New South Wales report, December 2016

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In this report

This report includes the following tables:

This report is issued by the Administrator of the National Health Funding Pool under section 240 of the National Health Reform Act 2011.

This report is prepared on a cash basis. It shows monthly and year-to-date (YTD) National Health Reform (NHR) funding and payments for New South Wales for December 2016 as part of the National Health Reform Agreement.

Local hospital networks and National Health Reform

A local hospital network (LHN) is an organisation that provides public hospital services in accordance with the Agreement. An LHN can contain one or more hospitals, and is usually defined as a business group, geographical area or community. Every Australian public hospital is part of an LHN.

Note: The term ‘local hospital network’ is a national term. Some states and territories use their own terminology to describe these networks, such as local health districts, health organisations, and hospital and health services.

Under the Agreement, LHNs receive funding for the following public hospital services:

  • All admitted and non-admitted services
  • All emergency department services provided by a recognised emergency department
  • Other outpatient, mental health, sub-acute services and other services that could reasonably be considered a public hospital service.

Note: LHNs also receive funding from other sources, including the Commonwealth, states and territories, and third parties for the provision of other specific functions and services outside the scope of the Agreement, for example dental services, primary care, home and community care, residential aged care and pharmaceuticals. For further information on total funding to a particular LHN, contact the NSW Ministry of Health to view the service agreement for that LHN.

Basis for National Health Reform payments – New South Wales, December 2016

For the basis of the Commonwealth contribution to NHR funding, see Basis of Commonwealth NHR funding, 2016-17.

The basis for NHR payments to local hospital networks (LHNs) in New South Wales was advised by the NSW Ministry of Health to be as follows:

Basis used to determine NHR payments to Local Health Networks (LHNs) – New South Wales

The process for determining 2016/17 NHR payments to LHNs encompassed three distinct elements of preparation for the individual LHN Service Agreements, including development of annual activity estimates, discussion/negotiation of activity levels with individual LHNs, and total state-wide activity across each activity type.

Consistent with last year’s methodology and pursuant with the National Health Reform Agreement (NHRA), the Ministry of Health has adopted the National Weighted Activity Unit (NWAU) as the currency for Activity Based Funding with the applicable version being NWAU16, which is different from the previous year.

The Independent Hospital Pricing Authority (IHPA) has issued the National Efficient Cost (NEC16) funding model that applies to small regional and remote hospitals. NSW has adopted the mechanics of this funding model expressed in the NEC16 matrix to determine the aggregate funding allocation to LHNs for these small hospitals within the NSW funding model parameters.

Ensuring access to health services for local populations is a key objective of NSW health policy. The Health Services Act 1997 stipulates that in determining LHN budgets, the Minister have regard to the size and health needs of the local population and provision of services to residents outside the local area. Accordingly, targets are adjusted considering factors appropriate to each LHN and service type, rather than simple extrapolation from historical activity data. The factors considered are reviewed on an annual basis.

In 2016/17, a series of elements will be applied to each in-scope service stream to ensure that activity targets are tailored to the requirements and patterns of each LHD/SHN. Activity targets are developed by the Ministry and LHDs/SHNs based on analysis of activity level drivers. This analysis was informed for 2016/17 by the following factors:

  • Weighted population change: providing an indication of expected 'natural' growth
  • Recent trends in activity growth for each LHD/SH
  • Rate of unplanned re-admissions within 28 days
  • Potentially preventable hospitalisations (PPH)
  • Relative Utilisation Rate adjusted for relevant demographic factors
  • Service quality and appropriateness performance in selected key area
  • Inter-district and cross-border flows (where relevant)
  • Current year activity relative to targets (for adjustment of baseline volumes, where relevant)
  • Known service changes and developments, including planned capacity increases.

Price weight adjustments which are being applied in 2016/17 include:

  • Paediatric Adjustment;
  • Specialist Psychiatric Age Adjustment;
  • Patient Remoteness Area Adjustment;
  • Indigenous Adjustment;
  • Radiotherapy Adjustment;
  • Dialysis Adjustment;
  • Intensive Care Unit (ICU) Adjustment for eligible facilities;
  • Private Patient Service Adjustment;
  • Private Patient Accommodation Adjustment;
  • Multidisciplinary Clinic Adjustment;
  • Emergency Care Age Adjustment.

