Annual Report 2017-18

Services to the community - Health (Program 1.2)

The department is responsible for administering Medicare, which is Australia’s health care system.

The department also delivers other health payments and services under various programs, and administers three health registers: the National Bowel Cancer Screening Register, the Australian Immunisation Register and the Australian Organ Donor Register.

The department has several administration roles in various health care schemes in Australia. It administers:

  • rural health programs that provide incentives and support for medical practitioners providing services in rural areas
  • medical indemnity schemes to strengthen the longer‑term viability and success of the medical insurance industry
  • the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS), which provide subsidised access to medicines.

The department also provides digital services for several national systems. The department:

  • is the Operator of the Healthcare Identifiers Service (HI Service)—a national system for uniquely identifying individuals and health care providers and organisations
  • supports the My Health Record system by delivering registration and enquiry services and some technical services
  • delivers authentication services to health care providers and supporting organisations for the National Authentication Service for Health (NASH).

Medicare

Medicare provides eligible people access to medical, optometry and hospital care and other allied health services.

In 2017–18, 25.3 million people were enrolled in Medicare and $23.5 billion was paid in benefits. The percentage of claims made digitally continues to grow, with 97.9 per cent of Medicare services claimed digitally in 2017–18. Approximately 52 per cent of all health practices digitally lodge 100 per cent of their Medicare claims at their practice.

The department also completed technology enhancements to promote digital transactions, including simplified claims processes.

Medicare eligibility

To be eligible for services under Medicare, a person must be:

  • an Australian citizen residing in Australia
  • a permanent resident or a New Zealand citizen residing in Australia
  • an applicant for permanent residency, meeting certain criteria—restrictions and other requirements apply to people who have applied for a parent visa
  • a Resident Return visa holder residing in Australia
  • a resident or citizen of a country with which Australia has a reciprocal health care agreement—only for medically necessary treatment while visiting Australia (a person must meet the specific eligibility requirements set out in the agreement), or
  • covered by a ministerial order.
Table 10: Medicare enrolments
 

2015–16

2016–17

2017–18

People enrolled at 30 June

24.6 million

24.9 million

25.3 million

Active cards at 30 June

13.9 million

14.1 million

14.4 million

New enrolments

588,574

593,976

567,143

Medicare Entitlement Statements

People who do not meet the eligibility criteria for Medicare may apply for an exemption from paying the Medicare levy. If the application is approved, the department issues a Medicare Entitlement Statement. When a person lodges their income tax return and applies for a Medicare levy exemption, the ATO requires the applicant to acknowledge that they have been issued with a Medicare Entitlement Statement.

Table 11: Medicare Entitlement Statements
 

2015–16

2016–17

2017–18

Accepted applications

122,529

116,918

109,765

Rejected applications

2,452

2,503

2,505

Total applications

124,981

119,421

112,270

Medicare Safety Net

The Medicare Safety Net provides benefits to eligible individuals, couples and families who have high out‑of‑hospital medical expenses.

When the level of out‑of‑pocket costs a customer pays reaches certain thresholds, the customer can receive higher Medicare benefits. There are two Medicare Safety Net thresholds:

  • the Original Medicare Safety Net
  • the Extended Medicare Safety Net.

The Original Medicare Safety Net threshold for the 2018 calendar year is $461.30 and applies to all Medicare cardholders. Under this threshold, the gap amount that consumers pay counts towards the threshold. The gap amount that consumers pay is the difference between the Medicare Benefits Schedule fee and the Medicare benefit paid.

The Extended Medicare Safety Net has two threshold levels for the 2018 calendar year:

  • $668.10 for Commonwealth concession cardholders and Family Tax Benefit Part A recipients
  • a general threshold of $2,093.30 for all other Medicare cardholders (singles and registered families).

Under these thresholds, out‑of‑pocket costs count towards the thresholds. Out‑of‑pocket costs are the difference between the doctor’s charge and the Medicare benefit.

Medicare claiming

Health professionals can ‘bulk bill’ their patients. This means that the patient agrees to have their Medicare benefit paid directly to the health professional. The health professional can claim the Medicare benefit directly from the department as full payment for the service.

If a health professional charges the patient a fee (that is, the patient is not bulk billed), there are three ways that the patient can claim the Medicare benefit:

  • The patient can pay the account directly to the health professional. Then, if the health professional or practice offers digital claiming, practice staff can lodge the claim digitally with the department, with most claims paid into the patient’s bank account within 48 hours.
  • The patient can pay the account and then claim the Medicare benefit from the department. To claim the benefit, patients can use the Express Plus Medicare mobile app; claim through their Medicare online account via myGov; or claim by mail, phone or in person at a service centre. Medicare benefits claimed this way are processed within two to three days.
  • The patient can lodge the unpaid account with the department and receive a cheque payable in the health professional’s name. The patient then gives the cheque to the health professional and pays any outstanding balance.

Where a patient has received in‑hospital services, Medicare claims can be made through simplified billing arrangements. Simplified billing streamlines the way patients pay their bills and claim benefits from the department and their private health insurer. Simplified billing claims can be lodged by hospitals, billing agents, providers and day surgeries with the department and private health insurers—through the Electronic Claim Lodgement Information Processing Service Environment (ECLIPSE), through Electronic Data Interchange transmitted by Simple Mail Transfer Protocol (SMTP) systems, or manually.

