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Department of Health and Aged Care Reports, including report on the administration and operation of the Therapeutic Goods Administration 2000-01 Volume 1
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Commonwealth Department of Health and Aged Care
Annual Report 2000-01
Volume 1
© Commonwealth of Australia 2001
ISSN 1443-0509
ISBN 0 642 73582 4
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth available from Ausinfo. Requests and inquiries concerning reproduction and rights should be addressed to the Manager, Legislative Services, Ausinfo, GPO Box 1920, Canberra ACT 2601.
The report meets the requirements of section 8 of the Freedom of Information Act 1982.
An index showing compliance with annual reporting requirements is on page 471.
Front cover photographs (clockwise from top right):
1. Soldiers receiving vaccination for typhoid in Egypt before heading to the battlefields of Gallipoli. Used with permission; National Library of Australia; FN: 1900/6.
2. Two Aboriginal medical service staff members discussing pharmaceuticals, 1980s. Used with permission; National Archives of Australia; A6180/ 10, 22/4/80/ 19.
3. The Department works to promote culturally-appropriate services for Indigenous Australians. Department of Health Archives.
4. Dr Clyde Fenton, the first flying doctor poses with his plane. Used with permission; National Archives of Australia; FN: 1930/3.
5. Australian schoolgirls receive sabin oral vaccine to immunise against poliomyelitis in 1966. Used with permission; National Archives of Australia; Australian Overseas Information Service; A1200, L58781.
6. A Red Cross blood bank worker collecting donated blood in 1960. Used with permission; Department of Immigration and Multicultural Affairs.
7. Dr WJ Penfold, director of the Commonwealth Serum Laboratories (right) and Mr Considine at work in the laboratory, early 1920s. Used with permission; Commonwealth Serum Laboratories.
Publications approval number 2885
Produced by Looking Glass Press for the Department of Health and Aged Care
Printed by Goanna Print
Preface
About this report This report is prepared in accordance with the Requirements for Departmental Annual Reports, as issued by the Department of the Prime Minister and Cabinet. The report is a formal accountability document that details the Department's activities during the 2000-01 financial year against the performance indicators presented in the 2000-01 Portfolio Budget Statements.
Although the primary purpose of this report is to provide members of Parliament and Senators with an accurate description of the activities of the Department during the 2000-01 financial year, we recognise that the report should also be a valuable source of information for the community as a whole. In preparing this report, we have endeavoured to take into consideration the requirements of such a diverse audience and provide all readers with a useful and informative picture of the Department's performance over the past 12 months.
With this in mind, we have elected to break this year's Annual Report into two volumes. We believe that this revised format is more user friendly with Volume 1 being a snapshot of the Department's performance over the past 12 months while Volume 2 provides a more detailed analysis of the Department's performance against individual performance measures and includes the appendices to the annual report.
Structure of this report The Department's 2000-01 Annual Report is structured in five parts, split over two volumes as follows:
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Volume 1
Part !-Overview
The Overview provides an explanation of the Department's activities, broad strategic directions and priorities, noting key issues and achievements during the year.
A key feature of Part 1 is the Secretary's Portfolio Overview, which provides an insight into the portfolio's major areas of focus for the year from the Secretary's unique viewpoint.
Part 2-0utcome performance reports
This section discusses the main activities, including major achievements and under achievements, of individual outcomes within the Department. Activities are based on a set of performance indicators outlined in the 2000-01 Portfolio Budget Statements. These indicators are listed at the end of each outcome report. As a helpful reference tool, footnotes are included throughout each outcome report to assist the reader in identifying which indicator is being addressed and also where a crossover with another outcome exists.
Outcome reports are written in an 'essay-style' to make them easier to read and to provide more background information, particularly contextual material that will assist the reader develop a stronger appreciation of the Department's leadership role in health and aged care in Australia.
Part 3-Financial statements
The complete set of financial statements for the Department of Health and Aged Care and the Therapeutic Goods Administration Trust Account.
Volume 2
Part 4-Performance information
This part reports, by Outcome, the Department's performance against specific performance measures as detailed in the 2000-01 Portfolio Budget Statements. The results provide useful supplementary information to that provided in the outcome essays in Volume 1.
Part 5-Appendices
The appendices provide a range of statistical and other information relating to the Department. Information in this section includes a description of ministerial responsibilities, staffing information and details of consultancy services engaged by the Department. A complete list of appendices is provided on page 349 (Volume 2).
This year's report also contains two new appendices: a report against the Commonwealth Disability Strategy (Appendix 6); and a report on ecologically sustainable development and environmental performance (Appendix 14).
Two appendices have been omitted this year (Client consultation and Additional information). Neither appendix is required under the Requirements for Departmental Annual Reports, however the flexibility of the 'essay style' of the outcome reports has allowed much of this information to be placed throughout both volumes.
Additional information This report is available on the internet at www.health.gov.au/pubs/anmep/ar2001/index.htrn The electronic version contains links to most documents referred to in the report, including the Portfolio Budget Statements, as well as links to previous annual reports.
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Readers seeking information on the activities of the portfolio, not contained in the annual report, are directed to the Department's general web site www.health.gov.au.
Readers' comments If you would like to comment on this year's Annual Report or have any questions, please contact us either by:
Fax: (02) 6289 7177; Phone: (02) 6289 7181; E-mail: anrep@health.gov.au; or writing to
The Editor 2000-01 Annual Report (MDP 51) Department of Health and Aged Care GPO Box 9848 CANBERRA ACT 2601 AUSTRALIA
COMMONWEALTH OF AUSTRALIA
OFFICE OF THE SECRETARY GPO Box 9848 ACT 2601 Telephone: (02) 6289 8400 Fax: (02) 6289 1994 ABN 83 605 426 759
The Hon Dr Michael Wooldridge MP Minister for Health and Aged Care Parliament House CANBERRA ACT 2600
Dear Minister
Health and Aged Care
As required under section 63(1) of the Public Service Act 1999, I provide you with the 2000-01 Annual Report of the Commonwealth Department ofHealth and Aged Care, for your presentation to the Parliament.
This report has been prepared in accordance with the Requirements for Annual Reports, approved on behalf of the Parliament by the Joint Committee of Public Accounts and Audit, as required under section 63(2) of the Public Service Act 1999.
The report also includes information on the administration and operation of the Therapeutic Goods Administration, which is required under section 41D of the Audit Act 1901.
Yours sincerely
/ 2 October 200 I
Contents
Part 1
Overview
Portfolio overview
Departmental overview
Part 2
Outcome performance reports
1 Population health and safety
2 Access to Medicare
3 Enhanced quality of life for older Australians
4 Quality health care
5 Rural health
6 Hearing services
7 Aboriginal and Torres Strait Islander health
8 Choice through private health
9 Health investment
Part 3
Financial statements
Index
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3
11
31
63
81
111
133
149
163
179
195
213
329
Part 4
Performance information
Part 5
Appendices
See Volume 2
See Volume 2
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1
Part 1: Overview
...
Dr Clyde Fenton, the first flying doctor, poses with his plane.
Commemorating 80 years of providing Commonwealth health services to the Australian community.
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Portfolio overview
Centenary of Federation In this Centenary year of the Australian Federation, the Department also celebrated its 80th birthday. On 7 March 1921, the first Commonwealth Department of Health was created.
At Federation, the Commonwealth's role in health was limited to quarantine, and the Department's initial remit in 1921 was restricted essentially to help manage the risk of communicable diseases. While the States still play a major role, today it is this Department which has primary financial responsibility for our huge and sophisticated national health and aged care system. It is a complex system where responsibility is shared amongst governments, the private sector and the charitable sector, which relies upon the expertise of health professionals, and where consumers are rightly demanding increased influence. The Department's leadership role is one of shaping and enabling, rather than controlling and directing.
I suspect the first Director-General of the Department, Dr JHL Cumpston, would be pleased to see how the Commonwealth's role has evolved since his 25 year stewardship of the organisation. In particular, Dr Cumpston was keen that any national health insurance scheme should be more than just a financing system; it should be used to support improvements in services and the health of the population.
A major project to celebrate our history has been the production of a book on the Commonwealth's role in Australia's health since 1901, Putting Life into Years by Francesca Beddie. The Department is the main character in the
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book, but the book goes well beyond that, identifying the remarkable increases in life expectancy and health status of most Australians over the last hundred years, the various developments in policy and research, and some of the personalities inside and outside the Andrew Podger: Secretary
Department who have had a major influence. The book identifies some of the challenges for the future, including the unfinished business of improving Indigenous health. In tracing the
history of the Department, the book demonstrates the continuing professionalism of the Australian Public Service which also celebrates its Centenary this year.
Major developments in 2000-01 Further progress was made in developing the national health and aged care system during the year, particularly in leveraging the Commonwealth's financing role to improve
health services and health outcomes. Increasingly, Medicare is more than an insurance scheme reimbursing people for the costs of health services. With the cooperation of the professions, it is funding health services and medicines that must be effective and of good quality, and available where they are needed.
Primary health care - particularly the role of general practitioners in delivering first-contact care, ensuring continuity of care and preventative care, and coordinating services for many people with complex or chronic health needs - has been given priority over the last
four years. Under the GP Memorandum of Understanding (GP MoU), participation in the Practice Incentives Program (PIP) has increased substantially, reaching 5,260 general practices, which covers 80 per cent of the population. As an indicator of the impact of this, of the 5,260 PIP practices 89 per cent are computerised. The Enhanced Primary Care measures announced in the 1999-2000 Budget are now being used widely, providing better support for chronically ill patients and annual health assessments for older people. These build on the earlier measures to improve child immunisation rates. The latest Budget includes additional measures to support improved care of people suffering from diabetes or asthma, and more systematic screening for cervical cancer. The Relative Value Study, a five year review with the medical profession into the structure of medical benefits, was completed during the year. It pointed to the need to better reward general practice and to remove incentives to maximise patient throughput via short consultations. The Department developed proposals in response to these findings and, following Budget announcements of new funding for general practice, commenced negotiations on changes to the Medical Benefits Scheme and on extending the GP MoU.
Quality improvement has been another major theme this year. The new Residential Aged Care Accreditation System was introduced by 1 January 2001. Ninety-nine per cent of homes, or all but 20, were accredited with 19 allowed an extension of up to six months to meet the requirements and one having its subsidies terminated. In the two year period 1 January 1999-31 December 2000 leading to the full introduction of the new system, there was a considerable shake-up in the industry with about
105 homes changing hands, closing down or moving and most homes seeking capital investments or changes in care arrangements to meet the new standards. For the most part, the
OVERVIEW
changes have been managed smoothly with the Department actively involved to ensure minimum disruption for residents. This has been a herculean task under the closest of media scrutiny.
Safety and quality have also been high on the agenda for the rest of the health system. The National Safety and Quality Advisory Council chaired by Professor Bruce Barraclough, with Departmental support, developed an action plan for improving safety particularly in hospital settings, and the Australian Health Ministers' Council has allocated a total of $50 million over five years in support.
An important strategy to address safety, and to improve patient care, is to improve information management across the health system. Further development of a national health information capability was pursued during the year on a number of fronts. Health Ministers agreed in principle to develop a national health record system, HealthConnect, and funds have been allocated for pilot projects to be managed by a project team in the Department under direction from a multi-jurisdictional Interim HealthConnect Board. During the year, legislation was passed to ensure the Medicare number for individual patients was included on every prescription, with full implementation in 2002. Considerable progress was made on the Better Medication Management System designed to provide all Australians with the option of a continuous electronic medication record. Draft legislation for the system was circulated for discussion. The Health Insurance Commission has also been authorised to re-engineer its claims and payments system over the next four years in a way that will facilitate wider connectivity of the health system.
Integration remains a major theme for improving the health system. Apart from a greater role for primary care and better information links, advances were made to improve the linkages between the Pharmaceutical Benefits Scheme
PORTFOLIO OVERVIEW
(PBS) and public hospitals (Victoria being the first State to agree to a deal that will see prescriptions for outpatients and patients on discharge financed through the PBS) and between hospitals and aged care (with the Commonwealth offering flexible aged care packages that might offer more appropriate care for some long-term hospital patients). New arrangements were put in place for pharmacist-general practitioner collaboration on medication reviews for people at risk.
Improving access to services for those not well served to date by Medicare has also been a priority. For Indigenous Australians, regional plans have been developed under the Framework Agreements with the States and Territories, the community controlled health sector and ATSIC. These are allowing the sort of
pooled funding that has proven successful in the Indigenous Coordinated Care Trials to be extended to other areas around the country, as real increases in funding are being made available for Indigenous health. The National
Aboriginal and Torres Strait Islander Health Council has also been developing a revised national strategy for consideration and endorsem*nt by all jurisdictions and the framework partners. Rural health services have also been a priority, with the measures announced in the previous two Budgets coming into operation. These include new university departments of rural health to support health workers in the bush, new rural health services and various incentives to encourage doctors and other health workers to work in rural areas.
The major gains in private health insurance participation were consolidated during the year. The Department increased its on the 'gaps' issue with significant results. The majority of
privately insured medical services now have no gaps or a known gap, and fund members can be increasingly confident that their contributions will cover all their costs, or all but a known amount of their costs. This is critical to the
attractiveness of private health insurance and the sustainability of higher participation rates.
Departmental capability Efforts to enhance further the Department's capability focussed on the skills and training of staff, improved internal governance and improved information and research support. The Performance Development Scheme for all
staff was complemented by work to identify the specific skills and knowledge required in each area of the organisation and increased investment in training and development. Significant numbers of staff are undertaking courses such as Masters of Public Health as well as internal training on project management, information technology and management. The new Indigenous Staff Network has also been very active in developing and supporting Indigenous staff across the organisation. The Department's governance arrangements were refined with a new Finance Committee to support the Departmental Management
Committee, and with revamping of our other committees. Mr Bill Scales, formerly the head of the Productivity Commission and the Victorian Premier's Department, joined the Departmental Management Committee as an external member. In addition, lines of accountability have been tightened, flowing through to the performance agreements for all senior staff. Ethical standards have also been revisited with the new chief executive instruction on conflict of interest being implemented for all staff and all committees, including committees with external membership.
Policy research, both inside the Department and commissioned work, has also received increased attention. Such work is critical to our capacity to advise Ministers and the Government. The Department's Occasional Papers this year include substantial work on health financing and other key issues. The National Strategy on Ageing also
OVERVIEW
provided the opportunity for internal and commissioned work to support policy development. The Department is closely involved in the new Priority Driven Research fund set up by the Australian Health Ministers' Council.
Another core capability is the strength of our relationships with key partners and stakeholders. Foremost amongst these is the State and Territory health departments. Over the last year, in addition to the formal processes of the Australian Health Ministers' Advisory Committee (advising the Australian Health Ministers' Council), the Department proposed regular CEOs-only meetings, and bilateral Commonwealth-State (or Territory) meetings. These meetings took place during the year and have proven to be very valuable, encouraging better dialogue in a confidential way, based upon acceptance that responsibility for the whole health system is shared. The Commonwealth has gained from better understanding of hospital management and planning, and the States and Territories have gained from better understanding of PBS and MBS developments (including improved primary care) and aged care developments. As a result there have been considerable advances in joint planning and close cooperation in service delivery.
Performance The Departmental performance against the indicators and targets set out in the 2000-01 Portfolio Budget Statements are provided elsewhere in this report, and in the separate volume of detailed performance information. Often, the impact of actions on health outcomes is not clear for several years. The following are highlights this year, some of which relate to actions taken in earlier years.
Achievements
⢠The new Residential Aged Care Accreditation System was introduced from 1 January 2001, the culmination of several
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years of improvements in capital investment and care arrangements, and substantial restructuring in the industry, with limited disruption for residents.
⢠There have been sustained improvements in childhood immunisation with 91.5 per cent of children aged 12-15 months now fully immunised. A key achievement is that measles is becoming rare in Australian children due to the impact of better vaccine coverage supported under the Measles Control Campaign (with most cases now only occurring in unvaccinated adolescents and young adults).
⢠On 25 March 2001 the National Illicit Drugs Campaign was launched by the Prime Minister. The year 2000-01 has also seen the implementation of the Illicit Drug Diversion Initiative to provide the capacity to divert illicit drug users into a range of appropriate education and treatment programs.
⢠Recent surveys suggest an overall reduction in smoking prevalence from 24 per cent in 1995 to 22 per cent in 1998, with preliminary results from a survey commissioned by the Department in November 2000 suggesting that a further reduction in smoking prevalence to around 20.8 per cent for people aged 18 years and over.
⢠Significant improvements in regulatory arrangements for food and for gene technology are being achieved, including the establishment of the Office of the Gene Technology Regulator on 21 June 2001.
⢠5,260 general practices in Australia covering 80 per cent of the population are now participating in the Practice Incentives Program (PIP).
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PORTFOLIO OVERVIEW
Under arrangements to improve access to medical services for Indigenous people, 350,000 Medicare services were provided at a cost of $10.5 million through Aboriginal Community Controlled Health Services.
New Zealand, Singapore and now Germany have chosen to use the Australian Refined Diagnosis Related Groups (Casemix) as a basis for their
hospital services financial arrangements.
The Australian Organ Donor Register (AODR) was launched in November 2000. Over 70,000 people registered their willingness to be a donor by 31 May 2001.
Several initiatives to improve access and services in rural and remote Australia were progressed, including the location of nine new Rural Clinical Schools in regional
universities, awarding of over 430 medical scholarships under the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme and approval of 52 new regional health services.
Ten high priority sites were selected for funding of new services for Indigenous communities under the Primary Health Care Access Program (PHCAP) in the
orthern Territory and South Australia and an evaluation of the four Aboriginal coordinated care trials concluded they were highly successful in improving access to effective primary health services.
By 30 June 2001, 32 health funds had introduced new style gap schemes following the passage of legislation in August 2000 enabling them t0 provide cover for their members to eliminate, or allow them to know in advance, any out of-pocket payments that they may have had to make for doctors' services in hospital or day surgery - without the
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need for doctors to enter into any contracts.
Health Ministers agreed to commit resources to undertake two years' research and development work on HealthConnect, the proposed national health information network.
Professor Alan Pettigrew was appointed as the inaugural Chief Executive Officer of the National Health and Medical Research Council (NHMRC) in January 2001, and research funding increased with a further tranche towards the doubling announced in the 1999 budget.
Under-achievements
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Projected Pharmaceutical Benefits Scheme (PBS) expenses during the year were underestimated. Major factors behind the growth were the cost of new PBS listings of medicines for treating arthritis (Celebrex®) and nicotine dependence (Zyban®), and growth in expenditure on cholesterol-lowering medicines.
Delays were encountered in implementing some components of the Regional Health Strategy due to the extent of consultation required with rural stakeholders to ensure community engagement and a rigorous planning and priority setting process.
Delays occurred in signing new framework agreements on Aboriginal and Torres Strait Islander Health. As at 30 June 2001 only the Northern Territory partners (Commonwealth, State and Territory governments, community sector and the Aboriginal and Torres Strait Islander Commission) had re-signed a new
Framework Agreement. It is expected that the remaining Framework Agreements with other jurisdictions will be re-signed by the end of 2001.
OVERVIEW
The year ahead Indigenous health remains the most critical challenge. The infrastructure is now in place for increased investments in primary health care to be effective. Some further growth funding has been provided already in the forward estimates. The revised National Strategy for Aboriginal and Torres Strait Islander Health is likely to require further commitments by all governments not only for primary health care but also for community capacity building and for health workforce development. It will also require support from agencies outside the health sector, and leadership from the Indigenous communities. Achieving wide endorsem*nt of the strategy is the particular challenge for the coming year.
The current Australian Health Care Agreements run until 30 June 2003. Work on their replacement must commence in earnest in the coming year. While hospital activity for public patients has been increasing under the current agreements, faster than the population and the impact of ageing, there remain significant issues to be resolved between the Commonwealth and the States if the national health and aged care system is to be well integrated, coherent and provide appropriate and effective care.
Important amongst these is the most appropriate care for older people. The health and aged care system must be responsible to the range of care needs, and support extension of the gains of recent years in both life expectancy and years of health living. There is a strong case for greater emphasis on restorative care and services to help people stay at home.
Another area requiring further work relates to the relationships between hospitals and primary care, building on developments such as information strategies, the Commonwealth's initiatives to improve general practice and proposals for better linking hospitals to the PBS, and drawing on the lessons from the coordinated care trials.
More generally, the new agreements will need to specify more clearly the agreed outputs from shared Commonwealth and State/Territory funding commitments, not only in terms of acute care episodes but also in such other important areas as teaching and research.
Other priorities in the year ahead include better targeting of the benefits of the Pharmaceutical Benefits Scheme, and responding to the full impact on the health system of the major increase in private health insurance participation. The system needs to be able to respond to the inevitable pressures on capacity, particularly the skilled workforce, if the reasonable demands of members are to be met, and if the public hospital system is to gain full advantage from increased private hospital activity.
The Department's management challenges in the coming year include the Corporate Activities Review, which involves systematically re engineering and/or market-testing all corporate services. Further improvements in the Department's skills development are also essential given the policy and program challenges, and a new certified agreement is to be negotiated before the end of the coming financial year. Following the election, the Department will need to review its Corporate Plan and ensure it is fully aligned to Ministers' policies and priorities.
Acknowledgment I am grateful for the commitment and hard work of our highly skilled and experienced staff, in Canberra and our State and Territory offices, and the productive relationships they have forged across the health and care system. Our achievements are entirely dependent upon them.
AS Podger
Secretary Department of Health and Aged Care
PORTFOLIO OVERVIEW
Whole of portfolio health and aged care targets The portfolio's success in its vision of creating a world class health and aged care system for all Australians is reflected in part by the achievement of the fo llowing broad health and aged care service targets, which are measured biannually by the Australian Institute of Health and Welfare.
Continued improvements in life expectancy
for both males and females over time
Life expectancy at birth continues to increase each year. Life expectancy in 1997-99 was 76.2 years for males and 81.8 years for females. This is an increase since 1979 of 5.4 years for males and 3.9 years for females and an increase since
1989 of 2.9 years for males and 2.2 years for females. Significant gains in life expectancy have occurred over recent decades following reductions in mortality among the elderly, especially for diseases of the circulatory system.
Further reductions in infant mortality rates
over time
During the 20 year period from 1979 to 1999, infant mortality rates have halved from 11.4 to 5.7 infant deaths per 1,000 live births. For the
ten years to 1999, infant mortality rates decreased by around 30 per cent. Although annual changes in infant mortality rates show more fluctuation (increasing, for example, by 0.7 deaths per 1,000 live births from 1998 to
1999), the long-term trend is one of decline. Today, only one in 177 infants born will not survive their first year of life. The factors contributing to declining infant mortality rates
include medical technology such as neonatal intensive care units and the success of the national prevention campaign for Sudden Infant Death Syndrome.
Additional improvements in years of
healthy living over time
For Australia in 1999, disability-free life expectancy (DALE), which estimates the expected years of life free of disability, is estimated by the World Health Organization (WHO) to be 70.8 years for males and 75 .5 years for females (73.2 years for persons). This represents around 8 per cent of total life expectancy, which could be expected to be lived with disability. just under half of the life years remaining after age 65 will be spent free of disability (41 per cent for men and 45 per cent for women).
Unpublished preliminary estimates of Healthy Life Expectancy (HALE) for Australia for 2000 by WHO show a decrease in HALE to 69.6 years for males and 73.3 years for females (71.5 yea rs for persons), however as these are estimates based on a new experimental methodology, their reliability has not been verified.
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Departmental overview
General overview For Departmental management, the focus over the last year has been on consolidating financial and workplace reforms, and on further improvement of governance and capability. The absence of a major new reform agenda should not disguise the extent of activity or the scale of the challenges 'to do more with less'.
With further experience of accrual accounting and the outcomes/outputs budget framework, the Department moved beyond implementation to begin realising real gains from improved financial management, particularly of departmental expenses where the potential benefits of accrual are greatest. A new Finance
Committee has helped develop a capital fund for the Department and a more disciplined approach to capital investment. An Output Pricing Review has provided benchmarking of performance in the corporate services area and the ensuing Corporate Activities Review will involve extensive re-engineering and market testing to achieve best practice. This will also meet the Government's requirement for competitive tendering and contracting.
Other significant achievements for the Department have occurred in relation to the development and implementation of the SAP Financials and Human Resource Management Systems, in the implementation of government on-line requirements, and in the . implementation of commitments made in the current Certified Agreement to further improve staff development.
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The Department's role and function The Department is responsible to two Ministers, the Minister for Health and Aged Care, Dr
Michael Wooldridge, and the Minister for Aged Care, Mrs Bronwyn Bishop. Senator Grant Tambling is Parliamentary Secretary.
⢠Dr Wooldridge, as portfolio Minister, has overall responsibility with direct carriage of matters relating to population health, Medicare, Indigenous health, rural health services, private health insurance and health and medical research.
⢠Mrs Bishop has direct carriage of matters relating to residential aged care, community care, hearing services and strategies for an ageing population.
⢠Senator Tambling has direct carriage of matters relating to food and drugs regulation, complementing medicine, radiation regulation and aspects of the Pharmaceutical Benefits Scheme.
Details of the Department's responsibilities are set out in the Administrative Arrangements Orders. A list of ministerial responsibilities are set out in Appendix 2 while the main legislation administered by the Department is at Appendix 8.
Ministers have endorsed statements of the Department's vision and mission:
⢠the vision is a world class health and aged care system for all Australians based in particular on achieving the objectives for the nine portfolio outcomes identified in the Portfolio Budget Statements;
⢠the mission is to Lead the development of Australia's health and aged care system, through:
- providing expert policy advice, analysis and other services to the government;
- working with consumers, communities, providers, peak bodies, industry groups, professional organisations, State and Territory governments and portfolio agencies through consultation and collaboration;
- promoting healthy living and communicating information about health and aged care services;
- managing the Commonwealth 's health and aged care programs to ensure the provision of quality, cost effective care; and
- safeguarding health, safety and equity in a way that imposes the minimum necessary regulatory burden.
Organisation structure
Outcomes and outputs structure
The Government has set nine outcomes for the portfolio:
⢠Outcome 1: to promote and protect the health of all Australians and minimise the incidence of preventable mortality, illness, injury and disability
⢠Outcome 2: access through Medicare to cost-effective medical services, medicines and acute health care for all Australians
⢠Outcome 3: support for healthy ageing for older Australians and quality and cost effective care for frail older people and support for their carers
⢠Outcome 4: improved quality, integration and effectiveness of health care
OVERVIEW
⢠Outcome 5: improved health outcomes for Australians living in regional, rural and remote locations
⢠Outcome 6: to reduce the consequences of hearing loss for eligible clients and the incidence of hearing loss in the broader community
⢠Outcome 7: improved health status for Aboriginal and Torres Strait Islander people
⢠Outcome 8: a viable private health industry to improve the choice of health services for Australians
⢠Outcome 9: knowledge, information and training for developing better strategies to improve the health of Australians
The first four of these represent the ongoing responsibilities of the portfolio, with the other five representing particular priority areas in the medium term.
Departmental output groups within each outcome are:
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services to the ministers and parliament;
national leadership;
information;
program management;
⢠regulatory activity; and
⢠direct delivery of services.
Divisional structure
The Department's management structure broadly follows the Outcomes structure, with some differences reflecting the need for manageable spans of control and the need for department-wide corporate support. The Department's divisional responsibilities are:
⢠Population Health Division - Outcome 1 (part)
⢠Therapeutic Goods Administration -Outcome 1 (part)
DEPARTMENTAl OVERVIEW
⢠Health Access and Financing Division Outcome 2
⢠Aged and Community Care Division -Outcomes 3 and 6
⢠Health Services Division - Outcomes 4 (part) and 5
⢠Office of Aboriginal and Torres Strait Islander Health - Outcome 7
⢠Health Industry and Investment Division -Outcomes 4 (part), 8 and 9 (part)
⢠Corporate Services Division
⢠Portfolio Strategies Division
The Office of the NHMRC is no longer a division of the Department as it now has its own Chief Executive Officer (though its staff belong to the Department). It has responsibility for part of Outcome 9.
State and Territory offices
The Department also has offices in each State and Territory.
Their role is to work in partnership with local stakeholders to ensure that service provided through Departmental programs are responsive to diverse local needs and conditions, while maintaining consistent standards of equity, quality and efficiency in the pursuit of Government policy objectives. In particular, they contribute uniquely to the integration agenda of the Department as they are in an excellent position to identify policy links between programs and to identify overlaps and gaps, and to ensure appropriate integration of
services on the ground with those o.f State and Territory government agencies.
Management accountability
The Executive
The Secretary, Andrew Podger, has overall responsibility for the Department and is the senior adviser to the Ministers and the Parliamentary Secretary. The Secretary has statutory responsibilities under program and administrative legislation. Mr Podger has extensive experience in public administration, with particular expertise in social policy, financial analysis and management. He has been Secretary of the Department since March 1996.
(C lockwise from top left): David Borthwick, Deputy Secretary; Mary Murnane, Deputy Secretary; Professor Richard Smallwood, Chief Medical Officer; and Andrew Podger, Department Secretary.
Deputy Secretary Mary Murnane is the senior adviser to the Minister for Aged Care. Ms Murnane has executive responsibility for aged and community care and corporate services, including audit and fraud control. She also has specific responsibility for overseeing the State and Territory Offices of the Department, and for the development and implementation of rural health policies. Ms Murnane has extensive experience in community services and social
policy in both State and Commonwealth Government.
As at 30 June 2001, Deputy Secretary David Borthwick was the senior adviser to the
OVERVIEW
Parliamentary Secretary. Mr Borthwick had executive responsibility for health financing and regulation. Mr Borthwick has extensive experience as an economic policy adviser, including fiscal, taxation, structural, financial and international economic policies. (Mr Borthwick has since transferred to the Department of the Prime Minister and Cabinet).
Chief Medical Officer (CMO) Professor Richard Smallwood AO has final responsibility for professional medical advice, particularly in public health matters, evidence-based medicine, national health priorities and the safety and quality of health care. He is an internationally recognised expert in clinical medicine and medical research and is a member of numerous professional bodies. In 1997, Professor Smallwood was made an Officer of the Order of Australia for his services to medicine.
The Departmental Executive comprises the Secretary, two Deputy Secretaries and the Chief Medical Officer. The Executive works as a team to carry forward the strategic directions of the Department. It takes particular responsibility for senior appointments, major issues requiring prompt decisions or action not suitable for reference to the Departmental Management Committee, promoting portfolio and cross program perspectives, maintaining top level relationships with key stakeholders and ensuring consistent advice to the parliamentary team.
Corporate management
The Departmental Management Committee (DMC) is the Department's key governance committee and primary decision making forum, advising the Secretary on strategic policy and management matters. Membership of the DMC comprises the Departmental Executive, Central and State/Territory Office senior executive managers, and an external independent member.
The DMC is supported by a network of major committees and forums including:
⢠Performance Assessment Committee with responsibilities in the areas of corporate and business planning, performance monitoring, evaluation and reporting, and risk management;
⢠Human Resource Management Committee - responsible for setting the directions and priorities for developing and management of staff;
⢠Finance Committee- responsible for budget management, and improvements in financial management and accountability;
⢠Information Planning and Privacy Committee - with responsibilities including the identification of the Department's key information and communication needs and strategies, the development and monitoring of the Department's Information Management Plan, the Corporate Communications Strategy, the Information Technology Strategic Plan, and the Department's approach to its privacy obligations;
⢠Information Technology Committee, supporting the Information Planning and Privacy Committee and responsible for developing the long-term capital strategy for the Department's IT requirements, identifying IT needs and priorities, and assessing and monitoring IT investments in the Department;
⢠Research and Development Committee -providing leadership in the development of the Department's collective research and development needs and establishment of priorities; and
⢠Policy Forum, State and Territory Managers' Forum and the National Staff
DEPARTMENTAL OVERVIEW
Participation Forum, the latter providing an important avenue for involvement by staff in management processes through staff elected and union representatives.
The Secretary is also advised by an Audit Committee that includes membership external to the Department.
Portfolio governance
The Department maintains close relations with portfolio agencies through regular meetings of portfolio Chief Executive Officers (CEO) and supporting consultative forums. The Secretary chairs the Portfolio CEO meetings, and is also a member of the Boards of some portfolio entities.
The Department was also actively involved in significant corporate governance and structural reform changes across the portfolio during the year, including:
⢠advising on appointments to, and remuneration matters in respect of, the governing bodies of portfolio entities, promoting a suitable balance of expertise and taking account of the Government's commitment to increasing the
representation of women at senior levels;
⢠guiding decisions within the Department for establishing sound governance processes, including consideration of arrangements for establishing new portfolio entities;
⢠advising Ministers and the Parliamentary Secretary, as representatives of the Government's ownership of a number of business enterprises within the portfolio,
on governance aspects of the ·operations and performance of those business enterprises; and
⢠involvement in the scoping study of the future ownership options for Health Services Australia, announced by the Government in December 2000 and undertaken by the Office of Asset Sales
15
and Commercial Support (formerly the Office of Asset Sales and Information Technology Outsourcing).
Corporate planning The Corporate Plan sets out the Department's strategic directions and how these link with Government policy. It also identifies the key opportunities the Department must take
particularly with its portfolio partners to promote these strategic directions and to achieve the nine outcomes set by the Government for the portfolio. The plan was endorsed by Ministers in early 2000 and applies for the remainder of the current parliamentary term (with minor updating each year after the Budget).
Mission, vision and values
The plan sets out the vision and mission for the Department. It also sets out the values of the organisation of professionalism, openness and trust, collaboration, innovation and integrity which are underpinned by the Australian Public Service values. The values are also reinforced in the plan by a series of obligations staff are expected to meet, including the APS code of conduct.
Ethical issues are taken very seriously in the Department, with regular ethics awareness training that continues to use the 'Fork in the Road Cafe' theme and a hypothetical-style video, Name Your Poison dealing with realistic scenarios in health and aged care. The new chief executive instruction on conflict of interest issued in June 2000 has been followed through during the year across the Department and all its internal and external committees.
Cross-program opportunities
The plan identifies four opportunities relevant to all program areas for the Department to lead the improvement of the health and aged care system:
OVERVIEW
⢠developing the Department's leadership role to support a coherent national health and aged care system;
⢠using knowledge and information to deliver better services;
⢠using integrated funding to deliver more effective services; and
⢠driving the system with the experience of the customer.
Considerable progress was made in 2000-01, particularly on the second and third opportunities. Examples of more integrated funding include the developments in primary health care, rural services, Indigenous health, and private health insurance gaps. Improvements in the use of information and knowledge were advanced by, for example, the further development of the health information agenda and the establishment of priority-driven research processes, both being done in close cooperation with the States and Territories. Increasing the role of consumers remains a major challenge, though the Department's communications work has continued to increase and improve.
Management opportunities
The Plan also identifies four opportunities to improve the way the Department works:
⢠committing to an agreed and understood direction;
⢠being more accountable and disciplined in priority setting;
⢠more systematic and consistent ways of assisting staff to reach their full potential; and
⢠building openness and cooperation in the Department.
A lot of progress has been made in all these areas over the last year. Refinements made to business planning and corporate management have helped to ensure firmer commitments to
corporate directions and greater accountability, and have also helped to ensure cooperative approaches to resource allocation in line with corporate priorities. The Department's Performance Development Scheme has also been enhanced, and complemented by increased training and development activity and closer involvement of supervisors' supervisors in performance feedback and career planning. There has also been continued improvement in cross department involvement in policy analysis and development, including in particular on primary care, aged care, rural services and Indigenous health. The National Staff Participation Forum is also operating well as one means of promoting dialogue between staff and management.
Other plans
The Corporate Plan is complemented by other plans and instructions:
⢠The Portfolio Budget Statements set out the outcome and output targets - in effect they focus on 'what' is to be achieved while the Corporate Plan focusses on 'why' and 'how';
⢠the Risk Management Guidelines identify the high level risks faced by the Department and the main strategies for amelioration or contingency;
⢠the Financial Management Framework includes the Chief Executive Instructions, Procedural Rules, adherence to the provisions of the Financial Management Act 1997, delegations and financial management governance arrangements;
⢠the People Management Framework sets out corporate strategies to ensure the right skills in the right place at the right time, a flexible and quality work environment and an achievement orientated culture;
⢠the Information Management Plan outlines the key strategic goals for information management in the
DEPARTMENTAL OVERVIEW
Department, and the plans for meeting them. It focusses on the emerging issues, and the strategies which will be developed to address these, in the areas of information policy, statistical data and research, and corporate information; and
⢠the Communication Framework sets down principles for effective internal and external communications.
Business units in the Department prepare business plans each year linked to the Corporate Plan and the PBS in particular, with regular reports on achievement against the plans. Performance agreements for individuals are also linked to these business plans. For senior staff, a common framework of 'business, resources and people' helps to tie business plans and performance agreements together.
Service charters
The Corporate Plan includes a set of principles for delivering high quality services to the public, including open and constructive communication, quality relationships, clearly stated standards of service, information about customers' rights and responsibilities, and complaints handling and resolution processes.
The Department's role is primarily in developing policy and funding health and aged care services, rather than in the direct delivery of services.
Staffing and related resource management Staffing
As at 30 June 2001, the Department employed 3,580 staff in Central, State and Territory Offices. Of these, 2,787 worked in Central Office in Canberra (including all Therapeutic Goods Administration staff), and 793 worked in State and Territory Offices. Details of the classification and gender balance of the Department's staff are set out in Appendix 3.
The staff employed by the Department have a wide range of skills, qualifications and experience. In addition to good generic skills and qualifications, the Department also has a requirement for particular professional and technical expertise. These requirements have been identified by work units as essential for
meeting performance outcomes of the departmental programs and supplement the core skills of the Performance Development Scheme (PDS). They include expertise in the areas of science, medicine, nursing, economics/health economics, public health, community services and people management and leadership.
The Department has continued its successful graduate recruitment program, ensuring the recruitment of high quality graduates as trainees with the aim of positioning the Department well for its future requirements. The Department has also increased the number of Indigenous staff, and the Indigenous Staff Network established in 1999-2000 to support these staff
is operating successfully.
Work continued on key human resource tasks that were identified for implementation in the Certified Agreement 2000:
⢠a review of the Performance Development Scheme (PDS) to ensure more consistency and to build in career planning;
⢠Job Level Description and Evaluation Project to ensure greater consistency of work level standards and to promote more responsibility down the line, including preparation of work level standards;
⢠workforce planning; and
⢠consideration of extension of leadership and manager learning and development activities.
Training and development
The Department provides a program of training courses aligned to the nine core departmental
OVERVIEW
skllls outlined in the PDS and the priorities identified in the Business Unit Statements of Knowledge and Ability. Courses are advertised to staff through the renamed PDS Skills Planner and monthly fact sheets. These enable individuals to select training courses that meet the development needs they have identified through the PDS. Courses are also advertised on the intranet together with additional suggestions for on-the-job learning and development activities.
The PDS Skills Planner also identifies a number of courses that specifically meet the needs of staff who are new to the Department. These courses are also promoted through the Orientation Program that provides information about the Department's role, structure, working arrangements and conditions of service.
The Department has also continued to support staff to gain formal qualifications through access to Development Awards, the Corporate Postgraduate Public Health Program and the Studybank Scheme. The Studybank Scheme is currently under review, as recommended in the Certified Agreement 2000, to ensure it meets the strategic needs of the Department and the learning and development needs of staff. Further details about the Department's awards and recognition scheme are set out at Appendix 3.
The Department conducted an evaluation of the impact of the Manager Development Strategy to ascertain its future direction. While there were initial delays in reaching agreement on a way forward for the Department, it is anticipated that the development and implementation of a new Manager Development Strategy will be underway in 2001-02.
Australian Workplace Agreements
Australian Workplace Agreements (AWAs) have been offered to all SES Officers, Medical Officers Class 1-6, Executive Level 2 and selected Executive Level 1 staff in the State and Territory
Offices. They include a range of initiatives aimed at retaining and attracting quality staff. The Department's ability to attract and retain high calibre senior staff is improved through the use of these agreements, especially where the Department requires specialist skills and knowledge not easily obtainable from the general labour market.
The main features of AWAs in the Department include:
⢠SES and equivalent staff: general conditions of service including performance payments, salary advancement, provision of vehicle, travel and special annual leave bank and;
⢠Executive Level 2 and equivalent staff: performance payments, attraction/retention allowance, and professional staff receive an annual skills allowance or professional development allowance.
While the benefits of A WAs lies in their flexibility, the Department is also conscious of the dangers of inconsistency. The discretion available therefore is managed very closely, with variations from standard pay and conditions for individuals subject to the specific approval of the Executive.
The Department's Certified Agreement
The Department's Certified Agreement 2000 contains a number of recommendations for reviews, and all are either ongoing or complete. These include a change to the standard working day, from 7 hours 21 minutes to 7 hours 25 minutes, to allow for an official Christmas/ ew Year closedown of the Department without staff having to use their own leave entitlements. They also include a commitment to review the
PDS, Studybank and Home Based Work.
The other main features of the Certified Agreement include:
18
DEPARTMENTAL OVERVIEW
⢠comprehensive agreement;
⢠salary increase of 3.6 per cent annualised over 28 months;
⢠further refinement of the PDS with salary advancement linked to PDS outcomes;
⢠flexible leave package;
⢠salary packaging;
⢠commitment to implement a Work and Life Strategy within the life of the Agreement;
⢠Fair Treatment System; and
⢠commitment to develop departmental work level standards and evaluate positions against these standards.
Further details of the Department's Certified Agreement are set out in Appendix 5.
Competitive tendering and contracting
Phase 1 of the Corporate Activities Review (CAR), which began in mid-2000, is now complete. Phase 1 focussed on detailed reviews of each corporate support service area including the services delivered, service providers, costs, customer feedback, benchmarks, gaps compared with best practice, and opportunities for service improvement. Actions will soon be implemented tore-engineer and/or market test a range of services with the objective of ensuring the most appropriate service delivery to meet business requirements.
Purchasing
The Department complies with all relevant Government purchasing policies principles. The majority of purchases by the Department are made through the calling of quotations and/or tenders. The main exceptions to this would be where period contracts have been put in place, for example, for stores and stationery, travel and paper copy supplies.
19
External scrutiny
Australian National Audit Office (ANAO)
During 2000-01, the ANAO undertook a number of audits involving the Department. Included were audits specific to the Department, cross-agency audits where the Department was included and other audits where the
Department was not directly involved but where recommendations were targeted at all agencies.
Audits specific to the Department were as follows.
Drug Evaluation by the Therapeutic Goods Administration-Follow-up Audit (Audit Report No.2)
The ANAO undertook a follow-up audit of drug evaluation by the Therapeutic Goods Administration (TGA) , as a result of a 1996 audit. The audit was conducted due to the importance of effective drug evaluation processes to public health.
Of the three recommendations of the follow-up audit, all were agreed to by the Department, and progress is continuing on the two recommendations that remain incomplete. These are expected to be finalised by the end of
the 2001 calendar year.
Fraud Control Arrangements in the Department of Health and Aged Care (Audit Report No.6)
The audit was undertaken to assess whether the framework and systems that the Department has in place to prevent, control, monitor, detect and investigate fraud operate effectively in practice.
The ANAO concluded that the Department had taken appropriate steps to protect Commonwealth resources under its administration from fraud, with the effectiveness indicated by the relatively low level of reported fraud. The two recommendations of the audit have been implemented by the Department.
The National Cervical Screening Program (Audit Report No.SO)
The audit was undertaken to provide an assurance to the Parliament that the Department's administration of the National Cervical Screening Program was sound.
The audit found the Department was administering the program satisfactorily. The Department has accepted all of the findings of the report and is acting on them. Of the four recommendations all were agreed to by the Department and will be acted upon.
Control Structures as part of the Audit of the Financial Statements of Major Commonwealth Entities for the Year Ended 30 June 2001 (Audit Report No.1 of 2001-02)
The audit found that some monies for aged care had been incorrectly charged to the wrong appropriation. This error was remedied as a result of the audit. There were a number of other findings in relation to aged care payments and the Department's new financial management system.
Across agency audits were as follows.
⢠Audit Activity Report: January to June 2000 (Audit Report No.4);
⢠Implementation of Whole-of-Government Information Technology and Infrastructure Consolidation and Outsourcing Initiative (Audit Report No.9);
⢠Certified Agreements in the Australian Public Service (Audit Report No.13);
⢠Benchmarking the Internal Audit Function (Audit Report No.14);
⢠Agencies' Performance Monitoring of Commonwealth Government Business;
⢠Enterprises (Audit Report No.15);
⢠Management of Public Sector Travel Arrangements-Follow-up Audit (Audit Report No.19);
OVERVIEW
⢠Audits of the Financial Statements of Commonwealth Entities for the Period Ended 30 June 2000 (Audit Report No.23);
⢠Benchmarking the Finance Function (Audit Report No.25);
⢠Audit Activity Report: July to December 2000-Summary of Outcomes (Audit Report No.28);
⢠The Use of Confidentiality Provisions in Commonwealth Contracts (Audit Report No.38);
⢠Payment of Accounts (Audit Report No.S2);
⢠Commonwealth Management of Leased Property (Audit Report No.S3); and
⢠Engagement of Consultants (Audit Report No.S4).
Details of the above reports, including the Department's responses to the recommendations, can be found at the ANAO website at www.anao.gov.au.
Other enquires regarding the reports should be directed to the Assistant Secretary, Audit and Fraud Control Branch, in the Department.
Joint Committee of Public Accounts and
Audit (JCPAA)
During 2000-01 the Department attended two hearings of the JCPAA:
⢠on 3 November 2000, in relation to the consideration of Audit Report No 42, 1999-2000, MRI services- effectiveness and probity of the policy development process and implementation; and
⢠on 22 June 2001, in relation to the review of accrual budget documentation.
Other Parliamentary scrutiny
The Department appeared before the Senate Community Affairs Legislation Committee
DEPARTMENTAL OVERVIEW
(Senate Estimates) on three occasions during the year for a total of five days. It also gave evidence and/or made a submission to a number of Parliamentary Committees including:
⢠Senate Community Affairs References Committee
- Inquiry into public hospital funding
- Inquiry into the Gene Technology Bill 2000
⢠Senate Finance and Public Administration References Committee
- the Government's information technology outsourcing initiative
⢠Joint Standing Committee on Foreign Affairs, Defence and Trade
- Enterprising Australia-planning, preparing and profiting from trade and investment
⢠Joint Standing Committee on Foreign Affairs, Defence and Trade (UN Subcommittee)
- Inquiry into Australia's relations with the UN in the post-Cold War environment
⢠Senate Select Committee on Information Technologies
- Inquiry into e-Privacy
⢠House of Representatives Standing Committee on Legal and Constitutional Affairs
- Inquiry into human cloning
⢠House of Representatives Standing Committee on Family and Community Affairs
- Substance abuse in Australian communities
⢠Senate Environment, Communications, Information Technology and the Arts References Committee
- Inquiry into electro-magnetic radiation
⢠Senate Legal and Constitutional References Committee
- Inquiry into the Federal Government's implementation of the recommendations made by the Human Rights and Equal Opportunity Commission in 'Bringing Them Home'
In addition the Department had a significant workload of Parliamentary questions with a total of 84 taken on notice for the House of Representatives, 85 for the Senate and 565 for the Senate Community Affairs Legislation Committee.
Freedom of Information
One-hundred-and-three requests for access to documents were received during 2000-01, a 39 per cent increase from the previous reporting year. One-hundred-and-two requests were finalised, which included the finalisation of
19 of the 20 requests that were current as at 30 June 2000. Twenty-one were current as at 30 June 2001.
Thirty-nine per cent of all requests received were seeking access to documents held by the Therapeutic Goods Administration, 18 per cent of requests sought access to documents (primarily
relating to aged care) held by State and Territory Offices, 12 per cent of requests were for documents relating to issues dealt with by the Health Access and Financing Division and the remaining 31 per cent of requests were distributed around the Department.
In addition, the Minister for Health and Aged Care received one request, which remained current as at 30 June 2001.
OVERVIEW
The Department submitted quarterly and annual returns of operations under the FOI Act 1982 for the purposes of the Attorney-General's report to Parliament under section 93 of the Act. For further details regarding FOI please refer to Appendix 8.
Ombudsman
In 2000-01 the Commonwealth Ombudsman's office received 94 complaints about the Department of Health and Aged Care. Within these 94 complaints, 97 separate issues were identified.
The number of complaints closed was 96, covering 103 separate issues. Of these 103 issues, the Ombudsman exercised his discretion not to investigate and closed 71. Seven were withdrawn by the complainant, or lapsed.
Of the 25 issues which proceeded to investigation, an agency defect was identified in 10 cases, no apparent agency defect in 11 cases, and in four cases a conclusion was not reached.
In july 2000 the Ombudsman released a report of his review of the Aged Care Complaints Resolution Scheme flowing from a complaint made in November 1999. The Department cooperated closely with the Ombudsman's Office on this review and has accepted and acted on the recommendations made in the report. The Department uses information from the scheme and from all feedback, including from the Ombudsman's review, to systematically improve the program as well as address the immediate concerns of complainants in line with the legislative framework governing the scheme.
Judicial decisions and decisions of
Administrative Tribunals that have had, or
may have, a significant impact on the
operations of the Department
In 2000- 01 the Department was involved in 56 matters before the Administrative Appeals
Tribunal, 26 matters before the Federal Court, four matters in State and Territory Supreme Courts, two matters before the Federal Magistrates Court, two matters before the Australian Industrial Relations Commission and six matters before the Professional Services Review Tribunal.
The majority of cases arose out of the aged and community care program. However the two cases that are worth noting under this heading arose from other programs.
In Minister for Health and Aged Care v Harrington Associates Ltd, Harrington (Silver Cross Insurance) Associates Ltd & Woodco*ck the Federal Court held that Harrington Associates had breached the National Health Act 1953 by carrying on a 'health insurance business' without being registered under that Act to provide health insurance and that Harrington Associates' claims had breached the Trade Practices Act 1974. The provision of health
insurance is subject to government regulation under the National Health Act 1953. The Court's decision confirmed the Department's views on what constitutes health insurance within the meaning of that Act.
In Tankey v Adams a full bench of the Federal Court dismissed an appeal by Dr Tankey from a decision of a single judge. Dr Tankey's case arose after consideration by a Professional Services Review Committee and the Professional Services Review Tribunal relating to the manner in which he provided 'professional services' under the Health Insurance Act 1973. The Act allows for the payment of Medicare Benefits for 'professional services' rendered by medical practitioners. An earlier decision to seek recovery of $258,277.45 because that represented the amount of Medicare Benefits that should not have been paid to Dr Tankey was confirmed by the full bench.
22 ______ _
DEPARTMENTAL OVERVIEW
Internal scrutiny The primary responsibility for internal scrutiny within the Department rests with the Audit and Fraud Control Branch under the broad direction of the Department's Audit Committee. The goal of the Branch is to promote and improve the Department's corporate governance arrangements, through the conduct of audits and investigations, and the provision of independent high quality assurance and advice.
Key activities in 2000-01 included:
⢠undertaking a range of audits and reviews relating to:
- grants and contract management;
- departmental control frameworks;
- departmental expenditure and procurement activities;
- the Electronic Transactions Act 1999; and
- IT systems, including pre and post implementation reviews of the Department's new financial and human resource information system (SAP);
⢠the continued delivery of ethics awareness sessions to staff across the Department;
⢠the ongoing provision of risk management awareness sessions, and advice and assistance to areas in relation to specific business risk assessments; and
⢠the provision of fraud presentation and investigation services and the maintenance of the Department's Fraud Control Plan.
Appendix 9 on internal scrutiny provides further details.
OVERVIEW
Central Office management structure chart, 30 June 2001
Executive
Regulatory Reform
Taskforce
Mr G Peachey a/g
P ortfolio Strategies Division
Dr R Wooding a/g
Budget
Ms V Hart
Information and
Research
Mr P Hagan
Policy and International
Mr A Kingdon
Health Information
Policy and Projects
Mr P Fitzgerald
Secretary - -- Mr Andrew Podger
Population Health
Division
Mr B Corcoran
National Centre for
Disease Control
Prof J Mathews
Drug Strategy and
Population Health
Social Marketing
Ms S Kerr
National Population
Health Planning
Ms M Dunlop
Communicable Diseases
and Environmental
Health
Mr G Sam
I
Primary Prevention and
Early Detection
Ms J Blazow
MOS
Dr J Straton
Health Access and
Financing Division
Dr L Morauta
Medicare Benefits
Mr I McRae
MOS
Dr J Cook
Pharmaceutical Benefits
Mr B Lennon
MOS
Dr G Harris a/g
Financing and Analysis
Mr C Maskell-Knight
Diagnostics and
Technology
Mr A Keith
I
MOS
Dr J Primrose
Better Medication
Management Scheme
Implementation
Taskforce
Ms J Badham a/g
I
Pharmaceutical Access
and Quality
Mr A Rennie
Mr S Piperoglou a/g
Chief Medical Officer ---
Deputy Secretary
Prof Richard Smallwood
Ms Mary Murnane
Deputy Secretary
Health
Services Division
Mr P Broadhead a/g
Acute and Coordinated
Care
Mr I Thompson a/g
Mental Health
Mr D Casey
General Practice
Mr A Tongue
MOS
Dr P Macisaac
Blood and Organ
Donation Taskforce
Mr J Benyei a/g
GP Strategic
Development Unit
Dr R Pegram
I
Office of Rural Health
Ms J Davidson
Mr David Borthwick
Office of
NHMRC
Prof A Pettigrew
Centre for Health
Advice, Policy and
Ethics
Dr C Morris a/g
Centre for Research
Management
Ms S Northcott a/g
Senior Medical Advisor
Dr A Proudfoot
Health Industry and
Investment Division
MrRWells
Health Capacity
Development
Ms C Cobbold
Private Health Industry
Ms P Sperli ng a/g
National Health
Priorities and Quality
Dr V Mcloughlin
NSW ---- Mr Nick Mersiades
VIC Ms Maree Bowman
QLD Ms Jenny Thomas
ACT Mr Joseph Murphy
Office for Aboriginal
and Torres Strait
Islander Health
Ms H E vans
Program Planning and
Development
Mr M lok a/g
Health and Community
Strategies
Ms M Norington a/g
Workforce, Information
and Policy
Ms Y Cass a/g
Corporate Services Division Mr N Tomkins
Legal Services
Ms W Hannon
Corporate Development
Mr BRae a/g
Financial Management
Mr R Mclaren
Staff Support and
Development
Mr A Wood
I
Public Affairs,
Parliamentary and
Access
Ms J Feneley
I
Corporate Activities
Review
Ms S Gunn
Business Systems
Mr P Jones a/g
Contestability
Mr P Moran
MANAGEMENT STRUCTURE
Aged and
Community Care
Division Dr D Graham
Community Care
MrW Bruen
Accountability and
Qua lity Assurance
Mr R ?erring a/g
Office for Older
Australians
Ms L Racic a/g
WA
SA
TAS
NT
Policy and Evaluation
Mr A Stuart
Residential Program
Management
Mr M James
Office of Hearing
Services
Mr P DeGraaff
Complaints and
Compliance Taskforce
Ms J Hefford a/g
MrS Taylor a/g
I
Aged Care Advisor in
Clinical Care
Ms J Ramadge
State and Territory offices
---- Mr Michael O'Kane a/g ---- Mr Chris Sheedy ---- Ms Angela Reddy ---- Ms Leonie Young Therapeutic Goods Administration Mr T Slater Drug Safety and E valuation M06 Dr L H unt MO S Dr P Chipman MOS Dr C Anantharajah a/g MOS Dr J McGinness MOS Dr N M itchell MOS Dr G Dickson Adverse Drug Reaction Unit MOS Dr J McEwen I Office of the Gene Technology Regu lator Ms E Cain a/g I Pol icy and Coordination Ms E F lynn a/g E valuation and Compliance Ms L Bowler I
Chemicals and
Non-Prescription
Medicines Mr P Cesarin a/g
I
Scientific Director
Dr B Priestly
I
Office of
Complementary
Medicines
Dr F Cumming
I
TGA Laboratories
Dr J Sm ith
Business and Services
Ms N B ryan
Conformity Assessment
Ms R Maclachlan
MOS
Dr G Maynard a/g
I
Principal Medical
Adviser
DrS Alder
Audit and Fraud Control
MrS Dellar
Part 2: Outcome performance reports
The benefits of complimentary medicines continue to be discovered.
Commemorating 80 years of providing Commonwealth health services to the Australian community.
FINANCIAL SUMMARIES
Financial summaries
ALL OUTCOMES: FINANCIAL AND STAFFING RESOURCES SUMMARY
ADMINISTERED
Outcome 1 - Population Health and Safety Outcome 2 - Access to Medicare Outcome 3 - Enhanced Quality of Life for Older Australians Outcome 4 - Quality Health Care Outcome 5 - Rural Health Outcome 6 - Hearing Services Outcome 7- Aboriginal Health and Torres Strait Islander Health Outcome 8 - Choice Through Private Health Outcome 9 - Health Investment
DEPARTMENTAL
Total Expenses all Outcomes
Total Revenues from Other Sources
28
2000-01 Actual Expenses $'000
367,552 18,244,990 4,342,324 628,307
61,441 156,541 185,431 1,939,658
356,863 26,283,107
735,740
27,018,847
2000-01 Appropriation Total $'000
385,919 18,365,029 4,271 '197 435,830
63,670 153,843 174,257 2,007,031
309,411 26,166,187
664,794
26,830,981
736,796
FINANCIAL SUMMARIES
RECONCILIATION OF OUTCOMES AND APPROPRIATION ELEMENTS 2000-41
Appropriation Appropriation Special Total Departmental Annotated Total
Outcome Bill No 1 & 3 Bill No2&4 Appropriation Administered Outputs Appropriation Outcomes
$'000 $'000 $'000 Expenses $'000 $'000 $'000
$'000
116,549 157,151 93 ,852 367,552 50,870 50,686 469,108
2 341,000 102,456 17,801 ,534 18,244,990 404,983 1,040 18,651,013
3 193,674 608,859 3,539, 79 1 4,342,324 83,434 437 4,426,195
4 289,350 72,236 266,721 628 ,307 36 ,240 571 665,118
5 61,441 61 ,441 13,386 61 74,888
6 156,541 156,541 10,066 44 166,651
7 185,431 185,431 24,471 116 210,018
8 9,420 1,930,238 1,939 ,658 17,906 286 1,957,850
9 346 ,863 10,000 356 ,863 23,436 546 380,845
TOTAL 1,700 ,269 950,702 23,632,136 26,283 ,107 664 ,792 53,787 27,001,686
Outcome 1: Population health and safety
To promote and protect the health of all Australians and minimise the incidence of preventable mortality, illness, injury and disability
31
Outcome 1 is managed in the Department by the Population Health Division (including the National Centre for Disease Control) and incorporating outputs from the Portfolio Strategies Division (International Health) and the Therapeutic Goods Administration (TGA).
Contribution to this outcome is also made by the Department's State and Territory Offices. The outcome focuses on measures which influence the health of whole populations or communities, rather than individuals and takes
account of the broad determinants of health and ill health. This involves an emphasis on prevention, multi-disciplinary investigations and community partnerships.
The outcome also includes the Australia New Zealand Food Authority (ANZFA) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), both of which
produce their own annual reports.
For ease of reporting, the following separates the performance of the activities managed by the Population Health Division and that of the activities managed by the Therapeutic Goods Administration.
OUTCOME 1
Major achievements ⢠The proportion of young children who are fully immunised continued to increase. At 30 June 2001, 91.5 per cent of children
aged 12-15 months (an increase of 3.1 percentage points from 30 June 2000) and 86.6 per cent of children aged 24-27 months (an increase of 4.9 percentage points from 30 June 2000) were fully immunised.
⢠The evaluation of the Measles Control Campaign reported 96 per cent of primary school age children had been vaccinated against measles, mumps and rubella.
⢠Progress also continued in the Influenza Vaccine Program for Older Australians with 7 4 per cent of those aged 65 and over now immunised (up from 70 per cent in the previous year).
⢠The Western Pacific region was certified polio free in November 2000.
⢠There has been a decrease of 3.4 per cent in smokers aged 18 and older since the National Tobacco Campaign commenced in May 1997. Thirty countries have now asked to license the campaign television advertisem*nts for use and/or adaptation outside Australia.
⢠Following the National Alcohol Campaign, 88 per cent of 15-17 year olds and 81 per cent of parents said they had seen, read or heard advertising about teenagers and alcohol in the previous month. Forty-five per cent of parents reported having had discussions with their teenage children.
⢠The National Illicit Drugs Campaign, which was launched in March 2001, raised community awareness of the issues and generated discussion and media debate. The campaign aimed to inform
2
parents and the community about the harms of illicit drug use, and of their important role in preventing illicit drug use among young people.
Under-achievements ⢠The Consumer Perspectives Survey is intended to allow the community's expectations and concerns about the
health system generally, as well as particular issues, to be identified and tracked over time, and to provide information which will inform policy development. The survey was originally planned for late in 2000-01 but more preparatory work has been required than originally envisaged and the survey has not yet taken place.
POPULATION HEALTH AND SAFETY
Outcome summary - the year in review Through its population health initiatives, the Department aims to promote and protect the health of the Australian population by minimising the incidence of preventable mortality, illness, injury and disability, in areas such as tobacco control, preventing heart disease, and HIV I AIDs control. This complements activity undertaken by many other agencies, including State and Territory governments, health care providers, researchers and non-government organisations.
In recent years, Australia has developed a reputation as a world leader in many of these fiel ds . Examples of direct interventions to improve population health include childhood immunis ation, tobacco control, illicit drug diversion and nutrition and food regulatory reform.
Funding arrangements for population health activity reflect the diverse roles of Commonwealth, State, Territory and local governments, non-government organisations and, in some cases, industry. The States and Territories are responsible for most public health legislation and for implementing most public health programs. Part of the Department's financial commitment to population health is
provided to States and Territories through the Public Health Outcome Funding Agreements, for the period 1999-2000 to 2003-04.
There are good ongoing trends in a number of key areas. Deaths caused by alcohol and tobacco are declining in Australia, as are deaths from cervical and breast cancer. These outcomes are all directly related to key screening and educational programs. Three key immunisation rates continued to improve in 2000-01: children aged 12-15 months, children aged 24-27 months and, for influenza vaccine, persons 65 years and older. These are all very significant achievements that have been building up over a
' Relates to Indicators 1, 2 and 3.
number of years. However, rates of illicit drug use and associated deaths and hospitalisation continue to be of major concern.
Emerging issues included managing antibiotic resistance arising from the injudicious use of antibiotics, including in animal feed, and the potential threat of Transmissible Spongiform
Encephalopathies (TSE), including the risks from imported beef and beef products.
During 2000-01 the Department continued to concentrate its efforts in three key areas: action to improve population health outcomes, effective national leadership, and strengthening capacity to respond to population health pressures.
Action to improve population health outcomes Population health initiatives were progressed in
the areas of communicable diseases, chronic non-communicable diseases, and prevention of injury and substance misuse.
Reduction of communicable diseases
The Department manages the control of communicable diseases by developing a capacity to cope with new and anticipated threats, as well as providing programs to combat current threats. Efforts to control and eradicate disease have focused on prevention surveillance and treatment research, with particular attention on several fronts to combat the threat of antimicrobial resistance.
Immunisation and vaccine-preventable
disease 1
Immunisation continues to be one of the world's most valuable medical interventions in reducing mortality rates with a high degree of cost-effectiveness. The Department provided
$105 million in 2000-01 for the Immunise Australia program, which aims to reduce
OUTCOME 1
incidence of vaccine-preventable disease and associated mortality and morbidity.
Achievements included:
⢠continued increases in the number of fully immunised children. At 30 June 2001, 91.5 per cent of children aged 12-15 months (an increase of 3.1 percentage points from 30 June 2000) and 86.6 per cent of children
aged 24-27 months (an increase of 4.9 percentage points from 30 June 2000) were fully immunised;
⢠provision of $19.8 million to States and Territories for the Measles Mumps Rubella (MMR) Initiative for the purchase of vaccine for young adults (18-30 year olds) in a two-stage approach in May and June 2001. A further $2 million was made available in May 2000 to all States and Territories to assist in developing appropriate service delivery structures to effectively target this 'hard to reach' target group and work towards achieving an 80 per cent coverage target;
Figure 1.1: Proportion of children fully immunised-Australia, June 1997-June 2001
100
90
80
70
Q) Cl
60
Source: Australian Childhood Immunisation Register (ACIR) for age as at 31 December 2000
⢠an increase of about 4 per cent (up from 70 per cent) in the number of Australians aged 65 and over who were vaccinated against influenza, in the third year of the Influenza Vaccine Program for Older Australians;
⢠certification of the Western Pacific region as polio free in November 2000;
34
⢠establishment of the National Q Fever Management Program to substantially reduce the incidence of disease caused by Q fever in regional Australia. A vaccine preventable disease, Q fever is spread by the inhalation of infected droplets of aerosols from parturient or slaughtered animals. It is primarily an occupational disease affecting workers in the meat and livestock industry; and
POPULATION HEALTH AND SAFETY
updating and national distribution of a range of immunisation resources; including the Understanding Childhood Immunisation booklet in 15 non-English languages, Myths and Realities: Responding to arguments against immunisation, Keep It Cool: the vaccine cold chain, and National Guidelines for Immunisation Education for Registered Nurses and Midwives.
HIV/AIDS and Hepatitis (2
Australia is recognised internationally as a world leader in developing and implementing national responses to blood-borne viruses such as HIV.
The annual number of HIV diagnoses in Australia continued to decline substantially to around 650 in 2000. However, new HIV infections continued to occur. In 2000 it is estimated that HIV incidence remained at 500 cases per year.
The annual number of AIDS diagnoses in Australia, after adjustment for reporting delay, peaked in 1994 at 955. It is estimated to have declined to 255 cases in 2000. The decrease in diagnoses has been due to the decline in HIV incidence in the mid-1980s and the use of effective combination antiretroviral therapy for the treatment of HIV infection. The increase in AIDS incidence in Australia from 1999 to 2000 may be due to more complete reporting of AIDS diagnoses in 2000 compared to the previous year.
In 1999 Australia compared favourably to other OECD countries in regard to the rate of HIV prevalence. For example, Australia's prevalence (0.15 per cent) was lower than Canada's (0.30 per cent) although the nature of the two countries' epidemics are very similar, with 80 per cent and 72 per cent respectively of transmission being identified as being through
hom*osexual/bisexual contact. Australia's prevalence rate also compared favourably with
Figure 1.2: New HIV and AIDS diagnoses-Australia, 1991-2000
1400
1200
1000
"' (]) "' 800 0 c 0'1 ro 0 600 400
200
--<>- AIDS diagnosis
-New HIV diagnosis
p)'
...._0)
PJ'),
...._0)
PJ'?
...._0)
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...._0)
...._ 0)
P>ro
"Oj
PJ'\
...._ 0)
PJ
...._0)
PJOJ
...._0)
Rl\)
'),(j
HIVIAIDS, Hepatitis C and Sexually Transm issible Infections in Austra lia Annual Surveillance Report 2000. National Cent re in HIV Ep idemi ology an d Clin ical Research, University of NSW. Sydney
Source: National Centre in HIV Epidemiology and Clinical Research . HIV/AIDS, Hepatitis C and Sexually Transmissible Infections in Australia Annual Surveillance Report 2001.
' Relates to Indicators 1 and 4.
35
OUTCOME 1
Mexico (0 .20 per cent), Austria (0.23 per cent), Portugal (0.74 per cent), and Spain (0.58 per cent).
The Department's support for continued population health efforts in HIV I AIDS prevention, education, treatment, care and research has focussed on the changing nature of the epidemic in Australia. ew initiatives have been developed to target at-risk populations.
Reflecting the emergence of HIV I AIDS as a global crisis, the Department played a significant role in Australia's participation in the United Nations General Assembly Special Session on HIVIAIDS, held in June 2001, especially through the provision of support to the Australian delegation, led by the Minister for Health and Aged Care.
Hepatitis C is now Australia's most commonly diagnosed notifiable disease. It is estimated that 200,000 Australians have been infected with the virus, and that 11,000 new infections occur each year. Following the launch in June 2000 of the National Hepatitis C Strategy 1999-2000 to 2003-04, the Department established bilateral funding agreements with all States and Territories in relation to the Council of Australian Governments Supporting Measures on eedle and Syringe Programs, and Commonwealth funding for Hepatitis C Ed ucation and prevention measures.
Surveillance and management of
communicable diseases 3
The Department has a national leadership and coordination role for disease surveillance and management and national and international disease control. Achievements in 2000-01
included:
⢠further development of the National Notifiable Diseases Surveillance System, the Communicable Diseases -Australia website and the Communicable Diseases
' · ⢠Relate to Indica tors 1 and 3.
Intelligence for the analysis, interpretation and dissemination of epidemiological data;
⢠publication of the revised national meningococcal disease guidelines and finalisation of the infection control and Transmissable Spongiform
Encephalopathies (TSE) guidelines;
⢠the provision of technical, administrative and financial support for the successful Communicable Diseases Conference 2001: Harnessing New Technologies held from 2-3 April 2001 in Canberra;
⢠beginning to implement the Report of the Joint Expert Technical Advisory Committee on Antibiotic Resistance. This included a National Summit on Antibiotic Resistance held in May 2001 to engage Australia's leaders in health, agriculture and industry as well as consumers. Work has also commenced towards developing a national antibiotic resistance surveillance system; and
⢠establishment of a Transmissible Spongiform Encephalopathies (TSE) Task Force within the Department to take a leading role in developing measures to address the population health risk from TSEs, including the risks from imported beef and beef products.
Environmental health4
Environmental health management is a critical contributor to population health. In 2000-01 the Department played a pivotal role in establishing Australia's first Environmental Health Peer Review Journal, a publication forum for environmental health practitioners.
The Department addressed health inequalities in Indigenous environment health through its support for environmental health workers. It provided support for the National Indigenous
36
POPULATION HEALTH AND SAFETY
Environmental Health Forum, established in May 2000 to progress national action for education and training of Environmental Health Workers.
Internationally the Department was a lead agency in negotiating the Persistent Organic Pollutants Convention in South Africa in December 2000. This Convention is a major milestone in environmental treaty making, demonstrating Australia's environmental and health intentions in relation to minimising the releases of toxic and persistent chemicals to the environment and associated health impacts.
Food policy 5
The Council of Australian Governments (COAG) food regulatory reform package has largely driven the nature of work undertaken by the Department. The new food regulatory reforms will ensure a nationally coordinated approach to food regulation, to apply across the whole food supply chain. It will also ensure that public health and safety is strengthened and maintained, that there is national consistency in the interpretation, administration and enforcement of food regulation, and that consumers will have sufficient information to make informed choices.
This agenda will require continuing work in reforming the food regulatory system in Australia and New Zealand. An independent Food Regulation Secretariat has been established within the Department to support the expanded Ministerial Council, the new Standing Committee of Departmental Secretaries and other associated committees.
Food safety and surveillance6
The Department is responsible for coordinating the Commonwealth's position, on both national and international levels, on policy issues such as dioxins, irradiated foods, genetically modified foods, new additives, novel foods, functional foods,
'·' Relate to Indicators 2 and 3.
heavy metals, toxins and pesticide residues. It also provides input into international forums such as Codex, the Food and Agriculture Organisation and World Health Organization (WHO), and food standards developed by the Australia- New Zealand Food Authority. A two year program of work has been established involving over thirty projects, covering six areas of food safety and surveillance: the incidence and causes of foodborne illness through OzFoodNet; enhancing surveillance for food borne disease in Australia; food safety management systems; information for consumers; assistance for local and state government; assistance for charities; and assistance for industry.
