health insurance commission annual report 2002-2003 web viewhic annual report 2002-03. ... a revised...

HIC ANNUAL REPORT 2002-03Chairman’s Report15 October 2003

The Hon Tony Abbott MP

Minister for Health and Ageing

Parliament House

CANBERRA ACT 2600

Dear Minister

The Board of the Health Insurance Commission (HIC) is pleased to submit HIC's Annual Report for the period 1 July 2002 to 30 June 2003 for presentation to each House of Parliament. The report is submitted in accordance with Section 9 of the Commonwealth Authorities and Companies Act 1997.

I am pleased to report that HIC has enjoyed a successful year of growth and development in a number of significant and ground-breaking areas. The Business Improvement Program has achieved substantial success with product development resulting in the delivery of key initiatives. It is a consolidated program of activity being undertaken over four years to 2004 – 05 and will transform a range of HIC products and services using new and improved service delivery channels that are emerging from advances in eBusiness technologies.

The activities of HIC’s business improvement initiatives are aligned with HIC’s strategic purpose of ‘Improving Australia’s health through payments and information’, and support the Government’s Online agenda. HIC has received strong support from the Government for its agenda to modernise its claims and payment systems and to better connect the health sector.

Achievements over the year in this area are detailed in the report, but include the successful deployment of a number of new applications. A new high availability eBusiness IT Infrastructure for Medicare and PBS claims submission was used for the MediConnect Field Test – a new development in health care which, by drawing together comprehensive information about the medicines people use, will help to enable doctors, pharmacists and hospitals to prevent health problems caused by adverse drug reactions and interaction. The year also saw the implementation of a new eBusiness IT architecture enabling Medicare bulk bill and patient claims to be transmitted through the internet from doctors’ practices, using Public Key Infrastructure (PKI) technology.

The Board of Commissioners is pleased with HIC’s direction in regard to its eBusiness activities.

The impact of the Canberra Bushfires in January needs special mention. This was a time of considerable disruption and impact on the operations of HIC’s National Office, with several staff being either directly or indirectly affected by the fires. What is notable of mention about this event however, is the magnificent response of HIC’s State Offices in rallying support for the victims of the fires in Canberra. This was a tremendous example of the corporate perspective and concern which staff of HIC embody throughout the land. I, together with the Board of Commissioners, heartily congratulate the staff of HIC nationally for their loyalty, their generosity and their commitment during those harrowing times.

In a similar vein, I would also like to congratulate the Medicare Claims Section for their continued good work on Balimed during the year. Balimed was established to help the victims of the Bali bombings by covering all their out-of-pocket expenses for the treatment of injuries resulting from the bombings. The section has worked hard over the year to ensure that the Bali victims’ interests, and those of the Government and HIC, have been dealt with efficiently and effectively.

The Board of Commissioners itself has seen a number of changes this year. Consequent upon amendments to the Health Insurance Commission Act 1973 that came into effect on 1 November 2002, the number of Commissioners was reduced from eleven overall to nine, and with one vacancy at the time this resulted in the need for one Commissioner to leave the Commission. Mr Ian Fletcher graciously agreed to stand aside and his appointment terminated on 10 November 2002. Over the short term of Ian’s appointment he proved himself a worthy and valuable member of the Board. On 3 March 2003, Mr Ron Harris resigned his position on the Board, owing to a change in his business interests which he perceived presented a potential conflict of interest to his role as a Commissioner. Ron also was a valuable member of the Board and his absence will be missed. I take this opportunity to thank both Ian and Ron for their sterling contribution during their respective terms of office.

In February 2003, the Board learnt of the appointment of the Managing Director of HIC, Dr Jeff Harmer, to the position of Secretary to the Australian Government Department of Education, Science and Training. Accordingly, on 10 March 2003, Dr Harmer resigned his position as Managing Director. Jeff was a man of exceptional talent and enthusiasm, with a real commitment to HIC, and during his almost five-year term as Managing Director, he was the instigator of several business initiatives that placed HIC at the forefront of modern business practice. His departure was sadly felt by all who knew him or who had associated with him, and the reaction of the staff of HIC in offices around the country to his leaving was testimony to the high level of esteem in which Jeff was held. I join with my fellow Commissioners, and the staff of HIC, in offering our heartfelt thanks to Jeff for his outstanding contribution to, and leadership of, HIC over the past five years.

Mr Jeff Whalan commenced his duties as the new Managing Director of HIC on 8 September 2003. Jeff joined HIC from the Department of the Prime Minister and Cabinet, where he was a Deputy Secretary. Jeff has been appointed for a term of five years. The Board of Commissioners considers that Jeff will provide excellent leadership to HIC in the coming years.

I take this opportunity to thank Mr James Kelaher, who enthusiastically stepped into the role of Acting Managing Director virtually overnight upon Dr Harmer’s departure, for the professional and diligent manner in which he has led the organisation in this period.

The Board of Commissioners and the Executive are justly proud of HIC’s achievements over this reporting year. We are confident and enthusiastic about its future.

We take much pleasure in commending our Annual Report to you.

Yours sincerely

Peter Bunting

Chairman

HIC IS TRUSTED BY OUR CUSTOMERS AND THE COMMUNITY… THAT’LL PUT A SMILE ON EVERYONE’S FACE.

MANAGING DIRECTOR’S REPORTThis financial year was a year of change, challenges and successes for HIC. Our Business Improvement Program continued to gather momentum and build a framework for our future business processes, and we also started to explore new functions and prepare for the introduction of new programs such as Medical Indemnity.

Our Business Improvement Program has been designed to take advantage of emerging technology to improve the service we offer our customers, especially the channels our customers use to do business with us. This year saw a number of our business improvement initiatives successfully implemented. For example, the information technology architecture has been developed which allows online applications such as HIC Online, PBS online services, eAuthorities and MediConnect to provide more efficient, value added interaction between HIC and its customers. Work on other

systems has also enabled the easy extraction and analysis of Medicare data to assist health decision-makers.

Earlier this year the Australian Government announced a new framework for Medical Indemnity insurance for the medical profession. HIC will administer two of the schemes associated with this new Medical Indemnity framework – the Incurred but Not Reported Indemnity Scheme and the High Cost Claim Indemnity Scheme.

It is rewarding to see the inroads we are making with new business opportunities as a result of our Business Improvement Program and our subsequent eBusiness capability. We are looking forward to using our eBusiness platform to deliver new and innovative programs on behalf of Government.

HIC Online is one of the key business improvement initiatives. The system allows doctors and patients to claim their Medicare entitlements online. At 30 June 2003 there were 69 sites transmitting claims to HIC with a total of 326,902 bulk billed claims and 20,954 patient claims processed since the system was introduced in March 2002.

HIC has also played an important role in implementing changes to the Pharmaceutical Benefits Scheme (PBS). The 2002 Federal Budget measures aimed at sustaining the PBS have resulted in a number of projects which HIC is leading. These include the Prescription Shopping project, Overseas Drug Diversion project, PBS Risk, PBS Restrictions, and Enhancing PBS Authorities.

The Australian Organ Donor Register, also administered by HIC, had a very successful year – 4.7 million Australians are now listed as potential organ and tissue donors. This year the Australian Childhood Immunisation Register recorded more than 400,000 meningococcal C vaccinations following the introduction of the National Meningococcal C Vaccination Program in January 2003.

In 2002–03, HIC placed a priority on reaching Aboriginal and Torres Strait Islander communities to increase understanding of the health system and improve access to health services. This work will continue in 2003–04.

It is pleasing to note that the Australian community continues to hold HIC’s services in administering programs such as Medicare and the PBS in high regard with a satisfaction rating of 93 per cent.

We continue to work with doctors and pharmacists to improve our service to them. Our Stakeholder Advisory Committee has provided an opportunity for timely and meaningful consultation on many aspects of our business and we are working closely with the Red Tape Taskforce to identify and re-engineer business practices which could be streamlined further. Over the past year we have also worked to implement a range of new and dynamic initiatives to ensure our front line staff particularly have the best possible information to pass on to our customers and the tools to do their work more efficiently.

The developments over 2002–03 have resulted in significant change for HIC. The changes are aimed at providing a better service to the Australian public and to other key customers including doctors and pharmacists. These changes are only possible as the result of a very high level of dedication and professionalism of staff across HIC. Maintaining HIC’s reputation for being a people focused organisation is valued highly by the Executive team and will continue to be supported at every opportunity.

I also want to thank Mr James Kelaher and the Executive for their excellent contribution over the period before my appointment. On behalf of my HIC colleagues I am proud to commend our 2002-03 Annual Report to you.

Jeff Whalan

Managing Director

HISTORICAL HIGHLIGHTS

1974 Wealth Insurance Commission Act 1973 is passed in August at an historic joint sitting of both Houses of Parliament

1975 Medibank offices are opened across Australia on 1 July to administer Medibank

1976 Medibank Private is established on 1 October to compete with other private health insurance funds

1978 Operation of Medibank Private becomes HIC's sole function

1982 Medibank Private becomes Australia's largest national private health insurer

1984 Medicare is introduced in February

1985 Fraud and over servicing function {new Professional Review) is transferred to HIC

1989 Administration of the Pharmaceutical Benefits Scheme is transferred to HIC Medclaims {electronic direct billing) is introduced

1993 HIC begins processing and paying claims on behalf of Australian Hearing Services HIC is chosen to administer the Commonwealth Childcare Rebate Scheme

1994 Commonwealth Childcare Cash Rebate Scheme begins in July

1995 HIC is chosen to administer the Australian Childhood Immunisation Register from 1 January Wealth and Other Services (Compensation) Act 1995 becomes effective from 1 February for HIC administration

1996 HIC begins processing of Veterans' treatment accounts on behalf of the Department of Veterans' Affairs

1997 Commonwealth Government announces separation of Medibank Private from HIC Private Health Insurance Incentives Scheme begins in July General Practice Immunisation Incentives Program begins in August

1998 Medibank Private is separated from HIC

Government announces the introduction of two-way agency arrangements between Medicare and private health insurance funds

Medicare offices cease to assess Medibank Private claims from 30 June Practice Incentives Program replaces the Better Practice Program from 1 July

1999 Federal Government 30% Health Insurance Rebate supersedes the Private Health Insurance Incentives Scheme from 1 January

2000 HIC begins providing services under the Family Assistance Office HIC begins administering the Australian Organ Donor Register

2001 Health eSignature Authority Pty Ltd is established to facilitate PKI infrastructure

2002 HIC Online is launched, allowing direct bill claims to Medicare to be made over the internet PBS Online is launched and HIC receives more than 90.000 scripts in its first six months

2003 The first MediConoecf consumer has their medication and prescription details registered with HIC

2003 The Australian Organ Donor Register has more than 4.5 million people registered

REPORT OF OPERATIONSThe information required in the report of operations is included throughout this annual report. The table below shows where this information can be found.Clause of FMO Requirement

8(a) Enabling legislation, objectives and functions

8(b) Name of all responsible Ministers

9 Outline of organisational structure

10 Review of operations and future prospects

11 Judicial decisions and reviews by outside bodies

12 Effects of Ministerial directions

14 Directors (Commissioners)

15(1) Governance practices

15(2) Committees

16 Indemnities and insurance premiums for officers

18 Commonwealth disability strategy

CertificationIn accordance with the Finance Ministers Orders, the Board of Commissioners hasresponsibility for the preparation and content of the report of operations under section 9 ofthe Commonwealth Authorities and Companies Act 1997.Signed in accordance with a resolution of the Board of CommissionersPeter BuntingChairman12 September 2008Jeff WhalanManaging Director12 September 2008

CHAPTER-1YEAR IN SUMMARYMedicare

Active Medicare cards at 30 June 2003 11.7 million

Persons enrolled in Medicare at 30 June 2003 20.6 million

Cards issued and re-issued 3.03 million

Medicare services processed 221.4 million

Medicare services bulk billed 150.1 million

Percentage of Medicare services bulk billed (of all services) 67.8%

Bulk bill services lodged electronically (Medclaims/HIC Online) 75.4%

Total Medicare benefits paid $8.1 billion

Community satisfaction with HIC 93%

Medical practitioner satisfaction with HIC 75%

Providers audited to ensure legislative compliance 188

Services audited to ensure legislative compliance 9,277

Recovery amount identified for non-compliance with legislation $0.25 million

Medicare offices at 30 June 2003 226

Medicare easyclaim

Medicare easyclaim self-service fax devices operating in pharmacies across Australia 501

Patient claims lodged by fax 246,168

Medicare easyclaim phone booth facilities operating in Rural Transaction Centres and State Government shopfronts

562

Telephone claims lodged using Medicare easyclaim telephone claiming 70,084

Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme* (RPBS)Total benefits paid $5.2 billion

Total number of PBS/RPBS services 174 million

Authority prescriptions authorised 4.76 million

Authority prescriptions authorised by telephone 4.49 million

Pharmacist satisfaction with HIC 91%

*Payments to veterans processed by HIC on behalf of the Department of Veterans’ Affairs.

Veterans’ treatment accounts

Cards produced 193,113

Lines processed 18.11 million

Benefits paid $1,610 million

Australian Organ Donor Register

Number of potential donors registered 4.7 million

Australian Childhood Immunisation Register

Immunisation episodes recorded 4.03 million

Children (under 7 years) registered 1.8 million

Payments to immunisation providers $8.1 million

Percentage of children registered with full (age-appropriate) immunisation coverage:

Aged 12-15 months at 30 June 2003 91.2%



General Practice Immunisation Incentives Scheme

Total practices registered at 30 June 2003 5,487

Service incentive payments $19.9 million

Total practices registered at 30 June 2003 5,487

Total outcomes payments $17.0 million

Practice Incentives Program

Practices participating at 30 June 2003 4,624

Total payments $244 million

Rural Retention Program

Eligible medical practitioners participating at 30 June 2003 2,309

Total number of payments 1,907

Total payments $18.0 million

General Practice Registrars’ Rural Incentive Payments Scheme

Eligible medical practitioners participating 374

Total number of payments 695

Total payments $5.5 million

Compensation Recovery Program

Cases finalised 65,960

Refundable benefits recovered $38.1 million

HECS Reimbursement Scheme

Eligible medical graduates participating 67


Total payments $459,951

Federal Government 30% Health Insurance Rebate

Memberships registered 4,816,238

Total paid in cash claims $2.8 million

Total paid to health funds $2,163 million

Two-way agency arrangements with health funds

In-hospital gap claims lodged under two-way agency arrangements 730,329

Participating health funds 37

Simplified billing

Medicare in-hospital services claimed through simplified billing 69.5%

Health funds transmitting simplified billing claims electronically to HIC 40

Billing agents registered for simplified billing 25

Office of Hearing Services

Services processed 769,538

Benefits paid $154 million

Family Assistance Office

Services provided to customers 194,737

OUR PRIORITY IS TO SERVICE OUR CUSTOMERS’ INDIVIDUAL NEEDS…NOW THAT’S SERVICE WITH A SMILE.

CHAPTER-2HIC’S STRATEGIC PLANOur Strategic Plan affirms HIC’s purpose of improving Australia’s health through payments and information. It was developed in consultation with customers, stakeholders and staff. HIC aims to build on its strong base of payments, processing and customer service to provide information for better health decision-making and we will develop and customise new services to supply secure and reliable information to our customers.

The 7 levels of our Strategic Plan are:

Level 1 - Our purpose: improving Australia’s health through payments and information.

Level 2 - What we want to be known for: being trusted by our customers and the community;

helping to connect Australia’s health sector; and

being a valued strategic partner in delivering the health portfolio’s agenda.

Level 3 - The driving force of our business shows: we are continuing our efforts to be a customer-driven organisation in conjunction with strategic partners in the health portfolio.

Level 4 - Our business approach describes how we will: ensure customer access;

create value for our customers;

grow and develop; and

organise ourselves through our business approach.

Level 5 - Our national strategic themes are: building confidence in HIC;

stimulating strategic thinking and the creation of knowledge within HIC;

producing complete, accurate and timely payments and information;

building strategic alliances to connect the health sector;

customising our services; and

efficient and effective program delivery through emphasis on regulatory frameworks and risk management.

Level 6 - Our key result areas are: commitment to strengthening HIC’s financial position and ensuring accountability for the financial aspects of all programs;

our customers and stakeholders have confidence in HIC’s provision of services and its commitment to relationship-building and open communication;

commitment to internal processes that support the efficient delivery of HIC products and services that reflect responsible business practices;

commitment to supporting innovation, learning and continuous improvement for individuals and the organisation as a whole while also respecting the objectives of external parties;

commitment to our staff and to making a positive contribution to the community; and

commitment to contributing to and improvement in the physical environment.

Level 7 - Strategies to achieve our Strategic Plan include: engaging with customers in accordance with our Charter of Care;

realigning our processes to seamlessly provide payments and information to our customers;

working with the Astralian Government Department of Health and Ageing to improve connectivity within the health sector;

investing in human resources so that staff skills are aligned with organisational strategies;

aligning our investment strategies to support the needs of our customers; and

proactively approaching new business opportunities that are consistent with our Strategic Plan.

Our values Our top priority is meeting customer needs.

People can trust us to protect the privacy of all information we handle.

We trust and respect each other and work as a team to achieve the best results.

We improve our business efficiency with new products, ideas and ways of working.

We deliver results with honesty, integrity, accountability and enthusiasm.

Our commitment to continuous improvementHIC is committed to continuous improvement and:

uses customer feedback to help identify and resolve any problems;

provides training programs to ensure staff are skilled and customer-focused; and

monitors and evaluates services against our Charter of Care standards.

For more information about our strategic direction see HIC’s website www.hic.gov.au

Turning the Strategic Plan into action

Corporate scorecardAn organisational performance management system was developed in 2001 to replace the key performance objective reporting system. The new system provides a comprehensive coverage of performance measures organised along balanced scorecard perspectives (customer, financial, internal business and growth, and development).

Development of the corporate scorecard continued in 2002-03 with a major review completed towards the end of the financial year. A revised and more detailed scorecard will be operating from early in 2003-04 and will be available to appropriate staff within HIC via the HIC intranet.

Balanced scorecard perspectives from 2000-01 to 2003-04

2000-01 Actual %

2001-02 Actual %

2002-03 Actual %

2003-04 Target

Customer perspective

Community satisfaction 92 90 93 90% or better

Medical practitioner satisfaction 71 72 75 80% or better

Pharmacist satisfaction 90 92 91 90% or better

Prompt processing 93 93 93 90% or better

Internal business processes perspective

2000-01 Actual %

2001-02 Actual %

2002-03 Actual %

2003-04 Target

Claim processing accuracy 93 98 98 99%

Medicare transactions online* 49 50 50 N/A†

General practices online 86 86 90 N/A††

Growth and development perspective

Staff satisfaction 66 73 72 Improvement reflected in 2004 survey

*Includes Medclaims and internet electronic transactions.

†To be calculated differently from 2002.

††Currently no target set although practices are being encouraged to move online.

Customer satisfactionHIC annually measures satisfaction with its services within three main customer groups: medical practitioners, pharmacists and health consumers. The results remained steady, with no significant statistical difference from last year’s scores. Of consumers surveyed,

93 per cent were satisfied with HIC services, and 91 per cent of pharmacists were satisfied. Among doctors, satisfaction also remained steady at 75 per cent. Practice manager satisfaction also remained steady at 85 per cent.

Market researchHIC undertook a range of research projects to improve customer service, business understanding of initiatives, and as part of effective marketing communications and promotion work.

These included:

research into customer service issues and needs for all key customer segments, including those from Indigenous communities and culturally and linguistically diverse backgrounds, within the context of business plan targets for customer satisfaction;

specialised study of communication effectiveness and Medicare claims satisfaction within Indigenous communities from the point of view of consumers, health practitioners and pharmacists (the latter in relation to medicine access and Pharmaceutical Benefits Scheme claims);

study of attitudinal issues and business impact around an initiative to improve the use of the internet as a key channel for Medicare claims for bulk billed and patient claims in medical practices and Pharmaceutical Benefits Scheme (PBS) claims from pharmacies;

evaluation of Medicare easyclaim fax and booth facilities for Medicare claims from pharmacies and Rural Transaction Centres in regional Australia side by side with a market study on customer demand for a shift from Electronic Funds Transfer (EFT) to the credit card market for Medicare claims;

various studies related to PBS including a tracking study on trends in relation to community attitudes, overseas drug diversion, PBS risk (stockpiling of prescription medications) and restrictions; and

in-depth study into the Australian Organ Donor Register (AODR), exploring the motivators and barriers to people deciding whether or not to register and donate organs or tissue for transplantation and other related issues.

Corporate Business PlanHIC’s Corporate Business Plan outlines major initiatives over three years in support of HIC’s Strategic Plan. The organisation’s performance is measured through the Corporate Business Plan and reported using a balanced scorecard approach.

The first cycle of the Corporate Business Plan is now complete. HIC enhanced its processes to better integrate the annual budget construction with the business planning process. This resulted in a more streamlined process to obtain funding for both business-as-usual and specific projects. In particular, it will allow more accurate reporting of the progress of key business initiatives.

The structure of the Strategic Plan and Corporate Business Plan were amended to ensure better alignment between HIC’s key result areas and the reporting balanced scorecard perspectives. This has ensured that progress against key business plans within HIC is clearly demonstrated as contributing to progress against the Strategic Plan.

Further refinements included development of corporate objectives to be used at all levels of planning and refined accountabilities for planned initiatives. These have assisted in maintaining consistency across all levels of business planning and have enhanced personal accountabilities for managers.

Reporting progress against the Corporate Business Plan continues to occur mid year and at the end of the financial year.

Business Improvement ProgramThe Business Improvement Program has been in existence for two years and has achieved substantial success with product development and key initiatives such as the delivery of services using an eBusiness capability in addition to existing service delivery channels. It is a consolidated program of activity that is addressing both Government and health online agendas, as well as meeting the expectations of HIC customers. The program is expected to be completed in 2004-05, and is using new and improved service delivery channels that are emerging from advances in eBusiness technologies to transform the range of HIC products and services.

HIC has received strong support from the Government for its agenda to modernise its claims and payment systems and to better connect the health sector. In the 2001 Budget the Government agreed to fund an investment in eBusiness capability for HIC. Total funding for the proposal is $125.7 million and comprises capital funding of $98.1 million and operating funding of $27.6 million. Funding commenced in 2002-03 with the receipt of $34.0 million, with $32.0 million as capital for software developement projects and a further $2.0 million for staff training.

The investment strategy includes:

provision of new technical infrastructure;

facilitation of electronic business with medical providers and pharmacies;

substantial reduction in paper-based processing; and

continued strong emphasis on fraud prevention and maintenance of high standards of privacy and security.

Achievements to date include:

successful deployment of new applications development tools;

new high availability eBusiness IT infrastructure which is being used in Medicare and PBS claims submission and for the MediConnect Field Test;

implementation of a new eBusiness IT architecture including a new mid-range infrastructure, integrated applications development methodologies and tools, common software components and applications development best practices;

Medicare bulk bill and patient claims being transmitted through the internet from doctors’ practices with 319,440 vouchers claimed in this way from 69 practices since July 2002; and

PBS online transactions submitted by email have resulted in 150,805 prescriptions being received since September 2002, with 16,535 prescriptions received in June 2003 from 4 pharmacies.

MediConnectMediConnect (formerly the Better Medication Management System) is a voluntary scheme that creates comprehensive medication records for participating consumers that can be accessed by participating doctors and pharmacists with the consent of the consumer. It is a new development in health care which, by drawing together comprehensive information about the medicines people use, will enable doctors, pharmacists and hospitals to prevent health problems caused by adverse drug reactions and interactions. It is currently being field tested in two locations: at Launceston in Tasmania and Ballarat in Victoria.

The MediConnect Field Test (or trial) commenced in March 2003 and is designed to trial both the technical and policy aspects of MediConnect. Participating pharmacists in Launceston are providing information to consumers about the benefits of joining MediConnect and registering interested participants. Consumers can also register to participate at a Medicare office. Doctors and pharmacists in Ballarat joined the Field Test in June 2003.

The Field Test is expected to run until December 2003 and the results will be used to inform future design of MediConnect to ensure it meets the needs of professionals and consumers and improves health outcomes.

Web Channel Development projectThe project is designed to bring relevant information products and services to HIC customers. It will deliver an integrated approach to operating HIC’s corporate web channel and coordinating, maintaining, improving and delivering internet and intranet web-based products.

New policies and standards for web look and feel have been developed and introduced to achieve a consistent interface for new applications. Tenders were also received and evaluated for a new Content Management Solution that will improve the efficiency and accuracy of web content preparation and maintenance.

Automated Risk Management System (ARMS)This risk mitigation measure has two systems components: the Program Review (PR) Desktop and a new payment risk assessment tool. The PR Desktop is a national system that supports all aspects of program review work in the State Offices and National Office.

It is used to record, manage and report on all activities arising from program integrity work. The new payment risk assessment tool, which is still under development, identifies payments to providers that exceed their normal pattern of claiming, thus providing an early opportunity for integrity checks to be made.

DirectoriesDevelopment of the new Directories infrastructure will support the provision of better customer services, increased productivity and the use of new technology that can support eHealth and emerging customer service requirements.

The Directories project will allow HIC to enhance its ability to provide complete, accurate and timely payments and information and deliver on other Business Improvement strategies including: protecting individual privacy and confidentiality, connecting the health sector and customising its services.

At 30 June 2003, the project was nearing the completion of the Consumer Directory, a single central repository of data relating to health service consumers registered with HIC. The Provider Directory project also commenced during the year and its aim is to improve the quality and quantity of HIC provider information for program administration as well as making that information available to providers, consumers and health sector organisations. The Consumer and Provider Directories are key enablers in HIC’s four-year Business Improvement Program.

HIC OnlineHIC Online is the new electronic way of doing business with HIC. It has evolved from HIC’s Medclaims channel to take full advantage of the latest developments in internet technology. As part of HIC’s Business Improvement Program, the HIC Online project allows internet claiming for both bulk bill and patient claims at the point of service, that is, at the doctor’s surgery. The successful implementation of HIC Online has:

enabled claiming at the time and place of care (the doctor’s surgery), reducing or eliminating the need to visit a Medicare office;

delivered an easier bulk billing system integrated into existing practice management software, making it administratively easier for doctors to bulk bill Medicare for patient services;

reduced paperwork for the practice because supporting documentation no longer needs to be sent to HIC;

improved practice cash flow for providers who bulk bill as the claims can be made daily, in contrast to batch claiming;

decreased claim rejection rates as claims are assessed immediately and any data errors can be corrected at the time of claiming; and

significantly reduced administrative costs due to secure and economical web technology which enables accurate claims transaction processing.

HIC Online was developed in response to the 1999 General Practitioner Memorandum of Understanding in which general practice groups asked for electronic patient claiming from doctors’ surgeries.

Another driver was customer research, ‘Development of ways to improve access to Medicare (March 1999)’, which looked at current consumer claiming behaviour and potential use of new technology. The study found that 82 per cent of consumers of Medicare services would find electronic claiming convenient.

Further, the Business Improvement Program, and HIC Online in particular, was established in response to the Government’s online agenda, which aims to improve equity of access to Government services by making appropriate services available online. The project also fulfils Government online objectives by developing its capacity for electronic communication, facilitating information exchange through partnerships and communication systems, and resolving issues such as the privacy, security and authentication of electronic transactions. HIC has developed an Application Program Interface (API) for use by software vendors to allow for the integration of this claiming technology with practice management software. Transmissions are secured using Public Key Infrastructure (PKI), which provides security for electronic communications by using digital certificates and digital keys. PKI is internationally renowned for its innovative approach to online security.

There have been two releases of the HIC Online API, with each new release offering more functions. Release 3 is expected to be implemented in early 2004. It will deliver additional functionality which will allow specialists, hospitals and private health funds to access the new system to electronically exchange eligibility, entitlement and claiming information, and will assist in the provision of Informed Financial Consent for patients and streamlined claiming for in-hospital episodes of care.