Table 12: Medicare services and benefits by claim type
 

2015–16

2016–17

2017–18

Bulk billing

305.2 million

313.6 million

332.3 million

Patient claiming

53.3 million

52.9 million

53.5 million

Simplified billing

30.5 million

32.9 million

34.0 million

Total services processed

389.0 million

399.4 million

419.9 million

Bulk billing

$14.8 billion

$15.6 billion

$16.5 billion

Patient claiming

$4.2 billion

$4.3 billion

$4.4 billion

Simplified billing

$2.4 billion

$2.5 billion

$2.6 billion

Total benefits paid

$21.4 billion

$22.4 billion

$23.5 billion

Average benefit per service

$55.05

$56.08

$56.04

Average period (date of lodgement to processing)

1.6 days

2.5 days

2.3 days

  1. Totals take account of rounding.
  2. Cheques to claimants ended from 1 July 2016.
Table 13: Medicare services by payment type
 

2015–16 million

%

2016–17 million

%

2017–18 million

%

Cheque to claimant

2.7

0.7

n/aSee footnote(b)

n/aSee footnote(b)

n/aSee footnote(b)

n/aSee footnote(b)

Electronic Funds Transfer (EFT) to claimant

35.3

9.1

38.0

9.5

38.2

9.1

EFTPOS payment to claimant

11.0

2.8

11.6

2.9

12.3

2.9

EFT to health professional

305.2

78.5

313.5

78.4

332.3

79.1See footnote(c)

Pay doctor via claimant cheque

4.3

1.1

3.7

0.9

3.1

0.7

Payment to private health fund or billing agent

30.5

7.8

32.9

8.2

34.0

8.1

Total servicesSee footnote(a)

389.0

100

399.7

100

419.9

100

  1. Totals take account of rounding.
  2. Cheques to claimants ended from 1 July 2016.
  3. Numbers may differ due to rounding.
Table 14: Volumes of services transmitted digitally
 

2015–16

2016–17

2017–18

Medicare Online

Bulk billing

279.9 million

288.6 million

308.0 million

Patient claiming

32.2 million

33.8 million

35.2 million

Medicare Easyclaim

Bulk billing

19.9 million

20.1 million

19.7 million

Patient claiming

11.2 million

11.8 million

12.5 million

Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE)

Simplified billing

24.4 million

28.0 million

29.8 million

Simple Mail Transfer Protocol

Simplified billing

5.9 million

4.8 million

4.1 million

Claiming Medicare Benefits Online

Patient claiming

208,200

130,500

138,000

Health Professional Online Services (HPOS)See footnote(a)

Bulk billing

274,100

820,900See footnote(b)

1,557,600See footnote(b)

Patient claiming

n/a

43,700

131,800

Total services

374.0 million

388.1 million

419.9 million

Percentage of overall claims lodged electronically

96.1

97.1

97.9

  1. 2016–17 is the first year that HPOS figures have been included in this table.
  2. The HPOS Webclaim bulk billing channel has shown strong growth since it was released in June 2015. In particular, this free claiming has been taken up by allied health professionals, dentists and some general practitioners.

Health professionals under Medicare

Where an eligible health professional provides services covered by Medicare, they must be allocated a specific Medicare provider number for each practice location. A Medicare provider number uniquely identifies the health professional and the location from which a service is delivered. The provider number allows the health professional to prescribe, refer or request health services for patients and claim benefits under the Medicare Benefits Schedule (MBS) and on behalf of DVA.

In 2017–18 the department issued 185,368 Medicare provider numbers. A health professional providing health services at multiple locations must apply for and be issued with a subsequent provider number specific to each location.

Practices that have diagnostic imaging services, including radiation oncology, must be registered with the department and have a Location Specific Practice Number to claim Medicare benefits. The number of diagnostic imaging practices that register with the department continues to increase each year. In 2017–18, 5,058 diagnostic imaging practices were registered with the department.

Health professionals who provide pathology services must have departmental approval to claim Medicare benefits. In 2017–18 there were 107 Approved Pathology Authorities, 495 Approved Pathology Practitioners, 741 Accredited Pathology Laboratories and 3,581 Approved Collection Centres registered with the department.

Table 15: Health professionals under Medicare
 

2015–16

2016–17

2017–18

Medicare provider numbers issuedSee footnote(a)

175,703

178,411

185,368

Diagnostic imaging practices registered

4,957

5,026

5,058

Approved Pathology Authorities

127

117

107

Approved Pathology Practitioners

541

507

495

Accredited Pathology Laboratories

743

750

741

Approved Collection Centres

3,513

3,457

3,581

  1. This figure does not equate to individual health professionals, as health professionals can be issued more than one provider number if providing services at multiple locations. This figure is correct as at the date of extraction on 3 July 2018.

In 2017–18 medical practices received benefits administered by the department for eligible services such as operating outside of major metropolitan areas, making earlier diagnosis of diabetes and delivering after‑hours services.

Medicare Compensation Recovery

When a person receives a lump‑sum compensation payment of more than $5,000 for an injury or illness, they may have to repay moneys that the government paid to them for treatment of their injury or illness. This amount is repaid by the insurer from the compensation sum before the residual amount is paid to the claimant.

Medicare Compensation Recovery aims to recover any Medicare benefits, nursing home benefits or residential care or home care government subsidies paid to a claimant as a result of their compensable injury or illness.

In 2017–18, the number of cases finalised was 28 per cent lower than in 2016–17. The numbers of cases finalised in the 2015–16 and 2016–17 financial years were higher as a result of the closure of a large number of discontinued older cases that did not have an associated recovery amount. Additional funds were recovered in 2017–18 as a result of resolving large numbers of aged complex cases in 2016–17 and 2017–18.

Table 16: Compensation recovery
 

2015–16

2016–17

2017–18

% change since 2016–17

Cases finalised

87,504

62,867

45,287

–28

Amount of benefits recovered

$42.6 million

$41.8 million

$63.6 million

+52

Health Payments and Services

The department delivers many health payments and rebates on behalf of other government departments:

  • DVA health services payments
  • the External Breast Prostheses Reimbursement Program
  • the National Bowel Cancer Screening Program
  • the Continence Aids Payment Scheme
  • the Child Dental Benefits Schedule
  • the Stoma Appliance Scheme
  • the Hearing Services Program
  • the Practice Incentives Program
  • the Practice Nurse Incentive Program.

The department also administers three health registers:

  • the National Bowel Cancer Screening Register
  • the Australian Immunisation Register (AIR)
  • the Australian Organ Donor Register.

Payments and rebates

Department of Veterans’ Affairs health services payments

The department is responsible for making payments to health professionals for health services on behalf of the DVA. The department assesses claims and processes payments for the treatment of eligible DVA clients for medical, specialist, diagnostic imaging, pathology, allied health and dental services, and for private hospital admissions and prostheses.

