Introduction by Croakey: The Federal Budget’s Medicare package has been hailed as a game changer by the health sector, but there is also deep disappointment that measures on income support and housing do not go far enough, and that public health threats such as climate change and long COVID are missing in action.
In this #LongRead, Croakey editor Jennifer Doggett discusses some of the main budget initiatives and highlights the health and community sector responses.
Jennifer Doggett writes:
The Albanese Government has delivered a carefully crafted budget which targets key pain points in the health system and paves the way for longer term reforms.
The centrepiece health package of $5.7 billion (over five years) to strengthen Medicare focuses on boosting bulk billing rates and delivering some modest reforms to support multi-disciplinary and preventive care.
Along with cost of living relief and a reduction in medication charges, this should make primary healthcare more accessible and better value for millions of Australians.
The aged care package, which at $12.4 billion represents the largest single item in the budget, will deliver a much overdue increase in wages for aged care workers and help address the widespread workforce shortages which have been a barrier to the implementation of other measures to improve quality of care.
The positive response from the health and aged care sector (see our rolling wraps here and here) shows that the Government has achieved both political and policy wins in this budget, which should provide a strong foundation for it to embark on the structural reforms required over the longer term.
As always, there are questions around implementation issues, gaps in key areas of need and criticism from stakeholders that many of the initiatives are insufficient to meet demand.
Health groups and experts responded positively to the budget’s centrepiece $5.7 billion (over five years) package to strengthen Medicare.
This included a $3.5 billion measure to triple the incentive for doctors to bulk bill general practice consultations for children under 16 and Commonwealth concession card holders, as well as $2.2 billion for a range of primary healthcare measures, including funding for nurses and allied health professionals in primary health care and a new Medicare rebate for consultations of 60 minutes or longer.
Adjunct Associate Professor at the Menzies Centre for Health Policy, Dr Lesley Russell, told Croakey that this is a budget that will make a difference.
“There are substantial funding increases in MBS items for GPs and the beginnings of Medicare reform and the building of a primary care system,” she said.
Former Secretary of the Department of Health and current Honorary Enterprise Professor at The University of Melbourne, Stephen Duckett, also supported the overall framing and focus of the budget.
Writing at The Conversation, he said that it “starts the process of the primary care rebuild, modernising the system in response to the transition to a population with more people with multiple chronic conditions, such as diabetes, heart disease and depression.”
Community health service provider cohealth described the budget as having “health at its heart”. CEO Nicole Bartholomeusz said the Government “has listened to the concerns of Australians when it comes to accessing essential healthcare, particularly for people who face the greatest barriers to good health.”
The Consumers Health Forum of Australia also welcomed the budget measures which they said will go a long way towards giving consumers greater access to affordable primary care.
In a statement declaring “Labor saves Medicare”, Doctors Reform Society (DRS) President, Dr Tim Woodruff said that the DRS “strongly supported” the tripling of the bulk billing incentive for the most disadvantaged as a first step to saving Medicare after years of neglect.
“So many of my patients will be relieved at the change as for months they have been chasing a bulk billing clinic they can afford, where they can get consistent care from a doctor they have known for years,” he said.
“Decreases in the prescription costs will also delight our patients as they can be less inclined to spread their prescription medicines out to every second day, or not even fill the script because the fridge needs fixing.”
However, despite the strong support from peak bodies, Russell pointed out that it is not clear how GPs in the community will respond to the bulk billing incentives and therefore how they will impact consumer access to GP care.
This was acknowledged by Duckett, who wrote that it was not certain that the measures will increase bulk billing.
“Practice owners could simply pocket the increased incentive for patients who are already bulk billed, leaving bulk billing rates unchanged. Or GPs could use the increased revenue from their existing bulk-billed patients to reduce their hours of work, rather than bulk billing more patients.”
Some commentators have also raised concerns about the targeting of the incentives to children and concession card holders, leaving many people on low incomes and those with chronic conditions without any additional support for the out-of-pocket costs they face when accessing primary health care.
In addition, it’s worth noting that the bulk billing incentives will do nothing address the high cost of specialist services which attract significantly higher out-of-pocket costs than GP care.
My Medicare patient enrolment
In the Department of Health’s budget webinar, Minister for Health and Aged Care Mark Butler discussed the ‘My Medicare’ voluntary patient enrolment initiative which will provide additional benefits for enrolled patients, including access to rebates for longer telehealth consults.
He emphasised that this initiative is being driven by National Cabinet with input from the states and territories who see this as a measure to reduce preventable presentations at public hospital emergency departments.
