Introduction by Croakey: Leaders in the health and social service sectors have delivered their verdicts on the first year of the Albanese Government, applauding major improvements in health equity delivered since the May 2022 election.
However, they are urging greater courage and vision in the Government’s next two years, particularly on social determinants like the country’s housing and income support crisis – raising similar concerns as they did in our Federal budget coverage.
A Croakey survey found that tripled incentives to encourage more bulkbilling by GPs was easily the most applauded (though not universally acclaimed) initiative from the Government’s first year, with support also for the upcoming Voice referendum, extended GP consultations, pay rises for aged care workers, and many other initiatives across the health and other portfolios.
But there is deep disappointment that the Government appears to be in COVID denial and has yet to meaningfully raise the rate of income support, address the housing crisis, or face up to the climate crisis and invest in a comprehensive climate and health policy. Nor has it acted decisively on greater dental care access or addressed workforce and rural health issues, our survey found.
The National Health Leadership Forum, representing Aboriginal and Torres Strait Islander health organisations, recognised that the Government’s first budgets have provided much investment in First Nations peoples across a range of portfolios.
“But how well this investment is implemented, and outcomes achieved, will be dependent on how well the relevant government portfolio agencies take up the intent of the priority reforms under the National Agreement to Closing the Gap and work with First Nations peoples/communities to deliver the intended benefits,” it warns.
See below for responses to our survey from: Climate and Health Alliance, Adjunct Prof Kathy Eagar, Dr Faye McMillan, the Aust Healthcare & Hospitals Association, Professor Kathryn Backholer, National Health Leadership Forum, Jennifer Doggett, RACGP, Everybody’s Home, Charles Maskell-Knight, Dr Sav Zwickl, National Rural Health Alliance, Professor Ian Hickie, Professor Raina MacIntyre, AMA, Medical Association for the Prevention of War, Jesuit Social Services, Australian Medical Students Association, Doctors for the Environment Australia.
Ramp up action on climate and health
Climate and Health Alliance (CAHA) founder Fiona Armstrong
- What are the best things the Albanese Government has done to date for health equity?
The increase in funding to support more bulk billing is welcome as well as long awaited funding to expand primary care teams beyond GPs to support more nursing and allied health practitioners.
This will improve access to care, provide the opportunity to reach more people with chronic and preventable illnesses and potentially (if maintained and expanded) reduce pressure on the tertiary health system.
Reductions in the prices of prescription medicines will also mean those on low incomes will face the choice between food, other household expenses and vital medicines less frequently.
- What are the biggest disappointments?
The lack of dedicated funding to significantly ramp up action on climate change and health is a big disappointment [as Croakey reported recently]. There is so much to do, and so little time to waste on this issue.
Funding to improve governance and co-ordinated action between the Commonwealth and the states and territories, educate and upskill the health workforce, support efforts to decarbonise healthcare and reduce its damaging environmental footprint all have flow on effects for health and health equity — as those most vulnerable, and who have contributed the least to the problem, are hit worst and first (and again and again, as we have seen with floods and ongoing issues with food security).
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Continued and dedicated investment in identifying and supporting those most vulnerable.
Working with health consumers and communities to understand their needs and shaping responses accordingly.
Investing in joined up policy to address the social, environmental, cultural determinants of health — all the things advocates have been calling for, for decades.
There are signs of progress, but let’s get on with it, before climate change hits us even harder, and health equity is deprioritised in a series of rolling, escalating crises.
Denial on COVID
UNSW Adjunct Professor Kathy Eagar, Director, Consultants in Health Services Development (CHSD), Foundation Director, Australian Health Services Research Institute (AHSRI), University of Wollongong
- What are the best things the Albanese Government has done to date for health equity?
By far the best thing the Albanese Government has done for health equity is to begin to address access to affordable primary care.
The increases in the GP bulk billing initiative are terrific and deserve top marks. The bulk billing incentive applies only to children under 16 and to Commonwealth concession card holders (Pensioner, Health Care Card or Seniors Health Card). The amount depends on where you live with the incentive for bulk billing in report areas increased to $39.65 on top of the MBS item.
I am delighted by the introduction of a new item for a GP consultation that goes over an hour. This is excellent for patients with complex and chronic health issues including mental health and end of life care. This new item will be particularly good for women GPs who already do the majority of the work that involves long consultations.
I cannot go past commenting on the 15 percent pay rise for aged care workers. This will improve the viability of aged care services in rural and regional areas and go a small step toward closing the salary gap between health care and aged care.
- What are the biggest disappointments?
By far the biggest disappointment is to see the Government remain in denial about the need for significantly better management of the COVID pandemic.
I was hopeful that the Government would use the budget to reset its approach to COVID and recognise the ongoing devastating impact on individuals and on the economy. This means stepping back from its claim that ‘COVID exceptionalism’ is over and its plan that COVID is now to be treated just like any other respiratory virus.
