Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

5.4 Analysis of program expenditures and costs

Page last updated: 28 February 2012

Table 40 details funding allocations across fundholders for 2010-11. In this year a total of $27.6 million was allocated for the program with $19.7 million allocated for MSOAP Core and $7.8 million for MSOAP-ICD.

Table 40 – Overall MSOAP allocations by fundholder 2010-11

 

Fundholder:

MSOAP Core

MSOAP- ICD

MSOAP Ophth.

Total

 

 

 $'000

 $'000

 $'000

 $'000

NSW

NSW Rural Doctors Network

     2,696

     1,100

 

    3,796

NSW

NSW Health

     2,206

      900

 

    3,106

Vic.

Rural Workforce Agency Victoria

     3,832

      388

 

    4,220

Qld

General Practice Queensland

     1,979

     1,928

 

    3,908

Qld

Queensland Health

     1,979

      374

 

    2,353

WA

Rural Health West

     2,074

      962

 

    3,036

WA

WA Country Health Services

      250

        -  

 

      250

SA

Rural Doctors Workforce Agency

     1,697

      331

 

    2,027

Tas.

Tas Department of Health and Human Services

     1,131

      424

 

    1,555

NT

NT Department of Health

     1,508

     1,091

 

    2,599

NT

Baker IDI

        -  

      275

 

      275

Nat.

Australian College of Rural and Remote Medicine

      377

        -  

 

      377

Nat.

Australian Society of Ophthalmologists

        -  

        -  

        63

       63

Total

 

    19,728

     7,772

        63

   27,563


Table 41 shows the allocations across jurisdictions for 2010-11. Allocations across jurisdictions range from 25% in New South Wales to 6% in Tasmania.

Table 41 – Overall MSOAP allocations by jurisdiction 2010-11

 Jurisd.

MSOAP Core

MSOAP- ICD

MSOAP Ophth.

Total

% of allocation

 

$’000

$’000

$’000

$’000

%

NSW

    4,901

    2,000

        - 

    6,901

25%

Vic.

    3,832

      388

        - 

    4,220

15%

Qld

    3,959

    2,302

        - 

    6,261

23%

WA

    2,324

      962

        - 

    3,286

12%

SA

    1,697

      331

        - 

    2,027

7%

Tas.

    1,131

      424

        - 

    1,555

6%

NT

    1,508

    1,091

        - 

    2,599

9%

Nat.

      377

      275

       63

      715

3%

Total

   19,728

    7,772

       63

 27,563

 


A total of $2.2 million was explicitly allocated for administration of the MSOAP Core by the fundholders (and their affiliates), representing 11% of program expenditures. $1.6 million was allocated for administration of MSOAP-ICD representing around 20% of program expenditures. Fundholders estimated that they employ around 25 full time equivalent staff in managing the program. As well as the management of the program, in some situations, fundholder staff have a direct role in assisting service providers in making and paying for travel and accommodation bookings.

The DoHA employees an estimated 17.4 average staffing level positions in administration of the program. This includes 2.9 ASL positions in the Central Office on MSOAP Core and associated programs, 1.5 MSOAP-ICD and one for MSOAP-MS. In the state and NT offices there are an estimated 12 average staffing positions. The estimated costs for DoHA in administration of the program are estimated to be around $1 million per year in 2009-10, increasing to around $1.2 million in 2011-12.

Expenditures on services under MSOAP are reported by fundholders and collated into a national database. This database was analysed to examine the characteristics of services funded. Services with the database were allocated to ASGC-RAs (see Appendix H). Some of the data for 2007-08 was problematic in relation to patient numbers, as there appears to be duplication of records. Therefore these sections of tables related to these statistics for that year have not been included below.

Table 42 presents data on numbers of services and expenditure by RAs. Around 21% of expenditures under the program are allocated to services visiting inner regional areas, 39% to services in outer regional areas, 10% to remote and 29% to very remote.

Table 43 presents data on forecast number of visits and actual numbers of patients seen. Overall, an estimated 10,392 visits were forecast to occur in 2009-10. Service providers reported consultations with an estimated 164,661 patients of whom 21,618 (13%) were Aboriginal and Torres Strait Islander people. Indigenous patients represent 2% of patients in inner regional, 3% in outer regional, 21% in remote and 55% in very remote RAs.

