1999-2000
Outcome 2: Access to Medicare
The 1999-2000 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.
Access through Medicare to cost-effective medical services, medicines and acute health care for all Australians.
Outcome Summary - The Year Ahead
Health Access and Financing Division
The outcome sought is access to cost-effective and high quality health care services for all Australians. Australia's universal health care system, Medicare, comprises three main elements designed to provide access to different types of health services. The Medicare Benefits Schedule (MBS) provides access to medical, including diagnostic, services. The Pharmaceutical Benefits Schedule (PBS) provides access to medicines. Through the Australian Health Care Agreements (AHCAs) with the States and Territories, the Commonwealth ensures access to hospital services.
Access to Medicare complements health-related services purchased by private individuals and through private health insurance in funding Australia's health system.
Medical and pharmaceutical services under this outcome are provided almost entirely by the private sector. Public hospital services are managed and partly funded by the States and Territories and delivered through a mix of public and privately owned and managed facilities. The Health Insurance Commission provides payment services to consumers and providers related to the outcome while the Department of Health and Aged Care provides policy advice to Government and purchases the payment services provided by the Health Insurance Commission. The Professional Services Review supports high quality practice through a peer review process.
In 1999-2000, the emphasis will continue to be on maintaining and improving the contribution Medicare makes to the well being of all Australians, while at the same time continuing to refine Medicare financing arrangements so that the system is sustainable and affordable to Governments.
Key strategies for 1999-2000 are reflected in budget measures. They should be seen alongside a continuing commitment to ensuring the programs are run effectively and efficiently and the implementation of the Government's measures from its first term and those announced in the 1998 election.
In 1999-2000, interwoven strategies focus on the three themes of access, quality and outlays management.
In terms of access, key strategies include:
- the extension of Medicare Easyclaim facilities in rural and remote areas;
- a new range of services from GPs funded under the Medical Benefits Scheme as part of enhanced primary care; and
- improved access by Aboriginal and Torres Strait Islander people to Medicare.
- provision of a series of measures to enhance primary health care services for the elderly and those with chronic and complex conditions, as announced by the Prime Minister, in relation to the International Year of the Older Persons;
- linking financial incentives to improvements in the quality of care in general practice;
- measures to improve the quality use of pathology; and
- working with the States on implementing Part 5 of the Australian Health Care Agreements (AHCA) in relation to service reform.
- the second pathology agreement providing savings and outlays certainty; and
- continuing implementation of the Diagnostic Imaging Agreement signed in 1998.
Professional Services Review
The Professional Services Review (PSR) Scheme is founded on a process of peer review which focuses on a practitioner's conduct to determine whether the practitioner has inappropriately rendered or initiated services which attract a Medicare benefit, or has inappropriately prescribed under the Pharmaceutical Benefits Scheme. Practitioners whose conduct may be examined under the Scheme are doctors, dentists, optometrists, chiropractors, physiotherapists and podiatrists. The Scheme is the Government's primary means of investigating inappropriate practice.
The review process has three distinct and independent processes: referral by the Health Insurance Commission of a practitioner to the Director of Professional Services Review (DPSR) for review where there is concern about his or her practice; the hearing of, and reporting on, the referral by a Professional Services Review Committee made up of members of the profession or specialty of which the person under review is a member; and the making of a determination on the appropriate sanction to be applied by an independent Determining Officer, currently located in the Department of Health and Aged Care.
Appeals are permitted to an independent Professional Services Review Tribunal and on points of law to the Federal Court.
A recent review of the Scheme by a committee chaired by the Australian Medical Association has recommended substantial changes to this administrative structure.
Currently the PSR is a separate agency within the Minister's portfolio and provides administrative support to the review committees. The Department provides administrative support to the Determining Officer and retains responsibility for policy aspects of the Scheme.
