Section 2 – Department Outcomes – 3 Access to Medical Services
Outcome3
Access to Medical Services
Access to cost-effective medical, practice nursing and allied health services, including through Medicare subsidies for clinically relevant services
Outcome Strategy
The Australian Government, through Outcome 3, provides access for eligible people to high quality and clinically relevant medical, dental and associated services. This access is provided through the Medicare system. The Government also aims to ensure that Medicare services are safe and cost-effective.
In 2013-14, an estimated 353 million medical and associated services, or an average of 14.9services per capita, will be funded through Medicare.[1]
The Government is seeking to maintain the sustainability of Medicare in the face ofcost pressures and demand for medical services. Between 2010-11 and 2011-12, MBS expenditure increased by 8%. To respond to this challenge, funding decisions will be based on the best available evidence.
The quality and effective use of diagnostic imaging, pathology and radiation oncology services is an essential part of any contemporary health system. The Government will continue to support these services through improvements to accreditation processes, increased stakeholder engagement and funding for procedures and infrastructure.
Outcome 3 is the responsibility of Medical Benefits Division, Acute Care Division, and Population HealthDivision.
Programs Contributing to Outcome 3
Program 3.1: Medicareservices
Program 3.2:Targeted assistance – medical
Program 3.3: Diagnostic imagingservices
Program 3.4:Pathology services
Program 3.5:Chronic disease –radiation oncology
Outcome 3Budgeted Expenses and Resources
Table 3.1 provides an overview of the total expenses for Outcome 3 by program.
Table 3.1: Budgeted Expenses and Resources for Outcome 3
2012-13Estimated
actual
$'000 / 2013-14
Estimated
expenses
$'000
Program 3.1: Medicare services
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 6,078 / 9,509
Special appropriations
Dental Benefits Act 2008 / 83,087 / 244,034
Health Insurance Act 1973 - medical benefits / 18,459,874 / 18,838,215
Departmental expenses
Departmental appropriation1 / 28,880 / 29,318
Expenses not requiring appropriation in the budget year2 / 846 / 1,143
Total for Program 3.1 / 18,578,765 / 19,122,219
Program 3.2: Targeted assistance - medical
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 31,292 / 41,223
Departmental expenses
Departmental appropriation1 / 1,399 / 1,243
Expenses not requiring appropriation in the budget year2 / 38 / 52
Total for Program 3.2 / 32,729 / 42,518
Program 3.3: Diagnostic imaging services
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 3,349 / 3,370
Departmental expenses
Departmental appropriation1 / 629 / 559
Expenses not requiring appropriation in the budget year2 / 17 / 23
Total for Program 3.3 / 3,995 / 3,952
Program 3.4: Pathology services
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 4,738 / 4,287
Departmental expenses
Departmental appropriation1 / 1,014 / 901
Expenses not requiring appropriation in the budget year2 / 28 / 38
Total for Program 3.4 / 5,780 / 5,226
Table 3.1: Budgeted Expenses and Resources for Outcome 3 (Cont.)
2012-13Estimated
actual
$'000 / 2013-14
Estimated
expenses
$'000
Program 3.5: Chronic disease - radiation oncology3
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 71,622 / 73,033
Departmental expenses
Departmental appropriation1 / 2,272 / 2,020
Expenses not requiring appropriation in the budget year2 / 63 / 85
Total for Program 3.5 / 73,957 / 75,138
Outcome 3 totals by appropriation type
Administered expenses
Ordinary annual services (Appropriation Bill No. 1) / 117,079 / 131,422
Special appropriations / 18,542,961 / 19,082,249
Departmental expenses
Departmental appropriation1 / 34,194 / 34,041
Expenses not requiring appropriation in the budget year2 / 992 / 1,341
Total expenses for Outcome 3 / 18,695,226 / 19,249,053
2012-13 / 2013-14
Average staffing level (number) / 206 / 204
1Departmental appropriation combines "Ordinary annual services (Appropriation Bill No 1)" and "Revenue from independent sources (s31)".
2Expenses not requiring appropriation in the Budget year" is made up of depreciation expense, amortisation expense, makegood expense and audit fees.
3This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework. National partnerships are listed in this chapter under each program. For budget estimates relating to the National Partnership component of the program, please refer to Budget Paper 3 or Program 1.10 of the Treasury Portfolio Budget Statements.
Program3.1: Medicare services
Program Objectives
Improve access to evidence-based, best-practice medical services
The Australian Governmentaims to ensure that all Australians have universal access to free or low-cost medical, optometrical and hospital care and in special circumstances allied health services. Medicare provides access to free treatment as a public patient in a public hospital and free or subsidised treatment by practitioners such as doctors (including specialists), participating optometrists and dentists (specified services only).