Provisional activity estimates are created at a LHD level to provide the basis for discussion and negotiation with individual health services to determine agreed LHD level activity targets, with the activity volumes measured using the NWAU for each Service Category. Additionally, where applicable, activity estimation is split by financial class to allow differential funding mechanisms to be applied to the respective service groups to reflect the variation in funding source.

Provisional estimates and historical activity measures provide the basis for discussions with individual LHDs and subsequent negotiations for approval or adjustment.

The negotiation process allows for relevant local LHN service issues and activity impacts to be communicated with the NSW Ministry of Health (Ministry) to assess the potential impact on future year activity volumes and the relevance of related service strategies to address these. It is important that negotiation processes recognise that funding and purchasing are undertaken in the environment of a capped State / Commonwealth funding pool for 2016/17 and recognition that NSW contributes the larger portion of these funds as well as being responsible for management of the system as a whole. When negotiations have concluded, the Ministry incorporates the final activity targets in each LHN’s annual Service Agreement. Where an LHN achieves delivery of selected services through Affiliated Health Organisations or contracted services with a private provider these arrangements are to be specified in agreements between the LHN and the respective provider. Both the funding (and subsidy) and associated activity pertaining to such providers are included in the budget and the activity estimates appearing in the LHN’s annual Service Agreement.

Cash payments processed within the National Health Funding Pool (NHFP) Payments System and included within the Administrator’s monthly reports are based on the accrued budget for both ABF and in-scope block funding derived from the LHN Service Agreements after deducting an allowance to recognise own sourced revenue earned, and retained by the LHNs and liabilities for superannuation and long service leave which are accepted by the Crown.

The resultant cash value is processed through the state pool account (ABF) or the state managed fund (in-scope block). Although a consistent methodology has been applied, variations in cash prices between LHNs reflect the differing mix of the above components (own sourced revenue and Crown accepted liabilities) of each local hospital network’s accrued cost.

In addition to receiving weekly cash payments from the state pool account and the state managed fund, LHNs also receive direct State Government funding for 2016/17 for all “out of scope” services not subject to the National Health Reform Agreement arrangements as required under their 2016/17 Service Agreements.

Monthly reports– Basis on which payments were made

For NSW, all dollar values included in the tables issued by the Administrator are cash payments from either the NSW state pool account to LHNs and or cash payments from the state managed fund to LHNs. This includes cash payment to the Victorian Department of Health for Albury-Wodonga inter-jurisdictional agreement.

The weekly cash payment to an LHN reflects the estimated cost of patient related services anticipated to be delivered during the monthly cash payment period. The estimated monthly activity and the weekly cash payments are determined based on the annual LHN Service Agreements.

Cash payments from the NSW state pool account and from the state managed fund to LHNs are processed each Tuesday. Reporting by the Administrator is based on cash payments made during a given month and is therefore dependent on the number of Tuesdays in a particular month. During 2016/17, August 2016, November 2016, January 2017 and May 2017 each have five Tuesdays. If accrual accounting principles were being applied within the NHFA Payments System, the value of the reported cash payments would recognise only the number of calendar days in a particular month, not the 35 days (five weeks paid) or 28 days (four weeks paid), as reported by the Administrator.

In 2016/17 cash payments to LHNs from the NSW state pool account are generally calculated based on equal weekly instalments to health services unless otherwise negotiated.

State Managed Fund cash payments occur as cash is required and dependent on the LHD bank balance in accordance with NSW Treasury Circular TC15-01 Cash Management – expanding the Scope of the Treasury Banking System. As a result not all of the Commonwealth funding was paid to LHNs. The residual of $6.2M Commonwealth will be paid in August 2016.

Other payments will occur in 2016/17 that are outside the regular weekly (Tuesday) payment cycle for payments to other States/Territories for NSW residents treated in their public hospitals. Payments to LHNs may also vary where their cash entitlement alters during the financial year.

Monthly comparison of cash payments from the NSW state pool and state managed fund can vary month to month predominately due to these planned payments and cash requirements of an LHN.