Budget Measures Affecting Outcome 2
New pathology partnership to strengthen quality
Expense ($m)
 | 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | -7.7 | -18.4 | -30.2 | -46.5 |
| Department of Veterans' Affairs | -0.7 | -1.4 | -2.3 | -3.1 |
Total | -8.4 | -19.0 | -32.5 | -49.7 |
Explanation
The Government has entered a further three year agreement with pathologists for the period 1999-2000 to 2001-2002. The Government's objective is to contain growth in pathology under the Medicare Benefits arrangements, while addressing areas for reform within the industry and strengthening the quality use of pathology. This agreement builds on the success of the first agreement with pathologists, which delivered significant savings to the Government. Growth in expenses will be an average of 5 per cent per annum compared to an average of 6 per cent per annum under the previous agreement.
A Quality Use of Pathology Programme will be established to bring together requesting doctors and pathologists to develop and implement a range of initiatives to promote quality ordering, practice and use of pathology services. To support the wider adoption of these initiatives, an incentives programme, including financial incentives, will be established.
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Quality incentives for prescribing pharmaceuticals
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | -23.3 | -28.9 | -35.5 | -64.7 |
Explanation
The Government will provide incentives for general practitioners prescribing pharmaceuticals to change their prescribing behaviour, both to improve the quality of patient care and to lead to better use of resources through the Quality Incentives for General Practice Programme.
The programme involves measuring the savings accruing from changes in prescribing practices, and allocating half of these savings to general practitioners. Three high cost/high growth drug groups (antibiotics, peptic ulcer drugs and cardiovascular drugs) which account for around $1.4 billion in expenses per annum have been identified as having the most potential for achieving improved prescribing practices.
Changes in practice will be driven by improved information provision, in conjunction with the financial incentives. This information will be based on 9Quality Use of Medicines' educational principles.
Further Information
Changes in prescribing patterns will be measured from 1 July 1999. The initial incentive payments will be made early in 2000-01, based on changes achieved in prescribing in the previous financial year. The detailed design of the package will be done in full consultation with the medical profession.
Strengthening the Professional Services Review Scheme
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Professional Services Review | 1.5 | 2.1 | 3.9 | -4.4 |
Explanation
The Government will consolidate the existing Professional Services Review Scheme functions from the Department of Health and Aged Care into a single agency to be known as the Director of Professional Services Review. The new agency will have increased funding to support expanded investigative and administrative function.
The changes are aimed at improving the Scheme's administration to ensure that the needs for legal effectiveness, transparency and natural justice are met as well as ensuring the maintenance of the peer review process upon which the Scheme is constructed. Increased funding for the new agency is partly offset by decreased funding to the Department of Health and Aged Care (for Professional Services Review Tribunal functions).
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General practitioner involvement in coordinated care planning
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 3.6 | 11.2 | 16.3 | 22.9 |
Explanation
The Government will provide, through the Medicare Benefits Schedule, for general practitioners to work with other health professionals, including other medical practitioners, domiciliary nurses, and home and community care providers, to develop coordinated care plans for people with chronic and complex care needs. This measure forms part of the Government's package of initiatives to enhance primary care, in particular, for older Australians, people with chronic illnesses and those who require a range of different services to support them in the community.
The measure includes an incentive for achieving such plans for a prescribed proportion of those aged 65 and over attending a practice. This measure is related to the General Practitioner Education and Training measure, which supports participation in multidisciplinary care.
Multidisciplinary case conferencing
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 3.8 | 2.1 | 3.1 | 4.2 |
| Department of Veterans' Affairs | 3.1 | 0.3 | 0.5 | 0.7 |
Total | 3.9 | 2.4 | 3.5 | 4.0 |
Explanation
The Government will provide, through the Medicare Benefits Schedule, for medical practitioners to work with other health professionals to undertake multi-disciplinary case conferencing. This is part of a package of Government initiatives which will enhance primary care in particular for older Australians, people with chronic illnesses and those who require a range of different services to support them in the community.
Case conferences facilitate better communication between a patient's health care providers. Involving general practitioners and other care providers in case conferences will also help ensure that for patients with complex needs, the right health care providers are providing the most appropriate services at the right time.
