Section 2 – Department Outcomes – 13 Acute Care
Outcome 13
ACUTE CARE
Improved access to public hospitals, acute care services and public dental services,
including through targeted strategies, and payments to state and territory
governments
Outcome Strategy
The National Health Reform Agreement includes a commitment by the
Commonwealth to meet 45% of efficient growth in public hospital costs from
2014-15, increasing to 50% in 2017-18, at an estimated cost of $16.4 billion over the
period ending in 2019-20. A national system of activity based funding (ABF) for
public hospital services was introduced from 1 July 2012, with payments made
through a National Health Funding Pool. As a result, public hospital funding has
become more transparent and, by linking Commonwealth funding to a national
efficient price determined by the Independent Hospital Pricing Authority (IHPA),1
will help to drive efficiency in the delivery of public hospital services. The National
Health Performance Authority (Performance Authority)2 has been established to
monitor and report on the performance of hospitals, Local Hospital Networks and
primary health care services at the local level.
Under the National Partnership Agreement on Improving Public Hospital Services,
governments also agreed to deliver faster access to emergency department and
elective surgery procedures, through the establishment of a 4-hour target for
emergency waiting times, and a 100% elective surgery target to ensure all patients
waiting for elective surgery are treated within clinically recommended times.
The Australian Government recognises the expense and long waiting lists that
prevent many Australians from accessing the dental care they need. In August
2012, the Government announced a $4.1 billion Dental Reform Package to
commence on 1 January 2014. It builds on the dental measures announced in the
2012-13 Budget, which will deliver $515.3 million for dental reforms targeting
disadvantaged Australians.
The Australian Government aims to provide Australians with access to an
adequate, safe, secure and affordable blood supply and access to life-saving and
life-transforming organ and tissue transplants.
1
For further information on the work of the Independent Hospital Pricing Authority, refer to the IHPA chapter in
these Portfolio Budget Statements.
2
For further information on the work of the National Health Performance Authority, refer to the NHPA chapter in
these Portfolio Budget Statements.
203
Outcome I 13
The Australian Government is committed to improving access to, and the
efficiency of, public hospitals and acute and subacute care services. Through
Outcome 13, the Government will deliver the major reforms agreed by the Council
of Australian Governments (COAG) in the National Health Reform Agreement,
and the associated National Partnership Agreements on Improving Public Hospital
Services and Health Infrastructure.
Budget Statements – Department of Health and Ageing
Outcome 13 is the responsibility of Acute Care Division, Medical Benefits Division,
and Regulatory Policy and Governance Division.
Programs Contributing to Outcome 13
Program 13.1: Blood and organ donation services
Program 13.2: Medical indemnity
Program 13.3: Public hospitals and information
Outcome 13 Budgeted Expenses and Resources
Table 13.1 provides an overview of the total expenses for Outcome 13 by program.
Table 13.1: Budgeted Expenses and Resources for Outcome 13
Program 13.1: Blood and organ donation services1
Administered expenses
Ordinary annual services (Appropriation Bill No. 1)
Special appropriations
National Health Act 1953 - blood fractionation, products and
blood related products - to National Blood Authority
Departmental expenses
Departmental appropriation2
Expenses not requiring appropriation in the budget year3
Total for Program 13.1
Program 13.2: Medical indemnity
Administered expenses
Ordinary annual services (Appropriation Bill No. 1)
Special appropriations
Medical Indemnity Act 2002
Midwife Professional Indemnity (Commonwealth Contribution)
Scheme Act 2010
Departmental expenses
Departmental appropriation2
Expenses not requiring appropriation in the budget year3
Total for Program 13.2
Program 13.3: Public hospitals and information
Administered expenses
Ordinary annual services (Appropriation Bill No. 1)
to Local Hospital Network Special Account
Special accounts
Local Hospital Network Special Account
2012-13
Estimated
actual
$'000
2013-14
Estimated
expenses
$'000
14,600
16,374
674,348
716,039
3,492
90
4,595
122
692,530
737,130
175
150
96,589
98,602
334
1,391
489
13
435
18
97,600
100,596
207,203
(107,000)
108,803
-
107,000
-
49,894
1,013
258,110
46,785
1,348
156,936
1
Departmental expenses
Departmental appropriation2
Expenses not requiring appropriation in the budget year3
Total for Program 13.3
204
Section 2 – Department Outcomes – 13 Acute Care
Table 13.1: Budgeted Expenses and Resources for Outcome 13 (cont.)