On behalf of DVA, the department produces DVA’s Gold Cards (for all clinically necessary health care needs and all health conditions, whether they are related to war service or not), White Cards (for care and treatment of war‑caused or service‑related specific conditions) and Orange Cards (for pharmaceuticals only) for eligible veterans.

In 2017–18, the department continued to highlight the benefits of electronic claiming to providers by promoting the DVA Webclaim channel. DVA Webclaim offers an alternative to manual claiming and delivers significantly faster payments and reconciliation for health professionals.

As a result of ongoing promotion of electronic claiming channels, DVA electronic claiming across all services increased to 91.8 per cent in 2017–18. Electronic claiming for allied health services increased to 81.8 per cent, electronic claiming for medical services increased to 96.0 per cent and electronic claiming for hospitals increased to 87.6 per cent.

Manual claiming for DVA decreased to 8.2 per cent in 2017–18.

Table 17: Department of Veterans’ Affairs processing
 

2015–16

2016–17

2017–18

Cards produced

17,866

19,148

22,717

Services processed

18.4 million

17.8 million

17.3 million

Total benefits paid

$2.0 billion

$2.0 billion

$2.0 billion

External Breast Prostheses Reimbursement Program

The External Breast Prostheses Reimbursement Program reimburses up to $400 for each new or replacement external breast prosthesis for women who have had breast surgery as a result of breast cancer.

Claimants must be eligible for Medicare and must not have claimed under the program in the previous two years unless there is a medical reason.

In 2017–18 the department updated its website for customers who are experiencing financial difficulty and paying for their prostheses upfront before they claim from the program. This update advised customers that, if they receive an income support payment, they may be eligible for an advance payment under that program which they can use to pay for their prostheses before claiming a reimbursement. Any advance payment is subject to the income support advance payment rules.

Table 18: External Breast Prostheses Reimbursement Program
 

2015–16

2016–17

2017–18

Number of claims processed

14,986

14,880

14,747

Amount paid

$6.2 million

$6.1 million

$6.2 million

Continence Aids Payment Scheme

The Continence Aids Payment Scheme gives eligible people with severe and permanent incontinence yearly ($583.20) or twice‑yearly ($291.60) payments to help buy continence aids products.

Table 19: Continence Aids Payment Scheme
 

2015–16

2016–17

2017–18

Number of applications processed

29,221

28,325

29,972

Total amount paid

$80.2 million

$84.5 million

$90.2 million

Child Dental Benefits Schedule

The Child Dental Benefits Schedule provides families, teenagers and approved care organisations with financial support for basic dental services for eligible children. Dental services include examinations, x‑rays, cleaning, fissure sealing, fillings, root canals and extractions.

Benefits for basic dental services are capped at $1,000 per child over two consecutive calendar years.

To be eligible, children must:

  • be aged between two and 17 years on any one day of the calendar year
  • receive (or their family, guardian or carer must receive) certain Australian Government benefits such as Family Tax Benefit Part A for at least one day of the calendar year
  • be eligible for Medicare.

In 2017–18 the department processed 5.5 million services and paid $334 million in benefits.

Private Health Insurance Rebate

The Private Health Insurance Rebate reimburses or discounts the cost of private health insurance cover. It is available to all people who are eligible for Medicare and have a complying health insurance policy.

The rebate is income tested. The level of rebate that people are entitled to claim depends on their age and income. The rebate can be claimed in one of two ways:

  • as an upfront reduction in the cost of premiums—the Premiums Reduction Scheme (administered by the department)
  • as a tax offset in annual income tax returns (administered by the ATO).
Table 20: Private Health Insurance Rebate
 

2015–16

2016–17

2017–18

Memberships registered

7.0 million

7.3 million

6.7 million

Total paid to private health funds

$5.9 billion

$6.0 billion

$6.0 billion

Stoma Appliance Scheme

The Stoma Appliance Scheme gives patients subsidised access to stoma aids and appliances after surgery.

The products are distributed through 21 regional stoma associations across Australia. Approximately 45,000 association members access the products.

The scheme operates under the National Health Act 1953.

Hearing Services Program

The Hearing Services Program aims to reduce the incidence and consequences of avoidable hearing loss in the Australian community by providing high‑quality hearing services and devices to those who are eligible for assistance.

The department processes and pays claims to accredited hearing service contractors via the HPOS eClaims facility.

Table 21: Hearing Services Program services and payments
 

2015–16

2016–17

2017–18

% change since 2016–17

Services processedSee footnote(a)

1,394,933

1,434,052

1,461,036

+1.9

Total amount paidSee footnote(b)

$404.6 million

$419.0 million

$431.1 million

+2.9

  1. Services provided to individuals.
  2. Payments made to hearing service contractors.

Practice Incentives Program

The Practice Incentives Program (PIP) pays incentives to medical practices and individual providers to encourage improvements in general practice.

The PIP consists of 11 incentives, shown in Table 22 below.

In 2017–18 the department undertook a range of activities, including publication of articles in the quarterly Incentives news, to raise awareness of the PIP Indigenous Health Incentive (IHI), which helps to improve the health of Aboriginal and Torres Strait Islander people who are at risk of developing a chronic condition.

These activities saw an increase in the participation of eligible practices in the PIP IHI and a rise in the number of outcome payments made.

Table 23 below contains data on practice participation in the PIP.

Table 22: Practice Incentives Program payments

Incentive

Description

After hours Incentive payments to practices encourage general practitioners (GPs) to provide their patients with access to after‑hours care.
Aged care access Service Incentive Payments (SIPs) to GPs encourage increased and continuing services in Australian Government funded residential aged care facilities.
Asthma Sign‑on payments to practices encourage GPs to better manage the clinical care of people with moderate to severe asthma. SIPs are available to GPs for each asthma cycle of care completed for a patient with moderate to severe asthma.
Cervical screeningSee footnote(a) Sign‑on and outcomes payments to practices encourage GPs to screen women aged between 24 years and nine months and 74 years inclusive who have not had a cervical smear in the past four years, increasing overall screening rates.
Diabetes Sign‑on and outcomes payments to practices encourage GPs to provide earlier diagnosis and effective management of people with established diabetes mellitus. SIPs are available to GPs for completing an annual diabetes cycle of care.
eHealth Incentive payments encourage practices to adopt new digital health technology as it becomes available to improve administration processes and the quality of care provided to patients.
Indigenous health Payments to practices encourage GPs to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease.
Procedural GP payment Incentive payments to practices encourage rural GPs to provide procedural services.
Quality prescribing Payments to practices encourage GPs to keep up to date with information on the quality use of medicines by taking part in activities recognised or provided by the National Prescribing Service.
Rural loading A rural loading is applied to PIP payments to practices where the main location is outside a major metropolitan area.
Teaching Incentive payments to practices encourage GPs to provide teaching sessions to undergraduate medical students to ensure that the practitioners of tomorrow are trained and have actual experience of general practice.
  1. On 1 December 2017 the age cohort was amended from 20 to 69 years to 24 years and nine months to 74 years.
Table 23: Practice participation in the Practice Incentives Program
 