COVID is not like any other virus, it has exceptional infection, mortality and morbidity rates and it disproportionally impacts the poor, the old and the sick.
OzSage did a great job explaining why National Cabinet got it wrong and why the Albanese Government must do better.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
This is a government that is pacing itself for at least two terms and there is still time to make a real dent in addressing health inequities.
The GP bulk billing initiative does not go far enough. My concern is for older teens, young families, working poor and adults with chronic and complex health problems who don’t qualify for a concession card. A comprehensive primary care strategy, implemented over the next two terms of government, is fundamental to addressing health inequities.
More focus needs to be on mental health and the needs of the ‘missing middle’ – people who need more than the Better Access Program can provide but who are not sick enough to access scarce public mental health care funded by states and territories.
Better containment of COVID is fundamental. Leaving it to individuals to protect ourselves as best we can is not the way to contain a pandemic. The Commonwealth needs to step up and lead the implementation of an effective COVID containment strategy.
We need better access to vaccine boosters, improved access to early diagnosis and improved access to early treatment. We need mandated national standards for ventilation and air quality in public spaces. We need a major public investment in culture change about masks.
We need to treat COVID as a significant occupational health and safety issue. We need to better protect health and care workers as well as teachers and others on the frontline. We are walking with our eyes wide open to worsening staff shortages as thousands more staff develop long COVID. COVID is a public health issue. But it is now also a significant economic issue.
The Voice and a flipside
Dr Faye McMillan AM, Wiradjuri, Professor of Indigenous Health, School of Public Health, UTS
- What are the best things the Albanese Federal Government has done to date for health equity?
Honouring the election Commitment to the Voice referendum has been one of the best. But like with so many good measures there’s a flipside (see next question).
The appointment of Australia’s inaugural Ambassador for First Nations People (Justin Mohamed). Whilst that may not immediately seem a health equity gain, it’s an opportunity for departments to think more holistically.
2. What are the biggest disappointments?
Whilst honouring the election promise, the preparation on the Voice and the responses to criticisms have not been strong enough to counter the No narrative, and that the timeline is a constraint to the broader consultation that is being called for.
As is so often the case, any improvements are welcome, however it can be used as a deflection to the work that still needs to be done to completely change health inequities.
Similarly I’m pleased there is funding for increased mental health support for Aboriginal and Torres Strait Islander people in the lead up to, during and after the Voice referendum, but it’s a double-edged sword that it is needed. We talk about trauma-informed responses but why do we have to keep having trauma in order to get a response?
3. What does it need to do over the next year to get a high distinction for addressing health inequities
A stronger focus on rural and remote communities, and the solutions that are unique to each community (which are different to solutions that have been used in urban communities). Health inequalities still stem from your postcode.
Addressing the racism that is still experienced in health.
No strong system without strong workforce
Kylie Woolcock, Chief Executive Officer, Australian Healthcare & Hospitals Association (AHHA)
- What are the best things the Albanese Government has done to date for health equity?
Recognition of the investment needed to improve access to primary care.
- What are the biggest disappointments?
While Budget announcements went some way to address the determinants of health, housing affordability and adequate levels of income support must be addressed to improve the wellbeing of Australians.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Workforce: Recognise that the health system cannot function without a strong workforce. Achieving this requires effective cooperation and governance across multiple sectors. We need the political commitment to drive the necessary intersectoral support and this will require much more sophisticated workforce planning.
It needs to be needs-driven, not just demographically driven. It will need transparency in responding to, and informing, skill-mix innovation, so that this is driven by needs rather than commercial interests. It needs to be integrated with place-based planning for healthcare services and healthcare funding.
(We expand on this in our submission to the mid-term review of the NHRA).
Dental: Improve access to dental services. This has been a longstanding issue, and we are hopeful that the commitment in this budget to the developmental work and interim funding for long term dental funding reform means that this Government will finally drive action.
Positives and also room to do better
Kathryn Backholer, Professor and Co-Director, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University
- What are the best things the Albanese Government has done to date for health equity?
The referendum for the Voice to Parliament, which provides Aboriginal and Torres Strait Islander people with constitutional recognition and representation. It’s early days, but I’m hopeful it will be successful and, if it is, has huge potential to positively influence the health of Aboriginal and Torres Strait Islander peoples. The proposed vaping reforms are also ground-breaking – like tobacco control, Australia can be leading the world in this area, which will benefit population health and health equity
- What are the biggest disappointments?
There has been very little action to implement the National Preventive Health Strategy. Many of the actions included in this strategy are structural in nature and have great potential to reduce inequities in health. But it will do nothing sitting on a shelf gathering dust.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Many things! Some that stand out are: Increase Jobseeker payments — the $20 a week increase in last budget is certainly welcomed, but it’s well below what is required for people to cover basic costs. Implement that National Preventive Health Strategy, making sure actions that change the environment to support health, are prioritised.
