1999-2000
Outcome 4: Quality Health Care
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.
Improved quality, integration and effectiveness of health care.
Outcome Summary - The Year Ahead
The outcome sought is improved health for individuals and communities through access to a high quality health system that is integrated, cost-effective and appropriate to their needs.
Health care in Australia is provided by population health experts, primary health care practitioners, community-based specialist services and hospitals. These services are delivered by the public, private and non-government sectors.
The Commonwealth's role is primarily that of funder and purchaser and setting the broad policy framework. It involves strong national leadership in a collaborative process of health sector reform aimed at improving the availability of high quality, integrated and cost-effective services with a strong consumer focus.
To achieve this outcome, the Department of Health and Aged Care will work in partnership with key stakeholders on health sector reform at a national level. The Department will also manage directly a small number of programs targeted at health sector reform and specific health needs. In addition, it will foster performance measurement activities, benchmarking and reporting through the development of national minimum data sets and system-wide performance indicators and ongoing monitoring, review and evaluation.
The key goal for 1999-2000 will be to involve key stakeholders and consumers in implementing the government's national reform agenda for the health system. This framework will:
- enhance primary health and community care, by building on the reforms to general practice, co-ordinated care trials and investments in mental health;
- promote integrated and coordinated care in community and hospital settings. Specific activities to be undertaken in this area in 1999-2000 will include the Coordinated Care Trials and the Integrated Mental Health Service Projects, Phase 3 of the National Demonstration Hospitals Program and initiatives aimed at improving the interface between general practice, the community and hospital care;
- strengthen community and consumer involvement in health system planning, delivery, monitoring and evaluation. Key activities in this area include the Consumer Focus Collaboration and development of local-level consumer involvement strategies in both public and private sectors;
- promote quality improvement processes and evidence-based medicine in the Australian health system and the development of associated information systems and tools. Over the coming year, this will be addressed by further development of casemix classifications, clinical care pathways, decision support systems for clinicians, accreditation of general practice, and national health data sets; and
- coordinate national action in the National Health Priority Areas: diabetes mellitus, cancer control, cardiovascular health, injury prevention and control, mental health and the proposed sixth area of asthma. In 1999-2000, the focus will be on developing frameworks, strategies or action plans and establishing baseline data and agreeing arrangements for targets to monitor changes in the incidence, prevalence, morbidity and mortality associated with the National Health Priority Areas.
Budget Measures Affecting Outcome 4
Helping general practitioners participate in multidisciplinary care planning
Expense ($m)
 | 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 2.4 | 2.4 | 1.6 | 1.7 |
Explanation
The Government will provide for education and training for general practitioners to engage in the new arrangements in the enhanced primary care package. The measure forms part of a package of initiatives to enhance primary care, in particular, for older Australians, people with complex and or chronic illnesses and those who require a range of different services to support them in the community. The measure links with other existing strategies in the area of general practitioner education and training.
The measure will make use of existing structures and programs that are part of the strategy and will have four key elements:
- a targeted research programme to explore the impact of the overall package;
- development and trialing of a clinical audit package for use by general practitioners over the years 1999-2000 to 2000-2001;
- assistance to Divisions of General Practice to enhance implementation of the overall package at the local level; and
- in partnership with the Royal Australian College of General Practitioners, the development of aged care core curriculum components of a postgraduate training program.
Further Information
This measure links closely with changes to research, education and evaluation strategies which were recommended in the General Practice Strategy Review.
Integration of health information systems to support better delivery of care
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 3.4 | 6.7 | - | - |
Explanation
The Government will provide funding for a two year programme to:
- support research and development into the wider adoption of data communications to support care delivery; and
- support consideration of data communications across health and community care services as part of planning information technology investments in both the public and the private sectors.
Timely communication of relevant information is an important element in the coordinated delivery of care across different services and localities. The rapidly developing area of data communications provides new opportunities to facilitate such communication where it can help achieve better care.