Outcome 13 totals by appropriation type
Administered expenses
Ordinary annual services (Appropriation Bill No. 1)
to special accounts
Special appropriations
Special accounts
Departmental expenses
Departmental appropriation2
Expenses not requiring appropriation in the budget year3
Total expenses for Outcome 13
Average staffing level (number)
2
3
2013-14
Estimated
expenses
$'000
221,978
(107,000)
771,271
107,000
125,327
816,032
-
53,875
1,116
51,815
1,488
1,048,240
994,662
2012-13
211
2013-14
203
This program includes National Partnerships paid to state and territory governments by the Treasury as part of
the Federal Financial Relations (FFR) Framework. National partnerships are listed in this chapter under each
program. For budget estimates relating to the National Partnership component of the program, please refer to
Budget Paper 3 or Program 1.10 of the Treasury Portfolio Budget Statements.
Departmental appropriation combines "Ordinary annual services (Appropriation Bill No 1)" and "Revenue from
independent sources (s31)".
“Expenses not requiring appropriation in the Budget year" is made up of depreciation expense, amortisation
expense, makegood expense and audit fees.
Program 13.1: Blood and organ donation services
Improve Australians’ access to organ and tissue transplants
Improving Australians’ access to life-saving and life-transforming organ and tissue
transplants is a priority of the Australian Government. In order to improve patient
access to transplantations and increase the number of available organs and tissues,
the Department will continue to support the Australian Organ and Tissue
Donation and Transplantation Authority (AOTDTA) 3 in implementing,
coordinating and monitoring a national approach to organ and tissue donation for
transplantation.
To provide patients in need of life-saving stem cell transplants with the best
possible chance of finding a suitable stem cell match, the Department will continue
to support patients through the Australian Bone Marrow Donor Registry and Bone
Marrow Transplant Program, and the National Cord Blood Collection Network.
The Government will provide additional funding to the Bone Marrow Transplant
Program, to ensure continuing financial assistance to bring an overseas donor or
stem cells to Australia for transplantation, and meet the costs not covered under
the Medicare Benefits Schedule. The Department will continue to monitor the
performance of the National Cord Blood Collection Network in implementing the
agreed Clinical Services Plan 2011-12 to 2014, which sets out new cord blood
3
For further information on the work of AOTDTA, refer to the AOTDTA chapter in these Portfolio Budget
Statements.
205
Outcome I 13
1
2012-13
Estimated
actual
$'000
Budget Statements – Department of Health and Ageing
collection and banking strategies to increase the likelihood of a compatible unit
being available for Australian patients requiring a transplant.
The Australian Government is helping to alleviate the financial burden of living
organ donation. Through the Supporting Leave for Living Organ Donors pilot, the
Australian Government will make a contribution, via the donor’s employer,
towards leave taken during the donation process and recovery period.
Support access to blood and blood products
The Australian Government is committed to ensuring that the blood products
funded by governments are used to achieve best clinical practice and provide
value for money. Under the National Blood Agreement, the Australian
Government will continue to provide funding for 63% of blood and blood products
through the National Blood Supply Plan and Budget to which all Australian
governments contribute.
The Australian Government will work with states and territories and the National
Blood Authority (NBA)4 to develop evidence-based policies that support
continuing access to an adequate, safe, secure and affordable blood supply. This
includes seeking advice from the Medical Services Advisory Committee (MSAC).