The Australian Government is committed to building a comprehensive management framework for the Medicare Benefits Schedule (MBS) to ensure theMBS supports cost-effective, evidence-based best practice. In 2013-14, theDepartment will further progress 16 reviews which began in 2011-12 and201213 and commence a further two specialty reviews to ensure that items listed on the MBS remain clinically relevant and consistent with best practice.
To support these activities, the Australian Government will continue to seek independent expert advice from the Medical Services Advisory Committee (MSAC) on the circumstances under which public funds should be used to support medical services.
The Government will realign the indexation of the MBS with the financial year. The Government will also increase the upper (general) threshold of the extended Medicare safety net (EMSN) to $2,000 from 2015. There will be no changes to the eligibility threshold for people with a concession card, or who are eligible for Family Tax Benefit (Part A). Changes to Chronic Disease Management will assist in improving patient care and removing double billing.
These savings will be directed towards meeting the broader commitments of the Australian Government to deliver and sustainably fund important reforms.
Improveaccess to clinically relevant dental services
The Australian Government aims to improve the dental health of Australian teenagers by increasing access to preventive dental checks. The Government provides a voucher to eligible teenagers, once per each calendar year. The voucher provides up to $166.15 per eligible teenager between 12-17 years of age.
From 1 January 2014, a new child dental benefit schedule, called Grow Up Smiling, replaces the teen dental program. Grow Up Smiling increases access to preventive dental checks as well as basic dental treatment for eligible children 2-17 years of age. The program provides up to $1,000 over two calendar years for essential dental services.
This assistance will help children develop good oral health habits early in life and help to arrest the increase in child dental decay.
Program 3.1 is linked as follows:
- The Department of Human Services (Services to the Community – Program1.1) for administering Medicare services and benefits payments, including veterans treatment accounts, MBS online claims, electronic claim lodgement and information processing service environment, benefit payments under the Better Start for Children with Disability , Helping Children with Autism and the Medicare Teen Dental Plan and Grow Up Smiling.
Program 3.1: Expenses
Table 3.2: Program Expenses
2012-13Estimated
actual
$'000 / 2013-14
Budget
$'000 / 2014-15
Forward
year 1
$'000 / 2015-16
Forward
year 2
$'000 / 2016-17
Forward
year 3
$'000
Annual administered expenses
Ordinary annual services / 6,078 / 9,509 / 8,687 / 549 / 560
Special appropriations
Dental Benefits Act 2008 / 83,087 / 244,034 / 594,607 / 620,336 / 645,940
Health Insurance Act 1973 - medical benefits / 18,459,874 / 18,838,215 / 20,240,156 / 21,540,402 / 23,015,427
Program support / 29,726 / 30,461 / 29,640 / 27,639 / 27,105
Total Program 3.1 expenses / 18,578,765 / 19,122,219 / 20,873,090 / 22,188,926 / 23,689,032
Program 3.1: Deliverables
Qualitative Deliverables for Program 3.1
Improve access to evidence-based, best-practice medical services
Qualitative Deliverable / 2013-14 Reference Point or TargetMBS Reviews will analyse the best available evidence to ensure safety, quality and sustainability of the MBS / Anyamendments to the MBS recommended by each review reflect current clinical practice based on best available evidence
Improve access to clinically relevant dental services
Qualitative Deliverable / 2013-14 Reference Point or TargetImplement the child dental health benefit scheme, Grow Up Smiling / Legislation tabled before 1 January 2014
Quantitative Deliverable for Program 3.1
Improveaccess to clinically relevant dental services
Quantitative Deliverable / 2012-13 Revised Budget / 2013-14 BudgetTarget / 2014-15 Forward
Year1 / 2015-16 Forward
Year2 / 2016-17 Forward
Year3
Number of vouchers provided to eligible teenagers[2] / 2012
1.2m / 2013
1.2m / N/A / N/A / N/A
Program 3.1: Key Performance Indicators
QualitativeKey Performance Indicators for Program 3.1
Improve access to evidence-based, best-practice medical services
Qualitative Indicator / 2013-14 Reference Point or TargetContinuation of MSAC processes to ensure ongoing improvement in rigour, transparency, consistency, efficiency and timeliness / Improved stakeholder engagement and timeliness of application assessments and implementation of outcomes
Improve access to clinically relevant dental services
Qualitative Indicator / 2013-14 Reference Point or TargetImproved affordability of, andaccess to, a range of dental services for eligible children 2-17 years of age / Eligible children are able to access the dental benefit schedule from 1 January 2014
QuantitativeKey Performance Indicators for Program 3.1
Improve access to evidence-based, best-practice medical services
QuantitativeIndicator / 2012-13 Revised Budget / 2013-14 Budget
Target / 2014-15 Forward
Year 1 / 2015-16 Forward
Year 2 / 2016-17 Forward
Year 3
Number of services delivered through Medicare by providing rebates for items listed on the MBS / 343m / 353m / 372m / 389m / 407m
Improveaccess to clinically relevant dental services
QuantitativeIndicator / 2012-13 Revised Budget / 2013-14 Budget
Target / 2014-15 Forward
Year 1 / 2015-16 Forward
Year 2 / 2016-17 Forward
Year 3
Percentage uptake of preventive dental checks by eligible teenagers[3] / 2012
33% / 2013
39% / N/A / N/A / N/A
Program3.2: Targeted assistance – medical
Program Objectives
Provide medical assistance to Australians overseas
The Australian Government provides health care assistance to eligible victims ofspecific overseas incidentsresulting from acts of terrorism, civil disturbances or natural disasters. The Department provides ex-gratia payments to victims who meet the eligibility criteria, to cover out-of-pocket expenses for health care delivered in Australia for ill health or injury which has arisen as a result of such disasters. These have included incidentssuch as the Bali bombings and the 2004 Asian tsunami.
