New South Wales report, May 2019

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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 May 2019 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, May 2019

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 2018/19 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 NWAU18, which is different from the previous year.

The Independent Hospital Pricing Authority (IHPA) has issued the National Efficient Cost (NEC18) funding model that applies to small regional and remote hospitals. However, NSW has introduced a better methodology to better account the significant challenges faced by small hospitals in rural settings and better integrate care between small regional and remote hospitals and ABF hospitals. The mechanics of the NSW funding model is used 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 2018/19, 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 2018/19 by the following factors:

  • Weighted population change: providing an indication of expected 'natural' growth
  • Recent trends in activity growth for each LHD/SHN
  • Relative Utilisation Rate adjusted for relevant demographic factors
  • 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 2018/19 include:

  • Paediatric Adjustment;
  • Specialist Psychiatric Age Adjustment;
  • Patient Residential 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 2018/19 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 liabilities for superannuation and long service leave which are accepted by the Crown.

Based on the fact that not all cash related funding for in-scope services is flowed through the state pool account (ABF) or the state managed fund (in-scope block) and that those funds are retained by the LHD to contribute to the cost of service delivery, the Administrator’s reported level of commonwealth vs state cash paid through the pool does not truly reflect the full cash component funded by the State.

Further, although a consistent methodology has been applied, variations in cash prices between LHNs will also 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 2018/19 for all “out of scope” services not subject to the National Health Reform Agreement arrangements as required under their 2018/19 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 tables provided do not include the level of additional state funding derived from own source revenues and retained by LHN’s and acceptance of crown liabilities (eg LSL & Superannuation) that are also available to LHN’s monthly to meet the cost of services.

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 2018/19, August 2018, November 2018, January 2019 and May 2019 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 2018/19 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.

In respect to Albury Wodonga, the Victorian Department of Health has direct budget responsible for provision of services at Albury/Wodonga Health and the current and proposed IGA for Albury Wodonga, requires NSW to Pay the Victorian Department of Health.

The payment that NSW makes to Victoria Health includes ABF, Block and a share of Public/Population Health funds received under NHR plus the NSW funded component.

On this basis NSW makes a single total payment to Victorian Department of Health each month however for transparency of Commonwealth monies under the NHRA, NSW established an ABF virtual entity for the Albury component of the Commonwealth.

Other payments will occur in 2018/19 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 July 2018 there was a carry over amount of cash of $8.6M from 2017/18 to be used as a source of funds in 2018/19 to cover any liability to the NHFB for final reconciled prior year activity.

For more information on budget allocations, see the 2018/19 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, May 2019

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 May 2019.

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
493,571,594 493,571,594 493,571,594
Commonwealth
Block funding
72,126,133 72,126,133 72,126,133
Commonwealth
Other funding
10,111,751 10,111,751 10,111,751
Total C'wealth
funding
575,809,478 493,571,594 72,126,133 10,111,751 575,809,478
NSW
funding
448,220,725 430,827,617 108,108 17,285,000 448,220,725
Other state/territory funding 5,650,000 0 5,650,000 5,650,000
Total 1,029,680,204 924,399,212 72,126,133 15,869,859 17,285,000 1,029,680,204

See definitions and explanatory notes following table 1b.

Table 1b – State pool account transactions YTD – New South Wales, May 2019

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 May 2019.

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
5,233,872,144 5,233,872,144 5,233,872,144
Commonwealth
Block funding
809,576,656 809,576,656 809,576,656
Commonwealth
Other funding
117,442,381 117,442,381 117,442,381
Total C'wealth
funding
6,160,891,181 5,233,872,144 809,576,656 117,442,381 6,160,891,181
NSW
funding
5,790,104,208 5,598,069,919 1,899,289 190,135,000 5,790,104,208
Other state/territory funding 62,150,000 0 62,150,000 62,150,000
Total 12,013,145,390 10,831,942,064 809,576,656 181,491,670 190,135,000 12,013,145,390

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.

State managed fund transactions

Table 2a – State managed fund transactions – New South Wales, May 2019

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 May 2019.

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 72,126,133 72,126,133
State/territory Block funding -47,861,318 -47,861,318
Total 24,264,815 24,264,815 0 24,264,815

See explanatory notes following table 2b.

Table 2b – State managed fund transactions YTD – New South Wales, May 2019

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 May 2019.

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 809,576,656 809,576,656
State/territory Block funding 1,024,735,323 1,024,735,323
Total 1,834,311,979 1,834,311,979 0 1,834,311,979

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.

NHR funding and payments by service category

Table 3 – NHR funding and payments by service category – New South Wales, May 2019

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 May 2019. 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 530,064,960 530,064,960 6,256,175,248 6,256,175,248
Admitted mental health 48,132,906 48,132,906 571,700,589 571,700,589
Sub-acute 58,948,112 58,948,112 701,207,970 701,207,970
Emergency department 111,280,990 111,280,990 1,325,242,958 1,325,242,958
Non-admitted 175,972,243 175,972,243 1,977,615,298 1,977,615,298
Total ABF (Pool) 924,399,212 924,399,212 10,831,942,064 10,831,942,064
Block
Small rural hospitals 14,664,595 14,664,595 954,487,484 954,487,484
Teaching, training & research 4,252,008 4,252,008 390,667,836 390,667,836
Non-admitted mental health 5,175,994 5,175,994 451,126,102 451,126,102
Other non-admitted services 172,218 172,218 38,030,558 38,030,558
Total Block (SMF) 24,264,815 24,264,815 1,834,311,979 1,834,311,979
Other
Public health funding 10,111,751 10,111,751 117,442,381 117,442,381
Overdeposit 0 0 0 0
Cross-border 22,935,000 22,935,000 252,285,000 252,285,000
Interest 108,108 108,108 1,899,289 1,899,289
Total Other (Pool) 33,154,859 33,154,859 371,626,670 371,626,670
Grand Total 981,818,886 981,818,886 13,037,880,713 13,037,880,713

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.

