HEALTHCARE FINANCING REFORM IN AUSTRALIA - PowerPoint PPT Presentation

1 / 25
About This Presentation
Title:

HEALTHCARE FINANCING REFORM IN AUSTRALIA

Description:

Overall utilisation per 1000 persons increased by 9.7 ... National monitor utilisation and performance in Commonwealth State hospital ... – PowerPoint PPT presentation

Number of Views:215
Avg rating:3.0/5.0
Slides: 26
Provided by: haO7
Category:

less

Transcript and Presenter's Notes

Title: HEALTHCARE FINANCING REFORM IN AUSTRALIA


1
HEALTHCARE FINANCING REFORM IN
AUSTRALIA International Hospital Federation
Congress 2001 Pre Congress Health Summit , Hong
Kong 14 May 2001 Presented by Mark Cormack,
National Director Australian Healthcare
Association
2
Healthcare Financing Reform in Australia
  • Overview of Government Responsibilities for
    Healthcare
  • Finance
  • Sources, Growth, Expenditure
  • Profile of Hospital Services
  • Health Financing Reform
  • Health Insurance
  • Pharmaceutical Benefits
  • Casemix Funding of Acute Hospital Care
  • Medical Services Payments

3
Government Responsibilities for Healthcare
  • Population
  • 18.7 Million
  • Settlement concentrated in coastal cities
    regions
  • Government
  • Federal system since 1901
  • 3 tiers
  • Commonwealth,
  • 6 States 2 Territories
  • Local, Municipal

4
Government Responsibilities for Healthcare The
National Healthcare Package
  • Medicare
  • Hospital care emergency, elective and
    continuing care from a public
    hospital.
  • National, compulsory health insurance scheme, tax
    funded.
  • Medical optometric care ambulatory and
    in-hospital
  • Other programs
  • Pharmaceutical Benefits Scheme
  • Aged Care
  • Community Allied Healthcare
  • Private Health Insurance Subsidy 30

5
Government Responsibilities for
Healthcare Commonwealth (National)
Responsibilities
  • Leadership in health policy national
    initiatives
  • Funding medical services Medical Benefits
    Schedule (MBS) and pharmaceuticals -
    Pharmaceutical Benefits Scheme (PBS)
  • Joint funding of public hospital and related
    healthcare services with States / Territories
  • Funding of residential and community based aged
    care services.
  • Private Health Insurance regulation, subsidy
    program
  • Special Health Programs indigenous health,
    veterans services
  • Research funding

6
Government Responsibilities for Healthcare State
/ Territory Responsibilities
  • Joint funding of public hospital and related
    services with Commonwealth
  • Purchasing and delivery of public hospital,
    community, allied health and related services.
  • Provision of care services for older people
  • Public environmental health
  • Regulation of health professionals and health
    facilities
  • Research

7
Private Non-Government Sector Role in Health
Care
  • Private Health Insurance
  • Private Hospitals
  • Aged Community Care
  • Medical Practitioners
  • Dental and Allied Healthcare
  • Diagnostic Laboratory Services
  • Pharmaceutical Dispensing

8
Financing Healthcare Sources 1998/99 Total
Expenditure A 50.3 BN
9
Financing Healthcare
10
Financing Healthcare - Growth
11
Healthcare Expenditure - Type
12
Healthcare Expenditure - Type
13
Healthcare Expenditure - Type
14
Profile of Hospital Services
  • From 1994-95 1998-99
  • Private Hospital proportion of total activity
    increased from 29.9 to 32
  • Overall utilisation per 1000 persons increased by
    9.7
  • Day only admissions increased from 40.2 - 47.9
    of total
  • Average stay decreased from 4.3 to 3.9 days
  • Beds per 1000 decreased from 3.3 to 2.9
  • Structure
  • Networks of public hospitals and community based
    services under integrated area / regional
    management.
  • Private and not for profit hospitals merging and
    vertical integration.
  • Private Hospitals have more restricted range of
    services and lower overall complexity (Cost
    weight0.91 v 0.99 public)

