PATIENT ASSISTED TRAVEL SCHEMES:

ARE THEY ACTUALLY ASSISTING RURAL AUSTRALIANS? Authors: S. Bachman1, D. Ferguson1, E. Gilritchie1, M. Heggart1, R. Irwin1, F. Longordo1, M. Roberts1, B. Simsic1 Supervisors: F. Brooke2, M. Moore3

1 Medical Student, Australian National University 2 Policy Advisor, National Rural Health Alliance 3 Associate Professor of Rural Health, Australian National University

Conclusion

A nationwide approach is needed. It is necessary to harmonise the current eligibility

criteria and to provide uniform levels of financial support across jurisdictions to ensure

equitable provision of health care services to regional, rural and remote Australians.

Furthermore, PATS must be adequately promoted and the application processes

simplified to facilitate accessibility by patients and clinicians.

Recommendations

1. Simplification and Nationwide Uniformity

We propose that current eligibility criteria are simplified and standardised across

States and Territories.

2. Promotion and Accessibility

We recommend nationwide standardisation of PATS branding, application forms and

materials to ease promotion and education of both patients and clinicians.

1. 1. Australian Institute of Health and Welfare. Demography. 2006 [Cited 7 April 2016]. Available from URL: http://www.aihw.gov.au/rural-health-demography/

2. Health Consumers of Rural and Remote. Submission 69: Reforming patient assisted travel schemes. 2007 [Cited 15 February 2016]. Available from URL: http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2004-07/pats/report/c07#c07f1

3. The Senate Standing Committee on Community Affairs. Highway to health: better access to rural, regional and remote patients. Canberra: APH, 2007.

4. WA Legislative Council Standing Committee on Public Administration. Report 25, Report on the Patient Assisted Travel Scheme in Western Australia. WA Government: Perth, June 2015

5. Filby, D. Review of the South Australian Patient Assistance Transport Scheme. SA Health: Adelaide, Dec 2013.

6. Northern Territory Government Department of Health. Review of the Patient Assistance Travel Scheme. 2013 [Cited 20 March 2016]. Available from URL: http://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/570

7. NSW Health. NSW Health submission to the Senate Community Affairs Committee Inquiry into the operation and effectiveness of patient assisted travel schemes. NSW Government; 2007. [Cited 07 April 2016].

8. Queensland Health. Patient Travel Subsidy Scheme guideline (part A) v1.05. Queensland Health; 2015. 18p. [Cited 06 April 2016]. Available from URL: https://www.health.qld.gov.au/ptss/docs/ptss-guideline-pta.pdf

9. New South Wales Government. Isolated Patients Travel and Accommodation Assistance Scheme Guidelines for Assessment. NSW Government, 2015. 47p. [Cited 7 April 2016]. Available from URL: http://www.enable.health.nsw.gov.au/__data/assets/pdf_file/0007/274912/

IPTAAS_Guidelines_for_Assessment.pdf 10. Australian Capital Territory Government. ACT Interstate Patient Travel

Assistance Scheme Guidelines. Canberra: ACT Government; 2013. 18p. [Cited 06 April 2016]. Available from URL: http://health.act.gov.au/sites/default/files/IPTAS%20guidelines%20%28December%202013%29.pdf

11. Victorian Government, Health and Human Services. Victorian Patient Assistance Scheme (VPTAS) Guidelines 2015. Melbourne, VIC; 2015. 60p. [Cited 06 April 2016]. Available from URL: https://www2.health.vic.gov.au/hospitals-and-health-services/rural-health/vptas-how-to-apply

12. Tasmanian Government, Department of Health and Human Services. Patient Travel Assistance Scheme Operational Protocols. Tasmanian Government; 2013. 36p. [Cited 06 April 2016]. Available from URL: http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0003/165333/PTAS_Operational_Protocols.pdf

13. Northern Territory Government. Guidelines for the Patient Assisted Travel Scheme. Department of Health; 2014. 34p. [Cited 7 April 2016]. Available from URL: http://health.act.gov.au/sites/default/files/IPTAS%20guidelines%20%28December%202013%29.pdf

14. South Australian Government, Department of Health and Ageing. Patient Assisted Transport Scheme Information Booklet. South Australian Government; 2014. 21p. [Cited 7 April 2016]. Available from URL: http://www.countryhealthsa.sa.gov.au/LinkClick.aspx?fileticket=jRzR71%2fd%2bvE%3d&tabid=678

15. WA Country Health Service. Patient Assisted Travel Scheme Policy. Government of Western Australia; 2009. 32p. [Cited 07 April 2016]. Available from URL: http://www.wacountry.health.wa.gov.au/index.php?id=630#c1981

Introduction

Patient Assisted Travel Schemes (PATS) aim to provide equitable access to essential

healthcare services for the 30% of Australians living in regional, rural and remote areas

(1). PATS provide travel and accommodation subsidies for non-metropolitan residents

to access specialist healthcare services that are not available within a certain distance

of a patient’s residents address (1). It is paramount that PATS function effectively,

given the limited provision of specialist medical services in regional, rural and remote

areas of Australia and the increasing prevalence of chronic diseases (2).

