Introduction by Croakey: In the run up to the federal budget on 29 March and an election by 21 May, what health issues do Croakey readers want to see elevated in national debate?
As we mark Medicare’s 38th birthday this week, we are keen to hear your health reform wish-list. Linda Doherty has compiled the conversation-starters below, and we will publish more such submissions in coming weeks.
A renewed commitment to Medicare
Australian Healthcare & Hospitals Association
Acting CEO Kylie Woolcock
Health has been at the forefront of public policy issues for most of the Morrison Government’s current term, first with the 2019 bushfires and then with the pandemic. Most of the policy work has been reactive. Proactive policy-making has been focused on a series of plans and agreements, such as the National Health Reform Agreement and the National Preventive Health Strategy, but without the necessary funding for implementation and often a shift of responsibility from the Commonwealth to the states and to individuals. A renewed commitment to Medicare and universal healthcare, including ensuring adequate funding for public services and addressing out-of-pocket costs, should be a focus, as should health workforce planning and investment, particularly in areas of significant need such as the aged care sector and in rural areas.
We’d like to see an injection of funding for public hospitals and emergency services that have been significantly impacted, not only by surges in demand during the pandemic, but through changes to the way all care is provided. We’d also like to see additional funding for general practice, which has been left to support communities without appropriate resourcing; for rural communities which remain seriously under-served; for mental health services; and for the aged and disability care sectors. Growing out-of-pocket costs and the lack of investment in public oral health services are ongoing systemic issues requiring funding commitments.
An immediate practical requirement is funding for rapid antigen tests so that all Australians can access these, not just those who have a concession card or can afford the inflated costs being charged by some retailers. Funded community care for people with COVID and Long COVID is also needed – for example for oximeters, for nursing support, for allied health services. We can’t have a healthy economy if we don’t have a healthy community and a healthy workforce.
The community expects that it will receive high value healthcare, yet Commonwealth health policy does not always prioritise high value. A value-based approach to healthcare requires a focus on the outcomes that matter most to patients. Personalised healthcare, delivered by the right people in the right place at the right time, should not just be available to those who can afford it but should be central to a reorientation of Medicare.
We expect that the major parties will continue to focus on the pressing issues related to the management of the pandemic. We urge all political parties to focus on how we strengthen our health services and rebuild the health of our community. Political games and point-scoring are not helpful at this crucial time, when thousands are becoming ill and hundreds are dying each week. We need to look beyond the false claims of some political players who have sought to undermine the efforts of the health sector during the past two years. The next Australian Parliament needs members and senators who value health, science and evidence.
Australia’s health system relies upon the skills, knowledge, professionalism and wellbeing of its health workforce. Our workforce faced significant challenges prior to COVID-19 and is continuing to bear the burden of ‘let it rip’ policy. The ability of the workforce to provide safe and high-quality care has been compromised by decisions outside their control, as well as risks to their personal safety and wellbeing. Yet, given trust and supported by devolved authority structures and the right management styles, we saw our workforce innovate to overcome long-standing challenges.
Reorientating Medicare will require our health workforce to be supported to think creatively and be problem-solvers. It will require policy that influences governance structures that support a smooth patient journey through the system, improvements to the way we use data and information, and funding models and policies that incentivise teams across both the clinical and non-clinical workforce to work together for the outcomes that matter to people and communities.
Invest in primary care
Consumers Health Forum
CEO Leanne Wells
The capacity of the health system to meet extraordinary demands has been tested by the pandemic and while, overall, the system has been able to continue to provide high quality care there are cracks emerging that will widen and last longer than the epidemic.
We need to make sure that lessons are learnt about under-investing in health, because without a healthy and safe population it is impossible to deliver on some of the other goals we have as a community.
The Federal Budget must step up investments in health and social wellbeing if Australia’s health system is to come out of the COVID pandemic in strong shape. CHF’s Budget submission proposes measures that reflect the lessons learned from the pandemic, including more investment in income support and public housing, as crucial to promoting a healthier Australia.
We are urging the Government to release the 10-year Primary Care Plan and make down payments to support the leadership roles of GPs in coordinating care. A first step would be to increase the Medicare Benefits Schedule rebates for primary health services for GPs and others to restore the real value of the rebates and improve healthcare affordability and accessibility by reducing out-of-pocket costs faced by consumers. This would be good news for patients, GPs and our strained hospitals.