At 30 June 2003, 69 sites were transmitting HIC Online claims. A total of 326,902 bulk bill and 19,110 patient claims have been processed since the system was introduced in March 2002.

PBS online servicesThe PBS online project continues to be an integral part of HIC’s Business Improvement Program with a focus on:

delivering efficiencies to pharmacies;

encouraging the uptake of electronic services resulting in savings to pharmacists and HIC; and

developing an enhanced authority approval system with electronic access for prescribers.

A key feature of PBS online services is the use of Public Key Infrastructure (PKI) to ensure security of transmissions.

In September 2002 several pharmacists participated in an interactive trial of the Claims Transmission System/Electronic Reconciliation Statement which was the subject of the first stage of PBS online services. The successful submission of claims via internet email and the receipt of electronic reconciliation statements gave rise to a demand for an additional but related service. In mid-2003 PBS online services will enhance HIC’s electronic services for pharmacists by providing the ability for online requests of duplicate reconciliation statements. Strategies for taking these products beyond the trial stage will be developed in late 2003.

Stage 2 of PBS online services allows pharmacists to submit email files containing prescription details for partial-batch pre-assessment. Results are then returned to the pharmacist in a format similar to the emailed electronic reconciliation information, thus providing an opportunity for errors to be corrected before submitting an actual Claims Transmission System (CTS) claim file for processing and payment.

Enhancements to the Stage 2 pre-assessment functions, including making use of online access as an alternative to the email option, will become available during early 2004.

PBS online services is also developing an enhanced authority approval system which will allow prescribers to electronically submit PBS authority requests and receive authority approvals over the internet.

PBS online transactions submitted by email have resulted in 150,805 prescriptions being received since September 2002, with 16,535 prescriptions received in June 2003 from four pharmacies.

HIC’S PURPOSEHIC’s purpose is to improve Australia’s health through payments and information.

HIC is a Commonwealth statutory authority and was established by an Act of Parliament in 1974, the Health Insurance Commission Act 1973, to administer what has become Australia’s universal health insurance scheme, Medicare.

Programs administered by HICHIC administers many health-related programs on behalf of the Australian Government:

Medicare;

Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme;

Compensation Recovery Program for Medicare and nursing home benefits;

Australian Organ Donor Register;

Australian Childhood Immunisation Register;

Medical Indemnity;

General Practice Immunisation Incentives scheme;

Practice Incentives Program;

Rural Retention Program;

HECS Reimbursement Scheme;

General Practice Registrars’ Rural Incentive Payments Scheme;

Federal Government 30% Rebate on Health Insurance;

Family Assistance Office — in partnership with Centrelink, the Australian Taxation Office and the Department of Family and Community Services;

claims processing and payments for the Department of Veterans’ Affairs (the veterans’ treatment accounts), the Office of Hearing Services, the Health Department of Western Australia, Vietnam Veterans’ Children’s Program; and

Balimed.

Statutory information is detailed in Appendix A on page 165.

HIC’s relationshipsAll HIC’s activities are conducted within the Australian Government policy framework set by the Department of Health and Ageing, the Department of Veterans’ Affairs, the Department of Family and Community Services and relevant legislation. HIC seeks to be an active contributor to policy development by providing regular information and feedback from its day-to-day operations.

HIC’s relationship with the Department of Health and Ageing is underpinned by a service level agreement, the Strategic Partnership Agreement, and a funding agreement, the Output Pricing Agreement.

HIC processes medical, hospital and allied health services claims for veterans’ treatment accounts on behalf of the Department of Veterans’ Affairs in accordance with a services agreement covering services, service standards and financial arrangements between HIC and the Department of Veterans’ Affairs.

HIC’s role in delivering Family Assistance Office services is covered by a business service agreement with the Department of Family and Community Services.

Funding arrangements

Department of Health and AgeingHIC’s current funding arrangement for the provision of services under the Strategic Partnership Agreement with the Department of Health and Ageing is based on the 2000-2002 Output Pricing Agreement adjusted for volume variations and indexation. Estimated revenue under this arrangement in 2003-04 is $396.3 million. The Government is providing funding of $34.3 million in 2003-04 to HIC to ensure it is appropriately resourced to continue to deliver a range of family health and family services programs. This is the first phase of a process to update HIC’s resourcing arrangements, with further funding to be decided after an activity-based costing and benchmarking exercise has been undertaken in 2003-04.

Department of Veterans’ AffairsFollowing the expiry of a Memorandum of Understanding that lasted from December 1996 to 30 November 2001, HIC has entered into a five-year services agreement with the Department of Veterans’ Affairs and the Repatriation Commission to continue to provide processing services for veterans’ treatment accounts. The services agreement is based on a two-tiered payment arrangement comprising a fixed charge and a variable charge per transaction processed. Under the agreement, estimated revenue to HIC in 2003-04 is $16.9 million.

Department of Family and Community ServicesHIC receives a single annual payment from the Department of Family and Community Services to cover the costs of providing services under the Family Assistance Office program. Under this agreement, the estimated revenue to HIC in 2003-04 is $8.4 million.

Health Department of Western AustraliaOn 17 June 1999, an agreement was reached between HIC and the Health Department of Western Australia for the development and implementation of a visiting medical practitioner fee-for-service payment and information system. This system was implemented in April 2000 and currently provides public non-teaching hospitals in Western Australian with an intranet processing system (in real time) to assess and pay invoices submitted by visiting medical practitioners for services rendered to public patients. Negotiations are currently underway to renew the agreement.

Office of Hearing ServicesHIC processes and pays claims to accredited hearing service contractors on behalf of the Office of Hearing Services at the Department of Health and Ageing according to the Output Pricing Agreement between HIC and the Department. Payments comprise a fixed component and variable payments (depending on the number of claims paid). Under the agreement, the estimated revenue to HIC in 2003-04 is $0.539 million.

Data security and access to informationHIC maintains strict confidentiality of all data it holds. Personal information held by HIC is restricted to that which is necessary to administer HIC programs and for audit and postpayment review requirements. Policies and standards set out in the Commonwealth protective security manual are observed and strict security controls are in place to ensure a high level of protection for the stored data.

Information held by HIC is strictly protected by legislation and there are severe penalties for HIC employees who improperly use, release or communicate personal information. Requests for the release of information are processed in accordance with the relevant legislation and legislative release provisions, for example, the Freedom of Information Act 1982, the Privacy Act 1988, the Health Insurance Act 1973, and the National Health Act 1953. See Appendix B on page 171 for a detailed report on the release of information under the Freedom of Information Act.

HIC computer systems can provide an audit trail of operator access that enables detection of possible improper use of data. HIC staff are regularly reminded of their obligations regarding the use of personal information and automatic warning notices are a further reminder whenever they access electronic data.

HIC complies with the Privacy Commissioner’s Guidelines on data matching and the storage and destruction of data. It can, however, provide de-identified statistical information in accordance with the relevant legislation to assist research projects with the potential to improve Australia’s health.

HIC privacy training — internal and external stakeholdersHIC’s Privacy Branch plays a fundamental role in raising awareness of privacy issues through training and promotions, participating in various privacy forums and providing expert advice to internal and external stakeholders.

HIC is meeting its legislative training responsibilities by ensuring all new (and existing) staff complete the National privacy and security training module, which includes temporary and permanent staff, consultants and contractors. Staff experience the benefits of a robust privacy training program via new and improved methods and tools to assist staff to assimilate legislative responsibilities in their daily roles.

External customers have also benefited from quality tailored products developed by the Privacy Branch. These include a series of tailored manuals and forms to assist in streamlining the processes for requesting information from HIC.

Customers and staff can access a wide range of privacy-related information on HIC’s web channels, which include HIC’s internet (available to customers) and intranet (available to staff).

Public Key InfrastructurePublic Key Infrastructure (PKI) is a combination of policies, procedures and technology designed to provide secure and confidential conduct of electronic business (eBusiness).

It has been successfully used for payment authentication (claims reimbursement), secure messaging, secure document storage, retrieval and exchange. It is a key element for supporting secure and reliable electronic communications in the framework of eHealth.

Health eSignature Authority Pty LtdThe Health eSignature Authority Pty Ltd (HeSA), a company wholly owned by HIC, was established in February 2001 to provide digital certificates to the Australian health sector. HeSAs digital certificates, or Public Key Infrastructure (PKI) certificates, enable the secure electronic exchange of data between health professionals and organisations within the health sector.

Strategic priorities for HeSA in 2002-03 had a strong customer and business enhancement focus. They included:

support for HIC’s Business Improvement Program, and HIC Online and PBS online services in particular;

provision of efficient and reliable digital certificate registration services to health providers and organisations throughout the health sector in Australia;

transition of Certification Authority services to a new service provider; and

positioning HeSA to meet future certificate demand.

Significant achievements for HeSA in 2002-03 included:

successful re-accreditation under the Australian Government’s gatekeeper framework, with appreciably less complex and more user-friendly policy documents and administrative processes;

increased automation of processes;

positive engagement with stakeholders across the health sector;

the development of information products, resources and tools to support the take-up and use of PKI in the health sector; and

continuing upward trends in the take-up of digital certificates, which increased from 2,200 in June 2002 to 5,250 in June 2003.

HeSA continues to play an active role in helping HIC to achieve its strategic objectives and in promoting the Government’s broader eBusiness agenda. Further information about HeSA, including access to a range of information services and resources, can be found at www.hesa.com.au

Health sector connectivityHIC continues to facilitate connectivity in Australia’s health sector by implementing information management strategies that leverage HIC’s technical, intellectual and strategic assets to improve health outcomes.

In the past year, an Office of the Chief Information Officer (OCIO) was established to promote HIC’s reputation as a responsible information manager by leading corporate initiatives to connect the health

sector, as well as providing advice to the Managing Director, Commissioners and Senior Executives on ways of developing HIC’s role within the health sector.

HIC actively supports initiatives aimed at connecting the Australian health sector. For example, at the national level HIC is working with the Department of Health and Ageing to inform the Department’s HealthConnect initiative, while also continuing to work with State and Territory Governments on their projects. HIC’s role in this process is reinforced through its representation on a wide range of stakeholder forums including those incorporated within the Australian Health Ministers Advisory Council framework.

Health information servicesStatistical information collected from HIC administered programs is used, within strict privacy guidelines to develop and provide health information and services for the Australian community and health sector. HIC information services assist health decision-making to improve community health by:

supporting clinicians to evaluate and improve clinical practice;

promoting evidence-based approaches to health care;

coordinating care between medical practitioners and integrating information from different sources; and

providing health care consumers with information to make more informed decisions and improve access to services.

HIC information strategyA key initiative has been the development and implementation of HIC’s information strategy which builds on HIC’s information management achievements to date, improves information services for HIC staff and provides a clear direction for improving HIC’s capacity to turn data into useful health information that will lead to improved decision making and health outcomes.

Corporate metadata managementIn September 2002, HIC began implementing the recommendations of an independent review of HIC metadata management practices. HIC’s corporate metadata management strategy sets out a comprehensive range of initiatives for HIC to work towards the establishment of an enterprise wide metadata management framework for its information and data assets. Work undertaken this year included improvements to business processes, establishment of standards, practices and governance arrangements, and increasing staff awareness of the importance of metadata.

Knowledge managementContinued implementation of HIC’s knowledge management strategy has enhanced HIC’s capability to make the best use of its intellectual assets. Its successful implementation is dependent on a consistent whole-of-organisation approach which collectively pieces together HIC’s knowledge management building blocks. A primary focus is on improving the way information flows around the organisation and working collaboratively with other HIC business units to support knowledge management incorporation into work practices.

Key organisational knowledge management initiatives included:

redevelopment of HIC’s reference suite, using innovative systems and metadata, to provide HIC Customer Service Officers with electronic decision support tools enabling delivery of quality information to customers;

development of a national induction program;

development of a functional web-based corporate directory to proof of concept stage;

establishment of State and Divisional Coordinators’ Communities of Practice to encourage greater understanding and coordination between Divisions, National Office and the States; and

creation of a monthly knowledge management team newsletter, In the Know, an internal communication and education tool.

Integrated Business Information System (IBIS)The Information Services Branch (ISB) sponsored the IBIS (Data Warehouse) project, which is built and being loaded. The IBIS facility is recognised as an essential underpinning to HIC’s information strategy and eBusiness initiatives. It aims to be a single source of reliable and complete health related (and other) information that supports HIC’s goal of making health information accessible to managers, policy makers, service providers and consumers. In 2002-03, IBIS included the development of a range of information products based on Medicare data to meet internal business needs in the Program Management Division, Professional Review Division and Information Strategy and Business Development Division. At the end of 2002-03, IBIS was transitioned from project status to core HIC business.

This transition provided for the establishment of a team within the Information Technology Services Division to manage infrastructure and maintenance of the facility. A steady program of information product development will now continue within a number of areas across HIC.

Provider feedbackISB continues to provide a service delivery point for a range of mailout and provider feedback activities. During 2002-03, the Branch successfully completed 34 mailouts involving over 367,000 mail pieces on a range of health related issues, with the majority undertaken for clients external to HIC. Five (involving 49,000 mail pieces) were provided for internal (HIC) stakeholder groups.

The Branch is also committed to developing systems that provide secure access to feedback information over the internet. Continued development of HIC’s feedback reporting facility during 2002-03 enabled optometrists to join vocationally and non-vocationally registered practitioners in being able to access their Medicare service utilisation via the internet. The facility will continue to be provided to practitioner groups who currently receive HIC feedback through the post.

HIC’s web statistics pagesIn line with HIC’s strategic objectives, ISB continues to maintain and provide both Medicare and PBS item statistic reports on the internet.

During 2002-03, trend analysis indicates the number of ‘users’ compiling Medicare and PBS statistical reports using HIC’s website facility averaged about 8,000 hits per month.

Data qualityA number of significant data quality initiatives were conducted during the year under the auspices of the National Continuous Data Quality Improvement (CDQI) Committee.

preliminary review of the Medicare quality control system;

establishment of the National quality control procedures manual (encompassing a range of programs);

establishment of the data quality intranet site;

launch of the National CDQI initiative award;

National data quality awareness week in September 2002;

establishment of HIC’s data quality framework; and

establishment of the Eligibility CDQI working party.

HIC’s data quality framework incorporates a CDQI strategy for addressing data quality issues in a holistic and coordinated manner, guided by CDQI working parties with appropriate stakeholder

representation. Its primary focus is to promote and develop a CDQI culture within HIC, which will facilitate continuous improvement of business practices and information quality.

Health information deliveryIn line with HIC’s strategic direction of improving Australia’s health through information delivery to internal/external stakeholders and customers, ISB processed about 14,000 formal requests for information in 2002-03.

Information channels with key stakeholdersHIC maintains regular communication with key stakeholder groups through various publications and HIC’s website.

Mediguide is a guide to the Medicare claiming system and other health programs administered by HIC and is updated annually and distributed to medical practices and new practitioners. Medical practitioners also receive the Forum newsletter on a quarterly basis. Pathologists are sent a bi-annual newsletter, Pathology Notes.

HIC representatives also communicate with medical practitioners and practice staff through conferences, seminars and presentations.

Health Industry News, a new quarterly electronic newsletter, was developed specifically for private health fund operators, billing agents, software vendors and other interested parties. Bulletin Board, a quarterly newsletter, provides pharmacists with regular updates on PBS, program initiatives and online developments and is also available on HIC’s website.

HIC’s website provides medical practitioners and pharmacists with information about HIC programs, online initiatives, incentives and allowances, as well as access to health statistics and forms.

Your Health Matters, a quarterly lifestyle magazine for consumers, is available free of charge from Medicare offices, doctors’ surgeries, pharmacies, and some child-care centres, fitness centres and health food outlets. The magazine is popular with a range of groups interested in health and health issues and demand for the Autumn 2003 issue lead to an increase in the number printed, with 280,000 copies now distributed each quarter throughout Australia.

The Good Health TV network, which is shown in doctors’ surgeries throughout Australia also provides regular consumer information.

Program integrity and assurance roleHIC is responsible for ensuring payments of benefits are correctly made for services properly rendered while preventing, detecting and investigating fraud and abuse. To ensure program integrity in accordance with the requirements of the Health Insurance Act 1973, the National Health Act 1953 and the Health Insurance Commission Act 1973, HIC applies a balance of education, audit and data analytical methods

HIC provides information, education and conducts interviews regarding the appropriate use of the Medicare Benefits Schedule, the Schedule of Pharmaceutical Benefits and other programs administered by HIC.

To achieve compliance, HIC:

employs a range of sophisticated data analytics;

conducts comprehensive post-payment audits;

investigates cases of suspected fraud and inappropriate practice;

coordinates and manages investigation of suspected cases of fraud and inappropriate practice using a case-management approach; and

provides feedback and educational material to providers in relation to the various programs.

Fraud investigationHIC investigators in each State investigate fraud against Medicare, the PBS and other Government programs administered by HIC. In some cases, investigations are conducted in liaison with State and/or Federal Police.

HIC’s investigative powersThe Health Insurance Commission Act provides HIC with a comprehensive range of powers with which to perform its functions in relation to fraud investigation. The Act allows HIC to:

issue a notice requiring a person to give information or produce documents;

enter premises with the consent of the occupier and conduct a search for the purpose of monitoring compliance with regulatory requirements; and

enter premises, conduct searches and seize evidential material under warrant, where there are reasonable grounds for suspecting that a ‘relevant offence’ is being or has been committed, and the Managing Director has approved the use of the powers for that specific investigation.

The use of these powers is required to be reported in HIC’s Annual Report pursuant to section 42 of the Health Insurance Commission Act. See Appendix A on page 165.

Review of HIC’s national investigation functionIn 2001, HIC’s Board of Commissioners approved a review of the national investigation function within HIC. The review was considered timely given the increasing challenges of eBusiness and other initiatives that are part of business improvement throughout the organisation.

As a consequence of the review, recommendations were made to enhance HIC’s activities in program integrity. In particular, the review team identified the need to enhance the existing role of HIC’s National Office in:

setting national program review priorities;

monitoring the performance and productivity of program review activity nationally;

ensuring the delivery of education and training programs;

promoting a nationally consistent approach; and

performing ongoing quality assurance.

These recommendations were successfully implemented during the year.

Information technology roleHIC seeks to use technology to continually improve customer service. The Information Technology Services Division’s (ITSD) purpose is to lead HIC’s Information Technology agenda as a key contributor in delivering HIC’s business.

Initiatives included:

extending system development expertise to deliver new services;

consulting customers during development to better meet their requirements;

consolidating and unifying system capabilities;

integrating our help desk services;

formulating an IT charge back process to accurately reflect the true usage of assets throughout HIC; and

introduction of the design authority to ensure streamlined architectural systems.

Outcomes have been:

handling customer enquiries through an expert system;

reduction of time required by HIC staff and customers to conduct business;

increased accuracy and consistency of information;

improved useability and simplified navigation through improvement of interfaces;

development of a standards management process that will allow HIC to identify, evaluate, select, maintain and retire IT standards in a timely manner;

establishment of technical and documentation standards;

seamless transfer of data;

easy access to information;

improved access for people with disabilities to information and services;

improved coordination of services to customers; and

increased efficiencies and productivity within ITSD by restructuring the Division.

IT applicationsHIC is the only agency which services all Australians through its large claims processing and payment systems.

HIC is extending its services by using real time web-based systems which customers can access via the internet or within HIC’s branch network, for example, the Organ Donor registration system and various systems that support the HIC Online Medical Desktop Project (which enables doctors to claim online, on behalf of patients from their practice, for all medical services rendered).

ArchitectureIts purpose is to improve HIC’s ability to deliver flexible, integrated business focused systems in a cost-effective manner. HIC’s enterprise architecture is comprised of functional, application, information and technology architectures. These provide frameworks, standards and guidelines for delivery of their components in a consistent manner.

The Architecture Branch is responsible for working with stakeholders and developing these architecture frameworks, standards and guidelines and managing their evolution to meet new and emerging business requirements.

The initial focus of architecture is to:

transition the Business Improvement Division’s architectural roles into ITSD’s core business, thus extending and promoting HIC enterprise architecture;

monitor and advise on the architecture of projects;

establish architectural standards and ensure compliance with standards, strategies and guiding principles; and

establish architectural infrastructure and research and development projects as required.

Infrastructure and business continuityInfrastructure is physical architecture used to support IT solutions. The Infrastructure Delivery and Business Continuity Branch ensures:

HIC’s information technology infrastructure meets its business objectives and the appropriate engagement models are used;

relationships with vendors are actively managed to support business as usual and growth and change;

vendor contracts are optimised for service improvement at reduced costs;

uninterrupted availability of all key business resources required to support essential activities through disaster recover management; and

privacy security framework creates and endorses a security culture within HIC.

Performance of IBM Global Services Australia (IBMGSA)IBMGSA has managed HIC’s IT infrastructure delivery since 2000. During this time, IBMGSA has consistently met or exceeded service level achievements of greater than 95 per cent. IBMGSA services include managing HIC’s IT helpdesk and desktop support groups, and provides the desktop, LAN, mainframe and mid-range (including ebusiness) platforms which deliver and support the corporate applications (such as email) and business related applications including PBS, DVA, Medicare and ACIR.

Planning and business managementThe Planning and Business Management Branch was created to streamline the administrative and business side of the Division to allow those who service the business areas to continue to do so with minimal interruption to their core business.

The objective of the Planning and Business Management Branch is:

to monitor, report and advise on the Division’s finances;

initiate and implement the IT charge back program;

currently undergoing an activity based costing project for further transparency of expenditure and value;

administer the business, financial and IT plans for the Division; and

administer and coordinate software contracts and licences for HIC.

Enterprise services and projectsThe Enterprise Services and Projects Branch was created to administer the newly transitioned programs from the business improvement areas back into HIC’s core business.

Its role is to:

ensure project management principles are applied to all growth and change projects;

administer the continuing PKI authentication program and continue with the development of PKI software; and

manage the data warehouse IBIS.

IT quality assurance and testingAll new and changed IT solutions must be independently tested in a production-like environment to verify that the solution is fit for purpose and meets business continuity requirements.

The IT Quality Assurance and Testing Branch: is responsible for engaging quality assurance and testing services as early as possible to ensure IT solutions are fully testable;

tests for the integrity and robustness of systems developed by HIC;

ensures accuracy of data from HIC systems before implementation; and

ensures IT solutions are signed off for production implementation.

Web channel services managementThe web channel incorporates both the corporate intranet as well as HIC’s internet presence. Its role is to:

ensure all content web pages and web enabled applications delivering information via the web channel are approved in accordance with the web channel policies and guidelines; and

develop a more streamlined and interactive web channel through implementing a content management system.

Initiatives and challengesChallenges for Information Technology Services Division include:

taking new applications from development through to operational stage;

conversion/retiring of legacy applications and processes;

creation of new architectural standards;

managing a multisourcing strategy for the provision of essential business services;

removing old systems to realise benefits;

working with external parties (eg IBMGSA/Telstra/Optus) for the shared delivery of services;

ensuring the IT charge back process is efficient and continually work together with all stakeholders; and

communicating its evolving roles and skills to the business areas to ensure smooth transitioning of business improvement projects back to HIC’s core business.

HIC consultancy services roleHIC has provided high quality consultancy services to international and domestic clients since 1989 and has been awarded projects against stringent international competition. Projects have been undertaken for international government agencies in Slovenia, Bulgaria, Croatia, Romania, Hungary, Mongolia, Turkey, Indonesia, Saudi Arabia, Malaysia, the Philippines, Vietnam and Kenya. The majority of projects were funded through the World Bank, while development agencies such as AusAID, the International Labour Organisation and the World Health Organisation funded others. On occasion, a commissioning government has directly funded a project.

HIC’s consulting projects in Eastern Europe, Asia and Africa have been in health financing, health insurance administration, health information systems, information technology, training and institutional development. These include the design and implementation of an improved health insurance program for the Bulgarian National Health Insurance Fund and a current project which involves providing assistance to the Slovenian Ministry of Health to improve the health sector reimbursement system.

Health financing modelWith the aid of funding from the World Bank, HIC has developed a generic health financing model comprising a generic framework and software. It will assist policy makers in the health sector to evaluate different policy options at both physical and financial resource levels in terms of sustainability, affordability and equity.

Development of the model led to significant consulting opportunities in Romania, Bulgaria, Slovenia and China. The generic health financing model framework is currently being used to develop an Australian health financing model to assist with health policy decision making in Australia.

International projectsDuring 2002-03, HIC was involved in international projects in:

Slovenia — adapting and improving the health sector reimbursement systemThis World Bank funded project is being undertaken in collaboration with Callund Consulting, United Kingdom for the Slovenian Ministry of Health. Its objective is to improve performance of the health sector through setting more coherent policies, establishing effective purchasing and surveillance

facilities, and case management for the unified national health information system. To achieve this, there is a need for appropriate management education and training at the level of governance by national and regional authorities in the health care sector. A comprehensive accounting system will be developed that has the ability to link medical and financial data for enhancing the rationality of utilisation of available resources.

Bulgaria — health information standardsThis World Bank funded project is being undertaken in collaboration with the Health Information Management Association of Australia for the Bulgarian National Health Insurance Fund (NHIF). It will formulate standards for the provision of health related information. A major expected outcome is the ability of NHIF to obtain information, at a national level, on all activities associated with the provision of health care. There is also a need to reduce or eliminate the numerous methods of reporting so there is less of a burden on health care providers, enabling them to deliver a high standard of health care. The standards will reflect national needs and practices and reflect international best practice, including European Union standards.

Croatia — pharmaceutical sector reformThis World Bank funded project is being undertaken in collaboration with the World Health Organisation Collaborating Centre for Training, Pharmacology and Rational Drug Use, University of Newcastle. The objective is to reform the Croatian pharmaceutical sector. It is proposed to reduce the overall cost to the community of essential drugs supply and improve the quality and effectiveness of drug prescribing by physicians and other health care workers.

The reform also seeks to create a more informed environment within which both prescription and consumption of essential drugs occurs. Health economies and pharmacoeconomics concepts and tools will be used in national drug policy development. Guidance will be provided on ways to mobilise and allocate sufficient funds to finance pharmaceuticals within the framework of the national health policy and health sector reform. In addition, guidelines will be created on drug financing alternatives and alternative methods for paying pharmaceuticals within a new payer-system. An education program will be developed for physicians and clinical pharmacologists aimed at improving rational disease management and pharmaceutical prescribing.

Malaysia — a universal government health fundHIC provided consulting advice on the proposed establishment of the National Health Financing Authority in Malaysia. Its role was to prepare a submission to the Government of Malaysia for the purpose of documenting the key issues that prompted the Government to consider reforming the national health financing system and to advise on an appropriate approach to manage the national health financing function. The submission covered the identification of the underlying principles, issues, institutional and organisational requirements necessary to support a national health financing authority for Malaysia.

Saudi Arabia — a health insurance scheme for expatriatesHIC provided consulting advice on the proposed establishment of the National Health Insurance Scheme in Saudi Arabia. It prepared a submission to assist the Nukhba Medical Group to document key issues that had prompted the Saudi Arabian Government to consider reforming the national health system and to provide advice on the requirements and challenges posed by the introduction of a social health insurance scheme. The submission identified the objectives of delivering the best health outcomes and efficient use of available health resources to properly design a new health system for expatriates in Saudi Arabia.

International delegationsHIC has hosted international delegations from countries such as Slovenia and Vietnam and conducted formal presentations to officials from other countries including Canada, Japan, the Philippines, China, Malaysia and Korea.

National project activity

Department of Veterans’ Affairs provider feedback project for diversified health systemsHIC is contracted to Diversified Health Systems, a subsidiary of GlaxoSmithKline Pty Ltd, to undertake activities within the prescriber feedback program for the Department of Veterans’ Affairs.

