DVA Fees for Medical and Allied Healthcare

• Veterans should not need to rely on the good-will of health care providers, or to pay privately, to receive treatment for accepted conditions.
• Fees paid by DVA should not deter providers from taking on veteran clients.

Veterans who have an injury or illness because of their Defence Force service are entitled to have treatment for that condition paid for by the Commonwealth.

Some veterans are entitled to have all medical expenses, regardless of whether or not an injury or illness is service related, paid for by the Commonwealth, such as:

• Veterans with significant permanent impairment.
• Veterans with operational service who are 70 years of age or older.
• Served in Japan during occupation.
• Participated in British nuclear testing.
• Blind veterans with some permanent impairment.

Health care providers bill the Department of Veterans’ Affairs (DVA) for treatment. Providers are generally not permitted to charge a gap fee. Some services such as pharmaceuticals, hearing, optometry, and dentistry, veterans may pay extra (for example, eyewear frames about a certain amount or high-cost dental procedures).

These arrangements are consistent with modern expectations of workplace injury compensation, and importantly, the unique nature of military service.

DVA provides payments to healthcare providers when they treat veteran clients. The payments are set by DVA through its fee schedules, which vary for different healthcare professionals.

Many veterans have difficulty accessing health care and treatment related to their accepted Defence Service-related conditions because they are unable to find providers who accept DVA clients.

Many health care providers will not take on new DVA clients, because in many cases, the fees paid are significantly lower than those paid by private patients, NDIS, Comcare or state-based workers compensation schemes. In some settings the fees paid to providers may not cover costs.

Many health care providers feel obligated out of charity or good will to provide services to veterans, despite receiving lower fees. Relying on goodwill of providers is not a sustainable funding model.

In the Preliminary Report of the National Commissioner for Defence and Suicide Prevention, Dr Bernadette Boss CSC, observed:

I have heard, for example, of veterans needing to travel significant distances to receive treatment due to the shortage of practitioners treating DVA patients in their geographic areas.

I have also heard of issues arising from the disparity between the DVA fee schedule and the fees that healthcare providers would otherwise charge clients – either through the private system or through other Australian Government schemes, such as the National Disability Insurance Scheme (NDIS). These issues may result in veterans being at a disadvantage.

Interim National Commissioner for Defence and Veteran Suicide Prevention (2021) Preliminary Interim Report

The Productivity Commission’s report A Better Way to Support Veterans recommended

An independent review into fee setting arrangements should be commissioned to look at DVA’s fee setting arrangements and how they can be set to promote accessible and high-quality care for veterans with service-related conditions, while maintaining financial sustainability.

Productivity Commission, A Better Way to Support Veterans, Report no. 93

According to Dr Boss:

In 2019, DVA commissioned an independent review to examine its medical and allied health provider fees, in response to recommendation 16.3 of the Productivity Commission’s report. I requested a copy of the independent report; however, I was advised that DVA was not in a position to provide this, as it contained sensitive and complex material.

Interim National Commissioner for Defence and Veteran Suicide Prevention (2021) Preliminary Interim Report

The Government has committed to funding veterans’ treatment, for service-related conditions. The growing gap between the fees paid by DVA to providers and those paid by private patient or other schemes is an issue affecting veterans’ access to healthcare. The current funding model is not sustainable.

Veterans should not need to rely on the good-will of health care providers, or to pay privately, to receive treatment for accepted conditions. Fees paid by DVA should not deter providers from taking on veteran clients.

The following are typical examples of the differences in fees provided to various medical and allied healthcare providers.

General Practice

General practice is the appropriate setting for preventive health care and care coordination. Having a regular GP is associated with fewer barriers and more positive attitudes to health system navigation and may provide better engagement with and coordination of care.

GPs are critical to the good health of veterans who often have complex medical needs.

The table below compares the fees paid for a standard level B in rooms consultation with a GP (Medicare Benefits Schedule Item 23).

Mental Health Accredited Social Worker

Accredited Mental Health Social Workers deliver clinical social work services in a mental health setting using a range of evidence-based strategies. They help individuals to resolve psychological problems, the associated social and other environmental problems, and improve their quality of life. Social workers recognise the broader implications of an individual having a mental illness and the impact on friends, family, work, and education.

The table below compares the fees paid for a one-hour consultation (ongoing/subsequent consultation) with a Mental Health Accredited Social Worker. Note that Open Arms is a DVA direct service provider.

Physiotherapist

Physiotherapists diagnose and manage a broad range of conditions with the bones, muscles, cardiovascular system, nerves and other parts and systems of the body. They can help people to manage chronic diseases, give lifestyle advice, prescribe exercises and aids to help people manage better, and give advice.

It is difficult to come up with like for like comparisons between schemes. Some schemes pay per type of consultation, others pay per hour. The table below is a reasonably fair comparison, though should not be considered definitive. It is based on a 40 minute (on-going/subsequent consultation) for two cronic condition treatment areas (e.g. back and shoulder).

Note that DVA’s fee can include up to $54.10 in legitimate consumables used during the consultation. This may have the effect of incentivising a physiotherapist to perform treatments that include consumables that can be invoiced to DVA.

Specialist

Medical specialists are doctors who have completed advanced education and training in a specific area of medicine. You usually need a letter of referral from your general practitioner (GP) to make an appointment to see a specialist.

The table below compares the fees paid for an initial in-rooms consultation with a specialist (Medicare Benefits Schedule Item 104).

Read more about DFWA’s policy objectives.