Medicare AustraliaAnnual Report 2007-2008;€¦ · Web vieware subject to quarterly review and...

Section 01 IntroductionLetter of transmittalSenator the Hon Chris Ellison

Minister for Human Services

Parliament House

CANBERRA ACT 2600

Dear Minister

It is my pleasure to present Medicare Australia’s Annual Report for 2006–07 as required by section 70(1) of the Public Service Act 1999 for tabling in Parliament.

This report has been prepared in accordance with the Requirements for Annual Reports, approved on behalf of the Parliament by the Joint Committee of Public Accounts and Audit as required under section 70(2) of the Public Service Act 1999.

Yours sincerely

Catherine Argall PSM

28 September 2007

Chief Executive Officer’s reviewAt a time where our key message has been ‘Medicare Australia is changing’, flagging our intention to leverage our great brand for greater public convenience, we have had a highly successful and productive year. While maintaining our focus on our traditional health related programs, we are becoming involved in other areas of service delivery, as our traditional business is increasingly moving to electronic services.

In addition to delivering major government programs such as Medicare, the Pharmaceutical Benefits Scheme and payments for aged care providers, Medicare Australia implemented a range of new government initiatives. Family Assistance services are now available through all Medicare offices and applications for the Australian Government’s LPG vehicle rebate can also be lodged at a Medicare office.

Medicare Easyclaim has been a major priority for the organisation. Medicare Australia has proved its responsiveness, with the delivery of this additional electronic service. Our systems and technical infrastructure were in place by April 2007, more than three months ahead of schedule.

The success of Medicare Easyclaim to date is the result of the substantial efforts we have made in working with banks, listening to stakeholders and supporting our people. Medical practitioners now have a choice of electronic channels to use to make Medicare claims. We continue to work cooperatively with all peak medical groups, suppliers and across government to deliver greater convenience to the Australian public in accessing Medicare. This will be a key focus for the coming year.

The take-up of PBS Online is an impressive achievement for Medicare Australia. We successfully partnered with the Pharmacy Guild of Australia and the software industry to encourage and support pharmacies to sign up to online claiming. There were 4 490 pharmacies registered for PBS Online at 30 June 2007.

Medicare Australia continues to work closely with the Department of Human Services to progress the development and implementation of the access card initiative. We are well advanced in ensuring that our organisation is able to seamlessly transition to the use of the access card across the broad range of programs we administer including Medicare and PBS.

More and more Australians are choosing to deal with Medicare Australia online. We now have more online services offering greater choice and convenience for people to do business with us. This is a clear demonstration that Australians trust us.

In March 2007, we added our latest online service—the ability to view and print Medicare benefit tax statements online—in addition to our real-time update of the Australian Taxation Office’s e-tax product.

At 30 June 2007, over 216 000 people were registered for Online Services, compared to 33 774 people registered the previous year. This year we successfully processed 516 549 online service transactions, including over 132 000 downloads to e-tax. People dealing with Medicare Australia

And the Australian Taxation Office now enjoys greater convenience in the way they do business with government. The service also reduces the need for the printing and mailing of statements.

The Family Assistance service offer is a huge success story for Medicare Australia. The rollout of extended Family Assistance services to all 238 Medicare offices was completed in November 2006, eight weeks ahead of schedule.

In 2006–07, nearly 540 000 people received face-to-face Family Assistance services through Medicare offices. In December 2006, 97 per cent of respondents to a feedback survey told us they were satisfied with our service. We see this service offering as a strong part of our future.

We are a leader in service delivery on many fronts. We are achieving great things by working in partnership with the public, providers, our policy and business partners and our people.

Medicare Australia cares about convenience for the Australian community. As an agency with one of the largest footprints in the community, we have a strong reputation for performance in service delivery. This year we achieved certification in the International Customer Service Standard for the third year in a row.

Our stakeholder satisfaction levels remain very high. The results from recent research continue to be positive, with high levels of satisfaction across all sectors ranging from 87 per cent to 96 per cent satisfaction with Medicare Australia. The most notable results were the increase in practitioner satisfaction, from 71 per cent in 2006 to 89 per cent in 2007 and the increase in practice manager satisfaction, which rose from 86 per cent in 2006 to 95 per cent in 2007. Public satisfaction was 90 per cent with an increase of 27 per cent in the very satisfied category.

Given the amount of change facing Medicare Australia, one of the most pleasing results in 2006–07 was the increase in our overall staff satisfaction results. Our staff see a strong connection between what they do and the value we provide to the Australian public. More than 79 per cent of our people are satisfied with Medicare Australia as an employer. This is an increase of over seven per cent from the results in 2005–06. The increased satisfaction result is a tribute to the dedication and commitment of all our people.

In addition to the increased satisfaction result, Medicare Australia won two major awards in the Customer Service Institute of Australia’s 2006–07 Australian Service Excellence Awards. Medicare Australia was a finalist in three categories – National Service Charter, Large Business (Medicare Office Network) and Call Centre (Queensland). We won the National Service Charter and Large Business categories.

Financial performance has been a key focus area for Medicare Australia for the past three years. I am proud to report that we have achieved a real turnaround in our financial performance by exercising strong financial discipline. This year, Medicare Australia recorded a surplus of $2.3 million.

This is an improvement on the previous year, when we reported a loss of $6.8 million. Compliance activities are an important part of achieving community confidence. Medicare Australia’s focus in 2006–07 has been on reviewing the legislative, governance and resourcing framework supporting compliance activities and identifying opportunities for improvements. In 2006–07, this has resulted in a 32 per cent increase in the number of completed investigation cases into potential fraud committed against Medicare Australia’s administered payments and a 24 per cent increase in the number of completed reviews into potential inappropriate practice by medical practitioners. Referrals of cases to the Commonwealth Director of Public Prosecutions and the Director of Professional Services Review have also increased.

Closer working relationships have been developed with the Department of Health and Ageing, the Commonwealth Director of Public Prosecutions and the Director of Professional Services Review.

These relationships have helped to improve communications with health professionals and the outcomes of our compliance activities. In November 2006, Medicare Australia’s Corporate Management Committee endorsed the National Indigenous Strategy. The strategy was developed to provide a blueprint for the next three years of Medicare Australia’s actions to improve Indigenous access to our programs and services.

Since the establishment of the National Bowel Cancer Screening Register in August 2006, Medicare Australia has sent more than 405 000 invitations to participate in the screening, to eligible Australians in all states and territories. We have received positive feedback from a number of participants who strongly support the program. We have also received thanks from some participants whose test results were positive, indicating a possible problem to which they might not have been alerted had they not participated in the program.

One of the key challenges ahead for Medicare Australia is to promote the take-up of electronic Medicare claiming at doctors’ surgeries. A major focus for 2007–08 will be to execute contracts with more financial institutions to deliver Medicare Easyclaim, in order to increase the availability of this claiming choice. Medicare Australia will also be working closely with medical practices to enhance understanding of electronic claiming choices and on how each option, or a combination, can fi t their business needs.

Medicare Australia is actively identifying and responding to challenges arising from changes taking shape in the health system. These include impacts from eBusiness, growth in types of services and providers, community demand for services beyond medical needs, identity crime and the increasing complexity in how medicines are prescribed and medical services are provided.

These challenges create opportunity and pressure in the system for non-compliance, which generally takes the form of incorrect claiming or inappropriate practice. As a result, the National Compliance Program for 2007–08 has been developed to deal with these areas of potential non-compliance.

The coming year will be challenging, as we focus on business transformation in response to the changing nature of our service delivery. We will strive to build on our great reputation to ensure the community’s continuing confidence in Medicare Australia. We will be agile and flexible in our delivery of services for government and the community.

Catherine Argall PSMChief Executive Officer

Section 02About Medicare AustraliaMedicare Australia touches the lives of all Australians. We play a vital role in delivering a wide range of services on behalf of the government to the Australian public.

The programs we administered during 2006–07 included Medicare, the Pharmaceutical Benefits Scheme (PBS), the Australian Childhood Immunisation Register, the 30% Rebate on Private Health Insurance, the Bowel Cancer Screening Register and the Australian Organ Donor Register. These programs demonstrate our strong presence in the Australian community.

Medicare Australia also plays an integral role in the Australian health sector by administering a wide range of health-related programs, such as aged care payments, the Practice Incentives Program, the General Practice Immunisation Incentive Scheme, the Rural Retention Program and the Training for Rural and Remote Procedural GPs Program. Medicare Australia is also changing. While maintaining our focus on our traditional health-related programs, we are becoming increasingly involved in other areas of service delivery. Family Assistance services are now available through all Medicare offices and applications for the Government’s LPG Vehicle Scheme rebate can also be lodged at a Medicare office. Medicare Australia has heard what all Australians want from us.

“Make it easy for me” “Get it right” “Be genuinely interested in me” “Respect my rights”.

Medicare Australia cares about choice and convenience for the Australian public. All aspects of our service delivery are tested against the community ‘wants’. We listen when people tell us what they really want from us. Every staff member takes pride in providing friendly, timely and accurate service, protecting the privacy of the personal information we hold and making the experience of the public and health providers positive. Medicare Australia sits within the Human Services portfolio, under the responsibility of the Minister for Human Services, Senator the Hon Chris Ellison. We work together with health care providers, peak health bodies, external stakeholders and other agencies within the portfolio.

Our purpose is ‘working together to improve the health and wellbeing of Australians by delivering information and payment services’.

Medicare Australia is a prescribed agency under the Financial Management and Accountability Act 1997 and a statutory agency under the Public Service Act 1999.

We administer programs on behalf of the Department of Health and Ageing (DoHA), the Department of Veterans’ Affairs (DVA), the Department of Families, Community Services and Indigenous Affairs (FaCSIA), the Department of Industry, Tourism and Resources (DITR) and the Department of Health, Western Australia. Section 4 of this annual report has further information about our role and performance for these programs.

Each year, Medicare Australia processes around 500 million transactions and pays more than $30 billion in benefits and payments to the Australian public and health care providers.

The government expects Medicare Australia to protect the integrity of the programs it administers. An important part of this role is ensuring that the right person gets the right payment at the right time.

We actively support and promote a system of voluntary compliance through a range of education programs aimed both at the public and health care providers. We use a range of strategies to identify,

monitor and change non-compliant behaviour, escalating to rigorous pursuit of deliberate non-compliance and fraud.

Medicare Australia uses a range of communication tools to inform the public, health care providers and our stakeholders about our services and programs. Medicare offices and Access Point booths enable us to communicate with the Australian public through posters, brochures and flyers. Information our service officers receive, through face-to-face interactions, also allows us to target our communications.

As the need arises, we use media liaison and paid media advertising to communicate information about specific programs and services. Pharmacies and doctors’ surgeries carry Medicare brochures and our website also carries a wide range of information.

Human Services Portfolio

OverviewIn October 2004, the Department of Human Services was established within the Finance and Administration Portfolio. In January 2007, the Department became an

Australian Government portfolio department in its own right. Its primary role is improving the development and delivery of government social and health related services to the Australian people.

The MinisterThe Minister for Human Services is Senator the Hon Chris Ellison, who has been a senator for Western Australia since 1993 and Minister for Human Services since 9 March 2007.

The Minister is responsible for the administration of the following legislation:

Australian Hearing Services Act 1991, except to the extent that it is administered by the Minister for Health and Ageing insofar as it relates to the exercise of the powers and functions conferred on the Child Support Registrar under the Act

Child Support (Assessment) Act 1989, insofar as it relates to the exercise of the powers and functions conferred on the Child Support Registrar under the Act

Child Support (Registration and Collection) Act 1988, Insofar as it relates to the appointment of the Registrar and the exercise of the powers and functions conferred on the Child Support Registrar under the Act

Commonwealth Services Delivery Agency Act 1997 Medicare Australia Act 1973.

During the reporting period, the position of Minister For Human Services was also held by The Hon Joe Hockey MP (to January 2007) and the then Senator the Hon Ian Campbell (to March 2007).

Portfolio structure1. The Portfolio Department of Human Services (DHS) includes the Core Department, the Child

Support Agency (CSA) and CRS Australia: the Core Department directs, coordinates and brokers improvements to service delivery across

Human Services agencies the Child Support Agency helps separated parents transfer payments for the benefit of their

children CRS Australia provides vocational rehabilitation services to people with a disability, injury or

health condition, and helps employers keep their workplaces safe.2. Centrelink delivers a range of government payments and services for retirees, families, carers,

parents, people who are seeking work or studying, people with disabilities, Indigenous people, and

people from culturally and linguistically diverse backgrounds, and provides wider services at times of major change.

3. Medicare Australia administers a range of health and payment programmes, including Medicare, the Pharmaceutical Benefits Scheme, the Australian Organ Donor Register, the Australian Childhood Immunisation Register and aged care payments to approved aged care providers. Medicare Australia also delivers Family Assistance services.

4. Australian Hearing provides a range of hearing services for a broad group of eligible Australians, including children and young people up to the age of 21 years, eligible adults and aged pensioners, and war veterans.

5. The HSA Group focuses primarily on providing occupational health, safety and medical assessments.

Performance information for outcomeOutcomes and outputsMedicare Australia has one outcome This is achieved through one output.

Outcome 1: Improving Australia’s health through payments and information.

Output Group 1.1: Delivery of Australian Government health payments and information.

Performance information for Outcome 1Medicare Australia’s business performance is guided by the themes articulated in the Medicare Australia Strategic Direction Statement.

Table 1 – Performance information for Outcome 1

Strategic Themes Key Performance Indicator Business Performance

Delivering great customer service

Client and provider satisfaction with the services provided by Medicare Australia.

2006–07 Satisfaction research results

Initiatives are implemented on time, within budget and to expectations.

Community – 90%Pharmacists – 87%Practice Managers – 95%Practitioner – 89%

Aged care providers – 96%

Medicare Australia continues to work closely with our strategic partners to provide advice and guidance and to implement new policy and government initiatives in accordance with agreed schedules. We continue to deliver services on behalf of other agencies in line with agreed Key Performance Indicators.

Providing accurate and reliable information and payments

Payments are accurate and timely.

Medicare Australia achieved 96% of claims within stipulated


Staff awareness and procedures protect Customers privacy

payment times against a target of 90%. Accuracy of payments for Medicare was 97.8% (target 97.8%) and 98.4% (target 97.6%) for PBS.

There is a strong culture in Medicare Australia of maintaining our reputation as a reliable custodian and protector of private information. This was identified as the number one priority for Medicare staff in the 2006–07 staff survey. We continue to foster this culture through a number of measures including mandatory privacy training for all staff.

Being a well run organisation

Resources are managed in accordance with the requirements of the Financial Management and Accountability Act and to the financial plan. A sound governance framework is in place.

Medicare Australia achieved an operating surplus of $2.3 million in 2006–07, demonstrating a strong financial management framework.

Medicare Australia has a range of structures in place to ensure that our governance is strong. The primary governance committee is the Corporate Management Committee, which is supported by five subcommittees covering customer service, people, security and eBusiness and technology.

Ensuring the integrity of the government programs we deliver

Education and compliance programs minimise system leakage.

Payments are accurate and timely.

In 2006–07 we developed a range of new approaches in managing compliance across the programs we administer including:

the introduction of new risk analysis tools

the introduction of a new streamlined Practitioner Review Program

an increase in the visibility of the compliance program


an improvement in the productivity of compliance operations

Being a valued strategic partner in delivering agreed health and other government initiatives

Strategic partners including the Department of Health, Veterans’ Affairs, Families, Community Services and Indigenous Affairs and Human Services are satisfied with Medicare Australia’s performance. Government initiatives are implemented on time, within budget and to expectations.

Medicare Australia has current Service Level Agreements with DVA, FaCSIA, DIAC, DITR and the Department of Health in Western Australia. A new Memorandum of Understanding is expected to be finalised with DoHA shortly, while its intent and governance framework is already in place.

Being a great place to work

Feedback gained through staff survey is acted on. Staffs have access to development opportunities and participate in individual performance assessments and absenteeism is reduced.

The response rate for Medicare Australia’s 2006–07 staff survey increased by 1% to 91.8% with 78.9% of staff indicating that they experience job satisfaction at Medicare Australia. This is up 7.9% on the 2005–06 staff survey result. Medicare Australia has made a significant achievement in reducing absenteeism. Average unplanned leave was 12.17 days per FTE at 30 June 2007, down from 12.91 days per FTE at June 2006.

Our structureMedicare Australia’s structure is designed to support our strategic direction and the achievement of our outcome of improving Australia’s health through payments and information.

During 2006–07, Medicare Australia’s executive management team consisted of the Chief Executive Officer (CEO), three deputy CEOs, five general managers and the Chief Financial Officer.

Our national office is in Canberra and each state has a headquarters located in the state capital, responsible for day-to-day operations. State managers are responsible for Medicare offices, contact centres and payment processing centres in each state. To cater for Australia’s highly dispersed population, there are nine payment processing centres and a network of 238 community-based Medicare offices.

The main functions of Medicare Australia’s national office include the following divisions and branches.

Customer Services DivisionThe Customer Services Division supports the core business of making payments and collecting and providing information. Services and products delivered by the division support customer service officers to do their jobs and meet or exceed customer expectations. The division also provides mainframe and other business system support, training and information tools.

The state infrastructure, which is supported by the division, is responsible for day-to-day operations and service delivery.

In May 2007, the Customer Services Division was restructured to better meet the changing requirements of the organisation and to continue to meet increasing customer expectations. A new branch, the National Operations and Performance Branch, was created. Its primary objective is to ensure nationally consistent, effective and efficient performance through Medicare Australia’s service delivery network.

The new branch complements the existing two branches in the division: the Business Analysis and Support Branch and the Customer Service Strategy Branch.

eBusiness and Development DivisionThe eBusiness and Development Division’s function is to focus strategically on improving the effectiveness of service delivery through the development and delivery of Medicare Australia’s eBusiness initiatives.

The core business activities of the division include driving the take-up of online claiming, developing new online services and managing our website.

Financial Management DivisionThe Financial Management Division comprises the Financial Control and Development Branch, the Budget and Management Accounting Branch and the National Corporate Services Branch.

The division provides Medicare Australia’s budgeting and financial management and reporting functions, as well as purchasing, property and office services, security and records management.

Information Technology Services DivisionThe Information Technology Services Division provides and manages information technology (IT) services, including system applications and works closely with all areas to maximise our internal and outsourced IT resources.

The division ensures that infrastructure services support our business requirements. The division also researches and assesses IT-related technologies, tools and processes to increase Medicare Australia’s capability.

Program Management DivisionThe Program Management Division comprises the Medicare and Veterans’ Affairs Processing Branch, the Pharmaceutical Benefits Branch, the Associate Government Programs Branch and the Aged Care Branch.

The Program Management Division manages the development and implementation of operational policy across a wide range of programs and related activities.

In 2006–07, this included more than 20 programs, such as Medicare, the Pharmaceutical

Benefits Scheme, aged care payments, the Australian Childhood Immunisation Register, the National Bowel Cancer Screening Register, the Rural Retention Program, payments on behalf of the Department of Veterans’ Affairs, hearing services and the LPG Vehicle Scheme. The division monitored the performance of each program, developing administrative policy for existing programs and for proposed Australian Government initiatives. The Division provides the relationship management ‘gateway’ to our policy departments.

During 2006–07, the Aged Care Branch moved from the eBusiness Division to the Program Management Division to better align with Medicare Australia’s other program responsibilities.

Program Review DivisionThe Program Review Division’s role is to ensure the integrity of the programs we administer. It does this through a range of activities to detect and prevent fraud and inappropriate claiming. The division also promotes and encourages compliance with Medicare

Australia’s programs by providing the community and health care providers with high quality information products. The division is made up of the Professional Review and Education Branch, the Compliance Risk and Systems Branch, the Compliance Policy and Standards Branch and the National Compliance Operations Branch.

The National Compliance Operations Branch has regional offices in all state capital cities, except Darwin. Northern Territory matters are managed through our Adelaide office.

Access Card DivisionThe Access Card Division works across Medicare Australia to ensure our organisation is well prepared for the access card and that our service delivery experience is contributing to the ongoing development of the access card program.

Legal, Privacy and Information Services BranchThe Legal, Privacy and Information Services Branch support the organisation by providing comprehensive legal advice on Medicare Australia programs, projects and human resource management issues.

The branch ensures that we meet our statutory Freedom of Information and release of information obligations and comply with relevant privacy legislation. The branch also provides statistical analyses for the programs that we administer and mailouts on behalf of customers.

Human Resources BranchThe key role of the Human Resources Branch and the state based human resources teams is to support staff and management through developing and implementing quality people management practices and initiatives

Media, Communication and Government Relations BranchThe Media, Communication and Government Relations Branch works with a broad range of internal and external stakeholders to produce and provide high quality information and communication products through a range of print, media and other information services.

The branch focuses on providing high level and timely communication support to the Minister, DHS and the government, health care providers, the Australian public and Medicare Australia staff.

Audit and Risk Assurance Services BranchThe Audit and Risk Assurance Services Branch provides independent and objective assurance on the adequacy and effectiveness of Medicare

Australia’s internal control framework. The branch also supports the Audit Committee’s review of our risk management and fraud control activities and the implementation of audit recommendations by management.

The following page shows our senior executive management structure at 30 June 2007.

Figure 1 – Organisation Chart

Our relationship with other agenciesMedicare Australia delivers services on behalf of DoHA, DVA, DITR and FaCSIA. We remain focused on the delivery of services to all Australians on behalf of our external stakeholders. We consult industry peak bodies and health practitioners to ensure that the government’s policy objectives are effectively realised, while also considering the needs of health practitioners and the public.

Medicare Australia works closely with DHS and its agencies to seek synergies, where possible, and to achieve the most cost effective outcomes.

Our activities are conducted within the Australian Government policy framework set by legislation administered by DoHA, DVA, DITR and FaCSIA. We actively contribute to policy development by providing information and feedback from our day-to-day operations.

Medicare Australia delivers services on behalf of DoHA, DVA, DITR and FaCSIA. We remain focused on the delivery of services to all Australians on behalf of our external stakeholders. We consult industry peak bodies and health practitioners to ensure that the government’s policy objectives are effectively realised, while also considering the needs of health practitioners and the public.

Medicare Australia works closely with DHS and its agencies to seek synergies, where possible, and to achieve the most cost effective outcomes.

Our activities are conducted within the Australian Government policy framework set by legislation administered by DoHA, DVA, DITR and FaCSIA. We actively contribute to policy development by providing information and feedback from our day-to-day operations.

Our funding arrangementsMedicare Australia is part of the Human Services Portfolio and reports to the Minister for Human Services.

The organisation is funded mainly by direct appropriation through the annual budget cycle. In addition, Medicare Australia is funded for and performs a number of services under purchaser provider arrangements with other Australian Government agencies.

Medicare Australia is also funded for services performed under contract with other entities, including the Western Australian Government and for some services on behalf of the World Bank.

Resourcing for Outcome 1 includes direct appropriations from government, revenue from other government agencies and cost recovered funds.

The chart below shows the main sources of funding for Medicare Australia in 2006–07.

Figure 2 – 2006–07 Revenue

Direct appropriationFunding for health programs, which make up a significant portion of Medicare Australia’s operations, comes from direct appropriation. Our funding agreement with the government includes both fixed and variable amounts. The variable component is determined by the number of services and payments processed in any financial year. The revenue paid to Medicare Australia under this arrangement was $554.4 million in 2006–07 and is estimated to increase to $586 million in 2007–08. The estimate may change as a result of significant volume changes or new policy proposals approved in the budget context.

This direct appropriation funding also includes revenue for the LPG Vehicle Scheme (a DITR initiative). This is a fixed funding arrangement for which we received revenue of $0.7 million in 2006–07 (2007–08 estimates: $0.9 million).

Department of Health and AgeingMedicare Australia provides a range of additional services to DoHA under business practice agreements. The services provided are the administration of the aged care payments function, the Broadband for Health Incentive Payments Scheme (General Practice and Pharmacy) and the National Bowel Cancer Screening Register.

Under these arrangements we received revenue of $27.2 million in 2006–07 (2007–08 estimate:$17.6 million).

Department of Veterans’ AffairsMedicare Australia provides services to DVA through a service level agreement. We process claims for veterans’ treatments, including medical, hospital and allied health services. As with health outputs, the pricing structure for DVA services is based on a variable price per processed service, with fixed revenue covering related infrastructure costs. Revenue received under the service level agreement in 2006–07 was $16.7 million (2007–08 estimates: $17.6 million).

Department of Families, Community Services and Indigenous Affairs/CentrelinkMedicare Australia provides Family Assistance services through the Medicare branch office network on behalf of FaCSIA. Revenue from this program includes a fixed amount from FaCSIA and a variable amount from Centrelink.In 2006–07; we received $8.6 million from FaCSIA (fixed) under this arrangement. We also received $11.1 million (variable) from Centrelink (2007–08 estimates: $14.0 million).

Department of Health, Western AustraliaThrough an agreement with the Department of Health, Western Australia, Medicare Australia administers a visiting medical practitioner fee-for-service payment and information system. This system provides public non-teaching hospitals in Western Australia with an intranet processing system to assess and pay invoices submitted by visiting medical practitioners providing services to public patients. Under the agreement, funding for 2006–07 was $1.2 million (2007–08 estimates: $1.2 million).

Other sources of fundingCosts are recovered for various consultancy works, usually negotiated with overseas governments and non-governmental organisations. Medicare Australia also recovers costs for the provision of statistical information and accommodation space in sub-lease arrangements.

Summary of key performance statistics, 2006–07Note: Financial and other data in this annual report has been rounded to the nearest decimal point. This may lead to some discrepancies in the total figures.

On behalf of the Department of Health and AgeingMedicare

Persons enrolled in Medicare* at 30 June 2007 21.1 million

Active Medicare cards at 30 June 2007 11.8 million

Bulk billed services 187.9 million

Patient claimed services 70.0 million

Total services processed 257.9 million

Percentage of services bulk billed 72.9%

Total benefits paid $11.8 billion

* includes some people who are not Australian residents (such as long-term visitors for more than six months and eligible short-term visitors).

Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme(Payments to veterans processed by Medicare Australia on behalf of DVA)

PBS services processed** 168.3 million

RPBS services processed 14.8 million


PBS benefits paid $6.0 billion

RPBS benefits paid $449.5 million


Authority prescriptions authorised 7.3 million

** including stoma

Aged Care

Residential claims processed 34 832

Community Aged Care Package claims processed 12 219

Flexible care claims processed 3 456

Total claims processed 50 507

Total amount paid $6.3 billion

Australian Childhood Immunisation Register

Valid immunisation episodes recorded 3.9 million

Children (under 7) registered 1.9 million

Total amount paid to immunisation providers $8.4 million

Children registered with appropriate immunisation coverage

aged 12–15 months 91.2%



Australian Organ Donor RegisterNumber of consent registrations (including registrations of intent by 16–17 year olds) 951 417

Practice Incentives Program

Participating practices 4 784

Total amount paid $279.1 million

Rural Retention Program

Number of providers paid 2 085

Number of payments made 2 110


General Practice Immunisation Incentive Scheme

Number of practices registered 5 499

Total payments* $37.6 million

* includes Service Incentive Payments and Outcomes payments

General Practice Registrars’ Rural Incentive Payments Scheme

Medical practitioners paid 467

Number of payments made 887


Training for Rural and Remote Procedural GPs Program

Number of providers paid 2 487

Number of payments made 3 296


Compensation Recovery Program

Number of cases finalised 46 561

Total amount of benefits recovered $29.0 million

HECS Reimbursement Scheme

Eligible medical graduates participating 411

Medical graduates paid 313

Number of payments made 528


Hearing Services Program

Services processed 917 208


30% Rebate on Private Health Insurance

Memberships registered 5.1 million

Total paid in cash claims $2.1 million

Total paid to health funds $3.3 billion

Medicare Australia online claiming

Number of registered sites 7 455

Increase in registered sites 1 507

Number of registered sites transmitting via online claiming 6 632

Increase in registered sites transmitting via online claiming 1 263

Bulk bill services submitted via online claiming 59.2 million

Patient claimed services submitted via online claiming 4.4 million

Simplified billing

Simplified billing services lodged via ECLIPSE 157 840

Increase in sites transmitting in-patient claims via ECLIPSE 70

ECLIPSE = Electronic Claim Lodgement and Information Processing Service Environment

On behalf of the Department of Veterans’ AffairsVeterans’ Treatment Accounts

PTEC*, STEC**, RPBC*** and TPIG**** cards produced 173 090

Provider cards produced 3 146



* Personal Treatment Entitlement Card

** Specific Treatment Entitlement Card

*** Repatriation Pharmaceutical Benefits Card

**** Totally Permanently Incapacitated Gold Card

Before the 2004–05 financial year, Medicare Australia’s funding for the processing of DVA services was allocated based on the number of lines processed. The output pricing agreement has since changed and Medicare Australia’s funding is now allocated based on the number of DVA services processed. Care should be taken when comparing the statistics in this table with those of earlier years, which used lines instead of services.

Service and benefit figures include incentive items.

On behalf of DITRLPG Vehicle Scheme

Number of applications received 44 013

Percentage of applications received by Medicare Australia 66.9%

On behalf of FaCSIAFamily Assistance

Number of Medicare offices offering full service 238

Number of people accessing extended Family Assistance services 538 160

Section 03: Management and accountabilityCorporate governanceThe Chief Executive Officer (CEO) of Medicare Australia reports to the Minister for Human Services through the Secretary of the Department of Human Services (DHS). Section 8AB of the MedicareAustralia Act 1973 states that the CEO is responsible, under the Minister, for:

deciding the objectives, strategies, policies and priorities of Medicare Australia managing Medicare Australia Ensuring that Medicare Australia performs its functions in a proper, efficient and effective manner.

The CEO is supported by an executive management team, consisting of three deputy CEOs, five general managers and the Chief Financial Officer. Six state managers also support the CEO.

The Minister for Human Services issued the CEO of Medicare Australia with a Statement of Expectations for the period 1 October 2005 to 30 September 2006 and a further Statement of Expectations for the period 1 December 2006 to 30 June 2007. These statements set out the Minister’s priorities and included key deliverables for our ‘strategic themes’ of service delivery for payments and information and program integrity.

The CEO formally responded to the Minister with Statements of Intent outlining Medicare Australia’s commitments to meet the Minister’s expectations. Both these documents are available on our website.

The CEO and other members of the executive management team meet with the Secretary of DHS and with other DHS staff on a monthly basis to report formally on progress in priority activities.

Internal governance arrangementsThe CEO has a range of corporate committees and other arrangements in place to ensure that our governance is robust and meets the requirements of the Financial Management and Accountability Act. These arrangements include the Audit Committee and Program Integrity Committee, both of which have independent members. While the Program Integrity Committee is not a statutory requirement, the work it does highlights the importance of program integrity to Medicare Australia.

Corporate Management CommitteeThe primary governance committee in Medicare Australia is the Corporate Management Committee – its role is to provide strategic advice to the CEO. Its objective is to help the CEO discharge her obligations to ensure that Medicare Australia:

has appropriate governance frameworks in place conforms with all legislative requirements operates effectively to deliver the government’s service delivery objectives is strategically positioned to meet future requirements.

There are five Corporate Management Committee subcommittees:

customer service finance eBusiness and technology people security.

During 2006–07, the operations of the subcommittees were reviewed to ensure they provide effective support and have robust operating procedures to support the Corporate Management Committee. The outcome of the reviews saw the development of standard operational procedures to improve the effectiveness of subcommittee operations. There were some minor amendments to the terms of reference and improved record-keeping arrangements were introduced.

Corporate governance information for staffMedicare Australia has corporate governance information on its intranet to guide the day-to-day work of staff.This information includes the Chief Executive Instructions and a range of policy and procedural documentation.

DelegationsMedicare Australia operates its business in accordance with a number of instruments of delegation. These include financial and human resource delegations made under a range of legislation, including the Financial Management and Accountability Act and the Public Service Act 1999.In addition, delegations are also made under the MedicareAustralia Act 1973 and other relevant health legislation, including the Health InsuranceAct 1973, the National HealthAct 1953, the Health and other Services (Compensation) Act 1995, the Private HealthInsurance Incentives Act 1998, the Medical Indemnity Act2002, the Aged Care Act 1997 and other legislation.

The CEO has made instruments of delegation specific to Medicare Australia officers in respect of statutory powers that are directly held and in respect of statutory powers that are performed on behalf of the Minister for Health and Ageing and the Secretary of the Department of Health and Ageing (DoHA).

External and internal scrutinyThe Audit Committee, chaired by an independent external member, provides independent assurance and assistance to the CEO in relation to Medicare Australia’s risk, control and compliance framework and its external accountability obligations. In particular, the committee oversees:

the effectiveness of our internal control framework the internal audit program, which reviews the adequacy and effectiveness of our operations

our corporate risk management and planning activities the development of the Fraud Control Plan and implementation of the Fraud Control Action Plan Our compliance with external accountabilities and obligations, including the preparation of our

annual financial statements.

The Audit Committee has five members: Mr Bruce Jones(chair) and Ms Meryl Stanton(external members); a Medicare Australia deputy CEO; one state manager; and one branch manager. The committee met seven times in 2006–07.

The chair of the committee meets regularly with the CEO and the committee as a whole reports annually to the CEO. Consistent with our commitment to be open and transparent, representatives from the Australian National Audit Office(ANAO) and DHS are invited to attend Medicare Australia’s Audit Committee meetings.

In 2006–07, the committee:

increased emphasis on monitoring the implementation of internal and external audit recommendations

endorsed the internal audit work plan advised on matters arising from the committee’s consideration of Medicare Australia’s financial

statements and recommended the signing of the financial statements Maintained awareness of Medicare Australia’s operating environment through regular

presentations and discussions with executive management.

External scrutinyThe Audit and Risk Assurance Services Branch (ARAS) is responsible for liaising with the ANAO and for providing coordinated responses to draft audit findings and recommendations. Details of ANAO reports affecting Medicare Australia are provided on the following page.

Australian National Audit Office During 2006–07, the ANAO tabled in Parliament a number of reports on audits involving

MedicareAustralia.

Cross-agency audits that Medicare Australia was involved in:

Audit Report No.12 2006–2007: Management of Family Tax Benefit Overpayments Audit Report No.15 2006–2007: Audits of the Financial Statements of Australian Government

Entities for the Period Ended 30 June 2006 Audit Report No.51 2006–07: Interim Phase of the Audit of Financial Statements of General

Government Sector Agencies for the Year Ending 30 June 2007.

Audit of another agency that involved consultation with Medicare Australia:

Audit Report No. 38 2006–2007: Administration of the Community Aged Care Packages Program.

Audits in progressThe following ANAO performance audits affecting Medicare Australia were in progress at 30 June 2007:

Accuracy of Medicare Claims Processing. The audit will examine Medicare Australia’s policies and procedures to ensure government expenditure on Medicare is appropriately controlled. The audit report is expected to be tabled in late 2007

National Cervical Screening Program – Follow-up. The audit will focus primarily on DoHA and actions taken by DoHA and Medicare Australia (Recommendation 3 only) to implement four recommendations from the original audit conducted in 2000–01. The audit report is expected to be tabled in late 2007.

Medicare Australia’s Audit Committee maintains scrutiny over the implementation of ANAO recommendations where they are applicable to Medicare Australia.

Joint Committee of Public Accounts and AuditOn 28 February 2007, the Joint Committee of Public Accounts and Audit conducted a public hearing in relation to its review of the Auditor-General’s Audit Report No.12 2006–2007: Management of FamilyTax Benefit Overpayments. Medicare Australia attended the public hearing and gave evidence. No findings were recorded against Medicare Australia.

Internal scrutinyThe Audit and Risk Assurance Services Branch (ARAS) operates under the authority of a Chief Executive Instruction and the Audit and Risk Assurance Services Charter. It is directly accountable to the CEO and Medicare Australia’s Audit Committee. ARAS is responsible for:

the planning and delivery of a risk-based annual internal audit work program to evaluate and provide assurance on the effectiveness, efficiency and ethical performance of Medicare Australia’s activities

Providing advice and assistance on risk management and fraud control, including the development of policies and procedures and the Corporate Risk Management Plan and Corporate Fraud Control Plan.

Internal control frameworkInternal audit evaluates and reports on the performance of management in maintaining our strategic direction, achieving our operational objectives and ensuring appropriate standards of probity and accountability.

There is a focus on improving the overall management control framework. In developing the audit workplan for 2006–07, ARAS considered:

the views of the CEO, the Audit Committee and senior management Medicare Australia’s risk assessments recent ARAS and ANAO audit coverage Medicare Australia’s Fraud Control Plan the CEO’s requirements to certify compliance with the Financial Management and Accountability

Act 1997 issues raised by the ANAO affecting both Medicare Australia and other agencies the level of materiality associated with programs or activities Requirements imposed on Medicare Australia under service agreements with other agencies.

Other major activities included monitoring the progress of the implementation of audit recommendations, through the development and maintenance of an audit monitoring database and providing advice to management and staff.

Risk managementMedicare Australia has an integrated risk management framework that includes a Chief Executive Instruction, policies, guidelines, a planning handbook and reporting templates. These are accessible to staff through the intranet. Risk management advisers are available to facilitate risk management education, workshops and report preparation.

The Audit and Risk Assurance Services Branch is responsible for preparing the Corporate Risk Management Plan and facilitating the executive’s monitoring of the plan. The risk management plans are subject to quarterly review and updates to ensure that momentum for implementing treatments is maintained and potential or emerging risks are identified and monitored. Our risk management framework is consistently reviewed and revised. The business planning and risk management teams

work closely together to ensure risk awareness in decision making at all levels of business planning and program management.

The risk management unit reports to the Audit Committee and the management of risk across the organisation is also monitored through the internal audit program.

In June 2007, Medicare Australia achieved a score of eight out of a possible ten in the Comcover Risk Management Benchmarking Survey. Our achievement entitled us to an eight per cent discount on our Comcover insurance premium.

Fraud controlAs part of its responsibilities to protect the public interest, Medicare Australia has a fraud control program that complies with the Commonwealth Fraud Control Guidelines.

In this program:

fraud risk assessments and fraud control plans are prepared in accordance with the guidelines appropriate fraud prevention, detection, investigation and reporting procedures and processes are

in place annual fraud data is collected and reported in line with the guidelines.

Program integrity assuranceTo ensure that Medicare rebates, Pharmaceutical Benefits Scheme (PBS) subsidies and health related incentives are claimed properly, Medicare Australia has implemented a compliance program. This National Compliance Program is administered by the Program Review Division. The program focuses on areas of risk to health programs. The table below summarises compliance activities by the Program Review Division in managing those risks. Section 4 of this report has further details of the Program Reviews compliance activities in 2006–07.

Table 2 – Compliance activities

Risk Detection tools Compliance activities

1. Claiming for services not provided

non-provision of Medicare services

non-supply of PBS items

Medicare claims fraud by patients

top providers and cash claiming data analyses

intelligence analysis *

tip-offs from the public and referrals

criminal investigation and prosecution

2. Identity and related crimes

false or stolen identity

misrepresentation of concessional entitlement

data and intelligence analysis

intelligence and information sharing with other agencies



referrals to other agencies (for example, the Australian Federal Police)

3. Incorrect claiming or inappropriate servicing

Medicare mis-itemisation artificial intelligence ** education

Risk Detection tools Compliance activities

or incorrect claiming

inappropriate prescribing inappropriate PBS supply and claiming

audits

top providers data analysis


targeted feedback

recoveries

compliance interview

Practice Review Program and referral to the Director of Professional Services Review

4. Oversupply

overseas drug diversion

prescription shopping

data and intelligence analysis

joint operations with the Australian Customs Service and Australia Post at overseas departure and mail exchange centres


education

targeted feedback

compliance interviews


5. Abusing eligibility for incentives and rebates

non-compliance relating to incentive payments

incorrect claiming of rebates and other payment programs

artificial intelligence

audits


education

compliance interviews

* analysis of information specific to a case or person for operational purposes

** predictive computer programs

Financial frameworkThe Financial Management and Accountability Act 1997 sets out the CEO’s functions and responsibilities relating to Medicare Australia’s financial management. Medicare Australia has issued Chief Executive Instructions supported by detailed financial management policies, procedures and delegations to help staff comply with legislative obligations. These were reviewed and revised during the year to ensure their continued relevance and effectiveness.

In 2006, the Government introduced a requirement that CEOs provide certification to their responsible Minister on their agency’s financial management and sustainability by 15 October each year.

During 2006–07, we developed policies and procedures and trained all relevant staff in requirements for the preparation of the annual Certificate of Compliance.

Financial performance is regularly reviewed both within Medicare Australia and by the Department of Human Services and the Department of Finance and Administration. Within Medicare Australia,

budget and resourcing decisions are considered by the Finance subcommittee, which reports to the Corporate Management Committee.

Corporate business continuityBusiness disruption could damage Medicare Australia’s ability to deliver services and our reputation if the speed or scale of an emergency compromised or challenged our operations and management systems and disabled our services to providers and the public. We use business continuity principles to ensure that we are prepared to manage emergencies when they occur.

As part of this preparation, our divisions and state offices maintain business continuity plans to ensure that effective interim operating arrangements can be put in place to support critical business processes and resources. Medicare Australia tests the business continuity plans regularly and incorporates experience gained from real emergencies to ensure the effectiveness of the plans.

Medicare Australia introduced a new emergency management and business continuity framework in 2006–07 and completed a series of business continuity tests involving all parts of the organisation. The tests included annual disaster recovery tests, which ensure that our information technology infrastructure is robust and recoverable.

Balanced scorecardDuring 2006–07, Medicare Australia examined its balanced scorecard and refined key performance indicators to improve their alignment with corporate and management reports. The indicators in the scorecard measure a range of financial and non-financial functions against internal targets and benchmarks and are categorised under six perspectives:

finance growth and development service (public and government) internal business processes people social and environmental.

We continue to review and refine our key performance indicators to enable the effective monitoring ofthe overall health of the organisation. Balanced scorecard measures are summarised in table 3.

Table 3 – Balanced scorecard

Actual2004-05

Actual2005-06

Target2006-07

Actual2006-07

Finance

Revenue $596.1 m $577.6 m $627.5 m $626.0 m

Operating expense $593.0 m $584.5 m $627.5 m $623.7 m

Net result $3.1 m ($6.8 m) $0.0 m $2.3 m

Service (public and government)

Community satisfaction 90% 96% ≥90% 90%

Actual2004-05

Actual2005-06

Target2006-07

Actual2006-07

Medical practitioner satisfaction 85% 71% ≥70% 89%

Practice manager satisfaction 90% 86% ≥85% 95%

Pharmacist satisfaction 85% 92% ≥90% 87%

Call centre response time 93% 91.5% ≥90% 91.9%

Claim processing accuracy 98% 97.8% ≥97.8% 97.8%

Internal business processes

IT service availability n/a n/a 99.9% 99.9%

IT service performance n/a n/a 99.1% 99.9%

Growth and development

Online claiming take-up – Medicare bulk bill 9.93% 24.7% 33% 31.5%

Online claiming take-up – Medicare patient claim

1.8% 5.1% 6% 7.9%

PBS online take-up – no. and percentage

of participating pharmacies

n/a n/a≥1 500

(30%)

4 490

(81%)

PeopleOverall staff satisfaction 73% 62% 71% 79%

Unscheduled absenteeism – leave rate/FTE

n/a n/a 13.33 12.17

Social and environmentalDue to a change in the reporting process on energy usage at Medicare Australia, results for 2006–07 will not be available until October 2007. For information about Medicare Australia’s environmental activities, see ‘Environmental sustainability’ on page 70 in this section.

Our stakeholdersStakeholder Consultative GroupThe Stakeholder Consultative Group consists of members from groups, such as the Australian Association of Practice Managers, the Australian General Practice Network (formerly the Australian Divisions of General Practice), the Australian Private Hospitals Association, the Australian Medical Association, the Pharmacy Guild of Australia, the Medical Software Industry Association and the Rural Doctors Association of Australia. Meetings with the group give stakeholders an opportunity to discuss and influence Medicare Australia’s business activities at a strategic level.

The Stakeholder Consultative Group usually meets two to three times a year. During 2006–07, the group met in December 2006 and March 2007. Key issues raised at the meetings included access card, PBS Online, electronic Medicare claiming and compliance and reducing fraud.

Consumer Consultative GroupThe Consumer Consultative Group meets two or three times a year. Representatives are from various organizations and community groups such as the Consumers’ Health Forum, Chronic Illness Australia, Carers Australia and the Australian Federation of Disability Organisations.

Members provide input on issues, discuss the potential impacts of services and products and advise on how Medicare Australia can add further value in the delivery of services to the Australian public. The Consumer Consultative Group met in August and November 2006 and March 2007.Key issues raised at these meetings included electronic Medicare claiming, customer satisfaction research results and queue management in Medicare offices.

Stakeholder researchMedicare Australia has undertaken annual satisfaction research with the community since 1984 and with medical professionals since 1991.We use a combination of qualitative and quantitative research methods to track and evaluate satisfaction levels, including measures aligned to our service charter.

The results and recommendations give us a deeper understanding of the needs and expectations of the Australian public and providers. We use the results to inform strategic priorities, service delivery, channel management and communication.

Following the results of the 2005–06 satisfaction research, we conducted a complementary body of qualitative research in 2006–07 to better understand the changing relationship between Medicare Australia, practitioners and practice managers. The findings identified areas for improvement in support, service and communication with medical practices.

As part of Medicare Australia’s commitment to continuous improvement, we revised and adopted a whole of business approach to research in 2006–07. We communicated the annual satisfaction research findings widely and integrated them into plans across the organisation. This process involved extensive consultations, a series of tailored research presentations and workshops with internal and external stakeholders. We used insights from these activities to modify and refine the scope and methodology of research in 2006–07.

2006–07 research findingsIn 2006–07, surveys were conducted with the Australian public, practitioners (general practitioners, pathologists, imaging and other specialists, optometrists and ancillary immunisation providers), practice managers, pharmacists and aged care providers.

Satisfaction among the Australian public has remained strong at 90 per cent and there has been a significant 27 per cent rise in satisfaction levels from ‘quite satisfied’ to ‘very satisfied’.

There has been an increase in the satisfaction levels of practitioners and practice managers and a slight decrease in pharmacists’ satisfaction.

Table 4 – Overall stakeholder satisfaction levels 2004–05 to 2006–07

2004-05 2005-06 2006-07

Community 90% 96% 90%

Practitioner 85% 71% 89%

Practice managers 90% 86% 95%

Pharmacists 85% 92% 87%

Aged care providers n/a 97% 96%

Figure 3 – Stakeholder satisfaction 2002–03 to 2006–07

Service charterMedicare Australia’s charter includes our service delivery strategy statement to stakeholders.

Delivering great service to all Australians

We listen when you tell us what you really want from Medicare Australia. Every staff member takes pride in providing friendly, timely and accurate service, protecting your privacy and making your experience as easy as possible. Our promise is that we will deliver great service to all Australians.

The service charter centres on four key statements from the Australian public, which tell us what they really want from Medicare Australia.

‘Make it easy for me’ ‘Get it right’ ‘Be genuinely interested in me’ ‘Respect my rights’.

To ensure that we deliver against these statements, the service charter also makes specific promises in relation to each statement, provides quantitative and qualitative reporting on each promise and links the customer service focus directly to individual performance agreements.

The charter is provided as a brochure and is supported by more detailed information on our website. We also publish the measures and performance against the promises in the service charter on the website. We update this information quarterly.

Make it easy for meWe will improve convenience and access for all Australians by improving a range of service options, including online.

Measure

Satisfaction with the range of options available to make a Medicare claim

Performance

As shown in the 2006–07 satisfaction survey, 69 per cent of the public were satisfied with the range of options available.

Measure

New developments in online access

Performance

We have launched a new website design to help the public find our online information and access our services more easily.

Our Online Services continue to expand and the public can now:

view and update their Medicare details and request a replacement card register and check their Medicare Safety Net balance view their organ donor registrations details and their children’s immunisation history statements view their Medicare tax statement access information about health and medicines consent for Medicare Australia to communicate electronically with them in the future.

We will stay open longer in our busiest Medicare offices.

Measure

Number of busy Medicare offices (based on claiming patterns) staying open longer to meet the public’s needs and demands.

Performance

117 Medicare offices open 9.00 am to 12.30 pm on Saturdays. 193 offices have extended their Monday to Friday opening hours. 54 offices have opened their doors until 6.00 pm and in some offices to 7.00 pm, one evening

each week to coincide with local evening trading.

Measure

Satisfaction with opening hours

Performance

68 per cent of the public were satisfied with the opening hours.

We will keep queue times in Medicare offices to a minimum.

Measure

The Australian public is served in less than 10 minutes.

Performance

In 2006–07, 98.3 per cent of the public waited less than10 minutes in the queue to be served, with an average waiting time of 2 minutes 14 seconds. Where we do not meet the service standard of 10 minutes, we find out why and make improvements.

We will answer the phone quickly.

Measure

We answer calls within 30 seconds.

Performance

In 2006–07, 92 per cent of calls were answered within 30 seconds.

We will increase awareness of our services among Indigenous Australians.

Measure

Number of Indigenous Australians registered for Medicare.

Performance

Indigenous Australians can voluntarily identify when enrolling for Medicare. At 30 June 2007, there were 168 706 Medicare enrolments in which the voluntary Indigenous identifier was completed.

Measure

Number of calls made to the dedicated Aboriginal and Torres Strait Islander access line.

Performance

In 2006–07, the dedicated Aboriginal and Torres Strait Islander access line received 48 452 calls.

We will help you access other agencies in the Department of Human Services.

Measure

Access to Family Assistance services

Performance

Family Assistance services have been extended in all 238 Medicare offices.

Measure

Access to Medicare services from Centrelink customer service centres

Performance

Basic Medicare services are offered through 49 Centrelink sites across northern Australia. Nationally, a further 36 Centrelink agent sites perform an information brokerage service on behalf of Medicare Australia.

In partnership with Centrelink, we conducted a flexible service delivery arrangement to trial the provision of Medicare Australia services from four Centrelink sites and the provision of Centrelink services in four Medicare offices.

Get it rightWe will make accurate and timely payments.

Measure

Payments are timely and accurate.

Performance

In 2006–07:

96 per cent of Medicare bulk bill claims were finalised within 15 days 96 per cent of Medicare simplified billing claims were finalised within 10 days 94 per cent of all Medicare patient claims were finalised within 18 days 99 per cent of PBS claims were finalised within 17 days accuracy of payments for Medicare was 97.8 per cent against a target of 97.8 per cent accuracy of payments for PBS was 98.4 per cent against a target of 97.6 per cent Continuous random sampling and compliance audits of Medicare and PBS payments provide

assurance of accuracy of payments and areas for improvement.

We will give you clear and accurate information.

Measure

Satisfaction with information provided.

Performance

77 per cent of the public agreed that they received clear and accurate information.

We will give you consistent advice.

Measure

Satisfaction with advice provided.

Performance

64 per cent of the public agreed they received consistent advice.

Be genuinely interested in meWe will provide service with a smile.

Measure

Satisfaction with the friendly service provided by Medicare Australia staff

Performance

76 per cent of the public agreed that Medicare Australia’s staff provide service with a smile, in an engaging and friendly manner.

We will listen to your feedback and be responsive to your needs.

Measure

Satisfaction with services and responsiveness to needs by Medicare Australia staff.

Performance

Satisfaction with Medicare Australia’s services was rated as follows:

90 per cent of the public 89 per cent of medical practitioners 95 per cent of medical practice managers 87 per cent of pharmacists.

Measure

An 1800 complaints and feedback line have been established for the public and providers.

Performance

In 2006–07, 680 calls were made to the complaints and feedback line. All have been resolved.

We will respond to your complaints promptly.

Measure

Respond quickly to complaints.

Performance

51 percent of the public agreed that Medicare Australia responded to complaints promptly. Only six percent disagreed; the remainder were neutral or did not know.

We will acknowledge your feedback within two days and respond to all feedback within14 days.

Measure

We will acknowledge your feedback within two days.

Performance

75 percent of feedback was acknowledged within two days.

Measure

We will respond to all feedback within 14 days.

Performance

77 percent of feedback was responded to within 14 days.

We will treat you with respect and courtesy.

Measure

Satisfaction with respectful and courteous services provided by Medicare Australia staff

Performance

86 percent of the public agreed that Medicare Australia’s staff treated them with respect and courtesy.

Respect my rightsWe will respect the privacy and the confidentiality of your personal information.

Measure

We respond to all complaints about the use and disclosure of personal information and publish results in the annual report.

Performance

We received 92 complaints about the use and disclosure of personal information we hold. Of these complaints, 38 were found to be not substantiated, 50 were substantiated and appropriate action was taken. As at 30 June 2007, four complaints were still being assessed. Of the 92 complaints, four were originally lodged with the Office of the Privacy Commissioner, who referred them to Medicare Australia for action. One was substantiated and three were not substantiated.

