Part 2: Payments for Specific Purposes
Health
In 2009‑10, the States will receive $12.2 billion in payments from the Commonwealth for health services, including $2.1 billion over five years for health services as part of the COAG reform package agreed on 29 November 2008. This includes:
- an additional $500 million in recurrent base funding in 2008‑09 for the National Healthcare SPP — the Government is also providing a new indexation formula, which will deliver an estimated indexation rate of 6.7 per cent in 2010‑11;
- a $1.4 billion package of reforms under the National Partnership Agreement on Hospital and Health Workforce, including $150 million for activity-based funding, $750 million in 2008‑09 to relieve pressure on public hospital emergency departments and $500 million in 2008‑09 to enhance sub‑acute care services; and
- funding of $800 million over six years from 2009‑10 under the National Partnership Agreement on Preventive Health to address the rising prevalence of lifestyle‑related chronic diseases.
Policy decisions included in this Budget that will be implemented through National Partnership payments include:
- $3 billion over seven years from 2008‑09 under the Health and Hospital Fund on three reform priorities: expanding and modernising key public hospitals; funding infrastructure to deliver nationally consistent cancer services; and investing in translational research;
- $4 million over three years from 2010‑11 for the Northern Territory Medical School;
- $16 million over four years to the Queensland government to continue to provide health care to Papua New Guinean nationals in Queensland's public hospitals under the Torres Strait Treaty;
- $4 million over four years for the Torres Strait Islander health protection strategy to continue mosquito control and eradication in the region; and
- $2 million over three years to fund health infrastructure projects in Tasmania.
The Torres Strait Islander health protection strategy and the Tasmanian health infrastructure fund payments have been integrated into the National Partnership for Health Services and the National Partnership for Health Infrastructure, respectively. Further information on these two policy decisions is included in Budget Paper No. 2, Budget Measures 2009‑10.
From 1 July 2009, the Government will provide a financial contribution to support state health services under the new National Healthcare SPP, including an additional $500 million in recurrent base funding from 2008‑09 and new indexation arrangements. The National Healthcare SPP will also incorporate the following payments under the previous payment arrangements:
- $10.3 billion in 2008‑09 under the Australian Health Care Agreements, which assist in the provision of public hospital services free of charge to eligible individuals;
- $239 million in 2008‑09 in broad‑banded payments and other arrangements under the national public health program, to provide subsidies for health promotion and disease prevention — covering areas such as women's health, cancer screening, and AIDS control and drug strategies;
- $8 million in 2008‑09 for the service delivery component of the essential vaccines program for the delivery of immunisation vaccines; and
- $3 million in 2008‑09 under the Youth health services program to develop and implement innovative primary health care services for homeless and at‑risk youth.
Table 2.2 provides information on payments to support state health services, including the new National Partnership payments and existing payments, including those that will be paid under the Health Infrastructure or Health Services National Partnerships.
Table 2.2: Payments to the States to support health services
National Healthcare SPP
The Commonwealth will provide a financial contribution to support state healthcare services. This funding includes a $500 million increase in recurrent base funding for 2008‑09 and a new rate of indexation, placing public hospital funding on a more sustainable footing. The 2009‑10 base funding for the National Healthcare SPP will be provided on an on-going basis and indexed from 1 July 2010 by a growth factor.
The additional funding will be used to improve health outcomes for all Australians and the sustainability of the health system, including with respect to prevention, primary and community health, hospital and related care, aged care, patient experience, promoting social inclusion and improving Indigenous health.
Table 2.3: National Healthcare SPP
Growth factor
The Intergovernmental Agreement defines the growth factor for the National Healthcare SPP as the product of:
- a health‑specific cost index (the Australian Institute of Health and Welfare health price index);
- the growth in population estimates weighted for hospital utilisation; and
- a technology factor (the Productivity Commission‑derived index of technology growth).
In November 2008, the growth factor was estimated at 7.3 per cent per annum. The growth factor is estimated to fall to 6.7 per cent in 2010‑11, mainly due to a decrease in the estimate of the health-specific cost index. However, the payment for 2009‑10 is provided for in the Federal Financial Relations Act 2009 and will not change from the estimate that was agreed by COAG in November 2008.
