1997-1998
Budget measures which affect more than one sub-program
The 1997-1998 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.
The following Budget measures affect more than one sub-program.
1. National Public Health - Continuation of Public Health Programs
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 1.1 | Public Health Development and Programs | 11.5 | 21.1 | 0.0 | 0.0 |
| 2.3 | Acute Care | 0.0 | 1.3 | 0.0 | 0.0 |
| TOTAL | 11.5 | 22.3 | 0.0 | 0.0 | |
Purpose of the measure
Funding for some elements of the National Public Health Program (ie Women's Health, the National Health and Medical Research Council National Breast Cancer Centre, Health Australia - Tobacco Harm Minimisation Strategy, and Hepatitis C Surveillance and Education) was due to cease during 1997-98 and 1998-99.This measure provides additional funding for those elements to continue until the end of 1998-99, with funding beyond that date to be considered in future Budget rounds.
In addition, funding for the Health Care Access for Survivors of Torture and Trauma program has also been extended to the end of 1998-99. These services have been specifically designed to promote the health and well-being of people who have experienced torture and trauma before coming to Australia by improving their access to health and related services.
Expected implementation strategies for the measure
The implementation strategies for these elements remain unchanged.Impact of the measure
In the 1996-97 Budget, a number of health advancement programs were broadbanded into a single National Public Health Program for which the Commonwealth is currently negotiating new bilateral outcomes-based funding agreements with the States and Territories covering the period to the end of 1998-99. This measure allows elements for which funding was to cease to be included in the negotiations.2. Hepatitis B Pre-adolescent Immunisation Delivery Program
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 1.1 | Public Health Development and Programs | 0.8 | 1.6 | 1.6 | 1.6 |
| 2.1 | Medicare Benefits and General Practice Development | -0.6 | -1.1 | -1.1 | -1.1 |
| TOTAL | 0.2 | 0.4 | 0.5 | 0.5 | |
Purpose of the measure
To provide specific funding for the delivery of Hepatitis B vaccination in the school setting, which is expected to result in better rates of immunisation.Administration of the Hepatitis B vaccine (HBV) to pre-adolescents has recently been included in the National Health and Medical Research Council recommended immunisation schedule and the Commonwealth has also approved funding for the supply of the vaccine in this Budget.
Expected implementation strategies for the measure
Vaccinations are normally delivered to adolescents through school based programs. General practitioners and health clinics may provide some vaccinations but as adolescents use these services infrequently, it is estimated that the coverage would be low if these were the only delivery mechanisms utilised.The measure will involve the Commonwealth working with the States and Territories, the Commonwealth covering the cost of vaccines and contributing up to half the additional cost of delivering Hepatitis B vaccination in schools. States and Territories will be responsible for the delivery of the program as well as the provision of their half of the additional funding.
A February 1998 commencement is envisaged. This lead-time will ensure that States and Territories have sufficient time to overcome the logistical difficulties in implementing this program in the school setting.
The first dose of vaccine will be given at the same time as measles-mumps-rubella vaccine, which is administered in the last year of primary school or the first year of high school. The second dose of HBV is required one month after the first dose, while the third dose to complete the course is required six months after the first dose.
Impact of the measure
This measure is expected to result in a reduction in the incidence of Hepatitis B, a serious disease which can cause prolonged illness in the acute stages and can result in chronic liver disease, cirrhosis of the liver, liver failure and cancer of the liver.Some small savings are expected to be made on Medicare as the new school-based delivery of HBV will mean fewer adolescents will be vaccinated through their GP.