Measure

Satisfaction with Medicare Australia staff respecting the privacy and confidentiality of personal information

Performance

88 per cent of the public agreed that Medicare Australia respected their privacy.

We will respect your rights to seek a review of our decisions.

Measure

Complaints lodged with the Commonwealth Ombudsman.

Performance

During 2006–07, the Commonwealth Ombudsman received 123 complaints about Medicare Australia, a decrease of 34 (21.7 per cent) from the previous year.

Certification with the International Customer Service StandardMedicare Australia first achieved certification with the International Customer Service Standard in 2004 and was awarded with recertification again in 2005 and 2006.

The most recent certification assessment report indicated the following:

The design, content and integration of the Medicare Australia Service Charter are very impressive. The Charter is now ranked as one of the best in Australia and the determination of the Medicare Australia leadership team to pursue its vision and achieve a revolutionary result are to be commended. The Service Charter rollout was an example to how all organisations should introduce new Charters.

External awards and recognitionMedicare Australia won three state awards and a national award in the Call Centre Government category from the 2005–06 Customer Service Institute of Australia (CSIA) awards. Three award nominations were submitted to the CSIA’s 2006–07 Australian Service Excellence Awards in the open categories of Service Charter, Large Business (Medicare office network) and Call Centre (Queensland). The awards are highly contested by both public and private organisations.

Medicare Australia was a finalist in all three categories and won two of the major awards in the Service Charter and Large Business categories.

FeedbackMedicare Australia values all feedback. We have established a dedicated team to improve the way feedback from the Australian public is recorded and reported. This has led to an increase in the number of compliments and complaints recorded in 2006–07.

The service managers in each state analyse complaints and ensure that problems are resolved and opportunities for business improvements are identified and implemented.

Table 5 – Feedback register

Feedback type Volume

2005-06 2006-07

Suggestions 109 125

Compliments 417 721

Complaints* 786 1325

* A complaint is entered onto the feedback register only if it is not satisfactorily resolved by either the staff member initially contacted or the staff member’s supervisor.

In one of the four promises in our service charter (‘be genuinely interested in me’), we promised to respond to feedback in a timely and efficient manner. We committed to reduce the time we take to acknowledge feedback from 14 days to two days and to reduce the time we take to respond to complaints from 28 days to within 14 days. We have now implemented processes to fulfil these promises.

OmbudsmanWe have centralised our handling of complaints to the Commonwealth Ombudsman to ensure that we respond to the needs of the Australian public. Between 1 July 2006 and 30 June 2007, the Commonwealth Ombudsman received 123 complaints concerning Medicare Australia, a 21.7 per cent decrease (34) from the previous year. During the year, the Commonwealth Ombudsman closed 116 cases concerning Medicare Australia, covering 124 issues. Of the cases closed, 31 (26.7 per cent) covering 34 issues were investigated. No findings of administrative deficiency were recorded.

Local Liaison Officer ProgramThe Local Liaison Officer (LLO) Program continued to operate throughout 2006–07.Local Liaison Officers are a channel where Members of Parliament and Senators can receive advice in response to constituent concerns about any DHS agency, including Medicare Australia. The program aims to make all DHS agencies more responsive to information requests and complaints that come directly through Ministers, other Members of Parliament, Senators and their staff.

We currently have 16 LLOs supporting 16 of the 150 Members of Parliament and 17 LLOs supporting 22 of the 76 Senators. The remaining Members and Senators are supported by LLOs from other DHS agencies.

To ensure that all Medicare Australia LLO referrals are acknowledged within 48 hours, a network of back-up LLO staff and contact officers has been established.

In 2006–07, 4 580 referrals were received throughout DHS, of which Medicare Australia LLOs received 424. Of these, 92 were enquiries that related directly to Medicare Australia.

People with disabilitiesDuring 2006–07, Medicare Australia continued to respond to the Commonwealth Disability Strategy with a range of activities guided by the principles of equity, inclusion, participation, access and accountability. Information kits about our programs are available in Braille, large-print and audio formats from Medicare offices and Medicare Australia contact centres. Large-print information is also available from the Medicare Australia website.

We provide access to the Telephone Typewriter Service and the National Relay Service for people with hearing or speech impairments.

The provisions of adequate physical access to Medicare offices is mandatory elements in all lease negotiations. Elements that are continuously upgraded include the installation of automatic doors, sit-down service counters and writing slopes. Adequate seating, along with the electronic queue ticket systems in our busiest offices, makes our offices more comfortable for the public.

Counter hearing systems will be installed in a number of Medicare offices to provide better access to services for people with hearing disabilities.

Indigenous AustraliansThe Australian Bureau of Statistics preliminary estimates indicate that, as at 30 June 2006, Indigenous people make up 2.5 per cent of Australia’s population, which equates to around 517 000 people. Most Indigenous people live in New South Wales and Queensland, followed by Western Australia and the Northern Territory.

Indigenous Access ProgramMedicare Australia’s Indigenous Access Program was established in 2000 to improve Aboriginal and Torres Strait Islander people access to our programs. The program supports health service providers and Indigenous people to make full use of Medicare Australia programs and ultimately to improve their health outcomes.

The Indigenous Access Program is led by a national office team responsible for setting the strategic direction for initiatives and policies relating to Indigenous service delivery. This includes the management and coordination of the key activities of the national network of Medicare Indigenous Access liaison officers. Liaison officers operate in each state and territory and have a range of culturally appropriate skills and expertise. They work closely with Aboriginal and Torres Strait Islander medical services and other health service providers to promote and support the use of Medicare Australia programs.

The network improves enrolment and access to Medicare Australia services, providing systematic, dedicated support and outreach services to Indigenous people and communities.

The responsibilities of the Indigenous Access liaison officers are to:

provide Medicare education and training to Aboriginal and Torres Strait Islander Health Service (ATSIHS) staff to increase enrolments in Medicare and to ensure that correct Medicare benefits are claimed, resulting in increased Medicare revenue for the service

provide support and expert advice to health service staff and providers when new Medicare initiatives are released

make field trips and visits to health services, local communities, prisons and schools Represent and promote Medicare Australia programs and services at local Indigenous forums and

events.

Medicare Australia also has a dedicated telephone service to assist health service providers and Indigenous Australians with enquiries.

The Aboriginal and Torres Strait Islander Access line (1800 556 955), supported by liaison officers in state headquarters, receives around4 000 calls per month.

Stakeholder engagementMedicare Australia is represented on the Cross Agency Indigenous Servicing Task force, which strengthens collaboration between DHS agencies to improve service delivery to Indigenous Australians. Since its inception, the taskforce has overseen the implementation of a rangeof DHS partnering initiatives, which have extended access to Medicare services.

These initiatives include the following.

Throughout northern Australia, basic Medicare services are provided through the Centrelink Remote Area Service Centre network and some small service centres and agent sites. Services offered from these sites include Medicare enrolments, updating contact details, manual collection of Medicare claims, ordering new or replacement Medicare cards and general enquiries.

People in northern Australia can now access Medicare Australia information and support through the Centrelink Indigenous Call Centre network. Under this initiative, Centrelink staff transfer calls directly to Medicare Australia’s Aboriginal and Torres Strait Islander access line.

Department of Human Services’ agencies schedule joint field trips where appropriate. The field trips increase the breadth of community access and foster networking between agencies and communities.

Medicare Australia also works with industry groups, such as the National Aboriginal Community Controlled Health Organisation, to develop culturally appropriate education materials and policies for ATSIHS staff.

Business practice agreements have been established to define the arrangements and obligations agreed between Medicare Australia and DoHA’s Office of Aboriginal and Torres Strait Islander Health(OATSIH), including funding for additional Indigenous Access liaison officers and otherstrategic initiatives.

Medicare Australia also continues to work withhealth authorities, medical practitioners and communities to improve the accuracy of immunisation data for Indigenous children.

Key activities in 2006–2007In November 2006, Medicare Australia’s Corporate Management Committee endorsed the National Indigenous Strategy. The strategy was developed as a blueprint for three years (2006–2009) of action to improve Indigenous access to our programs and services. It aims to create a collaborative and nationally consistent platform to enhance our service delivery to Indigenous Australians.

The strategy incorporates the findings and recommendations of a 2006 Urbis Keys Young market research study, jointly commissioned by Medicare Australia and DoHA. We have formed the Indigenous Strategy Steering Committee to oversee the implementation of the strategy.

The National Indigenous Access Program Conference, held in Canberra in November 2006, was attended by all Medicare Australia Indigenous Access liaison officers, their managers and the stakeholders of the Indigenous Access Program. The conference discussed factors affecting Indigenous service delivery and set the planning framework for improving the capacity of the Indigenous Access Program.

The development and rollout of the Voluntary Indigenous Identifier Communication and Education Strategy aims to encourage all Indigenous Australians to self identify.

The Indigenous identifier allows Medicare Australia to capture vital information about Indigenous enrolments and is part of a broader government initiative to identify areas of high Indigenous populations so areas of greater need can be targeted. The identifier gives us information for future program planning, policy development and service improvements.

Between July and October 2006, Medicare Australia participated in eight Croc Fest events across Australia.

The Department of Human Services sponsored the ‘I Want to Be’ and ‘Climbing Wall’ activities and Medicare Indigenous Access liaison officers assisted with these events and provided promotional materials for those attending (including an estimated 17 500 children).

The Indigenous Access Program supported OATSIH with a national rollout of Medicare education workshops. The workshops were targeted at the OATSIH funded Indigenous health services and relevant health professionals and provided a great opportunity to meet some of the key stakeholders and to strengthen our alliance with OATSIH.

We strengthened our commitment to Indigenous communities in northern Australia by establishing regional offices in Broome, Cairns and Darwin, significantly improving access to services and support and we continued to operate the Aboriginal and Torres Strait Islander access phone number.

Reconciliation Action PlanMedicare Australia has developed its first Reconciliation Action Plan. Underpinned by the National Indigenous Access Strategy and the Indigenous Employment Plan, it commits us to initiatives under the four key result areas of the National Indigenous Access Strategy.

1. Improving Indigenous access to our programs.

2. Increasing Indigenous Australians’ awareness of our services.

3. Delivering great service to all Australians.

4. Becoming an employer of choice for Indigenous Australians.

Collection of health service informationMedicare Australia collects information on medical practitioners providing services at Indigenous health services registered under section 19(2)of the Health Insurance Act. Under the Act, the Minister for Health and Ageing has directed that Medicare benefits be paid to these health services. Benefits are not payable where a health service is funded from another source, unless the Minister directs otherwise.

The information we collect enables the identification of Medicare payments provided to these health services and subsequently used to improve Indigenous health.

Cultural diversityAustralia is one of the most culturally diverse nations. Around 25 per cent of Australians were born overseas and more than 40 per cent have one or both parents who were born overseas. Australia’s people are drawn from about 185 countries and speak more than 200 languages at home. Medicare Australia continuously develops strategies to communicate effectively with this diverse audience.

We receive eligibility information about migrants and applicants for permanent residence from the Department of Immigration and Citizenship. This electronic data transfer helps to streamline enrolment processing for new arrivals.

In line with the Charter of Public Service in a Culturally Diverse Society, endorsed by the Council of Australian Governments, we offer a number of services and activities to assist people from culturally and linguistically diverse backgrounds. Information kits about the programs administered by Medicare Australia are available in 18 languages from Medicare offices, call centres and our website.This information is also available in English on audio cassettes for people.

People can access more than 100 languages through the telephone interpreter service and speak to a qualified interpreter by phone or at a face-to-face interview.

In 2006–07, more than 2600 accessed Medicare Australia information through the telephone interpreter service. Many Medicare Australia employees are bilingual and use their language skills to make communication with the Australian public easier and more effective.

Staff mattersLike most organisations in Australia, Medicare Australia faces increasing challenges in attracting and retaining staff in a tight labour market affected by high employment levels and an ageing workforce.

A major focus in 2006–07 was on developing innovative and flexible practices to attract, develop, remunerate and reward staff, to ensure they want to stay with us.

Attraction and development: a capability frameworkMedicare Australia must identify the capabilities required of our future workforce, support current staff to develop those capabilities and use targeted recruitment. To meet this challenge, we developed and introduced our Capability Framework in 2006–07. The framework is the first step in realigning the capabilities of our people and identifies the broad, nationally consistent, capabilities we need to maintain our reputation for excellence in service delivery.

The framework will be integrated progressively into all our human resources functions. It will inform the core selection criteria for all vacancies and underpin performance and development agreements as well workforce planning at organisational and job-specific levels.

The Capability Framework defines six ‘capability clusters’.

1. Exemplifies great service.

2. Shapes strategic thinking.

3. Achieves results.

4. Cultivates productive working relationships.

5. Exemplifies personal drive and integrity.

6. Communicates with influence.

‘Exemplifies great service’ is from the Medicare Australia service charter and the behaviours that demonstrate our promises to the Australian public and service providers. The other fi ve are based on those developed by the Australian Public Service Commission and reflect the capabilities required of all Australian Public Service (APS) employees.

RecruitmentIn 2006–07, Medicare Australia developed innovative recruitment practices to attract the widest possible field for vacant positions. We used a wide range of media for advertising, including online employment sites, community newspapers and university career and websites.

Application processes have been greatly simplified, particularly by reducing the requirement to address individual selection criteria in favour of a broad statement of claims and selection is now consistent across the organisation. As a result, we have been able to attract many new staff from outside the APS, including the Canberra market, bringing in new skills and experience.

In 2006–07, Medicare Australia developed a nationally consistent employee induction program. The program aims to ensure all new starters understand our business context and challenges and provide a guide to working in the organisation.

Medicare Australia’s principlesTo ensure a good fi t between potential employees and Medicare Australia, we continued work to develop a set of principles specific to the organisation. The principles will translate the APS Values to Medicare Australia’s operating environment and align with our service charter and strategic themes.

We created a draft set of principles after analysing responses to a question in our 2005–06 staff survey: ‘What words best describe what you most value about working for Medicare Australia?’. Extensive consultation followed with more than 200 staff in the national and state offices. We expect to produce a final set of principles during 2007–08.

Certified agreementMedicare Australia’s current certified agreement (2005–2008) has a nominal expiry date of 5 December 2008. The agreement applies to all Medicare Australia employees, other than Senior Executive Service (SES) staff and those staff covered by an Australian Workplace Agreement (AWA).

The certified agreement establishes a clear link between salary increases and organisational performance. This helps to ensure all staff can see how their commitment and performance contributes to the success of the organisation. Of the four per cent annual salary increase available in 2006 and 2007, one per cent is conditional on staff supporting strategies to achieve organisational outcomes. In December 2006, the Corporate Management Committee confirmed that staff had met this criterion for 2006. Consequently, the one per cent increase was paid to all staff covered by the certified agreement. A further one per cent was paid if the individual employee achieved a rating of ‘fully effective’ or higher in their annual performance assessment.

Australian Workplace AgreementsMedicare Australia has used AWAs as a means to attract and retain quality people in

a tight employment market. Non-SES AWAs offer access to performance pay, increased annual salary rates and, for specialists such as medical officers, a professional development allowance.

We are broadening the use of AWAs as a retention and recognition strategy, offering them progressively to frontline managers of branch offices, managers of information and processing

centres and some other staff at the APS 5 and APS 6 levels. With the exception of performance based pay, non-SES staffs covered by an AWA receive conditions of employment (for example, leave, overtime, shift work allowances) consistent with the agency’s collective agreement.

Senior executive remunerationSenior executive remuneration is offered as a package through an AWA. Australian Workplace Agreement remuneration levels are subject to approval by the CEO and are based on work value, individual capability, individual contribution, performance and market considerations.

A notional salary range for each classification level is set with reference to market comparisons, taking into account:

the annual survey of APS SES remuneration commissioned by the Department of Employment and Workplace Relations

general economic conditions Medicare Australia’s need to sustain a high level of performance.

The CEO reviews senior executive remuneration at the end of the annual performance cycle, taking into account the organisational performance of Medicare Australia, individual performance and comparative remuneration data.

Managing performanceMedicare Australia places great emphasis on establishing clear performance agreements between managers and staff. Under our certified agreement and AWAs, all staff are required to enter into performance support agreements with their managers.

The Performance Support Program is linked to our business planning, so staff understand how their work contributes to the objectives of the wider organisation and have a clear understanding of what is expected of them over the year.

In the 2006–07 staff survey, 90.6 per cent of all staff agreed that ‘I know what is expected of me at work’, demonstrating that performance support agreements are effective. Performance reviews are undertaken mid-term in December. Annual assessment occurs in June–July.

We encourage managers and staff to undertake quarterly reviews in September and March.

Performance payAll staff covered by AWAs is eligible for performance bonuses. Staff who receive a performance rating of ‘fully effective’ or above are entitled to the bonus. Staffs are assessed each June at the completion of the performance cycle. Where the bonus is applicable, it is paid in August.

Medicare Australia Excellence AwardsThe Medicare Australia Excellence Awards began in July 2006, establishing a consistent means to identify, recognise and reward outstanding performance across the organisation. Certificates and gift vouchers are awarded to winning teams or individuals in each state office and the national office every six months. Winners from these rounds are considered in December and January for the National Excellence Award.

In January 2007, the CEO presented the first National Excellence Award to the Victorian Environmental Focus for Ongoing Results Team (EFFORT). The award recognised the team’s major contribution to Medicare Australia and the Australian public in developing new initiatives that

contributed to environmental improvement and significant cost savings for the agency. Policy and practice for the awards was reviewed in early 2007, including independent comment from the Customer Service Institute of Australia. As a result, improvements will apply from late 2007.

Staff surveyMedicare Australia conducts an annual survey of all staff to determine their level of engagement with the organisation. Nearly 92 per cent of staff completed the questionnaire for the 2006–07 survey, which was conducted on 2 May. Results were extremely encouraging, with 79 per cent of staff saying they were satisfied with Medicare Australia (up from 71 per cent the previous year) and 89 per cent saying they were committed to contributing to the success of the organisation (up from 84 per cent).As in previous years, all business and risk management plans will integrate specific actions and timeframes to address concerns raised in the survey. Business units will report back regularly on progress made.

Human resource consultantsEach state and national office human resources team employs a number of consultants to advise and guide managers and staff and clarify policy. This support covers a broad range of matters, including remuneration strategies, counselling, performance management, recruitment, retention, conditions of service, flexible working arrangements and managing absenteeism.

Learning and developmentAn integrated learning and development framework is fundamental to retaining staff and ensuring they have the skills to meet emerging challenges. During 2006–07, the learning and development focus in Medicare Australia was on the design, development, implementation and evaluation of training to give staff relevant skills and to train new staff in current programs.

We placed particular emphasis on providing nationally consistent program content to all staff, regardless of their location. To do this, we used blended learning techniques and a number of media presentations for training, while complying with adult learning principles.

One major achievement was the development and implementation of CustomerFirst, a customer service training program for all Medicare Service Officers. This program was developed in response to the changing environment in which Service Officers operate and particularly their higher level of interaction with the public arising from such new responsibilities as Family Assistance.

Implemented nationally with outstanding results, the program uses in-house facilitators with current operational experience. Customer First will be offered to all new Service Officers as part of their induction and will become part of the operational training curriculum.

e-LearningMedicare Australia has continued to develop eLearning training programs to support its blended learning philosophy. The programs, which have been developed in-house to meet corporate and operational technical needs, cover:

Online Services records management business process flows environmental management awareness organ donor program electronic funds transfer

consumer directory maintenance system Medicare and PBS.

Core skillsPerformance support agreements identify individuals’ learning and development needs. We run a range of training programs in-house and externally. Major programs delivered in 2006–07 included contract management, project management, writing skills and business analysis.

Knowing theBusiness ProgramThe Knowing the Business Program is an important recent initiative in Medicare Australia. The program enables our people to better understand the work of others in the organisation and to appreciate how the work environment is changing. It has three elements.

1. Knowing the Business – Frontline takes national office staff into the Medicare office network so they can understand and appreciate the work done by Service Officers. Eleven senior staff undertook this element in 2006–07.

2. Knowing the Business – Corporate enables staff from state offices and Medicare offices to visit and work in the national office, to understand the relationship between operational requirements and national office strategic policy and planning. Nine staff from various locations participated in this element in 2006–07.

3. Knowing the Business – Customer was developed to foster relationships between Medicare Australia and external stakeholders by conducting visits to a particular area of our business. Ten staff from DHS participated in this element in 2006–07.

Equity and diversityMedicare Australia’s Equity and Diversity Plan 2004–07 entered its third year of operation amid continued organisational change. To continue to assist staff to transition to the APS, a training program was completed in late 2006 for all people managers, who then provided training for their staff. The program was complemented by an eLearning module that provided an introduction to the APS Values and Code of Conduct, with some scenario activities to help staff understand how the values and code apply in the workplace.

Medicare Australia has committed to increasing Aboriginal and Torres Strait Islander staff to two per cent of the agency’s workforce by the end of 2008 and has made significant steps towards this goal. By the end of June 2007, 1.62 per cent of staff had identified themselves as Indigenous Australians. Medicare Australia recently developed a new Indigenous Employment Plan, which is focused on developing a nationally consistent approach and framework for the recruitment and retention of Indigenous Australians. Key elements of the plan were included in our Reconciliation Action Plan, which was formally presented to Reconciliation Australia at a ceremony on 30 May 2007.

The plan commits us to further reconciliation initiatives and will help us work towards important strategic goals, such as improving Indigenous access to our programs and becoming an employer of choice for Indigenous Australians.

The Indigenous Employment Plan includes participation in the National Indigenous Cadet Program. Our Information Technology Services Division placed three Indigenous cadets during the year. The cadets, who are undertaking tertiary studies, gain valuable work experience by working at Medicare Australia for a total of 60 days each year during term and semester breaks.

This program will continue as it is benefiting both the organisation and the cadets.

In response to the Management Advisory Committee’s 2006 Report on Employment of People with Disability in the APS, Medicare Australia is developing a Disability Action Plan with the assistance of the Australian Employers’ Network on Disability. The network has undertaken a desktop review of our recruitment process and will work with us to review our approach to reasonable accommodation and adjustment.

Our Western Australian state office has worked successfully with CRS Australia to provide work training for CRS Australia clients. In the past 18 months the office provided 34 work training placements for CRS jobseekers; 14 obtained employment with us after the placement, most through merit-based selection. CRS Australia nominated the state office for the 2006 Prime Minister’s Employer of the Year Awards for this work.

A significant percentage of Medicare Australia staff originate from a non-English speaking background which is consistent with our role of delivering services to the entire Australian community. At 30 June 2007, 15.7 per cent of all staff were from a non-English speaking background.

Occupational health and safetySecuring the health and safety of all staff at work is a key priority for Medicare Australia, in accordance with the requirements of the Occupational Health and Safety Act (OHS Act). In 2006–07, we focused on developing national occupational health and safety (OHS) strategies.

Significant Achievements in 2006–2007The Safety Management Unit in National Office was at the centre of work to develop preventive strategies to reduce the number and severity of workplace injuries. All state headquarters and the national office have a designated position responsible for day-to-day OHS, rehabilitation and compensation operations.

These OHS representatives work closely with the Safety Management Unit to implement OHS strategy in a coordinated way. An emerging task for the Safety Management Unit was to develop health and safety management arrangements in line with changes to the OHS Act. A two day workshop in Queensland on 30 April and 1 May began developing the arrangements, which we expect to, implement in September 2007.

Medicare Australia’s National OHS Strategy and state OHS action plans focus on two areas. The fi rst focus is on the agreed priorities identified in the Medicare Australia National Business and Risk Management Plan. The two key OHS priorities included in the plan for 2006–07 were:

providing a safe workplace by design

providing an integrated framework for the management of return to work for staff with compensable or non-compensable injuries or illness

The second focus is on meeting Comcare’s highly challenging health, safety and rehabilitation targets. Initiatives in 2006–07 to address these areas of focus included:

a review of protracted workers’ compensation and non-compensation cases

a rollout to all managers of OHS training, including ‘Prevention and Management of Body Stressing Injuries for Managers’

a national campaign to promote good office hygiene

promotion of an online injury and hazard report form

a new OHS intranet site

promotion of World Day for Health and Safety at Work on 27 April 2007

Development of the new workplace health and safety management arrangements required under the Occupational Health and Safety Amendment Act 2006.

We used various means to ensure consistency in approach across Medicare Australia, including monthly teleconferences of state and national office OHS representatives. The teleconferences helped the consultants keep abreast of the latest OHS and workers compensation issues and initiatives, such as:

updates on prevention from the states progress on national initiatives rehabilitation issues and diffi cult workers compensation cases Comcare advice notices and training activities.

Medicare Australia held a three-day conference for Medicare Australia’s OHS representatives in November 2006. The conference focused on ‘providing a safe workplace by design’ and included sessions on duty of care and the new penalty regime; accident investigation; OHS risks related to relocation and refurbishments; bullying and harassment; an introduction to OHS contracting; and rehabilitation provider expectations.

The Safety Management Unit provided quarterly reports to state managers on their performance in compensation and injury management.

The reports detailed how each state’s performance contributed to meeting Comcare’s health, safety and rehabilitation targets. Quarterly teleconferences were also held with each state manager, human resource manager and OHS consultant to help the states reach the targets. Medicare Australia reinforced reporting with targeted training. During March, April and May, Comcare conducted training in preventing and managing body stress injuries for managers in all states. The training is one of our initiatives to reduce such injuries. Medicare Australia also implemented a suite of generic plant risk assessments for the 20 most frequently used items of plant throughout Medicare Australia during the year. Medicare Australia participated in quarterly DHS national OHS networking meetings.

The meetings were hosted by different DHS agencies in rotation and allowed us to share experience in the prevention and management of occupational injury.

Health and safety outcomesMedicare Australia’s approach to managing workers compensation claims had a positive impact on key performance indicators and the workers compensation premium rate. The excellent results achieved in 2006–07 were due to our injury prevention strategies over the past three years. The premium rate was also influenced by improvements in average compensation claim costs and by legislative changes that reduced access to journey injury claims.

Medicare Australia achieved the following results in 2006–07, compared to 2005–06:

five per cent decrease in injury frequency 19 per cent decrease inclaims frequency 11 per cent decrease in claims resulting in fi ve days or more off work four per cent decrease in total weeks off work 24.7 per cent decrease in the 2007–08 workers’ compensation premium rate.

Despite an increase in overall staff numbers, the number of accepted claims has dropped over the last three years from 160 in 2004–05 to 92 in 2006–07.

