Online version of the 2013-14 Department of Health Annual Report

Outcome 3: Access to Medical Services

Access to cost-effective medical, practice nursing and allied health services, including through Medicare subsidies for clinically relevant services

Page last updated: 31 October 2014

Major Achievements

  • Implemented a number of Budget measures to improve the sustainability of Medicare, including changes to Medicare Benefits Schedule (MBS) Indexation.
  • Introduced new cost-effective services to the MBS, following Medical Services Advisory Committee (MSAC) evaluations.
  • Supported the national rollout of the Bariatric Surgery Registry (BSR) in conjunction with the Obesity Surgical Society of Australia and New Zealand (OSSANZ).
  • Concluded nine reviews of existing MBS items and commenced six new reviews to ensure that services listed on the MBS are appropriately targeted, align with modern medical practice and are supported by contemporary evidence.
  • Added four new items to the MBS for magnetic resonance imaging (MRI) services requested by GPs for patients aged 16 and over.

Challenges

  • Ensuring long term sustainability of Medicare whilst supporting access to cost-effective care.

Looking Ahead

The Department will implement a range of measures announced in the 2014-15 Budget, aimed at making health expenditure more sustainable. The Department will continue to meet challenges in ensuring the MBS arrangements support ongoing access of patients to clinically necessary evidence-based care which is sustainable in the broader constraints of public finances.

Programmes Contributing to Outcome 3

  • Programme 3.1: Medicare services
  • Programme 3.2: Targeted assistance – medical
  • Programme 3.3: Diagnostic imaging services
  • Programme 3.4: Pathology services
  • Programme 3.5: Chronic disease – radiation oncology

Divisions Contributing to Outcome 3

In 2013-14, Outcome 3 was the responsibility of Acute Care Division, Medical Benefits Division and Population Health Division.

Outcome Strategy

Outcome 3 aims to provide access for eligible people to high quality and clinically relevant medical, dental and associated services. In 2013-14, the Department worked to achieve this Outcome by managing initiatives under the programmes outlined below.

Programme 3.1: Medicare services

Programme 3.1 aims to improve access to evidence-based, best-practice medical services.

Improve access to evidence-based, best-practice medical services

The Department aims to ensure all Australians have appropriate access to cost-effective medical, optometry and hospital care and, in special circumstances, allied health services.

The number of Medicare services provided annually grew steadily from 221.4 million in 2002-03 to 356.1 million in 2013-14. In 2013-14 more than 77 per cent (or 275 million) were bulk billed at no cost to the patient. The compound average growth rate for services over this time period was 4.4 per cent per annum. While population growth averaging 1.6 per cent was a factor, services per capita increased over the period from 11.2 in 2002-03 to 15.1 services per capita in 2013-14.

Figure 3.1: Total Medicare services and services per capita, 2002-03 to 2013-14

Figure 3.1 is a vertical bar graph which shows a steady increase in Medicare services provided, from 221.4 million services in 2002-03 to 356.1 million services provided in 2013-14. This equates to an increase from 11.2 services per capita in 2002-03 to 15.1 services per capita in 2013-14.

Quantitative KPI
Number of services delivered through Medicare by providing rebates for items listed on the MBS
2013-14 Target
353m
2013-14 Actual
356m
Result
Met
The number of services delivered through Medicare by providing rebates for items listed on the MBS: 2010-11 318.8 million services, 2011-12 332.2 million services, 2012-13 343.6 million services.Medicare rebates were provided for 356 million services. This is an average of 15.4 services per capita.

Medicare benefits paid rose from $8.1 billion in 2002-03 to $19.1 billion in 2013-14. In 2013-14 Medicare benefits averaged $813 per capita.

In 2013-14, under the Comprehensive Management Framework for the MBS (CMFM), the Department continued to undertake evidence-based assessment of new health services and technologies, and identified and reviewed existing services on the MBS, to ensure listed items remain clinically relevant and consistent with best practice.

The CMFM is supported by the MSAC who provides independent expert advice to Government relating to the comparative safety, effectiveness and cost-effectiveness of medical services.

