National Health Reform Agreement
Appendix A - Definitions
- A reference in this Agreement to the Health Insurance Act 1973 or the National Health Act 1953 is a reference to the Acts as at 1 July 2011 or as amended thereafter.
- Words and phrases which are not defined in this Agreement or defined in the Health Insurance Act 1973 are to be given their natural meaning.
- In this Agreement, unless otherwise specified, words and phrases are to be interpreted as follows.
Activity Based Funding (ABF)Refers to a system for funding public hospital services provided to individual patients using national classifications, cost weights and nationally efficient prices developed by the Independent Hospital Pricing Authority.
AdministratorMeans the Administrator of the National Health Funding Pool, who is appointed in accordance with clause B24, and performs the functions set out in clauses B26-B27.
Admitted patientMeans “Admitted patient” as defined in the National Health Data Dictionary.
Australian Commission on Safety and Quality in Health CareMeans the authority performing the functions set out in Schedule B.
Block FundingMeans funding provided to support:
- Public hospital functions other than patient services; and
- Public patient services provided by facilities that are not appropriately funded through ABF.
COAGRefers to the Council of Australian Governments, being the peak intergovernmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association (ALGA).
COAG Senior OfficialsMeans the group comprising the chief executive officer of the Department of the Prime Minister and Cabinet, the Premier’s Department in each state and the Chief Minister’s Department in each Territory.
Compensable patientMeans an eligible person who is:
- receiving public hospital services for an injury, illness or disease; and
- entitled to receive or has received a compensation payment in respect of an injury, illness or disease; or if the individual has died.
Complaints bodyMeans an independent entity established or commissioned to investigate complaints and/or grievances against providers of States’ public hospital services.
Default bed day rateMeans the rate set by the Commonwealth Minister under the Private Health Insurance Act 2007,
Eligible admitted private patientMeans an eligible patient who is admitted and chooses to be treated as a private patient, and excludes compensable patients and other patients funded by third parties.
Eligible personMeans, as defined in subsection 3(1) (6) (6A) and (7) of the Health Insurance Act 1973, excluding compensable patients.
Emergency departmentMeans admission level three or above emergency service under the Australian College for Emergency Medicine guidelines, or as otherwise recommended by the IHPA and agreed by the Standing Council on Health.
Entitled veteranMeans a Department of Veterans’ Affairs patient referred to in the Veterans' Entitlements Act 1986.
Implementation principlesMeans the principles that should underpin National Health Reform as set out in clause 13.
Independent Hospital Pricing Authority (IHPA)Means the authority established by Commonwealth legislation in accordance with clause B1 to perform the functions set out in clauses B3 to B8.
Ineligible personMeans any person who is not an eligible person.
Local Hospital NetworkMeans an organisation established in accordance with Schedule D and providing public hospital services.
Medicare Benefits Schedule (MBS)Means the Commonwealth government’s scheme to provide medical benefits to Australians established under part II, IIA, IIB and IIC of the Health Insurance Act 1973 together with relevant Regulations made under the Act.
Medicare LocalsMeans organisations funded by the Commonwealth to be the GP and primary health care partners of Local Hospital Networks in accordance with Schedule D of this Agreement.
Medicare PrinciplesMeans the principles set out in clause 4 of this Agreement.
National efficient priceMeans the base price(s) which will be determined by the IHPA and applied to those services funded on the basis of activity for the purpose of determining the amount of Commonwealth funding to be provided to Local Hospital Networks. The IHPA may determine that there are different base prices for discrete categories of treatment, for example admitted care, sub-acute care, non-admitted emergency department care and outpatient care.
In the event that there are multiple national efficient prices, the IHPA will determine which national efficient price applies.
National Health Data DictionaryMeans the publication (in hard copy and/or the internet) containing the Australian National Standard of Data Definitions recommended for use in Australian health data collections; and the National Minimum Data Sets agreed for mandatory collection and reporting at a national level.
National Health Funding BodyMeans the body established by Commonwealth legislation to assist the Administrator in carrying out his or her functions under Commonwealth and State legislation, in accordance with Schedule B of this Agreement.
National Health Funding PoolMeans the pool established by enabling Commonwealth and State legislation in accordance with Schedule B of this Agreement.
National Health Performance Authority (NHPA)Means the authority established by Commonwealth legislation in accordance with clause B76 to perform the functions set out in clauses B78-B79.
Non-admitted patient servicesMeans services of the kind defined in the National Health Data Dictionary, under the data element “Non-Admitted Patient Service Type”.
Outpatient departmentMeans any part of a hospital (excluding the Emergency department) that provides non-admitted patient care.
Patient election statusMeans the status of patients according to the National Standards for Public Hospital Admitted Patient Election Processes in Schedule G.
Performance and Accountability FrameworkMeans the framework established in accordance with Schedule C.
Pharmaceutical Benefits Scheme (PBS)Means the Commonwealth government’s scheme to provide subsidised pharmaceuticals to Australians established under part VII of the National Health Act 1953 (the Act) together with the National Health (Pharmaceutical Benefits) Regulation 1960 made under the Act.
Pharmaceutical Reform ArrangementsMeans arrangements which provide for public hospitals that are Approved Hospital Authorities under Section 94 of the National Health Act 1953 to supply pharmaceuticals funded by the PBS for specific categories of patients including:
- admitted patients on separation;
- non-admitted patients; and
- same day admitted patients for a range of drugs made available by specific delivery arrangements under Section 100 of the National Health Act 1953.