1999-2000
Supporting quality in our health system
This Budget introduces a number of measures to improve the quality of health services provided to the community, around three themes: quality in health services, support for population health initiatives and developing the evidence base for quality care.
Fact sheet 8
Supporting quality in our health system
This Budget introduces a number of measures to improve the quality of health services provided to the community, around three themes:
- quality in health services;
- support for population health initiatives; and
- developing the evidence base for quality care.
1. Quality in health services
In pursuing this objective, this Government has made a very clear choice to work with the medical profession, drawing on the Australian medical community's knowledge and expertise to develop programs jointly which support improved care and focus on the better co-ordination of health care.
In this Budget, there are measures to enable general practitioners (GPs) to work with other providers to care for those with chronic and complex needs. These include new Medicare items for multi-disciplinary primary care services, combined with broader measures to support primary health care. Primary health care involves GPs, community services, dentists, pharmacists, and other allied health professionals.
There are also specific measures which support a focus on quality in general practice. There will be:
- incentives for better quality prescribing;
- a program for better quality use of pathology; and
- a strengthening of the peer review processes of the Professional Services Review Scheme.
New Medicare Benefits Schedule items to enhance primary care, especially for older Australians
New items covering the involvement of GPs in case-conferencing and planning care for people with chronic illness and complex needs will be a part of the Medicare Benefits Schedule from November 1999.
These new items will be particularly important for older Australians, especially people who rely heavily on the health system, helping to enhance their quality of life and increasing the likelihood of them continuing to live independently in their own homes.
Care planning improves patient care through better coordination of health services and more efficient use of resources. In the past, Medicare did not provide rebates when GPs did this kind of work. This Budget measure will encourage team approaches by providing Government subsidies when GPs plan care in collaboration with other providers.
The benefits of case conferencing are well established in Australia, particularly in aged care, and case conferencing involving several medical practitioners has occurred in hospital settings and some community settings for many years. The new case conferencing items will provide funding through Medicare for medical practitioners to be involved in case conferences for the benefit of their patients, including work with Aged Care Assessment Teams.
The Government will also introduce for the first time an MBS item for annual voluntary health assessments for people 75 years of age and over.
The medical profession will be closely involved in the development of all the Medicare Schedule items discussed above.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m | |
| General Practitioner involvement in Coordinated Care Planning | 3.6 | 11.2 | 16.8 | 22.9 |
| Multi-disciplinary Case Conferencing | 0.9 | 2.4 | 3.6 | 4.8 |
| Voluntary Annual Health Assessments for those aged 75 Years and Over | 1.8 | 10.5 | 14.1 | 17.9 |
Practice Incentives Program (PIP) - new care plan targets
An incentive will be provided through current funding of the Practice Incentives Program for GPs to ensure that their patients aged 65 and over with chronic and complex needs have care plans if they need them. This incentive will complement the Medicare Benefits Schedule items for general practitioner involvement in care planning and encourage faster uptake of care planning by GPs.
This new incentive will be funded from within the existing allocation for the Practice Incentives Program.
Quality incentives for prescribing
The Quality Incentives for General Practice program is designed to encourage GPs to change their prescribing behaviour leading to improved quality of patient care, while at the same time reducing prescribing costs.
There are three high-cost, high-growth drug treatment areas being targeted under the program: cardiovascular medicines; medicines for peptic ulcer and reflux disease; and antibiotics.
For example, patients with mild hypertension or high cholesterol and no other heart risk factors could be encouraged to improve diet and exercise rather than immediately commence on lifelong drug therapy. Similarly, alternative treatments for patients with duodenal ulcers can be used rather than taking long-term antacid therapy.
Savings resulting from these changes in prescribing practices will be shared equally between general practice and the Government. Initial incentive payments to general practitioners will be made early in the financial year 2000-01. The savings shown below are net of the incentive payments to doctors that will commence in 2000-01.
The detailed design of the package will be developed in consultation with the medical profession.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
-28.3 | -38.9 | -55.5 | -64.7 |
New pathology partnership to strengthen quality
A Second Pathology Agreement - the Pathology Quality and Outlays Agreement - which is to apply from 1 July 1999 to 30 June 2002 - has been negotiated with the two peak pathology bodies, the Australian Association of Pathology Practices (AAPP) and the Royal College of Pathologists of Australasia (RCPA).
The Agreement, a partnership between the profession and the Government, builds on the achievements of the first Pathology Agreement. It will:
- continue to constrain growth in pathology expenditure under the Medicare benefits arrangements;
- facilitate further structural reform of the pathology sector; and
- improve quality in pathology testing, use and practice.
The Quality Use of Pathology Program will bring together requesting GPs and pathologists to develop and implement a range of initiatives to promote quality ordering, practice and use of pathology services.
The adoption of these initiatives will be supported by a Quality Incentives Program which will include a range of incentives, both financial and non-financial. A wider review of the regulatory framework for pathology under the Medicare benefits arrangements will be undertaken over the course of the agreement.