Focus on Closing the Gap priority reforms
National Health Leadership Forum
The National Health Leadership Forum was not able to respond to this Q&A but forwarded its Budget reply, which welcomes a number of measures and highlights important gaps particularly in housing policies:
There is much about the 2023 Commonwealth Budget that for the Government to be congratulated with its investment in First Nations Health and its beginnings to address social and economic disadvantage due to the cost-of-living crisis.
However, there is a glaring gap and that is the lack of investment in social housing and investment in homelessness experienced by many Aboriginal and Torres Strait Islander peoples and the broader Australian community.
Secure, affordable shelter is intrinsic to good health outcomes for all Australians. Housing should not be viewed as a means to wealth creation or a property ownership opportunity, but as a foundation for a healthy and thriving Australia.
Housing as well as many other social determinants such as employment, education, a respectful social support system, health, justice, water and food security and so on, are essential components of well-being and having the ability to participate in the social and economic life of this country.
The Chair of the NHLF, Fiona Cornforth, said that without our communities having safe, secure and affordable housing it will not be possible to address the health gap and tackle chronic disease, mental ill-health, or improve the social and emotional wellbeing of people when they are in a day-to-day fight to put a roof over their heads.
The NHLF recognises that this budget and the October 2022 Budget has provided much investment in First Nations peoples across a range of portfolios. But how well this investment is implemented, and outcomes achieved, will be dependent on how well the relevant government portfolio agencies take up the intent of the priority reforms under the National Agreement to Closing the Gap and work with First Nations peoples/communities to deliver the intended benefits.
“The National Aboriginal and Torres Strait islander Health Plan specifically and consciously highlights the needs for governments to acknowledge the value of investment in the social determinants of health to achieve good health outcomes. This investment is good for the economy and our long-term investment in health care. We ask all governments to accept investment in the social determinants is a benefit not a cost burden,” Ms Cornforth said.
Read Alastair Lawrie: Albanese Government Must Do Better, and Do More, on LGBTIQ Rights in Second Year
Also see: Just Equal Report Card
Scrap Stage 3 tax cuts to spend on equity
Jennifer Doggett, Croakey editor and health policy analyst
- What are the best things the Albanese Government has done to date for health equity?
The Medicare and primary health care package in the 2023-24 budget is a substantial investment in general practice and should increase access to care for people on low incomes and others who experience cost barriers to accessing care. Primary healthcare is the most important sector to get right if we are to improve health equity in Australia.
The cost-of-living package in the Budget, including a $40 a fortnight boost to JobSeeker and Youth Allowance payments, will also help reduce the numbers of Australians living in poverty, a key determinant of health.
- What are the biggest disappointments?
The Government’s insistence on progressing with the Stage 3 tax cuts, despite their clear inequities and a growing cost of living crisis, will reduce the funding available to health and social services and increase income inequality.
The lack of a comprehensive approach to out-of-pocket health care costs means that many people with chronic and complex conditions still face significant cost barriers to accessing care.
A failure to adequately respond to the ongoing impact of the COVID-19 pandemic is resulting in increased numbers of cases in the community and a largely preventable burden resulting from long COVID.
The mental health ‘system’ remains fragmented, with variable levels of service quality and access depending on people’s geographic location, income level and health care needs. This increases health inequities and compounds the impact of other co-existing health and social disadvantages, such as physical illness, housing stress and poverty.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
As above, to improve its performance, the Government should commit to spending the proposed Stage 3 tax cuts on health and social services in order to address current inequities, focusing on groups with reduced access to health care and poorer health outcomes, including Aboriginal and Torres Strait Islander people, people with mental illnesses, people in rural and regional communities and people from diverse linguistic and cultural backgrounds.
A commitment to working with state and territory governments, the community and private sectors and people with lived experience to develop a comprehensive and integrated approach to mental health would help address the significant inequities that exist in this area.
Continue listening to GPs
Dr Nicole Higgins, president of the Royal Australian College of GPs
- What are the best things the Albanese Federal Government has done to date for health equity?
Every patient deserves access to high-quality, affordable, and accessible general practice care, irrespective of their postcode or income. Yet if you live in one of Australia’s lowest socioeconomic areas, you are more than twice as likely to die from an avoidable cause, and your life expectancy is also significantly lower. The 2023 Federal Budget includes a massive – and welcome – investment in general practice that is targeted at making access to a GP more affordable for those who can least afford out-of-pocket costs.
Tripling the bulk billing incentive will help to stop or slow the sharp decline in bulk billing we have seen, especially over the last few years. This incentive is paid on top of the Medicare patient rebate to incentivise bulk billing for children, pensioners and healthcare card holders, especially outside major urban areas where chronic and complex disease is more common.