2015–16

2016–17

2017–18

Total number of practices participating

5,550

5,811

5,985

Practices registered per incentiveSee footnote(a)

After hours

4,787

5,169

5,389

Asthma

3,799

4,134

4,363

Cervical screening

3,851

4,175

4,394

Diabetes

3,846

4,177

4,398

eHealth

5,037

4,557

4,922

Indigenous health

4,351

4,743

5,000

Practices receiving outcomes paymentsSee footnote(b)

Cervical screeningSee footnote(c) See footnote(d)

467

473

131

DiabetesSee footnote(c)

1,168

1,219

1,272

Procedural GPSee footnote(e)

367

349

316

Indigenous healthSee footnote(f)

6,186

6,958

7,830

Other

Indigenous health incentive patient registration payments

76,360

87,053

98,717

Teaching session payments

223,894

220,125

219,409

SIPSee footnote(g) (asthma, cervical, diabetes, aged care access incentive)

69,705

70,570

71,551

Total amount paid at 30 June

$340.1 million

$341.7 million

$342.9 million

  1. Practices are automatically registered for the teaching, rural loading and quality prescribing incentives when they are approved for the program.
  2. Outcome payments are made to practices that have reached the target level required to receive the incentive under the program. This relates to the number of practices that received an outcome payment in the May quarter for the cervical screening and diabetes incentives.
  3. Cervical screening practices must screen at least 70 per cent of their eligible patients in a 30‑month reference period. For diabetes, the outcome payment is made to the practice when at least 2 per cent of practice patients are diagnosed with diabetes, and GPs have completed a diabetes cycle of care for at least 50 per cent of these patients.
  4. On 1 December 2017 cervical screening underwent a number of changes, including to MBS items and age eligibility, which impacted on the PIP cervical screening.
  5. The number of practices that received a Procedural GP payment.
  6. This relates to the number of outcome payments made to practices. This includes both Tier 1 and Tier 2 payments. Tier 1 is paid to practices for each registered Indigenous patient when the practice provides a target level of care in a calendar year. Tier 2 is paid to the practice for providing the majority of care for registered Indigenous patients in a calendar year.
  7. The total service incentive payments made for the asthma incentive, cervical screening incentive, diabetes incentive and GP aged care access incentive.

Practice Nurse Incentive Program

The Practice Nurse Incentive Program makes incentive payments to practices to support an expanded and enhanced role for nurses working in general practice.

General practices across Australia, including those in urban areas as well as Aboriginal Medical Services and Aboriginal Community Controlled Health Services, may be eligible for an incentive to help with the costs of employing a practice nurse. To be eligible the practice must be accredited under the Royal Australian College of General Practitioners Standards for general practices.

In 2017–18 the number of practices participating in the program increased by 5.21 per cent, continuing the trend seen in previous years.

Table 24: Practice Nurse Incentive Program
 

2015–16

2016–17

2017–18

Number of practices participating

4,594

4,910

5,166

Amount paid to practices

$335.7 million

$347.0 million

$364.3 million

Health Care Homes

The stage one trial of Health Care Homes began on 1 October 2017. This program is designed to improve health care for patients with chronic and complex conditions by providing them with a ‘home base’ for the ongoing coordination, management and support of their treatment.

Health Care Homes medical practices receive a monthly bundled payment. There are three tiers of payments, which are linked to the level of patient complexity and need. The monthly payment is based on the tier levels of each of the practice’s registered patients. Payments are retrospective, allowing for regular patient review and, if necessary, adjustment of the patient’s Health Care Homes tier level.

Health registers

National Bowel Cancer Screening Register

The National Bowel Cancer Screening Program aims to reduce the rate of bowel cancer and death from bowel cancer in Australia.

The department administers the National Bowel Cancer Screening Register. This is a free screening initiative under the Department of Health’s National Bowel Cancer Screening Program. The department:

  • identifies and invites eligible people to participate in the program
  • makes payments to medical professionals for providing information on the register about consultations and medical procedures for people who have received positive test results
  • operates the information phone line for the general public and health professionals.

Since the phased introduction of biennial screening in 2015 (that is, screening every two years instead of every five years), there have been incremental increases in participation.

In 2017–18 the department continued to encourage people to undertake screening for bowel cancer. The department invited eligible people who turned 50, 54, 55, 58, 60, 62, 64, 65, 66, 68, 70, 72 and 74 years in 2018 to undertake screening.

Table 25: National Bowel Cancer Screening Program
 

2015–16

2016–17

2017–18

Invitations distributed

1,585,211

2,082,916

2,700,703

Information line calls received

183,209

171,640

262,582See footnote(a)

  1. Increase has occurred due to a national awareness‑raising campaign through various media outlets.

Australian Immunisation Register

The AIR is a whole‑of‑life national register that records all National Immunisation Program (NIP) vaccines. In addition to vaccinations given as part of the NIP, the AIR can record most privately purchased vaccines given by recognised vaccination providers and community clinics and vaccines given overseas. The department administers the AIR on behalf of the Department of Health.

The AIR has over 26 million registrations. It has increased functionality and enhanced reporting for state and territory health authorities and vaccination providers.

Immunisation records, including Immunisation History Statements, can be accessed through the AIR by recognised vaccination providers, individuals aged 14 years or over, and parents or guardians of younger children. Individuals can easily download their own Immunisation History Statement through Medicare Online accounts in myGov or the Express Plus Medicare mobile app.