Project objectives include:

improving health outcomes;

improving prescriber awareness of potential medication problems for individual veterans;

encouraging best practice for specific conditions;

encouraging proper medicine use; and

reducing expenditure on pharmaceuticals.

WE HAVE A STRONG, FORWARD THINKING NETWORK OF PEOPLE DEDICATED TO DELIVERING THE BEST RESULTS FOR THE FUTURE OF AUSTRALIAN HEALTH …NOW THAT’S SOMETHING TO BE PROUD OF.

CHAPTER-3CORPORATE GOVERNANCE, SERVICES AND ARRANGEMENTSHIC recognises that effective corporate governance is essential to manage its strategic direction and day-to-day operations. HIC’s Board of Commissioners and senior management have implemented a strong corporate governance framework.

HIC’s Board of CommissionersHIC’s Board of Commissioners operates within the framework of a corporate governance charter which guides Commissioners in adopting the highest ethical and professional standards in carrying out their governance roles. Its code of conduct emphasises the need for Commissioners to act honestly, in good faith and in HIC’s best interests. It outlines HIC’s Board of Commissioners functions in terms of goal setting and strategy formulation and delineates these from senior management responsibilities. The charter also sets out the obligations of Commissioners in relation to possible conflicts of interest, expanding upon their obligations according to Subdivision B, Division 4, Part 3 of the Commonwealth Authorities and Companies Act which relates to the conduct of officers.

StructureThe Health Insurance Commission Act stipulates that HIC’s Board of Commissioners has a chairperson, a managing director and nine other members. These are appointed by the Governor-General for periods of up to five years and may be reappointed. The Commissioners, including the chairperson, are part-time appointments. The Managing Director is a full-time appointment and is HIC’s Board of Commissioners only executive director. The Managing Director manages HIC’s operations as directed by HIC’s Board of Commissioners.

Commissioners must disclose any pecuniary interests that may conflict with matters being considered by HIC’s Board of Commissioners in session. Meetings are presided over by the chairperson. HIC’s Board of Commissioners’ decisions are by majority vote with the chairperson having a casting vote. In the absence of the chairperson, the Commissioners present may conduct a vote for the election of a person to preside at an HIC Board of Commissioners’ meeting. The Managing Director is not eligible for election.

RemunerationThe chairman’s remuneration is $57,410 a year. Commissioners receive $24,240 a year. The Managing Director receives a total remuneration package of $270,000 a year including superannuation and fringe benefits, plus access to performance pay. Committee fees of $5,200 a year apply to membership of HIC’s Board of Commissioners Audit Committee and the Fraud and Service Audit Committee. The chairs of both committees receive $10,000 a year. HIC’s chairman does not receive additional fees for attending these committee meetings.

Directors’ and officers’ liability insuranceHIC has in place directors’ and officers’ liability insurance covering both HIC and its subsidiary, HeSA Pty Ltd, against liability for an act or omission in the capacity of director, officer or employee of the company.

Membership and attendance at HIC’s Board of Commissioners meetings

Commissioners during 2002-03 Appointment expiry date

Number of meetings eligible to attend

Number of meetings attended

Mr Peter Bunting, LLB, FCA — Chairman

22 December 2005

11 10

Mr Robert Collins, BSc, FAICD, FAIM 4 July 2005 11 10

Sr Maria Cunningham, FCNA, MAICD 4 July 2005 11 7

Dr Jeff Harmer, ba (Hons), Dip Ed, PhD, FAIM — Managing Director 13 April 2004 7 7

Mr James Kelaher*, BA, MBA, FCPA, MAICD

4 4

Mr Colin Johns, OAM, AUA, FAIPM 24 November 2003

11 11

Dr Bryce Phillips, AO, MBBS, FAMA Reappointed 1 September 2001

30 August 2006 11 9

Mr ian Fletcher,

BA, FAIM, MAICD, CMAHRI, JP

10 November 2002

4 4

Ms Jane Halton, BA (Hons), FAIM, PSM 10 November 2006

11 5

Mr Ron Harris 10 November 2006

6 5

Dr Sally Warneford, BSc (Hons), PhD 30 August 2006 11 9

Retirements during the year

Commissioners during 2002-03 Appointment expiry date



Mr ian Fletcher,

BA, FAIM, MAICD, CMAHRI, JP

10 November 2002

Mr Ron Harris 3 March 2003

Dr Jeff Harmer, ba (Hons), Dip Ed, PhD, FAIM — Managing Director

10 March 2003

*Appointed Acting Managing Director from 10 March 2003 - 7 September 2003

HIC’S BOARD OF COMMISSIONERS

The CommissionersPeter D. Bunting, LLB, FCA, was appointed Commissioner on 23 December 1997. His term expires on 22 December 2005. Mr Bunting was appointed Chairman on 25 May 2000.

He is the Managing Director of PDB Associates Pty Ltd, which provides corporate advisory services. He is also a director of several public and private companies and is a Fellow of the Australian Institute of Company Directors, the Taxation Institute of Australia and the Institute of Chartered Accountants in Australia.

Robert J. Collins, BSc, FAICD, FAIM, was appointed Commissioner on 5 July 2000. His term expires on 4 July 2005. Mr Collins is Managing Director of Candle Australia Ltd, a publicly listed company involved in personnel services. His previous roles include Chief Executive Officer of FreeOnline Holdings Ltd, a company involved in online consumer marketing, and Chief Executive Officer of Icon Recruitment and Ajilon Australia, companies owned by the world-wide Adeco group. Mr Collins was founding past president of the Information Technology Contracting and Recruiting Association.

Maria Cunningham, FCNA, FAICD, was appointed Commissioner on 5 July 2000. Her current term expires on 4 July 2005. Sister Cunningham is a Sister of Charity and holds qualifications in nursing, community health and health administration. She has recently been appointed to the Sister of Charity Community Care Services and is a Director of the Sisters of Charity Health Service (SCHS) and Trustee of Catholic Health Care Services. Sr Cunningham has previously held the position of Regional Chief Executive Officer of SCHS Darlinghurst.

Jeff A. Harmer, BA (Hons), Dip Ed, PhD, FAIM, was appointed Managing Director from 14 April 1998 until he retired on 10 March 2003. His term was due to expire on 13 April 2004. Dr Harmer was formerly Deputy Secretary of the Department of Social Security, Deputy Secretary of the Department of Housing and Regional Development and a First Assistant Secretary in the Department of Human Services and Health.

James S. Kelaher, BA, MBA, was appointed Acting Managing Director from 10 March 2003. Mr Kelaher has largely worked in finance and manufacturing, mostly in Sydney and Melbourne, with brief stays in the UK and Europe. Before his appointment to HIC Mr Kelaher assisted the Federal Government with restructuring and reforming the Australian Federal Police. Mr Kelaher is a Fellow of the Australian Society of CPA’s and an Associate of the Australian Institute of Company Directors.

Ian R. Fletcher, BA, FAIM, MAICD, CMAHRI, JP, was appointed Commissioner on 1 September 2001. His term expired on 10 November 2002. Mr Fletcher is the Chief Executive Officer of the City

of Kalgoorlie-Boulder, has 20 years’ experience in senior positions in Commonwealth, State and Territory Governments and has also run his own business consultancy firm. He has had considerable experience in the health sector and with eBusiness. Mr Fletcher is a Fellow of the Australian Institute of Management, associate Fellow of the Australian College of Health Service Executives, member of the Australian Institute of Company Directors, Local Government Managers Australia and the Institute of Public Administration Australia, and a chartered member of the Australian Human Resources Institute.

Jane Halton, BA (Hons), FAIM, PSM, was appointed Commissioner on 18 January 2002. Her term expires on 10 November 2006. Before her appointment in January 2002 as Secretary of the Department of Health and Ageing, Ms Halton was Executive Coordinator for the Department of the Prime Minister and Cabinet and was responsible for advising in all aspects of Commonwealth Government Social Policy. In addition, she was responsible for the Office of the Status of Women and for advising the Minister Assisting the Prime Minister for the Status of Women. Previously, Ms Halton was National Program Manager (First Assistant Secretary) of the Australian Government’s Aged and Community Care Program in the Department of Health and Aged Care with responsibilities for long term care. Ms Halton is a Fellow of the Australian Institute of Management.

Ron Harris, was appointed Commissioner on 1 September 2001. His term expired on 10 November 2002. Mr Harris has worked with his own information technology companies since 1980. He is Managing Director of Harris Technology which he founded in 1986, Managing Director of Liquorland Direct/Vintage Cellars Direct and a director of Quids Technology, a software company partly owned by Coles Myer. Mr Harris is also a director of Tanake Pty Ltd and Tanabo Pty Ltd, private investment companies specialising in property investment.

Colin R. Johns, OAM, AUA, FAIPM, was appointed Commissioner on 24 November 1998. His term expires on 24 November 2003. Mr Johns is a pharmacist and was Chairman of the Australian Community Pharmacy Authority until 30 June 2000. He was National President of the Pharmacy Guild of Australia from 1990 to 1994 and Director of Guild Commercial Ltd in 1999. Mr Johns is a Fellow of the Australian Institute of Pharmacy Management and a member of the Pharmaceutical Society of Australia.

F. Bryce M. Phillips, AO, MBBS, FAMA, was initially appointed Commissioner on 28 August 1996 and reappointed on 1 September 2001. His term expires on 30 August 2006. Dr Phillips is a general practitioner. He was President of the Australian Medical Association from 1988 to 1990 and is Deputy President of the Medical Practitioners’ Board of Victoria. He is also a member of the Royal Australian College of General Practitioners.

Sally G. Warneford, BSc (Hons), PhD, was appointed Commissioner on 1 September 2001. Her current term expires 30 August 2006. Dr Warneford is currently an investment manager with Credit Suisse Asset Management. From 1998 to 2000, she was an industrial equities analyst with Merrill Lynch, covering the health care and biotechnology and chemicals sectors.

Jeff Whalan, BA, FAIM, FAICD, was appointed Commissioner on 15 August 2003. His term expires on 14 August 2008. Before his appointment as Managing Director of HIC,

Mr Whalan was a Deputy Secretary in the Department of Prime Minister and Cabinet. He was responsible for advising the Prime Minister on social policy issues including health, ageing, immigration, Indigenous Australians, employment, education, income support and veteran’s. Mr Whalan has a background in health and social policy issues. He has led areas responsible for disability services, housing, income security, family services, mental health, rural health and health workforce issues. Mr Whalan is a member of the ACT advisory committee and a Fellow of the Australian Institute of Management. He is also a Fellow of the Australian Institute of Company Directors.

CommitteesHIC’s Board of Commissioners operates five standing governance committees:

Audit Committee;

Fraud and Service Audit Committee;

Business Outcomes Committee;

Human Resource Committee; and

Remuneration Committee.

Audit CommitteeIts broad objectives are to: ensure HIC meets its strategic objectives; promote accountability to the Minister, Parliament and the community; support measures to improve management performance and internal controls; oversee the Audit and Risk Assurance Services Branch function; and ensure effective liaison between senior management, internal audit and external audit functions. At 30 June 2003 the Committee had six members and met five times during 2002-03.

Audit Committee membership 2002-03



Mr Colin Johns — Chair

5 5

Mr Peter Bunting 5 4

Mr Ron Harris 4 3

Dr Bryce Phillips 1 1

Fraud and Service Audit CommitteeThe Fraud and Service Audit Committee (FASAC) monitors and reviews the effectiveness of the Program Review Division’s practices in preventing, detecting and investigating fraud and inappropriate practice by service providers and the public. At 30 June 2003 the Committee comprised six members. Committee meetings are held bimonthly and the Committee met five times during 2002-03.

FASAC membership 2002-03



Dr Bryce Phillips — Chair

5 5

Mr Colin Johns 5 5

Mr Robert Collins 5 3

Dr Sally Warneford 5 3

Sr Maria Cunningham 1 1

Mr James Kelaher 2 2



Dr Jeff Harmer 3 3

Business Outcomes CommitteeThe Business Outcomes Committee considers strategic issues relating to HIC’s business activities and monitors its performance under the obligations of the Strategic Partnership Agreement with the Department of Health and Ageing. It also reviews business proposals and examines performance indicators to ensure overall continuous improvement in HIC’s business outcomes. At 30 June 2003 the Committee comprised three members and it met once during 2002-03.

Business Outcomes Committee membership 2002-03



Mr Peter Bunting — Chair

1 1

Mr Robert Collins 1 1

Mr Ron Harris 1 1

Human Resource CommitteeThe Human Resource Committee is responsible for ensuring HIC has in place human resource management approaches and practices that support the business objectives of the organisation. In addition, it reviews remuneration issues for senior executives, not including the Commissioners and Managing Director. At 30 June 2003 the Committee comprised three members and it met three times during 2002-03.

Human Resource Committee membership 2002-03



Sr Maria Cunningham — Chair

3 3

Mr Ian Fletcher 1 1

Dr Jeff Harmer 3 3

Remuneration CommitteeThe Remuneration Committee is responsible for reviewing remuneration issues for the Managing Director. At 30 June 2003 the Committee comprised three members and met once during the year.

Remuneration Committee membership 2002-03



Sr Maria Cunningham — 4 4



Chair

Mr Peter Bunting — Chair 1 1

Dr Bryce Phillips 1 1

ReportingHIC’s Board of Commissioners receives regular reports covering all aspects of HIC’s operations, including key issues and trends from management. At any time HIC’s Board of Commissioners may request reports concerning any aspect of HIC operations.

Internal control frameworkThe Audit and Risk Assurance Services Branch provides assurance on HIC’s corporate governance framework and internal control framework to HIC’s Board of Commissioners through its Audit Committee. It examines and evaluates the adequacy, effectiveness, efficiency and economy of activities of HIC and its subsidiaries.

The Branch also evaluates and reports on the performance of management in maintaining HIC’s strategic direction, achieving its operational objectives, and ensuring appropriate standards of probity and accountability. It promotes management’s ownership of the control process and contributes to an institutional culture of accountability and integrity through ongoing risk management training and support.

The Audit Committee, as part of its oversight function, defines the Branch’s responsibilities and approves its business plan. The work schedule is based on an assessment of possible audit topics ranked against relevant business risks to determine a scope and level of coverage sufficient to provide an appropriate level of assurance to HIC.

Business risksHIC’s Board of Commissioners, its committees and the executive management committees discuss business and financial risks applying to all HIC functions. Strategies to minimise economic risk and audit plans are integrated into all major HIC activities.

Ethical standards and Code of ConductThe Code of Conduct contained in the Corporate Governance Charter sets out the principles that guide HIC’s Commissioners in adopting the highest ethical and professional standards in carrying out their governance roles. All HIC employees sign the Code of Conduct, which includes specific reference to the secrecy provisions in the Health Insurance Commission Act.

Corporate governance information for HIC staffInformation, including the Managing Director’s instructions, finance policies, human resource management policies and audit policies/charters, are available on HIC’s intranet to guide the day-to-day work of staff.

Management CommitteesWhile HIC’s Board of Commissioners set HIC’s goals and considers strategies to achieve them, internal management structures manage the competing priorities of timely decision making and consideration of HIC’s future vision and operating environment. During 2002-03, HIC operated three

senior management committees, with two committees merging in September and the formation of a new committee in April.

Executive Planning Committee, which shared information, developed and reviewed the Strategic Plan. Meetings allow senior managers to discuss strategic issues including developments in the external environment. The Committee met three times and was chaired by the Managing Director. Members were: the Deputy Managing Director; the National Manager Operations; the Commission Secretary; the Chief Information Officer; the Chief Finance Officer; the Manager — Audit; all General Managers and all State Managers.

Output Review Committee, which monitored HIC’s business performance during 2002-03 against a number of indicators including HIC’s Charter of Care. The Committee also initiated enhancements to improve performance, discussed stakeholder issues relative to business performance and reported on revenue and expenditure issues. It met monthly and was chaired by the Deputy Managing Director. Members were: all General Managers and State Managers; the Manager, — Associate Government Programs, the Manager — Medicare Program and the Manager — Pharmaceutical Benefits.

Business Change Board, which reviewed the performance of strategic projects, maintained a corporate timetable for all projects, and examined project delivery, risk, schedule and budget performance. The Committee met monthly and was chaired by the Executive General Manager — Business Improvement. All General Managers, the Director — Project Office and a State Manager attended each meeting.

Business Management Committee, established in September and combined the functions of both the Output Review Committee and the Business Change Board. The Committee met monthly and was chaired by the Managing Director. Members were: the Deputy Managing Director; the National Manager Operations; the Commission Secretary; all General Managers; all State Managers; the Manager — Audit; and the Chief Finance Officer.

Organisational structureHIC has a decentralised organisation and structure, which includes a National Office in Canberra, a headquarters in each State capital, a number of processing centres and a Medicare office network throughout Australia.

HIC’s organisational structure at 30 June 2003 is detailed on page 41. The functions of each HIC division, which are based at the National Office, are outlined below.

HIC’s divisionsExecutive Support aims to provide high quality legal, parliamentary, secretariat and other services to HIC’s, Board of Commissioners, HIC Senior Executive, Minister and Parliament.

Business Improvement Program Division is responsible for the planning, design and implementation of new capabilities that will enable HIC to deliver its services and products through the internet. In particular, the Division has been established to progress HIC’s Strategic Plan and eBusiness strategy through the implementation of major components of its IT and business architectures. The business architecture describes how HIC will be organised to deliver services in the future and achieve the objectives of the Strategic Plan. The IT architecture provides the infrastructure and technical capabilities required to deliver these business requirements.

Program Management Division manages Medicare, the Pharmaceutical Benefits Scheme and other health and allied programs administered by HIC. It monitors performance of each program, develops administrative policy and undertakes business development for existing programs and proposed Australian Government initiatives.

Finance and Planning Division supports the achievement of HIC’s strategic direction by providing high quality financial management, business planning, project management and procurement services to the whole organisation.

Corporate Development Division supports HIC’s line areas achieve their business goals by delivering human resource strategies and corporate services. In line with HIC’s Strategic Plan, the Division has a strong focus on achieving and maintaining a high performing culture and developing a workforce planning framework to ensure HIC’s people have the right skills in the right locations at the right time.

The Office of the Chief Information Officer implements information management strategies that leverage HIC’s technical, intellectual and strategic assets to improve health outcomes. The Chief Information Officer is responsible for promoting HIC’s reputation as a responsible information manager, and providing advice to the Managing Director, Commissioners and Senior Executives on developing HIC’s role within the health sector.

Information Technology Services Division provides and manages information technology services including system applications, and works closely with all areas to get the best out of HIC internal and contracted IT resources.

Program Review Division is responsible for ensuring the integrity of programs administered by HIC through the prevention, detection and investigation of fraud and abuse.

State OfficesThese cater for Australia’s highly dispersed population. State Managers administer the operations of Medicare offices, processing centres, telephone enquiry lines and customer service areas, and each State Office is responsible for day-to-day operational activities.

HIC’s staffHIC staff are employed under the Health Insurance Commission Act.

As at 30 June 2003, HIC employed 4706 staff, an increase of 235 staff or 5.25 per cent since 30 June 2002. Of these, 1014 were employed as part-time staff and 268 as temporary staff. The significant proportion of part-time staff, 21.5 per cent, ensures HIC can maintain high standards of customer service during peak hours.

Of all staff employed at 30 June 2003, 3761 or 80 per cent were female. Staff are located across Australia, at National Office in Canberra, each of the State Offices, several processing centres and 226 Medicare offices.

Performance Support ProgramHIC’s Performance Support Program (PSP) is part of HIC’s business planning framework. For the first time, in 2002-03, team leaders and managers were required to apply a four point rating scale as part of the assessment process.

At 30 June 2003, 4004 (86%) of staff had signed Performance Support Agreements (PSAs). In December 2002, HIC engaged Results Consulting to conduct a qualitative PSA audit. One hundred PSAs were included in the audit, the purpose which was to gauge the quality of PSAs developed and the extent to which they were linked to business plans. Overall, the Audit indicated a good quality of PSAs. Their strengths were that performance goals and performance measures were closely linked to the employee’s work, and learning and development needs were also strongly tied to work performance needs.

As agreed in HIC’s (Business Improvement) Certified Agreement 2001-2003, the PSP was evaluated jointly with the Community and Public Sector Union to assess its application. MOZ Consulting undertook the evaluation which commenced in February 2003 and concluded in April 2003. Overall,

the evaluation report observed that HIC has been successful in its introduction of the PSP Recommendations focused on continuous improvement.

In 2003-04, HIC will begin implementing recommendations arising out of both the PSA audit and the joint evaluation of the PSP

To ensure all staff continues to be trained in applying the PSP, ongoing training is being provided to new managers and staff, including refresher training for all managers.

Property managementUnited KFPW Pty Limited provided HIC with property and lease management services under contract to 30 June 2003. During 2002-03, HIC reviewed the management of its property function and, as a result, has decided to manage a range of property functions internally while retaining professional assistance for lease administration, lease management and maintenance help desk services. These changes will be introduced from July 2003.

All services provided by external organisations have been subject to an open tender process. During the year HIC continued its leasehold improvement program for Medicare offices, with 13 offices being refurbished and 16 offices relocated.

Learning and developmentTo ensure HIC’s learning and development environment fully meets current and future HIC strategic requirements, a learning and development review took place in February 2002.

Its outcomes have guided the direction of national learning and development activity within HIC in 2002-03.

In response to the review there has been the:

appointment of a National Learning and Development Manager;

alignment of the structure of Learning and Development nationally to reflect the model recommended; and

development of the Learning and development strategy 2003-2006.

The focus of the Learning and Development Strategy, which was developed after significant internal consultation, is to set future directions and strategic priorities for HIC learning and skill development until 2006. The consultative process was supported by a national analysis of aggregated learning and development needs arising from individuals’ Performance Support Agreements.

Key priority areas identified in the Learning and development strategy 2003-2006, are:

transition from management to leadership;

supporting performance through the development of identified key capabilities (core skills);

customer service skills to exceed customer expectations; and

supporting business improvement and change related activities.

Leadership for change strategy — under the key priority area of ‘Transition from management to leadership’, the Leadership for change strategy was launched in 2003. It is underpinned by five initiatives for specific target groups that will be progressively rolled out. Each initiative provides a range of learning and development opportunities for individuals in the target groups — Top Team, Senior Executive, Senior Manager, Middle Manager and Front Line Managers. HIC’s values, the leadership capability framework, the PSP process and implementation of the cascading coaching model form the basis of each initiative.

360 degree feedback — during 2002-03 HIC extended the 360 degree feedback process to include Senior Management in National and State Offices. This builds on the success of the implementation of 360 degree feedback with HIC’s Senior Executive group in 2001-02.

Leadership for Frontline Managers — following a successful pilot program in 2001-02, HIC introduced the Frontline Manager support service coaching initiative to improve the skills and knowledge of Frontline Managers.

Based on the National Frontline Management competencies, this initiative provides one-on- one coaching for Frontline Managers. The initiative also involves participation in accredited frontline management at either the Certificate IV or Diploma level. During 2002-03, 155 managers participated in this formal training.

eLearning — to support HIC learning and development activities, HIC has included implementation of eLearning and a Learning management system into its Learning and development strategy. This forms part of the Learning and Development Infrastructure component of the strategy. Implementation and consolidation of this initiative will be a major focus in 2003-04.

During 2002-03 eLearning trials were conducted with a range of commercial ‘off-the-shelf’ eLearning packages. Selection and implementation of the Learning management system will take place in 2003-04.

Core skills — as part of HIC’s commitment to the development of staff, the national Performance Support Agreement analysis, conducted as part of the development of the Learning and Development Strategy 2003-2006, resulted in targeted core skill programs being run nationally. At 30 June a high proportion of identified learning needs have either already been addressed or planned for the near future. Areas addressed as a priority included project management, PC skills, time management and interpersonal skills. Nationally, key operational skills have also been addressed, with significant training in areas such as pathology understanding and interpretation.

Customer Service Officer (CSO) program — the CSO program is a graduated, competency-based program allowing for the development and assessment of skills within customer service roles. It has undergone a review, and a project is underway to initiate both short and longer-term changes that will give it a more contemporary focus. The National operations manual for CSOs is currently being rewritten.

Employment frameworkCertified Agreement In January 2003 HIC commenced negotiations with staff and the Community and Public Sector Union to establish a new Certified Agreement for when the current one expires. These have focused on:

maintaining and enhancing a strong performance-based culture — this includes enhancing the PSP, gaining a further reduction in absenteeism and introducing a staff innovation scheme;

supporting the business improvement process — through a revised classification structure, job rotation flexibility and ability to utilise agency staff; and

further streamlining and simplifying conditions of employment — rationalisation of overtime, single leave entitlement for fixed term employees, streamlining part-time work clauses, standardising personal leave for part-time staff in line with full-time staff and reducing the minimum amount of long service leave that can be taken to seven days.

A revised Human resource delegations’ instrument will take into account changes reflected in the new Certified agreement and revised HIC terms and conditions, and will also incorporate changes suggested through the evaluation of the devolution of delegations process. It will take effect from the date the new Certified Agreement is certified.

The Certified Agreement negotiations are expected to be finalised early in 2003-04.

Australian Workplace Agreements All HIC Senior Executives and Medical Advisers are covered by Australian Workplace Agreements (AWAs). Negotiations are underway with HIC to revise these. HIC also continues to use AWAs for Senior Managers below the executive level to promote flexibility and performance and, where necessary, to address attraction and retention issues.

Classification structure HIC is introducing a rationalised classification structure and associated work level standards as part of the current Certified Agreement negotiations. The proposed structure will reflect the needs of the organisation throughout the business improvement process. The adoption of organisation-specific work level standards will describe the type and level of work performed in HIC, and establish the basis for classifying jobs and distinguishing between work levels.

Attendance management HIC’s 2001-2003 Certified Agreement provided for a bonus of 0.5% of salary contingent upon HIC achieving a reduction in unscheduled absenteeism from an average of 12.7 to 12 days per annum to the end of May 2003. HIC was able to meet this target with the actual level of absenteeism being reduced to 10.96 days. The achievement bonus was paid to all staff covered by the Certified Agreement on 3 July 2003.

HIC is continuing to give the reduction of unscheduled absenteeism a high priority and as part of the 2003-2005 Certified Agreement, is intending to link other pay increases and bonuses to further reductions in absenteeism.

During 2002-03, HIC initiatives to further reduce absenteeism levels included strategies aimed at raising awareness of attendance issues with staff and managers such as:

conducting absence management workshops and briefings for Managers and Team Leaders;

producing a range of educational material for staff and Managers; and

encouraging Managers and Team leaders to use available statistical information on absenteeism.

In addition, improved recruitment and induction processes have been introduced and high users of unscheduled leave have been identified.

Equity and diversityHIC’s annual report on equity and diversity to the Minister for Health and Ageing for the 2001-02 reporting period was submitted to the Minister in September 2002. It noted significant achievements including:

continued implementation and monitoring of the Indigenous recruitment and retention strategy, aimed at increasing the number of Indigenous staff employed in HIC and retaining these staff for a period of at least five years;

high level of attendance at training aimed at raising awareness about equity and diversity principles; and

identification and analysis of customer profiles and using Australian Bureau of Statistics census data to better inform communication and other strategies aimed at engaging HIC customers.

In November 2002, a meeting of HIC’s Indigenous staff network was held in Canberra to give Indigenous staff the opportunity to review progress under the Indigenous recruitment and retention strategy and develop an action plan for future activities.

Safety managementHIC has continued to maintain a strong emphasis on the effective management of work- related injuries and illness, with a particular focus on high cost claims. HIC continues to pursue a reduction in claim numbers and costs.

In 2002-03, the focus on occupational health and safety (OHS) and claims management has been assisted through the engagement of external consultants (SRC Solutions), who have provided professional and skilled resources in injury prevention and management. In addition, the National OHS Sub-Committee met on a regular basis to discuss issues of national significance in relation to OHS matters. State OHS Committees also met regularly to discuss OHS issues of relevance to their area.