15
Health Financing Reforms - Key Drivers
  • Management of financial risk associated with
    uncapped national programs Commonwealth
  • Pharmaceutical Benefits
  • Medical Benefits
  • Management of political and social risk
    associated with capped, jointly funded hospital
    programs State Territory.
  • Technical Efficiency
  • Rationing services
  • Differing views on the role of the private
    sector.
  • Complementary
  • Duplicate System

16
Health Financing Reforms Pharmaceutical
Benefits Scheme
  • Key Features of PBS
  • Co-payments
  • Access to a comprehensive range of drugs with
    affordable co-payment dispensed by private sector
    pharmacies
  • Control of Drugs on the Schedule
  • Clinical and cost effectiveness
  • Generic substitution
  • Monopsony purchasing arrangements
  • Reductions in dispensing overheads
  • Low overall cost to government affordable access
    to consumers

17
Health Financing Reforms Casemix / episode
funding of acute hospital care
  • Key Features
  • National casemix development program introduced
    as part of 1988-1992 Commonwealth State Health
    Financing Agreement
  • AN DRGs developed and progressively revised
    and updated
  • Implemented for the funding of acute hospitals
    progressively from 1993 now in place in all
    States/Territories for most hospitals
  • Functions
  • National monitor utilisation and performance in
    Commonwealth State hospital funding agreements
  • State / Territory Allocation and purchasing of
    hospital services
  • Private Insurers Purchasing and Payment
  • Providers planning, benchmarking and quality
    improvement

18
Health Financing Reforms Casemix / episode
funding of acute hospital care
  • Developments
  • National Hospital Cost Data Collection
  • Sub acute, non acute and rehabilitation
    classification system
  • Ambulatory classification system
  • Technical efficiency gains in a capped funding
    environment

19
Health Financing Reforms Private Health
Insurance
  • PHI Coverage
  • Private hospital care
  • Choice of medical practitioner
  • Medical co-payment
  • Ancillary / extras cover
  • Recent problems and Issues
  • High premium cost and annual increases
  • High co-payments for medical components
  • Competition with a free, good quality public
    system
  • Community rating

20
Health Financing Reforms Private Health
Insurance
  • Consequences
  • Decline in membership 50 (1984) to 30.5(1998)
  • Selective use of public and private systems due
    to co-payments
  • Pressure on the public system
  • Financial viability of the PHI funds
  • Government Initiatives
  • 1 income tax levy for high income earners (1998)
  • Subsidy of 30 for all PHI fund members (1999)
  • Legislation
  • Co-payments price control prudential
    arrangements consumer information
  • Abolition of community rating replaced by
    Lifetime Healthcover (2000)

21
Health Financing Reforms Private Health
Insurance
  • Results so far
  • PHI coverage up from 30.5 (1998) to 45.4 (2000)
  • Increase in proportion of claims with no
    co-payment from 50 to 65
  • 27 increase in the PHI fund reserves in 12
    months
  • Minimal or no increases in PHI premiums
  • A 2.0 BN cost to government or 5.7 of total
    government sourced health expenditure (0 in 1996)

22
Health Financing Reforms Private Health
Insurance
  • Criticism
  • Impact on public hospital activity
  • New PHI fund members are young, low risk
  • High cost
  • Opportunity Cost
  • Range of causal factors
  • Subsidy, tax impost, Lifetime Healthcover
  • Durability cost effectiveness

23
Health Financing Reforms Medical Services
Payments
  • Medicare (MBS)
  • Patient billing versus Bulk Billing (71.2)
  • Cost Containment
  • Supply of medical practitioners
  • Restrictions on new technology
  • Primary care gateways
  • Restrictions on level of benefits paid
  • Blended payment methods
  • Capping agreements
  • Results
  • 4.9 p.a. average growth since 1989/90

24
Health Financing Reforms Next Steps Conclusion
  • Gradual, not revolutionary reform
  • No change to Medicare as the central policy
    setting
  • Trial / pilots to reform Commonwealth State
    issues
  • Political dynamics

25
For more about Australias Health Care system
..
AHA National Congress 2001 Fremantle, Western
Australia 13 14 September 2001
Mark Cormack National Director Australian
Healthcare Association Email m.cormack_at_aha.asn.au
Web www.aushealthcare.com.au m.
Write a Comment
User Comments (0)
About PowerShow.com