Department of Health Annual Report 2016-17

Outcome 4: Individual Health Benefits

Page last updated: 19 October 2017

Access to cost-effective medicine, medical, dental and hearing services, and improved choice in health services, including through the Pharmaceutical Benefits Scheme, Medicare, targeted assistance strategies and private health insurance

Analysis of performance

In 2016-17, the Government continued to improve access to cost-effective medical, dental and hearing services, and medicines. The Government worked to improve choice in health services and targeted assistance strategies through the Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS).

The Government continued to work with health insurers to provide affordable private health insurance and to support individuals and families with the cost of private health insurance through the private health insurance rebate. During 2016-17, the Department also enhanced the integrity of health provider claiming and supported an independent taskforce to continue to methodically review all items currently on the MBS.

These activities have contributed to the Department’s achievements of objectives under Outcome 4 and our Purpose.

Highlights

This icon depicts a magnifying glass examining a document.

More than 2,850 MBS items are currently under active review

Aligning rebated services with contemporary, evidence-based medical practices are improving patient outcomes.
Refer Program 4.1

This image depicts a DNA strand.

Streamlining evaluation of genomic testing for heritable medical conditions

A Clinical Utility Card was developed for use by the Medical Services Advisory Committee to streamline the evaluation of genomic test applications for heritable medical conditions in Australia that can significantly affect clinical management and patient outcomes.
Refer Program 4.1

This image depicts two test tubes.

Improving pathology services

The Quality Use of Pathology Program provided funding to support a range of quality initiatives to improve requesting processes and service provision. The National Pathology Accreditation Program continues to assure that laboratories follow best practice including through quality standards for cervical screening and genomic testing.
Refer Program 4.1

This icon depicts a person with three sound lines next to their ear.

Improving access and reducing red tape for hearing service providers

The creation of a new website and online portal improved access and reduced red tape for hearing service providers and suppliers of hearing technology, making claiming and payments for hearing services and devices faster.
Refer Program 4.2

This icon depicts three pharmacists.

Recognising and strengthening the role of pharmacists

Variations to the Sixth Community Pharmacy Agreement recognise and strengthen the role of pharmacists in providing medicines, services and advice to patients.
Refer Program 4.3

This icon depicts a hand receiving money.

Raised $29 million in debts and recovered more than $13 million

Changes to the provider compliance program through the use of new and sophisticated data analytics capability and behavioural economics approaches have seen improvements in the integrity of health provider claiming.
Refer Program 4.7

This icon depicts a glucose monitor and drop of blood.

More than 4,000 eligible children and young people have benefited from continuous glucose monitoring

Access to continuous glucose monitoring products were fully subsidised for eligible children and young people aged under 21 years with type 1 diabetes through the National Diabetes Services Scheme.
Refer Program 4.8

Looking ahead

  • Implement changes to the Radiation Oncology Health Programs Grants Scheme to ensure the ongoing quality and efficacy of radiotherapy equipment and treatment in Australia for cancer patients.
  • Streamline the PBS listing processes and implement strategic agreements with our industry partners.
  • Examine reforms to private health insurance to simplify and deliver better value to consumers; improve transparency; simplify consumer products; and improve affordability.
  • Review the schemes funded under the Indemnity Insurance Fund to examine whether the current schemes remain fit for purpose and to inform potential future reform options for the schemes.
  • Strengthen compliance against prohibited practices under the Health Insurance Act 1973 relating to pathology approved collection centres.
  • Create an Office of Health Technology Assessment to build the Department’s expertise as world leaders in health technology assessment, and its integral role in making available to all Australians the best health services, devices and medicines at an affordable cost.

Purpose, programs and program objectives contributing to Outcome 4

Purpose
Lead and shape Australia’s health and aged care system and sporting outcomes through evidence-based policy, well targeted programs, and best practice regulation.
Supporting a Medicare System that is modern, sustainable and in line with current clinical evidence
Facilitating access to health services for Australians who travel to countries with a Reciprocal Health Care Agreement
Supporting access to clinically necessary medical services, which are not available in Australia
Providing financial assistance to eligible persons for out-of-pocket costs for ill health or injury arising from specific overseas disasters
Supporting safe and effective diagnostic imaging services
Supporting quality pathology services
Improving access to prostheses for women who have had a mastectomy as a result of breast cancer
Supporting the delivery of high quality radiation oncology services
Performance criteria from the 2016-17 Corporate Plan
Supporting access for eligible clients to quality hearing services
Supporting research into hearing loss prevention and management
Supporting timely access to medicines and pharmacy services
Listing cost-effective, innovative, clinically effective medicines on the PBS
Increasing the sustainability of the PBS
Providing access to new and existing medicines for patients with life threatening conditions
Undertaking post-market surveillance
Monitoring the use of diagnostics, therapeutics and pathology
Supporting the affordability of private health insurance through the private health insurance rebate
Ensuring access to safe and effective medical devices through the Prostheses List
Promoting a viable, sustainable and cost-effective private health insurance sector
Performance criteria from the 2016-17 Corporate Plan
Ensuring the insurance products are available and affordable
Ensuring the stability of the medical indemnity insurance industry
Improving access to public dental services for children and adults
Performance criteria from the 2016-17 Corporate Plan
Supporting the integrity of health provider claiming
Improving health outcomes for people with diabetes across Australia through the provision of subsidised products and self-management services
Assisting people with a stoma by providing stoma related products
Improving the quality of life for people with Epidermolysis Bullosa

Program 4.1: Medical Benefits

The Department met the majority of performance targets related to Program 4.1: Medical Benefits.

The Department continued its commitment to improving health service delivery to the Australian community by supporting the Medicare Benefits Schedule (MBS) Taskforce in their work to review all MBS items. This review aims to improve patient outcomes by aligning MBS items with evidence-based, contemporary best-clinical practice. The Taskforce, with the support of the Department, has established over 65 clinical committees and working groups with more than 440 clinicians, consumers and health system experts participating. Currently more than 50 per cent of over 5,700 MBS items are under review. While the performance target on the MBS Review has not been met, the Taskforce has made significant progress towards reviewing the large number of items currently listed on the MBS.

The Medical Services Advisory Committee (MSAC) developed a Clinical Utility Card (CUC) to assist in streamlining the evaluation of genomic test applications for heritable medical conditions in Australia. The CUC can significantly affect clinical management and improve patient outcomes. The CUC is a pathway to/through MSAC, that permits evaluation of a group of genes or gene mutations for diagnostic testing. Instead of evaluating the cost-effectiveness of testing each individual gene mutation in the group, the CUC relies on a ‘star performer’ gene to drive the evaluation. This is expected to provide patients with access to a wider range of genetic tests for a given disease and improve disease detection and treatment rates, with minimal increase in cost of testing.

