OVERVIEW OF HIC
OUR PURPOSE IS TO IMPROVE AUSTRALIA’S HEALTH
THROUGH PAYMENTS AND INFORMATION.
WE ADMINISTER A RANGE OF PROGRAMS
We were established as a Commonwealth statutory authority in 1974 to
administer what has become Australia’s universal health insurance scheme,
Medicare. However, we have grown over the years to administer a wide range
of other health-related programs on behalf of the Australian Government.
Our key programs are:
> Pharmaceutical Benefits Scheme
(and Repatriation Pharmaceutical Benefits Scheme)
> Australian Organ Donor Register
> Australian Childhood Immunisation Register.
We also administer a range of programs relating to general practice, including the
Medical Indemnity Scheme, the General Practice Immunisation Incentives Scheme,
the Practice Incentives Program, the Rural Retention Program, and the General
Practice Registrars’ Rural Incentive Payments Scheme.
We administer community rebate and reimbursement schemes, such as the
Higher Education Contribution Scheme (HECS) Reimbursement Scheme and the
30% Private Health Insurance Rebate. We facilitate payments through the Family
Assistance Office in partnership with Centrelink, the Australian Taxation Office and
the Department of Family and Community Services (FaCS).
We also administer the Compensation Recovery Program for Medicare and nursing
home benefits, as well as the Balimed scheme for victims of the Bali bombings
in October 2002.
We arrange claims processing and payments for the Department of Veterans’
Affairs (DVA) (veterans’ treatment accounts), the Office of Hearing Services,
the Health Department of Western Australia, and the Vietnam Veterans’
‘Appendix A ∙ Statutory reports’, provides additional information about our
functions, authority, delegations, judicial decisions and reviews, and activities
relating to secrecy and privacy, and occupational health and safety.
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Our strategic plan
Our purpose of ‘improving Australia’s health through payments and information’
was developed in consultation with customers, stakeholders and staff.
We aim to build on our strong base of payments, processing and customer service
to provide information for better health decision making, and we will develop and
customise new services to supply secure and reliable information to our customers.
The seven levels of our plan are:
LEVEL 1 ∙ OUR PURPOSE
> To improve Australia’s health through payments and information.
LEVEL 2 ∙ WHAT WE WANT TO BE KNOWN FOR
> Being trusted by our customers and the community.
> Helping to connect Australia’s health sector.
> Being a valued strategic partner in delivering the health portfolio’s agenda.
LEVEL 3 ∙ THE DRIVING FORCE OF OUR BUSINESS
> We are continuing our efforts to be a customer-driven organisation in
conjunction with strategic partners in the health portfolio.
LEVEL 4 ∙ OUR BUSINESS APPROACH
> We ensure customer access.
> We create value for our customers.
> We grow and develop.
> We organise ourselves through our business approach.
LEVEL 5 ∙ OUR NATIONAL STRATEGIC THEMES
> We build confidence in HIC.
> We stimulate strategic thinking and the creation of knowledge within HIC.
> We produce complete, accurate and timely payments and information.
> We build strategic alliances to connect the health sector.
> We customise our services.
> We provide efficient and effective program delivery through an emphasis
on regulatory frameworks and risk management.
LEVEL 6 ∙ OUR KEY RESULT AREAS
> We have a commitment to strengthening HIC’s financial position and
ensuring accountability for the financial aspects of all programs.
> Our customers and stakeholders have confidence in our provision of services
and our commitment to relationship-building and open communication.
> We have a commitment to internal processes that support the efficient delivery
of our products and services that reflect responsible business practices.
> We are committed to supporting innovation, learning and continuous
improvement for individuals and the organisation as a whole, while also
respecting the objectives of external parties.
> We have a commitment to our staff and to making a positive contribution
to the community.
> We are committed to contributing to—and improving—the physical environment.
LEVEL 7 ∙ STRATEGIES TO ACHIEVE OUR STRATEGIC PLAN
> We are engaging with customers in accordance with our Charter of Care.
> We are realigning our processes to seamlessly provide payments and
information to our customers.
> We are working with the Department of Health and Ageing (DOHA)
to improve connectivity within the health sector.
PART 02 ∙ MEET THE HIC | 9
> We are investing in human resources so that staff skills are aligned with
> We are aligning our investment strategies to support the needs of our customers.
> We are proactively approaching new business opportunities that are consistent
with our strategic plan.