Table 44 presents data on forecast costs by visit and actual costs per patient consultation. This excludes fundholder and DoHA administration costs and other costs involved with outreach services. The average cost per visit, based on forecasts, is estimated to be $1,528 for 2009-10. This ranges from $1,395 in inner regional locations to $2,417 in very remote localities.

The average cost per patient consultation, based on actual reported patients and expenditures, is estimated at $93 (excluding fundholder and DoHA administration costs). This ranges from $71 per patient consultation in inner regional locations to $157 in very remote regions.

If administration costs are included, it is estimated that the average cost per patient under the core program in 2009-10 was $112, with $13 per patient consultation associated with fundholder administration and $5 per patient consultation associated with DoHA administration (Figure 12). This ranged from $86 per patient consultation in inner regional areas to $190 per patient consultation in very remote areas.Top of page

Table 42 – Services, forecast and annual expenditure (excluding administration), by ASGC remoteness areas, MSOAP Core, 2005-06 to 2009-10
  2005-06 2006-07 2007-08 2008-09 2009-10
MSOAP Services
Major Cities - - - - -
Inner Regional 179 183 228 184 172
Outer Regional 467 517 616 472 477
Remote 136 146 177 141 148
Very Remote 534 524 640 490 510
Not identified 2 5 15 3 6
Total 1,318 1,375 1,676 1,290 1,313
 
Forecast Annual Expenditure $'000
Major Cities - - - - -
Inner Regional 3,234 3,222 3,809 3,729 3,377
Outer Regional 4,918 6,207 7,203 6,626 6,236
Remote 940 1,214 1,431 1,439 1,598
Very Remote 2,706 3,288 4,294 4,762 4,665
Not identified 162 260 207 95 107
Total 11,961 14,191 16,944 16,651 15,984
 
Actual Annual Expenditure $
Major Cities - - - - -
Inner Regional 2,780 2,938 3,834 3,433 3,273
Outer Regional 4,502 5,722 6,793 6,100 5,937
Remote 1,249 1,156 1,403 1,258 1,558
Very Remote 3,853 3,236 4,450 4,272 4,515
Not identified 259 320 182 83 121
Total 12,643 13,371 16,662 15,147 15,404

Table 43 – Forecast number of visits, number of patient and number of Aboriginal and Torres Strait Islander patients, by ASGC remoteness areas, MSOAP Core, 2005-06 to 2009-10
  2005-06 2006-07 2007-08 2008-09 2009-10
Forecast number of visits for the year
Highly accessible - - - - -
Accessible 2,473 2,287 2,655 2,469 2,421
Moderately accessible 4,353 5,043 6,008 5,386 5,207
Remote 911 714 986 980 834
Very Remote 1,878 1,651 2,067 1,818 1,930
Not identified na na na na na
Total 9,615 9,695 11,716 10,653 10,392
 
Number of patients for the year
Major Cities - - na - -
Inner Regional 32,554 37,798 na 46,628 45,786
Outer Regional 63,028 87,324 na 88,619 78,431
Remote 10,182 11,340 na 9,987 11,667
Very Remote 28,509 27,476 na 26,675 28,777
Not identified na na na na na
Total 134,273 163,938 na 171,909 164,661
 
Number of Indigenous patients for the year
Major Cities - - na - -
Inner Regional 1,029 924 na 829 927
Outer Regional 1,955 3,660 na 2,657 2,506
Remote 2,710 2,641 na 1,675

2,463

Very Remote 16,163 14,784 na 14,129 15,722
Not identified na na na na na
Total 21,857 22,009 na 19,290 21,618
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Table 44 – Forecast expenditure per planned visit, and per patient, by service type, by ASGC remoteness areas, MSOAP Core, 2005-06 to 2009-10
  2005-06 2006-07 2007-08 2008-09 2009-10
Forecast expenditure per planned visit $
Major Cities - - - - -
Inner Regional 1,308 1,409 1,435 1,510 1,395
Outer Regional 1,130 1,231 1,199 1,230 1,197
Remote 1,032 1,700 1,452 1,469 1,917
Very Remote 1,441 1,992 2,078 2,619 2,417
Not identified na na na na na
Total 1,227 1,437 1,429 1,554 1,528
 