The Commonwealth will provide advances to the States in respect of the National SPPs, based on estimates of the growth factor. Once outcomes data for each component of the growth factor is available, a balancing adjustment will be made to ensure that the States receive their correct entitlement.
National Partnership on Hospital and Health Workforce Reform
The Commonwealth will provide $3.0 billion over 5 years from 2008‑09 under the National Partnership Agreement on Hospital and Health Workforce Reform. This National Partnership aims to improve the efficiency of public hospital services, enhance health workforce capability and supply, increase the volume and quality of sub‑acute care services, and improve the operations of emergency departments. It will support an efficient and effective public hospital system that delivers high‑quality and safe services to patients.
The outputs of this National Partnership include a nationally consistent approach to activity‑based funding of public hospital services, increased capacity and productivity for the health workforce, enhanced sub‑acute care services and better outcomes for emergency department patients.
Table 2.4: Estimated payments for the National Partnership on Hospital and
Health Workforce Reform
Note: In addition, the Commonwealth will incur flow-on costs to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme as a result of the measure.
Activity-based funding
In addition to its own-purpose funding for national leadership and coordination, the Commonwealth will provide funding to the States to assist with the development and implementation of nationally consistent activity-based funding for public hospital services. Activity-based funding is a management tool that has the potential to enhance public accountability and drive technical efficiency in the delivery of health services.
Table 2.5: Estimated payments to the States for activity-based funding
Taking pressure off public hospitals
The Commonwealth will provide $750 million to the States to improve the operations of emergency departments. This funding will relieve some of the pressure on public hospitals, while initiatives to improve the efficiency of public hospitals and the primary care reforms of the Commonwealth are implemented.
Table 2.6: Estimated payments to the States for taking pressure off public
hospitals
Sub‑acute care
In addition, the Commonwealth will provide funding of $500 million to the States for the enhancement of sub-acute care services. This funding will assist the States to expand the volume and quality of the sub-acute care services in hospital and community settings, and better address regional availability.
Table 2.7: Estimated payments to the States for sub‑acute care
National Partnership on Preventive Health
The Commonwealth will provide $872.1 million over six years from 2009‑10 for the National Partnership Agreement on Preventive Health. This National Partnership has been established to address the rising prevalence of lifestyle‑related chronic diseases. It will lay the foundations for healthy behaviours in the daily lives of Australians, including instituting programs across the risk factors related to smoking, nutrition, alcohol, and physical activity.
The National Partnership will contribute to increasing the proportion of children and adults at healthy body weight and meeting national guidelines for healthy eating and physical activity; reducing the proportion of adults smoking daily; and reducing harmful consumption of alcohol. This will be achieved through the delivery of a range of programs related to healthy children, workers and communities, as well as partnerships with industry, enabling infrastructure and social marketing campaigns.
Table 2.8: Estimated payments for the National Partnership on Preventive
Health
Note: The National Partnership agreement provides funding over the six years from 2009‑10 to 2014‑15.
Healthy children
The Commonwealth will provide funding for the States to deliver a range of programs for children, covering physical activity, healthy eating and prevention in settings such as child care centres, pre-schools and schools. The payments to the States for healthy children programs will be structured as 50 per cent facilitation payment and 50 per cent reward payment.
Table 2.9: Estimated payments to the States for healthy children
Healthy workers
In addition to developing a national healthy workplace charter with peak employer groups, the Commonwealth will provide funding to the States to facilitate the delivery of healthy living programs in workplaces, covering topics such as physical activity, healthy eating, harmful consumption of alcohol and smoking cessation. The payments to the States will be structured as 50 per cent facilitation payment and 50 per cent reward payment.
Table 2.10: Estimated payments to the States for healthy workers
Social marketing
In addition to funding a social marketing campaign to extend and complement the Australian Better Health Initiative campaign, the Commonwealth will fund the States to provide reinforcing local activities. These payments will be provided as facilitation payments.