Immunisation records are used as proof of immunisation for enrolment in school or child care, and they help with determining eligibility for various family assistance payments (under the No Jab No Pay policy, to be eligible for certain family assistance payments, individuals aged zero to under 20 must have received their childhood immunisations). People who work with vulnerable people (for example, in aged, health and child care) may also be required to produce these records for employment purposes.

In 2017–18, the department continued to promote the AIR and encourage vaccination providers to record vaccines given to people of all ages.

Table 26: Australian Immunisation Register
 

2015–16

2016–17

2017–18

Valid immunisation episodesSee footnote(a)

4.1 million

10.2 millionSee footnote(b)

14.8 millionSee footnote(b)

Total amount paid to immunisation providersSee footnote(c)

$9.7 million

$10 million

$9.9 million

  1. The AIR reports on the number of vaccination episodes. A single episode can include one or more vaccination antigens. For example, the measles, mumps and rubella vaccination given at 18 months under the NIP schedule is only one injection, but it includes three vaccination antigens—measles, mumps and rubella. This would be recorded as a single episode on the AIR.
  2. There was a significant increase between 2015–16 and 2016–17 because, until 30 September 2016, the AIR was the Australian Childhood Immunisation Register and only included immunisation episodes for children aged zero to seven years. The 2016–17 and 2017–18 figures reflect the whole‑of‑life nature of the AIR from 30 September 2016.
  3. Payments are made on completion of the early childhood (aged less than seven years) NIP schedule. Medical practitioners and other recognised vaccination providers are paid based on a completed schedule which may require more than one injection.

Australian Organ Donor Register

The Australian Organ Donor Register is a national register that records people’s decisions about becoming organ and/or tissue donors for transplantation after death.

The register enables authorised medical personnel to verify a person’s decision about donating their organs and/or tissue for transplantation. People can register their donation decision online using Medicare Online accounts in myGov or the Express Plus Medicare mobile app on the department’s website. The website also has general information about organ and tissue donation for transplantation.

There are two types of registration for organ donation:

  • consent registration
  • intent registration.

A legally valid consent registration occurs when a person aged 18 years or older provides a signed registration form or submits their registration using Medicare Online accounts in myGov or the Express Plus Medicare mobile app.

Intent registration occurs when a person registers their decision to donate through a channel that does not require a signature or electronic authentication—for example, by phone or email. Whether registration is by consent or intent, approval will always be sought from the person’s family before proceeding with the donation process.

The department promotes and raises national awareness of the Australian Organ Donor Register by supporting DonateLife week and the annual Gift of Life Walk.

The Australian Organ Donor Register has seen steady annual growth. Table 27 shows the cumulative total of the numbers of consent and intent registrations since the inception of the register.

Table 27: Australian Organ Donor Register
 

2015–16

2016–17

2017–18

Consent registrations

1,958,925

2,150,789

2,300,828

Intent registrations at 30 June

4,275,431

4,245,259

4,264,541

Total registrations

6,234,356

6,396,048

6,565,369

Enquiry line calls received

19,301

13,495

13,788

Health and Aged Care

Aged Care Program

The department delivers subsidies and supplements to approved aged care providers to help them deliver cost‑effective, quality care for older Australians.

The department’s role is to provide timely and accurate payments efficiently and effectively on behalf of the Department of Health and DVA.

The department is responsible for paying subsidies and supplements to aged care providers for:

  • Home Care, which provides older people who want to stay in their home with access to a range of ongoing personal services, support services and clinical care to help them with their day‑to‑day activities
  • Residential Care, which provides a range of accommodation and care options for older people who are unable to continue to live independently in their own homes. The payment can be offered on both a respite and a permanent basis
  • Transition Care, which provides time‑limited, goal‑oriented and therapy‑focused packages of services to older people after a hospital stay
  • Short Term Restorative Care (STRC), which provides older Australians with a program of care that allows them to be supported to stay in their own home, living independently. It can also support people to be independent again after a setback, like an illness or a fall.

Supporting aged care in 2017–18

The Residential Care, Transition Care and STRC were implemented on 27 February 2017. This increases the flexible care options available to older Australians. STRC services aim to reverse or slow functional decline in older Australians, thereby improving their capacity to stay independent and live in their homes longer.

STRC services are time limited (up to eight weeks) and can be accessed where a customer has experienced functional decline. They are provided in either a home or a residential setting, or a combination of both, depending on the needs of the client.

The department also supported the Department of Health in implementing the first stage of Increasing Choice in Home Care, which gives eligible people the ability to choose from any approved service provider (rather than allocating a specific number of Home Care Packages to individual providers) and changes payment arrangements so that funding is paid to the provider that the care recipient chooses.

Table 28: Aged care overview
 

2015–16

2016–17

2017–18

Residential Care claims processed

32,128

32,227

32,526

Home Care Package claims processed

21,875

27,488

28,746

Transition Care claims processed

941

997

982

Short Term Restorative Care claims processed

n/a

53

713

Total claims processed

54,944

60,765

62,967

Total amount paidSee footnote(a)

$13.2 billion

$13.7 billion

$14.5 billion

Residential care services

2,672

2,703

2,719

Home Care Package services

2,107

2,202

2,466

Transition Care services

83

83

84

Short Term Restorative Care services

n/aSee footnote(b)

17

53

Active services transmitting (online claiming)

5,042
  1. Includes $1.2 billion in 2015–16, $1.1 billion in 2016–17 and $1.0 billion in 2017–18 paid on behalf of DVA.
  2. Historical data unavailable.

In early 2017 a large number of Home Care providers were still lodging paper claims and in some cases they were several months behind in their claims. In an effort to improve online self service usage, the Aged Care Programmes Branch improved the design of this process and increased direct support to service providers.

This resulted in an increase in online claim lodgement: online usage grew from 68 per cent in March 2017 to over 91 per cent by September 2017. Online usage was maintained over the last nine months of 2017–18 at over 90 per cent—something that has not been achieved in any other month since the system was introduced.