Actual expenditure per patient $
Major Cities - - na - -
Inner Regional 85 78 na 74 71
Outer Regional 71 66 na 69 76
Remote 123 102 na 126 134
Very Remote 135 118 na 160 157
Not identified na na na na na
Total 92 80 na 88 93

Estimated total expenditure per patient, MSOAP program 2009-10
Figure 12 – Estimated total expenditure per patient, MSOAP program 2009-10

Table 45 presents statistics on the MSOAP Core services supported during 2009-10 analysed by specialty. Psychiatry – Other (principally adult psychiatry) was the most common service supported under MSOAP, accounting for around 19% of expenditures. This was followed by ‘physician – other’, which included a range of specialties (14% of expenditures), paediatricians (8%), general physicians (7%) and general surgeons (7%). In terms of patients seen, ‘physician – other’ accounted for 15% of patients, followed by ophthalmology (11%), ‘surgeon other’ (11%) and dermatology (10%). For Aboriginal and Torres Strait Islander patients, the specialty seen most often was paediatrics (18%), ophthalmology (12%), obstetrics and gynaecology (11%) and psychiatry (11%).

The budgeted subsidy per visit was highest for ENT surgeons ($2,686), followed by palliative care ($2,251) and dermatology ($2,236). Subsidies per patient were highest for child and adolescent psychiatry ($343 per patient), geriatrics ($256) and palliative care ($227).

Table 46 and Table 47 show statistics by specialty across the remoteness region of the location visited.Top of page
Table 45 – Key statistics by specialty, MSOAP Core, 2009-10
  MSOAP Services Actual Annual Expend. Forecast visits Actual total patients Actual Indig. Patients % Indig. Forecast $ Per visit Actual $ per patient
  n $'000 n n n % $ $
01. Physician - General 98 1,130 914 10,784 2,205 20% 1,196 105
02. Physician - Cardiologist 55 777 427 9,354 1,084 12% 1,686 83
03. Physician - Endocrinology 48 584 310 5,215 1054 20% 1,989 112
04. Physician - Oncology 10 201 249 3,654 35 1% 964 55
05. Physician - Palliative 64 451 233 1,983 46 2% 2,251 227
06. Physician - Geriatrics 31 340 357 1,326 48 4% 1,391 256
07. Physician - Other 142 2,089 1,370 25,270 1,338 5% 1,551 83
08. Paediatrician 154 1,190 1,199 13,322 3,916 29% 1,087 89
09. Dermatologist 60 960 415 17,141 513 3% 2,236 56
10. Ophthalmology 98 934 478 17,509 2,658 15% 2,101 53
11. Obstetrics and Gynaecology 120 912 758 9,882 2316 23% 1,182 92
12. Surgeon - Orthopaedics 34 443 341 7,414 667 9% 1,245 60
13. Surgeon - ENT 50 630 285 7,375 1,886 26% 2,686 85
14. Surgeon - Other 102 1,117 1,064 18,587 1,044 6% 994 60
15. Psychiatry - Child & Adolescent 62 459 260 1,338 263 20% 1,830 343
16. Psychiatry - Other 177 2,931 1,512 13,416 2,265 17% 1,987 218
17. Other 27 158 67 176 28 16% 2,978 na
18. Telemedicine 11 99 na 1,125 261 23% na 88
Total 1,343 15,404 10,239 164,871 21,627 13% 1,561 93
 
  % % % % %  
01. Physician - General 7% 7% 9% 7% 10%
02. Physician - Cardiologist 4% 5% 4% 6% 5%
03. Physician - Endocrinology 4% 4% 3% 3% 5%
04. Physician - Oncology 1% 1% 2% 2% 0%
05. Physician - Palliative 5% 3% 2% 1% 0%
06. Physician - Geriatrics 2% 2% 3% 1% 0%
07. Physician - Other 11% 14% 13% 15% 6%
08. Paediatrician 11% 8% 12% 8% 18%
09. Dermatologist 4% 6% 4% 10% 2%
10. Ophthalmology 7% 6% 5% 11% 12%
11. Obstetrics and Gynaecology 9% 6% 7% 6% 11%
12. Surgeon - Orthopaedics 3% 3% 3% 4% 3%
13. Surgeon - ENT 4% 4% 3% 4% 9%
14. Surgeon - Other 8% 7% 10% 11% 5%
15. Psychiatry - Child & Adolescent 5% 3% 3% 1% 1%
16. Psychiatry - Other 13% 19% 15% 8% 10%
17. Other 2% 1% 1% 0% 0%
18. Telemedicine 1% 1% na 1% 1%
Total 100% 100% 100% 100% 100%

