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Health Insurance Commission Act - Health Insurance Commission - Report - 1992-93


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H E A L T H

I N S U R A N C E

ANNUAL REPORT

1 9 9 2 - 9 3

A U D ITO RS

Australian National Audit Office

BANKERS

Medibank Private - Australia and New Zealand Banking Group Limited Medicare and the Pharmaceutical Benefits Scheme - Reserve Bank of Australia

SO LIC ITO RS

Medibank Private - Minter Ellison Morris Fletcher Medicare and the Pharmaceutical Benefits Scheme - Australian Government Solicitor

Photography by John Half hide and Alan Milson

Design and art production by Advision (069) 218 025 Printed by National Capital Printing (06) 280 7477

The design featured on the cover of this report uses colours from the logos of the three programs currently administered by the Health Insurance Commission:

Medibank Private, Medicare and the Pharmaceutical Benefits Scheme.

H E A L T H I N S U R A N C E C O M M I S S I O N

A N N U A L R E P O R T 1 9 9 2 - 9 3

C O N T E N T S

C h airm an ’s R ep o rt 4

Mission S ta te m e n t an d C orporate P hilosophy 6

Five Year Financial S u m m ary 7

O p eratio n s S um m ary 8

P R I V A T E H E A L T H I N S U R A N C E

M edibank Private 10

Program Overview 10

• Products 10

• Customer Service 10

• Cost Containment 11

Casemix 11

Financial Performance 12

• Reinsurance 12

• Investments 13

The Market 14

• Membership and Market Share 15

• Marketing 15

• Grants and Sponsorships 16

Overseas Student Health Cover 16

Comparative Performance 17

G O V E R N M E N T P R O G R A M S

M edicare 18

Program Overview 18

• Payment of Medicare Benefits 18

• Education and Promotion 19

Enrolment and Claims Processing 19

• Medclaims 20

• Medicare Card Re-issue 20

Vocational Register of General Practitioners 21

Reciprocal Health Care Agreements 21

P h arm aceu tical Benefits Schem e 22

Program Overview 22

• Payment of Pharmaceutical Benefits 22

• Education and Promotion 23

Claims Processing 23

• Eligibility Checking 23

Pharmacy Restructuring 24

Financial Performance 25

O ther P rogram s an d Services 26

Veterans’ Treatment Accounts 26

Australian Hearing Service 26

HIB Vaccine Payments 26

Child Care Rebates 26

Doctor and Pharmacist Research 26

Inquiries Services 27

Branch Offices and Processing Centres 27

Information Technology 27

Data Services and Security 28

• Privacy Act Compliance Audit 28

P R O F E S S I O N A L R E V I E W

Overview 29

• Medical Consultants 29

Education 29

Verification 30

Excessive Servicing 30

Fraud 30

• Recovery of Medicare benefits paid incorrectly 30

Bates Report 30

Australian National Audit Office Report 31

• Structural and Administrative Changes 31

• Legislative Reform Project 31

• Automated Data Analysis 31

Consultants to the

Commission during 1992-93 31

Financial P erfo rm an ce 21

External C om m ittees and T ribunals 32 B oard of C om m issioners

Intern atio n al Projects 33 M a n a g em en t

Commission People 34 fin a n c ia l S tatem en ts

Staffing Profile 34

Skills and Training 34 Tables a n d Graphs

• Performance Appraisal 34 Private Health Insurance (Medibank Private):

• Senior Executive Development 34

Financial Performance

•Training 35

Operating Results and Reserves by State

•Competency Based Training 35

Reserves

•Staff Attitude Survey 35

Income and Expenditure

• Management Development 35

Assets and Liabilities

Industrial Relations 35

Market Share

Occupational Health and Safety 36

Membership

Equal Employment Opportunity 36

Solvency Margin

Management Expenses Per Membership

Audit 37 Comparative Performance

Audit Committee 37 Government Programs:

Internal Audit 37 Medicare Financial Performance

Pharmaceutical Benefits Financial Performance

S ta tu to ry S ta te m en ts 38 Medicare Enrolments, Claims and Benefits

Statutory Powers of the Minister 38 Medicare Proportion of Services Direct Billed

Freedom of Information 38 Pharmaceutical Benefits Approved Suppliers

Principles for Apportionment of

Pharmacy Restructuring Matters

Costs between Functions 40

Branch Office Network

Principles for Calculation of

Assets Rental Charges 41

Employee Numbers

Freedom of Information

Principles for Apportionment of

Medibank Private Investment Income

between Funds in Each State 43 In d e p e n d e n t Audit R ep o rt

M edicare and P h arm aceu tical

B enefits Statistical Tables 84 -

C om m ission Office L ocations

44

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47

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12

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15

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122

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3

C H A I R M A N ’ S R E P O R T

Senator the Hon Graham Richardson, M.P. Minister for Health Parliament House Canberra ACT 2601

Dear Minister

I submit the Commission’s nineteenth annual report to you for presentation to Parliament in accordance with section 42 of the Health Insurance Commission Act 1973-

M ED IB A N K PRIVATE

In 1992-93 Medibank Private attained a national operating surplus of $52.6 million. This was an improvement on the operating surplus of $41.0 million last year.

At 30 June 1993 reserves equalled 4.1 months of break-even contributions or $325.2 million. This compares favourably with total reserves at 30 June 1992 of $241.3 million or 3.1 months of break-even contributions.

This means Medibank Private is well placed to cope with continued cost increases while holding member contributions to the lowest practical levels in the forthcoming year.

The continuing trend towards higher health costs and reduced numbers of privately insured Australians (only 39.9 per cent are now covered) made 1992-93 a challenging year for Medibank Private. Retaining members and attracting new contributors remained difficult.

Despite an overall loss of membership during the year, Medibank Private achieved membership growth in four States and remains the largest private health insurer in Australia. At 31 March 1993 it had 25.9 per cent of the market.

There is some evidence which suggests that the rate at which members are leaving private health insurance funds has begun to decline. Certainly, this is the case with Medibank Private. This may, in part, be the result of the introduction of the “Select & Save” products. These enable members to pay a lower contribution rate by electing to carry some of the risk themselves while being protected against the major hospitalisation costs. If so, this indicates that there is a basic and continuing demand in the market for affordable and relevant private health insurance.

During 1992-93 contributions totalling $968.3 million were received, an increase of $33 million or 3.5 per cent. Benefits for many hospital and ancillary services increased in all States. Medibank Private was able to cover the increased benefits while only having to raise

contribution rates in South Australia. Medibank Private’s benefit payments increased by 1.5 per cent, from $842.8 million to $855 million, although the cost of hospital and other charges did not increase as much as in past years.

Those benefit payments included $45.6 million in payments to the reinsurance pool, which represents 5.3 per cent of benefit payments or 4.7 per cent of total contributions paid by Medibank Private members. Medibank Private continues to be a net contributor to the reinsurance pool.

The Com m ission awaits w ith interest the outcom e o f the current review into reinsurance arrangem ents a n d hopes that a m ore equitable schem e will be recom m ended.

M edibank Private funds th roughout Australia con tin u e to offer a high level of services and benefits at com petitive rates.

M EDICARE

During 1992-93 work proceeded on the development of ‘Medclaims’, a system whereby medical practitioners transmit direct bill claims electronically to the Commission. Practitioners will communicate with the Commission from an electronic address via an approved communications supplier. To participate in Medclaims, third party suppliers will be required to enter into a contractual agreement with the Commission, subject to certain security and privacy conditions.

P R O F E S S IO N A L R E V IE W

The Commission has continued to place great emphasis on detecting and containing the level of excessive servicing and fraud. It has been the subject of reports by Harvey Bates and Company and the Australian National

Audit Office (ANAO), both of which identified deficiencies in the Commission's legal capacity to conduct its tasks in this area.

Work has commenced to remedy these deficiencies. In line with recommendations in the ANAO report, the Commission has also proceeded with administrative and structural changes.

IN T E R N A T IO N A L PR O JE C T S

As in past years international organisations such as the International Labour Organisation, the World Health Organisation and the World Bank continued to draw

upon the Commission’s expertise in administering programs in health insurance.

C O M M ISSIO N STAFF

T he M edicare card re-issue, as reported last year, is n o w alm ost com plete. People w ere required to confirm the accuracy of their particulars before n e w cards w ere

issued. This e n ab led the Com m ission to m aintain the integrity o f th e M edicare enrolm ent file.

PH A RM A CEU TIC A L B E N E F IT S

In April 1993 staff of the Commission’s Queensland State Headquarters moved to new premises in 444 Queen Street, Brisbane. This move, welcomed by all staff, means that staff in only two of the Commission’s State

Headquarters are now housed in older style accommodation. Renovations under way in the Victorian State Headquarters are expected to be completed early in 1994, while an assessment is being made of the South Australian Headquarters to determine the long term

management of the building.

In October 1992 the Commission introduced the first stage of new entitlement checking routines for this program. The result was a remarkable

increase in the correctness of entitlement numbers submitted by pharmacists, with less than 1 per cent of prescriptions now

rejected for invalid entitlement numbers. In May this year the Commission began checking patients' claims for subsidised benefits against the period of entitlement, as notified by the Department of Social Security. Trials are continuing prior to the introduction of this check into the Commission’s payment system.

T he Com m issioners place on record their gratitude to C om m ission staff for their c ontinued dedication to the organisation. Staff have m ade notable efforts and contin u ed to adapt readily to the use of new

technologies. This has again resulted in a widely recognised efficient a n d friendly service.

Yours sincerely

F.W. MILLAR Chairm an

S eptem ber 1993

5

M I S S I O N S T A T E M E N T

The Health Insurance Commission (HIC) is a Commonwealth statutory authority established by the Health Insurance Commission Act 1973.

The mission of the HIC is to support delivery of quality health and child care to Australian residents by providing the highest quality benefit payment services and private health insurance services and to ensure that all benefit payments are correctly made for services properly rendered.

The functions of the HIC, as specified in legislation, are:

• to conduct in each state and territory, the private health benefits funds known as Medibank Private, membership of which is open to all Australian residents - authorised by the Health Insurance Commission Act and subject to the National Health Act;

• to pay Medicare benefits as provided for in the Health Insurance Act and undertake all administrative activities necessary to ensure the effective performance of this function - authorised by the Health Insurance Commission Act and regulations thereto;

• to pay Pharmaceutical benefits services as may be prescribed, and undertake all administrative activities necessary to ensure the effective performance of this function - subject to the National Health Act and authorised by the Health Insurance Commission Act and regulations thereto;

• to detect and prevent the occurrence of fraud and excessive servicing with respect to the payment of benefits under the government programs which the HIC administers - authorised by the Health Insurance Commission Act and regulations thereto;

• to provide services for the processing of the Department of Veterans’ Affairs treatment accounts - authorised by regulations to the Health Insurance Commission Act.

C O R P O R A T E P H I L O S O P H Y A N D A I M S * •

The HIC has a commitment to efficiency, integrity and professionalism in performing its functions. HIC has adopted the following underlying philosophy to govern the performance of its functions:

• emphasis will be on customer service excellence for both HIC based and external customers rather than processing efficiency and accuracy alone.

• the need for organisational discipline will be balanced with the opportunity for individual discretion.

• each employee will be provided with the information and advice necessary for the satisfactory discharge of individual responsibilities.

• the need to operate within finite resources by establishing priorities will be recognised.

• the environmental implications of proposed strategies will be recognised.

• good management requires that performance be measured against targets.

• advice to government will be designed to ensure that a contemporary legislative framework exists in which the HIC can successfully operate to achieve the outcomes required by its stakeholders (government, public, Medibank Private members, health services providers and employees).

F I VE Y E A R F I N A N C I A L S U M M A R Y

M e d ib a n k P r i v a t e : F i n a n c i a l P e r f o r m a n c e 1 9 8 8 - 8 9 t o 1 9 9 2 - 9 3

1988-89 1989-90 1990-91 1991-92 1992-93 % change

1991-92 to 1992-93

$m $m $m $m $m %

Contributions 648.8 678.4 799.1 935.3 968.3 3.5

Benefits expenditure (582.8) (639.1) (751.4) (798.2) (809.5) 1,4

Reinsurance (11.7) (29.6) (45.0) (44.6) (45.6) 2.2

Management expenses (69.6) (77.2) (84.7) (94.3) (97.3) 3.2

Investment & other income

Abnormal & extra-ordinary items

47.0 45.4

(4,7)

38.6

2

42.7 36.7 (14.1)

Operating profit/loss 26.7 (26.8) (43.1) 41.0 52.6 28.3

Asset/investment revaluation (6.3) " 1.7 5.2 28.7 451.9

Total reserves 263.4 236.6 195.2 241.3 325.2 34.7

Reserves as months of break-even contributions 5.1 4.0 2.6 3.1 4.1 32.3

M e d ic a r e : F i n a n c i a l P e r f o r m a n c e 1 9 8 8 - 8 9 t o 1 9 9 2 - 9 3

Units 1988-89 1989-90 1990-91 1991-92 1992-93 % change

1991-92 to 1992-93

Benefits expenditure $m 3 394.8 3 776.3 4227.1 4577.0 5153.7 12.6

Management expenses $m 155.0 154.2 161.6 175.3 181.3 3.4

Management expenses/benefits % 4.6 4.1 3.8 3.8 3.5 (7.9)

P h a r m a c e u t i c a l B e n e f i t s S c h e m e : F i n a n c i a l P e r f o r m a n c e 1 9 8 9 - 9 0 t o 1 9 9 2 - 9 3 *

Units 1989-90 1990-91 1991-92 1992-93 % change

1991-92 to 1992-93

Benefits expenditure** $m 1136.1 1241.4 1274.8 1574.6 23,5

Management expenses $m 35.7 39.8 38.4 41.9 9.1

Management expenses/benefits % 3.1 3.2 3.0 2.7 (10.0)

* Scheme transferred to the Commission 17 July 1989. ** Includes Stoma appliances and Repatriation benefits.

7

O P E R A T I O N S S U M M A R Y

MEDI BANK PRIVATE _ _ _ _ _ _ _ _ P e r f o r m a n c e a n d A c h i e v e m e n t s

•936,110 memberships covering 2.1 million Australians

• National reserves of $325.2 million or 4.1 months of break-even contributions

• Contributions of $968.3 million

• Claims for 10.6 million services processed

• Operating surplus of $52.6 million

• Contributions to the reinsurance pool of $45.6 million (5.3 per cent of total benefits expenditure)

• Increased administrative efficiencies resulted in a further decrease in management expenses per member (10.0 per cent of contributions)

• 94 per cent of members satisfied with service received from Medibank Private staff

• Position as Australia's largest private health insurer maintained with 25.9 per cent of the market

f u t u r e S t r a t e g i e s

• Increase national market share

• Provide a comprehensive range of highly competitive products aligned to the specific needs of members

• Minimise the cost of premiums by actively pursuing cost containment

• Continue developing internal processing systems to enhance levels of service to members.

• Further involvement in Casemix discussions as a potential alternative to current hospital funding arrangements

O u t l o o k •As the perceived need for private health insurance continues to diminish, the market will continue to contract. A more innovative approach

towards the market will be needed if traditional roles in health care financing are to be maintained

MEDICARE _ _ _ _ _ _ _ _ _ _ _ _ _ _

P e r f o r m a n c e a n d A c h i e v e m e n t s

• Claims for 172.1 million services processed

• Benefits expenditure of $5153.7 million

• Management expenses reduced to 3.5 per cent of benefits paid

• Development of ‘Medclaims’ or electronic data interchange to give practitioners the opportunity to submit claims to the Commission electronically

• Number of direct billed services increased to 112.1 million, and increased to accounting for 65.1 per cent of all services

f u t u r e S t r a t e g i e s

• Continue to encourage electronic data interchange to increase processing efficiency

• Maintain a responsible attitude to Medicare costs and optimise the value to the community of expenditures

O u t l o o k • Increased use of the ‘Medclaims’ system will improve processing efficiency

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1

PHARMACEUTICAL BENEFITS P e r f o r m a n c e a n d A c h i e v e m e n t s

• 111.8 million pharmaceutical and repatriation benefits services processed

• Pharmaceutical benefits expenditure of $1476.3 million

• Repatriation benefits expenditure of $81.8 million

• Stoma appliance benefits of $16.5 million

• Management expenses reduced to 2.6 per cent of benefits paid

• Extension of Claims Transmission System to cover 97.5 per cent of pharmacies

• Successful introduction of first stage of entitlement checking into the claims payment system, with less than 1 per cent of prescriptions now rejected for invalid entitlement numbers

F u t u r e S t r a t e g i e s

• Introduce computerised entitlement checking against a person’s period of entitlement, as notified by the Department of Social Security

• Increase pharmacists’ satisfaction with claims processing services

O u t l o o k

HEALTH INSURANCE COMMISSION P e r f o r m a n c e a n d A c h i e v e m e n t s

• Management costs per service processed $1.06

• 72,415 services processed per paid year of labour

• 58 per cent of employees were highly satisfied or satisfied with the Commission as an employer

• Further assistance provided to international organisations and governments of other countries

• Continued development of computerised processing systems and favourable comparison of systems with other countries

• Introduction of structural and other changes to address deficiencies identified by the Australian National Audit Office which inhibit the Commission’s ability to deal with fraud and excessive servicing

• Improved logical security controls over personal data

• Finalisation of an enterprise bargaining agreement with the Public Sector Union

• Claims processing accuracy will continue to improve by the verification of patient entitlement with resultant savings in benefits expenditure.

LOWER COST PRESCRIPTIONS a r e y o u m is s in g o u t?

F u t u r e S t r a t e g i e s

• Maintain a high level of commitment to providing quality services to all client groups

• Implementation of an integrated financial system using a proprietary software package to facilitate better financial management

• Systems and procedures development in preparation for the introduction of child care rebates

O u t l o o k • Restructuring of the Commission’s procedures and administrative arrangements will enable it to investigate and control excessive servicing and

fraud more effectively

• Technological improvements will continue to increase operational efficiency

• Implementation of the Government’s policy of child care payments by 1 July 1994 9

M E D I B A N K P R I V A T E

PR O G R A M O V E R V IE W

For the last twelve of its seventeen year history, Medibank Private has been the leading private health insurance fund in Australia.

It has maintained that position by offering competitive products which meet individual needs at affordable prices. It has provided a high level of customer service and has offered an attractive range of benefits for hospital and ancillary health care services.

In 1992-93 Medibank Private continued to build on its strengths in product design, customer service and cost containment.

P r o d u c t s

P R I V A T E H E A L T H I N S U R A N C E

The wide range of insurance covers provided by Medibank Private offers a variety of value- for-money benefits which substantially cover the cost of hospital, medical and ancillary services. The hospital insurance options vary from “Blue Ribbon” which covers up to 100 per cent of hospital charges to “Select & Save” products which offer a number of ways to reduce premiums.

People may also choose from three ancillary insurance products which offer cover for health care such as dentistry, physiotherapy and optical appliances.

C u s t o m e r S e r v ic e

In addition to maintaining its achievements in operational efficiencies, Medibank Piivate has always aimed to provide a high level of service. To discern members’ thoughts on existing customer service and where improvements could be made, Medibank Private commissioned an Australia-wide survey of those members who recently had contact with Medibank Private.

It was extremely pleasing to find that 94 per cent of those members expressed satisfaction with tire service tiiey had received. There are, of course, areas which can be improved and programs are currently being designed to address these.

Medibank Private reviewed all of its fund rules during 1992-93 in order to simplify and consolidate them. The rules are also being rewritten in “plain English” so that they can be easily understood by members.

As part of its commitment to provide all Australian residents with access to private health insurance, Medibank Private has in the past produced a range of product and

general information brochures in eight community languages. It is currently reviewing these in order to produce new material which is more suited to Australia’s changing multicultural society.

C o s t C o n t a i n m e n t

In common with the community, Medibank Private is concerned about escalating health care costs. It is actively pursuing cost containment measures which allow improved benefits for members while maintaining controls on contribution rate increases and out-of-pocket expenses of members. In 1992-93 Medibank Private was

able to increase benefits offered to members on many items, while increases in the overall cost to Medibank Private for ancillary health care services were kept to CPI increases.

Medibank Private has also reduced the health care expenses of its members by entering into special agreements with certain providers in some states to obtain discounts on health care services and products. It will continue to investigate opportunities in this area.

In addition, Medibank Private has concluded special benefits arrangements with a number of private hospitals to provide accommodation and associated services at agreed rates so that members will know before they enter hospital exactly what their co-payments will be. Members with Blue Ribbon cover will be fully covered for all hospital accommodation and theatre fees at those

hospitals.

CASEMIX

One of the most important current developments within the Australian health care system is the use of Casemix and Diagnostic Related Groups (DRGs) to identify hospital episodes of care and their relative costs. Medibank Private considers that this approach to hospital funding has the potential for more equitable allocation of funding for patient care episodes, encouraging quality of care and controlling escalating health care costs.

Medibank Private participates on a number of committees and working parties involved in developing systems for more effective and equitable health care funding. These include the Casemix Technical Reference Group, the

Casemix Education and Training Committee, the Quality Assurance and Utilisation Review Working Party, the Industry Procedure Banding Committee and the Management Board of the Private Sector Casemix Unit.

F IN A N C IA L PER FO R M A N C E

In 1992-93 Medibank Private paid hospital benefits of $615.3 million, compared with $604.6 million the previous year, an increase of 1.8 per cent. Extras (ancillary) benefits totalled $194.2 million, compared with $192.4 million last year, an increase of 0.9 per cent.

Medibank Private further improved its financial position during 1992-93· It again achieved a national operating surplus, this year of $52.6 million. Nationally, as at 30 June 1993, reserves totalled $325.2 million, representing 4.1 months of break-even contributions, compared with 3.1 months at 30 June 1992. Break-even contribution income is the amount necessary to pay benefits and net management expenses

R e i n s u r a n c e

During the 1992-93 financial year Medibank Private paid a net $45.6 million into the Health Benefits Reinsurance Trust Fund. In 1992 the Department of Health, Housing, Local Government and Community Services arranged for an independent review of the reinsurance arrangements by a consultancy firm MIRA Pty Ltd. During the review the consultants met with Commission management to discuss existing reinsurance arrangements. It is understood that the consultants have presented their report to the Department.

Table i

M e d i b a n k P r i v a t e : O p e r a t i n g r e s u l t s a n d r e s e r v e s b y s t a t e

Units NSW VIC QLD SA W A TAS AUST

O perating profit/loss $m 17.0 19.1 12.9 (0.003) 2.6 1.0 52.6

Total reserves $m 97.2 122.2 60.1 14.0 22.0 9.7 325.2

Reserves/break-even contribution income months 4.1 3.8 5.5 2.6 4.8 5. 4.1

As at 30 June 1993

(total cost of management less investment income).

Graph i

M e d i b a n k P r i v a t e : R e s e r v e s 1 9 8 3 t o 1 9 9 3

350

Frank Russell Australia was appointed as the Commission’s asset allocation consultant during the year. Commission staff manage the liquid and property sectors of the Medibank Private portfolio while the other sectors are managed by the following companies:

Australian Equities: County NatWest Australia Investment Management Ltd. Offshore Equities Unit Trusts: Macquarie Investment Management Ltd. Domestic Fixed Interest: AMP Financial Services Pty Ltd.

Associated Companies and Business Ventures:

The Commission’s investments currently include interests in the following two companies;

•Health Care Corporation Pty Ltd: owns and conducts private hospitals and medical centres and engages in the provision of health care services. Medibank Private invested in Health Care Corporation on 5 February 1987 and holds 10 per cent of shares.

•Truck Dock Pty Ltd: formed on 14 December 1979, the company’s activities are restricted to paying the expenses of operating a truck dock facility adjacent to Medibank House in the ACT. Medibank Private holds 50 per cent of Truck Dock shares.

The Commission’s interest in MedNetWork Systems Pty Ltd, jointly owned by Medibank Private, IBM Australia Ltd and the Australasian Medical Publishing Company Ltd (a subsidiary of the Australian Medical Association), was disposed of during the year.

TH E M ARKET

The proportion of Australians who are privately insured continued to decline; as at 31 March 1993, only 39.9 per cent of the population was covered by private health insurance. The rate of decline in the number of people covered by private health insurance slowed considerably during 1992-93. Between 1991 and 1992, the proportion covered dropped by almost 3 per cent; between

1992 and 1993, the decrease was halved. Nevertheless, it is expected that the market will contract further over the next few years, although at a lower rate.

As the market is shrinking, the risk profile of the funds is also deteriorating since there is still a trend for healthier and younger members not to have private cover. The higher claims rate therefore experienced by insurers means increases in contribution rates are needed for funds to remain

viable. This spiral of increasing premiums and decreasing affordability continues to put downward pressure on the membership numbers of health funds.

14

M e m b e r s h i p a n d M a r k e t S h a r e

Nationally, Medibank Private membership was 936,110 at 30 June 1993, a reduction from the previous year of 2.8 per cent.

Its market share declined slightly from 26.4 per cent at 30 June 1992 to 25.9 per cent at 31 March 1993 (the latest data available).

In 1992-93 there was net membership loss Australia-wide owing primarily to the recession and the high cost of premiums. This loss occurred despite the fact that

except for South Australia there were no contribution rate increases this financial year. The loss in membership was much smaller than in 1991-92. However, Medibank Private’s membership actually grew in four States.