A second step would be more innovative funding models to ensure primary care can respond with flexible, patient-centred, prevention-oriented, multidisciplinary team-based care. If primary care teams are to spend time with patients on preventive care, such as healthy eating as well as illness management, they need to be flexibly funded.
Other practical innovations would support patients with chronic conditions and their doctors by incorporating social prescribing into routine care. Referring patients to community activities such as art classes, meditation or exercise can improve health outcomes.
A glaring gap in Australia’s so-called universal health system has been the absence of realistic funding for dental health services. CHF calls on the Federal Government to develop a plan to move to a universal dental health scheme. The first step should be the establishment of a Seniors Dental Benefit Scheme, modelled on the Child Dental Benefit Scheme to provide access to services for older people living in residential aged care facilities and others in need.
We have also called for funding for all pandemic testing and treatment services to ensure cost is not a barrier to access and the establishment of a National Centre for Disease Control to respond to, coordinate, and manage communicable diseases and outbreaks. Australia needs a more independent, focused, national coordinating centre that pulls together global expert advice as occurs in other comparable countries.
The CHF also guest tweeted for @WePublicHealth during the week of 31 January.
National focus for LGBTIQ+ health and wellbeing
LGBTIQ+ Health Australia
CEO Nicky Bath
LGBTIQ+ people are identified as a priority population in a range of national strategies, including the National Drug and Alcohol Strategy, National Men’s Health Strategy, National Women’s Health Strategy and National Mental Health and Suicide Prevention Plan. These strategies acknowledge the disproportionate rates of illness and disadvantage experienced by LGBTIQ+ people, the limited impact of existing approaches, and the need for targeted responses. Progress has been variable due to limited coordination and investment.
LHA is seeking commitment and funding for a national LGBTIQ+ health and wellbeing coordination office to drive whole-of-government delivery of national priorities and strategies, in consultation with LGBTIQ+ communities. A priority outcome needs to be the consolidation of existing national policies, strategies and action plans to develop a 10-year whole-of-government National LGBTIQ+ Health and Wellbeing Action Plan.
We are also seeking funding for better data and research to drive policy and action. We seek targeted support for the LGBTIQ+ community-controlled health sector to increase sustainability, enhance capacity to meet demand and expand geographical reach
Budget priorities identified in our submission include investment in:
- Intersex organisations to work with government to deliver change in response to the 2021 Australian Human Rights Commission report
- A targeted program with Primary Health Networks to undertake a needs assessment on the health needs of LGBTIQ+ people and communities
- LGBTIQ+ Health Australia capacity to engage with the National Suicide Prevention Office
- Specific LGBTIQ+ mental health funding to build the capacity of LGBTIQ+ community-controlled organisations
- Extending aged care community volunteer visitors schemes to all jurisdictions and areas, and
- Reviewing the feasibility and strategies to effectively deliver gender-affirming care through the public health system.
Equity for rural health
National Rural Health Alliance
CEO Dr Gabrielle O’Kane
People living in rural and remote Australia should not be denied reasonable access to primary health care; yet we are a long way from achieving health equity. It’s not acceptable that the glass is ‘half empty’ with rural areas having around half the number of health providers per capita than major cities.
If rural health services don’t exist, people cannot access the health care they need. Lack of services means rural people utilise Medicare and the Pharmaceutical Benefits Scheme at a much lower rate, which results in an expenditure shortfall in rural and remote areas.
The National Rural Health Alliance estimates there is a ‘spending shortfall’ of $4 billion in rural health annually – that’s $4 billion in taxpayer funding that doesn’t reach country areas. A new holistic and strategic approach is needed to put the brakes on the rural health crisis.
Over the past several decades, fragmented approaches, such as small trials and pilot initiatives, have not had sufficient impact to solve the fundamental systemic issues of workforce shortages, lack of access to services and the affordability of rural healthcare.
To coalesce the well-intended efforts of many groups and health professions, the National Rural Health Alliance is proposing a new National Rural Health Strategy. We are asking government to commit to whole-of-system change rather than reactive piecemeal approaches.
The Alliance is proposing the immediate funding and rollout of 30 Rural Area Community Controlled Health Organisations (RACCHOs), which have four pillars: block funding, team-based employment, place-based health care, and strong local governance.
Complementing Aboriginal Community Controlled Health Organisations (ACCHOs), the structure and governance of RACCHOs are flexible to accommodate local community circumstances. RACCHOs can differ in each jurisdiction, with strong community input and service planning and delivery based entirely on local needs.
