury or illness which has resulted from one of the incidents covered by the schemes. In 2012-13, all reimbursements were provided in a timely manner.
National External Breast Prostheses Reimbursement Program
The National External Breast Prostheses Reimbursement Program provides 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.
KPI: Percentage of claims by eligible women under the National External Breast Prostheses Reimbursement Program processed within ten days of lodgement
2012-13 Target: 90%
2012-13 Actual: 98%
- During 2012-13, 14,591 reimbursements were processed under this program. Of the 14,591 eligible claims made, 98% were processed within 10 days of lodgement.
Support access to necessary medical services not available through mainstream mechanisms
During 2012-13, the Department continued to support access to necessary medical services which are either not available through mainstream mechanisms, such as Medicare, or which are not available in Australia.
The Department funded three organisations through health program grants for a range of targeted services which support groups with special needs, such as the homeless, the disadvantaged and the visually impaired, to overcome barriers to accessing services through mainstream mechanisms such as Medicare.
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.
Deliverable: Regular review of gaps in service provision to improve individuals’ access to medical services
2012-13 Reference Point: Timely and responsive review process
- The Department reviews reports from funded organisations to monitor the volume of services offered and to gauge whether people’s actual needs are being met through the program. Organisations have sought feedback from their clients about the services provided. This feedback has informed the delivery of better tailored services. These include the expansion of services to assist visually impaired young people to become more independent and the extension of local service networks to better meet the primary health care needs of the homeless and those living with a mental illness or suffering drug addiction.
KPI: Number of health services provided to eligible Australian residents, such as the homeless, the disadvantaged and the visually impaired that could not be provided through Medicare, due to patient access barriers
2012-13 Target: 36,800
2012-13 Actual: 34,864
Result: Substantially met
- In 2012-13, 34,864 services were provided to eligible Australians. This compares with 38,738 in 2011-12 and 33,332 in 2010-11. These programs are demand driven. Demand for services in 2012-13 was less than anticipated.
Medical Treatment Overseas Program
The Medical Treatment Overseas Program provides eligible Australians with funding to access approved medical treatments overseas for life threatening illnesses, where treatment is not currently available in Australia. In 2012-13, the Department received 23 applications for financial assistance, of which only 12 applications were eligible for further assessment. On the basis of the assessments, the Department provided financial assistance to six eligible Australian residents to access approved medical treatment overseas.
Improve access to specialist medical services through the use of telehealth
Incentive payments to practitioners encourage and support provision of telehealth services. In 2012-13, the Department implemented changes to the non-MBS financial incentives to encourage telehealth into normal practice. The telehealth on-board incentives were restructured to be paid in two instalments – one third following the first telehealth service and two thirds following the tenth service. There has been an increase in the proportion of practitioners who have provided five or more telehealth services since splitting the on-board incentive into two instalments.
A total of 12% of medical specialists have provided a telehealth service funded under Medicare. This is an increase from 7% of specialists as at the end of June 2012.Top of Page
Program 3.3: Diagnostic imaging services
Program 3.3 aims to strengthen the provision of quality diagnostic imaging services and ensure ongoing affordable and effective use of diagnostic imaging services.
Magnetic resonance imaging
The Department continued to implement reforms for MRI arising out of the 2011 Review of Funding for Diagnostic Imaging. These reforms ensure more Australians have access to affordable diagnostic imaging and benefit from faster diagnosis and early detection performed by an appropriately qualified practioner at facilities that meet all necessary accreditation standards.
From 1 November 2012, the MRI expansion included the extension of Medicare requesting rights to GPs for children under the age of 16 years presenting with specified clinical indications. This will enable young Australians to have more direct access to Medicare-eligible MRI services and will also limit the exposure to radiation from alternative imaging modalities such as computed tomography (CT).
During 2012, the number of Medicare-eligible MRI units in Australia increased to 338. This includes the extension of full Medicare eligibility for MRI units operating in regional areas and partial Medicare eligiblity for MRI units operating in metropolitan areas before May 2011. Full Medicare eligibility was granted to 12 MRI units in areas of need, which will become operational between 2012 and 2015. Medicare eligibility has been extended for MRI items listed on the MBS for the initial staging of rectal and cervical cancer, and the screening of breast cancer in women under 50 years of age for all partial Medicare-ineligible MRI units operating in major cities.