Graph iv

M e d i b a n k P r i v a t e : M a r k e t S h a r e 1 9 8 3 t o 1 9 9 3

30

□ $ Millions

84 85 86 87 88

Medibank Private’s “Select & Save” products have helped to reduce the attrition rate as they offer an opportunity for people to maintain their private health cover at an affordable price rather than drop their cover completely.

M a r k e t i n g

During 1992-93 Medibank Private continued with its popular “I feel better now” theme and in early 1993 launched a campaign which offered prizes of six months free membership for new members as well as waiving the usual two month waiting period.

Since their introduction in June 1992, the “Select & Save” products have remained popular. By increasing the range of excess levels available and allowing members to choose a modified private hospital cover, Medibank Private has provided private

health insurance which gives people choice and control over their health care needs at a competitive price.

Graph v

M e d i b a n k P r i v a t e : M e m b e r s h i p 1 9 8 3 t o 1 9 9 3

,2 0 -------------------------------------------

I I M em bership (T housands)

15

G r a n t s a n d S p o n s o r s h i p s

Medibank Private again sponsored a wide range of activities which encourage healthy lifestyles. As part of the Life Be In It program in the Northern Territory, the Medibank Private Corporate Cup has become an established event. Medibank Private also provided financial support for projects promoted by national organisations such as the Anti-Cancer Council, St John Ambulance and the Bone Marrow Foundation. It continued to sponsor the “Health in the Workplace” program conducted by the National Heart Foundation at a total cost of $110,000. It also sponsored various programs at the state level.

In addition, Medibank Private sponsored a variety of cultural events at the local level, such as Eisteddfods, Young Achiever Awards and the Canberra Festival Finale. It also supported sporting teams ranging from the West Coast Eagles in the Australian Football League to community-based teams such as those in the Queensland State League Netball Series.

A grant of $20,000 was again made to Monash University Graduate School of Management for the ongoing development of studies in health/hospital administration.

O V ERSEAS STU D EN T HEALTH COVER

Medibank Private continued to offer private health insurance to overseas students on behalf of the Commonwealth. The insurance plan covers health care services for all overseas students and their dependants, including those sponsored by a government department or agency. Specifically, it covers those services generally available through Medicare as well as some private hospital benefits.

The Overseas Student Health Cover is not underwritten by the Commonwealth, nor is it subsidised in any way by other Medibank Private contributors. The premiums payable fully cover the cost of the plan and ensure that adequate reserve levels are met.

As at 30 June 1993 there were 49,101 registered contributors. These contributors are not included in Medibank Private membership figures quoted elsewhere in this report.

Medibank Private team at Herald-Sun Cycling Tour 1992.

16

COM PARATIVE PE R FO R M A N C E

The performance indicators used in graphs (vi) and (vii) and table (ii) provide a picture of Medibank Private’s performance over ten years relative to the industry. The indicators are limited to those for which comparable industry data is available. Industry data for the 1992-93 financial year has not yet been released.

Graphs vi & vii

M e d i b a n k P r i v a t e a n d t h e I n d u s t r y 1 9 8 3 t o 1 9 9 3 ( y e a r e n d e d 3 0 J u n e 1 9 9 3 )

M edibank Q | In d u stry (including M edibank Private) Note 1992 - 1993 In d u stry figures are n o t available

Table ii

M e d i b a n k P r i v a t e a n d t h e I n d u s t r y : C o m p a r a t i v e P e r f o r m a n c e 1 9 8 2 - 8 3 t o 1 9 9 2 - 9 3

indicator Unit 83-84 84-85 85-86 86-87 87-88 88-89 89-90 90-91 91-92 92-93

Contributions MP $ 540 402 450 489 589 655 684 780 972 983

per membership ind $ 598 466 532 623 740 817 802 893 1058 -

Management expenses MP $ 58 55 52 69 66 71 78 83 100 104

per membership Ind $ 66 63 72 83 93 104 105 1 14 1 19 -

Closing solvency MP mths 2.1 6.0 6.8 5.0 5.2 5.1 4.0 2.6 3.1 4.1

margin Ind mths 2.0 4.5 4.3 3.8 4.0 3.8 3.5 3.0 3.0 -

MP: Medibank Private

Ind: Industry (including Medibank Private)

Notes: (1)1992-93 industry data not available

(2) Solvency calculated using annualised data

(3) Industry data provided by th e Private Health Insurance Administration Council (PHIAC)

17

G O V E R N M E N T P R O G R A M S

18

M E D I C A R E

PR O G R A M O V E R V IE W

Medicare, Australia’s national health insurance scheme, provides free accommodation and treatment in public hospitals by hospital doctors for all Australian residents and certain categories of visitors to Australia. Medicare also helps meet the cost of a range of medical and other services itemised in the

The Prime Minister a n d the Deputy Prime Minister at tha f Bankstown branch to celebrate Medicare’s ninth birthdayy.

The Medicare Benefits Schedule details the services which attract benefit and specifies a fee from which Medicare benefits are calculated. The Schedule is reviewed by the Department of Health, Housing, Local Government and Community Services in consultation with the relevant professional bodies. The latest review of the Schedule took effect from 1 November 1992.

P a y m e n t o f M e d i c a r e B e n e f it s

The Commission is responsible for:

• payment of benefits for out-of-hospital professional services (medical and optometrical) at the rate of 85 per cent of the Schedule fee (providing the benefit does not exceed the charge for the service). The maximum “gap” between the Medicare benefit and the Schedule fee that can be paid by a patient is limited to $27.20 (indexed annually). However, the maximum amount that an individual or family needs to pay in “gap” payments is limited to $247.90 (reviewed annually), following which benefit is paid at

100 per cent of the Schedule fee.

• payment of benefits at 75 per cent of the Schedule fee for professional services provided to private patients in public or private hospitals (Medicare does not pay benefits for hospital accommodation charges). Private health insurance will cover the 25 per cent difference between the Medicare benefit and the Schedule fee;

• performance of administrative tasks associated with the payment of benefits, such as the maintenance of a register of medical practitioners who may claim under the program and the identification and management of systems to detect fraud and excessive servicing.

All claims are paid in one of three ways:

• by cash at a Medicare office or by cheque payable to the claimant where the claimant has paid the practitioner’s account;

• by cheque payable to the practitioner (and forwarded to the patient) where the claimant has not paid the account. •

• direct to the practitioner where the patient has assigned the benefit to the practitioner in full settlement of the account;

MEDIGUIDE A GUIDE TO

E d u c a t i o n a n d

P r o m o t i o n

The Commission publishes “Mediguide”,

a handbook .c»

companion to the Medicare Benefits Schedule, and the quarterly newsletter “Medicare Forum”, both of which are well received by the professions.

Consistent with its three year Access and Equity plan, the Commission continues to produce Medicare information brochures for non-English speaking people. Brochures are currently available in English and 15 other languages, two more languages having been added since last year. New brochures were published in June. Medicare information is also being

developed for the non-English television and radio stations. It is proposed to provide 18 non- English language versions of the

Medicare claim form for display in a book in Medicare offices.

The latest of the yearly surveys on community attitudes to Medicare and to the level of service provided was conducted in July-August 1992. The survey confirmed that Medicare remains popular, with community support of 70 per cent. Additionally, 90 per cent of Australians

indicated their satisfaction with the claiming system.

E N R O L M E N T AND CLAIMS PR O C E SSIN G

Medicare enrolment and claims processing data over five years is shown in table (iii) and more detailed information is provided in the Statistical Tables supplement to this report. The proportion of services

direct-billed has risen every year since Medicare’s inception. It now represents 65.1 per cent of all services claimed. General practitioner services are still the most frequently direct-billed, accounting for 6l.6 per cent of direct billed services in 1992-93.

During the year the Commission adjusted its claims payment procedures to comply with the Government’s 1990-91 Budget decision to extend payment times this year for direct bill claims to eleven days (excluding specialist pathology) and for specialist pathologists who direct bill to twenty-eight days. In 1992-93 the average lag time between the date of receipt of Medicare claims by the Commission and the date of processing for payment was still pleasing at four days. Where claims were processed within the minimum payment periods mentioned above payment was withheld to comply with the Government’s policy on minimum payment times.

Table iii

M e d ic a r e : E n r o l m e n t , C l a im s a n d B e n e f i t s 1 9 8 8 - 8 9 t o 1 9 9 2 - 9 3

Units 1988-89 1989-90 1990-91 1991-92 1992-93

Enrolment -(as at 30 June each year)

Persons enrolled millions 17.2 17.5 17.8 18.1 17.3

Active cards millions 9.2 9.4 9.6 9.8 9.1

Claims -Services processed millions 142.9 145.4 146.6 156.7 172.1

Benefits processed $m 3 394.6 3 805.4 4 238.3 4 583.5 5018.1

Average benefit per service $ 23.8 26.2 28.9 29.2 29.1

Average period service to lodgement days 24.9 24.9 21.2 19.5 18.2

Average period lodgement to processing days 4.6 4.1 4.5 5.8 4.0

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Table iv

M e d i c a r e : P r o p o r t i o n o f S e r v i c e s D i r e c t B ille d 1 9 8 8 - 8 9 t o 1 9 9 2 - 9 3

State / Territory 1988-1989 1989-1990 1990-1991 1991-1992 1992-1993

% % % % %

Australian Capital Territory 37.9 42.5 46.7 50.3 53.7

N ew South W ales 61.6 64.1 65.6 67.0 69.2

Victoria 49.1 52.1 55.1 59.3 62.4

Queensland 55.7 59.8 62.9 63.1 65.1

South Australia 50.8 53.7 56.1 58.3 59.9

W estern Australia 53.5 56.8 60.6 63.0 65.2

Tasmania 45.0 46.5 49.8 50.4 51.9

N orthern Territory 64.7 63.1 64.6 66.6 69.9

Australia 55.4 58.4 60.8 62.8 65.1

M e d d a i m s - e l e c t r o n i c d a t a i n t e r c h a n g e (E D I)

‘Medclaims’ is the Commission’s initiative for electronic data transmission of direct bill claims from medical practitioners to the Commission via third parties. A number of practitioners currently transmit claims direct to the Commission; but for technical and administrative reasons, this has been limited to large volume practices. There has also been some difficulty with data transmission from PC based systems to the Commission’s mainframe.

With Medclaims practitioners transmit data from a unique electronic address via an approved supplier of communications services. Practitioners need to use the services of both software and communications suppliers for this. To participate, software and communications suppliers need to enter into a contractual arrangement with the Commission, which includes strict conditions relating to security and transmission of data.

M e d i c a r e C a r d R e - is s u e

New Medicare cards have now been issued to most eligible Australians. The cards were re-issued because many were wearing out and imprinted details were not reproducing clearly on direct-bill claims.

New cards were only issued to people who confirmed their personal particulars when submitting claims. Direct billing practitioners were also asked to ensure that any patient with an old-style card was advised of the need to obtain a new card. These measures allowed the Commission to maintain the integrity of the Medicare enrolment file. The few remaining people with old-style cards may still have an entitlement to Medicare but would need to contact a Medicare office to arrange for the issue of a new card.

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VOCATIONAL R E G IS T E R OF G E N E R A L PR A C T ITIO N ER S

The Commission maintains the Vocational Register of General Practitioners. To be eligible for inclusion on the Register, practitioners must be mainly in general

practice and involved in appropriate continuing medical education and quality assurance programs approved by the Royal Australian College of General Practitioners

(RACGP). Applications for inclusion on the register must be made to the Commission following certification of eligibility by the RACGP, a Vocational Registration Eligibility Committee or the Vocational Registration Appeals Committee.

General Practitioners listed on the Register may use content-based consultation items listed in the Schedule, which provide for a higher rate of benefit. This is in recognition of the practitioner's involvement in continuing education, the quality assurance program and the tasks undertaken by the

practitioner during a consultation rather than only the time spent with a patient.

Australians visiting Malta and Italy are entitled to access the health care schemes of those countries for a maximum period of six months while Australian visitors to the other reciprocal countries are eligible for the

duration of their visits. The Agreements also provide a restricted access to Medicare for visitors from reciprocal countries visiting Australia.

FIN A N C IA L PER FO R M A N C E

Medicare benefits for claims processed in 1992-93 totalled $5018.1 million. Medicare benefits paid in 1992-93 totalled $4971.2 million. Total benefits expenditure (this includes unpresented cheques, sundry

debtors, processed but unpaid benefits and adjustments to provisions for outstanding claims) was $5153.7 million compared with $4577 million at 30 June 1992. These figures exclude radiation oncology health program

grants which totalled $10 million compared with $9.5 million in 1991-92. The figures also exclude HIB virus payments of $249,606 and Australian Hearing Service payments of $851,870 which were made for the first time during the year.

Management expenses totalled $181.3 million or 3.5 per cent of the total benefits expenditure compared with $175.3 million or 3-8 per cent in 1991-92.

R E C IPR O C A L HEALTH CARE A G R E E M E N T S

Australia has signed Reciprocal Health Care Agreements with the United Kingdom and Northern Ireland, New Zealand, Malta, Italy, Sweden and the Netherlands. An Agreement with Finland has been signed

and is expected to come into force later this year.

The Agreements provide Australian residents visiting a reciprocal country with access to that country’s health care scheme for immediately necessary medical treatment. Pre-arranged or elective treatment is specifically precluded under the terms of the Agreements.

P H A R M A C E U T I C A L B E N E F I T S S C H E M E

PR O G R A M O V ERV IEW

The Pharmaceutical Benefits Scheme (PBS) provides Australians with access to a wide range of pharmaceuticals at affordable prices. The Commonwealth negotiates a set price with drug suppliers at which PBS drugs are sold to pharmacists. When these drugs are supplied on prescriptions the pharmacist recoups the cost via a Commonwealth reimbursement and a patient contribution. Both of these vary according to the status of the patient and the cost of the dmg.

The Commission administers the PBS on behalf of the Commonwealth. It processes pharmacists’ claims, reimburses them for medication dispensed and undertakes tasks associated with the detection and prevention of abuse. It also has as one of the objectives the education of, and promotion of the Scheme to, its clients.

P a y m e n t o f P h a r m a c e u t i c a l B e n e f i t s

The Commission is responsible for payments to:

• pharmacists for drugs supplied, Isolated Pharmacist Allowance and Essential Pharmacy Allowance;

• Ileostomy and Ostomy Associations for pharmaceutical items and appliances;

• In-vitro Fertilisation Clinics for hormone and fertility drugs; and

• Veterans for drugs supplied under the Repatriation Pharmaceutical Benefits Scheme.

The Commission has a responsibility to pay clients accurately and in a timely fashion, according to legislative requirements and a patient’s level of entitlement. By agreement with the Pharmacy Guild of Australia, claims which are lodged on diskette are paid 20 days after their receipt by the Commission. Claims submitted for manual keying of the data are paid 30 days after receipt.

Under PBS there are three levels of entitlement:

• General category where patients pay up to $15.90

• Concessional category where patients pay $2.60

• Entitled group where patients receive their medication free of charge.

E d u c a t i o n a n d P r o m o t i o n

During 1992-93 the ‘PBS Bulletin Board’ became a regular feature of the Commission's communication with pharmacists. It is issued on average every two months with some special editions. This format will continue in 1993-94.

The Commission was represented at all Pharmacy Trade Fairs during the year as well as at the Australian Pharmacy Professional. Stands with Commission staff

to handle inquiries make these venues an important point of contact.

Brochures designed to explain aspects of the PBS to the public were produced and displayed in Medicare offices and distributed with Medicare cheques. The first set, covering entitlements to the

Safety Net Scheme, were distributed at the start of the 1993 Safety Net year.

Pharmaceutical Benefits display fo r the Australian Pharmacy Professional and Trade Fairs.

CLAIMS PR O C E SSIN G

E l i g i b i l i t y C h e c k i n g

Following the changes to claim data requirements as outlined in last year’s report, the Commission introduced the first stage of checking routines on patients’ eligibility to receive free or concessional medication. Where the

prescription supplied to the Commission contains an invalid entitlement number, the pharmacist is first advised on the statement of account. Prescriptions with this incorrect number supplied after notification are rejected and returned to the pharmacist.

This stage of entitlement checking was introduced in October 1992, not without some opposition by the Pharmacy Guild of Australia. The Guild took legal action to prevent the introduction of checking routines. The Commission resolved the issues raised by the Guild.

Since the introduction of these measures, the quality of entitlement numbers submitted by pharmacists has improved dramatically with less than 1 per cent of prescriptions being rejected for invalid entitlement numbers.

The checking of a patient’s claim for subsidised benefits against the entitlement period, as notified by the Department of Social Security, was introduced in May 1993- Trials with this check are continuing prior to its

introduction into the Commission’s payment systems. Where there is a claim for benefit after the expiry date on the entitlement card, the prescription is rejected and returned to the pharmacist. If eligibility is withdrawn

before the expiry date on the card, the pharmacist is first advised of the withdrawal of entitlement; any subsequent prescriptions supplied after notification are rejected.

Pharmacist Peter Holder with Commission Pharmaceutical Adviser Mary Sharp.

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PHARM ACY R E STRU CTU RIN G

While pharmaceuticals may be prescribed and dispensed by doctors as well as hospitals, most medication is dispensed by community pharmacists. Over the past year, pharmacy numbers have reduced in line with the Government’s Pharmacy Restructuring policy.

Table v

A p p r o v e d S u p p l i e r s o f P h a r m a c e u t i c a l B e n e f it s 1 9 9 1 - 9 2 t o 1 9 9 2 - 9 3

Location Pharmacies Medical Practitioners

1992 1993 1992 1993

Hospitals

1992 1993 1992

Total

1993

N SW 1,795 1,759 25 24 7 7 1,827 1,790

Vic 1,261 1,245 1 1 3 3 1,265 1,249

Qld 946 936 12 10 1 1 959 947

SA 399 392 9 7 1 1 409 400

W A 460 458 16 14 1 1 477 473

Tas 145 144 13 13 1 1 159 158

ACT 60 59 0 0 0 0 60 59

NT 25 25 0 0 0 0 25 25

Total 5,091 5,018 76 69 14 14 5,181 5,101

The Commission has significantly supported the work of the Pharmacy Restructuring Authority (PRA). All applications by pharmacists for approval under the National Health Act are received by the Commission through each State office. These must be vetted for clerical completeness before being forwarded to the PRA.

The Commission is also involved in confirming details on applications for closure and applications for the Essential Pharmacy Allowance.

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Table vi

P h a r m a c y R e s t r u c t u r i n g A u t h o r i t y M a t t e r s D e a l t w i t h 1 9 9 2 - 9 3

: :

Processing state NSW VIC QLD SA W A TAS Total

New Pharmacy 17 8 25 3 4 1 58

Transfer of Ownership 96 88 86 35 39 3 347

Relocation 60 32 37 14 20 2 165

Deceased Estate 3 2 5 0 0 0 10

Closure Application 43 14 10 9 10 1 87

Amalgamation Application

Essential Pharmacy Allowance Application 4

2 0

7 5

0

1

0 2 2

5 4 26

Total 224 153 168 62 78 13 698

As part of the restructuring process, newly approved persons under the Act must be aware of their roles and responsibilities. During 1992-93 the Commission developed a comprehensive Information Kit for all newly approved persons.

FIN A N C IA L PE R FO R M A N C E

Pharmaceutical Benefits paid as at 30 June 1993 totalled $1547.3 million. The total benefits expenditure for the year (after allowing for movement in unpresented cheques, provision for outstanding claims, sundry

debtors and creditors) was $1574.6 million. This was comprised of $1476.3 million for pharmaceutical benefits, stoma appliance benefits of $16.5 million and Repatriation benefits of $81.8 million.

Management expenses totalled $41.9 million or 2.6 per cent of total benefits expenditure, compared with $38.4 million or 3.0 per cent in 1991-92.

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O T H E R P R O G R A M S A N D S E R V I C E S

V E TER A N S’ TR EATM EN T A CCO UNTS

The Commission provides the computing environment for processing veterans’ treatment accounts received by the Repatriation Commission, and prepares cheques in payment of those claims. Details of benefits paid on behalf of the Repatriation Commission during 1992-93 (for which the Commission received an advance from the Department of Veterans' Affairs) are listed in the financial statements.

AU STRALIAN H E A R IN G SERVICE

The Australian Hearing Service (AHS) has been responsible for processing claims for the supply and fitting of hearing aids free of charge to pensioners. In the 1992 Budget the Federal Government expanded the program to allow access to part-pensioners. A further 30,000 clients became eligible for this benefit.

The Commission has developed for AHS a claims processing and payment system to pay approved providers for the supply and fitting of hearing aids to these additional clients. It is estimated that there will be approximately 52,000 claims annually.

H IB VACCINE PAYMENTS

Changes to the Health Insurance Commission Act 1973 on 17 May 1993 enabled the Commission to make payments for valid Haemophilus Influenza Type B (HIB) vaccination claims. Under this arrangement the Commission reimburses the cost of the HIB vaccine provided to children who satisfy the eligibility criteria for the scheme.

CH IL D CARE REBATES

During the 1993 election the Government announced its intention to introduce child care rebates to assist families who incur child care expenses as a work related expense. The Health Insurance Commission Act has been amended to give the Commission the function of making these payments from 1 July 1994. The Commission will develop the systems and procedures in the coming year to manage the program.

D O CTO R A N D PH ARM A CIST RESEA R CH

In October 1992 the Commission requested Elliott and Shanahan to determine, through qualitative research, the perception among doctors and pharmacists of how the Commission performs its functions. The research confirmed that the Commission newsletters have been well received by the professions. It also found however that some confusion exists about the role of the Department of Health, Housing, Local Government and Community Services vis-a-vis the Health Insurance Commission. Following a number of recommendations, the Commission is working to further improve its communication with the professions.

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Table vii

H e a l th I n s u r a n c e C o m m i s s i o n : B r a n c h O f f ic e N e t w o r k

State/Territory City Metropolitan

Australian CapitalTerritory 1 3

New South W ales 4 38

Victoria 3 35

Queensland 3 16

South Australia 2 12

W estern Australia 1 14

Tasmania 1 4

Northern Territory 1 1

AUSTRALIA 16 123

IN Q U IR IE S SERVICES

The Commission provides information about each of its functions at all branch offices. Telephone inquiries services are also available in each state and Medibank Private, Medicare and PBS inquiries are quickly followed up by specially trained staff. Separate Medicare and PBS telephone lines are available for practitioners and their receptionists and pharmacists. Correspondence units in each state are able to respond quickly to written inquiries.

BRANCH OFFICES AND PROCESSING CENTRES

The distribution of the Commission’s branch offices is shown in the table above and the list of State Headquarters locations can be found at the end of this report.

In addition to the branch network where staff deal with the public, the Commission’s various processing centres play a crucial part in claims processing. Staff at these centres process Medicare and Medibank Private claims received by post and paid by cheque, as well as pharmacists’ claims.

IN F O R M A T IO N TE C H N O L O G Y

The Health Insurance Commission is a highly computerised organisation with a national network of 4,500 terminals connected to a central computer complex in Canberra. Some two million messages are processed every day to validate cash payments in branches and the issue of 100,000 cheques per day.

The Commission was one of the first organisations in the world to use optical fibre for linking computer equipment. It also recently acquired the most advanced Automated Tape Library system, making it the first organisation in Australasia with this system. The system uses a robot to load high density tape cartridges and transfers information via fibre-optic channels.

27

B B S

The Commission’s assessment of its expertise in computer systems in health care administration was confirmed during the Managing Director’s visit in July 1992 to various computing system suppliers and health industry bodies in the United Kingdom, Canada and the United States.

The Commission’s operations compared favourably with other organisations. Few overseas programs can match the Commission's processing times. Australia, with its national scheme and a national data base, does not have other countries’ problems of separate and unrelated data bases.

DATA SERVICES AN D SECURITY

As detailed in the 1991-92 report the Commission receives much personal information and aims to protect the integrity of its records and the personal information of individuals and organisations. The information held by the Commission is limited to that which allows correct payment of benefits and post payment review. The Commission must establish that people have an entitlement to the benefits they receive, that service providers are authorised and that benefits claimed are for services covered by the programs.

The Commission continues to review its operations and its policies to ensure that the highest level protection of confidential information is maintained.

In addition to the usual review processes undertaken during the year as specified in last year’s report, the Commission has concentrated on developing appropriate operational policies in three particular areas:

• enhancement of computer systems that enable an audit trail of operator access to Medicare and Pharmaceutical Benefits processing systems. Development of systems based on the application of artificial intelligence, which enable the identification of potential concerns, are being assessed;

• a detailed review of the administrative procedures which support the allocation and alteration of employees’ access to Commission computer systems has been undertaken. A number of initiatives ensure that correct procedures will be followed at all times, that the procedures are monitored continually and that any authorisation for access is made at an appropriate level;

• discussions with the Privacy Commissioner's office in relation to matters such as data matching and the maintenance and destruction of data are continuing. The Commission supports the draft data matching guidelines and is now seeking to develop the necessary policies and procedures to enable the guidelines to be applied wherever required.

P r i v a c y A c t C o m p li a n c e A u d i t

During December 1992 the Privacy Commissioner conducted an audit in the Commission’s South Australian Headquarters. This was to determine the extent to which the Commission complies with certain provisions of the Information Privacy Principles. The audit focused on the Pharmaceutical

Benefits Scheme, in particular, the Safety Net Scheme and the Authorities Processing System. The audit indicated that in general terms the controls covering the collection, quality, use and disclosure of personal information were satisfactory.

