What is the number one health issue that the Government should address in next Tuesday’s Federal Budget? Jennifer Doggett analyses the pre-Budget Submissions from 21 health groups and finds surprising agreement among them on the urgent need for action in one key area.
Read on to find out what this issue is and the six key measures the Government should announce on Tuesday night if it wants to keep the health sector onside. Check back on Wednesday to see how closely the Federal Government has followed the proposals from health and medical groups in this (possibly) pre-election Budget.
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Jennifer Doggett writes:
Every year peak health groups allocate significant time and resources to preparing pre-Budget submissions for the following financial year’s Federal Budget. These submissions represent – collectively – hundreds of hours of staff, management and board time and result in thousands of pages of ideas for improving the funding and delivery of health care.
Few of these ideas ever actually get picked up in that year’s Budget, so in one sense the return on investment for the time spent in preparing these submissions is questionable. But they can be useful in signalling the key priorities of the health sector to the Government and the wider community and in this way can guide future policies and funding decisions, even when they do not directly result in short-term Budget commitments.
Of course there are valid reasons the Government of the day may not fund a specific proposal from an interest group. After all, the role of peak bodies is to advocate for their specific area of interest whereas governments have to balance the interests of all areas of the health system (as well as the community’s need for health care with that for other services and priorities, such as education, infrastructure, social security and tax cuts).
There are also less valid reasons why governments may ignore proposals from peak bodies, such as political pressure from powerful vested interests to maintain rent seeking policies and funding structures which benefit some groups of providers at the expense of consumers and the community.
2018/19 Federal Budget priorities
So what do this year’s crop of Pre-Budget submissions tell us about the current priorities of the health sector? After reviewing a slew of health-related pre-Budget submissions it is clear that there is one stand-out issue that has the overwhelming support of the health sector, with virtually every submission supporting action on this issue in some form or other.
That issue is prevention. The clear message emerging from the submissions was that preventive health is the glaring gap in health policies at the federal level and the most pressing issue that needs to be addressed to improve the health of our community.
Almost every health-related pre-Budget submission included a strong focus on prevention, in particular those from the Public Health Association of Australia (PHAA), the Consumers Health Forum (CHF), the Australian Healthcare and Hospitals Association (AHHA), the Australian Medical Association (AMA), the Complementary Medicines Association (CMA), the Victorian Healthcare Association (VHA) and the Royal Australian College of Physicians (RACP).
AHHA’s submission summed up the views expressed in many others stating: Preventive health measures aim to reduce illness, prevent disease and promote wellness. This in turn reduces individual, intergenerational and health system burden, improves health system resource use and boosts productivity through greater economic participation and productivity. Yet Australia spends less on public health and prevention than most other OECD countries
The most strongly supported proposal overall was for the establishment of a national preventive health body to oversee and coordinate preventive health policies across all sectors and level of government.
The AMA’s submission reflected the reasons expressed in many submissions for such a national body: Obesity, nutrition, alcohol, tobacco and physical activity are health policy areas desperately in need of funded national strategies and measurable targets. These are best delivered through an independent, dedicated organisation.
Obesity was the most commonly mentioned health issue with a number of groups supporting a sugar tax, junk food advertising restrictions and physical activity programs.
CHF’s submission highlighted the importance of addressing obesity stating: There is an urgent need to reverse this trend and put much more effort into combatting obesity if we are not to lose many of the gains we have seen over the last decades and to see our children and grandchildren have lower life expectancy than we have.
The Royal Australasian College of Physicians (RACP) suggested establishing a national obesity taskforce including ‘sustained funding, regular and ongoing monitoring and evaluation of key measures and regular reporting around targets.’
The decline in preventive health funding (as a proportion of overall health funding) was raised by a number of submission with calls made to return funding levels to (at least) the average in recent years of around 2.3% of recurrent health expenditure or the international average or around 3%.
Four key areas
After prevention there were four other key areas that stood out as high priorities for action. These were:
Private health insurance – there was strong support for a review of the current private health insurance (PHI) rebate by the Productivity Commission on the basis that this scheme represents a significant investment of public funding and has not been rigorously reviewed to determine whether or not it delivers good value to the community (although the PHAA just wants the rebate scrapped and the AMA and the health funds want to keep it).
The equity concerns of health groups about the PHI rebate were summed up by the following comment by the PHAA: The combination of the private health insurance rebate and the Medicare surcharge levy means that compared to the rest of the population, those with private health insurance in Australia are richer, better educated, more health conscious, healthier and more likely to use certain discretionary health services. Private health insurance use is highest among those who have the least need for health care, but are given the best access to it. Health inequities in Australia may be increasing, and private health insurance may be one of the causes
Indigenous health – there was broad agreement across the submissions that we need to do more to close the health and life expectancy gap between Indigenous and non-Indigenous Australians and that supporting Indigenous community-controlled initiatives and services are the best way to achieve this. Supporting and growing the Indigenous health workforce was a key feature of NACHHO’s submission, along with establishing an Aboriginal and Torres Strait Islander Commonwealth Advisory Group to support consideration, implementation and monitoring of an Indigenous position in efforts to Close the Gap and on jurisdictional agreements that have high impact on Indigenous peoples. The AHHA and the AMA called for funding to implement the National Aboriginal and Torres Strait Islander Health Plan and the AMA also called for the Government to support the Redfern Statement.
