Cost of Victorian Local Government
Immunisation Services
April 2004
Table of Contents
Glossary of Terms .............................................................................. 2
Executive Summary ........................................................................... 3
Introduction ........................................................................................ 6
Objectives .......................................................................................... 8
Methodology....................................................................................... 8
Study Results ................................................................................... 11
1.
2.
3.
4.
Scheduled Vaccinations at Infant (Public) Sessions...................................12
Scheduled Vaccinations at School Sessions ..............................................17
General Comments........................................................................................23
Impact of the Introduction of the Meningococcal C Vaccine......................27
Attachments ..................................................................................... 36
Attachment 1:
Attachment 2:
Attachment 4:
Attachment 5:
Attachment 6:
Australian Standard Vaccination Schedule – Free Vaccines...36
Project Team................................................................................39
Total Costs & Unit Costs for Scheduled Vaccinations .............41
Survey Instructions.....................................................................45
Survey Form ................................................................................50
1
Glossary of Terms
ACIR
Australian Childhood Immunisation Register
ASVS
The Australian Standard Vaccination Schedule is a list of vaccines
recommended by the NHMRC. Not all vaccines listed on the ASVS
are funded under the NIP.
Clinic
Session run by councils where vaccinations are provided to members
of the public.
DHS
Department of Human Services, Victoria
EBAs
Enterprise Bargaining Agreements
EFT
Effective Full Time
Encounter
Refers to a visit in which one or more vaccinations is given.
Episode
Refers to an individual injection given during an immunisation visit.
MAV
Municipal Association of Victoria
MCV
Meningococcal C Vaccine
MOsH
Medical Officers of Health
NIP
National Immunisation Program which provides free vaccines to
Australians and is a Federal and state government initiative.
NHMRC
National Health and Medical Research Council which advises the
Federal Government on immunisation and sets the Australian Standard
Vaccination Schedule.
2
Executive Summary
This study, undertaken by the MAV with the support of the Department of Human
Services (DHS), examined the immunisation programs of 12 councils from a crosssection of metropolitan, regional and rural councils using 2002/2003 data. It
focussed in particular on vaccines recommended by the Australian Standard
Vaccination Schedule set by the Australian National Health and Medical Research
Council (NHMRC).
Councils deliver immunisation programs in two main ways with each having its own
distinct mode of delivery. These are:
 infant/preschool immunisation programs that are mainly delivered by councils
holding community clinics or providing immunisations as part of the local
Maternal and Child Health Service; and
 school-age immunisation programs where councils organise visits to schools
to immunise those students not previously immunised by other providers,
such as GPs.
The study found the unit costs per council immunisation encounter1 were $22.70 for
infant/pre-school children and $11.60 for school-age children. These costs are
significantly higher than the subsidy provided by the Commonwealth and State
Governments and are outlined in the following table:
Immunisation
Category
Unit Cost
per
Encounter
Subsidy per
Encounter
Council
Contribution
Federal/State
Government
Contribution
Infant/preschool
$22.70
$6.00
74%
26%
School age
$11.60
$2.00 metro
83%
17%
$3.50 rural
70%
30%
$3.00 metro
74%
26%
$4.50 rural
61%
39%
2
ADT:
HepB
1
Encounters, rather than episodes, are used as the basis for deriving a unit costing because
the Federal Government subsidy is based per encounter, rather than per individual injection
or episode. “Encounter” refers to a visit where one or more vaccinations are given.
2
Federal Government subsidy administered by the ACIR.
3
Although there is considerable variation in the way councils deliver their
immunisation service, median unit costs for both infant and school programs were
found to be generally close to the mean. It is believed that these findings therefore
reflect a unit cost estimate that can be used as a reasonable guide to immunisation
costs in the local government sector in Victoria.
There was a small difference in the mean unit cost per immunisation episode at
infant and school sessions. Unit costs found were found respectively as $10.90 for
infant sessions and $10.30 for school sessions.
Simple linear regression points to the existence of a relationship between numbers of
episodes or encounters and total costs for infant and school vaccinations, although
this is not a strong relationship. The relationship is strongest for infant sessions. A
poor relationship exists between numbers of episodes or encounters at special
sessions held to provide Meningococcal C vaccinations and vaccinations given at
other sessions.
The data shows that economy of scale has some relevance for service delivery
costs, however higher levels of episodes or encounters in some of the surveyed
councils did not necessarily translate into low unit costs. Clearly, other factors are
also significant. In particular, the mixture of staff involved, the time in which certain
activities are undertaken and specific costs, for example the cost of MOsH.
Lower cost councils generally display lower labour costs for nurses and
administration staff, who tend to be the key staff involved and lower costs for actual
“service delivery” components. These components include the activities immediately
preceding, including and following a vaccination, rather than “service planning” and
“reporting” activities for both infant and school immunisations.
A council’s unit costs for infant sessions was not found to be necessarily a good
guide of their unit costs for school sessions.
The study also examined preliminary data concerning the introduction of the
Meningococcal C vaccine (MCV) into the Australian Standard Vaccination Schedule
from 1 January 2003 and the effect this had on council immunisation programs.
Councils were required to provide MCV to designated age groups that had not
received the injection prior to it becoming part of the free schedule.
Difficulties in isolating the costs of the introduction of MCV to the schedule meant that
it has only been possible to make some general observations about unit costs after
the introduction of MCV and specifically the effects on unit costs where MCV has
been provided through special sessions. Further work needs to be undertaken to
clarify these costs. The data contained in this study potentially significantly
understates the impact of the introduction of a new vaccine.
Preliminary observations about the introduction of MCV include:
 most councils needed to provide additional sessions to accommodate
introduction of the new vaccine;
 a special MCV encounter has more in common with a school-age encounter
because of the number of episodes involved;
4
 increases in the number of scheduled episodes and encounters was
accompanied by scale economies; and
 introducing a new vaccine that needs to be administered to school age
children requires considerable more effort and cost than infant sessions, even
though school-age sessions can achieve more episodes per hour.
5
Introduction
Local government in Victoria has historically played an important role in delivering
immunisation services to the Victorian public on behalf of Federal and state
governments. It currently provides over half of all preschool immunisations and
nearly all school-age immunisations given in Victoria, and contributes significantly to
raising the importance of immunisation in local communities. Both Federal and State
Governments have acknowledged that it is no coincidence that Victoria, with its
strong local government involvement, has one of the highest rates of immunisation in
Australia3.
Councils incur significant costs in providing this service and anecdotal evidence in
recent times has indicated that the costs to councils of providing immunisation
services far outweigh the subsidies provided by Federal and state governments.
This is putting councils’ public health budgets under pressure, particularly when they
also have increasing responsibilities in regulating other state government
requirements, such as food safety and implementing anti-smoking legislation.
In recognition that giving adequate acknowledgement and recompense to local
government is necessary for councils to continue to implement national and state
government public health goals, the MAV initiated discussions with the Department of
Human Services (DHS) about undertaking a detailed costing study to enable policy
makers to make informed decisions concerning the funding arrangements between
state and local government. This funding study was subsequently agreed, with
support and financial contribution provided by DHS.
This study examines what it cost councils to provide immunisation services in
2002/2003. Although a previous costing study was undertaken a number of years
ago by the Department of Human Services, the data on which it was based is now
quite dated, and it extrapolated information to an unreliable degree in the absence of
actual data provided by councils.
A case study approach has been taken to enable cost-effectiveness in delivering the
project in a short time frame. This approach has enabled more detailed questions to
be put to councils than would have been possible had all 79 councils been surveyed.
The results are therefore indicative, rather than definitive. They do provide, however,
the most up-to-date and detailed analysis of immunisation services provided by
Victorian councils currently available.
The immunisation programs covered in this study are those vaccines currently given
for free to the public under the National Immunisation Program (NIP) and set out in
the Australian Standard Vaccination Schedule. The list of vaccines and the
recommended age they be given are set out in Attachment 1. The study does not
cover other vaccines provided to the public, such as flu injections, chicken pox, etc.
During the middle of the study period (1 July 2002 to 30 June 2003) the
Meningococcal C Vaccine was introduced with effect from 1 January 2003. Effort
was made to isolate the effect of this introduction to age groups other than those
routinely scheduled to receive it, so that the costs could be separated from routine
immunisation activities. It was not possible to measure this accurately because this
study focussed on encounters rather than episodes and in certain areas it was
3
ACIR statistics show 92.11% immunisation rate for children aged 24 months as at 20.12.03
6
practically impossible for councils participating in this study to differentiate routine
expenditure from that relating to the new vaccine.
The introduction of the MCV complicated routine council immunisation programs
because not only did it need to be given to additional age groups, it was also given
as an additional episode within an encounter already taking place (for
children/students over 12 months, eligible age groups were offered the MCV as part
of the routine immunisation encounter).
This study notes that since the data for this report has been collated there have been
further changes to the National Immunisation Program, with the 18th month Infanrix
vaccine being removed from the list of recommended vaccines amongst others.
While this change is likely to have had an effect on council costs, this study is still
useful in providing councils with a greater understanding of the costs relating to their
immunisation programs.
This study is focussed on council costs. Councils make a significant financial
contribution to immunisation services. The requirement to do so is directly related to
the difference between the subsidies provided by the Commonwealth and State
Governments and councils’ respective costs of service provision for scheduled
vaccinations.
It should be noted, however, that the other main immunisation provider, GPs, receive
payments which bear little relationship to the cost of providing that service, rather
being incentive payments for GPs to participate in encouraging members of the
community to immunise their children. These payments are included in Attachment
1, and show that GP’s receive over $50 per immunisation encounter. This amount is
a minimum, with a possible $68 being provided to GPs when certain criteria are met.
The project team that developed this report is outlined in Attachment 2.
7
Objectives
The aim of this project was twofold:
 to quantify council costs relating to the provision of immunisation services and
more specifically the cost of scheduled immunisations; and
 to identify the impact on councils’ costs of the addition of a further
vaccination, for the Meningococcal C vaccine (MCV), to the schedule.
Methodology
A survey of councils was conducted from July to September 2003 involving twelve
(15%) councils using 2002/2003 financial year data. A range of councils was
selected to cover different service model types (contracted out/in-house service
provision), high population growth areas, municipalities with high numbers of people,
and those with low numbers of people.
One of the regional cities in the survey also provided an immunisation service for one
of the small shires. This data is consolidated into the records of the specific regional
city and for the purpose of this project the findings reflect a regional city and small
shire in combination.
The survey form was developed with the assistance of DHS and input from a
selection of Environmental Health Managers responsible for organising immunisation
services within their council.
The project involved a costing of up to 39 activities covering comprehensively
councils’ responsibilities for immunisation for each of the following programs:
 infant/preschool age;
 school age;
 other (such as commercial or staff programs); and
 special sessions for MCV.
For each activity councils were asked to allocate the corresponding staff hours
involved. Staff hours for each activity were respectively detailed for the Coordinator,
Nurses, Senior Environmental Health Officers, Environmental Health Officers,
Technical/Immunisation Officers, Student Environmental Health Officers and
Administration Officers.
Councils were also asked to provide information on the EFT of permanent and
temporary staff members and person hours of casual staff devoted to immunisation
services. This estimate was used to validate the total number of staff hours provided
by councils against immunisation activities. In cases where there were significant
discrepancies between staff hours estimated for immunisation activities and overall
estimates of EFTs/Person Hours, councils were asked to revisit their figures for
accuracy.
8
An effective hourly cost for 2002-03 was calculated for each staff type that took into
account all permanent, part-time and casual relief staff. The effective hourly rate
took into account annual leave, public holidays, absences for sick leave and training
and the standard weekly hours worked. Requirements for activities to be
undertaken in overtime were also taken into account but overall were not significant.
The effective hourly cost also included relevant non-labour costs for each staff type
and activity involved. The breakdown of both staff hours and effective hourly costs
made it possible to calculate for each council the total cost and mean cost of each
activity.