Measures implemented to ensure the health and safety of HIC employees, contractors and third parties accessing HIC workplaces included:

review of HIC’s OHS policy and agreement, in consultation with the CPSU;

development of an online accident/incident report form;

development of the following OHS policies and guidance notes:

First aid policy;

Home based work policy;

Safe use of laptop computers;

Duty of care relating to contractors and consultants;

Visitor information;

development of the OHS Strategic Plan; and

implementation of a nationally consistent hazard identification, risk assessment and risk control process.

The statutory report required under section 74 of the Occupational Health and Safety (Commonwealth Employment) Act 1991 is included in the statutory reports at Appendix A on page 170.

Staff surveyThe HIC Staff survey is an effective, transparent and powerful way of obtaining the views of staff across the organisation. Staff surveys have been conducted in HIC since 1990 to identify areas of high performance and areas for improvement. The survey measures staff perceptions, attitudes, concerns and areas of satisfaction across a range of key organisational topics.

The 2003 survey was held on 13 March, with 3,884 staff participating, representing a response rate of 94%. The staff satisfaction key performance indicator (KPI) derived from the Staff survey indicates that 72% of staff are satisfied with HIC overall. This compares well when benchmarked with approximately 150 organisations across the public and private sector that form part of a benchmarking network. In all categories benchmarked, HIC continues to maintain its position within the top quartile of the benchmarking group.

People PlanThe People Plan is an ongoing initiative addressing the impact on people and the workforce of planning requirements resulting from HIC’s business changes. The first People Plan was released in March 2002. It, and subsequent updates, aim to provide clear information to staff on the changes they will experience as a result of the Business Improvement program and other new business initiatives. HIC will release new versions of the plan as change unfolds.

An update of the People Plan was released in August 2002, and a further update was released in May 2003. The August 2002 update covered the main business improvement changes across HIC, whereas the May 2003 update focused on HIC’s contact centres (previously known as processing and call centres). It identified the intended number and location of these centres in the medium to longer-term and described the future structure and working arrangements of each one. The update also outlined future working arrangements for Medicare offices and the PBS transition timeline.

It is anticipated that future releases of the People Plan will address, among other things, updates about the emerging contact centres, arrangements for Medicare offices and the National Office, learning and development requirements associated with changes, and staff support initiatives.

Consultancy services engaged by HICHIC engaged a diverse range of consultants during 2002-03 to undertake consultancy work for which a total of $11,663,091 was paid.

Consultants are engaged where HIC does not have sufficient specialist expertise available or where an independent assessment is considered desirable. The types of consultancies cover quantitative and qualitative research, strategic policy related advice, information gathering and analysis, attitude surveys, public relations advice (including the development and testing of promotional campaigns), business improvement initiatives and the development of staff training materials to improve customer service.

Consultants paid $10,000 or more during 2002-03 are listed in Appendix E on page 179.

Stakeholder Advisory CommitteeThe Stakeholder Advisory Committee is the peak stakeholder consultation forum, where matters of a strategic nature impacting HIC are discussed. The forum provides an opportunity for key stakeholder groups to influence HIC’s activities and agenda at a strategic level.

The Stakeholder Advisory Committee influences the agenda of the subordinate committees: the Pharmacists’ Communication Group, the Doctors’ Communication Group and the Consumer Communication Group. The Stakeholder Advisory Committee meets approximately quarterly with the communication groups meeting as issues arise, usually biannually. The purpose of the subordinate committees is to engage with a specialist stakeholder set on issues germane to that group.

Membership of the Stakeholder Committees includes peak body and individual representatives from:

consumers;

providers;

IT industry;

government;

private health insurer groups; and

HIC.

Tenure of membership is two years.

HIC service charterHIC’s service charter, the Charter of Care, was launched in June 1999 following extensive consultation with customers, health care providers, stakeholders, government agencies and staff.

The Charter of Care describes:

HIC’s current obligations and standards of service;

benchmarks against which HIC’s service performance can be measured;

how customers can access HIC’s services;

customer rights and responsibilities; and

complaints handling procedures.

Service Charter brochures are available at any Medicare office or by contacting the Medicare customer enquiry number 132 011*. Brochures can also be viewed at HIC’s website, www.hic.gov.au or by sending a request via email to [email protected]

*Local call rates. Normal mobile and public phone charges apply.

As a customer-focused organisation committed to continuous improvement, HIC monitors and evaluates its services against its Charter of Care standards on a regular basis. Regular monitoring of service levels and receipt of customer feedback helps HIC to identify problems, implement improvement strategies, develop skilled and customer-focused staff and reinforce HIC’s commitment to high external and internal customer service standards.

Key Charter of Care activities undertaken in 2002-03 include:

ensuring national complaints handling procedures are in line with Australian Standard AS4269-1995;

holding regular management meetings where performance against Charter of Care standards are discussed and reviewed;

reporting Charter of Care standards within the monthly Executive business report to HIC’s Board of Commissioners;

reviewing the public and provider service charter brochures to ensure they remain relevant to customer needs and in line with HIC’s strategic direction;

updating and reprinting the public and provider service charter brochures;

commencing customisation of a new customer feedback system that will incorporate work flow management and improve reporting capabilities; and

ensuring national induction procedures continue to emphasise the importance of the Charter of Care.

See Appendix F on page 183 for a report on performance against the Charter of Care standards.

Responding to Australia’s culturally diverse society and people with disabilitiesUnder its Charter of Care, HIC makes a commitment to be responsive to all customer needs. In particular, this means being sensitive to and ensuring flexible and easy access to our services for a diverse range of consumers including people with disabilities, Indigenous people and people from culturally diverse backgrounds.

Actions include strengthening employees’ knowledge and awareness of equity and diversity principles through the compulsory National equity and diversity training program which is also a mandatory goal in Senior Executive Performance Support Agreements. This reflects corporate commitment to equity and diversity principles and ensures senior managers are accountable and can ensure staff and projects reflect these principles.

Improving access for Indigenous peopleHIC developed and implemented a national communications strategy for Indigenous Australians and their health service providers. It aims to improve access to Medicare, the PBS and other relevant programs for Aboriginal and Torres Strait Islander people and their health service providers and was developed in consultation with the National Aboriginal Community Controlled Health Organisations (NACCHO) and the Department of Health and Ageing, with the support of an Indigenous communications consultant.

Channels of communication include HIC publications, direct mail, press inserts, radio, a program of visitations by HIC liaison officers for Indigenous access, a dedicated 1800 hotline number, a word-of-mouth campaign within Indigenous communities, promotional activities and strategic sponsorship of community events. Strategy materials were developed in direct consultation with the community and market tested across Australia.

Key components of the communication strategy included:

Well & Good, an Indigenous focused magazine, featuring stories about HIC’s programs, major health problems, personalities and communities;

a promotional poster;

a toolkit for Indigenous health workers to support the educational activities of HIC’s Liaison Officers for Indigenous access in their visits to Indigenous health service providers;

health worker information sheets and consumer fliers containing key messages about Medicare, the PBS and the Australian Childhood Immunisation Register;

a series of English and traditional language radio announcements;

Indigenous specific information on HIC’s website; and

development of a CD music compilation disc for distribution to Aboriginal Health Services and a youth focused multimedia/IT strategy.

The communication strategy was the winner of the highly regarded international Dalton Pen Award for communication innovation and excellence. It is ongoing with planned further growth and development.

Cross cultural awareness training is provided to Customer Service and Liaison Officers for Indigenous access, and it is HIC’s aim that all staff will undertake this training. It provides participants with an appreciation and understanding of Indigenous culture, history, and communication differences and protocols. In turn, it enables staff to effectively deliver services to Indigenous customers in a culturally appropriate manner.

The Indigenous recruitment and retention program to increase Indigenous Australians’ representation in HIC continues to grow and develop. The annual Indigenous network workshop identified areas of need and support with positive outcomes including increased communication between the network members using email contact.

Liaison Officers for Indigenous access and Medicare office staff have continued the provision of outreach services to Indigenous Australians and their health service providers. Detailed policy and access information is contained in the relevant program area sections below.

Improving access for new arrivals and residents from culturally and linguistically diverse backgroundsHIC works in partnership with the Department of Immigration and Multicultural and Indigenous Affairs to make Medicare enrolment for new arrivals easier by using information supplied electronically by the Department as part of the process. Staff also work closely with migrant resource centres and volunteer groups to provide new arrivals with information regarding Medicare requirements.

HIC’s Welcome Kit for newly arrived immigrants includes information about Medicare, Pharmaceutical Benefits Scheme, Immunisation, the Australian Organ Donation Register, the Family Assistance Office and HIC’s Charter of Care. It also contains information relevant to longer term residents and is available in English and 16 other languages from the Department of Immigration and Multicultural and Indigenous Affairs overseas posts, migrant resource centres, Medicare offices and HIC’s website. Plans to make the Welcome Kit available in audio format will enable people with vision difficulties or low literacy skills to also access the information. A promotional leaflet has been widely distributed to promote the Welcome Kit.

As a positive reflection on HIC’s dedication to customer service, a language selector has been included on the front page of HIC’s website providing easy access to the range of translated information. Recently developed translated language gateway pages have been added to the website to guide access to the general translated information. The introduction of these pages also allows for effective international search engine registration.

At 30 June 2003, 60 HIC employees throughout the State network were formally recognised (through the payment of an allowance) for using their cultural or linguistic skills to provide interpreter services to customers.

HIC is a member of the interdepartmental committee on multicultural affairs and reports annually to the Department of Immigration and Multicultural and Indigenous Affairs regarding HIC activities under the Charter of Public Service in a Culturally Diverse Society.

Contact details for the Translating Interpreting Service (TIS) are included on all communication material to ensure all people have access to information on HIC’s programs and services.

HIC also promotes its services to people from different cultural and language backgrounds in key publications such as Australian Mosaic and a range of ethnic print and radio media.

Improving access for people with disabilitiesHIC continues to respond to the Commonwealth Disability Strategy with a range of activities that are guided by the principles of equity, inclusion, participation, access and accountability.

For example, the consumer health magazine, Your Health Matters, has the following features to make it more accessible for people with a vision impairment:

Contrast — uses mainly black type on white or yellow paper. When text is printed over tints the background colour is very pale;

Type size — 14 pt is used throughout the magazine, reflecting research that indicates a significant number of blind and partially sighted people can read large print;

Type weight — medium to bold type weights are used to provide good contrast.

Font type — standard sans serif font is used, which is easy to read;

Paper stock — stock chosen is matt and has minimum show-through; and

Other considerations — adequate space is left between paragraphs, layouts are simple and clear, e.g. text is not placed around illustrations.

Some HIC information is available in alternative formats in audio and braille and HIC has begun a program to expand availability into large print and easy English.

HIC continues to provide high quality disability access to HIC’s website and is committed to ongoing review and implementation of accessibility for people who are blind or vision impaired.

HIC promotes its services to people with disabilities through publications such as Link magazine, the Telephone Typewriter (TTY) directory and the Australian captions journal.

Contact details for HIC’s Telephone Typewriter (TTY) number are included on all communication material to ensure all people have access to information on HIC’s programs and services.

Physical access issues are incorporated as a component of any agreed ‘scope of works’ concerning fit-out and refurbishment of HIC premises. Sit down counters and low writing slopes are available in all Medicare offices for customers and additional seating has been provided in waiting areas for disabled or elderly customers. Automatic doors have also been installed.

In addition to specific research projects, key components are included in the annual customer service and satisfaction research in relation to people from culturally and linguistically diverse backgrounds, Indigenous Australians and people with disabilities and their health service providers.

HIC telephone enquiry serviceHIC manages 68 incoming telephone enquiry lines, which cover most of the programs it administers. There were approximately 10.5 million calls made to these lines during the financial year. Eleven enquiry lines are available 24 hours a day, seven days a week, while the remainders are available during normal business hours.

Calls are answered by customer service staff with the exception of an interactive voice response system for optometrists to check dates of services.

Over 4.4 million telephone calls were handled by the PBS authority approval line.

See Appendix G on page 188 for a report on the telephone enquiry service.

Contact details for accessing HIC are listed in Appendix H on page 189 and at www.hic.gov.au

EASY AND AFFORDABLE ACCESS TO HEALTHCARE FOR THE WHOLE FAMILY…IT’S JUST A WALK IN THE PARK.

CHAPTER-4MEDICAREKey business resultsIn 2002-03, HIC processed 221.4 million services, representing $8,115.5 million in Medicare benefits.

At a glance

Medicare expenditure 2001-02 and 2002-03

At 30 June 2001-02 2002-03 % change

Total benefits (includes adjustments to provisions for outstanding claims)

$7,832.0 million

$8,174.5 million

4.4% increase

Radiation oncology health program grants $23.0 million $36.0 million56.5% increase

Medicare enrolments, claims and benefits 1998-99 to 2002-03

As at 30 June Units 1998-99 1999-00 2000-01 2001-02 2002-03

Enrolment

Persons enrolled* Million 19.4 19.7 20.1 20.4 20.6

Active cards Million 10.8 11.0 11.3 11.5 11.7

Claims

Services processed Million 206.3 209.6 213.9 220.7 221.4

Benefits

Benefits processed $million 6,669 6,945 7,327 7,830 8,116

Average benefit per service $ 32.32 33.14 34.25 35.48 36.65

Average period service to lodgement

Days† 15.1 15.3 15.7 16.5 16.3

Average period lodgement to processing

Days†† 5.1 5.7 6.1 5.1 4.4

*Medicare enrollees include some people who are not Australian residents (e.g. long-term visitors greater than six months and eligible short-term visitors).

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

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

OverviewMedicare is Australia’s universal health insurance scheme. Introduced in 1984, its objectives are to:

make health care affordable for all Australians;

provide all Australians with access to health care services, with priority according to clinical need; and

provide a high quality of care.

Medicare provides access to:

free treatment as a public (Medicare) patient in a public hospital; and

free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (specified services only).

The Australian Government funds health care through:

grants to State and Territory governments for the operation of public hospitals through Australian Health Care Agreements;

access to medical benefits offering eligible patient rebates on fees paid to eligible medical practitioners; and

grants to government and non-government medical practitioners for a range of other services, such as screening programs to meet special needs.

HIC’s responsibilitiesHIC’s responsibilities primarily relate to:

ensuring Medicare benefits are paid for services to eligible health care consumers by eligible medical practitioners;

assessing and paying Medicare benefits for a range of medical services, whether provided in or out of hospital, based on the Medicare Benefits Schedule (MBS) fees set by the Australian Government on advice from expert committees; and

protecting the integrity of the programs it administers through the prevention, detection and investigation of fraud and abuse.

Medicare Benefits ScheduleThe Department of Health and Ageing has primary responsibility for the MBS and advises HIC on any changes. HIC is responsible for the day-to-day operation of the MBS, and also monitors and analyses the operation and performance of service item usage under Medicare to identify trends in specific item usage, broad types of service, costs and future audit topics.

Medicare levyThe Medicare levy was established on the principle that all Australians should contribute to the cost of health care, according to their ability to pay through taxation revenue and a levy on taxable income.

Medicare Safety NetThe Medicare Safety Net is designed to protect people who have high medical expenses. When an individual or registered family that pays ‘gap’ amounts reaches the Medicare Safety Net threshold in a calendar year ($319.70 from 1 January 2003, for individuals or families — indexed annually from 1 January), Medicare benefits increase to 100 per cent of the MBS fee for any further services that are not bulk billed in that year. ‘Gap’ amounts are the difference between the Medicare rebate and MBS fee.

To be eligible for the Medicare Safety Net using combined gap amounts, families and couples need to complete a Medicare Safety Net registration form (even where its members are listed on a single Medicare card). Individuals do not need to register.

Medicare eligibilityPeople who reside in Australia are eligible for Medicare if they:

hold Australian citizenship; or

have been issued with a permanent visa; or

hold New Zealand citizenship; or

have applied for a permanent visa (restrictions apply to persons who have applied for a parent visa — other requirements apply).

Australian citizens who have resided overseas for more than five years will be required to demonstrate their intention to permanently reside in Australia before a Medicare card is granted. A blue interim Medicare card was introduced in September 2000 for people eligible for Medicare benefits based on their application for permanent residency. An interim Medicare card helps medical practitioners and their staff to identify people with limited Medicare eligibility.

Medicare cards and Medicare levy exemptions 2001-02 and 2002-03

Medicare 2001-02 2002-03 % change

Cards

Total cards issued* 3.43 million 3.03 million 11.6% decrease

Reciprocal health care cards 51,373 46,932 8.6% decrease

Medicare levy exemption

Total applications 24,458 19,994 18.25% decrease

Accepted applications 24,317 18,500 23.92% decrease

Rejected applications 141 488 246.10% increase

*Includes reciprocal health care cards issued under agreements

Customising services for Indigenous AustraliansAs an ongoing response to recommendations in the 1997 Keys Young report, HIC continued to make significant progress in ensuring Indigenous Australians have access to Medicare, the PBS and other HIC programs.

Key initiatives during 2002-03 included:

support to program changes and policy initiatives with the Department of Health and Ageing such as payments for pathology services;

introduction of a voluntary Indigenous identifier on the Medicare enrolment file;

provision and enhancement of outreach services to Indigenous communities and providing advice and support to Aboriginal Health Services;

continued sponsorship of Indigenous events, such as Croc Festivals and the National 3-on-3 Basketball Challenge, and providing information about HIC programs at these events; and

launch and implementation of the Indigenous Communication Strategy (see page 50).

HIC continues to work in partnership with the Department of Health and Ageing, including the Office of Aboriginal and Torres Strait Islander Health, the Department of Immigration and Multicultural and Indigenous Affairs, and to develop working relationships with other key organisations such as the National Aboriginal Community Controlled Health Organisations (NACCHO) and the Aboriginal and Torres Strait Islander Commission (ATSIC).

Liaison Officers for Indigenous access in each State and Territory work closely with Aboriginal Health Services and Aboriginal Health Workers in community health services, providing outreach services. These include conducting on-the-ground promotion and education about HIC’s programs for Indigenous Australians and their health service providers. For example, through Medicare enrolment drives, visitations, training, and building relationships at local community events.

Relationships between Aboriginal Health Services and their local Medicare offices continue to be fostered, based on the success of reducing rejected claims and improving enrolment data in areas where these relationships exist. The introduction in 2002 of a national free call 1800 number specifically for Aboriginal and Torres Strait Islander customers and their health service providers has proved to be extremely effective in providing additional support for enrolment, claiming and general advice. Approximately 20,500 calls were answered during 2002-03.

The voluntary Indigenous identifier is an initiative that aims to enable HIC to improve service delivery to Indigenous customers, research Indigenous health data and measure performance. It was a commitment of the Minister for Health and Ageing and a recommendation of the Keys Young report.

HIC continues to provide cross-cultural awareness training for staff, and is committed to improving HIC staff understanding and appreciation of Indigenous culture.

With the support of NACCHO, the Office of Aboriginal and Torres Strait Islander Health and an Indigenous communications consultant, HIC developed a communication strategy in 2002-03 for Indigenous customers and their service providers. Its aim is to effectively provide information to Indigenous people and their service providers about HIC programs and how to access them. As part of the communication strategy, a toolkit for Aboriginal Health Services was developed to assist Aboriginal Health Service staff with Medicare billing and enrolment. For further information see page 50.

HIC will continue to work with authorities, medical practitioners and communities to improve the accuracy of immunisation data for Indigenous Australian children.

The Northern Territory District Medical Officers Project is a partnership between HIC, the Department of Health and Ageing and Northern Territory Health which has provided a further 60 Indigenous communities and health services with approval to claim Medicare benefits for medical services provided to community members.

Aboriginal health service practice dataTo improve access to Medicare benefits for customers of nominated Aboriginal and Torres Strait Islander Health Services, the Minister for Health and Ageing directed (in accordance with existing section 19(2) orders under the Health Insurance Act) that Medicare benefits be paid to these health services. Medicare benefits are not payable where a health service is funded from another source unless the Minister otherwise directs.

HIC collects information on medical practitioners providing services at 168 Aboriginal and Torres Strait Islander Health Services. This information enables the identification of Medicare payments provided to these Aboriginal and Torres Strait Islander health services.

Memorandums of understanding signedHIC supports a number of Indigenous health projects involving the Tiwi Health Board, Katherine West Health Board and Maari Ma Health Aboriginal Corporation (Wilcannia, NSW). HIC’s responsibilities include verification of Medicare eligibility of project participants, enrolment of new Medicare applicants, and the addition to/withdrawal of participants from the projects. HIC also provides fortnightly aggregated financial Medicare and PBS usage information to help in identifying funds to be reimbursed to the Australian Government.

To ensure its obligations under the Privacy Act are met, HIC entered into memorandums of understanding with each of the project fundholders where they agreed to:

provide relevant Medicare information for each new participant to enable HIC to establish their Medicare and PBS entitlement and to enable linking back to the fund holder for billing purposes; and

advise HIC of any participant who is to be withdrawn from the project.

Improved services for immigrantsHIC and the Department of Immigration and Multicultural and Indigenous Affairs continue to work together through the electronic transmission of information with an aim 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; and

simplify Medicare enrolment.

HIC staff also work closely with Migrant Resource Centres and volunteer groups working with migrants to provide information regarding Medicare requirements.

Visitors to AustraliaThe Australian Government has signed Reciprocal Health Care Agreements with some countries, which entitles residents of these countries to restricted access to health cover while visiting Australia. Currently, these are Finland, Ireland, Italy, Malta, New Zealand, Sweden, The Netherlands and the United Kingdom.

Provider eligibility and registrationMedical practitioners must satisfy the eligibility requirements of the Health Insurance Act before Medicare benefits are payable for professional services. They may apply to HIC for a provider number at each location at which they practice by completing an application form and attaching relevant documentation.

Services provided by a medical practitioner who does not satisfy the eligibility requirements will not attract a Medicare benefit. However, this may not affect the practitioner’s ability to prescribe pharmaceutical benefits, or refer or order pathology and diagnostic imaging services.

CommitteesHIC is represented on a number of MBS related, inter-departmental and inter-professional committees including:

Medicare Benefits Consultative Committee;

Diagnostic Imaging Management Committee;

Pathology Services Table Committee;

Pathology Consultative Committee;

Optometrical Benefits Consultative Committee; and

Medicare Claims Review Panel.

HIC also provides administrative support for expert committees under the Medicare program. The Minister for Health and Ageing appoints committee members from panels of nominees put forward by the relevant professional bodies and colleges.

The committees are:

General Practice Recognition Eligibility Committee;

General Practice Recognition Appeal Committee;

Medical Benefits (Dental Practitioner) Advisory Committee;

Medical Benefits (Dental Practitioner) Appeal Committee;

Overseas Specialist Advisory Committees;

Overseas Specialist Appeal Committee;

Specialist Recognition Advisory Committees; and

Specialist Recognition Appeal Committee.

Location specific practice registrationThe Health Insurance Amendment (Diagnostic Imaging, Radiation Oncology and Other Measures) Act 2003 requires all practice sites and bases for mobile equipment where diagnostic imaging and radiation oncology services are undertaken, to be registered with HIC in order to claim Medicare benefits.

The main purpose of this amendment is to provide a mechanism to collect information about the rendering of diagnostic imaging and radiation oncology services. This assists the Government and the diagnostic imaging industry to monitor the nature of services provided and assess compliance for benefits by ensuring equipment used in relation to a Medicare claim meets the eligibility requirements. The information will also allow the development of future programs to maintain and improve patient access to high quality services.

As at 30 June 2003, 2,544 diagnostic imaging or radiation oncology premises or mobile bases have registered with HIC and been allocated a unique location specific practice number (LSPN). Under the new legislation, from 1 July 2003 Medicare benefits will not be payable to practice sites for diagnostic imaging or radiation oncology items unless a LSPN is quoted on patient accounts, receipts, or bulk billing assignment forms.

To assist doctors in identifying registered practices eligible for Medicare benefits, a list of LSPN registered practice sites and mobile facilities have been published on HIC’s website www.hic.gov.au

PathologyThe Pathology quality and outlays agreement 1999-2004 between the Minister for Health and Ageing, the Royal College of Pathologists Australasia and the Australian Association of Pathology Practices, provides the basis for developing an improved regulatory environment in the health sector with potential benefits to all parties.

Approved collection centre listings are now available on HIC’s website www.hic.gov.au

Medicare Claiming

Bulk bill claimsBulk billing occurs when the patient’s right to a Medicare benefit is assigned by the patient to the medical practitioner who rendered the service. The medical practitioner accepts 85 per cent of the MBS fee as full payment for the medical service and bills HIC directly.

In 2002-03, there were 150.1 million services bulk billed, accounting for 67.8 per cent of all services by all categories of medical practitioners. Additional statistical information is available in the electronic version of HIC’s annual report www.hic.gov.au

HIC OnlineAs at 30 June 2003, 69 sites were transmitting claims to HIC via HIC Online. A total of 326,902 bulk bill claims have been processed since the system was introduced.

MedclaimsThe proportion of bulk bill services made electronically using Medclaims increased to 75.4 per cent with the number of sites transmitting claims decreasing from 6,957 at 30 June 2002 to 6,231 at 30 June 2003.

Scanning and document imaging systemHIC continues to use a generic imaging system for scanning. In 2002-03, some 15 per cent of bulk bill services were processed using this system.

Patient claimsRecognising that consumers of health services have different preferences when it comes to accessing Medicare benefits, HIC has developed a range of benefit claiming options. The challenge for HIC is to maintain an efficient service that is responsive to unique customer groups and provides ongoing innovation in claiming and related services, while further broadening information service provision.

Paid accountsWhere the medical practitioner does not bulk bill, and the patient pays the account in full at the time of service, a Medicare benefit may be claimed from HIC by the patient.

Unpaid accountsWhere the medical practitioner gives the patient an account, the patient may choose to lodge an unpaid account with HIC. A cheque for the Medicare benefit made payable to the medical practitioner will be sent to the patient who gives the cheque to the medical practitioner plus any additional amount owing.

Medicare office claimingHIC’s network of 226 Medicare offices throughout Australia is supported by its national computing and communications infrastructure. All Medicare offices provide a full range of Medicare services including processing of enrolments and registrations, and cash, cheque and electronic funds transfer (EFT) payments. They also accept lodgement of participating health fund claims under Medicare two-way arrangements, and process claims for the Federal Government 30% Health Insurance Rebate and benefits for the PBS. Medicare offices also provide Family Assistance Office services. Medicare office address details are available at www.hic.gov.au/yourhealth/where_to_find_us/index.htm

Medicare claims can be made in person by submitting a claim over the counter or via a drop box at a Medicare office. Innovations, such as formless cash claiming and EFT payment of Medicare benefits directly into the patient’s bank or credit union account, are an important part of customer-focused

service in Medicare offices. EFT payment is offered to people lodging claims by post and through Medicare easyclaim facilities as an alternative to payment by cheque.

Medicare easyclaimThere have been 990,281 Medicare claims since the Medicare easyclaim project commenced, providing an alternative Medicare claiming option for people living in rural and remote areas around Australia who do not have direct access to Medicare offices.

At 30 June 2003, 501 facsimile devices and 562 telephone booths were operating in Rural Transaction Centres, State Government agencies, post offices, pharmacies and many other locally based shops and services. The locations of Medicare easyclaim devices are available at HIC’s website www.hic.gov.au

Medicare mail claimingMedicare claims can still be made by posting the claim form and account or receipt to HIC.

Two-way lodgement of Medicare claimsMedicare Two-Way Agency allows people to lodge Medicare claims at their health fund or health fund claims at Medicare offices. A total of 730,329 in-hospital gap claims were lodged under the two-way agency arrangements and there was a total of 37 participating health funds in 2002-03.

