Evaluation of the National External Breast Prostheses Reimbursement Program

Interview guide - Department of Health and Ageing

Page last updated: 05 November 2010

Introduction

Thank you for meeting with me today. My name is # from Urbis. As you are aware, we are carrying out an evaluation of the National External Breast Prostheses Reimbursement Program for your department. In undertaking this research project, we are looking at both the administrative aspects of the program, and the impact of the program on women who have undergone a mastectomy as a result of breast cancer, with reference to the program's principles and objectives.

As you are aware, the program's principles are:
  • Ease of access to reimbursement for all eligible women
  • Efficiency of reimbursement to eligible women
  • Efficiency of implementation of the program through minimal additional infrastructure costs
  • Appropriate accountability structures in place to monitor and audit the program
  • Consistent national approach across all jurisdictions and
  • Sensitivity to the needs of the eligible women accessing the reimbursement.
The program's objectives are to:
  • Provide financial support towards the costs of external breast prostheses for women who have undergone mastectomy as a result of breast cancer
  • Ensure national consistency in the provision of support towards the cost of breast prostheses and
  • Improve the quality of life of women who have undergone mastectomy as a result of breast cancer.
Medicare Australia administers the program for the department in accordance with a service level arrangement and business rules in place between the two organisations. Today's interview will focus on the department's satisfaction with the administration of the program by Medicare Australia, across a range of areas identified in the business rules for the program, such as claims assessment, claims processing, reporting and communication.

As the department also receives some feedback from women about the program's impact, including through issues escalated by Medicare Australia and through written enquiries directed to the Minister or the department, we also have some questions about the department's knowledge of women's experience of the program.

Your responses in this interview will remain confidential to the research team and will not be attributed without your permission.

Do you have any questions before we start? Top of page

Questions

Role description

  1. To give me a clear understanding of your organisations' involvement in the program, please describe your organisation's role with respect to the program.

Administrative review

  1. In the first 12 months of the program's operation, to what extent has Medicare Australia administered the program in accordance with the program's business rules, including:
      1. Establishing and managing appropriate consumer eligibility arrangements?
      2. Meeting specified reporting requirements (prompt for monthly and annual statistics etc)?
      3. Meeting specified performance indicators (prompt for processing timeframes)?
      4. Establishing and managing appropriate claims assessment arrangements?
      5. Establishing and managing appropriate payment arrangements?
      6. Establishing and managing appropriate enquiry management arrangements?
      7. Having adequate audit and access provisions?
      8. Undertaking relevant communication activities in relation to the program (prompt for display of posters, brochures and/or other promotional material in Medicare Offices)
      9. Consulting with the department in a timely way in relation to any changes to program administration arrangements (prompt for system enhancements, emerging policy issues etc)?
      10. Consulting with the department in relation to any release of information about the program (prompt for statistics, responses to media enquiries etc)
  2. Are you aware of any opportunities for future improvements/ directions for the administration of the program? (e.g. increased efficiency)

  3. What are the key outcomes achieved as a result of Medicare Australia administering the program?

  4. To what extent has the program functioned effectively as part of the broader policy environment?

Impact review

  1. To what extent is the program appropriate, effective and efficient in meeting the goals defined by the objectives of the measure?

  2. Does the program provide outcomes that meet the needs of women requiring an external breast prosthesis following a mastectomy as a result of breast cancer? (If so, how? If not, why not? Is this assessment based on feedback that has been provided to the department?)

  3. Can you identify any opportunities for future improvements/ directions for the program (prompt to include consideration of the costs and benefits of these improvements)?