For this reason, he said that the first cohort to be targeted by this initiative will be patients who are frequent attendees at hospital emergency departments. These people will be offered registration with GPs who will receive payments for keeping them out of hospital. The Minister nominated aged care residents as the next cohort to be targeted in a bid to incentivise GPs to visit facilities.
He noted the large number of pilots already conducted looking at options for blended payments in primary healthcare and said he was keen to work with the sector to deliver sustainable changes which are supported by general practice and ensure patients get improved outcomes.
The range of health and aged care workforce budget initiatives included both short term measures to address current pressures and longer term workforce reforms.
These were welcomed by nursing and allied health groups which stressed the need for ongoing consultation with the sector on the implementation of these measures.
The Australian Nursing and Midwifery Federation Federal Secretary Annie Butler said the budget’s $445 million Workforce Incentive Payment would encourage eligible general practices to employ more nurses, NPs and midwives.
She also called on the Government to continue to develop funding models which genuinely incentivise multi-disciplinary models of care, where a consumer can choose their lead clinician, to improve chronic disease management and, critically, reduce pressure on Emergency Departments and hospitals.
Allied Health Professions Australia (AHPA) welcomed the initiative to invest $6.1 million to support allied health professionals to develop connections to My Health Record which CEO Bronwyn Morris-Donovan described as a “first significant step toward integrating allied health in the MHR and improving the consumer experience of primary care.”
AHPA also welcomed funding for PHNs to commission multidisciplinary care from allied health professionals, nurses and midwives and expressed their willingness work closely with the PHNs to improve access to multidisciplinary care.
Dr Chris Helms, Primary Healthcare Nurse Practitioner and Adjunct Associate Professor at Charles Darwin University, told Croakey that the budget measures were a significant step forward in addressing the barriers nurse practitioners face in providing efficient and timely health services for their patients and communities and in recognising the professional autonomy and independence of nurse practitioners.
He acknowledged the collaborative approach taken by the government working with nursing, medical and allied health leaders and thanked the Australian College of Nurse Practitioners and other peak professional nursing bodies for their role in leading transformational change in our health system.
“The Budget is investing significantly into our future nursing and midwifery workforces, which will translate to improved access to expert healthcare for all Australians,” he said.
“Further work is required to address the significant policy and legislative barriers patients experience when choosing a nurse practitioner as their provider. For example, current policy and legislative mechanisms financially disadvantage patients who seek certain medicines or diagnostic imaging exams when prescribed or requested by a nurse practitioner,” Helms said.
Helms also noted that Aboriginal and Torres Strait Islander communities, who choose a nurse practitioner as their health provider, are still excluded from subsidies arising from health assessments and chronic disease management items, which exemplifies systemic racism in healthcare.
“There is still much work to be done, and I look forward to the Commonwealth’s upcoming Nurse Practitioner 10-Year Strategy, and the actions arising from that,” he said.
On the Closing the Gap Facebook page, the Government stated improving the health and education of Indigenous Australians and listening to their voices were priorities for the budget.
Minister for Indigenous Australians Linda Burney outlined $1.9 billion in measures which would she said make a “practical difference”. These include funding for the referendum to enshrine an Indigenous Voice in the constitution, cancer services targeted at First Nations people and a dedicated action plan to improve Indigenous women’s safety and tackle family violence.
However, the national voice for Aboriginal and Torres Strait Islander children, SNAICC, said the budget was a missed opportunity by the Albanese Government to deliver funding that supports its commitments to improve life outcomes and safety for Aboriginal and Torres Strait Islander children and families.
CEO Catherine Liddle welcomed commitments to make childcare cheaper for all families and support the skills and training of workers in early childhood education.
But she said much more needs to be done to remove the barriers facing Aboriginal and Torres Strait Islander children and families accessing early education and to close the gap so children can thrive.
“What we’d also like to see is a renewed commitment to the National Partnership Agreement on Closing the Gap priority reforms, so Aboriginal and Torres Strait Islander people drive some of these Budget commitments, such as the $200 million to tackle community disadvantage through place-based reforms,” she said.
Climate groups and experts were lukewarm in their response to the budget climate measures which they said were inadequate to address the enormity of the challenges posed by climate change.
The Climate and Health Alliance (CAHA) welcomed funding for action on climate in the Budget, but said more is needed to unlock the health benefits associated with climate action.
CAHA commended the government for the substantial investment in social housing to improve energy performance and its commitment to fund the establishment of a National Net Zero Authority and the Australian Centre for Disease Control.
However, CAHA CEO Roland Sapsford said the budget does not provide much needed resources for the implementation of the National Health and Climate Strategy, expected later this year.
“In our pre-budget submission, we called for a commitment to tangible funding that will support the implementation of the Strategy. Funding like this is needed to ensure that action on climate change secures better health outcomes for all,” he said.