Simplified billingThe simplified billing initiative is designed to simplify medical billing and payment arrangements for private patients for in-hospital care. It reduces:

the number of separate accounts sent to the patient;

delays in patient billing;

administration costs for accounts; and

the level of bad debts as providers have evidence that the claim has been lodged.

There are four major simplified billing models currently in use.

Medical Purchaser Provider Agreement (MPPA) — where a health fund can make an agreement to pay provider benefits above the Medicare Benefits Schedule fee. Legislation was introduced prohibiting any health fund from interfering with the clinical freedom of medical practitioners. This addresses any concerns a medical practitioner may have with entering into such an agreement with a health fund. The patient need not be involved unless there is an agreed out-of-pocket expense.

Hospital purchaser provider agreement/Practitioner agreement (HPPA/PA) — where a medical practitioner need not deal directly with health funds if submitting claims for simplified billing. The agreement is a combination of agreements between medical practitioners and hospitals and between hospitals and health funds.

Approved billing agency model — where a billing agent acts on behalf of the patient to claim Medicare benefits and health insurance medical benefits. The maximum amount of benefits a billing agent can collect on the patient’s behalf is equal to 100 per cent of the schedule fee.

Registration of simplified billing agents — on 8 October 2002 the Health Legislation Amendment (Private Health Industry Measures) Act 2002 (the Amending Act) transferred responsibility for the registration of billing agents from the Private Health Insurance Administration Council (PHIAC) to HIC effective from 8 April 2003.

Between 8 April and 30 June 2003, HIC received and approved one new application for registration as a Public body simplified billing agent. Two previously registered simplified billing agents renewed their registrations, one as a public body and one a body corporate.

Gap cover schemes — where the purpose is to enable a health fund to offer insurance coverage for the cost of hospital treatment and associated professional attention for the person insured. This can apply where;

the cost of the treatment is greater than the schedule fee;

there is no other form of agreement between the health fund and the provider; and

the person insured pays a specified amount or percentage under a known gap policy or the full cost of treatment is covered under a no-gap policy.

Simplified billing claims have increased from 65.9% to 69.5% of all Medicare in-hospital services in 12 months. Twenty-five billing agents were registered to coordinate claims for medical accounts under simplified billing arrangements at 30 June 2003. Eight were transmitting claims electronically and 17 were lodging claims manually. Forty health funds also transmitted simplified billing claims electronically to HIC.

Of the claims transmitted from health funds and billing agents, 97% were transmitted electronically and 3% manually.

BalimedIn recognition of the extreme difficulties faced by those injured in the Bali bombings, the Australian Government agreed to cover all out-of-pocket expenses, incurred in Australia, for the treatment of injuries received. The scheme covers Australian residents and eligible overseas nationals.

A Balimed Steering Committee was established in order to generate and oversee guidelines and procedures. The committee includes representatives from the Department of Health and Ageing, the Department of Family and Community Services, the Department of Finance and Administration and HIC.

A Bali special health care benefits hotline has been established 1800 660 026.

The scheme covers eligible persons until 12 October 2005 and HIC has the discretion to terminate coverage of a person on reasonable grounds, on a case-by-case basis. It will cover costs faced by eligible patients for the following kinds of goods and services:

Medical — gap payments between normal Medicare benefits and the fee charged by the doctor, to the extent that the amount is not covered by private health insurance;

Hospital — costs not otherwise covered by public patient arrangements or private insurance;

Pharmaceutical — the full cost of pharmaceuticals covered by the Pharmaceutical Benefits Scheme; and

Allied Health — costs of services such as physiotherapy, speech therapy and occupational therapy, less any amounts covered by private health insurance.

As at 30 June 2003, 141 victims were registered with HIC to receive assistance and $111,811 has been paid to 84 victims.

Professional Services Review SchemeEstablished under the Health Insurance Act, the Professional Services Review Scheme came into effect on 1 July 1994 and applies to health professionals who provide or initiate services under Medicare or the Pharmaceutical Benefits Scheme. These include medical practitioners, optometrists, dentists, podiatrists, chiropractors, physiotherapists and practice proprietors.

The Professional Services Review Scheme provides a system of peer review to determine whether a practitioner is inappropriately rendering or initiating services under Medicare, or inappropriately prescribing under the Pharmaceutical Benefits Scheme.

The Director of Professional Services Review, the Professional Services Review Committees and the determining authority are independent of HIC. Their role is to report on the question of inappropriate practice. If a Committee makes a finding of inappropriate practice against a medical practitioner, the determining authority will decide the sanction to be imposed. During the year ending 30 June 2003, 52 practitioners were referred to the Director of Professional Services Review. Of those referred, 47 were general practitioners and five were specialists.

Prescribed pattern of service (80/20 rule)In 2002-03, nine practitioners who had a prescribed pattern of service were referred to the Director of Professional Services Review. A ‘prescribed pattern of service’ occurs when a medical practitioner renders 80 or more professional services on each of 20 or more days in a 12-month period.

Recoveries under the Professional Services Review SchemeIn 2002-03, $150,155.40 was recovered from 10 practitioners pursuant to agreements and final determinations under the Professional Services Review Scheme.

Inappropriate practice‘Inappropriate practice’, as defined by section 82 of the Health Insurance Act, occurs where a Professional Services Review Committee could reasonably conclude that a medical practitioner’s conduct in relation to rendering or initiating a service would be unacceptable to their general body of peers. For this purpose, a service is either one for which a Medicare benefit was payable or a prescription was written for supply of medication under the Pharmaceutical Benefits Scheme (or supplied by a health care provider).

HIC identifies medical practitioners whose statistics with respect to rendering or initiating services appears abnormal when compared with their peers. HIC’s State Case Management Committees review patterns of practice and decide when medical practitioners should be interviewed.

HIC medical, pharmaceutical or optometrical advisers may meet with the medical practitioners for further information and discussion. The interview, also referred to as an intervention, provides the opportunity for the medical practitioner to discuss particular issues with the adviser and explain possible reasons for the pattern of practice.

Following the meeting, any concerns are reconsidered by the State Case Management Committee. In the majority of cases no further action is required.

If after this review, the medical practitioner’s servicing remains a concern, a request will be made by HIC to the Director of Professional Services Review to review the provision of services by the practitioner. The Director may decide to:

dismiss the request;

enter into an agreement with the medical practitioner to repay Medicare benefits; undertake a period of disqualification from Medicare, or revoke or suspend the authority to prescribe items under the PBS; or

set up a Professional Services Review Committee comprising the medical practitioner’s peers to determine if the medical practitioner has engaged in inappropriate practice.

Summary of counselling undertaken 2002-03

Specialty NSW VIC QLD WA SA TAS ACT NT Total

General practice 212 140 56 67 31 16 0 5 527

Specialists 20 17 8 5 3 2 0 0 55

Specialty NSW VIC QLD WA SA TAS ACT NT Total

Optometrists 22 11 7 9 1 1 0 0 51

Total 254 168 71 81 35 19 0 5 633

Compliance auditsHIC monitors payments on claims paid for Medicare through a program of audits.

Post payment auditsHIC conducts an annual program of post payment audits to monitor and evaluate legislative compliance with claiming and payment of claims by HIC. To support the post payment audit process for Medicare, purpose based and source based audits are conducted throughout the year.

Purpose based auditsPurpose based audits are specific, in-depth reviews designed to confirm compliance with the applicable legislation and the MBS. They complement other HIC activities used to address risks to, or abuse of, Medicare. HIC conducts purpose based audits throughout the year; however, the audit results are reported only in the year in which they are completed.

Medicare purpose based audits undertaken during the year involved 188 medical practitioners and 9,277 services. Various levels of non-compliance were found and the total amount of identified recoveries was approximately $0.25 million.

State and National Office audit officers’ conduct the audits, supported by Medical Advisers within HIC. National consistency is achieved through regular conferences with State audit staff and a common methodology.

Source based auditsSource based audits are a post payment review process used by HIC. Their principal objective is to determine high-risk areas within the Medicare program by verifying all aspects of the claimed service with documents and parties relevant to the transaction, including patients, medical practitioners and HIC processing areas.

A secondary objective is to identify administrative errors; these errors generally do not affect the amount of benefit paid.

Source based audits are used to identify the errors in services examined and to quantify the amount of improper payments made in relation to those services. In the audits conducted in 2002-03, there were no improper payments identified, however, errors without payment implications were identified in the claims examined. This resulted in providers being advised of the errors and counselled where appropriate. Examples included dates of services provided not being advised and tick boxes not checked.

Fraud investigationsHIC uses a participative approach to ensure uniform and consistent guidelines to fraud investigations are implemented nationally and conform with Government best practices.

This is done through the National Central Coordinating Committee which consists of representatives from the Australian Federal Police, Department of Health and Ageing, Department of Veterans’ Affairs, the Office of the Director of Public Prosecutions and HIC.

Summary of investigations into fraud 2002-03

Investigations Total

Public fraud* investigations started (all programs) 112

Public fraud investigations finished (all programs) 122

Practitioner fraud investigations started (all programs) 104

Practitioner fraud investigations finished (all programs) 164

Receptionist fraud investigations started (all programs) 4

Receptionist fraud investigations finished (all programs) 2

Public/provider/receptionist/pharmacist fraud referred to Australian Federal Police (all programs)

1

Public/provider/receptionist fraud referred to State Police 46

Public/provider investigation briefs-of-evidence referred to Director of Public Prosecutions 28

*‘Public fraud’ refers to patients and members of the public who unlawfully seek to obtain health benefits.

Of Medicare related investigations in 2002-03 the following stand out:

Provider fraud In March 2003 in Victoria, Dr Jack Freeman pleaded guilty in the County Court to one charge of defrauding the Commonwealth in relation to approximately $680,000 of fraudulent Medicare claims.

In April 2003 in Victoria, Dr Michelle Wielicki pleaded guilty to three charges under section 128B of the Health Insurance Act 1973 relating to the submission of fraudulent Medicare claims.

Public fraud In July 2002 in South Australia, Miss D Kennedy was forging accounts/receipts and using them to obtain cash benefits from Medicare. The charges were proved and Miss Kennedy received a three-month suspended sentence and ordered to repay the money.

In November 2002 in Victoria, Susan Green, a person working for a medical stationery supplier, manufactured false invoices and receipts on which fraudulent payments were obtained from HIC. As a result the offender was sentenced to 12 months imprisonment and ordered to repay the money.

InternalIn October 2002, Sandra Di Filippo, a former HIC customer service operator from Queensland, was sentenced to three years imprisonment with a minimum sentence to serve of four months for defrauding HIC. The money defrauded by the employee was repaid before the the trial.

Provider investigations (PBS)In September 2002 in Victoria, a major pharmacy investigation was concluded with the sentencing of Thi Xuan Phoung Le to three years imprisonment and an order to repay $350,000.

TrainingAll HIC investigators will hold Certificate IV Fraud Control (Investigation) qualifications and relevant investigation managers will meet the Commonwealth Fraud Control Guidelines issued by the Attorney-General’s Department.

Program Review (PR) desktopThe PR desktop is a national system that supports all aspects of Program Review work in the States and National Office. It is used to record, manage and report on all activities arising from program integrity work.

Medicare Participation Review CommitteePractitioners convicted of offences against Medicare must be referred to the Medicare Participation Review Committee (MPRC) for review of their future involvement in the Medicare scheme. The MPRC can determine if a person, including where relevant, a body corporate, has breached an Approved Pathology Practitioner (APP) or Approved Pathology Authority (APA) undertaking, or has engaged in a prohibited diagnostic imaging practice. Medical practitioners with two final determinations of inappropriate practice under the Professional Services Review Scheme also come before the MPRC.

The Health Insurance Act requires that the MPRC include a legally qualified chairperson and, depending on the matter being considered, two to four members drawn from a pool of medical, optometrical or dental practitioners. The MPRC is administratively supported by HIC but is an independent statutory body.

An MPRC determination can result in five years total disqualification from professional participation in the Medicare Scheme and further action by State and Territory registration bodies. During 2002-03, six cases were referred to an MPRC and three determinations were made. There is a time lag between referral and determination and, as a consequence, matters may span more than one financial year.

Cases referred to the Medicare Participation Review Committee 2002-03

Type of practitioner No. Reason

General practitioner 2 Convicted or found guilty of Medicare offences

Pathology company 1 Potential breach of APA undertaking

Determinations by the Medicare Participation Review Committee 2002-03

Determination No.

Total disqualification for one year and six months 1

Revocation of APA undertaking for three months 1

Reprimanded 1

Dismissed due to out of time appeal by practitioner referred 1

Risk management developmentsHIC has developed new Artificial Intelligence (AI) tools to detect anomalies in a number of areas. All systems for diagnostic imaging and general practice were field tested in August 2002 and November 2002 respectively. Initial in-house testing was very promising.

Education and promotion

CommunityMedicare information revamped in 2002-03 included: Medicare — your questions answered, Health care for visitors to Australia, The Safety Net helps protect you from high medical costs, the Medicare Two-way Agency information sheet and poster, One easy step to enrol your new baby in Medicare, and Welcome to Australia — How to use your Medicare card. Your Health Matters continues to provide consumers with information relating to Medicare, including how to claim benefits and the importance of keeping card details up-to-date.

Medical practitionersEducation and information activities for medical practitioners and practice staff included quarterly production of HIC’s newsletters Forum, Pathology Notes and Health Industry News — an electronic newsletter developed specifically for private health fund operators, billing agents, software vendors and other interested parties. An upgrade of Mediguide — a guide to the Medicare claiming system and other health programs administered by HIC was completed. HIC representatives attended conferences, seminars and presentations for medical practitioners and practice managers.

Communication to medical practitioners on HIC Online occurred through Forum, the reference publication Mediguide, articles and media releases, national and local conference participation and workshops with Divisions of General Practice. Information kits including sheets and booklets were also produced for medical practitioners and practice managers on the HIC Online claiming channel. An HIC Online helpdesk enquiry line is also in place to answer HIC Online enquiries.

Software vendorsCommunication to medical software vendors on HIC Online occurred through the Software Vendor helpdesk, information booklets and guides, consultation with the Medical Software Industry Association and electronic updates.

Customer researchNinety-three per cent of health consumers indicated they were satisfied with HIC service for Medicare. Ninety-three per cent of consumers who recently visited a Medicare office were satisfied with the experience.

Seventy-three per cent of general practitioners were satisfied with claiming and receiving Medicare payments. Practitioners were also satisfied with HIC’s phone services and believe that HIC customer service staff do a good job administering Medicare, PBS and other programs given the growing complexity of the health system.

AFFORDABLE AND RELIABLE ACCESS TO PRESCRIPTION MEDICINES ALLOWS US TO ENJOY LIFE TO THE FULL…ALL I HAVE TO WORRY ABOUT NOW IS REDUCING MY HANDICAP.

CHAPTER-5PHARMACEUTICAL BENEFITS SCHEMEKey business resultsIn 2002-03, HIC processed 174 million services, representing $5.1 billion in benefits paid under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) collectively called the PBS.

At a glance

PBS expenditure 2001-02 and 2002-03

At 30 June 2001-02 2002-03 % change

Total benefit expenditure (after allowing for movement in outstanding claims)

$4,706.4 million $5,211.6 million 10.7% increase

Comprises:

PBS benefits $4,333.1 million $4,783.9 million 10.4% increase

RPBS benefits $373.3 million $427.7 million 14.5% increase

Stoma appliances $37.6 million $40.5 million 7.7% increase

OverviewThe PBS ensures all Australian residents and eligible overseas visitors are provided with affordable, reliable and timely access to prescription medicines. Most medicines available on prescription are subsidised by the Australian Government under the PBS.

The Department of Health and Ageing is responsible for program policy development and overall management of the PBS, including the Schedule of Pharmaceutical Benefits, and the Department of Veterans’ Affairs is responsible for the overall policy for the RPBS.

PBS beneficiariesThere are two types of PBS beneficiaries — general patients, who pay up to $23.10* for prescription medication, and concession patients, who pay up to $3.70* for prescription medication. All patients, general and concession, must provide their Medicare number (or Department of Veterans’ Affairs file number) to the pharmacist at the time the PBS (or RPBS) medicine is supplied. This ensures subsidised medicines are provided only to those who are eligible to receive them.

Concession beneficiaries must also provide their concession card number to the pharmacist at the time of supply. Concession beneficiaries hold either a Health care card, Pensioner concession card or Commonwealth senior’s health card issued by Centrelink. The Department of Veterans’ Affairs also issues Pensioner concession cards and Commonwealth seniors health cards.

*These figures are adjusted annually in line with CPI and do not cover surcharges for more expensive alternative brands/medicines.

PBS Safety NetThe PBS Safety Net helps protect people and their families who spend large amounts of money on prescription medicines. It sets a threshold amount that a person or family would pay for PBS prescription medicines in a calendar year. The 2003 Safety Net threshold* for concession card holders was $192.40 and $708.40 for general patients. Once the relevant threshold is reached, and a Safety Net card obtained, PBS medicines are cheaper or free for the rest of the calendar year.

To qualify for the PBS Safety Net a person needs to keep a record of all PBS medicines supplied to them and their family. They can ask their pharmacist for a prescription record form and hand this form in whenever they have a prescription filled or, if they have a regular pharmacist, they can ask them to keep a record on their computer. Pharmacists are able to provide more information about how the Safety Net works.

Further information on the PBS Safety Net can also be found at www.hic.gov.au

*Safety Net amounts change each calendar year.

HIC’s responsibilitiesHIC is responsible for the operation of the PBS and the RPBS. This involves:

processing pharmacists’ claims using the claims transmission system (CTS), which uses electronic data provided by pharmacists from their pharmacy computers;

administrating Safety Net arrangements to help with the cost of PBS medicines for families and individuals;

approving authority prescriptions for medicines limited to specific circumstances;

approving pharmacists to supply PBS medicines;

approving doctors to supply PBS medicines where there are limited pharmacy services;

approving private hospitals to supply PBS medicines to their patients; and

approving participating public hospitals to supply PBS to eligible patients under the pharmaceutical reform measures.

Processing claims and payment to approved pharmacistsHIC makes payments to approved pharmacists for:

cost of medicine (Commonwealth price to pharmacists);

mark-up (depending on cost of medicine — see Explanation of Current Pricing booklet);

dispensing fee;

PBS Safety Net recording fee; and

other fees as required (e.g. Dangerous drug fee — Schedule 8 medicines).

HIC also makes payments under section 100 of the National Health Act to:

Colostomy and Ileostomy Associations for ostomy supplies;

drug companies for the supply of in-vitro fertilisation hormones, fertility drugs and botulinum toxin; and

remote Aboriginal and Torres Strait Islander communities.

PBS claims lodged on computer disk must be paid on or before the seventeenth day after receipt by HIC. Claims submitted for manual keying by HIC must be paid on or by the thirtieth day after the data is keyed.

Approving authority prescriptionsUnder the authority prescription approval arrangements, medical practitioners are required to obtain prior approval from HIC for all PBS authority prescriptions before an approved pharmacist can make a supply. As at 30 June 2003, of the 1,451 PBS items listed, 778 are restricted to use for a particular condition or purpose. Of these 778 items, 288 are subject to criteria set by the Pharmaceutical Benefits Advisory Committee that limits supply to a PBS authority prescription.

Authority prescriptions are also required where an increased supply is needed in the treatment of an individual patient. During 2002-03, 4.76 million authority prescriptions were approved, with 4.49 million of these being handled by telephone through HIC’s 1800 service which operates 24 hours a day, seven days a week.

Internet ordering of repeat authorisation stationeryPharmacists can now order repeat authorisation forms via the internet at www.norcross.com.au. The process is secure and orders are confirmed online and promptly delivered, enabling pharmacies to store less stock.

Approving pharmacists to supply PBS medicinesThe authority to supply PBS medicines is defined under section 90 of the National Health Act. Provisions under section 92 of the Act also give approval for doctors to dispense in rural areas where a pharmacist is not available.

During 2002-03, HIC received 368 applications for new or relocated pharmacies. These were referred to the Australian Community Pharmacy Authority, which recommended 281 pharmacies for approval with a further nine being deferred. Of the remainder, 55 were not recommended and the rest were withdrawn. HIC also processed 584 pharmacy applications for approval relating to changes in ownership in 2002-03.

Approval was granted to 14 medical practitioners to supply pharmaceutical benefits under section 92 of the National Health Act.

Third Community Pharmacy AgreementThe Third Community Pharmacy Agreement between the Australian Government and the Pharmacy Guild of Australia was implemented on 1 July 2000. Under the Agreement,

HIC is responsible for making payments for:

Highly Specialised Drug Program — remuneration for pharmacies supplying highly specialised drugs to private hospitals;

Rural Pharmacy Maintenance Allowance — a financial incentive for pharmacy proprietors to remain in rural and (designated) remote locations in Australia;

Start-up Allowance — a staggered payment, over two years, to encourage the establishment of new pharmacies in rural/remote locations where there is a need for a community pharmacy. Eligibility for the allowance is stipulated in the Third Community Pharmacy Agreement;

Succession Allowance — a staggered payment, over two years, to pharmacists wishing to purchase an existing pharmacy in an identified area of need. Eligibility depends on the degree of remoteness according to agreed categories as defined under the Pharmacy Accessibility/Remoteness Index of Australia (PHARIA);

Quality Care Pharmacy Program — embodies the professional practice standards of the Pharmaceutical Society and encourages community pharmacies to achieve and maintain accreditation. Financial incentives are paid as appropriate once Quality care pharmacy program milestones are achieved; and

Improved Monitoring of Entitlement Medicare Number Allowance Payments — a continuing payment to all approved pharmacies for residual administration costs associated with recording Medicare numbers on PBS prescriptions. During 2002-03, two payments were made totalling $10 million to all approved pharmacies. The first payment was made in January and the second in March.

Applications for the Rural Pharmacy Maintenance Allowance, Start-up Allowance and Succession Allowance are available at www.hic.gov.au

Payments under the Third Community Pharmacy AgreementHIC payments under the Third Community Pharmacy Agreement initiatives totaled $30 million (and an additional $10 million for Improved Monitoring of Entitlement payments) in 2002-03.

Payments made under the Third Community Pharmacy Agreement 2002-03

Type of payment Number of payments

Total amount paid

Medicines Information to Consumers Incentive Allowance

4,301 $4.3 million

Medicines Information to Consumers Participation Allowance

6,420 $4.1 million

Quality Care Pharmacy Program 1,145 $7.2 million

Rural Pharmacy Maintenance Allowance 9,181 $10.5 million

Start-up and Succession Allowance 18 $610,125

Home Medicine Review Services 3,735 $2.9 million

The Medicines Information to Consumers Incentive Allowance was paid to pharmacies that had undertaken to provide consumer medication information to customers. The incentive was to encourage pharmacists to register for the Medicines Information to Consumers program before 31 December 2002. It involved payment of $1,000 to 4,301 participating pharmacies; with payments being made in December 2002, January 2003, and February 2003. The total payment was $4.3 million.

The Medicines Information to Consumers Participation Allowance is an ongoing payment, made every two months to pharmacies providing consumer medication information. It is paid at the rate of ten cents for every claimable PBS or RPBS prescription dispensed. To date a total of 6,420 payments have been made, totalling $4.1 million.

The Medicines Information to Consumers program provides a framework for pharmacists to use Consumer Medicine Information when informing patients about their medicines. The provision of Consumer Medicine Information does not replace counselling by pharmacists nor does it in anyway reduce the pharmacists’ duty to counsel patients about medicines.

Payments made to 1,145 approved community pharmacies under the Quality Care Pharmacy Program totalled $7.2 million.

The Rural Pharmacy Maintenance Allowance was implemented in January 2001. In 2002-03, the total amount paid was $10.5 million, to about 705 community pharmacies.

Start-up and Succession Allowance payments totalling $610,125 were made to 18 community pharmacies.

The Home Medicine Review Services program is designed to allow patients’ medication regimes to be reviewed upon request of the patient, medical practitioner or carer. The review is conducted in the patient’s home and is undertaken by an accredited pharmacist upon referral of a medical practitioner. The outcome is discussed by the medical practitioner and pharmacist, followed by the development of a medication management plan. Payments for 3,735 Home Medicine Review Services totalled $2.9 million.

Indigenous and Torres Strait Islander Access to the PBSHIC continued to administer the Australian Government PBS arrangements that make PBS medicines accessible in remote Indigenous and Torres Strait Islander communities.

HerceptinIn December 2001, the Australian Government agreed to fund Herceptin (trastuzumab), a new drug used in the treatment of metastatic breast cancer. This program is administered by HIC as a separate program to the PBS, with Herceptin supplied to the prescriber on a monthly basis after patient eligibility has been determined.

Since its inception, over 700 eligible patients have been approved for Herceptin use with total benefits paid exceeding $23 million.

Australian Health Care Agreements — pharmaceutical reform measures for public hospitalsUnder the Australian Health Care Agreements, the Government, States and Territories are reforming the supply of pharmaceuticals to patients in public hospitals. Key features of the reform proposal are to extend the PBS to admitted patients on discharge and outpatients and to provide access to chemotherapy drugs for day patients of public hospitals. Participating hospitals will be required to adopt the Australian Pharmaceutical Advisory Council guidelines on continuum of pharmaceutical care between the hospital and the community.

The Australian Government has made offers to all States and Territories and discussions are now proceeding on a bilateral basis. The pharmaceutical reforms are operating across Victorian public hospitals and are being implemented in a staged process with Queensland. The Western Australian Government has agreed to the reforms, with the first Western Australian hospitals expected to participate from October 2003. It is expected other States will also participate.

HIC has worked closely with the Australian and State Governments to implement these reforms. At 30 June 2003, HIC approved 31 Victorian and four Queensland public hospitals under these arrangements and paid benefits in excess of $18 million.

A second phase will enable hospital pharmacists, on behalf of oncologists, to obtain electronic approval for chemotherapy authority prescriptions for day admitted patients. This facility builds on the Authority Notification System and will use Public Key Infrastucture (PKI) technology to safeguard the privacy of hospital patients. Paperless claiming is a feature of these arrangements, which commenced in three hospitals in December/January 2002-03.

Management of risks to the PBSIn its 2002 Budget, the Australian Government announced a series of budget measures aimed at ensuring sustainability of the PBS. HIC was assigned responsibility for a number of these measures and is implementing them over a four-year program.

Restricted PBS medicinesThe prescribing of drugs outside pharmaceutical benefits listing restrictions has been identified as a major risk to sustainability of the PBS. HIC has developed and implemented strategies aimed at

promoting understanding and observance of the restrictions required when prescribing on the PBS. In 2002-03, this activity focused on three specific drug groups: proton pump inhibitors, lipid lowering agents and Cox-2s.

Strategies adopted included:

revision of prescribing instructions to ensure there is a clear understanding of the restricted use of the pharmaceutical where obtaining a pharmaceutical benefit;

general feedback and education to all prescribers of the targeted medications on prescribing requirements; and

targeted feedback and counselling to particular prescribers.

Authority PBS medicinesThis project aims to enhance the PBS authorities process. It involves reviewing and, as necessary, revising the wording of authority medication restrictions listed in the PBS Schedule to more accurately reflect the intent of the listing restriction. The process is conducted in conjunction with the Pharmaceutical Benefits Advisory Committee. During 2002-03, approximately 40 per cent of authority items in the Schedule were reviewed. Additionally, HIC is developing an electronic authority system which will provide prescribers with an alternative to the existing manual authority approval process. The first release of this channel to prescribers is planned for 1 August 2003.

Prescription Shopping projectThrough a range of strategies, the project aims to:

educate persons who may be obtaining PBS medicines in excess of therapeutic need;

identify persons who may be obtaining medicines in excess of therapeutic need; and

intervene with these persons or their prescribers.

Unlike the Doctor Shopping program, which it replaced and which was limited to three drug groups, the Prescription Shopping project will examine all PBS medicines being used in excess of therapeutic needs.