The cash payments from the NSW state pool account or state managed fund do not reflect the full budgeted funding available to health services in NSW. Other sources of funds available to LHNs include separate payments from the Crown (for example, defined superannuation scheme and long service leave cash recovery) as well as own sourced revenues earned and retained by each LHN.

In the months of August 2016 to October 2016 NSW continued to pay its estimated cashflowed amount into the NHFP despite the increase in the Commonwealth contribution for those months. This resulted in an accumulated amount of $69M for the State contribution that was remaining in the account as at 31 October 2016. $30M of the accumulated State deposit was subsequently paid out to LHN’s in the first week of November 2016 and a further $13.7M was paid out in the last week of November 2016. A further additional state deposit was made in December of $13.7M and as at 31 December 2016 there is a residual of $39M which will be paid from the account during the year in accordance with NSW cashflow. There will be a zero balance of State contributions as at 30 June 2017.

For more information on budget allocations, see the 2016/17 LHN Service Agreements which are available on each NSW LHN website as the Chief Executive and Board of the LHN’s provide sign off.

Reference information

The financial information outlined in the following report is categorised as:

  • NHR funding – when the Commonwealth or state or territory government pays NHR funding into a state pool account or state managed fund.
  • NHR payments – when NHR funding that has been deposited into a state pool account or state managed fund is paid out of the state pool account by the Administrator, or is paid out of the state managed fund by the state or territory.

State pool account transactions

Table 1a – State pool account transactions – New South Wales, December 2016

This table shows funding paid into the New South Wales state pool account by the Commonwealth, New South Wales or other states/territories, and payments out of the state pool account to LHNs, the state managed fund, the NSW Ministry of Health or the state pool accounts of other states/territories for December 2016.

NHR funding by source Paid into state pool account Paid out of state pool account
To Local hospital networks To State
Managed Fund
To state
health department
To state pool (other State) Total paid out
($) ($) ($) ($) ($) ($)
Commonwealth
ABF funding
407,995,826 407,995,826 407,995,826
Commonwealth
Block funding
54,993,779 54,993,779 54,993,779
Commonwealth
Other funding
9,920,382 9,920,382 9,920,382
Total C'wealth
funding
472,909,988 407,995,826 54,993,779 9,920,382 472,909,988
NSW
funding
441,351,070 419,709,737 123,825 7,800,000 427,633,562
Other state/territory funding 1,600,000 0 1,600,000 1,600,000
Total 915,861,058 827,705,564 54,993,779 11,644,207 7,800,000 902,143,550

See definitions and explanatory notes following table 1b.

Table 1b – State pool account transactions YTD – New South Wales, December 2016

Following on from table 1a, this table shows year-to-date (YTD) funding paid into the New South Wales state pool account by the Commonwealth, New South Wales or other states/territories, and payments out of the state pool account to LHNs, the state managed fund, the NSW Ministry of Health or the state pool accounts of other states/territories as at December 2016.

NHR funding by source Paid into state
pool account
Paid out of state pool account
To Local hospital
networks
YTD
To State
Managed Fund
YTD
To state health
department
YTD
To state pool (other State)
YTD
Total paid out
YTD
($) ($) ($) ($) ($) ($)
Commonwealth
ABF funding
2,488,734,289 2,488,734,289 2,488,734,289
Commonwealth
Block funding
329,962,677 329,962,677 329,962,677
Commonwealth
Other funding
59,522,292 59,522,292 59,522,292
Total C'wealth
funding
2,878,219,257 2,488,734,289 329,962,677 59,522,292 2,878,219,257
NSW
funding
2,894,721,406 2,808,011,551 909,855 46,800,000 2,855,721,406
Other state/territory funding 9,600,000 0 9,600,000 9,600,000
Total 5,782,540,664 5,296,745,839 329,962,677 70,032,147 46,800,000 5,743,540,664

Commonwealth ABF funding represents Acute admitted, Non-admitted, Emergency department, Sub-acute, and Admitted mental health service categories, which are funded by the Commonwealth through the state pool account and subsequently paid to LHNs.