P R O F E S S I O N A L R E V I E W

OVERVIEW

The Commission is responsible for developing operational policy and implementing strategies for dealing with the prevention, detection and investigation of fraud and excessive servicing in its government programs and also the Medibank Private program.

The Commission’s objective is to ensure that, in support of the highest quality health care, payment of benefits is correctly made for services properly rendered. This is addressed through education and verification, supported by detection,

investigation and management of inappropriate payment.

The policies developed by the Commission are reviewed by the Fraud and Service Audit Committee (FASAC), a Standing Committee of the Board of Commissioners. It is chaired by Ms R.A. Layton and met on ten occasions during the financial year.

It is the Commission's premise that the majority of service providers and the public are honest and ethical in their dealings with the Commission. The Commission’s challenge is to develop a system which does not impose unreasonable administrative burdens on those who are honest while attention is focused on those who are not. The Commission also recognises that the health-care professions are best able to determine appropriate standards of care. It is encouraging to note that the learned colleges are moving towards the adoption of “minimum” or

“appropriate” standards for their members.

M e d ic a l C o n s u l t a n t s

During 1992-93 the Commission continued to employ eminent members of the medical professions as consultants. They provide the Commission with advice in various

specialities and supply feedback from professional groups about the impact of the Commission’s activities. Appointments during 1992-93 are listed at the end of this section.

ED U C A TIO N

The Commission aims to inform service providers and the public about the programs it administers and their

obligations under those programs. Regular feedback is provided to general practitioners about their rendered services and ordering of pathology and diagnostic imaging. Also included is information about the level of services provided or ordered by all general practitioners in each state. This feedback enables practitioners to critically assess their own practices. The Commission’s medical and dental advisers play a major role informing and educating members of the profession. Of particular importance is information provided to new service providers: undergraduates, resident medical officers and family medicine program trainees. The Commission’s pharmacists are also

actively involved with practising pharmacists and doctors.

The Commission's Medical Director, Dr Nearhos, a n d some o f his staff.

VERIFICATION

The Commission needs to verify the correctness of claims for which benefits have been paid. Auditing of pathology and diagnostic imaging practices is regularly undertaken by the Commission’s medical advisers. An extensive audit program of pharmaceutical claims is carried out by Commission pharmacists.

EXCESSIVE S ERVICING

An excessive service is defined by the Health Insurance Act 1973 as one which is not reasonably necessary for the adequate medical, dental or optometrical care of the patient.

When it becomes apparent that an inappropriate benefit payment has occurred, the matter is investigated to determine the reasons for, and the extent of, the inappropriate payment. Where possible instances of excessive servicing have been identified the Commission’s advisers counsel practitioners. Where counselling fails to achieve changed practice patterns, practitioners may be referred to Committees of Inquiry for independent review. The Committees and their determinations during the year are detailed on page 32.

F R A U D

Where criminal matters are concerned, the Commission’s investigators liaise closely with the Australian Federal Police (AFP). In 1992-93 seven practitioners and 49 members of the public were referred for prosecution.

Practitioners who have been convicted of offences against the Medicare program must be referred to a Medicare Participation Review Committee (MPRC) for review of their future participation in the Medicare program. Details of 1992-93 MPRC decisions are provided on page 32.

R e c o v e r y o f M e d i c a r e b e n e f i t s p a i d i n c o r r e c t l y

The amount of $2,002,026 representing benefits paid incorrectly was recovered from providers and the public in 1992-93. This includes recovery of benefits paid to prohibited non-citizens (illegal immigrants), duplicate payment of benefits, recoveries in respect of successful prosecution actions and other instances where benefits have been identified as having been incorrectly paid.

BATES R E P O R T

In 1992 the Commission engaged the services of Harvey Bates & Company to review and report on the Commission’s performance in the conduct of fraud investigations. The Bates Report identified a number of structural and administrative deficiencies which handicapped the Commission’s work. The report also pointed to legislative inadequacies which limited the Commission’s capacity to investigate and prosecute fraud. Following acceptance of the Bates Report the Commission retained Mr Bates as a consultant to assist in the implementation of those of his recommendations which the Commission is able to achieve.

30

AUSTRALIAN NA TION AL A U D I T O F F IC E (ANAO) R E P O R T

On 17 December 1992 the ANAO Report No. 17 entitled "Medifraud & Excessive Servicing” was tabled in Federal Parliament. The ANAO Report concluded that “with the exception of the last 12 months or so, there has been little if any improvement in combating fraud and overservicing”. The theme of the ANAO Report was that

there needed to be administrative changes to enable the Commission to “organise its resources more effectively". Additionally it was recommended that “strengthening of the Commission’s legislative powers” over fraud and excessive servicing would assist in protecting taxpayers who are ultimately

required to meet the cost of abuses of the Medicare system”.

S t r u c t u r a l a n d A d m i n i s t r a t i v e C h a n g e s

In November 1992 the Professional Review Division (PRD) in Central Office was reorganised into functional units reflecting the Division's activities. A unit was established to address the inadequacies

identified by both the Bates and ANAO Reports. National and State Case Management Committees now provide

policy direction, co-ordination and management of individual cases. A national audit plan has also been developed.

L e g i s l a t i v e R e f o r m P r o j e c t

In December 1992 officers began on this project and developed draft proposals to address the issues raised in the Bates and ANAO reports. These and other proposals are currently being examined by representatives from the

Department of Health, Housing, Local Government and Community Services, the Australian Medical Association (AMA) and the Commission.

A u t o m a t e d D a t a A n a l y s i s

These techniques are being used in the ophthalmological, dermatological and general practice disciplines and are being extended to further areas of medical practice.

C O N S U L T A N T S TO T H E C O M M I S S I O N D U R I N G 1 9 9 2 - 9 3

Psychiatry Internal Medicine Pathology Dermatology

Dental Diagnostic Imaging Orthopaedic Ophthalmology Optometry Anaesthesia Neurosurgery

Obstetrics & Gynaecology General Practice

Medical Scientist

Dr John Ellard Dr John B. Hickie Prof Syd Bell Dr Brian Florence

Dr Brian Mor Dr Angus Robertson Mr Kingsley Mills Dr Stephen E. Cains

Ms Heather Waldron Prof Tess Cramond Dr M.R. Fearnside Dr Raymond Newcombe Dr Keith Barnes Dr Paul Hemming Dr Fiona Joske

Dr Noela Whitby Mr Ed Wilson

31

E X T E R N A L C O M M I T T E E S A N D T R I B U N A L S

There are a variety of independent Committees and Tribunals established both under the Health Insurance Act 1973 and the National Health Act 1953 in relation to the Medicare and Pharmaceutical Benefits schemes. Their functions and powers are specified in the Health Insurance Act [sections 79 to 124U] and the National Health Act [sections 107 to 132], The Commission provides administrative support to the committees and tribunals.

Medical practitioners may be referred to the Medical Services Committee of Inquiry (MSCI) or optometrical practitioners to the Optometrical Services Committee of Inquiry (OSCI). During 1992-93, 12 medical practitioners were referred. No optometrical practitioners were referred. Four medical practitioners were found to have rendered excessive services, costing a total of $154,124.95 in Medicare benefits. The Health Insurance Act now provides an administrative penalty equal to the amount determined as payable for the rendering or initiation of excessive services. The penalty amount will be recovered along with the recovery of benefits paid for excessive services, resulting in a total possible repayment of $308,249-90. A further $9,200.15 was found by the MSCI to have been paid for services incorrectly claimed and is to be recovered by the Commission.

Practitioners may appeal a determination by the Minister following reports by the MSCI or OSCI to a Medical Services Review Tribunal or an Optometrical Services Review Tribunal, with further recourse to the Federal Court of Australia.

When possible instances of abuse or contravention of the Pharmaceutical Benefits Scheme are identified, a medical practitioner may be referred to a Medical Services Committee of Inquiry (Pharmaceutical Benefits) by the Minister for Health or his delegate; a pharmacist

may be referred to a Pharmaceutical Services Committee of Inquiry (PSCI) and a dentist to a Dental Services Committee of Inquiry (DSCI). During the year one practitioner was referred to a MSCI(PB) and three pharmacists were referred to a PSCI. Appeals following inquiries by these National Health Act Committees are made to the Administrative Appeals Tribunal.

Practitioners who have been found to have abused the Medicare program must be referred to a Medicare Participation Review Committee (MPRC) for review of their future participation in the Scheme. Three practitioners were referred to the MPRC during

1992-93. One practitioner was reprimanded and two determinations are yet to be made.

A person who is thought to have breached an Approved Pathology Practitioner (APP) or Approved Pathology Authority (APA) undertaking, or been involved in a prohibited diagnostic imaging practice, may also be referred to a MPRC. During 1992-93 one practitioner was referred for a possible breach of an APP undertaking and one practitioner was referred for a possible prohibited diagnostic imaging practice. While no decision has yet been made in the former case, the practitioner involved in the latter case was disqualified for six months as a result of the prohibited diagnostic imaging practice. That practitioner has appealed the determination to the Administrative Appeals Tribunal.

I N T E R N A T I O N A L P R O J E C T S

During 1992-93 the Health Insurance Commission was again invited to participate in a variety of international projects.

The Commission continued to provide assistance to the International Labour Organisation (ILO) and the Government of Indonesia on the development of social health insurance and health care.

In May 1993 the Commission’s Victorian State Manager, Mr John Evered, worked with an international team of ILO officials in Jakarta and Geneva to provide a report on health insurance.

The Commission answered a request by the ILO by providing the services of Mr Marshall Silver, from the Commission’s Information Technology Systems Division,

to assist the Kenyan Government in implementing a new computer system for that country’s social insurance system. Mr Silver spent a year in Kenya on this project.

Mr Michael Parsons a n d M r David Pedler with a delegation o f Thai officials in Australia fo r a health insurance seminar.

M r Malcom Murray in Vietnam with Government officials a n d members o f the WHO team.

The World Health Organisation (WHO) sought the Commission’s participation in its review of Vietnam’s health care structure and financing. All health services in

Vietnam had previously been free to the consumer and all doctors were salaried. In 1989 the Government allowed some rights of private practice and therefore also

introduced the concept of health insurance. The Commission’s General Manager, Finance and Planning, Mr Malcolm Murray, was invited to Vietnam by the WHO in January and in June this year, to participate

in a cost-analysis of hospitals and an examination of the rural population’s response to health insurance.

During 1992-93 the Commission, under the direction of Mr Michael Parsons, General Manager, Private Health Insurance, continued to provide assistance to the

Government of Hungary.

τ

C O M M I S S I O N P E O P L E

STAFFING PR O FILE

Commission staff are employed under the Health Insurance Commission Act. The Commission has continued its successful tradition of employing large numbers of part­ time staff to maintain high standards of customer service during peak hours. Of the 4675 staff employed, 781 work part-time. Using a ratio based on the proportionate number of hours worked, the total number of staff employed converts to 4284 full time staff equivalents.

The proportion of women employed by the Commission has dropped slightly from last year, but remains high at 79.9 per cent. Table (vi) shows the number of staff employed with the Commission at 30 June of each year, regardless of the basis or period of employment.

Table viii

H e a l t h I n s u r a n c e C o m m i s s i o n E m p l o y e e N u m b e r s 1 9 8 9 t o 1 9 9 3

State 1989 1990 1991 1992 1993

Central Office (ACT) 463 539 582 585 64

N ew South W ales 1 275 1 477 1 365 1 383 1 392

Victoria 1 160 1 249 1 251 1 234 1 161

Queensland 566 696 653 683 647

South Australia 348 407 3583 69 346

W estern Australia 364 4263 873 98 382

Tasmania 138 146 142 141 133

Australia 4314 4 940* 4 738 4 793 4 675

As at 30 June 1993

* Pharmaceutical Benefits Scheme transferred to the Commission on 17 July 1989

SKILLS A N D T R A I N I N G

P e r f o r m a n c e A p p r a i s a l

Following the introduction of performance appraisal for the senior executive service, the scheme was extended to senior officers. Performance pay will be available to senior officers and senior executives in 1993-94.

S e n i o r E x e c u t i v e D e v e l o p m e n t

The Commission has continued to focus on the development of present and potential senior managers in order to maintain a core group of highly experienced staff. The Public Service Commission (PSC) has invited the Commission to use its programs in this development.

Training M a n a g e m e n t Developm ent

In 1992-93 the Commission continued to train staff in the core skills identified last year. During the year there was a focus on

management training.

C o m p e t e n c y B a s e d T r a i n i n g

A team has been established to identify the skills and attributes required by the Commission’s administrative staff. Staff at all levels will be involved in validating the

team’s findings. Future training programs will be linked directly to those "competencies”. The introduction of competency based training forms part of the Commission’s enterprise agreement with the Public Sector Union (PSU) and is

expected to be implemented in 1994.

S t a f f A t t i t u d e S u r v e y

The Commission has conducted its second staff attitude survey, with a pleasing response rate of 80 per cent. The Commission uses the Australian Employee Survey Group (AESG) as a benchmark for responses to a number of

questions. In the 1992 survey the Commission compared favourably with the AESG, with 58 per cent of staff indicating that they were satisfied or highly satisfied with the Commission as a whole; the

average AESG response to this question was 44 per cent. The Commission is currently working on some of the problems

staff identified, such as the need to improve communication between supervisors and staff as well as requirements for further supervisory training.

As a result of the staff attitude survey and the competencies identified for senior officers, the Commission is introducing a management development strategy. The strategy will cover progression from supervisory levels to executive management.

It will include provision for in-house development for supervisors, use of consultations for middle and senior level managers, induction training for new senior

executive service (SES) staff, and greater involvement in public sector programs. Rotations will also be encouraged as an adjunct to other development opportunities.

I N D U S T R I A L R E L ATI ON S

During the year the Commission finalised an Enterprise Agreement, which provided three salary increases for all staff. The Agreement will operate for two years, but is

subject to further consultation with the PSU to negotiate another salary increase based on achieved productivity measures in that period.

During 1992 arrangements were made which permitted staff on-line access to their award entitlements and the terms and conditions of employment. This will be followed up during 1992-93 with similar ready access to personnel policies and procedures.

Branch office staff Toowoomba, Queensland

35

OC C U PA TI O N A L HEALTH A N D SAFETY

The Occupational Health and Safety (Commonwealth Employment) Act 1991 came into effect on 6 September 1991. On 6 June 1992, the Commission and the PSU formalised an agreement on how occupational health and safety measures are to be administered in the organisation. The major features of the agreement include:

• an opportunity for staff to have an input into decisions which affect health and safety at work;

• identification of designated work groups (DWGs) which group staff of the Commission by location, type of work performed, nature of the workplace and potential hazard level;

• the appointment and training of occupational health and safety (OH&S) representatives for each of these DWGs;

• agreed OH&S responsibilities for staff at all levels of the Commission and their union;

• a structure of joint committees at the local, state and national level.

During 1992-93 designated work groups have been identified, OH&S representatives have been appointed and trained, and joint committees established at the local and state levels.

A requirement to report on accidents or dangerous occurrences as well as investigations or provisional improvements does not come into force until 29 July 1993 and results will be available for next year’s report.

E Q U A L E M P L O Y M E N T O P P O R T U N I T Y ( E E O )

In September 1992 the Commission submitted its sixth annual EEO report to tire (then) Minister for Health, Housing and Community Services as required under the Equal Employment Opportunity (Commonwealth Authorities) Act 1987.

The Commission considers the integration of EEO into mainstream activities as essential. It has actively sought to link EEO planning more closely with corporate planning and human resource management processes as well as day to day management of operations and decision making. A knowledge of EEO principles is an essential criterion for all supervisory positions. EEO principles are also included in manager and supervisor training.

As part of the Commission’s commitment to workers with family responsibilities, a pilot child care survey was conducted in Central Office. The data evaluations will seek to identify areas where staff are experiencing difficulties in balancing family and work responsibilities. A similar exercise will be conducted in all states after further consultation with the PSU.

36

A U D I T

AUDIT COMMITTEE

The Audit Committee is a Standing Committee of the Commission, which currently consists of two part-time Commissioners, MrW.J. Locke (Chairman)

and Mr R.L. Gradwell. Dr R.J. Morris’ term as a member of the Audit Committee expired during the year and a new member

is yet to be appointed. The Committee operates under terms of reference prescribed by the Board of Commissioners

and reports to the Board. The Committee met on five occasions during the year.

The Committee’s major functions are to review the scope, planning and results of the Commission’s Internal Audit function. It also serves to ensure the independence of the Internal Audit Branch. In particular, the Committee reviews matters arising from completed audits and other management issues raised within the Commission.

The Committee also promotes the co-ordination of Internal Audit and External Audit (Australian National Audit Office) activities.

I N T E R N A L A U DI T

The Internal Audit Branch provides assistance to Commission management and to the Australian National Audit Office by performing audits and clearly

communicating the outcomes.

The responsibilities of the Internal Audit Branch extend to all of the Commission’s operations and systems in both Central Office and the States. The Branch reports

to both the Audit Committee and the Managing Director. Audits are conducted in accordance with a three year plan, which is developed with input from senior

management and approved by the Audit Committee. The plan includes reviews of:

• financial, operational and administrative controls

• existing computer applications systems

• branch office operations

• computer application systems during their design and development phases

• logical and physical security

• legislative compliance

The annual audit plan involved the conduct of around 100 audits including responses to management requests for special reviews.

The performance of management initiated reviews is considered as a positive means of enhancing the service provided by the Internal Audit Branch.

S T A T U T O R Y S T A T E M E N T S

STATUTORY P O W E R S O F THE MINISTER

The Minister responsible for the Health Insurance Commission is Senator the Honourable Graham Frederick Richardson, Minister for Health. Under Section 8J of the Health Insurance Act 1973, the Minister may give written directions to the Commission. This power was not exercised during

1992-93.

F R E E D O M OF I N F O R M A T I O N

The Health Insurance Commission is a prescribed authority under the Freedom of Information Act 1982 and is listed in Part 2 of Schedule Z of that Act, as an agency which is exempt in respect of particular documents, i.e. in relation to documents in respect of its commercial activities. Table ix gives a summary of the Commission’s freedom of information activities during 1992-93.

A description of the Commission and its functions as required by section 8 of the Freedom of Information Act can be found elsewhere in this report. Therefore, this statement is restricted to access information and a list of documents held by the Commission.

One request for internal review was received and finalised during the year. The initial decision was modified on review.

A request under the Freedom of Information Act for access to Commission documents should be made in writing and be accompanied by a $30.00 application fee to:

Freedom of Information Officer Executive Support Branch Health Insurance Commission PO Box 1001 TUGGERANONG ACT 2901

Telephone: 06 203 6311 Facsimile: 06 282 5025

Table ix

H e a l t h I n s u r a n c e C o m m i s s i o n F r e e d o m o f I n f o r m a t i o n 1 9 9 2 - 9 3

Requests on hand at 30 June 1992 3

Requests received 6

Requests finalised 8

Requests outstanding at 30 June 1993 1

Action on requests in 1992-93: lllBliiiaii

access granted in full

access granted in part

access refused

request withdrawn

Requests finalised during 1992-93 in:

0 - 30 days

3 1 - 6 0 days

6 1 - 9 0 days

9 1 days o r m ore

Fees and charges levied in 1992-93:

application fees received $ 160.00

0

0

3

3

0

2

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 the Commission’s State Headquarters can help with initial inquiries. State Headquarters’ telephone numbers are listed at the

back of this report.

The Commission does not hold any publicly accessible documents or documents in accordance with any other Act where access is subject to a fee or charge. Brochures explaining the Medicare program, Pharmaceutical Benefits

Scheme and Medibank Private are available free of charge from Commission branch offices.

Annual statements of Medicare benefits paid on behalf of an individual, which may be used for taxation purposes, are available free of charge and can be requested at any Medicare office.

The following broad categories of documents are held by the Commission:

• administration and policy;

• computer records;

• buildings and property;

• financial management and administration;

• personnel and industrial relations;

• legal opinions and advice; and

• correspondence.

39

P R I N C I P L E S FOR A P P O R T I O N M E N T O F COSTS B E T W E E N F U N C T IO N S

The following principles were determined by the Minister for Health, Housing and Community Services under the provisions of section 34C(1) of the Health Insurance Commission Act 1973, on 26 June 1991.

(1) The Commission will nominate each cost centre within its organisational structure as being either “Medicare", “Medibank Private”, “Pharmaceutical Benefits” or “joint".

(2) All costs incurred by cost centres nominated as “Medicare” will be charged to the Medicare function of the Commission.

(3) All costs incurred by cost centres nominated as “Medibank Private” will be charged to the Medibank Private function of the Commission.

(4) All costs incurred by cost centres nominated as “Pharmaceutical Benefits” will be charged to the functions referred to in Regulations 3D and 3E.

(5) At the end of each calendar month the Commission will calculate the proportion that overhead staff bears to total Commission staff. This ratio will be the “Pharmaceutical Benefits ratio”.

(6) The Pharmaceutical Benefits ratio will be applied to the costs in "Pharmaceutical Benefits” cost centres and the resulting value will be charged to the functions referred to in Regulations 3D and 3E.

(7) All references in this determination to numbers of computer transactions will be taken to mean computer transactions weighted to reflect the relative time taken to process each transaction.

(8) Costs incurred by cost centres nominated as “joint”, and computer transactions processed by the Commission will be categorised as relating to either: • contributions; • enrolment and membership;

• claims; • branches' overhead; • branches; and • processing centres.

(9) Where a cost centre cannot be reasonably nominated as relating totally to a category mentioned in the preceding paragraph, the costs incurred by that cost centre will be distributed to categories relevant to that cost centre in the proportions that the number of computer transactions for each relevant category bear to the total number of computer transactions for all relevant categories.

(10) All costs incurred by cost centres nominated as “joint” in central office will be distributed to all states in the proportions that the number of computer transactions for each state, in each category of costs, bears to the total number of computer transactions for all states in the same category of costs. When recorded in state's records, the costs from central office will be entered under the same category of costs as they were in central office records.

(11) The total costs incurred by cost centres nominated as “joint” in state’s records and those costs transferred from central office will be reduced by the amount charged to those functions referred to in Regulations 3D and 3E per paragraph (6). The reduction will be apportioned between the categories referred to in paragraph (9) in the proportions that the costs charged to each category bear to the total cost of all categories.

(12) The net costs incurred by cost centres nominated as “joint” in state's records and those costs transferred from central office will be charged to the Medicare function and the Medibank Private function of the Commission as follows:

(i) costs categorised as “contributions” will be charged to the Medibank Private function;

(it) costs categorised as “enrolment and membership” will be charged to each function on the basis of the share of the number of enrolment and membership transactions of each function in each state;

40

(iii) costs categorised as “claims" will be charged to each function on the basis of the share of the number of claims transactions of each function in each state;

(3) All references in this determination to “Pharmaceutical Benefits ratio” will refer to the ratio as calculated under paragraph (5) of the determination made under section 34C(1) of the Act.

(iv) costs categorised as "branches overhead” will be charged to each function on the basis of the share of the number of computer transactions of each function that were

processed in branch offices in each state;

(v) costs categorised as “branches” will be charged to each function on the basis of the share of computer transactions processed through each branch office for each function;

(vi) costs categorised as "processing centres” will be charged to each function on the basis of the number of computer transactions processed

through each processing centre for each function.

(13) The apportionment process undertaken with this determination will be applied at the end of each calendar month against all costs

incurred in the financial year to that point, with the exception that the charge to functions referred to in Regulations 3D and 3E as set out

in (6) above will be calculated and charged at the end of each month on the basis of the costs in Pharmaceutical Benefits cost centres and

Pharmaceutical Benefits ratio calculated for that calendar month.

P R I N C I P L E S F O R C A L C U L A T I O N OF ASSETS R E N T A L C H A R G E S

The following principles were determined by the Minister for Health, Housing and Community Services, under the provisions of section 34B(2) of the Health Insurance Commission Act 1973 on 26 June 1991:

(4) All references in this determination to the “other functions ratio” w'ill be taken to mean the result of subtracting the Pharmaceutical Benefits ratio from 100. This result will be

applied as if it were a percentage.

R e n t p a y a b l e b y f u n c t i o n s r e f e r r e d t o i n R e g u l a t i o n s

3 D a n d 3 E o n a s s e t s w h i c h a r e n o t l a n d a n d b u i l d i n g s

(5) The rental payable by the functions referred to in Regulations 3D and 3E to Medicare and Medibank Private on assets wrhich are not land and buildings shall be calculated at the end of each calendar month by applying to the value of assets as defined in (6) hereunder an annual interest rate equivalent to the average bid by successful tenderers to the most recent tender for 3-6 year Commonwealth Bonds; where the most recent tender contains bonds in more than one category in the range of 3 years to 6 years, the shortest term shall be used.

(6) The value of assets as referred to in (5) above is the total net book value of those assets identified under sections 34B(l)(a) and 34B(l)(b) each month which are not land and buildings

multiplied by the Pharmaceutical Benefits ratio.