Practice Incentives Programme - new care plans targets
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 3.4 | 0.1 | 0.1 | 0.1 |
Explanation
The Government will make payments to general practitioners to achieve coordinated care plans for a proportion (yet to be prescribed) of their patients aged 65 years and over with chronic and complex health care needs. The measure is a part of a package of initiatives to enhance primary care in particular for older Australians, people with chronic illnesses and those who require a range of different services to support them in the community. This practice based incentive will complement the payment of Medicare Benefits Schedule fee items for each individual care plan provided.
The cost of the incentive payments for this measure will be met from within the existing Practice Incentives Programme. The minor expenses shown for this measure reflect departmental expenses required to establish this new programme.
Voluntary annual health assessments for those aged 75 years and over
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 1.7 | 9.2 | 12.1 | 15.0 |
| Department of Veterans' Affairs | 0.1 | 1.3 | 1.9 | 2.2 |
Total | 1.8 | 10.5 | 14.1 | 17.9 |
Explanation
The Government will provide for Medicare Benefits Schedule rebates for voluntary annual health assessments for those Australians aged 75 years and over. The measure forms part of a package of initiatives to enhance primary care, in particular, for older Australians, people with chronic illnesses and those who require a range of different services to support them in the community.
These assessments will be designed to ensure early identification of health problems of old age, particularly those problems amenable to early intervention, and opportunities for prevention (for example, of falls).
Expanded Medicare easyclaim facilities
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 1.6 | 6.2 | 6.7 | 4.7 |
Explanation
The Government will establish up to 600 additional Medicare easyclaim facilities in rural and remote areas across Australia to assist people in those areas to access Medicare claiming services in a timely and convenient manner. Medicare claiming services will be provided via one of the various easyclaim technologies and from various outlets such as pharmacies, shire headquarters and rural transaction centres.
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Further Information
Approximately 600 Medicare easyclaim facilities have already been installed in rural and remote communities and outer metropolitan growth areas. This measure will expand this network of Medicare claiming services.
Medicare - electronic commerce initiative
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | - | - | --4.0 | 6.0 |
Explanation
The Health Insurance Commission is actively pursuing innovation in health related electronic commerce within the current legislative and policy framework. A number of trials are currently in progress to maximise the benefits to consumers, taxpayers and the medical profession. The outcomes of these trials will deliver savings from 2001-02 onwards.
Cross-Portfolio Budget Measures affecting this Portfolio
Veterans' Affairs
Align Invalidity Service Pension Assessments
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Family and Community Services | 0.3 | 6.0 | 9.1 | 10.0 |
| Department of Health and Aged Care | - | 0.5 | 1.0 | 1.1 |
| Department of Veterans' Affairs | 0.4 | -6.4 | -13.0 | -16.1 |
Total | 0.7 | 0.2 | -2.9 | -5.0 |
Explanation
The Government will apply a more consistent and equitable approach to the assessment of the eligibility criteria for invalidity service pensions within the Department of Veterans' Affairs. This will align the measurement of permanent incapacity for an invalidity service pension with the measurement applied in disability compensation assessment.
This will ensure a more objective and soundly based method for the determination of the invalidity service pension assessment.
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Family and Community Services
Tax reform family package
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Family and Community Services | 12.6 | 48.2 | 60.9 | 76.5 |
| Department of Health and Aged Care | - | 6.8 | 6.0 | 6.6 |
Total | -12.6 | 54.1 | 67.0 | 83.1 |
Explanation
The Government's tax reform package simplifies the structure and delivery of family assistance by reducing from twelve to three the number of assistance types for families through the tax and social security systems. This will reduce the expenses associated with delivering the social safety net to Australians.
The three new forms of assistance are:
- Family Tax Benefit Part A (FTB(A)) which replaces Family Allowance, Family Tax Payment (Part A) and Family Tax Assistance (Part A);
- Family Tax Benefit Part B (FTB(B)) which replaces Basic Parenting Payment, Guardian Allowance, Family Tax Payment Part B, Family Tax Assistance Part B, the 9with children' rate of the Dependent Spouse Rebate and the Sole Parent Rebate; and
- Child Care Benefit (CCB) which replaces Childcare Cash Rebate and Childcare Assistance.