Over the past 40 years PATS have had a number of variations, with changes in

funding arrangements and governing authority between State and Territory

Governments and the Commonwealth Government (3). Following a review in 1985,

responsibility for PATS were transferred from the Commonwealth to State and Territory

Governments in order to better address the different needs of local communities (3).

In 2007, the Federal Senate launched an inquiry into the effectiveness of State and

Territory based PATS (3). Little redevelopment of the PATS has occurred following the

Senate inquiry in 2007 and subsequent reviews of the different State and Territory-

based PATS (4-7). It has been nine years since a nationwide systematic critique has

been undertaken.

Aims

1. Review the State and Territory based PATS

2. Highlight current issues with PATS

3. Develop key recommendations to improve PATS

Method

Literature review and point in time analysis of PATS in Australia (May 2016). Search

strategy included PubMed, the Australian Institute of Health and Welfare database, the

Australian Bureau of Statistics database and Hansard publications. Broad search

terms included: Patient Assisted Travel Schemes, Government review, Policy, Issues

and Recommendations. Only English language papers were included.

Current Issues

1. Non-uniform Principles of Eligibility.

Distance eligibility vary from 50 km to 200km one way, with the average distance

eligibility criteria 100km one way (8-15). Only New South Wales (NSW), Victoria (VIC)

and Northern Territory (NT) provide weekly distance criteria; 200km, 500km and

400km respectively (8-15).

Eligible medical, allied health and dental services differ dramatically (Table 1).

Escort eligibility is a component of all PATS , including automatic provision for

paediatric patients (8-15).

2. Non-uniform and Inadequate Travel and Accommodation Benefits.

Travel benefits differs for private vehicles with reimbursements ranging from

16cents/km to 38cents/km depending on State or Territory PATS (8-15). All schemes

provide economy rate reimbursement for public transport, however only some provide

Taxi reimbursement (8-15). The current schemes do not make optimal use of air

transport and require some patients to travel 16 hours by car one way before being

eligible for air travel (see Table 2).

Accommodation benefits are inadequate across all States and Territories. Benefits

vary between $41/night to $66/night for commercial accommodation depending on the

State or Territory PATS (see Figure 1). Only five out of eight States and Territory PATS

provide private accommodation financial reimbursement (8-15).

3. Lack of Promotion and Complexity of the Application Process.

There is a lack of awareness among health professionals and clients due to varying

degrees of promotion of PATS across each State and Territory (8-15).

The application process is complex and differs in each State and Territory. It often

involves multiple forms, electronic and/or paper based for both patients and clinicians

to complete (8-15).

Current State and Territory-based PATS

Common features

All provide partial financial reimbursement for travel and accommodation expenses

for attending specialist health services when they are not available within a certain

distance of the patients residential address (8-15).

Travel is based on the most economical form of transport and patients are only

reimbursed for attending the nearest specialist, regardless of preference or state

borders. All schemes allow a patient to travel with an escort (8-15).

STATE

TERRITORY

ELIGIBLE SERVICES

SPECIALIST FERTILITY CLINICAL

TRIALS

HEALTH SCREENING

PROGRAMS

SPECIAL

DENTISTRY

GENERAL

DENTISTRY

ALLIED HEALTH

SERVICES

SECOND

OPINION

NSW

VIC

QLD

SA

WA

TAS

NT

ACT

Table 1: Eligible medical, allied health and dental services.

Green: Eligible service Yellow: Service available only in special circumstances

Red: Non-eligible service : Not addressed within State or Territory guidelines

LEGEND

STATE/

TERRITORY

TRAVEL BENEFITS

PRIVATE VEHICLE

(cents/km)

PUBLIC TRANSPORT

AIR TRAVEL TAXI

NSW 22 Economy Rate Medical reasons 20 dollars/visit

VIC 20 Economy Rate > 350 km Reimbursement

QLD 30 Economy Rate Economy Rate -

SA 21 Economy Rate Medical reasons Reimbursement

WA 16 Economy Rate if > 16 hours by car Exceptional Circumstances

TAS 21 Economy Rate Economy Rate -

NT 20 Economy Rate Economy Rate Reimbursement

ACT 38 Economy Rate Medical reasons -

Table 2: Travel financial benefits.

$60/night

$60/night

$43/night

$41/night

$60/night

$40/night

$41/night

$66/night

Figure 1: Commercial accommodation benefits.

References

Limits on escorts can disadvantage those from remote communities where cultural

and language differences make navigating health care difficult. Specifically, in the

NT, many pregnant women from remote communities are transferred to tertiary

hospitals at 38 weeks gestation. Yet there is no escort or accommodation provision

for the woman’s other children unless they are below the age of two (6).