Commonwealth Block funding represents Non-admitted mental health, Small rural hospitals, Teaching, training & research, and Other non-admitted categories, which are funded by the Commonwealth and paid to the state managed fund.

Commonwealth Other funding represents other amounts funded by the Commonwealth, transacted through the state pool account and subsequently paid to state or territory health departments. This currently represents the Commonwealth contribution to public health.

NSW funding represents funding contributions paid by New South Wales into its own state pool account, and subsequently paid to LHNs within the state, to the New South Wales health department and/or to other state pool accounts.

Other state/territory funding represents contributions paid to New South Wales by other states and territories for cross-border activity.

Note: The grey shaded areas in these tables reflect cells that are not applicable for a particular 'paid out' column. For example, Commonwealth block funding is only paid to state managed funds and not to local hospital networks or state or territory health departments.

NHR funding and payments shown in these tables include GST where applicable.

For more information, see National Health Reform funding and payments.

State managed fund transactions

Table 2a – State managed fund transactions – New South Wales, December 2016

This table shows funding paid into the New South Wales state managed fund by the Commonwealth and New South Wales, and payments out of the state managed fund to LHNs and other provider organisations for December 2016.

NHR funding by source Paid into state managed fund Paid out of state managed fund
To local hospital networks To Other Total paid out
($) ($) ($) ($)
Commonwealth Block funding 54,993,779 54,993,779
State/territory Block funding 43,028,303 43,028,303
Total 98,022,082 98,022,082 0 98,022,082

See explanatory notes following table 2b.

Table 2b – State managed fund transactions YTD – New South Wales, December 2016

Following on from table 2a, this table shows year-to-date (YTD) funding paid into the New South Wales state managed fund by the Commonwealth and New South Wales, and YTD payments out of the state managed fund to LHNs and other provider organisations as at December 2016.

NHR funding by source Paid into state
managed fund
YTD
Paid out of state managed fund YTD
To local hospital
networks
YTD
To Other
YTD
Total paid out
YTD
($) ($) ($) ($)
Commonwealth Block funding 329,962,677 329,962,677
State/territory Block funding 438,079,694 438,079,694
Total 768,042,371 768,042,371 0 768,042,371

Block funding represents Non-admitted mental health, Small rural hospitals, Teaching, training & research, and Other non-admitted categories.

Commonwealth Block funding represents Commonwealth block funding contributions paid into the state managed fund from the state pool account, and block payments out of the state managed fund to LHNs and other provider organisations.

State/territory Block funding represents New South Wales block funding contributions into the state managed fund, and block payments out of the state managed fund to LHNs and other provider organisations.

Note: The grey shaded areas in these tables reflect that these block payments cannot at this stage be identified by source of funding (state, territory or Commonwealth contribution).

NHR funding and payments shown in these tables include GST where applicable.

For more, see National Health Reform funding and payments.

NHR funding and payments by service category

Table 3 – NHR funding and payments by service category – New South Wales, December 2016

This table shows NHR funding and payments by service category on both a monthly and year-to-date (YTD) basis for New South Wales for December 2016. NHR funding and payments are separated into the following service categories – activity-based funding (ABF), block funding, and other funding.

Service category NHR
funding
NHR
payments
NHR
funding YTD
NHR
payments YTD
($) ($) ($) ($)
ABF
Acute admitted 482,607,456 482,607,456 3,088,056,806 3,088,056,806
Admitted mental health 44,780,437 44,780,437 286,107,212 286,107,212
Sub-acute 55,624,022 55,624,022 356,080,678 356,080,678
Emergency department 99,961,178 99,961,178 639,619,729 639,619,729
Non-admitted 144,732,470 144,732,470 926,881,413 926,881,413
Total ABF (Pool) 827,705,564 827,705,564 5,296,745,839 5,296,745,839
Block
Small rural hospitals 47,145,170 47,145,170 417,797,645 417,797,645
Teaching, training & research 22,424,569 22,424,569 167,226,597 167,226,597
Non-admitted mental health 28,452,343 28,452,343 183,018,130 183,018,130
Other non-admitted services 0 0 0 0
Total Block (SMF) 98,022,082 98,022,082 768,042,371 768,042,371
Other
Public health funding 9,920,382 9,920,382 59,522,292 59,522,292
Overdeposit 0 0 0 0
Cross-border 9,400,000 9,400,000 56,400,000 56,400,000
Interest 123,825 123,825 909,855 909,855
Total Other (Pool) 19,444,207 19,444,207 116,832,147 116,832,147
Grand Total 945,171,853 945,171,853 6,181,620,358 6,181,620,358

Total ABF (Pool) is an aggregate of both Commonwealth and state or territory NHR funding and payments for activity-based funding (ABF) which is transacted through the state pool account.