- eligibility for FTB(A) has been extended to cover young people up to the age of 21 (both job-seekers and students) who are receiving Youth Allowance. Further, where the rate of Youth Allowance is less than the rate of FTB(A), they will be able to choose to receive FTB(A);
- easing of the income test tapering arrangements for Parenting Payment recipients who are members of a couple;
- changes to the definition of income and indexation arrangements for the three forms of assistance (FTB part A and B and the Child Care Benefit);
- removal of a number of minor 9grand-fathering' provisions (mainly for family allowance) that currently exist;
- extension of FTB to 16 and 17 year olds who attend tertiary education; and
- decrease loading by 10 per cent on Child Care Benefits for children in care for more than 34 hours.
New Income support arrangements for separated parents sharing the care of a child
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Family and Community Services | - | 3.3 | 1.3 | 2.2 |
| Department of Health and Aged Care | - | - | -0.2 | -0.2 |
Total | - | 3.3 | -1.5 | 2.4 |
Explanation
The Government has decided that separated parents sharing the care of their children between 40 per cent and 60 per cent of the time will each be eligible for Job Entry Training and Newstart or Youth Allowance with a modified activity test. Parenting Payment will then only be payable to new claimants with at least 60 per cent care of a child.
To ensure that Parenting Payment recipients sharing care are not disadvantaged, the Government will protect their entitlements until the youngest qualifying shared care child at January 2001 turns 16 or otherwise ceases to be a qualifying child.
Performance Information and Resource Allocation
The following indicators are designed to measure how effectively this outcome has been achieved.| Indicator 1: | Client support for Medicare. |
| Target: | High levels of client support. |
| Info source/rept freq: | Structured feedback through the HIC customer surveys. |
| Indicator 2: | Aboriginal and Torres Strait Islander access to Medicare. |
| Target: | Increasing Aboriginal and Torres Strait Islander access to Medicare in accordance with need. |
| Info source/rept freq: | During 1999-2000 as part of the implementation of a budget measure, the Department is seeking to place a voluntary Aboriginal and Torres Strait identifier on Medicare records. |
| Indicator 3: | Percentage of Medicare services that are bulkbilled. |
| Target: | Significant changes from current 72% to be analysed. |
| Info source/rept freq: | Quarterly Medicare Statistics. |
| Indicator 4: | MBS outlays per capita in rural and remote compared to other areas. |
| Target: | More equal distribution between localities. |
| Info source/rept freq: | Annual HIC data. |
| Indicator 5: | Number of persons per approved pharmacy in Australia, and the ratio of pharmacies in urban areas to those receiving remote or isolated allowances. |
| Target: | The ratio is similar for urban and remote or isolated areas. |
| Info source/rept freq: | Annual HIC data. |
| Indicator 6: | Percentage of cost of PBS prescriptions covered by the Government. |
| Target: | Changes from 81.6% to be analysed for underlying drivers. |
| Info source/rept freq: | Annual HIC data. |
| Indicator 7: | PBS outlays per capita in rural and remote compared to other areas. |
| Target: | More equal distribution between localities. |
| Info source/rept freq: | Annual HIC data. |
| Indicator 8: | Overall growth rates in Medicare outlays, including MBS, PBS and AHCA growth rates. |
| Target: | Growth rates slowing over time. |
| Info source/rept freq: | Budget papers. |
| Indicator 9: | MBS, PBS and AHCA and total Medicare outlays as a percentage of GDP. |
| Target: | Steady or declining percentage of GDP. |
| Info source/rept freq: | Budget papers. |
| Indicator 10: | Departmental expenses (Health Insurance Commission and Department) as a percentage of administered expenses for Outcome 2. |
| Target: | Ratio of departmental to administered expenses is not increasing. |
| Info source/rept freq: | Budget papers - Annual. |
| Indicator 11: | Commonwealth expenses per capita on Medicare, both total and by MBS, PBS and AHCA components. |
| Target: | Monitor trends in Commonwealth expenses. |
| Info source/rept freq: | Budget Papers. |
Resource Allocation
The allocation of resources for Outcome 2 is described in the following two Tables:
- Table C2.1 describes the relationship between the appropriation structure for Outcome 2 and the 1998-99 appropriation structure; and
- Table C2.2 sets out the allocation of resources across administered items and output groups for the Department and the Portfolio agencies that contribute to Outcome 2.