(7) The rent payable by functions referred to in Regulations 3D and 3E to Medicare and Medibank Private on assets which are not land and buildings will be apportioned between Medicare and Medibank Private in the proportions that the net book value of the assets of each function other than functions

referred to in Regulations 3D and 3E which are not land and buildings bears to the sum of the net book value of assets of Medicare and Medibank Private which are not land and buildings.

R e n t p a y a b l e b y f u n c t i o n s r e f e r r e d t o in R e g u l a t i o n s

3 D a n d 3 E o n l a n d a n d b u i l d i n g s

(1) The identification of assets by the Health Insurance Commission pursuant to section 34B(2) shall distinguish betw een assets which are land and buildings and assets which are not land and buildings.

(2) All references in this determination to numbers of computer transactions will be taken to mean computer transactions weighted to reflect the relative time taken to process each transaction.

(8) The rental payable by functions referred to in Regulations 3D and 3E to Medicare and Medibank Private on assets which are land and buildings shall be calculated at the end of each calendar month by reducing the assessed monthly rental value as defined in (9) hereunder by an amount calculated by applying the other functions ratio to that assessed monthly rental.

(9) The assessed monthly rental value referred to in (8) above is the sum of the annual rental value of assets which are land and buildings identified under sections 34B(l)(a) and 34B(l)(b) as assessed by an independent valuer divided by twelve and reduced by the monthly rental receivable from tenants other than Medicare or Medibank Private or functions referred to in Regulations 3D and 3E.

41

(10) The rental payable by functions referred to in Regulations 3D and 3E to Medicare and Medibank Private on assets which are land and buildings will be apportioned between Medicare and Medibank Private in the proportions that the assessed monthly rental value, as defined in (9) above of each of function other than those referred to in Regulations 3D and 3E bears to the sum of the assessed monthly rental value of Medicare and Medibank Private.

R e n t p a y a b l e t o f u n c t i o n s r e f e r r e d t o in R e g u l a t i o n s 3 D a n d 3 E o n a s s e t s w h i c h a r e n o t l a n d a n d

b u i l d i n g s

(11) The rental payable by Medicare and Medibank Private to functions referred to in Regulations 3D and 3E on assets which are not land and buildings shall be calculated at the end of each calendar month by applying to the value of assets as defined in (12) hereunder an annual interest rate equivalent to the average rate bid by successful tenderers to the most recent tender for 3-6 year Commonwealth Bonds; where the most recent tender contains bonds in more than one category in the range 3 years to 6 years, the shortest term shall be used.

(12) The value of assets as referred to in (11) above is the total net book value of those assets identified under section 34B(l)(c) each month which are not land and buildings multiplied by the other function ratio.

R e n t p a y a b l e t o f u n c t i o n s r e f e r r e d t o in R e g u l a t i o n s 3 D a n d 3 E o n l a n d a n d b u i l d i n g s

(13) The rental payable by Medicare and Medibank Private on assets which are land and buildings shall be calculated at the end of each calendar month by reducing the assessed monthly rental value as defined in (14) hereunder by an amount calculated by applying the Pharmaceutical Benefits ratio to that assessed monthly rental value.

(14) The assessed monthly rental value referred to in (13) above is the annual rental value of assets which are land and buildings identified under section 34B(l)(c) as assessed by an independent valuer divided by twelve and then reduced by the monthly rental receivable from tenants other than Medicare or Medibank Private or functions referred to in Regulations 3D or 3E.

A p p o r t i o n m e n t b e t w e e n M e d i c a r e a n d M e d i b a n k P r i v a t e o f r e n t p a y a b l e p e r p a r a g r a p h s ( I I ) - ( I 4 )

(15) The rental payable by Medicare and Medibank Private to functions referred to in Regulations 3D and 3E on all assets shall be apportioned between Medicare and Medibank Private in the proportion which the computer transactions of each of these two functions bears to the sum of the computer transactions of both functions.

R e n t p a y a b l e b y M e d i c a r e t o M e d i b a n k P r i v a t e

(16) The rental payable by Medicare to Medibank Private on assets which are not land and buildings shall be calculated at the end of each calendar month by applying to the value of assets as defined in (17) hereunder an annual interest rate equivalent to the average rate bid by successful tenderers to the most recent tender for 3-6 year Commonwealth Bonds; where the most recent tender contains bonds in more than one category in the range 3 years to 6 years, the shortest term shall be used.

(17) The value of assets as referred to in (16) above is the total net book value of those assets identified under section 34B(l)(b) each month which are not land and buildings as reduced by an amount calculated by applying the Pharmaceutical Benefits ratio to the total net book value and then further reduced by an amount calculated by applying to the previously reduced value a ratio equivalent to the Medibank Private share of the total number of computer transactions processed in each month.

(18) The rental payable by Medicare to Medibank Private on assets which are land and buildings shall be calculated at the end of each calendar month by reducing the assessed monthly rental as defined in (19) hereunder by an amount calculated by applying the Pharmaceutical Benefits ratio to the assessed monthly rental value and then further reducing it by an amount obtained by applying to the previously reduced value a ratio equivalent to the Medibank Private share of the total computer transactions processed in each month.

42

(19) The assessed monthly rental value referred to in (18) above is the annual rental value of assets which are land and buildings identified

under section 34B(l)(b) as assessed by an independent valuer divided by twelve and then reduced by the monthly rental receivable from tenants other than Medicare or Medibank Private or functions referred to in Regulations 3D and 3E.

R e n t p a y a b l e b y M e d i b a n k P r i v a t e t o

M e d i c a r e

(20) The rental payable by Medibank Private to Medicare on assets which are not land and buildings shall be calculated at the end of each calendar month by applying to the value of

assets as defined in (21) hereunder an annual interest rate equivalent to the average rate bid by successful tenderers to the most recent tender for 3-6 year Commonwealth Bonds; where them most recent tender contains bonds

in more than one category in the range 3 years to 6 years, the shortest term shall be used.

P R I N C I P L E S F O R A P P O R T I O N M E N T 0 E M E D I B A N K PRIVATE I N V E S T M E N T I N C O M E B E T W E E N F U N D S IN EACH STATE

The following principles were determined by the then Minister for Health under the provisions of 36(6B) of the Health Insurance Commission Act 1973 on 4 May 1984:

(1) Income earned each month from specified investments made by the Commission on behalf of nominated health benefits funds will be credited directly to those funds.

(2) Income earned each month from investments made by the Commission on behalf of all health benefits funds will be separated so that the income earned from the investment of capital is distinguished from other investment income earned in

the month.

(3) Income earned each month from the investment of capital will be distributed to the funds in the same proportions that the funds share the total amount of capital.

(4) Other investment income earned each month will be distributed to the funds on the basis of each funds’s share of the total interstate transfer accounts.

(21) The value of assets as referred to in (20) above is the total net book value of those assets as identified under section 34B(l)(a) each month which are not land and buildings as

reduced by an amount calculated by applying the Pharmaceutical Benefits ratio to the total net book value and then further reduced by an amount calculated by applying to the previously

reduced value a ratio equivalent to the Medicare share of the total number of computer transactions processed in each month.

(22) The rental payable by Medibank Private to Medicare on assets which are land and buildings shall be calculated at the end of each

calendar month by reducing the assessed monthly rental as defined in (23) hereunder by an amount calculated by applying the Phamiaceutical Benefits ratio to the assessed monthly rental value and then further reducing

it by an amount obtained by applying to the previously reduced value a ratio equivalent to the Medicare share of the total computer transactions processed in each month.

(23) The assessed monthly rental value referred to in (22) above is the annual rental value of assets which are land and buildings identified

under section 34B(l)(a) as assessed by an independent valuer divided by twelve and then reduced by the monthly rental receivable from tenants other than Medicare or Medibank

Private or functions referred to in Regulations 3D and 3E.

(5) For the purposes of this determination:

(a) Capital is defined as the sum of all moneys provided by the Commonwealth for the establishment or conduct of health benefits funds by the Commission.

(b) Income from the investment of capital is defined as an amount which is calculated by applying to the total sum of capital provided an interest rate equivalent to tire rate of return earned by the total Medibank Private investment pool.

(c) Each interstate transfer account is the surplus funds of each health benefits fund adjusted by a share of the value of assets (excluding investments and accrued investment income) purchased for the total of such surplus funds and by a share of

the value of liabilities (excluding capital and amounts held on behalf of other registered organisations) charged against the operations of all states.

(d) Adjustment of the interstate transfer accounts as required by paragraph (c) of this determination is to be effected by transfer to each interstate transfer account in the same proportion that the number of Medibank Private computer transactions for each

state each month bears to the total number of Medibank Private computer transactions in that month.

43

B O A R D O F C O M M I S S I O N E R S

CHAIRMAN

FREDERICK W. MILLAR, AO, CBE, LLB

Commissioner from 1 November 1978, Chairman from 1 November 1980. Current term expires 31 October 1995.

Chairman of TNT Ltd, Hoechst Australia Ltd, The University of New South Wales Foundation Ltd, Bliss Corporation Ltd, Clutha Ltd, ANZ Managed Investments Ltd, ANZ Life Assurance Co Ltd, Thomson Australian Holdings Pty Ltd and other companies. Chairman of The Australian Ballet Foundation and Director of Ansett Transport Industries Ltd and other companies.

JENNIFER A. ALEXANDER, MBBS, MHP, MComm, FRACMA, FAFPHM, FCHSE

Commissioner from 28 June 1993. Current term expires 27 June 1998.

General Superintendent, Westmead Hospital and Community Health Services.

ANTHONY S. COLE, BEc

Commissioner from 27 May 1993. Current term expires 26 May 1998. '

Secretary, Commonwealth Department of Health, Housing, Local Government and Community Services. Member of the Australian Institute of Health and Welfare and of the Australian Graduate School

of Management Advisory Council.

JOHN S. DEEBLE, BCorn, PHD, Dip Hosp Admin

Commissioner and Deputy Chairman from 25 September 1974 to 16 January 1976. Reappointed as Commissioner 21 December 1983. Current term expires 28 February 1994.

Health Services Fellow, National Centre for Epidemiology and Population Health, Australian National University.

ROBERT L. GRAD WELL, OAM

Commissioner from 1 November 1978. Current term expires

31 October 1995. Member of the Audit Committee from 5 February 1979.

Director of the Australian Postal Corporation. Former Assistant Secretary of the Australia Council of Trade

Unions.

ROBYN A. LAYTON, LLB, QC

Commissioner from 1 November 1985. Current term expires 31 October 1995.

Barrister at Law. Chairperson of the Australian Health Ethics Committee of the National Health and Medical Research Council. Member of the South Australian Churchill Fellowship Committee. Former Judge of the South Australian Industrial Court, former Deputy President of the Administrative Appeals Tribunal and former Chairperson of the Medicare Benefits Review Committee.

WILLIAM J. LOCKE, FCA

Commissioner from 1 October 1986. Current term expires 30 September 1996.

Chairman of the Audit Committee from 3 October 1986.

Chartered Accountant. Deputy Chairman of OPSM Protector Ltd.

LAWRENCE J. WILLETT

Chief Executive from 21 January 1991. Current term expires 20 January 1996.

Director of Commonwealth Funds Management Ltd. Chairman of Jupiters Development Ltd, Deputy

Chairman of Jupiters Management Ltd. Past- President of Building

Owners and Managers Association. Director of Aboriginal and Torres Strait Islander Commercial

Development Corporation.

ROBERT MARR, MBBS, MPH, FAFPHM

Commissioner from 28 June 1993. Current term expires 27 June 1998.

General Practitioner.

M A N A G E M E N T

M AN AG EMENT

Managing Director Mr Lawrence Willett

Commission Secretary Mr John Brewer

General Manager Private Health Insurance Mr Michael Parsons

General Manager Government Programs Mr Ken Hazell

General Manager Information Technology Systems Mr Peter Hatch

General Manager Finance and Planning Mr Malcolm Murray

General Manager Personnel Management Mr John Bentley

General Manager Professional Review Dr John Nearhos

State Manager New South Wales Australian Capital Territory and Northern Territory Mr Grahame Cannon

State Manager Victoria Mr John Evered

State Manager Queensland Mr Neville Dickson

State Manager South Australia Mr Pat McKinney

State Manager Western Australia Mr John Coates

State Manager Tasmania Mr John McArdle

F I N A N C I A L S T A T E M E N T S

STATEMENT BT TH E CHAIRMAN AND MANAGING DIRE CTO R

The financial statements of the Health Insurance Commission are presented in a manner aimed at clearly distinguishing between its Medicare, Pharmaceutical Benefits and Medibank Private functions.

They have also been prepared in accordance with the Guidelines for Financial Statements of Public Authorities and Commercial Activities approved by the Minister for Finance.

In our opinion, the Medicare and Pharmaceutical Benefits operating statements and the Medibank Private profit and loss statement show fairly the financial transactions of each function for the year ended 30 June 1993.

It is also our opinion that the Medicare and Pharmaceutical Benefits statements of financial position and the Medibank Private balance sheet show fairly the state of affairs of each function as at 30 June 1993-

It is also our opinion that the statements of cash flows for Medicare, Pharmaceutical Benefits and Medibank Private show fairly the cash flows of each function for the year ended 30 June 1993-

At the date of this certificate there are reasonable grounds to believe that Medibank Private will be able to pay its debts as and w hen they fall due.

F W Millar Chairman

L J Willett Managing Director

I N D E P E N D E N T A U D I T R E P O R T

TO THE MINISTER FOR HEALTH

S c o p e I have audited the financial statements of the Health Insurance Commission for the year ended 30 June 1993 in respect of its Medibank Private, Medicare and Pharmaceutical Benefits functions. The statements comprise an overall statement by the Chairman and Managing Director, notes A to F

explaining common policies for each of its functions and:

for its Medibank Private function:

• Profit and loss statement • Balance sheet • Statement of cash flows, and • Notes to and forming part of the financial statements, and

for each of its Medicare and Pharmaceutical Benefits functions:

• Operating statement • Statement of financial position • Statement of cash flows, and • Notes to and forming part of the financial statements.

The Commissioners of the Health Insurance Commission are responsible for the preparation and presentation of the financial statements and the information contained therein. I have conducted an independent audit of the financial statements in order to express an opinion on them to the Minister for Health.

The audit has been conducted in accordance with Australian National Audit Office Auditing Standards, which incorporate the Australian Auditing Standards, to provide reasonable assurance as to whether the financial statements are free of material misstatement. Audit procedures included examination, on a test basis, of evidence supporting the amounts and other disclosures in the financial statements, and the evaluation of accounting policies and significant accounting estimates. These procedures have been undertaken to form an opinion whether, in all material respects, the financial statements are presented fairly in accordance with Australian accounting concepts and standards and statutory requirements so as to present a view which is consistent with my understanding of the entity’s financial position, the results of its operations and its cash flows.

The audit opinion expressed in this report has been formed on the above basis.

A u d i t O p i n i o n

In accordance with sub-section 42(2) of the Health Insurance Commission Act 1973 I now report that the statements are in agreement with the accounts and records of the Commission, and in my opinion:

(i) the statements are based on proper accounts and records

(ii) the statements show fairly, in accordance with Statements of Accounting Concepts and applicable Accounting Standards, the financial transactions and cash flows for the year ended 30 June 1993 and the state of affairs of the Commission as at that date

(iii) the receipt, expenditure and investment of moneys, and the acquisition and disposal of assets by the Commission during the year have been in accordance with the Health Insurance Commission Act 1973 and, to the extent to which the National Health Act 1953 applied to and in relation to the receipt and expenditure of moneys by the Commission, the receipt and expenditure of moneys have also been in accordance with that Act, and

(iv) the statements are in accordance with the Guidelines for Financial Statements of Public Authorities and Commercial Activities.

P.A. Farrelly Group Director Australian National Audit Office CANBERRA 24 September 1993

NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 JUNE 1993

Health Insurance Commission

A. Explanatory information

The Health Insurance Commission is required by statute to separately account for each of its functions - Medibank Private. Medicare and Pharmaceutical Benefits. However the functions are jointly managed and common accounting policies are applied to the greatest extent possible.

These notes, identified as A through F, explain those common policies. The separate financial statements and notes prepared for each function should be read in conjunction with these common notes.

The separate financial statements of each function provide only summary information with each summary item being detailed in a referenced note. This approach allows full explanation of each significant item.

B. Method of preparation

The accounts of each function of the Health Insurance Commission have been prepared in accordance with the historical cost convention and do not take account of changing money values or, except where stated, current values of assets.

Prior year figures have been am ended as necessary to reflect the current year’s format and to allow valid comparison.

C. Employee entitlements

This description encompasses provisions for holiday pay, long service leave, productivity superannuation and, in the case of Medibank Private, workers’ compensation.

The provision for holiday pay reflects the value of the total recreation leave entitlement of all Health Insurance Commission employees at 30 June 1993. It is determined from examination of employee leave records.

The provision for long service leave reflects the value of the total actual liability at 30 June 1993 plus an allowance for emerging liability. This allowance is set at a threshold of one year’s service.

The provision for long service leave is dissected into current and non-current components based on an estimate of the amount of long service leave likely to become payable within the coming twelve months.

The provision for productivity superannuation reflects the value of total productivity benefits payable to all Health Insurance Commission employees as at 30 June 1990. Liability for the productivity benefit after this date is discharged on a “pay as you go” basis to the Retirements Benefits Office. The provision existing at 30 June 1990 is being written back by the Commission over a five year period which commenced 30 June 1992. This reflects the Commission’s understanding that the current payments to the Retirements Benefits Office include a component aimed at recouping the outstanding liability.

The movement in the value of each provision has been apportioned between the functions of the Commission in accordance with the principles which are described at note F.

Since the introduction of COMCARE on 1 July 1989 the Commission’s liability for workers’ compensation has been discharged on an ongoing basis. Medibank Private, as a commercial activity, is required to meet its share of costs related to those staff injured prior to the introduction of COMCARE. To this end a provision for workers’ compensation is maintained in the Medibank Private accounts.

49

D. Depreciation and amortisation of non-current assets

Non-current assets are depreciated using the straight-line method at rates based on their expected useful economic lives.

E. Apportionment of assets usage between Medicare, Pharmaceutical Benefits and Medibank Private

Section 34B of the Health Insurance Commission Act 1973 requires the Commission to identify the assets owned by each function and to calculate a rental payable by each function for the use each function makes of the other function’s assets. The principles for fixing the rental charge are required to be determined by the Minister. Sub-section 42(3) of the Act requires these principles to be included in the Commission's annual report.

The Act also requires that where the principles are changed from one year to the next the areas of difference are to be referred to in the Commission's annual report.

The principles applied in 1992-93 for Medicare, Pharmaceutical Benefits and Medibank Private are the same as those applied in 1991-92.

The management expenses determined by these provisions are classified as “asset rental charges” for assets other than land and buildings. Rental charges on land and buildings are classified as “occupancy”.

F. Apportionment of expenditure between Medicare, Pharmaceutical Benefits and Medibank Private

Section 34C of the Health Insurance Commission Act 1973 requires expenditure of the Commission which relates to the performance of more than one of its functions to be apportioned between the functions in accordance with principles determined by the Minister. Sub-section 42(3) of the Act requires these principles to be included in the Commission’s annual report. The Act also requires that where the principles are changed from one year to the next the areas of difference are to be referred to in die Commission’s annual report.

The principles applied in 1992-93 are the same as those applied in 1991-92.

50

M edibank Private

PROFIT AND LOSS STATEMENT FOR THE YEAR ENDED 30 JUNE 1993

1992-93 1991-92

Note $000 $000

Operating revenues Contributions 968,259 953,310

2 Investment and other income 36,720 42,750

TOTAL OPERATING REVENUES $1,004,979 $978,060

Operating expenses 3 Benefits 855,058 842,776

4 Management expenses 97,270 94,285

TOTAL OPERATING EXPENSES $952,328 $937,061

OPERATING PROFIT $52,651 $40,999

Accumulated profits at beginning of financial year 204,117 163,118

6 Aggregate of amounts transferred from reserves 2,560 0

ACCUMULATED PROFITS AT END OF FINANCIAL YEAR $259,328 $204,117

The accompanying notes form an integral part of these financial statements.

51

Health Insurance Commission Medibank Private

STATEMENT OF CASH FLOWS FOR YEAR ENDED 30 JUNE 1993

1992-93 1991-92

Note $000 $000

Cash flows from operating activities Inflows:

Contributions 972,547 943,232

Interest income 10,305 10,421

Dividend income 5,029 2,658

Other income 22,411

1,010,292

21,901

978,212

Outflows:

Benefits 855,428 842,217

Management expenses 87,794

943,222

77,885

920,102

19(b) Net cash provided or used by operating activities 67,07058,110

Cash flows from investing activities Inflows:

Investment maturity 634,876 716,061

Proceeds from sale of assets 2,872

637,748

1,257

717,318

Outflows:

Investment purchases 671,890 768,364

Asset purchases 28,115

700,005

10,757

779,121

Net cash provided or used by investing activities (62,257) (61,803)

Net increase or decrease In cash held 4,813 (3,693)

Cash at beginning of reporting period (21,636) (17,943)

19(a) Cash at end of reporting period ($16,823) ($21,636)

The accompanying notes form an integral part of these financial statements.

53

Health Insurance Commission Medibank Private

NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 JUNE 1993

1. Statement of significant accounting policies

1.1 Calculation of contribution income

Contribution income receivable is calculated using contributor records. This calculation is made by reference to contributions processed and contributions in arrears and advance.

1.2 Calculation of outstanding claims

The calculation of outstanding claims is based on membership numbers and estimated drawing rates. The calculation has regard to the record of historical payment patterns of services rendered in each month. The amount estimated to be outstanding as at 30 June 1993 was $64.29 million which has decreased by $0.28 million during the year.

This decrease is included in the item benefits in the profit and loss statement.

The provision also allows for an estimate of management expenses associated with the processing of outstanding claims. This estimate amounts to $7.07 million and is based on the expected ratio of management expenses to benefit payments. The 1992-93 ratio stands at 11.0 per cent the same rate that occurred in 1991-92. The estimate has decreased by $0.03 million this year and this decrease is included in management expenses in the profit and loss statement (refer note 4).

1.3 Revaluation of fixed assets

The values of land and buildings are reviewed every three years to adjust book values to reflect the current value of such assets. The last review occurred in 1991, and the effect in the change in the market values was brought to account in the 1990-91 financial year. Refer to notes 1.5 and 10.

1.4 Investments

Investments with a maturity date of 12 months or less are shown as current assets in the balance sheet. These investments are shown at market value. Other investments are shown in the balance sheet as non-current assets at market value, except where otherwise specified. Details of each type of investment are shown at notes 9 and 10 respectively.

1.5 Classification of land and buildings

Land and buildings owned by Medibank Private are classified according to the purpose for which they were purchased. Property purchased to provide office accommodation for Commission staff, where the Commission is the major occupant, is classified as property, plant and equipment in the balance sheet. Property purchased where the Commission is not the major occupant is classified as non-current investments in the balance sheet.

54

Health Insurance Commission Medibank Private

2. Investment and other income ($000)

1992-93 1991-92

Investment income Interest 10,333 9,394

Dividends - unrelated corporations 5,029 5,078

Other investment income 4,055 8,039

Profit on equity transactions 387 446

Reversal of previous revaluation decrement 1,854 5,192

Total investment income 21,658 28,149

Assets rental charges (note E) 14,644 13,910

Miscellaneous income 418 691

Total investment and other income $36,720 $42,750

A dissection of this income across each health benefits fund is shown at note 5.1.

Investment and other income is apportioned to each health benefits fund in accordance with principles determined by the Minister under sub-section 36(6A) of the Health Insurance Commission Act 1973. Sub-section 42(3) of the Health Insurance Commission Act 1973 requires these principles to be included in the Commission’s annual report.

3. Benefits ($000)

Under the provisions of the National Health Act 1953 some basic and ancillary hospital benefits paid to each membership may be charged to the reinsurance account. Where a fund has directly paid benefits which are proportionally less than the average of other funds in the State it is required to pay to the reinsurance trust fund an amount equal to the shortfall.

Conversely where the direct payment is proportionally greater than the average the difference is paid to the organisation by the trustees.The benefits paid to members and the payments made to/from the reinsurance trust fund are shown in the table that follows:

NSW V IC O LD SA W A TAS AUST

Benefits paid to 1992-93 235,141 321,670 131,30753,312 47,690 20,373809,493 members 1991-92 237,230 328,580 123,96443,300 46,062 19,051 798,187

Payments to (by) hospital benefits reinsurance 1992-93 6,514 35,232 (2,627) 3,981 2,515 (50) 45,565

trust fund 1991-92 6,582 35,532 (2,997) 3,176 2,051 245 44,589

Total benefits 1992-93 241,655 356,902 128,680 57,293 50,205 20,323 855,058 1991-92 243,812 364,112 120,967 46,476 48,113 19,296 842,776

55

Health Insurance Commission Medibank Private

5.2 Members' Equity

NSW V IC O LD SA W A TAS AUST

Balance at 1 July 1992 70,364 90,105 43,669 11,810 17,563 7,848 241,359

1 July 1991 56,898 77,836 30,872 10,469 14,102 5,023 195,200

Profit / (Loss) 1992-93 16,997 19,094 12,944 (3) 2,576 1,043 52,651

1991-92 12,132 9,953 11,950 1,153 3,060 2,751 40,999

Transfers 1992-93 0 0 2,560 0 0 0 2,560

from reserves 1991-92 0 0 0 0 0 0 0

Movement in 1992-939,907 12,987 2,403 734 1,855 787 28,673

reserves 1991-92 1,334 2,316 847 188 401 74 5,160

Reserves 1992-93 0 0 (1,500) 1,500 0 0 0

transfers 1991-92 0 0 0 0 0 0 0

Balance at 30 June 1993 97,268 122,186 60,076 14,041 21,994 9,678 325,243 30 June 1992 70,364 90,105 43,669 11,810 17,563 7,848 241,359

5.3 Composition of members’ equity

NSW V IC O LD SA W A TAS AUST

Accumulated 1992-93 82,671 96,563 47,425 7,019 18,012 7,638259,328

profits 1991-92 65,674 77,469 33,421 5,522 15,436 6,595 204,117

Capital 1992-93 1,873 0 5,671 1,440 1,021 995 11,000

1991-92 1,873 0 5,671 1,440 1,021 995 11,000

Reserves 1992-93 12,724 25,623 6,980 5.582 2,961 1,045 54,915

(note 7) 1991-92 2,817 12,636 4,577 4,848 1,106 258 26,242

Balance at 30 June 1993 97,268 122,186 60,076 14,041 21,994 9,678 325,243 30 June 1992 70,364 90,105 43,669 11,810 17,563 7,848 241,359

The allocation of capital was approved by the Minister for Health in 1983-84.