The budget also reinstates Medicare rebates for longer telehealth consultations and invests in the Workforce Incentive Program, or WIP, to help practices build multidisciplinary health teams. Longer telehealth consultations are vital for the many people who have limited information technology access in isolated areas and small communities. Investment in multidisciplinary health teams will enable practices to provide more and better services to more patients, especially those with complex and chronic conditions, who are overrepresented in rural, Indigenous and many culturally and linguistically diverse communities.
After many years of neglect, our health system was never going to be fixed in one budget, but the 2023 Federal Budget is a commendable start. One of the best things about this budget is that it shows the Albanese Government is listening to GPs and is willing to work with us to fix Australia’s primary care system.
- What are the biggest disappointments?
Any GP can tell you about the damage that low or zero Medicare rebate increases have done to the affordability and accessibility of healthcare. Even before the rate was frozen for six years last decade, the rebate had been increased by less than the consumer price index (CPI) most years – the freeze alone took $3.8 billion out of primary health. While we know the Government was not going to fix the whole healthcare system in one budget, many GPs are disappointed there was not a higher increase in Medicare rebates.
The Government has committed to a $1.5 billion boost to Medicare rebate indexation, which reflects that GPs are being heard, but GPs and doctors who aspire to become GPs need to know their contribution to health will be recognised. Setting appropriate Medicare rebate indexation into the future would be a sensible approach that will decrease inequity and take pressure off other, more expensive, parts of the health system.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
We look forward to working with government on the implementation of the various reforms and funding measures outlined in the budget. To get a high distinction, the Federal Government should continue to listen to GPs as budget measures are implemented and consider their next steps to fix our health system. We worked productively together on the Strengthening Medicare Taskforce and a similarly high level of engagement will help to ensure the policy approaches work as intended on the ground.
GPs see patents who are struggling with cost of living every day. We’re the people best placed to ensure policies are well-implemented and effective, so it’s vital the Government maintains that engagement with the general practice profession.
Scale up on housing and scrap investment handouts
Maiy Azize, spokesperson for Everybody’s Home
- What are the best things the Albanese Government has done to date for health equity?
Housing is central to our health. A decent, affordable home allows people to be healthy, happy, and get on top of their lives. Whether it’s skipping a meal, cancelling a health appointment, or taking on a payday loan, everyday more Australians are making sacrifices just so they can keep a roof over their heads.
The Albanese Government recognised that early by making housing a key focus of their legislative agenda and their work with states and territories. The challenge now is to convince the Government to scale up their ambition to match the scale of Australia’s housing crisis.
- What are the biggest disappointments?
The Government must develop a plan to tackle Australia’s shortfall in social and affordable rentals. Hundreds of thousands of people are waiting for a home, and our shortfall has ballooned to 640,000 homes across the country.
A shortfall that big means that hundreds of thousands of people are in serious rental stress and on the verge of homelessness. It also means that there is enormous pressure on affordable rentals in the private market for everybody else. We simply cannot end Australia’s housing crisis without tackling this shortfall.
The Government’s target to build 30,000 homes over five years doesn’t even replace the social and affordable rentals we’re set to lose over the next few years — and it certainly won’t touch the sides of Australia’s shortfall.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
If it wants to address the biggest housing crisis in living memory, the Government can’t keep sticking with the status quo. We need to see funding and action that matches the scale of this emergency.
We’re calling on the Federal Government to invest in building 25,000 social homes each year to tackle the nation’s shortfall. It also needs to wind back handouts to landlords, like negative gearing, which have driven up demand and led to overheated prices.
The good news is that phasing out these handouts would save billions of dollars. That is money would be far better spent building social housing — and helping renters who are doing it tough.
Bulk-billing reform unlikely to increase rates
Charles Maskell-Knight, former senior public servant, Croakey contributor
- What are the best things the Albanese Government has done to date for health equity?
I think the changes to the Pharmaceutical Benefits Scheme (PBS) to reduce co-payments and introduce extended prescribing are the most positive measure the Government has taken to improve health equity.
- What are the biggest disappointments?
While I may be in a small minority for thinking this, I think the biggest disappointment has been tipping $5 billion and change into increasing bulk-billing incentives. This may stop the decline in bulk-billing, but it is probably not going to increase bulk-billing. There are many disadvantaged areas where bulk-billing is low (especially in the regions, including Tasmania), and the measure is very unlikely to address this problem.
Then there is the hidden problem of very large out-of-pocket costs for specialist consultations in the community, which does not seem to be on the agenda at all.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Any government looking for a high distinction needs to address these two issues (above) over the next 12 months.
It should also make real progress on ensuring access to timely and affordable dental services for lower income groups. Extending the agreement with the states for two years pending development of “A Plan” is promising, but the plan needs to be bold and properly funded.