In addition to increased online activity, a secondary outcome was also achieved: an increase in the number of services up to date with their claiming. In mid‑February 2017, 71.3 per cent of services were fully up to date with their claims. In February 2018 this number had grown to 88.6 per cent of services fully up to date with their claims.

Aged care worker education and training

The Aged Care Education and Training Incentive Program provides incentive payments to eligible aged care workers who undertake specified education and training programs. Aged care workers must be employed by approved facilities. The program helps aged care workers to improve their qualifications as a personal care worker, enrolled nurse or registered nurse within the aged care sector.

Eligible aged care workers can apply for two incentive payments—one at the start of their course and the other on completion of their study. Incentive payment amounts depend on the level of study.

The program closed to new applicants on 31 March 2016 and ends on 30 June 2020.

Table 29: Aged Care Education and Training Incentive Program
 

2015–16

2016–17

2017–18

Participants in vocational education and training

5,857

1,810

88

Participants in enrolled nurse training

1,267

592

381

Participants in registered nurse training

905

911

219

Amount paid

$6.5 million

$3.1 million

$1.6 million

Rural Health Programs

The department administers two rural health programs that offer incentives and support for medical practitioners providing services in rural areas:

  • the General Practice Rural Incentives Program (GPRIP)
  • the Rural Procedural Grants Program (RPGP).

The GPRIP aims to encourage medical practitioners to practise in rural and remote communities and to promote careers in rural medicine.

Table 30: General Practice Rural Incentives Program
 

2015–16

2016–17

2017–18

Medical practitioners paid (GPs and specialists)

17,243See footnote(a)

7,589

8,229

Payments made

21,051

7,589

8,273

Amount paid

$110.8 million

$111.9 million

$117.3 million

  1. The large volume of GPRIP participants paid in 2015–16 was a result of the one‑off pro‑rata payments made in December 2015. This finalised all outstanding payments under the old GPRIP program rules up to 30 June 2015.

The RPGP assists GPs who deliver procedural or emergency medicine services in rural and remote areas to attend training courses to maintain and improve their skills. Under the program, up to $20,000 is paid per GP per year.

The RPGP works closely with the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners to streamline the payment process for eligible providers.

Table 31: Rural Procedural Grants Program
 

2015–16

2016–17

2017–18

GPs paid

2,054

1,728

1,737

Amount paid

$19.3 million

$16.4 million

$17.2 million

Medical Indemnity

The government’s medical indemnity framework consists of a number of schemes to strengthen the longer‑term viability and success of the medical insurance industry. These include:

  • the Exceptional Claims Indemnity Scheme
  • the High Cost Claims Indemnity Scheme
  • the Premium Support Scheme
  • the Run‑off Cover Indemnity Scheme for doctors
  • the Incurred But Not Reported (IBNR) Indemnity Scheme
  • the Midwife Professional Indemnity Scheme.

Under these schemes the government provides financial support to reduce the effect of large claims and makes medical indemnity insurance more affordable for medical practitioners. The department administers the schemes under the Medical Indemnity Act 2002, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and associated legislation.

Exceptional Claims Indemnity Scheme

Under the Exceptional Claims Indemnity Scheme, medical practitioners are protected against personal liability for eligible claims that exceed the level of their insurance cover.

In 2017–18 no claims were submitted against this scheme.

High Cost Claims Indemnity Scheme

Under the High Cost Claims Indemnity Scheme, the government funds 50 per cent of the cost of medical indemnity insurance payouts that are greater than the threshold amount up to the limit of a medical practitioner’s insurance cover.

In 2017–18, the number of claims paid increased by 14.6 per cent compared with the previous year.

Table 32: High Cost Claims Indemnity Scheme
 

2015–16

2016–17

2017–18

Claims received

310

378

433

Benefits paid

$49.9 million

$47.7 million

$58.6 million

Premium Support Scheme

Under the Premium Support Scheme, eligible medical practitioners receive a subsidised reduction in their insurance premiums. Insurers are then reimbursed the subsidised amount.

  • For premium periods starting before 1 July 2012, the scheme subsidises 80 per cent of the cost of the premium beyond the 7.5 per cent threshold.
  • For premium periods starting on or after 1 July 2012 and before 1 July 2013, the scheme subsidises 70 per cent of the cost of the premium beyond the 7.5 per cent threshold.
  • For premium periods starting on or after 1 July 2013, the scheme subsidises 60 per cent of the cost of the premium beyond the 7.5 per cent threshold.
Table 33: Premium Support Scheme
 

2015–16

2016–17

2017–18

Eligible practitioners

1,237

1,268

985

Amount paid

$8.0 million

 $7.6 millionSee footnote(a)

$8.2 million

Administration fees

$1.4 million

$1.4 million

$1.4 million

  1. Figure reflects recovery undertaken for a previous financial year ($120,000).

Run‑off Cover Indemnity Scheme for doctors

Under the Run‑off Cover Indemnity Scheme, the government covers the cost of claims for eligible medical practitioners who have left the private medical workforce. The government uses funds paid into the scheme by medical indemnity insurers to cover incidents that occur in connection with a medical practitioner’s practice. Indemnity cover for eligible medical practitioners reflects the last claims arrangement they had with their insurer.

In 2017–18, the number of claims paid increased by 68.1 per cent compared with the previous year.

Table 34: Run‑off Cover Indemnity Scheme for doctors
 

2015–16

2016–17

2017–18

Claims received

56

47

79

Benefits paid

$2.6 million

$2.9 million

$4.9 million

Run‑off Cover Support Payment

The Run‑off Cover Support Payment is imposed as a tax on each medical indemnity insurer for each contribution year. This is used to fund eligible claims made under the scheme. Medical indemnity insurers are reimbursed for compliance costs.

In 2017–18, $2.1 million was paid in administration fees. This figure includes $289,000 paid to an insurer for the 2015–16 year.

Incurred But Not Reported Indemnity Scheme

Under the Incurred But Not Reported Indemnity Scheme (IBNR), the government covers the costs of claims from medical defence organisations that do not have adequate reserves to cover their liabilities. United Medical Protection—now known as Avant Insurance Limited—is the only medical defence organisation actively participating in the scheme.

