Continuing Croakey’s series of pre-Budget articles, today’s post highlights some of the stand-out Budget recommendations from the health and community sectors that don’t fit within any disease group or area within the health system.
From social security changes to single data sets to self-care, the health and community groups featured below have wide-ranging ideas to improve the health and well-being of the Australian population.
Croakey’s coverage of Pre-Budget Submissions is based on those made available at the Treasury website, which does not include all submissions from stakeholders. Please add links to any other relevant submissions in the comments below.
See here for previous 2019/20 Budget articles on Mental Health, Indigenous Health, Prevention, Oral Health, Rural Health, and Climate Change.
Anglicare
Key points from Anglicare’s Pre-Budget Submission
As of 2018, more than three quarters of a million people in communities across Australia live on unemployment and student payments that do not cover the cost of housing, food, transport and healthcare.
The single rate of Newstart is less than $40 per day and living on Newstart and Youth Allowance presents the biggest risk to living in poverty. All of this means that lifting the single rate of Newstart, Youth Allowance and related payments would be the most effective step to reducing poverty in Australia.
Research by the University of NSW shows that the rate of the single unemployment payment falls short by $96 per week to meet the cost of housing, food, basic healthcare and transport. UNSW found that a single unemployed person needs $434 per week to cover the cost of the basics. Newstart is just $278 per week.
This deterioration in payments highlights why Anglicare Australia has long argued for the need to establish an independent Social Security Commission. Like Fair Work Australia or the Remuneration Tribunal, such a body could independently assess the cost of living and set rates accordingly. Anglicare Australia also supports calls from the Raise the Rate campaign to raise Newstart and Youth Allowance by $75 to provide immediate relief.
Recommendations
Anglicare Australia recommends the immediate increase of income support payments, using two mechanisms:
- The establishment of an independent Social Security Commission. The commission would have the power to set, and adjust, income support payments based on the actual cost of living and job seeking.
- An immediate increase of $75 a week to those on Newstart and Youth Allowance. This would provide much needed relief while a Commission is established for the long-term.
Australian Council of Social Services
Key points from ACOSS’s Pre-Budget submission
ACOSS remains concerned by the lack of attention being paid to rising out-of-pocket costs for healthcare consumers and the impact this has on access to services for people on low incomes who are more likely to experience poor health.
By encouraging specialists to lift their fees, the Extended Medicare Safety Net (EMSN) is more likely to inflate medical costs than to reduce them for most patients. An independent review of the EMSN showed that less than 4 per cent of EMSN benefits go to the most socioeconomically disadvantaged 20 per cent of the population.
This is because they struggle to afford the gap fees that enable them to reach the EMSN thresholds. While EMSN benefit caps were set on all consultations as part of the 2012-13 budget, ACOSS is concerned by the lack of public data to assess whether this has reduced the costs (or reduced growth in costs) of specialist and allied health services and led to a more equitable distribution of EMSN benefits across the income distribution.
In addition to abolishing the EMSN, more fundamental reform is needed including greater transparency for consumers on the outpatient fees charged by specialists and out-of-pocket costs to patients.
Recommendation
Abolish the Extended Medicare Safety-Net and used the saved funds to support public health services
Australian Healthcare and Hospitals Association
Key points from AHHA’s Pre-Budget Submission
With more than $6.15 billion of public money given to private health insurers through the private health insurance rebate in 2018–19, and only half of Australians having private health insurance coverage, the Commonwealth Government should establish a comprehensive Productivity Commission inquiry to examine the costs and benefits of private health insurance within the overall health sector.
The Productivity Commission inquiry should also consider whether private health insurers, whose products are subsidised by the Government, should be required to provide health data to government agencies such as the Australian Institute for Health and Welfare. In addition, this inquiry should investigate the appropriate level of risk adjusted returns and management expense ratios, and associated annual premium increases, within the private health insurance industry.
This should explicitly include recognition that a large proportion of industry revenues are significantly de-risked through Government policies including the Australian Government Rebate on private health insurance, the Medicare levy surcharge, Lifetime Health Cover and premium discounts for 18 to 29 year olds.
Recommendation
Funding of $1.5 million be allocated for a comprehensive Productivity Commission inquiry examining the costs and benefits of private health insurance within the overall health sector, including appropriate levels of profitability in the context of annual increases in policy premiums.
Australian Nursing and Midwifery Federation
Key points from ANMF’s Pre-Budget Submission
The members of the Australian Nursing and Midwifery Federation are committed to the provision of health as a public good with shared benefits and shared responsibilities. We consider that access to adequate healthcare is the right of every Australian and a crucial element of the Australian social compact.
Government investment in health is in effect a growth and infrastructure investment that will pay dividends in the development of social capital and increased productivity for generations, and is therefore worth proper investment.