Unit costs were derived by dividing the total costs of all the activities associated with
delivering an immunisation service by the total number of units.
Comments about the study data:
Some councils provide non-scheduled vaccinations on a fee for service basis during
public sessions, such as the chicken pox or flu injections at infant sessions.
However, as these represent a very small proportion of total immunisation
encounters their effect is not considered material to the findings in this report.
MCV was added to the Australian Standard Vaccination Schedule from January
2003. A simple comparison of unit costs between the first and second six months
periods of 2002-03 does not give an accurate indication of the impacts of the
introduction of MVC to the schedule. This is because:
 some councils regularly timetable a greater proportion of vaccinations in a
certain half of the year;
 effects of increases in labour costs (eg, EBAs, salary progression) and other
costs (e.g. materials and services) occur at different points in time;
 materials and other services may be purchased in advance;
 certain activities, for example, service planning and the development of
rosters generally occur at the start of the year;
 encounters in which MCV is administered include both those where other
vaccinations or just MCV are given and these may occur in infant, school, or
special MCV sessions.
These factors mean that it is not possible to isolate the cost implications of MCV
being added to the schedule because differences in cost between the first and
second halves of the year may be due to other factors. It is however possible to
make some general observations about unit costs after the introduction of MCV and
specifically the effects on unit costs where MCV has been provided through special
sessions. These are provided in greater detail in the Study Results section.
The study revealed a range of council financial reporting issues which impact the
degree to which each council was able to fully document all the relevant costs
associated with immunisation. As with all services there are various indirect costs
involved in the delivery of immunisation and in some cases not all these costs have
been allocated in the form of corporate overheads. An attempt has been made to
ensure that a minimum level of these costs have been incorporated for all councils
9
included in the survey. In the case of two of the councils the level of corporate
overheads had been seriously understated. “Low” figures based on the responses of
the other councils were used to deal with these omissions.
The general tendency for councils to understate the full costs of services because of
the absence of corporate overheads is noted. The project group is however
generally satisfied that a reasonable level of these costs have been included,
although costs for the rental/use of council buildings to conduct immunisation
sessions may be understated in some cases.
There is a greater degree of confidence with respect to unit costs calculated for each
broad category (for infant scheduled, school scheduled, special Meningococcal C
scheduled and other vaccinations) than for unit costs calculated at an activity level.
The latter are subject to greater estimation. On top of the estimations of staff time
divided between immunisation and other responsibilities was the further requirement
to extend these estimates across numerous activities. Unit costs reported at an
activity level should therefore be regarded as a guide rather than as definitive.
Despite significant time being spent validating councils’ data, some figures provided
by councils have in some cases resulted in unreliable data. These have been
identified where they occur.
Finally, this analysis is purely a quantitative one and does not take into consideration
the quality of immunisation services that are provided by the councils.
A description of the councils studied is outlined in Attachment 3.
10
Study Results
This study analyses the unit costs to councils of providing free vaccinations funded
through the National Immunisation Program as set out in the Australian Standard
Vaccination Schedule. Its findings should assist federal, state and local governments
better understand the funding contributions from each level of government and the
impacts of changes to vaccines administered by councils.
As the different types of immunisation services have different costs and councils
receive differing levels of subsidy for each, the study results are presented in two
sections:
Section 1:
Section 2:
Infant/preschool immunisations
School age immunisations
General comments arising from the data obtained through the study are included in
Section 3. The impact and preliminary data of the introduction of the Meningococcal
C Vaccine are provided in Section 4.
Consolidated figures are provided in Attachment 4 for those interested in examining
councils’ immunisation program as a whole.
11
1.
Scheduled Vaccinations at Infant (Public) Sessions
Infant sessions in some of the councils may include a relatively small number of
commercial (fee for service) vaccinations. These are not considered to have a
significant effect on the finding for scheduled vaccinations given at infant sessions.
Commercial vaccinations, where provided during infant sessions in specific councils,
are probably no more than 7% of the total in any case. Given that commercial
vaccinations during infant sessions are likely to be provided more quickly and involve
less planning time, the cost of vaccinations for scheduled infant sessions is likely to
be slightly understated by these findings.
Table 1: Infant/Preschool Vaccinations: Total & Unit Costs
Council
Number of
Sessions
Number of
Episodes
Number of
Encounters
Total Cost
Cost per
Session
Cost per
Episode
Cost per
Encounter
A
89
9,441
4,970
$88,256
$992
$9.30
$17.80
B
107
11,625
5,389
$152,532
$1,426
$13.10
$28.30
C
54
3,633
1,668
$51,276
$950
$14.10
$30.70
D
120
8,655
3,823
$91,585
$763
$10.60
$24.00
E
164
9,519
4,491
$99,658
$609
$10.50
$22.20
F
84
10,621
5,470
$116,834
$1,391
$11.00
$21.40
G
108
6,784
3,111
$97,850
$906
$14.40
$31.50
H
84
3,199
1,500
$38,137
$454
$11.90
$25.40
I
201
11,570
5,110
$90,871
$452
$7.90
$17.80
741
347
$5,811
$7.80
$16.70
J
K
91
11,969
6,012
$151,605
$1,666
$12.70
$25.20
L
132
10,154
5,092
$82,187
$623
$8.10
$16.10
Total
1,234
97,911
46,983
$1,066,602
Mean
$860
$10.90
$22.70
Median
$906
$10.80
$23.10
Stdev
$481
$2.40
$5.40
Note:
Council K delivers infant vaccinations through M&CH Service.
Simple linear regression analysis indicates a relationship, although this could not be
described as strong, between the number of episodes and encounters and total costs
(r2 values of .79 and .78). The mean unit costs found were $10.90 per episode and
$22.70 per encounter, with median unit costs very close to the mean.
The data show the highest unit costs overall recorded by two councils with the lowest
number of episodes and encounters (Councils C and G) although Council B, with
relatively high levels of episodes and encounters, had high unit costs. All three
councils recorded unit costs per encounter of more than one standard deviation
above the mean unit cost.
The lowest cost council delivering scheduled infant immunisations per episode was
Council J, which provided infant vaccinations through its maternal and child health
12
service. It also has relatively low costs per encounter, only bettered by one other,
Council L. Both these councils were able to deliver an immunisation encounter at
more than one standard deviation below the mean unit cost.
Higher levels of episodes or encounters do not necessarily translate into low unit
costs as both councils B and K recorded higher than mean unit costs despite having
relatively high levels of episodes and encounters.
The data show considerable variation in the labour applied to infant immunisations.
At one extreme is Council J that provided 8.5 immunisation episodes and 4.0
immunisation encounters per direct4 labour hour. For the other councils ratios
ranged between 2.9 and 6.8 immunisation episodes and between 1.3 and 3.4
encounters per direct labour hour. Group mean and median values for direct labour
hours per episode and encounter are approximate.
Table 2:
Infant/Preschool Vaccinations: Episodes & Encounters per Direct Labour
Hour
Council
Episodes per
Direct Labour Hour
Encounters per
Direct Labour Hour
A
4.19
2.20
B
3.18
1.47
C
2.90
1.33
D
6.19
2.73
E
Na
Na
F
4.40
2.27
G
2.87
1.32
H
3.75
1.76
I
4.98
2.20
J
8.54
4.00
K
3.70
1.86
L
6.85
3.43
Mean
4.15
2.00
Median
4.19
2.20
Stdev
1.81
0.86
Notes:
Includes MOH hours where actual involvement
Council K delivers through M&CH services
Activity level analysis indicates, in particular, the tendency for lower cost councils to
be more efficient in the actual “service delivery” components for infant immunisations.
These components include:
4
Direct labour hours include all labour at coordinator level or below
13
 preparation - drawing up of vaccines, packing of equipment, travelling to &
from venues and preparing the venue for the encounter (eg signs, seating,
computers);
 checking records and that consent has been given;
 entering immunisation data on computer;
 providing immunisation/vaccine information to parent;
 checking of infants’ health status, identifying contraindications, providing
advice to parents;
 administering vaccine to recipient;
 repacking and removal of equipment and returning venues to usual order;
and
 sending letters to absentees.
The data indicates that the three lowest cost councils that conducted infant sessions
(ie, excluding Council J that provided infant vaccinations via its M&CH service)
carried out these activities at between $3.4 and $6.4 per encounter less than the
group mean. These results were not affected by a relatively low cost for travel time
to and from venues. Two of these low cost councils showed higher than mean costs
per encounter for travel time, while for the third travel time was 80% of the mean.
14
Table 3: Infant/Pre-school Encounters Service Elements 2002-03
Service Elements
Major tasks
Service Planning Development of
immunisation service
plan
Components
Total
Max
Min
Mean
$/enc
$/enc
$/enc
Median
$/enc
Stdev
$
$/enc
Organising encounter times & venues for the year,
staffing & administering arrangements such as rosters
and schedules. Developing of a service budget
including obtaining management approval.
23,820
3.1
0.1
0.6
0.6
1.0
Equipment & vaccines
Ordering and storing vaccines. Ordering of equipment.
Monitoring cold chain & recording results. Monitoring
of stock & recording inventory.
54,298
7.2
0.2
1.4
0.8
2.3
Health promotion ,
advertising & marketing
Advertising immunisation services including: putting
together hard copy for inclusion in newsletter, updating
the website, developing media releases, printing of
immunisation resource materials for staff and parents,
developing marketing strategies for specific target
groups
24,546
2.2
0.2
0.6
0.7
0.6
Quality assurance
Conducting the Best Value process for immunisation
services including community consultation, analysis,
feedback and reporting processes. Managing service
complaints including recording, investigating and
communicating with complainant. Carrying out service
reviews and reporting to Council. Developing and
implementing Council risk management & OH&S
policies including incident investigation and reporting
eg. adverse reaction reporting. Developing and
implementing procedures to comply with privacy
legislation eg health records procedures
77,013
5.6
0.6
2.0
1.8
1.5
Drawing up of vaccines. Packing of equipment.
Travelling to & from venues. Preparing the venue for
the encounter (eg signs, seating, computers).
185,014
7.8
3.6
4.8
5.0
1.2
Identification &
confirmation
Checking records and that consent has been given.
Confirming identification.
81,112
4.7
0.4
2.1
1.3
1.5
Recording
Entering immunisation data on computer. Providing
immunisation/vaccine information to parent.
117,916
5.6
1.6
3.1
2.4
1.2
Clinical screening
Checking of infants’ health status; identifying
26,320
1.7
0.2
0.7
0.4
0.4
Service Delivery Preparation
15
Service Elements
Major tasks
Components
Total
Max
Min
Mean
$/enc
$/enc
$/enc
Median
$/enc
Stdev
$
126,071
7.2
1.0
3.3
2.4
2.3
$/enc
contraindications; providing advice to parents.
Reporting &
Acquittal
Processes
Staff Training
Immunisation
Administering vaccine to recipient.
Completion of encounter
Repack and removal of equipment. Returning venue
to usual order.
37,209
2.0
0.5
1.0
1.1
0.5
Follow up
Sending letters to absentees. Organising special mail
outs for ACIR.
21,842
1.5
-
0.6
0.3
0.5
Reporting
Reporting to the ACIR on date for under 7 years of
age group.
11,984
1.2
-
0.3
0.2
0.4
Accreditation and
Professional
development
Accreditation training for immunisation nurses (initial &
3 yearly accreditation; annual CPR updates)
6,364
0.7
-
0.2
0.1
0.2
Quality assurance
First aid training for administration staff. OH&S & QA
training for service staff. Privacy & health records
training for service staff
10,178
0.9
-
0.3
0.2
0.3
5,108
0.4
-
0.1
0.1
0.1
3,717
0.5
-
0.1
0.1
0.2
1,000,322
31.1
21.3
21.9
5.9
MOH
43,357
3.5
-
0.9
0.5
1.0
Management
22,923
1.3
-
0.5
0.3
0.5
1,066,601
31.5
16.1
22.7
23.1
5.4
Contract
Contract initiation and
Management & management
Reporting
Service
Agreement &
Reporting
Negotiation of MOH contract/arrangement. Drawing up
of service contract. Contract management (tender
process costs, performance review costs, reporting)
Agreement initiation and Managing service agreement with DHS including
management
providing reports. Managing immunisation provider
service agreement.