Table C2.1: Relationship between old appropriation structure and new Outcome structure for Outcome 2
| Outcome | Program |
| 2. Access through Medicare to cost-effective medical services, medicines and acute health care for all Australians. | 2.1 Medicare Benefits and General Practice Development (part)
2.2 Pharmaceutical Benefits 2.3 Acute Care (part) |
| Appropriations
Department Special Appropriations Health Insurance Act 1973 - Medical benefits National Health Act 1953 - Pharmaceutical Benefits National Health Act 1953 - Aids and appliances (p) Health Insurance Act 1973 - Australian Health Care Agreements - provision of designated health services (p) Appropriation Bill 1 Departmental outputs Administered expenses Appropriation Bill 2 Specific payments to the States and Territories Other administered expenses Professional Services Review Appropriation Bill 1 Departmental outputs | Appropriations
Sub-program 2.1 Special Appropriations Health Insurance Act 1973 - Medical benefits Appropriation Bill 1 Alternative funding for general practice services (340.4.07) Grants to service providers (including payments under the Health Insurance Act 1973) (340.4.03) Financial support to individuals (340.4.04) Professional Services Review Scheme - running costs (347.1) Health Insurance Commission - for expenditure under the Health Insurance Commission Act 1973 (343.1) (p) Education, accreditation and review of diagnostic services (340.2.03) Running Costs, including Section 31 receipts (340.1)(p) Appropriation Bill 2 Grants for provision of health services (including payments made under the Health Insurance Act 1973) (891.2.02) (p) Diagnostic imaging package - implementation and management (892.0.04) Improving access to magnetic resonance imaging services (892.0.03)
Sub-program 2.2 Special Appropriations National Health Act 1953 - Pharmaceutical Benefits Appropriation Bill 1 Pharmaceutical restructuring measures (340.4.05) Health Insurance Commission - for expenditure under the Health Insurance Commission Act 1973 (343.1) (p) Running Costs, including Section 31 receipts (340.1)(p) Appropriation Bill 2 Payment to National Prescribing Service Limited (892.0.08) Sub-program 2.3 Special Appropriations National Health Act 1953 - Aids and appliances (p) Health Insurance Act 1973 - Medicare Agreements - provision of hospital services and other health services (p) Health Insurance Act 1973 - Australian Health Care Agreements - provision of designated health services (p) Appropriation Bill 1 Financial assistance for life-saving medical treatment (340.2.10) Payments under Section 33 of the Financial Management and Accountability Act 1977 (340.2.12) Running Costs, including Section 31 receipts (340.1)(p) Appropriation Bill 2 Grants for provision of health services (including payments made under the Health Insurance Act 1973) (891.2.02) (p) Other Appropriation Bill 1 Compensation and legal expenses (340.2.03) (p) |
In order to achieve this outcome the Government has decided to spend $16,406m. These funds will be spent on three areas: access to high quality and cost effective medical services for all Australians, access to high quality and cost effective medicines for all Australians, and access to public hospital services for public patients. To support the Government decision to allocate funds to these three areas the Department will provide a range of outputs in seven output groups.
To ensure that the funding allocated to this outcome is used in the most effective and cost effective way the Department provides a policy advice service to the Minister and Parliamentary Secretary. The advice provided covers the operations of the current system as well as possible changes to the system to meet the future needs of the Australian population and improve performance against the outcome sought. The Department and the Health Insurance Commission also carry out a number of regulatory activities under the Health Insurance Act 1973, and the National Health Act 1953 and provide a range of outputs to the Ministers and Parliament such as drafting responses to Ministerials and the preparation of question time briefs.
The Department will provide a contract administration and minor funds management service to ensure that the administered funds are used to provide effective and quality services. An important feature of this outcome is that it provides both for the management of funds provided to the Health Insurance Commission (output 5) and the delivery of services by the Commission (output 7). As the achievement of this outcome is dependent on a range of stakeholders, including State and Territory governments and private-for-profit and private-not-for-profit organisations, the Department plays a national leadership role in ensuring that these different stakeholders work together to achieve the outcome. To support the national leadership and contract administration role the Department and the Health Insurance Commission also provide information services to service providers and the community.