Table 2.11: Estimated payments to the States for social marketing
Enabling infrastructure
In addition to establishing a national preventive health agency and expanding the National Nutrition and Physical Activity Survey, the Commonwealth will fund the States to support soft infrastructure, such as a complementary system of more frequent health, nutrition and physical activity monitoring surveys. The payments will be provided as facilitation payments.
Table 2.12: Estimated payments to the States for enabling infrastructure
National Partnership on Closing the Gap in Indigenous Health Outcomes
The Commonwealth will provide $805.5 million over four years under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. This National Partnership addresses the targets set by COAG, including to close the gap in life expectancy between Indigenous and non‑Indigenous Australians within a generation. It implements initiatives with respect to preventive health, primary health care and hospitals and hospital‑related care that also improve continuity of care for Indigenous patients.
The National Partnership is centred on five priority areas related to tackling smoking, delivering effective primary healthcare services, fixing the gaps and improving the patient journey through the health system, providing a healthy transition to adulthood and making Indigenous health everyone's business.
National Partnership for Health Infrastructure
Several payments will be integrated into a National Partnership for Health Infrastructure.
Tasmanian health package
The Commonwealth will provide funding to improve health services in Tasmania. The Tasmanian package includes expanded radiation oncology services in north/north west Tasmania, increased patient transport and accommodation services through the Tasmanian Patient Transport Initiative and investment in the Launceston Integrated Care Centre.
Table 2.13: Estimated payments for the Tasmanian health package
Tasmanian health package — PET scanner for the Royal Hobart Hospital
The Commonwealth will provide funding for the purchase of a positron emission tomography (PET) scanner at Royal Hobart Hospital.
Table 2.14: Estimated payments for the Tasmanian health package — PET scanner for
the Royal Hobart Hospital
PET scanner for Calvary Mater Hospital, Newcastle
The Commonwealth will provide funding for the purchase of a PET scanner at Calvary Mater Newcastle Hospital. This will complement the Hunter New England region's major centre for oncology services.
Table 2.15: Estimated payments to New South Wales for a PET scanner for
the Calvary Mater Hospital
PET scanner for the Westmead Hospital, Sydney
The Commonwealth will provide funding to New South Wales for the provision of PET services and research.
Table 2.16: Estimated payments to New South Wales for a PET scanner for
the Westmead Hospital
Olivia Newton‑John Cancer Centre, Melbourne
The Commonwealth will contribute funding towards the establishment of the Olivia Newton‑John Cancer Centre at the Austin Hospital, Melbourne. The centre will be a purpose‑built facility that will combine cancer treatment services with the clinical research programs currently run by Austin Health and the International Ludwig Institute for Cancer Research.
Table 2.17: Estimated payments to Victoria for the Olivia Newton‑John
Cancer Centre
Children's cancer centre, Adelaide
The Commonwealth will provide funding to South Australia for the construction of a purpose‑built children's cancer centre at the Women's and Children's Hospital in Adelaide. The new centre will establish a fully integrated, dedicated children's cancer facility that will provide state‑of‑the‑art care and treatment facilities.
Table 2.18: Estimated payments to South Australia for the children's cancer
centre
Lismore integrated cancer centre
The Commonwealth will contribute funding to bring forward the completion of the integrated cancer centre at the Lismore Base Hospital to March 2010. The integrated cancer centre will be a purpose‑built facility offering a range of cancer treatments including a radiation oncology service.
Table 2.19: Estimated payments to New South Wales for the Lismore
integrated cancer centre
Cairns Base Hospital chemotherapy cancer initiative
The Commonwealth will provide funding toward the Cairns Base Hospital chemotherapy initiative.
Table 2.20: Estimated payments to Queensland for the Cairns Base Hospital
chemotherapy cancer initiative
Cairns integrated cancer centre
The Commonwealth will contribute funding towards the establishment of an integrated cancer centre at the Cairns Hospital. The integrated cancer centre will be a purpose‑built facility offering a range of cancer treatments including a radiation oncology service.