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1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
-8.4 | -19.8 | -32.5 | -49.7 |
Strengthening the Professional Services Review Scheme
This measure provides an additional $11.9 million over the next four years to improve the capacity of the Professional Services Review Scheme to ensure that Medicare funds are not paid for inappropriate medical practice. The scheme also helps to ensure that the Medicare Benefits Schedule, which costs in the region of $6.9 billion a year, is protected against over-servicing and abuse.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
1.5 | 2.1 | 3.9 | 4.4 |
Developing a National Strategic Approach to Improving Asthma Management
This meets the Federal Government's election commitment to allocate new funding of $9.2 million over three years to support Australia's asthma sufferers who number more than two million, thus recognising the considerable burden that asthma places on the Australian community.
The Government has pledged to work with State and Territory Governments to make asthma the sixth National Health Priority Area (the other priority areas are: cardiovascular health, cancer control, injury prevention and control, mental health and diabetes mellitus).
Aspects of this initiative will include:
- Education resources will be developed to improve the content and availability of information about asthma to those affected and to improve adherence to management regimes;
- Best practice guidelines on asthma management in different settings (eg hospitals, post-acute care) by different professionals (eg GPs, pharmacists) will be developed, disseminated and evaluated;
- A systematic review of the factors that contribute to life-threatening asthma will be undertaken;
- A national system for the collection and collation of asthma statistics will help ensure consistency in the reporting of asthma data, identify gaps in data collection, and determine trends in the prevalence of asthma in Australia; and
- A national strategic plan for asthma will be developed involving all key stakeholders.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
1.9 | 3.6 | 3.9 | - |
Strengthening Support for Women with Breast Cancer
This measure recognises the dramatic impact breast cancer has on women and fulfils the Government's 1998 election commitment to provide funding of $4.1 million over four years for support services for women who have been diagnosed with breast cancer. This will be focussed particularly on women living in regional and rural areas.
Breast cancer is the most common cancer and causes the greatest number of cancer-related deaths in Australian women. Approximately 25 per cent of breast cancer incidence in Australia may occur in women outside urban areas and it is estimated that about 1.5 million women in rural areas are at risk of developing breast cancer.
Women diagnosed with breast cancer living in regional and rural areas face many barriers, particularly geographic isolation and limited contact with specialist health care workers, to accessing treatment options and support services.
Funding will be used to establish health professional positions in selected regional sites across Australia, who will receive specialised training so that they can best provide support and information for women with breast cancer.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
0.8 | 1.3 | 1.0 | 1.0 |
Assistance for the Survivors of Torture and Trauma
The Federal Government will continue to provide assistance for survivors of torture and trauma.
Funding of around $5.5 million over four years from within existing resources will support the eight member services of the National Forum for the Survivors of Torture and Trauma. Forum member services are located in each State and Territory.
Services provided include advocacy and counselling, referral to health services and community education.
1999-2000
$m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
1.3 | 1.4 | 1.4 | 1.4 |
Innovative Health Services for Homeless Youth (IHSHY)
The Innovative Health Services for Homeless Youth Program will receive a further $8.8 million over four years from within existing resources.
The program provides approximately 45 health services to homeless youth nation wide, including rural/regional and Aboriginal and Torres Strait Islander services.
Services include:
- Advocacy and counselling,
- Medical services,
- Referral to other health services,
- Health prevention and promotion and
- Mobile outreach services.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
2.2 | 2.2 | 2.2 | 2.2 |
Fighting suicide
The Fighting Suicide initiative, of around $39.2 million over four years, fulfils a Federal Government election commitment. Fighting Suicide will build upon links and partnerships with government, non-government, business and community organisations which already provide valuable services and support to people at risk of suicide.
Proposed activities will increase education and training within communities; build networks between primary care providers such as general practitioners and community organisations; and promote initiatives that aim to address risk and protective factors for suicide including media activities, community development and community education activities.
The measure aims to reduce the impact of suicide and suicidal behaviour on the Australian community. The community will have access to more information about how to keep themselves mentally healthy and better access to well-trained community services linked to appropriate specialist providers.
Specialist programs will be developed for community members who are at high risk of suicide or bereaved by suicide. Fighting Suicide will keep a continuing focus on youth suicide but will also address other high-risk groups such as:
- people with a mental illness and self-harming behaviours,
- prisoners,
- people with substance use problems and
- Indigenous communities.
- extend youth counselling and youth health services;
- reduce access to methods of suicide;
- monitor media reporting and portrayal of suicide;
- build networks between primary health care providers including non-government, general practice and other organisations at a community level;
- implement promotion and prevention initiatives that aim to address risk and protective factors for suicide including media activities, community development and community education activities;
- provide education and training for professionals;
- enhance specialist services;
- follow up from hospital emergency departments;
- support for rural and Indigenous communities that have high incidence of suicide;
- improve the evidence base in suicide prevention; and
- develop practice guidelines
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
8.0 | 10.2 | 10.4 | 10.6 |
2. Increase in support for population health initiatives
High quality treatment services and substantial investment in detection, screening and health promotion activities form a balanced and intelligent approach to health care.