During the year, 26 incidents required notification to Comcare, of which one incident was investigated. While no action was taken under the enforcement provisions of the OHS Act, an action plan and timeframe for the implementation of Comcare’s recommendations were developed. No

directions were given under section 45 of the OHS Act; nor were any notices given under sections 46 or 47.

One provisional improvement notice was issued under section 29. The work area took the necessary action to address the concerns raised in the notice and the notice was lifted.

Access to personal informationMedicare Australia ensures high standards of privacy protection. We have an extensive range of privacy protection measures in place to ensure that we maintain community confidence by meeting our legislative responsibilities and attain best privacy practice. We conduct Privacy Impact Assessments (PIA) for new business initiatives and significant revisions to existing business and for personal information audits. Business units receive comprehensive and timely privacy advice from the Legal, Privacy and Information Services Branch. Staffs also receive twice-yearly messages from the CEO about privacy standards.

The secrecy provisions of the Health Insurance Act and the National Health Act make it an offence for a Medicare Australia officer to disclose information about a person to a third party, unless a specified exception or release provision applies. For example, information may be released to state health regulatory authorities, such as medical and pharmacy boards, on matters affecting the registration of professional health providers. There is also provision under section 130(3) of the Health Insurance Act and section 135A(3) of the National Health Act for the Minister for Health and Ageing, or an officer to whom this authority is delegated, to certify that it is in the public interest for information to be released.

Requests for the release of Medicare and PBS claims history information are processed in accordance with the Health Insurance Act and the National Health Act, respectively. Requests for other types of information or documents are processed under the Freedom of Information Act 1982. Appendix B of this report contains statistics on Freedom of Information requests.

Medicare Australia is capable of auditing transactions within all its systems. Our staff are regularly reminded of their obligations regarding the use of personal information; automatic warning notices on computer screens are a further reminder whenever staff access electronic data.

Medicare Australia complies with the Privacy Commissioner’s guidelines on data matching and the storage and destruction of personal information. We can provide de-identified statistical information, in accordance with the relevant legislation, to help research projects that have the potential to improve the health and wellbeing of Australians.Policies and standards set out in the Commonwealth Protective Security Manual are observed and security controls are in place to ensure a high level of protection for the data stored in Medicare Australia records.

Privacy trainingThe Privacy and Information Release Section of our Legal, Privacy and Information Services Branch plays a fundamental role in raising awareness of privacy issues through training, participation in various privacy forums and the provision of expert advice to internal and external stakeholders. Medicare Australia meets its legislated training responsibilities by ensuring that all ongoing and non ongoing employees, contractors and consultants complete the ‘National Privacy and Security Training’ module. The module includes the Medicare Australia privacy awareness raising video, Minding Your Business, which is a part of the Medicare Australia Privacy Training Kit. An eLearning version of the training module was implemented in 2006–07.

Privacy Impact AssessmentsMedicare Australia has developed PIA guidelines and a checklist to help managers determine whether a PIA is necessary for their project. A PIA is an analysis of the personal information flows and potential privacy risks of a project, conducted to mitigate privacy risks and impacts, ensure compliance with legal obligations and build best privacy practice into projects.

In 2006–07, Medicare Australia established a working group to assist the Access Card Consumer and Privacy Taskforce. The working group provided the taskforce with experience in conducting PIAs, knowledge of Australian Government privacy policies and an understanding of the application of current privacy policies in the key participating agencies. The taskforce’s PIA was presented to the Minister for Human Services before revised access card legislation was introduced into Parliament in June 2007.

The working group was headed by a deputy CEO of Medicare Australia and included a senior officer from Centrelink, a legal officer from Medicare Australia and privacy officers from Medicare Australia and Centrelink.

Medicare Australia also conducted PIAs for e-tax and online services projects in 2006–07.

In 2007–08, the Privacy and Information Release Section will continue to work closely with the Unique Health Identifier and access card projects.

ConsultanciesMedicare Australia engages consultants when we do not have sufficient specialist expertise available or when we consider that independent assessment is desirable. Consultancies have provided advice on:

management of organisational change analysis of Medicare Australia’s audit and compliance programs finalisation of the qualitative component of customersatisfaction research in 2006.management of

organisational change

During 2006–07, we entered into 37 new or extended consultancy contracts, involving total expenditure of $3.2 million.

Consultants or consulting firms who were paid $10 000 or more during 2006–07 are listed in Appendix D.

National procurementThe DHS procurement principles require portfolio agencies to combine their procurement activities wherever practicable to maximise combined purchasing power. During 2006–07, Medicare Australia participated in procurement processes conducted by other agencies for services including:

accommodation brokering

short term vehicle hire

supply of safes, security and storage containers and storage solutions

information technology vendor panels.

We were the lead agency for DHS in the procurement of:

records storage stationery and office products Express air freight services.

National propertyIn 2006–07, Medicare Australia entered into a new lease for accommodation for the Victorian state headquarters at 595 Collins Street. Victorian staff moved into their new premises in the last week of June. The fi t out of this office incorporates the latest design features for office accommodation, including an open plan environment, flexibility in design to meet business needs and an appropriate level of amenity.

We also negotiated a new lease for the Queensland state headquarters. Fit out of the new premises has begun and we expect staff to move in during February 2008.

A major accommodation program was undertaken to consolidate the national office staff within the Tuggeranong precinct in the Australian Capital Territory. To achieve this, we have leased additional space in Tuggeranong and surrendered leased accommodation outside the immediate area.

The national Medicare branch office fi t out to incorporate Family Assistance office service delivery into the branch office network was completed during 2006–07. Electronic queue ticketing systems are being installed progressively to improve efficiency and customer service.

Records managementInformation management and record keeping are important components of governance in Medicare Australia. As an Australian Government agency, we are obliged to maintain good records of our business activities for legal purposes.

Key activities undertaken during 2006–07 were:

publication of the Medicare Australia Records Management Framework 2007 continuation of education and training in record keeping compliance a move towards national outsourced storage of archived records a move towards national consistency in the sentencing and disposal of corporate records.

Environmental sustainabilityEnvironmental managementMedicare Australia is committed to best practice environmental performance through an environmental management system that aligns to the ISO 14001 international standard.

We have adopted a structured management approach to report our ongoing management of environmental risks and environmental initiatives. After a review of Medicare Australia’s environmental impacts; we developed a policy to systematically address the environmental aspects of:

business decision making and procurement energy, water and paper use Waste management.

A key requirement of the environmental management system framework is environmental awareness rising among staff and contractors. To raise awareness, we have established:

fully interactive eLearning modules on energy, paper, water and waste recycling, available to staff on the corporate intranet

an intranet site dedicated to environmental information, initiatives, targets and general performance

a nationwide network of environmental coordinators to achieve consistent and standardised environmental practices

induction training on environmental awareness for new employees whole-of-lifecycle assessment and environmental requirements in the procurement process, such

as the use of certified environmental labelling meeting ISO 14000 series standards enhanced business planning processes to mitigate environmental risks Environmental impact statements in costing templates for new business proposals.

After environmental audits and data gathering exercises to determine baseline measurements, Medicare Australia has developed a series of initiatives for energy, water, paper and waste management. The initiatives are performance managed (or governed) under our balanced scorecard through environmental key performance indicators and targets.

Environmental PerformanceThe whole-of-government energy performance is reported to the Australian Greenhouse Office (AGO) by 31 October each year and is externally reported in the Energy Use in the Australian Government Operations Report. The Medicare Australia energy consumption for 2006–07 is currently being determined for this reporting exercise.

Medicare Australia is currently achieving the 2011–12 energy targets set in the 2006 Energy Efficiency Government Operations (EEGO) policy. This is as a result of utilisation of energy efficient technologies as well as maximising occupancy density – based on a three dimensional fi t-out design approach. In 2005–06, Medicare Australia achieved an energy use rating for tenant office light and power of 6 944 mega joules per person against an EEGO policy target for 2011–12 of 7 500 mega joules per person.

These efficiencies have been achieved in a business environment where Medicare Australia has extended its branch office trading hours to late night shopping and Saturday morning trading.

Medicare Australia strives for continuous energy improvements in its property network with independent energy audits scheduled for 2007. In addition, to offset greenhouse gas emissions, Medicare Australia purchases 2.5 per cent green energy.

This is expected to increase to 8 per cent by January 2008. Medicare Australia has 156 fleet motor vehicles comprising of both pool vehicles and executive vehicles. Of these, 30 per cent have a green vehicle guide rating of 10.5 or above. This figure is expected to increase to 39 per cent by December 2007 and 57 per cent by December 2008. Greenhouse gas emissions produced from all fleet vehicles have been offset through an offset subscription scheme. Medicare Australia also performance reports on motor vehicle fuel consumption as well as E10 usage in its balanced scorecard.

Medicare Australia is a member of the AGO Greenhouse Challenge Plus (GHCP) Program, to demonstrate a commitment to reduce greenhouse gas emissions. As part of the AGO program, Medicare Australia will undertake independent verification to quality assure energy data as well as take an active role in seeking new energy efficient technologies and/or offsets. In recognition of greenhouse performance, Medicare Australia was a finalist in the 2007 GHCP Awards in the Government and Essential Services category.

PaperMedicare Australia consumes 33 million sheets or 174 tonnes of internal copy paper per annum. This equates to 6 234 sheets per person per annum. In order to improve environmental performance,

Medicare Australia has introduced 50 per cent recycled copy paper for internal printers, faxes and photocopiers. On a consumption level, internal copy paper has steadily grown over the past few years

due to an increase in business activity as well as the rapid movement to high speed printer technology and competitive pricing structures of high speed printers.

To mitigate this issue, Medicare Australia has undertaken an extensive staff education program to reduce consumption through re-promoting double sided printing and introducing a tighter printer policy. It is expected that internal copy paper will reduce by 15 per cent by January 2008 with the introduction of these initiatives.

On an external level, Medicare Australia has achieved significant environmental benefits with the introduction of e-claiming and the associated declines in paper based claiming channels – also through projects, such as the forms and envelopes consolidation strategy. The combinations of these initiatives are expected to deliver a savings equivalent to five million A4 sheets of paper or 25 tonnes of virgin fibre paper in 2007. Over the coming years, Medicare Australia will be seeking to introduce recycled paper for external business arrangements providing the paper is fi t for purpose and cost effective.

WaterAs the drought continues in most parts of Australia, local governments have applied harsher water restrictions to minimise water consumption.

As such, Medicare Australia staff and property owners have assisted in this process of complying with water restrictions as well as developing initiatives to further address water consumption. The introduction of low flow taps and showers as well as high pressure flush systems have been introduced into the larger Medicare Australia property sites. New technologies and innovative designs to conserve water will be introduced into existing and new building designs.

During 2006 the total estimated water usage for Medicare Australia was 54 million litres. On a per person consumption level, the average water consumption during the year was 10 031 litres per person per annum. Of this amount, air conditioning represents 4 831 litres per person per annum and the remaining 5 200 litres per person per annum is for drinking, showers, toilets, cleaning, hand basin, kitchen and garden use.

Medicare Australia expects personal consumption (net of air conditioning) to decline by 10 per cent over 2007 through the above initiatives.

WasteIt is Medicare Australia’s aim to maximise recycling streams and to minimise waste to landfill. Key to this objective is providing easy accessibility to recycling bins and improved signage. In addition, the promotion of adverse environmental impacts of landfill, as well as benefits of recycling (waste to resources), is promoted to staff. Medicare Australia will continue to develop new recycling streams in order to divert landfill waste.

Medicare Australia sends 33 kg of waste per person per annum to landfill. With the introduction of recycling standardisation practices across the property network, improved recycling infrastructure and signage as well as the development of new recycling streams, Medicare

Australia expects to reduce personal landfill waste by 25 per cent over 2007.In addition, Medicare Australia has successfully introduced Medicare Australia Re-use Stations (or MARS) into communication centres, as a mechanism to reuse usable office supplies and equipment. Staffs seeking office supplies or equipment are encouraged to investigate MARS before placing new orders.

Section 04 ProgramsMedicareMedicare was introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care. Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and, in special circumstances, allied health services.

Medicare Australia administers Medicare enrolments and medical benefit payments through its network of Medicare offices and other information and claiming services.

We processed 257.9 million services in 2006–07, involving almost $12 billion in Medicare benefits. The figures in the following tables are adjusted on an accrual accounting basis.

Table 6 – Medicare enrolments, claims and benefits – key business results

2005-06 2006-07 % Change

Enrolments

Persons enrolled* at 30 June 2007

20.7 million 21.1 million +1.9%

Active cards at 30 June 2007


Services

Medicare bulk billed services 177.2 million 187.9 million +6.0%

Patient claimed services 70.2 million 70.0 million –0.3%

Total services processed 247.4 million 257.9 million +4.2%

Benefits

Average benefit per service $44.37 $45.74 +3.1%

Average period service to lodgement**

13.5 days 13.1 days –3.0%

Average period lodgement to processing***

3.9 days 3.3 days –15.4%

Total benefits paid $10.9 billion $11.8 billion +8.3%

* Persons enrolled include some people who are not Australian residents, such as visitors from countries that have reciprocal health care agreements with Australia and people covered under ministerial orders.

** Time between date of a medical service and lodgement of a Medicare claim.

*** Time between date of lodgement and processing of a Medicare claim.

Medicare claimingThe 257.9 million services were processed for payment by cheque, cash and electronic funds transfer (EFT) for paid accounts. Unpaid accounts were paid by cheques issued to the provider via the claimant.

Table 7 – Medicare services by bill type

2005-06 % 2006-07 %

Services paid by cheque to claimant 4.5 million 1.8% 4.5 million 1.7%

Services paid by cheque to practitioner via claimant 14.6 million 5.9% 12.9 million 5.0%

Services paid by cash (Medicare offices) 34.5 million 14.0% 34.4 million 13.3%

Bulk bill services – benefits assigned to practitioner by claimant

177.2 million 71.6% 187.9 million 72.9%

Services paid via simplified billing – in-hospital claims lodged electronically

13.1 million 5.3% 14.1 million 5.5%

Services via EFT 3.5 million 1.4% 4.1 million 1.6%

Total services 247.4 million 100% 257.9 million 100%

One service was processed via reverse EFTPOS transaction through Medicare Easyclaim

Figure 4 – Medicare services by bill type

Medicare Safety NetThe Medicare Safety Net is designed to help protect Australians and their families from high medical costs for out-of-hospital medical services. There are three safety net thresholds.

The concessional and Family Tax Benefit (part A) thresholdapplies to concession cardholders and families eligible for Family Tax Benefit (part A). Medicare will pay 80 per cent of the out-of-pocket cost for medical services provided out-of-hospital, after a threshold of $519.50 per registered family or individual per calendar year is reached. An out-of-pocket cost is the difference between the provider’s charge and the Medicare benefit paid for that service.

The general threshold applies to all Medicare cardholders. Medicare will pay 80 per cent of the out-of-pocket cost for medical services provided out-of-hospital, after a threshold of $1 039 per registered family or individual per calendar year is reached.

The gap threshold applies to all Medicare cardholders and is based on the difference between the Medicare Benefits Schedule (MBS) fee and the Medicare benefit paid for out-of-hospital services. Medicare will pay the full 100 per cent of the MBS fee after the gap threshold of $358.90 per registered family or individual per calendar year is reached.

Medicare eligibilityPeople who reside in Australia are eligible for Medicare benefits if they hold Australian or New Zealand citizenship, have been issued with a permanent visa or have applied for a permanent visa.

Restrictions and other requirements apply to people who have applied for a parent visa.

Australian citizens who have resided overseas for more than five years and permanent resident visa holders, who have resided overseas for more than 12 months, are required to demonstrate their intention to reside permanently in Australia before a Medicare card can be issued to them.

Medicare cardsMedicare cards are issued to eligible people to make it easy for them to access Medicare benefits. Four different Medicare cards indicate the holder’s level of Medicare eligibility to medical professionals and their staff.

Green Medicare cards are issued to Australian citizens and permanent residents and indicate that the holder has access to all eligible Medicare services.

Blue Interim Medicare cards are issued to consumers who are granted eligibility for Medicare while their application for Australian permanent residency is under consideration and indicate that the holder has time-limited access to all eligible Medicare services.

Yellow Medicare Reciprocal Health Care Cards are issued to visitors to Australia who are residents of countries with which Australia has reciprocal health care agreements. The holder’s access to Medicare services is time limited and does not cover treatment as a private patient in a public or private hospital.

Green Medicare smartcards were issued, as part of a trial conducted in 2005, to Australian citizens and permanent residents who lived in Tasmania. Like the green Medicare card, the smartcard indicates that the holder has access to all eligible Medicare services.

Medicare levy exemptionsThe purpose of the Medicare Levy Exemption program is to assess applications for a certificate which confirms that the applicant is eligible for exemption from paying the Medicare levy.

Exemption certificates are issued to people who, while living or working in Australia, are not entitled to Medicare coverage but are liable to pay the Medicare levy through their taxes.

When an application is approved, a certificate is issued to the applicant for the financial year. The certificate is then included with the applicant’s tax return at the end of the financial year.

The increase in rejected applications for 2006–07 was as a result of the tightening of regulations and documentation requirements.

Table 8 – Medicare cards and Medicare levy exemptions Medicare

Medicare 2005-06 2006-07 % Change

Cards

Total cards issued* 3 354 997 3 824 858 +14.0%

Medicare levy exemption

Total applications 26 342 27 216 +3.3%

Accepted applications 25 580 24 567 –4.0%

Rejected applications 762 2 649 +247.6%

* Includes health care cards issued under reciprocal health care agreements.

Eligible visitors to AustraliaThe Australian Government has signed reciprocal health care agreements with some countries, entitling residents of those countries to restricted access to health cover while visiting Australia. Currently, these countries are Finland, the Republic of Ireland, Italy, Malta, New Zealand, Sweden, Norway, the Netherlands and the United Kingdom.

Improved services for migrants and conditional migrantsDuring 2006–07, Medicare Australia and the Department of Immigration and Citizenship continued to work together, through the electronic transmission of information, to:

improve service delivery for people who have applied for, or been granted, permanent residency status in Australia

reduce administrative burdens associated with establishing Medicare eligibility

Simplify Medicare enrolment.

Staff at Medicare Australia also worked closely with migrant resource centres and volunteer groups dealing with migrants to provide information about Medicare requirements.

Mental healthThe Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative was developed as a core element of the Australian Government’s $1.9 billion contribution to the Council of Australian Governments’ mental health package to reform Australia’s mental health system. The aim of the initiative is to increase community access to better and more affordable team-based mental health care.

New MBS items wereintroduced on 1 November 2006 and 1 May 2007, including for services provided by psychiatrists, general practitioners (GPs) and allied mental health providers, such as:

registered clinical psychologists

registered psychologists

registered occupational therapists

Registered social workers.

General practitioners are best placed to coordinate the treatment needs of patients with mental disorders in the primary care setting and the new GP Mental Health Care Plan and Consultation MBS items support them to do this. The items provide a structured framework for general practitioners to undertake early intervention, assessment and management of patients with mental disorders and provide new referral pathways to clinical psychologists and other allied mental health service providers.

In addition, 20 new MBS items were introduced for allied mental health services provided to patients on referral from a general practitioner who is managing the patient either:

under a GP Mental Health Care Plan and/or

a psychiatrist assessmentand management plan, or

From a psychiatrist or a paediatrician.

Eligible allied mental health services include psychological assessment and therapy services provided by eligible clinical psychologists and focused psychological strategies provided by eligible psychologists, social workers and occupational therapists. Allied mental health professional bodies have provided information on their websites about members who are eligible to provide these services.

Enhanced Primary Care Plans – Allied Health and Dental Care initiativeThe Medicare Allied Health and Dental Care initiative commenced on 1 July 2004. It provides for Medicare benefits to be paid for certain services provided by eligible allied health professionals, dentists and dental specialists to people with chronic conditions and complex care needs who are being managed by a medical practitioner (not including a specialist or consultant physician) under an Enhanced Primary Care plan.

The initiative is open to Aboriginal health workers, audiologists, chiropodists, chiropractors, dental practitioners/specialists, diabetes educators, dieticians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists and speech pathologists.

The Medicare rebate for allied health professionals providing services under an Enhanced Primary Care plan is currently $46.80 per service. In the first three years of the initiative, over 1.7 million allied health services have been provided, representing around $79 million in Medicare benefits.

The take-up of allied health services has grown from over 248 000 services in the first year (2004–05) to nearly 931 000 in 2006–07. Almost a quarter of all services are provided in rural areas.

Medicare Australia special assistanceThrough Medicare Australia, the Australian Government provides assistance to meet individuals’ health and community care costs arising from certain adverse events, such as natural disasters and terrorist attacks. The government decides which events are to be covered. Usually, the people assisted in this way are people at the scene of the event or its aftermath, or their close relatives.

The assistance is in the form of ex-gratia payments to clients or health care providers for activities performed under guidelines agreed to or approved by an Australian Government Minister, by a taskforce or by various agencies. The activity is usually part of a whole-of-government initiative involving several government agencies and sometimes non-government organisations.

Medicare currently administers the following special assistance:

Balimed

Tsunami Healthcare Assistance

London Assist

Bali 2005

Dahab Egypt Bombing Health Care Costs Assistance.

Veterans’ Affairs processingMedicare Australia processes medical, hospital and allied health services claims for services provided to veterans on behalf of DVA. A service level agreement between Medicare Australia and DVA outlines the services, service standards and financial arrangements. In December 2006, we celebrated our 10th year of processing claims on behalf of DVA.

On 1 November 2006, we implemented significant system enhancements to support new Veterans’ Affairs policy and budget initiatives.

From 1 January 2007, a revised governance model took effect to ensure effective communication at all levels between the two organisations. The model includes senior level meetings and more regular project and operational meetings.

Representatives from both agencies continued a business rules taskforce to review health business rules and develop strategies for continuous processing and customer service improvement. The taskforce consulted key business areas to determine priorities. The focus was on DVA related medical claims to meet new online requirements and business rules associated with allied health providers. The taskforce identified problems and developed strategies to resolve them.

In 2006–07, we processed 21.8 million services for DVA, totalling nearly $2 billion. Medicare Australia also took on both the Gold and White card bulk re-issues during 2006–07 and introduced the new totally and Permanently Incapacitated Gold in February 2007.

Table 9 – Veterans’ Affairs activities – key business results

2005-06 2006-07 % ChangePTEC*, STEC**, RPBC*** and TPIG**** cards produced

75 503 173 090 +129.2%

Services processed 21.5 million 21.8 million +1.4%


* Personal Treatment Entitlement Card

** Specific Treatment Entitlement Card

*** Repatriation Pharmaceutical Benefits Card

**** Totally Permanently Incapacitated Gold card representing $6.5 billion in benefits.

Broadband for HealthThe Australian Government’s Broadband for Health initiative supports the use of broadband internet services by general practices, Aboriginal community-controlled health services and community pharmacies.

The Government provides an incentive for the take-up of Broadband for Health qualified services by eligible locations. The incentive assists with the installation costs and with the 12-month subscription cost of at least one broadband qualified service.

Visiting Medical Practitioners ProgramThrough an agreement with the Department of Health, Western Australia, Medicare Australia administers a visiting medical practitioner fee-for-service payment and information system. The system provides public non-teaching hospitals in Western Australia with a real time intranet processing system, which connects to the Medicare system, to access and pay invoices submitted by visiting medical practitioners for services to public patients.

This agreement, which has been in place since April 2000, was replaced with an updated service agreement in January 2007.

Medicare Australia has assessed invoices valued at approximately $57 million for around 330 000 lines processed.

Medicare office networkMedicare Australia has a network of 238 Medicare offices throughout Australia, supported by our national computing and communications infrastructure. Over 93 percent of people living in the greater metropolitan areas of Australia have access to one of 119 Medicare offices within a 12 km drive from their home. All the offices give the Australian public convenient access to the following services:

processing of enrolments and registrations

cash, cheque and EFT payments

lodgement of participating health fund claims under two-way arrangements

processing of claims for the Australian Government 30% Private Health Insurance Rebate

benefits for the PBS

Family Assistance services

LPG Vehicle Scheme services.

Across Australia, 54 Medicare offices are open for extended evening hours on Thursday or Friday evenings and 193 open longer from Monday to Friday. Along with the 117 Medicare offices that are open on Saturday mornings, these additional hours enable us to provide a higher level of service, more convenience and greater choice for the public. The locations of Medicare offices within each state and territory are published on our website.

We continually review Medicare office design to ensure that it meets the needs of our customers. Physical access features include automatic doors, sit-down customer service counters and sit-down customer writing slopes.

The current Medicare office design incorporates a combination of modular and standard seating arrangements to suit different people’s requirements. Along with the electronic queue ticket systems introduced in our busiest offices, this provides comfort and convenience for the waiting public. We are implementing a new self-service facility, in the form of sit down self service zones, to give the public easy access to our internet and telephony channels.

In a number of offices, counter hearing systems are to be installed to provide better access to services for people with hearing disabilities.

Medicare Australia Access PointsAcross Australia there is a network of over 1 000 Medicare Australia Access Points providing easy access to Medicare claiming and information. These outlets are self-service telephone booths in rural transaction centres, state government agencies, pharmacies, post offices and shops. Their locations are published on our website.

Most of the services available at a Medicare office are also available at an Access Point, with the exception of cash services and face-to-face interaction. As well as claiming a Medicare benefit, a person can request a copy of their Medicare benefit tax statement, update their Medicare details, register as an organ donor and access information about the PBS and the Australian Childhood Immunisation Register. If a claimant lodges paid accounts at these facilities and selects the EFT option, the rebate is paid into their bank account promptly.

Flexible service deliverySince October 2006, Medicare Australia and Centrelink, working with DHS, have trialled new and more flexible service delivery arrangements to extend the reach of government services and public access to services, while maximising the use of the office network capacity of the two agencies.

Medicare Australia provided Centrelink Seniors and Carers access services in four Medicare offices: Box Hill, Victoria; Hillarys, Western Australia; Port Macquarie, New South Wales; and Marion, South Australia. The servicesincluded general enquiries about the Age Pension and Carers Allowance, lodgement of new claims for the Age Pension and changes of personal details, such as personal information, income, assets and marital status.

Centrelink offered non-cash Medicare services in four Centrelink offices: Sutherland, New South Wales; Earlville, Queensland; Broome, Western Australia; and Launceston, Tasmania. The services included all those offered by Medicare offices, with the exception of cash refunds.

During the trial period, Centrelink provided 6 405 Medicare Australia services, while Medicare Australia provided Centrelink services to 4 624 customers.

Customers valued the convenience of having more than one place to do business in their local area. Of surveyed customers, 69 per cent said the experience was better than their previous interactions with the agency and 86 per cent rated their satisfaction as very high.