The Health Insurance Commission is responsible for the delivery of payment and other regulatory services under Strategic Partnership and Output Pricing agreements with the Department. The Professional Services Review produces regulatory activity outputs in relation to the examination of health practitioners' conduct to ascertain whether or not the practitioner has practiced inappropriately in relation to services which attract Medicare benefits.
The following performance information provides an overview of the administered items and departmental outputs for Health Access and Financing Division and Professional Services Review together with performance measures for these items and outputs.
Quantity: Rebates will be provided for an estimated 11medical services per capita
Efficiency: An estimated 30% of MBS expenses will be subject to financing agreements with the medical profession.
Quality: Increase in the percentage of practices taking up outcomes based elements of the Practice Incentives Program (PIP).
Quantity: Increase in number of practices participating in PIP above current level of 52%.
Quality: 100% of new medical services, which are listed on the MBS and for which a financial subsidy is provided, have been assessed for evidence of safety, effectiveness and cost-effectiveness (see also Departmental Output Group 6). Quantity: An estimated 7.2 PBS prescriptions per capita will be supplied.
Efficiency: Total cost of price increases to PBS drugs approved by the Pharmaceutical Benefits Pricing Authority compared with increases in previous year.
Quality: Percentage of PBS benefits paid for pharmaceuticals listed following evidence based assessment of comparative effectiveness and cost (see also Departmental Output Group 6). Quality: Achievement of performance levels by States and Territories for emergency department and elective surgery waiting times as agreed in 1997-98 Quantity: Policy, research and advice service commensurate with the funds allocated.
Price: $8.997m. Agreed timeframes met for ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefing.
Quantity: Number of responses to ministerial correspondence, Question Time Briefs, Parliamentary Questions on Notice and ministerial requests for briefing will be recorded in 1999-00 and used as a benchmark.
Price: $3.668m. Quantity: National leadership service commensurate with the funds allocated.
Price: $6.041m. Timely production of MBS and PBS schedules.
Timely production of regular statistical reports on MBS, PBS and Australian Health Care Agreements.
Quantity: Information service commensurate with the funds allocated.
An estimate of 22,500 calls to PBS Information Line.
Price: Production of MBS schedules: $1.722m;
Production of PBS schedules: $2.440m;
PBS information line: $1.579m; Other activities: $8.610m. Quality: 100% of payments are made accurately and on time.
Quantity: Approximately 150 contracts administered (based on 1998-99 figures).
Quantity: Dollars administered via Strategic Partnership Agreement with HIC and HIC Output Pricing Agreement with HIC and Department of Finance and Administration.
Efficiency: Departmental expenses allocated to managing the agreement with HIC as a percentage of departmental expenses for HIC and administered expenses for MBS and PBS.
Price: $3.573m. All applications for listing on the PBS have been assessed for evidence of safety, effectiveness and cost effectiveness.
Average time taken to assess applications to the Medicare Services Advisory Committee for funding new medical technologies and procedures.
Time taken to process new applications for listing in the Pharmaceutical Benefits Schedule.
Quantity: Number of new listings and item descriptors amended on the MBS.
Number of new listings or descriptors changed on the PBS.
Quality: A high level of compliance with the elements of the Government's regulation reform agenda, and their particular reporting requirements.
Price: $6.832m. High level of client satisfaction with the services provided by HIC.
Quantity: An estimated 346 million claims for MBS and PBS benefits to be processed.
Efficiency: An estimated 70% of MBS and PBS claims will be processed electronically.
Price: $325.334 m to the HIC.
($283.028 m for administration of the MBS; $42.306 m for administration of the PBS). Number of referrals finalised.
Quality: Successful implementation of Professional Services Review legislation changes.
Successful outcomes to court challenges in regard to the Committee processes and findings.
Rate of re-referral.