PBS Risk projectThe project aims to identify and intervene in higher risk areas of PBS claiming. During 2002-03 initiatives included:

an audit of pharmacy claims which identified and recovered from pharmacies receiving two or more payments for the one prescribed supply of a PBS item;

market research and a community awareness campaign in relation to the PBS Safety Net program; and

availability of high cost drugs on the PBS identified as a high risk factor in relation to the program’s sustainability. HIC is undertaking detailed data analysis to reduce the risk associated with these drugs.

Overseas Drug Diversion projectThis replaces HIC’s Prescription Drug Smuggling (PDS) project. Its purpose is to develop and implement a range of initiatives to reduce the amount of PBS medicines being illegally exported or carried out of Australia.

The Overseas Drug Diversion project involves conducting, with the assistance of the Australian Customs Service, a series of interventions at sea, air and land ports to detect and seize prescription drugs illegally leaving Australia.

An HIC help line provides advice to consumers and practitioners on requirements when carrying prescription drugs overseas.

Overseas Drug Diversion information line calls received in 2001-02 and 2002-03

2001-02 2002-03

PDS Help Line calls received 2,203 2,494

Source based auditsComprehensive post payment audits are regularly conducted to ensure compliance with claiming and payment regulations and to determine if HIC functions are being carried out in line with legislation.

To support the post payment audit process for PBS, source based audits are also conducted to determine high-risk areas within the PBS. They identify incorrect payment in claims and indicate the steps necessary to improve integrity.

During 2002-03, the source based audit program randomly reviewed 94,625 PBS-funded medicine supply events nationally. The audit program identified incorrect payments, and also benign paperwork errors that are technically non-compliant with PBS rules but do not result in any adverse consequences.

Examples of incorrect payments included instances where the pharmacist had generated more repeats than prescribed, and supply made on a prescription more than 12 months old. Examples of benign paperwork errors include instances where the patient address was shown as a post office box, instead of a street address as required by PBS regulations.

Suspension or revocation of PBS approvalsSection 133 of the National Health Act permits the Minister for Health and Ageing or the Secretary to the Department of Health and Ageing to suspend or revoke the approval of a pharmacist to supply pharmaceutical benefits under the PBS following a charge or conviction for offences related to PBS.

In 2002-03, action under section 133 of the Act was considered in respect of certain PBS approvals involving four pharmacists. Two matters relating to convictions resulted in the pharmacists in question ceasing to operate their pharmacies.

Education and promotionThe PBS education program targets pharmacists, medical practitioners and consumers, as well as special case users such as those who use prescription medicines in excess of therapeutic need, those who stockpile PBS medicines, and exporters of prescription drugs.

CommunityAs a member of the PBS Communication Working Group—made up of representatives from HIC and the Department of Health and Ageing—HIC played an active role in ensuring delivery of consistent messages around PBS communications and the 2003 PBS awareness campaign.

A suite of information products were produced to educate consumers about Saving Money on Medicines.

The Good Health TV network and HIC’s Your Health Matters featured information about various aspects of the PBS, including creating awareness about the availability of generic medicines and Safety Net co-payments.

HIC purchased a sponsorship package from the Pharmaceutical Society of Australia, which includes placing an article in each edition of the Society’s monthly magazine, inPHARMation, for one year.

A number of promotional activities also took place, including PBS Safety Net advertisements and communication materials, developed in conjunction with the Department of Health and Ageing, to promote generic brand medicines.

PharmacistsInformation and presentations on the PBS were provided at conferences, training venues and information sessions for pharmacists, pharmacy assistants and other medical practitioners. Building strategic relationships with pharmacists to support PBS online services also formed a large part of communication activities in 2002-03. These focused on the benefits of HIC’s improved claiming solutions.

HIC’s Bulletin Board continued to be a key means of communication with pharmacists. In addition, the annual PBS Safety Net kit for pharmacists was distributed and articles and media releases were written for professional publications and newspapers.

Updated education booklets and fliers for pharmacists included:

Reference guide for approved providers of PBS and RPBS medicines;

Pharmaceutical Benefits Scheme Explanation of Current Pricing—2003;

Use of the Pharmaceutical Benefits Scheme in Private Hospitals and Nursing Homes— A Guide for Staff; and

Pharmaceutical Benefits Entitlement Cards.

HIC supports the Pharmaceutical Society of Australia by assisting with the development of pharmacy assistant training materials.

Medical practitionersCommunication to medical practitioners on pharmaceutical matters continued through HIC’s newsletter, Forum, the reference publication, Mediguide, articles and media releases, new medical practitioner sessions, talks and presentations, and conference participation. Information sheets were also produced for medical practitioners on a range of PBS initiatives including Overseas Drug Diversion, PBS Restrictions, Lipid lowering, PBS Risk, Enhancing PBS Authorities and the Prescription Shopping project.

Customer researchNinety-eight per cent of pharmacists surveyed indicated strong support for the overall policy of the PBS and 79 per cent said they are satisfied with HIC’s PBS claims administration service. Pharmacists continued to support the requirement for consumers to show a Medicare card to receive a PBS medicine subsidy and the associated communication work undertaken by HIC and the Pharmacy Guild of Australia. Also well received were HIC’s phone enquiry lines for PBS enquiries, with 85 per cent of pharmacists describing the service as prompt, polite and efficient.

GIVING SOMEONE LIKE ME ANOTHER CHANCE AT LIFE IS THE BEST PRESENT IN THE WORLD…I FEEL LIKE SUPERMAN!

CHAPTER-6AUSTRALIAN ORGAN DONOR REGISTERKey business resultsThe number of potential organ donor and tissue registrations increased 160.9 per cent during the year. There are now 4,672,117 individuals who have had their details included on the Australian Organ Donor Register (the Donor Register).

At a glance

Potential organ donor registrations at 30 June 2001-02 and 2002-03

Australian Organ Donor Register 2001-02 2002-03 % change

Number of potential organ donor registrations 1,790,967 4,672,117 160.9% increase

Number of serviced calls to enquiry line 14,891 29,757 99.8% increase

Overview

The Donor Register was officially launched on 12 November 2000 and is sponsored by the Department of Health and Ageing. It has helped raise the profile of organ and tissue donation for transplantation in Australia and provides a national coordinated method for Australians to record their intentions in regard to organ and tissue donation for transplantation.

Individuals wishing to record their intention to donate may register online or download a paper registration form to return to HIC. The form is available at www.hic.gov.au or from Medicare offices. Entry onto the Donor Register is voluntary and allows individuals to have complete choice over which organs and tissue they are prepared to donate for transplantation.

HIC developed a national database of intending organ and tissue donors and continues to work with existing State registers to negotiate the transfer of State data. Existing State registers data has been transferred from New South Wales, Victoria, Queensland,

South Australia, Western Australia and Tasmania (neither the Australian Capital Territory nor the Northern Territory have existing data to transfer). Most States now include the donor register insert in the driver’s licence renewal process.

Australian Organ Donor Register websiteThe website provides general information about:

organ and tissue donation for transplantation;

statistics on the number of potential organ and tissue donors; and

a registration mechanism for potential donors.

It contains a secured area where authorised members of the organ and tissue donation network can identify the donation wishes of a potential organ donor throughout Australia,

24 hours a day, seven days a week.

How information in the register is usedAccess to information on the Donor Register is strictly controlled utilising PKI security and protocols to ensure privacy and confidentiality of participants are protected. Only authorised medical personnel, upon the death of an individual, are able to use the information. With knowledge of the donor’s intentions, as registered with the Donor Register, they notify the next of kin and seek final consent to allow donor proceedings to begin.

Education and promotionThe Donor Register asks Australians to ‘sign on to save a life’. HIC delivered this message nationally during 2002-03 through a marketing and communication strategy that included:

distributing information brochures and registration forms through driver’s licence renewal mailouts and Medicare card mailouts;

participating in Australian Organ Donor awareness week;

managing the Donor Register’s 1800 777 203 hotline;

liaising extensively with the media;

updating monthly Donor Register statistics on HIC’s website;

using HIC publications such as Your Health Matters, Forum and Bulletin Board to reach key audiences such as doctors, pharmacists and consumers;

publishing monthly stakeholder newsletters, carrying current processing figures for the Donor Register and general program information;

distributing promotional material at conferences, workshops, educational seminars and in Medicare offices; and

assisting with the promotion of the 2002 Australian Transplant Games through the Medicare office network.

ResearchHIC commissioned Woolcott Research Pty Ltd to carry out extensive market research to gauge attitudes towards, and awareness of, organ donation and the Donor Register. In developing the research questions, HIC consulted closely with the Department of Health and Ageing and Australians Donate, the organ donor network’s representative body. The research found there was overwhelming public support (96 per cent) for the concept of organ donation, but revealed a gap between attitudinal and behavioural support. The research will help the Donor Register to develop effective, targeted communication strategies in 2003-04 and beyond.

Australian Organ Donor Awareness WeekThe third Australian Organ Donor Awareness Week was launched by the Minister for Health and Ageing, Senator The Hon Kay Patterson, at the Melbourne Cricket Ground, on Monday 17 February 2003. A collaborative effort between HIC, the Department of Health and Ageing, Australians Donate and the state-based organ donation agencies, it was successful in achieving its objectives of raising awareness of organ and tissue donation and encouraging Australians to join the Donor Register. The key messages of ‘think, talk, tell’ and ‘sign on to save a life’ were well reported in the national and regional media, resulting in a rise of 16,378 registrations over the six weeks following the launch.

Bowel Cancer Screening RegisterIn the 2000-01 Budget, the Australian Government announced it would invest $7.2 million over four years to improve knowledge about the early detection of bowel cancer. This funding is being used to implement the Bowel Cancer Screening Pilot Program, which is designed to assess the feasibility, acceptability and cost effectiveness of a bowel cancer screening program in Australia.

The pilot aims to reduce the number of Australians who die each year from bowel cancer. On 1 January 2003 approximately 69,000 people, aged between 55-74 years, were invited to participate in the pilot (which is not a clinical trial). The results will be used to decide whether and how to implement a national bowel cancer screening program.

HIC’s role in the Bowel cancer screening pilot program is to assist in its administration including:

establishment of the Bowel Cancer Screening Register;

collection of information about participation in the pilot; and

mailing house functions.

Through the Bowel Cancer Screening Register HIC is responsible for:

creating and maintaining a register of pilot participants;

inviting participants to be screened (pilot sites are located in the town of Mackay, parts of Southern and Western Adelaide, and parts of North East Melbourne);

reminding participants who have been called or recalled to screening, but who have not completed a screening test within a specified interval, to undertake screening;

issuing reminders to participants at agreed intervals, where a participant has had a positive Faecal Occult Blood Test (FOBT) result, and where a participant has not commenced follow-up investigation procedures;

creating payment arrangements for the medical services components of the screening program, e.g. GP consultations, pathology and colorectal procedures;

collecting clinical and diagnostic data about patients participating in the pilot;

providing monitoring and performance reporting mechanisms; and

operating and servicing a 1800 information line for participants and providers.

DAD COULD FIND ALL THE INFORMATION ABOUT THE AUSTRALIAN CHILDHOOD IMMUNISATION REGISTER ON THE INTERNET…I JUST HAD TO HELP HIM TURN THE COMPUTER ON.

CHAPTER-7AUSTRALIAN CHILDHOOD IMMUNISATION REGISTERKey business resultsOver four million valid immunisations were recorded on the Australian Childhood Immunisation Register (the Immunisation Register) and almost $8.7 million was paid to immunisation providers during 2002-03.

More than 400,000 meningococcal C episodes were recorded on the Immunisation Register this year following introduction of the National meningococcal C vaccination program in January 2003.

Consistent with the maturing of the Immunisation Register, immunisation coverage rates were expanded to include an older cohort of children in the 72 to 75 month age range.

At a glance

Immunisation of Australian children 2000-01 and 2001-02

Australian Childhood Immunisation Register 2001-02 2002-03 % change

Number of children under 7 years registered at 30 June 1,860,689 1,844,679 0.9% decrease

Number of valid immunisation episodes recorded 3,582,703 4,028,036 12% increase

Children 12-15 months age appropriately immunised at 30 June

90.2% 91.2% 1% increase


88.1% 89.3% 1.2% increase

Australian Childhood Immunisation Register 2001-02 2002-03 % change


80.6% 82.3% 1.7% increase

OverviewThe Immunisation Register is a national online database which was established in January 1996. Its aims are to increase the level of immunisation coverage for children under seven years against vaccine-preventable diseases capable of causing serious complications and even death, to promote age-appropriate childhood immunisation in Australia through the provision of payments and information, and to improve the level of immunisation service delivery.

Details of vaccinations given to children under seven years in Australia are recorded on the Immunisation Register and are available upon request to the provider, the parent or child’s guardian.

The Immunisation Register was enhanced to record Meningococcal C vaccinations as an amendment to the Australian Standard Vaccination Schedule from 1 January 2003. Changes were also made to support the catch-up provisions of the National Meningococcal C vaccination program for children born since 1 January 1998.

First and second readings of the Health Legislation Amendment Bill 2003 occurred in March 2003. The Bill proposes changes to the legislation governing the Immunisation Register arising from recommendations to the Australian Government Department of Health and Ageing by two national immunisation committees, that immunisations given to children while overseas should be able to be recorded on the Register.

Pending passage of this legislation and Royal Assent, the Immunisation Register will be able to contain a complete immunisation record for more children. It will also assist parents of children immunised overseas, to claim the Australian Government child care benefit and maternity immunisation allowance. At present, these immunisations cannot be recorded on the Immunisation Register.

In the Australian Capital Territory (ACT), immunisation records for children under seven years of age have previously been forwarded to the Immunisation Register after they are processed by the ACT Health Department’s Immunisation Unit. Plans to decommission the ACT’s immunisation processing function were brought forward immediately following the January bushfires in Canberra so immunisation providers could report immunisation services directly to the Immunisation Register.

At 30 June 2003, 1.8 million children under seven years were recorded on the Immunisation Register and 27,188 immunisation providers had supplied information since its inception in 1996.

How information in the Immunisation Register is usedHealth professionals use the Immunisation Register to monitor immunisation coverage levels and service delivery, and to identify regions at risk during disease outbreaks.

The data also:

enables immunisation providers and parents to check on the immunisation status of an individual child, regardless of where in Australia the child was immunised;

forms the basis of an optional immunisation history statement which informs parents and guardians of their child’s recorded immunisation history;

provides information about a child’s immunisation status to help determine payment of the child care benefit and the maternity immunisation allowance;

provides feedback and incentive payments to registered general practitioners who monitor, promote and provide age-appropriate immunisation services to children under seven years in their practice; and

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

ChallengesAn independent evaluation about the operations of the Immunisation Register was completed in 2003. HIC will take advice from the Australian Childhood Immunisation Register Management Committee in its response to the evaluation’s findings and recommendations.

Challenges for the Immunisation Register include promotion and uptake of improved immunisation electronic lodgement data streams for immunisation providers and the establishment of long-term strategies to improve data collection and immunisation coverage rates. HIC will undertake the setting up of longer-term strategies in collaboration with the Australian Childhood Immunisation Register Management Committee and stakeholder participation.

HIC will continue to work closely with immunisation stakeholders to improve complete and timely reporting of data to the Immunisation Register. For example, reductions in the time taken by providers to report immunisation services and in the numbers of children receiving late immunisations (not age-appropriate to the Australian standard vaccination schedule) will improve immunisation coverage rates reported by the Immunisation Register.

Education and promotion

ParentsInitiatives include:

changes to Immunisation history statements provided to parents and guardians as their child turns one, two and five years of age, and at any other time at their request, to include details of meningococcal C vaccinations notified to the Immunisation Register;

publishing information about the Immunisation Register in a number of parent and family magazines and outlets, including HIC’s Your Health Matters;

attending expos and health information days; and

publishing a five-step guide on how to access immunisation history statements.

Immunisation providersPromotional material aimed at immunisation providers includes:

information about the National meningococcal C vaccination program and changes to the General Practice Immunisation Incentives scheme via the Immunisation network newsletter;

new guides and publications to assist providers accessing the secure side of the website; and

maintaining and enhancing the website.

HIC staff also participated at forums for immunisation provider groups.

BEING A LONG WAY FROM THE NEAREST TOWN IS NO LONGER A BARRIER TO ACCESSING HEALTH SERVICES…WOOF!

CHAPTER-8OTHER HEALTH PAYMENTS AND ACTIVITIES

1 Medical Indemnity

Key business resultsUnder new legislation, HIC is responsible for administering two schemes on behalf of the Australian Government: the Incurred But Not Reported (IBNR) indemnity scheme and the High Cost Claim Indemnity scheme.

In line with legislative requirements, HIC is developing policy and systems to support the payment of claims under both schemes and collection of contributions under the IBNR indemnity scheme.

OverviewIn October 2002, the Prime Minister announced a new framework for Medical Indemnity insurance. Some of the measures under the new framework are outlined in the Medical Indemnity Act 2002 and other associated legislation that came into effect on 1 January 2003: Medical Indemnity (IBNR Indemnity) Contribution Act 2002, Medical Indemnity (Enhanced UMP Indemnity) Contribution Act 2002, and the MedicaJ Indemnity (Consequential Amendment) Act 2002.

The Government’s main objective in introducing the legislation is to support the continued provision of medical services to the Australian community by ensuring health professionals have access to affordable indemnity cover.

The Medical Indemnity Act gives effect to some new measures including:

Australian Government funding of IBNR liabilities of medical defence organisations (MDOs) that have not set aside sufficient funds to cover IBNR claims for incidents that occurred on or before 30 June 2002;

recouping the cost of unfunded IBNR claims through a contribution from members and former members of Medical Defence Organisations (MDOs) that the Minister for Health and Ageing has determined will participate in the IBNR indemnity scheme;

Australian Government funding for part of the cost of large claims against all MDOs or other Medical Indemnity insurers for incidents notified after 1 January 2003;

the Australian Government subsidising the cost of indemnity cover of some groups of medical practitioners; and

collection of payments by members of United Medical Protection Ltd (UMP) to cover the cost to the Australian Government of any payments under a deed of indemnity should UMP go into full liquidation.

Education and promotionA comprehensive communication and media strategy is being developed for major stakeholders including:

development of the Medical Indemnity contact centre in HIC’s Tasmanian State Office;

a Medical Indemnity website;

information kits for health professionals; and

consultation with key stakeholders including MDOs and the Stakeholder Advisory Committee.

2 General Practice Immunisation Incentives Scheme

Key business resultsAt 30 June 2003, the General Practice Immunisation Incentives scheme (the GPII scheme) had 5,487 registered practices. Using the Department of Health and Ageing’s baseline figure of 6,000 practices nationally, this represents a participation rate of 91.45 per cent.

The average immunisation coverage rate for practices was calculated at 90.20 per cent for May 2003, with 67.9 per cent of participating practices achieving rates of 90 per cent or higher.

At a glanceCosts of and participation in the General Practice Immunisation Incentives scheme 2001-02 and 2002-03

General Practice Immunisation Incentives scheme

2001-02 2002-03 % change

Practices registered 5,585 5,487 1.7% decrease

Service incentive payments $19.4 million

$19.9 million

2.5% increase

Outcomes payments $16.7 million

$17.0 million

1.7% increase

Adjustment outcomes payments $382,223 $298,825* 21.8% decrease

Total outcomes payments $16.8 million

$17.2 million

2% increase

Highest quarterly outcomes payment $11,261.95 $11,252.15 0.09% decrease

Average outcomes payment $917.41 $913.60 0.4% decrease

*In 2002-03 only three adjusted outcomes payments were made.

OverviewThe GPII scheme began in August 1997 with the introduction of quarterly immunisation coverage feedback statements to general practitioners and Divisions of General Practice.

It aims to improve levels of immunisation coverage and service delivery and encourage 90 per cent of practices to have 90 per cent of children in their practice fully immunised. Financial incentives are provided to immunisation providers who monitor, promote and provide age-appropriate immunisation services to children under seven years.

On 7 November 2002, the Federal Minister for Health and Ageing, Senator the Hon Kay Patterson, announced a number of changes to the GPII scheme.

They include:

funding for the scheme to continue to 30 June 2004;

vaccinations administered as catch-up schedules to be included in calculations for GPII outcomes payments from 1 July 2003; and

the planned increase in eligibility for receiving outcomes payments from 85% to 90% immunisation coverage, due to become effective from 1 January 2003, to be postponed until 1 July 2003.

Payments and informationThe GPII scheme is made up of three components:

service incentive payment — an $18.50 payment is made to general practitioners and other medical practitioners who notify the Australian Childhood Immunisation Register of a vaccination that completes one of the six age-appropriate vaccination schedules for children under seven.

outcomes payment — a tiered series of payments made to practices that achieve certain percentage proportions of full immunisation.

immunisation infrastructure funding (previously divisional funding) — provides funds to Divisions of General Practice and state based organisations and also funds a National General Practice Immunisation Coordinator to improve the proportion of children who are immunised at local, State and national levels.

Education and promotionA quarterly information sheet is sent to practices and Divisions of General Practice to provide comprehensive and regular program updates.

3 Practice Incentives Program

Key business resultsAt 30 June 2003, 4,624 registered practices were participating in the Practice Incentives Program and $244 million in payments were made.

At a glanceServices provided by general practices participating in PIP 2001-02 and 2002-03

Practice Incentives Program 2001-02 2002-03 % change

Number of practices participating at 30 June 4,513 4,624 2.5% increase

Provision of data to the Australian Government 4,513 4,624 2.5% increase

Electronic prescribing 3,978 4,158 4.5% increase

Capacity for electronic transfer 3,950 4,121 4.3% increase

After-hours care

Ensuring patients have access to 24-hour care 4,418 4,514 2.2% increase

Provision of at least 15 hours care from the practice

3,147 3,177 0.95% increase

Provision of all after-hours care for practice patients

1,302 1,333 2.4% increase

Practice Incentives Program 2001-02 2002-03 % change

Teaching

Number of teaching sessions 43,868 60,950 39% increase

Targeted incentives

Quality Prescribing Initiatives 1,211 1,422 17.4% increase

Total amount paid $202 million

$224 million

10.9% increase

OverviewThe Practice Incentives Program replaced the Better Practice Program on 1 July 1998 following a series of recommendations from the General Practice Strategy Review conducted by the Department of Health and Ageing.

It aims to recognise and provide financial incentives to general practices that provide comprehensive, quality care and are working towards meeting the Royal Australian College of General Practitioners Entry Standards for General Practices. Payments made through the program are in addition to other income earned by general practitioners.

HIC assesses all applications from general medical practices for participation in the program and administers the day-to-day operations. The Department of Health and Ageing manages program policy development, including eligibility criteria.

Types of incentive paymentsThere are five broad elements to the payments:

Information management — practices receive incentives for providing data to the Australian Government, using electronic prescribing software to generate scripts, and for having the capacity to send and receive data electronically. An additional payment was made in May 2003 to all practices to assist them with the move towards the capture and electronic storage of patient records.

After-hours care — payments are available to practices that ensure patients have access to 24-hour care or provide 24-hour care from within the practice. This includes the provision of after-hours home visits where necessary and appropriate.

Rural status — a rural loading is paid to all practices where the main location is situated outside a capital city or other major metropolitan area.

Teaching — an incentive payment is available for general practices that host undergraduate students for teaching placements.

Targeted incentives — Quality Prescribing Initiative — this helps practices to keep up-to-date on the quality use of medicines.

New incentivesThe 2001 Budget provided incentives to general practices to improve the management of diabetes, mental health, asthma and cervical screening, and incentives for employment of practice nurses in rural and remote Australia and other areas of need. These incentives, beginning with ‘sign on’ payments for practices indicating a willingness to meet certain criteria for diabetes, asthma and cervical screening, have been progressively implemented under the Practice Incentives Program from November 2001.

The diabetes outcomes payment was implemented in the May 2003 quarter (providing back-payment for the November 2002 and February 2003 quarters). The cervical screening outcomes payment will be introduced in the August 2003 quarter which will include back- payment for the previous three quarters. These incentives were developed in close consultation with the General Practice Memorandum of Understanding, other professional representatives, expert advisory groups and consumer groups.

EligibilityPractice accreditation provides a mechanism for acknowledging the quality of a general practice. Practices undergoing the accreditation process are assessed against the Royal Australian College of General Practitioners Standards for General Practices 2nd Edition.

In line with the 1988 general practice strategy review recommendations, access to the Practice Incentives Program is only available to accredited practices. Practices joining the program must be either fully accredited or registered for accreditation with one of the two accrediting bodies, and be fully accredited within 12 months of joining.

Program integrityA comprehensive review of general practices currently enrolled in the Practice Incentives Program was undertaken in 2002-03 in line with the Strategic Partnership Agreement between HIC and the Department of Health and Ageing.

There were 195 practices audited nationally, including rural and metropolitan practices in each State. Of these, 29 practices did not meet the program’s eligibility criteria, mainly in the areas of electronic data and provision of after-hours services. In some instances recovery of Practice Incentive Program (PIP) payments was undertaken.

In late 2002 HIC completed additional review activity of 139 practices by specifically examining payments to practices for the provision of after-hours care. The report of the review has gone to the Department of Health and Ageing.

The majority of practices audited this year responded favourably, with many finding the process useful and productive.

Education and promotionProviders are kept up to date on changes to the Practice Incentives Program by:

News Update — a quarterly information sheet about current and future program activities and incentives that are accessible on the Practice Incentives Program website;

the website — displays statistics, general program information and downloadable forms for providers and Divisions of General Practice; and

staff — provide support to practices and providers through the Practice Incentives Program enquiry line.

4 Rural Retention Program

Key business resultsHIC made 1,907 payments totalling $18.0 million to 2,309 medical practitioners participating in the Rural Retention Program during 2002-03.

At a glanceMedical practitioner participation in the Rural Retention Program 2001-02 and 2002-03

Rural Retention Program 2001-02 2002-03 % change

Eligible medical practitioners participating 2,147 2,309 7.5% increase

Total payments made 1,966 1,907 3% decrease

Total amount paid $22.9 million $18.0 million 2% decrease

Total percentage paid 99.5% 99.7% 0.2% increase

OverviewIn the 1999 Budget, the Australian Government committed $171 million over four years (2003-04 to 2006-07) to a range of programs to strengthen the rural health workforce including an amount of $60 million to help retain long serving doctors in rural and remote Australia.

The 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 these areas. It encourages medical practitioners to remain in rural and remote practices beyond the current average 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 these areas.

The Rural Retention Program comprises two components:

Central Payments System administered by HIC since December 1999. It seeks to recognise general practitioners, based on their Medicare service data in rural and remote locations, over a number of years; and

Flexible Payments System administered by State and Territory-based Rural Workforce Agencies since December 2000. It recognises long serving general practitioners who do not receive a fair and equitable level of support under the Central Payments System because their services are not captured by Medicare or their locations are not adequately taken into account.

Achievements and outcomesThis year payment rates have increased by 25 per cent.

Prior and revised qualifying periods and maximum payment rates by Retention Payment Category

Retention payment category

Qualifying periods

Payment rates

Prior maximum payment

New maximum payment

A 6 years $4,000 5,000

B 5 years $8,000 10,000

C 3 years $12,000 $15,000

D 2 years $16,000 $20,000

E 1 year $20,000 $25,000

5 General Practice Registrars’ Rural Incentive Payments Scheme

Key business resultsHIC made payments totalling $5.5 million to 374 medical practitioners participating in the General Practice Registrars’ Rural Incentive Payments Scheme during 2002-03.

At a glanceMedical practitioner participation in the General Practice Registrars’ Rural Incentive Payments Scheme 2002-03

General Practice Registrars’ Rural Incentive Payments Scheme 2002-03

Medical practitioners paid 374


Total amount paid $5.5 million

OverviewThe Government’s commitment to major reform in the area of general practice vocational training is reflected in the allocation of $102 million over four years in the 2000 Budget.