In this Budget, the Government has made commitments in the areas of hepatitis C, breast cancer and food hygiene and safety in addition to work on the evidence base for public health described below.
Hepatitis C Education and Prevention
Recent estimates indicate that more than 200,000 Australians have already been infected with hepatitis C, a blood borne virus that can lead to cirrhosis, liver failure and liver cancer. Around 11,000 new infections occur each year.
Over four years, around $12.4 million is being provided to lower the current rate of transmission of hepatitis C in Australia by providing improved education, prevention and health maintenance for those currently infected and those at risk of becoming infected.
This initiative also contains provision for commissioning of research which will provide information for designing elements of the national response to hepatitis C in key areas, including epidemiology; social and behavioural factors; and education and prevention programs.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
1.5 | 3.6 | 3.6 | 3.7 |
Ongoing funding for the National Breast Cancer Centre
As part of the Government's commitment to reducing the impact of cancer on Australia, ongoing funding of around $2 million per year will be provided over four years to enable the continued operation of the internationally acclaimed National Health and Medical Research Council (NHMRC) National Breast Cancer Centre.
The centre aims to improve breast cancer control by improving clinical management and information access, supported by the best scientific evidence available across the continuum of care.
To date, the centre has had a significant impact, particularly in the areas of improving the treatment of breast cancer, monitoring outcomes and disseminating information to women and health care professionals.
No other organisation within Australia provides a national focus nor coordinates this type of activity.
Continued funding will allow the centre to maintain its key role in improving outcomes for women with, or at risk of, breast cancer and will support the efforts of those involved in the prevention, diagnosis and treatment of breast cancer in Australia.
1999-2000 $m | 2000-2001 $m | 2001-2002 $m | 2002-2003 $m |
2.0 | 2.0 | 2.0 | 2.0 |
Reforms to food hygiene and safety standards
The incidence of food-borne illness is increasing worldwide and is a serious public health issue for Australia, with potential significant and long-term adverse effects on the food industry including insolvencies and substantial loss of market share.
A new range of reforms, at an initial cost of $1 million in 1999-2000 from within existing resources, will be introduced to improve the efficiency and effectiveness of Australia's food hygiene standards while providing pre-market evaluation of the safety of individual products to respond to health and safety concerns.
Implementation of the reforms will encourage the food industry to properly safeguard consumer health.
The results will be:
- reduced costs to the community from improved food safety control measures, once implemented;
- improved responsiveness of the food standards system to new food technologies;
- development of new and innovative products by the food industry to maintain competitiveness;
- improved responsiveness of the food standards system to consumers' demands for new and improved products; and
- pre-market safety approval of foods where there are high public concerns over safety, enabling innovation and product development while ensuring appropriate consumer protection.
3. Developing the evidence base for quality care
The Government has made a major commitment to the development of an evidence-based approach to improving the quality of health services.
It has supported the assessment processes of the Pharmaceutical Benefits Scheme and developed a new evidence-based approach to services on the Medicare Benefits Schedule.
The National Institute of Clinical Studies
Building on this evidence-based approach, the National Institute of Clinical Studies will be established later this year. It will play a leading role in achieving higher quality medical care in Australia and will help ensure the health care system is underpinned by world's best clinical practice.
As part of a comprehensive national approach to quality, safety and best practice, the institute will work closely with the medical profession to identify, develop and promote best clinical practice throughout the public and private health sectors.
The institute will give priority to effective health outcomes and, where appropriate, to the relative benefits of a range of possible interventions. Particular attention will be given to those conditions which are of national priority and for which there is currently no, or insufficient, evidence about best practice.
Population Health Evidence Base Advisory Mechanism (PHEBAM)
A Population Health Evidence Base Advisory Mechanism (PHEBAM) will be established using up to $5 million (over four years) from within existing resources with the aim of making health promotion and disease prevention strategies more cost effective, resulting in better utilisation of health resources and improvements in overall health outcomes.
The Population Health Evidence Base Advisory Mechanism will achieve this by:
- developing appropriate methodologies for assessing the effectiveness of population health intervention;
- reviewing systematically the evidence concerning the cost-effectiveness of population health interventions and their ability to improve the health of the population; and
- developing and disseminating guidelines to encourage the adoption of cost-effective interventions.
Contacts:
Quality in health services: Louise Morauta, First Assistant Secretary, Health Access and Financing Division, (02) 6289 8227
Liz Furler, First Assistant Secretary, Health Services Division, (02) 6289 8083
Population health intiatives: Jan Bennett, Acting First Assistant Secretary, Population Health Division, (02) 6289 8627
Evidence base for quality care: Robert Wells, First Assistant Secretary, Office of NHMRC, (02) 6289 5599