Electronic queue management systems in Medicare officesTo improve the public’s experience, we have installed electronic queue management software in 165 Medicare offices across Australia. This includes 65 offices with a full electronic ticketing system and sit-down waiting facilities. The remainder have a partial queue management system, enabling service officers to record details about the transaction. The systems improve customer flows and our monitoring of service delivery.

We signed a contract with Nexa Group Pty Ltd in May 2007 to expand the delivery of an enterprise-based queue management solution to all 238 Medicare offices across Australia. This will provide real-time queue management information that will be used to improve workforce planning.

Additional government services delivered through Medicare officesSince the commencement of Family Assistance in July 2000, Australian families have been able to access limited Family Assistance services at Medicare offices. A phased implementation of full services in all Medicare offices began on 1 July 2005 and was completed on 6 November 2006, eight weeks ahead of schedule, by which time full services were available in all 238 offices. Since July

2005, we have provided Family Assistance services to more than 665 000 customers – a daily average of 7.8 customers per Medicare office – with nearly 540 000 in 2006–07.

Medicare offices have also been providing information and receiving applications for rebates under the LPG Vehicle Scheme. Australians have shown a preference for accessing this service through Medicare offices, with 66 per cent of all applications for the rebate being lodged with us.

Pharmaceutical Benefits SchemeThe PBS gives all Australian residents and eligible overseas visitors access to prescription medicines in a way that is affordable, reliable and timely. Through the PBS, the Australian Government subsidises the cost of listed prescription medicines, making them more affordable for all Australians.

The Department of Health and Ageing (DoHA) is responsible for program policy development and the overall management of the PBS, including the Schedule of Pharmaceutical Benefits and DVA is responsible for the overall policy for the Repatriation Pharmaceutical Benefits Scheme (RPBS).

Medicare Australia is responsible for administering the PBS, which involves processing pharmacists’ claims, approving authority prescriptions, approving pharmacists and certain doctors to supply PBS medicines and approving private hospitals and participating public hospitals to supply PBS medicines to their eligible patients.

We make payments under section 100 of the National Health Act to pharmaceutical companies for the supply of in-vitro fertilisation hormones, fertility drugs and botulinum toxin and fund medications under the Highly Specialised Drugs Program.

We make payments to colostomy and ileostomy associations for ostomy supplies. We also make payments under a non-PBS program to fund the use of Herceptin for the treatment of patients with metastatic breast cancer.

In 2006–07, we processed 183.1 million services under the PBS and RPBS, representing $6.5 billion in benefits.

Table 10 – PBS expenditure – key business results

2005-06 2006-07 % Change

PBS benefits paid * $5.8 billion $6.0 billion +3.4%

RPBS benefits paid $469.7 million $449.5 million –4.3%


PBS services processed* 168.2 million 168.3 million +0.1%

RPBS services processed 15.2 million 14.8 million –2.6%

Total services processed 183.3 million 183.1 million –0.1%

* including stoma

PBS eligibilityThere are two levels of eligibility for the PBS: general rate and concessional rate. At the general rate, a person pays up to $30.70 for their prescription medicine; at the concessional rate, they pay up to

$4.90. These figures are adjusted annually in line with the consumer price index and do not cover additional costs for more expensive brands of medicines.

To receive subsidised medicines through the PBS, each time a person gets a prescription filled they must show their pharmacist a current Medicare card, a concession card from Centrelink or DVA, or a PBS Safety Net entitlement or concession card. This ensures that subsidised medicines are provided only to those who are eligible to receive them and that the person pays the amount appropriate for their level of eligibility.

PBS Safety NetMedicare Australia is responsible for administering the PBS Safety Net, which helps protect individuals and families who spend a large amount on prescription medicines in a calendar year.

Each year, the government sets a general and a concession safety net threshold. The 2007 general threshold is $1 059.00 and the concession threshold (for people holding a concession card from Centrelink or DVA) is $274.40. Once the relevant threshold has been reached, a person can apply for a safety net card and PBS medicines will be cheaper or free for the rest of the calendar year. Additional costs for more expensive brands of medicines do not count towards the safety net threshold.

To qualify for the PBS Safety Net, people need to keep a record of all PBS medicines supplied to them or their families. They can either:

ask their pharmacist for a prescription record form and present the form whenever they have a prescription filled, or

If they always use the same pharmacy they can ask the pharmacist to keep an electronic record.

Online claiming for PBSOnline claiming for PBS was developed in response to pharmacies’ requests for better and faster ways to claim PBS benefits. Online claiming allows more rapid and frequent payments. It also enables pharmacies to receive an online assessment of a prescription, including a patient’s entitlement to the PBS, allowing errors to be corrected on the spot.

In August 2006, Medicare Australia engaged Booz Allen Hamilton to assess the viability of a rollout of online claiming for PBS and to determine the most accelerated rate of rollout that could be achieved with stakeholder support.

We worked closely with the Pharmacy Guild of Australia and software vendors to ensure take-up of online claiming by addressing issues identified as barriers to take-up. By 30 June 2007, 4 490 out of nearly 5 250 pharmacies were transmitting online – a substantial increase from the 145 pharmacies transmitting online at the end of June 2006. We attribute this increase to the support of the Pharmacy Guild and software vendors, a series of system improvements, an improved support model for pharmacies and software vendors and incentives under the PBS reforms package.

Concessional entitlement validationA key feature of the PBS online claiming system is its ability to allow a pharmacy to check a customer’s concessional status when a PBS medicine is being dispensed. Using the online claiming system is the most reliable and accurate way for a pharmacy to confirm that a customer has a valid concessional entitlement.

During the early stages of the rollout in 2005, the system included an ‘override’ facility to give pharmacies some discretion where the pharmacy was uncertain about a customer’s concessional

entitlement. Since then, Medicare Australia and Centrelink have worked to improve the quality of concession data. In September 2006, we implemented a real-time online link with Centrelink to improve the timeliness of the data and are now very confident about its accuracy.

The Australian Government and the Pharmacy Guild of Australia agreed to policy changes for concessional entitlement validation. The changes, effective from 1 July 2007, include the following:

Pharmacists using online claiming for PBS will no longer be able to override advice that a patient is not eligible for concessional benefits.

Where pharmacists are not using online claiming for PBS, patients who have not held a valid concessional entitlement in the 12 months before the date of supply will not receive the concessional benefit.

Authority prescriptionsAuthority medications are limited to use for specific conditions and are subject to criteria set by the Pharmaceutical Benefits Advisory Committee, which limits medical practitioners to supply by authority prescription. Of the 2 347 PBS items listed, 1 502 are restricted to use for a particular condition or purpose. Of these, 832 are listed as authority required.

An authority prescription also provides a mechanism for medical practitioners to prescribe an increased supply of PBS medicine to treat an individual patient.

In 2006–07, 7.3 million authority prescriptions were approved. Of these, 7 million were handled by telephone through our 1800 service, which operates 24 hours a day, seven days a week. The remaining 300 000 requests for authority prescriptions were received in writing.

PBS reformsOn 16 November 2006, the Minister for Health and Ageing announced the PBS reforms package. Medicare Australia is involved in implementing:

PBS incentives

streamlined prescribing of authority prescriptions

PBS dispensing incentives

Software vendor assistance payments.

The first two initiatives will be implemented on 1 July 2007. Our work included a comprehensive communications strategy targeting key stakeholders, including the medical profession, consumers and software vendors.

Table 11 – PBS reforms initiatives implemented by Medicare Australia

Initiative Commencement date Change to the PBS

PBS incentives 1 July 2007

Incentive payments to pharmacists:

40 cents per prescription to pharmacies using online claiming for PBS and recognising price restructuring for medicines, or

10 cents per concessional prescription (concessional entitlement validation) to eligible pharmacies registered for, but not yet using, online claiming for PBS – ends 31 December 2007.

Streamlined Prescribing of authority prescriptions 1 July 2007

Changes to the current PBS authority process: Prescribers no longer have to

telephone Medicare Australia for certain authority required PBS items. Authority codes for these items are now listed in the PBS Schedule.

Software vendorAssistance payments August 2007

Assistance package that provides an incentive for software vendors to enable, via their software, approved suppliers to use online claiming for PBS.This incentive has two components: an installation fee a maintenance payment.Payments will be scaled according to the volume of scripts transmitted by pharmacies supported by the software vendor.

PBS dispensingIncentives 1 August 2008

Incentive payment for dispensing F2* medicine:an additional $1.50 incentive payment for every prescription dispensed that meets the criteria of: having multiple suppliers being substitutable not attracting a premium.

* multiple brands listed

Approval to supply PBS medicinesSection 90 of the National Health Act enables Medicare Australia to grant approval to a pharmacist to supply PBS medicines. Medicare Australia received 413 applications for new or relocated pharmacies in 2006–07. Medicare Australia referred the applications to the Australian Community Pharmacy Authority, which recommended 264 pharmacies. Of the remainder, 126 were not recommended and 23 applications were withdrawn.

Medicare Australia granted approval to:

994 community pharmacies to supply PBS medicines to the community under section 90 of the National Health Act (including 766 changes of ownership and 162 relocations/new approvals)

22 medical practitioners to supply PBS medicines to rural or remote communities under section 92 of the Act

30 hospital authorities to supply PBS medicines to hospital patients under section 94 of the Act (16 private hospitals and 14 public hospitals participating in the pharmaceutical reforms).

This brought total approvals at 30 June 2007 to:

4 976 section 90 approved community pharmacies

83 section 92 approved medical practitioners

184 section 94 approved hospitals (52 private hospitals and 132 public hospitals participating in the pharmaceutical reforms).

Fourth Community Pharmacy AgreementThe Fourth Community Pharmacy Agreement represents a five-year collaborative relationship between the Australian Government and The Pharmacy Guild of Australia from 1 December 2005 to 30 June 2010.

The agreement offers incentive payments to community pharmacy to provide services to consumers that are designed to improve the use of medication. These payments are administered by Medicare Australia and are listed in table 12.

In 2006–07, we made 45 144 payments, totalling over $42 million, under the Fourth Community Pharmacy Agreement initiatives. Pharmacies can obtain further information about payments under the agreement from our website.

Table 12 – Payment types covered by the Fourth Community Pharmacy Agreement

Payment type Description

Aboriginal Health Services

– Pharmacy Support Payment

A financial incentive for pharmacy proprietors to provide support services to Aboriginal health services in rural and remote locations in Australia.

Broadband for Health/Pharmacy

A financial incentive, available for a limited time, that is payable to pharmacies to help them upgrade their personal computer systems for the satisfactory use of broadband.

Concessional Entitlement Validation Payment A payment to the pharmacy of 10 cents for each PBS concessional prescription supplied.

Home Medicines ReviewDesigned to allow patients’ medication regimes to be reviewed on the request of the patient, medical practitioner or carer.

Home Medicines Review – Rural Loading Payment

Designed to reimburse pharmacies in rural and remote areas of Australia for travel costs incurred when conducting home medicines reviews.

Medication Review Accreditation IncentivesA financial incentive designed to increase the number of accredited pharmacists available to provide medication reviews.

Quality Care Pharmacy Program Payments for approved activities to embody the

Payment type Descriptionprofessional practice standards of the Pharmaceutical Society of Australia and to encourage community pharmacies to achieve and maintain accreditation.

Residential Medication Management ReviewsDesigned to encourage collaboration between pharmacists and GPs and to allow greater continuity of care to eligible aged care residents

Rural Pharmacy Maintenance AllowanceA financial incentive to encourage pharmacy proprietors to remain in designated rural and remote locations in Australia.

Start-up AllowanceA payment, staggered over two years, to encourage the establishment of new pharmacies in designated rural or remote locations.

Succession Allowance

A payment, staggered over two years, to encourage pharmacists who want to purchase an existing pharmacy in an identified area of need.

Training incentives for Pharmacy Assistants (TIPA)

A financial incentive to encourage pharmacy assistants to undertake Certificate III in Community Pharmacy.

Indigenous people’s access to the PBSDuring 2006–07, Medicare Australia continued to administer the PBS arrangements that make prescription medicines accessible in remote Indigenous communities.

We continued to pay pharmacists for the bulk supply of PBS medicines to remote Indigenous communities via the Aboriginal and Torres Strait Islander Health Service and some state-funded health services.

These arrangements under section 100 of the National Health Act currently make prescription medicines accessible to patients receiving treatment at more than 165 remote area health services across the Northern Territory, Queensland, South Australia, Western Australia and Tasmania.

Pharmaceutical reforms in public hospitalsUnder the Australian Health Care Agreements, the Australian Government, states and territories are reforming the supply of pharmaceuticals to eligible patients in public hospitals. Eligible patients include:

admitted patients on discharge

outpatients

day patients accessing chemotherapy drugs.

Participating hospitals are required to adopt the Australian Pharmaceutical Advisory Council guidelines on the continuum of pharmaceutical care between the hospital and the community.

The pharmaceutical reforms are being implemented gradually across the Northern Territory, Queensland, Victoria and Western Australia. The Australian Government will continue to liaise with the other states and territory, seeking agreement to implement the reforms.

At 30 June 2007, Medicare Australia had approved 132 public hospitals under these arrangements (66 in Queensland, 58 in Victoria, six in Western Australia and two in the Northern Territory) and paid benefits of more than $100 million.

Aged careThe Department of Health and Ageing is responsible for administering policy under the Aged Care Act, which provides for the payment of subsidies and supplements to approved aged care providers. On any day, about one in every 100 Australians receives care in a residential aged care service or through a community care program.

Medicare Australia manages aged care payments on behalf of DoHA. We make payments to approved aged care providers to help them provide quality, cost-effective care for frail, older people and support for their carers. Our role is to provide timely and accurate payments, with a focus on service and administrative efficiency.

Our responsibilities include the processing and payment of:

residential aged care subsidies and associated supplements for provision of high-level and low-level residential care

residential respite care subsidies and associated supplements for provision of short-term high-level and low-level residential care to provide carers with relief from their caring role

Community Aged Care Package subsidies for provision of support to people with low-level complex health needs and their carers, to enable them to remain at home

flexible aged care subsidies, including:

– extended aged care at home subsidies for provision of support to people with high-level complex health needs and their carers, to enable them to remain at home

– extended aged care at home dementia subsidies for provision of dementia-specific support to people with high-level complex health needs and their carers, to enable them to remain at home

– Transition care subsidies for provision of shortterm rehabilitation care to recipients after care in hospital, pending access to longer term care.

In 2006–07, we processed 34 832 residential claims, 12 219 Community Aged Care Package claims and 3 456 flexible care claims. These made up over $6 billion in aged care benefits.

Table 13 – Aged care – key business results

2005-06* 2006-07*

Number of residential claims processed 23 691 34 832

Number of CACP *** claims processed 8 014 12 219

Flexible care claims:

EACH ** (including dementia-specific EACH) 1 130 2 897

transition care 56 559

Total flexible care claims processed 1 186 3 456

Total claims processed 32 891 50 507

Total amount paid $3.9 billion $6.3 billion

Number of residential aged care services (aged care homes) 2 931 2 873

Number of CACP services (facilities providing CACPs) 1 012 1 054

Number of flexible care services (facilities providing

EACH transition care)227 378

Number of active services transmitting (eBusiness) 27 73

* Payments function transferred to Medicare Australia on 20 October 2005

** EACH = extended aged care at home

*** CACP = Community Aged Care Package

Aged care online claimingMedicare Australia introduced online claiming for the aged care sector using a three phase release process, the final phase of which was implemented in November 2006. The online claiming solution enables a seamless integration into the normal operating environments of aged care providers and state government aged care assessment teams. The aged care sector can now lodge and validate information electronically, in real time. Medicare Australia developed this solution in collaboration with DoHA, according to the requirements outlined by aged care providers and their software vendors.

New payment system projectThe establishment of a new aged care payment system was announced in the 2004–05 Budget as part of Investing in Australia’s Aged Care – Streamlining administration for better care. The Department of Health and Ageing commissioned Medicare Australia to design, develop and implement the system which would handle claims assessments and payments and integrate seamlessly with Medicare Australia’s online claiming system.

Medicare Australia will be providing the technical platform for the new Aged Care program by redeveloping the existing solution using a robust computing solution. New functions required for the Aged Care program will then be progressively introduced over the life of this redevelopment program.

Australian Organ Donor RegisterThe Australian Organ Donor Register, which is administered by Medicare Australia, provides a simple way for people to record their consent (or objection) to becoming organ or tissue donors.

The register ensures that an individual’s wishes can be verified by authorised personnel 24 hours a day, seven days a week, anywhere in Australia. In the event of a registered person’s death, information about their decision will be accessed from the donor register and provided to their family.

From July 2005, the register became operational as a ‘consent’ register, recording a person’s legally valid consent to donate organs. Before then, only a person’s intention to donate was registered. The

details of people who had previously recorded their intention to donate are retained on the register until they complete a consent registration form.

Wide distribution of the organ donation brochure and registration form during 2006–07, through Medicare offices and state-based organ donor agencies, created broader awareness and increased general registrations. The register was also promoted through doctors’ surgeries and the Medicare Australia website.

Medicare Australia supported Australian Organ Donor Awareness Week in February 2007 with targeted promotions in Medicare offices, on our website and through the Good Health TV network in some doctors’ surgeries. The key message during the week was ‘Organ donors save lives’.

More than 950 000 people have registered their consent to organ or tissue donation on the Australian Organ Donor Register. This figure includes the ‘intent’ registrations of 16–17-year-olds.

Table 14 – Australian Organ Donor Register – key results

2005-06 2006-07 % changeNumber of consent registrations (including intent

registrations of 16–17-year-olds)791 320 951 417 +20.2%

Number of registrations of potential organ donors* 4 823 095 4 764 895 –1.2%

Number of serviced calls to enquiry line 40 585 32 867 –19.0%

* Potential organ donors are those people who had previously registered their intent but have not updated this to consent to donate.

The donor register website encourages people to ‘sign on to save lives’ by registering online and provides general information about organ and tissue donation for transplantation, the numbers of registered organ and tissue donors and an online registration mechanism.

Authorised medical personnel, who have signed confidentiality agreements covering the access and use of personal information, can access the donor register through a secure internet site. They are authorised by a management committee comprising representatives from Medicare Australia, DoHA and state organ donation agencies.

Australian Childhood Immunisation RegisterThe Australian Childhood Immunisation Register is a national database established in January 1996. The aim of the register is to improve the rate of ageappropriate immunisation and to support parents and immunisation providers by providing information about a child’s immunisation status, regardless of where the child was immunised.

Details of vaccinations given to children under seven living in Australia are recorded on the register and are available on request to authorised immunisation providers and each child’s parent or guardian.

There is a secure area on Medicare Australia’s website that provides a channel for providers to access and update children’s immunisation details.

Health professionals use the register to monitor immunisation coverage and service delivery and to identify regions at risk during disease outbreaks. Coverage information can be at the local, state, territory or national level.

Data from the Australian Childhood Immunisation Register also provides:

an optional immunisation history statement that informs parents and guardians of their child’s recorded immunisation history

information about a child’s immunisation status to help determine eligibility for the Child Care Benefit and Maternity Immunisation Allowance Family Assistance payments

information for the delivery of feedback reports and incentive payments to eligible immunisation providers

Reporting mechanisms to assist the Australian Government’s monitoring of national immunisation programs.

In 2006–07, a revised brochure for parents explaining the immunisation register was distributed through Medicare offices and immunisation providers. Medicare Australia participated in baby expos and health information days to promote and educate people about the register.

At 30 June 2007, nearly two million children under seven were included on the register. In 2006-07, 66 680 child immunisation history statements had been viewed online and 60 492 child immunisation history statements had been provided over the counter in Medicare offices.

During 2006–07, $8.4 million was paid to immunisation providers and 3.9 million valid immunisations were recorded.

Table 15 – Immunisation rates of children in Australia – key business results

2005-06 2006-07 % Change

Children under 7 years registered at 30 June 1.9 million 1.9 million 0.0%

Valid immunisation episodes recorded at 30 June 4.0 million 3.9 million –2.5%

Children aged 12–15 months appropriately immunised at 30 June

90.7% 91.2% +0.5%


92.4% 92.5% +0.1%


83.9% 87.9% +4.0%

Total amount paid to immunisation providers $8.3 million $8.4 million +1.2%

General Practice Immunisation Incentives SchemeThe General Practice Immunisation Incentives Scheme provides financial incentives to GPs who monitor, promote and provide immunisation services to children under the age of seven years. The scheme aims to encourage at least 90 per cent of medical practices to achieve immunisation coverage of 90 per cent of children under the age of seven.

Providers are kept up-to-date on changes to the scheme by:

content on Medicare Australia’s website, which includes statistics, general program information and downloadable forms for providers and Divisions of General Practice

representation at various professional meetings and workshops

Field officers in each state and territory, who provide support and information about the scheme to practices and GPs.

The General Practice Immunisation Incentives Scheme is made up of three components.

1. Service Incentive Payment – an $18.50 payment to GPs and other medical practitioners who notify the Australian Childhood Immunisation Register of a vaccination that completes an immunisation schedule.

2. Outcomes Payment – a financial reward for practices that achieve 90 per cent or greater proportions of full immunisation.

3. Immunisation Infrastructure Funding – funds administered by DoHA and provided to Divisions of General Practice, state-based organisations and the National GP Immunisation Coordinator to increase the proportion of children at local, state and national levels who are immunised.

By May 2007, the scheme involved 5 499 registered practices. The average immunisation coverage rate for practices was calculated at 91.4 per cent for 2006–07, with 76 per cent of participating practices achieving rates of 90 per cent or higher.

Table 16 – General Practice Immunisation Incentives Scheme payments – key business results

2005-06 2006-07 % Change

Practices registered (calculated at May 2007) 5 491 5 499 +0.1%

Service Incentive Payments (SIPs) $18.8 million $21.4 million +13.8%

Outcomes Payments $16.4 million $16.2 million –1.2%

Highest quarterly outcomes payment $10 301 $10 534 +2.3%

Average outcomes payment $994 $1 011 +1.7%

Total payments (SIPs + Outcomes) $35.2 million $37.6 million +6.8%

Practice Incentives ProgramThe Practice Incentives Program (PIP) provides a number of incentives to help general practices improve the quality of patient care. Practices must be accredited or working towards accreditation against the Royal Australian College of General Practitioners’ Standards for General Practices. The PIP is part of a blended payment approach for general practices. Payments made through the program are in addition to other income earned by the GPs and the practice, such as patient payments and Medicare rebates.

Medicare Australia assesses all applications from general practices and administers the program on a day-to-day basis. DoHA has overall policy responsibility for the PIP, including the determination of eligibility criteria.

On 23 November 2005, the Minister for Health and Ageing announced changes to the PIP to simplify and improve the program. Changes made in 2006–07 included:

simplification of the information management/information technology incentive to a two-tier system

extension of the practice nurse/allied health worker incentive to urban practice nurses under the Workforce Shortage initiative

changes to the asthma and diabetes incentives to introduce a cycle of care

changes in GP procedural eligibility requirements to enable rural GPs to access the Tier 4 GP procedural incentive

Replacement of the mental health incentive with new MBS items for the three-step mental health process.

Practices may qualify for any or all of the 11 PIP components, which are described in the following table.

At 30 June 2007, 4 784 practices were registered as participating in the PIP. Over $279.1 million was paid in incentive payments during 2006–07.

Table 17 – Types of Practice Incentive Program payments

Payment type Description

After-hours carePayments to practices to ensure that patients have access to 24-hour care, including after-hours home visits where necessary

AsthmaPayments to practices for providing the asthma cycle of care and payments to GPs who complete asthma cycle of care for patients with moderate to severe asthma.

Cervical screening

Payments to practices that achieve targets in cervical screening and payments to GPs who screen women aged 20–69 years who have not had a Pap smear for four years or more.

Diabetes

Payments to practices that achieve targets in providing carefor their patients with diabetes and payments to GPs for providing diabetes care according to best practice guidelines.

Information management/ information technology

Payments to practices for providing data to the AustralianGovernment, using electronic prescribing software to generate the majority of scripts and having the capacity to send and receive data electronically.

Mental health Payments to GPs for using the three-step Mental Health Process with their patients.

Practice nurses/ alliedhealth workers

Payments to practices in eligible rural, remote or urban areas of workforce shortage and payments to Aboriginal medical services, to assist them to employ or retain the services of a practice nurse, Aboriginal health worker and/or allied health worker.

Procedural GP payment Payments to practices to support the provision of

Payment type Descriptionprocedures such as surgery, anaesthetics and obstetrics in rural and remote areas.

Quality Prescribing InitiativePayments to practices that participate in the quality use of medicines program endorsed by the National Prescribing Service.

RuralityA rural loading applied to the PIP payments of practices where the main location is outside a capital city or other major metropolitan area.

Teaching Payments to practices for teaching medical students.

Table 18 – Practice Incentive Program services – key business results

2005-06 2006-07 % Change

Number of practices participating at 30 June 4 745 4 784 +0.8%

Provision of data to the Australian Government 4 745 4 784 +0.8%

Electronic prescribing 4 417 nil* n/a

Capacity for electronic transfer 4 480 nil* n/a

IM/IT Tier One Nil 4 029 n/a

IM/IT Tier Two Nil 3 883 n/a

After-hours care

Ensuring patients have access to 24-hour care 4 601 4 652 +1.1%

Provision of at least 15 hours care from the practice 2 858 1 731 –39.4%

Provision of at least 10 hours care from the practice** 262 1 367 n/a

Provision of all after-hours care for practice patients 1 296 1 312 +1.2%

Teaching

Number of teaching sessions 83 496 90 316 +8.2%

Targeted incentives

Quality Prescribing Initiative 1 203 1 058 –12.1%

Procedural GP 337 354 +5.0%

2005-06 2006-07 % Change

Practice nurses and/or allied health workers 1 756 2 161 +23.1%

Cervical screening 3 187 3 221 +1.1%

Diabetes 2 023 2 110 +4.3%

Total amount paid $261.8 million $279.1 million +6.6%

IM/IT = Information management/information technology

* Incentives were replaced with IM/IT Tier One (Basic) and Tier Two (Enhanced) in November 2006.

** Provision of at least 10 hours care from the practice commenced in May 2006.

Rural Retention ProgramThe Rural Retention Program aims to improve health care for people in rural and remote areas of Australia through a system of incentive payments to medical practitioners practising in those areas. It encourages medical practitioners to remain in rural and remote practices beyond the current average period of two years and rewards those who do. This is expected to result in improved access to primary health care, greater stability and continuity in medical services and improved health outcomes for Australians living in such areas.

