Table of Contents <

Section A - Policy

• The 1999-2000 policy and funding directions are based on the successful consolidation of established policies introduced in previous years. The achievements to date have been impressive and only minor refinements to casemix purchasing are needed in 1999-2000. The focus for the coming year is on growth to expanding areas; new major trauma and associated services; extension of casemix funding models to rehabilitation; and establishing central service directions in terms of quality indicators and key service reviews. Maternity care, breast care and post-acute service initiatives continue to receive funding this year.
• Increased funding from the Australian Health Care Agreement (AHCA), negotiated during 1998-99, will again be passed directly to hospitals by way of additional operating funds; additional funding for capital equipment; and funding to support medical research and teaching. In 1999-2000, $54 million will be made available for equipment and infrastructure maintenance purposes and $10 million to support research and teaching activities. With the existing funding for teaching and research, this will ensure that Victorian hospitals continue to make their mark in international research and continue to offer high quality health care using up-to-date technology.
• A series of new initiatives funded through the National Health Development Fund will commence during 1999-2000. The Victorian National Health Development Strategic Plan comprises nine programs focused around the reform themes of appropriate triage and referral, strengthening health communications technology, re-engineering structural reform and developing a skilled workforce.
• During 1998-99 the Department commissioned a major review of health service policy and strategic directions as a precursor to review of the Health Services Act 1988. This review was triggered by the National Competition Policy process which require all Australian Governments to review legislation that may restrict competition by the year 2000. A discussion paper was prepared and public comment sought during April and May 1999. A final report will be prepared for the Minister for Health in early 1999-2000.
• The Review of Trauma and Emergency Services by the Ministerial Taskforce on Trauma and Emergency Services was released by the Minister for Health in April 1999. It recommended a tiered structure of hospitals to provide differing levels of treatment for patients with major trauma and trauma. The Department, together with the Transport Accident Commission (TAC), will be supporting the establishment of this system through a range of initiatives over 5 years.
• A new system for funding rehabilitation inpatients in major designated units will be introduced in 1999-2000. The new system, Victorian Rehabilitation Classification and Funding System (VicRehab), is based on the Casemix Rehabilitation and Funding Tree (CRAFT) classification. It will also provide new opportunities for transforming services to expand community and ambulatory services within service planning guidelines consistent with the directions outlined in Rehabilitation into the 21^st Century-A Vision for Victoria. A Monitoring and Review Committee with industry representation will oversee the implementation period.
• New funding arrangements for Department of Veterans' Affairs (DVA) eligible veterans commenced on 1 July 1998 and will continue until 30 June 2004. Under these new arrangements a premium will paid for a range of services provided to veterans in public hospitals. Public hospitals will compete with the private sector for these services.
• The public hospital system relies heavily on electronic equipment to provide services. Considerable attention has been, and will continue to be paid to the resolution of Year 2000 (Y2K) issues during 1999-2000. $68 million has been specifically provided to hospitals for Y2K remediation of all systems in 1998-99. Approximately $12 million further will be provided in 1999-2000 for information systems. Every hospital has undertaken a complete inventory of the equipment and services that may be affected by the Y2K problem including medical equipment, building plant and engineering information technology, telecommunications and supply chains.
• In 1999-2000, $100 million has been allocated for quality initiatives representing in excess of a 20 per cent increase in funding. Major quality initiatives will continue and include the Hospital Access Program and the Effective Discharge Strategy. The development, refinement and implementation of health care quality indicators also continues to be a key priority area.
• The Maternity Services Enhancement Strategy will continue to increase antenatal and postnatal care provision; improve maternity services for women with special needs; promote care during pregnancy and childbirth that reflects best available evidence on effectiveness; and improve the provision and quality of information on care options for women using maternity services. Funding of $16.4 million will be allocated to this Strategy in 1999-2000.
• In 1999-2000, $2 million will be provided for the continuation of the Breast Care Enhancement Program. Nine demonstration projects will be supported by the Program to promote integrated and networked breast care services, with a focus on the implementation of best practice and improving quality, accessibility and coordination.
• The comparatively low rates of organ donation in Victoria will be addressed in 1999-2000 by the establishment of a central coordination service for organ donation. The aim of this service is to develop an integrated and cohesive service system in Victoria which provides effective and caring services for donors, recipients and their families.
• 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.
• The findings of a number of major service reviews will be considered and implemented during 1999-2000. These include the evaluation of the relocated HIV/AIDS and infectious diseases services; the review of trauma and emergency services; the review of radiotherapy services; and the review of cystic fibrosis services.
• Throughput growth will be allocated according to the principles agreed within the budget process. This incorporates demographic growth, technology related growth, and 'unexplained' growth partly reflecting declining private health insurance levels.
• All hospitals will receive some throughput growth, with higher growth targetted to A1 hospitals (to assist in the cost pressure of new technologies); to targetted areas of demographic growth; and to large regional hospitals.
• The funds provided through the AHCA to the State now vary according to the level of private health insurance. Growth funds are carefully targetted to meet public patient growth demand. Funds are no longer provided to automatically restore site-specific declines in private patient revenue. As a result, the policy foreshadowed in the 1998-99 Policy and Funding Guidelines is now in place. Hospitals and Networks from 1999-2000 onward are effectively net funded and must manage their own revenue shortfalls or gains within any year.
• A major emphasis on rural hospitals will continue. The Rural Specialist Services Grant pool will total $7.9 million. The payment for each specialty will be up to $60,000. Smaller agencies will be assisted through new developments through the Healthstreams Program.
• The broad pricing system will continue in 1999-2000. 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.
• Higher payments will continue for all Aboriginal and Torres Strait Islander inpatients to enhance their care. All Aboriginal and Torres Strait Islander patients will continue to be funded at 10 per cent higher than the usual payment for WIES7.
• 1999-2000 will see the full implementation of ambulatory casemix funding for all major hospitals. These hospitals provide about 75 per cent of all outpatient services. This system pays on the basis of encounters in clinical specialty categories.
• Same day medical caps have been reviewed and a number of exclusions from the cap will apply for 1999-2000. A review of same day gastroenterological service provision will examine trends and costs of service provision and possible changed funding options for 2000-2001.
• AN-DRG Version 3 and the ICD-10-AM coding system will continue in 1999-2000. Separations will be coded in terms of the new ICD-10-AM codes and assignment of DRGs will differ from those used in the targets for this year only. Any financial impact will be neutralised through the introduction of a specific code mapping adjustment factor for each hospital.
• Under proposed new arrangements with the Commonwealth, Victorians will have access to Pharmaceutical Benefits Scheme (PBS) reimbursement for hospital initiated prescriptions for non-admitted patients and admitted patients on discharge in 1999-2000. In addition, the Commonwealth has agreed to move a range of chemotherapy agents from the PBS to the Highly Specialised Drugs Program (s100) to allow for access for patients who need to be admitted on a day only basis for the sole purpose of receiving their treatment. This historic, unparalleled financial reform is close to finalisation and details will be separately announced.
• In order to enhance the capacity for patients to receive sensible and consistent health promotion and illness prevention messages, together with illness care, selected outer suburban hospitals with emergency departments will each receive $85,000 to establish health promotion support centres focussing on emergency care. These centres are intended to provide teaching and resources for mainstream staff-importantly the very large number of hospital staff who rotate through emergency departments. It is intended that opportune health promotion be encouraged as part of emergency care, where appropriate-not an activity conducted by "someone else".
• Hospital waiting areas will also be provided with dedicated internet facilities, allowing patients and visitors to explore the Better Health Channel, which will progressively provide a wealth of information on good health, illness, care options, and available services.