The department determines claims lodged under the scheme on their merits, and claims can often take a number of years to finalise. Therefore, the amount paid under the IBNR can vary each year. The number of claims submitted for the IBNR over time will decrease because the eligibility criteria under the Medical Indemnity Act 2002 require that the incident must have occurred on or before 30 June 2002.

In 2017–18, the number of claims paid decreased by 34.8 per cent compared with the previous year.

Table 35: Incurred But Not Reported Indemnity Scheme
 

2015–16

2016–17

2017–18

Claims received

54

23

15

Benefits paid

$5.9 million

$1.1 million

$0.7 million

Midwife Professional Indemnity Scheme

The Midwife Professional Indemnity Scheme gives financial help to eligible insurers who provide indemnity to eligible midwives. The scheme includes a government contribution to help with claims made against midwives. It benefits private independent midwives by providing indemnity insurance policies.

In 2017–18, no claims were made under this scheme (to June 2018).

Administration fees are paid to midwife professional indemnity insurers to compensate for the work they undertake to administer the scheme.

In 2017–18, $142,000 in administration fees was paid (to June 2018).

Visiting medical practitioners

The department administers a payment and information system for hospital staff on behalf of the Western Australian Government. The payment is for claims processing from visiting health professionals who treat public hospital patients under individual contracts with participating public hospitals in Western Australia.

Table 36: Visiting medical practitioners
 

2015–16

2016–17

2017–18

Number of services

257,136

239,812

246,060

Total value

$77.9 million

$74.3 million

$77.4 million

National Health Funding Administrator Payments System

The National Health Funding Administrator Payments System facilitates payments from the Australian Government to states and territories for public hospital services through the National Health Funding Pool as required under the National Health Reform Agreement.

The department provides program, corporate and support services to the National Health Funding Body and the Administrator of the National Health Funding Pool to carry out their functions. All eight jurisdictions are successfully using the payments system.

In 2017–18 payments of $42.2 billion were made compared with $41.4 billion in 2016–17.

Health professional support and education services

The department provides high‑quality, accessible information through education resources and services to help health professionals to access programs. In 2017–18 the department regularly promoted current and new education resources to health professionals and their peak bodies, and products were enhanced to meet accessibility guidelines and to include infographics, simulations and demonstration models.

The department also developed targeted resources to help health professionals in understanding Medicare and other health‑related programs. These new resources include the:

  • redesign of the MBS and PBS suite of eLearning programs
  • DVA eLearning program
  • HPOS eLearning program
  • Incentives eLearning program
  • PRODA eLearning program
  • Form Upload Service eLearning module
  • Online PBS Authorities system module
  • Closing the Gap PBS Co‑Payment Measure module
  • Your Guide to Medicare for Indigenous Health Services
  • Expansion of the AIR eLearning program.

In 2017–18 there were 230,706 page views of the department’s education guides and over 163,514 views of the eLearning resources.

Pharmaceutical Benefits Scheme

The department administers two schemes that provide subsidised access to medicines:

  • the Pharmaceutical Benefits Scheme (PBS)
  • the Repatriation Pharmaceutical Benefits Scheme (RPBS).

The PBS provides subsidised access to a wide range of medicines for Australian residents and eligible overseas visitors.

The RPBS gives eligible veterans, war widows, widowers and eligible dependants subsidised access to some additional medicines and dressings at concession rates. If it is clinically justified, the RPBS also subsidises items that are not listed on either the PBS or RPBS schedules.

In administering these schemes the department processes requests for approval from prescribers for medicines that require prior authority to access the PBS subsidy. The department also processes approved supplier claims for the supply of PBS and RPBS medicines to eligible customers.

Table 37: Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme expenditure
 

2015–16

2016–17

2017–18

PBS benefits paidSee footnote(a)

$10.9 billion

$12.1 billion

$11.8 billion

RPBS benefits paidSee footnote(a) See footnote(b)

$0.3 billion

$0.3 billion

$0.3 billion

Total benefits paid

$11.2 billion

$12.4 billion

$12.1 billion

PBS services processedSee footnote(c)

210.1 million

198.5 million

198.6 million

RPBS services processedSee footnote(b) See footnote(c)

10.5 million

9.4 million

8.8 million

Total services processed

220.6 million

207.9 million

207.4 million

  1. Payments/services processed on behalf of DVA.
  2. Excludes payments for under co‑payment prescriptions; Patient Refund claims; and Aboriginal Health Service claims.
  3. Excludes services for under co‑payment prescriptions; Patient Refund claims; Aboriginal Health Service claims; and claims that are yet to be closed by approved suppliers.

PBS eligibility

The price paid for PBS medicines depends on a person’s level of eligibility and whether the approved supplier provides up to the optional maximum $1 co‑payment discount. The two levels of eligibility are the general rate and the concession rate. See also ‘PBS Safety Net’ below.

The patient contribution at the general rate from 1 January 2018 is $39.50. All Australian residents and eligible overseas visitors can access PBS medicines at the general rate.

Patients and their families with a valid concession card from either the department or DVA are eligible for the concession rate of $6.40.

These amounts change on 1 January each year in line with the consumer price index. Patients may pay extra for more expensive brands of medicines.

PBS Safety Net

The PBS Safety Net helps patients with the cost of their medicines when they or their families require a high number of prescription medicines in a calendar year.

The PBS Safety Net thresholds are updated each year on 1 January in line with the consumer price index. The 2018 general threshold is $1,521.80. For concession cardholders the 2018 threshold is $384.00.

After patients reach the relevant threshold, a pharmacist can give the consumer (and their family members covered by the scheme) a PBS Safety Net card. Their contribution for PBS medicines for the rest of the calendar year will then be:

  • $6.40 for general patients
  • nil for concession cardholders.

Patients may pay extra for more expensive brands of medicines or if prescription repeats are filled too close together.

Indigenous people’s access to the PBS

The department administers special PBS arrangements in remote Indigenous communities through Aboriginal Health Services and some state and territory funded health services. Patients of approved remote area Aboriginal Health Services can access PBS medicines directly from the health services at no cost. A medical practitioner or an Aboriginal Health Worker or nurse working under the supervision of a medical practitioner can supply these medicines to patients.