Our values are as follows:
> our top priority is meeting customer needs
> people can trust us to protect the privacy of all information we handle
> we trust and respect each other and work as a team to achieve the best results
> we improve our business efficiency with new products, ideas and ways of working
> we deliver results with honesty, integrity, accountability and enthusiasm.
As part of our commitment to continuous improvement, we:
> use customer feedback to help identify and resolve any problems
> provide training programs to ensure staff are skilled and customer-focused
> monitor and evaluate services against our Charter of Care standards.
For more information about our strategic direction, refer to our website
Time for a review
While our current strategic plan has successfully guided our direction since 1999,
five years is a long time in today’s environment of constant change. In view of this,
and in light of the challenges ahead, we began a review of our strategic plan in 2004.
The process we are using to review the plan involves:
> internal stakeholder engagement, including meetings with staff and
management groups in each state, and interviews with commission members
and senior management
> external stakeholder engagement, involving meetings with key stakeholders
(the minister, DOHA, DVA and FaCS), consultations with peak bodies (through
the Stakeholder Advisory Committee and various communication groups)
and an analysis of key findings from internal data collected about external
> an analysis of key findings and current strategic issues
> development of the strategic plan.
The Strategic Plan 2004–07 is due to be launched in September 2004.
We have a decentralised organisation and structure, which includes a national
office in Canberra, a headquarters in each state capital, a number of processing
centres and a Medicare office network throughout Australia.
Our organisational structure at 30 June 2004 and the functions of each
division are detailed on the next page.
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HIC Senior Executive top structure Managing Director
National Manager Operations Deputy Managing Director
Geoff Leeper James Kelaher
Manager Audit &
Risk Assurance Services Manager Information Services Aged Care Health eSignature Authority
Simon Moore Branch A/g Peter Thomson David Trabinger Suzanne Roche
Chief Information General Manager General Manager State Manager Corporate Development General Manager Manager New General Manager General Manager Commission Secretary
Officer Program Management Program Review Victoria Dominic Downie Information Technology Business and Business Finance & Planning Executive Support
Brian Richards Ellen Dunne Janet Mould Greg Johnson (Ellen Dunne) Services Lyn O'Connell Stakeholder Relations Improvement (Chief Finance Officer) Doug Hall
(A/g Peter Altree) *Anthony Honeyman Lou Nulley John D Lee (A/g Sharon Rose)
Privacy Branch Manager Risk Deputy Manager People Manager Planning and
Sharon Rose (A/g Manager Assoc Intervention and State Manager & Performance Business Management Manager Financial General Counsel
Gabrielle Davidson) Government Management Linda Bennett Julia Burns Vipan Mahajan Control and Legal Services
Manager Program Project Manager
Programs Gary Walsh Development Paul Fenton-Menzies
Strategy and PBS Online
Consultancy Carol Brain State Manager Manager Support Manager Ahalya Shakespeare
Planning *Trish Porter
Karl Karol Manager Risk New South Wales Services IT Architecture Daryl Lapsley Manager Public Affairs
Manager Program Analysis and Ralph Watzlaff Natalie Howson Mark Fraser Manager Budgeting Fiona McLean
Information Support & Assessment (A/g Paul McMahon) & Management Michele Hendrie
Project Manager Directories (A/g
Planning Group Development Susan Hextell State Manager Manager Enterprise Accounting
Medi Andrew Boxshall)
*Jenny McDowell Ai Tran Queensland Manager Corporate Services & Projects Krishna Kumar
Medical Director Sue Harrop Information Services (A/g Socorro Cue)
Manager Medicare Jo-Anne Benson *Poppy Thamsongsana Manager Project &
John Trabinger State Manager Manager Integration Office
Manager PBS South Australia Applications Delivery Leonie Whiting Tony Dunn
Manager PBS Initiatives Group Peter Altree (A/g Graham Gathercole
David Hancock Lynne O'Brien Natalie Howson)
Other BI Projects
Manager Infrastructure > HIC Online
Manager BI Project Officer State Manager Delivery & Business
Implementation Kerrie Foster Western Australia Continuity David Num
Graham Mynott Sandy Mamo
Manager Medicare State Manager Assurance
Reform Taskforce Tasmania Mark Fraser
Lou Andreatta Peter Sexton (A/g Wendy Austen)
PART 02 ∙ MEET THE HIC
> IBIS Unit
Telephony Channel > Information Security
Trevor Deeming Standards and PKI
of HIC Online API * Note: not all officers are senior executives
Office of the Chief Information Officer (OCIO)
The OCIO develops and implements information management strategies that
leverage our technical, intellectual and strategic assets to improve health
outcomes. The Chief Information Officer is responsible for promoting our
reputation as a responsible information manager, and providing advice to
the Managing Director, commissioners and senior executives on developing
our role within the health sector.