Reduction of chronic non-communicable
diseases and injury
During 2000-01, the Department continued its range of strategies and programs to promote healthy lifestyles and to prevent the detrimental impact on the community of non communicable diseases. This included promoting good nutrition, physical activity and healthy weight; screening programs for cervical, breast and bowel cancer, and men's and women's health programs.
Chronic disease strategies7
Two programs address the increasing problem of chronic disease in the Australian community. They aim to empower individuals and communities to help prevent and manage diseases such as diabetes, cardiovascular disease, arthritis and asthma.
⢠The Rural Chronic Disease Initiative aims to improve the awareness, prevention and management of chronic diseases in rural communities by supporting skills development and leadership, developing and disseminating high quality
information, and investing in innovative chronic disease and injury prevention and management projects.
' Relates to Indicators 2 and 4.
OUTCOME 1
In 2000-01 the Department invited over 500 rural and regional stakeholder organisations to help determine community needs and priorities. In 2001-02 a number of pilot sites will be established to develop local processes/models for implementing chronic disease/ injury prevention and management in rural communities.
⢠The Sharing Health Care Initiative increases awareness of the benefits from effective self-management of chronic disease. The initiative targets adults who are 50 and over (35 and over for projects targeting Aboriginal and Torres Strait Islander people) who suffer from chronic and complex or multiple conditions, such as cardiovascular disease (including stroke and hypertension), diabetes, arthritis, osteoporosis, respiratory disorders, and depression, where this exists as a co morbidity.
In 2000-01 eight demonstration projects were approved. The Department entered into funding agreements with the Arthritis Foundation of Queensland, the South Australian Centre for Rural and Remote Health, the Whitehorse Division (Vic) of General Practice, and the Tasmanian University Department of Rural
Health, to begin delivering self management programs. Additional projects will commence in 2001-02. Clinical guidelines, a 'short course' and a postgraduate module have been developed to assist in education and training within the demonstration projects. A specific component provides funding for projects targeting Aboriginal and Torres Strait Islander people. These are due to commence in 2001-02.
Primary Prevention of Disease through
Nutritions
Ninety-three projects were funded under the National Child Nutrition Program in 2000-01, targeting children, parents and pregnant women in high need areas such as rural and remote
' Relates to Indicator 4.
communities, Aboriginal and Torres Strait Islander communities and socio-economically disadvantaged communities. The projects will run for up to three years.
Cervical screening 9
The National Cervical Screening Program aims to reduce morbidity and deaths from cervical cancer, in a cost-effective manner, through an organised approach to screening.
The participation rate for cervical cancer screening in the two-year period 1997-98 was 64 per cent, an increase from 62 per cent in 1996-97. Death from cervical cancer has decreased by 40 per cent since 1986, largely due to screening. In 1998, 269 women died of cervical cancer, most of whom were not participating in screening.
Significant achievements for the program in 2000-01 included:
⢠a cost-effectiveness study of alternative screening intervals and target groups, and the initiation of a formal literature review;
⢠funding for the publication of Standards in Colposcopy and Treatment, a set of standards for follow-up procedures to cervical screening, developed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, in conjunction with the Australian Society for Colposcopy and Cervical Pathology;
⢠ongoing cooperation with stakeholders to improve quality assurance in cervical cytopathology and histopathology, including the design of a survey for the analysis of cervical histopathology practices to be conducted in 2001-02; and
⢠the establishment of an Aboriginal and Torres Strait Islander Women's Forum to advise the National Advisory Committee on Indigenous issues relating to cervical screening.
' Relates to Indicato rs 1, 2, 3 and 4.
38
POPULATION HEALTH AND SAFETY
Figure 1.3 : Age standardised death rates from cervical cancer-Australia, 1986-98
6
-<>-- All ages
5
c
- 20-69 years ClJ E 0 $ 4 0 0 0 0 0 3 ..... ClJ c.. "' ..c +' 2 l1l ClJ 0
Notes : (1) Mortality data from 1986-1996 based on year of death and 1997-98 based on year of registration. (2) Ra tes are expressed per 100,000 women and age-standardised to the Australian 1991 population.
Source: Australian Institute of Health and Welfare (AIHW), Cervical Screening In Australia 1997-98, Australian Government Publishing Se rvice, 2000
Breast cancer screening'0
Breast cancer is the most common cause of cancer-related death in women in Australia. In 1998, 2,542 women died from breast cancer. The BreastScreen Australia Program aims to
reduce morbidity and mortality attributable to breast cancer through early detection. Data from 1996 and 1997 showed that 52.2 per cent of women in the target group (aged 50-69 ye ars) attended a screening service. This increased to 54.3 per cent in 1997 and 1998.
Other mammography for screening and diagnosis (that is, investigating breast symptoms) is conducted outside BreastScreen Australia. The participation rates in BreastScreen Australia do not reflect the overall rates of screening on a national basis. For the population as a whole, there has been a reduction of 17 per cent in mortality in women aged 50-69 years since 1993.
w Relates to Indicators 1,2,3 and 4.
39
A booster phase of the BreastScreen Australia Campaign activity commenced in October 2000, with mass media activity running from October 2000 through to May 2001. Activity included national television and magazine advertising, as well as advertisem*nts on SBS and community radio. A public relations strategy was implemented to coincide with and reinforce the second wave of national advertising in February to May 2001.
Progress has been made in a number of important initiatives:
⢠a comprehensive evidence-based review of the BreastScreen Australia national accreditation requirements has been completed;
⢠a national data dictionary has been developed to enable a comprehensive set of consistent data to be collected across
OUTCOME 1
the national Program. This was the first priority project identified under the Breas tScreen Australia Evaluation Plan Phase 2;
⢠a literature review and discussion paper were developed investigating barriers to breast cancer screening for Aboriginal and Torres Strait Islander women;
The biggest risk factor for breast cancer?
⢠qualitative research has been initiated to determine why radiographers /radiologists either do or do not participate in the program. This will enable strategies to be developed that address the program's current workforce shortages; and
⢠a policy framework and guiding principles regarding symptomatic women presenting to the program has been developed.
11
Relates to In dicators 1, 2, 3 and 4.
Bowel cancer screening 11
Bowel cancer is the second most common cause of cancer deaths in Australia. In 1997, there were 11,245 new bowel cancer cases and 4,678 deaths. Around one in 21 Australians is likely to develop bowel cancer before the age of 75 years.
A national pilot to improve knowledge about the early detection of bowel cancer, costing $7.2 million over four years, commenced in 2000-01. The Department sought input from a range of consumers, non-government and government stakeh olders, including the professional medical community, on the design of the pilot. A committee of consumer and expert representatives was established in April 2001 to advise the Department on implementation issues. Funding will be used to pilot bowel cancer screening, using faecal occult blood testing on up to 50,000 people aged between 55 and 74 years. It is expected that bowel cancer screening will be offered in three pilot sites from early 2002.
Injury prevention 12
Injuries cause an estimated 7,000 deaths a year (6 per cent of deaths) and are responsible for an estimated 400,000 hospital admissions. They cost the health system about $2.6 billion per yea r. Injuries and poisoning were the most common cause of premature death amongst people in the 15 to 64 age group. Higher than average rates were experienced by men (particularly in the 15-24 years age group), people living outside capital cities, and by Aboriginal and Torres Strait Islander people.
The draft National Injury Prevention Action Plan 2000-02 is a broad framework for national action in four priority areas: prevention of falls in older people, falls in children, near drowning and drowning, and poisoning in children. The draft plan was submitted to the Australian Health Ministers Advisory Council during 2000-01, prior to consideration by Ministers in 2001-02.
" Relates to Indica tors 1, 3 and 4.
40
POPULATION HEALTH AND SAFETY
The National Falls Prevention for Older People Initiative commenced in 1999-2000. Activities during 2000-01 included:
completion of a national stocktake of falls prevention activities for older people;
completion of a study into the information needs and perceptions of older Australians concerning falls and their prevention; and
⢠design of a monitoring and evaluation framework for the initiative.
Other injury prevention activities during 2000-01 included:
⢠completion of a project to examine the laws, standards and codes of practice designed to prevent non-intentional injuries in children in Australia;
⢠completion of a project to identify the skills, knowledge, training and education needs of the Australian injury prevention workforce;
⢠the Department became a partner in the ational Health and Medical Research Council (NHMRC) Injury Partnership by contributing $1 million to a national research collaboration on falls in older people; and
⢠supporting the collation and analysis of available statistics and other relevant drowning data in order to determine which variables are significant in drowning, near-drowning and aquatic related injury in Australia.
Women's and men's health 13
In 2000-01 the Department funded men's, women's and sexual and reproductive health initiatives through direct grants and the Public Health Outcome Funding Agreements.
" Relates to Indicators 2 and 3.
Direct grants included:
⢠$12.9 million to ten non-government agencies to improve knowledge and service choice in family planning. In 2000-01 a total of 134,369 14 client visits were made to family planning organisations. Family planning organisations offered 643 14 accredited educational and training programs to health and other professionals, and
18,691 people participated in these courses. Services were also provided in natural family planning, and to support women who are pregnant.
⢠$545,000 to the Jean Hailes Foundation to produce best practice guidelines for women's health (especially for menopause), education for general practitioners and physicians on the management of women's health at mid life and beyond, and community information and education programs on health issues for women in the middle years.
⢠$500,000 to Andrology Australia - the Australian Centre of Excellence in Male Reproductive Health - which focuses on best practice in male reproductive health and research.
Prevention and reduction of substance
misuse
The prevention of injury and substance abuse involves major programs for reducing illicit drug use, controlling tobacco sale and use, and minimising alcohol misuse. A number of high profile campaigns underpin these activities.
The number of deaths attributable to tobacco use has declined from 19,878 deaths in 1996 to 19,019 in 1998, while the number of deaths attributable to illicit drugs has increased from 781 deaths in 1996 to 1,023 1998. A similar trend was observed for potential years of life lost (PYLL) .
" Stati stics provided for Family Planning Australia affiliates .
OUTCOME 1
In 1998 an estimated 3,271 people died as a consequence of consuming hazardous and harmful levels of alcohol (as defined by the NHMRC drinking guidelines), a decrease from previous years. The number of hospital separations increased for all substances between
1995-96 and 1997-98. However, because of the time lag between exposure to drugs (tobacco and alcohol in particular) and the onset of many diseases, many deaths and hospital episodes represent the result of drug use at a much earlier age.
Illicit drugs 15
The ational Illicit Drug Strategy - Tough on Drugs- aims to reduce the supply of, and demand for, illicit drugs. A complementary component of the strategy, the Illicit Drug Diversion Initiative, targets illicit drug users early in their involvement with the criminal
justice system.
The Commonwealth allocated $516 million over four years to the National Illicit Drug
Strategy. Of this, $263 million was allocated to health and diversion measures to reduce the demand for illicit drugs through treatment, prevention and early intervention, with the balance of funds being used to finance law enforcement, education and family support initiatives.
Measures implemented during 2000-01 included:
⢠the launch of the National Illicit Drugs Campaign to inform parents and the community of the important role they play in preventing illicit drug use amongst young people, and the harms associated with illicit drug use;
⢠after some initial delays in 1999-2000, bilateral funding agreements for the Diversion Initiative were in place in all but one jurisdiction ( orthern Territory) to allow for illicit drug users to be diverted from the criminal justice system to education, counselling and treatment;
Table 1: Deaths, hospital separations and potential years of life lost (PYLL) due to tobacco
use, hazardous and harmful alcohol use, and illicit drug use-Australia
Deaths Year Tobacco Alcohol Illicits
1996 19,878 3,398 781
1997 19,441 3,411 864
1998 19,019 3,271 1,023
PYLL 1996 196,200 56,357 19,407
1997 189,900 56,929 21,491
1998 184,579 54,087 25 ,375
Hospital separations 1995-96 126,414 70,630 11 ,057
1996-97 134,647 71,113 11,882
1997-98 142,525 71,422 14,471
Source: Ridolfo B, Stevenson C 2001. Th e quantification of drug-caused mortality and morbidity in Australia, 1998. AIHW cat. No. PHE 29. Ca nberra: AIHW (Drug Stati sti cs Seri es no. 7) .
" Re lates to Indicator 4.
42
POPULATION HEALTH AND SAFETY
⢠the launch of the Australian Drug Information Network (ADIN) website www.adin.com.au to provide the general community and health professionals with access to a range of quality assured web based information on licit and illicit drugs;
development of a National Action Plan on Illicit Drugs which provides a nationally agreed direction for addressing illicit drug issues; and
⢠development of a National Heroin Overdose Strategy aimed at reducing the incidence of fatal and non-fatal overdose in Australia.
National Drug Strategy16
The ational Drug Strategy provides a framework for addressing, in an integrated fashion, the misuse of both licit and illicit drugs and pursuing both demand reduction and supply reduction measures, in order to minimise the harmful effects of drugs on Australian society. The Department has a national leadership role in the development and implementation of the strategy and is a key partner in the development of national action plans on illicit drugs, tobacco and alcohol.
In February 2000, the Inter-governmental Committee on Drugs asked the Department to develop a national prevention agenda. The agenda aims ultimately to prevent and delay the onset of drug use and reduce harm associated with drug supply and use. Measures undertaken by the Department in 2000- 01 included development of a concept plan, establishment of a national expert steering committee, letting a consultancy for the establishment of a sound evidence base and the conduct of a national workshop to commence a process of consultation and planning.
In 2000-01, the National Drug Strategy Reference Group for Aboriginal and Torres Strait Islander
" Relates to Indicators 1 and 4.
43
peoples began to develop a complementary strategy for Aboriginal and Torres Strait Islander substance misuse. It is expected that this will be completed in 2001-02.
Tobacco 17
Findings from the latest National Drug Strategy Household Survey 1998 point to a reduction in smoking prevalence from 24 per cent in 1995 to 22 per cent in 1998.
Preliminary results from a survey commissioned by the Department in November 2000 suggest that there may have been a further reduction in smoking prevalence. The results indicate that the
current weekly smoking prevalence rate is around 20 per cent for people aged 18 years and over, and may fall below that in certain age groups. The reduction in smoking prevalence largely reflects a decrease in adult smoking. This is consistent with data on the effectiveness of the National Tobacco Campaign, which targeted 18-40 year olds.
One of the National Tobacco Campaign advertisem*nts - 'Eye ' (macular degeneration)
The National Tobacco Strategy 1999 to 2002-03 provides a comprehensive, cross-jurisdictional and multi-dimensional approach to the problem
17 Relates to Indicators 1 and 2.
OUTCOME 1
of tobacco use in Australia. Work under the strategy is organised under six key strategy areas: strengthening community action, promoting cessation, reducing the availability of tobacco, reducing tobacco promotion, regulating tobacco and reducing exposure to environmental tobacco smoke.
Major tobacco related activities undertaken in 2000-01 included the following:
⢠the first stage of the review of health warnings on tobacco products completed in October 2000. The evaluation affirmed the need to update current health warnings to include new information on the health effects of tobacco. The evaluation also indicated that new labels should be introduced on a regular basis, that they should be more gender and age specific, contain more personalised information, positive quit messages and tangible warnings or information; and
⢠publication of A national approach for reducing access to tobacco in Australia by young people under 18 years of age. The report 's primary purpose is to outline the key elements of a national best practice model to address young people's access to tobacco. The report was published and disseminated during May to June 2001.
Alcohol' 8
The National Alcohol Campaign, which commenced in February 2000, targets teenagers aged 15- 17, parents of 12- 17 year olds, and adults aged 18-24. The campaign aims to help young people to think about the choices they make about drinking in order to minimise and avoid alcohol-related harm. A booster phase of activity, which included national television and magazine advertising and an extensive public relations strategy, began in November 2000, targeting the potentially heaviest drinking period of the year for young people.
" Relates to Indicators 1, 2, 3 and 4.
Funding of $4 million over four years was made available in the 2000-01 Federal Budget for initiatives to support the implementation of the ational Alcohol Action Plan and the revised NHMRC Australian Drinking Guidelines.
The Department undertook consultations on the draft National Alcohol Action Plan on behalf of the Intergovernmental Committee on Drugs. A final draft was forwarded to the Ministerial Council on Drug Strategy in May 2001.
Event sponsorship
The Commonwealth provided sponsorship included naming rights for the 2000 Rock Eisteddfod Challenge'9 and national and regional television specials using the Na tional Alcohol Campaign's Drinking. Where are yo ur choices taking you? branding. The aim of the sponsorship is to communicate drug and alcohol misuse prevention messages to Australian teenagers aged 12- 18 in a popular and positive environment which is resonant with contemporary youth culture. Evaluation indicates that approximately one in three teenagers tuned in last year to watch the television specials. Health message recall from the program is extremely high, as is the self reported impact of the program on attitudes towards drug use.
The Croc Festivals20 target students living in rural an d remote Australia. The Department sponsored three Croc Festivals in 2000 and will be sponsoring five Festivals in 2001 promoting the Respect Yourself. Respect Your Culture health message. The Croc Festival is a health promotion intervention strategy implemented at the community level. The expected health outcomes include:
44
⢠increased awareness of alcohol, tobacco and other drug issues in the community and schools; and
" Relates to Indicator 2. "' Relates to Indicators 2 and 4.
POPULATION HEALTH AND SAFETY
increased social education and reinforcement of the positive benefits such as increased self-esteem, self-concept, problem-solving skills, bonding to school, self-efficacy, confidence, cooperation, social skills, self-control and communication skills.
An evaluation of the Weipa Festival in 2000 sh owed that the overall awareness amongst participants and ability to repeat the health messages was very high, as was the self reported impact of the festival on attitudes towards drug use.
National leadership The Department continued to engage with States and Territories on population health matters, particularly through the National
Public Health Partnership, and contributed to international health agendas in several fora.
National Public Health Partnership21
The Department continued to work with senior State and Territory public health officials through the National Public Health Partnership (NPHP) to promote a national population health effort. In addition to providing substantial support for NPHP infrastructure, the Department actively contributed to a number of NPHP achievements during 2000-01, including:
⢠a strengthened focus on Indigenous health through the establishment of an Aboriginal and Torres Strait Islander Working Group (ATSIWG);
⢠a consensus view of the core functions of public health in Australia, referred to States and Territories for adaptation to local planning processes;
⢠a planning framework for public health practice to demonstrate how an evidence based portfolio of interventions can be selected to facilitate health;
" Relates to Indicators 3 and 4.
⢠further development of a legislator's tool kit website to encourage best practice in public health laws and a consistent approach among jurisdictions, most recently to include a package of material on passive smoking; and
⢠development of national public health indicators and reliable estimates of public health expenditure.
International achievements The Department worked with international organisations, including the World Health Organization (WHO) and the Organization for
Economic Cooperation and Development (OECD), health ministries in other countries, and with independent research institutes to apply best practice in Australia and to
contribute to international developments in health policy.
A highlight of the year was the visit to Australia in October by the WHO Director General, Dr Gro Harlem Brundtland. During her visit, Dr Brundtland assessed service delivery in rural areas of Australia and to Indigenous communities. She also launched WHO's Global Vision 20/20 initiative, aimed at eliminating avoidable blindness, and attended the opening of the Paralympics.
A major international health policy initiative of the year was the release of the first WHO analysis of the world's health systems - the World Health Report 2000 - which used four performance
indicators to measure the performance of health systems in 191 member states. Australia scored well across the four performance indicators -overall level of health, inequality of health within the population, the level and distribution of responsiveness, and fairness in financing. The report confirmed that Australia's health system is delivering health outcomes above the OECD
average, for outlays around or slightly above the OECD average. Some questions about the report's
OUTCOME 1
methodology have been raised, particularly the use of 'years of education' as a proxy measure for the non-system determinants of health. The Department and the Australian Institute of Health and Welfare are committed to working with the WHO to discuss these anomalies with a view to refining the methodology.
In October 2000, Australia secured one of six vice-chair positions on the Bureau of the egotiating Body for the World Health Organization's Framework Convention on Tobacco Control. Australia represents the
Western Pacific Region in this position. Australia's role in negotiating meetings, held in October 2000 and May 2001, strengthened our
reputation as a tobacco control leader internationally and has resulted in increased assistance to the Western Pacific region through several current and proposed tobacco control capacity building activities.
Australia's international standing in the Asian region was considerably enhanced through the Department's engagement in policy dialogue and exchange of expertise in support of health and aged care sector reform. Influential collaborative networks have continued to be developed under agreements on health cooperation with China, Thailand, and Indonesia. Australia's relationship with China has been strengthened by a number of high
46
POPULATION HEALTH AND SAFETY
level visits and health financing and reform seminars. Providing assistance to Thailand with its decentralisation and health financing reforms and collaboration with Indonesia on a number of reforms increased Australia's strategic leverage in the region.
Australia agreed to undertake a cooperative research program with Japan on mental health - further evidence of Australia's expertise and standing in the region.
Strengthening population health infrastructure and response capacity The Departmen t contributes to Australia's capacity to respond to health issues at a
population level through a range of policies and programs to develop a stronger infrastructure, in areas such as information management, public health law, education and research.
Information management22
Two achievements to improve access to population health information were:
⢠release of an upgraded version of HealthWIZ with an improved health data library and software enhancements. HealthWIZ is a computer based system that provides public access to data on health status, health services, childcare and social services. The data are now available free of ch arge to Aus tra lian health agencies, universities and non government organisations, following the decision to support HealthWIZ as a non commercial community service obligation product. Discu ssions on the purchase and use of HealthWIZ by New Zealand are
nearin g completion; and
⢠improvements to the National Coronia! Information System (NCIS), wit h all jurisdictions except Queensland now
" Relates to Indicator 1.
47
contributing data. With the introduction of a core data set, users of NCIS can access standardised coronia! information to improve their research on causes of unnatural deaths in Australia.
Public health legislation 23
Improvements in public health legislation and regulation included:
⢠completion of a review of the human quarantine provisions of the Quarantine Act 1908 in December 2000, and preparation of consequent amendments; and
⢠amendment of the Australia New Zealand Food Authority Act 1991 to create the new food authority, Food Standards Australia New Zealand, in line with COAG foor
regulatory reform.
Improving public health workforce
education 24
Ph ase 3 of the Public Health Education and Research Program (PHERP) h elped to strengthen the national capacity for public health education, research and policy development . Funding arrangements for PHERP in 2001- 05 were revised to support and encourage innovation, and enhance the quality of public health education and research training across Australia. Seventeen tertiary institutions used
PHERP funding to support the development and delivery of a range of public health awards. Approximately 687 students participated in the
PHERP in 2000- 01.
An evidence-base for policy and programs zs
Research in population health priority areas continued to improve the evidence-base for policy and program development. Th e longitudinal study on women's health, Women's
Health Australia, continued to publish quality research covering factors that enhance or inhibit good health in women of all ages . The study
"· ' 0 5 Relate to Indi cat ors 3 and 4
OUTCOME 1
found, for example, a strong and consistent dose response relationship between tobacco use and the prevalence of menstrual symptoms and miscarriage. These findings will inform the Department's current review of health warnings on tobacco products.
The Health Inequalities Research Collaboration, consisting of experts in the fields of public and clinical health, sponsored a national conference in July 2000 entitled Social origins of health and wellbeing: from the planetary to the molecular. This was the first opportunity in Australia to bring together people from various sectors and disciplines to encourage interest and action in addressing health inequalities. The collaboration's current focus is in the areas of child/youth/families, sustainable communities and primary health care.
The Population Health Evidence-Based Advisory Mechanism progressed with the development of methodologies for evaluating evidence and for identifying 'best buys' or the most cost effective ways to prevent specific diseases and conditions.
Integrating population health approaches
within the wider health system 26
A number of initiatives were undertaken to integrate population health approaches within the wider Australian health system, especially preventative health care approaches through general practice.
The Department provided support to the Joint Advisory Group GAG) on General Practice and Population Health, a joint group of the General Practice Partnership Advisory Council and the National Public Health Partnership. JAG undertook extensive state-based consultations on the role of general practice in population health, and organised a successful national symposium. A consensus statement and action plan were developed, based on the
26 Relates to Indicators 3 and 4
48
recommendations of the symposium. JAG has developed a comprehensive framework document outlining integrated approaches to support general practice in the management of behavioural risk factors for chronic disease: smoking, poor nutrition, alcohol misuse and inadequate physical activity.
POPULATION HEALTH AND SAFETY
Performance indicators
Indicator 1: Incidence, prevalence and mortality rates of diseases or conditions in the main program areas covered by national strategies (where national data exist).
Indicator 2: Increased knowledge and skills, and changes in attitudes and (where possible) behaviours of specified target groups as a consequence of health promotion and disease prevention strategies such
as the National Youth Alcohol Campaign, the National Tobacco Campaign, National Illicit Drugs Campaign, Active Australia and the Family Planning Program.
Target: Reduction in incidence, prevalence and mortality in areas covered by nationally agreed programs. For example, the continuing decline in the incidence of measles and whooping cough (pertussis) and influenza (Haemophilias influenzae) type b infections compared to
previous years, the continuing decline in the number of HIV and AIDS diagnoses and mortality rates following HIV I AIDS, the decline in food borne illnesses.
Information source/reporting frequency: Incidence Annual reporting of selected diseases, illnesses and injuries from National Notifiable Diseases Surveillance System; National Injury Surveillance Unit; Australian Institute of Health and Welfare (AIHW) ; State and Territory data; and hospital separations. Prevalen ce
Household surveys; self-reported surveys; and selected small-sample surveys. All annual information for selected diseases and conditions. Mortality Australian Bureau of Statistics (ABS); State and Territory data registries; National Coronia! Information System and AIHW. Annual
reporting.
Target: Improvements in knowledge, skills, attitudes and behaviours to promote health and prevent illness over time (2-5 years). For example, an increase in the number of people quitting smoking in response to the National Tobacco Campaign, increased parental knowledge of, and willingness to discuss, illicit drug use prevention strategies with their children and improvements in levels of regular physical activity.
Information source/reporting frequency: Commissioned surveys of knowledge, attitudes and behaviour.
Indicator 3: The adoption and effective use of best practice approaches across strategies as well as nationally recommended screening and immunisation policies, agreed guidelines and participation targets. For example, immunisation protocols for general practitioners and breast and cervical cancer screening best-practice guidelines.
Indicator 4: Proportion of national population health strategies which target specified high need groups
(for example injecting drug users, hom*osexually active men, low socio economic groups and Aboriginal and Torres Strait Islander peoples) .
OUTCOME 1
Target: Progress towards nationally agreed targets and use of best practice guidelines. Some examples are: participation, cancer detection rates and incidence for breast
and cervical screening, e.g. BreastScreen Australia target of 70 per cent participation among women aged 50-69, adherence to NHMRC guidelines Screening to prevent cervical cancer: guidelines for the management of screen detected abnormalities; and the National Immunisation Strategy has a target of 90 per cent coverage of recommended immunisation for all children at two years of age by 2000.
Information source/reporting frequency: State and Territory data registries and the Australian Childhood Immunisation Register.
Target: 100 per cent of strategies take account of the needs of specified high need groups and provide information where available.
Information source/reporting frequency: Analysis of national population health strategy documents (annual); HIV I AIDS strategy reporting; and feedback from the Minister's office (some figures may be reported by Aboriginality).
50
Therapeutic Goods Administration (TGA)
Major achievemen ts
⢠Establishment of the Office of the Gene Technology Regulator.
⢠ew crisis management procedures for product tampering or extortion threats.
⢠Extension of the TGA's regulatory responsibility to cover all fresh blood.
⢠Working with New Zealand towards the establishment of a Trans-Tasman Therapeutic Goods Agency.
Outcome summ ary - the year in review The key objective of the Therapeutic Goods Administration (TGA) is the regulation of
therapeutic products in Australia to ensure they meet high standards of safety, quality and efficacy and are made available to the community in a timely manner.
Over the past year, the TGA has achieved this objective while working successfully with stakeholders and other regulatory agencies internationally to address the increasing demands of rapidly developing technology and consumer expectations of faster availability of a
wider range of therapeutic goods.
There were approximately 58,000 products on the Australian Register of Therapeutic Goods (ARTG) as at 30 June 2001. The number of products has risen by 1.9 per cent in the past year.
In addition to its primary responsibility for regulating therapeutic goods, the TGA has advised other regulatory authorities on potential public health risks posed by
agricultural, veterinary and industrial chemicals used in the community.
51
From 1 July 1998, the TGA has been required by the Government to fully recover its operating costs for all activities that fall within the scope of the Act, including regulation of industry and the TGA's public health responsibilities.
Establishment of the Office of the Gene
Technology Regulator
The Interim Office of the Gene Technology Regulator (IOGTR) became the Office of the Gene Technology Regulator (OGTR) on 21 June 2001, following the passage of the Gene Technology Act
2000 through the Commonwealth Parliament on 8 December 2000 and Royal Assent on 21 December that year.
Complementary State legislation and an Inter Governmental Agreement (IGA) will ensure a truly national scheme.
State and Territory parliaments are expected to consider complementary legislation in the second half of 2001. The IGA commenced circulation to premiers and chief ministers for consideration and signature at the end of April.
The Interim Office of the Gene Technology Regulator was established as a Branch of the Therapeutic Goods Administration in May 1999.
The IOGTR had two major roles:
⢠to undertake extensive consultation with stakeholder organisations to develop and implement the new national regulatory system for genetically m odified organisms
(GMO s); and
⢠to provide support and, where necessary, direction to the previous voluntary administrative arrangements for GMOs,
OUTCOME 1
including providing support for the Genetic Manipulation Advisory Committee (GMAC).
With the Gene Technology Bill 2000 being introduced into Parliament on 22 June 2000, the IOGTR developed and released a draft of the corresponding Gene Technology Regulations 2000. Key stakeholders were invited to attend advertised meetings and/or to provide written submissions in response to the draft regulations. Written submissions were also invited from the public. Various guidelines and licensing arrangements for the new regulatory system were also developed.
Ms Elizabeth Cain, acting Gene Technology Regulator, at the official opening of the Office of the Gene Technology Regulator on 21 June 2001.
Over the past year, the IOGTR/OGTR has maintained its proactive monitoring of field trials and sites subject to post-trial monitoring, for compliance with GMAC recommendations.
Regulatory reform
Medical device reforms
The Therapeutic Goods Amendment (Medical Devices Bill 2001) was introduced to Parliament on 29 March 2001. The Bill provides for a world leading internationally harmonised regulatory framework based on the principles of the Global Harmonisation Task Force. The new system introduces a comprehensive performance based
risk assessment system that will facilitate the operation of the Australian-European Union/Mutual Recognition Agreements. This will facilitate trade for both Australian manufacturers and importers.
An initial draft of the Therapeutic Goods (Medical Devices) Regulations 2001 has also been developed and made available for stakeholder comment.
Complementary medicine reforms
ew advertising arrangements for therapeutic goods were launched in April 2000. The arrangements include a new principles-based advertising code and clear guidelines on the levels and kinds of evidence sponsors must hold before making claims in relation to listable medicines.
The new guidelines were trialed by stakeholders for the six months to July 2000, with a TGA-convened advisory group to assist sponsors. The trial demonstrated that the new advertising arrangements opened a broad range of opportunities for sponsors to provide evidence-based information about their products to the community.
At the request of the complementary medicines industry, the Advisory Group remained in operation until December 2000, to provide support while sponsors began to operate under the new arrangements.
Review of access to unapproved
therapeutic goods
The TGA has reviewed and amended the mechanisms and legislation for allowing patients access to unapproved medicines and medical devices in Australia. Detailed reference documents have been produced for stakeholders involved with the supply and use of unapproved therapeutic products. The information is also available in a series of user friendly information sheets (At a glance and FAQ sheets). All of these documents are available on the TGA website - www.health.gov.au/tga
52
THERAPEUTIC GOODS ADMINISTRATION
-------ocn
Export review implementation
While the primary role of the TGA is to regulate medicines for the domestic market, it is also committed to ensuring the export of high quality, safe medicines. Australia is an active participant in international activities that protect public health and safety through prevention of the manufacture and sale of sub-standard and counterfeit medicines around the world.
The TGA recognises that timeliness and the minimisation of administrative and regulatory obstacles are of significant benefit to the medicines industry engaging in international trade. It has been working, in consultation with industry associations to implement recommendations arising from the Review of the Regulatory Regime for the Export of Therapeutic Goods.
Review of drugs and poisons and
controlled substances legislation
The National Competition Review of Drugs, Poisons and Controlled Substances Legislation was completed in 2000. The Review's final report was presented to the Australian Health Ministers' Conference (AHMC) and, after consideration of the report by Australian Health Ministers' Advisory Council (AHMAC), will be forwarded to the Council of Australian Governments.
Review findings include:
⢠confirmation of the need for Australia to have a comprehensive system of legislative controls regulating drugs, poisons and controlled substances;
⢠that the level of regulation should be reduced in some areas and, in other areas, a co-regulatory approach introduced;
⢠proposed changes to administrative and legislative controls to improve the efficiency of the regulatory system; and
⢠promotion of non-legislative measures to help meet the underlying objectives of drugs, poisons and controlled substances legislation.
An AHMAC Working Party has been established to assist the preparation of comments on the Final Report for the Council of Australian Governments (COAG). The Working Party held meetings in March and May 2001 and reviewed submissions from State and Territory health and agriculture/ veterinary departments, along with those from other stakeholders who had previously submitted to the review process. A comprehensive response is expected towards the end of 2001.
Ongoing regulatory obligations 1
Post-market issues
Aristolochic acid contamination
In response to increasing international concerns over the presence of aristolochic acid in some herbal products, the Office of Complementary Medicines (OCM) and the TGA Laboratories have surveyed herbal medicines considered to be at risk of contamination with this toxic substance. The TGA found that a small number of these products did contain aristolochic acids and subsequently cancelled permission to continue to trade in these products. The Australian-based sponsor of these products was required to recall all current stocks.
Product tampering and extortion threats
In 2000, two companies which supply over-the counter medicines to the Australian market conducted national consumer level recalls of products as a result of criminal tampering and extortion threats. These incidents have highlighted the importance of companies, the TGA and Commonwealth and State and Territory health departments having in place
up-to-date crisis management protocols to address such situations. A taskforce, comprising representatives from the TGA, therapeutic goods
' Relates to Indicators 1 and 2
54
THERAPEUTIC GOODS ADMINISTRATION
industry associations, the Consumers' Health Forum, the police and State and Territory health authorities was established to facilitate a systematic approach to these matters.
There has been agreement on a 'whole of industry' approach to crisis management, based on world's best practice. The TGA co ordinated a review of and refined the existing protocols to provide model crisis management guidelines for adoption by the therapeutic goods industry as a whole.
A new crisis management section has been inserted in the Uniform recall procedure for th erapeutic goods, requiring that the TGA be notified in the event of a product tampering threat. As part of the new procedure, the TGA will convene a Emergency Reference Group
(ERG) comprising representatives of the company, police and relevant health authorities. The ERG 's role is to determine an action plan to deal with the crisis, which may or may not involve recall of the relevant product.
The Th erapeutic Goods Act 1989 has also been amended to strengthen the TGA's recall powers in cases of product tampering and extortion.
The TGA also coordinated a review of tamper evident packaging requirements for therapeutic goods. These are currently being trialed by the industry associations with a view to being made a mandatory requirement in three years time.
Transmissible Spongiform
Encephalopathies (TSEs)
The TGA has taken further steps to minimising any risk of transmission of bovine spongiform encephalopathy (BSE) - otherwise known as mad cow disease - through the use of medicines and medical devices in Australia.
The TGA's actions reflect those being taken by other leading international regulatory agencies. All new products submitted to the TGA for inclusion on the Australian Register of Therapeutic Goods
55
and which contain or use in their manufacture animal or human products, must use material sourced from BSE-free countries or, where this is not possible, provide evidence as to safety from BSE and other transmissible spongiform
encephalopathies (TSEs).
The TGA has also been reviewing existing medicines and medical devices to identify any potential risks of exposure to TSEs, and removing the use of animal or human products sourced from non-BSE-free countries, except where such use can be fully justified. This review has included active and inactive biological ingredients, as well as biological materials used in production processes but which may not be present in significant amounts in the final product.
Regulation of blood and blood products
The TGA became the national regulator of fresh blood and blood products on 1 July 2000. Over the past year, the TGA has implemented the various standards, manufacturing principles
(including a revised Code of Good Manufacturing Practice) and recalls procedures for these products. This regulation covers the collection, processing and storage of fresh blood products.
The TGA provided key scientific input into government decisions aimed at protecting the Australian fresh blood supply from potential risks of transmission of variant Creutzfeldt Jakob Disease (vCJD, the human form of BSE).
Strategic Information Management
Environment (SIME)
The SIME project is an initiative of the TGA to improve the way in which regulatory information is managed. This will establish a base for electronic commerce, electronic lodgement of data packages in support of applications for entry of products onto the Australian Register of Therapeutic Goods
(ARTG) and will enable on-line client access to
I
legally appropriate information. Over the last 12 months the SIME initiative has produced the following:
⢠delivery of an on-line facility for the registration of devices manufacturing certificates and an electronic assessment engine for the validation of listed medicines submissions.
⢠progress on replacing the current ARTG, electronic lodgement facilities (for listed medicines) and adverse drug reaction systems, as well as work flow systems to progress and track submissions through the TGA.
⢠completion of industry pilots for the Devices Electronic Application Lodgement (DEAL) and the Electronic Lodgement Facilities (ELF) systems.
Chemical regulation
Chemical Adverse Experience Reporting
Scheme
The TGA Chemicals Unit is coordinating the Government's response to a push from various sections of the Australian community to monitor adverse health events arising from exposure to chemicals, particularly agricultural and veterinary (agvet) chemicals. The Chemicals Unit chaired a Working Party, including representatives from the Departments of Health and Aged Care, Agriculture Forestry and Fisheries and Employment, Workplace Relations and Small Business. The Working Party considered the development of a 'Chemical Adverse Experience Reporting Scheme' (CAERS) that would be used to identify adverse health outcomes associated with identifiable (or probable) chemical exposures.
National intake standard for dioxins
Dioxins and related compounds are formed by combustion processes such as industrial chemical synthesis, waste incineration and
bushfires. Because some of these compounds may be highly toxic at quite low levels, releva nt government agencies are undertaking programs to determine whether measurable levels of dioxins and related compounds are present in the environment and in certain agricultural commodities. As part of these monitoring programs and their reporting, Environment Australia (EA) and Agriculture, Fisheries and Forestry Australia (AFFA) sought ad vice from the Department of Health and Aged Care on a tolerable daily intake (TDI) standard for dioxins and related compounds.
The Chemicals Unit of the TGA has drafted a proposal for a TDI, largely based on the deliberations of a consultation between technical experts representing the WHO European Centre for Environmental Health and the WHO/ILO/UNEP International Programme on Chemical Safety in May 1998. A report including a proposed Provisional Tolerable Daily Intake (PTDI) was formally provided to EA, AFFA and the Australia- ew Zealand Food Authority (ANZFA) in January 2001.
International activities
Trans-Tasman Therapeutic Goods Agency
In mid-2000, a taskforce was established to consider the administrative arrangements for chemical safety assessments, regulation of medicines, medical devices, gene technology and food and to develop options that would harmonise Australian and New Zealand's regulatory arrangements for therapeutic goods.
Therapeutic goods, such as medicines, medical devices and complementary health care products, have a special exemption from harmonisation under the Trans Tasman Mutual Recognition Agreement (TTMRA) until 1 May 2002. This places an obligation on Australian and New Zealand regulators to resolve differences in regulating these goods, with a view to protecting public health and safety.
56
THERAPEUTIC GOODS ADMINISTRATION
Australian and New Zealand health ministers agreed last year to explore the feasibility of establishing a joint agency to harmonise therapeutic goods regulation between both countries. In December 2000, the New Zealand government supported 'in principle' the establishment of a joint agency, subject to certain issues being addressed. In January 2001, Australian State and Territory Health Ministers' accepted a TTMRA report that recommended the establishment of a single joint agency and, in July 2001, the Commonwealth government agreed to continue further work on assessing the feasibility of establishing a joint agency.
Subject to the government's final agreement, the new agency would be recognised in law in both Australia and New Zealand. It would assume responsibility for all regulatory functions currently undertaken by the Australian Therapeutic Goods Administration and New Zealand's Medsafe, including the power to implement and enforce decisions in both jurisdictions.
International agreements
This year has seen the development of a number of key international agreements in therapeutic goods and chemicals regulation.
United States: On 11 October 2000, the TGA signed a cooperative arrangement with the US Food and Drug Administration (FDA) , regarding the exchange of information on current Good Manufacturing Practice (GMP) inspections of
human pharmaceutical manufacturing facilities. The information shared would include inspection timetables, recall information and forecasts of shortages of medically necessary
human pharmaceuticals.
China: In November 2000, the TGA signed a MoU with the State Drug Administration (S DA) of China to strengthen the relationship and collaboration between the two countries on pharmaceutical regulation. An agreement of intention of collaboration with the State
57
Administration of Traditional Chinese Medicines (SATCM) has been in place since 1997.
Singapore: A mutual recognition agreement (MRA) on GMP inspections, between Australia and Singapore, was signed in Canberra on 26 February 2001. As a result of this international trea ty the TGA will recognise Singapore's GMP certificates in support of applications for entry on the Australian Register of Therapeutic Goods (ARTG).
United Nations: Staff of the TGA Chemicals Unit contributed to Australian Government inputs into the development of two United Nations Environment Program (UNEP) chemicals treaties - one on the control of Persistent Organic
Pollutants (the so-called POPs Convention) and the other on the control of certain hazardous chemicals in trade (the Rotterdam, or PIC Convention). In addition, arising from Australia's recent decision to remove the pesticide, monocrotophos, from the national market, Chemicals Unit staff were asked to present its toxicology and public health risk assessment to a meeting of the Interim Chemical Review Committee of the Rotterdam convention. This, together with a similar 'notification of regulatory action' from Hungary, led to the international decision to PIC-list monocrotophos. This means that future international movements of this chemical will have to be notified by exporting countries, with importing country governments having the right to refuse import shipments under international law.
OECD: In early 2001 the OECD published an environment, health and safety monograph drafted by staff of the TGA's Chemicals Unit on an agreed approach to the analysis and reporting of toxicology studies, titled Guidance Notes for Analysis and Evaluation of Repea t-Dose
Toxicity Studies.
WHO: Under the auspices of the WHO/ILO /UNEP International Programme on Chemical Safety (IPCS), Chemicals Unit staff
OIJTCGME 1
participated in the development of an harmonising approach to cancer risk assessment, and the publication of a document titled IPCS Conceptual Framework for Evaluating a Mode of Action for Chemical Carcinogenesis. This
framework will be used by agencies responsible for assessing the carcinogenicity of chemicals.
European Free Trade Association (EFTA): A Mutual Recognition Agreement on medicinal products, GMP inspections and medical device premarket assessment with the EFTA was implemented in July 2000. This extends the MRA in place with the European Union and will now cover the European economic area. The EFTA countries included in the agreement are Norway, Liechtenstein and Iceland.
Global Harmonisation Task Force
The Global Harmonisation Task Force (GHTF) was conceived in 1992 in an effort to respond to the growing need for international harmonisation in the regulation of medical devices. The Task Force comprises five founding members- Canada, USA, the European Union, Australia and Japan representing three regions, North America, Europe and Asia/Pacific.
In January 2001, Australia, represented by the TGA, assumed the GHTF Chair and Secretariat for 18 months.
The GHTF provides a forum in which official representatives of national regulatory bodies, working with medical device manufacturers and other organisations possessing relevant expertise, can harmonise global approaches to regulating the safety, clinical performance and quality of medical devices in ways that protect public health, promote technological innovation and facilitate international trade.
GHTF achieves its mandate via the publication and dissemination of harmonised guidance documents on basic regulatory practices. Once endorsed by the GHTF, national regulatory
authorities are encouraged to adopt the documents, where appropriate, into their medical device regulatory systems.
In February and June 2001, TGA convened the first two meetings of the newly established GHTF Steering Committee in Sydney and Brussels respectively. The Committee is responsible for management oversight and policy setting for the organisation. Its membership comprises 32 government regulators and medical device industry representatives from the five founding member countries.
TGA's key task as GHTF Chair is to undertake a strategic review of the organisation and develop a strategic plan for the next five years.
Other key activities include hosting the ninth GHTF Conference in London (October 2001), developing and hosting a training program for south-east Asian regulators in Australia (March 2002), convening the third and fourth Steering Committee meetings in conjunction with these events, continuing the review of regulatory guidance documents being developed by the GHTF Study Groups and outlining Founding Members' progress with the adoption of GHTF guidance documents.
Further information on the GHTF may be obtained from the website - www.ghtf.org
Training
The TGA has provided training on the regulation and testing of therapeutic goods to a number of regulators in the Asia-Pacific region over the past year.
Vietnam: The TGA provided technical assistance and training to staff from the Drug Administration of Vietnam, with funding from AusAID under the Asia Pacific Economic Cooperation (APEC) Support Program. The TGA also provided training on vaccine quality control in cooperation with the International Vaccine Institute.
58
THERAPEUTIC GOODS ADMINISTRATION
Taiwan: The TGA assisted the Centre for Drug Evaluation of Taiwan to build its capability for drug evaluation on a consultancy basis.
Hong Kong: The TGA provided two GMP training programs, on a cost recovery basis, to the Hong Kong Department of Health.
Papua New Guinea: The TGA conducted a one week training program on therapeutic goods regulation for the Medical Supplies Division of the Department of Health, Papua New Guinea.
Thailand: Senior officers of the TGA and the Thai Ministry of Public Health visited each other in 2000 to develop an appropriate training program regarding therapeutic goods
regulation. In May 2001, two senior inspectors of the Thai Food and Drug Administration participated in a comprehensive surveillance training program in Canberra, with funding provided by the Department.
Indonesia: TGA officers delivered three evaluation training courses to the Indonesia Directorate of Drug Control in 2000. These training activities focused on pharmaceutical chemistry, toxicology and clinical evaluation. This was undertaken thorough an APEC Support
Program funded mainly by AusAID.
Regional cooperation
In November 2000, the TGA chaired a Regulators' Forum in Sydney, in conjunction with the 4th Asia Pacific Regional Conference of the World Self-Medication Industry (WSMI). The Forum was designed to develop a regional approach to fostering closer relations between regulatory authorities in the region and to and lead towards increased harmonisation in the regulation of therapeutic goods.
Presentations and reports were given by regulators from Australia, Canada, the European Commission, Fiji, Indonesia, Japan, Korea, Myanmar, Nepal, New Zealand, the Philippines,
59
Singapore, Taiwan, Thailand and Vietnam. In addition to government regulators, there were industry representatives and a consumer advocate, with 120 invited guests acting as observers.
The forum also prepared and unanimously agreed to the Sydney 2000 Declaration, drawing on the key principles underpinning good regulatory practice and pointing towards future collaboration between regulators in the region.
The success of the forum has highlighted the TGA's position as a regional leader for therapeutic goods regulation. It has also greatly increased the level of cooperation and
understanding between stakeholders, such as the self-medication industry, and consumers.
Other notable achievements
Support for the Sydney 2000 Olympics
The TGA played a valuable role in the Government's support of the 2000 Olympic and Paralympic Games. In the months leading up to the Games, the TGA was involved in a number of activities to assist in ensuring timely and efficient entry to Australia for all overseas participants and visitors. These included:
⢠advice to the Australian Sports Drugs Agency and the Australian Customs Service on scientific, technical and administrative aspects of substances of interest, medicinal products and the import to Australia of medicines kits by
athletes, officials and passengers; and
⢠definition and clarification of suspected performance enhancing substances at the entry point to Australia.
During the period of the Games, the TGA provided round-the-clock advice to many organisations and individuals. The arrangements worked flawlessly.
TGA open day
As part of the Australian Science Festival 2001,
and in conjunction with the Department's 80th birthday celebrations, the TGA held an Open Day on Saturday 5 May 2001. Tours of the TGA building in Symonston (ACT) were conducted, and TGA staff were available to explain the role of the TGA and how it operates.
Performance indicators
Indicator 1: Proportion of products on the Australian Register of Therapeutic Goods (ARTG) withdrawn from the market, or requiring a change of condition of approval for safety related reasons.
Indicator 2: Pr<;>portion of products failing to meet a quality qr efficacy standard as a of post market
surveillance.
Target: No more than 2 per cent of products (on the ARTG) withdrawn for safety related reasons.
Information source/reporting frequency: Therapeutic Goods Administration Reporting Systems.
Target: A decrease in the percentage of product failures as a result of post market surveillance.
Information source/reporting frequency: Therapeutic Goods Administration .Quarterly Performance Reports.
60
OUTCOME 1 : FINANCIAL RESOURCES SUMMARY
t (A) (B)
Budget Actual Variation
Estimate Expenses (ColumnB 1 Budget
200011001 200011001 minus 200111002
$'000 $'000 ColumnA) $'000
Administered Expenses
Administered Item 1: Population Health National Health Act 1953 - Essential Vaccines 94,580 93 ,852 (728) 86,902
Total Special Appropriations 94,580 93 ,852 (728) 86,902
Appropriation Bill 1/3 122,796 116,549 (6,247) 114,252
Appropriation Bill 2/4 185 ,036 157, 151 (27,885) 171,603
Total Administered Exl!enses 402,412 367,552 (34,8602 372,757
Departmental Appropriations
Health & Aged Care Output Group I - Services to the Minister & Parliament 14,70 1 14,747 46 19,860
Output Group 2 -National Leadership 12,585 12,613 28
Output Group 3 - Information 8,540 8,584 44
Output Group 4- Program Management 8,539 8,958 419 26,973
Output Group 5 - Regulatory Activity 449 9,03 1 8,582
Output Group 6 - Direct Delivery of Services
Total price of departmental outputs 44,814 53,933 9, 119 46,833
(total revenue (iom Government & other so urces!
Total revenue from Government (appropriations) 44,3 15 50,810 6,495 46,465
contributing to price of departmental outputs Total revenue from other services 499 3, 123 2,624 368
Total price of departmental outputs 44,814 53,933 9, 119 46,833
(total revenue (iom Government & other sources!
Therapeutic Goods Administration Output Group I - Services to the Minister & Parliament 2,391 2,144 (247) 1,786
Output Group 2 - National Leadership 5,112 2,238 (2,874)
Output Group 3 - Information 2,495 3,286 791 52,982
Output Group 4 -Program Management Output Group 5 - Regulatory Activity 45,527 39,955 (5,572)
Output Group 6 - Direct Delivery of Services Office of Gene Technology Regulator Output Group 3 -Agency Specific Service Delivery 7,947
Total price ofTGA outputs 55,525 47,623 (7,902) 62,715
(total revenue (iom Government & other sources)
Total revenue from Government (appropriations) 6,262 60 (6,202) 11,409
contributing to price of departmental output⢠Total revenue from other services 49,263 47,563 (1,700)
TGA 49,234
Miscellaneous 2,072
Total price ofTGA outputs 55,525 47,623 (7,902) 62,715
(total revenue (iom Government & other sources!
Total revenue from Government (appropriations) 50,577 50,870 293 57,874
contributing to price of departmental outputs Total revenue from other services 49 762 50686 924 51 674
Totall!rice of del!artmental (lncludin!l} TGA outl!uts 100,340 101,557 1,217 109,548
Total price of outputs for Outcome 1 100,340 101 ,557 1,217 109,548
' total revenue f:om Government & other
Total estimated resourcing for Outcome 1 502,752 469,109 (33,643) 482,305
'total e,nce o! oute,uts & admin
1 TI1e Budget Estimate 2000/2001 includes the appropriations as per the 2000-2001 Portfolio Budget Statements (PBS), 2000-2001 Portfolio Additional Estimates and Advances to the Finance Minister. This amount may differ to the revised estimates for 2000/2001 published in the 200 1/2002 PBS. Such differences can arise from updated estimates and rephasings .
2 Budget prior to additional estimates . The number of output groups has reduced from 5 in 2000-2001 to 2 in 2001-2002. It is not possible to show direct comparatives
6
Outcome 2: Access to Medicare
Access through Medicare to cost-effective medical services, medicines and acute health care for all Australians
63
Outcome 2 is managed in the Department by Health Access and Financing Division. Contribution to this outcome is also made by the Department's State and Territory offices.
The Health Insurance Commission and the Professional Services Review Scheme (both of which produce their own annual reports) also contribute to achieving Outcome 2.
The major components of Outcome 2 are the:
⢠Medicare Benefits Schedule;
⢠Pharmaceutical Benefits Schedule; and
⢠Australian Health Care Agreements with the States and Territories.
UUII...UIVIt L
Major achievements â¢
â¢
485,000 Medicare services were provided at a cost of $12.9 million through Aboriginal Community Controlled Health Services.
Agreement was reached between doctor, pharmacist, consumer and government representatives on collaborative arrangements between doctors and pharmacists to review medications for patients in community settings.
⢠Passage of the National Health Amendment (Improved Monitoring of Entitlements to Pharmaceutical Benefits) Act 2000 which provided for the Medicare number to be included on prescriptions.
⢠Following an announcement in March 2001 by Dr Wooldridge, work began on a voluntary code of conduct for medical corporations.
Under-achievements ⢠Projected Pharmaceutical Benefits Scheme expenses during the year were considerably underestimated.
⢠Better Medication Management System implementation timeframe has been extended.
⢠The Incentives for Quality Prescribing measure introduced in the 1999-2000 Budget has still not moved to implementation.
Outcome summary - the year in review Australia's universal health insurance system, Medicare, comprises three main strands of subsidised access to health care for the community:
⢠medical and diagnostic services listed under the Medicare Benefits Schedule (MBS);
⢠drugs and medicinal preparations listed under the Schedule of Pharmaceutical Benefits (PBS); and
⢠public hospital services provided under Australian Health Care Agreements (AHCAs) with the States and Territories.
Universal access to necessary health services is provided to Australians under Medicare. These health services are complemented by additional services privately purchased at the patient's own cost, including services refundable under private health insurance. Together, this public-private mix of services provides Australians with a high class health care system well regarded both by the Australian community and internationally.
The Health Insurance Commission (HIC) provides payments to providers and the public, and information and compliance services under the MBS and PBS on behalf of the Department of Health and Aged Care. The HIC, as a statutory authority, produces its own annual report.
Medicare is a health insurance system funded through the taxation system, including but not limited to the contribution of the Medicare Levy.
The Australian community by and large and by international standards, enjoys good health. One indicator of good health is disability adjusted life expectancy, which for Australians is 73.2 years. This places Australia second only to ]apan1 ⢠However, there are specific inequities in
health status in the Australian community, with Aboriginal and Torres Strait Islander peoples being particularly disadvantaged. Action across a number of areas, including improved access to health services, is expected to lead to reductions in these inequities over time.
' World Heal th Report 2000 Statistical Annex - Jun e 2000, World Health Organiza tio n, Switzerland.
64
ACCESS TO MEDICARE
Figure 2.1: Annual growth in government outlays on Medicare, 1996-97 to 2000-01 18 17 co
16 01 ⢠1996-97 <!'
15
D 1997-98
14
N
13 01 N
""' 12
.....
11
c 10 2000-01 Q) v ..... 9 0 Q) c.. 8 7 6 5 4 0 3 2 1 0 -1 PBS MBS AHCA Total Notes: 1. 2000-01 prices applied throughout using non-farm GOP implicit price deflator for all programs. 2. The Government's contribution to public hospital funding was provided under the 1993-98 Medicare Agreements fo r 1995-96 to 1997- 98 and under the 1998-2003 Australian Health Care Agreements from 1998-99 to 2000-01. 3. Total funding under the 1993- 98 Medicare Agree ments and the 1998-2003 Australian Health Care Agreements is included in th is table as the allocation of funds between Outcomes 2 and 4 which can be applied in 1998- 99 to 2000-01 did not apply in previous years. 4. The figures underlying this table are based on cash not accrual numbers in order to prese rve the time series. For PBS and MBS the numbers are based on claims processed during the year. During 2000-01, Medicare continued to provide access to services under the three main areas -MBS, PBS and public hospitals -and continued to grow in terms of government expenditure. Policy development under the Medicare program focused on maintaining and improving access, improving quality and building financial sustainability. Government expenditure on access to Medicare was $18.2 billion, a real increase of 4.3 per cent on the previous year2 ⢠The highest rate of growth was in the PBS. The major factors behind this growth were the listing on the PBS of a new medicine for the treatment of arthritis, Celebrex®; the listing of a new medicine for treating nicotine dependence, Zyban® and growth in expenditure on cholesterol-lowering medicines listed on the PBS. ' Re lates to Indicator 8. 65 For Outcome 2 as a whole, real growth in per
capita expenditure was 3.1 per cent, rising from $872 per capita in the previous year (2000-01 prices) to $899' .
Outcome 2 outlays remained roughly steady as a percentage of GDP. In 2000-01 they were 2.60 per cent; in 1999-2000, 2.54 per cent'.
In terms of cost to patients, Outcome 2 has continued to improve or remain stable on a number of performance measures. The overall level of bulk billing on the MBS in 2000-01 was 71.4 per cent, a decline of 0.9 percentage points on
1999- 2000' . However, even after this marginal decline, bulk billing is still higher than in any other year from the start of Medicare in 1984 to 1995- 96.
3 Relates to Indicator 11. ⢠Relates to Indica tor 9. ' Re lates to indicato r 3.
Figure 2.2: Annual government outlays per capita on Medicare, 1996-97 to 2000-01
1000
900
800
700
VI 600 .._ 0 500 0 400
300
200
100
PBS MBS AHCA Total
Notes: 1. 2000-01 prices applied throughout using Non Farm GOP implicit price defla tor for all programs.
2. The Commonwealth's contribution to public hospital funding was provided under the 1993-98 Medicare Agre ements for
1995-96 to 1997- 98 and under the 1998-2003 Australian Health Care Agreements from 1998-99 to 2000-01.
3. Total funding under the 1993-98 Medicare Agreements and the 1998-2003 Australian Health Care Agreements is included in this table as the allocation of funds between Outcomes 2 and 4 which can be applied from 1998- 99 to 2000-01 did not apply in previous years.
4. The figures underlying this table are based on cash not accrual numbers in order to preserve the time se ries. For PBS and MBS the numbers are based on claims processed during the yea r.
Figure 2.3: Annual growth in government outlays as a percentage of GOP, 1996-97 to
2000-01
2.5
2.0
...,
c: Q) u
.._
1.5 Q) c._
1.0
0.5
0.0
PBS MBS AHCA Total
66
Notes: 1. The Government's contribution to public hospital funding wa s provided under the 199 3- 98 Medicare Agreements for
1995-96 to 1997- 98 and under the 1998-2003 Australian Health Ca re Agreements from 1998- 99 to 2000-01.
2. Total funding under the 1993-98 Medicare Agreements and the 1998-2003 Australian Health Care Agreements is included in this table as the allocation of funds between Outcomes 2 and 4 which can be applied from 1998-99 to 2000-01 did not apply in previous years.
3. The figures underl ying this table are based on cash not accrual numbers in order to preserve the time se ri es . For PBS and MBS the numbers are based on claims processed during the year.
ACCESS TO MEDICARE
Figure 2.4: Percentage of Medicare services that are bulk-billed, 1984-85 to 2000-01
Note:
...,
c:: Q) u
80
60
Q; a.. 40
20
f-
48.5
45.2
I
60 .8 62.8
58 .2
55.4
51 .8 53 .1
I I I I I
The MBS numbers are based on claims processed du ring the year.
71.1 71.8 71 .8 72.0 72.3 68.1 69.6 65 .1
I I I I
Figure 2.5: Percentage of cost of PBS prescript ion covered by government,
1994-95 to 2000-01
I
90.------------------------------------------,
Note:
....
c QJ u
85
80
Q:; 75
c..
70
65
The PBS numbers are based on claims processed during the ye ar.
67
71.4
UUilUMt: L
The percentage of the cost of PBS prescriptions covered by the Government increased from 83.0 to 83.7 per cent between 1999- 2000 and 2000- 01 6 ⢠Access to public hospital services continued to be free of charge for public patients.
Other measures of access to services indicate continuing inequities of access between rural and urban and between Indigenous and non Indigenous communities. MBS outlays per capita continue to be lower than the national average in rural and remote areas although the relationship to the national average has improved slightly in recent years' . Analysis by the Department indicates an inverse relationship between public h ospital and MBS expenditure by local area, suggesting that public
hospitals play an important role in providing services in areas where the private sector and MBS do not.
PBS per capita expenditure does not show the same variance in rural and remote areas as MBS per capita expenditure. Over the past six years, the ratio of expenditure by the Government on PBS per person between rural and remote and other areas has remained generally constant8 . The difference in access to MBS and PBS services in rural and remote areas may be attributable partly to the geographical distribution of private medical practitioners and retail pharmacists and partly to the provision of community medical services outside the MBS fee -for-service arrangements in rural and remote areas.
Table 2.1: MBS outlays per capita by regional category, 1995-96 to 2000- 01
Category 1995- 96 1996-97 1997-98 1998-99 1999- 200 0 2000- 01
$ $ $ $ $ $
Capital city 397.71 391.67 391.45 404.18 406.36 403.18
Other metro centre 384.95 380.45 380.65 394.97 398.51 397.15
Rural an d remote 290.88 288.45 290.95 303.03 308.37 314.29
Total 365.90 361.13 361.87 374.77 378.19 377.93
Notes : 1. Non Farm GDP implicit price deflator used for earlier years . 2. Population figures as provided by ABS to 30 June 2001. 3. The figures underlying this table are based on cash not accrual numbers in o rder to preserve the time series. The MBS numbers are based on claims processed during the year. 4. The allocation to regional category is based on postcode of patient enrolment.
Table 2.2: PBS outlays per capita by regional category, 1995-96 to 2000-01
Category 1995- 96 1996- 9 7 1997-98 1998- 99 1999- 2000 2000-01
$ $ $ $ $ $
Capital city 132.88 136.53 143.66 155.95 172.64 195.01
Other metro centre 152.59 157.08 166.94 178.69 196.07 222.66
Rural and remote 127.40 132.05 139.92 151.27 167.49 192.88
Total 132.78 136.79 144.35 156.35 172.98 196.54
Notes: 1. Non Farm GDP implicit price deflator used for earlier years. 2. Population figures as provided by ABS to 30 June 2001. 3. The figures underlying this table are based on cash not accrual numbers in order to preserve the time series. The PBS numbers are based on claims processed during the year. 4. The allocation to regional category is based on postcode of pharmacy.
' Relates to Indicator 6. ' Relates to Indicator 4.
8
Relates to Indicator 7.
68
ACCESS TO MEDICARE
The distribution of pharmacies across rural and urban areas underlies access to the PBS . In 2000-01, there were 3,823 people per pharmacy in urban areas, and 4,104 people per pharmacy in rural areas9 .
Figure 2.6: Distribution of Australian pharmacies by urban and rural areas
Urban: capital city or other metro
Rural: large rural centre, small rural centre, other rural area, remote centre, other remote area
Australia
umber of pharmacies: Urba n: 3,639
Rural: 1,333
People per pharmacy: Urban: 3, 823
Rural: 4,104
' Relates to Indicator 5.
Number of pharmacies: Urban: 288
Rural : 107
People per pharmacy: Urban : >J ,828
3, 742
.. '
Tasmania
Number of pharmacies:W Urban: 62
Rural: 78
Peo ple per pharmacy: Urban: 3, 129
Rural: 3,536
69
Victoria
ACT (all urban)
Number of pharmacies: 59 People p er pharmacy: 5,31;
Number of pharmacies: Urban: 916
Rural: 259
People per pharmacy: Urban: 4,014
Rural : 4,435
UUilUMI: L
Public attitudes to Medicare continued to be very positive during 2000-01 10 ⢠The HIC's customer satisfaction survey showed again this year that support for Medicare remains very strong, with overall public support at 92 per cent compared with 89 per cent last year. The survey also showed high levels of satisfaction among health consumers (92 per cent) and doctors (71 per cent) with services provided by the HIC.
Outcome 2 continues to be administered at a very low cost in relation to the volume of funds handled. As in 1999-2000, administration costs in the HIC and the Department were 2.2 per cent of funds administered 11â¢
Table 2.3: Departmental expenses as a
proportion of administered expenses
1999- 2000
Departmental expenses
Health Insurance Commission
Dept of Health and Aged Care
Total departmental expenses
323,223
40,131
363,3S4
2000-01
348,3S7
S7,666
406,023
Administered expenses
16,74S,127 18,244,990
Ratio of Departmental expenses to administered expenses
Note:
2.2%
The figures underlying this table are based on accrual numbers.
Key strategies
2.2%
Key strategies focused on four themes: access, quality, managing outlays and integration strategies. The broad outcomes identified in the introductory section have been achieved and will be sustained by the activities highlighted below.
10 Relates to Indica tor 1. " Relates to Indicator 10.
Access to services
During 2000-01, further improvements were made with existing access to health services, and increasing emphasis was given to the effectiveness of the services financed by the Government through this outcome, in terms of improved health for individual Australians and for population groups.
The Enhanced Primary Care (EPC) items on the MBS were introduced in November 1999 to provide annual health assessments for older Australians and care planning and case conferencing services for people of any age with chronic conditions and multidisciplinary care needs. During 2000-01, 162,122 EPC services were provided, including 109,293 annual health assessments, of which 47,849 were provided in people's homes. This represents a significant increase (98,610 additional services, or ISS per cent) over the number of EPC services provided in 1999-2000, even allowing for the part year implementation of EPC services in that year. Almost 97 per cent of EPC health assessments were provided at no cost to the patient. From November 2000, EPC planning and case conferencing services were made available to people living in residential aged care facilities, with 2,229 services provided to June 2001.
To address problems of access to the MBS by Aboriginal and Torres Strait Islander peoples, special arrangements were put in place in 1996 under sub-section 19(2) of the Health Insurance Act 1973 to allow Medicare benefits to be paid for services provided by medical practitioners working at Aboriginal Community Controlled Health Services (ACCHSs). Regular surveys of ACCHSs, commissioned by the Department and conducted by the HIC, are undertaken to gather information on the number of medical practitioners employed by ACCHSs . Based on information supplied by the ACCHSs and claims processed for the 1999-2000 financial year, over 48S,OOO services were provided at a cost to Medicare of $12.9 million. In addition,
70
ACCESS TO MEDICARE
State funded remote clinics in Western Australia and Queensland received Medicare payments of $2.4 million, covering some 93,000 services. These statistics relate to 1999-2000. Medicare expenditure statistics for services provided by AMSs for 2000-01 will not be available for some months.
To address problems of access to the PBS by Aboriginal and Torres Strait Islander people in remote areas, special arrangements under Section 100 of the National Health Act 1953 were put in place. These arrangements allow clients of a remote area Aboriginal Health Service (AHS) or Aboriginal Medical Service (AMS) to receive
PBS m edicines directly at the time of consultation, without the need for a formal prescription form and without charge. Since the introduction of the initiative in 1999, 39 of a total 50 Commonwealth-funded remote area AMSs have been approved to provide PBS medicines in this way. During 1999-2000 the Government offered all States the opportunity to introduce these arrangements in State-funded
remote area AHSs. Agreement has since been reached with the Northern Territory, South Australian and Queensland governments to extend the arrangements to their State funded remote area AHSs. Expenditure for the financial year 2000-01 was $6.6 million.
The Third Community Pharmacy Agreement between the Government and the Pharmacy Guild of Australia began on 1 July 2000. One feature of the Agreement is improving access to pharmacy services in rural and remote Australia. It contains specific measures designed to
provide a greater level of ongoing support for pharmacies in rural and remote areas, and provides incentives to attract and retain pharmacists in those areas. Further details of these initiatives are provided under Outcome 5.
The Third Community Pharmacy Agreement also expanded the successful Rural and Remote Pharmacy Workforce Development Program. Aspects of this initiative are addressed under Outcome 5 .
71
2222 44444 JOHN R CITIZEN JANE 5 CITIZEN
Two significant new medicines were added to the PBS - Celebrex® and Zyban®. Celebrex®, prescribed for the treatment of arthritis, was listed on the PBS on 1 August 2000. Zyban® which assists those with
nicotine dependence, has been available as a pharmaceutical benefit from February 2001. Both medicines have provided benefit to a large number of Australians.
VUILVIVIt L
In diagnostic imaging, new items were introduced to cover ultrasounds performed for multiple pregnancy, with commensurately higher fees. Previously, the benefit for these services was the same as that of single pregnancies, though the scan is longer and more complex and hence charged at a higher rate.
A tender process to recognise additional Magnetic Resonance Imaging (MRI) units for Medicare purposes was initiated, following the Report of the Review of Magnetic Resonance Imaging
in 2000. Tenders closed at the end of June 2001 and the process is expected to improve substantially the access of patients to MRI services, particularly in regional areas.
The Government and the Victorian Department of Human Services are jointly managing the National Radiotherapy Single Machine Unit Trial. The trial aims to increase access to
radiotherapy in rural communities, to test the commercial and clinical viability of single
machine units and to inform national policy. The trial units are being established in three rural locations in Victoria. They are based on a hub and spoke service delivery model, where the rural services are linked to major metropolitan services, with the aim of delivering quality, professional services.
Qu ality of services
In Outcome 2 the focus is on health financing that maintains and improves the quality of services provided to the community. Quality improvements have been a key theme in the financing agreements with the medical and pharmacy professions. The majority of general practices in Australia participate in the Practice Incentives Program (PIP). In May 2001, 5,260 PIP practices covered 80 per cent of patients (as measured by Standardised Whole Patient Equivalents) compared with 5,232 practices covering 78 per cent of patients in August 2000.
Figure 2.7: Practice Incentive Prog ram (PIP) update, February 1995- May 2001
14 6000
12
5000
Q) ·.;::; 4000 "' Q)
"'
u
c.
'+- 8
"' c g 6
·.;::; u
"' c.
3000 0..
a:
4 PIP practices
2000
-PIP patients 2 1000 0 0
72
ACCESS TO MEDICARE
In 2000-01, 5,543 general practices were participating in the GP immunisation incentives (GPII) program and 86 per cent of them had immunisation rates over 80 per cent. The proportion of practices with rates over 90 per cent rose to 48.6 per cent. The GPII program was evaluated in late 2000. The evaluation found that the scheme had been successful in rai sing actual rates of childhood immunisation in addition to increased reporting of immunisation activity. The scheme will continue with a further review in 2003.
The technical consultancies of the Relative Value Study (RVS) of the Medicare Benefits Schedule were completed in December 2000. Analysis of these studies shows that rebates for medical consultations, primarily provided by GPs, were on the whole under-funded relative to rebates for procedural services, provided primarily by specialists. Funding was provided in the 2001-02 Budget to increase GP rebates for longer consultations from 1 November 2001 in response to this outcome.
In response to the trend to corporatisation of general practice, the Department began facilitating the development of a voluntary code of conduct for medical corporations, as announced on 31 March 2001 by the Minister for Health and Aged Care, Dr Wooldridge. The intention of the code is to protect doctors' clinical autonomy and independence and ensure that consumers continue to receive
appropriate, high quality services. The Minister formally initiated the process of developing the code when he met with representatives of key corporate players, the Royal Australian College of General Practitioners and the Australian Medical Association, on 19 June 2001.