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Further Information
Research and development funds will be applied to address two issues central to wide adoption of data communications in support of coordinated health care delivery:
- developing approaches to secure electronic transactions in the health sector which are capable of being adopted system wide; and
- exploring mechanisms for consumers to be involved in decisions about access to information about them, in a new environment of electronic information exchange.
Additional coordinated care trials
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 6.2 | 10.3 | 10.5 | 6.2 |
Explanation
The Government will establish additional coordinated care trials in capital cities and selected regional centres to explore integrated delivery of health care to meet the needs of older people who are chronically ill or disadvantaged. There are currently nine general trials and four Aboriginal and Torres Strait Islander trials underway.
The measure forms part of the Government's package of initiatives to enhance primary care in particular for older Australians, people with chronic illnesses and those who require a range of different services to support them in the community.
This measure will support the extension and further development of existing coordinated care trials, where appropriate.
As with current trials, these new trials need to be developed in collaboration with the States and Territories as well as the medical profession and other health service providers. Cooperation in the new trials will also be sought from the non-government and charitable sectors.
The new trials will also support the establishment of a number of private sector trials targeting the development of new, more flexible forms of health insurance to cover coordinated care for those with private health insurance.
Trials for those with health insurance will explore the development of health insurance cover for community support services to enable people, particularly older people, to use their insurance to continue to live independently in the community, and to spend less time in hospital, where this is clinically appropriate.
Fighting suicide
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 8.0 | 10.2 | 10.4 | 10.6 |
Explanation
The Fighting Suicide measure involves a whole of community approach to suicide and builds 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. It will support primary prevention and community development projects, monitor media reporting and portrayal of suicide, reduce access to methods of suicide and provide support to rural and indigenous communities that have a high incidence of suicide.
Specific activities will include improving the evidence base in suicide prevention, providing professional education and training, enhancing specialist services, and building networks between primary care providers including non-government, general practice and other organisations at a community level.
Further Information
Fighting Suicide will draw on the experience of the successful Youth Homelessness Task Force and Tough on Drugs Strategy to involve community organisations in the development and implementation of practical initiatives to prevent suicide.
Retention payments for general practitioners in rural and remote areas
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 10.5 | 10.7 | 10.9 | 11.0 |
Explanation
The Government will introduce retention payments for long serving general practitioners as an incentive for them to continue to practice in rural and remote areas.
The exact nature of the incentive regime will be negotiated with rural doctors. However, it is envisaged that eligibility for incentive payments and the amount paid to individual doctors will take into account both the length of service and the remoteness of the area in which they practise.
Further Information
Rural and remote communities are disadvantaged by their inability to attract and retain general practitioners. There remains a need to provide adequate general practitioner services in rural areas and to provide support and encouragement for rural health workers.
About half of the general practitioners who move to rural areas remain there for less than two years. The Rural and Remote General Practice Programme, administered by State and Territory based Rural Workforce Agencies, currently attempts to address the recruitment and retention problems by providing flexible packages of incentives in particular communities. The retention payments scheme will complement this programme.
Developing a national and strategic approach to improving asthma management
Top of pageExpense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 1.9 | 3.6 | 3.7 | - |
Explanation
The Government will fund the development and implementation of a national strategic approach to improve asthma management.
This initiative will comprise a range of activities, including the development of education resources and tools to encourage best practice in asthma management. These activities will either be delivered by the Department of Health and Aged Care or private providers through competitive tendering processes. The Australian Institute of Health and Welfare will develop a national system for the collection and collation of asthma statistics.
Fly-in fly-out female general practitioner services to meet the needs of rural women
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 2.0 | 2.0 | 2.1 | 2.1 |
Explanation
The Government will establish fly-in fly-out female general practitioner services for women living in rural and remote areas who currently do not have access to a female general practitioner.
The service will provide primary health care interventions - such as cervical cancer screening, breast and skin examination - and other preventive health care for women living in remote locations. The service will identify and provide the necessary intervention for other complex conditions such as cardio-vascular disease, diabetes, psychosocial problems and conditions related to the reproductive system and/or sexual health.