6. Aggregate of amounts transferred from reserves

The item shown as aggregate of amounts transferred from reserves in the statement of profit and loss represents the realisation of amounts previously shown as asset revaluation reserve on the sale of 82 Ann Street Brisbane on 30 June 1993 (see note 7.1).

57

Health Insurance Commission Medibank Private

9. Current assets - investments ($000)

30 June 30 June

1993 1992

Debentures 0 1,102

Government and semi-government stocks and bonds 0 17,876

Options in respect of shares 1,925 399

Notes, bills etc of unrelated corporations 66,458 88,576

Unit trusts 6,307 0

Total investments - current assets $74,690 $107,953

All investments at 30 June 1993 are shown at market value. The difference between cost price of $73.7 million and market value of $74.7 million is included in one of either:

(i) management expenses item, where a decrement occurred (ii) the investment revaluation reserve; or (iii) investment and other income.

10. Non-current assets - investments ($000)

30 June 1993

30 June 1992

Shares - listed on an official stock exchange 148,918 93,589

Shares - unlisted 2,782 421

Unit trust (*) 76,782 84,348

Commonwealth and semi-government stocks and bonds 79,813 7,355

Property 7,929 20,681

Notes, bills etc of unrelated corporations 1,663 7,235

Other 190 190

Total investments - non-current assets $318,077 $213,819

All investments at 30 June 1993 are shown at market value as determined by independent valuers with the exception of unlisted shares and other investments, which are at Commissioners’ valuations.

The difference between cost price of $279.6 million and market value of $316.6 million is included in one of either:

(i) management expenses, where a decrement occurred (ii) the investment revaluation reserve; or (iii) investment and other income, where a revaluation increase occun'ed that reverses a decrement previously charged to profit and loss (see note 2).

Medibank Private holds 50 per cent of the shares of Tmck Dock Pty Ltd with an investment of $5.

(*) The investment in unit trust includes an amount of $74.6 million which is indirectly invested in overseas equities ($66.3 million at 30 June 1992).

59

Health Insurance Commission Medibank Private

11. Property, plant and equipment ($000)

30 June 30 June

1993 1992

Land (valuation per notes 1.3 and 1.5) 35,244 29,410

Leasehold land (valuation) 3,000 3,000

Less provision for amortisation (note 13.2) (67) (35)

38,177 32,375

Buildings and improvements (valuation per notes 1,3 and 1.5) 94,636 83,851

Less provision for depreciation (note 13.2) (3,336) (1,763)

91,300 82,088

Equipment furniture and motor vehicles (at cost) 32,007 30,520

Less provision for depreciation (note 13.2) (16,841) (14,366)

15,166 16,154

Leasehold improvements (at cost) 11,942 11,404

Less provision for amortisation (note 13.2) (8,011) (7,140)

3,931 4,264

Net property, plant and equipment $148,574 $134,881

All property, plant and equipment is carried at the lesser of written down cost or recoverable value as required by Australian Accounting Standard AAS10. In determining recoverable value cashflows were not discounted.

12. Creditors ($000)

30 June 1993

30 June 1992

Contributions in advance 117,426 116.262

Creditors 13,396 15,248

Unpresented cheques 20,315 27,189

Total creditors $151,137 $158,699

60

Health Insurance Commission Medibank Private

13. Details of movements in provisions etc. ($000) The following table provides a summary of movements in provisions in the year ended 30 June 1993:

Balance at 30 June 92

Amounts charged to provision in period

Amounts credited to provision in period

Balance at 30 June 93

13.1 Current assets Doubtful debts 22 11 0 11

Total current assets 22 11 0 11

13.2 Non-current assets Depreciation (buildings) 1,763 121 1,694 3,336

Depreciation (equipment furniture and motor vehicles) 14,366 2,281 4,756 16,841 Amortisation (leasehold improvements) 7,140 1,067 1,938 8,011

Amortisation (leasehold land) 35 0 32 67

Total non-current assets 23,304 3,469 8,420 28,255

13.3 Current liabilities Holiday pay (note C) 2,859 2,338 2,481 3,002

Long service leave (note C) 480 426 453 507

Outstanding claims (note 1.2) 71,669 71,669 71,359 71,359

Total current liabilities 75,008 74,433 74,293 74,868

13.4 Non-current liabilities Workers’ compensation (note C) 1,590 88 547 2,049

Long service leave (note C) 5,521 0 315 5,836

Productivity superannuation (note C) 1,125 12 (223) 890

Total non-current liabilities 8,236 100 639 8,775

Total provisions $106,570 $78,013$83,352 $111,909

14. Payments to Commissioners

Total payments to part-time Commissioners by way of allowances for the year amounted to $111,678 compared with $103,437 in 1991-92. The Medibank Private share of the total payments for 1992-93 was $23,050 compared with $22,301 in 1991-92.

The total amount paid by the Commission was distributed to part-time Commissioners as follows:

Number of

Income Received Commissioners

<$10,000 0

$10,001 - $20,000 6

$20,001 - $30,000 1

61

Health Insurance Commission Medibank Private

19. Statement of cash flows

The following notes provide a reconciliation of the cash at the end of the period, as shown in the statement of cash flows, and cash as per the balance sheet and a reconciliation of the cash flow from operating activities with the operating profit/loss shown in the profit and loss statement:

(a) Cash on hand ($000)

1992-93 1991-92

Cash on hand and at bank 3,492 5,553

Unpresented cheques (20,315) (27,189)

($16,823) ($21,636)

(b) Cash flows from operating activities ($000)

Operating profit 52,651 40,999

Amounts credited to provisions 83,352 82,485

Amounts charged to current provisions (74,444) (73,128)

Amounts charged to non-current provisions (100)(79)

Decrease/increase in receivables 5,917 (3,674)

Decrease/increase in creditors (688) 13,721

Decrease/increase in investment income accrual 28 (497)

Revaluation increase (1,361) (1,681)

GainZ(loss) on sale 1,715 (36)

Net cash from operating activities $67,070 $58,110

(c) Financing facilities Medibank Private maintained its standby credit arrangement with its bankers during 1992-93 to the extent of $5 million.

63

OPERATING STATEMENT FOR THE YEAR ENDED 30 JUNE 1993

Note

1992-93 $000

1991-92 $000

Cost of services Operating expenses Benefits 5,153,697 4,577,001

4.1 Health program grants 9,962 9,502

4,2 HIB 250 0

5 Management expenses 181,325175,330

Total operating expenses 5,345,234 4,761,833

3

Operating revenues from independent sources Miscellaneous revenue 3,893 4,693

Total operating revenues from independent sources 3,893 4,693

NET COST OF SERVICES 5,341,341 4,757,140

Revenue from government Appropriations Benefits 4,961,233 4,544,000

Administration 177,205168,679

Capital 3,637 0

4.1 Health program grants 10,645 8,601

4.2 HIB 390 0

2 Increase in amount due from Commonwealth 189,317 33,925

TOTAL REVENUE FROM GOVERNMENT 5,342,427 4,755,205

Operating result 1,086 (1,935)

Accumulated operating results at beginning of financial year (54,053) (52,118)

Accumulated operating results at end of financial year (52,967) ($54,053)

The accompanying notes form an integral part of these financial statements.

Health Insurance Commission Medicare

STATEMENT OF FINANCIAL POSITION AS AT 30 JUNE 1993

Note

1992-93 $000

1991-92 $000

Current assets Cash 75,708 72,267

7 Receivables 16,089 24,435

6 Inventories 660 1,213

2 Other 640,091 450,774

Total current assets 732,548 548,689

Non-current assets 9 Property, plant and equipment 14,653 7,633

Total non-current assets 14,653 7,633

TOTAL ASSETS $747,201 $556,322

Current liabilities 8 Creditors 331,121 294,218

17 Leases 2,062 430

10.3 Provisions 390,079 244,622

Total current liabilities 723,262 539,270

Non-current liabilities 10.4 Provisions 16,172 15,349

17 Leases 5,568 590

Total non-current liabilities 21,740 15,939

TOTAL LIABILITIES $745,002 $555,209

NET ASSETS $2,199 $1,113

Equity Capital 55,166 55,166

Accumulated operating results (52,967) (54,053)

TOTAL EQUITY $2,199 $1,113

The accompanying notes form an integral part of these financial statements.

65

Health Insurance Commission Medicare

STATEMENT OF CASH FLOWS FOR YEAR ENDED 30 JUNE 1993

1992-93 1991-92

Note $000 $000

Cash flows from operating activities Inflows:

Miscellaneous revenue Outflows:

2,128 4,452

Benefits 4,974,109 4,550,916

Health program grants 9,962 9,502

HIB 250 0

Management expenses 175,623

5,159,944

165,203

4,725,621

14(b) Net cash used by operating activities (5,157,816) (4,721,169)

Cash flows from investing activities Inflows:

Proceeds from sale of assets Outflows:

458 11,763

Finance lease payments 2,177 12,584

Asset purchases 2,916

5,093

2,187

14,771

Net cash used by investing activities (4,635) (3,008)

Cash flows from government Inflows:

Benefit appropriation 4,961,233 4,544,000

Administration appropriation 177,205168,679

Health program grants 10.645 8,601

Capital appropriation 3,637 0

HIB 390 0

Net cash provided by government 5,153,110 4,721,280

Net increase or decrease in cash held (9,341) (2,897)

Cash at beginning of reporting period (130,247) (127,350)

14(a) Cash at end of reporting period ($139,588) ($130,247)

The accompanying notes form an integral part of these financial statements.

66

Health Insurance Commission Medicare

NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 JUNE 1993

1. Statement of significant accounting policies

1.1 Capital

The capital of Medicare is defined as the sum of all parliamentary appropriations received for the acquisition of property, plant and equipment.

1.2 Calculation of outstanding claims

Outstanding claims for Medicare benefits refers to the estimated value of benefits which will be payable for services rendered prior to 30 June 1993 but for which claims have not been lodged or processed at 30 June 1993. The amount estimated to be outstanding at 30 June 1993 was $365.2 million which has increased by $140.4 million during the year. The provision for outstanding claims is included in the item provisions in current liabilities.

The calculation of the amount is based on estimates of the size of the Australian population and estimated drawing rates. The calculation has regard to the historical record of payment patterns for services rendered in each month.

The provision also includes an estimate of the management expenses expected to be incurred in the processing of the outstanding claims. This latter estimate amounts to $14.6 million and is based on the expected ratio of management expenses to benefit payments. The 1992-93 ratio stands at 4.0 per cent which has decreased from 4,5 per cent in 1991­ 92. The estimate has increased by $4.5 million this year and this increase is included in management expenses in the operating statement (refer note 5).

2. Current asset - Other ($000)

This item is comprised solely of amounts due from the Commonwealth. This represents the amount of liabilities relating to benefits and administration expenditure that have been incurred but which will not become payable by the Commonwealth until some future date. This is calculated as follows:

30 June 30 June

1993 1992

Provision for outstanding claims 365,236 224,859

Provision for cost of processing outstanding claims 14,609 10,118

Provision for long service leave 14,909 13,315

Provision for holiday pay 9,041 8,580

Provision for productivity superannuation 2,456 3,099

Provision for doubtful debts 128188

Processed but unpaid benefits 104,046 74,997

Benefit cheques drawn but unpresented 187,207 174,351

Liability for future lease payments 7,630 1,026

Gross future liabilities 705,262 510,533

Less advance from Commonwealth (65,171) (59,759)

Net amount due from Commonwealth $640,091 $450,774

All of this amount is expected to become payable in 1993-94.

The increase in the amount due from Commonwealth of $189-3 million ($33.9 million in 1991-92) in the operating statement is the difference between the amounts owed at 30 June each year.

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Health Insurance Commission Medicare

10. Details of movements in provisions etc. ($000)

The following table provides a summary of movements in provisions in the year ended 30 June 1993 and the classification under which they are shown in the statement of financial position:

Balance at 30 June 92

Amounts charged to provision in period

Amounts credited to provision in period

Balance at 30 June 93

10.1 Current assets Doubtful debts 188 16 (44) 128

Total current assets 188 16 (44) 128

10.2 Non-current assets Depreciation (equipment, furniture and motor vehicles) 10,979 906 1,391 11,464 Amortisation (leasehold improvements) 1,195 81 248 1,362

Amortisation (lease) 6,023 6,554 2,197 1,666

Total non-current assets 18,197 7,541 3,836 14,492

10.3 Current liabilities Holiday pay (note C) 8,580 7,042 7,503 9,041

Long service leave (note C) 1,065 977 1,105 1,193

Outstanding claims (note 1.2) 234,977 234,977 379,845 379,845

Total current liabilities 244,622 242,996 388,453 390,079

10.4 Non-current liabilities Long service leave (note C) 12,250 0 1,466 13,716

Productivity superannuation 3,099 29 (614) 2,456

Total non-current liabilities 15,349 29 852 16,172

Total provisions $278,356 $250,582 $393,097 $420,871

11. Payments to Commissioners

Total payments to part-time Commissioners by way of allowances for the year amounted to $111 678 compared with $103 437 in 1991-92. The Medicare share of these totals was $71 496 compared with $65 393 in 1991-92.

The total amount paid by the Commission to part-time Commissioners was distributed as follows:

Number of

Income Received Commissioners

<$10,000 0

$10,001 - $20,000 6

$20,001 - $30,000 1

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Health Insurance Commission Medicare

12. Executive remuneration

Payments to executives by way of remuneration received, or due and receivable, in excess of $100,000 per officer for the year amounted to $1,184 million compared with $1,160 million in 1991-92. The Medicare share of total payments for 1992-93 was $757 697 compared with $734 000 in 1991-92.

These payments were distributed as follows:

Income Received

Number of Commissioners

$100,000-$110,000 1

$110,000 -$120,000 7

$120,000-$130,000 1

$130,000-$140,000 0

$140,000-$150,000 1

13. Audit fees

Management expenses include an amount of $289 283 being the Medicare share of total audit fees of $490 000 payable to the Australian National Audit Office. In 1991-92 the total audit fee was $516 203 of which the Medicare share was $289,437.

The Australian National Audit Office received no other benefits.

14. Statement of cash flows

The following notes provide a reconciliation of the cash at end of the period, as shown in the statement of cash flows, and cash in the statement of financial position and a reconciliation of the cash flows from operations with the operating result as shown in the operating statement:

(a) Cash on hand ($000)

1992-93 1991-92

Cash on hand and at bank 75,708 72,267

Unpresented cheques (215,296) (202,514)

Total cash at end of reporting period ($139,588) ($130,247)

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Health Insurance Commission Medicare

(b) Cash flows from operating activities ($000)

Operating result 1,086 (1,935)

Amounts credited to provisions 393,097 248,888

Amounts charged to current provisions (243,012) (249,226)

Amounts charged to non-current provisions (29) (19)

Decrease/increase in receivables 8,406 (5,860)

Increase in creditors 24,121 42,298

Decrease in inventory 553 113

Gain/loss on sale 30 (421)

Interest on financing lease 359 198

Inflows from government (5,153,110) (4,721,280)

Movement in amount due from the Commonwealth (189,317) (33,925)

Net cash used in operating activities ($5,157,816) ($4,721,169)

15. Department of Veterans’ Affairs (DVA) ($000)

15.1 By virtue of Regulation 4 issued pursuant to Section 8E of the Health Insurance Commission Act 1973 responsibility was assigned to the Health Insurance Commission for the processing of claims received by the Repatriation Commission in respect of medical treatment under Division 2 of Part IV of the Seamens’ War Pensions and Allowances Regulations and Part V of the Veterans’ Entitlements Act 1986 for the preparation and issue of cheques in respect of those claims.

The table below summarises this activity:

1992-93 1991-92

Amount owed by DVA 1 July 16,881 12,768

Benefits processed on behalf of DVA 510,895 469,113

527,776 481,881

Less advance from DVA 520,300 465,000

Balance owed by DVA 30 June $7,476 $16,881

The balance owed by DVA at 30 June is included in the receivables figure (note 7) in the statement of financial position.

15.2 The fees received from DVA for the processing of these services are included in miscellaneous revenue in the operating statement (refer note 3).

73

Pharm aceutical Benefits

OPERATING STATEMENT FOR THE YEAR ENDED 30 JUNE 1993

Note

1992-93 $000

1991-92 $000

16

Cost of services Operating expenses Benefits 1,476,340 1,173,372

11 Repatriation Benefits 81,760 85,708

Stoma Appliances 16,480 15,692

4 Management expenses 41,877 38,378

Total operating expenses 1,616,457 1,313,150

3

Operating revenues from independent sources Miscellaneous revenue 9,911 5,707

Total operating revenues from independent sources 9,911 5707

NET COST OF SERVICES 1,606,546 1,307,443

Revenue from government Parliamentary appropriations Benefits 1,441,938 1,191,180

Repatriation 78,982 88,500

Stoma Appliances 16,600 16,200

Administration 24,384 38,443

2 Increase(Decrease) in amount due from Commonwealth 45,157 (27,119)

TOTAL REVENUE FROM GOVERNMENT 1,607,061 1,307,204

Operating result 515 (239)

Accumulated operating results at beginning of financial year (675) (436)

Accumulated operating result at end of financial year ($160) ($675)

The accompanying notes form an integral part of these financial statements.

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Health Insurance Commission Pharmaceutical Benefits

STATEMENT OF FINANCIAL POSITION AS AT 30 JUNE 1993

1992-93 1991-92

Note $000 $000

Current assets Cash 15,925 32,954

Receivables 3 0

2 Other 120,574 75,417

Total current assets 136,502 108,371

Non-current assets 5 Property, plant and equipment 26,916 35,251

Total non-current assets 26,916 35,251

TOTAL ASSETS $163,418 $143,622

Current liabilities 7 Creditors 5,498 7,261

6.2 Provisions 129,170 99,918

10 Leases 9,234 8,351

Total current liabilities 143,902 115,530

Non-current liabilities 6.3 Provisions 3,716 3,573

10 Leases 15,960 25,194

Total non-current liabilities 19,676 28,767

TOTAL LIABILITIES $163,578 $144,297

NET ASSETS ($160) ($675)

Equity Capital 0 0

Accumulated operating results (160) (675)

TOTAL EQUITY ($160) ($675)

The accompanying notes form an integral part of these financial statements.

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Health Insurance Commission Pharmaceutical Benefits

STATEMENT OF CASH FLOWS FOR YEAR ENDED 30 JUNE 1993

1992-93 1991-92

Note $000 $000

Cash flows from operating activities Inflows:

Miscellaneous revenue 9,905 5,708

Outflows:

Benefits 1,448,038 1,182,350

Repatriation benefits 81,760 85,708

Stoma appliances 16,480 15,692

Management expenses 28,349 26,185

1,574,627 1,309,935

8(b) Net cash used by operating activities (1,564,722) (1,304,227)

Cash flows from investing activities Inflows:

Proceeds from sale of assets Outflows:

90 6,887

Finance lease payments 13,118 17,015

Asset purchases 125 128

13,243 17,143

Net cash used by investing activities (13,153) (10,256)

Cash flows from government Inflows:

Administration appropriation 24,384 38,443

Benefits appropriation 1,441,938 1,191,180

Repatriation appropriation 78,982 88,500

Stoma appliances appropriation 16,600 16,200

Net cash provided by government 1,561,904 1,334,323

Net increase or decrease in cash held (15,971) 19,840

Cash at beginning of reporting period 31,013 11,173

8(a) Cash at end of reporting period $15,042 $31,013

The accompanying notes form an integral part of these financial statements.

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Health Insurance Commission Pharmaceutical Benefits

NOTES TO AND FORMING PART OF THE FINANCIAL STATEMENTS FOR THE PERIOD ENDED 30 JUNE 1993

1. Statement of significant accounting policies

1.1 Capital

The capital of Pharmaceutical Benefits is defined as the sum of all parliamentary appropriations received for the acquisition of property, plant and equipment.

1.2 Calculation of outstanding claims

Outstanding claims for Pharmaceutical Benefits refers to the estimated value of benefits for which claims have been lodged prior to 30 June 1993 but not processed at 30 June 1993. The amount estimated to be outstanding at 30 June 1993 was $123.2 million ($94.9 million at 30 June 1992). The provision for outstanding claims is included in the item provisions in current liabilities.

The calculation of the amount is based on estimates of the lag time between the lodging of a claim and its subsequent payment.

There is also a provision for the estimate of the management costs expected to be incurred in the processing of the outstanding claims. This latter estimate amounts to $3.6 million ($2.8 million at 30 June 1992) and is based on the expected ratio of management expenses to benefit payments. This estimate has increased by $0.8 million since 30 June 1992 and is included in management expenses in the operating statement (refer note 4).

2. Current assets - other ($000)

This item is comprised solely of amounts due from the Commonwealth which represents the amount of liabilities which have been incurred but which will not become payable by the Commonwealth until some future date. This is calculated as follows:

30 June 1993

30 June 1992

Provision for outstanding claims 123,192 94,890

Provision for cost of processing outstanding claims 3,572 2,752

Provision for long service leave 3,658 3,402

Provision for holiday pay 2,113 443

Provision for productivity superannuation 351 2,004

Provision for doubtful debts 0 0

Benefits cheques drawn but unpresented 883 1,941

Liability for future lease payments 25,194 33,545

Gross future liabilities 158,963 138,977

Less advances from the Commonwealth (38,389) (63,560)

Net amount due from the Commonwealth $120,574 $75,417

All of this amount is expected to become payable in 1993-94.

The increase in the amount due from Commonwealth of $45.2 million (decrease of $27.1 million in 1991-92) in the operating statement is the difference between the amounts owed at 30 June each year.

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Health Insurance Commission Pharmaceutical Benefits

5. Property, plant and equipment ($000)

30 June 1993

30 June 1992

Equipment, furniture and motor vehicles (at cost) Less provision for depreciation (note 6,1) 1,464 (606)

1,424 (405)

Leasehold improvements (at cost) Less provision for amortisation (note 6.1) 175 (173)

858

175 (150)

1,019

Equipment lease Less provision for amortisation (note 6,1) 39,531 (13,475)

2

39,704 (5,497)

25

26,056 34,207

Net property, plant and equipment $26,916 $35,251

The recoverable amount test has not been applied to the Pharmaceutical Benefits non-current assets in accordance with Australian Accounting Standard AAS10.

6. Details of movements in provisions etc. ($000)

The following table provides a summary of movements in provisions in the year ended 30 June 1993 and the classification under which they are shown in the statement of financial position:

Balance at 30 June 92

Amounts charged to provision in period

Amounts credited to provision in period

Balance at 30 June 93

6.1 Non-current assets Depreciation (equipment, furniture and motor vehicles) 405 40 241 606 Amortisation (leasehold improvements) 150 10 33 173

Amortisation (lease) 5,497 173 8,151 13,475

Total non-current assets 6,052 223 8,425 14,254

6.2 Current liabilities Holiday pay (note C) 2,004 1,610 1,719 2,113

Long service leave (note C) 272 235 256 293

Outstanding claims (note 1,2) 97,642 97,642 126,764 126,764

Total current liabilities 99,918 99,487 128,739 129,170

6.3 Non-current liabilities Long service leave (note C) 3,130 0 235 3,365

Productivity superannuation 443 5 (87) 351

Total non-current liabilities 3,573 5 148 3,716

Total provisions $109,543 $99,715 $137,312 $147,140

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Health Insurance Commission Pharmaceutical Benefits

7. Creditors ($000)

30 June 30 June

1993 1992

Administrative creditors 4,615 5,320

Unpresented cheques 883 1,941

Total creditors $5,498 $7,261

8. Statement of cash flows

The following notes provide a reconciliation of the cash at the end of the period, as shown in the statement of cash flows, and cash in the statement of financial position and a reconciliation of the cash flows from operations with the operating result, as shown in the operating statement:

(a) Cash on hand ($000)

1992-93 1991-92

Cash on hand 15,925 32,954

Unpresented cheques (883) (1,941)

Total cash at end of reporting period $15,042 $31,013

(b) Cash flows from operating activities ($000)

1992-93 1991-92

Operating result 515 (239)

Amounts credited to provisions 137,312 105,766

Amounts charged to current provisions (99,487) (101,167)

Amounts charged to non-current provisions (5) (9)

Increase in receivables 3 245

Increase/decrease in creditors 705 (3,773)

Gain/loss on sale 5 14

interest on financing lease 3,291 2,140

Inflows from Government (1,561,904) (1,334,323)

Movement in amount due from government (45,157) 27,119

Net cash used in operating activities ($1,564,722)($1,304,227)

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Health Insurance Commission Pharmaceutical Benefits

13. Payments to Commissioners

Total payments to part-time Commissioners by way of allowances for the year amounted to $111,678 compared with $103,437 in 1991-92. The Pharmaceutical Benefits share of this total was $17,131 compared with $15,743 in 1991-92.