Welcome 10 year LGBTIQ+ plan but action needed now
Dr Sav Zwickl, Research Fellow, Trans Health Research Group, The University of Melbourne (Austin Health)
The trans community are one of the most marginalised in Australia and experience significant healthcare inequity. Over 40 percent of trans Australians have ever attempted suicide, yet many trans people are unwilling to utilise mainstream mental health services due to previous negative experiences or fear of discrimination.
There is a heavy reliance on LGBTIQA+ community-controlled support services; however, these are underfunded and cannot meet demand. Additionally, trans Australians face significant barriers to accessing general and gender-affirming care, with many healthcare professionals lacking training in how to support trans patients, prevalent healthcare discrimination, and gender-affirming surgeries are often prohibitively expensive.
Our research demonstrates that both experiences of discrimination and violence and barriers to accessing gender-affirming healthcare are associated with an increased risk of suicidality in trans people.
Recently, the Albanese Government announced The 10 Year National Action Plan for the Health and Wellbeing of LGBTIQA+ people and investment of $26 million in LGBTIQA+ health and medical research.
While this is an exciting and important step in addressing health inequity longer term, more immediate action by the Federal Government is required to address the widespread discrimination and violence against trans people, the mental health crisis faced by the trans community and the significant barriers to accessing timely, affordable and safe mental health care and gender-affirming healthcare.
This should include investment in the expansion of existing LGBTIQA+ and trans-specific support services, training of health professionals in gender-affirming care, inclusion of gender-affirming surgeries under Medicare, and the implementation of strategies to reduce societal discrimination and violence against trans people.
Address equity in rural health
Susi Tegen, Chief Executive, National Rural Health Alliance
- What are the best things the Federal Government has done to date for health equity?
It seems like this budget is just the start for some major changes to come. There are some glimpses, and it will be interesting to see what the details will be, as they become available.
Boosting the incentive to bulk billing in the 2023-24 Budget, noting that the incentives increase with remoteness, was a very good measure.
This will go some way to addressing equity in access to primary care, but does not address equity in rural Australia, where even these incentives will not keep primary care practices going (many are at risk of closing, if they have not already done so, because of financial unviability). In addition, if there aren’t clinicians in those regions in the first place, due to work maldistribution, then the incentive will be underutilised. Market has often failed, and is not always just “thin“, as sometimes referred to.
The Government has taken some steps to addressing barriers that have prevented Nurse Practitioners and Endorsed Midwives operating to their full breadth of practice which is essential in rural Australia where all health professionals must be used to their full scope so that patients have more options to access essential healthcare.
The Government has introduced funding measures over the recent Federal Budgets to combat rheumatic heart disease, support a Birthing on Country Centre of Excellence, improve access to dialysis treatment and cancer care for Aboriginal and Torres Strait Islander people.
There have been a number of measures to improve access to mental health services but, while welcome in general terms, rural Australia does not seem to be benefiting as much as metropolitan Australia.
Some of the policy releases do not differentiate between rural and urban, which does not address the issues faced by rural populations. This makes it very difficult to understand where the actual funds and initiatives will be provided in rural Australia, as opposed to urban Australia.
- What are the biggest disappointments?
After a decade of inaction on so many social issues, rural Australians in particular are impatient for change. Also, many children are growing up in poverty while we wait for structural reform and change.
The Government has a good agenda, however rural Australia face two major problems – a lack of understanding that place-based decision making and planning ensures local solutions (rather than urban fitting rural models) and fear of courageous decisions and funding streams.
After a decade in opposition, this Government seems keen to see their plans through over a number of terms of government. The NRHA and its members and grassroots stakeholders are eager to work with government to work differently, as the current models of “innovation” have not brought about the changes needed over the last 30 years. We cannot continue to “starve” rural communities of the services they deserve and need.
The Government has not acted in any meaningful way on the recommendations of the Medicare Review Taskforce findings, as yet. There is a need for major reform in the way primary care is funded in rural Australia, so that multidisciplinary practices can be supported and/or built and to be viable. We cannot continue to fly in-fly-out and have revolving doors of clinicians, because we are not willing to solve the problems differently.
The health workforce is depleted across the country which is exacerbated in rural Australia. The government needs to take some serious measures to train and educate the health workforce and support health practitioners to be trained, retained and supported to live and work in rural Australia.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Rural communities are seeking government to commit to a new National Rural Health Strategy and Implementation Plan to address enduring healthcare workforce, access and affordability issues, and to include the rural health sector in responding to climate change and in local disaster planning and emergency management.
A National Rural Health Strategy is needed which is the foundation of changes for and in rural health access policies and funding. It would acknowledge that rural and remote communities are different to metropolitan communities and that each rural or remote community has circumstances and needs.
Any new Strategy must address the lack of progress in improving the health outcomes over the last 10 years for those living in rural Australia, so that they are equitably accessing health care and improve their health status. It should consider the barriers and incentives for attracting and retaining a rural health workforce, how to incentivise and provide greater investment in preventive health as well as acute care, and how to fund and administer models of care that are flexible and responsive to local needs.
