Recommendations to the NSW Government to improve the ... - NCOSS

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					                            Council of Social Service of NSW (NCOSS)
                                         Cancer Council NSW

   Recommendations to the NSW Government to improve the Isolated Patient
        Transport and Accommodation Assistance Scheme (IPTAAS)
                                              27 July 2011


NCOSS and Cancer Council NSW welcome the NSW Government’s commitment to increase funding
and review of the administrative requirements for IPTAAS. We provide the following recommendations
to make the scheme more equitable for people who must travel significant distances to access health
services.
Key issues with IPTAAS include the complex and time-consuming administrative process, up-front
cost burden for patients, inequitable eligibility criteria, and inadequate reimbursement rates. Further
details are available in the NCOSS 2011 State Election Platform Vote 1 Fairness in NSW.


1. Principles
We recommend the following principles underpin the design and administration of IPTAAS:
Equity – people living in rural, regional and remote areas who must travel to access health services
should not incur greater financial costs than people in metropolitan areas. Eligibility should be
determined on the basis of need not diagnosis.
Adequate - appropriate reimbursement for reasonable costs incurred when travelling to a health
appointment. Reimbursement rates should be indexed to reflect increases in the cost of living.
Flexible – capacity to review individual cases on an as-needs basis within program objectives.
Timely – payments are made up-front where possible so that people are not left out-of-pocket for
undue periods of time. Reimbursements are processed as quickly as possible.
Accessible – application and reimbursement processes should be simple. Information about the
scheme should be widely promoted to health professionals, service providers and consumers.


2. Eligibility criteria
2.1. Distance
Recommendation: Eligibility for IPTAAS should be based on a cumulative distance travelled over a set
period, with consideration given to extending the distance criterion for renal dialysis patients of at least
200km/week cumulatively to all patients requiring regular treatment.
Rationale: Patients who must make repeated trips for regular treatment may travel greater total
distances than patients who make a single or occasional long distance trip. This is currently
recognised in the NSW Health Policy Directive IB2010_063 which changes the distance criterion for
renal dialysis patients. This criterion should be expanded on the basis of need (and not limited by
diagnosis) to apply equitably to other patients who must also make repeated regular trips (e.g. for
radiotherapy).
2.2. Services
Recommendation: Eligibility should be expanded to cover all items on the Medical Benefits Schedule.
In addition, support should be given for live organ donor transplants (including organ donors), for
patients accessing clinical treatment trials, and artificial limb fitting.
Rationale: The current restriction to treatment by a medical specialist discriminates against those who
need to travel to access treatment by allied health professionals for chronic conditions or receive
treatment through medical trials. These services are important to improving the health of patients and
may reduce longer term costs to the health system.
2.3. Treating specialist
Recommendation: Eligibility should apply to treatment by the nearest specialist OR the most
appropriate specialist as determined by the referring medical practitioner. Factors that may warrant

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                            Council of Social Service of NSW (NCOSS)
                                         Cancer Council NSW

referral to a more distant specialist include: clinical care needs, referral urgency, waiting time for
treatment, patient’s capacity to pay for service, or the availability of family support in conjunction with
the gravity and duration of treatment. These should be stated upfront within the eligibility criteria rather
than as discretionary exemptions to the rule.
Rationale: GPs and patients are often unaware of the current exemption to the nearest specialist
ruling in the IPTAAS guidelines as it is only available on a case-by-case basis and is not routinely
offered. Consequently, patients may receive less clinically appropriate care which results in poorer
health outcomes and may require further or more costly treatment.
2.4. NGO Transport Providers
Recommendation: Consideration should be given to extending the eligibility for IPTAAS to include
patients travelling with NGO transport providers.
Rationale: The current exclusion of community transport users disadvantages those people for whom
other forms of transport are inappropriate or unavailable.