Sub-total
Total
16
11.4
2.
Scheduled Vaccinations at School Sessions
Councils are the only providers of immunisation services at schools in Victoria. Prior
to the introduction of the Meningococcal C vaccine, councils were mainly involved in
organising visits to schools for Year 7 HepB vaccinations and Year 10 ADT
vaccinations. The introduction of MCV from January 2003 has required councils to
also include primary schools and other secondary school years to “catch up” those
children not vaccinated by other providers or not due for the other routine
vaccinations.
Table 4: School Vaccinations: Total & Unit Costs
Council
Number of
Sessions
Number of
Episodes
Number of
Encounters
Total
Cost
Cost per
Session
Cost per
Episode
Cost per
Encounter
A
29
5,333
5,333
$63,474
$2,189
$11.90
$11.90
B
47
6,124
5,374
$43,678
$929
$7.10
$8.10
C
17
3,081
3,081
$25,516
$1,501
$8.30
$8.30
D
40
6,474
4,357
$65,514
$1,638
$10.10
$15.00
E
56
6,914
5,264
$58,243
$1,040
$8.40
$11.10
F
28
2,900
2,900
$53,611
$1,915
$18.50
$24.40
G
26
4,504
4,231
$42,606
$1,639
$9.50
$10.10
H
9
625
625
$15,435
$1,715
$24.70
$24.70
I
12
2,945
2,945
$22,747
$1,896
$7.70
$7.70
J
3
181
181
$5,527
$1,842
$30.50
$30.50
K
20
3,025
3,025
$28,526
$1,426
$9.40
$9.40
L
26
6,438
6,438
$74,120
$2,851
$11.50
$11.50
Total
313
48,544
43,754
$498,997
Mean
$1,594
$10.30
$11.60
Median
$1,677
$9.80
$11.30
Stdev
$522
$8.10
$8.30
Simple linear regression analysis indicates a relationship between numbers of
episodes and encounters and total costs (r2 values of .76 and .75) of similar strength
to that recorded for infant sessions. Median unit costs were again found to be very
close to the mean. The proximity of the cost per episode and per encounter reflects
the predominance of single vaccinations during an encounter.
17
The data show the highest unit costs overall were recorded by the three councils with
the least episodes and encounters, Councils F, H and J. These three councils were
the only ones with unit costs that were more than plus or minus one standard
deviation from the group mean. Council J, which delivered infant immunisations via
its M&CH service and recorded one of the lowest unit costs, registered by far the
highest unit costs for school vaccinations. This was in a large part due to a relatively
high cost associated with service planning and promotion & marketing components.
Interestingly, two of the councils recording the lowest unit costs for school
vaccinations, Councils B and K, were amongst the highest unit costs for infant
vaccinations. In fact, generally, councils’ ranking of unit costs for infant vaccinations
is not a good indicator of their position within the group for school vaccinations.
Again, higher levels of episodes or encounters did not necessarily translate into low
unit costs.
Table 5: School Vaccinations: Episodes & Encounters per Direct Labour Hour
Council
Episodes per
Encounters per
Direct Labour Hour
Direct Labour Hour
A
3.20
3.20
B
6.47
5.68
C
4.12
4.12
D
6.46
4.35
E
na
na
F
2.57
1.95
G
4.12
3.87
H
1.65
1.65
I
4.79
4.79
J
1.65
1.65
K
4.73
4.73
L
4.18
4.18
Mean
4.22
3.90
Median
4.12
4.12
Stdev
1.65
1.37
Notes:
Includes MOH hours where actual involvement.
The data show considerable variation in the direct labour applied to school
immunisations. Six councils provided more than four encounters per direct labour
hour while some of the other councils recorded ratios of less than half this.
Mean and median values for direct labour hours per episode and encounter were
found again to be approximate.
18
As with infant sessions, activity level analysis indicates that lower cost councils are
more efficient in “service delivery” components for school sessions. The data
indicate that the three lowest cost councils carried out these activities at between
$1.5 and $2.6 per encounter less than the group mean. These results were not
affected by relatively low costs for travel time to and from venues. Two of these low
cost councils showed lower than mean costs per encounter for travel time, but this
accounted for a maximum of only 49 cents or 19% of the above difference.
19
Table 6: School Encounters Service Elements 2002-03
Service Elements
Service Planning
Major tasks
Total
Max
Min
Mean
Median
St dev
$
$/enc
$/enc
$/enc
$/enc
$/enc
Development of
immunisation service plan
Organising episode times & venues for the year.
Staffing & administering arrangements such as
rosters and schedules. Developing of a service
budget including obtaining management approval.
19,750
3.7
0.1
0.6
0.5
1.3
Consents
Obtaining, collating and delivering consent cards
and fact sheets to schools. Collecting consent
cards from schools. Checking consent cards.
Following up of incomplete consent cards.
44,291
2.9
0.3
1.3
1.4
1.5
Equipment & vaccines
Ordering and storing vaccines. Ordering of
equipment Monitoring cold chain & recording
results. Monitoring of stock & recording inventory.
17,095
1.5
0.1
0.5
0.4
0.9
42,984
2.8
0.4
1.3
1.1
2.5
19,282
1.2
-
0.6
0.6
0.6
58,746
5.5
0.5
1.8
1.6
1.9
Health promotion,
advertising & marketing
Quality assurance
Service Delivery
Components
Preparation
Advertising immunisation services including putting
together hard copy for inclusion in newsletter;
updating the website, developing media releases.
Printing of immunisation resource materials for
staff and parents. Responding to enquiries about
immunisation history including issuing school entry
immunisation certificates. Developing marketing
strategies for specific target groups.
Conducting the Best Value process for
immunisation services including community
consultation, analysis, feedback and reporting
processes. Conducting meetings and consultations
with other service providers. Managing service
complaints including recording, investigating and
communicating with complainant. Carrying out
service reviews and reporting to Council.
Developing and implementing Council risk
management & OH&S policies including incident
investigation and reporting e.g. adverse reaction
reporting. Developing and implementing
procedures to comply with privacy legislation e.g.
health records.
Drawing up of vaccines Packing of equipment
20
Service Elements
Total
Max
Min
Mean
Median
St dev
$
$/enc
$/enc
$/enc
$/enc
$/enc
11,618
2.0
-
0.3
0.3
0.6
Identification & confirmation Confirming identification and that consent has been
given
17,084
1.9
-
0.5
0.3
0.7
Recording
Immunisation record provided to student
10,111
1.9
-
0.3
0.2
0.6
Immunisation
Administering vaccine to recipient
45,363
3.9
0.8
1.4
1.0
1.3
Completion of episode
Repacking and removal of equipment
14,414
1.6
-
0.4
0.3
0.5
Follow up
Entering immunisation data on computer Sending
letters to absentees Archiving consent cards
41,320
3.6
0.7
1.2
1.2
1.0
Reporting
Reporting quarterly to DHS on data for the over 7
years age group
4,736
0.6
-
0.1
0.1
0.3
Accreditation and
professional development
Accreditation training for immunisation nurses
(initial & 3 yearly accreditation; annual CPR
updates)
1,153
0.2
-
0.0
0.0
0.4
Quality assurance
First aid training for administration staff OH&S &
QA training for service staff Privacy & health
records training for service staff
4,386
0.6
-
0.1
0.0
0.3
Negotiation of MOH contract/arrangement Drawing
up of service contract Contract management
(tender process costs, performance review costs,
reporting)
550
0.1
-
0.0
-
0.0
Managing service agreement with DHS including
providing reports Managing immunisation provider
service agreement
1,341
0.1
-
0.0
0.0
0.1
11.1
10.8
8.2
Major tasks
Components
Travelling to & from venues Preparing the venue
for the episode (e.g. signs, seating, computers)
Clinical screening
Reporting & Acquittal
Processes
Staff Training
Contract Management &
Reporting
Service Agreement &
Reporting
Contract initiation and
management
Agreement initiation and
management
Sub-total
Checking recipients’ health status and identifying
contraindications
476,768
-
21
Total
Max
Min
Mean
Median
St dev
$
$/enc
$/enc
$/enc
$/enc
$/enc
MOH
11,382
1.0
-
0.3
0.2
0.3
Management
10,848
0.6
-
0.3
0.1
0.2
498,998
30.5
7.7
11.6
11.3
Service Elements
Major tasks
Total
Components
22
8.3
3.
General Comments
3.1 Staffing:
The staffing establishment to deliver immunisation services varies considerably
between councils, both in terms of staff type and the level of staffing. The tasks being
undertaken by each type of staff is not uniform across the councils, for example
coordinators may also undertake sessional work.
Table 7: Council Staffing per Person Hour
Council
Coordinator
SEHOs &
EHOs
Admin & Tech/
Imm Officers
Student
EHOs
Nurses
Total Person
Hours
A
355
263
2,373
65
1,254
4,310
B
560
47
2,656
49
2,304
5,615
C
297
95
1,149
484
2,026
D
921
343
793
2,400
E
649
1,193
1,162
3,004
1,093
3,529
343
F
172
155
2,058
51
G
190
1,097
1,377
866
3,529
H
367
584
816
1,767
I
476
1,387
1,608
3,471
261
261
J
K
1,128
712
1,183
365
1,513
4,901
L
154
30
1,756
6
925
2,870
Table 8: Staffing Roles as a % of Total Person Hours
Council
Co-ordinator
SEHOs &
EHOs
Admin &
Tech/Imm Officers
Student EHOs
Nurses
Total
Person
Hours
A
8%
6%
55%
2%
29%
100%
B
10%
1%
47%
1%
41%
100%
C
15%
5%
57%
0%
24%
100%
D
0%
38%
14%
14%
33%
100%
E
0%
22%
40%
0%
39%
100%
F
5%
4%
58%
1%
31%
100%
G
5%
31%
39%
0%
25%
100%
H
21%
0%
33%
0%
46%
100%
23
I
14%
0%
40%
0%
46%
100%
J
0%
0%
0%
0%
100%
100%
K
23%
15%
24%
7%
31%
100%
L
6%
1%
60%
0%
34%
100%
Total
10%
11%
42%
2%
35%
100%
Note:
Coordinator time not disclosed for two councils but likely to be incorporated in SEOs
Generally the main staff resources are centred on nurses and administration officers.
Officers designated as technical and immunisation officers are fundamentally an
administrative resource.
The data show as a general rule of thumb, direct labour costs account for 70% to
75% of the total cost of immunisation services (excluding the costs of vaccines for
commercial services).
3.2 Mean Effective Labour Rates:
There is a significant variation in the levels of remuneration (salaries, wages and
related on-costs) paid to staff. These fluctuations are due to comparative
remuneration levels for staff at the same level, the differing banding/level of various
staff and the use made of casual staff. Effective labour rates are provided below.
Effective labour rates are charge out rates that recover staff wages and salaries, oncosts (superannuation guarantee, WorkCover levy, Long Service Leave provision
and recreation leave loading if paid) and paid absences (for recreation leave, public
holidays, sick leave and training).