Further, we ask the Government to acknowledge that trials and pilots are no longer enough to keep primary care surviving in rural Australia. The NRHA encourages the government to commit to models of funding for primary care which support practitioners to stay working and be paid a reasonable salary for the work they do.
This will require further loading on Medicare, block funding, transferability of employment, ability for medical and health clinicians to be paid and receive the same conditions to those employed by government through public hospitals and other services. In addition it requires the ability for communities to lead and develop primary care models to suit their unique needs.
The NRHA is advocating for a primary care model we refer to as Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) — see more here — which are developed and built according to population health need, services already delivered in those regions, and the stakeholders collaboration.
Courage on mental health but more needed
Ian Hickie, Co-Director, Health and Policy and Professor of Psychiatry at the University of Sydney’s Brain and Mind Centre
- What are the best things the Albanese Government has done to date for health equity?
Most importantly, Health Minister Mark Butler has clearly stated that health equity, particularly relating to access to care and out-of-pocket costs for the most disadvantaged, really matters.
So two things stand out. One: increasing the incentive for GPs to bulk-bill those in greatest need and, two, NOT extending the 20 session psychology session rebate.
That latter decision was brave and based entirely on trying to get access for mental health care for those who had been locked out by the Morrison Government decision to favour those already in the system, and those with the capacity to pay large out-of-pocket costs (often residing in the more affluent parts of our large cities).
- What are the biggest disappointments?
Not yet taking on the need for enhanced support systems to reduce the costs of accessing specialist medical or psychological care. Simply, propping up the existing GP-focused and small-business model of primary care will not be nearly enough.
More radical changes, including serious digitisation of health care and a focus on real chronic illness management are critical to health equity. Within that mix, serious investments in new models of mental health care, for the most disadvantaged, are urgently required.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Fix access to more specialised psychological care for the most disadvantaged, this year. Seriously support the implementation of multi-disciplinary team care backed by smart and proactive information systems that enhance both access to and provision of much more personalised, responsive and high quality health care.
COVID protection needed for kids
Professor Raina MacIntyre, UNSW, head of the Biosecurity Program at the Kirby Institute
- What are the best things the Albanese Government has done to date for health equity?
The Voice. This is an important first step in addressing health equity.
Reducing the cost of PBS prescriptions and allowing 60 days of supply to be filled in one prescription.
The clean air forum and long COVID inquiry.
Public health can improve equity because the public health strategies go beyond individual interventions, to the health of the whole population. That needs us to accept that “personal responsibility” is not enough for health equity.
- What are the biggest disappointments?
The shifting of primary care provision to pharmacies – this may be a slippery slope into GP care becoming less accessible and less equitable. The greatest legacy of the ALP to healthcare was Medicare under the Whitlam Government. It needs to be strengthened, and GPs fairly compensated to make provision of primary care a viable career option.
COVID is also a disease that disproportionately affects people from lower socioeconomic backgrounds. This is why public health measures like safe indoor air and access to testing improve inequity.
In my opinion it is inequitable that children under five years cannot routinely get COVID vaccinated unlike in the US, where it is part of the routine childhood immunisation schedule. The evidence is accumulating that COVID is not trivial in kids, with serious longer term complications including Long COVID, diabetes and other diseases. COVID is on par with other diseases for which we provide vaccination to young kids, or worse in some cases, yet we do not provide equitable protection to children under five years.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
Show us that the new CDC is not simply more of the same but can address gaps that have hindered us previously. One area would be in integrating animal, vector and human streams to combat threats like Japanese Encephalitis, which somehow crept onto the mainland of Australia unnoticed, and is now here to stay.
Good news for primary care, action now on hospitals
AMA President Professor Steve Robson
The 2023 budget delivered a huge investment in primary care. The AMA particularly welcomes the $3.5 billion to triple bulk billing incentives for concession card holders and children under 16 and the $445.1 million in additional funding for the Workforce Incentive Program.
This investment will help address the threat to the viability of general practice and growing out-of-pocket costs for patients. The Government has also taken the first steps towards the reform of general practice, allowing patients to enrol with their practice of choice – opening up additional support for patients in addition to fee for service.
Improved indexation arrangements for Medicare more generally are a recognition, to some extent, of just how far Medicare rebates have fallen behind the costs of providing medical care for patients.
We also welcome the cheaper medicines announcement that will allow patients to access 60 days’ supply of medicines and a 12-month prescription from their doctor and measures to crack down on vapes.
But there’s more to do. As the Government approaches its second year in office we need to see funding reform and investment to get our struggling public hospitals out of logjam and tackle our burgeoning surgery wait lists and poor Emergency Department wait times.
We also need reform to support a viable private health care system with the establishment of a private health system authority to improve the transparency, performance and value of the private health system.