RACCHOs can provide primary care, in-reach services for residential aged care facilities, support for NDIS recipients, support chronic disease management plans and DVA health care services. They would address identified barriers to recruiting and retaining a rural health workforce. Health professionals would be employed with guaranteed income as part of a multidisciplinary team, allowing them to reach their full scope of medical and health-related practice.
RACCHOs would provide rural patients with access to affordable, comprehensive, multidisciplinary primary healthcare services.
The RACCHO model is gaining significant traction, including being embedded in the Draft Primary Health Care 10 Year Plan. It would be a game changer for rural health and empower the next federal government to ensure, once and for all, that the seven million people in rural and remote Australia have equitable healthcare.
A prepared workforce
Public Health Association of Australia
CEO Adjunct Professor Terry Slevin
The past two years have demonstrated that public health issues will be prominent in debates as Australians choose who will lead our next Parliament.
These issues include the importance of Australia having a prepared and effective public health workforce, institutions capable of addressing public health challenges, and a political climate in which pro-public health decisions can be taken rapidly by informed political leaders listening to expert advice, and not unduly influenced by pecuniary interests.
The pandemic has provided us with a stark reminder that our entire community is reliant on effective public and preventive health and disease control systems, and that these systems must be funded and strengthened today in order to build capacity for tomorrow.
The 2022-23 Federal Budget is a chance to learn from the experiences in recent weeks and months that led to the Omicron variant demonstrating how the economy and public health are interconnected. The PHAA’s pre-Budget submission outlines recommendations to improve the health of all Australians and restore public confidence and bolster Commonwealth revenue to help repair the government’s finances.
Among the PHAA’s recommendations are:
- Begin enacting the National Preventive Health Strategy, in particular that five percent in aggregate of all government health expenditure go toward preventive health investments by 2030 to tackle chronic diseases
- Urgently address the need for an expanded public health workforce for Australia, taking into account the challenges of education, training, permanent resourcing, and retention
- Establish an Australian Centre for Disease Control and Prevention
- Embrace levies relating to alcohol, tobacco, and sugar-sweetened beverages, which would simultaneously achieve public health goals while generating revenue to offset other public health investments.
The state of the national economy, and the Budget, will always be affected by public health policy choices, program resourcing, and effective delivery of programs such as testing, tracing, isolation and quarantine (TTIQ), clear evidence-based public messaging, and long-term recovery planning.
Never again should there be a failure to understand that public health policy IS economic policy.
The Public Health Association of Australia has launched VoteForPublicHealth.com to highlight seven major public health focus areas that require urgent action. This site will also be used as a forum to bring to public attention the positions which the leading political parties are taking on public health matters.
Share the burden
Health policy analyst
Both major political parties should agree to amend the public hospitals’ funding arrangements so that the Commonwealth funds half of “efficient growth” and the 6.5% annual cap on Commonwealth funding is removed.
There have been substantial delays in non-emergency (aka elective) surgeries over the past two years and a consequential increase in waiting times. The Commonwealth and states should share the burden of catching up. More generally, however, the Commonwealth should pay half the cost of the joint promise to have free public hospitals.
The Government should also fund a decent increase in aged care workers’ pay, and commit to implementing the second step in increased care times recommended by the Royal Commission into Aged Care Quality and Safety.
Dental care continues to be the forgotten element of a comprehensive public health system. The Federal Government spends about as much money subsidising dental care for the relatively well-off insured population as the states spend on public dental services for pensioners and cardholders.
Stopping the premium rebate on extras insurance and reallocating it to support and expand state dental services on a 50:50 basis would allow a dramatic improvement in state services and the dental health of disadvantaged people. Any savings not allocated to dental care could be used to offset the cost of the increased Commonwealth contribution to public hospitals.
I expect a sustained campaign from the Government trumpeting how good the health response to the pandemic has been – Health Minister Greg Hunt has already started – and an implicit argument that all is good in the health world and there is no need for any change. I hope that the Federal Opposition will undertake to increase hospital funding and aged care wages.
I have no idea about the outcome. I can’t see the Government significantly increasing its majority, but it is hard to see a Labor majority – perhaps a Labor minority government with supply and confidence support from a handful of Independents, in return for a commitment to accelerate measures to address climate change and introduce a real integrity commission.
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