Queensland Health Funding Policy and Principles 2019-20 Version
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Health Funding Policy and Principles 2019-20 financial year version 3.0 Contributors Special thanks go to those who contributed to the development of this document from the Department of Health (the Department) and Hospital and Health Services. Version history Version Date Modification 3.0 16 December 2019 Appendix 1 DRG B78C and U68B Queensland PBS weight amended to 0, Appendix 3 removed Du_Type and Designated Ward columns as no longer relevant, Appendix 8 Tier 2 Clinic 73.02 and 73.03 Queensland weights corrected, and Appendix 11 Bilateral Cochlear Implants procedure code updated. 2.0 17 October 2019 Updated National Admitted Acute prices and Tier 2 30.08 Clinical Measurement Queensland 1.0 4 October2019 Approved and published 2019-20 Queensland Health Funding Policies and Principles 2019-20 Published by the State of Queensland (Queensland Health), October 2019 This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Queensland Health) 2019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Healthcare Purchasing and Funding Branch, Department of Health, GPO Box 48, Brisbane QLD 4001, email [email protected], phone 07 3708 5901. An electronic version of this document is available at www.health.qld.gov.au Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information. Queensland Health Funding Policy and Principles 2019-20 Contents For ease of reading, please refer Acronyms and Glossary on page 137. Introduction ............................................................................................................................ 1 1. Overview of Queensland public health services funding .................................................. 1 2. Queensland Health budget and funding sources ............................................................. 2 2.1 State Appropriation .............................................................................................. 4 2.2 Commonwealth Appropriation .............................................................................. 4 2.3 Grants and Contributions ..................................................................................... 4 2.4 Own source revenue ............................................................................................ 4 3. Queensland healthcare purchasing and HHS funding ..................................................... 6 3.1 The process for determining health service purchasing and HHS funding ........... 6 3.2 Healthcare purchasing approach, funding policy and purchasing incentives ........ 7 3.3 HHS funding via service agreements ................................................................. 10 3.4 Queensland public hospital funding models ....................................................... 11 4. Activity based funding (ABF) model .............................................................................. 13 4.1 Overview of ABF ................................................................................................ 13 4.2 National ABF model ........................................................................................... 14 4.3 Queensland ABF model ..................................................................................... 15 4.4 Hospitals in scope for ABF model ...................................................................... 19 4.5 Services in-scope for ABF model ....................................................................... 19 4.6 Private and ineligible patients ............................................................................ 31 4.7 ABF model adjustments ..................................................................................... 32 4.8 Grants for ABF facilities ..................................................................................... 33 5. Block funded facilities and services – NEC ................................................................... 35 5.1 Block funded facilities - NEC .............................................................................. 35 5.2 Block funded services - NEC ............................................................................. 36 6. Population-based funding ............................................................................................. 37 7. Other specific funding ................................................................................................... 38 7.1 Community state-wide services – limited HHS delivery ...................................... 38 7.2 Prisoner Health services .................................................................................... 38 7.3 Third party funded health services ..................................................................... 39 7.4 Other funding ..................................................................................................... 39 8. Pricing for safety and quality ......................................................................................... 40 8.1 Sentinel events .................................................................................................. 40 8.2 Hospital Acquired Complications ....................................................................... 41 8.3 Avoidable Readmissions ................................................................................... 44 9. Data reporting for costing and funding .......................................................................... 47 9.1 Data collection ................................................................................................... 47 9.2 Data reporting .................................................................................................... 48 9.3 Data quality and integrity ................................................................................... 49 10. Governance .................................................................................................................. 53 Queensland Health Funding Policy and Principles 2019-20 10.1 Department of Health ......................................................................................... 53 10.2 System Performance ......................................................................................... 54 Appendices .......................................................................................................................... 57 Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22) ................... 58 Appendix 2 National Admitted Acute Price Weights 2019-20 (N1920) ...................... 71 Appendix 3 Mental Health Admitted (QH Standard Units) 2019-20 – Q22 Only ........ 83 Appendix 4 Queensland Subacute and Non-acute Admitted 2019-20 (Q2) .............. 86 Appendix 5 National Subacute and Non-acute Admitted 2019-20 (N1920)............... 88 Appendix 6 Paediatric SNAP Price Weights 2019-20 (N1920 and Q22) ................... 91 Appendix 7 Queensland Unscored SNAP price weights 2019-20 – Q22 Only .......... 93 Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22) ......................... 95 Appendix 9 Emergency Department price weights 2019-20 (N1920 and Q22) ....... 100 Appendix 10 Emergency Service price weights 2019-20 (N1920 and Q22) .............. 104 Appendix 11 ABF model adjustments and localisations 2019-20 .............................. 106 Appendix 12 Funding adjustments for Hospital Acquired Complications 2019-20 .... 111 Appendix 13 Specified Intensive Care Units 2019-20 ............................................... 112 Appendix 14 Radiotherapy procedures codes eligible for adjustment ....................... 113 Appendix 15 Dialysis codes eligible for adjustment .................................................. 115 Appendix 16 Specified Grants 2019-20 .................................................................... 116 Appendix 17 Clinical education and training grants .................................................. 118 Appendix 18 HHS hospitals and facilities by funding model 2019-20........................ 120 Appendix 19 2019-20 ABF and Non-ABF Service Category Definitions ................... 128 Acronyms and Glossary ..................................................................................................... 137 Bibliography ....................................................................................................................... 141 Figures Figure 1 Australian Public Hospital System Funding and Payment Framework ................. 3 Figure 2 Shadow Purchasing Hierarchy 2019-20 ............................................................... 7 Figure 3 Development of service agreements with the HHSs .......................................... 10 Figure 4 2019-20 HHS allocations by funding models ..................................................... 11