Table 2.21: Estimated payments to Queensland for the Cairns integrated
cancer centre
Health infrastructure projects in Tasmania
The Commonwealth will provide funding to Tasmania to upgrade chemotherapy and cancer facilities in north-west Tasmania, with a focus on the North West Region Hospital at Burnie. Funding will also be provided to upgrade a portion of the additional patient accommodation proposed for Launceston.
Table 2.22: Estimated payments to Tasmania for health infrastructure projects
Health infrastructure grants
This program covers a number of grants paid in 2008‑09 including:
- $1 million to upgrade the Bacchus Marsh and Melton Regional Hospitals in Victoria;
- $1 million to support the purchase of a computed tomography (CT) scanner and ultrasound machine for the Kempsey District Hospital in New South Wales;
- $4 million for the purchase of an MRI unit and other supporting equipment as well as contributing towards associated building works at the Cairns Base Hospital in Queensland; and
- $5 million for a renal dialysis unit in the North Lakes Health Precinct.
Table 2.23: Estimated payments to the States for health infrastructure grants
National Partnership for Health Services
Several payments will be integrated into a National Partnership for Health Services.
Healthy kids health checks
The Commonwealth will provide funding to the States for the healthy kids health check program. The program will support medical practitioners and practice nurses to undertake healthy kids health checks to ensure every four‑year‑old child in Australia has a basic health check to see if they are healthy, fit and ready to learn when they start school. The program will promote early detection of lifestyle risk factors, delayed development and illness, and introduce guidance for healthy lifestyles and early intervention strategies.
Table 2.24: Estimated payments to the States for healthy kids health checks
Reducing rheumatic heart fever for Indigenous children
The Commonwealth will provide funding to support disease registers and control programs for acute rheumatic fever and rheumatic heart disease to reduce rheumatic heart fever for Indigenous children.
Table 2.25: Estimated payments to the States for reducing rheumatic heart
fever for Indigenous children
National bowel cancer screening program
The Commonwealth will provide funding to the States to support follow‑up for national bowel cancer screening program participants with a positive test result. The second phase of the program commenced on 1 July 2008 and offers testing to people turning 50, 55 or 65 years of age between January 2008 and December 2010. The program is being phased in gradually to help ensure that health services, such as colonoscopy and treatment services, are able to meet any increased demand.
Table 2.26: Estimated payments to the States for the national bowel cancer
screening program
National perinatal depression Initiative
The Commonwealth will provide funding to the States for the national perinatal depression initiative. The initiative aims to improve prevention and early detection of antenatal and postnatal depression and provide better support and treatment for expectant and new mothers experiencing depression.
Table 2.27: Estimated payments to the States for the national perinatal
depression initiative
Victorian cytology service
The Commonwealth will provide funding for the Victorian cytology service. The service is a Government‑funded pathology laboratory, responsible for reporting cervical cytology tests.
Table 2.28: Estimated payments to Victoria for the Victorian cytology service
OzFoodNet
The Commonwealth will provide funding for OzFoodNet. OzFoodNet is a collaborative initiative with state health authorities for enhanced food‑borne disease surveillance to provide a better understanding of the causes and incidence of food‑borne disease in the community and to provide an evidence base for policy formulation. Enhanced food‑borne disease surveillance has been recognised by the World Health Organization and many countries around the world as an essential tool to help reduce the global burden of food‑borne disease.
Table 2.29: Estimated payments to the States for OzFoodNet
Pneumococcal disease surveillance
The Commonwealth will provide funding for the vaccine‑preventable pneumococcal disease surveillance program. The program will measure the incidence of pneumococcal disease in the community and provide an evidence base for policy formulation.
Table 2.30: Estimated payments to the States for pneumococcal disease
surveillance
Vaccine‑preventable diseases surveillance program
The Commonwealth will provide funding for the vaccine‑preventable diseases surveillance program. The program will measure the incidence of selected vaccine-preventable diseases in the community and provide an evidence base for policy formulation.