During 2016-17, the Department continued work to ensure that pathology services are safe and effective by developing national accreditation standards for pathology laboratories. The National Pathology Accreditation Advisory Council continued to refine the accreditation framework, including producing best practice standards for cervical screening and genomic testing. Four accreditation standards were developed and published. This included two new standards and two revised standards.

Supporting a Medicare System that is modern, sustainable and in line with current clinical evidence

Continued review of MBS items to ensure they are safe, effective and cost-effective.
Source: 2016-17 Health Portfolio Budget Statements, p. 91
2016-17 Target2016-17 Result
The majority of MBS items have been reviewed by June 2017.13% of items have been reviewed by the Clinical Committees and finalised. More than 50% are currently under review.
Result: Not met
The MBS Review Taskforce, clinical committees (including in diagnostic imaging and pathology), and working groups are supported in their work by the Department.
Source: 2016-17 Health Portfolio Budget Statements, p. 91
2016-17 Target2016-17 Result
The Department supports public consultation and stakeholder engagement processes as agreed by the MBS Taskforce.The Department has provided secretariat support for 18 Clinical Committees and over 40 working groups. The Clinical Committees have been assisted to review items and draft recommendations for public consultation.
Result: Met

More than 50% of over 5,700 Medicare Benefits Schedule (MBS) items are currently under active review. Since the Review commenced, over 65 Clinical Committees and working groups were established. 13% of items have been reviewed by Clinical Committees with draft recommendations prepared or agreed by the Taskforce for public consultation.

The review process has previously encountered challenges associated with the planning and phasing in of new committees. The clinical committee process established by the Taskforce is resource intensive but critical to ensuring broad support for Taskforce recommendations. The Department and the Taskforce continue to look for opportunities to refine this process.

The Taskforce has finalised its advice to the Minister on 232 MBS items, with 11 reports endorsed for public consultation. The Taskforce will consider stakeholder feedback from public consultation and provide its final recommendations to the Government.

As part of the 2017-18 Budget, the Government agreed to continue the Review for a further three years.

Facilitating access to health services for Australians who travel to countries with a Reciprocal Health Care Agreement

Australians visiting the 11 Reciprocal Health Care Agreement countries receive necessary treatment, and visitors from those countries are able to access public health care in Australia.
Source: 2016-17 Health Portfolio Budget Statements, p. 91
2016-17 Target2016-17 Result
Timely resolution of issues related to access to health services encountered by Australians visiting a country with a Reciprocal Health Care Agreement, and for visitors to Australia accessing the Australian health care system.Visitors from Reciprocal Health Care Agreement countries received necessary treatment and no significant issues were encountered when accessing public health care. All minor issues were resolved in a timely manner.
Result: Met

The Australian Government has Reciprocal Health Care Agreements with New Zealand, the United Kingdom, the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway.

During 2016-17, 110,711 MBS services were provided to visitors to Australia under the Reciprocal Health Care Agreements with a total of $7.34 million paid in benefits.

Supporting access to clinically necessary medical services, which are not available in Australia

Financial assistance is provided to eligible applicants through the Medical Treatment Overseas Program.
Source: 2016-17 Health Portfolio Budget Statements, p. 92
2016-17 Target2016-17 Result
Assessments of applications for medical treatment are managed in accordance with program guidelines.All applications for financial assistance were assessed in accordance with the established program guidelines, with financial assistance provided to eligible applicants.
Result: Met

In 2016-17, the Department received 19 applications for financial assistance. Of these, 12 individuals were eligible and received funding to undergo treatment overseas. Assessment of these applicants was supported by independent expert advice from professional medical groups.

Providing financial assistance to eligible persons for out-of-pocket costs for ill health or injury arising from specific overseas disasters

Financial assistance to eligible Australians for out-of-pocket health care costs incurred as a result of specific overseas disasters is provided.
Source: 2016-17 Health Portfolio Budget Statements, p. 92
2016-17 Target2016-17 Result
Appropriate assistance is provided through timely policy advice to the Department of Human Services.The Department continued to provide policy advice to the Department of Human Services, ensuring health care assistance was provided to eligible Australians.
Result: Met

In 2016-17, the Department of Human Services paid $409,864 for 2,224 claims on behalf of the Department of Health.

The Disaster Health Care Assistance Schemes are demand-driven programs. Eligible people receive reimbursement for out-of-pocket health care expenses related to any injury or illness which has resulted from one of the incidents covered by the Schemes. In 2016-17, all reimbursements were provided in a timely manner.

Supporting safe and effective diagnostic imaging services

Commence a review of the Diagnostic Imaging Accreditation Scheme to strengthen the standards and streamline processes.
Source: 2016-17 Health Portfolio Budget Statements, p. 93
2016-17 Target2016-17 Result
The Diagnostic Imaging Accreditation Scheme Advisory Committee agrees and commences their forward work plan by January 2017.The Diagnostic Imaging Accreditation Scheme Advisory Committee has met on two occasions and agreed a forward work plan on 30 June 2017.
Result: Not met

The Diagnostic Imaging Accreditation Scheme Advisory Committee (the Committee) considered a planning framework and priorities at their inaugural meeting in December 2016. The Committee requested further information about the operation of the Scheme before agreeing a forward work plan. A consolidated forward work plan was not agreed by January 2017. The Committee had agreed a small number of priorities and a framework for finalising the elements of an ongoing work plan.

As at 30 June 2017, the Committee had agreed the elements of an ongoing work plan, a Stakeholder Engagement Plan and convened a small number of working groups to provide advice on the interpretation of current standards. Work has commenced on designing a process for reviewing and developing future standards.

The Committee comprises individuals with expertise in diagnostic imaging policy, practice, standards development and accreditation, health administration and health consumer advocacy. The Committee’s role is to provide advice on the development of standards, implementation arrangements and conformity assessment, and associated regulation impacts.

Supporting quality pathology services

Number of new and/or revised national accreditation standards produced for pathology laboratories.
Source: 2016-17 Health Portfolio Budget Statements, p. 93
2016-17 Target2016-17 Result2015-162014-152013-142012-13
44
Result: Met
34130

In 2016-17, four accreditation standards were produced for pathology laboratories. Two new standards and two revised standards were listed, respectively. The standards published were:

  • Requirements for Human Genome Testing Utilising Massively Parallel Sequencing;
  • Requirements for Laboratories Reporting Tests for the National Cervical Screening Program;
  • Requirements for Transfusion Laboratory Practice; and
  • Requirements for Gynaecological (Cervical) Cytology.
Percentage of Medicare-eligible pathology laboratories meeting accreditation standards.
Source: 2016-17 Health Portfolio Budget Statements, p. 93
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%

Pathology laboratories must meet specific accreditation standards in order to be accredited and thereby eligible for Medicare benefits for pathology services.