Rein in military spend, ban nuclear weapons
Dr Sue Wareham OAM, National President, Medical Association for Prevention of War (Australia)
- What are the best things the Albanese Government has done to date for health equity?
Having spent my whole paid working life in general practice, I see the improvements in GP funding as long-overdue and extremely welcome, and I applaud the Government for them.
From MAPW’s perspective, we recognise that peace is a fundamental determinant of health, and a basic requirement for progress on health equity in Australia and globally. Unfortunately, there’s been mostly disappointment from the Government on that front.
There’s some cause for hope in that Anthony Albanese, before becoming Prime Minister, was a vocal advocate for nuclear disarmament, and supports Australia joining the nuclear weapons ban treaty. We’re looking forward to him making good on this commitment.
- What are the biggest disappointments?
We can’t achieve a healthy society or health equity while hyper-investing in preparations for war and orienting ourselves towards catastrophic conflict.
The ALP’s endorsement of AUKUS and the decision to acquire eye-wateringly expensive nuclear powered submarines are enormous disappointments: $368 billion spent on nuclear submarines is money that cannot be spent on measures that improve health for all.
The nuclear submarines are provocative, when regional tensions are already heading in the direction of war, and (although not being nuclear-armed) they set a precedent that could undermine global efforts to abolish nuclear weapons. The G7 meeting in Hiroshima just this week was a major missed opportunity for PM Albanese to restate his commitment to signing the nuclear weapons ban treaty.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
MAPW respects enormously the efforts of others to address specific inequities in our health care system. To free up resources for all the necessary measures, and to create the conditions for a healthy planet, our current exorbitant military expenditures must be reined in. Every other sector in society, including health, operates under strict limits on its spending, but for military spending there seem to be no limits.
We must start investing seriously in peace – peace studies, diplomacy, regional arms control agreements and a host of other measures – that improve prospects for health and health equity everywhere. And PM Albanese could practically get full marks from MAPW for one step alone: sign the nuclear weapons ban treaty!
Focus on SDOH, place-based approaches
Julie Edwards, CEO Jesuit Social Services
In Australia the discussion about health and wellbeing largely ignores the social determinants of health – determinants shaped by the distribution of money, resources and power that are mostly responsible for inequities and disadvantage, such as early childhood development, income, social inclusion, and the uneven impacts of climate change.
Through our research into locational disadvantage conducted over more than 20 years including five major reports, most recently Dropping off the Edge 2021, we know that a small number of communities across the country continue to face complex and entrenched disadvantage.
The Albanese Government’s budget announcement of a $200 million plan to address entrenched disadvantage, including funding place-based approaches, is a step in the right direction, but stronger long-term investment in place-based approaches is needed to improve health outcomes for our most disadvantaged communities.
More diverse, sustainable medical workforce
Tisshapaa Sivagnanan and Isabel Lee, Australian Medical Students Association
- What are the best things the Albanese Federal Government has done to date for health equity?
We were pleased with the focus on healthcare in the Federal budget this year, and the prioritisation of accessibility and supporting primary care.
As AMSA, we greatly support the centring of primary care and general practice in the budget as the keystone to equitable healthcare delivery, and are appreciative of the significant amounts of targeted funding towards improving different facets of the primary care workforce, such as $31.6 million towards improved training arrangements for international medical students working rural and remote locations.
The tripling of bulk billing incentives and two-month prescribing model are great first steps, and this attention towards the cost of living crisis will indirectly aid in achieving health equity by alleviating the financial burden of accessing care.
There have also been good moves to support under-served communities, with the recent announcements of $26m to LGBTQIASB+ research funding, the comprehensive National Plan to End Violence Against Women and Children, and specific budget points towards Aboriginal and Torres Strait Islander healthcare.
- What are the biggest disappointments?
AMSA has been disappointed at the lack of investment into students as the future of the healthcare workforce. There has been a lack of action towards increasing accessibility of healthcare training and degrees for those from diverse backgrounds – we need a diverse health workforce to treat and address diverse health inequities, and to be informed by those with lived experience.
The ongoing GP crisis is being fed by a lack of medical student interest in the pathway, however there has been no action taken towards improving this. Students need greater exposure to general practice throughout their degree, and for it to be seen as the centre of healthcare, rather than the second option after hospitals/tertiary care.
However, this mentality shift will not occur until there is overhaul of the poor Medicare co-payments and devaluing of GPs by the healthcare system over the past decade. There have been insufficient actions addressing the foundational issues of the primary health sector and workforce, instead funding band-aid solutions to past missteps.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
AMSA would be looking for the Government to direct their focus into long-term strategic workforce planning by increasing resources for, and capacity of, training available for graduates to match community needs. In the current environment, this would look like increased capacity for medical education and training in:
- regional, rural and remote locations to address the geographical workforce maldistribution
- primary healthcare and community based mental health services to address the specialty based maldistribution present in general practice and psychiatry.
