Workers compensation regulation bulletin - Issue 78 (November 2019)
Last chance to have your say on SIRA's Healthcare Review
We encourage you to provide feedback and participate in the consultation with a submission before it closes this Friday 29 November at 11.59 pm.
The consultation, EY report and consultation questions can be accessed on our website.
The review to date has found that increasing service utilisation (the increasing number of services and the increasing number of different service providers claimants are seeing) is the main driver of rising health care costs. Specifically:
- the growth in workers compensation medical expenditure between 2016/17 and 2017/18 was $72.3 million in total
- service utilisation was responsible for 61% of the growth, ie $44.2 million; and
- increases in the unit cost (the fee paid per service) accounted for 5% of the growth or $2.8 million. A growth in active claims has also contributed to the overall increase.
It is recognised that less than 14% of the total 2018/19 health care practitioner spend is for procedures performed under the workers compensation scheme that attract fees above Australian Medical Association rates.
SIRA is actively working with insurers and health practitioner groups on understanding and responding to the causes of these trends and on improving quality and outcomes. The review will result in improved regulatory and fee-setting approaches to ensure injured people have access to the right healthcare at the right time for optimal recovery and return to work, and so the schemes provide value-based healthcare.
The tables below present figures for growth in utilisation and growth in costs for different categories of health care expenditure. Growth rates vary by insurer type.
| Nominal Insurer (managed by icare) | Treasury Managed Fund (managed by icare) | Self and specialised insurers | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| FY16 | FY17 | FY18 | FY16 | FY17 | FY18 | FY16 | FY17 | FY18 | ||
| % increase in medical | Total* | 0% | 8% | 12% | -9% | -4% | 9% | -3% | -5% | 1% |
| GP attendances | -2% | 2% | 3% | -9% | -7% | 3% | -4% | -5% | -1% | |
| Allied health services | 1% | 12% | 17% | -9% | 0% | 15% | -1% | -7% | 2% | |
| Surgery | 4% | 13% | 21% | -7% | -7% | 11% | 0% | -1% | 6% | |
| Diagnostics | 2% | 13% | 16% | -7% | 1% | 3% | -5% | -3% | 5% | |
Note: this table relates to the workers compensation scheme only. Trend analysis is not yet available for the new CTP scheme.
| Nominal Insurer (managed by icare) | Treasury Managed Fund (managed by icare) | Self and specialised insurers | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| FY16 | FY17 | FY18 | FY16 | FY17 | FY18 | FY16 | FY17 | FY18 | ||
| % increase in medical | Total | 5% | 12% | 11% | 0% | 4% | 11% | 1% | -1% | 6% |
| GP attendances | 1% | 6% | 5% | -1% | 3% | 6% | -2% | -2% | 0% | |
| Allied health services | 3% | 14% | 22% | 1% | 9% | 19% | -1% | -7% | 5% | |
| Surgery | 4% | 15% | 17% | -3% | 8% | 12% | 3% | 1% | 7% | |
| Diagnostics | 3% | 13% | 13% | -2% | 6% | 7% | -5% | -1% | 5% | |
Note: this table relates to the workers compensation scheme only. Trend analysis is not yet available for the new CTP scheme.