The total amount paid by the Commission to part-time Commissioners was distributed as follows:

Number of

Income Received Commissioners

<$10,000 0

$10,001 -$20,000 6

$20,001 - $30,000 1

14. Executive remuneration

Payments to executives by way of remuneration received, or due and receivable, in excess of $100 000 per officer for the year amounted to $1,184 million compared with $1,160 million in 1991-92. The Pharmaceutical Benefits share of this total was $181 554 compared with $177 000 in 1991-92.

These payments were distributed as follows:

Number of

Income Received Executives

$100,000-$110,000 1

$110,001 -$120,000 7

$120,001 -$130,000 1

$130,001 -$140,000 0

$140,001 -$150,000 1

15. Economic dependency

As a Commonwealth statutory body, the Health Insurance Commission is economically dependant on the Commonwealth for the funding of the Pharmaceutical Benefits Scheme. The Health Insurance Commission receives appropriation monies from the Commonwealth for administration and benefit expenditure which is brought to account in the operating statement.

16. Pharmaceutical Benefits payments

The Health Insurance Commission has an objective to ensure that only patients who have an entitlement to free or concessional pharmaceutical benefits receive those benefits. The Commission is continuing to improve checking procedures but the eligibility of all patients to free or concessional prescriptions was not able to be checked in 1992­ 93. Some payments to pharmacists have been made for patients who have no such entitlements contrary to sub­ section 99(2) of the National Health Act.

83

M E D I C A R E S T A T I S T I C A L T A B L E S

E x p l a n a t o r y n o t e s

The statistics presented in this section relate only to the Commission’s Medicare operations. By­ publishing a range of statistics, the Commission hopes to ensure that debate about the Medicare program is well informed. Interested persons and organisations may request further statistical information by contacting the Commission’s Statistics Branch in its Canberra headquarters. The statistical tables which follow include only those services which qualify for Medicare benefits. Any apparent discrepancies in addition in the tables are due to rounding.

E n r o l m e n t s ( T a b le s I a n d 2)

Tables 1 and 2 refer to the enrolment status of individuals as at 30 June 1993. A person must be enrolled with Medicare before a claim for Medicare benefits will be paid. Each eligible person may have his or her own card (eg a single person without dependents) or be on another person’s card (eg a dependant child) or on two cards (eg a child of separated parents).

S e r v ic e s a n d B e n e f it s (T a b le s 3 t o 1 6 )

Tables 3 to 16 relate to professional services included in claims processed by the Commission during 1992-93, irrespective of when those services were rendered. The time lag between the date of service and the date of processing (see table 15) makes it impossible to produce reliable statistics on services rendered in a given period until many months after the end of that period.

All services eligible for Medicare benefits are described in the Medicare Benefits Schedule and each service is given an item number. All items in the Schedule have been grouped by broad type of service as follows:

B R O A D T Y P E O F S E R V IC E IT E M N U M B E R S

33,35, 36, 37, 38, 39, 40, 43, 44, 47,48, 49, 50, 51

Non-Vocationally Registered 52,53, 54,57, 58, 59, 60, 65, 66, 69, 71,72, 81,83,84, 86,87,89, 90, 91,92,93, 95,96

Other General Practitioners 1,2, 5, 6, 7,8,9,10,11,12,15,16, 17,18, 21,22,27,28,29, 30,31, 32, 34,41,42,45,46,55,56, 61, 62,63,64,67, 68, 70, 74, 75, 76, 77,78, 79, 82, 97,98,101,160,161,

162,163,164,170,171,172,173, 980,996, 997, 998, 73, 80,17600

Specialists 85,88, 94,100,102-159,177,189,

851,852, 886-893,17603,10801-10815

Obstetrics 190-383, 9011,16500-16573

Anaesthetics 401 -577, 748-764, 767, 9021-9060,

17901 -17959,18101-18122,18200-18224, 17986-18010,18013,17500,17965-17983

Pathology Collection Items 73901-73921

Pathology Other 1001-2399, 65001-65050,66201-66325

,66343,69201 -69257, 71001 -71151, 72801 -72808,73043-73052, 73281 -73286, 73521 -73530,73801 -73811,73053-73058,

66331,66335,66337,66339,66341,69261, 69263, 69265, 73287, 73289

Diagnostic Imaging 791,793, 794, 910, 911,913, 990-993,

995,999, 2400-2860, 2960-2981,8712, 8713,8716, 8717, 8720, 8721,8723, 8724, 8727-8849, 8851-8874, 9066,9341-9344,38250, 40942, 40969, 55000, 55003, 55004, 55006,

55009, 55012-55018, 55021,55024, 55027, 55028, 55029, 55030, 55031,55032, 55033, 55034, 55035, 55036, 55037, 55038, 55039,55040,55041,55042, 55043, 55044, 55045, 55048, 55049, 55050, 55051,55052, 55053, 55054, 55055, 55056, 55057, 55100, 55102, 55103, 55105, 55106, 55112, 55118, 55124, 55130,55201,55204,55225, 55231, 55234,55237, 55300 56000-60981, 61200, 61300-61452, 61455-61502, 61109

Operations 924,3004-3058, 3060-3067, 3069-3094,

3096-3102, 3104-3113, 3115, 3116,3118-3127, 3129-3133, 3135-3146, 3148-3174, 3176-3186, 3188-3228, 3231-3244, 3246-3257,3259-3267, 3269-3283, 3285-3289, 3291-3330, 3332-3385, 3387-3392, 3394-3399, 3401-3426, 3428-3455, 3457-3461,3463-3465, 3467-3474, 3476-3482,

3484-3499, 3501-3506, 3508-3520,3522-4825,

85

BROAD TYPE OF SERVICE ITEM NUMBERS

Operations (cont) 4826-4840, 4842-4861,4863-5248, 5250-5258, 5260-5273, 5275-5281,5283-5285, 5287-5290, 5292-5861,5862-7127, 7129-7133, 7135-7145, 7147-7401,7403-7484, 7486-7719, 7721,7722, 7725, 7727, 7728, 7730,7732-7744, 7746-7752, 7754-7769,7771-7803, 7805-7811, 7813-7817, 7819-7823,7825-7830, 7832-7835, 7837-7840, 7842-7848, 7850-7887, 7889-7906, 7908-8005, 8007-8174,8176-8459, 8461-8463, 8465-8467, 8469-8478, 8480, 8481, 8483-8505, 8507-8513, 8515-8519,8521-8557, 8559-8561,8565, 8567-8571,8573-8575, 8577-8579, 8581-8637, 8639-8641,8643-8645, 8647-8649, 8651-8653, 8655-8658, 8660, 8662, 8664, 8666, 8668, 8670, 8672, 8674-8699, 9401-9409, 9415-9435, 9440-9449, 9458, 9476-9850, 30000-30032, 30035, 30038-30045, 30048, 30049, 30052-30061, 30064, 30067, 30068, 30071, 30074-30078, 30081-30153, 30156, 30159-30186, 30189-30223, 30224, 30225, 30226, 30229, 30232-30241, 30244-30256, 30259, 30262, 30265, 30266, 30269, 30272, 30275, 30278, 30281-30283, 30286-35003, 35006-35206, 35300-35330, 35500-35729, 36500-36830, 36833-37623, 38470-38766, 38253, 38256, 38259, 38455, 38456, 38457, 38458, 38460, 38462, 38464, 38466,38468, 38469, 38200-38245, 38400-38454, 39000-39818, 39900-39906, 40000-40018, 40100-40118, 40300-40342,40600, 40700-40712, 40800-40903, 41500-41698, 41701,41704-41710, 41713, 41716, 41719, 41722, 41725-41904, 41907, 41910, 42503-42548, 42551-42599, 42602-42608, 42611-42620, 42623-42629, 42632-42713, 42716-42872, 43500-43503, 43506-43512, 43515-43524, 44324-44376, 43800-43860, 44100-44113, 45000-45027, 45030, 45033, 45036-45051,45502, 45552, 45554, 45560, 45563, 45566,45572-45602, 45605, 45753, 45754, 45755, 46363, 46414, 46420,46423, 46426, 46429, 46432, 46450, 46453,47471,47669, 47675,47703, 47735, 47681,47708,47903, 47909, 47912, 47921, 47933,47943, 47945,47960-47966, 47975, 47978, 47981 48200, 48206, 48212, 48218, 48239, 48406, 48409, 48424, 48639, 48654, 48657, 48912,49300, 49306, 49315, 49848, 46366, 48500-48512, 49854, 49869, 49872, 45200,45203, 45206-45239, 45400, 45403, 45439,45442-45451,45500, 45503-45518, 45548, 45521,45551,45524,45527-45545, 46507, 46510, 45608-45611,45614-45644, 45650, 45653, 45647, 45656-45704, 45707, 45710,45713,45716-45725, 45728, 45731, 45734, 45737, 45740, 45761, 45764, 45743,

86

B R O A D T Y P E O F S E R V IC E IT E M N U M B E R S

Operations (cont) 45767-45797, 45746, 45749, 45406-45436,

45752,46300-46360,46369-46411,46417, 46435-46447, 46456-46504, 47000-47468, 47474-47666, 47672,47678, 47684-47702, 47705, 47711-47732, 47738-47900, 47904-47906, 47915-47918,47924-47930, 47936-47942, 47948-47957, 47969-47972, 48203, 48209, 48215, 48221-48236,

\

)

48242-48403, 48412-48421,48427, 48600-48636, 48642-48651,48660-48909, 48915-49227,49303,49309,49312, 49318-49845,49851,49857-49866, 49875-50109,50112, 50115,50118, 50121-50239, 52021,52099-52111, 52117-52120, 52126-52147, 52303-52306, 52324-52330, 52345, 52351,52357, 52363, 52369, 52375, 52821,52824, 53018,

53206-53221,53227-53233, 53403,53409, 53411-53414,53416, 53419-53423, 53425-53429,52603-52625, 52627-52809

Assistance at operations 2951-2957,51300-51309

Optometry 180-186,10900-10929

Radio and Nuclear therapy 2861-2945, 8850, 8875, 8878, 8880, 8882, 8884, 8886, 9381-9392, 15000-15115,15203,15204,15207-15336, 15339-15357,15500-15533,16000-16012

Miscellaneous 770-790, 792, 795-850, 853-885, 894-909,

912, 914-923, 925-979, 981-989, 994, 3059, 3068, 3095,3103,3114, 3117, 3128,3134, 3147,3175,3187,3229, 3230,3245, 3258, 3268, 3284, 3290,

3331,3386, 3393, 3400, 3427, 3456, 3462,3466,3475,3483, 3500,3507, 3521,4841,4862,5249, 5259, 5274, 5282,5286, 5291,7128,7134, 7146, 7402, 7485,7720, 7723, 7724, 7726, 7729, 7731,7745,7753, 7770,7804, 7812,7818,7824, 7831,7836,7841 7849, 7888, 7907,8006, 8175, 8460, 8464, 8468, 8479,8482,8506,8514, 8520, 8558, 8562, 8564, 8566, 8572, 8576, 8580, 8638, 8642, 8646, 8650, 8654,8659, 8661,8663, 8665, 8667, 8669,8671,8673,8700-8711,8714, 8715, 8718, 8719,8722, 8725, 8726,

87

B R O A D T Y P E O F S E R V IC E IT E M N U M B E R S

Miscellaneous (cent) 8901-8990,9061-9065, 9067, 9410-9414, 9436-9439,9450-9457,9459-9475,11600, 13000,13003,11900-11918,13006, 13009,11603-11624,11000-11006, 11009-11027,11300,11303,13100-13112, 11921,13200-13221,11200,11203, 11206-11218,11306-11339,13300-13312, 11221 -11227,11627,11630,11700,11701, 11702,11703,11706,11708,11710,11713, 11718,11721,11709,11711,11712, 12006-12009,12203,12206,12500-12509, 12512,12515,12518,12521,12524,12527, 12530,13012,13809,13812,13815,13818, 13819,13821,13824,13827,13830,13833, 13836,13915,13918,13921,13924,13927, 13930,13933,13936,13939,13942,13945, 13948,1420914056-14095,13400, 11500-11506,13600,13603,13606,11509, 11512,13900-13912,13700-13706,13315, 13709,13318,13800,11715,13803,13806, 11810,11830,11833,12100,12103,12200, 14203,14206,11800,13500,13503,14200, 12106-12109,14050,14053,12000,12003, 27525, 27808, 29214, 29244, 52319, 45758, 52000, 52003, 52006, 52009, 52012, 52015, 52018, 52024,52027, 52030, 52033, 52036, 52039, 52042, 52045, 52048, 52051,52054, 52057, 52060,52063, 52066, 52069, 52072, 52075, 52078, 52081,52084,52087, 52090, 52093, 53000,53003, 53006, 53009, 53012, 53015, 52812, 52815, 52818, 53200, 53203, 53400, 53406, 53410, 53415, 53418, 53424, 53439, 52096, 52318, 52600, 52321, 52300, 52309, 52312, 52315, 52123, 52114, 53224, 52333,52336,52339,52342,52348,52354, 52360, 52366,52372,52378,51700-51703, 51800-51803, 52001,52092, 52122,52148, 52379, 52380, 52382,12112-12115,52420, 52626, 53019,53225,53453,53455, 52055, 75000-75051,75200-75206, 75400-75415, 75600-75609, 75800-75854

88

Patients (Tables 17 to 21)

Tables 17 to 21 are based on services rendered during 1991-92 and processed by the Commission prior to 30 June 1993. The total Medicare enrolled population is the total number of persons eligible for Medicare benefits. Patients are eligible persons who have had at least one Medicare service during the year.

In table 21, the number of general practitioners is the num ber of providers who rendered at least one GP attendance service to the patient during the year.

Definitions

State/territory: determined according to the address (at the time of claiming) of the patient to whom the service was rendered unless otherwise indicated at the foot of the table.

Date o f service: the date on which the provider performed the service.

Date o f lodgement: the date on which the Commission received the claim for Medicare benefit.

Date o f processing: the date on which the Commission processed the payment of a claim for Medicare benefit.

Bill type: the method by which the Medicare benefit was paid.

Cheque to claimant: the person who incurred the expense (usually the cardholder) pays the account raised by the service provider, presents a claim and receives a cheque for the Medicare benefit.

Cheque to provider via claimant: the claimant does not pay the account raised by the service provider, presents a claim, and a cheque for the Medicare benefit, payable to the provider, is posted to the claimant. The claimant then sends this cheque, together with the balance of the account, if any, to the provider.

Cash: the claimant pays the account raised by the service provider, presents a claim and the Medicare benefit is paid in cash to the claimant.

Direct bill: the service provider claims Medicare benefits directly for the services rendered. In this case, the provider must accept the benefit as full payment. There is no cost to the patient.

89

T a b l e 1 a

Medicare: Number of persons enrolled by age and sex - as at 30 June 1993

Age sex groups NSW VIC QLD SA WA TAS ACT

Male-0-4 223,557 161,092 114,921 50,556 63,033 17,635 11,676

5-9 218,384 160,287 116,110 51,852 65,868 18,285 11,571

10-14 214,241 156,623 118,009 50,160 63,482 18,306 11,843

15-19 215,808 162,611 119,443 51,325 62,777 17,881 12,361

20-24 232,327 181,643 122,763 56,924 64,994 18,003 13,269

25-34 451,074 343,031 225,325 110,670 125,406 33,741 23,354

35-44 438,033 324,225 224,366 107,177 127,987 34,359 23,756

45-54 354,302 258,211 182,573 84,307 98,493 27,129 18,497

55-64 257,652 187,328 122,049 62,654 64,635 19,527 9,768

65-74 195,219 138,693 91,114 52,527 46,196 14,330 6,021

75 + 106,553 74,496 51,490 28,004 24,638 8,036 2,562

All males 2,907,150 2,148,240 1,488,163 706,156 807,509 227,232 144,678

Female-0-4 211,167 153,434 109,295 47,703 60,322 16,892 11,116

5-9 208,139 152,997 109,608 49,546 62,488 17,735 11,165

10-14 203,163 149,147 110,827 47,935 60,321 17,451 11,269

15-19 206,992 155,024 114,646 48,722 59,711 17,072 11,918

20-24 235,401 184,667 126,725 56,525 66,008 18,347 13,934

25-34 476,313 364,790 241,784 114,615 135,076 36,603 25,762

35-44 446,583 335,993 229,679 110,358 131,310 35,170 25,521

45-54 342,749 254,822 175,296 84,659 93,186 26,533 18,228

55-64 255,185 187,457 118,740 63,617 63,110 19,700 9,308

65-74 231,222 164,256 103,876 61,120 51,722 17,516 7,040

75+ 186,399 130,591 83,860 48,677 41,034 14,054 4,538

All females 3,003,313 2,233,178 1,524,336 733,477 824,288 237,073 149,799

All persons 5,910,463 4,381,418 3,012,499 1,439,633 1,631,797 464,305 294,477

Total population* 6,021,194 4,495,463 3,062,230 1,471,694 1,674,455 474,774 297,245

Percentage enrolled# 98.16% 97.46% 98.38% 97.82% 97.45% 97.79% 99.07%

‘Population figures are based on the ABS estimated resident population as at 30 June 1993. See Table 1 b for breakdown of total population figures. ffMedicare enrollees include some persons who are not Australian residents (eg long term visitors (greater than 6 months) and eligible short term visitors).

N T

7,849 6,686 6,173 5,931

5,947 13,506 12,708 8,884

3,975 1,530 523

73,712

7,530 6,378 5,920 5,644

6,990 14,485 12,299 6,996

2,872 1,369 693

71,176

144,888

168,842

85.81%

A u s t r a lia

650,319 649,043 638,837 648,137

695,870 1,326,107 1,292,611 1,032,396

727,588 545,630 296,302

8,502,840

617,459 618,056 606,033 619,729

708,597 1,409,428 1,326,913 1,002,469

719,989 638,121 509,846

8,776,640

17,279,480

17,665,897

97.81%

O th e r

70 85 62 56

43 98 164 93

168 182 71

1,092

57 78 76 38

27 117 148 120

187 148 70

1,066

2,158

n/a

n/a

T a b l e 1 b

Medicare: Estimated resident population by age and sex - as at 30 June 1993 (figures supplied by ABS)

A g e s e x g r o u p s N S W V IC Q L D S A W A T A S A C T N T A u s t r a lia

Male-0-4 224,467 166,260 116,436 51,635 65,562 18,185

5-9 221,199 162,606 119,302 53,095 67,490 18,938

10-14 216,631 160,189 118,867 50,897 65,105 18,540

15-19 228,510 173,821 125,540 54,232 65,474 18,358

11,748 11,627 11,658 13,594

8,587 662,880 8,142 662,399 7,328 649,215 6,938 686,467

20-24 242,229 191,269 128,392 60,065 70,067 18,322

25-34 488,291 366,139 242,304 118,270 137,705 36,194

35-44 453,115 336,783 231,571 111,038 134,149 35,415

45-54 349,772 255,719 178,872 83,292 97,523 26,784

15,002 25,549 24,654

17,540

8,263 733,609 17,584 1,432,036 14,939 1,341,664

9,580 1,019,082

55-64 261,705 191,817 124,770 65,037 65,997 19,994

65-74 203,895 144,958 97,037 54,022 46,850 15,840

75 + 105,572 78,589 51,202 28,906 25,664 8,805

9,406 5,777 2,396

4,330 743,056 1,779 570,158 591 301,725

All males 2,995,386 2,228,150 1,534,293 730,489 841,586 235,375 148,951 88,061 8,802,291

Female-0-4 213,760

5-9 211,113

10-14 205,661

15-19 216,511

20-24 234,971

25-34 483,828

35-44 447,515

45-54 334,646

55-64 262,296

65-74 235,733

75 + 179,774

All females 3,025,808

158,454 110,245 48,307 62,259

154,473 112,361 50,432 63,658

152,081 111,438 48,411 61,042

165,211 119,677 51,451 62,274

188,107 124,946 57,397 67,254

368,422 242,504 116,423 136,709

338,684 229,028 110,925 131,886

247,617 168,751 81,944 90,191

191,666 122,165 65,257 64,174

169,319 106,204 62,204 52,182

133,279 80,618 48,454 41,240

2,267,313 1,527,937 741,205 832,869

17,498 11,117 8,157 629,797

18,189 11,014 7,842 629,082

17,725 11,197 6,811 614,366

17,375 13,196 6,324 652,019

17,813 14,509 8,375 713,372

37,088 25,533 16,932 1,427,439

35,230 25,082 13,350 1,331,700

25,867 16,662 7,434 973,112

20,141 9,066 3,256 738,021

18,352 6,802 1,582 652,378

14,121 4,116 718 502,320

239,399 148,294 80,781 8,863,606

All persons 6,021,194 4,495,463 3,062,230 1,471,694 1,674,455 474,774 297,245 168,842 17,665,897

N T A u s t r a lia

52,698 5,107,039 10,385 1,709,420 7,338 843,395

7,249 890,157

3,279 415,786

989 117,810

230 25,629

73 7,475

27 2,555

1 22

0 4

0 0

82,269 9,119,292

144,888 17,279,480

149,254 17,664,944

4,366 385,464

1.81 1.94

O th e r

631 322 74 108

36 11 2 1

0 0 0 0

1,185

2,158

2,197

39

1.85

T a b l e 3

Medicare: Number and percentage of services processed by bill type - for services processed from 1 July 1992 to 30 June 1993

Bill type NSW VIC OLD SA WA TAS ACT NT Australia Other

Number-Cheque to claimant 1,760,387 1,549,364 1,039,763 370,636 621,953 84,870 98,598 27,460 5,553,031 343

Cheque to provider via claimant 9,343,106 7,553,184 4,707,804 4,166,421 2,610,043 964,030 352,884 71,347 29,768,819 170

Cash 8,913,429 6,731,805 4,513,822 940,043 1,789,087 924,215 672,723 196,633 24,681,757 93

Direct bill 45,036,691 26,233,277 19,125,631 8,198,949 9,423,066 2,128,262 1,307,512 687,441 112,140,829 564

Total 65,053,613 42,067,630 29,387,020 13,676,049 14,444,149 4,101,377 2,431,717 982,881 172,144,436 1,170

% %

Percentage- Cheque to claimant 2.71 3.68

Cheque to provider via claimant 14.36 17.95

Cash 13.70 16.00

Direct bill 69.23 62.36

Total 100.00% 100.00%

% % % %

3.54 2.71 4.31 2.07

16.02 30.47 18.07 23.51

15.36 6.87 12.39 22.53

65.08 59.95 65.24 51.89

100.00% 100.00% 100.00% 100.00%

% % % %

4.05 2.79 3.23 29.32

14.51 7.26 17.29 14.53

27.66 20.01 14.34 7.95

53.77 69.94 65.14 48.21

1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 %

T a b l e 4

£

Australia Other

926,685 207,741,907 10,668

4,372,504 1,371,927,745 11,690 4,922,518 683,705,393 3,208

15,935,276 2,754,661,789 13,183

$26,156,982 $5,018,036,835 $38,749

Percentage-

% %

Cheque to claimant Cheque to provider

4.01 4.63

via claimant 23.35 28.64

Cash 13.18 15.27

Direct bill 59.46 51.46

Total 100.00% 100.00%

% % % %

4.45 2.45 4.64 2.49

25.54 44.10 28.38 32.52

14.90 5.64 12.19 19.05

55.10 47.82 54.78 45.94

100.00% 100.00% 100.00% 100.00%

% % % %

5.25 3.54 4,14 27.53

25.24 16.72 27.34 30.17

25.38 18.82 13.62 8.28

44.14 60.92 54.90 34.02

100.00% 100.00% 100.00% 100.00%

CD

Medici

Medicare: Average value of benefits processed per service by bill type - for services processed from 1 July 1992 to 30 June 1993

Bill type NSW VIC OLD SA WA TAS ACT NT Australia Other

T a b l e 5

$ $ $ $ $ $ $

Average value-Cheque to claimant 43.36 37.26 35.84 27.11 30.37 34.04 37.21

Cheque to provider via claimant 47.60 47.23 45.45 43.47 44.29 39.20 50.01

Cash 28.17 28.24 27.66 24.63 27.76 23.94 26.38

Direct bill 25.15 24.43 24.13 23.95 23.68 25.08 23.61

$

33.75

61.29 25.03 23.18

$ $

37.41 31.10

46.09 68.77

27.70 34.50

24.56 23.37

All services $29.28 $29.61 $28.50 $30.03 $28.20 $28.33 $28.76 $26.61 $29.15 $33.12