Improving access to prostheses for women who have had a mastectomy as a result of breast cancer

Percentage of claims by eligible women under the national External Breast Prostheses Reimbursement Program processed within ten days of lodgement.
Source: 2016-17 Health Portfolio Budget Statements, p. 93
2016-17 Target2016-17 Result2015-162014-152013-142012-13
90%95%
Result: Met
98%98%98%98%

Of the 14,393 eligible claims made, 95% were processed within 10 business days of lodgement.

Supporting the delivery of high quality radiation oncology services

Undertake a review of the Radiation Oncology Health Program Grants (ROHPG) Scheme.
Source: 2016-17 Health Portfolio Budget Statements, p. 94
2016-17 Target2016-17 Result
Review of the Radiation Oncology Health Program Grants Scheme to be completed by the first quarter of 2016-17. The review also provides an opportunity to respond to the 2015-16 Australian National Audit Office audit.The review of the ROHPG Scheme was complete in August 2016.
Result: Met

The Australian National Audit Office audit recommended that the Department should review the underlying program design of the ROHPG Scheme, including mechanisms to improve pricing transparency.

In 2016-17, the Department undertook a review of the Scheme. Reflecting the findings of the review,38 the Government announced in the 2016-17 Mid-Year Economic and Fiscal Outlook the measure Radiation Oncology Health Program Grants Scheme – Efficiencies. This measure aims to achieve efficiencies of $18.7 million over four years from 1 July 2017 through improvements in the administration of the ROHPG by: focussing funds towards high-cost linear accelerators and directing these funds to areas of need as agreed by States and Territories; and providing support of high use of radiotherapy as an affordable treatment in a way that is sustainable and consistent with broader Commonwealth policy and funding. Further, this measure has continued to provide targeted and sustainable Commonwealth support for radiotherapy as a high quality affordable treatment, while funding was provided to the Australian Radiation Protection and Nuclear Safety Agency for a new linear accelerator to ensure radiotherapy services are safe, accurate and high quality.

The number of sites delivering radiation oncology.
Source: 2016-17 Health Portfolio Budget Statements, p. 94
2016-17 Target2016-17 Result2015-162014-152013-142012-13
8283
Result: Met
80756966

The Department continues to improve access to high quality radiation oncology services by funding approved equipment, quality programs and initiatives to support the radiation oncology workforce and the number of sites providing radiation oncology. These payments allow for equipment to be replaced at the end of its lifespan so that treatment is delivered with up-to-date technology.

Performance criteria from the 2016-17 Corporate Plan

Continued review of Medical Benefits Schedule (MBS) items to ensure they are safe, effective and cost-effective, with the majority reviewed by June 2017.
Source: 2016-17 Health Corporate Plan, p. 25
Refer to performance criterion addressing the continued review of MBS items.

Program 4.2: Hearing Services

The Department met all performance targets related to Program 4.2: Hearing Services.

The Hearing Services Program provides a range of fully or partially subsidised hearing services to eligible Australians to manage their hearing loss and improve their engagement with the community.

The Department engaged with the hearing sector to facilitate the development of a Service Delivery Framework. Following completion of this work it was agreed that hearing services would be included in the development of the National Safety and Quality Health Service Standards for primary care settings and governed by the Australian Commission on Safety and Quality in Health Care under its Australian Health Services Safety and Quality Accreditation Scheme.

During 2016-17, the Government continued to fund research and development activities into hearing health, prevention and rehabilitation. The creation of a new website and online portal, through the Hearing Services Online Project, has improved access and reduced red tape for hearing service providers and suppliers of hearing technology. The final portal was released on 31 December 2016.

Supporting access for eligible clients to quality hearing services

Quality service provision and client outcomes are better supported through a proposed hearing sector endorsed Service Delivery Framework.
Source: 2016-17 Health Portfolio Budget Statements, p. 95
2016-17 Target2016-17 Result
Hearing sector endorsement of the proposed Service Delivery Framework is achieved by December 2016.The hearing sector continued to develop the Service Delivery Framework in 2016 and collaborated through an Implementation Planning Steering Group to determine the most appropriate regulation model. The hearing sector subsequently endorsed self-regulation of key components of the Service Delivery Framework, and the inclusion of hearing services in the National Safety and Quality Health Service Standards for primary care under development by the Australian Commission on Safety and Quality in Health Care.
Result: Met

During 2016, the hearing sector agreed that hearing services should be included in the National Safety and Quality Health Services Standards for primary care settings. The Australian Commission on Safety and Quality in Health Care is now working with the sector to develop the standards.

Policies and program improvements are developed and implemented in consultation with consumers and service providers.
Source: 2016-17 Health Portfolio Budget Statements, p. 95
2016-17 Target2016-17 Result
Stakeholders have adequate opportunities to participate in consultations, including consultation on National Disability Insurance Scheme transition arrangements.There were no consultations held on National Disability Insurance Scheme transition arrangements in 2016-17.
Stakeholder views were sought on a review of service items, fees and assistive technology supply. This was followed by the release of a public discussion paper, with a two month response period. Thirty seven responses were received and are currently being analysed.
Result: Met

Ongoing work with service providers to raise awareness of their obligations under the program continues. An independent organisation has been contracted to undertake a review of services and technology supply for the program which includes an initial information gathering exercise followed by a public discussion paper seeking comment and input.

Number of people who receive voucher services nationally.
Source: 2016-17 Health Portfolio Budget Statements, p. 95
2016-17 Target2016-17 Result2015-162014-152013-142012-13
723,319713,182
Result: Met
692,283669,793647,545636,389

The voucher component of the program is client demand-driven, and the projected target is an estimation based on population parameters. The performance result of ‘met’ is based on meeting all of the 2016-17 actual demand.

Supporting research into hearing loss prevention and management

Funding of hearing health research projects is in accordance with Hearing Services Program objectives.
Source: 2016-17 Health Portfolio Budget Statements, p. 96
2016-17 Target2016-17 Result
Research activities are consistent with, and support, the Hearing Services Program.Research and development activities into hearing health, prevention and rehabilitation, was undertaken by the National Acoustic Laboratories and various other research institutions, consistent with the Hearing Services Program funded through the Hearing Loss Prevention Program.
Result: Met

Through the Hearing Services Program, funding is allocated to National Acoustic Laboratories to progress work undertaken as part of an agreed project schedule.

Program 4.3: Pharmaceutical Benefits

The Department met or substantially met the majority of performance targets related to Program 4.3: Pharmaceutical Benefits.

Access to pharmaceutical products and services is key to improving the health of all Australians. In 2016-17, the Department worked with the pharmaceutical industry to support the Government strengthening the Pharmaceutical Benefits Scheme (PBS) and provide certainty to the pharmaceutical industry through a stable PBS pricing environment. This was expressed through agreements with the key industry associations in the sector. This will also provide patients access to more medicines by supporting the use of generic and biosimilar medicines.