Oral health – the need for greater more funding for public dental services, with Catholic Health Australia (CHA) proposing a national scheme and AHHA and VHA advocating for reinstituting funding for the National Partnership Agreement for public dental services to adults). CHA noted that our failure to address access and equity issues for oral health care undermined the fundamental Medicare principle of universality: The principle of universality that has been an essential principle of Australia’s healthcare system since the inception of Medicare is being undermined. Those who are disadvantaged socioeconomically are being excluded from appropriate dental care, which is affecting overall general health.
Mental health – action on mental health was supported by a broad range of groups, including the National Association of Community Controlled Health Organisations (NACCHO), the Australian Medical Students Association (AMSA), Community Mental Health Australia (CMHA), the Australian College of Mental Health Nurses (ACMHN), Connect Health and Community (CHC) and CHF. However, the specific measures recommended differed between the groups. ACMHN highlighted the financial cost of mental illness in its submission: According to the World Economic Forum report, The Global Economic Burden of Non-communicable Diseases, mental health accounts for the greatest lost economic output of all non-communicable diseases. Community Mental Health Australia defined the problem clearly as: There is no system architecture for mental health at the federal level which looks at all the areas which impact mental health – health, housing, employment, justice, disability. Other groups suggested a range of strategies with priority areas identified as: suicide prevention; Indigenous, veteran and youth mental health; psychiatric and rural mental health workforce; primary mental health care; and intersection with the NDIS.
Six key actions
After reviewing these submissions, the message is clear. If the Government wants to win over the health sector on Tuesday night it needs to do the following:
- Establish a National Preventive Health Body (although this could be slightly awkward for the Government, given it abolished a similar body, the Australian National Preventive Health Agency in 2014)
- Announce a national obesity strategy
- Set up a Productivity Commission review of private health insurance
- Increase funding for the community-controlled Indigenous health sector
- Increase funding for public dental services
- Take action on mental health
So what are the chances of next week’s Federal Budget looking something like the above? While it always pays to be cautious about the Federal Budget funding, this year may provide a ‘better than usual’ chance for health groups to see some pay-off for their pre-Budget submission efforts.
After the Budget being virtually written off as a boring ‘mid-cycle’ holding pattern, in the last few weeks the political climate has changed. With the polls looking slightly less bad for the Prime Minister and the economy ticking over at a reasonable rate, there are thoughts among political analysts that the Coalition may be in an ‘as good as it gets’ situation and go to an early election, with the side benefit that it might catch Labor on the hop without having locked-in its pre-election policy platform.
This means that Tuesday night might provide the best chance in years for health groups to see some of their proposals receive the Budget tick from the Government and finally see some returns on years of investment in preparing annual pre-Budget submissions.
Croakey will review how closely the Budget measures reflect the proposals from the health sector in our post-Budget analysis on Wednesday.
Submissions
The following submissions were reviewed for this article and are all available on the Treasury Federal Budget 2018/19 website (apart from the RACP submission, available on its website).
Australian College of Mental Health Nurses (ACMHN)
Australian Healthcare and Hospitals Association (AHHA)
Australian Medical Students’ Association (AMSA)
Australian Rural Health Education Network (ARHEN)
Carers Australia (CA)
Catholic Health Australia (CHA)
Community Mental Health Australia (CMHA)
Complementary Medicines Association of Australia (CMAA)
Connect Health & Community (CHC)
Consumers Health Forum of Australia (CHF)
Medicines Australia (MA)
Members Health Fund Alliance (MHFA)
National Aboriginal Community Controlled Health Organisation (NACCHO)
National Rural Health Alliance Inc. (NRHA)
Private Healthcare Australia (PHA)
Public Health Association of Australia (PHAA)
Royal Australasian College of Psychiatrists (RANZCP)
Royal Australasian College of Physicians (RACP)
Royal Australian College of General Practitioners (RACGP)
Victorian Healthcare Association (VHA)
Vision Australia (VA)
Caveats
Only those submissions listed on Treasury’s website and tagged as addressing health and related issues were reviewed (with the exception of the RACP submission). Some groups chose not to make their submissions publicly available and/or did not tag their submissions (making it difficult to search for them).
Organisations differ in their approach to preparing pre-Budget submissions. Some focus more narrowly on a small range of measures and this does not preclude support for broader issues not addressed in the submission. For example, the RACGP did not address the issue of a sugar tax in its submission but has previously supported the need to limit sugar in soft drinks.