This sentiment was echoed by other climate groups and experts which highlighted the missed opportunities in the budget to address the growing climate emergency.
The Wilderness Society said the Budget is a small step in the right direction for nature, but “falls short of the significant resources required to protect nature, rein in climate change, and stop biodiversity loss”.
The Budget investments in mental health were modest but, according to Dr Sebastian Rosenberg from the Brain and Mind Institute, the new measures are targeted at sensible, structural reforms.
Rosenberg told Croakey that the spending on new workforce initiatives and training places is a positive, along with the emphasis on building and expanding the use of digital systems to support deeper reform.
He also welcomed the investment in multidisciplinary teams in primary care, the increased emphasis on nursing in primary care and the extended prescribing measure which he said would benefit regular users of mental health medications.
Rosenberg noted that significant challenges remain in mental health, including how regional mental health planning, policy and service delivery will be organised, implemented and monitored. He also stressed the urgent need to build and include psychosocial services as part of multidisciplinary teams and to capitalise on the use of digital technologies to drive personalised planning and better accountability.
“The need for measures to assess and report progress is noted but needs real action and a full response to the Better Access Evaluation is yet to be seen,” he added.
Suicide Prevention Australia said the Federal Budget has overlooked people in crisis across the nation and not invested adequately in frontline suicide prevention services.
It had failed to “provide any investment of substance or scale for addressing suicide crisis – contradicting Labor’s claims that this is a ‘wellbeing budget’,” the peak body said.
In the departmental webinar, Assistant Minister for Health and Aged Care Ged Kearney highlighted the specific impacts of the health budget measures on Australian women. These include the bulk billing incentives and the new item number for long consultations which she said would benefit women with conditions hard to diagnose such as pelvic pain and mental health.
Specific initiatives she noted were the longitudinal study on women’s health, continued funding for the breastfeeding helpline, expanded access to donor human milk bank and subsidies for the retrieval and storage of eggs, sperm and embryos for cancer patients.
She also pointed out that the pay rise for aged care workers would disproportionately benefit women as 85 percent of aged care workforce is female.
There was a modest allocation for an interim Australian Centre for Disease Control (ACDC), which Butler told the Department of Health webinar will initially be housed inside the Department of Health.
The Minister welcomed the “terrific response” he had received to consultations on the ACDC but stressed that he needed buy-in from state and territory governments to develop its final model. He also emphasised the importance of including chronic disease and prevention in the remit of the ACDC over the longer term.
The announcement of $136 million to support the mental health of survivors of torture and trauma before moving to Australia on humanitarian grounds was welcomed by the Refugee Council of Australia, which said it would be delivered through the Program of Assistance for Survivors of Torture and Trauma, and other culturally and linguistically diverse communities.
The Council also welcomed funding to extend existing Youth Transition Support services to continue settlement services to young refugees and migrants to improve their employment outcomes.
Another initiative worth noting is the $0.9 million provided to develop a 10 Year National Action Plan to support the health and wellbeing of Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Asexual (LGBTIQA+) people and establish a LGBTIQA+ Health Advisory Group.
Income support and tax
Looking outside the health portfolio, there were a number of measures in last night’s budget which will have significant impacts on individual and population health.
These include the cost of living package, including subsidies for energy bills and increases in the JobSeeker base rate, rent assistance, Austudy and Youth Allowance.
Rosenberg noted the impact of these on people with mental illnesses, telling Croakey that the increases to the income support payments, as well as increased rent assistance and energy bill relief, were “perhaps the biggest budget item of positive impact in mental health”.
“These are all areas of key interest to people with mental illness, a significant proportion of which suffer the associated effects of poverty, although the boost is not large and still leaves people vulnerable to cost of living pressures,” he said.
Social welfare and justice groups also highlighted the inadequate level of the income support increases to address the compounding impacts of poverty, illness and disability.
Advocacy for Inclusion Acting Chief Executive Officer Craig Wallace said “There are very modest increases in income support payments including Jobseeker, Parenting Payment and Rent Assistance while Younger Disability Support Pensioners will also a receive a small increase but these are far from the levels needed to address adequacy.”
On the revenue front, change to the tax on large superannuation balances will generate an additional $2.3 billion in its first full year of operation, and more in future years as superannuation funds grow. This measure doubles the tax on earnings of superannuation accounts with balances over $3 million and was described by the Treasurer as a “modest but meaningful revenue measure”.
Despite strong calls from a broad coalition of social welfare groups and advocates, and a last minute bid from Tasmanian Senator, Jacqui Lambie, to scrap the planned Stage Three tax cuts, the Government appears to be going ahead with them, a cost to the budget of around $20 billion a year from mid 2024, rising to $31 billion by 2030.