The new five-year Community Pharmacy Agreement builds on the success of earlier agreements with new and improved programs providing a framework for community pharmacy to actively develop its professional
73
role. A major initiative in the agreement is the Pharmacy Development Program (PDP). This program provides a flexible funding source to promote quality and cost-effective service delivery focussing on improved outcomes for consumers. PDP initiatives developed and implemented during the year included a quality care accreditation system for community pharmacies and a research and development grant program.
A new contract was negotiated between the Government and Diabetes Australia for the provision of subsidised syringes and diagnostic test strips under the National Diabetes Services Scheme. Under the new agreement, Diabetes Australia will provide a range of additional services including best practice information to clients on management of their diabetes, a telephone advice
service and provision of information in community languages. Patients will continue to pay the same co-payments as under the previous agreement with Diabetes Australia.
A cornerstone of quality financing is the assessment process used for including new items on the MBS and PBS. Australia is held in high regard internationally for the rigour of its PBS processes. While these processes can sometimes be a point of tension with the pharmaceutical industry, they provide a sound evidence base for decisions by Government to bear the cost of including new medicines on the scheme.
Changes were made to diagnostic imaging items in order to ensure the quality of the service and provide more information to the Government and profession so that these services can be better managed. Musculoskeletal ultrasound and cardiac ultrasound both saw changes in November 2000, which were negotiated with a wide array of relevant provider and referrer groups. For example, the responsible doctor
must now personally attend during the provision of a musculoskeletal ultrasound and personally examine the patient.
OUTCOME 2
Managing outlays
The portfolio has continued to refine Medicare financing arrangements through agreements with the medical profession, pharmacy and the States and Territories providing continued fiscal certainty, so that the health care system is sustainable and affordable by the community.
The main strategies have focused on the funding agreements with the medical and pharmacy professions. The General Practice Memorandum of Understanding (GPMoU) provides a framework for the Government and the GP profession to manage outlays on general practice in ways which enhance the quality of general practice through the MBS and programs such as the PIP. Following the signing of the GPMoU, 67 per cent of MBS outlays are now subject to funding agreements offering the prospect of predictability of outlays over the medium term.
The Third Community Pharmacy Agreement contains a risk-sharing arrangement to protect both parties, to some extent, from volatility in the PBS estimates. Higher than forecast growth in prescription volume and average mark-up occurred in the PBS during 2000-01. This growth triggered the risk-sharing arrangement and consequently the pharmacists' dispensing fee was adjusted downwards from 1 July 2001.
Work continued with the medical profession to enhance the management of the diagnostic imaging and pathology agreements and to reinforce and improve the quality of services performed. The two-year extensions for the pathology and diagnostic imaging agreements have been set at the exit growth rates for the current agreements (both five per cent a year). Pathology fees were revised in February to bring expenditure back into line with agreement targets.
The work of the Pharmaceutical Benefits and Medical Services Advisory Committees is also important to the long-term sustainability of PBS
and MBS outlays. The assessment processes ensure that where cost benefit and evidence of effectiveness are poor, items are not included in the Schedules, ensuring the best possible use of the additional dollar. Nasal sprays were deleted from the PBS based on Pharmaceutical Benefits Advsory Committee (PBAC) findings that PBS funds on nasal sprays could be better spent on medications for patients with more severe illnesses.
Strategies have focused not only on listing and pricing but also on quality use of medicines. It is considered that improving the effectiveness and quality of prescribing is important to sustainable PBS outlays. Programs for the Quality Use of Medicines continued, including the publication of Australian Prescriber, grants programs, the work of the National Prescribing Service and the GP incentives payments under PIP. During 2000-01, an external review of Australia's consumer education activities was conducted. The results of the review have been incorporated into the 2001-02 Quality Use of Medicines Consumer Education budget initiative.
New arrangements were introduced in the 2000-01 Budget to help ensure that pharmaceutical benefits are only given to eligible recipients. The National Health Amendment (Improved Monitoring of Entitlements
to Pharmaceutical Benefits) Act 2000 was passed during the year. The new system is based on the use of the Medicare number on PBS prescription information provided to the HIC. It reduces the number of payments made, for example, to visitors from countries without a reciprocal health care agreement. The initiative is being phased in gradually with pharmacies beginning collection of Medicare numbers on PBS prescriptions in January 2001. Implementation of the final stage has been delayed until
1 May 2002.
As part of the tax reform package A New Tax System (ANTS), the Government announced a measure designed to stop overuse of the current
74
ACCESS TO MEDICARE
open-ended concessional fringe benefits tax (F BT) treatment available to public benevolent
institutions and certain other not-for-profit organisations. ANTS noted that a cap would be imposed on the value of concessionally treated fringe benefits that could be provided to employees of those organisations. To assist with
the transition to the revised arrangements, the Government provided funding of $240.5 million over three years (2000-01 to 2002-03) to public and private not-for-profit hospitals. Payments will be made on an annual basis. Payments for the 2000-01 financial year were made in May 2001.
Negotiations have been ongoing with diagnostic imaging providers to ensure that services paid for by Medicare are clinically relevant and of a high quality. As a result, growth in outlays covered by the Diagnostic Imaging Agreement was 4.2 per cent for the year, compared with expected growth of 6 per cent. The cumulative overspending of funds for the five year period covered by the Diagnostic Imaging Agreement declined to $53.2 million and is expected to be recouped by the end of the agreement in June 2003.
A review of Commonwealth legislation relating to pathology began during 2000-01, following invitations for public submissions. The draft report will be finalised in 2001-02 and its findings will inform policy direction in relation to pathology.
Following the completion of a review of Positron Emission Tomography (PET) in 2000, funding for PET services will be expanded under the Nuclear Medicine Imaging Agreement. The review recommended new arrangements for PET including a tender process to select a limited number of PET facilities to receive interim funding to enable further evaluation of PET services.
The review of the Health and Other Services (Compensation) Act 1995 was extended from its
75
scheduled conclusion in December 1999. The extension enabled an extensive analysis of the Health Insurance Commission 's (HIC) data, discussions with the advisory panel and key stakeholders, and development of options with considerable input by key stakeholders. The findings of the review were adopted as a
2001-02 Budget measure and will produce increased savings to Medicare as a result of improved administrative efficiency.
Integration strategies
The Department worked on ways to use Outcome 2 funding to seek a better integration of health care strategies across programs.
The Department began work with Victoria on implementation of pharmaceutical service reforms which improve equity of access for patients in the public and private hospital sectors, and improve the care for patients moving from hospital to community settings. Key elements of the reforms include the provision of access to the PBS for public hospital outpatients at discharge as well as access to PBS listed chemotherapy drugs for day patients. Work continues with other States and Territories that have indicated an intention to adopt the reform proposals.
To ensure the safe and effective prescribing and use of medications, a program of Domiciliary Medication Management Reviews was devised. The reviews involve collaboration between the
patient, their general practitioner, pharmacist and other members of the health care team, including community nurses. A new Medicare item will be introduced on the Medicare
Benefits Schedule to enable medical practitioners to participate with pharmacists in these reviews. A key feature of the development of this proposal was the joint work between doctors, pharmacists, consumers
and government.
VU ILVIVIt L
The Department has worked with the Health Insurance Commission, consumers, doctors, pharmacists and other interested organisations in developing the Better Medication Management System (BMMS) to create an electronic medication record. This will be a voluntary scheme, controlled by legislation, that shares medication information between prescribers, dispensers and consumers to improve health outcomes.
The purpose of the BMMS is to improve levels of access to information about consumers' medication to develop a safer prescribing and dispensing environment, which will result in reduced adverse drug outcomes and associated hospitalisations.
Professional Services Review (PSR)
The Professional Services Review arrangements are designed to ensure that cases, referred by the Health Insurance Commission involving practitioners suspected of engaging in inappropriate practice are investigated and, if necessary, reviewed by committees of practitioners' peers.
The arrangements focus on a practitioner's conduct to determine whether he or she has inappropriately rendered or initiated services which attract a Medicare benefit, or has inappropriately prescribed under the Pharmaceutical Benefits Scheme. Practitioners whose conduct may be examined under the arrangements are doctors, dentists, optometrists, chiropractors, physiotherapists and podiatrists. The PSR, as a statutory authority, produces its own annual report.
Since August 1999, a determining authority has assumed the role previously undertaken by the determining officer, under the PSR Scheme, in respect of all cases referred after that time. The Department continues to have a policy role in the scheme's operation and the determining officer within the Department continued to be
responsible, in 2000-01, for cases referred under the scheme prior to August 1999.
In 2000-01, 12 final determinations were issued by the determining officer. There are three cases referred to the determining officer awaiting final determinations. The determining officer did not take action on one case in which the PSR committee report did not contain a finding of inappropriate practice. The Professional Services Review Tribunal gave decisions on three cases involving requests from medical practitioners for review of the determining officer's final determinations. In the case of Dr Jessica Suk Yin Ho, the determining officer's decision was set aside and the Tribunal made its own determination to reduce the amount of medical benefits originally directed to be repaid. The Tribunal affirmed the determining officer's decision in the case of Dr Malcolm Adams Trail! and adjourned its hearing in the case of Dr Michael Joseph Christie.
The full Federal Court handed down decisions on appeals by Dr James Adrian Tankey and Dr Jean Fergus McFarlane against earlier court judgements. In both cases, the appeals were
dismissed with costs. Decisions on a further two appeals are awaited in the Federal Court.
Under-achievements
Forecasting Pharmaceutical Benefits
Scheme (PBS) outlays
Expenditure growth in the PBS in 2000-01 exceeded forecast levels. This was partly a result of prescriptions for two new medicines listed exceeding predicted levels. The two new medicines were Celebrex® (celecoxib), used in the treatment of arthritis, and Zyban®, a medication used to assist people stop smoking. There was also significant growth in the expenditure on the cholesterol-lowering group of drugs.
Two changes were introduced during 2000-01 to strengthen the PBS. Firstly, legislative changes
76
ACCESS TO MEDICARE
were enacted to allow appointments to the Pharmaceutical Benefits Advisory Committee (PBAC) to be made on the basis of expertise in specific areas and for members to be drawn from a wider pool of candidates. New members were appointed to the PBAC based on these criteria. The Department's capacity to advise the Government and the PBAC was also strengthened by enhancing resource allocation within the Department to deal with pharmaceutical issues, with a focus on pharmaceutical listing and pricing issues.
Better Medication Management System
The Better Medication Management System (BMMS) was a 2000- 01 Budget initiative with a planned implementation date of July 2001. The BMMS Development Group, made up of general practitioners, pharmacy and consumer stakeholders as well as government representatives, has made substantial progress on this initiative. However, the implementation of this measure has been delayed due to the need for continued development with stakeholders of the policy framework and the need to extend the development timeframe for desktop software. The draft Better Medication Management System legislation was released for public consultation and comment in May 2001.
Incentives for Quality Prescribing (IQP)
The IQP Program was a 1999- 2000 Budget measure designed to encourage practices to improve or maintain standards of patient care while reducing the rate of growth of prescribing costs in certain areas. There was a lack of support for the implementation of the IQP on a national level. A model has been developed to implement the program on a division by division basis, with a view to achieving full uptake over time. The proposal will now proceed on a trial basis.
77
UUilOI\lll: L
Performance indicators
Indicator 1: Client support for Medicare.
Indicator 2: Aboriginal and Torres Strait Islander access to Medicare.
Indicator 3: Percentage of Medicare services that are bulkbilled.
Indicator 4: MBS outlays per capita in rural and remote compared to other areas.
Indicator 5: Number of persons per approved pharmacy in Australia and the number of persons per pharmacy in urban areas compared with those pharmacies in rural and remote areas.
Indicator 6: Percentage of cost of PBS prescriptions covered by the Government.
Target: High levels of client support.
Information source/reporting frequency: Structured feedback through the HIC customer surveys.
Target: Increasing Aboriginal and Torres Strait Islander access to Medicare in accordance with need.
Information source/reporting frequency: Medicare benefits claimed by Aboriginal and Torres Strait Islander Health Services.
Target: Significant changes from current 71.4 per cent to be analysed.
Information source/reporting frequency: Quarterly Medicare Statistics.
Target: More equal distribution between localities.
Information source/reporting frequency: Annual HIC data.
Target: The ratio is similar for urban and rural and remote areas.
Information source/reporting frequency: Annual HIC data.
Target: Changes from 82.2 per cent to be analysed for underlying drivers.
Information source/reporting frequency: Annual HIC data.
78
Indicator 7: PBS outlays per capita in
rural and remote compared to other areas.
Indicator 8: Overall growth rates in Medicare outlays, including MBS, PBS and AHCA growth rates.
Indicator 9: MBS, PBS and AHCA and total Medicare outlays as a percentage of GDP.
Indicator 10: Departmental expenses (Health Insurance Commission and Department) as a percentage of administered expenses for Outcome 2.
Indicator 11: Commonwealth expenses per capita on Medicare, both total and by MBS, PBS and AHCA components.
ACCESS TO MEDICARE
Target: More equal distribution between localities.
Information source/reporting frequency: Annual HIC data.
Target: Growth rates slowing over time.
Information source/reporting frequency: Budget papers.
Target: Steady or declining percentage of GDP.
Information source/reporting frequency: Budget papers.
Target: Ratio of departmental to administered expenses is not increasing.
Information source/reporting frequency: Budget papers. Annual.
Target: Significant changes from the current levels of $359.84 for MBS, $182.91 for PBS and $310.11 for AHCA to be analysed.
Information source/reporting frequency: Budget Papers.
79
VU ILVIVIt L
OUTCOME 2 : FINANCIAL RESOURCES SUMMARY
'(A) (B)
Budget Actual Var iation
Estimate Expenses (Column B 2 Budget
2000/2001 2000/2001 minus 2001/2002
$'000 $'000 $'000
Adm inistered Expenses
Admin istered Item 1: Access to high quality & cost effective medical setvices for all Australians 3 Health Insurance Act 1973 - Medical Benefits 7,349,324 7,282,301 (67,023) 7,718,607
Total Special Appropriations 7,349,324 7,282,301 (67,023) 7,718,607
Appropriation Bill I /3 279,365 248,295 (3 1, 070)
Appropriation Bill 2/4 35,839 23,038 (12,801)
7,664,528 7,553,634
Administered Item 2: Access to high quality & cost effective medical services for all Australians National Health Act 1953 - Pharmaceutical Benefits 3,815,312 4,257,505 442, 193 4,564,636
National Health Act 1953 - Aids & Appliances (p) 53,875 58,858 4,983 59,301
Total Special Appropriations 3,869,187 4,316,363 447,176 4,623,93 7
Appropriation Bill 1/3 98,954 82,968 ( 15,986)
Appropriation Bill 2/4
3.968 141 4 399 331 43 1 190
Administered Item 3 : Access to public hospital services for public patients Health Care (Appropriation) Act 1988- National 79,542 69.689 (9,853) 66,576
health development - special assistance Health Care (Appropriation) Act 1988- Australian Health 6.128,040 6,133,181 5,141 6,517,868
Care agreements - provision of designated health services (p)
Total Special Appropriations 6,207,582 6,202,870 (4,712) 18,926,988
Appropriation Billl/3 15,449 9,737 (5,712) 432,329
Appropriation Bill 214 75,833 79,418 3,585 97,222
6,298,864 6,292,025 (6,839l 19,456,539
Total Adm inister ed Exl!enses 17,931,533 18,244,990 313,457 19,456,539
Departmental Appropriations
Healt h & Aged Care Output Group I - Services to the Minister & Parliament 13,019 13,828 809 28,307
Output Group 2 - National Leadership 9,434 9,428 (6)
Output Group 3 - Infonnation 15,626 15,765 139
Output Group 4 - Program Management 14, 119 14, 148 29 21 ,582
Output Group 5 - Regulatory Activity 4,500 4,497 (3)
Output Group 6 - Direct Delivery of Services 350,403 348,357 (2,046) 361,850
Total price of departmental outputs 407, 101 406,023 (1,078) 411,739
(total revenue (jym Government & other sourcesl
Total revenue from Government (appropriations) 406,778 404,983 (1,795) 411,361
contributing to price of departmental outputs Total revenue from other services 323 1,040 717 378
Total price of departmental outputs 407,101 406,023 (I ,078) 411 ,739
(!oral revenue (iom Government & other sourcesl
Total price of outputs for O utcome 2 407, 101 406,023 ( 1,078) 411,739
'total revenue t om Government & other sources)
Total est im ated resourcing for Outcome 2 18,338,634 18,651.013 312,379 19,868,278
t;.rice o.!: oute.uts & admin
I Tite Budget Estimate 2000/2001 includes the appropriations as per the 2000-2 001 Portfolio Budget Statements (PBS), 2000-2001 Portfolio Additional Estimates and Advances to the Finance Minister. This amount may differ to the revised estimates for 200012001 published in the 200 112002 PBS. Snch differences can arise from updated estimates and rephasings.
2 Budget prior to additional estimates. ·nte ruunber of output groups has reduced from 6 in 2000-2001 to 3 in 2001 -2002 . It is not possible to show direct comparatives
3 From 2001-02, the number of Administ ered Items have been reduced from three to one
80
Outcome 3: Enhanced quality of life for older Australians
Support for healthy ageing for older Australians and quality and cost-effective care for frail older people and support for their carers.
81
Outcome 3 is managed within the Department by the Aged and Community Care Division. The Department's State and Territory Offices also contribute to achieving this outcome.
The Aged Care Standards and Accreditation Agency also contributes in achieving this outcome, and produces its own annual report.
UUilUMt 3
Major achievements
Two Year Review of Aged Care Reforms
In July 1998, Professor Len Gray was appointed to undertake an independent review of the impact of the Structural Reform Package. Under the terms of reference for the review, Professor Gray was required to evaluate and report on the extent to which the Aged Care Act 1997 (the Act) was meeting its objectives and had addressed identified deficiencies of the previous system in relation to eight areas of interest: access, affordability, quality, efficiency, industry viability, State and Territory programs, choice and appropriateness and other considerations including dementia.
On 15 May 2001, the Government released the Report of the Two Year Review of Aged Care Reforms. In his report, Professor Gray drew the following overall conclusion:
'It is my conclusion, on completion of the review, that the reforms have delivered substantial improvements to the aged care system. The fine-tuning undertaken to smooth the implementation of the reforms and address unanticipated anomalies has been largely successful' (p.xxxi).
Professor Gray made seven recommendations; all of which the Government accepted in its published Government Response.
Progress with the National Strategy for an
Ageing Australia 1
The consultation phase and development of the Strategy has been completed.
Successful Completion of the Accreditation
process 2
All aged care homes have demonstrated a commitment to high standards of care, continuous improvement and improvement in building stocks. As at 30 June 2001, 100 per cent
' Relates to Indicator 7. 2
Relates to Indicator 1.
of all aged care homes were accredited and certified, with 92.8 per cent achieving accredit ation for the maximum period of three years.
Opening of the Commonwealth Carelink
Centre Shopfronts
Over 60 Commonwealth Carelink Centres were launched on 23 April 2001 along with the national Freecall number 1800 052 222 network.
Reforms to Home and Community Care
(HACC) Program to Focus on Outcomes
Major reforms were introduced into the HACC Program through new agreements with States and Territories. These agreements have provided for greater accountability, efficiency and quality assurance in the program.
Record releases of Aged Care Places in the
2000 and 2001 Allocation Rounds
Taking into account the requirements of special needs groups and increases in operational places, both residential and home based, the 2000-01 allocation rounds have been the largest ever. In the 2000 Round, a total of 14,174 places were allocated, which was the largest ever allocation of aged care places. In June 2001 there were 143,429 operational residential aged care places and 24,694 Community Aged Care Packages (CACPs) .
In April 2001, the Commonwealth announced that a further 9,541 new aged care places would be available for the 2001 Round. These comprised 8,391 places advertised for the 2001 Aged Care Approvals Round - 6,362 residential care places (including 750 places for restructuring), 2,029 CACPs (including 60 places for restructuring) and 400 packages for conversion from residential aged care to CACPs. An additional 400 packages were made available for conversion from residential aged care to CACPs. In addition, 1,150 places are available for emergency care, flexible care and Multipurpose Services.
82
Under-achievements
Home and Community Care (HACC) Program
No State or Territory submitted annual plans or business reports by the agreed date. The Department is attempting to improve on this process for the 2001-02 financial year.
Resident Classification Scale (RCS)
assessments
The number of RCS reviews completed in 2000- 01 was 9,300 compared to a projected number of 20,000. The under-achievement resulted from the use of the review officers in other compliance activity.
Outcome summary - the year in review The year has seen major progress in developing the focus on ensuring better outcomes for older Australians.
There has been increased awareness of the issues and implications arising from an ageing society. The development of the National Strategy for an Ageing Australia, which is expected to be completed in 2001-02, will identify the opportunities and roles for government, industry, consumer groups and individuals in responding to the challenges. It provides an opportunity for a whole of government approach to policy and program responses.
The aged care industry is responding well to their responsibility in providing quality care. The vast majority of providers has met accreditation and certification requirements for
residential aged care, whilst others h ave decided to leave the industry and sell their beds to providers who can meet the standards. Community care is progressing along a similar path with a focus on outcomes.
Good information is fundamental to outcome focused, consumer directed care. Considerable progress has been made on improving the
83
quality and availability of outcome data in aged care, including work to standardise data definitions and develop minimum data sets to provide relevant information.
Also, emphasis has been placed on providing good information about services to consumers. Information about residential aged care is being reviewed and improved and Commonwealth Carelink Centres have been established to provide information on community care.
An important aspect of quality care, is good coordination between the different areas of health and aged care. One area that is receiving particular attention is the need for older Australians to receive appropriate hospital care when required, including rehabilitation and discharge planning, for which the State governments are funded by the Commonwealth under the Australian Health Care Agreements. Work is progressing on investigating this challenging area.
Preparing for an Ageing Society
Building on the achievements of the International Year for Older Persons in 1999, the Office for Older Australians has continued the work to support the Government's National Strategy for an Ageing Australia.
The objective of the National Strategy is to provide a policy framework for governments, business, communities and individuals to meet the needs of Australians as they age .
During 2000-01 the consultation phase for the National Strategy3 was completed with the release of the final discussion paper on Attitude, Lifestyle and Community Support. This enabled
analysis of community consultation feedback and the commencement of drafting the broad framework document.
Related work included:
⢠working with business through the Business Mature Age Workforce Advisory Group to address the issue of employment for mature
3 Relates to Indicator 7.
UU ll.UIVIt j
age workers, and the economic benefits of retaining and retraining older workers;
⢠providing mature age design students with the opportunity to showcase their work and receive work placements with industry through the inaugural Student Design Awards commencing this year; and
⢠bringing the challenges and opportunities of population ageing to the attention of the broader community. The commissioning and release by the Minister of the Access Economics report Population Ageing and the Economy in March 2001 promoted the importance of Australia's mature age workforce to the continued growth of the nation.
The Office for Older Australians' website provides information on the matters being addressed in the National Strategy development process and supports the Office's role as a national foca l point on older people's issues.
Care Needs for Older Australians
Through Outcome 3, the Department has a primary role in providing the leadership and management for the care needs of older Australians. This leadership and management encompasses the support of healthy ageing for older Australians, quality and cost-effective care for frail older people and support for their carers. This work supports the Government's policy of, wherever possible, assisting people to live independently in their own homes and providing community care when needed. When this level of support is not sufficient, residential care is available.
Growth in Funding for Aged Care
Total funding for aged and community care has grown from some $3 billion in 1995- 96 to a projected $5.4 billion this year (2001--02) - an increase of 77 per cent. The 2001-02 Budget represents an increase of almost $600 million over and above 2000--01 funding levels (Figure 3.1).
Figure 3.1: Total Outcome 3 funding, 1995-96 to 2001-02
6000
5000
4000
c
.Q
E 3000 -2000
1000
Note: The $5.4 billion in budgeted funding for aged and community care for 2001-02 includes some $5 billion in the Health and Aged Care Portfolio Budget Statements, and a $462 million contribution to the residential care of veterans which appears in the Veterans' Affairs Portfolio Budget Statements.
84
FOR OLDER AUSTRALIANS
Figure 3.2: Commonwealth expenditure on aged residential and community care,
1995- 96 to 2001-02
Note:
Other $140m
HACC $423m
CAC Ps $33m
Re sidential care $2,464m
Total outlays $3.06bn
1995-96
Other $362m
CACPs $248m
Residential care $4,200m
Tota l outlays $5.43bn
2001-02
'Other' includes all other Outcome 3 spending aside from CACPs, HACC and Residential Care subsidies.
Over recent years the Government has emphasised community care, apportioning a greater share of a growing budget.
Figure 3.2 shows the changing composition within this total growth in funding. The Government has emphasised non-residential care options for older Australians including Home and Community Care (HACC) and Community Aged Care Packages (CACPs) as well as respite funding, dementia support, support for carers and other programs to support frail older people in the community.
The total growth in HACC plus CACPs over the six years since 1995-96 is some 89 per cent.
85
Community care
Community Aged Care Packages
Community Aged Care Packages (CACPs) are individually tailored low care services for frail older people who want to stay in their own homes.
The number of available Packages increased fo llowing the 2000 Aged Care Approvals Round. In that round, the largest ever, 6,532 new Packages were released, resulting in a total of
24,694, as at 30 June 2001, being available nationally. The release of a further 2,204 Packages was announced in April 2001. These will be allocated later in 2001.
UUilUIVIt j
Figure 3.3: Community Aged Care Package Funding, 1995-96 to 2001-02
250
200
c
.2
E 150
-100
50
Figure 3.3 shows a sixfold increase in funding for CACPs injected by the Government since 1995-96- an increase from $33.1 million in 1995-96 to $248 million this year (2001-02). As a result of the allocation of new places shown in Figure 3.3 above (inter alia) the appropriation for CACPs is continuing to rise strongly from $195 million in 2000-01 to $248 million in 2001-02- growth of $53 million or 27 per cent in a year.
This reflects the Government's emphasis on supporting frail older people at home in the community for as long as possible in line with the aspirations of older Australians (also see Figure 3.2).
Extended Aged Care at Home Packages
To complement CACPs which provide low level care, the Extended Aged Care at Home (EACH) pilot was established in 1998 to test the feasibility of providing high-level aged care to people in their own homes. In 2001, $8.4 million was spent
on this program. An evaluation of the EACH pilot was completed in 2001 with the aim of considering the future of this service delivery model. It found that EACH packages are economically viable, target recipients' needs effectively and are able to deliver a high level of care to people in their own homes provided clients are selected appropriately.
The evaluation also suggested that future work needs to be undertaken, including the development of quality standards and standards for financial reporting and information management, to further consolidate the EACH program.
The Government announced funding of $1.9 million over two years in the 2001-02 Commonwealth Budget to establish EACH as an ongoing program and for the continued development of its management and quality assurance framework.
86
FOR OLDER AUSTRALIANS
Safe at Home Initiative
Consumers consistently advise that a priority is to feel secure in their homes. The initiative tested the benefits of Personal Alert Systems (PAS), which are communication devices in times of need. The evaluation of the pilot was completed in late 2000 and an evaluation report submitted to the Department in January 2001. The broad findings of the evaluation were
positive about the potential benefit of PAS, particularly in reducing anxiety and complications associated with falls. There was some evidence to suggest that PAS may assist people to remain at home, when that is their preferred option, rather than moving to residential aged care. The 2001 Commonwealth Budget has provided funding to allow the Safe at Home program to continue. This is in addition to personal alert systems provided through the Home and Community Care Program and Community Aged Care Packages.
Day Therapy Centre program
Many changes have occurred in the delivery of aged care since the inception of the Day Therapy Centres Program in 1988, and are not necessarily reflected in the Program's current operations. Departmental officers visited a number of Day Therapy Centres during the year and confirmed
that there is a vast divergence in the type and quality of service being provided within the program. Visits also identified that some providers have introduced innovative approaches to the type of services they provide and delivery models.
Funding was increased in the 2001 Commonwealth Budget to identify innovative therapy approaches and to develop service delivery models.
Home and Community Care
Under the Home and Community Care (HACC) Program, care (including assistance with daily living activities) is provided in people's homes, which may delay or prevent the need for residential care.
87
The Commonwealth Government contributes approximately 60 per cent of HACC program funding nationally and maintains a broad strategic role. State and Territory Governments contribute approximately 40 per cent of program funding and manage its delivery.
In the five years to 2000-01 the Commonwealth has increased the funding available for HACC by 33.5 per cent or $142.3 million to $565 million in 2000-01. A total of $930 million of combined Commonwealth, State and Territory funding was provided nationally for the 2000-01 financial year, an increase of $65.5 million over the previous year.
The introduction during the year of the Veterans' Homecare Program by the Department of Veterans' Affairs has the potential to enable an extra 20,000 non veterans to access HACC services, as the veterans move to their own program.
Major reforms were also introduced in the HACC program through new agreements with States and Territories. These agreements have provided for greater accountability, efficiency and quality assurance in the program.
The new agreements have introduced output based funding which links the funds provided to services actually delivered to people, and have allowed for increased flexibility in service delivery enabling commercial operators to participate in the program.
To support the HACC reform agenda:
⢠the HACC Minimum Data Set, which will provide national information on the program, commenced live collection in January 2001. This information will allow
the program to be more responsive to the needs of the community; and
⢠measures of client dependency were developed and are under consideration in the context of developing a Common wealth care classification system for HACC.
VU II...VIVII: .)
Support for Carers - Respite
The National Respite for Carers Program continued to provide support for carers of frail older Australians and people with disabilities. Support has been provided in the following:
⢠$7 million recurrent funding was provided to Carer Respite Centres and Services to enable them to expand the coordination and delivery of flexible residential respite. This initiative aims to further assist carers by increasing the availability of residential respite care across government and private sectors;
⢠the National Dementia Behaviour Advisory Service freecall number 1300 366 448 was established. This service provides a 24-hour, free call telephone assistance line, managed by the Alzheimer's Association and answered by professionally qualified staff. The aim of the initiative is to assist carers and respite services to provide better care for people with dementia and challenging behaviours;
⢠Stage 2 of the Carer Education and Workforce Training Project commenced. Funded by the Commonwealth, the project is being implemented through a partnership between Alzheimer's Australia and the Carers Association Australia. The project will identify training needs and develop appropriate training packages for carers and the respite service workforce; and
⢠the Early Stage Dementia Support and Respite Project commenced. The objective of this project, which is funded by the Commonwealth and delivered by the Alzheimer's Association, is to provide support to people in the early stages of dementia and their carers.
Significant work has also been achieved this year in the development of an electronic reporting system for implementation next year in all Carer Respite Centres. The reporting system will provide data for more effective program information and policy formulation. Funding for the programs has increased from $19 million in 1996-97 to $73 million in 2001-02.
National Continence Management Strategy
Over one million Australians have regular or severe incontinence problems. This is a major reason for people entering aged care homes, especially where incontinence occurs in conjunction with frailty and/or dementia. This year the National Continence Management Strategy saw the completion of a number of major projects, including three pilot projects to trial improved management of incontinence in the community. The outcome of these projects is to provide the basis for initiatives in health professional education and awareness.
Two rounds of innovative grants were also approved (with 36 new projects now underway). The National Continence Helpline provided advice and resources to 9,188 people with incontinence, carers and health professionals.
Residential care
Care Standards Framework - Accreditation
An accreditation-based quality assurance system was introduced for aged care homes in the Act. Accreditation involves the management and staff of each aged care home analysing and adjusting the way the home operates, to ensure that its organisation systems respond to its changing needs in a way that results in continuous quality improvements.
Accreditation assesses the performance of homes against the four legislated Accreditation Standards:
88
⢠management systems, staffing and organisational development;
.------câ¢'inRI'i \:! co QOAt::ll r
FOR OLDER AUSTRALIANS
⢠health and personal care;
⢠resident lifestyle; and
⢠physical environment and safe systems.
The Accreditation Standards are standards for quality of care and quality of life for residents of Government subsidised homes.
A total of 2,938 aged care homes were accredited by the Aged Care Standards and Accreditation Agency (the Agency) by 1 January 2001, the date by which all homes had to be accredited in order to remain eligible for Commonwealth funding. A small number of homes failed to meet accreditation requirements by the deadline.
Under the Act the Secretary to the Department is able to determine, where there are exceptional circ*mstances, that an aged care home is taken to have met its accreditation requirements for a maximum period of six months from when the determination is made. A total of 21 homes were taken to have met the accreditation requirements, while they made the necessary improvements to become accredited by the Agenc y, or arrange an orderly closure.
One home was not accredited, was not granted an exceptional circ*mstances determination and closed .
By 30 June 2001 , a total of 2,950 homes had been accredited by the Agency. Of the 20 homes granted determinations in 'exceptional circ*mstances', 15 were subsequently accredited by the Agency, and four closed or relocated to new premises. One did not achieve accreditation.
Accreditation Standards Framework -Certification
Certification requirements set minimum standards of building quality for residential aged care. Certification is based on a principle of continuous improvement, and is linked to additional funding streams from both residents
and the Commonwealth. Residents in certified aged care homes can expect high quality and safe accommodation in return for their direct and indirect contributions.
During the financial year, over 200 Certification Assessments were undertaken. The average overall score was 87.45 out of a possible 100, with an average fire score 21.87 out of 25.
Since July 2000, all newly built aged care homes have had an average of 1.5 or fewer residents per room over a floor level' . There has been a decline in the average number of residents per room which reflects works carried out on homes to meet the 1999 Certification Assessment Instrument and the 2008 privacy and space requirements. This is indicative of improved resident privacy and amenity in aged care homes.
Compliance by Providers with Legislative
Requirements
The Department has continued a high level of support for homes that experience difficulties in complying with legislated care standards. In these cases, the Department, together with the Aged Care Standards and Accreditation Agency where appropriate, deals with each home to assist it to achieve and maintain the required standards. In these cases, the Department also ensures that residents of the homes, and their families or carers, are kept informed of developments which may affect the provision of services to them.
During the year, the Department took regulatory action against 207 homes, including sanctions against 27 homes and 199 notices of non compliance. Twenty-one homes were granted 'exceptional circ*mstances' determinations under s.42-5 of the Act. One unaccredited home was not granted exceptional circ*mstances. Four homes, which were not accredited on 1 January 2001, have closed. Their residents were assisted to move to suitable alternative accommodation of their choice.
⢠Relates to Indicator 2.
OUTCOME 3
Figure 3.4: Residential care funding, 1995-96 to 2001-02
4,500
4,000
35 ,00
3,0000
c: .Q 2,500 .E
- 2,000 1,500
1,000
500
9Jro :\
h" fd'OJ
OJOJ OJOj
" "
Funding
Residential care funding paid by the Commonwealth will rise from $2.5 billion in 1995-96 to $4.2 billion in the 2001- 02 financial year, an increase of $1.7 billion (Figure 3.4). This includes funding appropriated through the
Health and Aged Care portfolio ($3.7 billion in 2001-02) as well as funding for veterans in residential care appropriated through the Veterans' Affairs portfolio (totalling $462 million in 2001-02). These combined appropriations are paid as subsidies to aged care homes through the Health and Aged Care payment system.
Total residential aged care funding will increase by some $468 million from 2000-01 to 2001-02.
This significant funding growth is not presented as a Budget measure each year because it is a special appropriation which is legislated for under the Act. The special appropriation provides for ongoing growth in the program. As such,
annual funding increases are not separately announced as growth in budget funding. They are, however, real increases in Commonwealth Government funding for Residential Aged Care. This growth is presented in the Health and Aged Care and Veterans' Affairs Portfolio Budget Statements respectively.
Total funds available to aged care homes include resident fees and charges as well as the Commonwealth subsidies shown in Figure 3.4 above. The Commonwealth directly pays some three quarters of total funding to the sector. The remaining quarter is paid by permanent residents of aged care homes as a contribution to the cost of their accommodation, daily living costs and care.
Figure 3.5 shows that the total income to providers of residential aged care during the five years following the reforms is projected to increase from some $4.2 billion in 1997-98 to $6.0 billion in 2001-02- an increase of some 41 per cent.
90
..----c,YnHI'l r:o QOHl:l or [ft'E,_ __ ..,.
FOR OLDER AUSTRALIANS
Figure 3.5: Total income available to aged care homes in the five years following reforms,
1997-98 to 2001-02
c
·-E -
6000
5000
4000
3000
2000
1000
⢠Resi dent accommodation paymen ts and Commonwealth capita l funding
1997-98 1998-99 1999-2000 2000-01 2001-02
Capital Assistance
In the 2000 Aged Care Approvals Round, 65 residential aged care homes were allocated a total of $29.5 million in targeted capital assistance. Of this, $21.4 million (or 73 per cent) was allocated to 49 rural and remote aged care homes. These grants are to assist Providers who, as a result of their circ*mstances, are unable to meet the costs of necessary capital works through user contributions, particularly I in rural and remote areas
5 .
I Restructuring capital funding of $9.3 million
was allocated to 33 aged care homes to enhance their long term viability or to improve continuity of care in a region. Of this, $7.1 million (76.5 per cent) was allocated to services in rural and remote areas.
Rural adjustment grants of $1.5 million were separately targeted to small rural aged care homes to assist them in expanding or upgrading their buildings or for new homes to be
s Relates to Indicator 6.
91
established thereby increasing the number of aged care places in rural areas.
These three sources of funding support fire and other safety related improvements including kitchens and laundries, minor building upgrades and comparatively small scale works that were required for certification and accreditation, and
more extensive works such as the construction of extensions and new accommodation.
Allocation of Aged Care Places
The Commonwealth has in place a comprehensive planning framework to ensure that access to residential aged care places and Community Aged Care Packages (CACPs) is
related to the distribution of the population. The national targets are 100 residential aged care places and CACPs per 1,000 people aged 70 or over. The benchmark provides for 40
residential high care places, SO residential low care places and 10 CACPs for every 1,000 people aged 70 or over.
OOTCDIV1E 3
Figure 3.6: Residential places and CACPs released in Aged Care Approvals Rounds,
1995 to 2001
12000
10000 c
.Q
.E 8000 - 6000 4000 2000 0 Dec 95 May 97 Aug 98 In January 2001, the largest ever allocation of aged ca re places occurred, with a total allocation of 14,174 places. In June 2001 there were 143,429 operational residential aged care places and 24,694 CACPs . New allocations of aged care places are a significant driver of increased expenditure on aged care. Residential places and CACPs are increased directly in line with growth in the population of older Australians aged 70 or older. Figure 3.6 shows the release of new places since 1995. The figure shows significant increases in allocations of places as the Government has moved to meet and then exceed the target ratio of 100 aged care places for every 1,000 persons aged 70 or older. There are currently 111 allocated aged care places for every 1,000 older Australians6⢠At any one time, the number of operational places will differ from the number of places allocated because of the time required for resid ential allocations to become functional. With the introduction of time limits, the ratio ⢠Relates to Indicator 4. Nov 99 Year 2000
(al located Jan 200 1)
of allocated but not yet operational places has been steadily falling. As places allocated in 1999 and 2000 become operational, the ratio of operational places per 1,000 people aged 70 years and over is expected to move strongly to meet the benchmark in 2003 (taken together, the operational, approved and announced places would be sufficient to meet the benchmark ratio at the present time.)
Table 3.1 (page 94) shows the distribution of Residential Care Places and CACPs across Aged Care Planning Regions within each State and Territory.
In June 1985, there were 107,535 operating places. By June 2001, the number had increased to 168,122 an increase of 56 per cent.
In April 2001, the Commonwealth announced its intention to advertise a further 9,541 new aged care places in mid 2001. These comprised 8,391 places available for the 2001 Aged Care Approvals Round- 6,362 residential care places (including 750 places for restructuring), 2,029
FOR OLDER AUSTRALIANS
CACPs (including 60 places for restructuring). An additional 400 packages were made available for conversion from residential aged care to CACPs. In addition, 1,150 places are available for emergency care, flexible care and multipurpose services. These places will attract subsidy funding of $182.4 million in a full year once operational. This funding is guaranteed through the standing appropriation for residential and community aged care subsidies.
Resident Classification Scale (RCS)
Aged care providers are accountable for the subsidies they receive to give care to residents of aged care homes. Funding claims made by aged care homes are based on resident care plans, which are assessed by the homes
themselves. The Department checks that funding claims are justified to ensure that the individual in fact needs the level of care for which the subsidy is paid.
The Department has established an RCS Industry Liaison Group, which includes representatives of the industry and staffing groups to consult on potential improvements in the operation of the RCS. During the year this group completed a significant redevelopment of Chapter 5 of the Documentation and Accountability Manual and the Residential Care Manual. The group also recommended
modifications to some questions (the behaviour questions) of the RCS, which were accepted by the Minister for Aged Care and included in the amendments to Classification Principles on
15 June 2001.
During 2000-01 there were approximately 9,300 reviews of RCS appraisals completed. Of those reviews 6 per cent resulted in upgrading, 37 per cent resulted in downgrading, of which 6 per cent were appealed. On appeal, over half of the decisions were confirmed, with approximately one quarter reinstating the
93
original classification by the home. During the year, one home appealed to the Administrative Appeals Tribunal against the review classification of two care recipients. Of the nine cases outstanding at the commencement of the year, six cases have been finalised, one has had a full hearing and is awaiting a decision, and two are continuing.
Ageing in Place
Under the Government's aged care reforms, a policy of ageing in place was introduced which allows services, if they choose, to provide high and low level care in one service, as long as they provide the additional resources required under the Aged Care Act 1997. This means that services have the flexibility to meet a broader range of care needs, with more opportunities for older people to 'age in place', enabling a resident to move from low care to high care without changing homes. The strategy is aimed at enhancing the life of older Australians throughout their lives, by removing the previous requirement to move, for example, to another home when a resident's care needs increase from low to high care.
There is no requirement on aged care services to offer 'ageing in place'. Rather, it is an opportunity for providers to extend the range of care services they provide, and for residents to receive the care they need without changing their place of residence. It is a choice that providers must make in careful consideration of the financial, staffing and other implications.
The Department is developing new brochures and information sheets for providers and residents which describe ageing in place and what can be expected in a home that offers ageing in place. The Department is also
preparing a booklet for providers, which outlines various options for establishing ageing in place homes.
Table 3.1: Total operational and approved residential aged care places, Community Aged Care Packages and flexible
care places per 1,000 persons aged 70 and over by aged care planning regions, June 2001
Ratio of
operational and Ratio of Number of places released
approved places Operational places for allocation in 2001-02
Aged care planning region Residential CACPs Tot al Residential CACPs Total Residential CACPs Total
New South Wales Central West 105.7 13.1 118.8 96.8 12.5 109.3 10 10 20
Central Coast 84.3 15.9 100.1 61.0 15.2 76.2 260 25 285
Fa r North Coast 89.5 14.9 104.4 73.0 14.9 87.9 140 140
Hunter 91.2 12.9 104.1 80.4 12.6 93.0 100 15 115
lllawa rra 82.4 16.3 98.7 69.6 14.8 84.4 200 30 230
Inner West 128.9 16.9 145.8 122.1 15.6 137.7 40 56 96
Mid North Coast 82.1 14.9 97.0 65.9 14.6 80.5 250 10 260
Nepean 102.4 15.8 118.2 85.6 15.8 101.5 60 60
New England 92.2 17.8 110.0 85.9 16.7 102.6 10 10
Northern Sydney 105.6 11.2 116.8 99.4 10.9 110.3 60 20 80
O ran a Far West 90.1 17.1 107.2 82.9 16.4 99.3 15 10 25
1..0
"""'
Riverina/Murray 89.0 15.4 104.4 79.7 15.0 94.7 10 10 q
So uth East Sydney 80.4 17.1 97.5 73. 1 16.1 89.1 120 82 202 $l m
South West Sydney 89.6 15.5 105 .1 79 .1 14.6 93.7 90 45 135 w
So uthern Highlands 92.0 13.8 105.8 68.5 11.9 80.4 71 20 91
Western Sydney 101.5 14.6 116.1 90.5 13.6 104.1 80 45 125
State pool 245 190 435
State total 94.3 15.2 109.5 82.6 14.2 96.8 1, 761 558 2,319
Victoria Barwon-Southwestern 91.8 16.0 107.8 76.2 15.8 92.0 110 110
Eas tern Metro 93.7 14.1 107.8 85.2 13.5 98.7 80 so 130
Gippsland 90.1 14.6 104.6 70.8 13.2 84.0 170 36 206
Grampians 99 .3 15.3 114.6 94.1 15.3 109.4 10 10
Hume 93.2 14.4 107.7 80.8 13.4 94.3 80 80
Loddon-Mallee 95.7 14.0 109.7 86.7 12.6 99.4 60 40 100
Northern Metro 90.0 14.3 104.3 73.5 13.7 87 .2 130 35 165
Southern Metro 88.2 14.2 102.4 73 .6 13.7 87.3 290 so 340
Western Met ro 94.9 15.4 110.3 75.8 15.4 91.1 140 140
State pool 324 161 485
State total 93.1 14.9 108.0 78.4 14.0 92.4 1,394 372 1,766
U'1
Queensland Brisbane North Brisbane South
Cabool Central West Darling Downs Far North
Fitzroy Logan River Va lley Mackay North West Northern South Coast South West Sunshine Coast
West Moreton Wide Bay
State pool State total
Western Australia Goldfields Great Southern Kimberl ey
Metropolitan East Metropolitan North Metropolitan South East Metro politan So uth West Mid Wes t
Pilbara So uth Wes t Wheatbelt State pool State total
South Australia Eyre Peninsul a Hi ll s, Mallee and Southern Metropoli tan Eas t Metropolitan North Metropolitan South Metropolita n Wes t Mid North
111.3 91.3 83.6 80.4 100.2
92.7 108.9 82.2 93.9 105.4 109.5
85.8 113.2 88.5 105.7
89.8
95.4
143.4 87.7 149.7 114.9
82.5 114.1 85.1 75.8 114.6
83.5 80.8
96.4
8 7.1 82.4 131.9 85.6
85.8 80. 3 90.3
13.2 11.2 12.0 49.8 15.0 18.8 20.6 11.6 14.8 52.4
15 .1 15 .2 53 .3 12.3
9.2 14.0
14.6
32.3 15 .6 52.4 15.5
12.5 15.5 12.7 18.5 78.5 17.9 18.2
15.6
21.0 15.8 11.6 16.0 15 .3 16.6 15 .3
124.5 102.4 95 .6 130.1 115.2 111.5 129.6
93.8 108.8 157.8 124.6 101.0 166.5 100.8 114.9 103.9
110.0
175.7 103.3 202.1 130.3
95.1 129.6 97.8
94.3 193.1 101.5 99.0
112.0
108.1 98.2 143.4 101.6 101.1
97.0 105.5
109.1 85 .4 74.0 67.0 94.4 85.5 94.2 71.3 89.8 97.1 104.3
74.8 103.0 78.9 103.9
81.4
87.8
132.4 77.6 121.5 109.7
72.9 108.8 72 .3 70.2
76 .9 74.1 65 .8
85.7
81.7 56.2 129.8 63 .7
81.8 73.9 80.0
12.8 11.0 11.3 42.1 15.0 17.0 19.0 10.7 14.8 40.5 13.5 14.8 53 .3 12.0
9.2 14.0
13.6
28.5 13.2 52.4 15 .5
12.0 15.5 11.4 17.7 78.5 17.9 17.5
14.6
21.0 15.0 11.1 16.0 13.6 16.6
8.3
122.0 96.4 85.3 109.1 109.4 102.5 113.2
82.0 104.7 137.6 117.8
89.7 156.3 90.9 113.1
95.5
101.4
160.8 90.8 173.8 125.2
84.9 124.3 83.7 88.0 155.4
92.0 83.2
100.3
102.7 71.3 140.9 79.7
95.4 90.5 88.3
20 so 90
25 40 so 100
30
40 200
200 20 80 85
1,030
20 205 40 157
40
210 672
110
154 20 lOS
15 10 15
15 20 10
10 15
10
137
257
15
21
40
59 135
10
62
25
35 60 105
25 55 70 110
30
so 215
210 20 80 222 1,287
15
20 226 40 197
40
269 807
120
154 82 lOS 25
"T1
r-l'l
m ':j
::o.(j )>(j s;)
-1
::::0 )>
Table 3.1 : Total operational and approved residential aged care places, Community Aged Care Packages and flexible
care places per 1,000 persons aged 70 and over by aged care regions, June 2001 (cont)
Ratio of
operational and Ratio of Number of places released
approved places Operational places for allocation in 2001-02
South Australia (cont) Riverland 97.2 13.4 110.7 76.3 13.4 89.7 18 18
South Eas t 79.8 15.4 95.2 63.8 13.4 77.2 12 12
Whyalla, Flinders and 85.8 25.5 111.3 83.1 25.5 108.5
Far North Yorke, Lower North and 85.7 15.6 101.3 78.4 15 .6 93.9 30 30
Baros sa State pool 65 25 90
State total 94.6 15.4 110.0 85.1 14.5 99.6 502 134 636
Tasmania North Western 88.2 15.7 103.8 82.6 14.9 97 .5 23 23
Northern 92.2 15 .2 107.5 80.4 14.8 95.1 44 44 (j
Southern 97.2 14.3 111.5 85.5 14.3 99.8 8 8 a
1.0 State pool 48 41 89
(.l
0'\ State total 94.7 15.8 110.5 83.3 14.6 97.9 123 41 164 Cl
Australian Capital Territory
n
Australian Capital Territory 90.1 19.3 109.3 82.6 18.4 101.0 70 6 76 u
Territory tota l 90.1 19.3 109.3 82.6 18.4 101.0 70 6 76
Northern Territory Alice Springs 191.1 142.2 333.3 191.1 142.2 333.3
Barldy 118.1 131.9 250.0 118.1 131.9 250.0
Darwin 111.3 42.3 153.6 72.9 41.7 114.6
East Arnhem 71.9 274.5 346.4 71.9 274.5 346.4
Katherine 245.7 145.3 391.0 245 .7 103.8 349.5
Territory pool 60 66 126
Territory total 149.9 97.2 247.1 109.8 77.7 187.5 60 66 126
National pool Restructuring 750 60 810
Conversions 400 400
Fl exibl e, innovative or emergency care 625 175 1,150
National pool total 1,375 635 2,360
Australia- all places 95.3 15.7 111.0 83.0 14.3 97 .3 6,987 2,204 9,541
The fl ex ible, innovative or emergency ca re total includes 350 flexible care places which ca n be all ocated as either residential care or Community Aged Care Packages.
FOR OLDER AUSTRALIANS
Aged Care Assessment Program
The Commonwealth provides grants to State and Territory Governments specifically to operate Aged Care Assessment Teams (ACATs). In 2000-01, $38.1 million was provided to fund
124 teams nationally. ACATs are teams of health professionals who provide expert assessment and advice for people seeking access to aged care services. The main professional groups represented on ACATs are geriatricians, social workers, nurses, physiotherapists, occupational therapists, psychologists and psychogeriatricians.
People need to be assessed as eligible by an ACATs before they can receive Commonwealth subsidy for residential care, a CACPs, or flexible care. ACATs assess the whole care needs of an individual, using a multi-disciplinary and multi dimensional approach. As part of the holistic assessment process, a person's medical, physical, social, psychological and restorative care needs are assessed before a care approval is made.
ACATs play an important role in maintaining the balance of care between residential and community care. In recent times, ACATs recommendations for long term care in the community have exceeded those recommendations made for long term care in residential care. In 1999-2000, 48.5 per cent of ACATs recommendations for longer-term living arrangements were for community based living, including CACPs, while 43.4 per cent were
recommended for residential care' .
The Act establishes the rights of people to appeal against some ACATs decisions, such as the decision to approve or not approve a person to receive a type of care. Of a total 183,584 ACATs assessments in 1999-2000, 30 appeals were received and only four of these resulted in a different ACATs decision.
The Commonwealth, States and Territories are involved in a review of assessment practices
7
Relates to Indicator 5.
97
through the Australian Health Ministers' Advisory Council. This review will consider whether current assessment practices, including those undertaken by ACATs, are effective in matching patient needs to appropriate care services.
Workforce
As part of its response to the Productivity Commission Report, the Commonwealth has provided $1 million over two years from industry restructuring funds to invest in initiatives to address workforce issues faced by the aged care sector. In this way, the Commonwealth has assisted in providing leadership to support the industry, in helping to promote the aged care nursing workforce and lift its profile and professionalism, in assistance with the retention of the existing workforce and to attract new entrants to that workforce.
The inaugural Minister's Excellence in Aged Care Awards recognised and rewarded the pursuit of a culture of professional excellence. It is expected that this search for the 'best of the best' will become an ongoing feature in aged care to maintain the drive for excellence. The Awards were well regarded by the industry as an initiative to promote the aged care sector and there were 130 applications.
Research is being undertaken by Latrobe University to identify why qualified nurses are leaving aged care and working in professions other than nursing and what needs to be done to encourage those nurses to return to the aged care sector.
To further build community confidence in the aged care industry, a voluntary Code of Ethics and Guide to Ethical Conduct for Residential Aged Care has been developed as an initiative under the Minister's National Aged Care Accreditation and Compliance Forum. This was launched on the 13 August 2001. The Code sets out the ethical commitments made by the aged care sector
regarding care for the frail aged, and sets out
.-------oo I COIVIE::--.r------.
guidelines to the sector, its staff and those working with the frail aged for ethical conduct.
A Forum Working Group is exploring options to enhance the qualifications of Level IV aged care workers, especially around safer medication administration practices.
Empowering consumers in the aged care system
Advocacy Services
The Department funds Residential Aged Care Advocacy Services in each State and Territory to provide independent, individual advocacy case management for residents. The services play a significant educative role for residents and providers on the rights and entitlements of care recipients and complement the role of the Complaints Resolution Scheme.
The residential Aged Care Advocacy Program developed its first national Strategic Plan for the years 1999-2002. The Plan provides a blueprint for action to guide and support the program in a changing environment. The Advocacy Program has continued to be a vital element in supporting residents' rights, offering consumer protection in the current aged care environment of accreditation and continuous improvement.
Community Visitors Scheme (CVS)
The CVS was introduced to improve the quality of life of residents of aged care services who:
⢠have limited family and social contact; and
⢠may be at risk of isolation from the general community for social or cultural reasons, or through disability.
Steps to enhance national administration and consistency within the Scheme have been taken and will continue, together with improved national promotion of the Scheme.
Extra funding was provided in the 2001 Commonwealth Budget for the Advocacy Services Program and the CVS. Extra funds were also made available as a one-off payment to CVS services, in response to the increased target group resulting from the inclusion of low-care services in the CVS. Future directions include developing a national administrative structure, greater consistency of standards of service and support within the Scheme, and examining corporate sponsorship as an extra source of CVS funds.
Commonwealth Carelink Centre Shopfront
Program
Commonwealth Minister for Aged Care, Bronwyn Bishop launched the national Commonwealth Carelink Centre Shopfront Program and the freecall number 1800 052 222 network in Sydney on 23 April 2001. The Carelink Centres aim to provide general practitioners, other health professionals, service providers, individuals and their carers with a single point of access for information about community care, residential and other aged care support services.
Commonwealth Carelink Centres can offer older Australians, people with disabilities, their carers and families, general practitioners and other health professionals, information about service providers who deliver community, aged care, disability and other support services in their local region.
The information provided by centres can assist people with their choice to remain living independently in their own homes. For those who wish to enter an aged care home either for respite or long term care, centres can also provide information that will assist people to find out how to be assessed for these services.
The Government's initiative to establish the centres was in response to the Prime Minister's commitment to advance the quality of health
98
care delivered to older Australians. Over the next four years, $41.2 million will be provided for the initiative. There are over 60 Commonwealth Carelink Centre Shopfronts nationwide.
The Centres will be of particular benefit to rural Australians who will gain a single point of access to information about a disparate range of community and residential aged care services. They will also provide over 100 employment opportunities in rural and regional areas.
For more information on the Commonwealth Carelink Centre Program, visit the Commonwealth Carelink Program website at www.commCarelink.health.gov.au or contact the freecall number, 1800 052 222.
Aged Care Complaints Resolution Scheme
Media and public interest in the operation of the Scheme has continued and an increase in the complexity of complaints being handled is evident. In response the Government appointed the Commissioner for Complaints (the Commissioner) to oversee the Scheme. Legislation to establish the statutory role of the Commissioner was made on 31 August 2000.
The Commissioner's role is set out in the Committee Principles 1997. In addition to chairing Complaints Resolution Committees, the Commissioner's functions are to:
⢠supervise the chairpersons and other members of the Complaints Resolution Committees;
⢠coordinate and review complaints received;
⢠oversee the effectiveness of the Scheme;
⢠deal with complaints about the operation of the Scheme;
⢠manage the Determination process, including reviews of Determinations;
⢠promote an understanding and acceptance of the Scheme;
99
⢠advise the Minister for Aged Care on matters relevant to the operation of the Scheme;
⢠give regular reports to the Secretary to the Department of Health and Aged Care and the Minister about issues arising out of complaints dealt with under the Scheme; and
⢠annually review, and report to the Minister about the operation of the Scheme.
The Department has undertaken a full review of all procedures in order to increase the Scheme's effectiveness and efficiency.
As a result of the review, the Scheme has:
⢠developed a revised procedures manual for use by all Scheme staff;
⢠developed and implemented a comprehensive training program for all existing and new complaints handling staff;
⢠embarked on a program of enhancement/development of the Scheme's complaints handling database; and
⢠negotiated and begun implementing a comprehensive series of Memoranda of Understanding with a diverse range of external bodies to facilitate effective referral of complaints about issues over which the Scheme does not have jurisdiction.
Over the last 12 months the Scheme received approximately 1,700 new complaints. Of these, 64 per cent were lodged as open complaints, 27 per cent as confidential and 9 per cent as anonymous. Of all complaints handled by the scheme, 97 per cent related to aged care homes.
During the year, there were 180 referrals for the investigation of aspects of complaints to the Aged Care Standards and Accreditation Agency; 10 to the police or coroner; and 32 to State or Territory health authorities.
VU II...VIVIC .:>
Communication
To further assist in the development of appropriate information products and enhance communications with the aged care sector; a Consumer Working Group was established, comprising representation from key consumer organisations. An initial task has been to review and improve current information products.
Recognising People with Special Needs
Rural Services
Aged care has been a strong performer in the delivery of services to rural and remote areas and the Department has worked closely with older Australians in rural and remote areas to improve access to aged care services.
Over a third of aged care places are already located in rural and regional Australia, approximately equivalent to the proportion of older people living in these areas8⢠More than 6,200 additional places and $28.7 million in capital grants from the 2000 Aged Care Approval Round were directed to regional, rural and remote areas. This represents 44 per cent of the new places and 7 4 per cent of the capital grants in the Round.
Rural Review
The Government has recognised that communities in rural and regional Australia need greater flexibility and responsiveness in the way they deliver services. The 1999-2000 Commonwealth Budget provided funding of $5.3 million over four years to review the aged care planning process for rural and regional Australia 9⢠The objective of the review was to ensure that aged care services are structured in ways that best meet the needs of local communities.
The Review is structured around three objectives:
⢠planning - to improve the Department's planning capacity for rural areas. This focus
'·' Relates to Indicator 6.
will be on small rural and remote communities at a sub-regional level, but also included communities in the urban fringe;
⢠funding - to improve the viability of rural services, by developing a fair way of distributing the extra viability moneys from the 2000-01 Commonwealth Budget; and
⢠information - to improve the information on rural performance of aged care to develop more effective strategies for access to and quality of services.
A number of projects were initiated in 2000-01 to address these objectives. These include a detailed internal review of the Department's planning system in which more strategic approaches were identified to address the diverse range of aged care needs in rural and remote areas and the issues raised by the Australian National Audit Office report. This report made a number of recommendations, including reassessing strategies for eliminating regional inequities, in particular, between metropolitan and rural areas and taking into account the State government planning process. Consistent with a finding of Professor Gray's Two Year Review of Aged Care Reforms, the Department also developed and implemented a new methodology for determining eligibility for viability supplements, under which the number of aged care homes receiving viability funding increased from 211 to over 500, effective from
1 January 2001. Several other activities were aimed at producing better information on aged care's rural performance. These included improving the mapping of aged care service provision, identifying good care delivery by rural services and analysing Australian and international research on aged care. The main investigative work has been completed and the review is expected to report on its findings during 2001-02.
100
Flexible Aged Care
Flexible care services are available for older Australians who live in regional, rural or remote parts of the country10 ⢠The services focus on innovative and viable solutions that suit local situations and extend the distribution of aged care to areas where it would otherwise be financially viable to provide aged care services. They include:
⢠Multipurpose Services;
⢠Regional Health Services Centres; and
⢠flexible services for Indigenous Australians.
Multipurpose services
The Multipurpose Services (MPS) model provides economies of scale for small rural and remote health and aged care services and permits communities to decide on the range of services they require. As at 30 June 2001, there were a total of 56 operational MPS sites with
1,223 flexible aged care places. This is nearly a 10 per cent increase in the number of services and places in the last 12 months" .
Dement ia Care''
Key initiatives in supporting people with dementia and their carers include:
⢠ongoing funding for the Dementia Education and Support Program, providing education and support services to people with dementia and their carers. It provides a first point of contact through the Dementia Helpline for people with dementia;
⢠implementation of the Carer Education and Workforce Training Program which provides coordinated national education and training for carers and respite workers who are caring for people with dementia and challenging behaviours;
⢠introduction of the National Dementia Behaviour Advisory Service to provide 24-hour, seven day a week health
Table 3.2 : Provision of aged care services, as at 30 June 2001, persons aged 70 years and
over (SO and over for Indigenous persons) appropriate to proportion of the population
People from diverse cultural and linguistic Indigenous People residing in backgrounds Australians rural and remote areas
% % %
High care 13.29 0.72 24.97
Low care 9.70 0.68 31.41
CACPs 19.46 2.81 29.49
Total - residential care and CACPs 12.66 0.98 28.17
Home and Community Care' 13.03 2.41 35 .60
Population 70 and over' 18.70 2.32 29.82
1 Estimated from the 1998 HA CC User Characteristics Survey and the hours of service provided in 1999- 2000. 2 The data on the proportion of the above groups in the gen eral population is based on: (1) country of birth, estimated from the 1996 census, (2) the 2001 Experimental Aboriginal and Torres Strait Islander Population Projections, and (3) the 2001 general population projections.
" Relates to Indicator 6. "·1' Relates to Indicator 6.
101
------,om IVIE 3-----.......,
professional telephone support for carers of people with dementia and challenging behaviours;
⢠establishing the Early Stage Dementia Support and Respite Project, a nationally coordinated support and respite service for people in the early stages of dementia and their carers;
⢠ongoing support for Psychogeriatric Care Units (PGUs) . PGUs provide expert assessment, diagnosis, advice and training services to older people living with dementia and challenging behaviours and their carers, aged care homes and Aged Care Assessment Teams (ACATs). PGUs are not aged care homes, but are advisory services for existing residential care providers; and
⢠ongoing support for Aged Care Assessment Teams (ACATs). ACATs are teams of health professionals who provide expert assessment and advice for people seeking access to aged care services. The main professional groups represented on ACATs are geriatricians, social workers, nurses, physiotherapists, occupational therapists, psychologists and psychogeriatricians.
Aged Care for People from Culturally and
Linguistically Diverse backgrounds
Each year, the Aged Care Approvals Round specifically targets a proportion of new places to meet the needs of ethnic communities. Almost 1,800 places were allocated to aged care services for ethnic older people between 1996 and 1999.
In the 2000 Approvals Round, 1,091 places were allocated nationally for services for people from culturally and linguistically diverse backgrounds 13 â¢
In addition, the Government is providing grants to a range of different communities and organisations to help build linkages between
" Relates to Indicator 6.
ethnic communities and aged care providers. The Partners in Culturally Appropriate Care Projects and the Ethnic Aged Services Grants are enabling older ethnic people and organisations to participate more actively in the planning and delivery of services.
Currently, there are 160 ethno-specific aged care homes covering 34 major ethnic communities, and 118 clusters of clients from 29 communities within mainstream aged care homes.
The Government sponsored the publication by the Australian Institute of Health and Welfare, Projections of Older Immigrants -people from culturally and linguistically diverse backgrounds,
1996- 2026 which was released in June 2001. These projections will assist the Department, the aged care industry and the community sector to evaluate and prioritise current and future initiatives in ethnic aged care.
The 2001 Commonwealth Budget allocated $6.1 million over four years to improve the access to high quality aged care services for the increasing culturally and linguistically diverse population in Australia. These funds will be used to support existing services and increase the capacity for an extension of services, particularly in rural and remote areas.
Veterans and War Widows
On 15 August 2000, the Minister for Aged Care approved veterans and war widows as a 'Special Needs' group under the Act. The decision to designate veterans and war widows as 'people with special needs' was recommended in a report produced by the National Ex-Service Round Table on Aged Care entitled A Last Debt. The amendments to the Aged Care Allocation Principles 1997 were gazetted 29 May 2001.
The Report pointed out that veterans as a group are ageing faster than the average population. The numbers of veterans in need
102
of aged care will increase by 80 per cent in the next ten years and will peak around 2007 befo re declining. Designation as a 'Special Needs Group' will mean a deliberate focus on veterans' aged care needs in the planning of aged care provision and t he allocation of new aged care places.
Information targeting the needs of veterans was provided to Aged Care Planning Advisory Committees for consideration in recommending· the release of new aged care places in the 2001 Aged Ca re Approvals Round .
Aboriginal and Torres Strait Islander Peoples
Aboriginal and Torres Strait Islander people comprise 2.35 per cent of the total aged care population. In general, they are affected at an earlier age by disability and declining function. For these reasons planning of aged care places for Indigenous people is based on the number who are over SO years of age, rather than those over 70 yea rs of age, which is used for the rest of the population1' .
The Aboriginal and Torres Strait Islander Aged Care Strategy funding is provided for Aboriginal and Torres Strait Islander aged care homes to use a flexible approach to meet the special needs of this group, particularly those people in rural and remote areas.
The Strategy allows for the establishment of new services · as well as the reconfiguration of existing mainstream aged care services to change the mix of high, low and community care being provided in order to better meet community needs. The Department is now directly funding 23 flexible aged care services for Aboriginal and Torres Strait Islander communities.
A further 31 aged care homes are either operated under the auspices of Aboriginal and Torres Strait Islander organisations or are targeted to this group. All 31 services achieved
accreditation. The Department contracts Aboriginal Hostels Limited to provide ongoing support and assistance to ensure the services in rural and remote areas continue to be viable
(Table 3.3).
While residential care is an important part of aged care services for non-Indigenous people, Aboriginal and Torres Strait Islander people generally prefer to stay in their community and be cared for by members of their community, rather than seeking residential based aged care services. Nearly 3.0 per cent of Community Aged Care Packages funded by the Department in 2000-01 were provided to Indigenous Australians, whereas Aboriginal and Torres Strait Islander people account for 2.3 per cent of the target population.
Table 3.3: Number and distribution of Aboriginal and Torres Strait Islander res idential
aged care places and CACPs
Aboriginal and Torres Aboriginal and Torres Strait Islander Strait Islander
flexibe care places residential
Places (n=23) aged care places (n =31) Total
High care (nursing) 131 280 411
Low care (hostel) 164 363 527
CACPs 94 0 94
1 ⢠Relates to In dicator 6.
103
------om CO !VIE
Assistance with Care and Housing for the
Aged
The Government also recognises that people who are socially and financially disadvantaged may have difficulty accessing appropriate care services. The Commonwealth's Assistance with Care and Housing for the Aged (ACHA) program is designed to meet both care and accommodation needs for aged people on very low incomes whose accommodation is tenuous or unsuitable.
The primary role of the program is to link clients to appropriate mainstream housing and care services. ACHA plays an important role in assisting mainstream services to recognise and meet the needs of this target group.
In 2000-01 the program funded 46 projects nationally from an allocation of $2.6 million. The funding to each project varies according to identified community need. Most projects are located in inner city areas where there is a concentration of frail elderly people living in insecure accommodation.
Evaluation and Accountability
Ministers Report to Parliament on the
Aged Care Act
Under Section 63.2 of the Act, the Minister is required to table in Parliament a report on the operation of the Act for each financial year. The report must provide information on:
⢠the extent of unmet demand for places;
⢠the adequacy of the Commonwealth subsidies provided to meet the care needs of residents;
⢠the extent to which providers are complying with their responsibilities under the Act;
⢠the amounts of accommodation bonds and accommodation charges charged;
⢠the duration of waiting periods for entry to residential care;
⢠the extent of building, upgrading and refurbishment of aged care homes; and
⢠the imposition of any sanctions for non compliance under Part 4.4, including details of the nature of non-compliance and the sanctions imposed.
The Report is not limited to these issues. The Report is prepared from data collected by the Department through its information systems.
Information is also collected from the Aged Care Standards and Accreditation Agency, Complaints Resolution Committees, Aged Care Assessment Team data and Departmental records. The Department undertakes a survey of approved providers regarding accommodation payments and the extent of building activity.
Two Year Review of Aged Care Reforms
In July 1998, the Government commissioned Professor Len Gray to undertake the Two Year Review of Aged Care Reforms. In undertaking the review, Professor Gray, supported by an expert advisory group, was required to evaluate and report on the extent to which the Act is achieving its objectives and addressing the acknowledged deficiencies of the previous aged care system. The terms of reference of the Review related to the impact of the 1997 reforms on eight identified areas: access, affordability, quality, efficiency, industry viability, State and Territory programs, choice and appropriateness, and other considerations including dementia.
In conducting the Review, Professor Gray consulted widely with the aged care industry and the broader community. He conducted a series of nation-wide focus group consultations, called for written submissions, and undertook a detailed program of data collection and analysis. In order to ensure the currency of the input from the industry and stakeholder groups, Professor Gray
104
concluded the Review with a final series of targeted consultations in all States and Territories.
Two progress reports were released, in January 1999 and January 2000. In May 2001, Professor Gray presented his final Report to the Minister for Aged Care. In his Report, Professor Gray stated:
'It is my conclusion, on completion of the Review, that the reforms have deli vered substantial improvements to the aged care system. The fine-tuning undertaken to smooth the implementation of the reforms
and address unanticipated anomalies has been largely successful' (xxxi).
Professor Gray made seven recommendations for further fine-tuning of the aged care system, all of which were accepted by the Government. The Government Response and the Report of the Two Year Review of Aged Care Reforms are available from the Department and through the Department's website (www.health.gov.au/acc).
Aged Care Data
The Department has continued to support the dissemination of information about aged and community care services through the provision of data and statistics to external agencies such as the Australian Institute of Health and Welfare and the Productivity Commission. For example, the Department made a major contribution to the Aged Care chapter of the Report on Government Services 2001 which was published by the Productivity Commission on behalf of the Steering Committee for the Review of Commonwealth/State Service Provision.
Other Initiatives
International
The Government and the Department have been active in showcasing Australia's aged care system and policies. The Office for Older Australians
105
participated in a delegation to China in July 2001 to facilitate the development of China's aged care policies. The Minister for Aged Care lead a trade mission to Singapore and Malaysia in November 2000 - a second successful trade mission to Asia. The short report of the Comparison of Aged Care in Australia and Japan was published in February
2001. Australia, in partnership with the World Health Organization facilitated a healthy ageing workshop in November 2000, bringing together policy workers and academics from the Asia-Pacific region.