The Royal Flying Doctor Service will be centrally involved in the administration of the initiative, under arrangements that will seek to complement and draw together existing services in this area.
Strengthening support for women with breast cancer
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 0.8 | 1.3 | 1.0 | 1.0 |
Explanation
The Government will provide support services for women who have been diagnosed with breast cancer, particularly those in regional and rural areas. The measure will improve health outcomes for women with breast cancer through access to specialised health care and improved dissemination of information regarding existing support services.
Women diagnosed with breast cancer living in regional and rural areas face special barriers to accessing treatment options and support services, a result of both geographic isolation and limited contact with specialist health care workers. It is proposed to identify and establish appropriate health care worker positions for the provision of support and information for women with breast cancer. This measure will require the establishment and administration of specialised training for appropriate personnel.
Further Information
International experience has shown a significant improvement in outcomes for women with breast cancer who have received specialised health care.
Ongoing Funding for the National Breast Cancer Centre
Expense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | 2.0 | 2.0 | 2.0 | 2.0 |
Explanation
The Government will continue its funding for the National Breast Cancer Centre in Sydney. The measure will enable the Centre to maintain its key role in improving outcomes for women with, or at risk of, breast cancer.
Further Information
The Commonwealth has funded the National Breast Cancer Centre since 1995. The National Breast Cancer Centre aims to improve breast cancer control by improving clinical management and information access, supported by the best scientific evidence available across the continuum of care.
To date, the National Breast Cancer Centre has had a significant impact, particularly in the areas of improving the treatment of breast cancer, monitoring outcomes and disseminating information to women and health care professionals. There is no other organisation within Australia which provides a national focus and coordinates activity aimed at improving outcomes for women with, or at risk of, breast cancer.
Deferral of some acute health care microeconomic reform activities
Top of pageExpense ($m)
| 1999-00 | 2000-01 | 2001-02 | 2002-03 |
| Department of Health and Aged Care | -1.0 | - | - | - |
Explanation
This measure will defer commencement of some projects as part of acute health care microeconomic reform initiatives. This will allow sufficient time for consultation with key stakeholders within the community including consumers and health providers to ensure the reforms are delivered more effectively.
Performance Information and Resource Allocation
The following indicators are designed to measure how effectively the goals of this outcome have been achieved.
| Indicator 1: | Incidence, prevalence, mortality and morbidity in diseases or conditions in the National Health Priority Areas (NHPA). |
| Target: | Establishment of monitoring and surveillance systems and agreement on arrangements for new targets to detect changes in incidence, prevalence, mortality and morbidity. |
| Info source/rept freq: | Australian Institute of Health and welfare annual and regular reports; State and Territory data registries; hospital separations; NHPA reports. |
| Indicator 2: | Establish a national framework to guide future investment in primary health and community care. |
| Target: | National framework established by June 2000. |
| Info source/rept freq: | Ongoing evaluation. |
| Indicator 3: | Development of indicators of service integration for health care. |
| Target: | Indicators developed by June 2000. |
| Info source/rept freq: | Annual progress reports. |
| Indicator 4: | Extent to which health service planning, delivery, monitoring and evaluation processes incorporate opportunities for consumer participation. |
| Target: | Key stakeholders report improved opportunities for consumer participation. |
| Info source/rept freq: | Consumer Focus Collaboration Report, and other reports, for example, the Mental Health Report. |
| Indicator 5: | Nationally consistent methods of classifying all types of health care and associated costs. |
| Target: | Classifications covering inpatient, outpatient and community care under development or implemented by June 2000. |
| Info source/rept freq: | Project progress reports. |
| Indicator 6: | Continuous quality improvement incorporating evidence-based medicine to enhance quality and cost effectiveness of care. |
| Target: | Clinical care pathways and decision support systems for clinicians, as well as systems to monitor clinical practice and health outcomes to be developed in selected areas by June 2000. |
| Info source/rept freq: | Project progress reports. |
Resource Allocation
The allocation of resources for Outcome 4 is described in the following two Tables:
- Table C4.1 describes the relationship between the appropriation structure for Outcome 4 and the 1998-99 appropriation structure; and
- Table C4.2 sets out the allocation of resources across administered items and output groups for the Department for Outcome 4.