Table 9: Council Staffing: Mean Effective Labour Rates
Council
A
Coordinator
$
SEHOs & EHOs
$
40.98
34.83 32.82
Admin. & Tech/
Imm. Officers
$
19.69
Student
EHOs
$
Nurses
All Staff
$
$
25.98
31.39
25.91
12.73
40.06
33.11
-
30.54
28.56
26.48
B
40.57
C
38.34
21.33 24.70
26.04
-
-
18.19
31.13
29.48
D
na
na
na
na
na
na
E
na
na
na
na
na
na
F
52.29
-
32.17
33.49
-
14.34
38.81
35.00
24
G
38.40
H
36.29
I
29.60
J
-
K
26.51
L
43.18
All councils
except D&E
34.83
34.63
24.34
26.48
-
-
23.12
-
-
-
21.21
-
-
-
-
-
-
38.41
26.69
34.11
30.55
-
24.13
31.25
32.32
36.66
24.71
29.49
31.11
-
42.65
30.47
-
41.73
34.45
-
30.30
26.57
-
42.25
42.24
14.56
38.88
30.94
-
33.70
33.30
15.60
36.80
30.90
Note:
Includes casual staff
Generally all staff other than nurses are full-time or part-time permanent or temporary
staff. In the ten services that are delivered in-house, nurse resources consist of
permanent/temporary or casual staff, or a combination of both.
Lower cost councils tend to have lower labour cost rates for their staff, in particular
nurses and administration staff.
3.3 Other Costs:
The major other costs involved in immunisation include MOH retainer/contract,
vaccines for commercial and staff vaccinations, vehicle use and travel, consumables,
including syringes, swabs and dressings and corporate overheads related to
accommodation, intermediate services and management.
Contracts with MOsH vary and include retainers and/or fee for service arrangements.
In most cases little use is made of MOsH where nurses have been accredited. Two
councils incurred no costs for their MOH – one receiving an on-call service for free
and the other paying on an as needed basis but not having required the service. Five
of the councils had an actual involvement of the MOH in sessional or other activities
ranging from 2 hours up to 200 hours. In one case the MOH has a more wide
ranging involvement that includes providing training, auditing immunisation sessions
and researching occupational health and safety issues. Retained services generally
cover the MOH being on-call to answer enquiries from council immunisation and
M&CH services, answering enquiries from immunisation clients on difficult medical
issues and the investigation of immunisation incidents or complaints.
Costs of vaccines for commercial and staff vaccinations vary considerably from a few
thousand dollars up to more than $130,000 – a direct reflection of the amount of such
work that is undertaken.
25
Vehicle and travel allowance costs generally account for 4% of the cost of
immunisation services, although they are approximately double this in one of the
councils. Surprisingly, there is no apparent correlation between the proportion of
cost attributable to vehicle and travel allowance cost and the physical size of the
councils.
Corporate overheads account for on average 13% of the cost of immunisation
services and levels within the range of 8% to 19% for all councils were disclosed.
Involvement of management (council staff above the level of service coordinator)
varies considerably between councils. In several cases this contribution was
considered to be immaterial while at the other extreme management costs were
estimated to account for up to 7% of the total cost. Management responsibilities
indicated by respondents included involvement in contract management, business
planning, budget development, performance reporting, planning for quality assurance
and service agreement issues.
26
4.
Impact of the Introduction of the Meningococcal C Vaccine
The Meningococcal C Vaccine (MCV) was introduced to designated age groups over
a rolling three year period in January 2003. The details of which age groups eligible
to receive the free vaccine in which time period are included in Attachment 1.
Difficulties associated with isolating the costs of the introduction of MCV to the
schedule were identified earlier in this Study. These mainly relate to an inability to
quarantine the specific costs relating to MCV. The presence of accurate information
of how many MCV vaccinations were provided along with other scheduled
vaccinations or as a single vaccination encounter would have assisted the analysis.
However, this would have required councils to undertake an unreasonably high level
of data interrogation and may have ultimately affected the response rate.
This part of the study was only able to focus, therefore, on those additional sessions
run by councils to provide Meningococcal C vaccinations.
Seven of the councils held special sessions to provide Meningococcal C vaccinations
in the latter six months of 2002-03. Of these six councils were able to provide data
that was possible to examine. These sessions were run to provide Meningococcal C
vaccine only, once it had been added to the vaccination schedule. The number of
immunisation episodes and encounters is therefore identical.
Table 11: Total & Unit Costs of Special MCV Sessions
Council
No.
Special
Sessions
No.
Episodes
No.
Encounters
Total
Cost
Cost
per
Session
Cost
per
Episode
Cost per
Encounter
A
3
422
422
$3,187
$1,062
$7.60
$7.60
B
5
1,353
1,353
$30,240
$6,048
$22.40
$22.40
H
12
639
639
$16,590
$1,383
$26.00
$26.00
I
12
2,488
2,488
$18,145
$1,512
$7.30
$7.30
J
2
17
17
$497
$249
$29.20
$29.20
K
10
1,943
1,943
$17,886
$1,789
$9.20
$9.20
44
6,862
6,862
$86,545
Mean
$1,967
$12.60
$12.60
Median
$1,447
$15.80
$15.80
Stdev
$2,124
$11.10
$11.10
C
D
E
F
G
L
Total
27
Notwithstanding the small number of observations, simple linear regression analysis
indicates a poor relationship between the number of episodes/encounters and total
costs (r2 value of .42). The extent of the variation is supported by the relatively high
standard deviation.
The mean unit cost for meningococcal C vaccinations given at special sessions is
within 9% of that recorded for school sessions.
Table 12: MCV Episodes & Encounters per Direct Labour Hour
Council
Episodes per Direct
Labour Hour
Encounters per Direct Labour
Hour
A
5.78
5.78
B
1.96
1.96
H
1.64
1.64
I
5.12
5.12
J
1.74
1.74
K
4.65
4.65
Mean
3.32
3.32
Median
3.30
3.30
Stdev
1.92
1.92
C
D
E
F
G
L
While four of the councils providing MCVs at special sessions indicated a similar
labour requirement to that which they recorded for school immunisations, the
remaining two presented vastly different requirements and there may be some issue
as to their credibility. The results relating to MCV therefore need to be treated
cautiously – more detailed analysis of episodes administered by councils would need
to be undertaken to comment more accurately.
28
Table 13: Special Meningococcal C Encounters Service Elements 2002-03
Service
Major tasks
Components
Max
Min
Mean
Median
Stdev
$/enc
$/enc
$/enc
$/enc
$/enc
6,654
3.6
0.3
1.0
1.4
1.3
16,657
6.4
-
2.4
1.6
2.5
2,738
1.8
0.1
0.4
0.4
0.6
9,196
1.7
-
1.3
1.1
0.8
All
Elements
Service
Development of
Planning
campaign plan
Special School
encounters
Equipment & vaccines
Health promotion,
advertising &
marketing
Service
Delivery
Organising encounter times & venues.
Staffing & administering arrangements such
as rosters and schedules. Developing of a
service budget including obtaining
management approval.
Obtaining, collating and delivering consent
cards and fact sheets to schools. Collecting
consent cards from schools. Checking
consent cards. Following up of incomplete
consent cards.
Ordering and storing vaccines. Ordering of
equipment. Monitoring of stock & recording
inventory
Advertising immunisation services including
putting together hard copy for inclusion in
newsletter, updating the website, developing
media releases. Printing of immunisation
resource materials for the public.
Responding to enquiries about
meningococcal immunisation.
Quality assurance
Conducting consultations with other service
providers
1,602
0.5
-
0.2
0.1
0.2
Preparation
Drawing up of vaccines. Packing of
equipment. Travelling to & from venues.
Preparing the venue for the encounter (e.g.
signs, seating, computers)
9,861
8.2
0.4
1.4
0.9
3.2
29
Service
Major tasks
Components
All
Elements
Min
Mean
Median
Stdev
$/enc
$/enc
$/enc
$/enc
Checking recipients’ health status and
identifying contraindications
3,288
3.6
-
0.5
0.6
1.3
Identification &
confirmation
Recording
Confirming identification and that consent
has been given
3,830
3.6
-
0.6
1.4
1.7
Immunisation record provided to recipient
1,111
0.6
-
0.2
0.1
0.3
Immunisation
Administering vaccine to recipient
13,184
7.5
0.5
1.9
2.9
3.2
Completion of
encounter
Repacking and removal of equipment
1,828
3.6
-
0.3
0.5
1.6
Follow up
Entering immunisation data on
computerArchiving consent cards
10,682
3.1
-
1.6
1.0
1.1
2,502
1.8
0.1
0.4
0.2
0.8
83,133
28.8
6.9
12.1
15.2
11.0
-
-
-
MOH
1,466
0.6
-
0.2
0.2
0.2
Management
1,946
0.5
-
0.3
0.2
0.2
-
-
-
29.2
7.3
12.6
Clinical screening
Reporting
and
Acquittal
Process
Max
$/enc
Reporting
Reporting campaign statistics to DHS
Sub-total
Total
89,017
30
-
9.2
11.1
An important issue related to the cost of adding MCV to the schedule is the tendency
for associated costs to be one-off or more significant during the introductory stage.
For example, it might be expected that planning, advertising, printing and marketing
costs would be higher in the year of introduction, compared with proceeding years.
The requirement to provide Special MCV sessions might also be reasonably
expected to reduce over time.
Notwithstanding this, the following observations and comments are made:
 some councils were obviously unable to accommodate MCV within, or by
extending, the duration of, infant and schools sessions;
 seven of the twelve councils provided a total of sixty-three (additional) special
sessions specifically to deliver MCV when it became part of the schedule;
 as a proportion of the total number of sessions held by each council to deliver
scheduled vaccinations, these special sessions ranged from 2% to 40% (the
latter provided by a rural council where special sessions involved relatively
small numbers of encounters);
 a special MCV encounter has more in common with a school aged encounter
than an infant encounter because of the number of episodes involved;
 the ratios of cost per encounter for a MCV given at a special session and a
school session are reasonably close for four of the councils (within 5% of
each other);
 the data generally show lower unit costs for a special MCV encounter when
compared with a school encounter;
 in the case of two of the councils there was a significant variation in costs
when comparing their special MCV and school encounters, which appears to
be attributable to significant differences in the amount of time involved in both
service planning and service delivery activities.
Non Labour Costs:
Councils were asked where possible to identify specific non-labour costs that could
be attributed to the inclusion of MCV to the schedule. Very few of the councils felt
they were able to do so, although some could in relation to particular cost items.
31
The responses indicated by the councils indicated the following examples of cost
impacts:
 a 6% increase in the cost for swabs and dressings and a 5% additional cost
for advertising and promotion;
 a 33% increase in printing costs and a 73% increase in travel allowance
costs;
 a 29% increase in the cost for syringes;
 a 13% increase covering all other cost items;
 a 6 % increase covering all other cost items that included an 11% increase in
marketing and promotional costs;
 a 30% increase in the cost of swabs, dressings and syringes and the
introduction of some marketing/promotional spending– although not a
material amount;
 an 18% increase in the cost for swabs and dressings;
 a 60% increase in printing/promotional and marketing costs; and
 a 69% increase covering all other cost items including a 283% increase in
printing/promotional and marketing costs.
Clearly, the data show a wide variation in experience and this is probably not
surprising given the different factors pertinent to each council. For example, the
proportion of population that may be from a NESB may impact the need for additional
printing/promotional spending.
Labour Efficiency Impacts:
For those councils able to provide reasonable data for both six months periods in
2002-03, the data indicate increases in the number of scheduled episodes and
encounters was accompanied by scale economies. The addition of MCV to the
schedule was responsible for a significant proportion of this increase in episodes and
encounters: MCVs accounted from 27% up to nearly half of all vaccinations given
during the second half of 2002-03.
The table below shows a comparison of episodes, encounters and labour hours
comparing the second and first six months. The second six months corresponds with
the period when MCVs were being given. The figures do not take account of the fact
that some work undertaken in the first six months of the year was specifically related
to the introduction of MCV. The data show that in all cases the percentage change in
schedule encounters is less, and in some cases substantially, less than the
percentage change in associated effective labour hours.