There are two components of the program.

The Central Payments System – administered by Medicare Australia since December 1999. This system seeks to recognise GPs’ contributions in rural and remote locations, based on their Medicare service data over a number of years.

The Flexible Payments System – administered by state-based and territory-based rural workforce agencies since December 2000. This system recognises long-serving GPs who do not receive an equitable level of support under the Central Payments System because Medicare does not capture their services or their locations are not adequately taken into account.

During 2006–07, Medicare Australia made 2 110 payments totalling $20.4 million to 2 085 providers participating in the Rural Retention Program.

Table 19 – Rural Retention Program – key business results

2005-06 2006-07 % Change

Number of payments made

2 071 2 110 2 110


General Practice Registrars’ Rural Incentive Payments SchemeSince 2000, funds totalling over $100 million have been used to boost general practice training in rural and remote areas through the dedicated 250-place Rural Training Pathway, which operates alongside the primarily urban General Training Pathway.

To be eligible for rural training incentive payments, registrars must be formally registered in the Rural Training Pathway. Registrars qualify by completing a period of service in one or more of the four categories of eligible rural and remote locations. However, exceptions apply for registrars undertaking Advanced Rural Skills Posts, procedural, special skills and mandatory elective training.

The rural, remote and metropolitan area location categories are:

1. capital city2. other metropolitan centre3. larger rural centre4. small rural centre5. other rural area6. remote centre7. other remote area.

Financial incentives are offered to medical practitioners who undertake training in the Rural Training Pathway in practices in small rural centres and areas, or remote areas, that can particularly benefit from the scheme, as determined under a seven-part location classification system (for more information about the system, go to www.health.gov.au). Up to $60 000 is available per registrar over the three years of general practice training. Incentive payments are not available to registrars undertaking their mandatory hospital training.

In 2006–07, Medicare Australia made payments totalling $7.5 million to 467 medical practitioners participating in the General Practice Registrars’ Rural Incentive Payments Scheme.

Table 20 – General Practice Registrars’ Rural Incentive Payments Scheme – key business results

2005-06 2006-07 % Change

Number of medical practitioners paid

426 467 +9.6%

Number of payments made

786 887 +12.8%


Training for Rural and Remote Procedural GPs ProgramThe objective of the Training for Rural and Remote Procedural GPs Program is to help GPs in rural and remote areas attend relevant training, up-skilling and skills maintenance activities. The program has two components:

a grant for the cost of up to 10 days training, including the cost of locum relief, to a maximum of $20 000 per GP per financial year for procedural GPs practising in surgery, anaesthetics or obstetrics in areas other than capital cities

a grant for the cost of up to three training sessions, to a maximum of $6 000 per GP per financial year, for GPs practising emergency medicine in areas other than capital cities and metropolitan centres to attend approved skills maintenance and up-skilling activities.

The expansion of the program to include larger rural centres in the emergency medicine component and increase the grant amounts was introduced on 16 April 2007 and payments may be backdated to include activities undertaken from 1 January 2007. The expansion of the program to include metropolitan centres in the surgery, anaesthetics or obstetrics component and increase the grant amounts was introduced on 30 May 2007.

Table 21 – Training for Rural and Remote Procedural GPs – key business results

2005-06 2006-07 % Change

Number of providers paid 767 2 487 +224.3%

Number of payments made 1 514 3 296 +117.7%


Compensation Recovery ProgramThe Compensation Recovery Program, which began in February 1996, is administered by Medicare Australia on behalf of DoHA under the provisions of the Health and Other Services (Compensation) Act 1995 (HOSC Act).

The program aims to prevent ‘double dipping’ in Medicare and nursing home benefits and residential care subsidies paid by the Australian Government in relation to an injury or illness, where a person has already received compensation for the injury or illness. Where the amount of compensation is more than $5 000 (including costs), the value of the benefits or subsidies must be repaid.

To identify the amount of benefits or subsidies required to be repaid, Medicare Australia issues a Medicare history statement listing all Medicare services received from the date of injury to the date of judgement or settlement. The claimant is required to identify those services relating to the compensable injury or illness and return the statement to Medicare Australia. These services are then calculated to establish the repayment amount, if any.

Compensation payers and claimants have a number of ways in which to repay the government: advance payment option, non-advance payment option and bulk payment agreement.

An advance payment is a payment, equal to 10 per cent of the total amount of compensation set at judgement or settlement, made by the compensation payer. The amount must be sent to Medicare Australia within 28 days of judgement or settlement. This allows the remaining 90 per cent to be released to the claimant immediately. Any debt is deducted from the advance payment, with any excess being refunded to the claimant. If the advance payment does not cover the debt, the claimant is required to make up the difference.

In 2006–07, Medicare Australia experienced a slight, but expected, decrease in the number of cases finalised and the value of recoveries following on from changes made to the HOSC Act in 2001–02, which streamlined the administration of the program. Changes to legislation at a state level in relation to workers’ compensation, also tightened access to payments.

Table 22 – Compensation recovery cases and benefits – key business results

2005-06 2006-07 % Change

Cases finalised 49 232 46 561 –5.4%

Total amount of benefits recovered $31.3 million $29.0 million –7.3%

HECS Reimbursement SchemeThe Higher Education Contribution Scheme (HECS) Reimbursement Scheme was announced in the 2000 Budget as part of the more doctors, better health services regional health strategy. The scheme aims to promote careers in rural medicine and increase the number of doctors in rural and remote areas. For the purposes of the HECS Reimbursement Scheme, a designated rural area is defined as rural, remote and metropolitan area categories 3 – 7 locations.

These locations are large rural centres, remote centres and smaller rural and remote centres.

Participants who undertake training or provide medical services in rural and remote areas of Australia have one-fifth of their HECS debt reimbursed for each year of service. Through the scheme, as more doctors move to work in rural areas, communities gain improved access to health services and benefit from better general health levels over the longer term.

During 2006–07, Medicare Australia made 528 payments totalling $2.7 million to 411 medical graduates participating in the HECS Reimbursement Scheme.

Table 23 – HECS Reimbursement Scheme – key business results

2005-06 2006-07 % Change

Number of eligible medical graduates participating

421 411 –2.4%

Number of medical graduates paid 272 313 +15.1%

Number of payments made 440 528 +20.0%


Family AssistanceFamily Assistance aims to give Australian families better access to a range of government payments and services. It operates in over 550 offices throughout Australia, including Medicare offices, Centrelink customer service centres and Australian Taxation Office shop fronts.

The main payments and services provided by Family Assistance include:

Family Tax Benefit (part A), which provides help with the cost of raising children

Family Tax Benefit (part B), which provides extra help for families with one main income, including sole parents

Child Care Benefit, which offsets the cost of long and part-day child care

Maternity Payment, which helps with the extra costs of a new baby

Maternity Immunisation Allowance, which is a separate payment for children who have been fully immunised.

Since the commencement of Family Assistance in July 2000, Australian families have been able to access limited Family Assistance services at Medicare offices. During 2006–07, in partnership with Centrelink and ahead of schedule, Medicare Australia completed an ambitious program to extend Family Assistance services at all Medicare offices. The extended services include claims processing and handling of all levels of enquiries.

With the extension of Family Assistance services, Australian families can now have their claims for Maternity Payment, Maternity Immunisation Allowance, Child Care Benefit and Family Tax Benefit processed when they visit their local Medicare office. They can also change their income estimate, method of payment and contact details.

Satisfaction with Medicare Australia’s provision of extended Family Assistance services has been independently measured. Results show strong support from people accessing the extended services, both for the level of service and for the greater choice about where to access the services.

At 30 June 2007, nearly 670 000 families had accessed extended Family Assistance services in Medicare offices since the rollout began in July 2005.

Table 24 – Family Assistance services – key business results

2005-06 2006-07 % Change

Services provided to families* 380 405 653 288 +71.7%

Medicare offices offering access to extended services

190 238 +25.3%

Number of people accessing extended Family Assistance services

129 025 538 160 +317.1%

* Services include the number of forms submitted for payment and number of enquiries to Medicare offices.

LPG Vehicle SchemeDuring 2006–07, the Australian Government established the LPG Vehicle Scheme to assist private motorists with the purchase of a new LPG (liquefied petroleum gas) vehicle or the conversion of a new or used petrol or diesel vehicle to LPG. While DITR oversees the scheme, Medicare Australia and Centrelink are the public contact points for enquiries and applications. Centrelink is responsible for paying approved grants.

The scheme was launched on 14 August 2006 and applications were available from Medicare and Centrelink offices from 1 September. Payments of grants began on 1 October.

Since the introduction of the scheme, Medicare Australia offices have received over 44 000 application forms. This is nearly 70 per cent of the total applications received under the scheme.

Table 25 – LPG Vehicle Scheme – key business results

2006-07

Number of applications received 44 013

Percentage of applications received by Medicare Australia 66.9%

Hearing Services ProgramThe Australian Government provides hearing services and products to eligible people under the Hearing Services Program, which is administered by the Office of Hearing Services in DoHA. While the Office of Hearing Services manages all policy and eligibility aspects of the program, Medicare Australia processes and pays claims to accredited hearing service contractors on the office’s behalf.

In 2006–07, we processed 917 208 services and made payments totalling $215.3 million to accredited hearing service contractors. Approximately 95 per cent of all claims are submitted electronically.

Table 26 – Hearing Services Program services and payments – key business results

2005-06 2006-07 % Change

Services processed* 898 483 917 208 +2.1%

Total amount paid** $203.1 million $215.3 million +6.0%

* Service provided to individuals

** Payments made to hearing contractors

National Bowel Cancer Screening ProgramFollowing the success of the Bowel Cancer Screening Pilot Program and as part of its Strengthening Cancer Care initiative in the 2005–06 Budgets, the Australian Government allocated $43.4 million over three years for the phased introduction of a national bowel cancer screening program.

The program aims to reduce the number of people who die from bowel cancer, which is the most common internal cancer affecting Australians and the second most common cause of cancer-related deaths after lung cancer. Early diagnosis of bowel cancer or pre-cancerous abnormalities has been shown to increase the chance of survival.

The program began in August 2006 and will continue until 30 June 2008. Medicare Australia has entered into a service arrangement with DoHA to provide services relating to the administration of aspects of the program, including the establishment and maintenance of the National Bowel Cancer Screening Register.

In administering the screening register, Medicare Australia is responsible for:

identifying and inviting eligible participants to screen and re-screen at appropriate intervals, using Medicare and DVA enrolment files

issuing reminders to participants

recording participants’ screening and detection histories

establishing and operating the program information line for the general public and health professionals

overseeing the provision of mailing house services for the program

making payments to medical professionals for services and the transfer of data to the register

establishing eight information manager positions.

The information managers focus on following up participants and program data, developing relationships with key stakeholders and providing specialist advice and training on electronic data transfer to the register.

During 2006–07, we established the register and sent invitations to more than 405 000 eligible participants for a bowel screen. The calls received by the information line are general enquiries such as: opt out or suspend from program after receiving invitation; the caller’s eligibility for the program; and response to correspondence sent by the register. We will continue this work during 2007–08, identifying remaining eligible participants and distributing around 600 000 invitations to take part in the screening program.

Table 27 – National Bowel Cancer Screening Register – key business results

2006-07

Invitations distributed 405 608

Faecal occult blood test results processed 125 592

Information line calls received 50 003

Medical indemnityThe Australian Government’s medical indemnity framework comprises five schemes to strengthen the longer term viability of the medical insurance industry and create an environment in which the industry can operate successfully. This is being achieved through the provision of financial support to reduce the impact of large claims and by making medical indemnity insurance more affordable for medical practitioners. Medicare Australia is responsible for the administration of the schemes under the Medical Indemnity Act.

Medical Indemnity UMP Support Payments During 2006, DoHA received approval to create a United Medical Protection (UMP) Support Payment day (17 November 2006) for individuals who had not received notification of their liability for past contribution years. Amendments to the Medical Indemnity Regulations 2003 took effect on 30 March 2006 and all affected providers were contacted.

Incurred but Not Reported Indemnity Claims SchemeUnder the Incurred but Not Reported (IBNR) Indemnity Claims Scheme, the government covers the costs of claims from medical defence organisations that do not have adequate reserves to cover their liabilities. To date, United Medical Protection Limited is the only medical defence organisation actively participating in the scheme. The scheme covers IBNR indemnity claims and UMP Support Payments. Ongoing costs associated with the scheme are partly funded through a contribution payment (the UMP Support Payment) imposed on those people who were members of United Medical Protection Limited on 30 June 2000.

Table 28 – UMP Support Payments

2005-06 2006-07

Number of members invoiced a UMP Support Payment 10 131 10 168

Total amount invoiced $13.7 million $13.2 million

Table 29 – IBNR Indemnity Scheme claims processed – key business results

2005-06 2006-07

Number of claims received 375 166

Total benefits paid $14.8 million $9.5 million*

* A $39 million reduction in the outstanding claims provision, as assessed by the Australian Government Actuary, has not been included in this figure.

High Cost Claims SchemeUnder the High Cost Claims Scheme, the government funds 50 per cent of the cost of medical indemnity insurance payouts that are greater than the applicable threshold amount, up to the limit of a medical practitioner’s insurance cover. This scheme has three threshold levels, which are dependent on the date the claim was first notified to the insurer.

Notification dates (inclusive) Threshold amount 1 January 2003 to 21 October 2003 $2 000 000

22 October 2003 to 31 December 2003 $500 000

On or after 1 January 2004 $300 000

In 2006–07, Medicare Australia paid benefits of $8.8 million for the 10 claims received.

Exceptional Claims SchemeUnder the Exceptional Claims Scheme introduced in November 2003, medical practitioners are protected against personal liability for eligible claims that exceed the level of their insurance cover.The scheme has two threshold levels, which are dependent on the date the claim was fi rst notifi ed to the insurer. To date, no claims have been submittedagainst this scheme.

Notification date Threshold amount 1 January 2003 to 30 June 2003 $15 000 000

On or after 1 July 2003 $20 000 000

Run-off Cover SchemeUnder the Run-off Cover Scheme, the government will guarantee funding for claims against eligible medical practitioners who have left the private medical workforce and been provided with free run-off cover. A Run-off Cover Scheme support payment, paid by medical indemnity insurers to the government since 1 July 2004, will meet the cost of funding claims over time. Under the scheme, medical indemnity insurers will be reimbursed implementation and compliance costs under section 34ZN (1)(c) of the Medical Indemnity Act.

Premium Support SchemeUnder the Premium Support Scheme, eligible medical practitioners receive financial assistance through asubsidised reduction in their insurance premium costs, effective from 1 July 2004. Insurers are then reimbursed the subsidised amount by the government.

The Premium Support Scheme is designed to ensure that, if a doctor’s gross medical indemnity costs exceed 7.5 per cent of their gross private medical income, they will pay 20 cents in the dollar for the cost of the premium beyond that threshold limit.

Competitive Advantage PaymentUnder the Competitive Advantage Payment scheme, medical indemnity insurers that benefit from the IBNR Indemnity Scheme are required to make a payment to the government that refl ects their level of competitive advantage. To date, Australasian Medical insurance Limited is the only insurer to have made acompetitive advantage payment($56 million in 2005–06).

Table 30 – Run-off Cover Scheme

2005-06 2006-07

Total implementation fees paid $1.8 million $nil

Total administration fees paid $2.8 million $nil

Table 31 – Premium Support Scheme participation and revenue – key business results

2005-06 2006-07

Total eligible practitioners 4 139 6 858

Total amount paid $17.1 million $50.0 million

Total administration fees $2.2 million $2.3 million

30% Rebate on Private Health InsuranceThe 30% Rebate on Private Health Insurance program continues to be a major lever in the Australian Government’s initiative to encourage a mix of private and public provision of health services.

All Australians who are eligible for Medicare and who are members of registered health funds, are eligible for the rebate. Medicare Australia administers the program on behalf of the Australian Government and works with DoHA, the Australian Taxation Offi ce, the Private Health Insurance Advisory Council and health funds to improve the program’s administration.

While the program is still known as the 30% Rebate, the Australian Government expanded the program on 1 April 2005 to include a 35 per cent rebate for people aged from 65 to 69 years (inclusive) and a 40 per cent rebate for people aged 70 years and older.

During 2006–07, the 35 per cent and 40 per cent rebates were applied to around 579 000 claims per month, resulting in an additional $194.7 million being paid by Medicare Australia. The number of registered health fund memberships increased by 6.3 per cent. Cash claims paid directly to individuals remained at $2.1 million and health fund payments increased to $3.3 billion.

Table 32 – 30% Rebate on Private Health Insurance – key business results

2005-06 2006-07 % Change

Number of memberships registered 4.8 million 5.1 million +6.3%

Total paid in cash claims $2.1 million $2.1 million 0.0%

Total paid to health funds $3.0 billion $3.3 billion +10.0%

Audits of 12 health fund entities that participate in the program through the Private Health Insurance Premium Reduction Scheme were carried out during 2006–07. The aim was to identify differences between Medicare Australia data and health fund data relating to the registration of people who pay reduced premiums for private health insurance cover.

Any differences were identifi ed by comparing the registration records held by health funds with our records. The audit measured the risk associated with Medicare Australia paying a health fund for a policy that is not eligible for the premium reduction scheme.

We also audited health fund procedures for identifying and processing dishonoured member contributions. These audits were designed to assess the impact on claims under the premium reduction scheme and the validity and completeness of member applications for the scheme retained by health funds.

The health fund procedures audits established the extent to which claims for payment made by health funds were accurately calculated; correct in respect of payments madeby the member and supported by member application; and were claims for valid articipants in the scheme.

The audits concluded that current procedures reduced the risk of incorrect or inappropriate payments to health funds, but recommended further improvements to make data more complete and provide evidence for participant validity. The audited health funds implemented the recommendations.

Program risk managementDuring 2006–07, Medicare Australia’s Program Review Division began work on two Budget measures:

fraud and compliance – increasing Medicare compliance through education Improved cross agency activities.

The first initiative reflects our commitment to making it easy for the public and health care providers to comply, while the second supports more sharing of data and intelligence between Medicare Australia and other DHS agencies.

Our compliance program is based on a risk management approach involving activities to educate stakeholders and to detect, prevent and correct non-compliance.

EducationEducation and communication are important in our approach to supporting voluntary compliance. The broad focus of these activities is to make it easy for medical practitioners, pharmacists and patients to understand the requirements when they bill or claim for services under Medicare or prescribe, supply or receive medication under the PBS. This section outlines key activities completed in 2006–07.

Face-to-face and online education activitiesMedicare Australia supported face-to-face education sessions on a wide range of topics to support better access to and correct use of the MBS and the PBS for new and experienced health care providers.

Online PBS education accredited by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine contributed to continuing professional development.

Figure 5 – Summary of face-to-face and online education activities in 2006–07

* Other includes workers from the Aboriginal Medical Service, pharmacy technicians and practice staff.

Table 33 – Compliance Program – publications and advertising

Communication Channel(approximate circulation)

Examples of topic

Forum (up to 41 000)

Prescribing restricted medicine, including single-dose eye drops, injectable antibiotics and combination anti-glaucoma agents

Specialist trainees, private patients and Medicare

Requesting pathology services Overseas drug diversion Prescription shopping goes online Sending PBS medication overseas Prescribing restricted medication

Bulletin Board (up to 5 300) PBS random compliance audit Multiple payments audit

Medical Director (up to 21 000)

Article: How and when to write a non-PBS prescription

Software advertising: overseas drug diversion and prescription shopping

Medical Observer (up to 23 000) Article: How and when to write a non-PBS prescription

YMCA Backpacker magazine (up to 73 000) Taking and sending PBS medicine overseas

Lightbox advertising in overseas departureterminals in Brisbane, Sydney, Perth and Adelaide Video loop advertising on Skybus

Taking and sending PBS medicine overseas

Advertisements in community newspapersRadio announcements on community stations

Promoting awareness of overseas drug diversion issues among culturally and linguistically diverse groups

Table 34- Distribution of information on Medicare or PBS

Materials Topics Quantity

PBS and You CDsComprehensive introduction to the PBSand to prescribing PBS medicine for new medical practitioners

3 177

Overseas drug diversion information sheets

Information to medical practitioners,pharmacists and the public on taking or sending PBS medicine overseas

20 530(including17 languages*)

Getting more medicine than youneed: Prescription Shopping

Program brochure

To provide medical practitioners andpharmacists with information to explainto their patients the problems with getting more medicine than necessary

14 460

Non-PBS prescription stickynotes and private prescription

stamps

Explains why non-PBS prescription is necessary and that the patient will pay full cost for the medicine at the pharmacy. Stamps ensure prescribers’ intentions are clear when writing a non-PBS prescription

671 orders

* Including Arabic, Bosnian, Chinese, Croatian, Farsi, Filipino, Greek, Hindi, Indian, Italian, Khmer, Korean, Macedonian, Russian, Serbian, Turkish and Vietnamese.

Fraud awareness training for Medicare Australia staffMedicare Australia provides training on fraud awareness to new staff as part of their induction and to current staff in Medicare offices to maintain their awareness of fraud.

In 2006–07, we provided fraud awareness training sessions for 1 616 staff members in our state offices.

Travelling with PBS Medicine Enquiry LineThe Travelling with PBS Medicine Enquiry Line (1800 500 147) is an initiative of the Overseas Drug Diversion Program. The program targets individuals who might illegally send or carry PBS medicine overseas. The enquiry line advises on the rights and responsibilities of Australians when travelling.

Figure 6 - Number of calls to the Travelling with PBS Medicine Enquiry Line, 2005–06 and 2006–07

In 2006–07, the enquiry line received 6 126 calls. Theaverage number of calls permonth in 2006–07 was 511.

DetectionMedicare Australia identifies potential non-complianceby medical practitioners, pharmacies and pharmacistsand patients by using tip-offs, interagency intelligence, random sampling of claimingdata and targeted detectiontechniques.

Fraud hotlineMembers of the public can report suspected fraud by phone through the Australian Government Services Fraud Tip-Off Line (131 524) or online through the Medicare Australia website (www.medicareaustralia.gov.au).

Calls that warrant further assessment are assigned as cases and referred to the states from which the calls were made. In 2006–07, 2 315 calls to the hotline resulted in 768 being referred for further assessment.

Our Program Review Division also receives tip-offs about potential fraud cases from thepublic via fax, mail and email and from other areas within the agency, such as staff who detect suspicious claim patterns or behaviour. From October 2006 to June 2007, the division received 1175 tip-offs and referrals, more than 97 per cent of which were assigned as cases for further assessment.Because of system changes; data for the first quarter of 2006–07 is not available.

Random compliance audit programsRandom compliance audits are post-payment reviews that focus on whether the Medicare service or PBS supply that was claimed and paid for by Medicare Australia was actually provided to patients.

In 2006–07, two random compliance audit programs were undertaken, using records randomly selected from Medicare and PBS claiming and payment data.

Preliminary findingsfrom these audits were reported to the Australian National Audit Offi ce in July 2007 as part of the supporting evidence for Medicare Australia’s 2006–07 financial statements. Detailed reports of the findingsare expected to be finalised in 2007–08.

Targeted compliance audit programsIn 2006–07, Medicare Australia planned to carry out 12 programs of audits targeting potential non-compliance. The following table summarises the status of these audits at 30 June 2007.

Table 35 – Random compliance audit programs

Audit Details Number audited

Medicare Number of Medicare services (randomly selected) 2 227 services

PBS Number of PBS scripts (randomly selected) 5 376 scripts

Table 36 - Targeted compliance audit programs

Targeted Area Status (at 30th June 2007)

Practice Incentive Payments To be completed in 2007–08

Private Health Insurance Rebate Scheme Completed (report is being prepared)

Medical Indemnity Completed (report is being prepared)

Multiple payments (multiple claiming by

pharmacies) To be completed in 2007–08

Paediatric referrals Completed (report is being prepared)

Electronic bulk billing Completed (report is being prepared)

Care Plan Completed (report is being prepared)

Allied health workers To be completed in 2007–08

Targeted Area Status (at 30th June 2007)

Broadband for Health Completed (report is being prepared)

Home Medicines Review Program To be completed in 2007–08

Concessional entitlement validation (bulk bill) To be completed in 2007–08

Specialised drugs (Glivec and Herceptin) Completed (report is being prepared)

Data assessments, intelligence reports and artificial intelligence analysisMedicare Australia builds and maintains analytical tools that use sophisticated intelligence and data-mining techniques to scan and assess patient, medical practitioner and pharmacy/pharmacist populations for anomalous behaviour.

Data assessmentsIn 2006–07, we completed 18 data assessments to identify incorrect claiming and inappropriate servicing. The assessments covered Medicare and PBS claims worth around $470 million. The table below summarises selected assessments.

Intelligence reportsMedicare Australia uses intelligence analysis systems and processes to highlight potentially criminal activity, particularly in the areas of criminal associations, misuse of the PBS and identity fraud. Our tools include advanced geospatial and association charting systems.

In 2006–07, we prepared 29 intelligence reports: 23 to provide information supporting our own investigations and compliance operations and six to provide information for the development of future Medicare Australia compliance operations and to forward to other agencies.

Artificial intelligence analysis

In 2006–07, outputs from artificial intelligence analysis provided data for the Practitioner Review Program. This form of analysis has also been expanded to assess PBS claims data to identify anomalous behaviour by pharmacies.

Table 37 – Data assessments

Focus of the assessment Approximate number assessed

Benefit Assessed

Potential incorrect claiming of anaesthetic

item (Item 42702) for eye lens surgery

700 medical practitioners $6.6 million

Potential inappropriate prescribing of Cox-2 medicines

22 000 prescribers $2.8 million

Potential incorrect claiming of diagnostic percutaneous biopsy item (Item 30094)

1 900 medical practitioners $9 million

Potential misuse of concessionalEntitlement

8.4 million patients

23 000 medical practitioners$360 million

Table 38 – Artificial intelligence analysis

Analysis Outcomes

General Practitioner Risk

Analysis System

For each quarter: MBS claims data from around 22 000 GPs was reviewed Around 170 GPs were referred for assessment to

determine if further action was required.

PBS Risk Analysis System

Trial of PBS Risk Analysis System (using PBS claims data,September 2006): PBS claims data from 5 736 pharmacies reviewed 177 pharmacies referred for assessment to determine if

further action was required

CorrectionAs a result of detection activities, depending on the nature and significance of detected non-compliance, Medicare Australia may:

tell individuals of the behaviour that we have observed recover benefits paid incorrectly ask the Director of Professional Services Review to review possible inappropriate practice by

medical practitioners investigate and refer the matter to the Commonwealth Director of Public Prosecutions for criminal

prosecution where fraud is detected Where fraud by medical practitioners is proven, refer the matter to Medicare Participation Review

Committees for determination of disqualification.