3. Restructure arrangements for funding services related to the provision of methadone
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 1.1 | Public Health Development and Programs | 0.0 | 10.2 | 18.2 | 21.4 |
| 2.1 | Medicare Benefits and General Practice Development | 0.0 | -12.1 | -26.0 | -31.0 |
| TOTAL | 0.0 | -1.9 | -7.8 | -9.6 | |
Purpose of the measure
To improve cost efficiencies in methadone treatment services.Expected implementation strategies for the measure
Currently methadone services are provided by private medical practitioners or through publicly funded methadone programs. The current Medicare expenditure is considered to reflect a significant degree of inappropriate use of consultation and urinalysis (eg use of consultation to cover dispensing costs).The measure will fund methadone services as part of the Public Health Program, instead of through Medicare. Under the new arrangement, grants in lieu of Medicare payments for private methadone clients will be paid through Specific Purpose Payments to the States, subject to negotiation. Medicare benefits will no longer be available for consultations and urinalysis relating to methadone clients.
The level of funding will be based on an annualised allocation per private client, calculated from the average number of private clients treated in each jurisdiction over the previous 12 months (with an allowance for client growth and inflation). Payments will be subject to performance measures and other statistical reporting.
The new funding arrangements will be based on the outcomes of the Commonwealth's 1997 trials of alternative models of methadone service delivery. A November 1998 commence-ment is envisaged. This timetable will enable the trial to be evaluated and negotiations conducted with the States, and also gives States and Territories time to prepare for the changeover.
Impact of the measure
Savings are expected from Medicare because the new funding arrangements remove the scope for over-servicing inherent in the existing fee-for-service Medicare benefit structure.4. Public education campaign for private health insurance and Health Insurance Commission restructure
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 2.1 | Medicare Benefits and General Practice Development | 1.6 | 0.3 | 0.3 | 0.0 |
| 2.3 | Acute Care | 1.9 | 0.3 | 0.0 | 0.0 |
| TOTAL | 3.5 | 0.5 | 0.3 | 0.0 | |
Purpose of the measure
Under this measure, funding will be provided to conduct a public education campaign addressing two issues:- promotion of the benefits of private health insurance to the general population with the aim of encouraging higher private health insurance participation thereby supporting the continued viability of the Medicare system. This promotion campaign will be cost shared with the private health insurance and private hospital industry.
- changes to the Health Insurance Commission (HIC) including the separation of Medibank Private from the HIC and the introduction of a new option to allow electronic lodgement of Medicare claims by patients directly at their doctor's surgeries.
Expected implementation strategies for the measure
The proposal as it relates to private health insurance will involve: market research; concept development, focus testing and production; and evaluation. The HIC element will involve development of a generic issues management strategy for promotion of electronic commerce initiatives.Impact of the measure
It is expected that the proposal will result in an increase in the private health insurance participation rate beyond that expected from the private health insurance incentive scheme and Medicare levy surcharge, and will support implementation of electronic commerce by the HIC.5. Pilot study of alternative funding arrangements for rural obstetric services
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 2.1 | Medicare Benefits and General Practice Development | -5.0 | 0.0 | 0.0 | 0.0 |
| 2.3 | Acute Care | 5.0 | 0.0 | 0.0 | 0.0 |
| TOTAL | 0.0 | 0.0 | 0.0 | 0.0 | |
Purpose of the measure
Rural communities are disadvantaged in their access to obstetric services. The problem derives mainly from difficult practice conditions for practitioners in rural areas, including limited professional indemnity cover and a lack of peer support. The pilot study will demonstrate whether an alternative to the current funding arrangements can address these problems and improve access and quality of obstetric services.Expected implementation strategies for the measure
Under a one-year pilot study, $5m will be allocated for one or more State/Territory governments to fund, under arrangements developed in consultation with stakeholders, obstetric services, public and private, and address professional indemnity issues in identified rural areas. Funding will be provided by savings from Medicare benefits which will not be available for obstetric services provided in these identified areas for the period of the study. The study will assess the administrative feasibility of the new arrangements, their effect on service provision and the quality of obstetric services and workforce issues.Impact of the measure
The pilot study will deliver information about ways to alleviate problems in the delivery of obstetric services in rural remote areas.6. Efficiencies in Whole of Government Information Technology Infrastructure
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 2.1 | Medicare Benefits and General Practice Development | 0.0 | 0.8 | 5.7 | 5.3 |
| 2.2 | Pharmaceutical Benefits | 0.0 | 0.1 | 1.0 | 0.9 |
| 6.2 | Commonwealth Rehabilitation Service | 0.0 | 0.0 | 0.5 | 0.5 |
| 6.5 | Hearing Service | 0.0 | 0.0 | 0.4 | 0.4 |
| 7.3 | Information Services | 0.0 | 1.0 | 3.4 | 3.3 |
| TOTAL | 0.0 | 1.9 | 11.0 | 10.5 | |
Purpose of the measure
The purpose of this whole of Government measure is to achieve efficiencies by improving the structuring and sourcing of Information Technology (IT) services across Commonwealth Budget-funded agencies.The savings indicated above are based on estimates of the minimum savings the Health and Family Services portfolio is expected to achieve by consolidating and market testing its IT infrastructure.