32
Table 14:
Effect of MCV Introduction: Overall Episodes & Encounters per Labour
Hour
Total
Effective
Labour
Hours
Total
Schedule
Episodes
MCV
Episodes
st
1,545
4,894
-
nd
2,452
10,302
> 5,000
59%
111%
st
2,523
6,337
-
nd
2,771
12,765
3,469
Council
6 months
A
1
2
Change
B
1
2
Change
C
10%
101%
759
2,040
-
nd
1,242
4,674
1,745
64%
129%
st
1,463
4,952
-
nd
2,066
8,569
> 3,000
2
Change
F
1
2
Change
K
73%
2,175
6,878
-
nd
2,077
10,059
4,597
Change
L
-4%
46%
1,015
6,074
-
nd
1,810
10,518
4,307
78%
73%
st
9,478
31,175
-
nd
12,418
56,887
> 22,118
31%
82%
2
Change
All
1
2
Change
2,995
1.9
4.2
7,730
3.2
27%
2.5
3,520
1.4
4.6
8,596
3.1
37%
2.7
1,221
1.6
3.8
3,528
2.8
35%
3.4
2,653
1.8
4.1
5,017
2.4
89%
st
1
3.2
189%
41%
2
Encounters
per Labour
Hour
144%
st
1
49%
Episodes per
Total
Labour Hour Encounters
158%
st
1
MCV as %
Total
Episodes
46%
3.2
4,172
1.9
4.8
6,808
3.3
63%
41%
6.0
3,719
3.7
5.8
7,811
4.3
110%
39%
3.3
18,280
1.9
4.6
39,490
3.2
116%
Notes:
Excludes MOH hours
Includes MCV special sessions.
A review of the impacts for infant and school sessions indicates the varied
experience of these councils.
33
Table 15: Effect of MCV Introduction by Infant & School Sessions

Infant
Council
A
B
C
F
K
6 months
All
Schedule Labour
Encounters Hours
Encounters
per Labour
Hour
Schedule
Episodes
Schedule Labour
Encounters Hours
Encounters
per Labour
Hour
1st
3,837
1,938
1,128
1.7
1,057
1,057
417
2.5
2nd
5,604
3,032
1,128
2.7
4,276
4,276
1,252
3.4
Change
46%
56%
0%
56%
305%
305%
200%
35%
1st
5,248
2,431
1,986
1.2
1,089
1,089
479
2.3
2nd
6,377
2,958
1,671
1.8
5,035
4,285
467
9.2
Change
22%
22%
-16%
45%
362%
293%
-3%
304%
1st
1,495
676
642
1.1
545
545
116
4.7
2nd
2,138
992
610
1.6
2,536
2,536
632
4.0
Change
43%
47%
-5%
54%
365%
365%
445%
-15%
1st
4,252
1,953
912
2.1
700
700
551
1.3
2nd
6,369
3,517
1,487
2.4
2,200
1,500
578
2.6
Change
50%
80%
63%
10%
214%
114%
5%
104%
1st
6,026
3,320
1,731
1.9
852
852
404
2.1
2nd
5,943
2,692
1,464
1.8
2,173
2,173
235
9.2
-1%
-19%
-15%
-4%
155%
155%
-42%
338%
1st
4,687
2,332
548
4.3
1,387
1,387
467
3.0
2nd
5,467
2,760
752
3.7
5,051
5,051
1,058
4.8
Change
17%
18%
37%
-14%
264%
264%
127%
61%
1st
25,545
12,650
6,947
1.8
5,630
5,630
2,434
2.3
2nd
31,898
15,951
7,112
2.2
21,271
19,821
4,222
4.7
25%
26%
2%
23%
278%
252%
73%
103%
Change
L
Schedule
Episodes
School
Change
The introduction of MCV – conclusions:
The introduction of another vaccination to the schedule is likely, at least initially, to
result in a requirement for some special sessions.
Increases in non-labour costs associated with the introduction of a vaccination are
likely to vary considerably, depending on the characteristics and requirements of
particular councils.
The addition of MCV to the schedule, while increasing councils’ total costs, resulted
in reduced unit costs per encounter.
Any funding formula that seeks to address the introduction of an additional vaccine to
the schedule should acknowledge:
 the potential for special sessions to be required;
34
 the likelihood that the vaccination can be given coincidentally with other
vaccinations i.e. included within pre-existing encounters; and
 campaign costs when the vaccination is first introduced.
35
Attachments
Attachment 1: Australian Standard Vaccination Schedule – Free
Vaccines
The NHMRC recommends each year a list of vaccines for the Australian public in the
Australian Standard Vaccination Schedule. Although in its 2003 Handbook the
NHMRC recommends a number of additional vaccines be given to children (such as
the Varicella-zoster vaccine for chicken pox and 7vPCV (Prevenar) for pneumococcal
diseases), these are not currently available free-of-charge to the community. This list
focuses on vaccines which are free through the National Immunisation Program.
Age
No of vaccines given at
single encounter
Vaccine type
Infant/Preschool:
2 & 4 months
2 injections
1 spoon sabin (oral)
6 months
1 injection
DTPa (Infanrix), HepB/HIB (Comvax) &
Sabin
DTPa & Sabin
1 spoon sabin
12 months
3 injections
MMR & Hib/HepB (Comvax)
MCV
18 months
2
4 years
1
2
1 injection
DTPa
2 injections
DTPa, MMR & Sabin
1 spoon sabin
School age:
Year 7 (10-13 years)
2 dose course
HepB
(4-6 months apart)
Year 10 (15-17 years)
1 injection
ADT (diphtheria/tetanus)
Notes:
1.
MCV was introduced from 1 January 2003 as part of the Australian Standard
Vaccination Schedule for children aged 12 months. To enable coverage of all
people aged between 1 and 19 years, the Federal Government announced free
Meningococcal C vaccines would be provided for:
2002/2003:
1-5 year olds
15-19 year olds
2003/2004:
6-14 year olds
2005/2006:
‘catch up’ for those above who have been missed.
Councils have to therefore initiate visits to schools to “catch up” those who
otherwise would not receive the MCV at a routine immunisation session between
2003 and 2006.
2. This vaccine has since been dropped from the NIP, as advised in the October
2003 NHMRC 8th Edition Immunisation Handbook.
36
Federal & State Government Subsidies to Councils:
Age
Infant/Preschool
Current subsidy
Funding provider
$6.00
ACIR
per notification/encounter
Year 7
$3 metro/$4.50 rural
DHS via Federal Government
from DHS
Year 10
$2 metro/$3 rural
DHS via Federal Government
from DHS
“Catch-up” MCV to
school ages
$5 per dose
DHS via Federal Government
 Councils also receive $2.50 for every school entry certificate provided to
parents.
 DHS provides immunisation software (with a “helpdesk fee” paid by councils),
parent resources including consent cards, disease fact sheets, brochures and
other promotional materials.
 DHS is funding a project to assist councils and GP’s to “clean-up”
immunisation data to identify children who are not appropriately immunised
and to follow up those children.
37
Federal Government Subsidies to GPs :
The Federal Government provides incentive payments for General Practitioners to
administer vaccinations. Incentive payments have both a fee-for-service element
and an outcome element. Funding is also provided for divisions to support GPs to
attain immunisation targets. The following information summarises Federal
Government payments to GPs for immunisation service delivery:
GP Incentive Program
Federal
Government
Funding Agency
Vaccination notification record
ACIR
GP Immunisation Incentive Payment
for each adult & child immunisation
encounter
Health Insurance
Commission
$18.50
Consultation fee
Medicare
$25.70
TOTAL FUNDING TO GPs
Payment Per Encounter
$6.00
Minimum $50.20 per encounter
Additional Bonuses are available
in specified circumstances:
Bonus for achieving child
immunisation rates at 80% & 90% of
immunisation
Health Insurance
Commission
Extra $ 3.50 per patient
equivalent where practice
coverage is <90%
Medicare Plus incentive for bulk
billing
Medicare
$6 for bulk billed consultation for
children > 16 in non-metro areas
Medicare Care Plus initiative for
Practice Nurses
Medicare
$8.50 where practice nurse
provides immunisation
Total additional $ available to be
claimed by GPs
Total possible $ provided to GPs
$18.00
Possible $68.20 per encounter
38
Attachment 2: Project Team
The MAV, with financial contribution and assistance from the Department of Human
Services (DHS) conducted the study on behalf of local government in Victoria. The
team comprised:
Trevor Koops, Economist, MAV
Jim Smith, James C Smith & Associates
Rosemary Hancock, Project Officer, MAV
Helen Pitcher, Immunisation Nurse, Immunisation Program, DHS.
39
Attachment 3: Study Population
Council
1
Type
Model
Total
2
Episodes
Total
2
Encounters
A
Regional City &
Small Shire
In-House also
contractor for other
councils
18,232
13,691
B
Inner Metro
In-House
19,992
12,923
C
Large Shire
In-House
6,817
4,852
D
Outer Metro
External contract
15,129
8,180
E
Outer Metro
External contract
16,433
9,755
F
Inner Metro
In-House
13,521
7,670
G
Regional City
In-House
13,686
9,616
H
Large Shire
In-House
4,897
3,198
I
Outer Metro
In-House
17,371
10,776
J
Small Shire
In-House with Infant
Vaccinations via
M&CH Service
635
635
K
Outer Metro
In-House
18,788
12,592
L
Outer Metro
In-House
16,901
11,839
3
3
Notes:
1. Based on Department for Victorian Communities council classifications
2. Includes Infant (public), school, special meningococcal C and other (commercial & staff)
sessions
3. Number of episodes and encounters for council E is an estimate
40
Attachment 4: Total Costs & Unit Costs for Scheduled Vaccinations
Council
Number of
Sessions
Number of
Episodes
Number of
Total Cost
Cost per
Cost per
Cost per
Encounters
$
Session
Episode
Encounter
$
$
$
A
121
15,196
10,725
154,917
1,280
10.2
14.4
B
159
19,102
12,116
226,450
1,424
11.9
18.7
C
71
6,714
4,749
76,792
1,082
11.4
16.2
D
160
15,129
8,180
157,099
982
10.4
19.2
E
220
16,433
9,755
157,901
718
9.6
16.2
F
112
13,521
7,670
170,445
1,522
12.6
22.2
G
153
13,001
9,055
142,928
934
11.0
15.8
H
105
4,463
2,764
70,162
668
15.7
25.4
I
225
17,003
10,543
131,763
586
7.7
12.5
J
5
939
545
11,835
np
12.6
21.7
K
121
16,937
10,980
198,017
1,637
11.7
18.0
L
158
16,592
11,530
156,307
989
9.4
13.6
Total
1,605
155,136
99,312
1,654,616
Mean
1,026
10.7
16.7
Median
989
11.2
17.1
Stdev
357
2.1
4.0
Simple linear regression analysis indicates a reasonably strong relationship between
the number of episodes and encounters and total costs (respective r2 values of .87
and .84). The mean unit costs found were $10.70 per episode and $16.70 per
encounter, with median unit costs very close to the mean.
The highest unit costs were found for the two councils (H & J) with the least
episodes/encounters and Council F. Council I, the lowest cost council recorded a
cost per encounter just in excess of minus one standard deviation.
41
While the lowest unit costs were recorded by some of the councils recording higher
numbers of episodes and encounters, higher levels of episodes or encounters does
not translate into lower unit costs for all councils. The data show, for example, that
council C is providing scheduled vaccinations at a lower cost than councils B, D, F
and K, although these councils show far greater numbers of episodes and
encounters. Council C is also one of the largest in terms of physical size – although
this of course does not necessarily reflect on where immunisation sessions are being
held within a municipality.
Given the poor correlation found between vehicle/travel costs and size and the
above, the importance of other factors is presumed including the approach to the
staffing of immunisation services and the particular way they are organised and
carried out. Differences in the overall findings for scheduled services are also
influenced by the proportion of services dedicated to infant and school sessions that
may have contrasting unit costs.