Awards for Older Australians
The Department continues to oversee three sets of awards instigated by the Minister for Aged Care during the 1999 International Year of Older Persons. These awards recognise and increase community awareness of older Australians as vital, contributing members of our community:
⢠Senior Australian of the Year Award, administered by the National Australia Day Council;
⢠Commonwealth Media and Advertising Awards, which recognise excellence in the portrayal of older Australians and are administered by Older People Speak Out Inc.; and
⢠Commonwealth Recognition Awards, where up to ten recipients may be honoured in each Commonwealth electorate in recognition of the significant contributions that senior Australians have made, and continue to make, to their local communities.
Research
To facilitate participation in the community by older Australians, the Minister requested that the Department undertake research into the economic implications for reciprocity of
::1,-------,
transport concessions for interstate Seniors Card holders. The Department commissioned (on behalf of the Healthy Ageing Task Force and the Community Services Ministers Conference) Booz Allen Hamilton to undertake this task.
The Australian Ageing Research Directory was published in December 2000. This Directory provides a comprehensive overview of ageing research undertaken in Australia over the last three years" . The Department also managed a project on behalf of the Community Services Ministers' Advisory Council to conduct research into the extent of healthy ageing research in Australia, the gaps in research and possible future directions. The report outlines the drivers for ageing research and suggests ways forward toward a national approach.
The Year Ahead
During 2001-02, Outcome 3 will focus on the following key challenges and activities:
⢠coordinating a whole of Government approach to addressing issues associated with the ageing of the Australian population;
⢠promoting healthy ageing, mature aged employment and positive images of older Australians;
⢠promoting domestic and international research in ageing issues and sharing expertise in delivering aged care services;
⢠developing e-commerce capabilities to:
- support the efficient and timely payment of aged and community care subsidies;
- reduce administrative burden on providers by streamlining business processes; and
- provide better access to and quality of information for all aged and community care stakeholders.
" Relates to Indicator 7.
106
⢠monitoring the quality and availability of the aged care workforce;
⢠improving the continuity of care for individuals moving between the health and age care systems. This is a key area of investigation and policy development, under the Australian Health Ministers' Advisory Council;
⢠promoting ongoing improvement in both the built environment and care quality for residents of aged care homes; and
⢠investing further in our capacity to measure, evaluate and improve the outcomes of aged care services.
FOR OLDER AUSTRALIANS
Performance indicators
Indicator 1: Improvement in the quality of residential accommodation.
Indicator 2: Improvement in the privacy of residential accommodation.
Indicator 3: Dependency level of people newly admitted to residential care as measured by scores on the Resident Classification Scale.
Indicator 4: Residential and Community Aged Care Package places per 1000 persons aged 70 and over nationally (including places in flexible care).
Indicator 5: Proportion of people recommended for residential care as compared with Community Aged Care Packages and other community care options.
Target: 100 per cent of services funded under the Act achieve accreditation by 30 June 2001.
Information source/reporting frequency: Information from the Aged Care Standards and Accreditation Agency.
Target: Continuing from July 1999, new buildings will have a service average of no more than 1.5 residents per room, except where specifically exempted. By 2008, existing buildings will have no more than four residents in any room and the average will be falling towards 1.5.
Information source/reporting frequency: Administrative by-product of certification.
Target: Average dependency level rises between June 2000-June 2001.
Information source/reporting frequency: Departmental payment system. Annual.
Target: a) 100 places per 1000 persons aged 70 and over nationally between July 2000 and June 2001 (including places in flexible care). b) Equitable distritubtion between planning regions in line with
identified needs.
Information source/reporting frequency: Departmental payment system and ABS. Annual.
Target: Increased proportion of Community Aged Care Package and community care recommendations against previous year. Benchmark from 1997-98 is 45.4 per cent.
Information source/reporting frequency: ACAP National Minimum Data Set.
107
Indicator 6: Level of service provision for older people with dementia, older people from diverse cultural and linguistic backgrounds, older indigenous people and older people in rural and remote areas as compared with levels in the general aged population.
Indicator 7: Preparedness to respond to the needs of an ageing population.
01 \;;VIVIc-;Jâ¢-----
Target: Provision appropriate to proportion of target group in population.
Information source/reporting frequency: Departmental payment system. Annual.
Target: Implementation of some elements of a National Strategy for an Ageing Australia during 2000.
Information source/reporting frequency: Research into and analysis of the ageing of the Australian population.
108
FOR OLDER AUSTRALIANS
OUTC OME 3 : FINANCIAL RESO URC ES SUMMARY
Administered Expenses
Administered Item 1: Healthy lifestyles for older Australians
Appropriation Bill 1/3 Appropri ation Bill 214
Administered Item 2 : Community care & support for carers Aged or Disabled Persons Care Act 1954 & Aged Care Act 1997- Conununity care subsidies Aged Care Act 1997- Flexible care subsidies (p)
Total Special Appropriations Appropriation Bill 1/3 Appropriati on Bill 214
Administered Item J: Residential Care Aged Care Act 1997- Residential care subsidies Aged Care Act 1997- Flexible care subsidies (p)
Total Special Appropriations Appropriation Bill 1/3 Appropriation Bill 214
Administered Item 4 : Client Assessment by Aged Care Teams & referral to appropriate services
Appropriation Bill 1/3 Appropriation Bill 214
Total Administered Expenses
Departmental Appropriations
Output Group I - Services to the Minister & Parliament Outptrt Group 2 - National Leadership Outptrt Group 3 - Infon nation Otllptrt Group 4 -Program Management Otâ¢tput Group 5- RegulatOI)' Activity Ot1tput Group 6 -Direct Delivery of Services
Total price of departmental outputs (Io ta/ revenue[n>m Government & other sources}
Total revenue from Govenunent (appropriations) contributing to pri ce of departmental outputs Total revenue from other services
Tota l price of departmental outputs (total r evenue from Governmenl & other sources}
Total price of outputs for Outcome 3 (to /a/ revenue from Government & other sources)
Total estimated resourclng for Outcome 3 (Io ta / price of outputs & admin expenses)
' (A)
Budget Estimate 2000/2 001 s·ooo
205
205
215,489
8,897
224,386 126,740 561, 127
918,253
3,437,815 32,795
3,470,610 106,653
3,577,263
105
4 1,732
41 ,837
4,537,558
15,64 0 7,29 1 8,610 38,228
14, 102
83,87 1
83,049
822
83,871
83,871
4,621 ,429
(B)
Actual Variation
Expenses (C olumn B 2000/2001 minus
5'000 Column A)
(9) (214)
(9) (21 4)
194,620 (20,869)
8,426 (471)
203,046 (2 1,340)
119,208 (7,5 32)
567,127
889,381 (28,872)
3,3 14,498 (123,3 17) 22,247 (10,548)
3,336,745 (133,865) 74,524 (32,1 29)
3,411 ,269 (165,994)
(49) ( 154)
41,732
41,683 (154)
4,342,324 (195,234)
15 ,629 (1 1)
7,286 (5)
8,639 29
38,226 (2)
14,091 (II)
83,871
83 ,434 385
437 (385)
83,87 1
83,871
4,426,195 (195,234)
I The Budget Estirmte 2000/2001 includes the appropriations as per the 2000-2001 Portfolio Budget Statements Portfolio Additional Estimates and Advances to the Finance Minister. This amount may differ to the revised
estimates for 200012001 pubmhed in the 200 1/2002 PBS. Such differences can arise from updated estimates and rephasings.
2 Budget prior to additional estimates. The numberofoutputgroups has reduced fiom 6 in 2000-200 1 to 3 in It is not possible to show din:ct comparnt.ives
3 Administered expenses do not include S 194 .607 representing the net write down of assets as this amount is an ac crual provision that cannot be accurately allocated by appropriation or adminlstered item.
4 With Ule introduction of a new accounting system within the Department. a nwnber of internal adjustments were required to be made to various programs during the course of the year. Some irrunaterial negative balances remained at the end of the financial year as a result. of posting errors. These negative balances are deemed to be transitiomuy and will nol appear in future reports.
109
'Budget 2001/2002 $'000
107
107
248,444
9,083
257,527 122,743 615,582
995,852
3,738,695 34,895
3,773,590 80,586
3,854,176
107
43,635
43,742
4,893,877
23,777
72,330
96,107
95,177
930
96,107
96,107
4,989,984
Outcome 4: Quality health care
Improved quality, integration and effectiveness of health care
111
Outcome 4 is managed within the Department by Health Services Division with assistance from the National Health Priorities and
Quality Branch of the Health Industry and Investment Division. The Department's State and Territory offices also contribute to achieving this outcome.
UU 1\..UIVIt 4
Major achievements
Review of the Australian blood banking
and plasma product sector
The Review which reported to Minister Wooldridge in March 2001 on its comprehensive examination of the Australian blood system, was released publicly in June 2001.
Nucleic acid amplification testing
Nucleic acid amplification testing of blood donations for Hepatitis C and HIV (a measure announced in the 2000-01 Budget) commenced on 7 June 2000 with all blood collected by the Australian Red Cross Blood Service being tested in 2000-01.
National organ donor register
The Australian Organ Donor Register (AODR) was launched in November 2000, with over 80,000 people registering their willingness to be a donor as at 30 June 2001.
Rural women's GP service
More than 100 rural communities and larger remote centres where there is little or no access to a female doctor are being provided with the service through the Royal Flying Doctor Service.
Implementation of the Rural Retention
Program
The program's purpose is to recognise the contribution of general practitioners who continue to practice in rural and remote areas. A review of the program including eligibility criteria., the classification index for locations was undertaken in 2000-01 with results to be implemented from 1 July 2001. Since December 1999, payments totalling over $24 million have been made to more then 2,000 doctors under the program.
International interest in Australian Refined
Diagnosis Related Groups
In November 2000, the Federal Republic of Germany purchased rights to use Australian Refined Diagnosis Related Groups as the basis for developing a German casemix classifications system. In February 2001, New Zealand formalised an agreement with the Commonwealth to move from Australian National Diagnosis Related Groups to Australian Refined Diagnosis Related Groups. Singapore, a current user of Australian National Diagnosis Related Groups, continues to maintain close ties with the Australia on casemix-related issues .
Under-achievements
National Suicide Prevention Strategy
Funding was progressed through State and Territory offices for local suicide prevention projects, however not all jurisdictions have finalised project expenditure for 2000-01.
HECS reimbursem*nt
Progress on the HECS Reimbursem*nt Scheme has not proceeded as quickly as planned. Additional time was necessary to clarify legislative, taxation and administrative requirements.
Outcome summary - the year in review This outcome seeks, over the long term, to improve the quality, integration, cost effectiveness and appropriateness of primary health and community care and acute care services for individuals and communities. The Department sought to achieve this during 2000-01 by taking a national leadership role through consultation and collaboration with State and Territory governments, health care providers, professional organisations, industry groups and consumers to develop and
112
implement strategies to improve health care services for all Australians.
Service delivery arrangements are managed through a range of funding agreements, contracts and Memoranda of Understanding that specifies standards and quality of service delivery. Policy development that is based on high quality research through joint arrangements, including consumer and provider opinion, ensures that services are appropriate for the needs of all members of the Australian community. An ongoing performance evaluation program provides feedback on achievement of the quality, cost effectiveness and appropriateness of strategies.
Responsibility for this Outcome lies primarily with the Health Services Division of the Department, which collaborates with other areas across the Department. To ensure that the health needs of Aboriginal and Torres Strait Islander peoples are met, in the same way they are for other Australians, strategic links with Outcome 7 are critical.
Primary health and community care The primary health and community care sector is the most commonly used part of the health
system. Nine out of ten Australians access primary and/or community care services in any one year. The sector is responsible for approximately one third of all health expenditure in Australia. A recent international comparative study of 12 western countries indicated that countries with stronger primary care do better in terms of both outcomes and costs.
A strong network of comprehensive primary health and community care services provides an effective foundation for the Australian health system and contributes to maintaining health outcomes. This sector has important relationships with Outcomes 1, 2, 3, 5, 7 and 9, and continued collaborations with Outcome 4 through
113
initiatives such as the General Practice Memorandum of Understanding (GPMoU), will build the capacity of the sector to meet increasing demands for quality service provision.
The primary health and community care sector encompasses service provision, such as general practice and hospital emergency departments, community based care, population health programs, including mental health and services to assist in the management of chronic care.
Responsibility for primary health and community care services is shared across Commonwealth, State and Territory governments, and this split of responsibility has created difficulties for delivery of services in this area. Recognising these difficulties, Commonwealth, State and Territory Health Ministers in July 2000 for the first time agreed on priority areas for work to improve services in
this area. The priority areas are:
⢠improving continuity of care for consumers through developing and maintaining greater integration across the primary health and community care sector;
⢠improving the quality, appropriateness and cost-effectiveness of care by strengthening the interface between hospital care and community based care, including a focus on improving:
- the relationships between hospitals, emergency departments, outpatient departments and general practice;
- pre- and post-hospital care provision; and
⢠strengthening the role of primary health care providers in population health.
Since July 2000, work has commenced to address these priorities.
Strengthening this sector is also vital to providing continuing care and support for people with chronic conditions or general frailty. Many of
UUILUIVIt 4
these conditions share common risk factors like smoking, physical activity and nutrition, which are amenable to earlier intervention by primary health and community care providers.
Enhanced Primary Care Program 1
Continued investment in health services research is critical to the long term improvement of the health system. Developing and refining better models of care provision will continue to drive better quality health outcomes.
The continued implementation of the Enhanced Primary Care Package, introduced in the 1999-2000 Budget, has brought together health service administrators, planners and providers and facilitated the provision of more continuous and coordinated care where it is needed most. This includes, amongst others:
⢠General Practice Education, Support and Community Linkages program;
⢠roll out of the Enhanced Primary Care Medical Benefits Scheme Items;
⢠second round of coordinated care trials; and
⢠Information Technology Integration Initiative.
The General Practice Education, Support and Community Linkages program makes available information to general practitioners to support them in providing multidisciplinary care to their patients. This initiative is being rolled out through the Divisions of General Practice with the Australian Divisions of General Practice being funded to provide national coordination. Under the auspice of the General Practice Partnership Advisory Council the Enhanced Primary Care Taskforce was established to provide advice on the roll out of the program.
The National Evaluation of the General Practice Support and Community Linkages Program, to commence in late 2001, will report
' Relates to Indicator 1.
on the quality performance measure that every general practitioner will have had the opportunity to undertake education associated with the n ew Medicare items for enhanced primary care. Divisions of General Practice have used a variety of measures and innovative approaches to provide education opportunities to their general practitioners. The effectiveness of these various approaches will be examined as part of the evaluation.
As at 30 June 2001, 47 per cent of active doctors had provided an enhanced primary care item. Through monitoring the uptake within the three categories of enhanced primary care items -health assessment, case conferencing and
care planning- it was evident that a substantial and continuing increase in the uptake of the care planning items as a proportion of all enhanced primary care services has occurred. In May 2001 , care planning items rendered represented 38.7 per cent of all enhanced primary care items, in contrast to May 2000 where care planning items rendered accounted for 12.9 per cent of all enhanced primary care items. Outcome 2 provides details on the uptake of the items.
The Final Techn ical National Evaluation Reporf- of the first round of coordinated care trials, released in June 2001, highlighted the contribution of the trials to improving understanding of how to provide effective health services and the growing knowledge base for the advancement of future health system reform.
The second round of coordinated care trials3 will build on these findings and further test whether improved tailoring of health and related services for individuals with chronic and complex needs, particularly through enhanced coordination in service delivery and by making better use of existing resources, can improve health outcomes. The continuing development of the second round of coordinated care trials over the past year has provided an opportunity for
' Relates to Indicator 8(c). 3
Relates to Indicator 8(b).
114
UTY HEALTH CARE
stakeholders to work together to develop proposals for more integrated care in their region.
The Information Technology Integration Initiative recognises that effective coordination of care across different settings and locations relies on the timely and relevant communication of confidential patient information between different health and community services.
General practice is at the centre of primary care. It provides a major platform for the delivery of a wide range of Government programs targeted to this sector.
During 1999-2000 general practice was the focus for major investment and reform under Outcome 4. Significant reviews of existing activities were undertaken and several major new programs implemented. Key areas of activity included:
⢠improving the capacity of Divisions of General Practice;
⢠the recruitment and retention of doctors to rural and remote areas;
⢠improving service delivery to rural and remote communities;
⢠supporting the implementation of measures to improve primary care services;
⢠improving the responsiveness of general practice vocational training to community needs;
⢠developing enhanced capacity in the primary health care research sector; and
⢠developing an improved understanding of the role of general practice in population healthâ¢.
Divisions of General Practice 5
Divisions of General Practice are funded by the Government to improve health outcomes for patients by encouraging general practitioners to
' Relates to Indicators 1, 2 and 3. 5
Relates to Indicators 1 and 2.
115
work together to link with other health professionals to upgrade the quality of health service delivery at the local level.
The Government allocated $78 million for the Divisions of General Practice Program for 2000-01. Eighty per cent of this allocation was funding for the 123 Divisions of General Practice through payments under their three year outcomes based funding agreements. In the
past 12 months Divisions have used the outcomes based funding to address high priority issues in a number of key areas such as:
⢠improved governance and management arrangements in primary care;
⢠increased GP training programs;
⢠recruitment of allied health professionals to rural and remote areas;
⢠supporting GPs in delivering enhanced primary care;
⢠management of chronic and complex conditions;
⢠increased patient enrolment in programs addressing diabetes and cardiovascular disease; and
⢠designated primary care services to specific population groups, the most common being for young people and Aboriginal and Torres Strait Islander
people.
There has also been increased activity in supporting practice accreditation and in improving access to general practitioner services, particularly in rural Divisions.
The remaining 20 per cent of the allocation was for time-limited projects, funded under the General Practice National Innovations Funding Pool, and funding to eight State Based
Organisations (SBOs), the Australian Divisions of General Practice and the National Information Service at Flinders University.
VUILVIVIt 4
An independent evaluation of SBOs was conducted between October 2000 and March 2001. The purpose of the evaluation was to assess the progress made by SBOs since their establishment in 1998, identify ways in which SBOs could be strengthened in the future and inform the development of new three-year funding agreements between SBOs and the Department, to commence on 1 July 2001.
The evaluation found that:
⢠overall, SBOs have made reasonable progress against the aims and achievements expected of them in the Divisions of General Practice Program, but there is considerable variation between individual SBOs;
⢠SBOs are uniquely positioned between Commonwealth and State/Territory health authorities and general practice to play an important role in the development of an integrated primary health care system; and
⢠there needs to be a clear articulation of a national framework for SBOs, addressing issues such as key operating areas and functions, expected outcomes and a set of common performance indicators.
A national planning and reporting framework for SBOs has now been developed and incorporated into SBOs' new funding agreements from July 2001. The framework emphasises a stronger leadership role for SBOs at the State and Territory level.
Recruitment and retention of doctors to
rural and remote areas 6
As part of the Government's commitment to rural health, nearly $60 million has been provided over four years under the Rural Retention Program, to assist in retaining long serving doctors in rural and remote Australia. The purpose of this program is to recognise the contribution of GPs who continue to practice in rural and remote areas.
' Relates to Indica tors 3 and 4.
Doctors become eligible for payments under the program based on their services and location over a number of years. Between the commencement of the Program in December 2000 and July 2001, 2,015 doctors have become eligible for payments to a total value of over $24 million (see also Outcome 5).
The Workforce Support for Rural General Practitioners Program aims to ensure that the 66 eligible rural and remote Divisions of General Practice can provide effective support to practitioners in their areas, especially newly arrived doctors. This program is part of the Government's Regional Health Strategy: More Doctors, Better Services (see also Outcome 5) .
General practice information management
and technology
The Department has been working with the professions to improve the use and management of information technology as part of the General Practice Memorandum of Understanding. A number of initiatives have been implemented that provide incentives to expand and improve the use of information management and information technology in general practice for the provision of better health outcomes for patients and the population.
Funding was provided to Divisions of General Practice and State Based Organisations to enhance the provision of information management and information technology training and support activities for GPs. This function builds upon the increased computerisation of general practice achieved through the Practice Incentives Program (see also Outcome 2), Commonwealth support for the General Practice Computing Group, as well as previous Divisional and State Based Organisations Information Management/ Information Technology support funding.
In collaboration with the General Practice Computing Group, 28 General Practice
116
QUALITY HEALTH CARE
Information Management and Technology (IM / IT) Projects were funded in 2000-01. These projects addressed a range of initiatives including IM/IT integration trials. The majority of the projects are nearing completion. Once all the final reports have been received and evaluated, the Department will finalise a strategy for moving forward in areas of General Practice IM /IT and utilising the information discovered to date.
Improving the responsiveness of general
practice vocational training to community
needs 7
During the year the Government has undertaken a major reform of arrangements for general practice vocational training to better meet the needs of the medical profession and broader community.
A key component of the reform process was the establishment on 5 March 2001 of a Commonwealth company: General Practice Education and Training Limited (GPET). This company will provide the cornerstone of the new training environment, being responsible for the delivery of general practice vocational training. The charter of GPET requires it to develop
regionalised training arrangements and a contestable environment for training providers.
The board of GPET is broadly representative of the key players in general practice training, which includes the Royal Australian College of General Practitioners, the Australian College of
Rural and Remote Medicine, the Committee of Deans of Australian Medical Schools, Divisions of General Practice and the General Practice Registrars Association. The board also includes independent general practitioners with particular expertise in rural practice and general practice policy issues.
The General Practitioner Registrars Budget initiative restructured vocational training by
' Relates to Indicators 3 and 4.
117
introducing a dedicated, 200 place Rural Training Pathway from 1 January 2001. This initiative provides 50 new vocational training places per annum for the next three years. This
brings the total number of registrar places to 450 per year. The Rural Training Pathway will operate alongside a (primarily urban) General Training Pathway.
Th is initiative provides significant financial incentives to encourage registrars to take up the rural training pathway. Up to $60,000 is available per registrar over three years of general practice training. Payments commence in July 2001 (see also Outcome 5).
Another initiative, the Enhanced Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme, provides scholarship financial assistance of $10,000 per year to enable medical students from a rural background to enter and complete their study of medicine. Under the first application and selection round for the
RAMUS Scheme, over 400 medical students were awarded and paid the scholarship in late 2000. A further 80 new scholarships were awarded in May 2001 (see also Outcome 5).
The Higher Education Contribution Scheme (HECS) Reimbursem*nt Scheme provides financial incentives to graduating medical students to attract them to careers in rural medicine by offering them the opportunity to work off their HECS debt in designated rural areas.
The administrative arrangements for the scheme were substantially changed during 2000-01 to facilitate management of the program by the Department. This does not alter the financial benefits available to newly graduating doctors under this scheme.
In 2001, the first year of operation, approximately 100 doctors will be granted HECS reimbursem*nt for services provided in rural areas with the first payments being made in January 2002 (see Outcome 5.)
UUILUMI: 4
Enhanced capacity in the primary health
care research sector8
In April 2000, Minister Wooldridge approved a five -year Primary Health Care Research, Evaluation and Development Strategy, which aims to foster research capacity-building in Australian primary health care, with a specific focus on general practice. The key elements of the strategy are:
⢠the establishment of primary health care research priorities;
⢠a research grants and scholarship program;
⢠an institute of primary health care research; and
⢠research capacity development funding for University Departments of Rural Health and Departments of General Practice.
The first stage of the national research priority setting process, under the auspices of the General Practice Partnersh ip Advisory Council and the General Practice Partnership Advisory Council Research, Evaluation and Development Standing Committee, has been completed. The areas of research will be confirmed during the second stage of the process.
The arrangements for the development and implementation of the Primary Health Care Research Institute are now well advanced. An Institute Taskforce has been established to guide implementation of the institute during its foundation phase.
The University Research Capacity Building Program is well under-way. The University Departments of General Practice and Rural Health are being funded for four years to develop and build research capacity in Australian General Practice and Primary Health Care through a range of activity according to agreed planning mechanisms and performance criteria.
s Relates to Indicator l(c).
The first round of National Health and Medical Research Council (NHMRC) Primary Health Care investigator driven research awards will commence in December 2001. This program of research will be administered by the NHMRC.
New framework for general practice and
population health 9
The Joint Advisory Group on General Practice and Population Health, which is a collaborative partnership between the General Practice Partnership Advisory Council and the National Public Health Partnership, supervised a work program of research and consultation to help identify the best ways for general practitioners to have an enhanced role in population health.
In March 2001, participants in the Joint Advisory Group's Health National Symposium agreed on a consensus statement on general practice and population health and the key features of a framework for action that sets out the agenda for promoting a population health approach for general practice in primary health care. The seven key areas identified in the framework for action are:
⢠organisational structures and role;
⢠financing systems;
⢠workforce planning, education and training;
⢠IM/IT - data collection dissemination and analysis, guidelines, clinical support tools;
⢠communication, including community awareness and patient education;
⢠partnerships and referral mechanisms; and
⢠research and evaluation.
The Relative effectiveness study of population health interventions in the general practice setting, undertaken by the University of Melbourne and funded by the Department, examined the evidence to support an increased role for general
' Relates to Indicator 1.
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QUALITY HEALTH CARE
practitioners in a range of population health activities and suggested a supporting infrastructure to promote that role.
General Practice Partnership Advisory
Cou ncil' 0
In support of its work with general practice, the Department works with the General Practice Partnership Advisory Council (GPPAC) , the peak body for ensuring the involvement of the profession in primary care. GPPAC arranged local and national consultations to identify barriers and opportunities for improved
integration of general practice across the primary health care sector.
A series of focus groups were held with consumers, non-medical service providers and general practitioners to explore the question of what roles general practice and other service providers play in primary health care and the question of the need for better integration. The consultations highlighted that in moving towards a more integrated primary health sector in Australia the essential components are:
⢠improved health service information and communication systems; and
⢠improved resourcing of other services and professionals in primary health care.
The GP integration index"
The Department of General Practice at the University of Melbourne has developed a tool to measure general practitioners' degree of awareness of, and cooperation with, other local health care providers. This tool is known as the
GP Integration Index. The index is determined from a 70 item self-administered survey that measures 14 different factors. Examples of some of the factors that are measured are:
⢠the degree to which a general practitioner provides holistic patient care;
10 · " Relates to Indica tor L
11 9
⢠the level of GP flexibility, care coordination; and
⢠the knowledge those general practitioners have of other local medical services.
The GP Integration Index has the potential to be used as a benchmark for the future measurement of how well general practitioners are acquainted with, and work with, other health care workers. The index is currently being trialed in 25
Divisions of General Practice. This trial is expected to be completed in late October 2001.
GPs and hospitals
During the year the Government has continued to explore ways to build on the valuable lessons learnt from the Divisions Hospital Integration Program. This program was aimed at fostering partnerships between
selected Divisions of General Practice and hospitals to demonstrate effective strategies in developing key areas of collaboration between general practice and hospitals. Further work has been undertaken to build on the growing
knowledge base of successful methods and activities that have been shown to work in the community to improve the integration of health services between general practice and the hospital sector. The Commonwealth will
disseminate the outcomes of the work, and in consultation with interested parties from State governments and the primary health and community care sector, develop a framework of best practice that will be implemented through programs within the community.
After-hours primary medical health services
Another important element in the delivery of primary medical care is the provision of after hours primary medical care services. The Government has been working with the profession to develop a better understanding of both consumer and doctor needs, including the trialing of innovative ways of organising and
" Relates to Indicator 8(d).
VU I \...VIVIC 'f
delivering after hours services to ensure the continuity and consistency of care for patients. Five After Hours Primary Medical Care Trials have been implemented around Australia and are currently being evaluated through an overarching independent National Evaluation Program. This evaluation is due to report in the second half of 2001 and will inform further work in the development of viable models of after hours primary medical care.
The trials include a mix of general practitioner nurse telephone triage; cooperatives or collaborative general practice arrangements including with and co-located near emergency departments; deputising services; funded transport arrangements and sessional payments for general practitioners and needs based home visits.
The program also involved research into consumer preferences for after hours primary
medical care in Australia. This research is also due for completion in the second half of 2001.
The Commonwealth has also begun working with State governments on issues around the hospital emergency department and general practice interface, and the development of health call centres.
Strengthening partnerships in health
service delivery13
Enhancing the links between general practice and the wider primary health and community care sector aims to bring significant health benefits through improved coordination of services and a more streamlined approach to health service delivery.
The past year has seen the Commonwealth enter into a partnership with State and Territory Governments to support and strengthen the primary health and community care sector, including the interface with hospitals. In developing the collaborative work program, under the auspices of the Australian Health Ministers Council, it has become clear that there is a range of priority areas which are shared between the States and Territories and the Commonwealth within the primary health and community care sector. Feedback from consumers and providers have confirmed that these areas of shared responsibility hinder good quality, continuous care, particularly for those who require access to more than one health service.
In designing future priorities in the area of primary health and community care it is important to ensure that the concerns of service providers and consumers remain cental to planning considerations. To facilitate this, over the past 12 months consultations have been undertaken at both the national and State and Territory levels to elicit a broad range of views from these groups.
" Relates to Indicator 1.
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QUALITY HEALTH CARE
Primary mental health care 14
A major theme for primary health and community care and general practice this year has been mental health, with an emphasis on Divisions of General Practice. Our aim under this initiative is to support general practitioners' access to education in primary mental health care and improve linkages between general practitioners and specialist mental health services (both public and private) such as psychologists and social workers.
Outcomes under the education and training component of the National Primary Mental Health Care Initiative has seen development and liaison officers positioned in every State and Territory based Division of General Practice with 80 per cent of Divisions of General Practice providing support to general practitioners through health programs and education and training in primary mental health care. Key outcomes under this initiative include:
⢠100 of the 123 Divisions of General Practice have now implemented mental health education programs for general practitioners;
⢠a strategy linking research to improved training for primary care practitioners including general practitioners, improved uptake of research in primary care and general practice;
â¢
â¢
support for the Divisions of General Practice in their mental health activities through the Primary Mental Health Care Australian Resource Centre; and
59 Postgraduate Primary Care Psychiatry Scholarships for General Practice.
Relates to Indicators 2(a) and 2(b).
121
Mental health care
Mental health strategies
Mental disorders contribute substantially to the burden of disease in Australia. The Australian Burden of Disease Study (Mathers et al 1999) report shows that 15 per cent of the disease burden is due to mental ill health contributing
to the overall burden of ill health in the Australian community, third after heart disease and cancer. Of the top ten conditions, five are
mental disorders.
A national process to reform and improve mental health care in Australia, was agreed by all health ministers in 1992. The National Mental Health Strategy is now mid-way through the Second National Mental Health Plan (1998-2003) which is consolidating major improvements achieved in the delivery of State and Territory mental health
OUTCOME 4
services, with a focus on enhancing health care provided by general practitioners and an emphasis on population health measures. Key achievements under the National Mental Health Strategy are outlined annually in the National Mental Health Report - the latest edition being the 2000 report.
The strategy advocates the development of local, comprehensive mental health service systems, capable of responding to the individual needs of people with mental disorders, and providing for continuity of care. At the commencement of the National Mental Health Strategy, 29 per cent of mental health spending was dedicated to caring for people in the community. Under the strategy, spending on community treatment and support services available for people affected by mental illnesses has grown by over 80 per cent.
Achievements under the strategy include:
⢠increased participation of consumers and carers, as key stakeholders, to influence decisions on all aspects of mental health services. To support this participation, funding was provided to the Australian Mental Health Consumers Network to establish a national office and executive officer position;
⢠a joint National Mental Health Strategy/National Drug Strategy project to disseminate the National Comorbidity Workshop Report. The report included papers presented at the workshop as well as a summary of discussions and recommendations for future action in addressing the comorbidity of mental health issues with substance abuse;
⢠bringing together key players from each state and territory, prominent forensic mental health experts and representatives of relevant carer and consumer groups to identify next steps and agree priorities for
advancing a national approach to those in the correctional system with mental health issues. A National Forensic Mental Health Meeting was held in November 2000;
⢠National Education and Training Workshops for Centrelink social workers and occupational psychologists, addressing suicide prevention, self-harming behaviours, and mental health issues;
⢠a national phone-in and community consultation conducted by SANE Australia, a national charity supporting people with mental illness. Consumers, carers and mental health workers from all parts of Australia were invited to telephone, email and fax their views on how they felt life could be improved for people affected by mental health illness. Engaging consumers and carers is a key priority under the second National Mental Health Plan. The SANE phone-in and community consultation offers a snapshot of opinions from consumers, carers and mental health workers across Australia about how they felt life could be improved for people affected by mental illness. Whilst the consultation does not claim to be a scientific process, it offers valuable insight into community opinions. The report of the consultation has been used by SANE Australia to further develop its strategic directions and the findings have been disseminated within the mental health sector and the general community. The report of the consultations has also been disseminated to State and Territory Directors of Mental Health, the Mental Health Council of Australia and the AHMAC National Mental Health Working Group (NMHWG) to discuss how the report might be used at a national level with a view to future mental health policy consultation
122 _____ ___.
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options. The Survey results can be found on the SANE Australia website at http://www.sane.org
development of draft National Practice Standards for Mental Health by the National Mental Health Education and Training Advisory Group. Consultation on
these draft standards will be undertaken with mental health professionals, consumers and carers and other stakeholders;
⢠a workshop held in March 2000 to discuss the workforce issues raised in The Specialist Psychiatry Workforce In Australia: Supply, Requirements And
Projections 1999-2010 (Australian Medical Workforce Advisory Committee), and provide recommendations to the National Mental Health Working Group;
⢠funding to support the development and publication of a SO-page supplement to The Medical Journal of Australia on Sphere: a National Depression Project; and
⢠publish and disseminate the report of the National Comorbidity Workshop Report in conjunction with the National Drugs Strategy.
National Primary Mental Health Care
Initiative (NPMHCI) 15
The aim of the National Primary Mental Health Care Initiative is to strengthen partnerships across the health sectors and with the community. In strengthening partnerships, the Department provided funding to:
⢠employ development and liaison officers (DLOs) through each state-based organisation to represent General Practitioners and the Divisions of General Practice, undertake planning activities and develop collaborative relationships with the primary mental health care
" Relates to Indicators 2(a) and 2(b).
123
coordinators employed by State and Territory health departments;
⢠employ a national primary mental health care coordinator to provide national leadership to the state-based DLOs and build national partnerships with stakeholders relevant to the initiative;
⢠establish the Primary Mental Health Care Australian Resource Centre (PARC) to collate information on Divisions of General Practice programs and best
practice models in education, training and shared care; and
⢠establish mental health programs focused on education and training, and shared care in 100 out of 123 Divisions of General Practice.
National Action Plan for Promotion,
Prevention and Early Intervention for
Mental Health
Mental health promotion and mental illness prevention activities have continued as a key theme of the Second National Mental Health Plan that has been enhanced by the release in November 2000 of the revised National Action Plan for Promotion, Prevention and Early Intervention for Mental Health and associated monograph that provide a national policy framework for this activity. National strategies
have included enhancing mental health literacy and consumer participation and advocacy, national coordination of mental health promotion activities, funding of information and support resources and work with other
sectors including the media and education. The following initiatives give an example of the significant progress we are making in these important areas:
⢠MindMatters program - a landmark initiative developed in recognition of the need to support the mental health and
OUIC:OM 4
wellbeing of all young Australians at www.curriculum.edu.au/mindmatters;
⢠all education systems in the states and territories have agreed to support the program. Around SO per cent of schools have requested a copy of the resource, professional development has been conducted in all states and territories, and an Indigenous strategy is being developed, including the publication Community Matters;
⢠Achieving the balance: a resource kit for australian media professionals for the reporting and portrayal of suicide and mental illnesses developed in close consultation with media industry representatives, health professionals and researchers. This resource is available at www.mentalhealth.gov.au
A tender to evaluate the resource and develop proposals for a revised version, involving extensive consultation with the media and health sectors, is progressing;
⢠various initiatives focussing on early intervention with children and young people. A significant achievement has been the establishment of AusEinet, which will assist organisations to incorporate promotion, prevention and early intervention elements into their work. Consultations have taken place in most states and territories with government and non-government stakeholders. A newsletter has been produced and the web-site updated at http:/ /auseinet.flinders.edu.au; and
⢠Response ... Ability, suicide prevention resources for the undergraduate training of new professionals in secondary education and journalism, available at www.himh.org.au/index.htm Consultations have been held with key stakeholder groups including visits to every university with relevant courses. New resources are being developed with further information at www.himh.org.au/index.htm
The focus on partnership under the National Mental Health Strategy and the National Suicide Prevention Strategy has continued with:
124
⢠the media in promoting the accurate reporting and portrayal of mental illnesses and suicide in all sectors of the media;
⢠the education sector with the implementation of MindMatters (refer National Action Plan for Promotion, Prevention and Early Intervention for Mental Health above, for additional information);
⢠the Australian Rotary Health Research Fund and Rotary clubs nationally to raise
QUALITY HEALTH CARE
awareness of mental health issues through community awareness forums, http:/ /www.rotarnet.com.au and
community consultation between the National Advisory Council on Suicide Prevention and stakeholders at all levels of the community.
The Department continues to provide leadership in implementing the National Mental Health Strategy and continues to support:
â¢
Kids Help Line tele-counselling service, at the same time pursuing discussions with other agencies regarding the broad banding of Kids Help Line's
Commonwealth funding base; and
the development of Australia's first Web based health, mental health, community and allied services referral data-base to be trialed in partnership with Lifeline Australia, Kids Help Line, Reachout! and Men's Access Line (Department of Family and Community Services) during late 2001.
National Suicide Prevention Strategy
A number of developments under the National Suicide Prevention Strategy have laid the foundations for a sustainable, community centred approach to suicide prevention that
targets the population across the lifespan, as well as groups identified as being at high risk. Living is for Everyone (LIFE): a framework for prevention of suicide and self-harm in Australia was
released in October 2000 and was distributed widely in the community. LIFE aims to foster strategic partnerships and to position suicide prevention effort across all sectors. It was developed by the National Advisory Council on Youth Suicide Prevention, guided by consultation with key groups and evidence that suicide prevention requires a multi-faceted approach involving collaboration between all levels of government and the community.
125
Under the auspice of the ministerially-appointed National Advisory Council on Suicide Prevention, funding has been provided to a number of community suicide prevention initiatives in collaboration with States and Territories. In October 2000, initial funding of
$2.9 million dollars was provided across five States to implement 25 projects.
beyond blue
The National Depression Initiative seeks to foster greater awareness through community education, the promotion of professional training and development primarily in primary care, researching better prevention, treatment
and management approaches to deal with the burden of depression.
The 2000-01 Budget provided $17.5 million over five years to assist in the establishment of an independent company with a Board that is reflective of the broad community. beyondblue Ltd, a not for profit company, has been established for this purpose. The role of beyondblue Ltd is to address the major health burden of depression in Australia. Their objective is to destigmatise depression in the
community and to provide support to those providing treatment and care. The Government has agreed to beyondblue Ltd's corporate constitution and has been provided with a
strategic plan outlining how beyondblue Ltd will manage this work.
Mental health integration projects 16
In pursuing quality improvements in the primary health and community care sector, the
" Relates to Indicator 8(a).
Mental health
The World Health Organization has predicted that by the year 2020, depression will be the world's largest health problem behind heart disease. About one million people in Australia suffer from a mental health disorder, but only 40 per cent seek help. During the 1990s, the Commonwealth recognised the need to help the States to meet the costs of reforming mental health services. Together they designed a national mental health strategy, whose aim is to orient mental health service to more prevention and early intervention. In 2000, the Government also launched a national depression initiative. beyondblue is fos tering better understanding of the illness in order to reduce the stigma often attached to depression, as well as promoting professional training.
mental health integration projects are trialing ways to integrate private psychiatrist services and public sector mental health services. The first trial commenced in September 2000 at St Vincents Mental Health Service in Melbourne and has implemented a linkage unit and expanded activities for private psychiatrists. Two other projects in New South Wales will commence in July 2001. Both projects are of particular interest because they are whole of area projects with one being a remote rural area (Far West Area Health Service), and the other located in an urban industrial environment (Illawarra Area Health Service). A fourth project, a Brisbane-based trial, is soon to enter its planning phase to explore the viability of implementing this project.
Mental health information development
plan 17
Access to quality information will be essential in achieving the goals of the Second National
17 Relates to Indicator 5.
Mental Health Plan. Agreement has been reached with States and Territories on a workplan to implement the national mental health information plan which includes the introduction of consumer outcome measures and the review of specialised public mental health services against national standards.
The national blood supply18 The Commonwealth strengthened its national leadership role in the setting of strategic directions for the Australian blood system. At the same time, the Commonwealth has continued to share responsibility for national policy, supply planning, improvements in the quality and safety of the blood supply and funding with the State and Territory governments. The Therapeutic Goods Administration also extended its national regulatory role over blood and blood related products to include fresh blood products (see Outcome 1) .
The review of the Australian blood
banking and plasma product sector
The Minister announced a major policy review of the Australian blood system, under the chairmanship of Sir Ninian Stephen, in May 1999. The review undertook a comprehensive examination of the sector, from donor recruitment, collection, processing, distribution and use of blood and blood products.
The report of the review of the Australian blood banking and plasma product sector was publicly released in June 2001. The review made a number of recommendations to the Minister relating to quality and safety, national supply planning, information and research, and governance in the sector.
The Department has established a taskforce to implement the review's recommendations. The taskforce has commenced a period of intensive consultation and negotiation with key interest groups, including the States and Territories, the
" Relates to Indica tor 7.
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QUALITY HEALTH CARE
Australian Red Cross Blood Service and providers, consumers and professional groups, which will continue throughout 2001- 02.
Plasma Fractionation Agreement
The Department was also charged with responsibility for addressing criticism from the Australian National Audit Office on the Commonwealth's management and regulation of the Plasma Fractionation Agreement with CSL Limited. Two distinct reconciliation processes to audit the delivery of plasma and blood products manufactured by CSL Limited to a wide range of recipients (including the Australian Red Cross Blood Service, pathology laboratories, hospitals and clinicians) have been implemented. As data from the audits is analysed, enhancements will be introduced to both processes, as required.
During the year, the supply and demand for certain plasma products was better balanced. The Australian Red Cross Blood Service increased the supply of plasma to CSL Limited by around 10 per cent, resulting in an increase in the quantity of plasma products manufactured. In particular, the available quantity of intravenous immunoglobulin, a product for which demand has, from time to time, exceeded supply in recent years, increased by around 7.5 per cent.
The National Managed Fund
The National Managed Fund was established on 1 July 2000 to provide blood and blood products liability cover for the Australian Red Cross Blood Service. States, Territories, the Commonwealth and the Australian Red Cross Blood Service are parties to the fund, which provides blood and blood products liability cover for the Australian Red Cross Blood Service activities in Australia. A primary purpose of the fund is to indemnify the seamless transfer of fresh blood and blood products between States and Territories to meet needs and for donor screening tests to be undertaken regardless of the State and Territory of collection.
127
The responsibility for engaging a manager for the fund rests with the Department. An open tender process was undertaken to engage a suitable manager. The tenderer process has been
protracted due to complexities in establishing suitable arrangements, which adequately cater for identified risks and multiple jurisdictions. Negotiations are expected to be finalised early in 2001-02.
Improving safety and quality of the blood
supply
Two key initiatives were introduced during the year directed at improving the safety and quality of the blood supply. Nucleic Acid Amplification Testing (a measure announced in the 2000-01 Budget) was introduced by the
Australian Red Cross Blood Service on 7 June 2000 and now forms part of the Australian Red Cross Blood Service's routine screening of donors. Nucleic Acid Testing identifies serious blood borne disease in donor blood earlier than previous testing techniques and was
implemented to reduce the risk of transmission of blood borne diseases. In 2000- 01 the Therapeutic Goods Administration also extended their national regulatory role to cover
the collection, processing and storage of fresh blood products produced by the Australian Red Cross Blood Service.
One of the measures taken to promote best practice in the use of blood and blood products in clinical settings is the development of clinical practice guidelines. Guidelines development is proceeding in two phases:
⢠phase 1 - use of red cells; and
⢠phase 2 - use of platelets, fresh frozen plasma and cryoprecipitate.
Phase 1 has been completed and the guidelines were endorsed by the NHMRC in March 2001. There is substantial overlap between the two phases and the documents have now been
UUICOIVIt 4
combined into comprehensive guidelines about the appropriate use of blood and blood products. The proposed guidelines were released for public consultations in May 2001. The final guidelines will be endorsed once the consultation process has been completed.
Precautionary measure on blood donations
In September 2000, Australia's health ministers placed a temporary ban on blood donations from people who lived in the United Kingdom for six months or more (cumulatively) during the period 1980 to 1996. The decision was a precautionary measure, following research in the United Kingdom that identified blood as a possible means of transmission of variant Creutzfeldt-Jakob Disease. The Commonwealth worked in close conjunction with the Australian Red Cross Blood Service and the State and Territory governments to minimise any adverse impact of donor deferral.
Cord blood
Significant progress has been made towards the establishment of a National Cord Blood Collection Network, which was funded in the 2000-01 Budget. Cord blood is an alternative treatment to bone marrow transplantation in treating people, especially children, with life threatening diseases such as leukaemia. The objective of the network is to collect and store 22,000 cord blood units, including 2,000 Aboriginal and Torres Strait Islander cords, for transplantation as required, making Australia largely self-sufficient in this area. It is expected that this objective will be achieved within four years from the establishment of the network.
Organ and tissue donation
With the principal objectives of improving Australia's low level of organ donation and raising the profile of the importance of organ donation, Minister Wooldridge launched the Australian Organ Donor Register in November
2000. As at 30 June 2001, in excess of 80,000 people had registered with the Australian Organ Donor Register their intention to donate. The Australian Organ Donor Register, operated by the Health Insurance Commission, ensures that a person's donor intentions can be verified, 24 hours a day, seven days a week, by authorised medical personnel anywhere in Australia.
Acute care Acute care involves the provision of medical and other services in hospitals as well as specialist services in the community. The hospital sector is a crucial component of health care delivery in Australia. It delivers inpatient, emergency, and outpatient care for individuals with acute and chronic care needs. Hospitals account for nearly 40 per cent of recurrent health expenditure. While the States and Territories are primarily responsible for the delivery of public hospital care, the Commonwealth contributes directly about 50 per cent of recurrent government expenditure on hospitals. The Commonwealth is engaged in a number of activities to support the effective funding and management of hospitals in an environment of rapid technological and organisational change.
A range of strategies is being implemented to support the ongoing development of this sector.
National Demonstration Hospitals Program
During 2000-01 Phase 3 of the National Demonstration Hospitals Program (NDHP) was completed. Phase 3 of the program focused on integration of care between acute hospitals and the primary and community care sectors. Four lead hospitals, 20 collaborating hospitals and one associate collaborator hospital were funded to complete a wide range of projects. The lead hospitals were selected for their recognised expertise in linking and coordinating acute care services, including pre-admission, outpatient services, in-patient care (including day surgery),
128
QUALITY HEALTH CARE
and post discharge care planning, (including hospital-in-the-home and services provided in alternative locations).
The eval uation of Phase 3 indicates a range of positive outcomes in terms of better integrated services and streamlined systems and processes. The evaluation reports will be published and distributed during September/October 2001. They include quantitative and qualitative reviews of the program, monographs from each of the pro jects and a resource document for others who wis h to achieve improved service integration.
The lessons learned from NDHP are being disseminated in other ways. During 2000-01, NDHP hospitals presented the results of individual projects, as well as sharing lessons lea rned from the entire program's activities, at four highly successful national conferences.
The Australian Resource Centre for
Hospital Innovations
The Australian Resource Centre for Hospital Innovations (ARCH!) is also funded under this program. ARCH! provides a comprehensive dissemination service on current best practice in the acute care and related sectors. Its interactive website (www.archi.net.au) and satellite centres enable clinicians and health professionals to access innovative practices developed at hospitals and through NDHP pro jects. ARCH! also conduct targeted National Toolkit Seminars for professionals.
129
Australian Refined Diagnosis Related
Groups Classification 19
In 2000-01, all States and Territories adopted the Australian Modification of the tenth version of the International Classification of Diseases (ICD-10-AM) for coding hospital morbidity data. The Department has continued to update the
Australian Refined Diagnosis Related Groups (AR-DRG) classification, to incorporate new
editions of ICD-10-AM. The latest version, AR DRG Version 4.2, was released in January 2001.
The production of AR-DRG Version 5.0 commenced in December 2000 with a call for public submissions on the development process. Previous versions of Australian Diagnosis Related Groups were developed using hospital length-of-stay as a proxy for cost.
For AR-DRG Version 5.0 data from the National Hospital Cost Data Collection (Round 3) was used in the evaluation of the cost implications of proposals. The NHCDC is an annual, voluntary collection of hospital's cost and activity data. It reports cost and activity for over
75 per cent of all separations from public hospitals. AR-DRG Version 5.0 is due for release in 2002 and will incorporate ICD-10-AM Third Edition diagnosis and procedure codes.
Further refinement and use of hospital cost data, along with a high degree of clinical involvement in AR-DRG development, will ensure that Australian diagnosis related groups reflect advances in medical technology and treatment modalities.
" Relates to Indicator 6.
OUTCOME ZJ
Performance indicators
Indicator 1 Providers of primary care take up initiatives to enhance primary care services and research projects for enhanced primary care are completed.
Indicator 2 Education and training for GPs in Enhanced Primary Care and Mental Health.
Indicator 3 Number of full time equivalent providers of GP services.
Indicator 4 The number of GP services per patient (adjusted for age and gender).
IndicatorS Expenditure on mental health services delivered in the community as a proportion of Australia's mental health budget.
Target: a) Demonstration projects that test models of integrated primary care, including financial viability of the model, are in place by June 2001. b) Enhanced Primary Care Medicare Benefits Schedule items are being utilised by all general practices whenever appropriate by 2003. c) The National Primary Care and Research and Development Strategy is in place by June 2001.
Information source/reporting frequency: Regular reporting from the Australian Divisions of General Practice. Reports from pilot tests on primary care models. Results of research.
Target: a) 100 per cent of Divisions of General Practice providing support for education and training for GPs in mental health. b) Development liaison officers are in place in every Division of General Practice by June 2001.
Information source/reporting frequency: Departmental monitoring.
Target: a) More equal distribution of full time equivalent providers of GP services. b) Increase in the number of full time equivalent providers of GP services in rural and remote areas.
Information source/reporting frequency: Departmental data.
Target: Maintain the number of GP services per patient.
Information source/reporting frequency: Data from HIC.
Target: An increase in the proportion of expenditure on community based mental health services.
Information source/ reporting frequency: Departmental data.
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Acute care
Indicator 6 Availability of Diagnosis Related Groups and cost weights.
Indicator 7 Implementation of a range of blood sector initiatives including recommendations from the Review of the Australian Blood Banking and Plasma Product Sector commenced by June 2001.
Indicator 8 Effectiveness of trials of integrated health service delivery.
QUALITY HEALTH CARE
Target: a) Australian Diagnostic Related Groups classification in place and available in software form by January 2001. b) Diagnosis Related Groups cost weights based on 1999-2000 data available by May 2001.
Information source/reporting frequency: DRG data sources: medical opinion supplied by the Australian Casemix Clinical Committee. Hospital Morbidity Data from State Health Departments annually. Cost weights data is gathered through the National Hospital Data Collection by this Department.
Target: Nucleic Acid Testing commenced by June 2001. Cord Blood Banking network established by June 2001.
Information source/reporting frequency: Departmental data.
Target: a) Two models of integrated mental health care are being evaluated by June 2001. b) Ten new Coordinated Care Trials are established by June 2001. c) Analysis of the evaluation of the first round of Coordinated Care Trials finalised by December 2000.
d) Analysis of the After Hours Care Trials evaluation.
Information source/reporting frequency: Reporting as per project and trial contracts. Departmental data.
131
r-------'00 rCUWIE
OUTCOME 4: FINANCIAL RESOURCES SUMMARY
I (A) (B)
Budget Actual Variation
Estimate Expenses (Colum n B 2000/2001 200012001 minus
$'000 $'000 ColumnAl
Administered Expenses
Administered Item J. : Primary Care Strategies Appropriation Bill 1/3 259,975 252,566
Appropriation Bill214
259,975 252,566
Administered Item 2: Integrated and Coordinated Cm·e Strategies Appropriation Bill 113 55,367 8,505
Appropriation Bill 214
55,367 8,505
Administered Item l : Acute Care Strategies National Health Act 1953 -Aids & Appliances (p) 34,068 33,5 53
National Health Act 1953 - Blood fractionation, products 92,368 136,731
& hlood related products
Healtl1 Care (Appropriation) Act 1998 - Australian Health 45,464 35,519
Care Agreements- provision of designated health services (p)
Total Special Appropriation.< 171 ,900 205,803
Appropriation Bill 1/3 13,654 13 ,128
Appropriati011 Bill 214 88,020 72,236
273,574 291,167
Administered Item 4: A-/ental Health strategies Healtli Care (Appropriation) Act 1998- Australian Health 80,911 60,918
Care Agreements- provision of designated health services (p)
Total Special Appropriations 80,91 1 60,918
Appropriation Bill 1/3 26,486 15, 151
Appropriation Bill 214
107,397 76,069
Total Administered Exeenses 696,314 628,307
Departmental Appropriations
Output Group 1 - Services to the Mini ster & Parliament 18,0 17 17,831
Group 2 -National Leooerslri p 6,639 6,636
Output Group 3 - lnfonnation 3,408 3,682
Output Group 4 - Program Management 8,367 8,662
Output Group 5 - Regulatory Activity Outp ut Group 6 - Direct Delivery of Services
Total price of departmental outputs 36,431 36,811
(total revenue from Government & other sources)
Total revemte from Government (appropriations) 36, 188 36,240
contributing to price of departmental outputs Total revenue from oth er services 243 571
Total price of departmental outputs 36,431 36,8 11
{total revenue from Government & other sources)
Total price of out puts for O utcome 4 36,431 36,811
(total revenue from Government & other sources)
Tota l estimated resourclng for Outcome 4 732,745 665,118
{total price of outputs & ad min expenses)
1 The Budget Estimate 2000/200 I includes the appropriations as per the 2000 -2001 Portfolio Budget Statements 2000-2001 Portfolio Additional Estimates and Advances to the Finance Minister. Titis amount may differ to the re\ised estimates for2000/2001 published in the 2001 /2002 PBS. Such differences can arise from updated estimates and rephasings .
2 Budget prior to additional estimales. The number of output groups ha. reduced from 4 in 2000-2001 to 2 in 2001-2002. It is not possible to show direct co mpardtives
132
(7.409)
17,4091
(46,862)
(46,862)
(515) 44,363
(9,945)
33,903 (526) (15,784)
17,593
( 19,993)
( 19,993) (11 ,335)
(31,328)
168,007l
(186) (3) 274 295
380
52
328
380
380
(67,627)
'Budget 2001/2002 $'000
302,920
302,920
63,840
63,840
34,237 94,567
39,542
168,346 19,327 88,849
276,522
66,783
66,783 20,241
87,024
730,306
15 ,862
26,982
42,844
42,578
266
42,844
42 ,844
773 , 150
Outcome 5: Rural health
Improved health outcomes for Australians living in regional, rural and remote locations
133
Outcome 5 is managed by the Office of Rural Health in the Department's Health Services Division. The Department's State and Territory offices, and other program areas across the portfolio, also contribute to achieving this outcome. It is the role of the Office of Rural Health to coordinate the integration and implementation of the Department's overall rural health programs across a number of outcomes. The Office also has specific carriage of a number of targeted rural health programs.
OUTCOME 5
Major achievements
Additional University Departments of Rural
Health (UDRH) and Rural Clinical Schools
The locations for nine new Rural Clinical Schools were announced by the Minister in February 2001 and contracts with relevant universities for their initial implementation are now in place.
The first of three additional University Departments of Rural Health has been established in Warrnambool in the Greater Green Triangle region of Victoria and South Australia. The Minister announced that the other two University Departments of Rural Health will be located in Lismore and Tamworth.
The Rural Australia Medical Undergraduate
Scholarship (RAMUS) Scheme
Over 430 medical students were awarded and paid the scholarship in late 2000. A further 80 new scholarships were awarded in May 2001.
Medical Rural Bonded Scholarships
One hundred new medical students signed up for the scholarships in the first year of operation in 2001. The scholarships are provided to new medical students prepared to commit to at least six years of rural practice and are h ighly sought after by students, with demand exceeding the number of places available.
Regional Health Services Program
Fifty-two Regional Health Services were approved during 2000-01, bringing the total number of services approved by 30 June 2001 to 69.
The More Allied Health Services Program
Sixty-six eligible rural Divisions of General Practice received funding in 2000-01 to commence the provision of professional allied health services to rural and remote communities. Current estimates indicate that
there will be more than 130 full time equivalent allied health positions funded nationally through this program.
Under-achievements Delays have been encountered in implementing some components of the Regional Heath Strategy due to program complexity and the need to consult widely with rural stakeholders.
The Medical Specialist Outreach Assistance
Program (MSOAP)
There have been delays in rolling out the Medical Specialist Outreach Assistance Program. The program has required ongoing negotiations with a range of stakeholders including State and Territory governments, specialist colleges, consumer groups and rural communities. The platform is now set for a rapid rollout of new specialist services in rural areas.
Rural Chronic Disease Initiative
There has been some delay, causing an underspend in the Rural Chronic Disease Initiative largely due to slippage in timelines, consultations with a large number of diverse stakeholders and complex national, regional and local negotiations around the implementation strategy for this initiative. The foundations for implementation are now set in place and phase one implementation of the Rural Chronic Disease Initiative is currently underway.
Regional Health Services Program
There have been some minor shortfalls in expenditure of funds under the Regional Health Services Program. A key element of this program is working directly with rural communities to understand the local health issues and to develop and support new health services to meet these priorities. Throughout the past year it became increasingly apparent that the communities with the highest level of health
134
RURAL HEALTH
need had limited capacity to identify their health priorities. As a result there has been a high level of service planning. This has led to a slight delay in rolling-out new services in some areas. In all, the target of 35 new services has been exceeded, with 52 new Regional Health Services approved in 2000-01. In addition, 38 service planning projects have been approved.
Outcome summary - the year in review The Government is working in partnership with rural, regional and remote communities around Australia to improve access to quality health and aged care services. Since 1996, a series of programs has been introduced to strengthen the rural health workforce, improve rural health education and training opportunities and to deliver improved health services for country Australia.
The Government's commitment to improving rural health services was further demonstrated by the 2000-01 Budget's Regional Health Strategy: More Doctors, Better Services - an extensive and integrated package worth more than $550 million over four years.
In 2000-01, the Office of Rural Health has focused much of its energy on coordinating the Regional Health Strategy programs. Implementing these complex rural health programs involves working across the portfolio with other outcome areas, with the Department's State and Territory Offices, and most importantly with local communities to find out exactly what they need and how best to support the services to meet this need.
To ensure a more complete picture is presented of how the Regional Health Strategy is being implemented across the Department, the
initiatives administered by all relevant Outcomes are included in this chapter as outlined below:
135
Outcome 1: Managing rural chronic disease and illness;
Outcome 2: Pharmacy start-up, succession and maintenance allowances; allowance for pharmacist support services to remote area Aboriginal health services;
Outcome 3: Adjustment grants for small rural aged care facilities and services for older people;
Outcome 4: General practice initiatives including new general practitioner registrars; workforce support for rural general practitioners; HECS Reimbursem*nt Scheme; Rural Australia Medical Undergraduate Scholarship Scheme; more allied health services in rural areas;
Outcome 5: Support, Education and Training for Health Workers including the University Departments of Rural Health; Regional Health Services Program; Medical Specialist Outreach Assistance Program; Rural and Remote Pharmacy Workforce Development Program;
Outcome 8: Bush Nursing, Small Community and Regional Private Hospitals; and
Outcome 9: Medical Rural Bonded Scholarships Scheme; Rural Clinical Schools.
Visible results are becoming apparent in regional and rural areas due to the Regional Health Strategy programs that have been implemented, with several more ready to
commence in 2001-02.
Progress reports indicate there are now more students with a rural background studying medicine, more medical school places for students wanting to practice in rural areas and more facilities providing specific rural health
OUTCOME 5
education and training. Substantial progress has been made this year on the implementation of the Regional Health Services Program.
This chapter describes in more detail the implementation of the Regional Health Strategy initiatives and the specific programs administered by the Office of Rural Health to improve the health and well being of Australians living in regional, rural and remote localities.
Other programs that support the Department's rural health efforts can be found under Outcome 4 (GP education, training and support programs; the Rural Retention Program and the Rural Women's GP Service); Outcome 7 (Indigenous programs); and Outcome 9 (the Rural Locum Relief Program and the eligibility of overseas trained doctors to practice in rural and remote communities).
Components of the total rural health package of programs are mutually reinforcing and work together to increase the availability and viability of rural health services for the long term through three key strategies:
⢠enhancing rural education and training for health professionals;
⢠increasing workforce support for health professionals; and
⢠developing better health services for local rural communities.
Enhancing rural education and training for
health professionals,
The need for more doctors in rural and regional Australia is widely recognised, with many communities identifying having a local doctor as high on their list of health priorities. Several of the rural health measures are aimed at increasing the numbers of doctors in rural and regional areas now and into the future.
' Relates to Indicator 2.
More places to study rural medicine
In the 2000-01 Federal Budget funding was allocated to develop nine new Rural Clinical Schools and three additional University Departments of Rural Health (UDRH), building on the existing University Departments of Rural Health initially funded in the 1996 Budget. These facilities are the foundation of a national rural health education and training network, focusing on providing specific rural health training and encouraging medical and other health professionals to take up rural practice.
Medical students at the fames Cook University in Townsville
The Rural Clinical Schools initiative will strengthen the rural focus in medical training by enabling at least 25 per cent of medical students to receive a minimum of 50 per cent of their clinical training in rural and remote areas.
The nine new Rural Clinical Schools announced in 2000-01 will be located in Coffs Harbour, Dubbo, Rockhampton/Toowoomba, Kalgoorlie, Bairnsdale, Shepparton, Burnie, Whyalla and the Riverland district of South Australia with an
136
RURAL HEALTH
expansion of the Northern Territory Clinical School. To date the Government has established contracts with relevant universities for the initial implementation phase. The new clinical schools will complement the Greater Murray Clinical School at Wagga Wagga and the medical school at James Cook University, where construction is close to completion.
Activities of the University Departments of Rural Health are targeted at all levels of health professional education, such as health career promotion at rural high schools, vocational training and professional development. They also develop specific rural and remote curricula for undergraduate students.
During the financial year 2000-01, the Government continued to support the seven University Departments of Rural Health at Mt !sa, Broken Hill, Whyalla, Geraldton, Shepparton, Alice Springs and Launceston with core funding.
A contract was signed on 1 March 2001 with Flinders and Deakin Universities to establish the first of three new University Departments of Rural Health at Warrnambool in the Greater Green Triangle region of Victoria and South Australia. The University Department will be the first to provide services across state borders.
Negotiations have begun for the establishment of the remaining two additional University Departments of Rural Health to be located in Tamworth and Lismore.
More scholarships for rural students
The Rural Australian Medical Undergraduate Scholarship (RAMUS) Scheme aims to increase the number of students with a rural background studying medicine by providing financial support during their university study. The scheme has proved very popular with some 400 applications received for the 80 new scholarships available in 2001.
137
Rural Australia Medical Undergraduate
Scholarship {RAMUS) scheme eases
financial burden
For Adelaide University student, Matt Hutchinson, surviving financially last year proved to be a greater challenge than passing subjects in the first year of his medical degree.
But as one of more than 400 new recipients of the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme, Matt from the South Australian township of Victor Harbour
is now enjoying concentrating on his studies rather than on paying his next round of living expenses.
'It was an absolute nightmare last year. I had a job at a hardware store and found it really hard to juggle rent, bills and textbooks', Matt said.
'As a consequence I had a really bad year with my health, so now it is great because a lot of the pressure has been taken off me'.
The RAMUS Scheme is a national financial assistance scheme open to medical students with a rural background. It is part of a wide ranging strategy by the Federal Government to
increase the number of doctors in regional Australia and improve access to quality primary health care in rural and regional areas.
Matt, who is 21, plans to work in the country when he graduates from medical school.
As well as the financial assistance, Matt also
appreciates the opportunity RAMUS gives him to work with a rural mentor, to better understand the issues facing rural practitioners.
Pioneering role for North Queensland
student
Ayr medical student Benjamin Chapman is better placed than most to appreciate the importance of doctors in a rural community.
At just nine years of age, he was diagnosed with Acute Lymphoblastic Leukaemia and underwent 25 months of chemotherapy. More recently he lost his best friend from an unsuccessful heart transplant operation.
But Benjamin, who is now 19 and in long-term remission from his illness, is drawing strength from his experiences and building a career in rural medicine, recently becoming part of the first group of students to sign up for the Federal Government's new Medical Rural Bonded Scholarship Scheme.
For Benjamin -a fi rst year medical student at James Cook University in North Queensland making a long-term commitment to rural medicine was a natural choice.
'I grew up in the country and I intend on staying in the country, where I believe the benefits far outweigh the disadvantages', Benjamin said.
'As a doctor in a rural setting you become part of their society and are seen as a role model in the town and you also see a much wider variety of injuries and illnesses'.
Benjamin said the financial assistance he would receive from the bonded scholarship scheme during his medical degree would pay for university-related costs and allow him to concentrate on his studies.
He believes that this assistance, combined with the opportunities to study in a rural setting, will mean the chances of more doctors settling in rural areas become 'much more than a possibility'.
OUTCOME 5
Under the Medical Rural Bonded Scholarship Scheme, 100 new medical school places will be offered every year to students in return for a commitment to work in rural areas for at least six years once they complete their general practitioner or specialist fellowship. One hundred new medical students signed up for the scholarships in 2001. The first year's implementation process has been viewed as a trial and the Department and the universities are currently evaluating the administration of the scheme.
Rural health support, education and
training projects
The Rural Health Support, Education and Training (RHSET) Program has continued to provide funding for innovative projects that focus on the support, education and training needs of the rural health workforce. Projects funded under the RHSET program improve the accessibility of rural communities to appropriate health services by offering support to rural health professionals and addressing recruitment and retention issues in the longer term.
In 2000-01, the Commonwealth funded 23 projects through this program which included:
138
⢠a project that aims to improve relations between rural and remote health workers and Aboriginal people through an appropriate behaviour and hospital familiarisation program;
⢠a retention program for rural occupational therapists through training and support for supervision of students; and
⢠the creation of a database showing access to dental care in regional, rural and remote areas of New South Wales.
RURAL HEALTH
Increasing workforce support for health
professionals 2
A number of measures are focused on strengthening the rural health workforce through increased support and encouragement for health wo rkers to undertake vocational training.
Bush Crisis Line and emergency care support
The Bush Crisis Line is a 24-hour free call telephone service that offers crisis debriefing to isolated rural health professionals and their families. It targets the needs of multidisciplinary remote area health
practitioners including general practitioners, medical specialists, remote area nurses, allied health practitioners and Aboriginal health workers. In many instances, the Bush Crisis Line is the only support service available to help the rural and remote health workforce deal with personal and job related trauma.
In 2000-01, the Bush Crisis Line provided telephone support to over 360 callers, which equated to over 280 hours of counselling. Bush Crisis Line staff have also provided six Train the Trainer Surviving Stress in the Remote Workplace workshops since June 2000.
Access of remote area communities to quality emergency care is available through first line emergency care training of remote area health workers. The program delivers training courses in advanced trauma management and emergency care procedures. In 2000-01, 10 courses were held at locations such as Coober Pedy, Ballarat, Launceston and Alice Springs. A total of 192 remote area health professionals attended these courses and received first line emergency care training.
Workforce support for rural general
practitioners
The number of general practice registrars in Australia has increased with registrar training
' Re lates to Indicator 2.
139
places growing from 400 to 450 per year. A dedicated 200-place Rural Training Pathway was established from January 2001 within the overall allocation of general registrar places. The pathway operates alongside the primarily urban General Training Pathway which consists of 250
places. The General Practice Registrars Rural Incentive Payments Scheme has been established as an integral component of the Rura l Training Pathway. The scheme provides financial incentives of up to $60,000 over three years for each registrar who makes a commitment to training in rural and regional Australia. Payments commenced from July 2001.
The HECS Reimbursem*nt Scheme provides financial incentives to graduating medical students to attract them to careers in rural medicine by offering them the opportunity to work off their HECS debt in designated rural areas. The first payments under the Scheme will commence in January 2002. During 2001- 02 approximately 200 doctors will be assisted under this Scheme.
The Workforce Support for Rural General Practitioners Program is increasing the capacity of eligible Divisions of General Practice to support the newly arrived and existing general practice workforce in rural areas. Funding under the program is being distributed to 66 eligible rural Divisions of General Practice for a variety of activities, mainly around GP education, training and development; peer/family support including GP well-being; practice management/support; and orientation activities for newly arrived GPs including registrars and overseas-trained doctors.
Workforce support for pharmacists
Improved recruitment and retention of pharmacists to rural and remote areas will help to increase access to pharmacy services for rural communities. The Rural and Remote Pharmacy Workforce Development Program includes
OUTCOME 5
financial assistance in the form of scholarships, including Aboriginal and Torres Strait Islander scholarships, allowances for travel associated with continuing professional education, emergency locum services and other similar projects.
An electronic recruitment database has been established and guidelines for Aboriginal and Torres Strait Islander scholarships have been finalised.
Four undergraduate scholarships were awarded in 2000 and the scholarship holders have successfully completed their year of study. A total of 60 applications were received in 2001 with 12 applicants being offered scholarships.
Workforce support for specialists
The rural specialist workforce is strengthened through a number of programs including the advanced specialist training posts in rural and regional hospitals (a total of 33 in 2000); support for specialist rural training programs (the rural surgical training program had 43 trainees at the commencement of 2001); and through continued development of the rural locum support and recruitment initiatives for physicians, surgeons and anaesthetists under the auspices of the relevant Colleges. A total of 85 locum matches have been reported through these programs including some permanent placements in the years 1999 and 2000. These programs assist in providing upskilling opportunities for rural practitioners, and in recruitment and succession planning.
Workforce support for nurses and
midwives
A key longer term strategy for strengthening the rural nursing workforce is the financial assistance offered to nurses for professional development through the Rural and Remote Nursing Scholarship Scheme. The objective of the scheme is to assist professional development and skill training for registered and enrolled
nurses working in remote and rural areas as well as those wishing to train and practice in these areas. In 2000-01 a total of 222 scholarships were awarded to allow post registration nurses to experience practice in rural and remote settings and to address some degree of the professional isolation of nurses currently practising in rural and remote Australia.
The Rural and Remote Midwifery Upskilling Scheme was developed to increase accessibility of rural and remote communities to midwifery services. A shortfall in midwifery services stemmed from increasing fertility rates in country areas and an increase in the number of rural and remote midwives who were retiring or relocating. Funding was provided to the States and the Northern Territory to provide upskilling to at least 1,575 midwives over the four years of this program. During 2000-01, over 1,000 midwives attended training programs to update their skills as part of this program.
More health services in regional Australia 3
Many country towns in rural and regional areas often suffer from a lack of health services. New, restructured and more flexible services are gradually being implemented to help support doctors while also being more responsive to local needs.
Regional health and multipurpose services
The Regional Health Services Program, announced in the 1999-2000 Federal Budget and considerably enhanced in the 2000-01 Budget, enables communities to tailor local health services to better suit their needs.
The following map (Figure 5.1) illustrates the growing number of Regional Health Services across Australia.