Program Management Division (PMD)
PMD manages Medicare, the Pharmaceutical Benefits Scheme and other health
and allied programs that we administer. We monitor performance of each program,
develop administrative policy, and undertake business development for existing
programs and proposed Australian Government initiatives.
Program Review Division (PRD)
PRD works to protect the public purse from fraudulent or inappropriate claims.
We make the health care dollar go further by working with medical professionals
and the health industry to help them correctly interpret the Medicare and
Pharmaceutical Benefits schedules, and claim for their services appropriately.
Corporate Development Division (CDD)
CDD helps our business areas achieve their goals by delivering human resource
strategies, channel improvement, corporate information, physical security and
property management. We focus on achieving and maintaining a high performing
culture and developing a workforce planning framework to ensure our people
have the right skills in the right locations at the right time.
Information Technology Services Division (ITSD)
ITSD provides and manages information technology services including system
applications, and works closely with all areas to get the best out of our internal
and contracted IT services.
Business Improvement Program Division (BIPD)
BIPD was established to enable delivery of our services and products via the
internet. The implementation of major components of our information technology
and business architectures assists in this progression. These architectures
provide a guide to how we will deliver services in the future as well as identifying
the infrastructure and technical capabilities required to deliver these business
Finance and Planning Division (FPD)
FPD supports the achievement of our strategic direction by providing high
quality planning, project management and financial management services to
the whole organisation.
Executive Support Division (ESD)
ESD supports our Executive team and provides the whole organisation with
support in the form of legal services, parliamentary liaison, and public affairs
and marketing services. We provide the major secretariat services to our Board
of Commissioners via the Commission Secretary, who is also the Manager
of Executive Support.
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These cater for Australia’s highly dispersed population. State managers administer
the operations of Medicare offices, processing centres, telephone enquiry lines
and customer service area.
SUPPORTING OUR STAFF
Our staff are employed under the Health Insurance Commission Act 1973.
At 30 June 2004, we employed 5,010 staff—a 6.45% increase since 30 June 2003.
The majority of these (78%) were female.
Of the total staff, 926 were employed part-time and 253 as temporary staff.
The significant proportion of part-time staff (18.5%) ensures we can maintain
high standards of customer service during peak hours.
Staff are located across Australia, with National Office in Canberra and a
state headquarters in each state, as well as several processing centres and
226 Medicare offices.
For detailed staffing statistics, see appendix C.
We have pursued a major change management program since 2000, particularly in
enhancing online ways of claiming and obtaining information and authorisations.
This program has had a big impact on staff, particularly as some reduction in
numbers will result from the changes.
We are committed to advising our staff of forthcoming changes in as timely a
manner as possible and, to achieve this—and to help ensure staff understood the
changes and how they would be affected—we released a number of people plans.
These detailed documents, three of which were released in 2003–04, explain to
staff the key changes expected to take place in coming months, the impact on
various work groups, and what support would be provided to affected staff.
Commitment to equity and diversity
For the 2003–04 reporting period, our equity and diversity annual report noted
significant achievements, including:
> continued implementation and monitoring of the Indigenous recruitment and
> launch of the new Equity and Diversity Plan 2004–07. This plan reaffirms our
commitment to equity and diversity and provides for stronger linkages with our
business planning processes in order to better enable our employees to meet
customer needs while working in an inclusive and flexible environment.
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Certified agreement with staff
Our staff agreement was certified on 3 December 2003 and is a joint agreement
between staff and the Community & Public Sector Union (CPSU). The certified
agreement remains in force until 2 December 2005 and focuses on:
> enhancing and maintaining our strong performance-based culture
> providing support to the organisation as we face the challenges and
changes from business improvement processes
> simplifying and streamlining conditions of employment through
continued development and adoption of contemporary human resource
> promoting an environment that upholds and supports policies and principles
relating to equity and diversity, anti-discrimination, workplace participation,
and health and safety.
Supporting a work/life balance
During 2003–04, we participated in the fifth annual Work/Life Benchmarking Study
conducted by Families at Work in conjunction with CCH. We were named in the top
25 best practice organisations, and received a Certificate of Achievement.
