Online version of the 2012-13 Department of Health and Ageing Annual Report

Outcome 3: Access to Medical Services

Access to cost-effective medical, practice nursing and allied health services, including through Medicare subsidies for clinically relevant services

Page last updated: 29 October 2013

Major Achievements

  • 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.

Challenges

  • 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.

Performance

This is a doughnut chart and a table that summarises the results for all deliverables and key performance indicators in outcome 3 during 2012-13. The results show that 66.7% were met compared with 67.3% in 2011-12, 25% were substantially met compared with 23.6% in 2011-12 and 8.3% were not met compared with 9.1% in 2011-12.

66.7% MET

25.0% SUBSTANTIALLY MET

8.3% NOT MET

Period Met Substantially met Not met
2012-13 66.7% 25.0% 8.3%
2011-12 67.3% 23.6% 9.1%

Programs contributing to Outcome 3

Trends

Figure 3.1: Steady increase of specialists providing telehealth services funded under Medicare

The figure is a line chart. The y-axis denotes the percentage uptake of specialists providing video consultations, funded under Medicare during the 2011-12 and 2012−13 financial years commencing from July 2011 and ending at June 2013 (represented on x−axis). The chart shows that the percentage uptake of specialists providing video consultations under Medicare steadily increased over the two financial years from 0% in July 2011 to 12% (denoted on the y-axis) by June 2013.

Outcome Strategy

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.

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.

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.

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.

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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.

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.

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.

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.

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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.

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.

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.

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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.

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.

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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.

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.

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.

Outcome 3 - Financial Resource Summary

Program (A) Budget Estimate 2012-13
$’000
(B) Actual 2012-13
$’000
Variation (Column B minus Column A)
$’000
Program 3.1: Medicare Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 6,078 6,131 53
Special appropriations
Dental Benefits Act 2008 83,087 59,526 ( 23,561)
Health Insurance Act 1973 18,459,874 18,560,090 100,216
Departmental Expenses
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
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 31,292 24,549 ( 6,743)
Departmental Expenses
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
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 3,349 3,023 ( 326)
Departmental Expenses
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
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 4,738 4,263 ( 475)
Departmental Expenses
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
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 71,622 68,356 ( 3,266)
Departmental Expenses
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
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 117,079 106,322 ( 10,757)
Special appropriations 18,542,961 18,619,616 76,655
Departmental Expenses
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)
  1. Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
  2. '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.

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