Qualitative Deliverable
MBS Reviews will analyse the best available evidence to ensure safety, quality and sustainability of the MBS
2013-14 Reference Point
Any amendments to the MBS recommended by each review reflect current clinical practice based on best available evidence
Result
Met
A key component of the CMFM is a systematic process for reviewing existing services to ensure the MBS is contemporary, reflects best clinical practice and targets the most appropriate patient groups. A number of reviews have commenced under the process which focus on the collection and analysis of data to inform evidence-based changes to the MBS. Any proposed changes are developed in consultation with the medical profession, and are considered by the MSAC prior to Government decision making.
Qualitative KPI
Continuation of MSAC processes to ensure ongoing improvement in rigour, transparency, consistency, efficiency and timeliness
2013-14 Reference Point
Improved stakeholder engagement and timeliness of application assessments and implementation of outcomes
Result
Substantially met
The MSAC process is undergoing reform to streamline processes. This is being done in consultation with key stakeholders, including the Australian Medical Association, Medical Technology Association of Australia and Medicines Australia. The Department held information sessions in June 2014 in Melbourne, Sydney and Brisbane with stakeholders, including the contracted Health Technology Assessment (HTA) Groups and consumers, to provide updates to reforms such as fit-for-purpose pathways and the co-dependent process.

Improve access to clinically relevant dental services

The Medicare Teen Dental Plan provided a voucher to eligible teenagers for a preventative dental check once each calendar year. The voucher provided up to $166.15 per eligible teenager between 12-17 years of age. The Medicare Teen Dental Plan closed on 31 December 2013. The Child Dental Benefits Schedule commenced on 1 January 2014, and provides up to $1,000 in benefits, capped over two calendar years, for basic dental services for eligible children between 2-17 years of age.

Qualitative Deliverable
Implement the child dental health benefit scheme, Grow Up Smiling
2013-14 Reference Point
Legislation tabled before 1 January 2014
Result
Met
The Dental Benefits Amendment Act 2012 commenced on 1 January 2014. The Child Dental Benefits Schedule was formerly known as Grow Up Smiling.
Qualitative KPI
Improved affordability of, and access to, a range of dental services for eligible children 2-17 years of age
2013-14 Reference Point
Eligible children are able to access the dental benefit schedule from 1 January 2014
Result
Met
Eligible children 2-17 years of age are now able to access the dental benefits schedule. Dental benefits have been paid for services provided from 1 January 2014.
Quantitative Deliverable
Number of vouchers provided to eligible teenagers
2013 Target34
1.2m
2013-14 Actual
42,946
Result
Not met
In 2013-14, 42,946 vouchers were provided to teenagers eligible for the Medical Teen Dental Plan. This compares with 1.2 million vouchers in 2012-13. The Medicare Teen Dental Plan closed on 31 December 2013. The majority of vouchers are sent in January of each year.
Quantitative KPI
Percentage uptake of preventive dental checks by eligible teenagers
2013 Target35
39%
2013-14 Actual
Data not available
Result
Data not available
The Medicare Teen Dental Plan was a demand-driven, calendar year programme. As eligibility for benefits spanned the full calendar year, vouchers issued in 2013 could be used for services outside the 2013-14 financial year. Claims for benefits may also be made for several years after the date of service. In 2013-14, benefits were paid for 215,662 services under the programme. It is not possible to derive an uptake figure consistent with previous annual reporting as the programme did not operate for the full 12-month period.

Programme 3.2: Targeted assistance – medical

Programme 3.2 aims to provide medical assistance to Australians overseas and support access to necessary medical services not available through mainstream mechanisms.

Medical Treatment Overseas Programme

The Medical Treatment Overseas Programme provides eligible Australians with funding to access approved medical treatments overseas for life threatening illness, where treatment is not currently available in Australia. In 2013-14, the Department received 15 applications for financial assistance. After receiving independent expert advice from medical craft groups, six applicants were assessed as eligible and received funding to undergo treatment overseas.

Provide medical assistance to Australians overseas

The Australian Government continued to enable access to local health services for Australians travelling in certain countries through reciprocal health care agreements.36 These agreements also provide access to the Australian public health system for visitors from those countries. The Department maintained its role in managing 11 agreements, in collaboration with the Department of Foreign Affairs and Trade, and the Department of Human Services.

In 2013-14, 146,214 MBS services were provided to visitors to Australia under reciprocal health care agreements, with a total of $9.3 million paid in benefits.