The Government has signed Reciprocal Health Care Agreements with 11 countries to provide reciprocal access to public health facilities for Australian residents travelling overseas. The Department takes a lead role in the negotiation of any new agreement, in collaboration with the Department of Foreign Affairs and Trade.
Support access to necessary medical services which are not available through mainstream mechanisms
The Australian Government funds a range of targeted services supporting groups with special needs, such as the homeless, the disadvantaged and the visually impaired, who have difficulty accessing services through mainstream mechanisms. In 2013-14, the Department will fund organisations through health program grants to help individuals overcome barriers to accessing services such as: primary health care; intervention counselling; optometry and orthoptic consultations; and scientific aids, assisted technology and adaptive living aids for low vision. The Department will monitor funded organisations to ensure the needs of the target audience are being met.
The Government, through the Medical Treatment Overseas Program, also provides financial assistance for Australians with a lifethreatening medical condition to receive treatments which are not available in Australia. Applicants must meet four mandatory medical eligibility criteria before assistance can be provided, including that the life-saving medical treatment or an effective alternative treatment must not be available in Australia in time to benefit the applicant, that the treatment must be significantly life extending and potentially curative, there must be a real prospect of success and the treatment must be accepted as standard treatment by the Australian medical profession. In 2013-14, the Department will continue to assess applications for financial assistance under this program.
Improve access to specialist services through telehealth
In 2013-14, the Government will continue to provide incentives for medical practitioners, eligible nurse practitioners and midwives and residential aged care facilities to provide telehealth services.
Program 3.2 is linked as follows:
- The Department of Human Services (Services to the Community – Program1.1) for administering breast cancer external prostheses reimbursements, telehealth financial incentive payments and exgratia payments for the Disaster Health Care Assistance Schemes.
Program 3.2: Expenses
Table 3.3: Program Expenses
2012-13Estimated
actual
$'000 / 2013-14
Budget
$'000 / 2014-15
Forward
year 1
$'000 / 2015-16
Forward
year 2
$'000 / 2016-17
Forward
year 3
$'000
Annual administered expenses
Ordinary annual services / 31,292 / 41,223 / 11,691 / 11,728 / 11,765
Program support / 1,437 / 1,295 / 1,284 / 1,294 / 1,320
Total Program 3.2 expenses / 32,729 / 42,518 / 12,975 / 13,022 / 13,085
Program 3.2: Deliverables
Qualitative Deliverable for Program 3.2
Provide medical assistance to Australians overseas
Qualitative Deliverable / 2013-14 Reference Point or TargetProvide health care assistance to eligible Australians overseas in the event of overseas disasters / Assistance is provided in a timely manner
Program 3.2: Key Performance Indicators
QuantitativeKey Performance Indicators for Program 3.2
Support access to necessary medical services which are not available through mainstream mechanisms
QuantitativeIndicators / 2012-13 Revised Budget / 2013-14 Budget
Target / 2014-15 Forward
Year 1 / 2015-16 Forward
Year 2 / 2016-17 Forward
Year 3
Percentage of claims by eligible women under the National External Breast Prostheses Reimbursement Program processed within ten days of lodgement / 90% / 90% / 90% / 90% / 90%
Number of health services provided to eligible Australian residents, such as the homeless, the disadvantaged and the visually impaired that could not be provided through Medicare, due to patient access barriers / 36,800 / 37,000 / 37,200 / 37,400 / 37,600
Program3.3: Diagnostic imaging services
Program Objectives
Diagnostic Imaging Reform - Magnetic resonance imaging
The Australian Government will ensure ongoing, affordable, and convenient diagnostic imaging services for patients by expanding patient access to Medicareeligible magnetic resonance imaging (MRI) services.