3. Administration
3.1. Administration process:
Recommendation: Implement an on-line administration system. There should be provision for patients
to lodge the initial application, calculate estimates of their travel and accommodation costs, record
attendance at appointments, and log their incurred travel and accommodation costs. Medical
practitioners should be able to upload their referrals and sign-off patient attendance at appointments
with their provider number. LHDs’ IPTAAS clerks facilitate payments to patients based on the data
submitted on-line (either in advance based on estimated costs or post-treatment on the basis of the
patient’s on-line travel log evidenced with receipts) and monitor acquittals. Cancer Voices has a
developed a template that may serve as a guide for an online system (attached).
The initial application information requirements should be simplified and streamlined, including the
requirement for both the general practitioner and Medical specialist to complete the referral.
There should be a designated IPTAAS customer service support position within each Local Health
District to assist people with their applications, provide advice on appropriate travel and
accommodation options, and facilitate payments.
Rationale: The current administrative process is complex and time-consuming for both the patient and
medical practitioner. An online system would simplify the administration process.
3.2. Payment process
Recommendation: Payments should be available in advance. South Australia has recently
implemented an advance pre-payment system that enables payment directly to travel companies or in
the form of fuel cards in standard denominations based on estimated travel distances. Through an on-
line application system patients can access a GPS trip distance calculator to determine how many
kilometres need to be travelled and receive an estimate of their PATS reimbursement. Patients
planning to travel by car are issued with a fuel card in denominations of standard amounts from $10 to
$100. Patients booking public transport or accommodation in advance will have the costs paid directly
to the travel company via Electronic Funds Transfer (EFT). People making claims for travel costs after
their trip will receive the funds in their personal bank account via EFT.
Reimbursement and payment should take into consideration the circumstances of Aboriginal people.
This should recognise that some Aboriginal people may not have bank accounts for EFT or to cash
cheques (e.g. see the review of the Koori pilot in Victoria).
For more details on the SA model see:
http://www.countryhealthsa.sa.gov.au/Services/PatientAssistanceTransportSchemePATS.aspx
Rationale: Patients must currently bear the costs of travel up front and reimbursements can take up to
three months to be processed which can cause significant hardship for low income and disadvantaged
patients.



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                           Council of Social Service of NSW (NCOSS)
                                        Cancer Council NSW

3.3. Co-contribution fee
Recommendation: The co-payment requirement should be removed. If a co-payment is deemed
necessary, an annual cap on the required personal contribution should apply. For example, the
mandatory contribution for the Victorian Patient Transport Assistance Scheme (VPTAS) is currently
set at $100/year. It should not be applied to escorts deemed necessary for medical reasons.
Rationale: IPTAAS is not a full-cost recovery subsidy and the co-contribution fee makes the
reimbursement levels more inequitable to the extent that in some cases there is no rebate payable.


4. Monetary rates
Recommendation: Travel and accommodation expenses should be reimbursed at the equivalent NSW
public service rate. If comparable rates are not possible, reimbursement must be set at a reasonable
proportion of no less than 75% of the public service rate.
The reimbursements should be adjusted by CPI each year to reflect increases in the cost of living and
take into account the different costs associated with staying in large rural and metropolitan centres
Rationale: Reimbursement rates must be appropriate and more realistically reflect the true costs
associated with travel to access specialist health care.


5. Other points
5.1. Information and marketing
Recommendation: IPTAAS should be publically promoted and detailed information made as widely
available as possible. This would cover general practice staff including GPs, practice nurses, social
workers, and non-government health and community services.
Rationale: Many health consumers and service providers are unaware of IPTAAS and how to apply.
5.2. Data collection
Recommendation: Data collection on IPTAAS should be improved with information made publicly
available. This includes data on unmet need, the amount of funding available and reimbursements
made across Districts.
5.3. Consultation
Recommendation: Further consultation on any changes to IPTAAS should be undertaken with
consumers, health services, and transport providers.
Any review of IPTAAS should also give due consideration to the potential impact on both the Health
Related Transport and Community Transport programs.


Attachments:
   NCOSS Vote 1 Fairness in NSW - Factsheet on access to health and related services
    http://www.ncoss.org.au/vote1fairness/Vote-1-Fairness-in-NSW.pdf
   NSWCC & NCOSS, No transport, no treatment: Community Transport to Health Services in NSW
    http://www.cancercouncil.com.au/html/policyaction/reports/downloads/ComTransport_Report.pdf
   Cancer Voices NSW Position Statement IPTAAS January 2011
    http://www.cancervoices.org.au/images/7/7e/IPTAAS_Paper_Oct_2010.pdf
   Cancer Voices, IPTAAS on-line form (attached)




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