National Bariatric Surgery Registry

Obesity is one of the most important health issues facing Australia in the 21st century with around 2.6 million obese Australians. Obesity is associated with increased health factors and contributes to diseases such as diabetes and cardiovascular disease. In 2013-14, the Department provided funding to Monash University in conjunction with the Obesity Surgical Society of Australia and New Zealand (OSSANZ) to establish and implement a national bariatric surgery registry (BSR). The BSR enables collection of data to track the immediate surgical outcomes of bariatric surgery performed across Australia and will, over time, measure outcomes including weight loss as well as other obesity consequences such as diabetes incidence and control.

Disaster health care assistance schemes

Through the Disaster Health Care Assistance Schemes, the Department provides financial assistance to eligible Australian victims of disasters occurring overseas, including acts of terrorism, civil disturbances or natural disasters. This assistance, in the form of ex-gratia payments to victims and their families, covers out-of-pocket expenses for health care delivered in Australia for injury or ill health arising from specific disasters. There are five currently active schemes covering events such as the Bali bombings and the Asian tsunami.

In 2013–14, the Department of Human Services paid $475,869 for 2,432 claims on the Department of Health’s behalf.

Qualitative Deliverable
Provide health care assistance to eligible Australians overseas in the event of overseas disasters
2013-14 Reference Point
Assistance is provided in a timely manner
Result
Met

Support access to necessary medical services which are not available through mainstream mechanisms

During 2013-14, the Department continued to support access to necessary medical services which are either not available through mainstream mechanisms, such as Medicare, or which are not available in Australia.

In 2013-14, the Department funded three organisations through health programme grants. The grants provide funding for a range of targeted services for groups with special needs to overcome barriers to access services through mainstream mechanisms such as Medicare. These services include primary health care, intervention counselling, optometry and orthoptic consultations, and scientific aids, assisted technology and adaptive living aids for low vision.

Quantitative KPI
Number of health services provided to eligible Australian residents, such as the homeless, the disadvantaged and the visually impaired that could not be provided through Medicare, due to patient access barriers
2013-14 Target
37,000
2013-14 Actual
29,236
Result
Substantially Met
The number of health services provided to eligible Australian residents, such as the homeless, the disadvantaged and the visually impaired that could not be provided through Medicare, due to patient access barriers: 2010-11 33,332 services, 2011-12 38,738 services, 2012-13 34,864 services. In 2013-14, it is estimated that 29,236 services were provided to eligible Australians. Final figures were not known at the time of publication, and will be reported in the 2014-15 Annual Report. These programmes are demand-driven, and demand has been less than anticipated.
National External Breast Prostheses Reimbursement Programme

The External Breast Prostheses Reimbursement Programme provides a reimbursement of up to $400 every two years for eligible Australian women who have had a mastectomy as a result of breast cancer.

Quantitative KPI
Percentage of claims by eligible women under the National External Breast Prostheses Reimbursement Programme processed within ten days of lodgement
2013-14 Target
90%
2013-14 Actual
98%
Result
Met
The percentage of claims by eligible women under the National External Breast Prostheses Reimbursement Programme processed within ten days of lodgement: 2010-11 99 per cent, 2011-12 99.8 per cent, 2012-13 98 per cent. During 2013-14, 15,546 reimbursements were processed under the programme. Of the 15,546 eligible claims made, 98.26 % were processed within 10 days of lodgement.

Improve access to specialist services through telehealth

Medicare rebates are available for video consultations between specialists and patients in remote, rural and regional areas, and in eligible aged care facilities and Aboriginal Medical Services throughout Australia. Telehealth facilitates patient access to specialists sooner than might otherwise be the case, and without the time and expense involved in travelling to major cities. The telehealth incentive programme which was introduced in July 2011 to encourage the uptake of the Medical Benefits Schedule (MBS) telehealth items ceased on 1 July 2014.

In 2013-14, 101,741 MBS telehealth services were provided to 39,841 patients by 5,974 practitioners, with a total of $14.2 million in benefits paid. This compares to 71,333 services in 2012-13 and 26,062 in 2011-12. 14.6 per cent of specialists have provided a telehealth service.

Programme 3.3: Diagnostic imaging services

Programme 3.3 aims to strengthen the provision of quality diagnostic imaging services and ensure ongoing affordable and effective use of diagnostic imaging.