Total Block (SMF) is an aggregate of both Commonwealth and state or territory NHR funding and payments for block funding which is transacted through the state managed fund (SMF).

Total Other (Pool) represents other funding and payments transacted through the state pool account, including public health funding, overdeposits, cross-border funding and payments, and interest.

State and territory cross-border payments can either be:

  • Paid to the relevant state or territory's LHNs - included within ABF and/or block payments in the above table, or
  • Reimbursed to the relevant state or territory where the state or territory's LHNs are already being funded for the cost of treating cross-border patients - shown in the Cross-border row under Other in the above table.

NHR funding and payments shown in these tables include GST where applicable.

For more information, see National Health Reform funding and payments.

NHR contributions by local hospital network

Table 4a – NHR contributions by local hospital network – New South Wales, December 2016

This table shows NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales during December 2016.

NHR contributions to LHNs are separated into an activity-based funding (ABF) component and a block component.

Local hospital network (LHN) ABF component
(ex GST)
Block component
(ex GST)
Total NHR payment
(ex GST)
($) ($) ($)
Albury NSW Local Health District 3,053,493 989,341 4,042,834
Central Coast Local Health District 42,079,802 3,404,184 45,483,986
Contracted Services 0 0
Far West Local Health District 4,672,520 1,368,640 6,041,160
Hunter New England Local Health District 95,794,885 19,392,504 115,187,389
Illawarra Shoalhaven Local Health District 44,697,761 3,588,351 48,286,112
Justice Health & Forensic Mental Health Network 0 3,633,639 3,633,639
Mid North Coast Local Health District 30,526,187 3,568,834 34,095,021
Murrumbidgee Local Health District 19,129,006 4,933,893 24,062,899
Nepean Blue Mountains Local Health District 41,002,079 350,924 41,353,003
Northern NSW Local Health District 38,548,515 2,845,041 41,393,556
Northern Sydney Local Health District 67,809,575 7,295,246 75,104,821
South Eastern Sydney Local Health District 78,665,661 6,296,070 84,961,731
South Western Sydney Local Health District 94,116,295 5,208,244 99,324,539
Southern NSW Local Health District 18,827,240 4,133,832 22,961,072
St Vincent's Health Network 20,015,221 1,516,000 21,531,221
Sydney Children's Hospitals Network 32,915,784 2,557,050 35,472,834
Sydney Local Health District 76,297,246 10,471,264 86,768,510
Western NSW Local Health District 33,442,824 11,710,462 45,153,286
Western Sydney Local Health District 86,111,470 4,758,563 90,870,033
Total 827,705,564 98,022,082 925,727,646

See explanatory notes below table 4b.

Table 4b – NHR contributions by local hospital network YTD – New South Wales, December 2016

This table shows YTD NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales as at December 2016.

NHR contributions to LHNs are separated into an activity-based funding (ABF) component and a block component.