A broad range of primary care services can be supported under the program. Close consultation with local communities has resulted in a comprehensive mix of primary care
' Relates to Indicator 1
140
RURAL HEALTH
Figure 5.1: Location of regional health services across Australia, as at 30 June 2001
⢠Service delivery
⢠Service charter
services being supported in areas such as community nursing, mental health, social work and counselling, health promotion and education, palliative care, child and family health, youth services, drug and alcohol services, dietetics, podiatry, physiotherapy, speech and occupational therapy.
With program infrastructure in place, the focus has now shifted to funding communities identified as those with a high need for primary services. Areas of high need were determined in each State and Territory in collaboration with State and Territory based advisory committees, and targeted for funding. This process identified many communities with high need but a low capacity to develop service delivery proposals. To assist these communities, an additional 38
141
service planning projects were funded in 2000-01, bringing the total number funded under the program to date to 59. Many of these projects resulted in communities developing comprehensive service delivery plans which were funded for the first time under the
program during the year. In all, 52 Regional Health Services were funded for the first time during 2000- 01 , bringing the total number of services funded as at 30 June 2001 to 69.
The Multipurpose Services Program is also continuing to expand. Closely aligned with the Regional Health Services Program it aims to provide a more flexible, coordinated and cost effective framework for service delivery by pooling State and Commonwealth funds for health and aged care services.
OUTCOME 5
A regional health services success story
community driven health care
George Town may be one of the oldest towns on the Australian map, but its residents are determined to ensure there is nothing antiquated about its health and community care facilities.
Concerned about the impact of a local council amalgamation and tired of battling on with a range of fragmented and inadequate health care services, an enthusiastic group of locals got together and organised a committee to take control of the town's health care needs.
With some assistance from a local GP, Dr Brian Bowring, the committee applied for funding under the Commonwealth's Regional Health Services Program, and is among 69 communities around Australia currently benefiting from the program. As a result, the picturesque community on the mouth of the Tamar River in Tasmania's north will establish a one-stop information shop to access health care services, as well as fund a range of domestic violence, youth, mental health and pregnancy support programs.
Dr Bowring said the funding not only provided a tremendous morale boost, but was vital to the survival of the 6,000-strong community.
'If we don't keep our health services, we won't keep our population', Dr Bowring said.
'This Program empowers the community. It allows them to take a broad look at the provision of health care services, pick the gaps and, where possible, plug them'.
The program was developed in response to a range of health and aged care challenges in rural communities and works best in small communities which cannot sustain a stand alone aged care facility, and where integration of services is the most sensible option to allow the sustainability of the service. Importantly, it is designed to help communities whose catchment area is such that the call on aged care services is uneven or sporadic. Funding is provided at a "cashed- out" rate which is dependent on the number of aged care places approved and the consequent daily funding amount. This gives the multipurpose service some flexibility in providing care from within a set annual amount, and allows certainty in funding, irrespective of the actual call on services.
Over the past 12 months, 13 new multipurpose services were approved as flexible care services. Under the 1999-2000 Regional Health Services Budget initiative, 100 new flexible aged care places were made available for allocation in 2000-01. All of these places have been allocated.
More allied health and specialist services
for rural Australia
Employment of more allied health professionals in line with locally identified needs is being provided through the More Allied Health Services Program. Funding for the Program is being managed by 66 eligible rural Divisions of General Practice which cover thousands of rural communities across Australia. Depending on the model of service provision being used, these Divisions of General Practice were, at 30 June 2001, recruiting allied health professionals and/or finalising arrangements with State and Territory or private providers, and health service provision was commencing.
State and Territory offices report that Divisions' plans for the More Allied Health Services Program identify the employment of workers
142
RURAL HEALTH
from more than 16 different allied health professional groups. These professionals include mental health workers (such as psychologists, counsellors or social workers), diabetes educators, asthma educators, physiotherapists, occupational therapists, podiatrists, dieticians, speech pathologists, audiologists, Aboriginal health workers and registered nurses. Current estimates indicate there will be more than 130 full time equivalent allied health positions funded nationally through this program.
The Medical Specialist Outreach Assistance Program provides funding to improve the access of regional communities to specialist health services by addressing some of the disincentives for specialists to provide outreach services in rural and remote areas. The other major feature of the program is an emphasis on the specialists and local general practitioners working together on patient care and on the provision of ongoing support and training to local medical practitioners.
Extensive consultation, undertaken with a range of key stakeholders, highlighted the need to ensure that the program's implementation did not disrupt existing arrangements for the provision of specialist services, and the need to establish effective linkages between visiting specialists and local health service providers.
Implementation also required the need for services to be identified and addressed at the regional level. Advisory groups in each State and the Northern Territory have been established to assist with the identification of needs and the
establishment of new services.
Given the responsibility of State and Territory governments to fund and coordinate specialist service delivery, some funds are provided through State and Territory governments to support outreach services. New outreach services have now been established in Tasmania, South Australia and the Northern Territory, through
143
collaboration between the Commonwealth and the States and Territories, and the medical profession. Negotiation for additional services will continue.
Remaining funds are administered through a non government organisation in each State - the State Based Organisation of the Divisions of General Practice in Queensland, and the Rural Workforce Agencies in the other States. These organisations are undertaking regional consultation to prioritise service needs to inform the work of the State and Territory advisory groups.
Better support for pharmacies, bush
nursing and small regional hospitals
A range of measures to sustain or increase the number of pharmacies in more remote areas and provide workforce support are being introduced through the Enhanced Pharmacy Package. (See Figure 2.6 showing distribution of Australian
pharmacies by urban and rural areas on page 69 under Outcome 2).
The Rural Pharmacy Maintenance Allowance provides ongoing support to pharmacies in rural and remote communities. Around 800 pharmacies are eligible to receive this new allowance, more than double the previous number.
The Start-up Allowance is encouraging pharmacists to establish new pharmacies in remote areas of Australia. New pharmacies have already opened in remote areas of New South Wales and South Australia. The new Succession Allowance is available to assist in attracting pharmacists to more remote areas to take over existing pharmacies that would otherwise close
down. Several pharmacies in New South Wales, Western Australia and Victoria have already been retained through this initiative.
A new allowance is also in place for rural community pharmacists who provide support services to remote area Aboriginal health services under Section 100 of the National Health
OUTCOME 5
Act 1953. These arrangements are intended to improve the quality use of medicines in Aboriginal communities.
Funding is also available to revitalise bush nursing, community and other small , regional private hospitals.
Through this initiative the Commonwealth provides funding for the engagement of service planners to assess both the health service and business administration aspects of the hospital and put forward strategies for improving viability. In many cases further funding will be available to support the implementation of identified strategies. The Program has been predominantly focused on service planning, with the grants program beginning in March 2001 in response to completed service plans.
There are approximately 59 targeted hospitals throughout regional Australia. The second phase, the implementation of recommendations arising from the service-planning phase, is set to begin fro m June 2001.
Better support for older people and people
with chronic diseases in rural areas
To meet demand and suitable care standards for the frail aged, the Government has substantially increased funding for aged care, of which a substantial proportion is delivered in rural and regional areas.
Over a third of aged care places are located in rural and regional Australia, in proportion with the number of older people living there. In the 2000 Aged Care Approvals Round, which were announced in January 2001, more than 6,200 additional places were directed to regional, rural and remote areas. This represents 44 per cent of the new places in this round.
Funding was provided in 2000-01 for adjustment grants to improve the viability of smaller rural, regional and remote residential aged care homes. The measure has two components: additional funding for viability of
aged care homes and funding for capital projects to extend or upgrade homes. Principles have been prepared under the Aged Care Act 1997 to enable new viability funding arrangements, which will increase the number of services receiving funding from 211 to more than 500. Homes that were eligible under the previous arrangements will receive an increase in funding of at least 10 per cent.
Pilot programs are being established to develop local models to assist people in rural Australia to better prevent and manage chronic disease and injury. Up to 100 rural communities will receive one-off funding over the next three years to develop and implement chronic disease/ injury prevention and management programs in their local area. Also included is the establishment of a Special Projects Funding Pool to provide grants to individuals and organisations for new and innovative chronic disease/injury prevention and management ideas.
Royal Flying Doctor Service of Australia
(RFDS)
The Royal Flying Doctor Service of Australia (RFDS) provides a high quality aeromedical emergency and primary health care service to the people who live, work and travel in regional and remote Aus tralia. The RFDS primarily services small communities and homesteads outside the range of health services provided to other rural Australians. Currently, the RFDS has a five-year funding agreement with the Commonwealth, which began in July 1998 to assist with the delivery of these services, including additional funding in 2000-01 to replenish their capital reserves and maintain their service capacity.
The way forward - building on strong foundations The 2000-01 Federal Budget represented the largest commitment by any Australian Government to redress the imbalance between
144
RURAL HEALTH
Broken Hill medica l practice
rural and city health and built on work already happening in regional, rural and remote communities since 1996. Much progress has been made in opening the way for greater educational opportunities for country students, in strengthening the rural medical workforce and in establishing more targeted health services for local rural communities.
Over the next three years, more funding will go to programs that improve access to the highest level of health care services possible for rural Aus tralians. The focus will be on addressing shortfalls in the rural health workforce, particularly in the field of nursing, and strengthening existing measures to provide sustainable rural health services for the future.
Performance indicators -measuring health status in rural Australia The Office of Rural Health has revised the suite
of performance indicators reported in the 2000-01 Portfolio Budget Statements in order to make them program specific and more aligned to the programs being provided under Outcome 5. The new performance indicators covering the University Departments of Rural Health and Rural Clinical Schools, the Medical Specialist Outreach Assistance Program, the Rural and Remote Pharmacy Workforce Development and
145
Regional Health Services Programs will be reported on in the 2001-02 Annual Report.
The background to this development was that earlier substantial exploratory work had been undertaken to test the feasibility of developing a set of high level national rural health performance indicators, involving a collaborative approach by the Commonwealth and the States and Territories through the
ational Rural Health Policy Forum. Such indicators would have had a focus on access to health and allied health services, the number of health and allied health professionals practising and receiving training, education and support, and health status changes over the longer term.
However, it quickly became clear that the task was highly complex, and problematic, particularly in the area of health status change where it would take some considerable years to show changes. Further, there was some doubt that it was possible to construct indicators and data sets that would
show national progress in this area free of any confounding variables. In addition, such a national approach would not necessarily assist the Commonwealth in determining the impact of its own rural health programs.
As a separate activity, now outside the formal
Portfolio Budget Statements and Annual Reporting processes, the Office of Rural Health has engaged the Australian Institute of Health and Welfare to undertake a major rural health information project. The project is being undertaken over a twelve month period from May 2001 to April 2002 and will lead to the
provision of a range of reports on selected rural health issues. An expert Rural Health Information Advisory Committee has been established to advise the Department on the conduct of this project.
Performance indicators
Indicator 1:
Access to health and allied
health services for people
living in regional, rural
and remote locations.
Indicator 2:
The number of health and allied health professionals
practising in regional,
rural and remote locations
receiving training,
education and support.
Indicator 3:
Positive change in health
status for people living in
regional, rural and iemote locations over the longer
term. [Note: This indicator
is linked to Aboriginal and
Torres Strait Islander
health status changes.]
Target:
See page 145 for new rural health information project under way on
measuring health status in rural Australia.
Information source/reporting frequency:
See page 145 for new rural health information project under way on
measuring health status in rural Australia.
Target:
See page 145 for new rural health information project underway on
measuring health status in rural Australia.
Information source/reporting frequency:
See page 145 for new rural health information project under way on
measuring health status in rural Australia. ‘
Target:
See page 145 for new rural health information project underway on
measuring health status in rural Australia.
Information source/reporting frequency:
See page 145 for new rural health information project under way on
measuring health status in rural Australia.
$13,331:; «335$ ;, J r > :g 1 :N» 1.5“: ,» :1 H t J ‘ 1, , *1; 5x7}???
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OUTCOME 5: FINANCIAL RESOURCES SUMMARY
Administered Expenses
‘ (A)
Budget Estimate
2 000/2001
S '000
Administered Item 1: Supper), Education and T raining for Heallh Workers Appropriation Bill 1/3 Appropriau'on Bill 2/4
Administered Item 2: Regional Health Services Appropriation Bill 1/3
Appropriation Bill 2/4
Total Administered Ex enses
Departmental Appropriations
Output Group I - Services to the Minister & Pariiament Output Group 2 - National Leadership
Output Group 3 - Informafion Output Group 4 - Program Mamgemem Outpu! Group 5 — Regulatory Activity Outl Group 6 — Dimd Delivery of Servioa
Total price of departmental outputs (total revenue from Gova-nment & other sources)
Total revenue from Government (appropxiations)
connibufing to price of depmtmental outputs Total revenue from other services
Total price of depaltmental outputs (total revenue om Gova'mnml & other sources)
Total price of outputs for Outcome 5 (total revenue from Government & other sources)
Total estlmated resourcing for Outcome 5 (Iota! price of outputs &. admin apenses)
l The Budget Estimate 2000/2001 includes the appmprimions as per the 2000-2001Pontblio Budget Statements (PBS),
2000-200] Ponfoljo Addiional Estimates and Advances to the Finance Minister. This amount may differ to the revised
50,099
50,099
25,732
25,732
75,830
3,024 2,244 3,450 4,739
13.457
13.396
61
13,457
13,457
89,287
(3)
Actual Expenses
2 00 0/2001
3'000
46,382
46,382
15,059
15,059
61,441
3,022 2,242 3,448 4,735
13,447
13,386
61
13,447
13,447
74,888
Variation
(Column B
minus
Column A
(3,717)
3,717
(10,673)
(10,673) (14,389)
(2) (2) (2) (4)
(10)
(10)
(10)
(10)
(14,399)
estimates for 2000/2001 published in the 1301/2002 PBS. Such djfl‘erences can arise from updated estimates and Iephasings.
2 Budget priorto additional estimates. The number of output groups has reduced [mm 4 in 2000-2001 to 2 in 2001-2002.
It is not poasble to show direct compann’ves
1 Budget ,
2001/2002
5'000
80,254
80 254
27,253
27,253 107,507
3,121
7,407
10,528
10,486
42
10,528
10,528
1 18,035
b
Outcome 6: Hearing services
To reduce the consequences of
hearing loss for eligible clients an d the incidence of hearing loss in the broader community
149
Responsibility for managing Outcome 6 lies with the Office of Hearing Services within the Aged and Community Care Division of the Department.
Australian Hearing Services and the National Acoustic Laboratories also contribute to achieving this Outcome, and produce their own annual reports.
OUTCOME 6
Major achievements
Service level Agreement with Australian
Hearing Services
A Service Level Agreement with Australian Hearing Services for the delivery of Community Service Obligations (CSOs) was negotiated successfully and finalised.
Consumer feedback on services
National consumer roundtable discussions were conducted in early 2001 to validate the quality of service received by clients and the effectiveness of information provided by the Office of Hearing Services (the Office).
Payment of Claims
Significant reduction in time taken to process and pay claims to service providers.
Outcome summary - the year in review The Australian Institute of Health and Welfare, in its biennial report to Parliament, Australia 's Health 2000, gave an estimate that approximately 17 per cent of the Australian population had a hearing loss of sufficient level to cause problems in conversations with more than one person. This estimate placed hearing loss as the second most prevalent health condition in the Australian population.
Another study based on audiological testing of subjects in South Australia' indicated similar results and concluded that 10 per cent of the population would benefit from a hearing aid fitting.
Hearing loss can be a significant contributor to social isolation for older Australians in particular. It is also acknowledged that hearing is an essential factor in the acquisition of speech and learning by children. The provision of hearing services to hearing-impaired young
adults and children enables them to participate more full y in education and the community, increasing their acquisition of knowledge and improving their quality of life.
Th e Government recognises the importance of providing rehabilitation services to those affected by hearing loss through funding targeted specialist hearing services under the Commonwealth Hearing Services Program.
Th e Office, a Branch within the Aged and Community Care Division of the Department, is responsible for achieving the Commonwealth Hearing Services Program outcomes. It achieves this through the purchase of high quality h earing services from a national network of private sector service providers and Australian Hearing Services, the public provider.
The Office, as the Government purchaser and regulator for the program delivers:
⢠contestable hearing services for eligible adults through the Hearing Services Voucher System (see page 155 for an explanation of the Voucher System); and
⢠CSOs through Australian Hearing Services.
In the 2000-01 Budget the Government introduced three measures into the Commonwealth Hearing Services Progr!lm. These were:
⢠the introduction of a hearing reh abilitation item and a hearing aid adjustment item to the schedule of hearing services to provide both a reasonable alternative to hearing aids for clients with low levels of hearing loss, and reprogramming of hearing aids for clients who had experienced some change in hearing loss;
⢠the period between hearing services voucher reissue extended from one to two years (unless a clinical n eed to have a
' Wil son D, Wa lsh PG, Sa n chez I, Read P, (Ce ntre for Popul atio n Studies in Epidem iology, South Austra li an Departmen t of Human Services), 1998, Hearing Impairment in an Australian Population, HMRC Austra li a.
150
HEARING SERVICES
reassessment earlier could be demonstrated); and
the period between hearing aid refitting extended from four to five years (unless a clinical need to have a refit earlier could be demonstrated).
These measures were aimed at better targeting assistance to those with a clinical need and improving the efficiency of the program.
Services available through the
Commonwealth Hearing Services voucher
system
The range of services an eligible client may receive through the voucher system includes:
⢠assessment of hearing;
⢠audiological rehabilitation and management, as well as advice and counselling in relation to hearing needs;
⢠appropriate prescription, selection and fitting of quality hearing devices, with advice and counselling about hearing device use if the practitioner considers that the client would benefit from the fitting; and
⢠maintenance of hearing devices including battery supply and repairs for a nominal annual fee.
Eligibility for the Commonwealth Hearing
Services voucher system
Eligibility under the voucher system is prescribed by the Hearing Services Administration Act 1997. To be eligible, a person must be an Australian citizen or permanent resident,
21 years of age or older and the holder of a Pensioner Concession Card, Department of Veterans' Affairs (DVA) Gold Repatriation Health Card or DVA White Repatriation Health Card covering hearing loss, or be in receipt of Sickness Allowance from Centrelink.
' Relates to Indicator 6.
151
Dependants of a person in one of the categories mentioned above are also eligible.
Other eligible clients include members of the Australian Defence Forces; and clients of the Commonwealth Rehabilitation Services Australia undergoing a vocational rehabilitation program who are referred by their case manager.
Eligible adult clients can select their contracted service provider through the voucher system.
Community Services Obligations
All Australians under 21 years of age are eligible to receive services under the Commonwealth Hearing Services Program through CSOs, delivered on behalf of the Government by Australian Hearing Services, the public provider.
Iri addition, adult clients with eligibility as specified above for the voucher system, and who have complex hearing rehabilitation needs, or who are Aboriginal and Torres Strait Islander
people, or who live in remote areas of Australia, can receive services under the program as CSOs.
Hearing services to eligible Aboriginal and Torres Strait Islander people may be provided through the Australian Hearing Services network of hearing centres, or within Aboriginal and Torres Strait Islander communities under the Australian Hearing Specialist Program for Indigenous Australians (AHSPIA) . The focus is on providing tertiary level services, namely hearing assessment,
supply and fitting of hearing devices if appropriate, and on prevention, community awareness and education.
Eligible Aboriginal and Torres Strait Islander adults also have the option of applying for a voucher and receiving services from any contracted service provider.
Research activities2
CSO funding also contributes to research into issues related to hearing loss, hearing rehabilitation and the harmful effects of noise
OUTCOME 6
The Acoustic Research Laboratory
In 1947, the Department of Health took over responsibility for the Acoustic Research Laboratory, which had been set up in April 1943. The laboratory developed an earplug, which became standard Army issue, not only protecting the eardrum but also alleviating the fatigue caused by excessive noise. Munitions and other civilian workers were also issued with the earplugs. The laboratory developed hearing aids and other equipment to help repatriated service personnel whose hearing had been permanently affected.
By the end of the war, the laboratory had started
to investigate deafness in children caused by pre natal German measles. This research was much aided by the work already done on servicemen. Hearing aids were developed which brought deaf children out of the world of silence and back into the classroom.
The research conducted by the Acoustic Research Laboratory was the beginning of an Australian revolution in hearing aid technology that peaked in 1978, when the first 'bionic ear' was implanted in a patient by Professor Graeme Clark and his team of researchers at Melbourne University. The bionic ear is now used by more than 10,000 people worldwide.
undertaken by the ational Acoustic Laboratories ( AL), the research arm of Australian Hearing Services.
Research activities at the NAL were conducted in the areas of:
⢠hearing assessment;
⢠hearing loss prevention;
⢠hearing rehabilitation procedures; and
⢠hearing rehabilitation devices.
Research results in these areas were published in scientific journals and disseminated at scientific conferences, presentations to consumers, and professional continuing education programs for clinicians. A total of 24 scientific publications were accepted or published during the year, and 44 presentations were made at public conferences or seminars. Information is also available at the NAL website www.nal.gov.au A particularly significant publication was a comprehensive textbook on hearing aids, which was launched by the Minister for Aged Care, the Hon. Bronwyn Bishop, in February 2001. The book is being adopted as the major text in university audiology courses in Australia and around the world.
Another significant up of NAL research was the commercialisation by an Australian company, Polaris Pty Ltd, of a device that helps protect telephone call centre operators from receiving acoustic shocks caused by loud, high pitched sounds on the telephone. The research was carried out as part of the work of NAL within the Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation.
The Australian Hearing Services Act 1991 and the Declared Hearing Services Determination 1997 prescribe the CSOs.
HEARING SERVICES
Funding for the Voucher System and
Community Service Obligations 3
The introduction of the Hearing Services Voucher System has meant that there are now more people accessing services than before. Voucher system expenditure in 2000-01 was $127.8 million compared to $71.9 million at the commencement of the voucher system in 1997-98. Funding provided to Australian Hearing Services in 2000-01 for CSOs and research was $28.7 million compared with $26.2 million in 1997-98.
Access to hearing services through the
voucher system
Under the Voucher System, new applicants are referred to the Office by a medical practitioner, while returning clients are referred by a qualified hearing services practitioner or a
medical practitioner. Adult Australians apply to the Office for a voucher and upon confirmation of eligibility, are sent a voucher, a directory of accredited service providers and other printed
information about accessing the programâ¢.
Similar to 1999-2000, eligible clients received their voucher, on average, approximately two weeks after application during 2000-01. Clients may present their voucher to the service
provider of their choice from those listed in the directory. The voucher does not have a face value, rather it gives eligible clients access to the range of hearing services described on page 151.
There were 135 accredited hearing service providers (including Australian Hearing Services, the public provider) contracted by the Office to provide services under the voucher system in 2000-01.
Figure 6.1: Projected administered expenses for the Commonwealth Hearing Services
Program, 1999-00 to 2004-05
175
169.6
170
165 163.0
160 158.2
c
0 155 151.4
E
150.1
-150 145
140
135
130
125 1999-2000 2000-01 2001-02 2002-03 2003-04 2004-05
Source: Office of Hearing Services data
⢠Relates to Indicators 2 and 5. ⢠Relates to Indicator 2.
153
OUTCOME 6
Services are provided at more than 300 permanent sites and about 900 visiting sites throughout Australia by qualified audiologists and audiometrists.
The Office has contracts with 16 suppliers of quality hearing devices. These devices are subjected to an evaluation and are approved by the Office before being made available for supply under the program.
Information for program clients
The Office issues a comprehensive range of client information brochures to enable eligible clients to access, understand and participate successfully in the Commonwealth Hearing Services Program.
All program information pamphlets and brochures are available electronically on the Office website at www.health.gov.au/hear/.
Hearing devices
At 30 June 2001, a total of 777 hearing devices were approved for supply, including 422 available free to the client and 355 available as top-up devices (see below for an explanation of top-up devices) .
The range of approved hearing devices is comprehensive enough to meet virtually the full range of assessed clinical needs in the eligible client population. However, the clinical needs of a very small group of clients are not able to be fully met by the available device range. Following comprehensive audiological assessments, special approvals were given for 224 such clients to be fitted with non-standard devices during 2000-01. This represents 0.3 per cent of the total number of clients who received fittings in 2000-01 5 â¢
Maintenance and repairs
Clients may choose to enter into maintenance arrangements which include battery supply and
fohn Seymour (left) discusses, with Eric LePage and Narelle Murray, new click-evoked otoacoustic emission experimental work being carried out by National Acoustic Laboratories. This assesses an
individual's susceptibility to hearing loss by examining how the cochlear protects itself aga inst the short-term effects of low levels of noise. The outcomes are crucial to the prevention of hearing loss.
maintenance or repair services for a fee of $31.50 per annum, which includes GST of $1.50 levied on the service component. Currently around 263,000 clients receive maintenance services each year under the programâ¢.
Top-up hearing devices
Clients ma·y choose to 'top-up' into more expensive hearing aids with additional features by paying the difference in cost between the Government-provided benefit and the more expensive hearing aid. However, the wide range of quality hearing devices available free to clients through the Hearing Services Program provides a satisfactory hearing rehabilitation outcome to meet the assessed clinical needs of almost all eligible clients' .
Levels of participation in the
Commonwealth Hearing Services Program
In 2000-01 the contracted service provider network provided services to about 320,000
'" Relates to In dica to rs 1 and 2. ' Relates to Indicator 1.
154
HEARING SERVICES
adult clients, including about 82,000 hearing device fittin gs, both m onaural and binaural fittings8 ⢠Some 46,000 special needs clients received services under the CSOs.
The voucher system
In 2000- 01 almost 125,000 eligible adult clients were issued with a Hearing Services Voucher. This is a modest increase of around 4,000 vouchers on the previous year, reflecting growth in th e eligible client base due to the agein g of the Australian population, offset by m easures introduced in the previous Budget to help ensure the continued sustainability of the program.
Forward estim ates for voucher issue are based on expected demographic growth in the targeted client population, rising from 134,000 in 2001-02 to around 140,000 in 2004- 05 9 â¢
About 27 per cent of clients receiving an assessment were not fitted with a device, up from 20 per cent in 1999-2000.
A baby being tested using visual orientation reward audiometry.
Community Service Obligations
Each year the Government funds Australian Hearing Services through the Office to
'·' Relates to Indicator 2. â¢â¢ Relates to In dicator S.
155
provide specialised hearin g services as CSOs for about 35,000 children and young adults under th e age of 21 years, and to en sure access to appropriate hearing services for eligible adults with special needs.
Around 11,000 of th ese special needs adult clients received services in 2000-01, including nearly 2,000 Aboriginal and Torres Strait Islander people10 â¢
Quality assurance
How quality is assured in the
Commonwealth Hearing Services Program
The principal tool used to assure th e quality of service delivery under the Commonwealth Hearing Services Program is the Service Provider Contract. Monitoring the quality of service delivery is achieved through site audits and client record management reviews, which are undertaken to test contract compliance.
In addition, client complaints are investigated and resolved by Office of Hearing Services audiologists or other staff as appropriate. In 2000- 01 , 48 site audits were conducted, a considerable increase on the target of 37. A total of 98 client record management reviews were undertaken in 2000- 01 against a target of 119 11 â¢
These quality assurance measures are aimed at ensuring good clinical outcomes for clients. The Annual Client Satisfaction and Hearing Aid Usage Survey was undertaken in the firs t half of 2001. Results indicated that 96 per cent of
respondents were very satisfied or satisfied with the quality of service provided by thei r chosen practitioner (94 per cent in the previous yea r)12 ⢠It also indicated that 89 per cent were very satisfied or satisfied with their hearing aid(s) 13, compared to 86 per cent for the previous yea r.
The Hearing Services Advisory Committee
The Hearing Services Advisory Committee is
"·" Relates to Indicator 4. " Re lates to Indicator 1.
OUTCOME 6
appointed by the Minister for Aged Care to provide independent advice to the Government on quality assurance and strategic policy issues in the Commonwealth Hearing Services Program. This Committee comprises membership from consumers (including a veteran), hearing services providers (both public and private), scientists and researchers involved in hearing loss and rehabilitation, hearing device manufacturers and business members. The Office provides secretariat support.
The Committee met on six occasions during 2000-01, four times in Melbourne and twice in Canberra. Committee deliberations concentrated on the needs of consumers in general (especially consumer empowerment), people in rural and remote locations, Aboriginal and Torres Strait Islander people (especially children) and residents of aged care homes.
The Committee continues to monitor the Commonwealth Hearing Services Program and hearing health in Australia generally to make recommendations to the Minister for Aged Care.
Development of Memoranda of
Understanding with peak professional
bodies - the Audiological Society of
Australia and the Australian College of
Audiology (ACAud)
The Office made excellent progress in negotiating Memoranda of Understanding (MoU) with the two peak bodies representing hearing services practitioners. These MoUs were in place by the end of August 2001, and will enable an exchange of information between the Office and these bodies about practitioners, and will facilitate the implementation of the new qualifications model for practitioners. This will further assist in maintaining quality service delivery in the Commonwealth Hearing Services program.
The MoU requirement for practitioners to undertake continuous professional education
" Relates to Indicator 4.
will also assist in assuring quality in service provision".
Major projects
Service Level Agreement for delivery of
community service obligations
The Office successfully negotiated a service level agreement with Australian Hearing Services on service delivery and reporting requirements. The Service Level Agreement will provide baseline data and ongoing reporting requirements for the delivery of CSOS 15 â¢
Hearing services in aged care homes
Residents of aged care homes are typically dependent on care staff for their daily personal care. Delivery of hearing services in aged care homes therefore needs to focus on the skilling and involvement of care staff in assisting residents in the routine use, care and maintenance of their hearing devices, and support of the individual in accessing hearing services.
In early 2000 the Department commissioned a project to investigate alternatives to current service delivery for residents of aged care homes in order to improve the current situation and to recommend options for an optimum service delivery model.
The project report has now been delivered to the Department, has been accepted by the project steering group, and is now being considered by the Hearing Services Advisory Committee16â¢
Delivery of hearing services to Aboriginal
and Torres Strait Islander people
The Office is managing a project jointly with the Office for Aboriginal and Torres Strait Islander Health (OATSIH) to examine the delivery of hearing health services by the Commonwealth Government to Aboriginal and
" Relates to Indica to r 5. 16 Relates to Indica to rs 1 and 2.
156
HEARING SERVICES
Torres Strait Islander peoples. The main components of the project involve an evaluation of the National Aboriginal and Torres Strait Islander Hearing Strategy 1995-99 and a stocktake of hearing services delivered to eligible Aboriginal and Torres Strait Islander peoples by Australian Hearing Services. The project will also report on the extent and effectiveness of linkages in service delivery between agencies involved in this area of endeavour" .
Electronic claims for payment
With the introduction of the Electronic Tran saction Act 1999, the Office has committed to making business transactions available to clients and service providers electronically. The e-claim for payment methodology continues to prove popular and beneficial with 60 service
providers, representing approximately 80 per cent of all claims, utilising the electronic system 18 ⢠This facility will continue to be promoted to service providers during the next financial year.
Over time the period between providers lodging claims for services and receiving payment from the Office has decreased from around 12 weeks at the advent of the voucher system in late 1997 to around 4 weeks at the end of 2000. Figure 6.2 demonstrates this very significant improvement.
Future challenges Although clinical evidence remains equivocal on the benefits of digital devices, these devices are the major research focus of manufacturers internationally, and in time may become the industry standard.
Figure 6.2 Average time in weeks between date of service and payment for assessment
items, December 1997- December 2000
14
a..
12
" 10 c l1l 1/) 0 0 8 c C1J C1J +"' 6 C1J .0 ., .:..! C1J C1J 4 s 2 Source: Office of Hearing Services data base
17 Relates to Indicator 5. 18 Relates to Indicator 2.
157
OUTCOME 6
The Program needs to take advantage of any changes in hearing device technology for the benefit of clients within fiscal constraints. This will require a rigorous evidence-based approach to taking up new technology whilst managing any risks associated with current technology.
The supply of all Office approved hearing devices is currently managed under the Deed of Standing Offer arrangements. The Therapeutic Goods Administration (TGA) is introducing a new regulatory system for medical devices (including hearing devices) in 2001-02. The introduction of the new TGA system provides the opportunity to consider alternative device supply arrangements for the Program in conjunction with TGA.
Work is continuing towards the establishment and validation of baseline data about the participation in education and the community by children with a hearing impairment19 ⢠There is evidence that significantly better language development is associated with early identification and intervention for pre-linguistic deaf and hearing impaired children20 â¢
" Relates to Indicator 3.
" Yoshinaga-Itano eta! (1998) Language of early and later identified children with hearing loss. Pediatrics 102 (5 ): 1161- 1171.
158
HEARING SERVICES
Performance indicators
Indicator 1: Usage of Commonwealth funded hearing devices.
Indicator 2: Take up of hearing habilitation and rehabilitation services in
the community.
Indicator 3: Relative participation in education and the community by children with a hearing impairment compared to children who are not hearing impaired.
Indicator 4: Contracted hearing service providers provide eligible clients with quality hearing services, consistent with clinical standards and rules of conduct.
Indicator 5: The proportion of clients from special needs groups receiving hearing
assistance under the program in relation to the total volume of program clients.
Target: Maintain the level of the hearing device usage (38 per cent more than 8 hours a day, 27 per cent 5 to 8 hours a day, 29 per cent 1 to 4 hours a day- data from OHS Client Survey, May 1999).
Information source/reporting frequency: Survey data. Annual.
Target: Increase in the issue of hearing services vouchers in line with growth in age pension and DVA clients.
Information source/reporting frequency: Departmental and ABS data. Annual.
Target: Establish baseline survey data in 2000-01.
Information source/reporting frequency: Survey data. Annual.
Target: 100 per cent of service providers adhere to Clinical Standards and Rules of Conduct prescribed in service provider contracts.
Information source/reporting frequency: Departmental information systems. Ongoing.
Target: Maintain level of special needs groups receiving hearing assistance as a proportion of total number of program clients.
Information source/reporting frequency: OHS and AHS data bases. Quarterly.
159
Indicator 6: Research that contributes to improved habilitation and rehabilitation outcomes for hearing impaired people and to community health is relevant and available.
OUTCOME 6
Target: All research results are relevant and available to the community, service providers and manufacturers of hearing products.
Information source/reporting frequency: Feedback from hearing service delivery and manufacturing industry, hearing impaired people and overseas. Annual.
160
OlrrCOME 6 : FINA C IAL RESOURCF..S SUMMARY
'(A) (B)
Bu dget Actu al Variat ion
Estimate Expenses (Colum n B
200012001 200012001 minus
$'000 s·ooo ColumnA)
Administered Expenses
Admlnl!tered Ite m 1: Prtwision of services for contestable clients Appropriation Bill 113 I22,09I I27,838 5,747
Appropriation Bill 214
I22,09I I27,838 5,747
Administered Item 2 : Pro visio11 o. fCommun ity Obligations
Appropriation Bill Il3 28,702 28,703
Appropriation Bill 214
28,702 28,703
Total Admi nistered Ex(!enses I 50,793 I56,54 I 5,748
Departmental Appropriations
Output Group 1 - Services to the Mini ster & Parliament 963 962 ( I)
Output Group 2- National Leaders1rip I93 193
Output Group 3 - Information I,059 1,057 (2)
Outp1 rt Group 4 - Program Management 6,171 6, 167 (4)
Outp1rt Group 5 - Regulatory Activity 963 962 ( I)
Outpill Group 6 - Direct Delivery of Services 770 769 (I)
Total price of d e pa rtmental outputs 10.I18 10,I10 (9)
{toto/revenue from Government & other sources)
Total revenue from Government (appropriations) 10,024 10,066 42
contributing to price of departmental outputs Total revenue from other services 94 44 (50)
Total price of dE"partmental outputs: I0,118 10,110 (8)
(toto / 1'6\â¢enuel!:.om Government & other sources)
Total price or outputs for Outcome 6 10,1I8 10,110 (8)
{tota l t·evenuefrom Government & oth er sources)
Total estimated resourclng fo r O utcome 6 160,910 166,650 5,740
(tota l p rice of outputs & ad min expenses)
I Tite Budget Estimate 2000/2001 includes the appropriations as per the 2000-2001 Portfolio Budget State ments (PBS). 2000-2001 Portfolio Additional Estimates and Advances to the Finance Minister. This amount may differ to lhe revised estimates for 2000/200 I published in the 200 1/2002 PBS. Such differences can arise from updated estimates and rephasings.
2 Budget prior to additional estimates. The number of output groups has reduced from 6 in 2000-200 1 to 3 in 2001 -2002.
It is not poSS1ble to show direct comparntivcs
161
2
Budget 200112002 s·ooo
I23,463
I23,463
28,395
28,395
I5I ,858
I , I24
7,888
762
9,774
9,692
82
9,774
9,774
I6 I,632
Outcome 7: Aboriginal and Torres Strait Islander health
Improved health status for Aboriginal and Torres Strait Islander peoples
163
Outcome 7 is managed within the Department by the Office for Aboriginal and Torres Strait Islander Health.
The Office also works with all other areas of the Department to ensure other outcome areas focus on the needs of Aboriginal and Torres Strait Islander people.
OUTCOME 7
Major achievements
Primary Health Care Access Program
(PH CAP)
Ten high priority sites have been selected to implement the framework for the PHCAP program in the Northern Territory and South Australia. Planning has commenced in most South Australia sites.
Aboriginal coordinated care trials
The fo ur trial sites, Katherine West, Tiwi, Wilcannia and Perth/Bunbury received funding in 2000-01 through PHCAP to allow the services developed during the trial period to continue. The evaluation report of these four coordinated care trials was released and reported on the significant success of the trials in improving access to comprehensive primary health care.
Improving access to the mainstream health
system
Work has continued on making mainstream programs, particularly Medicare and the Pharmaceutical Benefits Scheme (PBS), more accessible to Aboriginal and Torres Strait Islander people. In this financial year, agreements were made to extend Section 100 arrangements to improve access to vital pharmaceuticals by remote Aboriginal health services in South Australia and Queensland.
The report Expenditures on hea lth services for Aboriginal and Torres Strait Islander people, 1998-99 shows that Indigenous access to Medicare and the PBS increased over the previous three years - in part due to the policy of encouraging Medicare use within Aboriginal health services. The level of access is still well below that of other Australians, however, and continued efforts will be required in this area .
Regional planning
During the year joint regional planning was completed in New South Wales, the Australian Capital Territory and the Northern Territory (Top End). Western Australia's and Victoria's plans are close to finalisation and once completed will mean that there is a plan in each State and Territory to allow additional funds to be targeted to areas of highest need. Eight projects providing additional primary health care services were funded in line with the completed plans during the year.
Infrastructure development in Aboriginal
and Torres Strait Islander health services
The Department has invested over $24 million for health infrastructure development in 2000-01 including new health clinics and staff houses required for the implementation of the Primary Health Care Access Program (PHCAP) in Central Australia, and the Remote Communities Initiative in Western Australia, Northern Territory and Queensland.
Under-achievements
Delay in signing new framework
agreements
As at 30 June 2001 only the Northern Territory partners (Commonwealth, State/Territory governments, community sector and the Aboriginal and Torres Strait Islander Commission) had re-signed a n ew framework agreement on Aboriginal and Torres Strait Islander Health. Negotiation s are continuing in other jurisdictions. It is expected that the remaining framework agreements will be re signed by the end of December 2001.
Progress on the National Aboriginal and
Torres Strait Islander Health Strategy
The National Aboriginal and Torres Strait Islander Health Council is overseeing the
164
Rr'olቢ.------..
TORRES STRAIT ISLANDER HEALTH
process for development of the revised National Aboriginal and Torres Strait Islander Health Strategy. The development of the Strategy has taken longer than initially anticipated, in part due to concerns of the National Aboriginal Community Controlled Health Organisation
(NACCHO) about the content and consultation process for the strategy. These concerns have been resolved and the consultation period on the draft strategy has been extended until 30 October 2001. A link to the document is available at: www.health.gov.au/oatsih/strategy/index.htm
Development of a preventable chronic
disease framework
The expected timeframe has proved to be insufficient. The nature of the diseases involved and the variety of stakeholders has meant that this work is still in the developmental stage. It is now anticipated that by January 2002, the Office will have significantly progressed the development of a policy framework for chronic diseases in Aboriginal and Torres Strait Islander populations.
Outcome summary - the year in review The activities of the Department in the past year, through the Office for Aboriginal and
Torres Strait Islander Health, have aimed to improve the health status of Indigenous Australians by ensuring access to effective, high quality health care at the community level.
Achieving this aim continues to require the cooperation and coordination of long term partnerships. The Commonwealth, State and Territory governments, the Aboriginal community controlled health sector, the
Aboriginal and Torres Strait Islander Commission and the Torres Strait Regional Authority have continued to work together to promote sustainable gains in health status for Aboriginal and Torres Strait Islander people.
165
Evidence is emerging that the strategic approach adopted by the Government since 1996 is working. Health is improving where there are local health services providing sound clinical and population health programs, delivered in a way that actively engages individuals and communities in managing their health. This integrated primary health care approach involves complementary action by mainstream and Indigenous specific services working together with local communities.
During the year the Department completed a comprehensive internal review to evaluate its management of Aboriginal health programs since the 1995-96 transfer from the Aboriginal and Torres Strait Islander Commission (ATSIC) for consideration by Government. This also encompassed a review of the implementation of the Primary Health Care Access Program. A series of occasional papers based on the review findings will be released for publication in 2002.
Changes in the health status of Aboriginal and Torres Strait Islander people have occurred. There have been reductions in deaths from infectious diseases and declining infant and child mortality
rates since the 1970s. These have been attributed to improved health services as well as improved housing and environmental conditions.
Overall, however, these continue to be offset by increased morbidity and mortality from chronic diseases such as diabetes, especially affecting people in middle age. Life expectancy at birth for Indigenous Australians in the period
1997-99 was estimated to be 56 years for males and 63 years for females, as compared with the all-Australian estimates of 76 years for males and 82 years for females. At this stage it is not
possible to provide reliable trend data for Indigenous life expectancy due to inadequacies with the quality of the data. Moreover, improvements in health status that can be reflected in national statistics ( eg life expectancy) will take time to develop'.
' Relates to Indicator 1.
OUTCOME 7
On 22 May 2001, the Commonwealth Government tabled its response to the House of Representatives Standing Committee on Family and Community Affairs Inquiry Report into Indigenous Health - Health is Life. The Government is already progressing many of the recommendations and directions set out in the report which are largely consistent with its overall strategic approach to improving the health of Aboriginal and Torres Strait Islander people. A link to the document is available at: www.health.gov.au/oatsih/healthlife/index.htm
The overall approach by the Department continues to be based on four strategic areas of action. These are:
⢠developing the infrastructure and resources necessary to achieve comprehensive and effective health care for Aboriginal and Torres Strait Islander peoples;
⢠addressing some of the specific health issues and risk factors affecting the health status of Aboriginal and Torres Strait Islander peoples;
⢠improving the evidence base which underpins the health interventions; and
⢠improving communication with health care services, Aboriginal and Torres Strait Islander peoples and the general population.
All policies relating to the health of Aboriginal and Torres Strait Islander peoples are based on the principle of community empowerment and participation in the development and delivery of health care services and partnerships with stakeholders including State and Territory governments, ATSIC and the Aboriginal community controlled health sector.
Developing the infrastructure and resources necessary to achieve comprehensive and effective care for Indigenous people
National Aboriginal and Torres Strait
Islander Health Council
The National Aboriginal and Torres Strait Islander Health Council met four times during 2000-01. The Council provides expert advice to the Commonwealth Minister for Health and Aged Care on Aboriginal and Torres Strait Islander health policy and planning. The Health Council includes members from the Commonwealth Government, Australian Health Ministers Advisory Council (AHMAC), the National Aboriginal Community Controlled Health Organisation (NACCHO), the Aboriginal and Torres Strait Islander Commission (ATSIC), the Torres Strait Regional Authority (TSRA), NHMRC (ex-officio), and five Indigenous Australians appointed in their own right by the Minister because of their expertise.
As one of its key roles, the National Aboriginal and Torres Strait Islander Health Council is overseeing the development of the National Aboriginal and Torres Strait Islander Health Strategy. This strategy will build on the progress made since the development of the 1989 National Aboriginal Health Strategy.
In December 2000, NACCHO formally resigned from the Council in protest over certain aspects of the draft National Aboriginal and Torres Strait Islander Health Strategy. Following discussions between the Department and NACCHO, these issues were resolved and NACCHO withdrew its resignation. A draft of the strategy was released in March 2001 for public consultation. The consultation period will continue until the end of October 2001. Following the consultations Council will redraft the strategy based on submissions received. Once the final draft has been endorsed by Council it will be distributed to the Framework Agreement partners for formal endorsem*nt.
166
TORRES STRAIT ISLANDER HEALTH
Technically, Aboriginal and Torres Strait Islander Framework agreements expired on 30 June 2000. Negotiations are currently underway in each jurisdiction to re-sign the agreements for a further three years. On 27 April 2001 a new agreement was signed in the Northern Territory. Other State and Territory agreements are expected to be signed by December 2001. The framework agreement partnerships have fostered better understanding and appreciation of the roles and responsibilities of each of the signatories. In particular, it has increased the confidence of both the Commonwealth and each State and Territory in the shared commitment to increase real resources for Indigenous health. The partnership approach has also facilitated participation by the community sector in policy development and planning for mainstream health programs and those targeted to Aboriginal and Torres Strait Islander people.
Improved access to services
Primary Health Care Access Program
Considerable progress has been made in implementing the Primary Health Care Access Program (PHCAP) in SA, Central Australia (NT) and Queensland. The program targets a few high priority areas based on the priorities identified through joint regional plans where need is high and there is capacity to use the funds effectively. Ten sites have been endorsed to date. As further funds become available this program will be implemented across Australia. The current
priorities include a mix of urban, rural and remote local areas. Working in partnership with the community controlled health sector, the State and Territory health departments and ATSIC in the Northern Territory and South Australia has resulted in agreed local implementation arrangements to maximise the impact of the funds and achieve the objectives of the program.
Figure 7.1: Services funded by OATSIH, as at 30 June 2001
â¢
â¢
â¢
⢠Primary Service Sites (Prim)
⢠Secondary Service Sites (Sec)
Source: OATSIH , July 2001 Produced for: OATSIH © Commonwealth of Australia 2001
Prim: 37
⢠.ti.. Sec: 1
â¢
â¢
â¢
⢠⢠⢠·:·· ⢠⢠⢠â¢
167
â¢
VIC
QLDPrim: 44 Sec: 29
â¢
Prim: 26 0 '
Sec:3 VTAS Prim : 5 Sec:
OUTCOME 7
These local arrangements will lead to an integrated local comprehensive primary health care system which allows the priority gaps in services to be addressed, ensures that the local mainstream services and systems are more responsive to the needs of Aboriginal and Torres Strait Islander people and encourages greater individual and community participation in and responsibility for health. The program reflects our strategy to maximise the responsiveness of the mainstream system and complement this with Indigenous specific funding and services. The community controlled health services are a cornerstone of that strategy.
Planning has commenced in the South Australian sites and the planning process for each site is being finalised in the Northern Territory. The priority site selection process for Queensland is well advanced and discussions on the local arrangements commenced. Negotiations are also well advanced on the formal agreements with the South Australia and Northern Territory governments for joint implementation of the program. The PHCAP has also provided funding for the continuation of services established through the Aboriginal Coordinated Care Trials and funding of staff housing and clinic upgrades for the remote sites in Central Australia has been approved and is being managed by ATSIC.
Aboriginal Coordinated Care Trials
The development of the PHCAP program has drawn on the Aboriginal Coordinated Care Trials and the different financing models used in those trials. The significant success of these trials has provided important lessons in the implementation framework for the PHCAP during the year. These trials demonstrated that local health care systems can be developed and reformed to better address the health needs of the Aboriginal and Torres Strait Islander people in a local area. The key lessons include:
⢠the need for significant investment in time, resources, local capacity building
and community empowerment to achieve health care reform;
⢠additional funding that can be used flexibly for comprehensive primary health care provides an important means of improving service access and the appropriateness of services (such as preventative health programs and care coordination);
⢠financing arrangements including funds pooling and flexible use of pooled funds are a useful mechanism for integrating Commonwealth and State and Territory funded services, objectives and commitments; and
⢠the importance of strong partnerships and the need to match the pace of funding with the capacity to effectively use the funds.
The fina l report on the evaluation of these trials is now available. A link to this document is available at: www.health.gov.au/oatsih/pubs/coord.htm
Working with the mainstream services to
increase access
Work has continued on streamlining the Medical Benefits Scheme arrangements so that they are more accessible to Aboriginal and Torres Strait Islander people and service providers. The exemption under Section 19(2) of the Health Insurance Act 1973 that allows salaried doctors in approved services to bill MBS assists these services in providing comprehensive primary health care. A trial to further streamline billing arrangements in remote settings has commenced in a large remote Aboriginal health service and will continue for a further 12 months.
Section 100 arrangements have been made available to all remote Aboriginal health services allowing them access to free pharmaceuticals. Substantial progress has been made with the
168
-----rulDUF
Northern Territory and agreements h ave been reached with the Queensland and South Australian governments.
Health financing
The report Expenditures on health services for Aboriginal and Torres Strait Is lander people, 1998-1999 has been prepared by the Australian Institute of Health and Welfare. The report was a two-year project and provides useful information on the total expenditu re, as well as the different patterns of h ealth expenditure, on Indigenous Australians across Australia. It also examines the extent to which this has changed in the three years since the first expenditure report2 which examined expenditures in 1995-96.
Ca pital works
Following a comprehensive internal review of the capital works program in 1999- 2000, the Office has implemented new program management arrangemen ts to improve health infrastructure planning, enhance project design and quality, foster strategic relationships with ATSIC and State governments, and maximise Aboriginal and Torres Strait Islander employment and training opportunities. A key component of the new arrangements has been the development of a strategic partnership with Ove Arup and Partners Pty Ltd for the provision of technical support and advice to the Office and to funded Aboriginal and Torres Strait Islander organisations.
The Department has extended its partnership with ATSIC through the development of a Memorandum of Understanding (MoU) for the planning and provision of doctors, nurses and health care staff housing in rural and remote areas. The MoU recognises ATSIC's competencies in the delivery of housing in rural and remote Aboriginal and Torres Strait Islander communities, its proven program delivery
' Relat es to Indicator 2.
169
methodology, and the opportunities for improving the quality and cost-effectiveness of projects by integrating projects into existing
ATSIC programs.
The Office has continued to invest significant resources in expanding and developing health infrastructure in Aboriginal and Torres Strait Islander communities. In 2000- 01, the Department approved an additional 30 health/substance use facility redevelopments and upgrades and 13 medical/health worker staff housing projects. These works have included new health clinics and staff houses required for the implementation of the Primary Health Care Access Program in Central Australia, and the Remote Communities Initiative in Western Australia, Northern Territory and Queensland. In all, the Department has provided over $24 million for health infrastructure development in 2000-01.
Tax reform
Over the years the new tax system has been incorporated into the funding arrangements with Aboriginal and Torres Strait Islander health and substance use services. As almost all Aboriginal and Torres Strait Islander organisations were previously exempt from taxes, grants subject to the Goods and Services Tax (GST) were increased (grossed-up) by
10 per cent to enable organisations to maintain the real value of their funding. The Office also worked with the GST Start-up Office and NACCHO to support the transition in Aboriginal and Torres Strait Islander organisations.
In March 2001 the government announced that it would provide supplementary funding to not-for-profit Aboriginal and Torres Strait
Islander organisations to enable them to continue to offer competitive salary packages to their staff following the introduction of the Fringe Benefits Tax (FBT) concessional benefits
OUTCOME 7
limit. The Office established a cross-agency working group (which included representatives from Aboriginal and Torres Strait Islander organisations) to develop funding guidelines for allocating the extra resources.
Patient information and recall systems
In 2000-01, the Office provided funding to an additional 24 organisations to implement patient information and recall systems, resulting in more than 60 per cent of Aboriginal and Torres Strait Islander health services now using, or implementing, computerised patient care systems.
Workforce development
Current data show a total of 835 full time equivalent health professional positions (doctors, nurses and Aboriginal health workers) in Commonwealth funded Aboriginal primary health care services. This included 133 doctor positions, 179 nurse positions and 523 Aboriginal health worker positions3 â¢
OATSIH has undertaken several major program reviews and evaluations that have provided valuable recommendations that will effect the future development of workforce strategies in Indigenous health over the next decade. These evaluations and reviews include the:
⢠Evaluation of Recruitment and Promotion Services Project;
⢠National Aboriginal and Torres Strait Islander Health Worker Training Review; and
⢠Health Service Management Training Review.
These evaluations and reviews will be used to support a consolidated Aboriginal and Torres Strait Islander health workforce strategic framework for future policy and program development to build workforce capacity, training, recruitment, support and retention of Indigenous and non-Indigenous professionals in Indigenous health.
' Relates to Indica tor 4.
OATSIH has also undertaken several other initiatives to build the Indigenous and non Indigenous health workforce. Some of these initiatives included:
⢠graduation of eleven students from the Masters of Applied Epidemiology in Indigenous Health (MAEIH) in 2000-01;
⢠graduation of 15 students from the pilot program for Health Services Management Training for Aboriginal and Torres Strait islander people;
⢠establishment of a biannual advanced users training course co-facilitated by ]ames Cook University and Kimberley Aboriginal Medical Services Council to
assist senior health staff and managers in the effective deployment of computer based patient information and recall systems. Two courses were held in 2000-01, attended by more than 40 staff from Aboriginal health services;
⢠development of a core nursing curriculum in Aboriginal and Torres Strait Islander health and strategies to improve recruitment and retention of Indigenous nursing students, and working with the Congress of Aboriginal and Torres Strait Islander Nurses and the Australian Council of Deans of Nursing; and
⢠working with the Council of Deans of Australian Medical Schools and other key stakeholders on a national medical curriculum on Aboriginal and Torres Strait Islander health and on improving the intake and support for Indigenous medical students. In 1999 the Department of Education and Youth Affairs figures show
77, or 0.74 per cent, of all medical students in Australia were Aboriginal or Torres Strait Islander.
The Office launched its own Recruitment, Retention and Staff Development Strategy in
170
1'4â¢-r-------.
TORRES STRAIT ISLANDER HEALTH
June 2001 as part of its overall approach to attracting and retaining quality staff. Another major focus of the strategy is to enhance the attractiveness of employm ent within the Office, particularly for Aboriginal and Torres Strait Islander people.
Improving the data on Aboriginal health
and health services
The Department continues to work closely with the Australian Bureau of Statistics (ABS) on the design of a number of data collections to ensure they produce key statistics on Aboriginal health and welfare and to improve the availability of quality data in this area. Current work includes
contributing advice and funding for an enhanced National Health Survey. As a result of this initiative the next National Health Survey will collect sufficient data from the Indigenous population in 2001 and 2004 for some national statistics to be produced on Indigenous health and service use. The Department is also working with ABS and ATSIC on the 2001 Community Housing Infrastructure Needs Survey (CHINS) to ensure that the data collected in this survey can be used to inform the government and communities on health care access in discrete Indigenous communities.
During 2000-01 key statistics on the services provided by Commonwealth funded Aboriginal primary health care services were made publicly available for the first time and are being used for policy development and planning by the services,
the sector, NACCHO and government. These statistics are collected through the Service Activity Reporting (SAR) questionnaire, a joint OATSIH and NACCHO initiative. SAR data for 1998-99 showed that 96 per cent of Commonwealth funded Aboriginal primary health care services routinely implemented population health promotion and/or education programs' .
Comprehensive data has been collected for the first time on the Indigenous substance use
' Relates to Indica tor 3.
171
services. The survey shows that 79 per cent of services provided community based education and prevention activities; 72 per cent provide residential rehabilitation care; and 62 per cent provide non-residential counselling. This was
for a service population of approximately 400,000 people.
On a national level, the Department continues to work closely with other Commonwealth jurisdictions to improve data and information about Indigenous health. The Commonwealth completed a revision of the National Performance Indicators and Targets for Aboriginal and Torres Strait Islander Health. The revised indicators were
approved by AHMAC in October 20005â¢
Since its inception the Research Agenda Working Group (RAWG), a sub-committee of the National Health and Medical Research Council (NHMRC) has built a foundation to further develop a
research agenda that is strategic, intervention based and supports linkage of research, policy and practice to evidence of need and potential effectiveness. The RAWG has been reconstituted for a second (NHMRC 2000-03) triennium, and the newly established Committee convened its first meeting in November 2000.
RAWG has commissioned six research projects into diabetes and related disorders in the Aboriginal and Torres Strait Islander population. These projects meet the
Indigenous health research criteria of being relevant to a community context, involving the active participation of the community, being planned for sustainability within the
community once researchers have withdrawn, and working on interventions that are transferable to other communities.
The NMHRC currently funds 44 research projects in the area of Aboriginal Health. For example:
⢠community-based interventions to reduce the risk of diabetes and cardiovascular
' Relates to Indica tor 6.
1
OUTCOME 7
disease in Indigenous Australians;
⢠improving medical services for rural and remote Aboriginal children with chronic suppurative otitis media; and
⢠an on-site test for the bacteriological quality of drinking water in remote Aboriginal communities.
Project grant applications where the study subjects are Aboriginal or Torres Strait Islander people are assessed through normal NHMRC Research Committee processes. In parallel with the regular NHMRC process, and in conjunction with RAWG, the specifically established Indigenous Australian Research Health Advisory Panel ensures that all relevant applications are not only of a high scientific calibre, but also culturally appropriate and acceptable to Indigenous Australians6 â¢
Targeted health strategies
Substance use
A key priority has been implementation of the recommendations from the Commonwealth's Review of the Aboriginal and Torres Strait Islander Substance Use Program which focused on the 65 services funded by the Department to help people who are misusing various substances (alcohol, drugs, petrol). This has included the establishment of a quality assurance project in Indigenous substance use services in South Australia and specific strategic planning with a number of community controlled health and substance use services in other jurisdictions. Also, a cross-jurisdictional government forum to coordinate volatile substance use activity within the cross border region of Central Australia has been established.
During the year the National Recommendations for the Clinical Management of Alcohol Related Problems in Indigenous Public Health Care Settings was distributed to all funded organisations and key stakeholders.
' Relates to Indicator 5.
Sustained improvement in reducing the us e of various substances requires community leadership and cooperation with industry and relevant authorities, as well as a range of social health support services. Success to date is mixed, with a number of communities developing integrated local and regional service delivery approaches to address the health and social health impact of substance use. Community wide strategies based within a comprehensive primary health care framework are essential for long-term gains and leading to high-risk behaviour change.
Emotional and social wellbeing
The Department has undertaken an evaluation of the Aboriginal and Torres Strait Islander Emotional and Social Wellbeing (Mental Health) Action Plan during 2000-01. The Department
has continued to support programs commenced under the action plan and will publish the evaluation report early in 2001-02.
As part of the Government's response to the Bringing Them Home report the Department has developed an agreement with the Department of Family and Community Services regarding administration of parenting and family support programs. In addition, the Department has approved funding for over 100 Bringing Them Home counselling positions around Australia to provide personal support for individuals, families and communities affected by past policies of the forced removal of children.
The Department has supported the establishment of a new emotional and social wellbeing regional training centre during the year, bringing the total to sixteen and has also approved funding for the expansion of seven of the existing centres. The Regional Centres help build effective infrastructure for the delivery of emotional and social wellbeing programs through developing curricula, supporting training, and providing supervision to
172
ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH
Aboriginal and Torres Strait Islander mental health and counselling staff and programs.
The Department assisted the Marumali Healing Training Program which is a training course based on a traditional model of healing developed by Ms Lorraine Peeters, an Aboriginal elder who was herself removed from her family as a child. The model is based on Ms Peeter's own experience of healing and was developed
with input from mental health professionals. It was delivered through a series of workshops, including some workshops which had been requested by communities where there had been
suicides of those experiencing grief and loss relating to family removal policies.
Dermatology handbook
OATSIH collaborated with the Australian Dermatology Research and Education Foundation and the National Aboriginal Community Controlled Health Organisation to
173
produce a handbook titled Skin Conditions in Aboriginal Populations in Australia. The handbook is being distributed to Aboriginal community controlled health services, educational and
other relevant organisations as a practical resource for primary health care providers and dermatologists.
National Aboriginal and Torres Strait
Islander Hearing Strategy
OATSIH funded the development of the first evidence-based recommendations for clinical guidelines to improve the clinical management of otitis media (middle ear infection) in Aboriginal and Torres Strait Islander populations. Distribution and an implementation strategy is being planned for
2001-02. The guidelines complement a range of hearing service development initiatives introduced under the National Aboriginal and Torres Strait Islander Hearing Strategy 1995-99.
An external review of the Hearing Strategy and of hearing services to Aboriginal and Torres Strait Islander populations provided under Outcome 6 (Hearing Services) was commissioned to inform future strategies to improve the hearing health of Indigenous Australians.
Eye health program
The National Aboriginal and Torres Strait Islander Eye Health Program, implemented to improve access to eye health care for Indigenous Australians particularly those living in remote and rural areas, is well advanced in all States and Territories, except Tasmania where plans are still under negotiation. Regional eye health
coordinators have been appointed in 25 of the 29 regional eye health service areas in Australia. Training for coordinators and Aboriginal health workers has been conducted in Queensland,
New South Wales, Victoria and South Australia and will be progressed in the remaining jurisdictions in 2001-02.
OUTCOME 7
Partnerships between key stakeholders are encouraged and already exist in many regions. For example, in New South Wales the collaboration by various State Area Health Services, International Centre for Eyecare Education (ICEE), OATSIH and Aboriginal community controlled health services is working to ensure regular optometry clinics for Indigenous communities throughout NSW. In far north Queensland a partnership involving the eye health coordinator, OATSIH, optholmologists and Queensland State Health (Northern Zone), saw around 30 Indigenous people receive eye surgery at locally based Weipa hospital instead of having to travel further afield.
Immunisation
The National Indigenous Pneumococcal and Influenza Immunisation (NIPII) Program, managed under annual bilateral agreements by OATSIH, provided funds to States and Territories to purchase pneumococcal and influenza vaccines for Indigenous Australians aged over SO and between 15 and 49 where risk criteria are met.
To support the program, the Department developed a new communication and education package specifically targeting Indigenous people and different in appearance to the existing Older Australians Influenza Immunisation Program.
Following approval for use in Australia of a new conjugate pneumococcal vaccine (Prevenar), suitable for children under two years of age, the National Childhood Pneumococcal Immunisation Program was announced in the May 2001 Budget. OATSIH worked collaboratively with Outcome 1 in the development of the implementation, communication and education strategies for this program. Funds will be provided to State and Territory Health Departments to purchase vaccines for children at high risk of contracting invasive pneumococcal disease including:
⢠all Aboriginal and Torres Strait Islander children up to two years (and up to five years in Central Australia);
⢠non-Indigenous children living in the Central Australian region; and
⢠other children at high risk because of specific medical conditions.
Preventable chronic diseases
Chronic diseases including renal, cardiovascular disease, diabetes, and chronic respiratory disease are significant causes of morbidity and mortality in Aboriginal and Torres Strait Islander people. In response to this the Office has commenced developing a policy framework for the prevention, early detection and management of chronic diseases.
A pilot of the near patient testing program to monitor diabetes, in cooperation with the Aboriginal community controlled health sector, was completed in December 2000. The Minister approved a rebate under the Medicare Benefits Scheme from 1 December 2000 for Aboriginal community controlled health services undertaking this testing.
Sexual health
The National Indigenous Australians' Sexual Health Strategy (NIASHS) has been extended to 2003-04, in line with the National HIV I AIDS and Hepatitis C Strategies, which end in 2003-04. Following the mid-term review of the NIASHS in 2000-01, the Minister approved the synchronisation of the period of operation of these three strategies which form the core responsibility of the Australian National Council on AIDS Hepatitis C and Related Diseases.
OATSIH in conjunction with Queensland Health, Territory Health Services and the Health Department of Western Australia are collaborating in a program from 2001 to 2003 to increase capacity of those jurisdictions to eradicate donovanosis, a sexually transmitted infection predominantly found in remote Indigenous communities.
174
TQRRES STRAIT ISLANDER HEALTH
At the request of the Indigenous Australians' Sexual Health Committee the National Centre in HIV Epidemiology and Clinical Research conducted a workshop in conjunction with the
Australasian College of Sexual Health Physicians National Conference in Sydney in May 2001, specifically looking at screening methodologies as an approach in lowering the sexually transmitted infections (STis) rates in Indigenous
Australians. The report from the workshop will assist communities in deciding what type of screening methodology best suits their particular circ*mstances.
Improving communication with primary
health care services, Aboriginal and Torres
Strait Islander peoples and the general
population
OATSIH continues to improve communication with the general population and Indigenous health service providers.
Four editions of the quarterly newsletter Indigenous Health Matters were released during the past year. The newsletter is an important avenue for distributing information on the
Department's activities in Indigenous health, and Indigenous communities across Australia are contributing articles. Indigenous Health Matters provides an important counterbalance to
the mainstream media by highlighting some of the successes achieved in improving health outcomes in Indigenous communities. A link to the document is available at: www.health.gov.au/oatsih/media/newslet.htm
The OATSIH website was launched early in the year and provides information on Indigenous health to the community. The website includes an e-mail address for feedback and inquiries and has become a popular way for people to provide and request information. A link to the site is available at: www.health.gov.au/oatsih/index.htm
175
OATSIH also continues to support the Australian Indigenous HealthinfoNet (formerly National Aboriginal and Torres Strait Islander Clearinghouse). The Australian Indigenous HealthinfoNet has been selected as finalist in the Stockholm Challenge 2001, a unique awards
program for pioneering information technology projects worldwide. A link to the site is available at: http:/ /www.healthinfonet.ecu .edu.au/
OATSIH has also established a pilot program to trial the use of electronic health information touch screens in Indigenous communities in conjunction with Julia Schofield Consultancy, the University of Queensland and supported by funding from SmithKline Beecham.
OUTCOME 7
Performance indicators
Indicator 1: Life expectancy at birth by sex (National Performance Indicator 1.1).
Indicator 2: Per capita funding for primary health care for Aboriginal and Torres Strait Islander peoples across all government health programs.
Indicator 3: Proportion of Common wealth funded Aboriginal Community Controlled Health Services routinely implementing population health promotion and education programs.
Indicator 4: Number of health professionals (doctors, nurses and health workers) in Common wealth funded Aboriginal health services; and the number of health professionals who have graduated from or are currently undertaking training in accredited Indigenous post-secondary health courses.
Target: Consistent with a 20 per cent reduction in age standardised all causes mortality rate ratios over ten years.
Information source/reporting frequency: Registered deaths and population estimates from reports against the National Performance Indicators provided by State Governments to the National Health Information Management Group.
Annual update and three-year trend analysis.
Target: a) Ratio of per capita funding by all jurisdictions for primary care to secondary/tertiary care of 3:4. b) Increase in future years of spending on primary care as a proportion of all health care spending.
Information source/reporting frequency: Expenditures on Health Services for Aboriginal and Torres Strait Islander People report prepared biennially for the Department.
Target: By June 2001, 60 per cent of services and 80 per cent by 2004.
Information source/reporting frequency: Service Activity Reports provided by services to the Department of Health and Aged Care and the National Aboriginal Controlled Community Health Organisation. Annual.
Target: By June 2001, strategies and mechanisms defined to collect baseline data on national workforce supply and demand.
Information source/reporting frequency: Service activity reports provided to Department of Health and Aged Care; one-off report updated annually; and national performance indicators annual reports.
176
Indicator 5: The proportion of OATSIH and NHMRC Indigenous health related research
projects undertaken consistent with the NHMRC Aboriginal and Torres Strait Islander
Health Research Agenda Working Group's Indigenous Health Research Criteria.
Indicator 6: Data on the performance of government programs to improve the health status of Aboriginal and Torres Strait Islander
peoples available from a comprehensive range of data sets and of sufficient quality to support policy development.
TORRES STRAIT ISLANDER HEALTH
Target: All OATSIH and NHMRC Indigenous health related research projects provide information on priority issues or areas identified under the Indigenous health research criteria.
Information source/reporting frequency: Department of Health and Aged Care records. Annual.
Target: Data collection improved through the technical refinement of the national performance indicators and targets for Aboriginal and Torres Strait Islander health. Refinement completed by February 2001.
Information source/reporting frequency: Annual reports on the national performance indicators held by the National Health Information Management Group.
177
OUTCOME 7
OUTCOME 7: FINANCIAL RESOURCES SUMMARY
'(A) (B)
Budget Actual Variation
Est imate EJqJenses (Column B
2000/2001 2000/2001 minus
s·ooo S'OOO Column A)
Ad mi nistered Expenses
Administered Item 1: Services in Aboriginal & Torres Strait/slander communities Appropriation Bill 1/3 161.887 167,536
Appropriation Bill2/4
161,887 167,536
Admfnlstererl Item 2: Jnfmstructure to support the development & operation of high quality health care services for Aboriginal & Torres Strait islander people Appropriation Bill 1/3 27,509 17,895
Appropriation Bill 2/4
27,509 17,895
Total Administered Exe enscs 189,396 185,431
DepartmentAl Appropriations
Outp1rt Group I - Services to tl1e Minister & Parliament 3,773 3,770
Output Group 2- National Leadership 5,440 5,436
Output Group 3- lnfom1ation 2,903 2,901
Output Group 4 - Program Management 12,483 12,480
Outp1rt Group 5 - Regulatory Activity Output Group 6 - Direct Delivery of Services
Tota l price of depa rtme ntal outputs 24,599 24,587
(total revenuef.·om Gover?1ment & other sources)
TotaJ revenue from Government (appropriations) 24,382 24,471
contributing to price of departmental mrtputs Total revenue from otl1er services 217 116
Total price of departmental outputs 24,599 24 ,587
(total revenue.f!;om Government & other sources)
Total price of outputs for O utcome 7 24,599 24,587
(total revenue from Government & other sources)
Total estimated resourclng for Outcome 7 213,995 210,018
(total price of outputs & ad min expenses)
1 The Budget Estimate 2000/2001 includes the appropriations as per the Portfolio Budget Starements 2000M200 1 Portfolio Additional Estimales and Advances to the Finance Minister. This amount may differ to the
estimates for 2000/2001 published in the 200112002 PBS. Such differences can arise from updated estimates and rephasin.gs.
2 Budget pri0rto additional estimates. The munber of output groups has reduced from 4 in 2000M2001 to 2 in 2001-2002. It is not possible to show direct compamtives
178
5,649
5,649
(9,614)
(9,614)
(3 ,965)
(3) (4) (2) (3)
(12)
89
( 101 )
(12)
( 12)
(3,977)
'Budget 200112002 s·ooo
177,616
177,6 16
25,591
25,591
203,207
6,221
15,626
21,847
21,691
156
21,847
21,847
225,054
Outcome 8: Choice through private health
A viable private health industry to improve the choice of health services for Australians
179
Outcome 8 is managed within the Department by the Health Industry Investment Division.
The Private Health Insurance Administration Council and the Private Health Insuran ce Ombudsman also work towards the achievement of Outcome 8. Both produce their
own annual reports.
OUTCOME 8
Major achievements
Stabilising participation rates and age
profiles
The Federal Government's series of private health insurance reforms continues to produce excellent results. Participation rates have increased from a low of 30.1 per cent in December 1998 to 43.0 per cent in June 2000 with a peak at 45 .8 per cent in September 2000. Rates now appear to have stabilised at 44.9 per cent in June 2001.
