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Program 2.1: General Medical Consultations and Services

Objective

Program 2.1 provides access to general and specialist medical and dental services to entitled DVA beneficiaries. The department develops arrangements with medical and dental practitioners in both the public and private sectors to deliver a comprehensive range of services throughout Australia.

Overview

A priority for DVA in 2012–13 was to provide the veteran community with access to medical services that were responsive to their unique clinical needs. The department continued to monitor new developments in medical treatment and trends in veteran health needs, to ensure its policies and practices are meeting changing circumstances.

This is important as the veteran population is ageing and presenting with more complex health issues and as the contemporary veteran cohort is increasing.

In 2012–13, the overall number of clients accessing medical and dental services declined but the costs and breadth of those services increased, reflecting fee increases and greater demand for services per veteran.

DVA continues to work with health providers to reduce red tape and minimise costs around processing payments for veterans’ health treatments, aimed at making it easier for providers to do business with DVA.

Expenses

Administered and Departmental expenses
  2012–13 PBS1 ($ million) Estimated actual2 2012–13 ($ million) Outcome 2012–13 ($ million)
Administered 37.8 28.3 27.3
Departmental 21.4 21.8 21.2
Total resources 59.2 50.1 48.5

1 PBS in performance reporting tables means Portfolio Budget Statements.

2 Estimated actual means the estimated expense or total for 2012–13 provided in the 2013–14 Portfolio Budget Statements. As the Budget is released in May each year but the financial year does not close off until 30 June, the current year numbers in the Budget can only be estimates.

Deliverables

Treatment population
  2012-13 PBS Estimated actual 2012-13 Outcome 2012-13
Treatment population 221 700 222 500 223 181

Key performance indicators

Unit cost per cardholder
  2012-13 PBS Estimated actual 2012–13 Outcome 2012–13
Price: Unit cost per cardholder $116 $105 $89

Report on performance

Administered expenditure for medical and dental services in 2012–13 was $913.7 million, a small increase from the expenditure of $912 million last financial year. This was due to a combination of fee increases and the change in the number of services per veteran.

As at 30 June 2013, there were approximately 223 181 veterans who were eligible to receive treatment via a Repatriation Health Card (Gold or White Card). In 2012–13, a total of 211 395 clients accessed 11 million medical and dental services.

Compared with the previous year, there was a decrease in the number of veterans accessing medical and dental services, consistent with the decline in the veteran population.

However, there was an increase in demand for services and overall expenditure due to fee increases and the more complex health needs of the veteran community.

Medical services

Number of medical services

Estimates are for approximately 10.5 million services for the full 2012–13 year.1 At the time of reporting, there were 10.2 million medical services provided in 2012-13 compared with 10.7 million at the same time of reporting in 2011–12. This will be a decrease on the actual number for 2011–12.

Price

The administration cost per cardholder for 2012–13 is calculated using the staff and administration expenses (Program Support costs) divided by the eligible treatment population. The unit cost of $89 per cardholder for 2012–13 was lower than in 2011–12, and lower than estimated because there was a greater shift to online claiming than expected. Client numbers stayed higher than estimated and, due to administrative changes, unit costs were lower.

Average cost per medical service

Average cost per medical service increased this financial year. This reflected the broader range of services provided and the increases in fees paid to providers. The 2012–13 average is expected to increase slightly as further billing is received for services provided with in the financial year but not processed at the time of reporting.

Percentage of veteran population using medical services

In 2012–13,94.6 per cent of the veteran population used medical services, similar to the percentage reported in 2011–12.

Table 20 shows the number of medical services provided and average cost over the past five years as currently available in departmental data.

1 There is always a lag in obtaining the most up-to-date service counts because of the time taken by some providers to bill DVA.

Table 20: Number and average cost of medical services 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Number of services 12 319 077 11 793 638 11 450 995 10 941 515 10 225 275
Average paid per service $67.86 $69.16 $70.43 $73.93 $75.53
Proportion of treatment population1 95.6% 95.5% 95.4% 95.1% 94.6%

1 Treatment population is measured at 30 June for each financial year.

Dental services

Number of dental services

There were 761420 dental services provided in 2012-13, compared with 755148 as at the same time of reporting in 2011–12. Current estimates are for 784270 services for the full year, a one per cent increase from the number now known for 2011–12.2

Average cost per dental service

The average cost per dental service has remained relatively consistent over the past few years but increased in the report year. The 2012-13 average is expected to increase once further billing data is received.

Percentage of veteran population using dental services

In 2012–13, 38 per cent of the veteran population used dental services, similar to the 38.5 per cent reported in 2011–12.

Table 21 shows the number of dental services provided and average cost over the past five years.

Table 21: Number of dental services provided and average paid 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Number of dental services 817 300 817 905 808 394 777 810 761 420
Average paid per service $130.59 $128.55 $128.54 $128.58 $132.51
Proportion of treatment population1 38.2% 38.2% 38.4% 38.5% 38.0%

1 Treatment population is measured at 30 June for each financial year.

Service items processed by the Department of Human Services

The Department of Human Services (DHS) processes payments for DVA to providers of medical, allied health and hospital services (refer to Program 2.2 for a full report on hospital services). A total benefit of $2.15 billion was paid by DHS to DVA providers in 2012-13, the same as the $2.15 billion paid in 2011–12.

Table 22 compares the number of items processed with the treatment population and average age at 30 June for the past five years, and the corresponding number of services per client in each year.

2There is always a lag obtaining the most up-to-date service counts because of the time taken by some providers to bill DVA.

Table 22: Items processed compared with number and age of the treatment population and average number of services per client 2008-09 to 2012-13
  Processed Treatment population Average age Services per client
2008–09 21.6 million 269 248 76.3 80
2009–10 21.7 million 260 513 76.4 83
2010–11 22.1 million 245 605 76.4 90
2011–12 21.2 million 233 800 76.2 91
2012–13 20.6 million 223 181 75.8 92

Business activity

Coordinated Veterans’ Care Program

The Coordinated Veterans’ Care (CVC) Program is now in its third year of operation and as at 30 June 2013, 18 683 Gold Card holders had been enrolled.

In December 2012 Grosvenor Management Consulting, engaged by DVA to independently evaluate the CVC Program, delivered the First Interim Evaluation Report to DVA, noting the CVC Program was performing well against the desired program outcomes able to be assessed at that point in time. Participating medical practitioners also reported very positive feedback about the model of care.

eHealth record

DVA continues to support the national Personally Controlled Electronic Health Record (eHealth record) initiative. Participants in DVA’s CVC Program and the telemonitoring trial will be encouraged to register for their eHealth record. Many in the veteran community have chronic conditions and complex care needs and, with the patient’s consent, eHealth records will support better, faster and easier sharing of important health information amongst health care providers.

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