Highlights of the 1998 - 99 Policy

• The 1998 - 99 budget consolidates past reforms and recognises the need for growth, over time, to meet current and future demand for hospital services. It provides a continuation of the key initiatives to enhance performance and manage demand in a more strategic manner. Additional funding ($133 million) has been provided to account for wage increases, growth in demand due to population growth and technological change, improvement to maternity services and the decline in private health insurance among Victorians.
• In 1998 - 99, a total of $76.7 million is provided for quality initiatives. This includes $29.5 million for the Hospital Access Program.
• Additional funding of $12.9 million is allocated to enhance maternity care by increasing antenatal and postnatal care provision; improving maternity services for women with special needs; promoting care during pregnancy and childbirth that reflects best available evidence on effectiveness; and improving the provision and quality of information on care options for women using maternity services.
• In metropolitan areas during 1998 - 99 and 1999 - 2000 the Austin and Repatriation Medical Centre (including relocation of the Mercy Hospital for Women which will continue to be managed by the Sisters of Mercy), and the proposed new hospitals at Berwick and Knox will be put to contestable tender. In rural areas the Latrobe Regional Hospital has been managed by Australian Hospital Care, Ltd since February 1997 with the commencement of services from the new hospital scheduled for August/September 1998. Tenders will be received during June for the new Mildura Hospital.
• For metropolitan Networks, the 1998 - 99 policy delivers modelled budgets and aggregate throughput levels which deliver modest growth. Activity targets have increased for most metropolitan Networks and Barwon Health with increases targetted to outer metropolitan areas. It is expected the Networks, in their fourth year of operation, will continue to deliver a steady improvement in performance covering quality, efficiency and access to a full range of services.
• With the exception of funding for veterans and Aboriginal and Torres Strait Islanders, the broad pricing system introduced two years ago will continue. This incorporates a strong base level of throughput (Target A) and growth options at three levels: a 2 per cent margin for flexibility; options; and a Tender Pool. The Tender Pool will continue for Networks and rural hospitals to enable them to undertake additional throughput volume at price rates specified by them. The Tender Pool has been increased by some 40 per cent.
• A major new funding program for veterans is under negotiation. When implemented, a new casemix based price will be available to all public hospitals treating veterans in Victoria. This price will be higher than that provided for other public patients, and hospitals are advised to develop service quality and marketing plans to attract and retain veterans.
• Higher payments will be provided for all Aboriginal and Torres Strait Islander inpatients to enhance their care. It is estimated that, in Victoria, Aboriginal and Torres Strait Islander patients account for about 0.6 per cent of all public hospital WIES. In 1998 - 99 the WIES6 formula will provide an additional payment for these patients. All Aboriginal and Torres Strait Islander patients will be funded at 10 per cent higher than the usual payment for WIES6.
• In 1998 - 99 ambulatory casemix funding will continue for all major (that is, Group A) hospitals. These hospitals provide about 75 per cent of all outpatient services. This system pays on the basis of encounters in clinical specialty categories. The new ambulatory classification and funding system will also be extended to the rural regional hospitals at Ballarat and Bendigo. Compensation funding has been continued this year with some minor adjustments following a review of targets and performance.
• Same day medical caps will be standardised and set at the level of 6.5 per cent across the State.
• As part of the introduction of the ambulatory classification and funding system, the funding of emergency departments has been previously shifted from an historical basis to one based on current costs and activities. This has been reviewed and there are more categories and a broader range of funding for the 1998 - 99 year.
• In 1998 - 99 the new ICD-10-AM coding system will be introduced. 1998 - 99 separations and WIES will be coded in terms of the new ICD-10-AM codes and assignment of DRGs will differ from those used in the targets. Any financial impact will be neutralised through the introduction of a specific code map ping adjustment factor for each hospital.
• A major emphasis on rural hospitals will continue. The Rural Specialist Services Grant pool will total $7.6 million. The payment for each specialty will be up to $60,000. Eligibility requirements for the Rural Specialist Services Grant have been changed to enable hospitals to have greater flexibility in using this funding for an appropriate mix of specialties. There is a continuation of funding for rural hospital self-sufficiency ($3.5 million) and new developments through the Healthstreams Program. Healthstreams is a service and funding model that encourages flexibility in the design and delivery of a diverse range of health services and substitution of acute hospital-based care to more appropriate forms of care.
• The Hospital Access Program brings together the former Elective Surgery and Emergency Services Enhancement Programs and the recently established targets for Acute Inter-hospital Transfers. It provides a common incentive program that encourages an integrated approach to managing demand for these services.
• Up to $3 million will be available to help implement strategies recommended by the Infection Control Taskforce to improve infection monitoring and control in hospitals throughout Victoria.
• Additional money of $2 million will be transferred to the Public Health Division to fund pneumococcal vaccination for all Victorians aged more than 65, through their general practitioners and other providers. It is expected that this will reduce hospital emergency department attendances and demand for inpatient care, especially for those with chronic cardiovascular or pulmonary disease.
• Indicators of health care quality at a State and hospital level in areas of clinical care, safety and effectiveness will continue to be developed. Priority will be given to further development of measures of patient satisfaction with specific processes of care, and to indicators that examine discharge planning, infection control and adverse events.
• Funding to encourage hospitals to achieve accreditation will continue until the year 2000. By this time accreditation/certification will be mandatory for all hospitals funded by the Department to provide acute health care services.
• The major programs to encourage innovative models of care such as Hospital in the Home will be continued as will the Post Acute Care Program which provides targetted support to patients at high risk of hospital readmission.
• Networks and hospitals will be asked to submit proposals for projects that promote practical use of research evidence on effectiveness of health care, improve continuity and safety of care, or improve information for consumers.
• Major providers will be invited to submit plans for sums of up to $200,000 per Network for projects that develop clinical resource usage and decision-making systems.