Deliverable: Number of additional MRI units in areas of need given Medicare eligibility
2012-13 Target: 2
2012-13 Actual: 4
- Of the 12 MRI Medicare-eligible units granted as a result of the MRI Areas of Need Invitation to Apply process, Medicare eligibility was granted to four diagnostic imaging providers in 2012-13. These are all currently operational.
Giving younger patients better access to MRI
Thousands of Australian children with suspected broken bones, arthritis, and other conditions requiring urgent attention have received quicker diagnosis and treatment following a change in Medicare regulations on MRI scans.
Between November 2012 and the end of June 2013, 10,354 MRI scans were provided to patients under 16 years using the new regulations.
The new regulations allow young patients with certain conditions to receive Medicare rebates on MRI scans referred by their GPs.
The change means that eligible children and teenagers no longer have to suffer the delays and extra costs involved in getting a referral from a specialist or consultant physician.
A major additional benefit is that these children are able to be diagnosed with MRI rather than being exposed to the radiation associated with computed tomography (CT) scans.
MRIs referred by GPs are now Medicare-eligible if the child needs a:
- scan of head for unexplained seizure or headache, or paranasal sinus pathology;
- scan of spine for significant trauma or unexplained neck or back pain with associated neurological signs;
- scan of knee following radiographic examination for internal joint derangement;
- scan of hip for suspected septic arthritis or suspected slipped capital femoral epiphysis or suspected Perthes disease;
- scan of elbow for significant fracture or avulsion injury; or
- scan of wrist where scaphoid fracture is suspected.
The new regulations follow a detailed review of funding arrangements for diagnostic imaging, to support access to quality diagnostic imaging services.
Encourage more effective use of diagnostic imaging
The Diagnostic Imaging Quality Program (DIQP) brings together the diverse diagnostic imaging specialties to encourage and facilitate industry collaboration and cooperation. This program promotes the funding of high-quality projects, which meet the expectations of both the industry and the Department, ultimately resulting in safer and better quality Medicare-funded services.
All DIQP projects are focused on ensuring that diagnostic imaging services funded through the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 are safe, effective and of the highest quality.
Deliverable: Fund activities to improve the quality of diagnostic imaging services
2012-13 Reference Point: Funding agreements with successful applicants to the Diagnostic Imaging Quality Program will be in place with monitoring activities conducted in 2012-13
- A total of 12 DIQP funding agreements are in place. These projects cover topic areas such as CT dose reduction, informed consumer consent, radiology education enhancement and ultrasound qualifications. Monitoring activities are being conducted to ensure each project outcome is achieved. All projects are running on schedule with most projects due to end by 30 June 2014.
Strengthening the provision of quality diagnostic radiology services
The Strengthen the Provision of Quality Diagnostic Radiology Services initiative, introduced on 1 November 2012, requires that those performing the actual diagnostic imaging procedure hold minimum qualifications for all Medicare funded x-ray, angiography and fluoroscopy services. This will address quality and safety concerns about minimum qualification levels of practitioners and technicians performing diagnostic imaging procedures. These concerns arose from the Review of Funding for Diagnostic Imaging Services. In 2012-13, the Department monitored and evaluated the impact of the new requirements.
Diagnostic Imaging Accreditation Scheme
To ensure uniform safety and quality standards across the entire diagnostic imaging sector, all diagnostic imaging sites wanting to provide MBS eligible services must be accredited through the Diagnostic Imaging Accreditation Scheme (DIAS). The Department continued to manage and work with external accreditors to assist diagnostic imaging providers gain full accreditation by 1 July 2013, under Stage 2 of the DIAS.
KPI: Number of practices participating in the Diagnostic Imaging Accreditation Scheme
2012-13 Target: 4,300
2012-13 Actual: 3,909
Result: Substantially met
- The current number of practices participating in the DIAS is slightly lower than anticipated, however it continues to increase. A number of small practices providing low service volumes have reported that they have withdrawn from the accreditation process as they do not believe it is worth the investment. Similarly, a number of chiropractic practices are no longer providing diagnostic imaging services as a result of the implementation of the Strengthen the Provision of Quality Diagnostic Radiology Services initiative, introduced on 1 November 2012. Phase two of the evaluation began in July 2012. The report was completed and submitted to the Department in January 2013. The third and final phase of the evaluation will be completed in February 2014.