Table 2.31: Estimated payments to the States for vaccine‑preventable
diseases surveillance program
National public health — human quarantine services
The Commonwealth will provide funding for the provision of human quarantine services to support the implementation of health measures at our international borders. The aim of these health measures is to manage the risk of travellers bringing designated quarantinable diseases into Australia.
Table 2.32: Estimated payments to the States for human quarantine services
Royal Darwin Hospital — equipped, prepared and ready
The Commonwealth will provide funding for the provision of the National Critical Care and Trauma Response Centre at Royal Darwin Hospital and to maintain it in a state of readiness to respond to a major incident in the region.
Table 2.33: Estimated payments to the Northern Territory for Royal Darwin
Hospital — equipped, prepared and ready
Health care grants for the Torres Strait
The Commonwealth will provide funding to assist in providing health services to Papua New Guinea citizens exercising their right to move freely across the Torres Strait.
Table 2.34: Estimated payments to Queensland for health care grants for the
Torres Strait
Torres Strait Islander health protection strategy — mosquito control
The Government will provide funding to Queensland to assist in mosquito detection and eradication in the region.
Table 2.35: Estimated payments for the Torres Strait Islander health
protection strategy — mosquito control
Sexual assault counselling in remote Northern Territory areas
The Commonwealth will provide funding to the Northern Territory to assist Indigenous communities affected by sexual assault‑related trauma. Small teams of professionally qualified counsellors and Aboriginal sexual assault workers will provide culturally safe mobile outreach services to children, families and communities in remote Northern Territory communities from regionally‑based sexual assault referral centres in Tennant Creek, Darwin, Katherine and Alice Springs.
Table 2.36: Estimated payments to the Northern Territory for sexual
assault counselling in remote Northern Territory areas
Satellite renal dialysis facilities in remote Northern Territory communities
The Commonwealth will provide funding to the Northern Territory to improve access to renal dialysis services for remote communities in the Northern Territory, to help reduce the pressure on existing renal services. In the Northern Territory, Aboriginal and Torres Strait Islander people have an incidence of end-stage renal disease 28 times higher than that for non‑Indigenous Australians.
Table 2.37: Estimated payments to the Northern Territory for satellite
renal dialysis facilities in remote Northern Territory communities
Supporting nurses to return to the workforce
The Commonwealth will provide funding to encourage qualified nurses to return to the nursing workforce in the public health system. This is part of the bringing nurses back into the workforce program to provide places for 7,750 extra nurses and midwives in the public and private sectors and 1,000 nurses in the aged care sector.
Table 2.38: Estimated payments to the States for supporting nurses to
return to the workforce
Helping public patients in public hospitals waiting for nursing homes
The Commonwealth will provide funding to assist long‑stay older patients in public hospitals who no longer require acute care or rehabilitation and who are waiting for residential aged care. The funding enables the States to provide a range of services relevant to their own service systems, to enhance the care of older people in public hospitals and reduce the risk of hospitalisation.
Table 2.39: Estimated payments to the States for helping public patients
in public hospitals waiting for nursing homes
Other National Partnership payments for health
Essential vaccines
The Commonwealth will provide funding for essential vaccines for immunisation to be included in the National Vaccine Schedule. The essential vaccines program was intended to be a Commonwealth own-purpose expense from 1 July 2009. To allow time for the Commonwealth to enter into centralised purchasing arrangements for individual vaccines, this program will be paid as a National Partnership payment to the States. The Commonwealth will negotiate a National Partnership agreement which provides for the transition of this program to a Commonwealth own‑purpose expense.
Table 2.40: Estimated payments to the States for essential vaccines
Organ transplantation services
The Commonwealth will meet its future payment commitments to the States in respect of organ transplantation by providing a single payment in 2008‑09 and ceasing future annual payments.
Under long-standing arrangements, the Commonwealth reimburses New South Wales and South Australia for 40 per cent of the cost of certain organ and tissue transplantation-related services that are conducted by the Australian Red Cross Blood Service.