CD

Medicari

T a b l e 6

Broad type of service NSW VIC OLD SA WA TAS ACT NT Australia Other

M e d ic a r e : N u m b e r a n d p e r c e n t a g e o f s e r v ic e s p r o c e s s e d b y b r o a d t y p e o f s e r v ic e - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 t o 3 0 J u n e 1 9 9 3

Number-Vocationally Registered 25,300,577 17,554,314 12,395,941 6,215,253 5,734,145 1,742,501 1,081,320

Non-Vocationally Registered 8,407,417 5,357,534 3,099,426 1,335,002 1,814,157 476,359 255,694

Other General Practitioners 600,075 415,607 301,411 261,531 201,829 49,679 18,606

ALL GENERAL PRACTITIONERS 34,308,069 23,327,455 15,796,778 7,811,786 7,750,131 2,268,539 1,355,620 Specialist attendances 6,233,061 4,335,249 2,409,915 1,478,657 1,175,813 364,209 222,099

Obstetrics 196,222 161,577 80,883 44,375 81,074 16,612 16,013

Anaesthetics 537,357 461,769 283,850 142,749 133,257 41,747 19,430

Pathology Collection Items 4,858,929 2,682,283 2,479,912 915,341 1,227,458 340,168 186,378

Pathology Other 10,829,942 6,195,321 4,744,430 1,679,522 2,277,323 595,152 350,559

ALL PATHOLOGY 15,688,871 8,877,604 7,224,342 2,594,863 3,504,781 935,320 536,937

Diagnostic Imaging 3,598,168 2,158,934 1,467,031 663,796 844,244 199,587 125,737

Operations 1,856,201 1,082,949 997,747 393,909 409,974 104,282 59,673

Assistance at operations 76,450 67,310 54,990 32,834 10,692 3,795 3,067

Optometry 1,076,380 725,654 543,561 229,437 265,195 91,626 50,009

Radio and Nuclear Therapy 136,756 78,388 37,311 28,796 28,819 12,259 5,087

Miscellaneous 1,346,078 790,741 490,612 254,847 240,169 63,401 38,045

Total 65,053,613 42,067,630 29,387,020 13,676,049 14,444,149 4,101,377 2,431,717

% % % % % % %

Percentage-Vocationally Registered 38.89 41.73 42.18 45.45 39.70 42.49 44.47

Non-Vocationally Registered 12.92 12.74 10.55 9.76 12.56 11.61 10.51

Other General Practitioners 0.92 0.99 1.03 1.91 1.40 1.21 0.77

ALL GENERAL PRACTITIONERS 52.74 55.45 53.75 57.12 53.66 55.31 55.75

Specialist attendances 9.58 10.31 8.20 10.81 8.14 8.88 9.13

Obstetrics 0.30 0.38 0.28 0.32 0.56 0.41 0.66

Anaesthetics 0.83 1.10 0.97 1.04 0.92 1.02 0.80

Pathology Collection Items 7.47 6.38 8.44 6.69 8.50 8.29 7.66

Pathology Other 16.65 14.73 16.14 12.28 15.77 14.51 14.42

ALL PATHOLOGY 24.12 21.10 24.58 18.97 24.26 22.81 22.08

Diagnostic Imaging 5.53 5.13 4.99 4.85 5.84 4.87 5.17

Operations 2.85 2.57 3.40 2.88 2.84 2.54 2.45

Assistance at operations 0.12 0.16 0.19 0.24 0.07 0.09 0.13

Optometry 1.65 1.72 1.85 1.68 1.84 2.23 2.06

Radio and Nuclear Therapy 0.21 0.19 0.13 0.21 0.20 0.30 0.21

Miscellaneous 2.07 1.88 1.67 1.86 1.66 1.55 1.56

283,214 70,307,265 190,909 20,936,498 7,485 1,856,223

481,608 93,099,986 60,757 16,279,760 7,444 604,200

8,056 1,628,215

102,840 12,793,309 206,916 26,879,165 309,756 39,672,474 56,265 9,113,762

23,801 4,928,536 972 250,110

26,467 3,008,329 773 328,189

6,982 3,230,875

982,881 172,144,436

% %

28.81 40.84

19.42 12.16

0.76 1.08

49.00 54.08

6.18 9.46

0.76 0.35

0.82 0.95

10.46 7.43

21.05 15.61

31.52 23.05

5.72 5.29

2.42 2.86

0.10 0.15

2.69 1.75

0.08 0.19

0.71 1.88

370 112 11 493

124 1 31 103 221 324

80 43 4 51

0

19

1,170

%

31.62 9.57 0.94 42.14

10.60 0.09 2.65 8.80 18.89 27.69

6.84 3.68 0.34 4.36

0.00 1.62

100.00% 100.00% 100.00% 100.00%

Medici

3

M e d ic a r e : V a lu e a n d p e r c e n t a g e o f b e n e f it s p r o c e s s e d b y b r o a d t y p e o f s e r v ic e - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 to 3 0 J u n e 1 9 9 3

B r o a d t y p e o f s e r v ic e N S W V IC Q L D S A W A T A S A C T N T A u s t r a lia O th e r

$ $

Value-Vocationally Registered 556,605,447 384,455,220 Non-Vocationally Registered 164,955,774 104,800,912 Other General Practitioners 15,916,532 12,581,689 ALL GENERAL PRACTITIONERS 737,477,752 501,837,821

Specialist attendances 291,719,144 206,052,699 Obstetrics 20,163,162 15,974,260

Anaesthetics 34,756,274 29,318,677

Pathology Collection Items 47,960,322 27,726,921 Pathology Other 201,206,113 114,104,856

ALL PATHOLOGY 249,166,434 141,831,777 Diagnostic Imaging 269,799,376 154,703,818 Operations 184,975,024 121,564,762

Assistance at operations 6,677,071 6,062,733 Optometry 41,697,386 28,241,042

Radio and Nuclear Therapy 8,282,233 4,627,445 Miscellaneous 59,998,749 35,276,409

$ $ $ $

267,710,099 136,069,889 122,983,378 38,033,750 59,346,357 26,267,486 34,446,103 9,211,290 8,163,685 8,840,312 5,043,001 1,677,444

335,220,141 171,177,686 162,472,482 48,922,483 112,696,590 69,142,625 53,263,193 16,636,039 8,644,986 4,483,258 5,655,988 1,552,648

17,759,005 9,087,344 8,616,058 2,530,240 25,415,704 8,520,739 12,738,301 3,179,409 93,498,532 32,093,046 42,806,202 10,490,359 118,914,236 40,613,784 55,544,503 13,669,768

99,589,330 46,769,260 55,760,241 14,064,315 95,703,526 44,196,510 41,364,921 11,356,196 4,917,767 2,968,683 1,083,899 338,050

20,948,883 8,880,957 10,569,403 3,603,016 2,471,900 1,833,445 1,842,016 786,161

20,773,106 11,505,110 11,102,432 2,718,314

$ $ $ $

23,530,634 6,111,078 1,535,499,494 8,039 4,938,726 3,672,963 407,639,611 2,165

453,210 213,124 52,888,997 261

28,922,570 9,997,165 1,996,028,102 10.465 10,166,886 2,584,756 762,261,933 5,318 1.196,592 525,247 58,196,142 19

1,297,321 521,626 103,886,545 1,888

1,833,607 984,227 128,359,230 975

6,636,058 3,886,319 504,721,485 4,219

8,469,666 4,870,547 633,080,715 5,194

9,212,389 3,683,671 653,582,401 6,680

6,347,477 2,399,860 507,908,276 5,676

257,127 81,312 22,386,642 452

1,989,934 1,055,098 116,985,719 2,111 306,663 48,225 20,198,087 0

1,758,678 389,475 143,522,273 945

Total $1,904,712,605 $1,245,491,443 $837,639,471 $410,658,663 $407,275,136 $116,177,231 $69,925,304 $26,156,982 $5,018,036,835 $38,749

% %

Percentage-Vocationally Registered 29.22 30.87

Non-Vocationally Registered 8.66 8.41

Other General Practitioners 0.84 1.01

ALL GENERAL PRACTITIONERS 38.72 40.29 Specialist attendances 15.32 16.54

Obstetrics 1.06 1.28

Anaesthetics 1.82 2.35

Pathology Collection Items 2.52 2.23

Pathology Other 10.56 9.16

ALL PATHOLOGY 13.08 11.39

Diagnostic Imaging 14.16 12.42

Operations 9.71 9.76

Assistance at operations 0.35 0.49

Optometry 2.19 2.27

Radio and Nuclear Therapy 0.43 0.37

Miscellaneous 3.15 2.83

Total 100.00% 100.00%

% % % %

31.96 33.13 30.20 32.74

7.08 6.40 8.46 7.93

0.97 2.15 1.24 1.44

40.02 41.68 39.89 42.11

13.45 16.84 13.08 14.32

1.03 1.09 1.39 1.34

2.12 2.21 2.12 2.18

3.03 2.07 3.13 2.74

11.16 7.82 10.51 9.03

14.20 9.89 13.64 11.77

11.89 11.39 13.69 12.11

11.43 10.76 10.16 9.77

0.59 0.72 0.27 0.29

2.50 2.16 2.60 3.10

0.30 0.45 0.45 0.68

2.48 2.80 2.73 2.34

100.00% 100.00% 100.00% 100.00%

% % % %

33.65 23.36 30.60 20.75

7.06 14.04 8.12 5.59

0.65 0.81 1.05 0.67

41.36 38.22 39.78 27.01

14.54 9.88 15.19 13.73

1.71 2.01 1.16 0.05

1.86 1.99 2.07 4.87

2.62 3.76 2.56 2.52

9.49 14.86 10.06 10.89

12.11 18.62 12.62 13.40

13.17 14.08 13.02 17.24

9.08 9.17 10.12 14.65

0.37 0.31 0.45 1.17

2.85 4.03 2.33 5.45

0.44 0.18 0,40 0.00

2.52 1.49 2.86 2.44

100.00% 100.00% 100.00% 100.00%

Table 8 Medicare: Average value of benefits processed per service by broad type of service - for services processed from 1 July 1992 to 30 June 1993

Broad type of service NSW VIC QLD SA WA TAS ACT NT Australia Other

$ $

Average value-Vocationally Registered 22.00 21.90

Non-Vocationally Registered 19.62 19.56

Other General Practitioners 26.52 30.27

ALL GENERAL PRACTITIONERS 21.50 21.51 Specialist attendances 46.80 47.53

Obstetrics 102.76 98.86

Anaesthetics 64.68 63.49

Pathology Collection Items 9.87 10.34

Pathology Other 18.58 18.42

ALL PATHOLOGY 15.88 15.98

Diagnostic Imaging 74.98 71.66

Operations 99.65 112.25

Assistance at operations 87.34 90.07

Optometry 38.74 38.92

Radio and Nuclear Therapy 60.56 59.03

Miscellaneous 44.57 44.61

Total $29.28 $29.61

$ $ $ $

21.60 21.89 21.45 21.83

19.15 19.68 18.99 19.34

27.08 33.80 24.99 33.77

21.22 21.91 20.96 21.57

46.76 46.76 45.30 45.68

106,88 101.03 69.76 93.47

62.56 63.66 64.66 60.61

10.25 9.31 10.38 9.35

19.71 19.11 18.80 17.63

16.46 15.65 15.85 14.62

67.88 70.46 66.05 70.47

95.92 112.20 100.90 108.90

89.43 90.41 101.37 89.08

38.54 38.71 39.86 39.32

66.25 63.67 63.92 64.13

42.34 45.15 46.23 42.87

$28.50 $30.03 $28.20 $28.33

$ $ $ $

21.76 21.58 21.84 21.73

19.31 19.24 19.47 19.33

24.36 28.47 28.49 23.73

21.34 20.76 21.44 21.23

45.78 42.54 46.82 42.89

74.73 70.56 96.32 18.75

66.77 64.75 63.80 60.90

9.84 9.57 10.03 9.46

18.93 18.78 18.78 19.09

15.77 15.72 15.96 16.03

73.27 65.47 71.71 83.50

106.37 100.83 103.05 132.01

83.84 83.65 89.51 113.09

39.79 39.86 38.89 41.40

60.28 62.39 61.54 0.00

46.23 55.78 44.42 49.73

$28.76 $26.61 $29.15 $33.12

Medici

T a b l e 1 0

M e d ic a r e : N u m b e r o f s e r v ic e s p r o c e s s e d b y a g e a n d s e x o f p a t ie n t - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 t o 3 0 J u n e 1 9 9 3

A g e s e x g r o u p s N S W V IC O L D S A W A T A S A C T N T A u s t r a lia

Male-0-4 2,353,666 1,543,834 1,146,061 511,600 544,600 154,359 113,285

5-9 1,280,451 863,789 625,063 275,925 308,553 88,453 59,501

10-14 1,065,672 683,720 553,294 218,923 254,660 76,069 51,459

15-19 1,139,969 745,110 586,378 234,056 261,665 71,355 55,297

52,523 6,419,928 24,078 3,525,813 19,231 2,923,028 18,837 3,112,667

20-24 1,346,771 933,117 606,820 276,835 283,133 76,795 60,435

25-34 3,029,477 1,934,263 1,237,295 611,889 612,636 164,105 116,601

35-44 3,313,176 2,020,941 1,449,629 658,697 717,974 187,211 130,239

45-54 3,396,258 2,014,178 1,495,283 644,146 721,074 195,469 127,543

22,130 3,606,036 58,595 7,764,861 65,384 8,543,251 59,317 8,653,268

55-64 3,795,975 2,277,780 1,498,264 733,772 749,665 215,467 103,663

65-74 3,247,015 2,010,248 1,315,012 737,566 671,538 165,855 78,353

75 + 2,189,308 1,489,241 952,207 512,757 454,091 135,520 44,557

38,285 9,412,871 17,422 8,243,009 6,305 5,783,986

All males 26,157,738 16,516,221 11,465,306 5,416,166 5,579,589 1,530,658 940,933 382,107 67,988,718

Female-0-4 2,048,579 1,322,975 1,004,173 432,803 473,604 137,023 98,297

5-9 1,212,321 823,235 590,989 268,121 290,787 86,417 58,772

10-14 1,025,820 683,240 533,025 220,744 259,000 80,742 50,144

15-19 1,831,784 1,179,075 1,020,986 379,603 477,156 141,747 91,524

44,733 5,562,187 23,560 3,354,202 19,778 2,872,493 41,268 5,163,143

20-24 2,862,365 1,962,767 1,418,945 571,812 713,701 198,401 145,406

25-34 6,361,959 4,367,217 2,948,041 1,331,374 1,595,562 425,520 294,328

35-44 5,561,523 3,624,047 2,576,853 1,163,109 1,371,093 358,863 252,182

45-54 4,871,529 3,071,289 2,231,363 1,008,773 1,103,507 310,579 192,153

70,835 151,340 114,713 73,085

7,944,232 17,475,341 15,022,383 12,862,278

55-64 4,351,882 2,681,641 1,815,856 877,959 873,752 268,839 118,897

65-74 4,617,773 2,874,899 1,934,628 996,479 865,233 283,465 106,300

75 + 4,150,340 2,961,024 1,846,855 1,009,106 841,165 279,123 82,781

32,478 11,021,304 18,661 11,697,438 10,323 11,180,717

All females 38,895,875 25,551,409 17,921,714 8,259,883 8,864,560 2,570,719 1,490,784 600,774 104,155,718

All patients 65,053,613 42,067,630 29,387,020 13,676,049 14,444,149 4,101,377 2,431,717 982,881 172,144,436

O t h e r

28 33 75 63

18 52 91 97

40 64 14

575

33 32 29 18

38 86 164 90

30 46 29

595

1,170

T a b l e 1 1

M e d ic a r e : V a lu e o f b e n e f it s p r o c e s s e d b y a g e a n d s e x o f p a t ie n t - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 to 3 0 J u n e 1 9 9 3

A g e s e x g r o u p s N S W V IC O L D S A W A T A S A C T N T A u s t r a lia O th e r

Male- $ $

0-4 57,231,323 37,980,101

5-9 32,232,556 21,843,920

10-14 29,231,398 18,760,475

15-19 31,508,569 20,908,452

20-24 36,832,542 25,912,152

25-34 85,031,747 55,513,828

35-44 98,976,047 61,016,907

45-54 107,527,422 63,279,547

55-64 123,865,588 72,817,512

65-74 106,702,681 65,081,877

75 + 69,312,533 46,631,697

$ $ $ $

27,045,762 12,845,943 12,661,519 3,713,670 15,443,208 7,048,621 7,555,303 2,230,968

14,647,184 6,032,611 6,712,389 2,067,827

15,683,124 6,692,064 7,089,589 1,966,077

16,196,959 7,791,768 7,679,740 2,150.297

34,409,669 18,022,686 17,084,979 4,776,835 42,629,777 20,688,041 21,086,351 5,646,758 46,051,473 21,062,984 22,463,576 5,990,619

47,524,138 24,227,181 23,707,973 6,653,232 42,237,074 24,074,004 20,787,415 5,060,440 29,876,415 16,192,726 13,420,716 3,984,805

$ $ $ $

2,705,804 1,274,878 155,459,000 621

1,470,369 593,643 88,418,588 732

1,402,928 524,597 79,379,410 2,429

1,538,875 507,084 85,893,834 1,568

1,624,092 573,315 98,760,865 470

3,243,231 1,545,721 219,628,696 1,540

3,842,540 1,843,256 255,729,676 4,385

4,094,109 1,761,782 272,231,511 3,675

3,524,214 1,159,123 303,478,961 1,602

2,579,072 495,732 267,018,296 1,237

1,429,782 189,154 181,037,828 769

All males $778,452,406 $489,746,468 $331,744,783 $164,678,628 $160,249,549 $44,241,528 $27,455,016 $10,468,285 $2,007,036,663 $19,028

Female- $ $

0-4 48,579,201 31,621,634

5-9 29,200,424 20,068,762

10-14 26,697,751 18,136,456

15-19 45,963,568 30,666,619

20-24 72,835,555 51,607,308

25-34 184,743,683 134,060,211

35-44 170,772,939 116,220,928

45-54 150,394,705 96,406,108

55-64 132,253,115 81,078,193

65-74 140,541,712 87,063,252

75 + 124,277,548 88,815,505

All females $1,126,260,199 $755,744,976

$ $ $ $

22,994,852 10,528,476 10,640,049 3,171,865 13,988,531 6,555,478 6,863,432 2,106,669

13,596,848 5,872,853 6,617,184 2,114,437

24,887,567 9,871,895 11,759,021 3,522,248

35,024,100 14,955,559 17,799,771 4,991,195 84,613,737 40,634,062 45,102,107 12,226,009 77,359,474 37,095,019 40,511,339 10,682,378 66,652,547 32,005,434 33,177,077 9,243,469

53,842,475 26,967,250 25,731,264 7,758,750 57,929,925 30,449,662 24,964,220 8,087,333 55,004,631 31,044,347 23,860,125 8,031,349

$505,894,689 $245,980,034 $247,025,587 $71,935,703

$ $ $ $

2,293,845 1,052,337 130,882,258 909

1,408,487 556,322 80,748,106 809

1,313,422 509,143 74,858,093 690

2,338,230 931,541 129,940,689 519

3,687,176 1,636,624 202,537,288 848

8,492,164 3,966,371 513,838,344 2,952

7,496,883 3,240,015 463,378,975 5,739

5,897,803 2,088,329 395,865,472 4,446

3,694,741 905,627 332,231,413 914

3,333,837 519,809 352,889,750 1,192

2,513,701 282,578 333,829,785 704

$42,470,288 $15,688,697 $3,011,000,172 $19,721

All patients $1,904,712,605 $1,245,491,443 $837,639,471 $410,658,663 $407,275,136 $116,177,231 $69,925,304 $26,156,982 $5,018,036,835 $38,749

T a b l e 1 2

M e d ic a r e : P e r c e n t a g e o f s e r v ic e s d ir e c t b ille d b y a g e a n d s e x o f p a t ie n t - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 to 3 0 J u n e 1 9 9 3

A g e s e x g r o u p s N S W V IC O L D S A W A T A S A C T N T A u s t r a lia O th e r

Male- % %

0-4 67.50 60.38

5-9 70.72 65.12

10-14 69.21 62.40

15-19 71.37 63.18

20-24 77.68 70.32

25-34 75.90 67.46

35-44 69.70 61.40

45-54 64.10 56.70

55-64 63.82 56.54

65-74 69.18 62.29

75 + 72.18 63.91

All males 69.30% 61.93%

% % % %

65.00 59.65 64.58 54.67

68.04 61.09 67.76 55.41

67.07 56.04 64,81 53.23

69.18 54.81 64.09 51.72

73.82 61.63 67.89 53.42

69.01 60.57 65.11 47.82

62.95 54.61 60.76 44.27

57.79 49.69 55.96 42.87

58.86 54.64 59.32 48.91

66.97 64.74 70.08 58.39

69.32 67.37 73.97 66.14

64.96% 58.52% 64.08% 51.54%

% % % %

57.02 65.73 63.96 50.00

58.07 68.66 67.25 45.45

52.25 66.16 65.11 65.33

55.05 69.57 66.39 66.67

65,59 73.74 72.38 88.89

58.90 70.34 69.75 53.85

51.98 66.10 63.82 57.14

41.93 64.44 58.73 41.24

41.52 67.31 59.62 27.50

52.73 81.04 66.48 23.44

62.41 86.22 69.09 0.00

52.94% 68.35% 64.86% 49.04%

Female- % %

0-4 68.56 62.08

5-9 72.06 66.01

10-14 70.81 63.48

15-19 75.39 68.73

20-24 75.08 69.58

25-34 66.15 59.26

35-44 63.85 56.72

45-54 61.37 54.53

55-64 68.61 62.67

65-74 74.88 68.69

75 + 76.68 69.49

All females 69.19% 62.64%

% % % %

66.06 60.70 66.35 55.26

69.69 62.75 69.21 56.62

68.08 58.19 66.53 54.44

73.86 63.68 71.80 57.97

71.52 63.73 69.08 51.28

61.52 57.85 61.65 44.60

58.87 54.20 59.26 42.10

56.14 50.38 56.05 41.81

64.14 61.94 66.67 55.41

72.00 69.72 76.33 64.26

72.01 71.00 79.22 66.32

65.16% 60.89% 65.96% 52.10%

% % % %

58.43 65.92 65.24 36.36

59.42 69.85 68.53 50.00

54.45 69.30 66.45 65.52

64.36 79.75 71.73 116.67

64.27 76.55 70.95 39.47

52.50 71.47 61.89 41.86

47.89 66.61 59.34 56.10

41.40 63.42 56.75 30.00

48.22 73.20 65.21 26.67

61.26 84.88 72.18 45.65

72.57 86.41 73.40 51.72

54.29% 70.95% 65.33% 47.39%

All patients 69.23% 62.36% 65.08% 59.95% 65.24% 51.89% 53.77% 69.94% 65.14% 48.21%

T a b l e 1 3

M e d ic a r e : A v e r a g e n u m b e r o f s e r v ic e s p r o c e s s e d p e r A u s t r a lia n r e s id e n t b y a g e a n d s e x o f p a t ie n t - f o r s e r v ic e s p r o c e s s e d f r o m 1 J u ly 1 9 9 2 to 3 0 J u n e 1 9 9 3

A g e s e x g r o u p s N S W V IC O L D S A W A T A S A C T N T A u s t r a lia

Male-0-4 10.49

5-9 5.79

10-14 4.92

15-19 4.99

20-24 5.56

25-34 6.20

35-44 7.31

45-54 9.71

55-64 14.50

65-74 15.92

75 + 20.74

9.29 9.84 9.91 8.31

5.31 5.24 5.20 4.57

4.27 4.65 4.30 3.91

4.29 4.67 4.32 4.00

4.88 4.73 4.61 4.04

5.28 5.11 5.17 4.45

6.00 6.26 5.93 5.35

7.88 8.36 7.73 7.39

11.87 12.01 11.28 11.36

13.87 13.55 13.65 14.33

18.95 18.60 17.74 17.69

8.49 9.64 6.12 9.68

4.67 5.12 2.96 5.32

4.10 4.41 2.62 4.50

3.89 4.07 2.72 4.53

4.19 4.03 2.68 4.92

4.53 4.56 3.33 5.42

5.29 5.28 4.38 6.37

7.30 7.27 6.19 8.49

10.78 11.02 8.84 12.67

10.47 13.56 9.79 14.46

15.39 18.60 10.67 19.17

Female-0-4 9.58

5-9 5.74

10-14 4.99

15-19 8.46

20-24 12.18

25-34 13.15

35-44 12.43

45-54 14.56

55-64 16.59

65-74 19.59

75 + 23.09

All females 12.85

8.35 9.11 8.96 7.61

5.33 5.26 5.32 4.57

4.49 4.78 4.56 4.24

7.14 8.53 7.38 7.66

10.43 11.36 9.96 10.61

11.85 12.16 11.44 11.67

10.70 11.25 10.49 10.40

12.40 13.22 12.31 12.24

13.99 14.86 13.45 13.62

16.98 18.22 16.02 16.58

22.22 22.91 20,83 20.40

11.27 11.73 11.14 10.64

7.83 8.84 5.48 8.83

4.75 5.34 3.00 5.33

4.56 4.48 2.90 4.68

8.16 6.94 6.53 7.92

11.14 10.02 8.46 11.14

11.47 11.53 8.94 12.24

10.19 10.05 8.59 11.28

12.01 11.53 9.83 13.22

13.35 13.11 9.97 14.93

15.45 15.63 11.80 17.93

19.77 20,11 14.38 22.26

10.74 10.05 7.44 11.75

8.18 5.82 9.75

T A S A C T A u s t r a lia

$

204.22 117.80 111.53 107.10

117.36 131.98 159.45 223.66

332.76 319.47 452.56

$187.96

$

230.32 126.46 120.34 113.20

108.26 126.94 155.86 233.42

374.68 446.44 596.74

$184.32

$

148.47 72.91 71.59 73.09

69.38 87.90 123.39 183.90

267,70 278.66 320.06

$

234.52 133.48 122.27 125.12

134.62 153.37 190.61 267.13

408.42 468.32 600.01

$118.88 $228.02

$

181.27 115.82 119.29 202.72

280.20 329.65 303.22 357.35

385.22 440.68 568.75

$ $ $

206.34 129.01 207.82

127.88 70.94 128.36

117.30 74.75 121.85

177.19 147.30 199.29

254.13 195.42 283.92

332.60 234.25 359.97

298.89 242.70 347.96

353.97 280.92 406.80

407.54 278.14 450.17

490.13 328.58 540.93

610.71 393.56 664.58

$300.48 $286.39 $194.21 $339.71

$244.70 $235.24 $154.92 $284.05

Medici

T a b l e 1 5

Medicare: Average lag between date of service, date of lodgement and date of processing by bill type - for services processed from 1 July 1992 to 30 June 1993

Bill type and lag type NSW VIC OLD SA WA TAS ACT NT Australia

Calendar days-Cheque to Claimant- Service to lodgement 73.0 76.2 54.9 45.5 67.6 65.4

Lodgement to process 5.0 5.4 5.2 5.6 5.8 6.1

Cheque to provider via Claimant- Service to lodgement 34.8 34.1 24.3 27.2 31.8 27.6

Lodgement to process Cash-

4.6 4.3 4.3 5.1 5.0 4.6

Service to lodgement 25.4 31.8 25.7 22.9 31.3 20.9

Lodgement to process* Direct bill-

0.0 0.0 0.0 0.0 0.0 0.8

Service to lodgement 9.9 10.7 9.1 10.5 9.9 10.3

Lodgement to process 4.7 4.6 4.4 4.9 5.0 3.6

All services-

Service to lodgement 17.4 20.8 15.7 17.5 19.1 18.0

Lodgement to process 4.1 3.8 3.7 4.6 4.4 3.2

80.5 5.1

33.8 4.4

25.9 0.0

11.9 4.6

22.4

3.3

74.5 68.1

4.3 5.3

40.6 31.4

3.8 4.6

30.1 27.4

0.0 0.0

14.8 10.1

4.2 4.6

20.1 18.2

4.2 4.0

Note: State/territory was determined according to the address of the office where the claim was paid (for cash claims) or according to the claimant's address (for other claims)*. Some cash claims are paid by organisations acting as agents for Medicare. As these claims must be reprocessed through the Health Insurance Commission’s system, this results in some lag between lodgement and processing.