Our certified agreement supports and encourages a healthy work/life balance
and has the following initiatives in place:
> healthy lifestyle subsidy—a subsidy for eligible employees of up to
$120 per calendar year to help staff meet the costs of health programs,
equipment or memberships
> vacation childcare subsidy—a subsidy for employees who have applied
for leave and are required to work due to operational requirements
> employee assistance program—access to confidential professional counselling
> carer assistance—information about child and dependant care services
> part-time work.
As part of the core skill program, we identified and ran a number of training
programs associated with work/life balance initiatives.
Staff initiative teams
Teams dedicated to improving the work environment of staff have been established
in National Office and state offices for a number of years. Staff are encouraged
to join these teams to play a part in developing and organising activities and
addressing staff concerns where possible, to help us maintain a happy and
healthy work environment.
Over the last 12 months, these teams have organised the following events
> monthly Excellence in Service awards, for which staff are encouraged to nominate
co-workers who have modelled our corporate values and have gone above and
beyond the call of duty. The winners and nominees are presented with certificates
of appreciation at monthly award ceremonies attended by most staff
> an art and craft display enabling National Office staff to showcase their
artistic talent near the entrance to the National Office main building
> Healthy Lifestyle Week, which includes events and speakers on health issues
> recycling of Christmas and greeting cards
> generating support and organising fundraising for various charities (see below)
and for HIC families in crisis.
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RELATIONSHIPS WITH OTHER AGENCIES
All of our activities are conducted within the Australian Government policy
framework set by DOHA, DVA, FaCS and relevant legislation. We try to be an
active contributor to policy development by providing regular information
and feedback from our day-to-day operations.
Our relationship with DOHA is underpinned by a service level agreement—
the Strategic Partnership Agreement—and a funding agreement—the Output
We process medical, hospital and allied health services claims for Veterans’
Treatment Accounts on behalf of DVA, in accordance with a service agreement
covering services, service standards and financial arrangements between
our two agencies.
Our role in delivering Family Assistance Office services is covered by
a business service agreement with FaCS.
Department of Health and Ageing
Our current funding arrangement for providing services under the Strategic
Partnership Agreement with DOHA is based on the 2000–02 Output Pricing
Agreement, adjusted for volume variations and indexation. Estimated revenue
under this agreement was $396.3 million.
In 2003–04 the government provided additional funding of $34.3 million to ensure
we were appropriately resourced to continue to deliver a range of family health and
family services programs. This was the first phase of a Department of Finance
and Administration (DOFA) review to update our resourcing arrangements.
As a result of this review, from 1 July 2004 we will be directly appropriated to
provide services on behalf of DOHA.
These new arrangements mean that the role of the Finance and Planning Division
will become more important. As a result, the position of General Manager Finance
and Planning Division has been upgraded to that of Chief Finance Officer (CFO), a
role that will be part of the Executive. The new CFO is due to start in August 2004.
Department of Veterans’ Affairs
Following the expiry of a memorandum of understanding that lasted from
December 1996 to 30 November 2001, we have entered into a new five-year
services agreement with DVA and the Repatriation Commission to continue
to provide processing services for veterans’ treatment accounts. The services
agreement is based on a two-tiered payment arrangement comprising a fixed
charge and a variable charge per transaction processed.
We also administer government initiatives that affect treatment accounts
processing on behalf of DVA. One of these programs is a supplementary
payment for general practitioners contracted with DVA to allow better access to
medical services for veterans and widows in both metropolitan and rural areas.
This initiative became effective on 1 July 2003.
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Department of Family and Community Services
We receive a single annual payment from FaCS to cover the costs of providing
services under the Family Assistance Office program. Under this agreement,
the estimated revenue to HIC in 2003–04 was $8.4 million.
Health Department of Western Australia
Through an agreement with the Health Department of Western Australia, we have
had a visiting medical practitioner fee-for-service payment and information system
in place since April 2000.
This system provides public non-teaching hospitals in Western Australia with an
intranet processing system (in real time) to assess and pay invoices submitted
by visiting medical practitioners for services to public patients.
We expect this agreement to be renewed in 2004–05.
Office of Hearing Services
We process and pay claims to accredited hearing service contractors on behalf of
the Office of Hearing Services in DOHA, according to the Output Pricing Agreement
between our two agencies. Payments are made up of a fixed component and
variable payments, depending on the number of claims paid. Under the agreement,
the estimated revenue to HIC in 2003–04 is $0.5 million.
16 | HIC ANNUAL REPORT 2003–04