The Government will continue to work with the states and territories and the NBA
to develop and implement waste reduction strategies and options to improve
supply chain efficiencies.
In 2013-14 the Government will seek to reduce unnecessary clinical variation in the
blood sector through working with states and territories, NBA and the Australian
Commission on Safety and Quality in Health Care to develop and implement a
National Blood Management Collaborative and stronger governance arrangements
for access to funded intravenous immunoglobulin (refer also Outcome 10.5).
Program 13.1 is linked as follows:


4
This Program includes National Partnership Payments for:
Hepatitis C settlement fund.
Partnership payments are paid to state and territory governments by the
Treasury as part of the Federal Financial Relations (FFR) Framework.
For Budget estimates relating to the National Partnership component of the
program, refer to Budget Paper 3 or Program 1.10 of the Treasury’s Portfolio
Budget Statements.
The Department of Human Services (Services to the Community –
Program 1.1) to administer the Australian Organ Donor Register.
For further information on the work of the NBA, refer to the NBA chapter in these Portfolio Budget Statements.
206
Section 2 – Department Outcomes – 13 Acute Care
Program 13.1: Expenses
Table 13.2: Program Expenses
2012-13
Estimated
actual
$'000
2013-14
Budget
Annual administered expenses
Ordinary annual services
Special appropriations
National Health Act 1953 Blood fractionation, products
and blood related products to National Blood Authority
Program support
Total Program 13.1 expenses
$'000
2014-15
Forward
year 1
$'000
2015-16
Forward
year 2
$'000
2016-17
Forward
year 3
$'000
14,600
16,374
18,080
18,812
20,769
674,348
716,039
764,121
811,904
867,896
3,582
4,717
3,972
3,599
3,503
692,530
737,130
786,173
834,315
892,168
Program 13.1: Deliverables
Qualitative Deliverables for Program 13.1
Qualitative Deliverable
2013-14 Reference Point or Target
Support the Australian Bone Marrow Donor
Registry and the National Cord Blood
Collection Network to identify matched
donors and stem cells for transplant
Increased diversity of tissue types of donors
and cord blood units available for transplant
Support access to blood and blood products
Qualitative Deliverable
2013-14 Reference Point or Target
Effective planning of the annual blood
supply through the National Supply Plan
and Budget
The 2014-15 National Supply Plan and
Budget agreed by all Health Ministers in
2013-14
Quantitative Deliverables for Program 13.1
Improve Australians’ access to organ and tissue transplants
Quantitative Deliverable
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
2,379
2,379
2,379
2,379
N/A
129
129
129
129
N/A5
Number of banked cord
blood units
5

Total

Indigenous
Targets for outlying years to be determined by Health Ministers following a review scheduled for late 2013 .
207
Outcome I 13
Improve Australians’ access to organ and tissue transplants
Budget Statements – Department of Health and Ageing
Support access to blood and blood products
Quantitative Deliverable
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
63%
63%
63%
63%
63%
Percentage of the total
contribution, made by the
Australian Government, to
the approved National
Supply Plan and Budget
Program 13.1: Key Performance Indicators
Qualitative Key Performance Indicators for Program 13.1
Support access to blood and blood products
Qualitative Indicator
2013-14 Reference Point or Target
Improved evidence based policy on funded
blood products and services
Proportion of applications for assessment of
new blood products submitted to MSAC
Quantitative Key Performance Indicators for Program 13.1
Improve Australians’ access to organ and tissue transplants
Quantitative
Indicator
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
Percentage of legitimate
Bone Marrow Transplant
Program applications
assessed and approved
within three days of receipt6
100%
100%
100%
100%
100%
Program 13.2: Medical indemnity
Program Objectives
Ensure the stability of the medical indemnity insurance industry
Medical indemnity insurance provides surety to medical practitioners and their
patients in the event of an adverse incident resulting from negligence. Affordable
and stable medical indemnity insurance allows the medical workforce to focus on
the delivery of high quality medical services.
