General practice after-hours incentive funding: a rationale for change
After-hours incentive funding was made available to accredited general practices in 1998 as a foundation component of the Practice Incentives Program (PIP). The PIP after-hours practice incentive payment was intended to “help resource a quality after hours service and compensate practices that make themselves available for longer hours, in recognition of the additional pressures this entails”.1 Funding for each participating practice was based on the formula shown in Box 1. The model thus predominantly focused on access to after-hours care and comprised four main components:
- a practice’s standardised whole patient equivalent (SWPE) — the sum of the fractions of care provided to practice patients weighted for the age and sex of each patient
- how that practice ensured 24/7 care, from arranged external provision (stream 1) to self-provision only (stream 3)
- the location of the practice, based on its Rural, Remote and Metropolitan Areas (RRMA) classification
- the value per SWPE ($2).
In 2010, the PIP was audited by the Australian National Audit Office (ANAO).2 In an analysis of data provided by Medicare, the ANAO estimated that 14.9% of practices were non-compliant with respect to after-hours incentive payments between the financial years 2005–06 and 2008–09, the highest level of non-compliance across…