During 2016-17, the Government ensured that pharmaceutical wholesalers continued to be financially supported through the Community Service Obligations Funding Pool, to supply PBS medicines to pharmacies across Australia within the guaranteed supply period, regardless of their location.

The Department continued to support the Pharmaceutical Benefits Advisory Committee (PBAC) to ensure new medicines are considered and listed on the PBS in a timely manner. This ensures the Australian public has access to new and affordable innovative medicines in a timely manner. The PBAC Guidelines were revised to ensure the PBAC submission and assessment process incorporates current international best practice, and the processes are consistent and transparent.

An agreement with the Pharmacy Guild of Australia to vary the Sixth Community Pharmacy Agreement recognises and strengthens the role of pharmacists in providing medicines, services and advice to patients. The Agreement focusses on supporting the viability of our network of community pharmacies, the supply of medications and the delivery of services, to help patients manage their medications.

New hope for people with lung and renal cancer

This image depicts two people examining an x-ray.Nivolumab, a new medicine that improves outcomes for people with late stage lung and renal cancer, was recommended in March 2017 for listing on the PBS.

In making its recommendation for listing, the Pharmaceutical Benefits Advisory Committee noted the clear community need for this significant new treatment. Nivolumab can extend life and improve quality of life for patients who meet the criteria for treatment, and is safer and more effective than current therapies.

Nivolumab is a type of immunotherapy that helps make cancer cells more vulnerable to attack by your body’s own immune system.

It activates T cells (white blood cells that help your body fight disease) so that they can attack cancer cells anywhere in your body.

It is very different to conventional treatments such as chemotherapy and radiation, because it uses the body’s own immune system to fight cancer.

The PBS listing means that patients will pay only a maximum of $38.80 per treatment phase for the medicines, with concessional patients paying just $6.30.

Without subsidy, the medicine would cost a patient more than $130,000 per year.

Clinicians have expressed their excitement at being able to offer this medicine, noting that it is a great advancement in the treatment of cancers that have typically had a very poor outcome.

Consumer groups also said they value nivolumab as another treatment option, due to better outcomes and tolerability in comparison with other available treatments.

This significant listing on the PBS will take effect on 1 August 2017 and will benefit more than 4,500 Australians each year.

“It’s a special feeling when you can recommend new effective medicines for people with diseases previously considered untreatable.” – Professor Andrew Wilson, Chair of the Pharmaceutical Benefits Advisory Committee

Supporting timely access to medicines and pharmacy services

Maintenance of PharmCIS and delivery of an increased suite of reporting and data related to pharmacy and PBS funded medicine access and cost made available to Parliament, consumers and business.
Source: 2016-17 Health Portfolio Budget Statements, p. 97
2016-17 Target2016-17 Result
Periodically increase the volume and nature of data on the Department of Health website during the course of 2016-17.During 2016-17 there were monthly updates of PBS related tables on the PBS website39 as well as the addition of a number of tables in the publication Expenditure and Prescriptions twelve months to 30 June 2016.
Result: Met

Aggregate tables on PBS prescriptions and expenditure by date-of-supply and date-of-processing are made publically available on the PBS website.40 These tables are updated monthly to provide the community with the latest available view of PBS prescription data.

The Department has a contract in place to maintain the PharmCIS application and manages a formal change control process to modify the PharmCIS application to accommodate policy, legislative and PBS listing changes each month.

Percentage of urban centres/localities in Australia with a population in excess of 1,000 people with a resident community pharmacy or approved supplier of PBS medicines.
Source: 2016-17 Health Portfolio Budget Statements, p. 97
2016-17 Target2016-17 Result2015-162014-152013-142012-13
>90%91.96%
Result: Met
91.8%N/AN/AN/A

91.96% of communities with a population of at least 1,000 people have timely access to PBS subsidised medicines at a community pharmacy or approved supplier when needed. Approved suppliers can be a pharmacy, a medical practitioner (in rural/remote locations where there is no access to a pharmacy) or an Aboriginal Health Service, approved to supply PBS medicines to the community.

Percentage of urban centres/localities in Australia with a population in excess of 1,000 people with a resident service provider of, or recipient of, Medscheck, Home Medicines Review, Residential Medication Management Review or Clinical Intervention.
Source: 2016-17 Health Portfolio Budget Statements, p. 97
2016-17 Target2016-17 Result2015-162014-152013-142012-13
>80%90%
Result: Met
97%N/AN/AN/A

In 2016-17, 90% of communities with a population in excess of 1,000 people had access to advice
and reviews, when needed. These activities support the quality use of medicines and aim to reduce medicine related problems.

Percentage of subsidised PBS units delivered to community pharmacy within agreed requirements of the Community Service Obligation.
Source: 2016-17 Health Portfolio Budget Statements, p. 98
2016-17 Target2016-17 Result2015-162014-152013-142012-13
>95%97.5%
Result: Met
96%N/AN/AN/A

The timely supply of PBS medicines is secured under the Community Service Obligations (CSO) Funding Pool. Wholesalers engaged under the CSO are contractually required to deliver PBS medicines within the guaranteed supply period of 72 hours for medicines on the high volume list, and 24 hours for all other medicines.

Average cost per subsidised script funded by the PBS.
Source: 2016-17 Health Portfolio Budget Statements, p. 98
2016-17 Target2016-17 Result2015-162014-152013-142012-13
$28.17$31.08
Result:
Substantially Met
$27.37N/AN/AN/A

In 2016-17 the average cost per subsidised script funded by the PBS was $31.08. The actual result was higher than target due to the higher than expected take-up of the new and expensive hepatitis C medicines.

The performance result of ‘significantly met’ is based on the result being 10% higher than the target.

Average cost per script paid by consumers for subsidised medicines.
Source: 2016-17 Health Portfolio Budget Statements, p. 98
2016-17 Target2016-17 Result2015-162014-152013-142012-13
$10.15$9.84
Result: Met
$9.27N/AN/AN/A

In 2016-17, the average cost of subsidised scripts paid by consumers under the PBS was $9.84. This is across all PBS Section 85 prescriptions, including under co-payment prescriptions.

Listing cost-effective, innovative, clinically effective medicines on the PBS

Percentage of submissions for new medicines for listing that are considered by PBAC within 17 weeks of lodgement.
Source: 2016-17 Health Portfolio Budget Statements, p. 98
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%N/AN/AN/A

The Pharmaceutical Benefits Advisory Committee (PBAC) met on six occasions in 2016-17, including three special meetings in August 2016, December 2016 and April 2017.41

All submissions were considered within the specified 17 week timeframe from lodgement. Approved medications were made publicly available in timeframes consistent with long standing arrangements agreed with the pharmaceutical industry.

All PBAC assessments are based on the clinical and cost-effectiveness of the medicine.