M e d ic a r e : F iv e y e a r c o m p a r is o n o f s e le c t e d k e y s t a t is t ic s w i t h p r e v io u s f in a n c ia l y e a r s - f o r s e r v ic e s p r o c e s s e d in e a c h f in a n c ia l y e a r

1988-89 1989-90 1990-91 1991-92

% change % change % change % change

1992-93 88/89-89/90 89/90-90/91 90/91-91/92 91/92-92/93

Number of services processed- 142,871,021 Value of benefits processed- $3,394,588,668 Average value of benefit processed per service- $23.76

Average number of services processed per Australian resident-(*) Male 6.650

Female 10.336

All persons 8.497

Average value of benefit processed per Australian resident—(*) Male $158.84

Female $244.73

All persons $201.89

Number of service processed by broad type of service- Vocatlonally Registered -

Non-Vocationally Registered Other General Practitioners ALL GENERAL PRACTITIONERS 80,071,598 Specialist attendances 13,653,292

Obstetrics ■ 537,646

Anaesthetics 1,373,979

Pathology Collection Items Pathology Other -

ALL PATHOLOGY 31,237,893

Diagnostic Imaging 7,143,238

Operations 3,772,106

Assistance at operations 191,398

Optometry 2,216,734

Radio and Nuclear Therapy 351,276

Miscellaneous 2,321,861

145,398,068 146,617,008 156,787,618 172,145,606 ,805,358,526 $4,238,365,342 $4,583,571,477 $5,018,075,584 $26.17 $28.91 $29.23 $29.15

6.735 6.717 7.112 7.724

10.296 10.238 10.812 11.751

8.520 8.483 8.968 9.745

$176.35 $193.53 $208.17 $228.02

$269.40 $296.59 $315.81 $339.71

$222.99 $245.22 $262.18 $284.05

12,920,176 34,127,261 50,133,893 70,307,635

28,447,699 47,829,835 36,970,714 20,936,610

43,723,410 2,903,950 1,899,128 1,856,234

85,091,285 84,861,046 89,003,735 93,100,479

14,284,676 14,893,789 15,587,321 16,279,884

561,592 575,730 587,922 604,201

1,436,124 1,510,810 1,574,141 1,628,246

- - 4,391,502 12,793,412

- 26,023,611 26,879,386

26,702,452 26,035,139 30,415,113 39,672,798

7,673,873 8,305,285 8,521,082 9,113,842

4,089,497 4,443,056 4,728,456 4,928,579

202,611 215,856 237,740 250,114

2,448,296 2,643,374 2,798,233 3,008,380

324,613 301,212 317,909 328,189

2,583,049 2,831,711 3,015,966 3,230,894

%

1.8 12.1 10.2

I. 3

-0.4 0.3

II . 0

10.1 10.5

% 0.8 11.4 10.5

-0.3 -0.6

-0.4

9.7 10.1 10.0

164.1 68.1

Total 142,871,021 145,398,068 146,617,008

Percentage of services processed by bill type-% % %

Cheque to claimant 4.3 4.0 3.9

Cheque to provider via claimant 21.4 19.3 18.5

Cash 18.9 18.3 16.7

Direct bill 55.4 58.4 60.8

% 6.9 8.1 1.1

5.9 5.6 5.7

7.6 6.5 6.9

46.9 -22.7

% 9.8 9.5 -0.3

8.6 8.7 8.7

9.5 7.6 8.3

40.2 -43.4

-45.4 -93.4 -34.6 -2.3

6.3 -0.3 4.9 4.6

4.6 4.3 4.7 4.4

4.5 2.5 2.1 2.8

4.5 5.2 4.2 3.4

191.3 3.3

-14.5 -2.5 16.8 30.4

7.4 8.2 2.6 7.0

8.4 8.6 6.4 4.2

5.9 6.5 10.1 5.2

10.4 8.0 5.9 7.5

-7.6 -7.2 5.5 3.2

11.2 9.6 6.5 7.1

1.8 0.8 6.9 9.8 156,787,618 172,145,606

%

3.6 17.9 15.7 62.8

3.2 17.3 14.3 65.1

%

-0.3 - 2.1

-0.6

3.0

%

-0.1

- 0.8

- 1.6

2.4

%

-0.3 -0.6

- 1.0

2.0

%

-0.4 - 0.6

-1.4 2.3

Total 100.0% 100.0% 100.0% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0%

Please note that the item composition of broad type of service is different to those in previous anm isl rennrtc n Auorano ,mi,,™ f„, „

Medici

T a b l e 1 7

Medicare: Percentage of enrolled persons by number of services - for services rendered from 1 July 1991 to 30 June 1992

Number of services NSW VIC OLD SA WA TAS ACT

% Cum% % Cum% % Cum% % Cum% % Cum% % Cum% % Cum%

0 20.31 20.31 20.92 20.92 20.64 20.64 20.66 20.66 22.56 22.56 20,31 20.31 22.14 22.14

1 8.60 28.91 9.99 30.91 9.44 30.07 9.61 30.27 10.59 33.15 10.40 30.70 10.75 32.90

2 7.47 36.38 8.60 39.51 7.98 38.06 8.43 38.71 8.80 41.94 8.85 39.55 8.96 41.85

3 6.62 42.99 7.42 46.94 7.01 45.07 7.46 46.17 7.45 49.39 7.72 47.27 7.70 49.55

4 5.88 48.88 6.41 53.34 6,17 51.23 6.52 52.68 6.36 55.75 6.61 53.88 6.63 56.19

5 5.22 54.10 5.51 58.85 5.41 56.64 5.61 58.29 5.46 61.21 5.74 59.62 5.67 61.86

6 4,63 58.73 4.73 63.58 4.71 61.36 4.87 63.16 4.69 65.90 4.82 64.44 4.82 66.68

7 4.08 62.82 4.08 67.66 4.13 65.49 4.20 67.36 3.95 69.85 4.17 68.60 4.19 70.87

8 3.62 66.44 3.54 71.20 3.62 69.11 3.65 71.02 3.44 73.29 3.61 72.21 3.55 74.42

9 3.21 69.64 3.08 74.28 3.15 72.26 3.14 74.16 2.98 76.28 3.08 75.30 3.08 77.50

10 2.84 72.49 2.67 76.95 2.81 75.07 2.74 76.90 2.59 78.86 2.67 77.97 2.63 80.13

11-12 4.78 77.26 4.41 81.36 4.65 79.72 4.52 81.42 4.22 83.08 4.41 82.38 4.25 84.38

13-15 5.45 82.71 4.85 86.21 5.19 84.91 4.96 86.38 4.58 87.67 4.75 87.13 4.55 88.93

16-20 6.00 88.71 5.10 91.31 5.53 90.45 5.19 91.57 4.77 92.44 4.94 92.07 4.62 93.55

21-25 3.07 91.78 2.46 93.77 2.71 93.16 2.51 94.08 2.30 94.74 2.38 94.46 2.13 95.68

26-30 2.93 94.71 2.27 96.04 2.52 95.68 2.26 96.34 2.05 96.79 2.17 96.63 1.85 97.53

31-40 2.50 97.20 1.85 97.89 2.07 97.74 1.75 98.09 1.62 98.41 1.66 98.29 1.34 98.88

41-50 1.16 98.36 0.84 98.74 0.93 98.67 0.78 98.87 0.69 99.10 0.73 99.02 0.53 99.41

51 + 1.64 100.00 1.26 100.00 1.33 100.00 1.13 100.00 0.90 100.00 0.98 100.00 0.59 100.00

NT Australia

% Cum% % Cum%

26.05 26.05 20.84 20.84 11.64 37.70 9.48 30.32

9.08 46.77 8.13 3844

7.57 54.34 7.09 45 54

6.37 60.71 6.20 51.74

5.31 66.02 5.40 57.14

4.45 70.47 4.70 61.84

3.90 74.37 4.09 6594

3.23 77.61 3.58 69.52

2.76 80.37 3.13 72.65

2.39 82.76 2.75 75.40

3.75 86.50 4.56 79.96

4.09 90.59 5.09 85.04

3.99 94.58 5.44 90.48

1.85 96.42 2.69 93.17

1.56 97.98 2.50 95.67

1.14 99.12 2.06 97.73

0.43 99.54 0.94 98.67

0.46 100.00 1.33 100.00

T o t a l 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 ,0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 % 1 0 0 .0 0 %

Note: State/territory was determined according to the enrolled person’s postal address in the Medicare records as at 30 June 1993.

T a b l e 1 9

Medicare: Number and percentage of enrolled persons, services and benefits by number of services - for services rendered from 1 July 1991 to 30 June 1992

Number of services Persons Services Benefits

Cum% % Cum%

0 3,974,332 20.84 20.84 0 0.00 0.00

1 1,807,165 9.48 30.32 1,807,165 1.17 1.17

2 1,549,590 8.13 38.44 3,099,180 2.00 3.17

3 1,353,002 7.09 45.54 4,059,006 2.62 5.78

0 0.00 0.00

42,252,349 0.94 0.94

72,659,412 1.61 2.55

96,788,707 2.15 4.70

4 1,182,405 6.20 51.74 4,729,620 3.05 8.84

5 1,030,770 5.40 57.14 5,153,850 3.33 12.16

6 897,187 4.70 61.84 5,383,122 3.47 15.63

7 780,229 4.09 65.94 5,461,603 3.52 19.16

115,220,079 2.56 7.26

128,189,854 2.84 10.10

136,727,531 3.03 13.13

141,485,581 3.14 16.27

8 682,972 3.58 69.52 5,463,776 3.53 22.68

9 596,952 3.13 72.65 5,372,568 3.47 26.15

10 524,137 2.75 75.40 5,241,370 3.38 29.53

11-12 869,706 4.56 79.96 9,974,719 6.44 35.97

144,102,177 3.20 19.47

143,990,430 3.20 22.67

142,562,399 3.16 25.83

276,606,498 6.14 31.97

13-15 969,836 5.09 85.04 13,501,826 8.71 44,68

16-20 1,037,490 5,44 90.48 18,449,072 11.90 56.58

21-25 512,662 2.69 93.17 11,469,577 7.40 63.98

26-30 477,454 2.50 95.67 12,998,957 8.39 72.37

385,230,266 8.55 40,52

545,568,000 12.11 52.63

349,869,974 7.76 60.39

405,767,330 9.01 69.40

31-40 392,871 2.06 97.73 13,673,631 8.82 81.19

41-50 178,497 0.94 98.67 8,019,218 5.17 86.37

51 + 253,873 1.33 100.00 21,128,726 13.63 100.00

439,277,324 9.75 79.15

264,553,173 5.87 85.02

675,140,078 14.98 100.00

T o ta l 1 9 ,0 7 1 ,1 3 0 1 0 0 .0 0 % 1 5 4 , 9 8 6 , 9 8 6 1 0 0 .0 0 % 4 , 5 0 5 , 9 9 1 , 1 6 2 1 0 0 .0 0 %

CD

Medii

T a b l e 2 1

Medicare: Percentage of patients by number of general practitioners consulted - for services rendered from 1 July 1991 to 30 June 19 92

Number of GPs NSW VIC OLD SA WA TAS ACT NT Australia

% % % % % %

1 42.03 40.92 39.26 40.89 43.48 44.93

2 28.60 28.21 27.93 28.75 28.97 29.71

3 14.87 15.17 15.49 15.35 14.55 14.23

4 7.25 7.61 8.05 7.39 6.82 6.20

5 3.52 3.79 4.19 3.62 3.12 2.63

6 1.74 1.94 2.21 1.78 1.48 1.15

7 0.87 1.02 1.20 0.92 0.73 0.53

8 0.46 0.54 0.66 0.50 0.36 0.26

9 0.25 0.30 0.37 0.27 0.19 0.13

10 0.14 0.17 0.22 0.16 0.11 0.08

11 + 0.27 0.33 0.40 0.38 0.20 0.15

% %

43.02 42.34

27.72 28.60

14.51 15.24

7.26 7.22

3.61 3.33

1.82 1.65

0.96 0.78

0.49 0.36

0.26 0.19

0.14 0.14

0.20 0.20

%

41.41 28.45 15.04 7.42

3.65 1.84 0.95 0.50

.28 0.16 0.30

100.00% 100.00% 100.00% 100.00%

Note: State/territory was determined according to the enrolled person’s postal address in the Medicare records as at 30 June 1993.

PHARMACEUTICAL BENEFITS STATISTICAL TABLES

T a b l e 2

Pharmaceutical Benefits Scheme: Number of Services Processed by Anatomic Therapeutic Chemical Classification - for services processed from 1 July 1992 to 30 June 1993

Description NSW+ACT VIC QLD SA WA TAS NT Australia

Alimentary Tract and Metabolism 4,046,523 2,558,149 1,675,846 862,370 800,916

Blood and Blood Forming Organs 1,574,860 867,065 515,080 337,272 290,982

Cardiovascular System 8,464,349 5,365,352 3,451,240 1,789,928 1,585,679

Dermatologicals 1,437,080 975,312 580,369 315,011 273,683

Genito Urinary System and Sex Hormones 2,002,329 1,194,600 1,047,300 540,881 487,516

Systemic Hormonal Preparations, Excl. Sex Hormones 603,643 370,091 267,951 133,868 121,526 General Anti-lnfectives For Systemic Use 5,608,024 3,595,354 2,555,274 1,221,494 1,181,183

Anti-Neoplastic and Immunomodulating Agents 122,138 95,673 58,528 29,761 30,297

Musculo-Skeletal System 2,354,118 1,488,954 1,006,697 530,262 559,749

Central Nervous System 7,431,980 4,924,245 3,551,095 1,888,273 1,521,919

Anti-Parasitic Products 372,616 216,186 165,285 77,852 85,253

Respiratory System 4,196,247 2,638,438 1,932,966 853,723 764,452

Sensory Organs 2,054,373 1,228,594 895,531 492,135 441,374

Various + 195,582 127,385 82,759 42,552 24,851

Other ++ 634,247 300,935 287,345 141,913 109,740

Total 41,098,109 25,946,333 18,073,266 9,257,295 8,279,120

+ ATC Group Various - includes Allergens, Immunosuppressive Agents, Diagnostic Agents, Urine Tests ++ Other - Extemporaneously Prepared Items and NHS Items With No ATC Equivalent

301,151 87,493 619,071 96,875

164,737 53,642 370,886 9,639

187,527 611,334 26,211 277,862

117,442 10,626 28,768

2,963,264

27,024 10,271,979 7,582 3,680,334

46,801 21,322,420 10,977 3,689,307 22,168 5,459,531 4,359 1,555,080

76,007 14,608,222 885 346,921

20,315 6,147,622 51,003 19,979,849 6,400 949,803

40,398 10,704,086 14,962 5,244,411 2,330 486,085

1,521 1,504,469

332,732 105,950,119

Pharmaceutical Benefits Scheme

Repatriation Pharmaceutical Benefits Scheme: Net Value of Benefits Processed by Anatomic Therapeutic Chemical Classification - for services processed 1 July 1992 to 30 June 1993

TAS

$

641,918 161,128 868,917 37,797

90,010 41,443 168,667 55,998

179,209 343,807 20,077 422,966

83,715 25,380 424,569

3,565,601

16,069 1,812 15,442 1,335

3,705 645 8,098 3,315

8,204 14,998 1,024 20,559

2,777 529

14,994

Australia

12,855,946 3,401,064 17,912,060 945,638

I, 906,074

613,528 4,204,030 2,258,826 3,821,578

7,235,425 458,791 II, 701,120

2,537,044 778,798 10,533,335

113,506 81,163,257

75

1

S ’ 1 I

CD

T a b l e 4

Repatriation Pharmaceutical Benefits Scheme: Number of services processed by Anatomic Therapeutic Chemical Classification - for services processed 1 July 1992 to 30 June 1993

Description NSW + ACT VIC QLD SA WA TAS NT Australia

$ $ $

Alimentary Tract and Metabolism 317,732 167,426 159,960 61,169 58,574

Blood and Blood Forming Organs 64,207 33,446 29,554 11,748 10,065

Cardiovascular System 413,093 235,628 200,605 82,469 77,168

Dermatologicals 143,890 66,917 70,345 21,935 24,882

Genito Urinary System and Sex Hormones 22,752 9,563 11,815 4,075 3,813

Systemic Hormonal Preparations, Excl. Sex Hormones 30,147 17,709 15,947 5,297 5,290

General Anti-lnfectives For Systemic Use 148,463 86,116 75,515 26,351 24,481

Anti-Neoplastic and Immunomodulating Agents 5,644 2,743 2,217 503 727

Musculo-Skeletal System 162,209 91,569 77,786 29,967 38,252

Central Nervous System 452,130 252,726 266,866 93,024 90,176

Anti-Parasitic Products 24,559 12,973 11,675 4,262 5,110

Respiratory System 283,807 152,639 148,227 57,643 53,481

Sensory Organs 142,175 69,319 66,822 24,259 29,833

Various + 38,609 16,313 18,598 5,397 4,879

Other ++ 61,164 19,358 30,818 10,000 9,546

36,539 7,601 50,290 13,136

2,285 4,635 15,903 416

19,857 58,307 2,673 29,118 11,855

2,801 5,456

1,016 802,416

158 156,779

1,176 1,060,429 465 341,570

88 54,391

133 79,158

807 377,636

39 12,289

970 420,610

2,068 1,215,297

164 61,416

1,336 726,251

464 344,727

71 86,668

136 136,478

Total 2,310,581 1,234,445 1,186,750 438,099 436,277 260,872 9,091 5,876,115

+ ATC Group Various - includes Allergens, Immunosuppressive Agents, Diagnostic Agents, Urine Tests ++ Other - Extemporaneously Prepared Items and RPBS Items With No ATC Equivalent

Pharm aceutical Benefits Scheme

Pharm aceutical Benefits Scheme

Table 8

Pharmaceutical and Repatriation Pharmaceutical Benefits S ch em es: Net Value of Benefits Processed 1988-89 to 1992-93 (a)

Patient Category 1988-89 1989-90 1990-91 1991-92 1992-93

($,000) ($,000) ($,000) ($,000) ($,000)

General - Co-Payment (b) 132,041 170,039 157,783 166,008 188,031

Concessional - Co-Payment (c) 63,272 74,758 342,720 750,966 910,345

Entitlement - Free (d) 795,027 890,753 593,960 214,492 304,318

Total PBS Benefits 990,340 1,135,550 1,094,463 1,131,466 1,402,694

Repatriation - (e) 80,912 83,685 85,023 85,663 81,164

(a) Figures for financial years ending 1989 to 1992 extracted from previous Departmental Annual Reports.

(b) Benefit values after General Patient Contribution (varied from $11.00 from 1 July 1988 to current contribution of $15.90),

(c) Benefit values AFTER a Concessional Patient Contribution (varied from $2.50 on 1 July 1988 to current contribution of $2.60). These benefits include 1991 onwards General Safety Net level 1, "Pensioner" scripts after 1 November 1990.

(d) Benefit values where there was no patient contribution. These benefits include "Pensioner" and Safety Net scripts before 1 November 1990, General Safety Net level 2 after 1 July 1991, Concessional Safety after 1 November 1990.

(e) Total RPBS script values for years ending up to 1992 provided by the Department of Veterans’ Affairs. RPBS script values for year ending 1993 from HIC processing figures.

121

P H A R M A C E U T I C A L B E N E F I T S S C H E M E

P h a r m a c e u t i c a l a n d R e p a t r i a t i o n P h a r m a c e u t i c a l B e n e f its S c h e m e s .

E x p l a n a t o r y N o t e s .

These statistical tables relate to the volume and net value of Pharmaceutical and Repatriation Pharmaceutical Benefits scripts processed by the Health Insurance Commission from 1 July 1992 to 30 June 1993.

A n a t o m i c T h e r a p e u t i c C h e m ic a l C la s s i f ic a ti o n

Tables 1-4 refer to the volume and net value of Pharmaceutical and Repatriation Pharmaceutical scripts by state of supply and Anatomic Therapeutic Chemical Classification (ATC) or Nordic Group.

Under the ATC, the drugs are divided into different groups generally by the site of action and therapeutic and chemical characteristics of the drug.

These tables only have statistics for the 14 main ATC groups.

P a t i e n t C a t e g o r y

Tables 5-7 refer to the volume and net value of Pharmaceutical and Repatriation Pharmaceutical Benefits processed by state of supply and Patient category.

The patient category refers to the patient’s status at the time of supply of the benefit script. Migration to other categories occurs once expenditure on NHS items reaches the applicable safety net thresholds for that patient’s family group in the relevant calendar year.

A Repatriation patient has the same rights as the Concessional patient but under the Repatriation Pharmaceutical Benefits Scheme.

P r o c e s s i n g H i s to r y

Table 8 shows a history of Pharmaceutical and Repatriation Pharmaceutical Benefits values from 1988-89 to 1992-93. These values give a outline of what has happened in the last 5 years but only on general terms owing to the historical changes to patient contributions, levels and thresholds of Safety Net.

O F F I C E L O C A T I O N S

C o m m i s s i o n O f f ic e L o c a t i o n s

Australian Capital Territory (Central Office) 134 Reed Street Tuggeranong ACT 2900 Telephone: (06) 203 6333

Facsimile: (06) 282 5025

New South Wales State Headquarters 33 Erskine Street Sydney NSW 2000

Telephone: (02) 561 2111 Facsimile: (02) 262 5700

Victoria State Headquarters 460 Bourke Street Melbourne VIC 3000 Telephone: (03) 284 3888

Facsimile: (03) 284 3899

Queensland State Headquarters 444 Queen Street Brisbane QLD 4000 Telephone: (07) 360 7211

Facsimile: (07) 360 7007

South Australia State Headquarters 209 Greenhill Road Eastwood SA 5063 Telephone: (08) 201 8844

Facsimile: (08) 272 6551

Western Australia State Headquarters R & I Tower 108 St Georges Terrace Perth WA 6000

Telephone: (09) 263 8000 Facsimile: (09) 263 8222

Tasmania State Headquarters 242 Liverpool Street Hobart TAS 7000

Telephone: (002) 32 1400 Facsimile: (002) 32 1499

PARLIAMENTARY PAPER 294 of 1993 No. ORDERED TO BE PRINTED

ISSN 0727-418 _