Encourage more effective use of diagnostic imaging

The Department continued to implement reforms to ensure more Australians have access to affordable diagnostic imaging and benefit from faster diagnosis and early detection performed by an appropriately qualified practitioner at facilities that meet all accreditation standards.

The Department worked with the Diagnostic Imaging Advisory Committee, a consultative committee comprising a range of diagnostic imaging stakeholders, on policies to support high quality, affordable and cost-effective diagnostic imaging services.

Diagnostic Imaging Quality Programme

The Department provided funding for projects that met identified priority areas in diagnostic imaging. This programme has ceased. Diagnostic imaging quality and safety continues to be addressed by other mechanisms, such as the Diagnostic Imaging Accreditation Scheme.

Qualitative Deliverable
Fund activities to improve the quality of diagnostic imaging services
2013-14 Reference Point
Funding agreements with successful applicants to the Diagnostic Imaging Quality Programme will be in place with monitoring activities conducted in 2013-14
Result
Met
12 Diagnostic Imaging Quality Programme (DIQP) projects were funded. A number of projects have required extensions of time and will therefore conclude during 2014-15 rather than 2013-14.

Diagnostic Imaging Reform – Magnetic resonance imaging

From 1 November 2012, GPs have been able to request MRIs for patients under 16 with certain clinical indications. This initiative has substantially improved access to Medicare-eligible magnetic resonance imaging (MRI) services for young Australians and will limit their exposure to radiation from alternative imaging modalities such as computed tomography.

Qualitative KPI
Patients have access to affordable and convenient diagnostic imaging services
2013-14 Reference Point
Increased access to MRI services for primary care patients through the introduction of new GP requested items for patients over the age of 16 years from 1 November 2013.
Result
Met
Four new GP requested items for patients over the age of 16 years were introduced from 1 November 2013. MBS data shows that patient access to Medicare eligible MRI services in the primary care setting has increased, with a steady rise in services since the items were introduced. The uptake of the new items will continue to be monitored.

The Department continued to implement arrangements for the expansion of Medicare-eligible MRI services in order to improve patient access nationally, with the number of Medicare-eligible MRI units increasing to 339 in 2013-14. This included granting partial or full Medicare eligibility for MRI units operating in metropolitan and regional areas before May 2011. Full Medicare eligibility was granted to 15 MRI units, while partial Medicare eligibility was granted for 10 other MRI units based in metropolitan areas.

Quantitative Deliverable
Number of additional MRI units in areas of need given Medicare eligibility
2013-14 Target
2
2013-14 Actual
4
Result
Met
Of the 12 MRI Medicare-eligible units granted as a result of the MRI Areas of Need Invitation to Apply process, Medicare eligibility was granted to four diagnostic imaging providers in 2013-14. Three of these were operational by the end of 2013-14.

Diagnostic Imaging Accreditation Scheme

All diagnostic imaging providers that wish to provide MBS eligible services must first be accredited through the Diagnostic Imaging Accreditation Scheme (DIAS). In 2013-14, the Department continued to manage the Scheme and work with the three external accreditors to assist diagnostic imaging providers who need to gain accreditation under Stage 2 of the Scheme.

The DIAS was reviewed to update the standards to ensure Medicare funding is directed to diagnostic imaging services that are safe, effective and responsive to the needs of health care consumers.

Quantitative KPI
Number of practices participating in the Diagnostic Imaging Accreditation Scheme
2013-14 Target
4,400
2013-14 Actual
4,008
Result
Substantially Met
The number of practices participating in the Diagnostic Imaging Accreditation Scheme: 2010-11 4,092 practices, 2011-12 4,106 practices, 2012-13 3,909 practices.The current number of practices participating in the DIAS is slightly lower than anticipated, however it continues to increase.

Programme 3.4: Pathology services

Programme 3.4 aims to provide access to high quality and affordable pathology services and ensure pathology services align with best clinical practice.

Assurance of quality and accessibility of services

The Department has continued to ensure access to high quality, clinically relevant and cost-effective pathology services through two programmes. The National Pathology Accreditation programme requires that pathology laboratories are accredited in order to be eligible for Medicare Benefits Schedule rebates. The Quality Use of Pathology Programme (QUPP) aims to improve health and economic outcomes from the quality use of pathology in health care. The QUPP has supported a range of initiatives focused on improved quality of pathology service provision, in particular quality assurance activities, consumer awareness of pathology testing and more appropriate requesting of pathology services.

