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Palliative Care in Australia
Greg Clarke
Social Policy Group
March 1997
Palliative Care in Australia
People suffering with progressive diseases whose illness is recognised
as being no longer curable may be offered palliative care: coordinated,
active, total care given to patients and their families in order to concentrate
on the quality of life and the alleviation of distressing symptoms.
At present it is not clear exactly what palliative care services are
offered across Australia, nor how they are funded. There are some identifiable
palliative care programs, but many other services have palliative elements.
For example In New South Wales, palliative and curative treatment is provided
across a wide range of programs, while in Queensland all palliative care
has been identified and separated from other care elements. However, in
many instances these elements have not been isolated and data has not
been collected on them. States and Territories are now assessing the extent
and effectiveness of their expenditure on palliative care.
Commonwealth Involvement
Federally, the Commonwealth contributes towards the cost of a wide range
of palliative care services provided by States and Territories in a variety
of settings including the home, hospices and acute care hospitals. The
way in which these services are provided varies widely, but most take
an holistic approach which addresses patients' and their carers' psychological
and pastoral needs, provides bereavement support and promotes participation
in decision making relating to appropriate care.
The Commonwealth currently uses two means to distribute funding for
palliative care. There is a four-year Palliative Care Program (PCP) commenced
in 1993-94 which ends this year. There is also a palliative care component
to hospital funding grants under Schedule G of the Medicare Hospital Agreements.
Palliative Care Program
In the 1993-94 Budget, the Government announced a four-year program
to provide palliative care costing $55 million. The program was designed
to maximise the quality of life of people suffering terminal illness,
to avoid inappropriate hospital admissions and to provide support to families
and carers. Most of the $55 million was allocated to State and Territory
Governments, but some States have not taken up their full funding allocations.
To date, this has resulted in an underspending of some $8.5 million of
this component of the PCP.
Funding under the PCP has enabled some States to review the present
and future delivery of their palliative care services. Queensland and
Victoria have produced reports on their findings and have developed options
for future delivery of palliative care services within their States.
$4 million of PCP funding has been retained by the Commonwealth for
direct support to projects of national significance. One such project
is the construction of a Palliative Care National Minimum Dataset, which
will allow national monitoring of palliative care provision. The project
is being undertaken by the Victorian Department of Health and Community
Services in conjunction with other Government departments, the Australian
Institute of Health and Welfare and the Australian Association of Hospice
and Palliative Care.
Medicare Agreement (Schedule G)
Funds allocated to States and Territories for hospitals under Schedule
G of the Medicare Agreements are based on formulae contained in the Agreements
and are subject to annual Medicare index price adjustments.
Hospital funding grants for palliative care services are available to
States and Territories on a monthly basis under the Medicare Agreements.
Unlike the PCP, there is a continuing commitment to this funding as
part of these Agreements at least until 1998, when current Agreements
expire. Future Medicare Agreement renegotiations will determine whether
this funding will continue past 1998.
Commonwealth Expenditure on Palliative Care 1993/94-1996/97
PCP State & PCP National Medicare TOTAL
Territory Projects Schedule G
$ $ $ $
1993/94 4,369,964 92,183 11,376,000 15,838,147
1994/95 11,775,263 822,523 11,758,195 24,355,981
1995/96 13,553,930 995,537 12,250,149 26,799,616
1996/97 12,769,090 2,090,000 12,795,151 27,654,241
TOTAL 42,468,247 4,000,243 48,179,495 94,647,985
(Department of Health and Family Services 3 February 1997)
Commonwealth-State Program
There is a small amount of funding for palliative care under the Commonwealth-State
Home and Community Care Program (HACC), but in recent times palliative
care has been treated as a 'no growth' component of HACC.
COAG discussions on devolution of aged and disabled care responsibilities
to the States may provide opportunities to review this and associated
issues.
Future Arrangements
Delivery of palliative care services, both in 1996-97 and beyond the
term of the PCP, will be influenced by the findings of a current review
of the program by the Commonwealth Department of Health and Family Services.
The first stage of this review has been completed, but its findings are
not yet available for public release. It is likely this initial report
will be available in April 1997.
The first stage of the review was intended to evaluate the effectiveness
of the PCP, comment on the appropriateness of existing palliative care
services and identify service gaps. Preliminary findings by the Department
in January 1997 indicate that Commonwealth funds have stimulated the development
of new models of community palliative care services. With a shift in the
funding and availability of services, people who have previously been
able to receive only institutional care will often be able in future to
choose to receive care at home.
The second stage of the review has commenced and is expected to be completed
by June 1997. It will identify principles for the delivery of holistic
and multi-disciplinary palliative care services and will provide advice
on service delivery models, options for future palliative care funding
and associated performance indicators.
As well as undertaking this program review, the Commonwealth has provided
a grant of $165 986 to the Australian Association of Hospice and Palliative
Care Inc. to develop standards for the provision of palliative care. It
is expected that these will form the basis of a national service accreditation
system for the provision of palliative care.
The Commonwealth Casemix Development Program includes a project on sub-acute
and non-acute casemix classification (SNAP). This project is designed
to measure the results of use of health system resources for patients
such as those requiring palliative care. It is expected to be completed
by 1 July 1997.
Discussions are taking place between the Commonwealth and the States
and Territories on the broadbanding of Specific Purpose Payments (SPPs).
Under this arrangement, federally funded programs will be pooled into
a single grant to each State. Palliative care is one of the programs being
considered in this process.
This year's federal Budget included a 3% efficiency dividend on all
SPPs as part of the broadbanding process and a further 7% reduction in
funds for administrative cost savings. These arrangements will apply to
all broadbanded programs.
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