Health reform is on the agenda in Canberra with the Federal Government in the process of developing the 2017/18 Federal Budget and Labor signalling a major review of its policies via its Health Policy Summit, to be held tomorrow.
Luckily for all sides of politics there is no shortage of expertise and willingness within the health sector to provide advice on potential reform options.
Most major health organisations have provided details Budget Submissions identifying the funding and policy changes they believe are required to improve the functioning of our health system. A complete list of Budget Submissions can be found on the Treasury website.
And 150 health policy experts will converge on Parliament House to discuss and debate Labor’s health policies. Thanks to a Pozible campaign, Croakey’s Marie McInerney will also be there covering the Summit – follow her coverage on the blog or via Twitter @CroakeyNews #ALPhealthsummit.
Below are summaries of some peak health organisations’ Budget submissions, identifying their key recommendations and themes. Croakey will be adding to this summary of submissions over the coming days.
Key themes emerging from the Budget submissions thus far include:
- The need for significant reform: Australia’s health system is facing a number of challenges, including increased demand for services due to our ageing population and the rise in chronic and complex conditions. Meeting these challenges will require more than just tinkering around the edges – some fundamental changes are require.
- The importance of system integration: many of the areas in which our health system falls down are at the intersection of different sectors or levels of care. Whether it is the hospital-aged care interface; the transition between primary and secondary care; the links between mental health and mainstream physical health services, the need for better integration at the policy, funding and service delivery level is clear.
- A focus on social determinants: the research in this area is clear, social determinants play a major role in health outcomes and they can no longer be ignored by the health system. If we want our health policies, programs and services to deliver optimum outcomes they will need to take into account all the major factors influencing health status, not just those that fit within the health portfolio.
- A more flexible health workforce: the structure and professional delineations of our health workforce have remained largely unchanged for decades. This has resulted in a workforce of highly skilled and competent health professionals who are not, in many areas, being used to their greatest potential. Breaking down some of the rigid barriers between professional groups and introducing more flexibility and integration across the system should help equip our health workforce to meet the future health care needs of our community.
Budget submission summaries
Organisation: Catholic Health Australia
Aged care access and funding; ‘future proofing’ the health system; equity issues.
The changing demographic and predicted increases in chronic disease pose a significant funding challenge. Systemic change is needed in order to finance the health care needs of this changing demographic.
Four main areas of focus for future-proofing our health system include; prevention of chronic disease, promoting healthy aging, increased health sector productivity, and funding reform. Efficient effective integrated systems are needed to reduce the impact of increasing chronic disease and an aging population and these concepts can be applied for long-term models.
Investment now in research in the field of biomedical and biotechnology can greatly enhance the effectiveness of treatments and promote non-hospital based care. However, the question remains as to who will, and how to, fund the healthcare of an increasingly expensive population.
Aged care: increase release of home care packages; removal of the control of package numbers at each of the four funding levels with a view to introducing a system comparable to residential care where financial assistance for individuals depends on their assessed needs, and access is not controlled at each funding level.
Primary care: PHNs to be given policy and funding stability in order to evaluate and achieve positive outcomes;
Health care homes trial: address doctors’ concerns regarding the level of reimbursement required; a robust evaluation; development of a culture of continuous quality improvement
Prevention: action on alcohol, diet and physical activity via taxation and other measures, with a specific focus on disadvantaged communities.
Health services: improving integration; expanding sub-acute services; increasing access to palliative care; universal dental insurance.
Private health insurance: support the current review and critically examine the role of PHI within the health system.
Health workforce: redesign of the workforce to increase integration across professional boundaries; more inter-disciplinary teaching; increased use of technology; greater role for the private sector in training.
Consumer issues: reduce out-of-pocket costs, particularly for disadvantaged consumers; improved health literacy; more performance information for consumers; increased involvement in resource allocation decisions.
Organisation: National Rural Health Alliance
Reducing the health gap between rural and urban Australians in order to promote economic growth
NRHA’s overarching considerations are:
- A focus on addressing youth unemployment in smaller regional and remote communities
- a socio-economic study to identify and enumerate the difference in health spending between major cities and regional and remote Australia and from that study identify priorities for action that provide, or are likely to provide, the best return on investment for governments and communities
- studies that identify regional and remote communities in greatest need of health care workers to support the delivery of education and training services in mental health, disability services and aged care services and the development of targeted policies and programs to support those needs
- an expanded Multipurpose Services program to provide flexible, effective and efficient health and social services support in smaller communities.
