1996-1997
2.3: Acute Care
The 1996-97 Portfolio Budget Statements, informs Senators and Members of Parliament of the proposed allocation of resources to portfolios outcomes and their objectives and targets including the agencies within the Health and Family Services portfolio.
Objective
- To support access to high quality acute health care service.
Goals
- Improvement in access and outcomes from public hospital services for public patients, including through continued improvement in the efficiency and effectiveness of the public system.
- Improvement in balance of demand for private hospital and public hospital facilities through stabilisation of private health insurance participation rates.
- Establishment and operation of quality of care and health outcome indicators in the health care system; continued improvement in quality and outcomes from that system; and improved and enhanced data collection and reporting arrangements.
- Improved structural relationships of Commonwealth and State health services to improve effectiveness and efficiency by allowing more flexibility in service provision and closer focus on the needs of patients.
- Better control over the supply and distribution of the medical workforce.
- Improved access to quality health care for people living in rural and remote areas through measures to support the rural workforce.
Strategies
- Provide funding to the States (and others) to allow access for public patients in public hospitals and to improve the operation of public hospitals and related services.
- Develop and apply a regulatory regime under the National Health Act to ensure that private health insurance provides efficient and affordable access to hospital services within the framework of community rating.
- From 1 July 1997, provide payments to persons and families with relatively moderate income to encourage them to remain in or join private health insurance.
- Fund projects to explore and implement best practice approaches in the hospital system and for the development of quality measures for national and local application.
- Gather and analyse data concerning the operations of the acute care system including the continuing development of casemix measures.
- Contribute to policy on medical workforce supply.
- Support projects for improved workforce arrangements in rural and remote Australia.
Performance Indicators and Targets
Note: Performance indicators and targets in respect of Home and Community Care Services for people needing post-acute care are the same as for Sub-Programme 5.3.
Effectiveness
- Private health insurance participation rate.
Target: Arrest the decline.
- Improved availability of health services in rural and remote areas through enhanced support for rural health workforce, increased specialist training posts in rural areas and dedicated research into rural health issues.
Efficiency
- States' adherence to agreed hospital performance targets in the following areas: levels of public inpatient activity; waiting times for elective surgery; levels of outpatient activity; and waiting times for accident and emergency services.
- Agreement about broadbanding funding arrangements for certain specific purpose payments.
Target: Revised Medicare agreements early in 1997, in line with COAG timetable.
- Progress towards a medical workforce supply more balanced with demand in terms of overall numbers and distributions.
Target: Permanent reductions in medical school intakes, reduced entry of foreign doctors to medical practice and increase in specialist training posts for specialties identified as in short supply.
Quality/Effectiveness
- Production of a fourth Australian DRG classification.
Target: The classification and associated software available for use by State Health authorities and the private sector in June 1998.
- Agreement between the Commonwealth, States and Territories on a set of quality of care and health service outcome indicators, and on collection of data for these indicators.
Target: Agreement on:
- indicators covering major system wide areas of access, efficiency, effectiveness, appropriateness, patient safety, consumer focus, coordination of care, and technical proficiency - including comparative indicators for indigenous peoples;
- indicators in several disease/diagnostic categories;
- States/Territories participation in trialing of the indicators;
- a process for data collection and publication of these indicators; and
- comparative analysis indicators.
- Satisfaction with private health insurance products and services.
Equity
- Continued access of patients to timely public hospital, inpatient, outpatient and emergency care, regardless of means.
- Improved availability and clinical effectiveness of health services to targeted groups residing in rural and remote areas, including remote Aboriginal and Torres Strait Islander communities.
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Budget Measures
Election Commitments
Private Health Insurance Incentive
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
- | 451.3 | 455.8 | 460.3 |
Purpose of Measure
To provide payments to members of private health insurance funds to encourage uptake of private health insurance.Expected Implementation Strategies for Measure
Contributors can elect to have their incentive paid through their health fund or as a taxation rebate.Intended Impacts of Measure
It is intended that the measure will stabilise the private health insurance participation rate. The funding estimates are based upon the assumption that the coverage of private health insurance will increase from 32 per cent of the population (expected at 1 July 1997) to 34 per cent in 1997-98.The Establishment of Six University Departments of Rural Health
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
3.0 | 6.0 | 9.0 | 9.0 |
Purpose of Measure
Establish six University Departments of Rural Health to provide practical training for rural health care providers, thereby improving the recruitment and retention rates of this workforce.Top of page
Expected Implementation Strategies for Measure
Institutions will be selected taking into account such factors as the geographical spread of these facilities, the range of health occupations covered, and types of linkages with other educational and health care facilities. Key stakeholders will be consulted on the arrangements.Intended Impacts of Measure
An increase in the number of health professionals working in non-metropolitan locations.Better access of rural based medical practitioners and allied health workers to post-graduate and continuing health education.
Improved continuity and accessibility of health care services provided by medical practitioners and other allied health practitioners in rural and remote communities.
Further Specialist and General Practitioner Rural Locum Support
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
0.2 | 0.3 | 0.3 | 0.2 |
Purpose of Measure
To establish a locum service for rural medical practitioners (general practitioners and specialists), thereby providing better support to rural doctors and also addressing disincentives for locum service in superannuation portability rules.Expected Implementation Strategies for Measure
Strategies will include providing support to organisations which assist practitioners with locum arrangements and with expert advice on practical matters such as the financial implications for doctors involved with rural locum services.Intended Impacts of Measure
Improvements in service delivery and continuity of service provision to rural areas, including Aboriginal and Torres Strait Islander populations with high levels of need for health services.Increase in the numbers of medical practitioners in rural areas who are able to access Continuing Medical Education (CME) and training and take leave as required, thereby improving their conditions of service and assisting to make rural practice a more attractive career option.