During 2013-14, the Department continued to work closely with the National Pathology Accreditation Advisory Council (NPAAC) and further refined the national pathology accreditation framework to address areas of potential risk for patient safety in the delivery of pathology services. The NPAAC has continued its strategic consideration of key issues in the pathology sector with the view to improving the responsiveness of the pathology accreditation framework to provide assurance of the quality of pathology services in Australia.

Quantitative Deliverable
Number of new and/or revised national accreditation standards produced for pathology laboratories
2013-14 Target
4
2013-14 Actual
13
Result
Met
As part of NPAAC’s initiative to streamline the accreditation standards framework, NPAAC published an overarching standard that outlines the key elements of good laboratory practice. NPAAC subsequently reformatted 10 other existing standard documents. Two other standards relating to in-house in vitro diagnostics and gynaecological (cervical) cytology have also recently been published.
Qualitative KPI
Pathology accreditation standards ensure the quality of pathology services and better outcomes for patients
2013-14 Reference Point
The recognition and effective implementation of pathology quality standards by the sector
Result
Met
The accreditation system in relation to Medicare benefits for pathology has been in place since 1986. The pathology sector understands that laboratories must meet the specified quality standards developed by NPAAC in order to be eligible for Medicare rebates. The effectiveness of the implementation of the pathology accreditation standards is reflected in the high level of compliance with the standards.
Quantitative KPI
Percentage of Medicare-eligible laboratories meeting pathology accreditation standards
2013-14 Target
100%
2013-14 Actual
100%
Result
Met
Under the administrative arrangements, the Department of Human Services has liaised effectively with the endorsed accreditation assessment agency to ensure that Medicare eligibility is only available to those laboratories that meet the pathology accreditation standards.
Quantitative KPI
Percentage of pathology services that are bulk-billed
2013-14 Target
86%
2013-14 Actual
87%
Result
MetThe percentage of pathology services that are bulk-billed: 2010-11 86 per cent, 2011-12 87 per cent, 2012-13 87 per cent.

Pathology Funding Agreement

The Pathology Funding Agreement (PFA) is a mechanism to promote value for money from Government outlays relating to the services described in the Pathology Services Table of the MBS.

Qualitative KPI
Work with the signatories of the PFA to promote value for money from Government outlays for pathology while maintaining quality, access and affordability of pathology services
2013-14 Reference Point
Pathology expenditure within the agreed expenditure caps and floors and maintenance of quality pathology services
Result
Substantially Met
Pathology expenditure exceeded the agreed expenditure caps in 2013-14. Quality of pathology services was maintained. The Department continues to monitor pathology expenditure and work with the sector to explore methods to address fiscal sustainability of Government outlays on pathology, and to maintain quality, accessible and affordable pathology services.
Quantitative KPI
Annual growth rate in MBS pathology expenditure37
2013-14 Target
4.9%
2013-14 Actual
6.07%
Result
Not Met
The annual growth rate in MBS pathology expenditure: 2010-11 6.73 per cent, 2011-12 6.40 per cent.Actual growth experienced by the sector was 6.07%, which exceeded the agreed caps. However, annual growth was lower than the previous two years: 6.40% in 2012-13 and 6.73% in 2011-12.

Programme 3.5: Chronic disease – radiation oncology

Programme 3.5 aims to improve access to high quality radiation oncology services.

Improve access to quality radiation oncology services

The Department continues to support improved access to high quality radiation oncology services by funding approved equipment, quality programmes and initiatives to increase the number of trained radiotherapy professionals.

Qualitative Deliverable
Develop a framework to improve patient safety and clinical outcomes from radiation treatment
2013-14 Reference Point
The evaluation of the three year trial of the Australian Clinical Dosimetry Service is completed by June 2014
Result
Met
The Australian Clinical Dosimetry Service (ACDS) was commissioned by the Department as a three year trial. The ACDS began auditing radiotherapy facilities on a voluntary basis on 1 January 2011 and the trial was completed in June 2014. All radiotherapy centres in Australia participated in at least one level of the ACDS audit process with the overwhelming majority of outcomes meeting internationally accepted safety limits. The ACDS has established that the standard of accuracy of radiotherapy services in Australia is excellent. An external evaluation of the ACDS was commissioned by the Department and conducted by KPMG. The findings of the evaluation are now being considered.
Qualitative KPI
Projects are undertaken to increase radiation oncology workforce capacity, both through increased training capacity and enhanced capability of the existing workforce
2013-14 Reference Point
Strategies and initiatives to increase workforce capacity are supported by key stakeholders
Result
Met
Funding was provided for the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) for the training and national accreditation of radiation oncology medical physicists. Funding also provides trainees access to virtual linear accelerators, allowing realistic hands-on training without disruption to patient treatment. These projects, together with other Government initiatives, increased the radiation oncology workforce capacity.