In addition to the increase in private health insurance participation, the age profile of people with private health insurance is also stabilising. The proportion of people with private health insurance under the age of 65 has remained steady at 89.1 per cent in June 2001 following the sharp increase to 88.6 per cent in the year to June 2000.
Prem ium ch anges
Only two out of 44 health funds announced premium increases for 2001, with one fund actually announcing a premium decrease. This has resulted in an average increase across the industry of -0.01 per cent. This was the lowest average increase in 11 years.
Implementation of Gap Cover schemes
In August 2000 legislation was passed to enable health funds to provide cover for their members that would eliminate, or allow them to know in advance, any out-of-pocket payments that they may have had to make for doctors' services in hospital or day surgery - without the need for doctors to enter into any contracts. Thirty-two health funds had introduced these new style gap schemes by 30 June 2001.
Health Legislation Amendment Act (No 1)
2001
On 21 March 2001 the Health Legislation Amendment Act (No 1) 2001 was passed enabling health funds to offer high quality care for admitted privately insured patients beyond the hospital walls. As a result health funds now have the flexibility to offer privately insured patients alternative models of health care delivery as a direct substitute for in-hospital care for admitted patients.
Under-ach ievements
Review of the Private Health Insurance
Ombudsman
There was a delay in the completion of the review of the functions of the Private Health Insurance Ombudsman (PHIO). This was to be completed in 2000-01 but was delayed due to implementation of other reforms and the need to take account of these reforms, once implemented, in the review process. The review is aimed at ensuring that the PHIO is able to continue to provide a high quality complaints service to the industry and its consumers in light of the increased workload. It is expected to be completed in 2001-02.
Review of the Impact of Regulation on the
Private Health Industry
Ongoing scrutiny of the impact of regulation on the private health industry is undertaken by the Department in conjunction with the implementation of reforms. The rapid development and implementation of policy currently makes a comprehensive review of the regulatory framework difficult. While the major review of the impact of regulation was not undertaken in 2000- 01, review of regulation is undertaken as part of policy development on an ongoing basis .
180
CHOICE THROUGH PRIVATE HEALTH
Outcome summary - the year in review In 2000-01, the Department continued to focus on improving the health care options for all Australians through the continued introduction
of important reforms to private health insurance. These reforms are designed to make private health insurance more competitive and attractive to consumers. They are part of the Government's commitment to giving Australians greater choice in health care while ensuring a sustainable and balanced health system for the future by supporting a private health sector that complements the public health system.
The four areas of reform are:
⢠improved affordability of private health insurance premiums;
⢠development of innovative products;
⢠improved health industry efficiency; and
⢠increased consumer awareness and confidence.
The first three areas of reform were identified in the 1999-2000 Portfolio Budget Statements. The fourth emerged during 2000-01 as an urgent priority as participation rates for private health insurance increased.
Improved affordability of private health
insurance premiums
The Department has successfully implemented a broad range of initiatives that have contributed to improving the affordability of private health insurance. A key priority has been to continue to stabilise health fund membership levels and to encourage new members hence reducing the overall costs to consumers. This objective is being pursued through initiatives such as the Federal Government 30% Rebate, the Lifetime Health Cover scheme, no or known gap activities, informed financial consent and simplified billing, deregulation of prostheses and the review of the default benefits schedule.
Reflecting the improvement in affordability of private health insurance is the level of fund premium increases. Only two funds announced
Figure 8.1: Private hospital insurance coverage, March 1996-June 2001
c 40
·.::; rc ::l a.
30 a. 0
Q) O'l rc +"
20 c Q) u OJ l:l. 10
181
OUTCOME 8
Figure 8.2: Health fund members by age group, as at 30 June, 1998-2001
9
⢠Members aged 65+ 8
⢠Members under 65
7
6
"' c .Q 5 = 4 3
2
1998 1999
premium increases for 2001 on 1 March and for the first time ever, a fund actually decreased premiums. This has resulted in an average increase in premiums borne by health fund members of -0.01 per cent. This was the lowest average increase in 11 years.
A second health fund has subsequently announced a premium decrease, which will take effect from 1 July 2001.
Stabilisation of participation rates and age
profiles
The 2000-01 year has seen a stabilisation in participation rates. At 30 June 2000, 43.0 per cent of the Australian population was covered by hospital insurance. Participation at 30 June 2001 was 44.9 per cent. (Figure 8.1). The participation rate has now stabilised following on from the low point of 30.1 per cent in December 1998. This stabilisation followed the rapid increase in participation following the
2000 2001
implementation of the Federal Government 30o/o Rebate on 1 January 1999 and the introduction of the Lifetime Health Cover scheme on 1 July 2000'.
With the stabilisation of private health insurance participation rates due to Federal Government initiatives, the age profile of people with private health insurance has also stabilised. The proportion of people with private health insurance under the age of 65 has remained steady at 89.1 per cent in June 2001 compared to 88.6 per cent at June 2000 following the sharp increase over the previous year, and the earlier downward decline (Figure 8.2) 2 â¢
Federal Government 30 % Rebate
The Federal Government 30o/o Rebate on private health insurance has continued to directly reduce the cost of premiums to consumers. This program gives Australians a rebate on the full cost of their private health insurance premiums
' Relates to Indica tor l a. 2
Relates to Indicator lc.
182
CHOICE THROUGH PRIVATE HEALTH
no matter what their level of cover, income or type of membership.
The total cost of assistance delivered under the Federal Government 30o/o Rebate for 2000-01 was $2.1 billion, consisting of $1.9 billion appropriated through the Department of Health and Aged Care and an estimated $197 million administered by the Australian Taxation Office
(of which $187 million or 95 per cent of claims were processed by 30 June 2001) .
Lifetime Health Cover scheme
In the 1999-2000 Budget, the Government announced the introduction of Lifetime Health Cover, which changed the way private health insurance operates. Lifetime Health Cover is a
long term structural reform designed to encourage people to take out hospital cover earlier in life and to maintain their cover over their lifetime.
Under Lifetime Health Cover, health funds are able to set premiums based on the age of each member when he or she first takes out hospital cover with a registered health fund. People who take out hospital cover with a registered health fund before they turn 31 and maintain that
cover over their lifetime will pay a lower premium throughout their lives relative to people who delay joining, regardless of their health status.
A grace period, beginning on 1 July 1999 and ending on 15 July 2000, gave everyone, regardless of age, a chance to take out private hospital cover and lock in the right to pay a premium based on age 30 for as long as they
maintain their cover. People who were born on or before 1 July 1934 are not affected by Lifetime Health Cover. They will be able to take out private hospital cover at any time in the future and pay the base rate premium. Additionally, specific Lifetime Health Cover hardship provisions may be accessed until 1 July 2002, effectively allowing eligible applicants
183
additional time to take out hospital cover at the minimum age rate.
Due to the administrative overload placed upon health funds by the number of people waiting to take out private health insurance, the deadline for Lifetime Health Cover was extended from 1 July 2000 to 15 July 2000. To inform the public of the decision to allow people to join up within the extension period, the Department ran a comprehensive communication campaign in early July 2000 that included television advertisem*nts and a telephone inquiry line.
No/Known Gap schemes
Departmental market research continued to show that the major ongoing consumer concern with private health insurance is the level of gap between the total cost of in-hospital care and that paid by Medicare and the health fund.
No gap health insurance covers the full cost of medical services provided by doctors in hospital. Known gap health insurance covers all but a specified amount or percentage of the full cost of these services, and ensures that patients are advised, in advance of treatment, the amount they will need to pay from their own pocket for the medical service. The Government is
OUTCOME 8
Figure 8.3: Proportion of insured in-hospital services covered by a no or known gap
arrangement, June 1998-June 2001
45
40
35
(])
30
01 ro +-'
25 c::: (]) v ... (]) c.. 20 15
10
5
?!'0 ?!'0 ?!'0 ?!Oj ?!Oj 05?!0j ?!Oj SJ(.J SJ(.J SJ(.J SJ(.J SJ" SJ"
...._o; ...._o; ...._o; ...._05 ...._0) " ...._05 ""<:5 ""<:5 ""<:5 ""<:5 ""<:5 ""<:5
\.::,0 <:;i"' \.::,0 '-;'8 <::/'' \.::,0 <::i' \.::,0
Quarter
committed to eliminating the gap to the greatest extent possible, by encouraging the spread of no and known gap insurance products.
Until August 2000, private health insurance funds were allowed to cover the gap only where a negotiated contractual agreement existed between the doctor, the hospital and/or the health fund about the price of the procedure. To address medical practitioner concern over contractual arrangements and therefore expand the level of no or known gap coverage, the Government passed legislation in August 2000 to enable health funds and doctors to enter into voluntary non contractual arrangements known as 'gap cover schemes' to cover part or all of the gap.
By June 2001, 32 health funds had approved gap cover schemes in place, while the 11 remaining retail health funds offered gap benefits under contractual agreements. The
Department continues to work with these health funds to facilitate the introduction of gap cover schemes. This includes a communication campaign designed to ensure consumers are aware of the new no/known gap cover schemes.
The percentage of insured in-hospital medical services covered by a no or known gap arrangement rose from 1 per cent in June 1998 to 5.4 and 12.6 per cent in June 1999 and 2000 and then to 40.3 per cent in the June 2001 quarter (Figure 8.3)3.
Informed financial consent and simplified
billing
Informed financial consent for consumers is closely linked to the development of no gap and known gap health insurance. Informed financial consent occurs when patients are clear about which doctors will be involved in their care and
3
Relates to Indicator 1 b.
184
CHOICE THROUGH PRIVATE HEALTH
are given estimates of the probable overall costs and gaps, for both medical and hospital charges.
Although the Government encourages doctors to provide information to patients prior to in hospital medical treatment, until recently doctors were only legally required to provide such information if they were delivering medical services under a contractual agreement to address the gap. No restrictions are placed on the manner in which doctors provide such information under contractual gap agreements, and it is acceptable to provide the information verbally. However the Health Legislation Amendment (Gap Cover Schemes) Act 2000, which
came into effect in August 2000 introduced a new non-contractual method of addressing the gap through 'gap cover schemes' and established a higher standard for provision of information to patients.
Informed financial consent requires medical practitioners providing services under a schem e:
⢠to inform the patient in writing, where the circ*mstances make it appropriate, of any amounts that h e or she can reasonably be expected to pay for treatment. As a further safeguard the patient must acknowledge receipt of this advice on charges; and
⢠to disclose to the patient any financial interest that he or she h as in any products or services recommended or given to the patient.
In further efforts to ensure patients do not receive unexpected bills for in-hospital medical treatment and to increase patient satisfaction with the private health insurance experience, the Department held consultations in September 2000 with health funds, practitioner groups and consumer organisations. These consultations were to advance an industry
standard form for the provision of information on medical charges in writing. As a result of this process, a form was developed for providing
Figure 8.4: Proportion of insured in-hospital services claimed under simplified billing,
July 1999-June 2001
45
40
35
30
Q)
25 Ol ro +-' c Q) 20 u a; c.. 15 10 5 0 Month/year 185
OUTCOME 8
information on charges to patients and received widespread support among the parties consulted and was accepted by the AMA Executive in October 2000.
Alongside informed financial consent, simplified billing addresses consumer understanding of the insurance product through the simplification of fees and charges. There are three elements to simplified billing:
⢠the aggregation of a patient's bills for in hospital care;
⢠the streamlining of claims procedures; and
⢠the provision of informed financial consent.
Through these elements, simplified billing is an attempt to overcome the current situation whereby private patients recovering from hospital treatment deal with the frustration and confusion of claiming from both Medicare and their health fund. This uncertainty extends to the level of Medicare rebate they will receive, what their out-of-pocket costs will be and not knowing when they will receive their final account.
To address this, the Department funded four simplified billing development sites, which operated from 1 September 2000 and will continue until 31 August 2001. They were designed to look at ways of reducing the overall cost for billing agents through the development of new business practices and the introduction of tailored billing systems.
The use of simplified billing by private patients has continued to grow over the past 12 months. This is a result of simplified billing being introduced as part of new gap cover schemes. The percentage of Medicare in-hospital services claimed under simplified billing as a percentage of the total insured in-hospital services claimed increased from 24.7 per cent in July 2000 to 42.5 per cent in June 2001 (Figure 8.4).
Prostheses deregulation
The prostheses arrangements for the private sector were deregulated in February 2001. Deregulation was phased in over the previous 12 months. The arrangements came out of a Commonwealth Government-initiated Ministerial round table meeting held in June 1999 attended by a wide representation of the health industry.
Under the new arrangements, the benefit payable by health funds for an item listed on Schedule 5 Benefits payable in respect of Surgically Implanted Prostheses And Human Tissue Items is no longer set by the Commonwealth. Instead this is negotiated and agreed between the health fund and the supplier, hospital or agent. The new arrangements ensure that there can be no gap payable by the patient, clinical choice remains with the doctor (in consultation with the patient) while at the same time market forces determine benefit levels.
As part of deregulation, the Department has also expanded Schedule 5 to include a new list of other medical devices that are cost effective and beneficial to the patient but do not meet the criteria for inclusion as a prostheses or human tissue item.
To assist the Government in its management of the Schedule, the Minister has appointed a Private Health Industry Medical Devices Expert Committee. This committee has commenced assessing the prostheses items that were targeted for review for inclusion on Schedule 5. The committee met three times during 2000--01 to determine protocols and procedures around their deliberations of items to be listed and commenced assessing items for inclusion on the list. This process will continue over the course of 2001--02.
Review of the default table of benefits
The default table of benefits is payable by health funds where benefit levels are not otherwise specified in an agreement between a health
186
CHOICE THROUGH PRIVATE HEALTH
fund and a hospital/day hospital facility. Because of the changing cost structures and treatment for in-hospital services, the default table is regularly revised and reviewed.
Overall, this year's review needed to take into account changes in pricing arrangements and changes to the contracting environment. In particular, a review of the second-tier default benefit arrangements has taken place during 2000-01 with wide ranging and comprehensive industry consultation. All second-tier eligibility criteria were reviewed and in particular, quality criteria were developed in agreement with the
industry. Methods to calculate second-tier benefit levels and an industry-run process for assessing eligibility for second-tier benefits were also generally agreed to by industry. It is expected that the new arrangements will be implemented in 2001-02.
Development of innovative products
During the year in review, the Government changed the relevant regulation and legislation to allow health funds to respond to consumers' needs and best practice service delivery models. This has been achieved through the exploration of alternative models of in-hospital care and a
review of long stay patient arrangements.
Alternative models to in-hospital care
Six private sector-based Hospital in the Home/Early Discharge Trials were conducted from early 1997 until June 2001. The trials provided substitute care for in-hospital treatment for admitted patients beyond the
hospital's walls. They were piloted with the involvement and support of the Commonwealth, consumer/carer
representatives, participating private hospitals, participating health funds and the medical profession and received favourable evaluation reports.
187
To follow up the trials, Hea lth Legislation Amendment Act (No 1) 2001 was given royal assent on 21 March 2001. This Act expands the meaning of hospital treatment to include
approved outreach services provided by or on behalf of a hospital or day hospital facility, as services that a health fund will be able to cover under their hospital tables. This legislation allows health funds the flexibility to offer privately insured patients alternative models of health care delivery as a direct substitute to in hospital care for admitted patients.
Progress, in consultation with industry, was also made on a new classification system for day only procedures. The review of day-only procedures and day hospital facilities proposes to move away from a defined set of benefits for certain procedures to a hospital categorisation arrangement that will best reflect the capability of the facility where the procedure is to be
performed.
Flexible approaches to health care delivery in the private sector were also discussed and developed with the industry in 2000-01. A small number of trials that explore new, more flexible forms of health insurance to support community-based coordinated care for people
with private health insurance were progressed for consideration as part of the second round of coordinated care trials. The trials offer the prospect of expanding the options available
under private health insurance to include a more flexible range of services. For health funds, coordinated care may offer the capacity to provide new and attractive forms of cover for non-hospital services, while reducing their exposure to hospital costs.
Privately insured long stay patients
During 2000-01, the Department commenced a review of the care and funding arrangements for privately insured long stay patients (many of
OUTCOME 8
whom are nursing home type patients) accommodated in private hospitals. The Department consulted widely with the industry regarding long stay patients, including investigating existing industry models. As a result, it became apparent that there are opportunities for hospitals and health funds to work together to develop suitable models of care and that such initiatives are already being developed by the industry itself. The Department will continue to monitor industry developments and models of care for these patients as well as industry development of innovative arrangements that enable choice and comprehensive care options for health fund members with complex care needs.
Improved health industry efficiency
Improvements in the efficiency of the private health industry are being achieved through revised private rehabilitation arrangements and the implementation of the regional and bush nursing hospital initiative.
To further support the private health industry, on 1 January 2001 new solvency and capital adequacy standards replaced the existing 'minimum reserve requirements' outlined in the legislation. To enable a smooth transition to the new standards, registered health benefits organisations extant at 1 January 2001 were required, as a minimum, to meet transitional standards up until January 2005. The new standards seek to ensure the on-going solvency and viability of the private health insurance industry. The standards are administered by the Private Health Insurance Administration Council, an independent body that is responsible for the prudential regulation of the health funds, and seek to promote the interests of contributors.
The new standards and the focus on prudential regulation go hand in hand with the Government's goal of ensuring that health
funds remain financially sound, become more commercially oriented, and are therefore able to meet their obligations to the increasing number of health fund contributors.
Private rehabilitation
Since May 1999, the Government has been working with the private rehabilitation sector to improve the quality of care and patient outcomes within the rehabilitation sector as well as establishing a viable private rehabilitation sector that complements the public sector.
Following an independent report commissioned in 1999, the Minister endorsed the Australian National Sub-acute and Non-Acute Patient Classification System (AN-SNAP Rehabilitation) as a national classification system for private rehabilitation. By 1 July 2001 all private rehabilitation facilities should be collecting and reporting nationally on the basis of the AN SNAP classification system for private rehabilitation services.
The 1999 Report also recommended a 'blended' payment model for private rehabilitation services. The aim of the 'blended' model is to share the financial risk between payers and providers through payment for rehabilitation services based on both length and type of episode. On 1 October 2000 the private sector commenced a trial of the 'blended' payment model simultaneously in New South Wales, Victoria and Queensland. The purpose of the trial was to address the suitability of the model for national private sector implementation. The trial concluded on 30 June 2001 and the evaluation report, which is expected around December 2001, will advise on the possible implementation of the model.
The Department has been working with the Australasian Faculty of Rehabilitation Medicine to establish an Australian Rehabilitation Outcomes Centre. The objective of the Centre is to develop a national benchmarking system
188
CHOICE THROUGH PRIVATE HEALTH
which will build a collection of comparative data to provide information on the efficacy and outcome measurements for both public and private rehabilitation facilities.
In 2000-01, the Government provided financial assistance for Phase One (the planning phase) of the Outcomes Centre and will continue to work closely with all stakeholders, including the public sector, with a view to establishing the Centre in early 2002.
Bush nursing, small community and
regional private hospitals
In the 2000-01 Budget, the Government introduced a budget measure to assist community hospitals in rural areas to identify the need for, and to implement, refurbishment, reorganisation, business re-engineering and restructuring activities. The aim of the initiative is to protect the ongoing viability of small rural private health services and ensure continuity of health service delivery and choice in health service provision for people li vi ng in rural communities.
In 2000-01, site visits were undertaken at hospitals throughout regional and rural Australia. The program was commenced in 31 of the 59 eligible hospitals nationally. The initial phase of the program consists of a service planning exercise whereby an initial assessment of the hospital's services is made in close consultation with the hospital's key stakeholders
including the local community, health funds with significant market share in the region, Divisions of General Practice and State Governments. Following this, funding is being made available to eligible not-for-profit
hospitals to assist with the implementation of service planning recommendations for the implementation of changes. In 2000-01, 13 hospitals received further funding under this program to implement the service planning recommendationsâ¢.
' Relates to Indicator 2c.
189
Increasing consumer awareness,
confidence and choice
The Department has made progress in improving consumer confidence in, and understanding of private health insurance. Initiatives are designed to increase consumer awareness through various means such as the information hotline, the private health insurance product key features statement and private patients' hospital charter. The clarification of the pre-existing ailment rule and private sector quality initiatives are also increasing the choice for private health care by consumers5â¢
The number of disputes as a proportion of all complaints to the Private Health Insurance Ombudsman (PHIO) regarding access to private health services is also indicative of consumer satisfaction with the choice for private health care. At June 2000, 37.7 per cent of all complaints were disputes. It is expected that this figure will be lower at June 2001 even with the increased level of participation due to the Lifetime Health Cover scheme6 ⢠This figure will be available in the PHIO Annual Report 2000-01.
Consumer hotline trial
As a result of the Private Health Insurance hotline trial, the Department determined that a national consumer hotline was not the most efficient and cost effective way to provide consumer information.
As such, it has combined the services offered by the trial hotline with information on other private health insurance initiatives as provided by the departmental telephone hotline. The Department also chose not to proceed with the proposal to develop an internet site providing consumers with comparable product information about private health insurance
(another proposed outcome following on from the consumer hotline trial in 1999-2000).
' Relates to Indi cator 2a. ' Relates to Indicator 3.
OUTCOME 8
Key Features Statement
Throughout the reporting period, the Department successfully worked with the industry and consumers to develop a proforma key features statement for private health insurance products.
Statements such as these are widely used to assist consumer understanding of complex products and services using clear definitions of entitlements allowing consumers to make broad comparisons between fund products.
During the course of the year, the Department worked toward finalisation of the content of a Key Features Statement for private health insurance products. This included revising the content to include the most up to date advice on government policy reforms as well as consumer testing of drafts of the document.
It is anticipated that the Key Features Statement will be finalised and distributed by health funds to consumers early in 2001-02.
Clarification of the pre-existing ailment
rule waiting period
An independent review into the operation of the 12 month waiting period for pre-existing ailments was carried out and a report released by the Minister for Health and Aged Care on 3 November 2000.
The report found the pre-existing ailment rule to be workable but made recommendations to improve consumer understanding of the rules and to achieve greater consistency in the way the rule is applied. During the remainder of the year the Department worked with an industry steering committee to implement these recommendations and it is expected the bulk of this work will be completed early in 2001-02.
Private patients' hospital charter
In 2000- 01, the Department undertook a revision of the Private Patients' Hospital
Ch arter. The Charter was first developed by the Department and distributed to consumers in 1996, and was last amended in 1998. The Department has undertaken substantial consultation in revising the Charter.
The purpose of the Charter is to empower private patients by providing general information on their entitlements and on what they can expect from health funds, doctors and hospitals. It also informs private patients about complaint mechanisms.
The text was finalised in 2000-01 and it is expected that the revised Charter will be released in September 2001. The revised Charter will be published in booklet form and distributed to consumers through health funds, private hospitals, day surgery facilities, general practitioners and specialists. The Charter will also be available on the internet, with links to key stakeholders such as the Private Health Insurance Administration Council and the Private Health Insurance Ombudsman.
Promoting private sector quality
improvements
As part of the Government's commitment to ensure quality in the private sector, the Department established the Private Health Industry Quality Working Group (PHIQWG) in January 2001, consisting of representatives from
all stakeholders in the private health industry including health funds, private hospitals, clinicians, consumers and the Government.
The PHIQWG brings together expertise and knowledge from across the industry, and provides a forum where all stakeholders can express their perspective, bring to the table issues of concern and work together towards meaningful outcomes that benefit all groups particularly patients and their families .
The PHIQWG is concerned with a mix of initiatives aimed at ensuring quality in private health services and has established strong links
190
CHOICE THROUGH PRIVATE HEALTH
with safety and quality agencies in the health sector, including the Australian Council on Safety and Quality in Health Care.
The first task of the PHIQWG was the development of a set of quality related criteria which are included in the revised second tier benefit determination. The successful development of these quality criteria has been a significant achievement as it is the first time that representatives of all stakeholders in the industry have come together and agreed upon a set of criteria to improve safety and quality of care in the private health sector.
Consumer choice of private health services
The increasing number of consumers choosing private health care, whether provided by a priva te or public hospital is a key indicator of
the success of Government private health reforms and the impact of these reforms upon the health system.
The measure of consumer choice for private health care is best demonstrated as the proportion of private patients of all patients in both public and private hospitals. The percentage trended upwards for the first time to 33.8 per cent in June 2000. This upward movement followed three years of decline to the lowest point of 32.7 per cent in June 1999
(Figure 8.5) ' .
Th is new trend is expected to continue as the recent major increase in private health insurance membership flows through to hospital use patterns.
Figure 8.5: Private patients as a percentage of all patients in public
or private hospitals, 1997-2000
QJ Ol
"' ... c:
34
33
Q; 0..
32
31
1997 1998 1999 2000
Year
7
Relates to lndicator 2b.
191
OUTCOME 8
Performance indicators
Indicator 1: Affordability of private health care.
Indicator 2: Choice for consumers between private and public health care.
Indicator 3: Complaints regarding access to appropriate private health care services.
Target: a) Stabilisation and improvement of private health insurance participation rates. Benchline at 31 December 1998 = 30.5 per cent. b) Increased proportion of in-hospital services covered by no/known gap arrangements. Benchline at 30 June 1999 = 5.4 per cent. c) Increased proportion of people with private health insurance who are under the age of 65. Benchline at 30 June 1999 = 85.4 per cent.
Information source/reporting frequency: a) PHIAC quarterly membership report. b) Medicare administrative data; and PHIAC Quarterly Report A. c) PHIAC Quarterly Report A.
Target: a) Increased consumer awareness of private health care services. b) Increased proportion of in-hospital services delivered to private patients (in public and private hospitals) compared to public patients. Benchline at 30 June 1999 = 32.7 per cent c) Maintain access to appropriate rural private hospital services. Benchline at 30 June 2000 = 59 private hospitals operating in rural Australia.
Information source/reporting frequency: a) Evaluations of promotional campaigns and telephone information services. b) Australian Hospital Statistics. c) Private hospital administrative data.
Target: Reduced disputes as a proportion of the overall complaints to the Private Health Ombudsman Benchline at 30 June 2000 = 37.7 per cent
Information source/reporting frequency: Private Health Insurance Ombudsman Annual Report.
192
CHOICE THROUGH PRIVATE HEALTH
OUTCOME 8 : FINANCIAL RESOURCES SUMMARY
'(A) (B)
Budget Actual Variation
Estimate Expenses (Column B
2000/2001 2000/2001 minus
$'000 $'000 ColumnA}
Administered Expenses
Administered Item 1: Federal Government 30% Rebate Private Health Insurance Incentives Act 1997 - Private Health lnsunmce incentives Scheme Private Health Insurance Rebate 1,995,777 1,930,238 (65,539)
Special Appropriations 1,995,777 1,930,238 (65,539)
Appropriation Bill 1/3 9,3 13 9,420 107
Appropriation Bill 2/4
Administered Item 2: Rural and Regional Private Hospital Support Appropriation Bill 1/3 Appropriation Bill 2/4
Total Administered Exeenses 2,005.090 1,939,658 (65,432}
Departmental Appropriations
Output Group I - Services to the Minister & Parliament 3,076 3,074 (2)
Output Group 2 - National Leadership 3,533 3,531 (2)
Output Group 3 - Information 3,706 3,704 (2)
Output Group 4- Program Management 879 892 13
Output Group 5 - Regulatory Activity 3,508 3,696 188
Output Group 6 - Direct Delivery of Services 3,297 3,295 (2)
Total price of departmental output. 17,999 18 ,1 92 193
Ctotal revenue (!om Government & other sourcesl
Total revenue from Government (appropriations) 17,871 17,906 35
contributing to price of departmental outputs Total revenue ifom other services 128 286 15 8
Total price of departmental outputs 17,999 18,192 193
(total revenue (!om Govenmzent & other sourcesl
Total price of outputs for Outcome 8 17,999 18, 192 193
' total revenue a "om Government & other sources)
Total estimated resourcing for Outcome 8 2,023,089 1,957,850 (65,239)
''total oJ:: oute,uts & admin
1 Tite Budget Es timate 20001200 I includes the appropriations as per the 2000-200 I Portfolio Budget Statements (PBS), 2000-2001 Portfolio Additional Estimates and Advances to tlte Finance Minister. This amount may differ to the revised es timates for 2000/200 t published in tlte 200 1/200 2 PBS . Such differences can arise from updated estimates and rephasings.
2 Budget prior to additional estimates . The number of output groups has reduced from 6 in 2000-2001 to 3 in 2001-2002 . It is not possible to show direct comparatives
193
2
Budget 2001/2002 $'000
1,924,864
1,924,8 64 8,689
4,623
1,938,176
7,409
4,835
1,756
14,000
13,983
17
14,000
14,000
1,952, 176
Outcome 9: Health investment
Knowledge, information and training for developing better strategies to improve the health of Australians
195
The Health Industry and Investment Division of the Department of Health and Aged Care has overall responsibility for Outcome 9, incorporating outputs from the Portfolio Strategies Division (Information Management Branch), the Corporate Services Division
(Community Sector Support Scheme), the National Health and Medical Research Council and its office and the Australian Institute of Health and Welfare (AIHW).
The National Health and Medical Research Council (NHMRC) is required, under legislation, to provide the Minister for Health and Aged Care with a report of its operations for the year. The latest report, for the calendar year 2000 was
tabled on 28 August 2001.
The AIHW also publishes its own annual report. Its achievements in 2000- 01 are not included in this report.
OUTCOME 9
Major achievem ents
The Health and Medica l Research Strategic
Review
The Health and Medical Research Strategic Review Implementation Committee report, Enabling the Virtuous Cycle, was presented to the committee of ministers in November 2000 and released in April 2001.
A significant recommendation of the review was the creation of the position of Chief Executive Officer (CEO) for the National Health and Medical Research Council (NHMRC). Professor Alan Pettigrew was appointed as the inaugural CEO in January 2001.
Coll aborative resea rch with States and
Territories
Collaboration with the States and Territories in a pilot collaborative research program has been undertaken. A set of priority research themes have been agreed and expressions of interest sought.
Medical Rural Bonded Scholarships
The Medical Rural Bonded Scholarship Scheme commenced at the beginning of the 2000 academic year. Through this scheme 100 new medical places have been made available across all medical schools nationally. Students will receive $20,000 per year while gaining their medical degree on the condition that they agree to work in rural and remote areas for six years once they are qualified.
Health/nsite
By June 2001, Healthlnsite had expanded to include links to over 5,000 resources on 47 information partners' websites and was visited by over 1,000 users each day. There were also 50 major topic areas, many of which included significant sub-topic pages, providing links directly to relevant pages on information partners' sites.
Reshaping of research funding
The NHMRC after extensive consultation, implemented significant changes to its research funding schemes. The two key achievements in this area were the introduction of a new grant to provide long term support to high achieving teams of researchers and the finalisation of the policy for providing competitive grants to block funded institutes.
World Health Organization - Effective
approaches to managing microbiological
water quality
The National Health and Medical Research Council's Framework for management of drinking water quality has achieved international recognition as a preferred approach for preventive management of drinking water quality.
Clinical practice guidelines for the
appropriate use of red blood cells
NHMRC guidelines for the appropriate use of red blood cells were produced addressing many aspects of blood compon ent therapy and clinical use of red blood cell s. Effective implementation of these guidelines will generate a number of positive outcomes.
National electronic health records taskforce
Health ministers agreed to commit resources to undertake two years' research and development work on Hea lthConnect, the proposed national health information network. A joint Commonwealth, States and Territory Program Office has been established within the Department of Health and Aged Care to oversee this work.
Health information standards development
Setting the Standards: A Health Information Standards Plan for Australia was published, and defines agreed national priorities in developing essential standards required to underpin the
196
HEALTH INVESTMENT
safe collection, storage and exchange of health information in an electronic environment.
Under-achievements
Asthma
Progress on the establishment of the Australian Monitoring Centre for Asthma has not proceeded as quickly as planned. This is particularly due to delays in the selection process of the centre. The tender process has now been completed and the Australian Monitoring Centre for Asthma will be established as a collaborating unit of the Australian Institute of Health and Welfare.
Nganampa specialist training project
The Nganampa physician training pilot project, based at Alice Springs, began in January 2001 and worked well initially but has not proven viable.
Outcome summary - the year in review The health investment outcome brings together a range of investment strategies aimed at improving the capacity and quality of the Australian health sector that are fundamental to all aspects of the health system in Australia. These strategies include improving quality and
safety, planning and support for the health and medical workforce and its infrastructure, information and support on health and welfare issues, community investment in health and aged care support and the maintenance of Australia's world class research capacity.
The 2000-01 Portfolio Budget Statements identified the following priority outcomes:
â¢
â¢
improving access to and use of health information by consumers, providers and planners; and
supporting world-class knowledge creation and research capacity- and the
197
translation of this knowledge, information and training for the benefit of all Australians.
Achievements against these priorities are addressed in detail under the following headings; health workforce development, engagement of the community in health care planning and delivery, promoting research to form the basis of best practice, coordination of national health priority areas to achieve health gains and information management in the health sector.
Health workforce development
The Department is working with the Royal Australasian College of Physicians and the Australasian College of Dermatologists to gather information and trial models for community training placements. The majority of other medical specialist colleges have also moved to enhance their capacity to provide community placements for specialist trainees.
During 2000, networked dermatology pilots in community settings were established in New South Wales and Queensland. These pilots also contain a rural component, with trainees spending time in Griffith, Longreach,
Charleville or Noosa. In early 2001 , another pilot was established in Darwin which includes training at a private practice, clinics at the Royal Darwin Hospital, and a research project on skin health in Aboriginal people that is being supervised by the Menzies Institute. It is anticipated that in both New South Wales and
Queensland all trainees will be rotated through a networked position during their four-year traineeship. Trainees recruited to the Northern Territory position spend a full year there.
The Nganampa physician training pilot project, based at Alice Springs, commenced in January 2001. The project was well received initially, however it has not been possible to recruit sufficient trainees to the post for it to remain
OUTCOME 9
viable. The purpose of the pilot was to trial community-based specialist training which had a strong Aboriginal health focus.
A pilot project in community-based paediatric training began at the Centre for Community Child Health (CCCH), Royal Children's Hospital Melbourne in January 2001. The aim of the project is to allow trainees to work outside teaching hospitals to gain a broader perspective on the needs of children and their families and an understanding of the roles played by the various professionals and organisations delivering health, educational and social services. Another community-based paediatric training position, funded by the Victorian Department of Human Services and based at Shepparton, is being included in the evaluation to provide information about a rural model.
The early stages of a major evaluation of these pilot projects has begun, including data collection'.
The objective of delivery of the best possible medical workforce to serve the Australian population has been significantly progressed through the passage of critical legislation, the Health Legislation Amendment (Medical Practitioners' Qualifications and Other Measures) Act 2001 (the Act), development and promotion
of a new workforce initiative, the Medical Rural Bonded Scholarships Scheme and the ongoing work to facilitate provision of doctors to rural and remote communities.
The Act, which passed through the Parliament on 29 June 2001, perpetuates a provision inserted into the Health Insurance Act 1973 in 1996. That provision required that Australian doctors graduating on or after 1 November 1996 were unable to access Medicare benefits unless they had obtained postgraduate qualifications or were participating on an approved placement. The impact of the legislation since 1996 has
' Relates to Indicator 6.
been to increase the number of doctors working in rural areas through approved placements on the Rural Locum Relief Program. By preventing newly graduating doctors from accessing Medicare, without further qualifications, it has also boosted the numbers of junior doctors in public hospitals and has increased the numbers of doctors choosing to enter specialist training2 ⢠It established general practice as a distinct discipline, requiring doctors to obtain postgraduate qualifications.
The Act also ensures that monitoring and research on postgraduate training places continues into the future. It does this by making the Medical Training Review Panel a permanent body with enhanced functions and also by expanding the scope of reporting on Medicare qualification restrictions. This will secure quality medical career paths for tomorrow.
The Commonwealth Medical Rural Bonded Scholarship Scheme was introduced following the May 2000 Budget. The scheme's rural focus is to address the scarcity of medical practitioners in country Australia over the long term. In return for a commitment to serve rural and remote communities for six years upon completion of postgraduate studies, medical students are granted a place in medical school and a scholarship for the duration of their medical studies. One hundred new medical students will be recruited to the Scheme each year. Over the long term the scheme will deliver doctors where they are most needed. The first intake of 100 scholars commenced their university studies in 2001.
Continued efforts have been undertaken to alleviate the maldistribution that exists in the medical practitioner workforce by issuing exemptions to overseas trained doctors subject to certain restrictions in the Health Insurance Act
1973. This encouraged both temporary and permanent resident overseas-trained doctors to
2
Relates to Indicator 5.
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HEALTH INVESTMENT
practice in rural and remote communities. During 2000, the numbers of permanent resident and citizen doctors who have committed to these areas has doubled from the previous year. This indicates that the policy focus to provide these communities with doctors who are willing and able to make long term commitments to rural and remote practice is working.
Engagement of the community and
consumers in health care planning and
delivery3
Healthlnsite
Health!nsite was launched on 28 April 2000 and is located at www.healthinsite.gov.au, to meet the needs of a growing number of Australians who use the internet to find health information. The period July 2000 to June 2001 represented the first full year of operation for Health!nsite.
During this year the Department worked closely with the Health!nsite editorial board to establish Health!nsite's credibility and relevance and to increase the number of Australians accessing the site. Over the year, the number of users rose steadily to an average of over 1,000 unique users per day in June 2001.
The major focus of 2000-01 was increasing the amount of quality health information that could be accessed through Health!nsite. At launch Healthinsite provided well referenced access to over 3,000 pages of information
provided by partner sites that had met editorial board quality requirements. By June 2001, over 5,000 referenced information resources and many new topic areas were available to
Health!nsite users .
New topics developed this year included the 'chronic diseases and injury' topic, which was developed collaboratively with Outcome 1.
' Relates to Indicator 7.
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Consumer Focus Strategy
The Consumer Focus Strategy has promoted consumer participation in planning, delivery, monitoring and evaluation of health care services to improve their quality and safety. A range of tools and resources have been produced and made widely available to health care providers, administrators, consumers and policy makers. The publications include a practical guide on how organisations can improve
consumer participation, a resource guide on education and training for consumer participation, a review of models of reporting to consumers on health service quality and a literature review on feedback, participation and consumer diversity. The National Resource Centre for Consumer Participation in Health has played a key role, not only in distributing these resources, but also in providing advice and support to organisations embarking on or involved in consumer participation.
The Commonwealth chaired and supported the Consumer Focus Collaboration, a body comprising health provider organisations, Commonwealth, State and Territory health departments, health complaints commissions and private health representatives, from its establishment in 1997 to its completion in 2001. The external evaluation of the Consumer Focus Strategy (of which the Consumer Focus Collaboration was an element) considered the extent to which the strategy has strengthened the role of consumers in health service planning, delivery, monitoring and evaluation at a local, State and/or national level. The evaluation found that 'the strategy has contributed to affirming consumer participation
as a legitimate and important part of health service activity in Australia ... and best practice for enabling consumer involvement'. The Department received substantial praise for how it carried out its role in relation to the strategy.
OUTCOME"9
Twenty-two projects have been funded in the public and private sectors under the Consumer and Provider Partnerships in Health Project to demonstrate good practice in consumer participation at the local level through partnerships between health consumers and health care providers. Major themes that have been addressed include performance reporting, accreditation, feedback from specific groups, and education and training.
A major national conference sponsored by the Consumer Focus Collaboration and the Australian Council on Safety and Quality in Health Care was held in Sydney on the theme of improving health services through consumer participation. Over 300 people attended, almost half of whom were consumers along with strong representation from clinicians, administrators and policy makers. There was significant support from Commonwealth, State and Territory departments and agencies as well as specific health services to fund consumers to attend the conference.
Community Sector Support Scheme
The Department continued to provide national secretariat funds to a range of nationally representative peak community organisations through the Community Sector Support Scheme (CSSS). The scheme aims to ensure that the funded organisations focus their efforts on activities that respond to the health and aged care needs of the Australian community.
In 2000-01, 12 nationally representative peak community organisations received funding under the scheme. In consultation with relevant program areas and the CSSS Secretariat, the performance of each organisation and its relevance to the Government's priorities was reviewed against their 2000-01 Individual Outputs and Performance Measures document.
Most organisations were judged to have been a valuable source of advice to the Department and
to have met the specific priority targets satisfactorily. Where this was not the case, contributing factors were discussed in detail and measures were introduced to address any concerns. Feedback from the community sector and from within the Department indicates that this process continues to be valuable and well received.
Promoting research to form the basis of
best practice
The strategic importance of research in forming the basis of policy and best practice in health services was recognised in the work undertaken by the Health and Medical Research Strategic Review 1999 (the Wills Report). Implementation
of the recommendations of that report is advancing the government's health and research agenda in partnership with the National Health and Medical Research Council, through the Department of Health and Aged Care Research and Development Committee and in cooperation with States and Territories.
Research and development database
Establishment of a database is in-train to provide information on research commissioned by the Department. The database will identify instances of the same or similar research and build on this work and /or avoid duplication. It will also allow the sharing of information to guide the priority setting process for future research and provide a pointer to the findings of completed research to enable the Department to improve its evidence based health and aged care policy advice.
Pilot Collaborative Research Program
Active liaison has been undertaken with States and Territories through the States/Common wealth Research Issues Forum to develop priorities for a pilot collaborative research program.
The program promotes a mechanism to instigate, coordinate and fund research addressing priorities determined by health services by providing funds for targeted research
200
HEALTH INVESTMENT
which aims to achieve better health through improved systems of care.
Th e program is being conducted under the auspices of the Australian Health Ministers' Advisory Council (AHMAC) and is an important outcome from the Health and Medical Research Strategic Review. Following extensive consultations, agreement was reached on a set of four priority themes for which expressions of interest have been called from the research co mmunity. The Office of the National Health and Medical Research Council (ONHMRC) will receive and rank expressions of interest before referring shortlist proposals to the SCRIP.
The Australian Health Ministers' Council agreed to a pilot program comprising $2.5 million to be matched by the States and Territories. If this pil ot round of collaborative funding is successful there will be opportunity in the future to expand the program and include other priority themes under the program.
The priority themes for the collaborative funding program are as follows.
Health services
⢠Changes in volume and nature of emergency presentations to hospitals.
Health economics
⢠Cost-effectiveness of health care interventions.
Health of individuals
⢠Evaluation of health promotion activities: how best to understand and influence self-care choices for improved health outcomes; and
⢠improved service delivery systems for rural and remote communities.
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National Health and Medical Research
Council and its office
The NHMRC has three primary programs -health advice, research and ethics. These are managed through the four principal committees - the Health Advisory Committee, the Strategic
Research Development Committee, the Research Committee and the Australian Health Ethics Committee - and their working parties.
Health Advisory Committeeâ¢
The Health Advisory Committee's primary role is to translate the findings of research into policy and practice and to advise the community on health and health issues.
This year's development of guidelines for the appropriate use of red blood cells and the Framework for Management of Drinking Water demonstrates the NHMRC's collaborative approach in developing public health and clinical practice guidelines. Partnerships have been established with several organisations to encourage a comprehensive and strategic approach to the development and implementation of guidelines, while maximising effectiveness and eliminating duplication of effort.
Research Committee
The primary role of the Research Committee is to develop and support an effective Australian health and medical research sector built on high
impact research, a high calibre workforce and infrastructure; and to fund research that will provide quality knowledge to underpin the health and welfare of the Australian people.
Major initiatives have included the introduction of a new program grants scheme which provides longer term, more flexible support to teams of researchers; and the finalisation of the policy for transition of the former block-funded institutes into the competitive grants scheme. These initiatives give effect to recommendations from the
' Relates to Indicator 3.
OOTCOTVIE 9
Wills Report relating to a stronger and more competitive Australian research and medical sector.
In 2000 a total of 2,091 new and continuing grants were serviced, compared with 1,992 that were administered during 1999.
The new project grants that received funding cover a diverse range of research such as infection and asthma; measuring anxiety and depression in children; chronic fatigue syndrome; health inequalities; understanding how connections in the brain develop; fighting obesity; inherited nerve disease; malformations of the head; pain relief; gastric reflux; malaria; bipolar disorder and the growth of normal and cancerous cells.
Strategic Research Development
Committee (SRDC) 5
The primary objective of SRDC is to develop strategic research capability in areas where the research effort is not commensurate with the magnitude of its importance to health care in Australia.
The SRDC has initiated a large number of new research program areas in the past year. Both these and the continuing programs have placed the SRDC in a position to maintain and further develop links made with stakeholders during its consultation process in late 1999. Workshops and forums have included:
⢠a workshop for new palliative care research ers in February 2001;
⢠site visits to researchers funded under the Centres of Clinical Excellence in Hospital Based Research Program as part of the program evaluation in March 2001;
⢠an Indigenous health workshop to tease out research areas for Indigenous health, and how SRDC's committee, who oversee the Research Agenda Working Group, could best stimulate and encourage research;
' Relates to Indicator 2.
⢠evidence-based Clinical Practice Research Program Forum in April 2001;
⢠two-day oral health research workshop in Adelaide in April 2001; and
⢠preparation for a joint workshop with Outcome 1 regarding the dimensions of chronic diseases (to be held in July 2001).
In addition, a large number of grants have been processed from initial expressions of interest to funding the successful full applications. New grants were funded in the following research program areas in the past year:
⢠National Illicit Drug Strategy (second round);
⢠translational grants in injury;
⢠health and economics;
⢠Indigenous health - diabetes; and
⢠electromagnetic energy (second round).
All strategic research funded by the SRDC is in areas identified in the consultative priority process conducted at the end of the last triennium.
The Australian Health Ethics Committee
(AHEC) 6
The primary role of AHEC is to provide high quality ethical advice with respect to health research and health care.
In 2000-01 the newly appointed Australian Health Ethics Committee (AHEC) prioritised support for Human Research Ethics Committees (HRECs). In this way AHEC intends to oversee a program of training leading to consistent and high quality ethical review of health and medical research. An issue of major community concern highlighted for attention was the ethical conduct of clinical trials.
AHEC developed and implemented a national series of workshops to enhance the environment for the ethical and efficient
' Relates to In dicator 4
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HEALTH INVESTMENT
conduct of clinical trials in Australia. Directed at members of HRECs and researchers, the workshops were held in every capital city commencing on 22 June 2001 to 19 July 2001. The workshop program addressed changes to
the Th erapeutic Goods Act 1989 and the responsibilities of human research ethics committees and researchers under that legislation as well as their responsibilities to comply with the National statement on ethical conduct in research involving humans (1999).
At the end of each financial year, HREC compliance is measured against the NHMRC's National Statement on Ethical Conduct in Research Involving Humans (1999) and Guidelines Under Section 95 of the Privacy Act 1988 (2000). The report provided to NHMRC in October 2000 was for the period 1 July 1999 to 30 June 2000.
During that year, 216 HRECs were registered with the Australian Health Ethics Committee.
Of these, four were outside the scope of the compliance assessment because they did not assess research proposals. However, all of the remaining 212 HRECs (i.e. 100 per cent), were assessed as being in compliance with the above mentioned NHMRC guidelines.
Coordination of national health priority
areas to achieve health gains7
The National Health Priority Areas (NHPA) Initiative focussed on cardiovascular disease, cancer, mental health, injury, diabetes and asthma which together represent 70 per cent of the burden of disease and cost to health systems. Figure 9.1 below shows the contribution of national health priority areas diseases and conditions to the overall burden of disease.
The National Health Priority Action Council (NHPAC) was established as a sub-committee of Australian Health Ministers' Advisory Council
Figure 9.1. Contribution of NHPAs to total burden of disease and injury in Australia - 1996
Cardiovascular disease
Cancer
Mental health
Injury
Diabetes mellitus
Asthma
All other causes
0 100 200 300 400 500
Disability-adjusted life years (, 000)
Source : AIHW:Mathers et a!, 1999, The burden of disease and injury in Australia (p.81)
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⢠Years of life lost
⢠Years of life lost due to disability
600 700 800
OOICOIVYt9
(AHMAC) in June 2000, and comprises representatives from the Commonwealth, each of the States and Territories, a representative of Indigenous issues and a representative of consumer issues.
The role for the NHPAC is to identify, advocate and facilitate actions and strategies both within and across national health priorities. The NHPAC has clarified its core principles which will underpin its work including:
⢠translating the evidence into policy and practice;
â¢
â¢
â¢
focusing on outcomes for disadvantaged groups (Aboriginal and Torres Strait Islander people, socio-economically disadvantaged, etc);
linking cross priority issues (ie common risk factors and co-morbidities - and especially mental health as a co-morbidity of other NHPAs);
involving consumers and clinicians, and incorporating a public health perspective;
⢠measuring health sector performance and outcomes; and
⢠working in partnership with others.
The NHPAC has overseen the establishment of expert advisory groups that will advise on best practice in clinical management and consumer and organisational issues.
Asthma
The National Asthma Action Plan was released in February 2001 and provides a focus for targeted national asthma management activity to 2002.
The National Asthma Reference Group was established in 2000 to provide advice on the implementation of initiatives designed to improve asthma health outcomes and asthma awareness, and on other specific activities identified by the Reference Group.
' Relates to Indicator 9.
The 2001-02 Federal Budget provides $48.4 million over four years to support GPs to better manage asthma using the evidence-based 3+ Visit Plan.
Diabetes
The Australian Diabetes, Obesity and Lifestyle Study concluded in December 2000 and has been an important element of the Commonwealth Government's actions under the National Diabetes Strategy 2000-04.
The main objectives of the Study included estimating the prevalence of diabetes and other forms of abnormal glucose tolerance in the Australian community as well as estimating the prevalence of related conditions of the metabolic syndrome, including obesity, hypertension, and lipid profile abnormalities.
The 2001-02 Federal Budget provides $43.4 million over four years to improve prevention, provide earlier diagnosis and improve management of people with diabetes through general practice.
Cardiovascular health and stroke
The Commonwealth continues to fund the National Centre for Monitoring Cardiovascular Disease located at the AIHW. Data collected by the Centre shows that there has been a substantial decline in heart, stroke and vascular disease mortality in Australia over recent decades. This decline is partly due to improved survival fo llowing cardiovascular events and partly due to falls in the rate at which people get the disease, owing to improvement in and better management of the associated risk factors.
Cancer
In 2001 the Cancer Strategies Group released for public consultation a strategy document Priorities for Action in Cancer Control 2001-03 to provide a framework for coordinated action in cancer control.
204
HEALTH INVESTMENT
Table 9.2: Deaths from cardiovascular diseases, 1998
Males Females
Annual" Annualb
Causes of death Number Rate' rate of change Number Rate' rate of changeb
(1998) (1998) (1998) (1998) (1998) (1998)
All cardiovascular disease 24,746 284.7 -3.9 26,051 188.0 -3.7
Coronary heart disease 15,024 171.3 -4.3 12,801 93.3 -4.1
Stroke 4,812 56.4 -3.4 7,170 50.9 -3 .6
Heart failure 988 12.0 -4 .3 1,567 10.3 -4.4
Peripheral vascular disease 1,717 13.5 -2.9 916 6.8 -1.2
Hypertensive disease 410 4.7 -3.2 730 5.2 -2.8
Rheumatic fever and 87 1.0 -5 .2 171 1.5 -4.8
rheumatic heart disease
All causes of death 67,073 759.9 -2.3 60,129 470.2 -1.9
Source: AIHW Nati onal Mortality Database. (a) Age-standardised rate per 100,000 population (b) Annual change in the age-standardised death ra te over the period 1987-98.
The Commonwealth continues to fund the National Cancer Control Initiative (NCCI) which has provided expert advice on all issues relating to cancer control. The NCCI also manages a range of discrete projects to establish best practice across the continuum of care for cancer, including prevention, early detection, curative treatment,
psychosocial support and palliative care.
The Commonwealth also funds the National Breast Cancer Centre (NBCC) which works in partnership with women, health professionals, cancer organisations and governments to reduce mortality from breast cancer and to increase the well being of women who are diagnosed with the disease.
Both NCCI and NBCC have produced a wealth of advice, guidelines, research initiatives and management protocols to improve cancer control.
As part of the Strengthening Support for Women with Breast Cancer Initiative, all
205
jurisdictions signed contracts with the Commonwealth to provide support, information and services for women diagnosed with breast cancer, with a particular focus on women living in rural and regional areas.
Information management in the health sector8
National Health Online Su mmit
The National Health Online Summit, held in August 2000, built on the themes introduced in Health Online: a Health Information Action Plan for Australia - the national strategy for information management and the use of online technologies within the health sector. The Summit provided participants with a
comprehensive picture of developments in information technology across the health sector as well as a report card on progress in relation to Health Online themes such as electronic health
' Relates to Indicator 10.
OUTCOME 9
records, telehealth, and standards development. The outcomes of the summit have informed the development of the second edition of Health Online. Most importantly, the summit reaffirmed stakeholder commitment and agreement to the Health Online agenda and overall direction. The Proceedings from the National Health Online Summit, Adelaide, 3-4 August 2000 were published in February 2001.
Health Connect
In July 2000, Australian Health Ministers endorsed the report of the National Electronic Records Taskforce which recommended the development of a health information network for Australia - HealthConnect. HealthConnect has the potential to be an Australia-wide network that would provide the means for safe health information exchange online - with the permission of the person receiving the care. The HealthConnect concept aims to improve the delivery of Australian health care, achieve better quality of care and consumer satisfaction, and promote better health for all Australians. Health Ministers have committed to undertaking two years' research and development work on HealthConnect. Overseen by a joint Commonwealth/State/Territory program office, this initial two year phase will test out different models for delivering HealthConnect as well as developing essential information management/information technology standards needed to underpin the safe and secure electronic transfer of health information across the health system. During this phase, processes will be put in place to ensure that consumers' and providers' views are taken on board.
Australian Health Ministers' Advisory
Council Privacy Working Group
The Australian Health Ministers' Advisory Council (AHMAC) Privacy Working Group was established by Health Ministers in July 2000 to develop a robust national health privacy framework in the context of emerging e-health
initiatives. A key component of this work is the development of a national health privacy code to achieve national consistency in health information privacy protection across the public and private sectors.
National Health Information Management
Advisory Council sub-committees
Work is underway to progress national plans for key priority areas within the Health Online framework through a number of key sub committees established under the National Health Information Management Advisory Council - namely standards, supply chain reform and telehealth. The National Health Information Standards Advisory Committee (NHISAC) is responsible for overseeing the development, coordination and implementation of national health information standards and advising Health Ministers on priorities for national adoption of health information standards. The National Health Supply Chain Reform Taskforce is developing the National Action Plan for Introducing E-Commerce in the Hospital Supply Chain as a blueprint for action. A draft National Telehealth Plan for Australia and New Zealand has been developed by the Australian New Zealand Telehealth Committee.
Improving information management and
information technology
The Department has undertaken a number of projects to improve the quality and accessibility of information for managing Departmental programs and for developing the research and analytical capacity of the Department. The major projects included enhanced Departmental information systems (electorate profiles) and collaborative arrangements with external agencies for program data collection (with the AIHW) and health-related research services (with the National Centre for Social and Economic Modelling (NATSEM), HIC, Commonwealth and State government agencies and tertiary institutions).
206
HEALTH INVESTMENT
Electorate Profiles publication
The processing system for producing Electorate Profiles information was successfully redeveloped from being a mainframe computer application system to a server-based system. This has simplified many of the processing steps
and allowed the use of improved methods for creating the publication. As a result of this, an electronic version of the publication is now produced and is available to the public from the Department's internet site www.health.gov.au/pubs/eps/index.htm
The most important aspect of the redevelopment is that address information collected for the database is now geocoded to a latitude/longitude reference point. This allows much more functionality in the uses that can be made of the data, including spatial analysis for a range of policy development and program administration purposes, the creation of maps and aggregation to various geographic boundaries.
The electorate profiles publication includes information on several programs that are now administered by the Department of Family and Community Services. In 2000-01, this arrangement was formalised and an inter-agency agreement was signed for the exchange of information between the two agencies. Future electorate profiles will be released as a joint publication of the two agencies, and will provide a broader range of program information.
Bilateral partnership with AIHW for information and statistical services
The Department and the Australian Institute of Health and Welfare (AIHW), as part of the Health and Aged Care portfolio, are committed to developing information sources, skills and frameworks conducive to developing and delivering world class health and aged care policies and services. The revised Memorandum of Understanding (MoU) with AIHW has
207
strengthened the working partnership between the two agencies and has provided bilateral administrative arrangements that support information and statistical services on public health, health care funding and aged care for the period 1 October 2000 to 30 June 2005. The MoU framework ensures that a collaborative approach will be used to develop complementary health information work programs; information and data will be shared for work in the national interest; and cooperation between the States and Territories, the Commonwealth and other agencies will be encouraged and fostered .
Research in health care
The Commonwealth has always placed emphasis on research into health care. In the 20s it established the Federal Health Council which was expanded to become the National Health and Medical Research Council (NHMRC) in 1937. The NHMRC remains the main funding body for health and medical research as well as the principal independent advisory body on matters of public health for the three tiers of government (local, State and Commonwealth),
health professionals and the wider community.
Investment in medical research was rewarded in the 60s, with two Australians winning the Nobel Prize for Medicine: Macfarlane Burnet in 1960 for his work on immunology, and John Carew Eccles in 1963 for his pioneering research into the chemical means by which signals to the brain are transmitted by nerve cells.
In 1996, another Australian immunologist, Peter Doherty, won the Nobel Prize for his explanation of how T-cells are recognised within the cellular immune system. Medical research gained
renewed priority in the late 1990s, culminating in a doubling of NHMRC funding in 1999.
OUTCOME 9
Multilateral agreement with NATSEM for data analysis, research and microsimulation modelling
The Department, in conjunction with the Department of Family and Community Services and the Department of Education, Training and Youth Affairs (DETYA), has a joint agreement with the National Centre for Social and Economic Modelling (NATSEM) for microsimulation modelling and micro-data analysis.
Dynamic microsimulation models have the capacity to generate highly detailed projections in health and aged care service demand and such quantitative information is utilised by policy makers for evidence-based outcomes.
Data and research agreements with HIC, other government agencies and tertiary institutions
Three projects have been negotiated involving other single and multi-agency collaboration:
⢠the Department has an ongoing arrangement for joint research and sharing of expertise with the Western Australian Health Department. This involves the exchange of Commonwealth
and State controlled data. This formal cooperation commenced in 1997 with the initial exchange of 1994-96 data, and has now expanded to exchange of data for the years 1997-99;
⢠a new cooperative agreement was reached in 2000 between the Department and the HIC, Department of Veterans' Affairs and Queensland Health to conduct joint research based on medical records datasets combined from Commonwealth and State systems; and
⢠a new agreement was made between the Department and the AIHW, the HIC, the Western Australian Health Department and the University of Western Australia to conduct research into diabetes, spanning ten years of data held by each party.
Negotiations have also commenced with the Department of Immigration and Multicultural Affairs, the Western Australian Health Department and the University of WA to conduct research into deep vein thrombosis and air travel. Negotiations are also proceeding with CSIRO to engage their expertise in the analysis of large datasets.
208
Mr Robert Wells, First Assistant Secretary, Health Industry and Investment Division and Ms Lynelle Briggs, First Assistant Secretary, Health Services Division signing the first contract between a scholar and
the Commonwealth for the Medical Rural Bonded Scholarship Scheme.
HEALTH INVESTMENT
Performance indicators
Indicator 1: NHMRC-funded health and medical research initiatives have internationally competitive research outputs.
Indicator 2: Targeted research that is responsive to health systems needs.
Indicator 3: Health advice documents submitted to NHMRC are approved.
Indicator 4: Level of compliance in Australian research organisations with NHMRC ethical standards and guidelines for health and medical research.
Indicator 5: Adjustment to the distribution of the medical workforce in Australia.
Target: NHMRC-funded research has citation rates that are at or above the international average citation rate in quality journals.
Information source/reporting frequency: Bibliometric analysis - every three years.
Target: 90 per cent of strategic research funding is in areas identified as priority research by Strategic Research Development Committee processes.
Information source/reporting frequency: Annual report of the Strategic Research Development Committee (in the NHMRC Annual Report).
Target: All documents submitted by the Department to NHMRC for approval meet specified criteria, including that they are evidence based, that legislative consultation requirements have been met and that they are appropriately targeted to their intended audience.
Information source/reporting frequency: Minutes of Council meetings to which documents are submitted for approval.
Target: 100 per cent compliance with the ethical standards and guidelines.
Information source/reporting frequency: Annual compliance reports from Human Research Ethics Committees.
Target: All doctors subject to provider number restrictions are working in districts of workforce shortage.
Information source/reporting frequency: Departmental workforce statistics and Medicare provider file.
209
Indicator 6: The number of specialist training placements which proVide experience in rural medicine.
Indicator 7: a) Availability of consumer health information, and b) The extent to which healt.h serVice planning, delivery, monitoring and evaluation processes incorporate opportuaities for consumer participation.
Indicator 8: Approaches to identify how to better use information, ensure ·· competence and the
appropriate environments to propwte quality . .
9:
·Developments in collaboration, data collection, monitoring . and analysis to identify "and support efforts to
prevent and ameliorate diseases or conditions in the National Health .. Priority Areas.
OUTCOME 9
Target: A 10 per cent increase in the number of specialist training placements in rural areas.
Information source/reporting frequency: AMWAC data, State and Territory and medical college data.
Target: a) Greater than 4000 information items available through Healthinsite. b) Implementation of agreed priorities of the Consumer Focus Collaboration, including better information for consumers and structures for effective consumer involvement.
Information source/reporting frequency: Healthinsite, Consumer Focus Collaboration, Strategic plan and Resource Centre for Consumer Participation reports.
Target: a) Identification of steps to improve the quality and safety of clinical practice and health service delivery, including the application of evidence based medicine through the Australian Council for Safety and Quality in Health Care and the National Institute of Clinical Studies. b) Plan of action to be agreed by the Australian Council for Safety and Quality in Health Care by December 2000. c) Establishment of the National Institute of Clinical Studies by September 2000.
Information source/reporting frequency: National and local project reports.
Target: a) Establish prevalence rates for diabetes by June 2001. b) Establish a monitoring system for asthma by March 2001. c) Pilot new clinical management protocols in asthma and diabetes by February 2001.
Information source/reporting frequency: Australian Institute of Health and Welfare annual and regular reports; State and Territory data registries; hospital separations; and NHPA reports .
210
Indicator 10: Agreement among key stakeholders in the health sector on a national approach to overall direction and key strategic issues in information management and the use of information technologies.
Indicator 11: Quality leadership provided by the Department of Health and Aged Care for the health information management agenda.
HEALTH INVESTMENT
Target: Agreement about the updated Health Online agenda, with a strategy for privacy protection, electronic health records and standards development by May 2001.
Information source/reporting frequency: Reports to be published by the National Health Information Management Advisory Council.
Target: High level of stakeholder satisfaction with the leadership shown by the Department.
Information source/reporting frequency: Informal surveys of stakeholders and feedback from formal discussions or other papers and legislation.
211
OUTCOME 9
OUTCOME 9 : FINANCIAL RESOURCES SUMMARY
I (A) (B)
Budget Actual Variation
Estimate Expenses (ColumnB
2000/2001 2000/2001 minus
$'000 $'000 ColumnA)
Administered Expenses
Administered Item 1: Research Grants Appropriation Bill 1/3 365,197 308,926
Appropriation Bill 2/4
365,197 308,926
Administered Item 2: Workforce Appropriation Bill 1/3 21,555 19,652
Appropriation Bill 2/4
21,555 19,65 2
Administered Item 3: National Health P1iorities & Quality Appropri ati on Bill 1/3 22,099 16,767
Appropri at ion Bill 2/4
22,099 16,767
Administered Item 4: Information management I information Technology Appropriation B ill 1/3 4,742 1,518
A ro riation Bill 2/4
4,742 1,518
Administered Item 5: Development Grant Appropriation Bill 113 Appropriation Bill 2/4 10,000 10,000
10000 10000
Total Administered Exeenses 423,593 356,863
Departmental Appropriations
Output Group I - Services to the Minister & Parliament 4,766 4,859
Output Group 2 - National Leadership 2,896 3,237
Output Group 3 - Infonnati on 5,733 5,729
Output Group 4 - Program Management 9,779 9,772
Output Group 5 - Regulatory Activity 385 385
Output Group 6 - Direct Delivery of Services
Total price of departmental outputs 23 ,559 23 ,982
(!otal re1â¢em1e (!om Government & other sources!
Total revenue from Government (appropriations) 23,524 23,436
contributing to price of departmental outputs Total revenue from other services 35 546
Total price of departmental outputs 23,559 23 ,982
(!otal revenue Government & other sources!
Total price of output⢠for Outcome 9 23,560 23,982
(!.otal revenue {tom Government &/};om other sources'
Total estimated resourcing for Outcome 9 447,153 380,845
(!.otal e,nce of oute,uts & admin exe,enses'
I TI1e Budget Estimate 2000/2001 includes the appropriations as per the 2000-2001 Portfolio Budget Statements (PBS), 2000-2001 Portfolio Additional Es tim ates and Advances to tl1e Finance Minister. This amount may differ to the revised estimates for 200012001 published h⢠tl1e 200 I/2002 PBS. Such differences can arise from updated estimates and rephasings.
2 Budget prior to additional estimates . The number of output groups has red uced from 5 in 2000-200 1 to 2 in 2001-2002 . It is not possible to show direct comparatives
212
(56,271)
(56,2712
(1,903)
(1,903 2
(5,332)
(5,3322
(3 ,224)
(3,2242
(66,7302
93 341 (4) (7)
423
(88)
511
423
422
(66,308)
2
Budget 2001/2002 $'000
379,470
379,470
23,568
23,568
26,362
26,362
2,327
2,327
10,000
10000
441,727
14,3 27
16,164
30,491
30,369
122
30,491
30,491
472,218
Part 3: Financial statements
..
Two Aboriginal medical service staff members discussing pharmaceuticals, 1980s.
Commemorating 80 years of providing Commonwealth health services to the Australian community.
Department of Health and Aged Care
Independent Audit Report
Statement by the Departmental Secretary
Statement of Financial Performance
Statement of Financial Position
Statement of Cash Flows
Schedule of Commitments
Schedule of Contingencies
Schedule of Administered Revenues and Expenses
Schedule of Administered Assets and Liabilities
Administered Cash Flows
Schedule of Administered Commitments
Schedule of Administered Contingencies
Notes to and forming part of the Financial Statements
216
219
220
221
222
223
224
225
226
227
228
229
230
Australian National
Audit Office
INDEPENDENT AUDIT REPORT
To the Minister for Health and Aged Care
Scope
I have audited the financial statements of the Department of Health and Aged Care for the year ended 30 June 2001. The financial statements comprise:
⢠A statement by the Departmental Secretary; ⢠Agency Operating Statement, Balance Sheet, Statement of Cashflows, Schedule of Commitments and Schedule of Contingencies; ⢠Schedules of Administered Revenues and Expenses, Assets and Liabilities, Cashflows,
Contingencies and Commitments; and ⢠Notes to and forming part of the Financial Statements.
The Department's Secretary is responsible for the preparation and presentation of the financial statements and the information they contain. I have conducted an independent audit of the financial statements in order to express an opinion on them to you .
The audit has been conducted in accordance with the Australian National Audit Office Auditing Standards, which incorporate the Australian Auditing Standards, to provide reasonable assurance as to whether the financial statements are free of material misstatement. Audit procedures included examination, on a test basis, of evidence supporting the amounts and other disclosures in the financial statements, and the evaluation of accounting policies and significant accounting estimates. These procedures have been undertaken to form an opinion as to whether, in all material respects, the financial statements are presented fairly in accordance with Australian Accounting Standards, other mandatory professional reporting requirements and statutory requirements in Australia so as to present a view of the Department which is consistent with my understanding of its financial position, its operations and its cash flows .
The audit opinion expressed in this report has been formed on the above basis.
GPO Box 707 CANBERRA ACT 260 1 Centenary House 19 National Circuit BARTON ACT Phone (02) 6203 7300 Fax (02) 6203 7777
Australian National
Audit Office
Audit Opinion
In my opinion,
(i) the financial statements have been prepared in accordance with Schedule 1 of the Financial Management and Accountability (Financial Statements 2000-2001) Orders;
(ii) the financial statements give a true and fair view, in accordance with applicable Accounting Standards, other mandatory professional reporting requirements and Schedule 1 of the Financial Management and Accountability (Financial Statements 2000-2001) Orders, of:
⢠the financial position of the Department of the Health and Aged Care as at 30 June 2001 and the results of its operations and its cash flows for the year then ended; and
⢠the Commonwealth assets and liabilities as at 30 June 2001 and the revenue, expenses and cash flows of the Commonwealth for the year then ended, which have been administered by the Department.
Australian National Audit Office
ian McPhee A/g Auditor-General 5 September 2001
217
GPO Box 707 CA NBERRA ACT 2601 Centenary House 19 National Circuit BARTON ACT Phone (02) 6203 7300 Fa x (02) 6203 7777
Statement by the Departmental Secretary
In my opinion, the attached financial statements give a true and fair view of the matters required by Schedule I of the Finance Minister' s Orders made under section 63 of the Financial Management and Accountability Act 1997.