Prescription Shopping ProgramThe Prescription Shopping Program aims to protect the PBS by focusing on patients who obtain PBS medicines beyond their medical need. It operates by providing information to selected patients, their prescribers, or both. The information is tailored to support medical practitioners (mainly GPs) in making more informed decisions about their patients’ therapeutic requirements. The program consists of a contact component and an information service.

Contact with medical practitionersWe contact medical practitioners through the mail or in face-to-face meetings to give them information about patients whom we suspect are prescription shopping. We also write to patients, notifying them of our concerns and advising them that we have contacted their medical practitioners.

Figure 7 – Medical practitioner contacts in 2005–06 and 2006–07

In 2006–07, Medicare Australia sent letters to or met 8694 medical practitioners to discuss 4 515 patients suspected of prescription shopping.

Prescription Shopping Information ServiceSince 31 January 2005, Medicare Australia’s Prescription Shopping Information Service has been providing medical practitioners with information on patients whom they suspect are prescription shopping.

In September 2006, we made a number of enhancements to improve the timeliness of data and to give prescribers online access to patient reports.

Figure 8 – Calls to and reports by the Prescription Shopping Information Service in 2005–06 and 2006–07

In 2006–07, the service received 18 259 calls and sent 3 812 patient reports. Compared to 2005–06, the number of calls has increased by 16 per cent (2 469) and the number of reports sent increased by 22 per cent (685).

Overseas Drug Diversion ProgramThe Overseas Drug Diversion Program focuses on individuals who may be illegally sending or taking PBS medicines overseas. The program provides education and communication on the rights and responsibilities of Australians when they take PBS medicines overseas, including through the Travelling with PBS Medicine Enquiry Line (1800 500 147). Medicare Australia also works with the Australian Customs Service and Australia Post to detect and prevent the illegal export of PBS medicines through international airports and mail exchanges.

From 13 to 15 March 2007, Medicare Australia conducted Operation Brillpen, a joint operation with the Australian Customs Service, at Sydney International Airport and Sydney International Mail Exchange as part of the Overseas Drug Diversion Program.

There were five incidences where PBS medicines were detained at the mail exchange. At the airport, a substantial number of passengers were found to be carrying PBS medicines with a letter from their medical practitioner in reference to their medicines. This underlines the success of our campaign to inform the travelling public about the needto carry such documentation.

Operation Brillpen was covered by Channel 7’s top rating Border Security television program. The screening of the operation should increase public awareness of the Overseas Drug Diversion Program and its aims.

Thirty cases of potential illegal exports of PBS medicines were detected in 2006–07. Most of the medicines were detained and earmarked for destruction and the exporters were issued with warning letters.

In May 2007, an Australian man was convicted of possessing an excessive quantity of PBS medication after a joint Medicare Australia – Customs operation at Sydney International Airport. The medicines were detected inside the man’s luggage while he was trying to board a flight to Vietnam. He was sentenced to a six month good behaviour bond and ordered to pay court costs.

Recovery of benefits incorrectly paidIn 2006–07, Medicare Australia initiated action to recover $3.37 million in incorrect payments from 499 individuals. The payments were identified through audits, investigations and reviews. Details of these recoveries are in the following table.

Table 39 – Recovery identified and to be repaid

Groups Number Amount

Medical practitioners 184 $1 695 388

Pharmacies/pharmacists 230 $679 626

Patients/members of public 77 $53 074

Other 8 $458 598

Total 499 $3 369 686

InvestigationWhen possible fraud is detected in programs administered by Medicare Australia, we investigate for potential prosecution. Prosecution is at the extreme end of the range of compliance intervention options available to us.

In 2006–07, we began550 investigations, completed487 and referred 79 to the Commonwealth Director of Public Prosecutions.

At 30 June 2007,423 investigations were ongoing, of which 92 (22 per cent) had been open for 12 months or longer, continuing a trend since January 2007. There is a correlation between the length of an investigation and the complexity of the case. Investigations into fraud by medical practitioners, pharmacies or pharmacists and into sophisticated public frauds (possibly involving multiple entities and intricate corporate and financial networks), take longer than investigations of fraud by individual members of the public.

In 2006–07, the Commonwealth Director of Public Prosecutions successfully prosecuted 56individuals referred by Medicare Australia for committing frauds against our health-related programs. The following table summarises those prosecutions.

Practitioner Review Program Medicare Australia reviews medical practitioners’ where claims data indicates that their claiming or prescribing practice profile differs from that of their peers.

The Practitioner Review Program took effect from1 November 2006, replacing the earlier Practice Profile Review Process. We contacted practitioners who were subject to a profile review at that time and provided them with a factsheet outlining what the change would mean for them.

In 2006–07, we completed a review of 324 medical practitioners through the Practitioner Review Program and sent requests concerning26 medical practitioners to the Director of Professional Services Review for review for possible inappropriate practice.

The Professional Services Review is a peer review process established in 1994to examine suspected cases of inappropriate practice. Professional Services Review (PSR) exists to protect the integrity of Medicare and the Pharmaceutical Benefits Scheme (PBS).

Medicare Australia sends requests to the Director of Professional Services Review to review any medical practitioner who fails to address our concerns through the Practitioner Review Program. Following the review, the Director can either decide to take no further action, negotiate and enter into an agreement with the medical practitioner, or refer the medical practitioner to a Professional Services Review Committee. The decision of the committee is then referred to the Determining Authority to decide the sanctions to be applied to the medical practitioner.

Table 40 – Summary of successful prosecutions, 2006–07

Population Number Recoveries

Medical practitioner 2 $28 379

Pharmacies/pharmacists 1 $4 021

Members of the public 53 $280 527

Total 56 $312 927

In 2006–07, the Director of Professional Services Review made fi nal determinations on 17 cases: two cases were from previous determinations, six were for reprimand under section 92 of the Health Insurance Act, two were dismissed under section 91 and seven were for counsel and reprimand under section 93. Repayments from the determinations totalled nearly $0.9 million.

Suspension or revocation of approval to supply under the PBSUnder section 133 of the National Health Act, the approval for pharmacists to supply PBS medicines and claim PBS benefits can be revoked by the Minister for Health and Ageing or suspended by the Secretary of DoHA.

In 2006–07, Medicare Australia considered using the section 133 process in two cases, but did not do so, as court proceedings are continuing in relation to both pharmacists.

Medicare Participation Review CommitteesMedicare Participation Review Committees (MPRCs) are independent statutory committees established on a case-by-case basis under Part VB of the Health Insurance Act. The role of the MPRC is to make independent determinations on whether a medical practitioner, or a person, should maintain the right to participate in Medicare.

MPRCs are able to suspend access to Medicare when:

a medical practitioner has been convicted of a relevant offence a medical practitioner has been found under the Professional Services Review Scheme to have

engaged in inappropriate practice on two separate occasions a medical practitioner or pathology company is reasonably believed to have breached a pathology

undertaking A medical practitioner or person is reasonably believed to have engaged in prohibited diagnostic

imaging practices.

The maximum penalty able to be applied as a result of an MPRC determination is five years total disqualification from participation in Medicare programs.

In 2006–07, Medicare Australia referred two medical practitioners to the MPRC. During the year, the MPRC held three hearings and made fi ve determinations. Details of MPRC determinations in 2006–07 are provided in the following table.

Table 41 – Medicare Participation Review Committee determinations

Case Reasons for referrals Determination

Medicalpractitioner

(GP)

The medical practitioner was convicted of a relevant offence in 2005–06 as a result of false and misleading statements in relation to Medicare claims

Disqualification from providing MBS services in all metropolitan areas for a period of eight weeks (excluding remote areas)

Medicalpractitioner

(GP)

The medical practitioner came before the MPRC as a result of two findings of inappropriate practice through the Professional Services Review Scheme

Disqualification from all MBS services for 18 months Effective 25 September 2006

Medicalpractitioner

(Optometrist)

Pleaded guilty to dishonestly causing a loss to a Commonwealth entity contrary to section 135.1(5) of the Criminal Code

Reprimand Effective 13 October 2006

Medicalpractitioner

(Optometrist)

Convicted of 38 charges under section 134.1 of the Criminal Code.Pleaded guilty to obtaining property by deception

Reprimand Effective 14 December 2006

Medicalpractitioner(GP)

Pleaded guilty to 122 offences (which were rolled into one charge) in relation to billing Medicare Australia for services that were not provided to patients

Disqualification from all MBS services for one monthEffective 21 April 2007

Medicare Australia onlineMedicare Australia’s online claiming facility was introduced in 2002 to enable medical providers to lodge claims (including Medicare bulk bill, patient claims and DVA claims) and to submit information to the Australian Childhood Immunisation Register over the internet.

Medicare Australia has been working closely with providers to implement online claiming and seek feedback about its use. Practices are continuing to register to use online claiming at the rate of150–200 per month.

While take-up of patient claiming for paid accounts has been lower than anticipated, bulk bill claiming online continues to rise. The significant benefit for the Australian public is the ability to lodge claims direct from the medical practice after the consultation, eliminating the need to visit a Medicare office. If the account has been paid, patients can also choose to have their benefit paid directly into their nominated bank account.

During 2006–07, we promoted online claiming through:

a presence at educational seminars engagement with the Association of Australian Practice Managers continued support for and engagement of business development representatives across Australia Education of the public through posters and brochures about the convenience of online claiming.

Table 42 – Medicare Australia online

2005-06 2006-07 % Change

Number of registered sites*

5 948 7 455 +25.3%

Number of transmitting sites**

5 369 6 632 +23.5%

Number of bulk billed services transmitted


Percentage of all bulk bill services

24.7% 31.5% +6.8%

Providers transmitting bulk bill services

20 186 24 120 +19.5%

Patient claimed services transmitted


Percentage of all patient claimed services transmitted

5.1% 7.9% +2.8%

Providers transmitting patient claimed services

6 475 9 094 +40.4%

Figure 9 – Practices with Online Claiming

Figure 10 – Medical services claimed via Online Claiming July 2003 – June 2007

ECLIPSEECLIPSE (Electronic Claim Lodgement and Information Processing Service Environment) uses secure internet connections between registered health benefit organisations, medical practitioners, hospitals, billing agents and Medicare Australia to help patients lodge claims and pay accounts.

Consultation with government and the private health sector identifi ed a need for an industry-wide, seamless eBusiness solution to streamline billing and claiming for in-hospital episodes of care. The manual billing process was considered to be complex, inconvenient for patients and expensive. In response, Medicare Australia released the fi rst elements of ECLIPSE in July 2004 and we have continued work since then to upgrade the system.

During 2006–07, Medicare Australia delivered further ECLIPSE features to allow hospital claiming, hospital online eligibility checking and overseas claiming. In-hospital claiming allows public and private hospitals and day facilities to submit a claim in relation to the patient’s hospital stay, including claims for accommodation, transfers and miscellaneous items, such as prosthetics.

While the components of ECLIPSE have been delivered on time and within budget, take-up by health insurance funds has been signifi cantly slower than expected. Therefore, we are reviewing the governance and administration arrangements for ECLIPSE, with the aim of increasing take-up. The private health industry has indicated its support for this approach and discussions about future operating arrangements have begun.

Table 43 – ECLIPSE

2005-06 2006-07 % Change

No. of transmitting sites* 94 164 +74.5%

No. of simplified billing services transmitted 70 926 157 840 +122.5%

Percentage of all simplified billing services

0.5% 1.1% +0.6%

Providers transmitting simplified billing services

513 1 056 +105.8%

Online patient verifications transmitted


RHBOs connected to ECLIPSE 23 29 +26.1%

Percentage of privately insured population represented

by RHBOs** connected to ECLIPSE

79.1% 86.3% 7.2%

Figure 11 – Medical services claimed using ECLIPSE 2005–06 and 2006–07

Medicare EasyclaimIn August 2006, the Prime Minister announced that the government would develop Medicare Easyclaim to allow the Medicare rebate to be claimed directly from the doctor’s surgery using electronic funds transfer (EFTPOS) technology. The government set Medicare Australia the goal of implementing Medicare Easyclaim from September 2007. We have been working closely with financial institutions to develop and deliver the new claiming service.

The service will transmit both bulk bill claims and patient claims and rebates. Around15 000 medical practices are either current or potential users of electronic claiming of some kind (EFTPOS or online claiming).

Medicare Easyclaim is available to all doctors, including GPs and specialists and their patients.

Participating institutionsProviders of EFTPOS services that are registered with the Australian Payments Clearing Association as participating members of the Consumer Electronic Clearing System are eligible to apply to be accredited providers of Medicare Easyclaim. All members have been formally approached about Medicare Easyclaim.

The contractual arrangements confer no special advantage for large participants’ and should prevent costs shifting across the sector.

On 22 December 2006, the Commonwealth Bank of Australia and MoneySwitch Limited (trading as Tyro Payments) signed contracts to deliver Medicare Easyclaim. National Australia Bank signed a contract on 5 April 2007.

Banks and other financial institutions will receive a transaction payment of 23 cents (including GST) for each claim transmitted via Medicare Easyclaim. We took this price after considering advice from commercial, government and specialist interests.

Each participating financial institution is required to undergo a rigorous accreditation process before being given approval to implement Medicare Easyclaim. The accreditation process covers all areas of system development, including security, as well as marketing and provider support.

In delivering value for money, we have sought to maximise take-up by the public and doctors by ensuring the broadest coverage of financial institutions offering EFTPOS services.

PromotionMedicare Australia has completed phase one of an ongoing public education campaign to increase awareness of Medicare Easyclaim among medical practitioners and their staff and to increase take-up of the system by practices. Promotional activities have included placing articles in stakeholder publications and newsletters, posting content on our website and engaging with key health journalists.

We also ran a major direct-contact campaign with the medical industry to raise awareness and provide information about the options available for point-of-service claiming. During this 11-week campaign, Medicare Australia officers contacted over 15 000 medical practices and held 220 information sessions around the country. This was an extremely successful campaign. Not only did it raise awareness of the new claiming choice, but it generated discussion on electronic claiming issues of concern to doctors and practice managers.

Stakeholder engagementMedicare Australia has used a comprehensive stakeholder engagement strategy as part of the development and implementation of Medicare Easyclaim. The strategy includes ongoing engagement and consultation with a number of peak medical bodies, including the Australian Medical Association and the Australian Association of Practice Managers at state and national levels; many professional colleges, including the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine; and various other medical industry representative groups.

PBS online claimingMedicare Australia has a long history of using electronic commerce. Today, Medicare eBusiness systems allow business-to-business communication with most players in the health sector, including medical providers, pharmacies, aged care facilities, hospitals and health funds.

During 2006–07, we worked closely with the Pharmacy Guild of Australia and major pharmacy software vendors to improve the PBS Online system. Combined with a new incentive package developed by DoHA, the system improvements have led to a large increase in pharmacists’ take-up of PBS Online (see the chart below).

By the end of June 2007, 4 490 pharmacies had converted to the new online system, which provides:

real time script processing, allowing errors to be corrected at the time of entry more frequent payments to pharmacists

real-time concessional entitlement validation at the time of dispensing, via a link between Medicare and Centrelink

Improved reconciliation reports for pharmacies.

By April 2007, more scripts were processed by the new system than by the old disk-based system.

Figure 12 – Pharmacies using PBS Online

Figure 13 – Script lodgement methods

Online ServicesMedicare Australia’s Online Services provide a convenient way for the general public to view, request and update their information online. People who are registered for Online Services can:

view and print their Medicare Safety Net balance

view and print their child’s immunization history statement

view their organ donation decision

request a replace mentor duplicate Medicare card

view and update their personal details

View and print their Medicare benefit tax statement details.

The Medicare benefit tax statement was made available online in March 2007. The statement is available for the previous financial year, or from the beginning of the current financial year to the date of the request. It cans be viewed, printed and saved. Medicare office staff promoted online access to the statement and online registrations have increased significantly since we made it available.

Medicare Australia conducts regular market research to gauge the public’s interest in proposed new online products before they are delivered. Online services are promoted through Medicare offices, Centrelink offices, universities and online search engines.

Medicare Australia had set an online registrations target of157 000 (one per cent of the15.7 million eligible people) by June 2007. We achieved the target in April, three months ahead of schedule.

During 2006–07, an average of 490 Australians a day registered for Online Services, bringing the total registered to216 142 by 30 June 2007.

Figure 14 – People registered for online services

Web servicesDuring 2006–07, 2.75 million visits were made to Medicare Australia’s website (www.medicareaustralia.gov.au) to access information or Online Services (10 per cent more than in 2005–06).

We launched a new website design in February 2007. The site now has a more contemporary look and a number of enhancements to improve navigation and usability.

e-taxFrom July 2006, tax return lodgers have been able to retrieve their Medicare benefit tax statement automatically through the e-tax lodgement process. For those who lodge their personal tax return electronically and complete the medical expenses section of the return, this service removed the need to phone or visit a Medicare office to request a Medicare benefit tax statement. This streamlined

process was made possible through close collaboration between Medicare Australia and the Australian Taxation Office.

Access cardThe Health Benefits, Veterans’ and Social Services Access Card is proposed to replace up to 17 health benefits, veterans’ and social services cards and vouchers.

The access card project is being led by the Office of Access Card in DHS. Medicare Australia is participating in the project through the provision of resources and by providing advice directly to the office on technical, policy and legislative issues.

Relevant activities include:

sharing our experience from the Medicare smartcardrollout in Tasmania providing information to support the development of key access card documents, including the

registration strategy, transition strategy, detailed business requirements, conceptual architecture and service delivery models

analysing the impact of access card on current program delivery arrangements (for example, Medicare, the PBS, the Australian Organ Donor Register and Australian Childhood Immunisation Register) and making the necessary system and policy modifications

doing preparatory work to ensure that our systems are ready to support the increased number of data transactions resulting from access card registrations(for example, upgrading the bandwidth available in Medicare offices)

providing technical expertise to assist in the office’s procurement activities Advising on aspects of our business model that could help manage registration demand (for

example, using expiring Medicare cards to drive take-up of access cards).

Our experience with the Medicare smartcard pilotproject in Tasmania has proved particularly useful to informing the development of the accesscard program. The smartcard was an optional replacement for the standard Medicare card and enabled people to choose to include their photograph on the chip on the card.

Approximately 4 500 people registered for the Medicare smartcard and 3 008 cards were issued. The Australia Post contract to manage smartcards in Tasmania ended on 25 November 2006.

Information technology servicesOur technology channels, core application portfolio and information assets play a critical role in the delivery of Medicare Australia services across the health sector. After our people, technology is our largest area of investment and it is important that we get the greatest possible value from that investment.

Medicare Australia is one of the worlds largest and most efficient health benefit information processing agencies. We are well positioned to leverage our capabilities and unique assets, which include:

extensive technology enabled delivery channels

238 Medicare offices in community accessible locations across Australia offering a wide range of services, including one-stop government access to Family Assistance services

over 1000 Medicare Access Points across Australia web-enabled self service capability, including access to letters and forms 24 hours a day, seven

days a week

comprehensive consumer and provider registries

a consumer registry of over 21 million people covered by Medicare services an extensive provider registry of health related organisations and practitioners authentication registrations through the issuing of public key infrastructure security certificates and

tokens

customer services capability based on integrated solutions

financial management, claiming and payment systems public registers, such as the Australian Organ Donor Register, the Australian Childhood

Immunisation Register and the Bowel Cancer Screening Register service integration:working with small and large health service vendors to integrate their services

into a secure and consistent service delivery framework Face of government: providing the public with a one-stop capability for communicating with

government through Family Assistance Offices offering cross-agency services and the ability to register changes of circumstance at a single point.

Each year, about 500 million transactions and more than$30 billion in payments and benefits are processed through Medicare Australia’s information technology services at exceptional levels of efficiency.

We play an important role as one of six DHS agencies and will continue our work to exploit synergies among those and other agencies. We will also continue to develop our unique services, information assets and capabilities to realize the benefits of those assets.

Key achievements in 2006–07Our key achievements in information technology in 2006–07 included:

development of Medicare Easyclaim in partnership with a number of financial institutions implementation of a better support model for pharmacies and suppliers of dispensing software that

has helped drive take-up of online claiming for PBS from 145 to 4 490 over the year introduction of real-time concessional entitlement checking for PBS in partnership with Centrelink transitioning to a new supplier for essential printing services, reducing the number of paper reports

and improving the designs of our forms and letters implementing a new telephony platform that provides the foundation for more flexible call routing

across the organization expanding the range of available Online Services to include concessional entitlement validation

and tax statements partnering with DHS, including Centrelink and the Child Support Agency, to make our Online

Services available through the new DHS portal, allowing a single sign-on for the public completing the rollout of Family Assistance services to all 238 Medicare offices implementing the National Bowel Cancer Screening Register, an eBusiness channel for the aged

care system and changes to Medicare to give the public the option of receiving benefit payments via EFT

adding functionality to the ECLIPSE and online claiming for Medicare systems to allow submission of DVA hospital claims

continuing the consolidation of information and corporate reporting in the enterprise data warehouse to provide accurate, single-source information and to remove the need for resource intensive ad hoc reporting

Updating Medicare Australia’s Information, Communications and Technology (ICT) Strategic Plan to take account of progress and environmental changes.

The Medicare Australia ICTStrategy is aligned with and supports the Medicare Australia Strategic Business Direction2007–2010. The ICT Strategy will be used as a blueprint to implement a number of key Medicare Australia strategies:

additional payment channels for Medicare online claiming integration of the proposed access card into our services continued focus on data cleansing and consolidation integration of new aged care systems web enablement of core services through the Service Office Portal front end cross-agency information and delivery channel for consumers leveraging of DHS agency purchasing power enhanced fraud prevention and compliance activities Standardisation of our data stores, including the application of standard geocodes to our address

data.

Aged care eBusinessIn 2005–06, responsibility for aged care claims processing was transferred to Medicare from DoHA.

In 2006–07, we implemented eBusiness for the aged care processing system, using our existing eBusiness assets, capability, processes and technology.

eCertificatesMedicare Australia provides electronic registration services for the Australian health sector, including registration for and distribution of digital keys and certificates.

We also undertake a range of other initiatives to support the integrity, validity and usability of all our registration services, including ongoing consultation with the sector to stay abreast of changing business needs.

Take-up of digital certificates increased significantly during 2006–07, taking the number of active digital certificates from 19 849 on 30 June 2006 to 32 361 at 30 June 2007.

Table 44 – Active digital certificates

Total as at 30 June 2006 Total to 30 June 2007

Individual certificates 8 981 11 034

Location certificates 10 868 21 327

Total certificates 19 849 32 361

Section 05 Financial StatementsSection 06 AppendicesAppendix A – Reports required by legislationOrganisation, function and powersDetails of Medicare Australia’s organisational structure are in Section 2, About Medicare Australia.

The functions of Medicare Australia’s Chief Executive Officer are specifi ed in the Medicare Australia Act, the Medicare Australia Regulations and functions directions issued by the Minister for Human Services.

Medicare Australia works in partnership with the DoHA to achieve the Australian Government’s health policy objectives. Our activities are conducted within the government policy framework set by DoHA, DVA, FaCSIA and DITR and relevant legislation.

Medicare Australia’s functions include:

paying Medicare benefits as provided for in the Health Insurance Act and undertaking all administrative activities necessary to ensure the effective performance of this function (authorised by the Medicare Australia Act)

paying pharmaceutical benefits and undertaking all administrative activities necessary to ensure the effective performance of this function (subject to the National Health Act and authorised by the Medicare Australia Act and Regulations)

preventing and detecting the occurrence of fraud and inappropriate servicing with respect to the payment of benefits under the programs administered by Medicare Australia (authorised by the Medicare Australia Act)

paying aged care benefits and undertaking all administrative activities to ensure the effective performance of this function (subject to the Aged Care Act and authorised by the Medicare Australia Act and Regulations)

administering theCompensation RecoveryProgram (under theprovisions of the Healthand Other Services(Compensation) Act)

administering the AustralianGovernment Private HealthInsurance Rebates (underthe provisions of the PrivateHealth Insurance IncentivesAct and the Private HealthInsurance Act)

maintaining andadministering theAustralian Organ DonorRegister (authorised byan arrangement madeunder section 7 of theMedicare Australia Act)

undertaking alladministrative activitiesunder the General PracticeImmunisation IncentivesScheme, the PracticeIncentives Program,the General PracticeRegistrars’ Rural IncentivePayments Scheme,the Rural RetentionProgram, the Trainingfor Rural and RemoteProcedures Scheme, theHECs ReimbursementScheme and the LPGVehicle Scheme (authorisedby arrangements madeunder section 7 of theMedicare Australia Act)

delivering services as partof the Family Assistance Office (under the provisions of the A New Tax System (Family Assistance) Act 1999 and A New Tax System (Family Assistance) (Administration) Act 1999 and authorised by an arrangement made under section 7 of the Medicare Australia Act)

providing services for the processing of DVA treatment accounts (authorised by an arrangement made under section 7 of the Medicare Australia Act)

providing services for the processing and payment of claims under the Australian Hearing Services Program (authorised by the Hearing Services Administration Act 1997)

administering the relevant schemes under the Medical Indemnity Act and related legislation undertaking the Prescription Shopping Project (authorised by a ministerial direction made under

section 5(1)(d) of the Medicare Australia Act) providing ex gratia payments for survivors of the bombings that occurred in Bali, Indonesia, in

October 2002 and family members of victims and survivors Administering various special assistance schemes, including the Tsunami Healthcare Assistance

scheme, the London Assist scheme, the Bali 2005 Special Assistance scheme and the Dahab Egypt Bombing Healthcare Costs Assistance scheme (authorised by a ministerial direction made under section 5(1)(d) of the Medicare Australia Act).

Details of the programs that Medicare Australia administers are in Section 4, Programs.

Decision-making powersIn 2006–07, the Minister for Human Services, Medicare Australia’s Chief Executive Offi cer and/or Medicare Australia’s officers exercised decision-making powers, made payments and undertook delivery of programs under the following Acts, or parts of those Acts:

Medicare Australia Act 1973 Health Insurance Act 1973 National Health Act 1953 Aged Care Act 1997 Veterans’ Entitlements Act 1986 Military Rehabilitation and Compensation Act 2004 Health and Other Services (Compensation) Act 1995 Medical Indemnity Act 2002 Private Health Insurance Incentives Act 1998 Private Health Insurance Act 2007 A New Tax System (Family Assistance) Act 1999 A New Tax System (Family Assistance) (Administration) Act 1999 Hearing Services Administration Act 1997.