Total & Unit Costs for Scheduled & Other (commercial & staff)
Vaccinations
Council
No.
No.
No.
Sessions Episodes Encounters
Total
Cost
Cost per
Session
Cost per Cost per
Episode Encounter
A
254
18,232
13,691
167,734
660
9.2
12.3
B
204
19,992
12,923
240,210
1,178
12.0
18.6
C
75
6,817
4,852
77,779
1,037
11.4
16.0
D
160
15,129
8,180
157,099
982
10.4
19.2
E
220
16,433
9,755
157,901
718
9.6
16.2
F
112
13,521
7,670
170,445
1,522
12.6
22.2
G
170
13,686
9,616
145,474
856
10.6
15.1
H
130
4,897
3,198
76,998
592
15.7
24.1
I
231
17,371
10,776
133,896
580
7.7
12.4
J
10
1,029
635
14,600
14.2
23.0
K
190
18,788
12,592
226,551
1,192
12.1
18.0
L
160
16,901
11,839
158,809
993
9.4
13.4
Total
1,906
162,902
106,427
1,727,496
42
Mean
899
10.6
16.2
Median
982
11.0
17.1
Stdev
329
2.3
4.3
Note:
Excludes Vaccine Costs
43
Activity Cost Proportions:
Council
Labour
Costs
MOH
Vehicles/ Syringes, Corporate
Corporate
Retainer/
Travel
Swabs & Overheads
Overheads Contract Allowance Dressings
- Other
Accommodation
Related
Other
Direct
Costs
Total Costs Management Total
ex.
Cost
Management
Costs
A
111,662
4,800
7,338
3,369
26,851
4,268
9,446
167,734
0
167,734
B
186,087
5,148
9,176
3,889
11,049
11,075
6,766
233,190
7,241
240,431
C
57,866
500
2,526
1,239
3,177
10,630
1,841
77,779
0
77,779
D
np
10,000
np
np
np
np
np
157,357
4,433
161,790
E
np
0
np
np
np
np
np
156,739
1,162
157,901
F
123,510
4,807
777
4,174
18,353
13,740
5,456
170,817
505
171,322
G
109,527
1,500
4,410
1,957
3,949
9,860^
14,272
145,475
0
145,475
H
60,868
2,900
1,200
2,765
1,274
6,100
1,890
76,997
0
76,997
I
92,215
2,788
10,249
3,800
9,779
5,739
5,227
129,797
4,100
133,897
J
11,025*
0
438#
12
21~
1,122~
1,547
14,165
434
14,599
K
151,623
5,250
4,900
2,300
15,645
17,300
20,700
217,718
8,833
226,551
L
91,788
19,410
7,288
2,543
17,866
5,172
3,943
148,010
10,800
158,810
Composition
70%
3%
3%
2%
8%
6%
5%
98%
2%
100%
Notes:
Figures exclude vaccines for commercial services
^ includes some corporate overheads - other
* includes travel/vehicles for M&CH Home Visits and corporate overheads for M&CH Home and Centre Based Visits
# excludes travel/vehicles for M&CH Home Visits and corporate overheads for M&CH Home and Centre Based Visits
~ excludes corporate overheads for M&CH Home and Centre Based Visits
44
Attachment 5: Survey Instructions
LOCAL GOVERNMENT IMMUNISATION COSTING PROJECT
1.0
Objective
The purpose of this exercise is twofold. Firstly, it aims to obtain information on
the costs incurred by councils in providing scheduled vaccinations for infant/preschool aged and school aged children. Secondly, it aims to isolate the impacts of
an immunisation campaign, specifically, the Meningoccocal C program, that was
introduced to the council immunisation program in the latter half of the 2002-03
financial year.
Data is therefore sought for both the first six months of the 2002-03 financial
year and for the full 12 months of the 2002-03 financial year in order to
undertake the necessary analysis.
2.0
How to Complete the Survey
Step 1 – Attach a copy of “actuals” from your council’s financial reporting
system for immunisation services for both the periods 1/7/02 to 31/12/02 and
1/7/02 to 30/6/03. If immunisation is included within broader environmental
health or health budgets please attach the actuals for these cost centres.
Step 2
- complete all fourteen worksheets in the Excel workbook
(“IMMOCOST”). These are:
 Contact – responsible person for follow-up and contact details.
 Unit Data – information on the number of immunisation sessions, episodes
and encounters.
 Staff_Costs – labour cost details for staff involved in immunisation including
immunisation services co-ordinators.
 Other_Costs – non-labour cost details for immunisation including contracted
services.
 Management – any management costs above immunisation coordinator
including Group Management and Directorate costs that can be attributed to
immunisation services. Co-ordinators should be included in Staff_Costs.
 Infant_Pre-School_31-12-02 and Infant_Pre-School_30-6-03 – workload
allocation for infant and pre-school aged immunisation sessions for
scheduled vaccinations. Include delivery of meningococcal C vaccine if
given at infant/pre-school scheduled vaccination sessions in this worksheet
if applicable.
45
 School_31-12-02 and School_30-6-03 - workload allocation for school
immunisation sessions for scheduled vaccinations. Include delivery of
meningococcal C vaccine if given at school scheduled vaccination sessions
in this worksheet if applicable.
 Special_ MeningococcalC_31-12-02 and Special_ MeningococcalC_30-6-03
workload allocation for special immunisation sessions for providing
meningoccocal C vaccine. Include any special (non-scheduled) school
sessions for meningococcal C in this worksheet.
 Other _31-12-02 and Other _30-6-03 - workload allocation for sessions
other than infant/pre-school sessions for scheduled vaccinations, school
sessions for scheduled vaccinations and special meningococcal C vaccination
sessions. For example, include council staff immunisation and commercial
services in this worksheet. Commercial services include vaccinations that do
not attract State and/or Commonwealth Government subsidies and that are
provided on a fee for service basis.
 Income – revenues that support immunisation services from various sources
including Commonwealth Government subsidies, State DHS subsidies,
commercial payments and revenue from other sources.
3.0
Notes to Assist Respondents
Definitions:
Immunisation Session – for the purposes of this project, a session refers to a single
period in which vaccinations are given that commences with the setting up of a venue
and concludes with the packing up of that same venue.
Immunisation Episode – refers to an individual vaccination.
Immunisation Encounter – a visit in which one or more vaccinations are given.
A. Contact
Contact details for council staff person. The person listed as the contact should be the
person with responsibility for completion of the survey, ideally the service
coordinator.
46
B.
Unit_Data Worksheet
This worksheet requires respondents to submit service information on the numbers of
sessions, episodes and encounters respectively for infant/pre-school, school, special
meningococcal C and other sessions as defined above.
C. & D. Staff Numbers, EFTs & Labour Costs – Staff_Costs Worksheet
The worksheet (Staff_Costs) requires respondents to identify the number of staff, the
number of full-time equivalent (EFT) staff, and labour costs, by category, involved in
the delivery of immunisation services. Respondents are asked to distinguish between
permanent/temporary and casual staff where indicated.
EFT of permanent staff means the total of the average weekly/fortnightly hours
worked by staff divided by the standard number of weekly/fortnightly hours of full
time employment. For example, where three staff members respectively work 38
hours, 38 hours and 30.4 hours per week, and there is a standard working week of 38
hours, the EFT is 2.8. For casual relief staff the total number of person hours should
be provided. Person hours are the cumulative total hours of all casual workers. For
example, three casual nurses respectively having worked a total of 100 hours, 28
hours and 86 hours amounts to 214 person hours for this type of worker. Changes in
EFTs over the course of the year should be reflected in these tables.
The labour costs breakdown requires information on total annual salaries, salary oncosts, allowances (excluding travel allowances for kilometres travelled) and overtime
payments by staff category. The labour costs identified should correspond with the
EFTs and person hours identified for each staff category. Salaries should include the
payment of higher duties, bonuses, and any “profit” returned to wages and salaries
through “gain sharing” arrangements.
Labour on-costs include employer
superannuation guarantee, long service leave provision, recreation leave loading and
WorkCover levy.
It is recognised that for accounting purposes immunisation services may be included
within broader Environmental Health budgets. If this is the case respondents are
asked to complete this table by apportioning staff to the each of the components of the
Environmental Health budget.
E.
Other Operational Service Costs – Other_Costs Worksheet
Other Operational Service Costs include costs for materials and goods, contracts &
other services, accommodation, and plant, equipment and furniture. Figures should
be net figures after taking account of any input tax credits for GST purposes.
The intention of the survey is to capture all costs relating to immunisation and
respondents are asked to consider operational costs which, for one reason or another,
are not reflected as an overhead or cost in the immunisation (Environmental Health)
budget. A good example of this is accommodation expenses.
47
All non-labour costs should be entered in the worksheet Other_Costs. Respondents
may again need to undertake an apportionment process of varying degrees, depending
on their accounting format, in order to do this. While some of the costs relating to
immunisation may be quite distinct, others may be “lumped together” with costs for
other environmental health services. The share of costs might be apportioned on the
basis of EFTs, workload or any other considered and arguable basis. For example, the
share of corporate overheads might be apportioned on the basis of EFTs, while the
share of vehicle lease/plant hire might be apportioned on the basis of an estimate or
actual usage.
This list is designed to capture all the other operational costs for the service. Council
budgets may not include some of the cost categories listed or combine several
together, particularly in the case of corporate overheads. Where the latter is the case
please asterisk or annotate the worksheet to show which costs/overheads have been
combined.
Where council immunisation services are delivered by another agency on behalf of
council under contract, the associated costs should be entered against the cost
category “immunisation contract”. Costs specifically related to a contract or retainer
paid to a MOH should be entered against the cost category “MOH Retainer/Contract”.
Please note that for the full financial year (12 months) the worksheet asks respondents
to both:
 identify all other immunisation costs associated with all types of
immunisation sessions including those that can be attributed to undertaking
the Meningococcal C campaign; and
 quantifying separately those costs that can be attributed clearly to
undertaking the Meningococcal C campaign.
F.
Higher Level Management Costs – Management_Costs Worksheet
Typically, in addition to the cost of the immunisation service there will be a
responsible manager, for example the Manager of Regulatory Services or Manager of
Community Services. Some councils may have separate contract management and
business support areas within council that provide an input to service delivery.
In these cases costs will generally be found in the budgets for other areas of Council.
For these areas respondents should complete the worksheet “Management_Costs” to
record such costs for 2002-03 where they are material. Information here is only
sought for the full 12 month period. The worksheet requires respondents to allocate an
estimate of any time
commitment that is material to the delivery of immunisation services, and using the
legend provided, indicate in which area this involvement takes place.
48
G. to N.
Breakdown of Immunisation Workload – Infant_Pre-school,
School Special_Meningococcal C and Other
These worksheets require respondents to enter total hours of staff time involved
specifically in:
 infant/pre-school sessions for scheduled vaccinations (G. and H.);
 school sessions for scheduled vaccinations (I. And J.);
 special sessions arranged specifically as part of the Meningococcal C
campaign (K. and L.); and
 other sessions, for example commercial services or sessions to vaccinate
council staff (M. and N.);
for the respective periods 1/7/02 to 31/12/02 and 1/7/02 to 30/6/03. A separate
worksheet is provided for each time period. Worksheets for the period 1/7/02 to
31/12/02 are labeled 31-12-02 in the worksheet name. Worksheets for the period
1/7/02 to 30/6/03 are labeled 30-6-03.
The worksheets require respondents to provide information on total hours worked.
Total hours are the cumulative hours worked by staff over the six and twelve month
periods being reviewed. These activities are provided as “process steps” and answers
are required for each cell.
It is also important to differentiate between the different staff involved with each
activity – Co-ordinators, Immunisation Nurses, Senior Environmental Health Officers,
Environmental Health Officers, Technical Officers, Student Environmental Health
Officers, Administration Officers, MOHs or others.