This will be used to boost general practice training in rural and remote areas by creating a dedicated 200-place Rural Training Pathway, which operates alongside a (primarily urban) general training pathway.

The Rural, Remote and Metropolitan Area (RRMA) location categories are:

1. Capital City;

2. Other Metropolitan Centre;

3. Large Rural Centre;

4. Small Rural Centre;

5. Other Rural Area;

6. Remote Centre;

7. Other Remote Area; and

8. Offshore Island.

Financial incentives are offered to medical practitioners who commit to undertake training in the rural training pathway in practices located in Rural, Remote and Metropolitan Area (RRMA) classification 4-7. Up to $60,000 is available per registrar over the three years of general practice training. (Incentive payments are not available to registrars for undertaking their mandatory hospital training year.)

Further information on the RRMA can be found at www.health.gov.au.

6 Compensation Recovery Program

Key business resultsChanges in legislation, implemented from 1 January 2002, streamlined the operation of the program for all customers (insurers, lawyers and compensable persons). This resulted in the number of

Compensation Recovery cases processed by HIC falling from a peak of 81,275 in 2000-01 to 65,970 in 2002-03. Actual recoveries have subsequently fallen from $42.1 million to $38.1 million.

At a glanceCompensation recovery cases and benefits 2001-02 and 2002-03

Compensation Recovery Program 2001-02 2002-03

Cases finalised 79,945 65,970

Benefits recovered $42.2 million $38.1 million

OverviewThe Compensation Recovery Program, which began in February 1996, aims to prevent ‘double dipping’ in Medicare and nursing home benefits/Residential care subsidies paid by the Government, in relation to an injury/illness where a person receives compensation for that injury/illness.

It is administered under the provisions of the Health and Other Services (Compensation) Act 1995 (HOSC Act) by HIC on behalf of the Department of Health and Ageing.

The operational requirements for the program are managed under the terms of the Output Pricing Agreement (OPA), a Strategic Partnership Agreement (SPA) and a Schedule, all agreed between HIC and Department of Health and Ageing.

Eligible people who are claiming compensation are able to claim Medicare and/or nursing home benefits and/or residential care subsidies, from the date of their injury/illness to the date of judgment/settlement of their case. However, once a case reaches judgment/settlement the HOSC Act requires insurers or other compensation payers to advise HIC of claims for compensation where the amount of compensation provided to a compensable person, is more than $5,000 inclusive of all costs.

HIC then determines the amount of Medicare and/or nursing home benefits and/or residential care subsidies, if any, that have been paid in the course of treatment of that injury/illness. This amount must be repaid to the Australian Government.

HIC’s National Office is responsible for the program’s policy and systems development and operational or processing aspects are carried out in the New South Wales and Queensland State Offices.

7 HECS Reimbursement Scheme

Key business resultsHIC made payments totalling $459,951 to 67 medical graduates participating in the HECS Reimbursement Scheme during 2002-03.

At a glanceMedical graduates participation in the HECS Reimbursement Scheme 2002-03

HECS Reimbursement Scheme 2002-03

Eligible medical graduates participating 67

Medical graduates paid 52

HECS Reimbursement Scheme 2002-03

Total payments made 91

Total amount paid $459,951

OverviewThe HECS Reimbursement Scheme was announced in the 2000 Budget as part of the Regional health strategy: more doctors, better health services. This initiative aims to promote careers in rural medicine and increase the number of doctors in rural and regional areas in the longer term.

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 with benefits also to general health levels over the longer term.

The Scheme will use the RRMA classification 3-7 to define eligible areas (see page 105).

8 Federal Government 30% Health Insurance Rebate

Key business results At a glanceFederal Government 30% Health Insurance Rebate 2001-02 and 2002-03

Federal Government 30% Health Insurance Rebate

2001-02 2002-03 % change

Memberships registered 4,686,455 4,816,238 2.8% increase

Total paid in cash claims $3.5 million $2.8 million 20% decrease

Total paid to health funds $1,972.9 million

$2,163.43 million

9.7% increase

OverviewHIC administers the 30% Rebate on behalf of the Australian Government and works with the Department of Health and Ageing, the Australian Taxation Office, the Private Health Industry Advisory Council and health funds to do so.

The Australian National Audit Office Performance Audit Report, Administration of the 30% Private Health Insurance Rebate, was tabled in Parliament in May 2002. The main recommendations affecting HIC were that:

HIC reviews its Premium Reduction Scheme registration procedures to ensure they comply with the Private Health Insurance Incentives Act 1998, all eligible Premium Reduction Scheme applicants are registered, and health funds are fully informed of their responsibilities with respect to the registration process;

HIC ensures arrangements for Premium Reduction Scheme reimbursements have adequate financial controls;

pending any changes in policy and related legislation for the Incentive Payments Scheme, HIC strengthens financial controls surrounding the scheme;

HIC and the Australian Taxation Office review their data exchange arrangements to ensure the Australian Taxation Office obtains timely access to the data it requires to undertake adequate data matching checks for inappropriate multiple claiming under the 30% Rebate; and

The Department of Health and Ageing and HIC develop clear performance indicators and standards in relation to the 30% Rebate payment accuracy by HIC (that is, the extent to which eligible people receive a rebate of the correct amount).

HIC generally accepted the Australian National Audit Office’s assessment and has already implemented improvements to bring administration of the 30% Rebate in line with HIC’s Business Improvement Program and the relevant legislation. These include:

forming a working group to review the legislation;

implementing new claiming procedures to allow validation of claims and facilitate identification and enforcement of registration requirements;

establishing working groups and processing manuals for health funds to enable them to better understand their responsibilities;

initiating an audit program;

reviewing the Schedule to the Strategic Partnership Agreement; and

forming a working group with the Australian Taxation Office to address data exchange issues.

Program auditPrivate health funds supply an annual audit certificate on the operation of the 30% Rebate. HIC checks claims made at Medicare offices to ensure no premium reduction has been applied to a policy.

Audits at 11 health fund entities that participate in the 30% Rebate for Private Health Insurance Premium Reduction Scheme were carried out during 2002-03. They identified the degree of congruence between HIC and health fund data relating to the registration of persons who pay reduced premiums for private health insurance cover.

The audits also established the extent to which claims for payment made by health funds are accurately calculated and in respect of persons who are valid participants in the Premium Reduction Scheme. There was a significantly lowered level of risk than existed in the previous financial year.

Where necessary, recommendations designed to strengthen and correct aspects concerning data completeness or evidence of participant validity have been made and acted upon by the health funds concerned.

Education and promotionAs part of the broader 30% Rebate campaign managed by the Department of Health and Ageing, HIC continues to provide information to consumers through articles in Your Health Matters. The claiming form, which is available from Medicare offices and HIC’s website, has been updated.

9 Veterans’ treatment accounts

Key business results At a glanceCosts and service claims for Veterans’ treatment accounts 2001-02 and 2002-03

Veterans’ treatment accounts 2001-02 2002-03 % change

Cards produced 83,604 193,113 131% increase

Veterans’ treatment accounts 2001-02 2002-03 % change

Lines processed 19.70 million 18.11 million 8.1% decrease

Total benefit expenditure $1,511.9 million $1,610 million 6.4% increase

OverviewHIC began processing medical and allied health services claims for Veterans’ treatment accounts on behalf of the Department of Veterans’ Affairs on 1 December 1996. Hospital claims processing began on 22 September 1997. This activity is carried out in accordance with a memorandum of understanding between HIC and the Department of Veterans’ Affairs that covers services, service standards and financial arrangements.

10 Family Assistance Office

Key business resultsWhile lodgement of Family Assistance Office (FAO) forms to HIC continues to increase, the number of enquiries and HIC customer contact has decreased overall as customers make greater use of telephone and internet facilities.

At a glanceFamily Assistance Office 2001-02 and 2002-03

Family Assistance Office 2001-02 2002-03 % change

Services provided by HIC 170,108 194,737 14.5% increase

OverviewThe FAO is a virtual organisation in partnership between the Department of Family and Community Services, Centrelink, the Australian Taxation Office and HIC that uses existing facilities and staff from all four agencies.

It delivers assistance for families in three main areas:

Family Tax Benefit Part A that provides help with the cost of raising children;

Family Tax Benefit Part B that provides extra help for families with one main income, including sole parents; and

Child Care Benefit that helps with the cost of child care.

HIC provides services such as responding to enquries on FAO services, and receiving and checking claims for benefits, before the claims are passed onto Centrelink for payment processing.

HIC is working with the Department of Family and Community Services and Centrelink to identify opportunities to extend the variety and volumes of FAO work processed through Medicare offices. A trial, including the rollout of software developed by Centrelink, will be conducted during 2003-04 to test the variability of its implementation throughout HIC’s Medicare office network.

Further information about FAO can be obtained at www.familyassist.gov.au

11 Hearing Services Program

Key business resultsThe Office of Hearing Services has encouraged the use of electronic claiming by hearing service providers and this has resulted in internet facility use increasing to 91 per cent of all claims.

At a glanceHearing Services Program services and payments 2000-01 and 2001-02

Hearing Services Program 2001-02 2002-03 % change

Services processed 722,825 769,538 6% increase

Total amount paid $143.2 million $153.6 million 7.2% increase

Comparison of electronic and manual hearing services claims 2001-02 and 2002-03

Claims 2001-02 2002-03 % change

Electronic data interchange 489,888 564,902 15% increase

Paper 79,619 57,036 28% decrease

Total claims 569,507 621,938 9% increase

Services processed

Electronic data interchange 622,177 697,250 12% increase

Paper 100,648 72,288 28% decrease

Total services 722,825 769,538 6% increase

OverviewThe Hearing Services program operates under the provisions of the Hearing Services Administration Act 1997. The Australian Government provides hearing services and products to eligible people under the Hearing Services Program administered by the Office of Hearing Services in the Department of Health and Ageing.

HIC processes and pays claims on behalf of the Office of Hearing Services to accredited hearing service contractors.

ORDERING A MEDICARE TAX STATEMENT ON THE INTERNET ANYWHERE, ANYTIME…ALL FROM THE COMFORT OF MY OWN HOME.

CHAPTER-9Financial StatementsWE IMPROVE OUR BUSINESS EFFICIENCY WITH NEW PRODUCTS, IDEAS AND WAYS OF WORKING…THE HEALTH OF MY CHILDREN IS IN SAFE HANDS

Chapter-10APPENDIXES

APPENDIX A: Statutory ReportsFunctionsHIC is a statutory authority established by the Health Insurance Commission Act 1973 (HIC Act). HIC’s functions include:

paying Medicare benefits as provided for in the Health Insurance Act 1973 and undertaking all administrative activities necessary to ensure the effective performance of this function (authorised by the HIC Act);

paying pharmaceutical benefits and undertaking all administrative activities necessary to ensure the effective performance of this function (subject to the National Health Act 1953 and authorised by the HIC 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 HIC (authorised by the HIC Act and regulations);

administering the Compensation Recovery Program (under the provisions of the Health and Other Services (Compensation) Act 1995);

administering the Federal Government 30% Health Insurance Rebate (under the provisions of the Private Health Insurance Incentives Act 1998);

maintaining and administering the Australian Organ Donor Register (authorised by an arrangement made under section 7 of the HIC Act);

maintaining and administering the Australian Childhood Immunisation Register (under the provisions of the Health Insurance Act);

undertaking all administrative activities under the General Practice Immunisation Incentives scheme, the Practice Incentives Program, the General Practice Registrars’ Rural Incentive Payments Scheme and the Rural Retention Program (authorised by arrangements made under section 7 of the HIC Act);

delivering services as part of the Family Assistance Office;

providing services for the processing of the Department of Veterans’ Affairs treatment accounts and Australian Hearing Services (authorised by regulations to the HIC Act);

administering the Incurred But Not Reported (IBNR) Indemnity scheme and High Cost Claim Indemnity scheme (under the provisions of the Medical Indemnity Act 2002, Medical Indemnity (IBNR Indemnity) Contribution Act 2002, Medical Indemnity (Enhanced UMP Indemnity) Contribution Act 2002, and the Medical Indemnity (Consequential Amendment) Act 2002);

undertaking the Prescription Shopping project (authorised by a Ministerial determination made under subsection 8AA(4) of the HIC Act); and

providing ex-gratia payments for victims and family members of victims of the Bali terrorist attacks.

The HIC Act determines the constitution of the Board of Commissioners, appointment of the Managing Director, HIC staffing and financial arrangements. It provides the Minister’s ability to delegate powers and HIC’s reporting requirements. The Act also permits HIC to operate outside Australia and to form companies.

HIC is a non-Government Business Entity Commonwealth authority under the Commonwealth Authorities and Companies Act 1997 (CAC Act), which provides the general governance, reporting and accountability framework for HIC and imposes a detailed regime for the conduct of officers.

Responsible MinisterThe Minister responsible for HIC in 2002-03 was Senator The Hon Kay Patterson, Minister for Health and Ageing.

Directions by the MinisterUnder section 8J of the HIC Act, the Minister may give written directions to HIC. This power was not exercised during 2002-03.

Notifications of general policy of governmentUnder section 28 of the CAC Act, HIC was not notified of any general policies of the Government during the financial year.

DelegationsHIC operates its business in accordance with a number of instruments of delegation. These include the Financial and Human Resources Delegations made under the HIC Act and delegations under other relevant health legislation including, but not limited to the Health Insurance Act, the National Health Act, the Health and Other Services (Compensation) Act, the Private Health Insurance Incentives Act and the Medical Indemnity Act.

Instruments of delegation specific to HIC officers have been made by the Minister for Health and Ageing, HIC’s Board of Commissioners, the Managing Director and the Secretary of the Department of Health and Ageing and are updated by HIC as and when required.

Powers of investigationThe HIC Act, as amended by the Health Legislation (Powers of Investigation) Amendment Act 1994, provides for the Managing Director to authorise the exercise of power to require a person to give information that the person has, or to produce a document that a person holds, and the power to obtain a search warrant to seize information or material needed to complete a chain of evidence. The use of these powers must be reported annually (see table below).

Statutory report under section 42 of the HIC Act 2002-03

Action Section No.

Instruments appointing an HIC officer as an authorised person 8M 26

Notices requiring information from non-patients 8P 81

Notices requiring information from patients 8P 100

Action Section No.

Searches of premises for the purpose of monitoring compliance 8U 3

Occasions during searches when powers were used 8V 5

Searches of premises and seizure of evidential material 8X 7

Search warrants issued in relation to possible offences 8Y 11

Search warrants issued by telephone or other electronic means 8Z 0

Patients advised in writing of the seizure of their clinical records 8ZN 511

Where records are taken from a medical practitioner, patients whose details are included in those records are issued with a section 8ZN notice advising that the records have been obtained (see above table). The notice does not imply the patient is under investigation. Below is a list of the type of cases in which these powers were used during 2002-03.

Use of Powers of Investigation 2002-03

Type of case No.

Medical practitioners

Magnetic Resonance Imaging 0

Diagnostic imaging 0

Pathologists 0

Pharmacists 12

General practitioners 11

Optometrists 1

Psychiatrists 0

Other specialists 1

Members of the general public

Benefit claims 0

Prescription drug smuggling 0

ProsecutionsThe prosecuted cases involved benefits claimed for services not rendered, rendered other than as claimed, or itemised for payment when the service was not payable.

Summary of prosecutions 2002-03

Prosecutions No.

Members of the public for offences against Medicare 21

Medical practitioners for offences against Medicare 5

Fifty-nine cases were referred to the Director of Public Prosecutions during the reporting period.

Judicial Decisions and ReviewsJudicial decisions and administrative tribunal decisions that have had, or may have, a significant impact on the operations of HIC from 1 July 2002 to 30 June 2003 include:

Clare v. Health Insurance Commission (V878 of 2002) - at 30 June 2003 the Federal Court proceedings in relation to this matter have not been concluded. The case involves an application made by provider Dr Clare, disputing a decision made by HIC on the Medicare eligibility of a MRI machine located at Bundoora Radiology, Melbourne. The Federal Court decision may impact upon HIC’s interpretation of the term ‘contract in writing’ in the relevant Regulations under the Health Insurance Act 1973, governing the eligibility of MRI machines for the purposes of Medicare benefits.

Sydney X-Ray v. Health Insurance Commission (641 of 2003) - at 30 June 2003 the Federal Court proceedings in relation to this matter have not been concluded. The case involves an application made by Sydney X-Ray Pty Ltd, disputing a purported decision by HIC regarding the Medicare eligibility of a MRI machine located at Randwick NSW. The Federal Court decision may impact upon HIC’s interpretation of the term ‘contract in writing’ in the relevant Regulations under the Health Insurance Act 1973, governing the eligibility of MRI machines for the purposes of Medicare benefits.

Medtest Pty Ltd v. Medicare Participation Review Committee and Health Insurance Commission (N2002/1953) - at 30 June 2003 this matter has not yet been heard by the Administrative Appeals Tribunal (AAT). This matter concerns Medtest’s refusal to allow an inspection of its laboratory premises. HIC formed the view that Medtest’s refusal to allow an inspection of its premises might constitute a breach of Medtest’s Approved Pathology Authority undertaking and referred the matter to the Medicare Participation Review Committee (MPRC). The MPRC determined that Medtest had breached its Approved Pathology Authority Undertaking by not allowing the inspection. It is likely that the AAT’s decision may have an impact upon the power to enter premises and the assessment of penalty for breach of an undertaking.

Nguyen v. Minister for Health and Ageing (2001) FCA 1241; Nguyen v. Secretary, Department of Health and Ageing (2002) FCA 1441; Nguyen v. Minister for Health and Ageing (2002) FCA 1462; Secretary, Department of Health and Ageing v Nguyen (2002) FCAFC 416. These matters concerned a decision by the Minister under section 133 of the National Health Act 1953, to revoke the approval of Teresa Phan and Kimberly Nguyen to supply pharmaceutical benefits. Teresa Phan claimed payment from HIC for drugs which had never been supplied. Teresa Phan was charged with defrauding the Commonwealth and was convicted of this offence. In October 2002, the Federal Court decided to set aside the Minister’s decision to revoke the approval on the basis that the Minister did not consider the option of partially revoking the approval. In November and December 2002, the Federal Court decided that the Secretary could not delay cancelling an approval on request while the Minister conducted procedural fairness in relation to a decision to revoke. The Federal Court’s decision will have an impact on any decision to revoke an approval held by a partnership, and the

revocation of an approval where the holder or holders of the approval decide to sell the pharmacy to which the approval relates before the revocation decision is made.

Grey v. Health Insurance Commission & ors (M83 of 2002) - on 14 February 2003, the High Court dismissed an application for special leave made by Dr Grey. The case involved interpretation of Part VAA of the Health Insurance Act 1973, relating to the Professional Services Review Scheme, and whether the Professional Services Review Scheme involved an exercise of judicial power contrary to the Constitution.

Doan v. Health Insurance Commission & ors (V202 of 2002) - on 18 September 2002, the Federal Court (Marshall J) dismissed the application by Dr Doan. The case involved a challenge to the validity of the investigative referral made under Part VAA of the Health Insurance Act 1973, which relates to the Professional Services Review Scheme. Issues included the relationship between counselling and the referral period, and whether HIC could be estopped from making a referral by statements made during counselling.

Crowley v. Holmes & ors (V259 of 2002) - on 18 December 2002, the Federal Court (North J) dismissed the application by Dr Crowley with costs. This case related to whether material in an investigative referral and an adjudicative referral relating to past conduct of the doctor invalidated the referrals. It also raised the question of whether this material resulted in bias on the part of the Professional Services Review Committee established under Part VAA of the Health Insurance Act 1973 to consider the adjudicative referral.

OmbudsmanBetween 1 July 2002 and 30 June 2003, the Commonwealth Ombudsman received 125 complaints about HIC. The following table shows 130 complaints covering 140 issues were closed.

Number of issues identified by the Commonwealth Ombudsman 2001-02 and 2002-03

Action taken 2001-02 2002-03

Closed/finalised by Ombudsman 149 130

Withdrawn/lapsed 11 9

Discretion exercised by Ombudsman 76 84

Investigated by Ombudsman 66 56

No defect found 34 31

Agency defect found 9 9

No need to investigate further 23 16

Secrecy provisions and privacy legislationSection 130 of the Health Insurance Act and section 135A of the National Health Act provide for the confidentiality of information obtained by HIC in the performance of its functions. These provisions make it an offence for an HIC officer to disclose information about a person except in the performance of their duties under the relevant Act. The secrecy provisions also provide specific powers enabling the release of personal information in certain circumstances. 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, or a HIC officer 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, provide for limits on the maintenance and storage of claims information and the separation of Medicare and PBS databases.

Privacy ActHIC is subject to the Privacy Act 1988, which regulates the collection, handling and use of personal information by most Australian government agencies. In accordance with the Privacy Act, HIC submits annual returns to the Privacy Commissioner listing the types and use of information it holds. The Privacy Commissioner has audited HIC’s compliance with the Privacy Act and found its procedures were satisfactory.

During 2002-03, HIC did not receive any complaints under the Privacy Act from the office of the Federal Privacy Commissioner. There was one complaint outstanding from the previous year and this has been partially resolved.

Of nine complaints about use and disclosure of personal information held by HIC, six have been resolved, two are ongoing and one was unsubstantiated.

Occupational Health and Safety ReportHIC is required under section 74 of the Occupational Health and Safety (Commonwealth Employment) Act 1991 to provide a report on occupational health and safety incidents that occurred during the year.

Statutory report under section 74 of the Occupational Health and Safety Act

Action No.

Deaths that required notice under section 68 0

Accidents that required notice under section 68 2

Dangerous occurrences that required notice under section 68 14

Investigations conducted under part 4 0

Tests on plant, substance, or thing in the course of investigations considered 0

Directions given to HIC under section 45 (that the workplace etc. not be disturbed) 0

Notices given to HIC under section 30 (requests from health and safety representatives) 0

Notices given to HIC under section 46 (prohibition notice) 0

Notices given to HIC under section 47 (improvement notice) 0

APPENDIX B: Freedom of InformationHIC is a prescribed authority under the Freedom of Information Act 1982 (FOI Act). HIC is therefore required to publish in its annual report information about the way it is organised, its functions and

powers, the categories of documents held by HIC and how the public can access them. Also included in this report are FOI statistics for the financial year, 2002-03.

Organisation, functions and powers

OrganisationAn organisational structure chart appears on page 41.

Functions and powersA description of HIC’s functions and powers as required by section 8 of the FOI Act is detailed in Appendix A on page 165.

List of documents held by HICBrochures explaining the Medicare program, the Pharmaceutical Benefits Scheme, the Australian Childhood Immunisation Register, the Compensation Recovery Program, the Federal Government 30% Health Insurance Rebate, the Australian Organ Donor Register, the Family Assistance Office and the Charter of Care are available free of charge from Medicare offices.

HIC’s website www.hic.gov.au features publicly available publications and forms that can be viewed or downloaded.

In accordance with section 9 of the FOI Act, the following types of documents are held by HIC:

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 recognition as a specialist or consultant physician;

applications for recognition as a vocationally registered general practitioner;

brochures relating to all HIC operations;

committee and tribunal files created as a result of a specific enquiry or hearing;

committee and tribunal member appointment papers;

computer records relating to all HIC operations;

financial budgetary documents;

internal audit terms of reference, reports and files;

legal advice and opinions;

legislative documents in the form of Acts, regulations and interpretations;

listings of approved Medicare pathology practitioners, authorities and laboratories;

listing 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 Pharmaceutical Benefits Scheme approved persons and pharmaceutical prescribers;

Medicare Benefits Schedule item rulings and interpretations;

Ministerial, Commonwealth Ombudsman and general correspondence;

Ministerial submissions;

operation instructions, circulars and directives relating to Medicare, Pharmaceutical Benefits Scheme, Australian Childhood Immunisation Register, Practice Incentives Program, Compensation Management System, Federal Government 30% Health Insurance Rebate, Veterans’ treatment accounts, Australian Organ Donor Register, Hearing Service Payments and Health Research and Coordinated Care Trials;

personnel records;

processed enrolment, withdrawn forms and claims documentation relating to all HIC operations;

property documents including leases, tenders and maintenance agreements;

records created as a result of a specific complaint, enquiry 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; and

undertakings for participating optometrists.

Access to HIC documents

Procedures and initial contact pointsA formal request under the FOI Act for access to HIC documents should be made in writing, be accompanied by a $30 application fee made payable to HIC and sent to:

Freedom of Information Officer HIC

PO Box 1001

TUGGERANONG DC ACT 2901

Telephone: (02) 6124 6025

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 liaison officers in HIC State Offices can help with initial enquiries.

Freedom of information statistics 2002-03

Requests No. or $ amount

On hand at 30 June 2003 1

Received 14

Resolved by being:

withdrawn (following consultation) 2

granted in full 3

granted in part 5

Requests No. or $ amount

denied in full 2

Outstanding at 30 June 2003 3

Requests finalised in:

0-30 days 4

31-60 days 6

61-90 days 0

91 days or more 0

Fees and charges levied

Application fees received 310

Charges notified 1,460

Charges collected 223

Internal reviews

Received 1

Finalised 0

Administrative Appeals Tribunal appeals

Received 0

Outstanding at 30 June 2003 7

APPENDIX C: Ecologically sustainable development and environmental performanceSection 516A of the Environment Protection and Biodiversity Conservation Act 1999 (EPBS Act) requires HIC to include in its annual report a section detailing HIC’s environmental performance and contribution to ecological sustainable development during the year.

The requirements of the EPBS Act are designed to promote the development of frameworks within which HIC, along with other Government organisations, integrates environmental, economic and social considerations. The identification, monitoring and reporting of environmental issues are intended to help HIC and other Government organisations improve their environmental performance.

HIC is committed to environment protection and biodiversity. As part of this commitment, HIC’s National Office continued the following activities during the year:

general waste recycling (aluminium and steel cans, PET bottles, glass);

photocopier toner cartridges recycling;

waste paper and cardboard recycling; and

security waste recycled via wet pulp methods.

APPENDIX D: Staffing overviewEmployee numbers at 30 June 2003 compared with 30 June 2002

State 2002 2003 Change

National Office 934 1158 23.9%

New South Wales 1152 1121 -2.7%

Victoria 851 882 3.6%

Queensland 720 721 0.13%

South Australia 332 327 -1.5%

Western Australia 328 331 0.9%

Tasmania 154 166 7.8%

Total 4471 4706 5.25%

Senior management* by gender at 30 June 2003

Classification Male Female Total

Senior Professional Staff 49 26 75

Total 49 26 75

*Senior Management includes all Senior Executives and Medical Advisors.

Employee numbers by gender and location at 30 June 2003

State Male Female Total

National Office 504 654 1158

New South Wales 117 1004 1121

Victoria 111 771 882

Queensland 95 626 721

South Australia 42 285 327

Western Australia 48 283 331


Tasmania 28 138 166

Total 945 3761 4706

Staffing by classification and location at 30 June 2003

Classification Nat. Off. NSW VIC QLD SA WA TAS Total

Deputy Managing Director 1 - - - - - - 1

General Managers 6 - - - - - - 6

Commission Secretary 1 - - - - - - 1

State Managers & Deputy State Managers

2 2 1 1 1 1 8

Senior Executives 39 6 6 4 2 2 - 59

Professional Officers 9 10 14 12 4 8 2 59

Senior IT Officers 193 - - - - - - 193

Principal Executive Officers 337 19 14 13 7 5 7 402

IT Officers 69 - - - - - - 69

Executive Officers 333 150 92 88 29 35 17 744

Administrative Officers 170 141 175 92 59 59 21 717

Customer Service Officers - 793 579 511 225 221 118 2447

Total 1158 1121 882 721 327 331 166 4706

Culturally and linguistically diverse (CALD) employees by classification at 30 June 2003

Classification CALD-1* CALD-2* Total

Administrative Officers 92 96 188

Customer Service Officers 260 240 500

Executive Officers 40 64 104

IT Officers 26 4 30

Principal Executive Officers 39 25 64

Classification CALD-1* CALD-2* Total

Science Officers 10 5 15

Senior IT Officers 32 7 39

Senior Executive Service 6 3 9

Total 505 444 949

*CALD-1 - Employees from a culturally and linguistically diverse background where a language other than English is spoken at home. F

*CALD-2 - Employees from a culturally and linguistically diverse background where English is spoken at home but the parents speak a language other than English.