The Government ensures that the medical indemnity industry continues to remain
stable and secure by subsidising claims resulting in insurance payouts over
$300,000 (High Cost Claims Scheme) and by providing a guarantee to cover claims
6
The wording of this indicator has been revised to better measure not only the reach, but also the efficient
administration of the program.
208
Section 2 – Department Outcomes – 13 Acute Care
above the limit of doctors’ medical indemnity contracts of insurance, so doctors are
not personally liable for very high claims (Exceptional Claims Scheme).
Ensure that insurance products are affordable for doctors
A stable and competitive medical indemnity industry assists in keeping medical
indemnity premiums affordable for doctors. Through the Premium Support
Scheme (PSS), the Government provides subsidies to assist eligible specialists
whose medical indemnity premiums are relatively high in proportion to their
income because of high levels of clinical and actuarial risk. The subsidies available
through the PSS reduce the need for these high risk specialties to pass on the cost
of their higher premiums to their patients.
The Government is continuing to gradually reduce the PSS subsidy rate over a two
year period, which commenced on 1 July 2012. This recognises that in a stable and
robust market, the Government is able to reduce its level of contribution while
continuing to maintain an appropriate level of support.
Other medical indemnity activities administered by the Department and supported
by Government funding, such as those covering high cost and run-off cover claims,
contribute to meeting the cost of eligible claims when they are lodged by medical
indemnity insurers.
Women and their families now have greater choice in maternity care through
access to midwifery services subsidised by the Government through the Medicare
Benefits Schedule and Pharmaceutical Benefits Scheme.
The Government ensures that affordable professional indemnity insurance is
available for qualified and experienced privately practising midwives.
Program 13.2 is linked as follows:

The Department of Human Services (Services to the Community –
Program 1.1) to administer medical indemnity activities including indemnity
for eligible midwives.
Program 13.2: Expenses
Table 13.3: Program Expenses
2012-13
Estimated
actual
$'000
Annual administered expenses
Ordinary annual services
Special appropriations
Medical Indemnity Act 2002
Midwife Professional Indemnity
(Commonwealth Contribution)
Scheme Act 2010
Program support
Total Program 13.2 expenses
2013-14
Budget
$'000
2014-15
Forward
year 1
$'000
2015-16
Forward
year 2
$'000
2016-17
Forward
year 3
$'000
175
150
150
150
150
96,589
98,602
104,448
110,895
118,342
334
1,391
4,385
7,813
9,691
502
453
449
453
462
97,600
100,596
109,432
119,311
128,645
209
Outcome I 13
Ensure availability of professional indemnity insurance for eligible midwives
Budget Statements – Department of Health and Ageing
Program 13.2: Deliverables
Qualitative Deliverables for Program13.2
Ensure the stability of the medical indemnity insurance industry
Qualitative Deliverable
Continued participation in the Medical
Indemnity National Collection through the
Medical Indemnity National Collection
coordinating committee and the Medical
Indemnity data working group
2013-14 Reference Point or Target
Reports published by the Australian Institute
of Health and Welfare
Quantitative Deliverables for Program 13.2
Ensure that insurance products are affordable for doctors
Quantitative Deliverables
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
100%
100%
100%
100%
100%
Percentage of eligible
applicants receiving a
premium subsidy through
the PSS
Ensure availability of professional indemnity insurance for eligible midwives
Quantitative Deliverables
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
Percentage of eligible
midwife applicants covered
by the Midwife Professional
Indemnity Scheme
100%
100%
100%
100%
100%
Program 13.2: Key Performance Indicators
Qualitative Key Performance Indicators for Program 13.2
Ensure availability of professional indemnity insurance for eligible midwives
Qualitative Indicator
The continued availability of professional
indemnity insurance for eligible midwives
2013-14 Reference Point or Target
Maintain contract with Medical Insurance
Group Australia to provide professional
indemnity insurance to eligible midwives
210
Section 2 – Department Outcomes – 13 Acute Care
Quantitative Key Performance Indicators for Program 13.2
Ensure the stability of the medical indemnity insurance industry
Quantitative
Indicator
Percentage of medical
indemnity insurers who
have a Premium Support
Scheme contract with the
Commonwealth that meets
the Australian Prudential
Regulation Authority’s
Minimum Capital
Requirement
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