Rural workforce: the prioritisation of digital infrastructure in regional and remote communities; expansion of health-related education and training options to support smaller regional and remote communities; long-term contracts for providers of health, mental health, disability and aged and community care services in small regional and remote communities to enable a stable base for recruitment and retention of staff; the development of a Regional and Remote Health Workforce Strategy; delivery of health care and medical education in regional and remote communities; development of the Health Care Home model for regional and remote communities and funded at levels that enable the delivery of the range of services needed in those communities; more mechanisms for information sharing between health care practices, Primary Health Networks and regional and remote health care providers.
Indigenous health: Review of the Indigenous Advancement Strategy by the National Health Leadership Forum; a commitment to Indigenous leadership in the development, implementation and support of health interventions at all levels; a holistic, Aboriginal and Torres Strait Islander led early childhood strategy with stable, long term funding
Primary healthcare networks: ongoing monitoring and adjustment of the effectiveness of the PHN funding model in regional and remote communities; long-term funding agreements to provide stability to PHNs to recruit and retain key staff; trial of the Health Care Home model in small regional and remote communities.
Maternal and infant health: Government recognition and funding for the First 1000 Days program for both Indigenous and non-Indigenous communities; Lessons from the Field programs to enable broader learning and development and cross cultural collaboration.
Organisation: The Public Health Association of Australia (PHAA)
Prevention, protection and promotion
PHAA would like to see a commitment to prioritising health initiatives that focus on Prevention, Protection and Promotion as set out in the Global Charter for the Public’s Health.
- Prevention: Primary: vaccination; Secondary: screening; Tertiary: Evidence and community based, integrated person-centred quality health care; healthcare management and planning.
- Protection: Regulation and coordination; Health In All Policies; communicable disease control; emergency preparedness; occupational health; environmental health; climate change and ecological sustainability.
- Promotion: Social, economic and ecological determinants of health; inequality, healthy settings, health literacy
PHAA’s top three asks for the 2017-18 Budget are:
- Increase the level of Federal funding for prevention from 1.5%4 to 5% of the health budget. Investing in prevention, along with promotion and protection of the public’s health keeps people well and out of hospital, significantly decreasing long term pressure on the health system.
- Address the harms associated with alcohol and sugar through appropriate consumption tax arrangements – hypothecation (ensuring savings are reinvested into health promotion and protection initiatives not only with regard to unhealthy consumption but across health).
- Focus on Aboriginal and Torres Strait Islander People’s health needs, including chronic diseases; tobacco; diabetes; mental health; youth suicide and closing the gap on life expectancy.
Organisation: The Royal Australasian College of Physicians (RACP)
Quality care across the lifespan, prevention, Indigenous health, social determinants
To respond effectively to the lifetime individual and community health needs of Australians, our healthcare system must be enabled and equipped to provide quality, patient-centred care across lifespans.
People’s health and medical needs are also impacted by a range of socioeconomic factors which individuals often do not have direct control over. These are commonly referred to as the social determinants of health and include early childhood experience, economic status, and access to suitable housing, education and employment. Put simply, health is an area that requires a whole-of-government approach.
Healthcare that gives Australians the best chance of living long and healthy lives requires:
- Patient-centred care from a young age, which takes a preventive focus and addresses the social determinants of health.
- Quality care underpinned by best-practice models of service provision and clinical practice.
- An innovative, integrated health system which provides a strong foundation for the above.
Child Health: more funding for home visits, addressing inequities, more action on Closing the Gap, a compulsory code of conduct for marketing baby formula
Adolescent and young adult health: extend health assessments to include all young people aged 10 – 24; more funding for sexual and reproductive health, specifically action on blood borne viruses and sexually transmitted diseases in Indigenous Australians.
Aboriginal and Torres Strait Islander Health: funding for the NATSIHP Implementation Plan, the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP); secured funding for the Aboriginal Community Controlled Health Sector; restoration of funding for a Closing the Gap clearinghouse.
Preventive Health: a national preventive health strategy; more funding for alcohol misuse prevention and treatment; including workforce development to address unmet demand for treatment; a volumetric tax on all alcohol products.
End-of-Life Care: a national campaign to raise awareness of end of life issues and advance care planning; more funding for palliative care services, particularly in non-hospital settings.
Climate Change and Health: a reduction in emissions consistent with the 2015 Paris Climate agreement; funding for a National Climate and Health Strategy; a Healthcare Sustainability Unit to lead the development and implementation of environmentally sustainable healthcare models.
Health System Reform: a trial of alternative funding structures for health care; new funding models for complex chronic disease management which integrate specialist care with general practice.
Supporting high-value, contemporary, best practice care: enhanced funding for translational research; quality improvement measures across the health system; a longer term, more sustained model of MBS review.