Table C4.1: Relationship between the old appropriation structure and the new Outcome structure for Outcome 4
| Outcome | Program |
| 4. Improved quality, integration and effectiveness of health care. | 1.1 Public Health Development and Programs (part)
2.1 Medicare Benefits and General Practice Development (part) 2.3 Acute Care (part) 2.4 Mental Health 7.2 Corporate Services (part) |
| Appropriations
Department Special Appropriations National Health Act 1953 - Aids and appliances (p) National Health Act 1953 - Blood fractionation, products and blood related products Health Insurance Act 1973 - National health development - special assistance 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
| Appropriations
Sub-program 1.1 Appropriation Bill 1 National public health (including expenditure under the Human Quarantine Act 1908 and payments to Human Pituitary Hormones Reserve) (340.3.01) (p) Sub-program 2.1 Appropriation Bill 1 General practice infrastructure training and support (340.0.06)
Trials of coordinated care for people with ongoing and complex health needs (including payments under the Health Insurance Act 1973) (340.211) Running Costs, including Section 31 receipts (340.1) (p) Sub-program 2.3 Special Appropriations National Health Act 1953 - Aids and appliances (p) National Health Act 1953 - Blood fractionation, products and blood related products Health Insurance Act 1973 - Medicare Agreements - provision of hospital and other health services (p) Health Insurance Act 1973 - National health development - special assistance Health Insurance Act 1973 - Australian Health Care Agreements - provision of designated health services (p) Appropriation Bill 1 Financial assistance for bone marrow transplants (340.2.06) CSL Limited - payment relating to antivenom production and influenza research (340.4.01) Health care access for survivors for torture and trauma (340.4.12) International search for unrelated bone marrow (340.4.08) Establishment of musculoskeletal medicine clinics (340.4.13) Acute health care - microeconomic reform initiatives (340.4.10) Running Costs, including Section 31 receipts (340.1) (p) Appropriation Bill 2 Innovative health services for homeless youth (891.2.01) Blood Transfusion Services (891.2.03) Sub-program 2.4 Special Appropriations Health Insurance Act 1973 - Medicare Agreements - provision of hospital and other health services (p) Health Insurance Act 1973 - Australian Health Care Agreements - provision of designated health services (p) Appropriation Bill 1 National mental health program (340.4.09) National youth suicide prevention strategy (340.4.11) Running Costs, including Section 31 receipts (340.1) (p) Appropriation Bill 2 National youth suicide prevention strategy (891.2.05) Sub-program 5.2 Appropriation Bill 1 Health and Community Services Ministerial Council (for payment to the Health and Community Ministerial Council Reserve) (340.2.04) Other Appropriation Bill 1 Compensation and Legal Expenses (340.2.01) (p) |
Table C4.2 Resource Summary
Contribution of Administered Items and Departmental Outputs to Outcome 4
In order to achieve this outcome the Government has decided to spend $639m. These funds will be spent on five areas: general practice reform; integrated and coordinated care initiatives; health systems development; strategic action on National Health Priority Areas and mental health strategies.
The achievement of this outcome is dependent on a range of stakeholders, including State and Territory governments, private-for-profit and private-not-for-profit organisations, and community groups. The Department will therefore play an important national leadership role in ensuring that these different stakeholders work together to improve the quality, integration and effectiveness of health care in Australia. In addition, the Department will provide an extensive contract administration and funds management service to ensure that the administered funds are used to provide effective and quality services. To support the national leadership and contract administration role, the Department will also provide an information service to service providers and clients.
To ensure that the funding allocated to this outcome is used in the most effective way the Department will provide a policy advice service to the Ministers. The advice provided will cover development and implementation of strategies and mechanisms to improve the quality, integration and outcomes of the health system. The Department will also provide a range of outputs to the Ministers and Parliament such as drafting responses to ministerials, providing advice and reports on policy development and implementation, and the preparation of question time briefs.