K.
Income
Figures should cover income from all sources including commercial services.
Commercial services are those services that do not attract any government subsidies.
Income figures should exclude any GST amounts that are remitted to the ATO.
49
Attachment 6: Survey Form
A.
MUNICIPAL ASSOCIATION OF VICTORIA
IMMUNISATION COSTING PROJECT
Name of Municipality:
Contact Officer:
Telephone:
Email:
Fax:
50
B. ACTUAL & ESTIMATED SERVICE DETAILS FOR YOUR COUNCIL
Standard Average Weekly Hours - Council Staff
35 hours
38 hours
1/7/02 to 31/12/02
1/7/02 to 30/6/03
6 months
12 months
Number of Immunisation Sessions
Infant/Pre-School - Scheduled vaccinations
School - Scheduled vaccinations
Special - Meningococcal C
Other
Number of Immunisation Episodes
At Infant/Pre-School Sessions for Scheduled vaccinations
At School Sessions for Scheduled vaccinations
At Special Sessions for Meningococcal C vaccinations
At Other Sessions
Number of Immunisation Encounters
At Infant/Pre-School Sessions for Scheduled vaccinations
At School Sessions for Scheduled vaccinations
At Special Sessions for Meningococcal C vaccinations
At Other Sessions
Important - Notes for Section B
- Session refers to a single period in which vaccinations are given that commences with the setting up of a venue and concludes with the packing
up of that same venue
- Episode refers to an individual vaccination
- Encounter is a visit in which one or more vaccinations are given
- Other Sessions are all other Sessions apart from "Infant/Pre-School Sessions for Scheduled vaccinations", "School Sessions for
Scheduled vaccinations" and "Special Sessions for Meningococcal C vaccinations" e.g. commercial services to business or council vaccinations
- Include Meningococcal C vaccinations given at "Infant/Pre-School Sessions for Scheduled vaccinations" and "School Sessions for
Scheduled Vaccinations" in respective figures for "Infant/Pre-School Sessions for Scheduled vaccinations" and "School Sessions for Scheduled
vaccinations"
- Include delivery of other Meningococcal C vaccinations in "Special Sessions for Meningococcal C vaccinations".
- Include any special (non-scheduled) school sessions for meningococcal C in "Special Sessions Meningococcal C vaccinations"
51
C.
STAFFING 1/7/02 to 31/12/02
% of Total EFT allocated to:
COUNCIL STAFF
No. of
Permanent Staff
Total EFT
of
Permanent
Staff
LABOUR COSTS 1/7/02 t
EnvironTotal
Person
Hours
Food Act
Health Act
ment
Residential
Protection Tenancies ImmunisAct
Act
ation
Other
Co-ordinator
Administrative
Officers
Total
Ordinary
Salaries
Ordinary
Salaries
On-costs
Allowances#
100%
Permament/
Temp
100%
Casual
100%
Senior Environmental Permament/
Health Officers
Temp
100%
Casual
100%
Environmental Health Permament/
Officers
Temp
100%
Casual
100%
Student
Environmental Health Permament/
Officers
Temp
100%
Casual
100%
Permament/
Immunisation Nurses Temp
Casual
100%
100%
100%
100%
Other Staff (specify)
100%
Total
Note: # Allowances exclude allowances for kilometres travelled.
D.
STAFFING 1/7/02 to 30/6/03
% of Total EFT allocated to:
No. of
Permanent Staff
COUNCIL STAFF
Co-ordinator
Administrative
Officers
Total EFT
of
Permanent
Staff
LABOUR COSTS 1/7/02
EnvironTotal
Person
Hours
Food Act
Health Act
ment
Residential
Protection Tenancies ImmunisAct
Act
ation
Other
Total
100%
Permament/
Temp
Casual
Senior Environmental Permament/
Health Officers
Temp
Casual
100%
100%
100%
100%
Environmental Health Permament/
Officers
Annual
Ordinary
Salaries
Temp
Casual
100%
100%
52
Annual
Ordinary
Salaries
On-costs
Annual
Allowances#
E. OTHER COSTS
1/7/02 to 31/12/02
1/7/02 to 30/6/03
6 months
12 months
All Immunisation
Costs
$
All Immunisation
Costs
$
Meningococcal "C"
Campaign Specific
$
Materials & Goods
Books & Periodicals
Consumables - Syringes
Consumables - Swabs, Dressings etc.
Office Supplies
Protective Clothing
Vaccines (commercial services)
Other (specify)
Contracts & Other Services
Accounts Payable
Accounts Receivable
Consultants
Consumer Surveys
Customer Service Centre
Human Resource Management
Immunisation Contract
Information Technology
Legal Costs
Management & Budget Accounting
Memberships & Subscriptions
MOH Retainer/Contract
Payroll
Photocopying
Postage/Freight/Couriers
Printing
Publicity/Advertising
Purchasing & Stores
Records Management/Registry
Risk Management/Insurances
Seminars & Conferences
Software
Training/Prof. Development
Other (specify)
Accommodation
Building Maintenance
Cleaning
Hall/Other Premises Rental
Mobile Phone
Office Rental
Power & Gas
Telephone
Waste Disposal/Sharps Disposal
Water & Sewerage
Other (specify)
Plant, Furniture & Equipment
Computer Repairs & M'nce
Computer Hire/Lease
Plant Repairs & M'nce
Plant Depreciation
Plant Hire
Vehicle Hire/Lease
Equipment Repairs & M'nce
Equipment Depreciation
Equipment Hire/Lease
Minor Equipment Purchase
Furniture Repairs & M'nce
Furniture Deprecition
Minor Furniture Purchase
Other
Travel Allowance
Other (specify)
53
F. MANAGEMENT 2002-03
Other Costs
Labour & On2002-03
Costs
$
including
Corporate
Overheads
$
Percentage
Total Cost
$
Apportioned to
Immunisation
%
Cost Apportioned
Immunisation
to Immunisation
Responsibility
$
Responsible Manager & Administrative
Support
Contract Management & Administrative
Support
Responsible Director & Administrative
Support
Other (specify)
Other (specify)
Total
Key for Responsibility:
a) Service Planning - Budget Development
b) Service Planning - Quality Assurance
c) Contract Management & Reporting
d) Service Agreement & Reporting
e) Other - specify
54
G. Infant/Pre-school Sessions Service Elements 1/7/02 to 31/12/02
Service
Major tasks
Scope of tasks
Elements
Service
Planning
Development of
immunisation service
plan
Equipment & vaccines
Health promotion ,
advertising &
marketing
Quality assurance
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times & venues for the
year
Staffing & administering arrangements such
as rosters and schedules
Developing of a service budget including
obtaining management approval
Ordering and storing vaccines
Ordering of equipment
Monitoring cold chain & recording results
Monitoring of stock & recording inventory
Advertising immunisation services including
putting together hard copy for inclusion in
newsletter; updating the website,
developing media releases
Printing of immunisation resource materials
for staff and parents
Developing marketing strategies for specific
target groups
Conducting the Best Value process for
immunisation services including community
consultation, analysis, feedback and
reporting processes
Conducting meetings and consultations with
other service providers
Managing service complaints including
recording, investigating and communicating
55
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service
Major tasks
Scope of tasks
Elements
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
with complainant
Carrying out service reviews and reporting
to Council
Developing and implementing Council risk
management & OH&S policies including
incident investigation and reporting eg
adverse reaction reporting
Developing and implementing procedures to
comply with privacy legislation eg health
records procedures
Service
Delivery
Preparation
Identification &
confirmation
Recording
Clinical screening
Immunisation
Completion of
session
Drawing up of vaccines
Packing of equipment
Travelling to & from venues
Preparing the venue for the session (eg
signs, seating, computers)
Checking records and that consent has
been given
Confirming identification
Entering immunisation data on
computer/M&CHN
Providing immunisation/vaccine information
to parent
Checking of infants’ health status;
identifying contraindications; providing
advice to parents
Administering vaccine to recipient
Repack and removal of equipment
56
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service
Major tasks
Scope of tasks
Elements
Reporting &
Acquittal
Processes
Staff
Training
Follow up
Returning venue to usual order
Sending letters to absentees
Organising special mail outs for ACIR
Reporting
Reporting to the ACIR on date for under 7
years of age group
Accreditation and
Professional
development
Quality assurance
Contract
Contract initiation and
Management
management
& Reporting
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Accreditation training for immunisation
nurses (initial & 3 yearly accreditation;
annual CPR updates)
First aid training for administration staff
OH&S & QA training for service staff
Privacy & health records training for service
staff
Negotiation of MOH contract/arrangement
Drawing up of service contract
Contract management (tender process
costs, performance review costs, reporting)
Service
Agreement
& Reporting
Agreement initiation
and management
Managing service agreement with DHS
including providing reports
Managing immunisation provider service
agreement
57
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
H. Infant/Pre-School Sessions Service Elements 1/7/02 to 30/6/03
Service Elements
Service Planning
Major tasks
Development of
immunisation service plan
Equipment & vaccines
Health promotion ,
advertising & marketing
Quality assurance
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times & venues
for the year
Staffing & administering
arrangements such as rosters and
schedules
Developing of a service budget
including obtaining management
approval
Ordering and storing vaccines
Ordering of equipment
Monitoring cold chain & recording
results
Monitoring of stock & recording
inventory
Advertising immunisation services
including putting together hard copy
for inclusion in newsletter; updating
the website, developing media
releases
Printing of immunisation resource
materials for staff and parents
Developing marketing strategies for
specific target groups
Conducting the Best Value process
for immunisation services including
community consultation, analysis,
feedback and reporting processes
Conducting meetings and
58
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service Elements
Service Delivery
Major tasks
Preparation
Identification &
confirmation
Recording
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
consultations with other service
providers
Managing service complaints
including recording, investigating
and communicating with
complainant
Carrying out service reviews and
reporting to Council
Developing and implementing
Council risk management & OH&S
policies including incident
investigation and reporting eg
adverse reaction reporting
Developing and implementing
procedures to comply with privacy
legislation eg health records
procedures
Drawing up of vaccines
Packing of equipment
Travelling to & from venues
Preparing the venue for the session
(eg signs, seating, computers)
Checking records and that consent
has been given
Confirming identification
Entering immunisation data on
computer/M&CHN
Providing immunisation/vaccine
information to parent
59
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service Elements
Major tasks
Clinical screening
Immunisation
Completion of session
Follow up
Reporting &
Acquittal
Processes
Staff Training
Reporting
Service
Total
Annual
Senior
EHO
hours
Checking of infants’ health status;
identifying contraindications;
providing advice to parents
Administering vaccine to recipient
Repack and removal of equipment
Returning venue to usual order
Sending letters to absentees
Organising special mail outs for
ACIR
Reporting to the ACIR on date for
under 7 years of age group
Quality assurance
Accreditation training for
immunisation nurses (initial & 3
yearly accreditation; annual CPR
updates)
First aid training for administration
staff
OH&S & QA training for service staff
Privacy & health records training for
service staff
Contract initiation and
management
Negotiation of MOH
contract/arrangement
Agreement initiation and
Drawing up of service contract
Contract management (tender
process costs, performance review
costs, reporting)
Managing service agreement with
Accreditation and
Professional development
Contract
Management &
Reporting
Scope of tasks
Total
Annual
Coord.