AS Podger Secretary Department of Health and Aged Care
) r August 2001
219
DEPARTMENT OF HEALTH AND AGED CARE STATEMENT OF FINANCIAL PERFORMANCE for the period ended 30 June 2001
Revenues from ordinary activities Revenues from government Sales of goods and services Interest Proceeds from disposal of assets Other Total revenues from ordinary activities
Expenses from ordinary activities Employees Suppliers Depreciation and amortisation Write down of assets Disposals of assets
Total expenses from ordinary activities
Borrowing costs expense
Net operating surplus (deficit) from ordinary activities
Restructuring
Net surplus (deficit) attributable to the Commonwealth
Total changes in equity other than those resulting from transactions with owners as owners
3
4
6
7
8
9
11
664,794 48,894 2,010 394
2,113 718,205
228,886 483,985 17,340 4,760
331
735,302
438
(17,535)
376
(17,159)
(17,159)
The accompanying notes form an integral part of these fmancial statements
619,803 51,053 1,285 773
6n,914
206,978 437,026 36,753 5,759
3,890 690,406
29
(17,521)
(1 7, 521)
(17,521)
DEPARTMENT OF HEAL1H AND AGED CARE STATEMENT OF FINANCIALPOSffiON as at 30June 2001
ASSETS
Financial assets Cash Receivables Total financial assets
Non-financial assets Land and buildings Infrastructure, plant and equipment Inventories Intangibles Prepayments Total non-financial assets
Total assets
LIABILITIES Interest bearing liabilities Loans Total debt
Provisions Employees Total provisions
Payables Suppliers Unearned income Otber Total payables
Total liabilities
EQUITY Capital ReseiVes Accumulated surplus (deficit) Total equity
Current liabilities Non current liabilities Current assets Non current assets
12 42,042
13 14,163
56,205
14 196
14 22,982
16 606
17 43,060
2,195 69,039
125,244
18 10,800
10,800
19 66,967
66,967
20 36,827
10,736
21 3,127
50,690
128,457
5,914 374 (9,501)
22 (3,213)
62,546 65,911 59,007 66,237
The accompanying notes form an integral part of these fmancial statements
16,880 27,194 44,074
522
21,881 1,363 41,199 1,247 66,212
110,286
4,000 4,000
60,341 60,341
18,386 9,063 3,728 31 ,1 77
95,518
4,073 374 10,321 14,768
42,8 53 52,665 45 ,253 65,033
DEPARTMENT OF HEALTH AND AGED CARE STATEMENT OF CASH FLOWS for the period ended 30June 2001
OPERATING ACTIVITIES
Cash received Appropriations for outputs Sales of goods and services Interest Other GSTrefunds Total cash received
Cash used Employees Suppliers Borrowing costs Total cash used
Net cash from operating activities
INVESTING ACTIVITIES
Cash received Proceeds from sales of property, plant and equipment Total cash received
Cash used Purchase of property, plant and equipment Purchase of intangibles Purchase of inventory Total cash used
Net cash from (used by) investing activities
FINANCING ACTIVITIES
Cash received Proceeds from equity injection Proceeds from loan Total cash received
Cash used Capital use paid Total cash used
Net cash from financing activities
Net increase!( decrease) in cash held
Cash at beginning of reporting period
Cash at end of reporting period
665,970 57,768 2,032 1,961 11,224 738,955
221,826 488,759 438 711,023
23 27,932
9,447 9,447
6,993 11,511
18,504
(9,057)
1,841 6,800 8,641
2,354 2,354
6,287
25,162
16,880
12 42,042
The accompanying notes form an integral part of these fmancial statements
222
609,412 43,962 2,094
655,468
203,757 431,975
635,732
19,736
773 773
12,504 15,524 620 28,648
(27,875)
4,073 4,000 8,073
86 1 861
7,212
(927)
17,807
16,880
DEPARTMENT OF HEALTH AND AGED CARE SCHEDULE OF COMMITMENTS as at 30June 2001
BY TYPE
CAPITAL COMMITMENTS Land and buildings Infrastructure. plant and equipment Investments Total capital commitments
Other commitments Operating leases 1
Other 2
Total other commitments
Total commitments payable
COMMITMENTS RECEIVABLE GST Total commitments receivable
Net commitments
BY MATURITY All net commitments One year or less From one to five years
Over five years
Net commitments
BY MATURITY Operating Lease Commitments One year or less From one to five years
Over five years
Net commitments
2,298
2,298
335,426 770,578 1,106,004
1,108,302
22,700 22,700
1,085,602
426,245 568,779 90,578
1,085,602
58,520 183,238 93,668
335,426
NB: Commitments are GST inclusive where relevant.
1 Operating leases included are effectively non-cancellable and comprise :
Nature o Lease
(a) Leases for office accommodation
(b) Leases for motor vehicles
(c) A lease in relation to computer equipment held as at 30 June 1999 which was sold and leased back on I July 1999
Lease payments are either fixed or subject to market review every two years. Where offered, lease renewal options range from 3 to 5 years
Lease payments fixed for term. There are no lease renewal or purchase options. Penalties exist for early return of vehicle or excessive kilometres travelled.
The lessor provides all computer equipment & software designated as necessary in the supply contract for 5 years with a 2 plus 2 option on the same terms & conditions. The initial equipment has an average useful life of 3 years from the commencement of the contract. The Department may vary its original designated requirement, subject to giving 3 months notice, at no penalty.
2 Includes Payment for Output Pricing Agreement to HIC for 2001-02 and 2002-03.
The accompanying notes form an integral part of these financial statements
223
3,320
3,320
184,442 57,576 242,018
245,338
17,822 17,822
227,516
138,618 64,891 24,007
227,516
122,168 47,416 14,858
184,442
DEPARTMENT OFHEALTHANDAGEDCARE SCHEDULE OF CONTINGENCIES as at 30June 2001
CONTINGENT LOSSES Claims for damages/costs 1
Total contingent losses
CONTINGENT GAINS Claims for damages/costs '
Total contingent gains
Net contingencies
5,007
5,007
215
215
4,792
1 The amount represents an estimate of the Department's liability. The Department is defending the claims.
2 The amount represents an estimate that the Department expects to receive, although the cases are continuing.
Remote contingencies are disclosed in Note 46
The accompanying notes form an integral part of these financial statements
8,277
8,277
106
106
8,171
DEPARTMENT OF HEALTH AND AGED CARE SCHEDULE OF ADMINISTERED REVENUES AND EXPENSES for the period ended 30June 2001
The accompanying notes fonn an integral part of these financial statements
225
DEPARTMENT OF HEALTH AND AGED CARE SCHEDULE OF ADMINISTERED ASSETS AND LIABILITIES as at30June 2001
The accompanying notes form an integral part of these financial statements
DEPARlMENT OF HEALTH AND AGED CARE ADMINISTERED CASH FWWS for the period ended 30June 200/
The accompanying notes form an integral part of these financial statements
227
DEPARTMENT OF HEALTH AND AGED CARE SCHEDULE OF ADMINISTERED COMMITMENTS as at 30June 2001
The accompanying notes fonn an integral part of these financial statements
DEPARTMENT OF HEALTH AND AGED CARE SCHEDULE OF ADMINISTERED CONTINGENCIES as at 30June 2001
SCHEDULE OF UNQUANTIFIABLE ADMINISTERED CONTINGENCIES as at 30June 2001
The accompanying notes form an integral part of these financial statements
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANC IAL STATEMENTS for the period ended 30June 2001
Note 1
2
3
4
5
6
8
9
10 11
12 13 14 15 16 17 18 19 20 21
22 23
24 25 26 27 28 29 30 31 32 33 34
35 36 37 38 39 40 41
42 43 44 45 46 47
Description Summary of Significant Accounting Policies Events Occurring after Balance Date Revenues from Government Sales of Goods and Services Proceeds and Expense from Sales of Assets Employee Expenses Suppliers Expenses Depreciation and Amortisation Expenses Write down of Assets Changes to Accounting Policy Restructuring Cash Receivables Non-Financial Assets Analysis of Property, Plant, Equipment and Intangibles
Inventories Intangible Assets Loans Employee Provisions Suppliers Liabilities other Debt Equity Cash Flow Reconciliation Administered Correction of Fundamental Error Administered Revenues Administered - Net Revenues from Extraordinary Items Administered Expenses Administered Assets Administered Investments Administered Inventories Administered Liabilities Administered reconcil iation of cash Administered Equity Financial Instruments Administered Financial Instruments Annual Appropriations (Administered and Departmental) Special Appropriations Receipts and Expenditure of Special Accounts Reporting of Outcomes Major Agency Revenues and Expenses Major Administered Revenues and Expenses Executive Remuneration Services provided by the Auditor-General Agency Act of Grace Payments, Waivers, Defective Administration Scheme Average staffing Levels Remote Contingencies Administered Act of Grace Payments, Waivers
230
DEPAR1MENI OF HEAL1H AND AGED CARE NOTES TO AND FORMING PART OF 1HE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note I Summary of Significant Accounting Policies
1.1 Objectives of the Department ofHealth and Aged Care
The objective of the Department of Health and Aged Care is to become a leader in promoting, developing and funding world class health and aged care for all Australians.
The Department of Health and Aged Care ('1he Department") is structured to meet 9 outcomes:
Outcome I: Population health and safety
Outcome 2: Access to Medicare
Outcome 3: Enhanced quality of life for older Australians
Outcome 4: Quality health care
Outcome 5: Rural health care
Outcome 6: Hearing services
Outcome 7: Aboriginal and Torres Strait Islander health
Outcome 8: Choice through private health
Outcome 9: Health investment
To protect and promote the health of all Australians and minimisation of the incidence of preventable mortality, illness, injury and disability.
Access through Medicare to cost-effective medical services, medicines and acute health care for all Australians.
Support for healthy ageing for older Australians and quality and cost-effective care for frail older people and their carers.
Improved quality, integration and effectiveness of health care.
Improved health for Australians living in regional, rural and remote locations.
To reduce the consequence of hearing loss for eligible Australians and the incidence of hearing loss in the broader community.
Improved health status for Aboriginal and Torres Strait Islander peoples.
A viable private health insurance industry to improve the choice of health services for Australians.
Knowledge, information and training for developing better strategies to improve the health of Australians.
Agency activities contributing toward these outcomes are classified as either Departmental or Administered. Departmental activities involve the use of assets, liabilities, revenues and expenses controlled or incurred by the Agency in its own right. Administered activities involve the management or oversight by the Agency on behalf of the Government of items controlled or incurred by the Government.
231
DEPARTMENT OF HEAL1H AND AGED CARE NOTES TO AND FORMING PART OF 1HE FINANCIAL STATEMENTS (or the period ended 30June 2001
Departmental activities are identified under the following Outputs for each Outcome:
- ('l ,.., """ "' 'D " " " " " " ;5 § § E E E s:: 0 0 0 0 0. u u u u u u 8 Description s ;5 ;5 ;5 s s 0 0 0 0 0 0 I Services to the Minister and ./ ./ ./ ./ ./ ./ Parliament 2 National Leadership ./ ./ ./ ./ ./ ./ 3 Information ./ ./ ./ ./ ./ ./ 4 Program Management ./ ./ ./ ./ ./ ./ 5 Regulatory activity ./ ./ ./ ./ 6 Direct delivery of services ./ ./ 1.2 Basis of Accounting r-- 00 0\
" " " § E E 0 0 u u s s 0 0 0 ./ ./ ./ ./
./ ./
./ ./ ./
./ ./ ./
./ ./
./
The Department is required to prepare financial statements under Section 49 of the Financial Management and Accountability Act 1997. The financial statements are a general purpose financial report.
The fmancial statements have been prepared in accordance with:
⢠Schedule I to Orders made by the Finance Minister for the preparation of Financial Statements in relation to financial years ending on or after 30 June 2001 ; Australian Accounting Standards and Accounting Interpretations issued by Australian Accounting Standards Boards; other authoritative pronouncements of the Boards; and Consensus Views of the Urgent Issues Group.
The statements have been prepared having regard to: Statements of Accounting Concepts; and ⢠the Explanatory Notes to Schedule I, and Guidance Notes issued by the Department of Finance and Administration.
The financial statements have been prepared on an accrual basis and are in accordance with the historical cost convention, except for certain assets which, as noted, are reported at valuation. Except where stated, no allowance is made for the effect of changing prices on the results or the fmancial position.
DEPARTMENT OF HEAL1H AND AGED CARE NOTES TO AND FORMING PART OF 1HE FINANCIAL STATEMENTS (or the period ended 30June 2001
Assets and liabilities are recognised in the Agency Statement of Financial Position when and only when it is probable that future economic benefits will flow and the amounts of the assets or liabilities can be reliably measured. Assets and liabilities arising under agreements equally proportionately unperformed are however not recognised unless required by an Accounting Standard. Liabilities and assets which are unrecognised are reported in the Schedule of Commitments and the Schedule of Contingencies (other than remote contingencies, which are reported at Notes 46).
Revenues and expenses are recognised in the Agency Statement of Financial Performance when and only when the flow or consumption or loss of economic benefits has occurred and can be reliably measured.
The continued existence of the Agency in its present form, and with its present programs, is dependent on Government policy and on continuing appropriations by Parliament for the Agency's administration and programs.
1.3 Changes in Accounting Policy
The accounting policies used in the preparation of these financial statements are consistent with those used in 1999-2000.
1.4 Revenue
The revenues described in this Note are revenues relating to the core operating activities of the Department.
Revenues from Government- Agency appropriations
Appropriations for Departmental outputs are recognised as revenue to the extent that the Finance Minister is prepared to release appropriations for use (that is, the full amount ofthe appropriation passed by the Parliament less any savings offered up at Additional Estimates and not subsequently released) .
Resources Received Free o[Charge
Services received free of charge are recognised as revenue when and only when a fair value can be reliably determined and the services would have been purchased if they had not been donated. Use of those resources is recognised as an expense.
Contributions of assets at no cost of acquisition or for nominal consideration are recognised at their fair value when the asset qualifies for recognition, unless received from another government agency as a consequence of a restructuring of administrative arrangements.
233
DEPAR1MENTOFHEAL1HANDAGEDCARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Other Revenue
Revenue from the sale of goods is recognised upon the delivery of goods to customers.
Interest revenue is recognised on a proportional basis taking into account the interest rates applicable to the financial assets.
Dividend revenue is recognised when the right to receive a dividend has been established.
Revenue from disposal of non-current assets is recognised when control of the asset has passed to the buyer.
Agency revenue from the rendering of a service is recognised by reference to the stage of completion of contracts or other agreements to provide services to Commonwealth bodies. The stage of completion is determined according to the proportion that costs incurred to date bear to the estimated total costs of the transaction.
1.5 Transactions by the Government as Owner
Appropriations designated as 'Capital- equity injections' are recognised directly in equity to the extent drawn down as at the reporting date.
Net assets received under a restructuring of administrative arrangements are designated by the Finance Minister as contributions by owners and adjusted directly against equity. Net assets relinquished are designated as distributions to owners. Net assets transferred are initially recognised at the amounts at which they were recognised by the transferring agency immediately prior to the transfer.
1.6 Principles of Consolidation
In the process of reporting the Department as a single unit all intra- and inter- outcome transactions and balances have been eliminated in full.
The financial statements of the Therapeutic Goods Administration Special Account (TGA) are consolidated into the Department' s financial statements. Where accounting policies differ between the TGA and the Department, adjustments are made on consolidation to bring any dissimilar accounting policies into alignment.
Administered investments in controlled entities are not consolidated on a line-by-line basis because their consolidation is relevant only at the Whole of Government level (see Note 29).
1.7 Cash
Cash means notes and coins held and any deposits held at call with a bank or financial institution.
234
DEPARTMENT OF HEAL Til AND AGED CARE NOTES TO AND FORMING PART OF TilE FINANCIAL STATEMENTS (or the period ended 30 June 200 I
1.8 Property, Plant and Equipment
Asset Recognition Threshold
Property, plant and equipment are capitalised in the year of acquisition where their value is $2,000 or over, except for information technology equipment and leasehold improvements for which the minimum threshold values are $500 and $50,000 respectively.
Asset Revaluations
This requirement has resulted in all property, plant and equipment held by the Department as at 30 June 1999 being valued under the deprival valuation methodology. No further revaluations have been completed in 2000-01.
The Department recognises all land at its current market buying price. Property, plant and equipment, other than land, is valued at its depreciated replacement cost. Any assets which would not be replaced or are surplus to requirements are valued at net realisable value. At 30 June 2001, the Department had no assets in this situation.
Recoverable Amount Test
Schedule 1 requires the application of the recoverable amount test to Departmental non-current assets in accordance with AAS 10 Recoverable Amount ofNon-Current Assets. The carrying amounts of these non-current assets have been reviewed to determine whether they are in excess of their recoverable amounts. In assessing recoverable amounts, the relevant cash flows have been discounted to their present value.
1.9 Depreciation and Amortisation
All depreciable non-current assets are depreciated to their estimated residual values over their estimated useful lives. Depreciation and amortisation rates and methods are reviewed at each balance, and any necessary adjustments are recognised in the current reporting period
Depreciation is calculated using the straight-line method, which reflects the pattern of usage of the Department's depreciable assets.
Leasehold improvements are depreciated on a straight-line basis over the term of the lease, or the estimated useful life of the improvements, whichever is the lesser.
Depreciation and amortisation rates are reviewed at each balance date and any adjustments made as necessary. Residual values are re-estimated for a change in prices only when assets are revalued.
235
DEPARTMENT OF HEAL1H AND AGED CARE NOTES TO AND FORMING PART OF 1HE FINANCIAL STATEMENTS (or the period ended 30 June 200 I
Depreciation and amortisation rates applying to each class of depreciable assets are as follows:
Buildings Leasehold improvements Plant and equipment
2000-01 25 years Lease term 3 to 7 years
1999-00 25 years Lease term 3 to 7 years
The aggregate amount of depreciation allocated for each class of asset during the reporting period is disclosed in Note 8.
1.10 Acquisition of Assets
Assets are recorded at cost on acquisition except as stated below. The cost of acquisition includes the fair value of assets transferred in exchange and liabilities undertaken.
Assets acquired at no cost, or for nominal consideration, are initially recognised as assets and revenues at their fair value at the date of acquisition, unless acquired as a consequence of restructuring administrative arrangements. In the latter case, assets are initially recognised at the amounts at which they were recognised in the transferor agency's accounts immediately prior to the restructuring.
1.11 Intangible Assets
Intangible assets, except internally developed software, are brought to account at cost and amortised over the period that expected benefits will be received.
Internally developed software was valued using reproduction cost under the deprival method at 30 June 1999 by officers of the Department.
1.12 Employee EntiUements
Leave
The provision for employee entitlements encompasses annual leave and long service leave. No provision has been made for sick leave as all sick leave is non-vesting and the average sick leave taken in future years by employees of the Department is estimated to be less than the accrued entitlement for sick leave.
The provision for annual leave reflects the value of total annual leave entitlements of all employees at 30 June 2001 and is recognised at the nominal amount.
The non-current portion of the provision for long service leave reflects the value of the estimated future cash flows to be made in respect of all employees at 30 June 2001. In determining the present value oftl1e liability, the Department has taken into account attrition rates and pay increases resulting from promotion and inflation.
236
DEPARTMENT OF HEALTII AND AGED CARE NOTES TO AND FORMING PART OF TilE FINANCIAL STATEMENTS (or the oeriod ended 30 June 2001
Separation and redundancy
Provision is made for separation and redundancy payments in circ*mstances where the Agency has formally identified positions as excess to requirements and a reliable estimate of the amount of the payments can be determined.
1.13 Superannuation
Staff of the Department contribute to the Commonwealth Superannuation Scheme and the Public Sector Superannuation Scheme. No liability is shown in the Department's Statement of Assets and liabilities as the employer contributions fully extinguish the accruing liability which is assumed by the Commonwealth.
Employer contributions totalling $24,360,548 (1999-00 $26, 125,903) in relation to superannuation schemes have been expensed in the financial statements.
1.14 Unearned Income
Revenue is only recognised when the service is provided. Where services have yet to be rendered, deposits are recorded as liabilities and transferred to the Statement of Revenues and Expenses at the time the service is provided.
1.15 Borrowing Costs
All borrowing costs are expensed as incurred, except to the extent they are directly attributable to qualifYing assets, in which case they are capitalised. The amount capitalised in a reporting period does not exceed the amounts of costs incurred in that period.
The Department has no qualifYing assets for which funds were borrowed specifically.
1.16 Foreign Currency
Transactions denominated in a foreigu currency are converted at the exchange rate at the date of the transaction. Foreigu currency monetary assets and liabilities as at 30 June 2001 are converted by the exchange rate prevailing at 30 June 2001. Associated currency gains and losses are not material.
237
DEPAR1MENT OF HEAL TII AND AGED CARE NOTES TO AND FORMING PART OF 1HE FINANCIAL STATEMENTS for the period ended 30 June 2001
1.17 Leases
Leases of non-cWTent assets, where substantially all the risks and benefits incidental to ownership effectively remain with the lessor, are classified as operating leases. Operating lease payments are charged as expenses in the determination of the operating result on a basis which is representative of the pattern of benefits derived from the leased a< sets. The net present value of future net outlays in respect of surplus space under non-cancellable lease agreements is expensed in the period in which the space becomes surplus.
Lease incentives taking the form of 'free' leasehold improvements and rent-free periods are recognised as liabilities. These liabilities are reduced on a straight-line method by allocating lease payments between rental expenses and reduction of the liability.
1.18 Bad and Doubtful Debts
A provision is raised for any doubtful debts based on a review of all outstanding accounts as at 30 June 2001.
Bad debts are written off during the year in which they are identified
1.19 Insurance
The Department has insured for risks through the Government's insurable risk managed fund, called 'Corncover'. Workern compensation is insured through Comcare Australia.
1.20 Inventories
Inventories held for resale are valued at the lower of cost or net realisable value . Inventories not held for resale are valued at cost, unless they are no longer required, in which case they are valued at net realisable value.
1.21 Capital Usage Charge
A capital usage charge (CUC) of 12% is imposed by the Commonwealth on the net Departmental assets of the Department. The charge is adjusted to take into account asset gifts and revaluation increments during the financial year.
1.22 Financial Instruments
Accounting policies for financial instruments are stated at Note 34.
1.23 Taxation
The Department is exempt from all forms of taxation except fringe benefits tax and the goods and services tax.
1.24 Comparative Figures
Comparative figures have been adjusted to conform to changes in presentation in the financial statements where required
1.25 Rounding
Agency amounts are reported to the nearest $1,000 except in relation to: I. Act of grace payments and waivers ; 2. Remuneration of executives; and 3. Remuneration of auditors .
238
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART O F THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 2 Events Occurring after Balance Date
There have been no events occurring after balance date that impact upon these financial statements.
239
DEPARlMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
OPERATING REVENUES
Note Revenues from Government
Appropriations for outputs Resources received free of charge Total revenues from government
Note Sales of Goods and Services
Goods Services Total sales of goods and services
Note Proceeds and Expense from Sales of Assets
Non financial assets Infrastructure, plant and equipment Revenue (proceeds) from sale Expenses associated with sale Total
Land and bWldings Revenue (proceeds) from sale Expenses associated with sale Total
Total Non financial assets Total Revenue (proceeds) from sale Expenses associated with sale Total
664,236 619,197
558 606
664,794 619,803
222
48,672 51 ,053
48,894 51,053
32 773
9 (3,890)
23 (3, 117)
362
p22l 40
394 773
(3,890)
63 (3,117)
DEPARTMENT OF HEALlli AND AGED CARE NOTES TO AND FORMING PART OF THE FINA NCIAL STATEMENTS for the period ended 30 J une 2001
OPERATING EXPENSES
Note Employee Expenses
Remuneration (for services provided) Separation and redundancy Total remuneration Other employee expenses Total Employee Expenses
Note 7 Suppliers Expenses
Supply of goods and services Operating lease rentals 1
Total suppliers expenses
1
These comprise minirmun lease payments only.
Note Depredation and Amortisation Expenses
Depreciation of infrastructure, plant and equipment Amortisation of intangible assets Total depredation and amortisation expenses
220,610 1,212 221 ,822 7,064 228,886
440,029 43,956 483,985
4,414 12,926 17,340
The aggregate amoWlts of depreciation or amortisation expensed during the reporting period for each class of depreciable asset are as follows:
Buildings Leasehold Improvements 2,513
Plant and Equipment 1,897
Intangibles 12,926
Total 17,340
Note Write down of Assets
Financial assets Receivables 4,037
Non-financial assets Infrastructure, plant and equipment 109
Intangibles 614
Total write down of assets 4,760
241
173, 118 5,000 178,118 28,860 206,978
420,178 16,848 437,026
18,424 18,329 36,753
10,495 7,922 18,329 36,753
780
4,979
5,759
DEPARTMENT OF HEAL Til AND AGED CARE NOTES TO AND FORMING PART OF TH E FI NANCIAL STATEMENTS for the period ended 30June 2001
Note 10 Changes to Accounting Polley
Amounts transferred from Administered to Departmental Superannuation leave provision adjusted for previous years Other items Total changes to accounting policy
Note 11 Restructuring
As a result of the establistunent of the Office of Gene Technology Regulation on 22 1Wle 2001 . the Department transferred a number of assets and liabilities.
The following assets and liabilities were transferred by the Department:
Total assets transferred Total liabilities transferred Net assets transferred
Office of Gene Technology
(44) 410 376
In respect of activities transferred to the Office of Gene Technology Regulation the following amomtts were recognised during 2000/0 l:
Revenues Recognised by Department of Health & Aged Care Total Revenues
Expenses Recognised by Department of Health & Aged Care Total Expenses
4,447 4,447
2,437 2,212 II
4,660
DEPAR1MENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
FINANCIAL ASSETS
Note 12 C ash
Cash on hand Cash at bank Trust fund balances Investments Total cash
Note 13 Receivables
Appropriations Goods and services GST receivable Interest Receivable
less provision for doubtful debts Total net receivables
Receivables (gross) are aged as fo llows:
not overdue Jess than 30 days 30. 60 days 60-90 days more than 90 days
less provision for doubtful debts Total Net Receivables
243
64 137
12,358 (6,947)
1,929
29,620 2 1,76 1
42,042 16,880
5,869 9,785
6,303 18,793
2,224 4
14,396 28,582
(233) (1,388)
14,163 27,194
11,939 27, 145
1,568 1,277
429 116
211 249 44
14,396 28,582
Q33l (1,388)
14,163 27,194
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF TilE FINANCIAL STATEMENTS for the period ended 30June 2001
NON-FINANCIAL ASSETS
Note 14 Non-Financial Assets
Land and Buildings
Freehold land- at 1998-99 valuation Total Land
Buildings on freehold land - at 1998-99 valuation Accumulated depreciation Total buildings (net)
Total Land and Buildings
Infrastructure, Plant and Equipment
Leasehold improvements - at cost Accurnulated depreciation
Leasehold improvements - at 1998-99 valuation Accumulated depreciation
Leasehold improvements (received free of charge) at officer's valuation Accumulated depreciation
Work in progress - leasehold improvements
Total Leasehold Improvements (net)
Plant and equipment - at cost Accumulated depreciation
Plant and equipment - at 1998-99 valuation Accumulated depreciation
Total Plant and Equipment (net)
Total Infrastructure, Plant and Equipment
120 120
100 (24) 76
196
12,742 (2,659) 10,083
11,101 (5,936) 5,165
3,719
18,967
6,216 (3,522) 2,694
6,092 (4,771) 1,321
4,015
22,981
All land, buildings, plant and equipment held by the Department is subject to valuation in accordance with the 'deprival' method of valuation, and will thereafter be revalued progressively on that basis every three years.
All valuations have been perfonned by officers of the Department and have been reviewed by the Australian Valuation Office.
">AA
295 295
300 (73) 227
522
11,591 (1,027) 10,564
9,394 (4,624) 4,770
1,790 (458) 1,332
486
17,152
2,201 (301) 1,900
9,563 (6,734) 2,829
4,729
21,881
DEPARTMENT OF HEALTH AND AGED CARE
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS
puiod ended 30June 2001
No te 15 Analy!ls of Property, Plant, Equipment and Intangibles
TABLE A - Movement summary 2000-01 tor a n assets Irrespective or valuation basis
Item Land Buildings Total
Land&
Buildings
S'OOO S'OOO $'000
Gross value as at 1 J uly 2000 295 300 595
Additions: Purchase of assets
Revaluations: write ups I (write downs)
Assets transferred in/( out)
Write-offs
Change in Accounting Policy
Disposals (175) (200) (375)
Gross value as at 30 June 2001 120 100 220
Accumulated Depreciation! Amortisation as at 1 July 2000 73 73
Adjustment for disposals (53) (53)
Depreciation I amortisation charges 4 4
Writeoffs
Accumulated Depredation/
AmorthaUon as at 30 June 2001 24 24
Net book value as at JO June 2001 120 76 !96
Net book value as at 1 July 2000 295 227 522
245
Infra- Computer Total Total
structure Software Intang.i.bles
Plant& Intangible
Equipment Assets
$'000 S'OOO S'OOO $'000
35,025 82,079 82,079 117,699
4,941 14,824 14,824 19,765
686 577 577 1,263
(593) (1,081) (1,081) (1,674)
( 189) (564)
39,870 96,399 96,399 136,489
13,144 40,880 40,880 54,097
(ISO) (2JJ)
4,410 12,926 12.926 17,340
(486) (467) (467) (953)
16,888 53,339 53,339 70,2!51
22,982 43,060 43,060 66,238
21,881 41.199 41.199 63,602
DEPARTMENT OF H EALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 15 Analysis or P roperty, Plant, Equipment and Intangibles (coot' d)
TABLE B - Summary or balances or assets at val uation as at JO J une 2001
Item Land Buildings Total
Land& Buildings
s·ooo S'OOO s·ooo
Gross value as a t JO June 2001 120 100 220
Accumulated depreciation/ (24) (24)
amortisation
Net book value as at 30 J une 2001 120 76 196
Gross vaJue as a t 30 June 2000 295 300 595
Accumulated depreciation/
amortisation (73) (73)
Net book value as atJO J une 2000 295 227 522
TABLE C - S ummary of bala nces of a ssets under construc Uon as a t 3 0 J une 2001
Item Land Buildings Leasehold
on Improve-
Freehold ments
Land
$'000 $'000 $'000
Gross value as a t 3 0 June 2001 3,719
Accumulated depreciation/
amortisation
Net book value as at 30 J une 2001 3,719
Gross valu e as at JO Juoe 2000 485
Accumulated depreciation/
amortisation
Net book value as at 30 J une 2000 485
Infra-structure Plant& Equipmenl
S'OOO
17,193
(10,707)
6,486
21,233
(11,816)
9,417
Total Land& Buildings
$'000
3,719
3,719
485
485
There are no assets held under finance lease.
Computer Total Total
Software/ Intangibles Intangible Assets S'OOO S'OOO $'000
40,598 40,598 58,011
(27,778) (27,m) (38,509)
12,820 12,820 19,502
59,745 59.745 81.573
(30,627) (30.627) (42, 516)
29,118 29,118 39,057
Intangibles ⢠Total Total
Computer Intangibles Software
$'000 S'OOO $'000
4,903 4,903 8,622
4,903 4,903 8,622
6,902 6,902 7,387
6,902 6,902 7,387
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 JunB 2001
Note 16 Inventories
Inventories held for sale Inventories not held for sale Total Inventories
Note 17 Intangible An ets
Purchased software - at cost Accumulated amortisation
Internally developed software - at cost Accurnulated amortisation
Internally developed software - at 1998-99 valuation Accumulated amortisation
Work-In-Progress
Total Intangible Assets
INTEREST B EARING LIABILmES
Note 18 Loans
Loans from Govenunent Total Loans
Loan maturity schedule one year or less one to two years two to five years more than five years Loan Total
247
350 573
156 790
606 1,363
15,1 89 15,431
(10,253)
3,541 5,178
35,609
11,796
40,598 59,745
(30,627)
11,820 29,118
4,903 6,903
43,060 4 1,199
10,800 4,000
10,800 4,000
1,800 1,800 5,400 1,800 4,000
10,800 4,000
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
PROVISIONS
Note 19 Employee Provisions
Salaries and wages Leave Superannuation Separation and redundancies Aggregate employee entitlement liability Other Total Employee Provisions
Current Non-current
PAY ABLES
Note 20 Suppliers Liabilities
Trade creditors Operating lease rentals Total Suppliers Liabilities
Note 21 Other Debt
SW"plus space liability Lease incentives Total Other Debt
4,493 4,630
61,714 54,843
754 560
308
66,961 60,341
6
66,967 60,341
11,420 55,547
30,650 !8,386
6,177 36,827 18,386
23
3,104 3,728
3,127 3,728
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period 30 June 2001
Note 22 Equity
Jt
results revaluation
2000--01 1999-00 2000-01
s·ooo S'OOO s·ooo s·ooo
Balance 1 J uly 2000 10,324 33,050 374 374
Net surplus (deficit) after extraordinary
items (1 7, 159) (17,520)
Equity Injection:
Appropriation
Capital Usc: Charge (2,666) (549)
Changes in accounting policy (4,660)
Balance 30 June 2001 (9 SU I 10,324 J74 374
249
Total Total
Capital Eq uity
2000-01 1999-00 2000-0 1 1999-00 2000-01 1999-00
$'000 $'000 S'OOO $'000 $'000 S'OOO
374 374 4,073 4,073 14,771 37,497
{17,159} (17,520)
1,841 1,841
(2,666) (549)
(4,660)
374 374 5914 4,073 3 2 13 14,771
D EPARTMENT O F HEAL Til AN D AG ED CARE NOTES TO AND FO RMING PART OF THE FINANC IAL STATEMENTS for the period ended 30June 2001
Note 23 Cash Flow Reconciliation
Reconciliation of Cash per Statement of Financial Position to Statement of Cash Flows ⢠Cash at year end per Statement of Cash Flows 42,042
⢠Statement of Financial Position items comprising above cash: 'Financial Asset Cash' 42,042
Reconciliation of operating surplus to net cash provided by operating activities:
Net Surplus (deficit)
Add: Equity adjustment Agency banking adjustment Depreciation and amortisation expense Net loss (gain) on sale of fixed assets Write down of assets Change in assets and liabilities:
(Increase) decrease in receivables (Increase) decrease in inventories (Increase) decrease in other assets Increase (decrease) in other debt Increase (decrease) employee provisions Increase (decrease) in suppliers Increase (decrease) in other provisions Net cash from operating adivttt es
(17,159)
3 ,865 757 (947) 1,075 6,625 17,031
27,932
16,880
16,880
( 17,520)
(312)
(877)
36,753
3,117
5,759
(21,423)
1,360 (297)
4,446
10,933
(2,204)
19,735
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
251
DEPAR1MENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
253
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
255
DEPARTMENT OF HEAL Til AND AGED CARE NOTES TO AND FORMING PART OF TilE FINANCIAL STATEMENTS for the period ended 30June 2001
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 33 Administered Equity
DEPARTMENTOFHEALTHANDAGEDCARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note34 Financial Instruments
(a) Terms, conditions and accounting policies
Financial Notes Accounting Policies and Methods Nature of underlying instrument
Instrument (including recognition criteria and (including significant terms &
measurement basis) conditions affecting the amount, timing
and certainity of cash flow)
Financial Assets Financial assets are recognised when control over future economic benefits is established and the amount of the benefit can be reliably measured
Cash 12 Deposits are recognised at their nominal The Department invests funds with a
amounts. Interest is credited to revenue as it commercial bank at calL Monies in the accrues Agency's bank accounts are swept into the
Official Public Account nightly and interest is earned on the daily balance. Interest is paid at the end of the month.
Receivables for goods 13 These receivables are recognised at the All receivables are with entities external to and services nominal amounts due less any provision for the Commonwealth. Credit terms are net 30 bad or doubtful debts. Collectability of debts days (1999-00:30 days) is reviewed at balance date. Provisions are
made when collection of the debt is judged to be less rather than more likely.
Investments 12 Investments in term deposits are recognised The Department invests funds with the at face value. Reserve Bank of Australia for fixed short
term periods. Interest is earned on the dsily balance and paid at the end of the term.
258
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note34 Financial Instruments (cont'd)
(a) Terms, conditions and accounting policies
Financial Not es Accounting Policies and Methods Nature of underlyi ng instrument
Instrument (including recognition criteria and (including significant terms &
measurement basis) conditions affecting the amount, timing
and certainty of cash flow)
Financial Liabilities Financial liabilities are recognised when a present obligation to another party is entered into and the amount of the liability can be reliably measured.
Loans 18 Loans are recognised at the amounts due. A loan has been provided by the
Interest is debited to expense as it accrues. Department of Finance and Administration for a period of7 years. The principle is to be paid over the period of the loan. The interest rate charged is based on the 1 0 year
long tenn bond rate, adjusted quarterly. Interest is calculated quarterly on the outstanding daily balance.
Trade Creditors 20 Creditors and accruals are recognised at their All Creditors are entities that are not part of nominal amounts, being the amounts at which the Commonwealth legal entity. Settlement the liabilities will be settled. Liabilities are is usually made net 30 days. recognised to the extent that the goods and services have been received (and irrespective of having being invoiced).
Lease incentives 21 The lease incentive is recognised as a liabilit) The Department has received incentives in on receipt of the incentive. The amount of the form of rent free periods on entering the liability is reduced on a straight line over property operating leases. the life of the lease by allocating lease
payments between rental expense and reduction of the liability.
259
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 34 Financial Instruments (cont'd)
(b) Interest rate risk: Agency
Financial Instrument
Financial Assets (Recognised) Cash at Bank Cashon Hand Trust Fund Balances Investments -Term deposits Receivables for goods and services Other debtors
Total Financial Assets (Recognised)
Total assets
Financial Liabilities (Recognised)
Notes
12 12 12
12 13
Trade creditors 20
Operating lease rentals Lease incentives Loan
Total Financial Liabilities (Recognised)
Total liabilities
20 21 18
Floating Interest Rate 2000-01 1999-00
$'000 $'000
12,358
12,358
10,800
10,800
60
Fixed Interest Rate 2000-01 1999-00
$'000 $'000
29,620 21,761
29,620 21,761
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 34 Financial Instruments (cont'd)
Weighted Average Effective lnteres
Non Interest Bearing Total Rate
2000-01 1999-00 2000-01 1999-00 2000-01 1999-00
$'000 $'000 $'000 $'000 % %
(6,947) 12,358 (6,947) 2.00% n/a
64 137 64 137 n/a nla
1,929 1,929 n/a n/a
29,620 21,761 4.95% 5.60"/o
6,303 18,050 6,303 18,050 n/a nla
743 743 n/a nla
6,367 13,912 48,345 35,673 n/a nla
100,976 89,833
30,650 18,386 30,650 18,386 n/a n/a
6,177 6,177 n/a nla
3,127 3,728 3,127 3,728 n/a n/a
4,000 10,800 4,000 6.04% nla
39,954 26,114 50,754 26,114 6.04% nla
106,379 85,975
261
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 34 Financial Instruments (cont'd)
(c) Net fair value of Financial Assets and Liabilities: Agency
Total Carrying Aggregate net Note Amount fair va lue
Financial Assets
Cash at Bank 12 12,358 12,358
Cashon Hand 12 64 64
Investments 12 29,620 29,620
Trust Fund Balances 12
Receivables for goods and services 13 6,070 6,070
Other Debtors
Total Financial Assets 48,112 48,112
Financial Liabilities (Recognised)
Trade creditors 20 36,827 36,827
Lease Incentives 21 3,127 3,127
Loan 18 10,800 10,800
Total Financial Liabilities (Recognised) 50,754 50,754
(d) Credit Risk Exposures
The Department's maximum exposures to credit risk at reporting date in relation to each class of recognised financial assets is the canying amount of those assets as indicated in the Statement of Assets and Liabil ities.
The Department has no significant exposures to any concentrations of credit risk.
262
Total Carrying Aggregate net fair Amount value
(6,947) (6,947)
137 137
21,761 21,761
1,929 1,929
16,662 16,662
744 744
34,286 34,286
18,386 18,386
3,728 3,728
4,000 4,000
26,114 26, 114
DEPARTMENT OF HEALTH AND AGED CARE
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS
for the period ended 30June 2001
Note35 Administered Financial Instruments
(a) Terms, conditions and accounting policies
263
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 35 Administered Financial Instruments (cont'd)
(b) Interest rate risk: Administered
264
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS f or the period ended 30June 2001
Note 35 Administered Financial Instruments (cont'd)
265
DEPARTMENT OF HEALTH AND AGED CARE
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS
for the period ended 30June 200/
Note 35 Administered Financial Instruments (cont'd)
(c) Net fair value of Financial Assets and Liabilities: Administered
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 36A- Agency appropriations
Annual appropriations for Departmental items (outputs)
IAioor·ooriallion Act No 1 and 3 credits: Section 7 - Act 1 - basic appropriations ( budget) Section 7 Act 3 - basic appropriations Section 10- adjustments Section 11 -Advance to the Finance Minister
Note 36B -Annual appropriations for Deoartmental Capital items
IAI>PrOplrial:ionAct No 2 and 4 credits: Section I 0- Act no 2 (budget) -loan Section 10 - Act no 2 (budget)- equity injection Section I 0 - Act no 4 Advance to the Finance Minister
Total Current Appropriation Acts Add: FMA Act appropriations s30 appropriations s30A appropriations (GST recoverables)
Total appropriated in the year
available at I July brought forward previous period
267
$'000 $'000
653,013 12,777
180
665,970
Loans/ Equity injection 2000-01 $'000
6,800 1,841
8,641
530
9,171
1,441
10,612
609,412
Loans/ Equity injection 1999-00 $'000
4,000 4,073
8,073
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS period 2001
Note J6C . Administered approprlaUons
Annual appropriations for administered expense ftem s Outcome 1 - Population health and safety
Administered expenses Appropriation Act No 1&3 2000-01 1999-00
124,884 69,483
(2,089) 43,881
122,795 113,364
3,508
126,303 113,364 3,586 5,258
5,052
Administered expenses Appropriation Act No2&4 2000-01 1999-00
$'000 $'000
State
Payment Items Appropriation Act No2&4 2000..01 1999·00
$'000
174,227 142.159 10,810
185,037 142,159
4,436
189,473 142,159 27,886 18,021
84
Balance or appropriations carried forward represents the estimated funding to be retained under section 8 of the Appropriation Acts. Dffferences arising between estimate and formal determination by the Finance Minister will be Included In 2001/02 nnandal statements.
268
Tohll
Outcome I
2000-0J 1999-00
$'000 $'000
299,111 211,642
8,72 1 43,881
307,832 255,523
7, 944
315,776 255,523 31 ,472 23,279
5,136
232.244
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 36C - Administered appropriations (coot' d)
Annual appropriations for administered expense Items Outcome 2 - Access to Medicare
Act credits:
Act 112 - basic appropriations ( budget) Act 3/4 -basic appropriations (budget)
Administered expenses Appropriation Act No 1&3 2000-01 1999-00
340,021 274,314 53,747 21,049
393,768 295,363
9,164
402,932 295,363 9,640 15,345
43,129 4,060
280,018
Administered e:rpenses Appropriation Act No2&4 2000-01 1999-00
State
Payment Items Appropriation Act No2&4 2000-01 1999-00
101,656 65,145
10,016 19,173
111,672 84,318
2,900
114,572 84,318
8,923 8,505
75,813
Balance of appropriations carried forward represents the estimated funding to be retained under section 8 of the Appropriation Acts. Differences arising between estimate and formal determination by the Finance Minister will be Included In 2001/02 financial statements.
269
Total Outcome2
2000-01 1999-00
441,677 339,459 63,763 40,222
50!'i,440 379,681
12,064
517,504 379,681 18,!563 23,850
43,129 4,060
4!'i9,872
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for tht. pt.riod t.ndt.d 30 Junt. 2001
Note 36C- Administered appropriations (coot' d)
Annual aporonrlations for administered expense Uems Outcome 3- Enhanced quality or IH'e ror older australlans
Administered expenses Appropriation Act No 1&3 2000-01 1999-00
S'OOO
202,834 183,006
30,849 11,530
233,703 194,536
!5,266
238,969 194,536
36,449 71,199
3,!578 12,931
Other
Admlnistered expenses Appropriation Act No2&4 2000-01 1999-00
S'OOO S'OOO
State
Payment Items Appropriation Act No2&4 2000-01 1999-00
$'000
606,982 565,627 1,877
608,839 565,627
17,1 87
626,046 565,627
JIS
Balance of appropriations carrted forward represents the estimated funding to be retained under secUon 8 of the ApproprtaUon Acts. Differences arising between esUmate and formal determlnatJon by the Finance Minister wtiJ: be Included ln 2001 /02 nnandal statements.
Total OutcomeJ
2000-01 1999-00
5'000
809,836 748,633 32,726 11,530
842,362 760,163
22,4!53
86S,OIS 760, 163 36,449 71,199
3,!578 13,249
688,964
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 36C - Administered appropriations (cont'd)
Annual appropriations for administered expense Items Outcome 4 - QuaUty health care
Current Appropriation Acts
Administered expenses Appropriation Act No 1 &3 2000-01 1999-00
$'000 S'OOO
289,718 283,736 65,764 5,374
355,482 289,110
8,393
363,875 289,110 29,022 44,992
37,110 17,270
Administered expenses Appropriation Act No2&4 2000-01 1999-00
S'OOO
State
Payment Items Appropriation Act No2&4 200()...01 1999-00
$'000 S'OOO
79,832 63,856
8,189 5,537
88,021 69,393
2,091
90,112 69,393
15,785 922
1,957
Balance or appropriations carried forward represents the estimated funding to be retained under section 8 of the Appropriation Acts. Dlrrerences arising between estlmate and formal determination by the Finance Minister wm be lnduded ln 2001102 financial statements.
271
Total Outcome4
2000-01 1999-00
$'000
369,550 347,592 73,953 10,911
443,503 358,503
10,484
453,987 358,503 44,807 45,914
37,110 19,227
312,589
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for Jh t pt n"od tndtd 30 Junt 2001
Note 36C approprlatJons (cont'd)
Annual aporoprtatlons for administered expense Items OutcomeS- Rural health care
FMA Act appropriations s30 appropriations s30A appropriations (GST recoverables) s31
appropriated In the year amounts lapsed by Ministerial rephasings brought forward from previous year
Administered expenses Appropriar.ion Act No 1 &3 2000-01 1999-00
$'000 S'OOO
83 ,600 23,129
(7,770) 15,097
75,830 38,226
1,740
77,570 38,226
8,532 7,719
5,857 1,272
64,453 30,507
63,389 29,235
Administered expenses Appropriation Act No2&4 2000-01 1999-00
S'OOO S'OOO
State
Payment Items Appropriation Act No2&4 2000-01 1999-00
S' OOO S'OOO
184
9,000
9,184
9,184
9,184 9,184
Balance of approprlatJons carried forward represents the esUmated fundJng to be retained under sectJon 8 of the Approprfatlon Acts. Dltrerences artslng between estimate and formal determlnaUon by the Finance Minister wm be Included In 2001/02 nnandal statements.
Total Outcome !5
2000-01 $'000
83 ,600 (7 ,770)
7!5,830
1,740
77,!570 8,532 5,857 1,272
1999-00 S'OOO
23,313 24,097
47,410
47,410 7,7 19
39,691 38,419
DEPARTMENT OF HEALTH AND AGED CARE NO TES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for I he period endrd .30 Junr 2001
Note 36C - Admlnl5tered appropriations (cont'd)
Annual appropriations for administered expense Items Outcome 6 - Heartng services
Admlnbtered expenses Appropriation Act No 1&3 2000-01 1999-00
131 ,602 142,928 4,370
9,604
150,7 93 147.298
4,2!50
1!5!5,043 147,298
4,305
2,630
157,673 142,993
Other
Admlntstered ex penses Appropriation Act No2&4 2000-01 1999-00
State
Payment Items Appropriation Act No2&4 2000-01 1999 -00
Balance of approprlatJons carried forward represents the estimated fundlng to be retained under sectlon 8 of the Appropriation Acts. Dffferences arising between esUmat.e and fo rmal detennination by the Finance Minister will be Included In 2001 /02 financial statements.
273
Total Oukome 6
2000-01 1999-00
131,602 142,928 4.370
9,604
147,298
4,2!50
15!5,043 147,298 4,305
2,630
142,993
DEPARTMENT OF HEALTH AND AGED CARE NOTES TOANO FORMING PART OF THE FINANCIAL STATEMENTS for the pen"od ended 30Junt 2001
Note 36C - Administered approprtaUon s (cont'd)
Annual appropriations for administered expense Items Outcome 7 - Aboriginal and Torres Strait Islander health
AdmlnUtered ex penses Appropriation Act No 1&3 2000-01 1999-00
sâ¢ooo s·ooo
189,709 181 ,840
(31 3) 1,252
189,396 183,092
4,800
194,196 183,092 1,7SS 21,053
8,639 29,613
Admtnbtered expenses Appropriation Act No2&4 2000-01 1999-00
s·ooo s·ooo
State
Payment Items Appropriation Act No2&4 2000-01 1999-00
S'OOO S'OOO
Balance or appropriations ca rried forward represents the es Hmated fundJne to be retaJned under sectio n 8 or th e Appropriation Acts. Differences arl!ltne between e5Umate and formal determination by the Finance Minister wf1J. be lnduded In 2001/01 nnandal statements.
Total Outcome 7
2000-01 1999-00
S'OOO $'000
189,709 181 ,840
(313) 1,252
189,396 183,092
4,800
194,196 183,092 1,1SS 21,053
8,639 29,613
213,415
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS forlht period ended JOJ11nt 2001
Note l6C AdmJnlstered appropriations (cont'd)
Annual approprtaUons for administered expense Items Outcome 8 through prtvate health
IApprojprlatlon Act credits: Act 112 basic appropri.ations: ( budget) Act 314 -basic appropriations (budget) Section II Advance to the Finance Section 12-
Administered expenses Appropriation Art No 1&3 2000-01
4,269 !5,044
S'OOO
1,870
Administered expenses Appropriation Act No2&4 2000-01 1999-00
5'000 $'000
State
Payment Items Appropriation Act No2&4 2000-01 1999-00
$'000 $'000
Balance or approprlaUons carrted forward represents the esUmated funding to be retained under section 8 or the Appropriation Acts. Dln'erences arising between estimate and formal determination by the Finance Mlnlster wUl be lnduded In 2001 /02 financial statements.
Total Outcome 8
2000-01 $'000 $'000
4,269 3,044
1,870
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the ptn'od ended 30 June 2001
Note 36C - Administered appropriations (cont'd)
Annual appropriations for administered expense Items Outcome 9- Health Investment
Administered expenses Appropriation Act No 1 &3 2000-01 1999-00
368,310 189,381 45,283 118,524
413,593 307,905
7,077
420,670 307, 905 111,341
14,123 14,640
196,564
Other
Administered expenses Appropriation Act No2&4 2000-01 1999-00
State
Payment items Appropriation Act No2&4 2000-01 1999-00
4,771 14,893
10,000
10,000 19,664
282
10,282 19,664
15,815
10,282
Balance or appropriations carried forward represents the estimated funding to be retained under section 8 of the Appropriation Acts. Differences arising between estimate and formal determination by the Finance Minister will be Included In 2001 /02 nnandal statemenU.
Total Outcome 9
2000-01 1999-00
368,310 194,152 45,283 133,417 10,000
423,593 327,569
7,359
430,952 327,569 127,156
14,123 14,640
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for 30 2001
Note J6D - Admlnlstered appropriations
Annual approprtaUons for administered capital Uems
IApp
Current Appropriation Acts
40,440 56,98!5
97,42!5
34,483
34,483
97,42!5 34,483
277
DEPARTMENT OF HEALTH AND ACED CARE
NOTES TO AND FORMING PART OF THE FlNANClAL STATEMENTS for the period ended :JO Jun1 2001
74,272 63,601
93,8!'11 61.585
11,061
Budget e!!Umate 74,172 63,601
Paymeats made 93,8.51 72,646
3,666,144 3 ,!'142,840
7,274,0!'10 6,983, llS 7,279,641 7,076,944
6,141,!87 5,714,493 6,203,198 5,861,994
3,847,672 3.357,388 4,236,678 3,491,003
17,26J,J09 16,054,996 3,666,144
17,719,!'117 16,429,941 3,542,840
3,313,392
3,666,144 3,313,392
3,348,035
3,542,840 3,348,035
7,274,0!'10 6,983,115 7,279,641 7,076,944
101,806 6,143,393 5,714,493 103,696 6,306,894 5,861,994
705 174,987 232.075 4,096,931 3,653,769 168,411 222,6 18 4,498,940 3,771,808
1,608,2!'10 1,290,426 1,608,2!'10 1,290.426
1,908,861 1,413,549 1,908,861 1,413,549
11,061
3,314,097 276,793 232,075 1,608,2!'10 1, 290,426 11,888,768 20,955,195 3,344,637 271,107 222,618 1,908,861 1,413,549 23,!'137,176 21,483,391
DEPARTMENT OF HEALTII AND AGED CARE NOTES TO AND FORMING PART OF TilE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 38 Receipts and Expenditure of Special Accounts
Special Account
OTHER TRUST MONIES SPECIAL ACCOUNT - Department of Health and Aged Care
Legal Authority- Financial Mangement and Accountability Actl997, Section 20
Purpose - for the receipt of monies temporarily held in trust for other persons.
Cash Balance canied forward Plus appropriations credited during year Plus other revenue credited during year Available for payments
payments made Balance carried to next period
2,048,629
123,216 2,171,845 513,099 1,658,746
SERVICES FOR OTHER GOVERNMENTS AND NON-DEPARTMENTAL BODIES- SPECIAL ACCOUNT Department of Health and Aged Care
Legal Authority- Financial Management and Accountability Act 1997, Se<:tion 20
Purpose - for payment of monies in connection with and services performed on behalf of other governments and non-departmental bodies.
Cash Balance carried forward from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
payments made Balance carried to next period
279
3,716,145 427,228,000 2,271,796 433,215,941 420,182,263
13,033,678
2,051,583
14,668,975 16,720,558 14,671,929 2,048,629
1,182,382
392,572,889 393,755,271 390,039,126 3,716,145
DEPARTMENT OF HEAL Til AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 38 Receipts and Expenditure of Special Accounts (cont'd)
Special Account
NATIONALLY -FUNDED MEDICAL SPECIALITY CENTRES SPEC[AL ACCOUNT
Legal Authority- Financial Management and AccountahilityActl997, Section 20
Purpose- to receive payments from the States, Territories and the Commonwealth and to pay out monies: -to specialist medical wtit* approved by State, Territory and Commonwealth Health M.inisten for the direct costs of operating those medical units; and
- for such other related activities as are specifically agreed by State, Territory and Commonwealth Health Ministers.
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
NURSING HOME SALE SPEClAL ACCOUNT
Purpose - to enable the efficient administration of funds relating to the sale or transfer of nursing homes.
Cash Balance carried from previous period Plus appropriations credited dwing year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
4,371 ,419 4,371,419 4,371,419
6,219,315
45,469 6,264,784
6,264,784
4,362,173 4,362,173 4,362,173
1,784,868
5, 167,696 6,952,564 7JJ,249 6,2 19,315
DEPARTMENT OF HEALTII AND AGED CARE NOTES TO AND FORMING PART OF TilE F INANCIAL STATEMENTil for the period ended 30 June 2001
Note 38 Receipts and Expenditure of Special Accounts (cont'd)
Special Account
PBPA FACTOR (F) SPECIAL ACCOUNT
Legal Authority - Financial Management and Accountability Act 1997, Section 20
Purpose: for expenditure in relation to the Factor (f) scheme, part of the Pharmaceutical Industry Development Program, to facilitate increases in manufacture, research, product process development in Australia.
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
STRATEGIC INTERGOVERNMENTAL NUTRITION ALLIANCE SPECIAL ACCOUNT
Legal Authority- Financial Management and Accountability Act 1997, Section 20
Purpose: for expenditure relating to the operations of the Secretariat to the Strategic Intergovernmental Nutrition Alliance.
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
281
1,407,531
1,407,531
1,407,531
123,384
31,531 154,915 26,957 127,958
1,407,53I
I,407,531
I,407,53 I
116,134
20,000 136,134 12,750 123,384
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 38 Receipts and Expenditure of Spec:lal Accounts (cont'd)
Special Account
AUSTRALIAN CHILDHOOD IMMUNISATION REGISTER SPECIAL ACCc*nt
Legal Auth ority- Financial Management and Accountahility Act 1997, Section 20
Purpose: for expenditure relating to the operations of the Australian Childhood Immunisation Register, including payments to providers for the provision of infonnation.
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
MEDICAL RESEARCH ENDOWMENT SPECIAL ACCc*nt
Legal Authority- National Health and Medical Research Council Act 1992 and Financial Management and Accountability Act 1997, Section 20.
Purpose - to provide assistance (subject to the Act): - to Departments of the Commonwealth or of a State engaged in medical research; - to universities for the purpose of medical research; - to institutions and penons engaged in medical research; and - in the training of persons in medical research.
Cash Balance canied from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payment.r
Payments made Balance canied to next period
24,093
3,803,517 3,827,610 3,181,161 646,449
5,106,321
198,075,509 203,181,830 183,280,298 19,901,532
517,083
8,207,010 8,724,093 8,700,000 24,093
1,869,551
176,847,607 178,717,158 I 73,610,837 5,106,321
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 38 Receipts and Expenditure of Special Accounts (c:ont'd)
Special Account
HUMAN PITUITARY HORMONES SPECIAL ACCOUNT
Legal Authority- Financial Management and Accountability Act 1997, Section 20
Purpose - for expenditure through grants and other payments for : - counselling and support services to recipients of pituitary-derived hormones and their families; and - medical and other care to people treated with pituitary-derived honnones should
they contract Creutzfeldt-Jakob Disease as a result of the treatment
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
AUSTRALIAN COUNCIL FOR SAFETY AND QUALITY IN HEALTHCARE
Legal Authority- Financial Management and Accountability Act 1997, Section 20
Purpose - to receive payments from the States, Territories and the Commonwealth and to pay out monies for expenditure relating to the administration of the Australian Council for Safety and Quality in Health Care and national programs to improve quality and safety in health care.
Cash Balance carried from previous period Plus appropriations credited during year Plus other revenue credited during year Available for payments
Payments made Balance carried to next period
283
4,169,424
4,169,424 53,571 4,115,853
979,681 5,429,894
6,409,575 269,991 6,139,584
1,432,734
5,840,000 7,272,734 3,103,310 4,169,424
1,017,942 1,017,942 38,261 979,681
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for lhe period ended 30 June 2001
Note 38 Receipts and Expenditure of Special Accounts (cont'd)
Special Account
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
Legal Authority- Financial Management and Accountability Act 1997, Section 21 and the Therapeutic Goods Act 1989
Purpose - for the receipt of all moneys and payment of all expenditures and disbursem*nts related to all operations of the Therapeutic Goods Administration.
Cash Current appropriation - Consolidated Revenue Fund (Special Appropriation) Balance carried from previous period Plus appropriations credited dwing year Plus other revenue credited during year A vailable for payments
Payments made Balance carried to next period
6,701,173
49,340,975 56,04Z,148 46,0Jl,OZ8 10,011,1ZO
11 ,024,152
14,882,126
29,923,004 55,829,282 49,128,109 6,701 173
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the end8d 30June 2001
Note l9 R eportblg o r Outcomes
Outcome 1 Outcome Z
Actual Budget Actual Budget
$'000 S' OOO $'000 $'000
Net Subsidies, benefits and grants expenses 367, 262 18,244,907
Other administered exp enses 290 82
T otal ne t ⢠dmb!J.rtered expeu et 36 7,552 373,383 18,244,989 17,704,986
Add net cost of departmenlal ....... .5 1,91 7 .50,286 44 9,443 399,934
C ort or otrtcome be fore ext.nonDruuy Items 41,,469 423,669 18,694,432 18,104,920
Extraordinary items
Net cort t o Budge t Outcome 419,469 423,669 18,694,432 18, 104,920
285
Outcome 3 Outcome 4
Actwol 8Uclg1't Ad.u .. Buclaet
$'000 $'000 S' OOO $' 000
4,342,2.5.5 627,924
264 381
4,342,519 4,4 75,880 628,305 646,343
72,.566 82,810 33,3S9 35,.505
4,415,085 4,558,690 661,664 681,848
4,415,085 4,558,690 661,664 681,848
DEPARTMENT OF HEALm AND AGED CARE NOTES TO AND FORMING PART O F THE FINANCIAL STATEMENTS for tM period '"ckd 301un⢠2001
Note 39 Reporting of Outcome⢠(Cont'd)
OutcomeS Outcome 6 Outcome 7 Olrtcome8 Oatcomef Totol
Actalll Budget A
S' OOO s·ooo t ' OOO S' OOO S' OOO s·ooo s·ooo S' DOO $' 00(1 s·ooo S' OOO S'OOO
61 ,439 l $6,.S4 1 183,306 1,931,5$9 3$6,2$4 26,273,447
126
'·""'
609 9,8$4
61 ,442 83,600 1!5 6,541 llU02 185,432 189,709 1,939,658 1,612,519 356,863 368,310 26 ,283 ,301 25,586,332
10,058 ll,l 77 8,425 9,989 18,783 24,321 15 ,139 16,042 22,263 22,93$ 681,953 65 2,999
71,500 94,777 164,966 141,5 91 204,115 214,030 1,954, 797 1,62.8,561 379,126 391,245 26,965,254 U: ,239,331
71,500 94 ,171 164,966 141,591 204,2 15 21 4, 030 1,954,797 1,628,561 379,126 391,245 U ,965,2S4 26,D 9,331
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 40 Major Agency Revenues & Expenses by Outcome
Outcome 1
Outpull Output2 Outpull Output 4
Actual Actual Actual Actual
s·ooo s·ooo S'OOO s·ooo
Operating revenues Revenues from government 14 ,627 12,522 8,500 8,495
Sale of goods and services 2,125 2,195 3,216 51
Other non-taxation revenues 139 133 154 412
Total operatine: revenues 16,891 14,850 11,870 8,958
Operating expenses Operating expenses 7,414 3,498 11,366 2,903
Employees 8,622 7,765 7,763 5,527
Other 460 394 269 267
Total operatine: expenses 16,496 11,657 19,398 8,697
Outcome 2
Output 1 Output2 Output3 Output4
Actual Actual Actual Actual
s·ooo $'000 s·ooo $'000
Operating revenues Revenues from goverrunent 12,951 9,385 15,545 14,046
Sale of goods and services 822 3 !54 43
Other non-taxation revenues 55 40 66 59
Total oueratin!! revenues 13,828 9,428 15,765 14,148
Operating expenses Operating expenses 11,382 1,365 3,586 1,006
Employees 10,311 2,741 4,106 3,818
Other 407 294 487 440
Total operating exuenses 22,100 4,400 8,179 5,264
Outcome 3
Output 1 Output2 Output3 Output4
Actual Actual Actual Actual
S'OOO S'OOO S'OOO $'000
Operating revenues Revenues from government 15,559 7,253 8,565 38,029
Sale of goods and services 4 2 38 36
Other non-taxation revenues 66 31 36 161
Total revenues 15,629 7,286 8,639 38,226
Operating expenses Operating expenses 1,651 1,559 2,386 10,671
Employees 7,291 3,363 4,876 23,995
Other 488 228 269 1,193
Total operatinR expenses 9,430 5,150 7,531 35,859
287
OutputS Total
Actual Actual
s·ooo s·ooo
6,726 50,870
40,803 48,390
1,458 2,296
48,987 101,556
14,589 39,770
29,547 59,224
2,218 3,608
46,354 102,602
OutputS Output6 Total
Actual Actual Actual
s·ooo $'000 $'000
4,477 348,579 404,983
I -1,698 -675
19 1,476 1,715
4,497 348,357 406,023
444 368,889 386,672
2,485 27,645 51,106
140 10,936 12,704
3,069 407,470 450,482
OutputS Total
Actual Actual
$'000 s·ooo
14,028 83,434
4 84
59 353
14,091 83,871
4,532 20,799
10,064 49,589
440 2,618
15,036 73,006
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ending 30 June 2001
Note 40 Major Agency Revenues & Expenses by Outcome (Cont'd)
Outcome4
Output 1 Output 2 Output3 Output4
Actual Actual Actual Actual
$'000 $'000 S'OOO S'OOO
Operating revenues Revenues from government 17,923 6,604 3,390 8,323
Sale of goods and seiVices -168 4 278 304
Other revenues 76 28 14 35
Total operat lne reven ues 17,831 6,636 3,682 8,662
Operating expenses Operating expenses 1,554 4,506 199 4,118
Employees 5,256 9,570 2,600 4,992
Other 563 207 106 261
Total operatlne expenses 7,3 73 14,283 2,905 9,371
OutcomeS
Output 1 Outpul l Output3 Output 4
Actual Actual Actua l Actual
s·ooo S'OOO s·ooo s·ooo
Operating revenues Revenues from government 3,008 2,232 3,432 4,714
Sale of goods and services I I I I
Other non-taxation revenues 13 9 15 20
Total oueratlne revenues 3,022 2,242 3,448 4,735
Operating expenses Opefating expenses 313 227 1,094 1,17 1
Employees 2,609 660 89 1 2,733
Other 94 70 107 148
Total operatlne exoenses 3,016 957 2,092 4,052
Outcome 6
Output 1 Output 2 Output 3 Output 4
Actual Actual Actual Actual
s·ooo s·ooo s·ooo S'OOO
Operating revenues Revenues from government 958 192 1,053 6,139
Sale of goods and services 0 0 0 2
Other non-taxation revenues 4 I 4 26
Tota l operatlne revenues 962 193 1,057 6,167
Operating expenses Operating expenses 187 37 75 529
Employees 335 62 356 2,363
Other 30 6 33 193
Total operatlne exuenses 552 lOS 464 3,085
Total
Actual S'OOO
36,240 418 153 36,811
10,377 22,418 1,137 33,932
Total
Actual s·ooo
13,386 4
57
13 ,447
2,805 6,893 419 10,117
OutputS O utput 6 Total
Actual Actual Actual
s·ooo $'000 s·ooo
958 766 10,066
0 0 2
4 3 42
962 769 10,11 0
54 3,222 4, 104
382 552 4,050
30 25 317
466 3,799 8,471
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ending 30 June 2001
Note 40 Major Agency Revenues & Expenses by Outcome (Cont'd)
Outcome 7
Output 1 Output2 Output3 Output 4
Actual Actual Actual Actual
s·ooo $'000 s·ooo $'000
Operating revenues Revenues from govenunent 3,753 5,412 2,888 12,418
Sale of goods and services 1 1 1 9
Other non-taxation revenues 16 23 12 53
Total operatlnl! revenues 3,770 5,436 2,901 12,480
Operating expenses Operating expenses 902 834 720 2,092
Employees 1,885 2,901 1,564 7,234
Other 117 170 91 389
Total operatlnl! eXPenses 2,904 3,905 2,375 9,715
Outcome 8
Output 1 Output2 Output3 Output 4
Actual Actual Actual Actual
$'000 $'000 s·ooo s·ooo
Operating revenues Revenues from govenunent 3,060 3,51 5 3,687 874
Sale of goods and services 1 1 1 14
Other non-taxation revenues 13 15 16 4
Total operatlnl! revenues 3,074 3,531 3,704 892
Operating expenses Operating expenses 594 295 1,304 3,120
Employees 1,282 1,751 1,038 697
Other 96 110 115 28
Total operatlnl! expenses 1,972 2,156 2,457 3,845
Outcome 9
Output 1 Output 2 Output3 Output 4
Actual Actual Actual Actual
$'000 $'000 $'000 s·ooo
Operating revenues Revenues from govenunent 4,741 2,881 5,703 9,728
Sale of goods and services 98 344 2 3
Other non-taxation revenues 20 12 24 41
Total operatln!! revenues 4,859 3,237 5,729 9,772
Operating expenses Operating expenses 747 1,508 3,591 906
Employees 3,176 4,180 2,532 4,977
Other 149 90 179 305
Total operatlnl! expenses 4,072 5,778 6,302 6,188
289
Total
Actual $'000
24,471 12 104 24,587
4,548 13,584 767 18,899
OutputS Output 6 Total
Actual Actual Actual
s·ooo $'000 $'000
3,490 3,280 17,906
191 1 209
15 14 77
3,696 3,295 18,192
254 2,572 8,139
1,536 418 6,722
109 103 561
1,899 3,093 15,422
Output 5
Total
Actual Actual
$'000 $'000
383 23,436
0 447
2 99
385 23,982
20 6,772
437 15,302
12 735
469 22,809
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 41 Major Administered Revenues & Expenses
Outcome
I 2 3
Actual Actual Actual
$'000 $'000 $'000
Operating revenues Non taxation Revenues from government 385,919 18,365,029 4,271,197
Other 5,079 894,973 5,309
Total non taxation 390,998 19,260,002 4,276,506
Total operating revenues 390,998 19,260,002 4,276,506
Operating expenses Subsidies - - 3,517,501
Personal Benefits - 11,536,619 43
Grants 367,262 6,708,288 824,711
Other 290 276 70
Total operating expenses 367,552 18,245,183 4,342,325
290
4 5
Actual Actual
$'000 $'000
435,830 63,670
456 337
436,286 64,007
436,286 64,007
- -
35,253 -
592,671 61,439
381 3
628,305 61,442
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30June 2001
Note 41 Major Administered Revenues & Expenses (cont'd)
Outcome
6 7 8 9
Actual Act ual Actual Actual
$'000 $'000 $'000 $'000
153,843 174,257 2,007,031 309,411
2,815 1,235 58,162 (285,357)
156,658 175,492 2,065,193 24,054
156,658 175,492 2,065,193 24,054
. . . .
127,847 1,930,557 .
28,694 185,306 1,002 356,254
. 126 8,099 609
156,541 185,432 1,939,658 356,863
291
Total
Budget Actual
$'000 $'000
25 ,586,352 26, 166,187 66,929 683 ,009
25,653,281 26,849,196 25,653,281 26,849,196
3,615,765 3,517,501
129,796 13,630,319
21 ,837,019 9,125,627
3,772 9,854
25,586,352 26,283,301
DEPARlMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 42 Executive Remuneration
The number of executive officers who received or who were due to receive remuneration of$100,000 or more:
$100,000 to $110,000 $110,001 to $120,000 $120,001 to $130,000 6
$130,001 to $140,000 18
$140,001 to $150,000 23
$150,001 to $160,000 2
$160,001 to $170,000 14
$170,001 to $180,000 2
$180,001 to $190,000 1
$190,001 to $200,000 1
$210,001 to $220,000 1
$220,001 to $230,000 1
$250,001 to $260,000 $300,001 to $310,000 $330,001 to $340,000
71
Aggregate total remuneration of executive officers as shown above is $10,632,393 (1999-00: $10,985,739)
Aggregate performance pay received/receivable by the above officers was $447,351 (1999-00: $285,982).
Aggregate separation and redundancy payments received was $0 (1999-00: $274,119)
Note 43 Services provided by the Auditor-General
Audit services provided free of charge by the Australian National Audit Office for the audit of the Department of Health and Aged Care financial statements for the year ended 30 June 2001 have been estimated by the Australian National Audit Office at $600,000 (1999-00: $600,000).
292
6
13 13
19 4
5
4
2
2
74
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS f or the period ended 30 June 2001
Note 44 Agency Act of Grace Payments, Waivers, Defective Administration Scheme
No Act of Grace payments were made during the reporting period.
No waivers of amounts owing to the Connnnwealth were made pursuant to Subsection 34( I) of the Financial Management and Accountability Act 1997
No payments were made under the Defective Administration Scheme during the reporting period.
Note 45 Average Staffing Levels
Average staffing levels by outcome and in total were as follows:
Outcome I 914 927
Outcome 2 503 407
Outcome 3 873 798
Outcome 4 334 342
Outcome 5 86 58
Outcome 6 68 75
Outcome 7 249 231
Outcome 8 115 80
Outcome 9 266 149
Total Average Staffing Levels 3,408 3,067
In 2000-01, the Outcome structure was reduced from 10 to 9. For comparative purposes, the average staffing level for 1999-00 was recast to the appropriate outcomes.
293
DEPARTMENT OF HEALTH AND AGED CARE NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Therapeutic Goods Administration
Special Account
Independent Audit Report
Statement by the Departmental Secretary and ational Manager
Statement of Financial Performance
Statement of Financial Position
Statement of Cash Flows
Schedule of Commitments
Schedule of Contingencies
otes to and forming part of the Financial Statements
297
298
301
302
303
304
305
306
307
Australian National
Audit Office
INDEPENDENT AUDIT REPORT
To the Minister for Health and Aged care
I have audited the financial statements of the Therapeutic Goods Admin istration for the year ended 30 June 2001. The financial statements comprise:
⢠Statement by the Departmental Secretary and the National Manager ;
⢠statements of Financial Performance, Financial Position and Cashflows;
schedules of Contingencies and Commitments; and
⢠Notes to and forming part of the Financial Statements.
The Department's Secretary and the National Manager of the Therapeutic Goods Administration are responsible for the preparation and presentation of the financial statements and the information they contain. I have conducted an independent audit of the financial statements in order to express an opinion on them to you .