Table 2.41: Estimated payments to the States for organ transplantation services
Repatriation general hospitals
The Commonwealth will meet its future payment commitments to the States in respect of repatriation general hospitals by providing a single payment in 2008‑09 and ceasing future annual payments. The final payment represents the present value of the stream of future annual payment.
The Commonwealth provides funds for payments of a non-treatment nature (for example, staff transfer costs such as accrued leave credits, income maintenance, superannuation differential) to the States in accordance with agreements reached on integration of repatriation general hospitals.
Table 2.42: Estimated payments to the States for repatriation general
hospitals
Northern Territory Medical School — funding contribution
The Commonwealth will provide funding towards recurrent costs for the Northern Territory Medical School. This recurrent funding is in addition to the capital grant of $27.8 million over three years provided by the Commonwealth for the establishment of the school. The capital grant will be funded from the Health and Hospitals Fund established in 2008‑09.
Table 2.43: Estimated payments to the Northern Territory for the Northern
Territory Medical School
Elective surgery waiting list reduction plan
The Commonwealth will provide funding under the elective surgery waiting list reduction plan. Funding will be provided for systemic improvements such as the construction of additional operating theatres and the purchase of new surgical equipment to improve long‑term elective surgery performance. Funding will also be provided as performance rewards for those States which reduce elective surgery waiting times and increase surgery throughput.
Table 2.44: Estimated payments to the States for elective surgery waiting
list reduction plan
Commonwealth dental health program
The Commonwealth dental health program will provide funding to reduce public dental waiting lists. The commencement of the program is on‑hold pending the outcome of the Government's negotiations with the Senate.
Table 2.45: Estimated payments to the States for the Commonwealth dental
health program
Health care grants
The Commonwealth will provide funding under the Australian Health Care Agreements, which assist in the provision of public hospital services free of charge to eligible persons. The Australian Health Care Agreements have been incorporated into the National Healthcare SPP.
Table 2.46: Estimated payments to the States for healthcare grants
National public health
The Commonwealth provides funding in broad‑banded payments and other arrangements under the national public health program, to provide subsidies for health promotion and disease prevention. Elements of the national public health program have been incorporated into the National Healthcare SPP.
Table 2.47: Estimated payments to the States for national public health
Youth health services program
The Commonwealth will provide funding under the youth health services program to develop and implement innovative primary health care services for homeless and at‑risk youth.
Table 2.48: Estimated payments to the States for youth health services
Essential vaccines — service delivery component
The Commonwealth will provide funding for the delivery of vaccines under the national immunisation program.
Table 2.49 Estimated payments to the States for essential vaccines — service
delivery component
Health program grants
The Commonwealth provided $11,000 to Victoria in 2008‑09 for alternative funding to Medicare benefits, with the aim of improving access to approved health services.
Table 2.50: Estimated payments to the States for Health program grants
Indigenous reforms
The Government has committed to improving outcomes for Indigenous Australians, recognising that Indigenous Australians face significantly worse outcomes than non-Indigenous Australians across a range of areas including life expectancy, mortality rates, education, employment outcomes and opportunities.
The Commonwealth is working closely with the States to address six ambitious targets, agreed by COAG, to help close the gap in Indigenous disadvantage.
As part of the COAG package agreed on 29 November 2008, the Government will provide:
- $173 million over five years from 2008‑09 as part of the Indigenous Economic Participation National Partnership to improve opportunities for Indigenous people to engage in private and public sector jobs;
- $188 million over six years from 2008‑09 to implement a new service delivery model across 26 remote locations as part of the Remote Service Delivery National Partnership;
- $806 million over four years from 2009‑10 as part of the Closing the Gap in Indigenous Health Outcomes National Partnership with a focus on five key priority areas; and
- $2.1 billion over five years and $4.8 billion over ten years from 2008‑09 as part of the Remote Indigenous Housing National Partnership to address significant overcrowding, homelessness, poor housing conditions and housing shortages in remote Indigenous communities.
The Government has also committed $490 million over six years from 2008‑09 as part of the Indigenous Early Childhood Development National Partnership to reduce the gap in health and developmental outcomes between Indigenous and non‑Indigenous children.
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