At 30 June 2018 there were 166 approved Aboriginal Health Services around the country.

Aboriginal and Torres Strait Islander people living with chronic disease, or at risk of it, can get help with the cost of PBS medicines through the Closing the Gap PBS Co‑Payment. This co‑payment enables eligible patients to receive free PBS medicines or medicines at the concession patient contribution rate.

Travelling with PBS medicines

Under the National Health Act 1953 it is illegal to take or send PBS subsidised medicines out of Australia unless they are for the personal use of the person to whom the medicine was prescribed.

The Pharmaceutical Benefits Scheme—Taking or Sending Medicine Overseas enquiry line and the Travelling Overseas with PBS Medicine page on the department’s website provide information and advice to people about their responsibilities when travelling overseas with PBS medicines.

In 2017–18 the enquiry line received almost 1,800 calls and the Travelling Overseas with PBS Medicine web page received 33,378 visits.

Online claiming for PBS

Online claiming for PBS allows approved suppliers to lodge prescription claims with the department each time a PBS or RPBS medicine is dispensed.

At 30 June 2018, 99.9 per cent of approved suppliers of PBS or RPBS medicines used online claiming.

Authority‑required prescriptions

The Schedule of Pharmaceutical Benefits lists authority‑required PBS medicines. Some of these medicines need prior approval from the department before they can be prescribed to patients. These medicines are for the treatment of specific conditions.

In 2017–18 6.2 million authority approval requests were received. (Note: Figures include RPBS authority approval requests administered by DVA of 0.3 million.)

From 1 July 2016 the department expanded the online capability to enable approved prescribers to get a PBS authority approval online. This removes the need for prescribers to phone the department for most authority approvals.

Approving suppliers of PBS medicines

Under the National Health Act 1953 the department approves community pharmacies, private hospitals, public hospitals and medical practitioners to supply PBS medicines.

Table 38: Approved Pharmaceutical Benefits Scheme suppliers
 

2015–16

2016–17

2017–18

Approved pharmacies

5,588

5,665

5,723

Approved medical practitioners

19

13

11

Approved hospital authorities—private hospitals

122

129

141

Approved hospital authorities—public hospitals participating in pharmaceutical reforms

161

164

164

Approved hospital authorities—highly specialised drugs only

79

79

84

Prescription Shopping Program

The Prescription Shopping Program helps prescribers to identify patients who get more PBS subsidised medicines than they medically need. It also provides information to help prescribers to make informed prescribing decisions and better manage the health outcomes of their patients.

The department administers the program on behalf of the Department of Health in accordance with the Human Services (Medicare) Regulations 2017.

The program has two components:

  • the Prescription Shopping Information Service
  • the Prescription Shopping Alert Service.

The Prescription Shopping Information Service is a 24‑hour phone line available to prescribers and approved suppliers. Each month the Prescription Shopping Alert Service assesses patients who meet the program’s criteria and contacts prescribers whose patients may be obtaining more medicines than they medically need.

Digital Health

During the year, the department worked closely with the Australian Digital Health Agency (ADHA) and the Digital Transformation Agency (DTA) to progress the national digital health agenda. This has included delivering some parts of the government’s 2017–18 Budget measure My Health Record—Continuation and Expansion. The measure supports the continued and improved operation of the My Health Record system.

The department also updated the Healthcare Identifiers Service (HI Service) and National Authentication Service for Health Public Key Infrastructure (NASH PKI) policies to align with the DTA’s Gatekeeper PKI Framework 3.1—a set of policies, standards and procedures that govern the use of digital certificates in government for the authentication of agencies and their customers.

The department delivers digital health services on behalf of the ADHA. The digital health services are:

  • the HI Service
  • components of the My Health Record system
  • the NASH.

Healthcare Identifiers Service

The HI Service is a national system for uniquely identifying individuals and health care providers and organisations. Healthcare identifiers help to ensure that health care providers and their patients can have confidence that the right information is assigned to the right patient at the point of care.

The department is the HI Service Operator, as defined in the Healthcare Identifiers Act 2010. The HI Service Operator assigns, collects, stores and maintains healthcare identifiers.

In 2017–18 there was a continued pattern of growth: the daily average number of transactions delivered by the HI Service exceeded 605,000, compared with 474,000 in 2016–17.

Table 39: Healthcare identifiers
 

2015–16

2016–17

2017–18

Assigned to individuals

591,597

597,008

545,416

Collected or assigned to health care providers

35,806

37,527

37,723

Assigned to health care organisations

796

943

2,500

The HI Service annual report, which is tabled in parliament each year, contains full details of HI Service operations.

My Health Record

My Health Record is a secure online summary of an individual’s health information. It allows the individual to access and control their own medical history and treatments, such as vaccinations.

The department supports the My Health Record system by delivering registration and enquiry services and some technical services.

In line with the My Health Record—Continuation and Expansion Budget measure, consumer support services were transferred to the ADHA in 2017–18.

Table 40: My Health Record registrations processed
 

2015–16

2016–17

2017–18

Consumers

337,318

278,573

243,078

Provider organisations

839

1,114

2,718

National Authentication Service for Health

NASH delivers authentication services to health care providers and supporting organisations by providing PKI certificates and associated services.

Health care providers and supporting organisations can use NASH PKI certificates to access the My Health Record system and send messages securely to other health care provider organisations.

The department issues the NASH PKI certificates to eligible health care providers and supporting organisations.

In 2017–18 the department and ADHA worked together to streamline access to the National Provider Portal for My Health Record by using the PRODA model.

Reporting under the Human Services (Medicare) Act 1973

The Minister for Human Services is responsible for administering the Human Services (Medicare) Act 1973, except to the extent that it is administered by the Minister for Health.

Part IID of that Act gives the Chief Executive Medicare certain powers to investigate whether civil or criminal offences have been committed in relation to health programs that the department delivers. Section 42 of the Act requires the department to report on the use of particular investigative powers. During the year the department did not exercise powers under Part IID.

This information was printed Monday 27 May 2019 from https://www.humanservices.gov.au/organisations/about-us/annual-reports/annual-report-2017-18/part-2-outcomes-and-programs/services-community-health-program-12 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 18 April 2019