Victoria - Public Hospitals Policy and Funding Guidelines 1997-1998
Section A: Policy

4.3 Emergency Services Funding
The Department commissioned a project in late 1996 to develop a funding allocation framework for emergency services in Group A and B hospitals. This was necessary in order to separate emergency funding from other non-admitted funding. A discussion paper Paying for Hospital Emergency Care was circulated to the field in March 1997 for comment. This paper raises a number of issues to improve and identify emergency service funding. Its primary theme was the relatively "fixed" nature of emergency department operations. Emergency departments need to be at or above a fixed operating level, regardless of the number of patients to be seen, for "stand-by" purposes.

The Victorian Branch of the Australasian College of Emergency Medicine and the Victorian Ambulatory Classification System Advisory Committee (VACSAC) agreed that broad information on staffing of emergency departments would be sought to assist in establishing the emergency services component of the non-admitted Grant for 1997-98.

Information on staffing of emergency departments was therefore sought from all Group A and B hospitals. The information was compiled and considered by representatives of the College of Emergency Medicine and VACSAC. Each hospital was considered in turn and broad groupings were applied based on the staffing numbers and related costs; the organisation of emergency departments at these hospitals; and a full assessment of all data and activity costs.

The information below was considered:

Staff Related Data by Award categories

Activity Data

Organisation

Categorisation

It was considered that the staffing data, both in terms of staff numbers and costs, are the most appropriate data on which to base the emergency services grants for 1997-98. As hospitals varied in the level of detail provided in the administrative and clerical, medical support, and hotel and allied categories it was felt that the most appropriate basis for the grants was the total medical and nursing staff related costs. These costs included on-costs such as overtime, superannuation, workcover, annual leave and sick leave.

In order to establish the modelled budgets a loading was applied to the costs submitted by hospitals to account for other staff related costs (such as administrative and clerical staff) consumables and other related diagnostic costs. The Grant is not intended to represent the total actual emergency department cost. Emergency services funding is also provided through inpatient WIES payments and hospitals can also gain revenue by meeting targets defined in the Emergency Services Enhancement Program. In addition the Training and Development Grant funds staff working in all areas of the hospital, including emergency medicine registrars and hospital medical officers.

The categorisation of hospital emergency departments for the purpose of establishing emergency service grants for 1997-98 is outlined in table 5.

Table 5: Emergency Department Categorisation and Notional Funding Levels for 1997-98
Categorisation and Funding Hospitals
E1$8 million Alfred, Austin and Repatriation Medical Centre, Monash Medical Centre, Royal Melbourne Hospital Centre,
E2$4.5 million Box Hill, Dandenong, Geelong, Mornington Peninsula PANCH*, St Vincent's, Western (Footscray)
E3$3 million Maroondah*, Ballarat Base, Bendigo
E4$2 million Angliss*, Goulburn Valley, Latrobe Regional, Mildura, Wangaratta, Warrnambool
E5$1 million Wodonga, Sandringham, West Gippsland, Williamstown, Swan Hill, Central Wellington, Wimmera, Echuca, Hamilton, Bairnsdale*
E6(Specialist) Royal Children's Hospital ($4m), Western (Sunshine) ($2.8m)*, Royal Victorian Eye & Ear Hospital ($2), Royal Women's Hospital ($1m), Mercy - East Melbourne ($0.7m)
* To be reviewed during 1997-98.

In 1997-98 a taskforce will be established to:

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Non-Admitted Patients
and Emergency Services Funding		 To: Victoria - Public Hospitals
Policy and Funding Guidelines
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