100%
100%
100%
100%
100%
Quantitative
Indicator
Number of doctors that
receive a premium subsidy
support through the PSS7
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
2,300
2,200
2,100
2,000
2,000
Program 13.3: Public hospitals and information
Program Objectives
Implement National Health Reform
In 2013-14, the Department will continue to engage with the Independent Hospital
Pricing Authority (IHPA) to further refine improvements to the funding of public
hospital services under the National Health Reform Agreement. This will include
finalisation of new national activity based funding classifications for subacute and
mental health services, which will be operational from 1 July 2014.8
Increase efficiency and capacity in public hospitals
Through the National Partnership Agreement on Improving Public Hospital
Services, the Australian Government has committed up to $3.4 billion to states and
territories over seven years between 2010 and 2017. This will help to reduce
waiting times for elective surgery, improve emergency department treatment times
and increase subacute care services.
7
Premium support is demand driven, with subsidies paid in response to applications from eligible doctors.
Therefore, actual funding may vary from estimates over the forward years. However, a decrease in the number of
doctors requiring premium support would indicate that medical indemnity premiums are becoming more
affordable.
8
For further information on the work of the Independent Hospital Pricing Authority, refer to the IHPA chapter in
these Portfolio Budget Statements.
211
Outcome I 13
Ensure that insurance products are affordable for doctors
Budget Statements – Department of Health and Ageing
During 2013-14 the Department will continue to monitor state and territory
progress towards the achievement of elective surgery and emergency department
targets, with reward payments linked to performance.
The provision of over 1,300 new subacute care beds and equivalent services
nationally in hospitals and in the community will ensure patients are cared for in
the most appropriate setting with access to the services they need.
The Tasmanian Health Assistance Package
In June 2012, a four year $325 million package was announced for Tasmania’s
health system, outlining a number of significant investments to ease immediate
pressures and equip Tasmania’s health system to meet future challenges through
innovation and redesign.
The package has 17 elements including $30.5 million to provide at least an
additional 2,600 elective surgery procedures for those patients who have waited
the longest beyond the clinically recommended period for their surgery, a further
$50 million to enhance access to community based palliative care services,
approximately $22 million to establish walk-in centres in Hobart and Launceston,
and approximately $40 million to undertake clinical redesign of its health and
hospital system.
Improve access to public dental services
Between 2012-13 and 2014-15, the Government will provide funding of
$344 million to deliver additional services to 400,000 patients of public dental
services through the National Partnership Agreement on Treating More Public
Dental Services with the states and territories. In addition, the Government is also
funding oral health promotion activities and is supporting the provision of pro bono
dental services to Australians who are unable to access services because of severe
disadvantage.
During 2013-14, work continues on the new Dental Reform Package, which
includes: Grow Up Smiling, a children’s dental scheme to commence in January
2014 (Program 3.1); expansion of services for adults in the public system from July
2014; and a Flexible Grants Program for dental infrastructure in outer
metropolitan, rural and regional areas from 1 July 2014.
Program 13.3 is linked as follows:

This Program includes National Partnership Payments for:
Health Care Grants for the Torres Strait – Contribution to Queensland for the
treatment of Papua New Guinea nationals in the Torres Strait;
Improving Public Hospital Services - New subacute beds guarantee funding;
Flexible funding pool for emergency departments, elective surgery and subacute
care; National emergency access target for emergency departments – capital
funding, and facilitation and reward funding; National elective surgery target–
capital funding and facilitation and reward funding;
Adult public dental patients;
Treating more public dental patients;
Improving Health Services in Tasmania – reducing Elective Surgery waiting
Lists in Tasmania;
212
Section 2 – Department Outcomes – 13 Acute Care
Improving Health Services in Tasmania – walk in centres in Hobart and
Launceston;
Improving Health Services in Tasmania – better access to community based
palliative care services; and
Canberra Hospital paediatric emergency care.