Percentage of submissions for new medicines that are recommended for listing by PBAC, that are listed on the PBS within six months of agreement of budget impact and price.
Source: 2016-17 Health Portfolio Budget Statements, p. 98
2016-17 Target2016-17 Result2015-162014-152013-142012-13
80%85%
Result: Met
92%N/AN/AN/A

Negotiations with product sponsors and listing activities for new listings of medicines on the PBS were completed in a timely manner, with 85% being listed on the PBS within six months of agreement on price, and the overall cost to Government, that is the Budget impact, meeting the performance target.

Increasing the sustainability of the PBS

Estimated savings to Government from price disclosure.
Source: 2016-17 Health Portfolio Budget Statements, p. 99
2016-17 Target2016-17 Result2015-162014-152013-142012-13
$3,268.3m$2,429.2m
Result:
Substantially met
$2,258.4mN/AN/AN/A

Consumers continue to receive benefit from price reductions through price disclosure. Lower than estimated savings occurred in 2016-17 which may reflect that many PBS drugs already have low prices due to price disclosure.

New price disclosure savings will continue into the future, driven in particular by the enhanced uptake drivers for biosimilars announced in the 2017-18 Budget.

Providing access to new and existing medicines for patients with life threatening conditions

Eligible patients have timely access to the Life Saving Drugs Program (LSDP).
Source: 2016-17 Health Portfolio Budget Statements, p. 99
2016-17 Target2016-17 Result
Patient applications are processed within 30 calendar days of receipt of the complete data package to support the application.All new applications were processed within 30 calendar days.
Result: Met
Number of patients assisted through the LSDP.
Source: 2016-17 Health Portfolio Budget Statements, p. 99
2016-17 Target2016-17 Result2015-162014-152013-142012-13
302393
Result: Met
335278257228
Percentage of Government-accepted recommendations from LSDP post-market reviews that are implemented.
Source: 2016-17 Health Portfolio Budget Statements, p. 99
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%N/AN/AN/AN/AN/A
Percentage of eligible patients with access to fully subsidised medicines through the LSDP.
Source: 2016-17 Health Portfolio Budget Statements, p. 99
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%

The LSDP processed new applications in accordance with the LSDP guidelines. New applications with all the required documents were processed within 30 calendar days. The actual number of treated patients exceeded the target due to new medicines being included on the LSDP and the number of patients increasing.

There were no Government-accepted recommendations from the LSDP review to implement in 2016-17. The LSDP continues to operate unchanged while the review is under consideration, with all eligible patients continuing to have access to fully subsidised medicines through the LSDP.

In 2016-17 there were 12 drugs funded through the program to treat eight serious and rare medical conditions. These conditions were: Fabry disease, Gaucher disease, Mucopolysaccharidosis Types I, II and VI, Pompe disease (Infantile-onset, Juvenile-onset or Adult Late-onset), Paroxysmal Nocturnal Haemoglobinuria, and Hereditary Tyrosinaemia Type I.

Undertaking post-market surveillance

Post-market reviews deliver relevant and high quality advice to the Pharmaceutical Benefits Advisory Committee (PBAC) and Government.
Source: 2016-17 Health Portfolio Budget Statements, p. 100
2016-17 Target2016-17 Result
Reference Groups established, and engage constructively with professional and community stakeholders in the conduct of the reviews.Reference Groups were established and engaged constructively with key stakeholders in the conduct of post-market reviews. To ensure relevant and high quality advice was delivered, each Reference Group included members with clinical and technical expertise, industry representatives, and consumer advocates.
For each review, key stakeholders were invited to provide input to the review, comment on the draft report, and attend stakeholder forums. On average, around 15 stakeholders provided a submission to each review and seven provided a submission on the draft reports. Input was received from up to 130 attendees for each stakeholder forum, either through face-to-face meetings or through surveys for stakeholders who were not well enough to attend in person.
Result: Met

Reference Groups supported each of the post-market reviews for:

  • PBAC Guidelines (one meeting held on 5 August 2016);
  • PBS Authority Required Medicines (all meetings were held in 2015-16);
  • Ezetimibe (three meetings were held: 23 September 2016, 30 November 2016 and 17 March 2017);
  • chronic obstructive pulmonary disease medicines (three meetings were held: 10 October 2016, 13 December 2016 and 26 April 2017);
  • pulmonary arterial hypertension medicines (first met in 2017-18); and
  • the use of biologics in the treatment of severe chronic plaque psoriasis (one meeting held on 18 May 2017).

In conducting these reviews, the Reference Groups provided: advice on the scope and requirements for medicine utilisation and literature reviews; comment on reports on medicine utilisation, efficacy, safety and cost-effectiveness; insight into clinical practice and consumer issues; and comments on the draft and final review reports.

Percentage of post-market reviews completed within scheduled timeframes.
Source: 2016-17 Health Portfolio Budget Statements, p. 100
2016-17 Target2016-17 Result2015-162014-152013-142012-13
90%100%
Result: Met
100%N/AN/AN/A

Two reviews were completed in 2016-17:

  • Pharmaceutical Benefits Advisory Committee Guidelines; and
  • PBS Authority Required Medicines.

Two reviews continued in 2016-17:

  • Ezetimibe; and
  • chronic obstructive pulmonary disease medicines.

Two reviews commenced in 2016-17:

  • pulmonary arterial hypertension medicines; and
  • the use of biologics in the treatment of severe chronic plaque psoriasis.
Percentage of Government-accepted recommendations from post-market reviews that have been implemented within six months.
Source: 2016-17 Health Portfolio Budget Statements, p. 100
2016-17 Target2016-17 Result2015-162014-152013-142012-13
80%85%
Result: Met
80%N/AN/AN/A

All recommendations from the PBAC Guidelines Review have been implemented. The revised guidelines are published on the PBS website. Education sessions were provided to promote a common understanding and interpretation of the guidance within the guidelines.

The Review of PBS Authority Required Medicines covered a total of 853 medicine items, of which the PBAC recommended changes to approximately 560. Around 70% of the Review recommendations were implemented concurrently during the Review. The remaining recommendations will be implemented as resources become available.

Monitoring the use of diagnostics, therapeutics and pathology

Information regarding quality use of medicines is provided to health professionals and consumers to support use of therapeutics wisely, judiciously and safely to achieve better health and economic outcomes.
Source: 2016-17 Health Portfolio Budget Statements, p. 101
2016-17 Target2016-17 Result
The Department will provide funding for the provision of quality use of medicines information to be available in a variety of formats throughout the year, designed to support health professionals and consumers.The Government funded NPS MedicineWise to produce its scheduled publications, resources, and educational visits which provided evidence-based information on therapeutics, including new and revised listings of medicines on the PBS, for health professionals and consumers.
Result: Met

Education was provided to health professionals in the form of educational visits, online modules, resources and publications. Targeted consumer information campaigns included appropriate use of antibiotics and other therapeutic topics. NPS MedicineWise published Rational Assessment of Drugs and Research, Australian Prescriber and an annual evaluation report of all NPS MedicineWise programs.