hours
60
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service Elements
Agreement &
Reporting
Major tasks
management
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
DHS including providing reports
Managing immunisation provider
service agreement
61
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
I. School Sessions Service Elements 1/7/02 to 31/12/02
Service
Major tasks
Scope of tasks
Elements
Service
Planning
Development of
immunisation
service plan
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
Organising session times & venues for the year
Staffing & administering arrangements such as
rosters and schedules
Developing of a service budget including
obtaining management approval
Obtaining, collating and delivering consent
cards and fact sheets to schools
Collecting consent cards from schools
Checking consent cards
Following up of incomplete consent cards
Equipment &
vaccines
Health promotion,
advertising &
marketing
Ordering and storing vaccines
Ordering of equipment
Monitoring cold chain & recording results
Monitoring of stock & recording inventory
Advertising immunisation services including
putting together hard copy for inclusion in
newsletter; updating the website, developing
media releases
Printing of immunisation resource materials for
staff and parents
Responding to enquiries about immunisation
history including issuing school entry
immunisation certificates
Developing marketing strategies for specific
target groups
62
Total
Annual
Student
EHO
hours
Total Total
Annual Annual
Admin. MOH
Officer hours
hours
Service
Elements
Major tasks
Quality assurance
Service
Delivery
Scope of tasks
Conducting the Best Value process for
immunisation services including community
consultation, analysis, feedback and reporting
processes
Conducting meetings and consultations with
other service providers
Managing service complaints including
recording, investigating and communicating with
complainant
Carrying out service reviews and reporting to
Council
Developing and implementing Council risk
management & OH&S policies including
incident investigation and reporting e.g.
adverse reaction reporting
Developing and implementing procedures to
comply with privacy legislation e.g. health
records
Preparation
Drawing up of vaccines
Clinical screening
Packing of equipment
Travelling to & from venues
Preparing the venue for the session (e.g. signs,
seating, computers)
Checking recipients’ health status and
identifying contraindications
Confirming identification and that consent has
been given
Immunisation record provided to student
Identification &
confirmation
Recording
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
63
Total
Annual
Student
EHO
hours
Total Total
Annual Annual
Admin. MOH
Officer hours
hours
Service
Elements
Major tasks
Immunisation
Completion of
session
Follow up
Reporting &
Acquittal
Processes
Staff Training
Contract
Management &
Reporting
Reporting
Accreditation and
professional
development
Quality assurance
Contract initiation
and management
Scope of tasks
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
Administering vaccine to recipient
Repacking and removal of equipment
Returning venue to usual order
Entering immunisation data on computer
Sending letters to absentees
Archiving consent cards
Reporting quarterly to DHS on data for the over
7 years age group
Accreditation training for immunisation nurses
(initial & 3 yearly accreditation; annual CPR
updates)
First aid training for administration staff
OH&S & QA training for service staff
Privacy & health records training for service
staff
Negotiation of MOH contract/arrangement
Drawing up of service contract
Contract management (tender process costs,
performance review costs, reporting)
Service
Agreement &
Reporting
Agreement
initiation and
management
Managing service agreement with DHS
including providing reports
Managing immunisation provider service
agreement
64
Total
Annual
Student
EHO
hours
Total Total
Annual Annual
Admin. MOH
Officer hours
hours
J. School Sessions Service Elements/1/7/02 to 30/6/03
Service
Major tasks
Scope of tasks
Elements
Service
Planning
Development of
immunisation service
plan
Equipment & vaccines
Health promotion,
advertising &
marketing
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
Organising session times & venues
for the year
Staffing & administering
arrangements such as rosters and
schedules
Developing of a service budget
including obtaining management
approval
Obtaining, collating and delivering
consent cards and fact sheets to
schools
Collecting consent cards from schools
Checking consent cards
Following up of incomplete consent
cards
Ordering and storing vaccines
Ordering of equipment
Monitoring cold chain & recording
results
Monitoring of stock & recording
inventory
Advertising immunisation services
including putting together hard copy
for inclusion in newsletter; updating
the website, developing media
releases
Printing of immunisation resource
65
Total Total Total
Annual Annual Annual
Student Admin. MOH
EHO Officer hours
hours hours
Service
Elements
Major tasks
Quality assurance
Service
Delivery
Preparation
Scope of tasks
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
materials for staff and parents
Responding to enquiries about
immunisation history including issuing
school entry immunisation certificates
Developing marketing strategies for
specific target groups
Conducting the Best Value process
for immunisation services including
community consultation, analysis,
feedback and reporting processes
Conducting meetings and
consultations with other service
providers
Managing service complaints
including recording, investigating and
communicating with complainant
Carrying out service reviews and
reporting to Council
Developing and implementing Council
risk management & OH&S policies
including incident investigation and
reporting e.g. adverse reaction
reporting
Developing and implementing
procedures to comply with privacy
legislation e.g. health records
Drawing up of vaccines
Packing of equipment
66
Total Total Total
Annual Annual Annual
Student Admin. MOH
EHO Officer hours
hours hours
Service
Elements
Major tasks
Clinical screening
Identification &
confirmation
Recording
Immunisation
Completion of session
Follow up
Reporting &
Acquittal
Processes
Staff
Training
Reporting
Accreditation and
professional
development
Quality assurance
Contract
Contract initiation and
Scope of tasks
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
Travelling to & from venues
Preparing the venue for the session
(e.g. signs, seating, computers)
Checking recipients’ health status and
identifying contraindications
Confirming identification and that
consent has been given
Immunisation record provided to
student
Administering vaccine to recipient
Repacking and removal of equipment
Returning venue to usual order
Entering immunisation data on
computer
Sending letters to absentees
Archiving consent cards
Reporting quarterly to DHS on data
for the over 7 years age group
Accreditation training for
immunisation nurses (initial & 3 yearly
accreditation; annual CPR updates)
First aid training for administration
staff
OH&S & QA training for service staff
Privacy & health records training for
service staff
Negotiation of MOH
67
Total Total Total
Annual Annual Annual
Student Admin. MOH
EHO Officer hours
hours hours
Service
Elements
Major tasks
Management management
& Reporting
Scope of tasks
Total Total Total Total Total
Annual Annual Annual Annual Annual
Coord. Senior EHO Nurse Tech.
hours EHO hours hours Officer
hours
hours
contract/arrangement
Drawing up of service contract
Contract management (tender
process costs, performance review
costs, reporting)
Service
Agreement
& Reporting
Agreement initiation
and management
Managing service agreement with
DHS including providing reports
Managing immunisation provider
service agreement
68
Total Total Total
Annual Annual Annual
Student Admin. MOH
EHO Officer hours
hours hours
K. Special Meningococcal C Sessions Service Elements 1/7/02 to 31/12/02
Service
Major tasks
Scope of tasks
Elements
Service
Planning
Development of
campaign plan
Special School
Sessions
Equipment &
vaccines
Health promotion,
advertising &
marketing
Quality assurance
Service Delivery
Preparation
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times & venues
Staffing & administering arrangements such
as rosters and schedules
Developing of a service budget including
obtaining management approval
Obtaining, collating and delivering consent
cards and fact sheets to schools
Collecting consent cards from schools
Checking consent cards
Following up of incomplete consent cards
Ordering and storing vaccines
Ordering of equipment
Monitoring of stock & recording inventory
Advertising immunisation services including
putting together hard copy for inclusion in
newsletter; updating the website, developing
media releases
Printing of immunisation resource materials
for the public
Responding to enquiries about
meningococcal immunisation
Conducting consultations with other service
providers
Drawing up of vaccines
Packing of equipment
Travelling to & from venues
69
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service
Major tasks
Scope of tasks
Elements
Clinical screening
Identification &
confirmation
Recording
Immunisation
Completion of
session
Reporting and
Acquittal
Process
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Preparing the venue for the session (e.g.
signs, seating, computers)
Checking recipients’ health status and
identifying contraindications
Confirming identification and that consent
has been given
Immunisation record provided to recipient
Administering vaccine to recipient
Repacking and removal of equipment
Follow up
Returning venue to usual order
Entering immunisation data on computer
Archiving consent cards
Reporting
Reporting campaign statistics to DHS
70
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
L. Special Meningococcal C Sessions Service Elements 1/7/02 to 30/6/03
Service Elements
Service Planning
Major tasks
Development of
campaign plan
Special School Sessions
Equipment & vaccines
Health promotion,
advertising & marketing
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times &
venues
Staffing & administering
arrangements such as rosters and
schedules
Developing of a service budget
including obtaining management
approval
Obtaining, collating and delivering
consent cards and fact sheets to
schools
Collecting consent cards from
schools
Checking consent cards
Following up of incomplete
consent cards
Ordering and storing vaccines
Ordering of equipment
Monitoring of stock & recording
inventory
Advertising immunisation services
including putting together hard
copy for inclusion in newsletter;
updating the website, developing
media releases
Printing of immunisation resource
materials for the public
Responding to enquiries about
71
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service Elements
Major tasks
Quality assurance
Service Delivery
Preparation
Clinical screening
Identification &
confirmation
Recording
Immunisation
Completion of session
Follow up
Reporting and
Acquittal
Process
Reporting
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
meningococcal immunisation
Conducting consultations with
other service providers
Drawing up of vaccines
Packing of equipment
Travelling to & from venues
Preparing the venue for the
session (e.g. signs, seating,
computers)
Checking recipients’ health status
and identifying contraindications
Confirming identification and that
consent has been given
Immunisation record provided to
recipient
Administering vaccine to recipient
Repacking and removal of
equipment
Returning venue to usual order
Entering immunisation data on
computer
Archiving consent cards
Reporting campaign statistics to
DHS
72
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
M. Other Sessions Service Elements 1/7/02 to 31/12/02
Service
Major tasks
Scope of tasks
Elements
Service
Planning
Development of
campaign plan
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times & venues
Staffing & administering arrangements such
as rosters and schedules
Developing of a service budget including
obtaining management approval
Equipment &
vaccines
Health promotion,
advertising &
marketing
Service
Delivery
Ordering and storing vaccines
Ordering of equipment
Monitoring of stock & recording inventory
Advertising immunisation services including
putting together hard copy for inclusion in
newsletter; updating the website, developing
media releases
Preparation
Drawing up of vaccines
Clinical screening
Packing of equipment
Travelling to & from venues
Preparing the venue for the session (e.g.
signs, seating, computers)
Checking recipients’ health status and
identifying contraindications
Issue, collect and check consent card
Immunisation record provided to recipient
Administering vaccine to recipient
Recording
Immunisation
Completion of
session
Repacking and removal of equipment
Returning venue to usual order
73
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service
Major tasks
Scope of tasks
Elements
Follow up
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Entering immunisation data on computer
Archiving consent cards
74
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
N. Other Sessions Service Elements 1/7/02 to 30/6/03
Service Elements
Service Planning
Major tasks
Development of
campaign plan
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Organising session times & venues
Staffing & administering arrangements
such as rosters and schedules
Developing of a service budget including
obtaining management approval
Equipment &
vaccines
Health promotion,
advertising &
marketing
Service Delivery
Preparation
Clinical screening
Recording
Immunisation
Completion of
session
Ordering and storing vaccines
Ordering of equipment
Monitoring of stock & recording inventory
Advertising immunisation services
including putting together hard copy for
inclusion in newsletter; updating the
website, developing media releases
Drawing up of vaccines
Packing of equipment
Travelling to & from venues
Preparing the venue for the session (e.g.
signs, seating, computers)
Checking recipients’ health status and
identifying contraindications
Issue, collect and check consent card
Immunisation record provided to
recipient
Administering vaccine to recipient
Repacking and removal of equipment
Returning venue to usual order
75
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
Service Elements
Major tasks
Follow up
Scope of tasks
Total
Annual
Coord.
hours
Total
Annual
Senior
EHO
hours
Entering immunisation data on computer
Archiving consent cards
76
Total
Annual
EHO
hours
Total
Annual
Nurse
hours
Total
Annual
Tech.
Officer
hours
Total
Annual
Student
EHO
hours
Total
Annual
Admin.
Officer
hours
Total
Annual
MOH
hours
O. Income Sources
1/7/02 to 1/7/02 to
31/12/02 30/6/03
Commonwealth subsidies
State DHS subsidies
Income from commercial services
Other (specify)
Notes:
commercial services are immunisations for which there is no government subsidy
77