Expected implementation strategies for the measure
Efficiencies are to be obtained by consolidating the portfolio's IBM and compatible data centres and subjecting IT infrastructure to competitive tendering processes which will be undertaken in accordance with whole of Government principles and arrangements on consolidation and competitive tendering.Impact of the measure
It is expected that the measure will lead to:- improved service delivery by integrating service to common client groups through the consolidation of IT infrastructure;
- rationalisation and standardisation across agencies;
- economies of scale from the integration of data centre processing requirements;
- cost effective technical and user support across mainframe, mid-range and desktop/network platforms;
- improved management of IT services; and
- market leverage from larger volumes.
7. Revised arrangements for carers of adults and children with disabilities
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 2.2 | Pharmaceutical Benefits | -0.3 | -1.6 | -1.7 | -1.9 |
| 5.1 | Community Care and Support for Carers | 0.0 | 22.0 | 24.5 | 27.6 |
| TOTAL | 0.3 | 20.4 | 22.8 | 25.7 | |
This measure also impacts upon the Social Security portfolio.
Purpose of the measure
To improve the adequacy and targeting of payments to carers, to simplify rules and improve customer service.Expected implementation strategies for the measure
Following a review of carer income support arrangements, new arrangements are being put in place for Domiciliary Nursing Care Benefit, administered in sub-program 5.1, and for Child Disability Allowance and Carer Payment, administered in the Social Security portfolio.Domiciliary Nursing Care Benefit will increase by about $16.60 a fortnight from July 1998 so that it aligns with the rate of Child Disability Allowance. Carers will also benefit from an increase in the time they can access respite care without losing their entitlement, from 42 days a year to 63 days a year.
In the Social Security portfolio, Carer Payment will be extended from July 1998 to carers of children under the age of 16 with profound disabilities. From March 1999, Carer Payment will also be available to carers who are required to care for an adult as well as care for, or supervise the care of, a child. Reforms to Child Disability Allowance will ensure better targeting of this payment.
Impact of the measure
The increase in Domiciliary Nursing Care Benefit will improve the adequacy of the benefit paid to more than 45,000 eligible carers of older people and adults with a disability. The wider reforms to carer income support will improve the adequacy and targeting of all payments to carers, simplify rules and improve customer service.Savings to the Pharmaceutical Benefits Scheme reflect a net decrease in access to concessional benefits for pharmaceuticals.
Overall, the above package of measures, including implications for the Social Security portfolio, will result in modest savings over the Budget and forward estimate years, with the new spending initiatives for the Domiciliary Nursing Care Benefit and Carer Payment being accommodated through better targeting of Child Disability Allowance.
8. Targeted support for people with dementia and their carers
Financial implications:| Affected sub-programs | 1997-98 $m | 1998-99 $m | 1999-00 $m | 2000-01 $m | |
| 5.1 | Community Care and Support for Carers | 1.5 | 1.5 | 1.5 | 1.5 |
| 5.2 | Assessment | 1.0 | 1.0 | 1.0 | 1.1 |
| TOTAL | 2.5 | 2.5 | 2.6 | 2.6 | |
