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Programme 2.1: General Medical Consultations and Services

Objective

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

Overview

The veteran population is in steady decline yet the forecast for future years is for an increase in demand for general, specialist medical and dental services. This is directly attributable to an ageing population with increased complex medical conditions and associated comprehensive care needs.

In 2013–14, the number of DVA clients declined to 217,562 and there was a corresponding reduction in the cost of providing medical and dental services.

Expenses

Administered and Departmental expenses – Programme outcomes against Budget
  2013–14 PBS ($m) ESTIMATED ACTUAL 2013–14 ($m) OUTCOME 2013–14 ($m)
Administered 915.7 902.1 897.7
Departmental 25.8 26.1 21.7
Total resources 941.5 928.2 919.4

PBS = Portfolio Budget Statements

Deliverables

Deliverables – Programme outcomes against Budget projections
  2013–14 PBS ESTIMATED ACTUAL 2013–14 OUTCOME 2013–14
Treatment population 211,000 215,900 217,562

Key performance indicators

Key Performance Indicators – Programme outcomes against Budget target
  2013–14 PBS ESTIMATED ACTUAL 2013–14 OUTCOME 2013–14
Price: Unit cost per cardholder $111 $110 $93

Report on performance

As at 30 June 2014, approximately 217,562 veterans were eligible to receive treatment via a Repatriation Health Card (Gold or White Cards). During 2013–14, a total of 203,245 veterans accessed 10.6 million medical and dental services.

In December 2013, approximately 3,500 new card holders were added to the treatment population when clients under the Safety, Rehabilitation and Compensation Act 1988 became eligible for White Cards. Despite this, when compared to 2012–13, there was a further decrease in the number of veterans accessing services and this was in line with the decline in the veteran population. Administered expenditure for medical and dental in 2013–14 was $897.7 million, a decrease of $16 million compared to $913.7 million last financial year.

Medical services

Number of medical services

The number of medical services for 2013–14 was approximately 10.6 million. At the time of reporting, 9.8 million medical services were provided and billed to date, compared to 10.2 million for the same period in 2012–13.

Price

The administration costs per card holder for 2013–14 is calculated using the staff and administration expenses (programme support costs) divided by the eligible treatment population. The per capita cost for 2013–14 was of $93 per cardholder compared to $89 per card holder in 2012–13.

Average cost per medical service

The average cost per medical service in 2013–14 increased to $77.72 from $76.61 in 2012–13. This reflected the broader range of services provided and the increases in MBS fees paid to providers.

Percentage of veteran population using medical services

In 2013–14, 93.4 per cent of the veteran population used medical services, compared to 94.6 per cent 2012–13.

Table 18 shows the number of medical services provided and average cost over the past five years as currently available in departmental data.

Table 18: Number of, and average cost for, medical services 2009–10 to 2013–14
  2009–10 2010–11 2011–12 2012–13 2013–14
Number of services 11,794,781 11,452,868 10,970,036 10,458,766 9,836,493
Average cost per service $69.17 $70.45 $73.93 $76.61 $77.72
Proportion of treatment population1 95.6% 95.4% 95.1% 94.8% 93.4%

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

Dental services

Number of dental services

There were 743,330 dental services provided and billed to date in 2013–14, compared with 761,420 as at the same time of reporting in 2012–13. Current estimates are for 764,991 services for the full year, a 2 per cent decrease compared with 2012–13.

Average cost per dental service

The average cost per dental service increased in 2013–14 to $136.32 from $132.72 in 2012–13.

Percentage of veteran population using dental services

In 2013–14, 37.2 per cent of the veteran population accessed dental services compared to 38 per cent in 2012–13.

Table 19 shows the number of dental services provided and average cost over the past five years.

Table 19: Number of dental services provided and average paid 2009–10 to 2013–14
  2009–10 2010–11 2011–12 2012–13 2013–14
Number of dental services 818,104 808,712 778,560 783,608 743,330
Average cost per service $128.55 $128.54 $128.64 $132.72 $136.32
Proportion of treatment population1 38.3% 38.4% 38.5% 38.7% 37.2%

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 on behalf of DVA to providers of medical, allied health and hospital services (see Programme 2.2 for a full report on hospital services).

$2.16 billion was paid by the DHS to DVA providers in 2013–14, compared to $2.15 billion paid in 2012–13.

Table 20 compares the number of items processed with the treatment population and average age at 30 June for the past five years.

Table 20: Items processed compared with number and age of the treatment population and average number of services per client 2009–10 to 2013–14#
  NO. PROCESSED TREATMENT POPULATION AVERAGE AGE NO. OF SERVICES PER CLIENT
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
2013–14 20.0 million 217,562 74.8 92

Business activity

Coordinated Veterans’ Care Programme

The Coordinated Veterans’ Care (CVC) Programme is now in its fourth year of operation and at 30 June 2014, 25,366 Gold Card holders had been enrolled since the programme commenced. The CVC Programme is designed to reduce unplanned hospital admissions for veterans and war widow/ers with chronic conditions through a coordinated approach to their health care.

DVA has engaged Grosvenor Management Consulting to independently evaluate the CVC Programme. The second interim evaluation report, delivered to DVA in December 2013, found that general practices and Gold Card holders were generally positive about the CVC Programme, noting benefits such as potentially avoided hospitalisations and improved self-management and social connectedness. The final evaluation report is due in December 2014.

Telemonitoring

DVA is contributing to technology-based reforms that are supporting innovation in service delivery by implementing the In-Home Telemonitoring for Veterans Trial.

Veterans participating in the trial must also be enrolled in CVC, and have an individual healthcare plan developed for them in consultation with their general practitioner (GP) and a practice nurse coordinator. Telemonitoring equipment is installed in their home and training is provided to the patient and their GP and practice staff. The equipment allows vital signs to be monitored, securely transmitting the data to the GP’s practice. It is used for the early detection of irregularities that require intervention.

As at 30 June 2014, 142 veterans were receiving telemonitoring services across the New England and North Coast Medicare Local regions in New South Wales, the Darling Downs South West Queensland Medicare Local, and the Bayside Medicare Local in Victoria. There have been multiple recorded interventions with telemonitoring patients, including at least three that have been described as potentially lifesaving.

Personally Controlled Electronic Health Record

DVA continues to support the national Personally Controlled Electronic Health Record (PCEHR) initiative. Many in the veteran community have chronic conditions and complex care needs and, with patients’ consent, the PCEHR supports better, faster and easier sharing of important health information amongst participating healthcare providers.

DVA is promoting assisted registration through a general practitioner and the Australian Government PCEHR Helpline as the most convenient ways to register.

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