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The Promotion of Support and Training for Nurse Practitioners
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
0.2 | 0.4 | 0.4 | - |
Purpose of Measure
To support the development of a defined role for nurse practitioners in rural and remote locations where they may be the only accessible providers of primary health care.Expected Implementation Strategies for Measure
Consultations will be held with the States and key stakeholders on priority actions for developing suitable roles and legislative authority for nurse practitioners.Intended impact of Measure
By defining the responsibilities of nurse practitioners practising in rural and remote locations, these practitioners will be able to provide suitable primary care treatment for people living in these localities.Establishment of Musculoskeletal Medicine Clinics
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
1.2 | 2.4 | 2.4 | 1.2 |
Purpose of Measure
To improve the care and treatment of people with musculoskeletal disease.Expected Implementation Strategies for Measure
Musculoskeletal clinics will be established in six public hospitals each to provide three sessions per week for three years. These clinics will provide training and continuing education for professionals involved in treating musculoskeletal disease as well as take part in a linked study to develop and demonstrate best practice in the treatment and management of musculoskeletal disease.Top of page
Intended Impact of Measure
It is expected that the medical and allied health professionals involved in the care and treatment of people with musculoskeletal disease will accept and adopt the best practice protocols developed in conjunction with this project. At the same time the practical training and education provided at the clinics should ensure that best practice protocols are accepted and implemented expeditiously in the wider musculoskeletal medical area. It is anticipated that both measures will eventually impact favourably on the care and treatment of people with musculoskeletal disease.Savings
Broadbanding of Blood Transfusion Service, Some Blood Products, Palliative Care and the Artificial Limb Scheme
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-6.8 | -5.1 | -4.4 | -3.7 |
Purpose of Measure
To achieve savings to the Commonwealth from measures to improve the efficiency of service delivery by providing greater flexibility to the States in programme delivery.Expected Implementation Strategies for Measure
It is proposed that a number of programmes currently provided as Specific Purpose Payments be included under more flexible arrangements. The exact programmes will be the subject of negotiations with the States. Intended Impacts of MeasureThe broad-banding of funding will provide the States more flexibility in service delivery arrangements. Financial savings are expected to arise from greater administrative efficiencies.
Cessation of the Commonwealth Dental Programme
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-55.6 | -112.8 | -114.5 | -116.5 |
Purpose of Measure
To support the need to reduce Commonwealth outlays consistent with overall priorities in health.Top of page
Expected Implementation Strategies for Measure
Funding will be phased out, by halving grants during 1996-97 and withdrawing all funding thereafter.Intended Impacts of Measure
States will resume full funding responsibility for dental services. The Commonwealth's programme of support was intended to reduce a backlog in provision of services to cardholders. These objectives will largely have been met during 1996-97.Reductions in Hospital Funding Grants to the States to Offset Cost-Shifting of Public Hospital Related Services
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-75.0 | -77.7 | -80.4 | -83.3 |
Purpose of Measure
To improve efficiency and discourage effort going into cost shifting by implementing arrangements which track such expenditure and allow adjustments to be made to grants, thereby reducing the incentive to cost shift.Expected Implementation Strategies for Measure
Changes to regulations will require doctors who provide a service which would generally be regarded as an outpatient, pre-admission or post-discharge service to identify on their account that the service was, in their opinion, such a type of service. Data would then be matched with Health Insurance Commission Medicare claims data on in-hospital admissions. Based on analysis of these data the additional cost to the Commonwealth of the identified cost shifting would be recovered from the States and Territories under the penalty provisions of the Medicare Agreements.Intended Impacts of Measure
The financial penalties will be a major disincentive for States and Territories to continue or enter into cost shifting.Reduction in Funding of Case Mix Development, National Mental Health Strategy and Health Workforce Development Programmes
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-5.2 | -5.6 | -5.5 | -5.7 |
Purpose of Measure
Savings to be achieved by:- streamlining of activities under the National Casemix Development Programme; and
- other savings measures, including abolishing several small programmes in Health Workforce Development: support for the National Community Services and Health Industry Training Advisory Board (ITAB) and the National Occupational and Health Strategy for the Health Industry, and funding 50% of the Australian Nursing Council for 1996-97 only.
Expected Implementation Strategies for Measure
To be implemented in 1996-97. Priorities under the Casemix Development Programme are to be reviewed.Intended Impacts of Measure
Savings to the Commonwealth health budget without reducing health services available to the public.Reduction in Migrant Places under the Humanitarian Programme
Financial Implications
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-0.1 | -0.4 | -1.0 | -1.6 |
See the description of the Reduction in Migrant Places under the Humanitarian Programme measure under sub-programme 2.1.
Application of an Efficiency Dividend to Commonwealth Own Purpose Outlays and Specific Purpose Payments of a Running Costs Nature
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-3.7 | -4.2 | -5.3 | -6.4 |
Across-the-Board Reduction of 2% in Running Costs
1996-97 $m | 1997-98 $m | 1998-99 $m | 1999-00 $m |
-0.20 | -0.20 | -0.20 | -0.20 |
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