Local hospital network ABF component YTD
(ex GST)
Block component YTD
(ex GST)
Total NHR payment YTD
(ex GST)
($) ($) ($)
Albury NSW Local Health District 22,917,067 5,936,046 28,853,113
Central Coast Local Health District 264,700,657 17,565,835 282,266,492
Contracted Services 784,141 784,141
Far West Local Health District 29,347,276 13,522,715 42,869,991
Hunter New England Local Health District 611,470,867 118,822,406 730,293,273
Illawarra Shoalhaven Local Health District 288,090,591 41,576,067 329,666,658
Justice Health & Forensic Mental Health Network 0 35,775,934 35,775,934
Mid North Coast Local Health District 192,986,028 16,904,534 209,890,562
Murrumbidgee Local Health District 121,996,417 113,704,558 235,700,975
Nepean Blue Mountains Local Health District 277,949,225 37,343,556 315,292,781
Northern NSW Local Health District 243,679,370 18,525,302 262,204,672
Northern Sydney Local Health District 433,911,825 46,860,091 480,771,916
South Eastern Sydney Local Health District 508,508,459 37,776,419 546,284,878
South Western Sydney Local Health District 594,877,299 26,251,552 621,128,851
Southern NSW Local Health District 120,667,953 29,056,179 149,724,132
St Vincent's Health Network 123,260,763 9,096,000 132,356,763
Sydney Children's Hospitals Network 212,475,876 15,342,291 227,818,167
Sydney Local Health District 478,232,807 60,511,782 538,744,589
Western NSW Local Health District 214,630,932 69,986,711 284,617,643
Western Sydney Local Health District 556,258,287 53,484,393 609,742,680
Total 5,296,745,839 768,042,371 6,064,788,210

NHR contributions in this table are GST exclusive to enable comparability of NHR payments in each LHN report.

Note: This table excludes GST.
The majority of government funding to LHNs is not subject to GST. However in some cases hospital funding to non-government entities does attract GST, for example, denominational hospitals, privately and commercially owned health facilities, or any other non-government third party provider of health services or related supplies.

For more information, see National Health Reform funding and payments.

Estimated monthly, YTD and annual activity

States and territories provide service volume estimates at the start of each financial year, and if required, can continue to refine these estimates during the course of the year. These estimates form the basis of monthly reporting of service volumes until actual service numbers become available. These estimates are expressed as National Weighted Activity Units (NWAU).

States and territories provide estimated annual NWAU to the Administrator as a basis for determining the Commonwealth activity-based funding. Current month NWAU estimates accumulate through the year-to-date (YTD) NWAU, to be equal to the annual NWAU at the end of the financial year.

States and territories may also provide activity information relating to the delivery of other public hospital functions funded.

Table 5 – Estimated monthly, YTD and annual NWAU by local hospital network – New South Wales, December 2016

This table shows estimated state or territory hospital activity for activity-based funding services expressed as NWAU for December 2016, the associated cumulative year-to-date (YTD), and total estimated annual NWAU for each LHN in New South Wales.

Local hospital network (LHN) Estimated NWAU delivered in current month Estimated NWAU delivered YTD Estimated annual NWAU 2016-17
Albury NSW Local Health District 1,608 9,646 19,911
Central Coast Local Health District 9,777 58,664 117,328
Contracted Services 338 2,025 4,050
Far West Local Health District 864 5,185 10,369
Hunter New England Local Health District 25,369 152,215 304,430
Illawarra Shoalhaven Local Health District 11,427 68,561 137,121
Mid North Coast Local Health District 7,963 47,777 95,554
Murrumbidgee Local Health District 4,700 28,201 56,402
Nepean Blue Mountains Local Health District 10,406 62,437 124,874
Northern NSW Local Health District 9,861 59,166 118,332
Northern Sydney Local Health District 16,929 101,575 203,150
South Eastern Sydney Local Health District 22,023 132,139 264,277
South Western Sydney Local Health District 23,528 141,171 282,342
Southern NSW Local Health District 4,546 27,274 54,547
St Vincent's Health Network 6,142 36,851 73,702
Sydney Children's Hospitals Network 8,251 49,504 99,008
Sydney Local Health District 20,288 121,731 243,462
Western NSW Local Health District 8,298 49,790 99,580
Western Sydney Local Health District 23,031 138,187 276,374
Total 215,350 1,292,098 2,584,814

An NWAU is a measure of health service activity expressed as a common unit. It provides a way of comparing and valuing each public hospital service, whether they are admissions, emergency department presentations or outpatient episodes, by weighting them for their clinical complexity. The average hospital service is worth one NWAU - the most intensive and expensive activities are worth multiple NWAU, the simplest and least expensive are worth fractions of an NWAU.

Monthly NHR payments relate to the cash needs of public hospitals and do not necessarily reflect the volume of services to be delivered in the month.

For more information on the NWAU calculation, see Calculation of NWAU.