The following tables provide a comprehensive overview of the administered items and departmental outputs and performance measures for these items and outputs.
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Table C4.3 Performance Information for Administered Items
1. General Practice reform, including:
| Quality: New strategy for primary health care, research, evaluation and development including a focus on the National Health Priorities implemented by end February 2000.
Quality: Five indicators of quality in general practice to be developed in conjunction with the General Practice Partnership Advisory Council and determined by April 2000. Quantity: More than 2,200 general practices registered with Australian General Practice Accreditation Limited (AGPAL) for accreditation by 2000. Quality: An index for measuring general practice integration is developed, tested and reported on by December 1999. All GP Divisions have moved to an outcomes based focus by September 1999. A framework incorporating principles for standards and evaluation of the Divisions of GP program is in place by June 2000. Quantity: 123 Divisions involving 50% of GPs. Quality: Improved electronic communication across the health care sector as demonstrated by increased adoption of appropriate IM/IT systems by general practices. Quantity: Significant increase in number of GP services in rural and remote areas. Quality: Rural undergraduate initiatives - Evaluation of John Flynn Scholarship Scheme completed by February 2000 and Rural Undergraduate Steering Committee evaluation commenced before June 2000. Improved quality of registrar education through monitoring of caseload in general practice placements, introduction of assessment of registrar performance (core competencies) and rigorous accreditation process for teaching practices. Quality: Joint Advisory Group on General Practice and Population Health workplan developed and agreed, and implementation commenced by June 2000. |
2. Integrated and coordinated care initiatives:
| Quality: Additional coordinated care trials for the disadvantaged aged will be developed in metropolitan and regional centres.
Quantity: 11,000 participants trialing coordinated care in 9 trials to be completed by December 1999 and evaluated by June 2000. |
3. Health systems development, including:
| Quantity: National Demonstration Hospital Program (Phase 3 - focusing on improving the integration of acute care and related services) established with 4 lead and 20 collaborating hospitals.
Quality: Establish baseline data on the percentage of acute health care services routinely collecting standardised information on quality of care. Quality: Agreed priority projects of the Consumer Focus Collaboration established and linked to the National Resource Centre for Consumer Participation by March 2000. Quality: Progress towards the development of national minimum data sets and performance indicators for palliative care. Improve balance in supply/demand for certain plasma products, partly by increasing the supply of plasma from the Red Cross to CSL Ltd for fractionation of those plasma products where there have been shortages. Quality: Produce second edition of Australian patient classification (ICD-10-AM) by February 2000. Produce version 4.2 of the Australian Refined Diagnosis Related Groups classification, and ensure availability of software, by January 2000. Quality: Develop Diagnosis Related Groups cost weights based on 1998/99 data by April 2000. Quality: Identify and develop key elements of a platform for delivering basic IT infrastructure for integrated communications and information sharing (such as with electronic patient record systems). |
4. Strategic action on National Health Priority Areas
| Quality: Agree arrangements for new targets for the National Health Priority Areas by June 2000.
National frameworks, strategies, and action plans developed for the National Health Priority Areas, as applicable, by June 2000. |
5. Mental health strategies, including:
| Quality: Implementation plans for promotion and prevention priority areas progressed with all States and Territories by June 2000.
Quality: States and Territories comply with 80% of mental health performance indicators agreed under the Australian Health Care Agreements. Quality: Implementation of nationally consistent data collection systems in private sector mental health services by June 2000. 25% of specialised mental health services reviewed against National Standards for Mental Health Services in 1999-00. 25% of specialised mental health services using nationally agreed consumer outcome measures in 1999-00. Quantity: Five integrated mental health service projects commencing by 1 July 2000. Quality: National agreement on a Suicide Prevention Strategy by October 1999. |
Table C4.4 Performance Information for Departmental Outputs
1. Policy advice to the Ministers and Government in relation to:
| Quality: A high level of satisfaction of the Minister and Parliamentary Secretary with the relevance, quality and timeliness of policy advice provided.