The Department continues to provide Radiation Oncology Health Program Grants. These grants gradually reimburse service providers for the cost of approved equipment used to provide treatment services, helping to ensure equipment is replaced regularly and patients are treated using current techniques and technologies. The grants complement the Medicare benefits payable for radiation oncology services under Programme 3.1.

Qualitative KPI
Radiation oncology services are safe and of a high quality
2013-14 Reference Point
Radiation oncology practice standards are promoted by the professions as a guide to good practice
Result
Met
The Radiation Oncology Practice Standards are voluntary but are recommended and promoted by the professions as a guide to good practice. The Department funded their development and publication but their ownership rests with the Tripartite Committee which comprises the three peak bodies representing the following professions: radiation oncologists, radiation therapists and medical physicists.
Quantitative KPI
The number of sites delivering radiation oncology
2013-14 Target
68
2013-14 Actual
69
Result
Met
The number of sites delivering radiation oncology: 2010-11 61 sites, 2011-12 63 sites, 2012-13 66 sites.By the end of 2013-14, 69 radiation oncology facilities were providing services to patients.

Outcome 3 – Financial Resource Summary

(A) Budget Estimate 1
2013-14
$’000
(B) Actual 2013-14
$’000
Variation (Column
B minus Column A)
$’000
Programme 3.1: Medicare Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
10,859
8,625
( 2,234)
Special appropriations
Dental Benefits Act 2008
244,034
161,319
( 82,715)
Health Insurance Act 1973
19,079,033
19,065,871
( 13,162)
Departmental Expenses
Departmental Appropriation 2
26,026
26,137
111
Expenses not requiring appropriation in the current year 3
1,308
1,279
( 29)
Total for Programme 3.1
19,361,260
19,263,231
( 98,029)
Programme 3.2: Targeted Assistance – Medical
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
42,223
23,773
( 18,450)
Departmental Expenses
Departmental Appropriation 2
2,334
2,358
24
Expenses not requiring appropriation in the current year 3
115
114
( 1)
Total for Programme 3.2
44,672
26,245
( 18,427)
Programme 3.3: Diagnostic Imaging Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
2,370
2,336
( 34)
Departmental Expenses
Departmental Appropriation 2
994
883
( 111)
Expenses not requiring appropriation in the current year 3
45
42
( 3)
Total for Programme 3.3
3,409
3,261
( 148)
Programme 3.4: Pathology Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
4,287
2,760
( 1,527)
Departmental Expenses
Departmental Appropriation 2
4,067
3,777
( 290)
Expenses not requiring appropriation in the current year 3
202
181
( 21)
Total for Programme 3.4
8,556
6,718
( 1,838)
Programme 3.5: Chronic disease – radiation oncology
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
73,033
68,224
( 4,809)
Departmental Expenses
Departmental Appropriation 2
2,236
2,308
72
Expenses not requiring appropriation in the current year 3
109
111
2
Total for Programme 3.5
75,378
70,643
( 4,735)
Outcome 3 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)
132,772
105,718
( 27,054)
Special appropriations
19,323,067
19,227,190
( 95,877)
Departmental Expenses
Departmental Appropriation 2
35,657
35,463
( 194)
Expenses not requiring appropriation in the current year 3
1,779
1,727
( 52)
Total Expenses for Outcome 3
19,493,275
19,370,098
( 123,177)
Average Staffing Level (Number)
228
220
( 8)

1 Budgeted appropriations taken from the 2014-15 Health Portfolio Budget Statements and re-aligned to the 2013-14 programme group structure.

2 Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.

3 ‘Expenses not requiring appropriation in the budget year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information. Some reclassifications have been made to the Budget estimates to more accurately reflect the allocation of departmental depreciation by outcome.