Partnership payments are paid to state and territory governments by the
Treasury as part of the Federal Financial Relations (FFR) Framework.
For Budget estimates relating to the National Partnership component of the
program, refer to Budget Paper 3 or Program 1.10 of the Treasury’s Portfolio
Budget Statements.
This Program includes the Department of Health and Ageing working with
relevant Commonwealth agencies to identify and address cross border health
issues in the Torres Strait Treaty zone.
-

Program 13.3: Expenses
2012-13
Estimated
actual
$'000
2013-14
Budget
$'000
2014-15
Forward
year 1
$'000
2015-16
Forward
year 2
$'000
2016-17
Forward
year 3
$'000
207,203
108,803
149,308
143,119
130,660
(107,000)
-
-
-
-
Annual administered expenses
Ordinary annual services
to Local Hospital Network
Special Account
Special accounts
Local Hospital Network
Special Account
Program support
Total Program 13.3 expenses
107,000
-
-
-
-
50,907
48,133
47,648
47,099
46,362
258,110
156,936
196,956
190,218
177,022
Program 13.3: Deliverables
Qualitative Deliverables for Program 13.3
Increase efficiency and capacity in public hospitals
Qualitative Deliverable
Provide financial contribution to states and
territories to support the delivery of
initiatives
2013-14 Reference Point or Target
Payments to states and territories are made
in a timely manner
213
Outcome I 13
Table 13.4: Program Expenses
Budget Statements – Department of Health and Ageing
Improve access to public dental services
Qualitative Deliverables
2013-14 Reference Point or Target
Implement National Partnership Agreement
on Treating More Public Dental Patients
Commence program and reporting in a
timely manner.
Implement the Flexible Grants Program
All applications received in 2013-14 are
assessed by the Department and
recommendations made to the Minister
during 2014
Quantitative Deliverables for Program 13.3
The Tasmanian Health Assistance Package
Quantitative Deliverable
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
500
500
500
500
N/A
Minimum number of
additional elective surgery
operations for Tasmania
Program 13.3: Key Performance Indicators
Qualitative Key Performance Indicators for Program 13.3
Increase efficiency and capacity in public hospitals
Qualitative Indicator
Enhanced provision and improved mix of
subacute care services in hospital and
community settings
2013-14 Reference Point or Target
States and territories reporting consistently
demonstrates enhanced provision and
improved mix of services
Improve access to public dental services
Qualitative Indicator
Improve access to public dental services for
public dental patients
2013-14 Reference Point or Target
Evaluation of the National Partnership
Agreement on Treating More Public Dental
Patients and associated data to determine if
increased access to dental services has
occurred
214
Section 2 – Department Outcomes – 13 Acute Care
Quantitative Key Performance Indicators for Program 13.3
Increase efficiency and capacity in public hospitals
Quantitative
Indicators
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
Percentage of elective
surgery patients seen within
the clinically recommended
times
85%
90%
95%
100%
100%
Percentage of emergency
department patients
admitted, referred or
discharged within 4 hours
70%
76%
83%
90%
90%
Quantitative
Indicator
2012-13
Revised
Budget
2013-14
Budget
Target
2014-15
Forward
Year 1
2015-16
Forward
Year 2
2016-17
Forward
Year 3
Number of additional public
dental patients treated,
under the National
Partnership on Treating
More Public Dental Patients,
by the states and territories
above agreed baseline 9
88,889
177,778
133,333
N/A
N/A
9
Indicator has been revised to reflect the final National Partnership Agreement.
215
Outcome I 13
Improve access to public dental services
Budget Statements – Department of Health and Ageing
216