Program 3.4: Pathology services
Program 3.4 aims to provide access to high quality and affordable pathology services and ensure pathology services align with best clinical practice.
Assurance of quality and accessibility of services
The Department has continued to ensure access to high quality, clinically relevant and cost-effective pathology services through the management of the Pathology Funding Agreement, National Pathology Accreditation framework and the Quality Use in Pathology Program.
During 2012-13, the Department undertook a funding round for the program to continuously improve already high quality pathology services. The streamlined accreditation framework refines the best practice standards for laboratories to ensure the delivery of high quality pathology services for consumers.
Deliverable: Number of new and/or revised national accreditation standards produced for pathology laboratories
2012-13 Target: 4
2012-13 Actual: 0
Result: Not met
- The Department has continued to work with the National Pathology Accreditation Advisory Council to streamline the pathology accreditation materials to improve the comprehensiveness of the documents and to reduce duplication in individual documents. Six other standards are also under review. The streamlining initiative was a complex process and was not able to be completed in this reporting period. However, it is expected that this will be completed in 2013-14 along with two other revised standards.
KPI: Percentage of Medicare-eligible laboratories meeting pathology accreditation standards laboratories
2012-13 Target: 100%
2012-13 Actual: 100%
- In accordance with 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 with the approved accreditation assessment agency to ensure that Medicare eligibility is only available to laboratories that meet the requirements set out in the national pathology accreditation materials.
KPI: Percentage of pathology services that are bulk-billed laboratories
2012-13 Target: 86%
2012-13 Actual: 87%
- A high bulk-billing rate of 87% was maintained during 2012-13. This compares to 87% in 2011-12 and 86% in 2010-11.
Pathology Funding Agreement
Under the Pathology Funding Agreement, the Department ensures patients have access to quality and affordable pathology services while giving taxpayers value for money. On 1 January 2013, MBS fee reductions were implemented to recover the overspend on MBS pathology services that occurred in 2011-12. In 2012-13, pathology expenditure continued to pose a challenge as it exceeded the expenditure cap (5% growth per year), therefore further MBS fee reductions will be required. Parties signatory to the Pathology Funding Agreement will need to cooperate to address overspends and prevent them in the future.
KPI: Annual growth rate in MBS pathology expenditure57
2012-13 Target: 4.875%
2012-13 Actual: 6.399%
- In 2012-13, the annual growth rate was 6.399%. This compares to 6.729% in 2011-12 and 4.285% in 2010-11. The Pathology Funding Agreement outlines the process to manage MBS pathology services outlays.
Deliverable: Work with the National E-Health Transition Authority (NEHTA) to develop national standards for electronic reporting of pathology results
2012-13 Reference Point: Introduce national standards by 30 June 2013
Result: Substantially met
- The Department continues to work with NEHTA and pathology stakeholders to support the introduction of national standards.58 The Department funded the Royal College of Pathologists of Australia to standardise units and terminology. National standards will help make pathology requesting and reporting more consistent and help to ensure high quality pathology services for patients.
Deliverable: Develop an approach to genetic testing
2012-13 Reference Point: Review of current genetic testing arrangements and options for reform to be finalised by 30 December 2012
Result: Substantially met
- The Genetics Working Party has made significant progress by conducting stakeholder consultations with states and territories. The report is expected to be finalised in late 2013.
Program 3.5: Chronic disease – radiation oncology
Program 3.5 aims to improve access to high quality radiation oncology services.
Improve access to quality radiation oncology services
The Department continues to improve access to high quality radiation oncology services by funding approved equipment, quality programs and initiatives to increase the number of trained radiotherapy professionals.
KPI: Projects are undertaken to increase radiation oncology workforce capacity, both through increased training capacity and enhanced capability of the existing workforce.
2012-13 Reference Point: Strategies and initiatives to increase workforce capacity are adopted by key stakeholders
- The Department works closely with states and territories and the radiation oncology professions to ensure sufficient numbers of qualified staff to meet the growing demand for radiation therapy services.
In 2011, a funding round for innovative workforce activities was conducted under the Better Access to Radiation Oncology Grant Program. Fourteen projects relating to radiation oncology workforce capacity and capability were funded. These grants run for three years until 2014. The types of activities being funded include workforce planning, reducing barriers to training and attracting staff to regional areas.