Secrecy provisionsSecrecy provisions in section 130 of the Health Insurance Act and section 135A of the National Health Act provide for the confi dentiality of information obtained by Medicare Australia in the performance of its functions.

The secrecy provisions make it an offence for a Medicare Australia offi cer to disclose information about a person to a third party, unless a specified exception or release provision applies. For example, information may be released to state health regulatory authorities, such as medical and pharmaceutical boards, in relation to matters affecting the registration of professional health providers. There is also provision under section 130(3) of the Health Insurance Act and section 135A(3) of the National Health Act for the Minister for Health and Ageing, or an offi cer to whom this authority is delegated, to certify that it is in the public interest for information to be released.

Section 135AA of the National Health Act and associated guidelines issued by the Privacy Commissioner regulate the maintenance and storage of claims information and require the separation of Medicare and Pharmaceutical Benefits Scheme databases.

Privacy ActMedicare Australia is subject to the Privacy Act 1988, which regulates the way most Australian Government agencies collect, handle, use and disclose personal information.

In 2006–07, we received 92 complaints about the use and disclosure of personal information we hold. Of these complaints, 38 were found to be not substantiated and 50 were substantiated and the appropriate action was taken. Four complaints were originally lodged with the Privacy Commissioner, who referred them to Medicare Australia for action.

In accordance with the Privacy Act, Medicare Australia submits an annual report to the Privacy Commissioner listing the types and use of information we hold(Personal Information Digest).

Statutory report under section 42The Medicare Australia Act provides for the Chief Executive Officer to authorise the exercising of powers requiring a person to give information or to produce a document that is in the person’s

custody, or under the person’s control; and the power to obtain a search warrant to search and seize evidential material, in respect of a ‘relevant’ offence, where warranted.

Section 42 of the Medicare Australia Act specifies that any uses of these powers must be reported annually (see table below).

Table 45 – Statutory report under Section 42

Section 42(1) subsections: a to h

2005–06a 2006–07

(a) The number of signed instruments made under section 8M

3 15

(b) The number of notices in writing given under section 8P

56 44

(c) The number of notices in writing given to individual patients under section 8P. Note: this is a subset of (b) above.

5 5

(d) The number of premises entered under section 8U

0 0

(e) The number of occasions when powers were used under section 8V

1 0

(f) The number of search warrants issued under section 8Y

5 20

(g) The number of search warrants issued by telephone or other electronic means under section 8Z

1 2

(h) The number of patients advised in writing under section 8ZNb

275 6 512

a. Data for 2005–06 was not included in the 2005–06 annual report. That data is included in this annual report for reference.

b. Where powers are exercised in relation to a record containing clinical records, the Chief Executive Officer must advise the patient in writing, except under specific circumstances, for example where, after reasonable enquiries, the patient could not be located or contacting the patient would jeopardise the investigation.

Occupational health and safety reportMedicare Australia is required under section 74 of the Occupational Health and Safety Act to provide a report on occupational health and safety activities and statistics on notifi able accidents, dangerous occurrences, investigations and notices under section 68 during the year.

Table 46 – Occupational health and safety report

Action Number

Deaths that required notice under section 68 0

Accidents that required notice under section 68 18

Dangerous occurrences that required notice under section 68

8

Investigations conducted under Part 4 1

Tests on plant, substance, or thing in the course of investigations considered

0

Directions given to Medicare Australia under section 45 (that the workplace etc not be disturbed)

0

Notices given to Medicare Australia under section 29 (provisional improvement notice)

1

Notices given to Medicare Australia under section 46 (prohibition notice)

0

Notices given to Medicare Australia under section 47 (improvement notice)

0

Appendix B – Freedom of InformationMedicare Australia is a prescribed authority under the Freedom of Information Act and is required to publish information about the way it is organised, its functions and powers, the categories of documents it holds and how the public can access them.

Details of Medicare Australia’s organisational structure are in Section 2, About Medicare Australia. Appendix A sets out the organisations functions and powers.

Freedom of information statistics for 2005–06and 2006–07 are included in this appendix.

Documents held by Medicare AustraliaBrochures explaining the Medicare program, the Pharmaceutical Benefits Scheme (PBS), the Australian Childhood Immunisation Register, the Compensation Recovery Program, the Australian Government 30% Rebate on Private Health Insurance, the Australian Organ Donor Register and Family Assistance are available free of charge from Medicare offices.

Medicare Australia’s website (www.medicareaustralia.gov.au) features publicly available publications and forms that can be viewed or downloaded.

Medicare Australia’s statement under section 9 of the Freedom of Information Act was updated in March2007 and is available on the National Archives of Australia website (www.naa.gov.au).

In accordance with section 8 of the Freedom of Information Act, the following types of documents are held by Medicare Australia and are available subject to the exemption provisions of the Act:

administration and policy files agendas, minutes and records of meetings of various internal and external committees and

tribunals agendas, minutes and submissions for commission meetings applications for approval as an accredited orthodontist applications for approval as a dentist or dental practitioner applications for recognitions a specialist or consultation physician applications for recognitions a vocationally registered general practitioner brochures relating to Medicare Australia operations committee and tribunal files created as a result of a specific inquiry or hearing committee and tribunal member papers computer records relating to all Medicare Australia operations financial budgetary documents internal audit terms of reference, reports and fi les legal advice and opinions legislative documents in the form of Acts, regulations and interruptions listings of approved Medicare practitioners and laboratories listings of certified patients for the cleft lip and palate scheme listings of participating Medicare medical practitioners, dentists and optometrists listings of pathology licensed collection centres and accredited pathology laboratories listings of PBS approved persons as defined under Sections 90 & 92 of the National Health Act

and pharmaceutical prescribers Medicare Benefits Schedule item rulings and interpretations Ministerial, Commonwealth Ombudsman and general correspondence Ministerial submissions operational instructions, circulars and directives relating to Medicare, the PBS, the Australian

Childhood Immunisation Register, the Practice Incentives Program, the Compensation Management System, the 30% Rebate on Private Health Insurance, Veterans’ Treatment Accounts, the Australian Organ Donor Register, the Hearing Service Payment and the Health Research and Coordinated Care Trials

personal records processed enrolment, registration and withdrawal forms and claims documentation relating to

Medicare Australia operations property documents, including leases, tenders and maintenance agreements records created as a result of a specific complaint, inquiry or review records in relation to the regulatory functions of pathology licensed collection centres and

accredited pathology laboratories records of contact between medical advisers and medical practitioners statistical reports and analyses undertakings for participating optometrists.

Procedure and initial contact pointsA formal request under the Freedom of Information Actfor access to Medicare Australia documents should be made in writing, accompanied by a $30.00 application fee made payable to Medicare Australia and sent to:

Freedom of Information Officer

Medicare Australia

PO Box 1001

Tuggeranong DC ACT 2901

Ph: (02) 6124 7914

Fax: (02) 6124 6935

Remission of the application fee may be sought. Applicants may be liable to pay charges for costs associated with processing a request and providing access to documents.

Freedom of Information reportThe following table sets out the reportable Freedom of Information matters for Medicare Australia in 2006–07.

Table 47 – Freedom of Information requests

Requests No. or $ amount

On hand at 30 June 2006 1

Received 14

Resolved by being:

Withdrawn (following consultation) 2

Granted in full 0

Granted in part 10

Refused in full 3

Outstanding at 30 June 2007 0

Finalised in:

0–30 days 7

31–60 days 5

61–90 days 1

91 days or more 0

Fees and levies charged

Application fees received $360.00

Charges notified $17 644.35

Charges collected $1 105.00

Internal reviews

Requests No. or $ amount

Received 1

Finalised 1

Administrative Appeals Tribunal appeals

Received 1

Outstanding at 30 June 2007 1

The table below shows Medicare Australia’s performance against Freedom of Information standards in 2006–07.

Table 48 – Freedom of Information standards

Standard Performance2005–06

Performance2006–07

We will acknowledge your request under the Freedom of Information Act 1982 within 14 days of receipt and respond within 30 days of receiving your request. If other parties need to be consulted, the law provides for another 30 days for a decision to be made.

One request was carried over and 19 requests were received in 2005–06. Of these, 19 decisions were made and one was carried through to 2006–07. All were acknowledged within 14 days of receipt. Of the 19 decisions, all were responded to within the legislative timeframes.

One request was carried over and 14 requests were received in 2006–07. Of these, 15 decisions were made and none were carried over to 2007–08. All were acknowledged within 14 days. Of the 15 decisions, 14 were responded to within the legislative timeframe; one was not, with the agreement of the applicant.

Appendix C – StaffingStaffing statisticsMedicare Australia has staff across Australia – in the national office in Canberra, in state headquarters in each state, in nine payment processing and call centres and in 238 community-based Medicare offices.

At 30 June 2007, 5 972 staff were employed by Medicare Australia under the Public Service Act. This was an increase of 579 staff or 9.6 per cent since 30 June 2006. Increases have occurred in state networks and are primarily aligned to Family Assistance business growth and other initiatives aimed at reducing queue times and enhancing service.

Part-time work participation has remained constant and applies to 21 per cent of the workforce. This is most evident through the Medicare office networks. Women comprised 81 per cent of all staff. All staff figures are based on headcount at 30 June 2007.

Table 49 – Staff by classification and location

Staff, by classification and location

Classification National office

NSW Qld SA/NT Tas. Vic. WA Total

CEO 1 0 0 0 0 0 0 1

SES Band 3 3 0 0 0 0 0 0 3

SES Band 2 9 1 0 0 0 1 0 11

SES Band 1 32 0 1 1 1 1 1 37

EL 2* 245 15 10 3 2 10 4 289

EL 1** 329 28 21 16 12 24 11 441

APS 6 285 43 23 20 3 31 13 418

APS 5 149 175 114 58 31 135 66 728

APS 4 100 97 58 36 19 83 43 436

APS 3 13 698 437 168 84 537 180 2 117

APS 2 4 179 142 57 48 179 72 681

APS 1 3 214 171 65 75 173 109 810

Total 1 173 *** 1 450 977 424 275 1 174 499 5 972

* Executive level 2

** Executive level 1

*** 214 staff report to the national offi ce directly but are located in the states. These staff are included in state totals.

Table 50 – Ongoing and non-ongoing staff by classification

Classification Non-ongoing Ongoing Total

CEO 0 1 1

SES Band 3 0 3 3

SES Band 2 0 11 11

SES Band 1 0 37 37

EL 2 0 289 289

EL 1 9 432 441

APS 6 31 387 418

APS 5 21 707 728

APS 4 26 410 436

APS 3 20 2 097 2 117

APS 2 20 661 681

APS 1 128 682 810

Total 255 5 717 5 972

Table 51 – Full-time and part-time staff by classification

Classification Full-time Part-time Total

CEO 1 0 1

SES Band 3 3 0 3

SES Band 2 11 0 11

SES Band 1 36 1 37

EL 2 268 21 289

EL 1 396 45 441

APS 6 389 29 418

APS 5 687 41 728

APS 4 414 22 436

APS 3 1 459 658 2 117

APS 2 473 208 681

APS 1 560 250 810

Total 4 697 1 275 5 972

Table 52 – Staff by gender and location

Staff, by gender and location

State Female Male Total

National office 680 493 1 173*

New South Wales 1 263 187 1 450

Queensland 846 131 977

South Australia/Northern Territory

365 59 424

Tasmania 239 36 275

Victoria 1 011 163 1 174

Western Australia 436 63 499

Total 4 840 1 132 5 972

* 214 staff report to the national office directly but are based in the states. This staffs are included in state totals.

Table 53 – Salary ranges for staff covered by the certifi ed agreement and AWAs

Salary ranges for staff covered by the certified agreement and AWAs

Classification Salary range ($)

SES Band 3*

SES Band 2* 145 600–186 000

SES Band 1* 106 000–144 087

EL 2** 87 452–136 244

EL 1** 73 150 – 93 540

APS Level 6 58 000–78 000

APS Level 5 52 913–75 000

APS Level 4 49 282–56 489

APS Level 3 42 854–49 072

APS Level 2 38 660–41 722

APS Level 1 20 615–36 386

* SES Band 3 salaries have not been included, as this would enable identifi cation of individual packages because of the small number of staff at that level.

** Salary ranges include Professional Officers in equivalent groups.

All SES employees are entitled to the use of private-plated vehicles or cash-out arrangements.

Table is based on annualised full-time pay rates.

Table 54 – Performance pay***

Performance pay

Staff groups Staff paid Amount paid($)

Average ($) Range ($)

Senior Executives (incl. CEO)

39 198 073 5 079 612.00–16 538.00

Executive Level 2 176 653 618 3 714 406.00–10 350.00

Executive Level 1 83 234 822 2 829 540.00–6 150.00

APS 6 and below 16 21 754 1 360 372.00–2 831.00

Total 314 1 108 267 3 245

*** These fi gures relate to the performance cycle ending 30 June 2006. Payments were made in September 2006.

Table 55 – Equity and diversity groups

Equity and diversity groups

Indigenous Disability NESB*

Location Ongoing Non-ongoing

Ongoing Non-ongoing

Ongoing Non-ongoing

National office 10 0 21 1 202 11

New South Wales 18 0 27 0 376 8

Queensland 15 1 18 0 50 0

South Australia 14 2 10 0 44 2

Tasmania 7 3 7 2 8 0

Victoria 16 1 31 2 176 2

Western Australia 10 0 4 0 54 2

Total 90 7 118 5 910 25

* NESB = Non-English speaking background

Appendix D – Consultancy servicesThe table in this appendix lists new and extended consultancy contracts let to the value of $10 000 or more (inclusive of GST) during 2006–07. Information for each consultancy includes the name of the consultant, a summary description of the nature and purpose of the consultancy, the contract price for the consultancy, the selection process used (including whether the consultancy was publicly advertised) and the reason for the decision to employ consultancy services.

KeySelection process1. Open tender – a procurement procedure in which a request for tender is published inviting all

businesses that satisfy the conditions for participation to submit tenders.2. Select tender – a procurement procedure in which the procuring agency selects which potential

suppliers are invited to submit tenders in accordance with the mandatory procurement procedures.

3. Direct sourcing – a procurement process, available only under certain defined circumstances, in which an agency may contract a single potential supplier or suppliers of its choice and for which conditions for direct sourcing apply under the mandatory procurement procedures.

4. Panel – an arrangement under which a number of suppliers, usually selected through a single procurement process, may each supply property or services to an agency as specified in the panel arrangements.

ReasonA. Skills currently unavailable within agencyB. Need for specialized or professional skillsC. Need for independent research or assessment

Table 56 – Consultancy services provided to Medicare Australia in 2006–07

Consultant’s name

Purpose of engagement

Price ($) Process Reason

Boston Consulting Group

Advice on Medicare Australia’s approach to managing significant organisational change

828 000 4 a/c

Booz Allen Hamilton

Review of the transfer of aged care functions

329 091 4 c

SMS Consulting (M&T)

Review of Medicare Australia’s audit and compliance programs

245 899 4 a/c

Consultant’s name



Booz Allen Hamilton

Benchmark the deployment of PBS Online to pharmacies

192 049 4 b/c

Pricewaterhouse Coopers

Provision of specialist support in audit and assurance

132 000 4 b


Advice and assistance in establishing project governance framework

108 955 4 a/c

Holocentric Pty Ltd

Development of a framework for end-to-end business modelling

94 244 3 b

Dattner Grant Pty Ltd

Development of a leadership program for Senior Executive Service officers

84 344 3 b

Wendy Bloom & Associates Pty Ltd

Survey of Medicare Australia Online Services

80 762 3 b

Ernst & Young Assistance with preparation of Capital Asset Management Plan

75 906 4 b/c

Valcare Pty Ltd Development of an Indigenous Employment Plan

75 482 3 a/b


Development of a business case for use of the SMS and email communication channels

75 075 4 a/c

Ucomm Pty Ltd Develop and 59 318 3 b

Consultant’s name



implement an internal communications strategy and change management framework


Advice on possibility of providing electronic Centrelink forms and medical certificates

59 125 4 b/c

Uncommon Knowledge

Complete 2006 customer satisfaction surveys

58 212 3 a/c

Acumen Alliance Advice on management of contracts and procurement within Medicare Australia

57 915 4 c

IT Newcom Provision of IT benchmarking and sourcing advice

56 000 3 b/c

Urbis Keys Young Research into Indigenous access to major health programs

54 988 1 c

Booz Allen Hamilton

Specialist banking advice to support Easyclaim project

54 671 4 b

Acumen Alliance Review of Information Technology Services Division accounting processes and

50 023 4 a/c

Consultant’s name



procedures

Excelerated Consulting Pty Ltd

Advice on and assistance with maintaining and developing Medicare Australia’s Budget Management System

41 646 3 a/b


Business continuity planning

38 500 4 b

Australian Government Actuary

Revaluation of Medicare Australia’s assets

38 280 3 c

Acumen Alliance Development of a strategy to support Medicare Australia’s financial forecasting function

29 700 4 a/c

Beames & Associates

Financial statement quality assurance services

25 254 3 c

HBA Consulting Review of impact of Family Assistance office functions on job classifications

24 628 3 c

Merry Beach

Conferences Pty Ltd

Code of Conduct reviews and reports

23 751 3 c

Ernst & Young Information technology security advice and assessments

23 325 4 b

Interaction Consulting Group

Review of framework for

20 890 3 c

Consultant’s name



people management policies and guidelines

Beames & Associates

FMA Act review 19 492


Data integrity review of Consumer Directory

19 392 4 c

KPMG Review of Activity Based Costing Model

18 700 4 a/c

Qualitative and Quantitative Social Research

Customer satisfaction research

18 300 3 c

Health for Industry Review of Attendance Management Program

16 500 3 b

Marilyn Roche Code of Conduct review and report

14 973 3 c

World Wide Webster Pty Ltd

Security advice on electronic procurement system

13 939 4 c

Workrisk Services Pty Ltd

Assistance in preparation of an Occupational Health and Safety Action Plan for the South Australian and Northern Territory areas

12 510 3 b

Total 3 171 839

Appendix E – Advertising and market researchSection 311A of the Commonwealth Electoral Act requires Australian Government agencies to report all payments of $10 300 or more made to advertising agencies or to organisations carrying out market research, polling, direct mailing or media advertising.

The following table outlines the use of such agencies by Medicare Australia in 2006–07.

Table 57 – Advertising and Market research

Payee Purpose Amount

Market Research

Instinct and Reason Annual customer satisfaction research

$109 989.00

Lote Marketing Pty Ltd Focus testing of translated information kits

$33 000.00

Wendy Bloom and Associates Online Services customer research

$56 430.00

Wendy Bloom and Associates Qualitative market research $84 359.00

Polling

No polling undertaken during period

Media Advertising

hma Blaze Pty Ltd To conduct recruitment advertising and standard non-campaign Medicare Australia advertising

$874 324.00

Direct mail

National Mailing and Marketing Forum newsletter mailed out to doctors*

$43 289.00

* Postage costs not included

Appendix F – Contact detailsTable 58 – Office locations

National office

134 Reed Street North

Greenway, Australian Capital Territory 2900

Phone: (02) 6124 6333

Fax: (02) 6282 5025

Postal address:

PO Box 1001

Tuggeranong DC, Australian Capital Territory 2901

State offices

New South Wales130 George Street

Parramatta, New South Wales 2150

Phone: (02) 9895 3333

Fax: (02) 9895 3082

Tasmania242 Liverpool Street

Hobart, Tasmania 7000

Phone: (03) 6125 5333

Fax: (03) 6125 5700

Queensland444 Queen Street

Brisbane, Queensland 4000

Phone: (07) 3004 5333

Fax: (07) 3004 5410

Victoria595 Collins Street

Melbourne, Victoria 3000

Phone: (03) 9605 7333

Fax: (03) 9605 7980

South Australia209 Greenhill Road

Eastwood, South Australia 5063

Phone: (08) 8274 9333

Fax: (08) 8274 9371

Western Australia11th Floor, Bankwest Tower

108 St Georges Terrace

Perth, Western Australia 6000

Phone: (08) 9214 8333

Fax: (08) 9214 8322

National telephone enquiry service and email contacts

People can contact Medicare Australia through our national telephone service, using the numbers listed by subject area on the following page. Calls to 1300 numbers cost 25 cents from anywhere in Australia and calls to 1800 numbers are free. Calls from public pay phones or mobile phones may be charged at higher rates. Further information is on our website (www.medicareaustralia.gov.au). People can also contact us about a range of matters through the internet, using the email addresses listed by subject area on the following page.

Table 59 – Enquiry lines open during business hours

Bowel Cancer Screening Register 1800 118 868

Compensation 132 127

Complaints and feedback line 1800 465 717

Department of Veterans’ Affairs – allied services 1300 550 051

Department of Veterans’ Affairs – hospital services

1300 551 002

Department of Veterans’ Affairs – medical services

1300 550 017

Doctor-shopping hotline 1800 631 181

Fraud hotline 1800 202 101

Indigenous Access line 1800 556 955

Medicare Australia online claiming 1800 700 199

Medicare Australia statistics 1800 101 099

Medicare Special Assistance 1800 660 026

Improved monitoring of entitlements 132 290

Medicare provider enquiries 132 150

Medicare public enquiries 132 011

Online Technical Support Helpdesk 1300 550 115

Optometrical IVR date-of-service check 1300 652 752

Pharmaceutical Benefits Scheme general enquiries

132 290

Practice Incentive Program payments 1800 222 032

Rural Retention Program 1800 010 550

Simplified billing 1300 130 043

Random Compliance Audits 1800 675 235

The 30% Rebate on Private Health Insurance 1300 554 463

TTY (telephone typewriter for the hearing impaired)

1800 552 152

Table 60 – Enquiry lines open 24 hours every day

Aged Care Online Claiming 1800 195 206

Australian Childhood Immunisation Register enquiry line and reports

1800 653 809

Australian Childhood Immunisation Register internet enquiry line

1300 650 039

Australian Organ Donor Register 1800 777 203

Australian Organ Donor Register (Approved Medical Practitioner)

1800 556 455

Customs Prescription Drug Smuggling 1800 032 258

General Practice Immunisation Incentives Scheme enquiries

1800 246 101

Travelling with PBS Medicine enquiry line 1800 500 147

PBS authority approvals 1800 888 333

Prescription Shopping Information Service 1800 631 181

Telephone claiming 1300 360 460

Table 61 – Email addresses for enquiries

Aged care [email protected]

Australian Childhood Immunisation Register [email protected]

Australian Organ Donor Register [email protected]

Compensation Recovery [email protected]

Feedback reporting facility for providers and specialists

[email protected]

Freedom of Information [email protected]

GPMOU 90-day scheme [email protected]

Goods and services tax (GST) [email protected]

Information release [email protected]

Location Specific Practice Number [email protected]

Medicare Australia general enquiries [email protected]

Medicare Australia online claiming [email protected]

Medicare Australia media communication and government relations

[email protected]

Ask Adele’ [email protected]

Medicare Australia’s service charter [email protected]

Medicare Australia statistics [email protected]

IBNR Indemnity Claims Scheme (medical indemnity)

[email protected]. au

Medicare provider enquiries [email protected]

Medicare public enquiries [email protected]

Online Services support [email protected]

Pathology [email protected]

Pharmaceutical Benefi ts Scheme [email protected]

Practice Incentives Program [email protected]

Premium Support Scheme

(medical indemnity)

[email protected]

Privacy [email protected]

Professional Review Division [email protected]

Run-off Cover Scheme Support Payments (medical indemnity)

[email protected]

Simplified Billing – National [email protected]

Simplified Billing – New South Wales [email protected]

Simplified Billing – Queensland [email protected]

Simplified Billing – South Australia [email protected]

Simplified Billing – Tasmania [email protected]

Simplified Billing – Victoria [email protected]

Simplified Billing – Western Australia [email protected]

Software vendor help desk/ Medclaims enquiries

[email protected]

Online Technical Support Vendor Liaison [email protected]

Online Technical Support EDI Help [email protected]

Online Technical Support EDI Testing [email protected]

Online Technical Support EDI Technical Support

Online Technical Support (Online Claiming)

[email protected]

[email protected]

Online Technical Support (ECLIPSE) [email protected]

Online Technical Support (PBS) [email protected]

Online Technical Support (Aged care) [email protected]

Online Technical Support (Easyclaim) [email protected]

UMP Support Payments [email protected]

Glossary, abbreviations and acronymsGlossary

Benefit The amount of rebate paid to a patient or provider for a service.

Claim A statement lodged by a patient or a provider relating to a supplied service or multiple services where the expectation is that they will receive a benefi t. The way the claim is lodged defi nes the maximum number of services that can be lodged in a single claim. For example, a bulk bill claim can contain a maximum of 80 vouchers, with each voucher allowed 14 service items.

Gap amount The difference between the Medicare benefit and the schedule fee.

Out-of-hospital services Medical services that are eligible for a Medicare benefit and are not provided in a hospital.

Out-of-pocket The difference between the Medicare benefit and the doctor’s charge

Payment Payment of a benefi t, incentive or allowance.

Schedule fee A fee for a service that is set by the government.

Service A medical service of an individual item number listed under the Medicare Benefits Schedule – sometimes referred to as a line – or an individual prescription medicine listed under the Pharmaceutical Benefits Scheme (PBS).

Transaction The act of processing – for example – a medical

service for rebate, updating a patient’s details, generating an online tax statement, or processing a PBS script.

Abbreviations and acronyms

ANAO Australian National Audit Offi ce

APS Australian Public Service

ARAS Audit and Risk Assurance Services

ATSIHS Aboriginal and Torres Strait Islander Health Service

DHS Department of Human Services

DITR Department of Industry, Tourism and Resources

DoFA Department of Finance and Administration

DoHA Department of Health and Ageing

DVA Department of Veterans’ Affairs

ECLIPSE Electronic Claim Lodgement and Information Processing Environment

EFT electronic funds transfer

FaCSIA Department of Families and Community Services and Indigenous Affairs

FOI Act Freedom of Information Act 1982

GP general practitioner

HECS Higher Education Contribution Scheme

IBNR incurred but not reported

IT information technology

LLO local liaison officer

MBS Medicare Benefits Schedule

MPRC Medicare Participation Review Committee

OATSIH Office of Aboriginal and Torres Strait Islander Health

OHS occupational health and safety

PBS Pharmaceutical Benefits Scheme

PIA privacy impact assessment

PIP Practice Incentives Program

RPBS Repatriation Pharmaceutical Benefits Scheme

RRMA rural, remote and metropolitan area

SES Senior Executive Service

UMP United Medical Protection

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