NPS also made significant progress through its Choosing Wisely Australia initiative. A large cross section of professional colleges, societies and associations worked with NPS to develop recommendations that address inappropriate, overused or harmful care practices.

Program 4.4: Private Health Insurance

The Department met all performance targets related to Program 4.4: Private Health Insurance.

During 2016-17, the premium round process identified opportunities for improved stakeholder consultation. This has resulted in a more streamlined application form, regular forums for feedback and discussion as well as opportunities for stakeholders to be involved in activities to improve industry compliance.

During 2016-17, the Government continued to work with insurers to provide affordable health insurance and supported individuals and families with private health insurance through the private health insurance rebate.

The Department also continued to administer the Prostheses List, with more than 11,000 items included for surgical implantation. This facilitates access to safe and clinically effective medical devices through the private health insurance system for consumers.

The Department has continued to consult with key stakeholders on reforms to improve the affordability and value for money of private health insurance. The number of people with hospital treatment policies has increased by 21,985 from March 2016 to March 2017. 11.4 million Australians have private health insurance and contribute to taking the pressure off the public health system.

Supporting the affordability of private health insurance through the private health insurance rebate

Consultation with stakeholders on ways to ensure that the private health insurance rebate is communicated to policy holders and delivered through private health insurance products.
Source: 2016-17 Health Portfolio Budget Statements, p. 102
2016-17 Target2016-17 Result
Ongoing stakeholder discussions (a minimum of two stakeholder consultation forums) to assist in the timeliness and streamlining of processes to enable consistent advice to consumers.Ongoing discussions were held with stakeholders, including two forums, regular meetings and weekly communications with the private health insurance sector.
Result: Met

The Department held two stakeholder consultation forums in Sydney and Melbourne. The Department provides weekly communications to the private health insurance sector outlining current policy initiatives undertaken by the Department, information on compliance and enforcement, information on the annual premium process and information about the rebate. Regular meetings were also held with the Department of Human Services, industry peak bodies, the Australian Taxation Office, the Australian Prudential Regulation Authority and the Private Health Insurance Ombudsman.

Percentage of insurers’ average premium increases publicly released in a timely manner.
Source: 2016-17 Health Portfolio Budget Statements, p. 102
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%

All insurers’ premium increases were published on the Department’s website42 on 10 February 2017.

The number of people covered by private health insurance hospital treatment cover.
Source: 2016-17 Health Portfolio Budget Statements, p. 102
2016-17 Target2016-17 Result2015-162014-152013-142012-13
10.9m11.3m
Result: Met
11.3m11.2m11.1m10.8m

Actual figures are published by the Australian Prudential Regulation Authority.

Ensuring access to safe and effective medical devices through the Prostheses List

Ensure consumers have access to safe and effective surgically implanted prostheses under the Prostheses List.
Source: 2016-17 Health Portfolio Budget Statements, p. 102
2016-17 Target2016-17 Result
Consumers have access to clinically appropriate and cost-effective surgically implanted prostheses.Consumers continue to have access to clinically appropriate and cost-effective surgically implanted prostheses.
Result: Met
Percentage of applications to list devices on the Prostheses List completed within 22 weeks.
Source: 2016-17 Health Portfolio Budget Statements, p. 102
2016-17 Target2016-17 Result2015-162014-152013-142012-13
87%97%
Result: Met
89.7%88. 9%N/AN/A

The Department has continued to administer and maintain the Prostheses List, which includes more than 11,000 items for surgical implantation to provide life-saving and life-enhancing therapy to patients. In 2016-17, 97% of applications submitted through the Prostheses Listing process were completed within 22 weeks.

Promoting a viable, sustainable and cost-effective private health insurance sector

Establish and work with the Private Health Sector Committee to develop and implement private health insurance reforms.
Source: 2016-17 Health Portfolio Budget Statements, p. 103
2016-17 Target2016-17 Result
Meet at least nine times during 2016-17 to provide technical and specialist advice on a range of reform activities.The Private Health Ministerial Advisory Committee met nine times during 2016-17.
Result: Met

This committee was established as the Private Health Ministerial Advisory Committee on 8 September 2016 to examine private health insurance reform and provide government with advice on reform options including developing easy-to-understand categories of health insurance and developing standard definitions for medical procedures across all insurers for greater transparency and simplified billing.

A summary of each meeting is published on the Department’s website.43

Ensure that all health funds complete due diligence when assessing the increase in annual premiums.
Source: 2016-17 Health Portfolio Budget Statements, p. 103
2016-17 Target2016-17 Result
Premium round applications demonstrate sufficient capital adequacy, solvency and prudential viability.All premium round applications demonstrated sufficient capital adequacy, solvency and prudential viability.
Result: Met

Australian Prudential Regulation Authority used the premium applications to assess insurer capital adequacy, solvency and prudential viability.

Performance criteria from the 2016-17 Corporate Plan

Increase in the percentage of Australians with private health insurance.
Source: 2016-17 Department of Health Corporate Plan, p. 25
Type of cover2016-172015-162014-152013-14
Hospital cover46.1%47.0%47.4%47.2%
General cover55.0%55.7%55.8%55.2%

In 2016-17 there was a slight decrease in the number of people who held Hospital and General cover compared with 2015-16. Further information can be found on the Australian Prudential Regulation Authority’s website.44

Program 4.5: Medical Indemnity

The Department met all performance targets related to Program 4.5: Medical Indemnity.

The Department works with the Department of Human Services to administer a number of schemes that support the stability of the medical indemnity industry and surety for privately practicing doctors, and midwives and their patients.

The Premium Support Scheme, funded by the Government, assists eligible doctors through a subsidy that reduces their medical indemnity costs. Government-supported, affordable professional indemnity insurance is also available for qualified and experienced privately practicing midwives. Improving the availability of affordable professional indemnity insurance helps to reduce out-of-pocket costs for patients and supports patient choice.

Ensuring that insurance products are available and affordable

The continued availability of professional indemnity insurance for eligible midwives.
Source: 2016-17 Health Portfolio Budget Statements, p. 104
2016-17 Target2016-17 Result
Maintain a contract with a medical indemnity provider to provide professional indemnity insurance to eligible midwives.A contract has been maintained with a medical indemnity provider for the provision of professional indemnity insurance to eligible midwives.
Result: Met
Percentage of eligible midwife applicants covered by the Midwife Professional Indemnity Scheme.
Source: 2016-17 Health Portfolio Budget Statements, p. 105
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%

Eligible midwives were able to purchase Commonwealth supported professional indemnity insurance from Medical Insurance Group Australia (MIGA).

All eligible privately practising midwives who applied for Commonwealth supported professional indemnity insurance through MIGA were offered cover.