Timely and appropriate advice from the Ministerial Councils to the Minister. Quantity: Policy, research and advice service commensurate with the funds allocated. Price: $3.224m. |
| 2. Services to the Ministers and Parliament. | Quality: A high level of satisfaction of the Ministers and Parliament with the relevance, quality and timeliness of services provided.
Agreed timeframes met for responses to 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 during 1999-00 and used as a future benchmark. Price: $3.853m. |
3. National leadership, including:
| Quality: Asthma identified as a priority health issue by Health Ministers at their meeting in July 1999.
Report to Health Ministers by June 2000 on a comprehensive planning process for the National Health Priority Areas initiative. High level of consumer satisfaction with participation in the general practice partnership. Quantity: National leadership service commensurate with the funds allocated. Price: $5.924m. |
4. Information, including:
| Quantity:
Reports:
http://www.health.gov.au/hsdd/mentalhe
Price: $4.933m. |
5. Contract administration and funds management, including:
| Quality:Budget predictions are met and actual cash flows vary by less than 10% from predicted cash flows.
100% of payments are made accurately and on time. Quantity: 1200 signed agreements, which includes grants, contracts and consultants for 1999/2000. Price: $7.733m. |
Performance Assessment: Evaluations and Reviews
- 1. Coordinated Care Trials
- establish whether the objectives of the AHPMCTs have been achieved;
- recommend whether it would be appropriate for any of the localised models tested during the 12 month trial period to be more broadly applied (based on a model's effectiveness, financial sustainability and transferability); and if appropriate,
- how best this could be implemented.
During 1999-2000 evaluation of the coordinated care trials will continue. The national evaluation is being conducted by external consultants, selected by open competitive tender. The evaluation is testing a primary hypothesis that the coordination of care for people with multiple service needs (where care is assessed through individual plans, and funds pooled from existing Commonwealth, State and joint programs) will result in improved individual client health and well-being within existing resources.
2. National Health Priority Areas
A broad, independent review of the National Health Priority Areas (NHPA) initiative is planned for 1999-2000. This will build on the first phase of the NHPA review undertaken in 1998-99 (which considered lessons learned and progress to date), and will report to Health Ministers by June 2000 on a comprehensive planning process to strengthen collaboration in the National Health Priority Areas.
3. National Evaluation of the After Hours Primary Medical Care Trials (AHPMCTs)
The purpose of the AHPMCTs is to test and evaluate different localised models of service provision and co-ordination that are designed to remove or reduce some of the current obstacles to the provision of effective after hours. A National Evaluation of the AHPMCTs will be conducted concurrently with the delivery of the AHPMCTs program. It will contribute to those processes, which will assist the Department:
4. National Evaluation of the Rural Workforce Agencies (RWAs)
The purpose of the evaluation is to measure the effectiveness of the RWAs in meeting the aim of the new Rural and Remote General Practice Program through agreed performance outcomes as outlined in the individual three year contracts between the RWAs and the Commonwealth. The evaluation is being conducted concurrently with the development and delivery of the Program and will be completed by July 2001.
5. The Rural Undergraduate Steering Committee (RUSC) Program
The RUSC Program was originally a component of the GP Rural Incentives Program, and has funded medical schools since 1993. This program is aimed at promoting rural general practice amongst undergraduate students, providing them with support and opportunities to undertake placements in rural general practice. A full evaluation of this Program will commence before June 2000.
6. The John Flynn Scholarship Scheme
The John Flynn Scholarship Scheme provides funds for undergraduate students to undertake 2 week vacation placements in a rural community each year for 4 years consecutively. The aim of the scholarship is to provide an opportunity for students to participate in rural medicine and rural life, and for them to develop a longer term relationship with a rural community. Evaluation of the Scheme is due to be completed by February 2000 to resolve a number of issues associated with the administration of the Scheme.