Table 46 – Expenditure and patients by specialty and ASGC Remoteness Areas, MSOAP Core, 2009-10
  Actual annual Expend. $'000 Actual total patients Actual Indig. patients
  Inner Regional Outer Regional Remote Very Remote Inner Regional Outer Regional Remote Very Remote Inner Regional Outer Regional Remote Very Remote
01. Physician - General 175 307 175 473 3,658 3,808 970 2,348 105 92 417 1,591
02. Physician - Cardiologist 195 336 76 171 3,276 4,769 496 813 208 260 242 374
03. Physician - Endocrinology 177 199 81 128 2,050 1,997 534 634 119 128 233 574
04. Physician - Oncology 57 144 - - 1,222 2,432 - - 4 31 - -
05. Physician - Palliative 196 186 36 18 821 1,036 70 33 6 25 5 10
06. Physician - Geriatrics 151 179 - 10 483 791 - 52 9 13 - 26
07. Physician - Other 1,047 676 147 120 14,632 9,070 657 682 459 349 155 366
08. Paediatrician 242 418 141 389 4,361 4,283 1,489 3,189 298 443 410 2,765
09. Dermatologist 345 275 84 256 10,930 4,770 431 1,010 69 23 77 344
10. Ophthalmology 117 350 229 239 4,269 7,772 3,481 1,987 24 174 853 1,607
11. Obstetrics and Gynaecology 65 375 99 373 1,290 5,447 916 2,229 5 266 411 1,634
12. Surgeon - Orthopaedics 78 172 111 82 1,332 3,395 2,028 659 2 28 356 281
13. Surgeon - ENT 24 209 115 281 1,167 3,511 1,105 1,592 - 144 478 1,264
14. Surgeon - Other 352 429 158 159 6,945 8,798 1,948 896 56 59 446 483
15. Psychiatry - Child & Adolescent 153 134 50 122 414 574 92 258 13 46 64 140
16. Psychiatry - Other 1,130 864 258 679 6,097 4,338 1,021 1,960 183 194 335 1,553
17. Other 10 85 54 9 - 158 - 18 - 11 - 17
18. Telemedicine - 84 12 3 - 843 261 21 - 89 171 1
Total 4,512 5,420 1,825 3,513 62,947 67,792 15,517 18,381 1,560 2,375 4,653 13,030

Table 47 – Proportion of patients who are Aboriginal and Torres Strait Islander and estimated MSOAP subsidy per visit, by specialty and ASGC Remoteness Areas, MSOAP Core, 2009-10
  % Indig. Patients Actual $ per patient
  Inner Regional Outer Regional Remote Very Remote Inner Regional Outer Regional Remote Very Remote
01. Physician - General 3 2 43 68 48 81 180 202
02. Physician - Cardiologist 6% 5% 49% 46% 59 70 154 210
03. Physician - Endocrinology 6% 6% 44% 91% 86 100 151 201
04. Physician - Oncology 0% 1%     47 59    
05. Physician - Palliative 1% 2% 7% 30% 238 179 513 555

06. Physician - Geriatrics

2% 2%   50% 312 226   197

07. Physician - Other

3% 4% 23% 54% 72 75 218 176
08. Paediatrician 7% 10% 28% 87% 55 98 95 122
09. Dermatologist 1% 0% 18% 34% 32 58 196 253
10. Ophthalmology 1% 2% 25% 81% 27 45 66 120
11. Obstetrics and Gynaecology 0% 5% 45% 73% 50 69 108 168
12. Surgeon - Orthopaedics 0% 1% 18% 43% 59 51 55 125

13. Surgeon - ENT

0% 4% 43% 79% 21 60 104 177
14. Surgeon - Other 1% 1% 23% 54% 51 49 81 177
15. Psychiatry - Child & Adolescent 3% 8% 70% 54% 369 233 542 474
16. Psychiatry - Other 3% 4% 33% 79% 185 199 253 346

17. Other

  7% na 94%   537   513
18. Telemdeicine   11% 66% 5%   99 45 165
Total 2% 4% 30% 71% 72 80 118 191

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