Percentage of eligible applicants receiving a premium subsidy through the Premium Support Scheme.
Source: 2016-17 Health Portfolio Budget Statements, p. 105
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%
Number of doctors that receive a premium subsidy support through the Premium Support Scheme.
Source: 2016-17 Health Portfolio Budget Statements, p. 105
2016-17 Target2016-17 Result2015-162014-152013-142012-13
1,5001,268
Result: Met
1,2371,4001,6131,847

All eligible applicants received a premium subsidy through the Premium Support Scheme in 2016-17. The reduction over time in the number of doctors seeking a premium subsidy indicates that the medical indemnity measures administered by the Department are helping make indemnity insurance premiums more affordable for doctors.

Ensuring the stability of the medical indemnity insurance industry

Percentage of medical indemnity insurers who have a Premium Support Scheme contract with the Australian Government that meets the Australian Prudential Regulation Authority’s Minimum Capital Requirement.
Source: 2016-17 Health Portfolio Budget Statements, p. 105
2016-17 Target2016-17 Result2015-162014-152013-142012-13
100%100%
Result: Met
100%100%100%100%

All medical indemnity insurers that have entered into a Premium Support Scheme contract with the Government in 2016-17 met the Australian Prudential Regulation Authority’s Minimum Capital Requirement.

Program 4.6: Dental Services

The Department did not meet the performance targets related to Program 4.6: Dental Services.

Following a Government decision, the Child and Adult Public Dental Scheme did not proceed. Instead, the Child Dental Benefits Schedule continued, with funding for adult dental services continued through a National Partnership Agreement. The continuation of these arrangements ensured that the Commonwealth continued to support the delivery of dental services to a potential recipient pool of over three million eligible Australians.

Improving access to public dental services for children and adults

Improved access to public dental services for eligible patients.
Source: 2016-17 Health Portfolio Budget Statements, p. 106
2016-17 Target2016-17 Result
Increase in the volume of public dental services adjusted for complexity.Following a Government decision, this initiative did not proceed.
Result: Not met

Following a Government decision the Child and Adult Public Dental Scheme did not proceed. Instead the Child Dental Benefits Schedule continued, with funding for adult dental services continued through a National Partnership Agreement.

Performance criteria from the 2016-17 Corporate Plan

Increased access to public dental services provided by State and Territory Governments.
Source: 2016-17 Department of Health Corporate Plan, p. 25
Refer above on this page for performance criterion addressing access to public dental services.

Program 4.7: Health Benefit Compliance

The Department met all performance targets related to Program 4.7: Health Benefit Compliance.

The Department continued to support the integrity of health provider claims through early intervention and identification, as well as detecting and investigating instances of fraud. The Department has undertaken activities that enhance the integrity of the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Child Dental Benefits Schedule and health incentive programs contributing to the sustainability of the health system. A detailed review was undertaken of the Department’s provider compliance function resulting in a restructure that better supports contemporary compliance approaches and efficient business processes, including through data analytics and behavioural economic approaches.

Improvements to the provider compliance program through the use of data analytics and behavioural economics has seen improvements in the integrity of health provider claiming. This has resulted in: 29 fraud cases successfully prosecuted; 81 requests to the Director of Professional Services Review to review the appropriateness of services of health practitioners; more than $29 million of debt raised following compliance activities; and more than $13 million of debt recovered. The Department completed 500 audits and reviews of health providers focussed on high risk/complex compliance issues however, these did not generate the target value of $50,000 per debt raised.

Supporting the integrity of health provider claiming

Implement a contemporary compliance program that utilises advanced analytics, effectual tools and behavioural economics to support the integrity of health provider claiming.
Source: 2016-17 Health Portfolio Budget Statements, p. 108
2016-17 Target2016-17 Result
Enhanced activities are delivered by 30 June 2017 that contribute to an agreed contemporary compliance program that results in a change in provider claiming practices.The Department has undertaken a number of activities to better support contemporary compliance approaches and efficient business processes, including through enhanced data analytics capability and behavioural economics approaches.
Result: Met

Key activities undertaken focussed on improving compliance outcomes through enhancement of data analytics, behavioural economics and contemporary compliance approaches. In addition, the Department invested in data analytics training and secure data infrastructure to support these approaches. The Department raised $29 million in debts against providers and recovered more than $13 million in 2016-17, both significant increases since 2015-16. Investments in improved capabilities in 2016-17 are expected to deliver further increases in debts raised and recovered, as well as in behaviour change from providers, in 2017-18.

Complete audits and reviews of health providers including general audits, practitioner reviews and criminal investigations.
Source: 2016-17 Health Portfolio Budget Statements, p. 108
2016-17 Target2016-17 Result2015-162014-152013-142012-13
2,5003,035
Result: Met
N/AN/AN/AN/A

3,035 audits and reviews were completed which includes general audits, practitioner reviews and criminal investigations.

Complete audits and reviews of health providers focussed on high risk/complex compliance issues.
Source: 2016-17 Health Portfolio Budget Statements, p. 108
2016-17 Target2016-17 Result2015-162014-152013-142012-13
500500
Result: Met
N/AN/AN/AN/A

An additional 500 audits and reviews were completed which focussed on higher risk/complex compliance issues. However, these did not generate the target value of $50,000 per debt raised.

Program 4.8: Targeted Assistance – Aids and Appliances

The Department met the majority of performance targets related to Program 4.8: Targeted Assistance – Aids and Appliances.

The National Diabetes Services Scheme ensures that people with diabetes have timely, reliable and affordable access to products and services to assist people to effectively self-manage their condition. This includes fully subsidised continuous glucose monitoring (CGM) products for more than 4,000 eligible children and young people aged under 21 years with type 1 diabetes, with most accessing CGM technology for the first time.

In 2016-17, the Government continued to assist over 40,000 people with a stoma by ensuring they have access to stoma related appliances through the Stoma Appliance Scheme. There are currently over 400 products available through the scheme.

The Department also continued to ensure access to clinically necessary dressings and products for people with Epidermolysis Bullosa.

Improving health outcomes for people with diabetes across Australia through the provision of subsidised products and self-management services

Number of people under 18 years of age, with type 1 diabetes receiving subsidised insulin pumps and associated consumables (under the Insulin Pump Program).
Source: 2016-17 Health Portfolio Budget Statements, p. 109
2016-17 Target2016-17 Result2015-162014-152013-142012-13
6866
Result:
Substantially met
666520476

Target of 68 subsidies was based on an average subsidy of $6,000 per recipient. However, 97% of recipients required a full subsidy of $6,400, resulting in total funding supporting slightly fewer people.

The performance result of ‘substantially met’ is based on meeting 97% of the target.