NHR contributions by local hospital network

Table 4a – NHR contributions by local hospital network – New South Wales, May 2019

This table shows NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales during May 2019.

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 3,795,880 1,009,879 4,805,759
Central Coast Local Health District 44,865,785 0 44,865,785
Contracted Services 7,501,073 0 7,501,073
Far West Local Health District 3,787,379 0 3,787,379
Hunter New England Local Health District 104,927,509 8,123,185 113,050,694
Illawarra Shoalhaven Local Health District 48,861,993 0 48,861,993
Justice Health & Forensic Mental Health Network 0 653,419 653,419
Mid North Coast Local Health District 33,736,618 0 33,736,618
Murrumbidgee Local Health District 22,982,235 0 22,982,235
Nepean Blue Mountains Local Health District 49,723,132 0 49,723,132
Northern NSW Local Health District 43,056,288 1,989,364 45,045,652
Northern Sydney Local Health District 72,520,995 0 72,520,995
South Eastern Sydney Local Health District 86,952,411 0 86,952,411
South Western Sydney Local Health District 110,462,562 0 110,462,562
Southern NSW Local Health District 21,375,440 0 21,375,440
St Vincent's Health Network 23,585,416 1,269,000 24,854,416
Sydney Children's Hospitals Network 37,489,056 0 37,489,056
Sydney Local Health District 86,010,114 0 86,010,114
Western NSW Local Health District 34,975,695 8,552,465 43,528,160
Western Sydney Local Health District 87,789,628 2,667,503 90,457,131
Total 924,399,212 24,264,815 948,664,027

See explanatory notes below table 4b.

Table 4b – NHR contributions by local hospital network YTD – New South Wales, May 2019

This table shows YTD NHR contributions (from state, territory and Commonwealth sources) made to each LHN in New South Wales as at May 2019.

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 38,799,560 11,166,023 49,965,583
Central Coast Local Health District 538,984,967 45,765,909 584,750,876
Contracted Services 18,447,959 16,051,700 34,499,659
Far West Local Health District 56,708,892 26,042,353 82,751,245
Hunter New England Local Health District 1,236,377,478 292,903,055 1,529,280,533
Illawarra Shoalhaven Local Health District 584,345,909 84,966,698 669,312,607
Justice Health & Forensic Mental Health Network 0 59,370,371 59,370,371
Mid North Coast Local Health District 395,411,041 55,708,952 451,119,993
Murrumbidgee Local Health District 265,298,075 159,641,489 424,939,564
Nepean Blue Mountains Local Health District 559,178,543 45,489,924 604,668,467
Northern NSW Local Health District 523,780,206 57,726,643 581,506,849
Northern Sydney Local Health District 884,642,181 142,357,117 1,026,999,298
South Eastern Sydney Local Health District 1,015,519,135 87,520,389 1,103,039,524
South Western Sydney Local Health District 1,277,756,646 102,301,358 1,380,058,004
Southern NSW Local Health District 264,527,668 57,209,018 321,736,686
St Vincent's Health Network 281,529,959 15,246,000 296,775,959
Sydney Children's Hospitals Network 429,831,409 43,248,306 473,079,715
Sydney Local Health District 997,521,258 143,862,604 1,141,383,862
Western NSW Local Health District 418,279,486 231,542,563 649,822,049
Western Sydney Local Health District 1,045,001,693 156,191,507 1,201,193,200
Total 10,831,942,064 1,834,311,979 12,666,254,043

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.

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, May 2019

This table shows estimated state or territory hospital activity for activity-based funding services expressed as NWAU for May 2019, 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 2018-19
Albury NSW Local Health District 1,735 19,082 20,817
Central Coast Local Health District 11,102 122,117 133,218
Contracted Services 325 3,574 3,899
Far West Local Health District 905 9,951 10,856
Hunter New England Local Health District 26,414 290,556 316,970
Illawarra Shoalhaven Local Health District 12,408 136,492 148,900
Mid North Coast Local Health District 8,326 91,583 99,908
Murrumbidgee Local Health District 5,572 61,292 66,864
Nepean Blue Mountains Local Health District 11,722 128,940 140,661
Northern NSW Local Health District 11,194 123,138 134,332
Northern Sydney Local Health District 18,416 202,579 220,995
South Eastern Sydney Local Health District 22,631 248,940 271,571
South Western Sydney Local Health District 26,107 287,182 313,289
Southern NSW Local Health District 4,930 54,233 59,164
St Vincent's Health Network 6,290 69,185 75,475
Sydney Children's Hospitals Network 8,766 96,425 105,191
Sydney Local Health District 22,167 243,836 266,003
Western NSW Local Health District 8,545 93,999 102,545
Western Sydney Local Health District 21,389 235,281 256,670
Total 228,944 2,518,384 2,747,328

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.