Funding was provided to 65 facilities to contribute to the cost of approved radiotherapy equipment through the Radiation Oncology Health Program Grants Scheme. These grants gradually reimburse service providers for the cost of approved equipment used to provide treatment services, helping to ensure that equipment is replaced regularly and that patients are treated using current techniques and technologies.
KPI: The number of sites delivering radiation oncology
2012-13 Target: 66
2012-13 Actual: 6659
- By the end of 2012-13, 65 radiation oncology facilities were providing services to patients. A further site, which was initially predicted to start operations in 2012-13, began treating patients in July 2013.
In addition, the Department continued to fund the Australian Clinical Dosimetry Service. A three year trial by the Australian Radiation Protection and Nuclear Safety Agency continues to undertake equipment audits of radiation oncology facilities to check that the doses of radiation delivered to patients are accurate. In November 2012, the Department engaged an independent consultant to work closely with the sector to evaluate this trial, to best consider future options for quality dosimetry.
KPI: Radiation oncology services are safe and of high quality
2012-13 Reference Point: Radiation oncology practice standards are promoted by the professions as a guide to good practice
- The peak bodies representing the three main groups of health professionals involved in delivering radiation treatment are promoting the standards on their member websites. The Department has continued to fund and evaluate the Australian Clinical Dosimetry Service to ensure radiation doses to patients are accurate.
Deliverable: Develop a framework to improve patient safety and clinical outcomes from radiation treatment
2012-13 Reference Point: Options for assessment against new radiation oncology practice standards are developed and costed with the professions
Result: Substantially met
- The Department has undertaken preliminary work on the development of this project, including reviewing submissions from stakeholders and working with an advisory group to refine implementation options. In 2013-14, more detailed proposals, underpinned by an independent costing analysis, will be developed for stakeholder consultation.
(A) Budget Estimate 2012-13
(B) Actual 2012-13
Variation (Column B minus Column A)
|Program 3.1: Medicare Services|
|Ordinary Annual Services (Annual Appropriation Bill 1)||6,078||6,131||53|
|Dental Benefits Act 2008||83,087||59,526||( 23,561)|
|Health Insurance Act 1973||18,459,874||18,560,090||100,216|
|Departmental Appropriation 1||28,880||28,138||( 742)|
|Expenses not requiring appropriation in the current year 2||846||1,339||493|
|Total for Program 3.1||18,578,765||18,655,224||76,459|
|Program 3.2: Targeted Assistance - Medical|
|Ordinary Annual Services (Annual Appropriation Bill 1)||31,292||24,549||( 6,743)|
|Departmental Appropriation 1||1,399||1,284||( 115)|
|Expenses not requiring appropriation in the current year 2||38||61||23|
|Total for Program 3.2||32,729||25,894||( 6,835)|
|Program 3.3: Diagnostic Imaging Services|
|Ordinary Annual Services (Annual Appropriation Bill 1)||3,349||3,023||( 326)|
|Departmental Appropriation 1||629||578||( 51)|
|Expenses not requiring appropriation in the current year 2||17||28||11|
|Total for Program 3.3||3,995||3,629||( 366)|
|Program 3.4: Pathology Services|
|Ordinary Annual Services (Annual Appropriation Bill 1)||4,738||4,263||( 475)|
|Departmental Appropriation 1||1,014||932||( 82)|
|Expenses not requiring appropriation in the current year 2||28||44||16|
|Total for Program 3.4||5,780||5,239||( 541)|
|Prog 3.5: Chronic Disease - Radiation Oncology|
|Ordinary Annual Services (Annual Appropriation Bill 1)||71,622||68,356||( 3,266)|
|Departmental Appropriation 1||2,272||2,086||( 186)|
|Expenses not requiring appropriation in the current year 2||63||99||36|
|Total for Program 3.5||73,957||70,541||( 3,416)|
|Outcome 3 Totals by appropriation type|
|Ordinary Annual Services (Annual Appropriation Bill 1)||117,079||106,322||( 10,757)|
|Departmental Appropriation 1||34,194||33,018||( 1,176)|
|Expenses not requiring appropriation in the current year 2||992||1,571||579|
|Total expenses for Outcome 3||18,695,226||18,760,527||65,301|
|Average Staffing Level (Number)||206||205||( 1)|
- 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.