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Hospital Circular 18/2009

Date Issued: 16 July 2009

Subject: National Healthcare Agreement

Purpose: To advise public hospitals and public health services of the conditions and business rules that guide the delivery of the public hospital services under the new National Healthcare Agreement.

Intergovernmental Agreement on Federal Financial Relations

Under the new financial arrangements agreed by Council of Australian Governments (COAG) in November 2008, there was a major rationalisation of the number of payments to the States and Territories for Specific Purpose Payments (SPPs), reducing the number of such payments from over ninety to five: Healthcare, Schools, Skills & Workforce Development, Disability Services and Affordable Housing. The National Healthcare Agreement is one of the National Agreements reached between the Commonwealth, States and Territories.  

Overview of the new National Healthcare Agreement (NHCA)

The NHCA came into effect from 1 July 2009 replacing the Australian Health Care Agreement between the Commonwealth and the State of Victoria, 2003-2008. The objective of the NHCA is to improve health outcomes for all Australians and the sustainability of the Australian health system. The NHCA defines the objectives, outcomes, outputs and performance measures and clarifies the roles and responsibilities that will guide the Commonwealth and States and Territories in the delivery of services across the health sector.

Specifically, the NHCA sets out:

  1. the objectives and expected outcomes and outputs, including a focus on social inclusion and addressing indigenous disadvantage;
  2. the role of each jurisdiction, and the responsibilities they undertake to be accountable for;
  3. the policy and reform directions that will be undertaken to work towards the intended outcomes;
  4. performance indicators that will inform the community on how governments are progressing towards achieving the stated objectives, outcomes and outputs; and
  5. performance benchmarks that provide an indication of the standard of service expected or the level of improvement expected in service delivery over a specified period.

In terms of the delivery of health and emergency services, the NHCA expands and clarifies the roles and responsibilities set out in the Australian Health Care Agreement.

Clause 19 of NHCA stipulates that:

  1. States and Territories will provide health and emergency services through the public hospital system, based on the following Medicare principles:
  2. eligible persons are to be given the choice to receive, free of charge as public patients, health and emergency services of a kind or kinds that are currently, or were historically provided by hospitals;
  3. access to such services by public patients free of charge is to be on the basis of clinical need and within a clinically appropriate period; and
  4. arrangements are to be in place to ensure equitable access to such services for all eligible persons, regardless of their geographic location.

Further, clause 25 of the NHCA provides that States and Territories will:

  1. provide public patients with access to all services provided to private patients in public hospitals;
  2. provide service planning, capital works and adequate infrastructure for public hospitals and community health facilities to meet future needs;
  3. provide and fund patient assistance travel schemes and ensure that public patients are aware of how to access the scheme;
  4. ensure that eligible persons who have elected to be treated as private patients have done so on the basis of informed financial consent;
  5. provide and fund pharmaceuticals for public and private inpatients and for public non admitted patients in public hospitals (except where Pharmaceutical Reform Arrangements are in place);
  6. maintain a Public Patients Hospital Charter and an independent complaints body and ensure that patients are aware of how to access these provisions;
  7. provide public health, community health, Home and Community Care, public dental,  deliver vaccines purchased by the Commonwealth under national immunisation arrangements  and health promotion programs;
  8. continue to provide agreed national minimum data sets; and
  9. regulate health services and professions and provide clinical training programs for undergraduates and specialists.

Attention is also drawn to the Schedule B of the NHCA which sets out the Business Rules that guide the delivery of the public hospital services such as patient arrangements (including patient election and eligibility), public patient charges, charges for patients other than public patients, cross border adjustments, and the public patients’ charter.

A number of public hospitals and public health services’ by-laws make reference to the Australian Health Care Agreement. It is recommended that Rules (including by-laws) are reviewed in light of the introduction of the NHCA. Any subsequent alterations or amendments to those Rules or by-laws must be approved, in writing, under the Health Services Act 1988 by the Secretary to the Department of Human Services.

Any queries in relation to Rules or by-laws, or requests to the Secretary to approve any changes should be directed to the Policy Instruments and Compliance Unit, telephone (03) 9096 2164

Public hospitals and public health services must ensure that all relevant staff understand and comply with the Medicare principles and related sections of the NHCA which can be downloaded from Australian Health Care Agreement between the Commonwealth and the State of Victoria website.

This Circular should be read in conjunction with the Victoria - Public Hospitals & Mental Health Services Policy & Funding Guidelines which are available from the Victorian Health Services Policy and Funding Guidelines 2010-11 website.

 

Lance Wallace
Executive Director
Metropolitan Health and Aged Care Services

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