The cost of the tax cuts in comparison with the small increase in income support has drawn criticism from the welfare sector, including ACOSS CEO Cassandra Goldie who said:
The Government is providing an increase of $2.85 a day for people with the least. The Stage Three tax cuts will deliver $25 a day to people on the highest incomes. We have our priorities wrong.”
Housing and homelessness
The challenges of housing affordability and homelessness were largely absent in this budget, leaving the sector unimpressed with the inadequacy of income support measures to address the rising costs of housing for people on low incomes.
Australia’s peak body for homelessness said the Budget will put desperately needed dollars in the hands of struggling renters, but the huge challenge of inadequate supply of social housing and overstretched homelessness services remains to be addressed.
Homelessness Australia CEO Kate Colvin said the increase in the base rate of JobSeeker, Youth Allowance and Austudy will be quickly eclipsed by further rental increases.
“Every dollar helps. But unfortunately, many recipients will still be treading water and more rent rises are expected. The truth is, the housing crisis and pressure on homelessness services will continue,” she said.
Mission Australia said the Budget takes small positive steps but is not enough to end the housing and homelessness emergency.
It said it is concerned, amidst cost-of-living pressures, that the Government’s refusal to increase JobSeeker to at least $76 daily will force more people into poverty and homelessness.
“We acknowledge the Government’s intent to ease some of the pressures for people who are doing it tough, and their genuine discussions with the community sector. However, the lack of a substantial increase to JobSeeker and other income support payments is disappointing.”
Everybody’s Home spokesperson Maiy Azize said the Federal Government had delivered “a mediocre budget for one of the biggest crises the nation is facing”.
“The budget has no plan to end Australia’s massive shortfall in social homes. Instead of acting on the biggest living cost facing Australians, it is tinkering around the edges,” she said.
The Government presented funding for the National Disability Insurance Scheme (NDIS) of $910 million over four years as a “first step” to getting the scheme back on track by improving outcomes for participants and ensuring its sustainability for future generations.
Reforming the National Disability Insurance Agency (NDIA) and ensuring more funding goes directly to NDIS participants were highlighted by the Government as key goals for this spending but the disability sector and the Greens remained unconvinced that this would be sufficient to ensure the scheme can meet the needs of Australians with disabilities.
Tuesday’s budget reveals a plan to significantly reduce growth of the NDIS between now and July 2026, when the government wants to impose an annual funding target of no more than 8 percent increase.
On a Facebook Live on Wednesday, NDIS Minister Bill Shorten rejected claims this represented a cut, saying “it’s a forecast, it’s what we hope, it’s not a cap or a roof”.
Shorten said the eight percent figure depended on whether the Government could implement all its planned NDIS reforms, co-designed with people with disability, and stamp out “some of the fraud”.
“The eight percent is a target, it if costs more than eight percent, it costs more than eight percent, it’s demand driven,” he said, but added: “why should people with disability put up with a shoddily run NDIS”.
If some of the money that currently gets wasted is no longer wasted in future, “that’s not a cut, that means we’re running the scheme better,” he said.
Public dental services seem to be a perennially under-funded federal budget area and this one was no different despite its record levels of overall spending.
While the National Partnership on Public Dental services for Adults received yet another extension of funding, this alone will not address the high levels of need for dental care in the community or reduce the rates of preventable hospital admissions caused through oral health problems.
The lack of new funding for dental services was described by the Australian Dental Association as a “lost opportunity” to provide financial support for the nation’s most vulnerable groups who spend years on public waiting lists in the hope of getting the dental treatment they so badly need.
Long COVID was another issue missing out on new money, apart from the $50 million for research (already announced) and funding to support the aged care sector to mitigate the impact of COVID-19 on residents.
Despite the recommendations from the recent parliamentary inquiry into long COVID and repeated infections, there was no additional funding to mitigate the impact it is having and will continue to have, on the health system and the economy.
Rural health was not an explicit focus of the budget, although the Medicare package provides some targeting of spending on bulk-billing incentives to rural and regional areas. The National Rural Health Alliance said this was a missed opportunity to significantly address healthcare needs in rural Australia.
“While there are some modest measures included to improve healthcare access, this is not a Budget that will provide rural health improvements – which is disappointing,” said Alliance Chief Executive Susanne Tegen.
Another notable omission in the budget was a focus on wellbeing, which was flagged by the Government in the October 2022 budget as one of its key priorities.
The only mention of wellbeing in this year’s budget was in the Women’s Budget Statement and no information was provided on the progress of the Measuring What Matters strategy, which is now in second round of consultations.
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