The Department will continue to implement the DiagnosticImaging Reform Package arising out of the 2011 Review of Funding for Diagnostic Imaging Servicesto ensure that more Australians have access to affordable diagnostic imaging and benefit from faster diagnosis and early detection.
To increase access to Medicare rebateable MRIs, from November 2013, GPs will be able to request Medicare-eligible MRIs for all patients over the age of 16 years for a small set of clinically appropriate indications. This builds on the 2012-13 initiative to extend Medicare requesting right to GPs for children under the age of 16 years.
Strengthening the provision of quality diagnostic radiology services
The Government will continue to monitor and evaluate the impact of thechanges introduced on 1 November 2012, which require those performing the actual diagnostic imaging procedure to hold minimum qualifications for all Medicare funded X-ray, angiography and fluoroscopy services. This initiativeaddresses quality and safety concerns that arose from the Review of Funding for Diagnostic Imaging Services.
Encourage more effective use of diagnostic imaging
In 2013-14, through the Diagnostic Imaging Quality Program, the Government will continue to fund projects that meet identified priority areas in diagnostic imaging such as safety, communication, appropriateness, efficiency and the consumer experience. These will contribute to the improved cost-effectiveness and clinical relevance of diagnostic imaging services.
Diagnostic Imaging Accreditation Scheme
All diagnostic imaging sites that wish to provide MBS eligible services must first be accredited through the Diagnostic Imaging Accreditation Scheme, to ensure that patients receive high quality and safe services. The scheme allows practices to move incrementally from a minimum entry level standard to full accreditation. In2013-14, the Department will continue to manage the scheme and work with external accreditors to assist diagnostic imaging providers who need to gain full accreditation under Stage 2 of the Scheme. Research to examine the impact of the Scheme on diagnostic imaging providers commenced in April 2011 and the results are expected to be published in 2013-14.
Enhancing the role of radiologists in appropriate imaging
As part of the Diagnostic Imaging Reform Package the Department will continue to work with peak bodies to improve the quality and value of diagnostic imaging services. Where appropriate the role of radiologists and other imaging specialists in relevant imaging selection will be increased and communication with the requesting practitioner improved to ensure patients are receiving only appropriate imaging.
Program 3.3: Expenses
Table 3.4: Program Expenses
2012-13Estimated
actual
$'000 / 2013-14
Budget
$'000 / 2014-15
Forward
year 1
$'000 / 2015-16
Forward
year 2
$'000 / 2016-17
Forward
year 3
$'000
Annual administered expenses
Ordinary annual services / 3,349 / 3,370 / 3,434 / 3,496 / 3,563
Program support / 646 / 582 / 578 / 582 / 594
Total Program 3.3 expenses / 3,995 / 3,952 / 4,012 / 4,078 / 4,157
Program 3.3: Deliverables
Qualitative Deliverable for Program 3.3
Encourage more effective use of diagnostic imaging
Qualitative Deliverable / 2013-14 Reference Point or TargetFund activities to improve the quality of diagnostic imaging services / Funding agreements with successful applicants to the Diagnostic Imaging Quality Program will be in place with monitoring activities conducted in 2013-14
Quantitative Deliverable for Program 3.3
Diagnostic Imaging Reform - Magnetic resonance imaging
Quantitative Deliverable / 2012-13 Revised Budget / 2013-14 BudgetTarget / 2014-15 Forward
Year1 / 2015-16 Forward
Year2 / 2016-17 Forward
Year3
Number of additional MRI units in areas of need given Medicare eligibility / 2 / 2 / 4 / 4 / N/A[4]
Program 3.3: Key Performance Indicators
Qualitative Key Performance Indicator for Program 3.3
Diagnostic Imaging Reform - Magnetic resonance imaging
Qualitative Indicator / 2013-14 Reference Point or TargetPatients have access to affordable and convenient diagnostic imaging services / Increased access to MRI services for primary care patients through the introduction of new GP requested items for patients over the age of 16 years from 1 November 2013.
Quantitative Key Performance Indicator for Program 3.3
Diagnostic Imaging Accreditation Scheme
QuantitativeIndicator / 2012-13 Revised Budget / 2013-14 Budget
Target / 2014-15 Forward
Year 1 / 2015-16 Forward
Year 2 / 2016-17 Forward
Year 3
Number of practices participating in the Diagnostic Imaging Accreditation Scheme / 4,300 / 4,400 / 4,500 / 4,600 / 4,600
Program3.4: Pathology services
Program Objectives
Assurance of quality and accessibility of services
The Government requires all pathology service providers accessing MBS rebates to be accredited through the National Pathology Accreditation program to ensure the safety and quality of services.
In addition, the Department manages the Quality Use of Pathology program to support innovative approaches to improve the quality of pathology services. Through the program, the Department collaborates with consumer representatives and professionals representing pathologists, scientists and other health and medical practitioners to identify where improvements to pathology services can be made.