Additionally, as aforementioned, a workforce that is reflective of the society it is serving is an integral step for the delivery of appropriate, safe and comprehensive healthcare.
Hence, we urge the Government to fund and support services aimed at increasing the recruitment and retention of diverse populations (Aboriginal and Torres Strait Islander students, regional, rural and remote students, LGBTIQA+ students, First in Family students, immigrants and refugees etc.) into health degrees in university. The living pressures of health students financially supporting themselves whilst attending unpaid 9-5 placements needs to be acknowledged, with opportunities provided to support these students throughout their degrees.
Climate action pace and scale is insufficient
Dr Genevieve A. Cowie, Doctors for the Environment Australia.
- What are the best things the Federal Government has done to date for health equity?
The health effects of our warming climate disproportionately impact the most vulnerable in our community and the Albanese Government has made some changes that help move our country in the right direction.
The establishment of a national Net Zero Authority is welcome – it will help workers and communities shift to green industries, reducing their dependence on polluting and redundant jobs in the fossil fuel sector. Having greater job security will help mental health of workers and reducing pollution will help their communities breathe more easily.
The Household Energy Upgrades Fund will help electrify the grid, improve social housing and reduce pressures from the cost of living, which disproportionately affect those on low incomes. However, to ensure equitable access across more low- income groups, private renters and owner-occupiers, more funding will be needed.
Measures to increase incentives for GPs to bulk-bill concession card holders will help strengthen primary care which is vital at a time of climate disruption. Illness managed in general practice offers a more person-centred experience and also is much less carbon-intensive than in the overburdened hospital system.
The promised Australian Centre for Disease Control has been funded and is important to manage threats from climate change, especially in vulnerable or remote communities.
The establishment of a Voice to Parliament for First Nations people provides the nation with an opportunity to move forward on reconciliation and self-determination, helping to address some of the lingering health effects of colonisation. Funding for Close the Gap directly affects health outcomes.
A Transport and Infrastructure Net Zero Road Map and Action Plan is welcome but must not further delay urgently needed action on transport-related air pollution and greenhouse gas emissions.
- What are the biggest disappointments?
The pace and scale of climate action by the Federal Government is insufficient to combat dangerous climate change — the IPCC report makes it clear that complete transformation is needed, which requires much greater investment.
The newly established National Health Sustainability and Climate Unit is insufficiently resourced and was not mentioned in the May budget. There is no funding for implementation of the forthcoming National Health and Climate Strategy.
Also unfunded are the National Preventive Health Strategy and the National Injury Prevention strategy, despite their potential reduce the burden of disease (including that related to climate change) on individuals and our carbon-intensive health system.
That the Albanese Government continues federal support for the fossil fuel industry is deeply disappointing. Any funding of this polluting industry is bad for health and reduces investment in solar and wind. Insufficient spending on climate action hurts the most vulnerable first and hardest.
- What does the Government need to do over the next year to get a high distinction for addressing health inequities?
The shift away from fossil fuels to renewable energy sources needs to be much faster and provide more help to those who can’t afford to make their homes and livelihoods climate resilient.
There also needs to be more investment in climate resilient infrastructure, prioritising our most vulnerable areas.
This includes incentives to massively upgrade the green canopy of urban areas to minimise heat and air pollution related illness. Less affluent areas in our cities have much less tree cover and so are much less protected from the urban heat island effect.
In addition to its commitments to a Fuel Efficiency Standard and charging infrastructure for electric vehicles, this Government should increase support for active transport, such as walking, cycling, and public transport.
These options are low-carbon, reduce cost of living pressures and traffic congestion and are healthier alternatives to driving.
Further strengthening of preventive and primary care is needed, particularly in lower socioeconomic areas. This will reduce unnecessary human suffering, manage cost, and reduce pressure on our struggling, carbon-intensive hospital system.
Investment in the social and environmental determinants of health, prevention and primary health care are good investments for human health and wellbeing — especially of our most vulnerable — as well as our planet.
A big disappointment and an embarrassment
Professor Bronwyn Carlson, Head of the Department of Indigenous Studies at Macquarie University, who is an Aboriginal woman, born and living on D’harawal Country in New South Wales
For me the Albanese government is a big disappointment. No surprise really – so hard to distinguish between governments these days.
I will say that the whole system is in urgent need to be restructured as politics has nothing to do with benefiting the people – only a very few people and they are not Indigenous.
Who buys useless submarines when your people have no homes and can’t afford to have a home. Shameful really. Who does not act immediately when police taser an elderly person that leads to her death. Not to mention the endless reporting on another death of an Indigenous person by police. People cannot afford to see a doctor, a specialist – mental health crisis with no solution offered.
Governments are an embarrassment.
- Professor Carlson’s response was added after original publication of this article.
See Croakey’s archive of other LongRead articles.
