All Queensland residents deserve equitable access to effective and high quality healthcare irrespective of where they live throughout the state.
Queensland Health (QH) provides assistance for eligible patients to access specialist medical services by way of the Patient Travel Subsidy Scheme (PTSS).
The PTSS provides travel and accommodation subsidies for patients who are required to travel more than 50 km from their nearest hospital to attend specialist medical appointments. The PTSS is aimed at ensuring that the cost of travel and accommodation is not a barrier to people living in rural and remote parts of Queensland obtaining adequate healthcare.
Generally, the PTSS provides a subsidy for the cheapest form of travel available for patients to access their nearest hospital or health facility providing the required specialist medical service. This includes travel by commercial air, bus or rail at the lowest available fare. A subsidy is also available for travel by private vehicle.
The PTSS is administered by each of the 16 individual Hospital and Health Services (HHSs) in Queensland. Patients submit their PTSS application at their local public hospital or health service centre along with any supporting documentation from their medical practitioner. When an application is received, the hospital is responsible for determining whether to approve the application, including the subsidy rate and dates of travel covered. If approved, hospitals can either reimburse patients after their travel or book the travel and accommodation on behalf of the patient.
While the PTSS provides valuable support to many thousands of Queensland patients each year, there are a number of deficiencies with the current administrative framework. Since 2010, QH has conducted four reviews or audits into the PTSS in an effort to make the scheme more effective and cost efficient and to ensure it meets the needs of patients. In general, these reviews have identified that the PTSS is overly administrative and needs to be more patient-friendly. QH has also identified that it has insufficient governance, oversight and control over the administration of the PTSS having regard to the current arrangement where service delivery for the scheme rests with the HHSs.
I decided to investigate, under the Ombudsman Act 2001, what action QH had taken in response to the findings and recommendations of its own reviews or audits conducted since 2010. I also reviewed the current PTSS administrative framework and complaints about the PTSS that have been received by the Office of the Queensland Ombudsman(Office) and the Office of the Health Ombudsman (OHO) over recent years.
The investigation found that many of the deficiencies identified in the QH reviews and audits since 2010 are still evident in the current PTSS framework and processes. These include:
- PTSS applications are received, assessed and approved by multiple public hospitals and health service centres across the state, meaning that inconsistent and inequitable decision-making can occur which may result in unfair outcomes for patients.
- Differing administrative practices by hospitals and health service centres about how patient travel is managed, together with an uneven level of resourcing allocated to assessing PTSS applications by different hospitals, have an impact on the equitable treatment of patients accessing the PTSS.
- The PTSS generally lacks patient-friendly processes.
- Delays experienced by some patients in receiving their reimbursement for approved travel result in those patients having incurred considerable expenses and sometimes financial hardship.
- QH has limited awareness about how funding allocated to HHSs to administer the PTSS is being spent, including whether this funding is sufficient to cover the requirements of patients accessing the scheme and whether some HHSs are underfunded or overfunded.
These deficiencies relate to three major issues:
- The PTSS has an inadequate governance framework to achieve the objectives of the scheme.
- There are problems with PTSS administration and management processes within HHSs.
- There is limited information about how funds allocated to HHSs to administer the PTSS are being spent.
The result of these issues for patients is a lack of equitable and consistent decisionmaking by hospitals, frustrating administrative processes which make patient access to the PTSS more difficult and delays in reimbursement leaving some patients struggling to afford their travel and accommodation expenses.
I am of the view that the reviews and audits QH has conducted into the PTSS have sufficiently identified the issues with the administration of the PTSS which need to be addressed.
Accordingly, I have recommended in this report that QH determine which of the recommendations from its own reviews and audits completed since 2010 should be implemented and set a timeframe for when that implementation will occur. This will require QH to determine how best to address the current administrative problems with the PTSS.
The Director-General of QH has accepted my recommendation and advised that an implementation plan, which addresses each recommendation from the reviews and audits, will be completed.
It should be noted that while this report is critical of aspects of QH’s administration of the PTSS, the scheme does successfully provide support for many thousands of Queensland patients each year. By accessing the scheme, these patients are able to receive essential specialist medical treatment that they otherwise may not have been able to access, orthat would have constituted a significant financial burden.
In this respect, I acknowledge the important role of the PTSS for regional, rural and remote Queenslanders. I hope this report will encourage further positive reform to the PTSS and result in improved patient experiences and more equitable outcomes.