Culturally and linguistically diverse (CALD) speaking employees by State at 30 June 2003

State CALD-1* CALD-2* Total



Queensland 26 30 56


Tasmania 5 5 10

Victoria 113 103 216


Total 505 444 949

*CALD-1 - Employees from a culturally and linguistically diverse background where a language other than English is spoken at home.

*CALD-2 - Employees from a culturally and linguistically diverse background where English is spoken at home but where the parents speak a language other than English.

Aboriginal or Torres Strait Islander employees by classification and gender at 30 June 2003







Total 1 27 28

Aboriginal or Torres Strait Islander employees by State and gender at 30 June 2003




Queensland 0 10 10


Tasmania 0 1 1

Victoria 0 4 4


Total 1 27 28

Employees with a disability by gender and classification at 30 June 2003






Science Officers 1 0 1

Senior IT Officers 4 0 4

Senior Executive Officers 1 1 2

Total 26 73 99

Employees with a disability by gender and State at 30 June 2002





Queensland 2 10 12


Tasmania 0 2 2

Victoria 3 28 31


Total 26 73 99

HIC employees covered by a Certified Agreement or an Australian Workplace Agreement at 30 June 2003

Type of Agreement Senior Executives Other employees Total

2001-03 Certified Agreement 0 4419 4419

Australian Workplace Agreement 75 212 287

Total HIC employees 75 4,631 4,706*

*Excludes Managing Director

APPENDIX E Consultancy services engaged by HICThe following table lists new and extended consultancy contracts let to the value of $10,000 or more (inclusive of GST) during 2002-03. Included is 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 for each individual consultancy.

Key:Selection process:

1 = publicly advertised tender;

2 = selective tender; and

3 = direct engagement without tender.

Reason:

a = project required specialist knowledge and/or skills not available within HIC at the time;

b = consultant was a recognised expert in the field and/or had particular skills/experience gained from similar work for HIC; and

c = project required input from a person/organisation accepted as independent of HIC.

Consultancy services provided to HIC in 2002-03

Company Name Purpose Price Process Reason

90East Asia Pacific Pty Ltd

Assist with planning and scheduling Consultancy DSD Certificate - Risk Assessment for Gateway; Participation in risk assessment for Gateway

$21,625.00 3 a

ABRM International Pty Ltd

Provision of OH&S Program $42,741.74 3 b

Accenture Australia Ltd

Business Architecture Organisation design and change;

Directories Project;

Business Improvement Planning and review Strategy and planning;

IT Architecture;

BMMS Risk Management;

PBS On-line eAuthorities;

Completion of high level BR Consultancy

$5,438,055.93 2/3 a/b

Access Economics Pty Ltd

PBS Initiatives savings measurement and reporting

$31,800.00 3 a

Acumen Alliance Support business analysis and business planning;

4 year plan review;

PBS Initiative group;

Review of Audit processes and practices; Financial Management;

PBS Initiative - prescription shopping and overseas drug diversion;

PBS electronic authorities and approvals; Midyear financial review;

HIC Desktop;

SAP Project Accounting;

IT transition and cost structure costing methodology; Asset revaluation for hard close and financial year end.

$144,001.26 2/3 a/b/c

Alchemy CDD input into WEB content $22,800.00 3 a


Management Solutions P/L

management solution

APIS Consulting Group

Development of scoping and vision/ parameters documentation for project requirements;

Provision of advice on an evaluation framework for the HIC Learning and Development strategy 2003-06; PMSS Project

$12,672.00 4 a/b

APT Associates Robyn Woodrow - Contract $21,000.00 1 a/c

AR Liband & Associates Pty Ltd

ITSD Organisation Development; Leadership Team Development;

HR Forum Planning and Facilitation; Develop On-line Integration;

Modern Stake Workshop;

$43,962.80 3/2 (a/b/c)

Aspect Computing Pty Ltd

HIC On-line

Document Writing and Training for PMD Reference Suite

$276,909.05 (1) (a/c)

Avanade Australia Pty Limited

Management Architecture $31,461.09 3 b

BOOZ Allen Hamilton

Develop BI support strategy and implementation plan

$11,905.66 1 a

CHIK Services Pty Ltd

PKI Site Identification - Consultancy Services

$47,730.27 3 a/c

Combined Management Consultants Pty Ltd

Manage BI infrastructure performance and schedule;

HALO project management;

IBIS project management;

WEB Channel content management system EDW project management;

FAO project management

$22,526.46 3 a

Coolong Consulting (Aust) Pty Ltd

Communications Review;

Channel Improvement Project;

CCA Project high level business and IT input;

$792,370.16 2/3 a


CCA Project Phase 3;

Performance compliance platform specialist - voice

Deloitte Consulting Pty Ltd

Simplified Billing Tender Evaluation $121,380.00 3 a/b

Deloitte Touche Tohmatsu

IT Audit $20,460.00 1 a

Department of Health & Ageing

Simplified Billing Project $47,365.02 3 a

Diversiti Pty Ltd Client services for performance compliance

$34,000.00 3 a

Dr Ian Breadon Professional Services - Dr Ian Breadon $25,036.23 3 b

Dr Stephen Vaughan

Professional Services - Dr Stephen Vaughan

$21,087.37 3 b

Dr Steve G Zantos Optometric Adviser Services $34,830.39 3 b

Empower Research Pty Ltd

HIC Staff Survey $103,172.68 1 c

EP Safety & Rehabilitation

Rehabilitation Case Management; Work Station Assessment Services

$97,595.25 2 b

Ernst & Young HIC Security Policy $101,963.00 2 a

FOTJOL Pty Ltd HIC Desktop Applications Rationalisation; Network disengagement;

Disaster recovery - Business continuity; PABX Strategy

$246,290.65 3 a

Foundation

Technology

Services

Develop an OO Metrics Tool $19,584.00 3 a

Galt

Business

Services

Professional Services for the BI Service Level Project;

Completion of Optus Negotiations

$190,121.82 3 a

Hay Group Pty Ltd Top Team Effectiveness Project Step 1 $154,325.75 1 c


Planning

Hays Personnel Services (Australia)

Professional Services - Colleen Doyle $16,132.75 3 b

HBA Consulting Professional Services for HIC Classification Review

$68,810.60 3 a

Health Infotech Solutions Pty Ltd

Simplified Billing Project $40,740.09 3 a

Hermes Precisa Pty Ltd

Scanning Improvement Project $10,000.00 1 c

IBM Global Services Australia

Security Architecture $854,136.38 3 a

IISM Group Program Management Medicare Reform; Eclipse, HIC On-line;

Integrity of Medicare Card Review;

Business Case development - Simplified Billing

$287,744.00 3 a

Indigenous

Employment

Specialists

Indigenous Recruitment Services; Delegates and Coordinator Workshop

$14,200 2 a

Iterative Consulting Pty Ltd

IT Architecture $243,950.52 3 a

Kaz Technology Services Pty Ltd

Consultancy Services - David Ritchie $26,940.32 3 a

Kenneth C - Turbet Disciplinary Consultancy Services $11,892.18 3 b

Kestral Computing Pty Ltd

Provision of expert advice regarding HL7 specifications

$28,766.27 3 a

KPMG Professional Services - Issues Medibank and HIC

$15,060.95 3 b

Lumbers Consulting

IT Planning $52,003.18 3 a

M&T Resources Account Management Framework within the area of Stakeholder Relations; Telephone Booth Rollout

$29,680.00 2/3 a/b


Mallesons Stephen Jacques

Legal Services $14,180.00 1/3 a/b/c

Mastech Asia Pacific Pty Ltd

HeSA Development $22,800.00 3 a/b

Moz Consulting Professional Fees for Management Consulting - Evaluation of PSP

$36,588.85 2 c

Naccho HIC Aboriginal and Torres Strait Islander Strategy

$30,000 3 c

NLP Australia Pty Ltd

Consulting Transition Planning $16,193.17

Open Health Pty Ltd

Simplified Billing New Claiming Model $40,000 3 b

Palm Management Pty Ltd

Property Management Services Project $10,500 1 a

Price Waterhouse Coopers

IT Audit Services $241,404.59 2/3 a

QMS Inquiry into ACT staff complaints; Investigation of Disciplinary Cases; Consultancy Disciplinary Services

$49,246.74 3 b/c

Rational Software Pty Ltd

IT architecture

Development Architecture and Implementation Office

$419,843.57 1/2/3 a/b

Red 3 Pty Ltd Project to incorporate PSTC Reference Group's Amendments;

Pathology Service Table Maintenance

$32,853.50 1 a

Results Consulting (Australia) Pty Ltd

Review and develop HIC's Equity and Diversity Plan 2003-2006

$11,790.91 2 b

Ruth Perrett Professional Services $27,550.00 3 a

SMS Consulting Group Limited

Development of ODC Database for Business Modelling;

Review of Diploma of Project Management Training;

CCA Project

$42,100.00 1/3 a/c

Taylor Nelson Professional Service - BIP Research $108,500.00 1 c


Sofres Australia P/L

Terra Firma Pty Ltd Automated Risk Management System Project

$34,750.00

The Boston Consulting Group Pty Ltd

Professional Fees - Strategic Advice $105,800.00 2 a/b/c

Tier Technologies (Australia) P/L

Review of Consolidation Criteria; Transition Strategy

$43,786.67 3 a

University of Wollongong

ARC SPIRT Automated Fraud Detection

$40,000 3 a

Urbis Professional Fees - Jones/Fallon $12,687.50 1 a

Value Focusing Pty Ltd

Consultancy Services - Relationship Value Workshop

$13,517.23 3 b

Waldrons

Optometrists Pty Ltd

Provision of Optometrical advice for QLD/WA/NT

$34,429.89 3 a

Walter and Turnbull Pty Ltd

Review Property Management Project $24,981.83 2 c

WalterTurnbull Consultancy Services Risk Management PBS On-line;

Professional Fees Business Strategic Sourcing

$82,863.18 1/3 a/c/b

WST Pacific Pty Ltd Consultancy Services - PMSS $62,131.74 3/1 a/b

APPENDIX F Charter of Care ReportThe following tables detail HIC’s performance against its Charter of Care standards and provide information about customer feedback for 2001-02 and 2002-03.

Table 1 Claims processing and payment standards for HIC public customers

Table 2 Claims processing and payment standards for service providers

Table 3 Telephone enquiry standards

Table 4 Correspondence standards

Table 5 Medicare office counter enquiry standards

Table 6 Freedom of Information standards

Table 7 Customer feedback

Table 1: Claims processing and payment standards for HIC public customers

Service Service standard Performance

2001-02 2002-03

Medicare Paid accounts will be reimbursed by cash on the day at a Medicare office (daily limits apply).

100% 100%

Paid accounts will be reimbursed by electronic funds transfer (EFT) to your nominated account (not available for passbook accounts) or by cheque posted to you 10 days after lodgement.

94% 97%

Claims for unpaid general practitioner (GP) accounts will be reimbursed by cheque made out to the doctor. The cheque will be posted to you 16 days after lodgement.

99% 100%

Claims for other unpaid medical provider accounts will be reimbursed by cheque made out to the provider. The cheque will be posted to you 18 days after lodgement.

99% 100%

For claims made electronically (including via a doctor’s practice):

Paid accounts will be reimbursed by EFT to your nominated if requested (not available for passbook accounts) or by cheque posted to you 10 days after lodgement.

95% 92%

Claims for unpaid GP accounts will be reimbursed by cheque made out to the doctor and sent to you 14 days after lodgement.

99% 99%

Claims for other unpaid medical provider accounts will be reimbursed by cheque made out to the provider. The cheque will be posted to you 15 days after lodgement.

99% 99%

Compensation A Medicare History Statement will be processed within 28 days of receipt of a Request for Notice of Past Benefits.

98% 98%

A Notice of Past Benefits will be processed within 28 days of receipt of an accepted Medicare Claims History Statement.

98% 98%

On receipt of an accepted Medicare Claims History Statement, refunds from an advance payment will be made within 3 months of HIC receiving both the Notice of Judgment or Settlement and the advance payment amount.

98% 98%

Table 2: Claims processing and payment standards for service providers


2001-02 2002-03

Medicare (Bulk bill) Manual bulk bill claims for all services except pathology and GP services will be reimbursed to providers by cheque 15 days after lodgement.

99% 98%

Manual GP claims will be reimbursed to providers by cheque 14 days after lodgement.

99% 99%

Manual pathology claims will be reimbursed to providers by cheque 28 days after lodgement.

96% 97%

Electronically lodged claims for all services except pathology will be reimbursed to providers by cheque or EFT 8 days after lodgement.

82% 84%

Electronically lodged pathology claims will be reimbursed to providers by cheque or EFT 28 days after lodgement.

95% 96%

Australian Childhood Immunisation Register

Australian Childhood Immunisation Register notification payments will be made by EFT, and a statement mailed to providers within 7 days of the end of each month.

100% 100%

General Practice Immunisation Incentives

A General Practice Immunisation Incentives payment calculation will be run quarterly in February, May, August and November of each year. All payments will be made and statements sent within 2 weeks of the quarterly calculations.

100%

(payments)

75%

(statements)

100%

(payments)

75%

(statements)

Service Incentive Payments

Service Incentive Payments will be made within 5 days of the end of each month.

100% 100%

Practice Incentives Payments

A Practice Incentives Program payment will be run quarterly in February, May, August and November of each year.

All payments will be made and statements sent within 2 weeks of the quarterly calculations.

100%

(payments)

75%

(statements)

100%

(payments)

50%

(statements)

When correct documentation is provided:

Pharmaceutical Benefits Scheme

Cash payments for claimants of patient refunds will be processed on the day at a Medicare office (daily cash limits apply).

100% 100%


2001-02 2002-03

Cheque payments for eligible patient refunds will be issued within 28 days of lodgement.

91% 94%

Claims Transmission System (CTS) benefits claims will be paid to the pharmacy within 17 days.

99% 100%

Written authority approvals will be provided within 3 working days from date of receipt.

98% 99%

Prescription pad orders will be dispatched within 4 weeks of receipt.

100% 100%

Veterans’ Affairs Processing

Medical claims will be reimbursed to medical practitioners within 28 days.

99% 99%

Hospital claims will be reimbursed to hospitals within 28 days, unless otherwise contracted.

98% 98%

Ancillary service claims will be paid to providers within 28 days, unless otherwise contracted.

98% 92%

Telephone enquiry standards

Standard:We aim to answer the majority of your phone calls within 30 seconds and resolve your enquiry during that call.

Performance:Of the 10.4 million calls received in 2002-03 (9.6 million in 2001-02), the majority were answered in less than 30 seconds. These statistics are automatically recorded using call centre software.

A breakdown of performance figures for HIC’s major programs is shown below.

Table 3: Telephone enquiry standards

Enquiry line Performance*

2001-02 2002-03

Australian Childhood Immunisation Register enquiry line and reports

92% 93%

Australian Childhood Immunisation Register internet enquiry line 93% 94%

Australian Organ Donor Register 96% 96%

Enquiry line Performance*

2001-02 2002-03

Botulinum Toxin - 100%

Compensation 98% 97%

Department of Veterans’ Affairs - Allied 96% 95%

Department of Veterans’ Affairs - Hospital 99% 99%

Department of Veterans’ Affairs - Medical 99% 99%

Federal Government 30% Health Insurance Rebate 97% 95%

Improved Medicare Entitlement Program - 94%

Location Specific Practice Number - Registrations - 75%

Medclaims 92% 94%

Medicare easyclaim 99% 99%

Medicare provider enquiries 94% 95%

Medicare public enquiries 93% 96%

Optometrical - transfer to operator 91% 97%

Pharmaceutical Benefits Scheme authority approvals 93% 93%

Pharmaceutical Benefits Scheme general enquiries 91% 93%

Practice Incentives Program payments 99% 99%

Rural Retention Program 98% 100%

Rural Transaction Centres - 99%

Simplified Billing - 94%

Telephone Claiming 95% 96%

* Proportion of calls answered by an operator within 30 seconds (average across Australia).

Table 4: Correspondence standards

Standard Performance in 2002- 03

Number recorded*

Average number of days to acknowledge

Average number of days to resolve

We will respond to you as quickly as possible within 28 days when you:

ask for information;

seek a decision;

lodge an objection; or

give us feedback, such as a complaint or suggestion, and you ask us for a response.

If we cannot meet the 28-day standard we will advise you of an expected reply date, and who to contact in the meantime, within 14 days of receipt of your query.

12,200 6 8

Table 5: Medicare office counter enquiry standards

Standard Performance

2001-02* 2002-03**

We aim to keep waiting times below 10 minutes.

100% of customers were served in under 10 minutes

100% of customers were served in under 10 minutes

*Based on 2,720 external observations conducted in Medicare offices during 2001-02.

**Based on 2,516 external observations conducted in Medicare offices during 2002-03.

Table 6: Freedom of information standards


2001-02 2002-03

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.

3 requests were carried over and 14 requests were received in 2001-02. Of these, 14 decisions were made, 2 were withdrawn and 1 was carried through to 2002-03. All were acknowledged within 14 days of receipt. Of 14 decisions,

14 were responded to within the legislated time frames.

1 request was carried over and 14 requests were received in 2002-03. Of these, 10 decisions were made,

2 were withdrawn and 3 were carried through to 2003-04.

All were acknowledged within 14 days of receipt and, of 10 decisions, 10 were responded to within the legislated time


2001-02 2002-03

frames.

Table 7: Customer feedback as recorded in HIC’s customer feedback register

Feedback type

Volume Further details

2001-02

2002-03

2001-02 2002-03

Suggestions 81 87 77% of all suggestions were Medicare related

89% of all suggestions were Medicare related

Compliments 131 185 83% of all compliments were Medicare related

80% of all compliments were Medicare related

Complaints* 392 300 Top 4 complaints categories were:

Medicare claims — general feedback

Pharmaceutical Benefits Scheme — miscellaneous

Medicare offices — general feedback

Medicare cheque — general feedback

Top 4 complaints categories were:

Medicare claims — general feedback

Medicare offices — general feedback

Medicare Public — miscellaneous

Medicare cheque — general feedback

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

APPENDIX G Telephone calls receivedTelephone call volumes for major programs in each of the States and the Australian Capital Territory are listed below.

Telephone call volumes received by States and in the Australian Capital Territory 2002-03

Program Total NSW QLD VIC SA TAS WA ACT

ACIR enquiry line and reports

210,922 29,892 4,484 176,546

ACIR internet helpline 7,409 782 6,627

ATSI access line 28,247 3,206 6,198 400 10,325 22 8,096


Australian Organ Donor Register

34,994 10,121 24,873

Botulinum Toxin (from May 2003)

65 65

Compensation 198,839 110,909 87,93

DVA — Allied 61,386 61,386

DVA — Hospital 6,040 3,072 2,968

DVA — Medical 56,704 34,798 21,906

Easyclaim booth enquiries

74,556 74,556

Easyclaim fax enquiries

40,296 26,562 13,734

IME line 284,914 76,548 208,366

LSPN (from March 2003)

2,023 2,023

Medclaims 93,573 33,413 24,273 20,978 7,567 7,342

Medicare levy exemption

15,609 15,609

Medicare provider enquiries

1,437,989 424,177 279,333 386,608 140,37329,928 177,570

Medicare public enquiries

1,959,996 637,337 363,384 474,102 214,08546,233 224,855

Optometrical — IVR* 1,203,058

1,203,058

Optometrical — transfer to operator

14,715 14,715

PBS authority approvals

4,438,018 1,330,8321,068,5521,020,168 324,953

104,488589,025

PBS general enquiries

250,189 82,064 80,761 42,365 18,485 5,593 20,921

PIP payments 23,132 23,132


Rural Retention Program

869 869

Simplified Billing (from March 2003)

17,544 5,849 2,402 6,788 17 40 2,448

Telephone claiming 18,384 2,846 10,737 182 4,279 340

30% Rebate 1,733 565 159 191 354 15 449

TOTALS 10,481,2042,707,7462,214,1671,989,470801,728323,9191,239,0931,205,081

Note: Blank areas indicate telephone calls for a particular program are not handled in that State. *Calls to the optometrical interactive voice response line are not recorded by State.

APPENDIX H Accessing HICHIC’s National Office134 Reed Street

North GREENWAY ACT 2900

Telephone: (02) 6124 6333

Fax: (02) 6282 5025

Postal Address:

PO Box 1001

TUGGERANONG

DC ACT 2901

State OfficesNew South Wales

150 George Street

PARRAMATTA NSW 2150

Telephone: (02) 9895 3333

Fax: (02) 9895 3082

Victoria

460 Bourke Street

MELBOURNE VIC 3000

Telephone: (03) 9605 7333

Fax: (03) 9605 7980

Queensland

444 Queen Street

BRISBANE QLD 4000

Telephone: (07) 3004 5333

Fax: (07) 3004 5410

South Australia

209 Greenhill Road

EASTWOOD SA 5063

Telephone: (08) 8274 9333

Fax: (08) 8274 9371

Western Australia

Bankwest Tower

108 St Georges Terrace

PERTH WA 6000

Telephone: (08) 9214 8333

Fax: (08) 9214 8322

Tasmania

242 Liverpool Street

HOBART TAS 7000

Telephone: (03) 6215 5333

Fax: (08) 6215 5700

HIC’s national telephone enquiry serviceHIC can be contacted by using HIC’s national telephone enquiry service. Calls to 13 numbers cost 25 cents from anywhere within Australia. Calls to 1800 numbers are free of charge. Calls from public pay phones or mobile phones may be charged at higher rates. Information is also obtainable from HIC’s website www.hic.gov.au

24-hour 7 day enquiry lines Telephone number

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/immunisation reports

1800 246 101

Medicare easyclaim fax 1800 633 201

Medicare easyclaim fax enquiries 1800 722 008

Pharmaceutical Benefits Scheme authority approvals 1800 888 333

PKI Customer Service Centre 1300 660 035

Telephone claiming 1300 360 460

Business hours enquiry lines

Aboriginal and Torres Strait Islander Access Line 1800 556 955

Bali special health care benefits hotline 1800 660 026

Compensation 132 127

Department of Veterans’ Affairs — Allied 1300 550 051

Department of Veterans’ Affairs — Hospital 1300 551 002

Department of Veterans’ Affairs — Medical 1300 550 017

Doctor shopping hotline 1800 631 181

Federal Government 30% Health Insurance Rebate 136 221

HIC Online 1800 700 199

Improved monitoring of entitlements (IME) 1300 302 122

Medclaims 1300 788 008

Medical advisory line 1800 800 314

Medicare provider enquiries 132 150

Medicare public enquiries 132 011

National electronic data interchange help desk 1300 550 115


Optometrical IVR Date of Service Check 1300 652 752

Pharmaceutical Benefits Scheme general enquiries 132 290

Practice Incentives Program payments 1800 222 032

Rural Retention Program 1800 010 550

Simplified billing 1300 130 043

Source based audit 1800 675 235

Teletypewriter (hearing impaired) 1800 552 152

HIC public email addresses email

Australian Childhood Immunisation Register [email protected]

Australian Organ Donor Register [email protected]

Compensation [email protected]

General Practice Immunisation Incentives scheme [email protected]

HIC general enquiries [email protected]

HIC’s Service Charter - Charter of Care [email protected]

Medicare provider enquiries [email protected]

Medicare public enquiries [email protected]

Pharmaceutical Benefits Scheme [email protected]

Public Key Infrastructure [email protected]

Practice Incentives Program [email protected]

Better medication management system, now known as MediConnect

[email protected]

MediConnect [email protected]

Software vendor helpdesk [email protected]

Software vendor liaison [email protected]


HIC Online [email protected]

Software Vendor Account Management [email protected]

Pathology [email protected]

HIC Statistics [email protected]

Public Affairs [email protected]

Program Review Division [email protected]

GPMOU 90 Day Scheme [email protected]

Feedback Reporting Facility for providers and specialists [email protected]

GST enquiries [email protected]

Victorian EDI Helpdesk [email protected]

Simplified Billing [email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

GLOSSARYABN Australian Business Number

ACIR Australian Childhood Immunisation Register

Australian Standard Vaccination Schedule

Recommendations made by the National Health and Medical Research Council which provide details of vaccinations and vaccines for all Australian children

AWA Australian Workplace Agreement

Balimed Assistance to victims of the Bali tragedy for medical treatment

BI Business Improvement

BMMS Better Medication Management System

Budget Refers to Australian Government Budget

Bulk billing When a medical practitioner bills Medicare directly, accepting the Medicare benefits as full payment for the service

CAC Act Commonwealth Authorities and Companies Act 1997

Consumer Advisory Committee

Stakeholders who advise HIC on key consumer health issues

Clinical Advisory Groups

Medical practitioners who are responsible for identifying indicators of best practice that can be supported using HIC data

CPI Consumer Price Index

CPSU Community and Public Sector Union

CTS Claims Transmission System

DC Distribution centre

eBusiness The application of electronic communication methods such as the internet or computer networks to conduct business transactions between HIC and other stakeholders

eLearning Electronic means (intranet, internet, CD ROM) to deliver course content

EFT Electronic funds transfer

EHR Electronic health record

FASAC Fraud and Service Audit Committee

FOI Freedom of Information

GP General practitioner

GPII General Practice Immunisation Incentives scheme

GST Goods and Services Tax

HALO Health Analysis Online project

HeSA Health eSignature Authority Pty Ltd

HIC Health Insurance Commission

HIC Act Health Insurance Commission Act 1973

IBIS Integrated Business Information system

IBM GSA International Business Machines Global Services Australia

IBNR Incurred But Not Reported

IME Improved Monitoring of Entitlements

Immunisation

provider

Registered medical practitioner or ancillary providers such as hospitals, local councils and immunisation clinics

Inappropriate

practice

Where a Professional Services Review Committee could reasonably conclude a medical practitioner's conduct in relation to the rendering or initiation of a service would be unacceptable to their general body of peers

Information

management

Management of the acquisition, organisation, storage, retrieval, and distribution of health information in order to improve health outcomes

ISB Information Services Branch

IT Information technology

KM Knowledge Management

LSPN Location Specific Practice Number

MDOs Medical Defence Organisations

Medicare easyclaim Provides customers with the option of lodging Medicare claims from locations other than a Medicare office

NACCHO National Aboriginal Community Controlled Health Organisations

OH&S Occupational health and safety

Output Pricing Agreement

An agreement that defines the financial relationship between HIC and another government agency

PBS Pharmaceutical Benefits Scheme

PHARIA Pharmacy Accessibility / Remoteness Index of Australia

PIP Practice Incentives Program

Professional Services Review Committee

An independent committee comprising a medical practitioner's peers formed to determine if a medical practitioner has engaged in inappropriate practice

PKI Public Key Infrastructure provides a secure method for the electronic transfer of data or information

Reciprocal Health Care Agreement

An agreement between the Australian Government and another nation to provide immediately necessary medical treatment to overseas visitors

RPBS Repatriation Pharmaceutical Benefits Scheme

Stakeholder Any individual or organisation with an interest, stake or ownership in the outcome of an activity conducted by HIC

SWIM Senior Women in Management program

UMP United Medical Protection Limited

health insurance commission annual report 2002-2003 web viewhic annual report 2002-03. ... a revised...

Documents