The National Diabetes Services Scheme (NDSS) meets the needs of stakeholders.
Source: 2016-17 Health Portfolio Budget Statements, p. 109
2016-17 Target2016-17 Result
Annual survey of registrants demonstrates that the needs of stakeholders are being met.Over 90% of surveyed registrants indicated that the NDSS improved their knowledge and understanding of diabetes and helped them manage their condition more effectively.
Result: Met
Number of people with diabetes receiving benefit from the NDSS.
Source: 2016-17 Health Portfolio Budget Statements, p. 109
2016-17 Target2016-17 Result2015-162014-152013-142012-13
1,397,8031,395,031
Result: Met
1,320,3281,259,2031,133,4121,086,860

The NDSS is a demand-driven program. In 2016-17, the number of people with type 1, type 2 and gestational diabetes receiving benefit from the NDSS was 1,256,070. There were also a further 138,961 people registered on the post-gestational diabetes register who were also eligible to receive services (but not products) from the NDSS. All eligible individuals were provided access throughout the financial year.

Assisting people with a stoma by providing stoma related products

Number of people receiving stoma related products.
Source: 2016-17 Health Portfolio Budget Statements, p. 110
2016-17 Target2016-17 Result2015-162014-152013-142012-13
44,00044,424
Result: Met
43,76742,67842,228N/A
Average cost per aid and appliance delivered to eligible persons.
Source: 2016-17 Health Portfolio Budget Statements, p. 110
2016-17 Target2016-17 Result2015-162014-152013-142012-13
Increase at a rate less than Consumer Price Index (CPI).$2.56
Result: Met
$2.52N/AN/AN/A

In 2016-17, 52 new products were listed on the Stoma Appliance Scheme, providing people with a stoma with greater choice of new improved products which could lead to improved health outcomes.

In 2016-17, the average cost per aid and appliance for the Stoma Appliance Scheme was $2.56. The cost per aid and appliance increased less than the CPI rate for the June quarter.

Improving the quality of life for people with Epidermolysis Bullosa

Number of people with Epidermolysis Bullosa (EB) receiving subsidised dressings.
Source: 2016-17 Health Portfolio Budget Statements, p. 110
2016-17 Target2016-17 Result2015-162014-152013-142012-13
180173
Result:
Substantially met
18517913699
Average time from receipt of an approved claim to delivery of aids and appliances.
Source: 2016-17 Health Portfolio Budget Statements, p. 110
2016-17 Target2016-17 Result2015-162014-152013-142012-13
No increase on prior year.Increase of 0.2 of a day.
Result: Not met
Average one business day – no increase.N/AN/AN/A

The Scheme is demand-driven and less people required access to dressings in 2016-17 than originally anticipated. The performance result of ‘substantially met’ for the number of people with EB receiving subsidised dressings is based on meeting 96% of the target.

There was a slight increase (0.2 of a day) in the average delivery time of aids and appliances from the previous year. External factors, such as delivery location, have impacted on the delivery of this measure.

Outcome 4 – Budgeted expenses and resources

Budget
estimate
2016-17
$’000
(A)
Actual
2016-17
$’000
(B)
Variation
$’000
(B) - (A)
Program 4.1: Medical Benefits
Administered expenses
Ordinary annual services (Appropriation Act No. 1)104,881106,2501,369
Special appropriations
Health Insurance Act 1973 – medical benefits22,092,45722,098,2815,824
Departmental expenses
Departmental appropriation127,81430,8293,015
Expenses not requiring appropriation in the budget year22,9144,8881,974
Total for Program 4.122,228,06622,240,24812,182
Program 4.2: Hearing Services
Administered expenses
Ordinary annual services (Appropriation Act No. 1)516,141498,327(17,814)
Departmental expenses
Departmental appropriation17,2737,558285
Expenses not requiring appropriation in the budget year21,840845(995)
Total for Program 4.2525,254506,730(18,524)
Program 4.3: Pharmaceutical Benefits
Administered expenses
Ordinary annual services (Appropriation Act No. 1)697,149686,315(10,834)
Special appropriations
National Health Act 1953 – pharmaceutical benefits11,297,94012,057,625759,685
Departmental expenses
Departmental appropriation154,21258,9694,757
Expenses not requiring appropriation in the budget year27,7105,820(1,890)
Total for Program 4.312,057,01112,808,729751,718
Program 4.4: Private Health Insurance
Administered expenses
Ordinary annual services (Appropriation Act No. 1)3,7685,1691,401
Special appropriations
Private Health Insurance Act 2007 - incentive payments and rebate6,054,6355,994,087(60,548)
Departmental expenses
Departmental appropriation110,39211,7121,320
Expenses not requiring appropriation in the budget year21,074967(107)
Total for Program 4.46,069,8696,011,935(57,934)
Program 4.5: Medical Indemnity
Administered expenses
Ordinary annual services (Appropriation Act No. 1)15022272
Special appropriations
Medical Indemnity Act 200291,80091,302(498)
Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 20106,870-(6,870)
Departmental expenses
Departmental appropriation19981,571573
Expenses not requiring appropriation in the budget year210816860
Total for Program 4.599,92693,263(6,663)
Program 4.6: Dental Services3
Administered expenses
Ordinary annual services (Appropriation Act No. 1)---
Special appropriations
Dental Benefits Act 2008331,860319,384(12,476)
Departmental expenses
Departmental appropriation12,5112,202(309)
Expenses not requiring appropriation in the budget year217024979
Total for Program 4.6334,541321,835(12,706)
Program 4.7: Health Benefit Compliance
Administered expenses
Ordinary annual services (Appropriation Act No. 1)12,0006,211(5,789)
Departmental expenses
Departmental appropriation164,74857,341(7,407)
Expenses not requiring appropriation in the budget year22,0506,5824,532
Total for Program 4.778,79870,134(8,664)
Program 4.8: Targeted Assistance - Aids and Appliances
Administered expenses
Ordinary annual services (Appropriation Act No. 1)4,4423,506(936)
Special appropriations
National Health Act 1953 – aids and appliances354,493338,991(15,502)
Departmental expenses
Departmental appropriation14,2454,120(125)
Expenses not requiring appropriation in the budget year2499404(95)
Total for Program 4.8363,679347,021(16,658)
Outcome 4 totals by appropriation type
Administered expenses
Ordinary annual services (Appropriation Act No. 1)1,338,5311,306,000(32,531)
Special appropriations40,230,05540,899,670669,615
Departmental expenses
Departmental appropriation1172,193174,3022,109
Expenses not requiring appropriation in the budget year216,36519,9233,558
Total expenses for Outcome 441,757,14442,399,895642,751
Average staffing level (number)999971(28)

Note: Budget estimate represents estimated actual from 2017-18 Health Portfolio Budget Statements.

  1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Act No.1)’ and ‘Revenue from independent sources (s74)’.
  2. Expenses not requiring appropriation in the budget year are made up of depreciation expense, amortisation, make good expense, operating losses and audit fees.
  3. This program excludes National Partnership payments to State and Territory Governments by the Treasury as part of the
    Federal Financial Relations (FFR) Framework.