The audit has been conducted in accordance with the Australian National Audit Office Auditing Standards, which incorporate the Australian Auditing Standards, to provide reasonable assurance as to whether the financial statements are free of material misstatement. Audit procedures included examination, on a test basis, of evidence supporting the amounts and other disclosures in the financial statements, and the evaluation of accounting policies and significant accounting estimates. These procedures have been undertaken to form an opinion as to whether, in all material respects, the financial statements are presented fairly in accordance with Australian Accounting Standards, other mandatory professional reporting requirements and statutory requirements in Australia so as to present a view of the Therapeutic Goods and Administration which is consistent with my understanding of its financial position, its operations and its cash flows.
The audit opinion expressed in this report has been formed on the above basis.
298
GPO Box 707 CANBERRA ACT 260 1 Centen ary House 19 Nati onal Circ uit BA RTO N ACT Phone (02) 6203 7300 Fa x (02) 6203 7777
Audit Opinion
In my opinion ,
(i) the financial statements have been prepared in accordance with Schedule 1 of the Financial Management and Accountability (Financial Statements 2000-2001) Orders;
(ii ) the financial statements give a true and fair view, in accordance with applicable Accounting Standards, other mandatory professional reporting requirements and Schedule 1 of the Financial Management and Accountability (Financial Statements 2000-2001) Orders, of the financial position of the Therapeutic Goods Administration as at 30 June 2001 and the
results of its operations and its cash flows for the year then ended .
Australian National Aud it Office
Delegate of the Aud itor-General
Canberra 3 September, 2001
299
Statement by the Departmental Secretary and National Manager
In our opinion, the attached financial statements give a true and fair view of the matters required by Schedule 1 of the Financial Management and Accountability (Financial Statements 2000/0 I) Orders.
!t* Secretary Department of Health and Aged Care s ) August 2001
301
Terry Slater National Manager Therapeutic Goods Administration
-JC( August 2001
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
STATEMENT OF FINANCIAL PERFORMANCE for the period ended 30 June 2001
Notes
Revenues from ordinary activities
Revenues from government Revenue for services Interest received Proceeds from disposal of assets Other
Total revenues from ordinary activities
Expenses from ordinary activities Employees Suppliers Depreciation and amortisation Write-down of assets Disposal of assets
Total expenses from ordinary activities
2A 2B 2C 3D 2D
3A 3B 3C
3D
Net operating surplus (deficit) from ordinary activities
Net Surplus/( deficit)
Equity interests Net surplus (deficit) attributable to the Commonwealth
Total changes in equity other than those resulting from transactions with owners as owners
2000-01 $
60,000
45,859,102 400,109
1,304,087
47,623,298
27,645,020 16,495,156 1,992,377
22,250
46,154,803
1,468,495
1,468,495
1999-00 $
215,825 41 ,434,418 538,283 614,869
1,579,828
44,383,223
28,742,040 17,397,480 2,482,129 54 ,388
956,942
49,632,979
(5,249,756)
(5,249,756)
1,468,495 (5,249,756)
1,468,495 (5,249,756)
The above statement should be read in conjunction with the accompanying notes.
2
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
STATEMENT O F FINANCIAL POSITION as at 30June 2001
Notes 2000-01 1999-00
$ $
ASSETS Financial assets Cash 4A 10,011,120 6,70 1,173
Receivables 4B 3,533,764 3,177,968
Total financial assets 13,544,884 9,879, 14 1
Non-financial assets Infrastructure, plant and equipment SA,B,C 6,556,156 7,19 1,744
Inventories SD 111,843 120,106
Intang ibles SE 4,162,896 3,393,480
Other SF 271 ,913 297,627
Total non-financial assets 11 ,102,808 11 ,002,957
Total assets 24,647,692 20,882,098
LIABILITIES Provisions Employees 6A 9,193,036 8,903,423
Total provisions 9,193,036 8,903,423
Payables Suppliers 7A 1,926,119 2,050,199
Other 7B 7,163,025 5,03 1,459
Total payables 9,089,144 7,081 ,658
Total liabilities 18,282,180 15,985 ,081
EQUITY Parent entity interest Reserves 356,588 356,588
Accumulated surpluses (deficits) 6,008,924 4 ,540,429
Total parent entity interest 8 6,365,512 4,897,017
Total equity 6,365,512 4,897 ,017
Current liabilities 11,539,635 9,606, 111
Non-current liabilities 6,742,545 6,378,970
Current assets 13,928,640 10,176,768
Non-current assets 10,719,052 10 ,705 ,330
The above statement should be read with the accompanyin g notes .
303
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
STATEMENT OF CASH FLOWS for the period ended 30 June 2001
Notes 2000-01 1999-00
$ $
OPERATING ACTMTIES
Cash received: Client recoveries 45,828,822 38,729,983
Interest receipts 422,053 505 ,793
GST refunds 1,129,245
Other 1,960,855 1,096,511
Total cash received 49,340,975 40,332,287
Cash used: Employees (27,355,407) (28,218,922)
Suppliers (16,291,725) (16,152,671)
Total cash used (43,647,132) ( 44,371 ,593)
Net cash from (used by) operating activities 9 5,693,843 ( 4 ,039 ,306)
INVESTING ACTIVITIES
Cash received: Proceeds from sales of infrastructure, plant and equipment 614,869
Total cash received 614,869
Cash used: Purchase of infrastructure, plant and equipment (2,383,896) (4,756,516)
Total cash used (2,383,896) (4 ,756,516)
Net cash from (used by) investing activities (2,383,896) (4,141 ,647)
Net increase (decrease) in cash held 3,309,947 (8,180,953)
Cash at the beginning ofthe reporting period 6,701,173 14 ,882, 126
Cash at the end of the reporting period 4A 10,011,120 6,701 ,173
The above statement should be read in conjunction with the accompanying notes
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT SCHEDULE OF COMMITMENTS as at 30 June 2001
BY TYPE
CAPITAL COMMITMENTS
Intangible assets
Total capital commitments
OTHER COMMITMENTS
Operating leases
Other commitments
Total other commitments
Net commitments
BY MATURITY
All net commitments
One year or less
From one to five years
Over five years
Net operating commitments
Operating Lease Commitments
One year or less
From one to five years
Over five years
Net commitments
Notes 2000-01
$
2,297,691
2,297,691
87,101,833
11,605,310
98,707,143
101,004,834
10,897,613
33,527,108
56,580,113
101,004,834
6,317,140
24,204,580
56,580,113
87,101,833
The above schedule should be read in conjunction with the accompanying notes.
1999-00 $
3,320,000
3,320,000
2,780,428
13 ,430,000
16,210,428
19,530,428
5,369,201
14,161 ,227
19 ,530,428
871,201
1,909,227
2,780,428
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT SCHEDULE OF CONTINGENCIES as at 30 June 2001
Notes
CONTINGENT LOSSES
Claim for damages/costs
Total contingent losses
CONTINGENT GAINS
Net contingencies
2000-01 $
1999-00 $
300,000
300,000
300,000
The amount represents an estimate of the Therapeutic Goods Administration 's liability based on precedent cases.
The above schedule should be read in conjunction with the accompanying notes.
6
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for lht period ended 30 Junt 2001
Note 1
2
2A 29 2C 20
3
3A
39 3C 30 4
4A 49 5
5A 59 5C 50
5E 5F 6
6A 7
7A 79 8
9
10 11
12
13
14 15 15A
159 15C
Description Summary of Significant Accounting Policies Operating Revenues Revenues from Government
Revenues for Services Interest Received other Revenue Operating Expenses Employee Expenses Suppliers Expenses Depreciation and Amortisation Proceeds and Expense from Sales of Assets Financial Assets Cash Receivables Non-Financial Assets Property, Plant and Equipment Analysis of Property, Plant, Equipment and Intangibles Analysis of Property, Plant, Equipment and Intangibles
Inventories Intangible Assets other Provisions Employee Provisions Payables Suppliers other Payables Equity Cash Flow Reconciliation Audit Fee Remuneration of Officers Economic Dependency Management and Information Technology Services Received from the
Department of Health and Aged Care Average staffing Levels Financial Instruments Terms, conditions and accounting policies
Interest Rate Risk Net fair value of Financial Assets and Liabilities
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 200 I
Note 1. Summary of Significant Accounting Policies
(a) Objectives of Therapeutic Goods Administration
The Therapeutic Goods Administration (TGA) contributes to Outcome I - the promotion and protection of the health of all Australians and minimising the incidence of preventable mortality, illness, injury and disability.
Therapeutic goods are regulated to ensure that medicinal products and medical devices in Australia meet standards of safety, quality and efficacy at least equal to that of comparable countries. These products and devices should be made available in a timely manner and the regulatory impact on business kept to a minimum. This is achieved through a risk management approach to pre-market evaluation and approval of therapeutic products intended for supply in Australia, licensing of manufacturers and post market surveillance.
(b) Basis of Accounting
The financial statements are a general-purpose financial report. These statements have been prepared in accordance with: ⢠Schedule I to Orders made by the Finance Minister for the preparation of Financial Statements in relation to financial years ending on or after 30 June 200 I;
Australian Accounting Standards and Accounting Interpretations issued by the Australian Accounting Standards Boards; ⢠Other authoritative pronouncements ofthe Boards; and Consensus Views of the Urgent Issues Group.
The statements have been prepared having regard to: Statements of Accounting Concepts; ⢠The Explanatory Notes to Schedule I issued by the Department of Finance and Administration; and Guidance Notes issued by the Department.
The Therapeutic Goods Administration Statements ofFinancial Performance and Financial Position have been prepared on an accrual basis and are in accordance with historical cost convention, except for certain assets which, as noted, are at valuation. Except where stated, no allowance is made for the effect of changing prices on the results or the financial position.
Assets and liabilities are recognised in the Statements of Financial Position when and only when it is probable that future economic benefits will flow and the amounts of the assets or liabilities can be reliably measured. Assets and liabilities arising under agreements equally proportionately unperformed are however not recognised unless required by an Accounting Standard. Liabilities and assets which are unrecognised are reported in the Schedule of Commitments.
Revenues and expenses are recognised in the Statement ofFinancial Performance when and only when the flow or consumption or loss of economic benefits has occurred and can be reliably measured .
(c) Rounding
Amounts are rounded to the nearest dollar.
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 1. Swnmary of Significant Accounting Policies (cont'd)
(d) Infrastructure, Plant, Equipment and Intangibles
Purchases of infrastructure, plant and equipment are recognised initially at cost in the Statement of Financial Position, except for purchases less than $2,000. Leasehold improvements to properties with values of $10,000 or greater are capitalised. Any purchases under these thresholds are expensed in the year of acquisition (other than where they form part of a group of similar items that are significant in total).
Infrastructure, plant and equipment that have been acquired free of charge or for a nominal amount are recognised initially at fair value.
The TGA is undertaking some internal software development. The costs of development are recognised and capitalised.
The TGA in compliance to Schedule 2 revalued the infrastructure, plant and equipment under the "deprival" method on the 30 June 1999. The internally developed software was valued under the "deprival " method by the Department of Health and Aged Care in the 1997-98 financial year.
The revaluations have been at the Agency' s valuation. In accordance with AAS!O Accounting for the Revaluation of Non-Current Assets, the carrying amounts of these non-current assets have been reviewed to determine whether they are in excess of their recoverable amounts.
Depreciable infrastructure, plant, equipment and intangible assets are written off to their estimated residual values over their useful lives to the TGA using, in all cases, the straight line method of depreciation . Leasehold improvements are amortised on the straight line basis over the lesser of the estimated useful life of the improvements or the unexpired period of the lease. Similarly, internally developed software is amortised on the straight line basis over the estimated useful life of the asset.
Depreciation/amortisation rates (useful lives) and methods are reviewed at each balance date and necessary adjustments are recognised in the current, or current and future reporting periods, as appropriate. Residual values are re-estimated for a change in prices only when assets are revalued.
Depreciation and amortisation rates applying to each class of depreciable asset are as follows :
Leasehold improvements Plant and equipment Intangibles
2000-01 Lease term 5 to 20 years 3 to 10 years
1999-00 Lease term 5 to 20 years 3 to 10 years
The aggregate amount of depreciation and amortisation allocated for each class of assets during the reporting period is disclosed in Note 3C.
(e) Liability for Employee Entitlements
(i) Leave
The liability for employee entitlements includes provisions for annual leave and long service leave. No provision has been made for sick leave as all sick leave is non-vesting and the average sick leave taken in future years by employees is estimated to be less than the annual entitlement for sick leave.
The liability for annual leave reflects the value of the total annual leave entitlements of all employees at 30 June 200 I and is recognised at its nominal value.
The provision for long service leave is recognised and measured at the present value of the estimated future cash flows to be made in respect of all employees at 30 June 200 ! . In determining the present value of the liability, the TGA has taken into account the attrition rate and pay increases through promotion and inflation.
309
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 1. Summary of Significant Accounting Policies (cont'd)
(e) Liability for Employee Entitlements (cont'd)
(ii) Separation and redundancy
Provision is made for the separation and redundancy payments in circ*mstances where the TGA has formall y identified positions as excess to requirements and a reliable estimate of the amount of the payments can be determined.
(0 Superannuation
Employees contribute to the Commonwealth Superannuation Scheme and the Public Sector Superannuation Scheme. Employer contributions amounting to $3,400,509 (1999-00 $3,517,145) in relation to those schemes have been expensed in the financial statements.
No liability is shown in the Statement of Financial Position for superannuation as the employer contributions have fully extinguished the accruing liability assumed by the Commonwealth.
Employer contributions include Productivity Benefit contributions.
(g) Property Leases
The leases undertaken by the TGA are accounted for as operating leases under the Australian Accounting Standard (AAS) 17. Operating lease payments are charged to the Statement of Financial Performance on a basis which is representative of the pattern of benefits derived from the leased assets. The net present value of future net outlays in respect of surplus space under non-cancellable lease agreements is expensed in the period in which the space becomes surplus.
The TGA does not have any finance lease to report.
(h) Unearned Income
The provision of service is recognised as revenue as the services are provided. However, for some services payment is required in advance. Where the moneys for these services have been received or the service has been invoiced at year end, but the service that has not been provided, the relevant amount has been disclosed as unearned income.
(i) Cash
Cash includes notes and coins held and deposits or money market instruments held at call with a bank or financial institution.
(j) Contingencies
The TGA will recognise a material contingency in its financial statements if the probability that the future event has a certainty it will eventuate with a gain or a loss.
Where a material contingency is not recognised as a revenue or expense, it will be disclosed in the Schedule of Contingencies.
310
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 1. Summary of Significant Accounting Policies (cont'd)
(k) Taxation
The TGA is exempt from all forms of taxation except Fringe Benefits Tax and the Goods and Services Tax.
(I) Comparative Figures
Comparative figures have been adjusted to conform to changes in presentation in these financial statements, where required.
(m) Resources Received Free of Charge
Resources received free of charge are recognised as revenues in the Statement of Financial Performance where their fair value can be reliably measured. Use of the resources is recognised as an expense or an asset, according to whether there is a long term benefit.
(n) Bad and Doubtful Debts
Bad debts are written off during the year in which they are identified. A provision is raised for doubtful debts based on a review of all outstanding receivables at year end.
(o) Financial instruments
Accounting policies in relation to financial instruments are disclosed in Note 15.
(p) Insurance
The TGA has insured for risks through the Government's insurable risk managed fund called "Comcover". Workers compensation is insured through Comcare Australia.
( q) Inventories
Inventories held for resale are valued at the lower of cost and net realisable value .
Inventories not held for resale are valued at cost, unless they are no longer required, in which case they are valued at the net realisable value.
311
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS f or the period ended 30 June 2001
Note 2. Operating Revenues
Note 2A. Revenues from government
Resources received free of charge
Total Revenues from government
Note 28. Revenue for services
Services
Total Revenue for services
Note 2C. Interest received
Bank interest
Total Interest received
Note 2D. Other revenue
Publications Laboratory testing Training and consultancy Commercial activities Other
Total Other Revenue
2000-01 $
60,000
60,000
45,859,102
45,859,102
400,109
400,109
23,965 117,182 48,213 163,012 951,715
1,304,087
1999-00 $
215,825
215,825
41 ,434,418
41,434,418
538,283
538,283
112 ,477 46,085 92,952 395 ,162 933 ,152
--- 1,579,828
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 3. Operating Expenses
Note 3A. Employee Expenses
Remuneration (for services provided) Separation and redundancy
Total remuneration
Other employee expenses
Total Employee Expenses
Note 38. Suppliers Expenses
Supply of goods and services Operating lease rentals
Total Suppliers Expenses
Note 3C. Depreciation and Amortisation
Depreciation of infrastructure, plant and equipment Amortisation of leasehold improvements Amortisation of internally developed software
Total Depreciation and Amortisation
Note 3D. Proceeds and Expense from Sales of Assets
Non-financial assets - infrastructure, plant and equipment Revenue (proceeds) from sale Expense from sale
Total
313
2000-01 $
22,855,648 787,807
23,643,455
4,001,565
27,645,020
14,323,481 2,171,675
16,495,156
665,881 282,746 1,043,750
1,992,377
22,250
22,250
1999-00 $
23 ,724,456 637,975
24,362,431
4,379,609
28,742,040
15,211,630 2,185,850
17,397,480
1,129,0 11 189,106 1,164,012
2,482)29
614,869 956,942
342,073
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 4. Financial Assets
Note 4A. Cash
Cash at bank and on hand
Investments: Term deposits and at call
Balance of trust bank account
Balance of cash as at 30 June shown in the Statement of Cash Flows
Note 48. Receivables
Goods and services GST receivable Other debtors
Less: Provision for doubtful debts
Net Receivables
Receivables (gross) are aged as follows:
Not overdue Overdue by: Less than 30 days 30 to 60 days
60 to 90 days More than 90 days
314
2000-01 $
11,080
8,120,447
8,131,527
1,879,593
10,011,120
3,101,372 368,044 64,348
3,533,764
3,533,764
1,864,906
1,174,472 390,925 45,495 57,966
3,533,764
1999-00 $
10,971
4,761 ,347
4,772,318
1,928,855
6,701 ,173
2,484,835 4,461 743,060
3,232,356 54,388
3,177,968
2,347,585
712,809 73,205 14,910 29,459
3,177,968
---
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS f or the period ended 30 June 2001
Note 5. Non-Financial Assets
Note SA. Property, Plant and Equipment
Plant and equipment - at cost Accumulated depreciation
Plant and equipment - at 1998-99 valuation Accumulated depreciation
Furniture and fittings - at 1998-99 valuation Accumulated depreciation
Computer equipment- at cost Accumulated depreciation
Computer equipment - at 1998-99 valuation Accumulated depreciation
Office machines - at cost Accumulated depreciation
Office machines - at 1998-99 valuation Accumulated depreciation
Laboratory equipment - at cost Accumulated depreciation
315
2000-01 $
56,938 (21,398)
35,540
258,032 (127,296)
130,736
36,342 (12,634)
23,708
94,340 (59,620)
34,720
238,409 (206,375)
32,034
---
14,693 (2,268)
12,425
628,916 (455,078)
173,838
---
577,065 (142,727)
434,338
1999-00 $
258,032 (113,004)
145,028
36,342 (10,420)
25,922
89,466 (29,374)
60,092
249,146 (189,673)
59,473
13,361 (1,196)
12,165
628,916 (382,787)
246,129
515,075 (54,095 )
460,980
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 5. Non-Financial Assets (cont'd)
Note SA. Property, Plant and Equipment (cont'd)
Laboratory equipment - at 1998-99 valuation Accumulated depreciation
Leasehold improvements - at cost Accumulated amortisation
Leasehold improvements - at 1998-99 valuation Accumulated amortisation
Leasehold improvements- Work in progress
Total Infrastructure, Plant and Equipment
2000-01 $
4,930,467 (3,969,801)
960,666
3,014,595 (165,889)
2,848,706
2,294,090 (424,645)
1,869,445
6,556,156
1999-00 $
5,029,225 (3,635,932)
1,393,293
2,778,727 (36,083)
2,742,644
2,294,090 (271 ,704)
2,022,386
23,632
7,191,744
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 5. Non-Financial Assets (cont'd)
Note 5B. Analysis of Property, Plant, Equipment and Intangibles
TABLE A
2000-01 movement summary for all assets irrespective of valuation basis
Item Plant& Buildings - Computer
Equipment Leasehold Software-hnprovements Total Intangibles $ $ $
Gross value as at 1 July 2000 6,843,196 5,072,817 5,719,850
Additions : - Acquisition of new assets 96,443 235,868 1,813 ,167
Disposals (104,437) - -
Gross value as at 30 June 2001 6,835,202 5,308,685 7,533,017
Accumulated Depreciation charge as at 1 July 2000 4,416,482 307,787 2,326,370
Depreciation/amortisation charge for assets held 1 July 2000 661,786 271,739 1,043,549
Depreciation/amortisation charge for additions 4,093 11 ,008 202
Adjustment for disposal (85,164) - -
Accumulated depreciation/
Amortisation as at 30 June 2001 4 997,197 590,534 3,370,121
Net book value as at 30 June 1,838,005 4,718,151 4,162,896
2001
Net book value as at 1 July 2000 2,426,714 4,765,030 3,393,480
Total
$
17,635,863
2,1 45,478
(104,437)
19,676,904
7,050,639
1,977,074
15,303
(85 ,164)
8,957,852 10,719,052
10,585,224
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 5. Non-Financial Assets (cont'd)
Note 5C. Analysis of Property, Plant, Equipment and Intangibles
TABLEB
Summary of balances of assets at valuation as at 30 June 2001
Item
Plant& Buildings - Computer
Equipment Leasehold Software-mprovement Total Intangibles
$ $ $
As at 30 June 2001
Gross value
6,092,166 2,294,090 3,299,959
Accumulated depreciation/amortisation 4,771 ,184 424 ,645 2,824,624
Net book value 1,320,982 1,869,445 475,335
As at 30 June 2000
Gross value 6,201 ,661 2,294,090 3,299,959
Accumulated 4,331,816 271 ,704 1,888,694
depreciation/amortisation
Net book value 1,869,845 2,022,386 1,411,265
2000-01 $
Note 50. Inventories
Inventories not held for sale (cost) 111,843
Total Inventories 111,843
318
Total
$
11 ,686,215
8,020,453
3,665,762
11 ,795 ,710
6,492,214
5,303,496
1999-00 $
120,106
120,106
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES T O AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 5.Non-Financial Assets (cont'd)
Note 5E.Intangible Assets
Internally developed software - at cost Accumulated amortisation
Internally developed software- at 1997-98 valuation Accumulated amortisation
Internally developed software - in progress at cost
Total Intangible Assets
Note 5F. Other
Prepaid property rentals Other prepayments
Total Other
Note 6. Provisions
Note 6A.Employee Provisions
Salaries and wages Superannuation Annual leave Long service leave
Separation and redundancy
Aggregate Employee Entitlement Liability
Note 7. Payables
Note 7 A. Suppliers
Trade creditors
Total Suppliers
319
2000-01 $
756,807 (545,497)
211,310
3,299,959 (2,824,624)
475,335
3,476,251
4,162,896
174,772 97,141
271,913
694,464 200,000 3,272,247 5,026,325
9,193,036
1,926,119
1,926,119
1999-00 $
748,738 (437,676)
311 ,062
3,299,959 (1 ,888,694)
1,411,265
1,671,153
3,393,480
179,818 117,809
297,627
750,131
3,1 44,840 4,808,872 199,580
8,903,423
2,050,199
2,050,199
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 7B.Other Payables
Unearned income
Total Others
Note 8. Equity
2000-01 $
7,163,025
7,163,025
1999-00 $
5,031,459
5,031,459
Item Accumulated results Asset revaluation Total reserves TOTAL EQUITY
00-01 99-00
$ $
Balance 1 July 2000 4,540,429 9,790,185
Operating result 1,468,495 -5,249,756
Balance 30June 2001 6,008,924 4,540,429
Note 9. Cash Flow Reconciliation
reserve
00-01 99-00
$ $
356,588 356,588
- -
356,588 356,588
00-01 99-00
$ $
356,588 356,588
-
356,588 356,588
00-01 $
4,897,017
1,468,495
6,365,512
2000-01 $
Reconciliation of Cash per Statement of Financial Position to to Statement of Cash Flows ⢠Cash at year end per Statement of Cash Flows ⢠Statement of Financial Position items comprising above
cash: 'Financial Asset - Cash'
10,011,120
10,011,120
Reconciliation of operating surplus to net cash provided by operating activities:
Net surplus (deficit) 1,468,495
Resources received free of charge Depreciation/amortisation of infrastructure, plant, equipment and intangibles 1,992,377
Loss on sale of non-current assets 22,250
Write down of assets (52,482)
Changes in assets and liabilities Increase/( decrease) in employee liabilities 289,613
(Increase )/decrease in inventories 8,263
(Increase)/decrease in receivables (301,408)
(Increase )/decrease in other assets 25,714
Increase/( decrease) in liability to suppliers 109,454
Increase/( decrease) in other payables 2,131,567
Net Cash provided (used) by Operating Activities 5,693,843
320
99-00 $
10,146,773
-5,249,756
4,897,017
1999-00 $
6,701,173
6,701,173
(5,249,756) (155,825)
2,482,129 342,073 54,388
523,118
(1,255,992) 113,008 1,071,801 (1 ,964,250)
(4,039,306)
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 10. Audit Fee
The auditing of the TGA's financial statements for the reporting period has been provided free of charge by the Australian National Audit Office.
The Australian National Audit Office provided no other services to the TGA.
Note 11. Remuneration of Officers
The number of Executives who received or were due to receive total remuneration of$100,000 or more:
$110,001- $120,000 $120,001 - $130,000 $130,001-$140,000 $140,001 - $150,000 $150,001 - $160,000 $160,001-$170,000 $170,001-$180,000 $180,001-$190,000 $190,001 -$200.000 $220,001 -$230,000 $260,001 - $270,000
The aggregate amount oftotal remuneration of Executives show n above
Note 12. Economic Dependency
2000-01 $
60,000
2
1
1
1
8
1,275,966
1999-00 $
60,000
3
2
8
1,317,658
For the year ended 30 June 2001 the TGA was economically dependent on a 100% cost recovery to fund its operation.
Note 13. Management and Information Technology Services Received from the Department of Health and Aged Care
The aggregate amount brought to account in respect of corporate management and information technology services provided by the Department of Health and Aged Care was $2,544,087 (1999-00 $4,985,101 ).
Note 14. Average Staffing Levels
The average staffing levels for the business operation during the year were:
321
2000-01 1999-00
375 419
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 15. Financial Instruments
(a) Tenns, conditions and accounting policies
Financial Notes Accounting Policies and Nature of underlying instrument
Instrument Methods (including significant terms &
(including recognition criteria conditions affecting the and measurement basis) amount, timing and certainty of cash flow) Financial Financial assets are recognised
Assets when control over future
economic benefits is established and the amount of the benefit can be reliably measured.
Investments- 4A The deposits are recognised at Temporarily surplus funds are Term deposits their nominal amounts. Interest placed on short term commercial and at call is credited to revenue as it bank bills and deposits at call
accrues. with Australian banks. Interest
is earned at the prevailing rate and paid at maturity from commercial bank bills and at month end for deposits at call.
Receivables 4B These receivables are recognised Credit terms are net 28 days for goods and at the nominal amounts due less with the exception of evaluation
services any provision for bad and fee debtors at net 60 days.
doubtful debts. Provisions are made when collection of the debt is judged to be less rather than more likelv.
Other debtors 4B As for receivables for goods and As for receivables for goods and services. services.
322
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 15. Financial Instruments (cont'd)
(a) TemtS, conditions and accounting policies (cont'd)
Financial Notes Accounting Policies and Nature of underlying
Instrument Methods instrument
(including recognition criteria (including significant temtS and measurement basis) & conditions affecting the
amount, timing and certainty of cash flow)
Financial Financial liabilities are recognised
Liabilities when a present obligation to
another party is entered into and the amount of the liability can be reliably measured.
Trade creditors ?A Creditors and accruals are Settlement is usually made net
recognised at their nominal 30 days.
amounts, being the amounts at which the liabilities will be settled. Liabilities are recognised to the extent that the goods or services
have been received (and irrespective of having been invoiced).
Other- 7B Where a service has been invoiced The provision of service is
Unearned in advance or a service payment only recognised as revenue
income has been received in advance, the when the service has been
relevant amount is disclosed as provided. unearned income.
323
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS (or the period ended 30 June 2001
Note 15. Financial Instruments (cont'd)
(b) Interest Rate Risk
Financial Notes Floating Interest Rate Fixed Interest Rate
Instrument 1 year or less
00-01 99-00 00-01 99-00
$ $ $ $
Financial Assets (Recognised)
Cash at Bank 4A 1,879,593 1,928,855
Cashon Hand 4A
Investments- Tenn deposits 4A 8,120,447 4,761 ,347
Receivables for goods and services 4B
Other debtors 4B
Total Financial Assets (Recognised) 10,000,040 6,690,202
Total Assets
Financial Liabilities (Recognised)
Trade creditors 7A
Others - unearned income 7B
Total Financial Liabilities (Recognised) Total Liabilities
324
THERAPEUTIC GOODS ADMINISTRATION TRUST ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 15. Financial Instruments (cont'd)
(b) Interest R ate Risk
Non Interest Bearing
00-01 99-00
$ $
11,080
3,469,416 64,348
3,544,844
1,926,119 7,163,025
9.089.144
10,971
2,434,908 743 ,060
3, 188,939
2,050,199 5,031,459
7,081,658
00-01 $
Total
1,879,593 11,080 8,120,447
3,469,416 64,348
13,544,884 24,647,692
1,926,119 7,163,025
9.089.144
18,282,180
325
99-00 $
1,928,855 10,971 4,761 ,347
2,434,908 743,060
9,879,141 20,882,098
2,050,199 5,031,459
7.081,658
15 ,985,081
Weighted Average Effective Interest Rate 00-01 99-00
2.00 nla 5.71
nla nla
nla nla
nla
%
nla nla 5.29
nla nla
nla nla
nla
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES T O AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 30 June 2001
Note 15. Financial Instruments (cont'd)
(c) Net fair value of Financial Assets and Liabilities
2000-01 1999-00
Total Aggregate Total Aggregate
carrying net fair carrying net fair
Note amount value amount value
$ $ $ $
Financial Assets
Cash at Bank 4A 1,879,593 1,879,593 1,928,855 1,928,855
Cash on Hand 4A 11,080 11,080 10,971 10,971
Investments 4A 8,120,447 8,120,447 4,761,347 4,761,347
Receivables for goods and services 4B 3,469,416 3,469,416 2,434,908 2,434,908
Other debtors 4B 64,348 64,348 743,060 743,060
Total Financial Assets 13,544,884 13,544,884 9,879,141 9,879,141
Financial Liabilities (Recognised)
Trade creditors 7A 1,926,119 1,926,119 2,050,199 2,050,199
Unearned income 7B 7,163,025 7,163,025 5,031,459 5,031,459
Total Financial Liabilities (Recognised) 9,089,144 9,089,144 7,081,658 7,081,658
Financial Liabilities (Unrecognised) Schedule of
Contingencies
Total Financial Liabilities (Unrecognised)
326
THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCOUNT
NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS for the period ended 3 0 June 2001
Note 15. Financial Instruments (cont'd)
(c) Net fair value of Financial Assets and Liabilities (cont'd)
Financial Assets
The net fair value of cash, deposits on call and non-interest bearing monetary financial assets approximate their carrying amounts.
The net fair value for interest bearing investments is the quoted market price at reporting date adjusted for the transaction costs necessary for realisation.
Financial Liabilities
The net fair value for trade creditors is short term in nature and is the approximated carrying amounts.
None of the classes of financial liabilities is readily traded on organised markets in standardised form .
(d) Credit risk exposures
The economic entity' s maximum exposures to credit risk at reporting date in relation to each class of recognised financial assets is the carrying amount of those assets as indicated in the Statement of Financial Position.
The economic entity has no significant exposures to any concentrations of credit risk.
All figures for credit risk referred to do not take into account the value of any collateral or other security.
327
In dex
A
2000 Aged Care Approvals Round see Aged Care Approvals Round 2000 Rock Eisteddfod Challenge, 44 2001 Aged Care Approvals Round, 82 A New Tax System (ANTS), 74-75 Abo riginal and Torres Strait Islander Aged Care
Strategy, 103 Abo riginal and Torres Strait Islander Commission, 5, 165, 166, 167, 168, 169 Abo riginal and Torres Strait Islander Emotional
and Social Wellbeing Action Plan, 172 Abo riginal and Torres Strait Islander Framework Agreements, 167 Abo riginal and Torres Strait Islander Health,
7, 8, 128 aged care services, 101, 103 capital works, 169 chronic diseases, 165, 17 4 coordinated care trials, 168 data collection, 171-172 diabetes, 17 4 environmental health, 36 eye health, 173-174 framework agreement, 164 health financing, 169 hearing services, 151, 155, 156-157 health status, 163, 165 life expectancy, 17 6 mental health, 123, 172-173 patient recall, 170 pharmaceutical services, 135, 143, 168-169 primary health care, 7, 164, 168, 170, 176 quality use of medicines, 144 scholarships, 140 sexually transmitted diseases, 174- 175 worforce, 170-171, 176
329
Aboriginal and Torres Strait Islander Health: Outcome 7, 163-178 achievements, 164 financial resources summary, 178 outcome summary, 165 performance indicators, 176-177 under-achievements, 164 Aboriginal and Torres Strait Islander Health
Council, 166 Aboriginal and Torres Strait Islander Health Framework Agreement, 7 Aboriginal and Torres Strait Islander peoples,
families and communities, 5, 38, 64, 65, 70, 71 , 78, 113 Aboriginal Community Controlled Health Services (ACCHSs), 7, 64, 70, 176 Aboriginal Coordinated Care Trials, 168 Aboriginal Health Service (AHS), 71 Aboriginal Hostels Limited, 103 Aboriginal Medical Service (AMS), 71 Access to Medicare: Outcome 2, 63-80
achievements, 64 financial resources summary, 80 key strategies, 70 outcome summary, 64 performance indicators, 78- 79 quality of services, 72 under-achievements, 64, 76- 77 accidents see injuries and injury prevention accreditation of aged care facilities, 82, 88-89 Accreditation Standards, 88-89 Achieving the Balance: a Resource kit for
Australian media professionals for the reporting and portrayal of suicide and mental illnesses, 124 Acoustic Research Laboratory, 152 Active Australia, 49 Acute Care, 128- 129 Administrative Appeals Tribunal (AAT), 22, 93
Administrative Arrangements Orders, 11 Advertising, 52, Advocacy Services Program, 98 After Hours Care Trials evaluation, 131
see also primary health care - after hours service delivery aged, 70 Aged and Community Care Division, 81, 149 Aged Care Act 1997, 82, 93, 144 Aged Care Approvals Round (ACAR), 85, 91,
102, 103, 144 Aged Care Assessment Teams (ACATs), 97, 102, 104 Aged Care Complaints Resolution Scheme, 22,
99, 104 aged care data, 83, 105 Aged Care Planning Advisory Committee, 103 Aged Care Planning Regions, 92 aged care reforms, 82, 93 aged care services, 8, 84, 135
rural and remote areas, 142 Aged Care Standards and Accreditation Agency, 81, 89, 99, 104 Agriculture, Fisheries and Forestry Australia
(AFFA), 56 AIDS/HIV See HIV I AIDS alcohol, 44 allied health professionals
see nursing and allied health allocation of aged care places, 91 Alzheimer's Association, 88 Andrology Australia, 41 annual reporting requirements compliance with
see reporting requirements (annual report) antibiotics, 36 aristolochic acid contamination, 54 Arthritis Foundation of Queensland, 38 Assistance with Care and Housing for the Aged
(ACHA), 104 Asthma, 197, 204 Audiological Society of Australia, 156 audit and fraud control, 19 Audit and Fraud Control Branch, 23
INDEX
Audit Committee, 15, 23 AusEinet, 124 Australasian College of Sexual Health Physicians National Conference, 17 5 Australasian Faculty of Rehabilitation Medicine,
188
Australia New Zealand Food Authority, 31, 37, 56 Australian Agency for International Development (AusAID), 46 Australian blood system, 126, 131
see also blood banks Australian Bureau of Statistics, 171 Australian Casemix Clinical Committee, 131 Australian Centre of Excellence in Male
Reproductive Health, 41 Australian College of Audiology (ACAud), 156 Australian College of Rural and Remote Medicine, 117 Australian Council of Deans of Nursing, 170 Australian Council on Safety and Quality in
Health Care, 191, 200, 210 Australian Dermatology Research and Education Foundation, 173 Australian Diabetes Obesity and Lifestyle Study,
204
Australian Diagnostic Related Groups Classification, 131 Australian Divisions of General Practice See Divisions of General Practice Australian Drug Information Network (ADIN),
43
Australian Health Care Agreements (AHCA), 8, 63, 64, Australian Health Ministers' Advisory Council (AHMAC), 6, 40, 54, 97, 106, 166, 171, 201,
203 Privacy Working Group, 206 Australian Health Ministers' Conference, 54 Australian Health Ministers' Council, 4, 120, 201 Australian Hearing Services, 149, 150, 151, 153 Australian Hearing Services Act 1991, 152 Australian Hearing Specialist Program for
Indigenous Australians (AHSPIA), 151
330
INDEX
Australian Indigenous HealthlnfoNet, 175 Australian Institute of Health and Welfare, 46, 102, 105, 150, 195, 206, 207, Australian Medical Association (AMA), 73 Australian Medical Workforce Advisory
Committee, 123 Australian Mental Health Consumers Network, 122 Australian Monitoring Centre for Asthma, 197 Australian National Audit Office, 19, 20, 100,
127
Australian National Council on AIDS Hepatitis C and Related Diseases, 17 4 Australian National Sub-acute and Non-acute Patient Classification System (AN-SNAP
Rehabilitation), 188 Australian New Zealand Telehealth Committee, 206 Australian Organ Donor Register (AODR) , 7,
112, 128 Australian Prescriber, 74 Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), 31 Australian Red Cross Blood Service, 112, 127,
128
Australian Refined Diagnosis Related Groups (Casemix) (AR-DRG), 7, 112 Australian Refined Diagnosis Related Groups Classification, 129 Australian Register of Therapeutic Goods
(ARTG), 51, SS-56, 60 Australian Rehabilitation Outcomes Centre, 18 Australian Resource Centre for Hospitals Innovations, 129 Australian Rotary Health Research Fund and
Rotary Clubs, 124-125 Australian Society for Colposcopy and Cervical Pathology, 38 Australian Workplace Agreements, 18 Australian-European Union/Mutual Recognition
Agreements, 52
331
B
Better Medication Management System (BMMS), 4, 64, 76, 77 Beyondblue, Bishop, Bronwyn, 11, 98, 105, 152 blood, 51 , 55 blood banks, 112, 126-127 blood donations, 128 Borthwick, David, 13 Bovine spongiform encephalopathies (BSE) , 55
see also transmissable spongiform encephalopathies (TSE), bowel cancer, 40 breast cancer, 39, SO BreastScreen Australia, 39, 50 BreastScreen Australia Evaluation Plan, 40 Bringing them home, 172 Brundtland, Dr Gro Harlem, 45 , 46 Budget, 4, 74, 75, 84, 90, 98, 100, 102, 114, 140,
144, 150, 204 bulk billing, 78 Bureau of the Negotiating Body for the World Health Organizations's Framework
Convention on Tobacco Control, 46 Bush Crisis Line, 139 bush nursing, 135, 189 Business Mature Age Workforce Advisory Group,
83
Business Unit Statements of Knowledge and Ability, 18
c
cancer, 204-205 Cancer Strategies Group, 204-205 cardiovascular health, 204 Carer Education and Workforce Training Project,
88, 101 Carer Respite Centres and Services, 88 Carers, 88 Carers Association Australia, 88 Celebrex®, 7, 65, 71, 76
Centre for Community Child Health (CCCH), Royal Children's Hospital Melbourne, 198 Centres of Clinical Excellence in Hospital-Based Research Program, 202 Certification Assessments, 89 Certified Agreement, 11 , 17, 18, 19 cervical cancer, 38, SO Ch emical Adverse Experience Reporting Scheme
(CAERS), 56 chemical regulation, 56 Chief Medical Officer see Smallwood, Professor Richard Choice through Private Health Insurance:
Outcome 8, 179-193 achievements, 180 consumers, 191 financial resources summary, 193 outcome summary, 181-191 performance indicators, 192 under-achievements, 180 chronic disease, 37, 174 cigarette smoking
see smoking claims for payment, 150 Clinical Practice Research Program Forum, 202 Code of Ethics and Guide to Ethical Conduct for
Residential Aged Care, 97-98 Code of Good Manufacturing Practice, 55 Codex, 37 Commissioner for Complaints, 99 Committee of Deans of Australian Medical
Schools, 117 Committee Principles 1997, 99 Commonwealth Carelink Centres, 82, 98-99 Commonwealth Government o/o Rebate on
private health insurance see rebates Commonwealth Hearing Services Program, 150, 154-155, 156 Commonwealth Media and Advertising Awards,
lOS
Commonwealth Ombudsman, 22 Commonwealth Recognition Awards, lOS communicable diseases, 33, 36
Communicable Diseases Intelligence, 36 Communication Framework, 17 Community Aged Care Packages (CACPs), 82, 85-86, 87, 91-93, 97, 103, 107 community care, 113-121
mental health, 121 partnerships, 120 Community Housing Infrastructure Needs Survey (CHINS), 171 Community Matters, 124 Community Pharmacy Agreement, 73 Community Sector Support Scheme, 200 Community Service Obligations (CSOs), 150,
151, 153, 155 Community Services Ministers Conference, 106 Community Visitors Scheme (CVS), 98 Competitive tendering and contracting
See outsourcing complementary medicines, 52 see also Office of Complementary Medicines compliance by providers witrh legislative
requirements, 89 Compliance Resolution Scheme, 98 Congress of Aboriginal and Torres Strait Islander Nurses, 170 Consumer and Provider Partnerships in Health
Project, 200 Consumer Focus Collaboration, 199, 200, 210 Consumer Focus Strategy, 199-200 Consumer Perspectives Survey, 32 Consumers, 98, 199-200 con testability
see outsourcing Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation, 152 Coordinated Ca re Trials, 114-115, 131, 164, 168 Corporate Activities Review, 8, 11 Corporate Communications Strategy, 14 corporate overview
see organisation and structure Corporate Plan, 8, 15, 17 Corporate Postgraduate Public Health Program, 18 Corporate Services Division, 195
332
Council of Australian Governments, 54 Council of Australian Governments Supporting
Measures on Needle and Syringe Programs, 36 Council of Deans of Australian Medical Schools, 170 Cre utzfeldt-Jacob Disease (vCJD), 55, 128 crisis management procedures, 51, 54 Croc Festivals, 44 cross program opportunities, 15 CSIRO, 208 CSL Limited, 127
Cu lturally Appropriate Care Projects, 102 Cumpston, Dr J H L, 3
D
data collection, 171 data bases m ental health and community and allied health, 125 Day Therapy Centres Program, 87 Declared Hearing Services Determination 1997,
152
Dementia, 101 Dementia Education and Support Program, 101 Dementia Helpline, 101 Department of Education and Youth Affairs,
170, 208 Department of Family and Community Services, 208 Department of Health and Aged Care history, 3 Department of Immigration and Multicultural
Affairs, 208 Department of Veterans' Affairs, 208 Departmental Management Committee, 5, 14 Departmental management structure, 12
chart, 24-25 dermatology, 173 Development Awards, 18 devise evaluation, 52 Devises Electronic Application Lodgement
(DEAL) , 56 Diabetes, 204
Diabetes Australia, 73
333
diagnosis related groups, 131 see also Australian Diagnostic Related Groups Classification diagnostic imaging, 72, 73, 74 Diagnostic Imaging Agreement, 75 diverse cultural and linguistic backgrounds
people from aged care services, 102 see also Aboriginal and Torres Strait Islander peoples families and communities Divisions Hospital Integration Program, 119 Divisions of General Practice, 114, 115-116,
117, 119, 121, 123, 130, 139, 142, 189 Doctors see medical practitioners Domiciliary Medication Management Reviews, 75 drugs, illicit see illegal drugs
E
e-commerce see electronic commerce early intervention children, 124 Early Stage Dementia Support and Respite
Project, 88, 102 Electorate Profiles, 207 electronic claims, 15 7 electronic commerce, 55, 106, 206 Electronic Lodgement Facilities (ELF), 56 Electronic Transaction Act 1999, 15 7
Enhanced Pharmacy Package, 143 Enhanced Primary Care (EPC), 4, 70, 130 Enhanced Primary Care Medical Benefits Scheme Items, 114, 130
Enhanced Primary Care Package, 114 Enhanced Quality of Life for Older Australians: Outcome 3, 81-109 achievements, 82
evaluation and accountability, 104 financial resources summary, 109 outcome summary, 83 performance indicators, 107 under-achievements, 82
.....------11\JDEX
Enhanced Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme, 117 Environment Australia, 56 environmental health, 36-37 ethical standards, 15 Ethnic Aged Service Grants, 102 ethnic people
see diverse cultural and linguistic backgrounds people from European Free Trade Association (EFTA) , 58 Evaluation of Recruitment and Promotion
Services Project, 170 events sponsorship, 44- 45 Excellence in Aged Care Awards, 97 export review implementation, 54 Extended Aged Care at Home (EACH), 86
F
family planning, 41 Family Planning Australia, 49 Far West Area Health Service, 126 Federal Court, 7 6 Federal Electorate Profiles
see Electorate Profiles Finance Committee, 5, 11, 14 Financial Management Framework, 16 financial summaries, 28, 29 financial statements, 213-327
Administered cash flow, 227 Independent Audit Report, 216-217 Notes to and forming part of the financial statements, 230-327 Schedule of administered assets and liabilities, 226 Schedule of administered commitments, 228 Schedule of administered contingencies, 229 Schedule of administered revenues and expenses, 225 Schedule of commitments, 223 Schedule of contigencies, 224 Statement by the Departmental Secretary, 219 Statement of cash flows, 222
Statement of financial performance, 220 Statement of financial position, 221 Flinders University. National Information Service, 115 Food and Agriculture Organization, 3 7 food borne diseases, 49 food policy, 3 7 Food Regulation Secretariat, 3 7 food safety and surveillance, 37 frail older people
see aged freedom of information, 21 fringe benefits tax (FBT) , 75, 169
G
gap fees, 5, 7, 180, 183-184 Gene Technology Bill 2000, 52 Gene Technology Regulations 2000, 52 general practice, 114-119, 130 General Practice Computing Group, 116 General Practice Education and Training Limited
(GPET) , 117 General Practice Education, Support and Community Linkages program, 114 General Practice Information Management and
Technology (IM/IT) Projects, 116-11 7 General Practice Memorandum of Understanding, 4, 74, 113, 116 General Practice National Innovations Funding
Pool, 115 General Practice Partnership Advisory Council (GPPAC), 114, 118, 119 General Practice Partnership Advisory Council.
Research, Evaluation and Development Standing Committee, 118 General Practice Registrars Association, 117 General Practice Registrars Rural Incentives
Payment Scheme, 139 general practitioners see medical practitioners General Practitioners Registrars Budget, 117 General Training Pathway, 117, 139
334
Genetic Manipulation Advisory Committee (GMAC), 52 genetically modified organisms (GMOs), 51-52 George Town, 142 Global Harmonisation Task Force (GHTF), 52, 58
GP Immunisation Incentives (GPII) program, 73 GP Integration Index, 119 Gray, Professor Len, 82, 100, 104
H
HAAC see Home and Community Care
HAAC Minimum Data Set, 87 Hameophilus influenzae type b infection see Hib infection
Health Access and Financing Division, 63 Health and Medical Research Strategic Review, 196, 200, 201 Health and Other Services (Compensation) Act
1995, 75 Health and Industry and Investment Division. National Health Priorities and Quality Branch, 111, Health Industry Investment Division, 179, 195 Health Inequalities Research Collaboration, 48
health information, 196 health insurance see Medicare
private health insurance Health Insurance Act 1973, 70, 168, 198 Health Insurance Commission (HIC), 63, 64, 70, 74, 75, 76, 128, 206, 208
Health Investment: Outcome 9, 195-212 achievements, 196-197 financial resources summary, 212 outcome summary, 197- 205 performance indicators, 209-211 under-achievements, 197 Health is life, 166 Health Legislation Amendement Act (No 1) 2001,
180, 187 Health Legislation Amendement (Gap Cover Scheme) Act 2000, 185
335
Health Legislation Amendement (Medical Practitioners' Qualifications and Other Measures) Act 2001, 198 Health Online: a Health Information Action
Plan for Australia, 205, 211 Health Service Management Training for Aboriginal and Torres Strait Islander people, 170 Health Service Management Training Review,
170
Health Services Division, 111, health workers, 135 see also rural and rerpote areas; medical
practitioners HealthConnect, 4, 7, 196, 206 Healthlnsite, 196, 199, 210 HealthWIZ, 47 Healthy Ageing Taskforce, 106 hearing devices, 151, 154, 157-158, 159 hearing impairments, 150
children, 159 hearing rehabilitation, 150, 159-160 Hearing Services: Outcome 6, 149-161 achievements, 150
financial resources summary, 161 future challenges, 15 7 major projects, 156 outcome summary, 150 performance indicators, 159-160 Hearing Services Advisory Committee, 155, 156 Hearing Services Voucher System, 150, 151,
153-154, 155 HECS Reimbursem*nt Scheme, 112, 117, 135, 139, hepatitis C, 35-36 Hib infection, 49 HIV/AIDS, 35, 36, 49 home and community care, 84-86 Home and Community Care (HAAC) program,
82, 83, 85, 87 home based work, 18 Home/Early Discharge Trials, 187 Hospitals, 8, 65, 75, 119, 128
alternative models to in-hospital care, 187 long stay patients, 187-188
Hospitals Morbidity Data, 131 House of Representatives Standing Committee on Family and Community Affairs, 21 House of Representatives Standing
Committee on Legal and Constitutional Affairs, 21 Howard, Han John, Prime Minister, 98 Human Research Ethics Committees (HRECs),
202-203 Human Resource Management Committee, 14
Illawarra Area Health Service, 126 illegal drugs, 42-43 Illicit Drug Diversion Initiative, 6 Immunisation, 6, 33, 35, 50
Aboriginal and Torres Strait Islander Health, 174 lmmunise Australia Program, 33 Incentives for Quality Prescribing (IQP), 64, 77 Indigenous Australian Research Health Advisory
Panel, 172 Indigenous Australians' Sexual Health Committee, 17 4 Indigenous Coordinated Care Trials, 5 Indigenous health
see Aboriginal and Torres Strait Islander Health Indigenous Health Matters, 175 Indigenous people
see Aboriginal and Torres Strait Islander peoples, families and communities Indigenous Staff Network, 17 infant mortality rates, 9 influenza vaccine, 32, 17 4 Influenza Vaccine Program for Older
Australians, 32 information management, 4, 47, 205- 206 Information Management Plan, 14, 16, 17 Information Planning and Privacy Committee,
14
information technology, 116, Information Technology Committee, 14
Information Technology Integration Initiative, 114, 115 Information Technology Strategy Plan, 14 informed financial consent, 184-186 injuries and injury prevention, 37, 40, 41 Inter Governmental Committee on Drugs, 43,
44
Interim Office of the Gene Technology Regulator, 51-52 see also Office of the Gene Technology Regulator international achievements, 45, 56-59 international agreements, 57- 58 International Centre for Eyecare Education
(ICEE), 174 International Classification of Diseases (ICD -10-AM), 129 International Year for Older Persons, 83, 105 invasive haemophilus influenzae type b (hib)
infections see Hib infection
J
]ames Cook University, 170 Jean Hailes Foundation, 41 ]ob Level Description and Evaluation Project, 17 Joint Advisory Group OAG) on General Practice
and Population Health, 48, 118 Joint Committee of Public Accounts and Audit OCPAA), 20 Joint Standing Committee on Foreign Affairs,
Defence and Trade, 21 Joint Standing Committee on Foreign Affairs, Defence and Trade (UN Subcommittee), 21 Julia Schofield Consultancy, 175
K
Key Features Statement, 190 Kids Help Line, 125 Kimberley Aboriginal Medical Services Council, 170
336
L
LaTrobe University, 97 leadership, 45 life expectancy, 9 Lifeline Australia, 125 lifetime community rating, 183 Lifetime Health Cover Scheme, 183, 189
M
Magnetic Resonance Imaging (MRI), 72 management opportunities, 16 Manager Development Strategy, 18 Marumali Healing Training Program, 173
measles 49, Measles Control Campaign 6 , 32 Medical Benefits Scheme, 4, 6 Aboriginal and Torres Strait Islander peoples,
168
medical practitioners, 123 Aboriginal and Torres Strait Islander communities in rural and remote areas, 112, 130, 135,
136, 138-140 Medical Rural Bonded Scholarships, 134, 135, 138, 196, 198 Medical Specialist Outreach Assistance Program
(MSOAP) , 134, 135, 143, 145 Medicare, 3 see also Access to Medicare: Outcome 2 Medicare Benefits Schedule (MBS), 63, 64, 65,
73, 74, 75, 78, 79 Aboriginal and Torres Strait Islander Health, 164 Medicare Benefits Scheme
Aboriginal and Torres Strait Islander Health, 174 Medicare Services Advisory Committee, 74, Medsafe Ministry of Health New Zealand, 57
meningococcal infections, 36 Men's Access Line, 125 men's health, 41
337
mental health, 130 Mental Health Council of Australia, 122 mental health integration projects, 125-126
mental health services, 121-126, 130 Menzies Institute, 197 microsimulation modelling, 208 MindMatters, 123, 124 Ministers
responsibilities, 11, 104 mission, 12, 15 More Allied Health Services Program, 134, 142 Multipurpose Services (MPS), 101, 141 Murnane Mary, 13 Mutual Recognition Agreement
N
see Australian-European Union/Mutual Recognition Agreements
nasal sprays, 7 4 National Aboriginal and Torres Strait Islander Eye Health Program, 173-174 National Aboriginal and Torres Strait Islander
Health Council, 164 National Aboriginal and Torres Strait Islander Health Strategy, 164-165, 166 National Aboriginal and Torres Strait Islander
Health Worker Training Review, 170 National Aboriginal and Torres Strait Islander Hearing Strategy 1995-99, 173 National Aboriginal Community Controlled
Health Organisation (NACCHO), 165, 166, 169, 171, 173 National Acoustic Laboratories (NAL) , 149 research, 151-152 National Action Plan for Introducing
E-commerce, 206 National Action Plan for Promotion, Prevention and Early Intervention for Mental Health, 123, 124 National Action Plan on Illicit Drugs, 43 National Advisory Committee on Indigenous
Issues, 38
National Advisory Council on Suicide Prevention, 125 National Aged Care Accreditation and Compliance Forum, 97 National Alcohol Action Plan, 44 National Alcohol Campaign, 32, 44 National Asthma Action Plan, 204 National Australia Day Council, lOS National Breast Cancer Centre (NBCC), 205 National Cancer Control Initiative (NCCI), 205 National Centre for Monitoring Cardiovascular
Disease, 204 National Centre for Social and Economic Modelling (NATSEM), 206, 208 National Centre in HIV Epidemiology and
Clinical Research, 17 S National Cervical Screening Program, 20, 38 National Child Nutrition Program, 38 National Childhood Pneumococcal
Immunisation Program, 174 National Comorbidity Workshop Report, 122, 123 National Competition Review of Drugs, Poisons
and Controlled Substances Legislation, 54, National Continence Helpline, 88 National Continence Management Strategy, 88 National Cord Blood Collection Network, 128 National Coronia! Information System (NCIS),
47
National Dementia Behaviour Advisory Service, 88, 101-102 National Demonstration Hospitals Program (NDHP), 128 National Depression Initiative, 125 National Diabetes Services Scheme, 73 National Diabetes Strategy, 204 National Drug Household Survey, 43 National Drug Strategy, 43, 123 National Drug Strategy Reference Group for
Aboriginal and Torres Strait Islander peoples, 43 National Education and Training Workshops, 122 National Electronic Records Taskforce, 206 National Evaluation of theGeneral Practice,
Support and Community Linkages program, 114,
INDEX
National Evaluation Program, 120 National Falls Prevention for Older People Initiative, 41 National Forensic Mental Health Meeting, 122 National Health Act 1953, 71, 143 National Health Amendment (Improved Monitoring
of Entitlements to Pharmaceutical Benefits) Act 2000, 64, 74 National Health and Medical Research Council, 7, 13, 118, 127, 166, 171-172, 195, 196, 200,
201 Australian Health Ethics Committee, 202-203 Guidelines for the appropriate use of red blood cells, 196 Health Advisory Committee, 201 Research Committee, 201-202 Strategic Research Development Committee
(SRDC), 202, 209 National Health and Medical Research Council Aboriginal and Torres Strait Islander Health Research Agenda Working Group's
Indigenous Health Research Criteria, 177 National Health and Medical Research Council (NHMRC) Injury Partnership, 41 National Health Information Management
Advisory Council, 211 National Health Information Standards Advisory Committee (NHISAC), 206 national health insurance
see Medicare National Health Online Summit, 205-206 National Health Priority Action Council (NHPAC), 203 National Health Priority Areas, 203-204 National Health Supply Chain Reform Taskforce,
206
National Hepatitis C Strategy 1999 2000 to 2003-04, 36 National Heroin Overdose Strategy, 43 National Hospital Cost Data Collection, 129,
131
National Illicit Drug Strategy, 42, 202 National Illicit Drugs Campaign, 6, 32, 49 National Immunisation Strategy, SO
338
INDEX
ational Indigenous Australians' Sexual Health Strategy (NIASHS), 174 National Indigenous Environmental Health Forum, 36-37 National Indigenous Pneumococcal and Influenza
Immunisation (NIPII) Program, 174 National Information Service see Flinders University. National Information Service National Injury Prevention Action Plan, 40 National Institute of Clinical Studies, 210 National Managed Fund, 127
ational Mental Health Education and Training Advisory Group, 123 National Mental Health Information Plan, 126 ational Mental Health Plan, 122, 123 National Mental Health Report, 122 National Mental Health Strategy, 121-122, 124,
125 ational Mental Health Strategy/ ational Drug Strategy, 122 National Mental Health Working Group
(NMHWG), 122, 123 ational Notifiable Diseases Surveillance System, 36 National Performance Indicators and Targets for
Aboriginal and Torres Strait Islander Health, 171 ational Practice Standards for Mental Health, 123 National Prescribing Service, 74 National Primary Care and Research and
Development Strategy, 130 National Primary Mental Health Care Initiative (NPMHCI), 121, 123 outcomes, 121 National Public Health Partnership (NPHP), 45,
118
National Radiotherapy Single Machine Unit Trial, 72 National Resource Centre for Consumer Participation in Health, 199 National Respite for Carers Program, 88 National Rural Health Policy Forum, 145
339
National Staff Participation Forum, 14, 16, National statement on ethical conduct in research involving humans (1999), 203 National Strategy for Aboriginal and Torres
Strait Islander Health, 8 National Strategy for an Ageing Australia, 82, 83, 108 National Suicide Prevention Strategy, 112, 124,
125
National Telehealth Plan for Australia and New Zealand (draft), 206 National Tobacco Campaign, 32, 43, 49 National Tobacco Strategy, 43 National Toolkit Seminars, 129 National Youth Alcohol Campaign, 49 Nganampa physician training pilot project,
197-198 NHMRC Australian Drinking Guidelines, 44 non communicable diseases, 37 non-English speaking background, people from
see diverse cultural and linguistic backgrounds, people from Nuclear Medicine Imaging Agreement, 75 Nucleic acid amplification testing, 112, 127, 131 nursing and allied health, 135 nutrition, 38
Office for Aboriginal and Torres Strait Islander Health Services, 156, 163, 165, 167, 170, 173, 174, 175 Recruitment, Retention and Staff Development Strategy, 170-171
Office for Older Australians, 83-84, 105 Office of Asset Sales and Commercial Support, 15 Office of Complementary Medicines (OCM), 54 Office of Hearing Services, 149
Office of Rural Health, 133, 135, 145 Office of the Gene Technology Regulator, 6, 51-52 see also Interim Office of the Gene
Technology Regulator
Office of the National Health and Medical Research Council, 201 see also National Health and Medical Research Council Older Australians Influenza Immunisation
Program, 17 4 older people see aged Older People Speak Out, 105 oral h ygiene, 202 organ and tissue donation, 128 organisation and structure, 12 Organisation for Economic Cooperation and
Development (OECD), 45, 57 Outcomes and outputs structure, 12 Output Pricing Review, 11 outsourcing, 19 Ove Arup and Partners Pty Ltd, 169 OzFoodNet, 37
p
paediatrics, 198 pathology agreements, 7 4 patient information and recall systems, 170 Peeters, Lorraine, 173 People Management Framework, 16 Performance Assessment Committee, 14 Performance Development Scheme (PDS), 5, 16,
17
Performance indicators see under individual programs Persistent Organic Pollutants Convention, 37 Personal Alert Systems, 87 Pertussis, 49 Pettigrew, Professor Alan 7, 196 Pharmaceutical Benefits Advisory Committee
(PBAC), 74, 77 Pharmaceutical Benefits Schedule, 63, 64 Pharmaceutical Benefits Scheme (PBS), 4, 6, 7, 8, 63, 64, 65, 66, 69, 70, 71, 73, 74, 75, 76, 78
Aboriginal and Torres Strait Islander peoples, 164 Pharmacies, 69, 78, 135 Pharmacy Development Program (PDP) , 73
Pharmacy Guild of Australia, 71 physicians see medical practitioners Pilot Collaborative Research Program, 200-201 Plasma Fractionation Agreement, 127 Pneumococcal vaccine, 17 4 Podger Andrew, 13 Polaris Pty Ltd, 152 Policy Forum, 14 Polio, 32 Population Ageing and the Economy, 84 population health, 113, 118-119 Population Health and Safety: Outcome 1, 31- 61
achievements, 32 outcome summary, 33 performance indicators, 49- 50 under-achievements, 32 Population Health Division, 31 Population Health Evidence-Based Advisory
Mechanism, 48 Portfolio Budget Statements, 16, 90, 145, 197 Portfolio Chief Executive Officers (CEO), 15 Portfolio Overview, 9 Portfolio Strategies Division, 31, 195 Positron Emission Tomography (PET), 75 Postgraduate Primary Care Psychiatry
Scholarships for General Practice, 121 Practice Incentives Program (PIP), 4, 6, 72, 74, 116 pre-existing ailment, 190 prescription medicines, 4-5 Prevenar, 17 4 primary health care, 3, 8, 113-121, 175
after-hours service delivery, 119-120 mental health, 120 partnerships, 120 regional areas, 140-142 Primary Health Care Access Program (PHCAP),
7, 164, 165, 167-168, 169 Primary Health Care Research, Evaluation and Development Strategy, 118 Primary Health Care Research Institute, 118 Primary Mental Health Care Australian Resource
Centre (PARC), 121 , 123
340
INDEX
Priorities for Action in Cancer Control 2001-03, 204 Private Health Industry Medical Devices Expert Committee, 186 Private Health Industry Quality Working Group
(PHIQWG), 190-191 private health insurance, 5, 8, 180-193 affordability, 192 age profiles, 180
consumer awareness, 189 participation, 180, 182 premium charges, 180, 181-182 Private Health Insurance Administration
Council (PHIAC), 179, 188, 192 Private Health Insurance Ombudsman, 179, 189, 192 Private Patients' Hospital Charter, 190 Privately insured long stay patients, 187-188 product tampering and extortion threats, 54 Productivity Commission, 97, 105 Professional Services Review (PSR), 63, 76 prostheses deregulation, 186 Psychogeriatric Care Units (PGU's), 102 Public Health Education and Research Program
(PHERP), 47 public health legislation, 47 Public Health Outcome Funding Agreements, 41 public hospitals
see hospitals purchasing, 19
Q
quality Access to Medicare: Outcome 2, 72 Commonwealth Hearing Services Program, 155 Enhanced quality of life for older Australians: Outcome 3, 88-89, 107 Hearing Services Advisory Committee, 155 Quality Health Care: 4, 111-132, Quality Health Care: Outcome 4, 111-132
achievements, 112 consultation, 122
341
financial resources summary, 132 outcome summary, 112 performance indicators, 130-131 under-achievements, 112 Quality Use of Medicines, 74, Queensland Health, 28
R
RCS Industry Liaison Group, 93 Reachout, 125 Rebates, 182-183 regional cooperation, 59 regional health services, 140-142, 189 Regional Health Services Budget Initiative
1999-2000, 142 Regional Health Services Centre, 101 Regional Health Services Program, 134-135, 136, 140, 141, 142, 145 Regional Health Strategy 7, 135, 136 Regional Health Strategy: More Doctors, Better
Services, 116, 135, rehabilitation, 188-189 Relative Value Study (RVS), 4, 73 remote Australia
see rural and remote Australia Remote Communities Initiative, 169 reporting requirements (annual report), iii-iv, research, 5, 105-106, 118, 130, 200, 207 Research Agenda Working Group, 171, 202 Research and Development Committee, 14, 200 research and development database, 200 Resident Classification Scale (RCS), 93 residential aged care, 83
funding, 90 hearing services, 156 Residential Aged Care Accreditation Scheme, 4, 6 Residential Aged Care Advocacy Program, 98, Residential Aged Care Advocacy Services, 98, residential aged care facilities, 88-93, 107, 144 Residential and Community Aged Care
Packages, 107 Residential Care Places, 92
Residential Classification Scale (RCS), 83, 107 Resource Centre for Consumer Participation, 210 respite services, 88, Review of Drugs, Poisons and Controlled
Substances Legislation see National Competition Review of Drugs, Poisons and Controlled Substances Legislation Review of the Aboriginal and Torres Strait
Islander Substance Use Program, 172 Review of the Default Table of Benefits, 186-187 Review of the Impact of Regulation on the Private Health Industry, 180 Review of the Private Health Insurance
Ombudsman, 180 Review of the Regulatory Regime for the Export of Therapeutic Goods, 54 Risk Management Guidelines, 16 Royal Australian and New Zealand College of
Obstetricians and Gynaecologists, 38 Royal Australian College of Dermatologists, 197 Royal Australian College of General Practitioners, 73, 117 Royal Australian College of Physicians, 197 Royal Darwin Hospital, 197 Royal Flying Doctor Service of Australia (RFDS), 112 rural and remote areas, 5, 7, 65, 71, 78, 79, 126
aged care services, 100-101, 144 allied health, 142-143 health information, 145 hospitals, 135 medical practitioners, 112, 130, 135, 136, 198 nursing workforce, 140 pharmacists, 139-140 specialists, 140, 142-143 Rural and Remote Midwifery Upskilling Scheme,
140
Rural and Remote Nursing Scholarship Scheme, 140 Rural and Remote Pharmacy Workforce Development Program, 71, 135, 139, 145 Rural Australia Medical Undergraduate
Scholarship (RAMUS) Scheme, 7, 134, 135, 137- 138
INDEX
Rural Chronic Disease Initiative, 37, 134 Rural Clinical Schools, 134, 135, 145 Rural Clinical Schools Initiative, 7, 136 Rural Health Care: Outcome 5, 133-147
achievements, 134 financial resources summary, 14 7 outcome summary, 135 performance indicators, 145-146 under-achievements, 134 Rural Health Information Advisory Committee,
145
Rural Health Support, Education and Training (RHSET) Program, 138 Rural Locum Relief Service, 136, 198 Rural Pharmacy Maintenance Allowance, 143 Rural Retention Program, 112, 116, 136 Rural Training Pathway, 117, 139 Rural Women's GP Service, 136
s
Safe at Home Initiative, 87 St Vincents Mental Health Service, 126 SANE Australia, 122 SAP Financials and Human Resource
Management Systems, 11 Second National Mental Health Plan (1998-2003), 121 Secretary
see Podger Andrew Senate Community Affairs Legislation Committee (Senate Estimates), 20 Senate Community Affairs References
Committee, 21 Senate Environment, Communication, Information Technology and the Arts References Committee, 21 Senate Finance and Public Administration
References Committee, 21 Senate Legal Consitutional References Committee, 21 Senate Select Committee on Information
Technologies, 21
342
INDEX
Senior Australian of the Year Award, 105 Senior's card, 106 Service Activity Reporting (SAR), 171 sexually transmitted diseases, 174-175 Sharing Health Care Initiative, 38 Smallwood, Professor Richard, 14 SmithKline Beecham, 175 smoking, 6, 43 44, South Australian Centre for Rural and Remote
Health, 38 special need groups, 108 Special Proj ects Funding Pool, 144 specialists, 140, 142-143, 197-198 staff training and development, 5, 17, 18 staffing resources, 17, 19 Start-up Allowance, 143 State and Territory Directors of Mental Health,
122
State and Territory Managers Forum, 14 State and Territory Offices, 13, 63, 81, 111 , 133 State Based Organisations, 115-116 States/Commonwealth Research Issues Forum,
200-2001 Stephen, Sir Ninian, 126 Stockholm Challenge 2001, 17 5 Strategic Information Management
Environment (SIME), 55-56 Strengthening Support for Women with Breast Cancer Initiative, 205 stroke, 204 Structual Reform Package, 82 Student Design Awards, 84 Studybank Scheme, 18 substance misuse, 41, 42, 44, 172 Succession Allowance, 143 suicide prevention, 124
T
Tambling, Senator Grant, 11 Tasmanian University Department of Rural Health, 38 taxes and tax reform, 169-170
343
TGA Chemicals Unit, 56 Therapeutic Goods Act (1989), 53, 55, 203 Therapeutic Goods Administration, 19, 31, 51-61, 126, 127, 158
achievements, 51, 59 financial resources summary, 61 performance indicators, 60 Therapeutic Goods Administration Laboratories
(TGAL) , 54 Therapeutic Goods Adminstration. Office of Complementary Medicines see Office of Complementary Medicines Therapeutic Goods Amendement (Medical
Devices Bill 2001), 52 Third Community Pharmacy Agreement, 71, 74 tobacco, 43, 44 Torres Strait Health Framework Agreement Torres Strait Regional Authority (TSRA) , 165, 166
training, 58, 170- 171 medical practitioners, 117, 197-198, 210 see also staff training and development transmissable spongiform encephalopathies
(TSE) , 36, 55 Trans-Tasman Therapeutic Goods Agency, 51, 56-57 Two year review of aged care reforms, 100,
104-105
u
Unapproved therapeutic goods, 52 Under-achievements, 7 United Nations, 57 United Nations General Assembly Special
Session on HIV I AIDS, 36 University Departments of Rural Health (UDRH), 134, 135, 136-137, 145 University of Western Australia, 208 University Research Capacity Building Program,
118
v
Vaccination see immunisation values, 15 veterans and war widows, 102-103 Veterans' Homecare Program, 87 vision, 11 , 15 voluntary code of conduct for medical
corporations, 64, 73
w Weipa Festival, 45 Western Australian Health Department, 208 Western Pacific region, 46 Whitehorse Division (Vic) of General Practice,
38
women's health, 41 Women's Health Australia, 47 Wooldridge Dr Michael, 11, 64, 112 Workforce, 97, 106, 135, 170-171, 197-199 Workforce Support for Rural General
Practitioners Program, 116, 139, World Health Organization (WHO), 37, 45, 46, 57, 196
z
Zyban®, 7, 65, 71, 76
INDEX
344
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
PARLIAMENTARY PAPER No. 130 of 2002 ORDERED TO BE PRINTED
ISSN 0727-4181