Price: $3.383m. The Government is undertaking a review of the Health and Other Services (Compensation) Act 1995 which was introduced to recover the costs of Medicare and related services provided to people who received compensation for accidents and injuries from other sources. The review is examining the effectiveness of the Act in achieving its objectives and the efficiency of its administration.
The three major components of the RVS, the determination of:
4. Evaluation of the diagnostic imaging reform package 5. Commonwealth/State Review of Pharmacy Arrangements under the Competition Principles. 6. Review of Community Pharmacy Agreement.
The Guild/Government Agreement is a two part agreement covering the payments to approved pharmacists in respect of the supply by them of pharmaceutical benefits and enhancing the development of an effective, efficient and well-distributed community pharmacy service in Australia.
The Agreement will be reviewed following the outcome of the National Competition Policy Review of Pharmacy Regulation. The review is scheduled to be completed by June 2000.
7. Review of Health Program Grants
Health Program Grants will be reviewed to ensure that they continue to be a cost effective means of funding medical services outside the Medicare Benefits Schedule. The review is scheduled to be completed by December 1999.
Contribution of Administered Items and Departmental/Agency Outputs to Outcome 2
Health Access and Financing Division
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Professional Services Review
Table C2.3: Performance Information for Administered Items
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1. Access to high quality and cost-effective medical services for all Australians:
Quantity: Rebates will be provided for an estimated 209 million medical services.
2. Access to high quality and cost-effective medicines for all Australians:
Quantity: An estimated 137 million PBS prescriptions will be supplied for general and concessional patients.
3. Access to public hospital services for public patients. Quantity: An estimated national average of 274.5 public hospital separations per 1,000 applicable weighted population.
Table C2.4: Performance Information for Departmental Outputs
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1. Policy advice to the Ministers and Government on medical and pharmaceutical services and the Australian Health Care Agreements.
Including advice on:
Quality: A high level of satisfaction of the Minister and Parliamentary Secretary with the relevance, quality and timeliness of policy advice provided.
2. Services to the Ministers and Parliament. Quality: A high level of satisfaction of the Ministers with the relevance, quality and timeliness of services provided.
3. National leadership, especially in relation to financing agreements with the medical and pharmaceutical profession and State and Territory governments.
Including:
Quality: A high level of satisfaction of the Ministers with achievements in this area.
4. Information, including provision of information to the community and providers on ongoing programs and new initiatives. The Health Insurance Commission also provides services of this type.
Including:
Quality: Information campaigns conducted during the year are evaluated for effectiveness.
5. Contract administration and funds management, including:
Quality: No unexpected under or over expenditure in performance against cash flow estimates in administrative and departmental expenses.
6. Regulatory activity, including:
Quality: All applications for listing on the MBS have been assessed for evidence of safety, effectiveness and cost effectiveness.
7. Direct Delivery of Services, namely services purchased from the HIC in relation to the MBS and PBS, being eligibility assessments, payment of benefits, education and compliance activities:
Quality: Health and HIC chief executives are satisfied with the performance results, advised to them annually by the Health-HIC Strategic Partnership Management Committee.
Professional Services Review
6. Regulatory activity.
Quantity:Number of referrals received from the Health Insurance Commission.
Performance Assessment: Evaluations And Reviews
1. Recovery of compensation double dipping. [ongoing from 1997-98]
3. Pathology services and treatment regimes.
The purpose of the evaluation is to measure the success of the new Pathology Agreement in restraining growth in Medicare outlays under the Medicare Benefits arrangements, while allowing quality and appropriate services to be provided. The evaluation will be ongoing during the life of the Agreement, that is until the end of 2001-02.
The purpose of the evaluation is to measure the success of the Diagnostic Imaging Agreement in restraining growth in Medicare outlays under the Medicare Benefits arrangements, while allowing quality and appropriate services to be provided. The evaluation will be ongoing during the life of the Agreement, that is until the end of 2000-01.
The National Competition Policy Review of Legislation for the Regulation of Pharmacy is reviewing State legislation in relation to pharmacy ownership and registration of pharmacists and Section 99L of the Commonwealth National Health Act as it relates to the regulation of the location of premises from which pharmacists may dispense pharmaceutical benefits. The review is scheduled to be completed by December 1999.
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