We are committed to publicly funded universal health insurance, i.e. Medicare, as the most efficient and effective mechanism to distribute resources in a manner that generally ensures timely and equitable access to affordable healthcare on the basis of clinical need rather than capacity to pay.
While Australia’s health system remains a world class health system and generally delivers good outcomes, too many inequalities persist. The lack of a genuine ‘whole of system’ approach to the delivery of health care across the country coupled with a lack of system coordination, and resulting fragmentation and duplication, means too many Australians miss out. Most notably, Aboriginal and Torres Strait Islander people and those living in rural areas.
Another key area that needs to be addressed across the sectors is the collection and management of health data, and performance reporting. It is disappointing that rates of complications by hospital, clinician, and procedure are collected by private insurance companies and State and Territory Governments, but are not readily available.
Due to this lack of transparency, patients and healthcare professionals lack the information they require to make informed treatment decisions and compare performance in order to learn from hospital sites with lower complication rates.
Recommendations
The ANMF calls on the Government to:
- Increase flexibility in the funding arrangements for public hospitals, the Pharmaceutical Benefits Scheme (PBS), the MBS and aged care so that regional health services are able to ‘pool’ some of these resources to meet the needs of their communities. For example, remote areas which are unable to recruit doctors could use the notional population share of the MBS to fund NP services for their communities.
- Establish an independent Health Performance Commission to be a specialist health data analytics and performance reporting body for both private and public health sectors responsible for:
- Mapping and co-ordinating the collection, analysis and publication of health data across the public, private and aged care sectors to enable value-based health care;
- Managing end-to-end data, working from collection to publication;
- Linking hospital and health data with other economic and social data as an evidence base for value based health care and new health programs;
- Developing the quality of clinical performance indicators for value-based health care;
- Undertaking further research to develop standardised, national nurse/midwife sensitive outcomes as important mechanisms for evaluating patient safety;
- Supporting viable and sustainable improvements in healthcare efficiency that reduce unnecessary care and waste without compromising optimal consumer outcomes and working conditions for staff.
- Improving access to clinical data by clinicians, boards, departmental and HHS staff;
- Consulting with consumers and interest groups on the format, content, context and accessibility of publication of health care data;
- Evaluating new technologies, treatments and drugs, e.g. the effective use of prostheses;
- Making research findings and raw data available to researchers where this has ethical approval and is in the public interest;
- Liaising with other States, Territories and the Commonwealth to compare and share data, produce economies of scale and ease the ongoing disagreements over funding; and
- Ensuring compliance with mandatory, public reporting requirements in the public, private and aged care sectors.
Australian Self-medication Industry
Key points from ASMI’s Pre-Budget Submission
Self Care is part of our everyday lives and refers to the activities we undertake every single day to enhance health and wellbeing, prevent disease, limit illness, and restore health.
Activities such as washing your hands, exercising, taking pain medication for a headache, reading labels on medicines or taking vitamins if needed all count as Self Care. Not only does Self Care lead to enhanced health and wellbeing for all Australians, it represents a significant cost saving to the Australian health system.
Australians that are empowered to play a central role in their own health and wellbeing practice Self Care with confidence by regularly undertaking or improving upon these seven habits:
- Health Literacy (Read, Learn, Ask)
- Self Awareness of Physical & Mental Conditions
- Physical Activity
- Healthy Eating
- Risk Avoidance
- Good Hygiene
- Rational Use of Products & Services
The benefits of greater Self Care are acknowledged internationally however, we need more advocates for Self Care here in Australia and a co-ordinated approach to research development and priorities.
Recommendations
ASMI recommends that the government establishes a Self Care Research Fund, with $500,000 made available over three years to fund further research into Self Care in an Australian health policy framework.
Researchers could apply for this funding to continue to build the health, economic and social case for Self Care. Research projects could focus on specific aspects and how they fit into the broader Self Care context or how to implement holistic trials of patient-centred care within the population.
Consumers Health Forum of Australia
Key points from CHF’s Pre-Budget Submission
Health expenditure is an investment in human capital. Investing in the health system not only saves lives, it is also a crucial investment in the wider economy. This is because ill-health impairs productivity, hinders job prospects and adversely affects human capital development.
Australia’s has a world class health system with universal access to health services through Medicare and access to a wide range of medicines through the Pharmaceutical Benefits Scheme. However, there is room for improvement. Many of the necessary reforms need additional expenditure now for society to reap the longer-term benefits.
The problem with the current approach to portfolio budgeting is that any improvements in one area of health have to be offset with savings in another within the health system This ignores completely the fact that the benefits of the health improvement will be spread across the whole community and economy.
Changing the process to allow savings which accrue in terms of other areas of the economy as a result of improved health outcomes would facilitate long term planning and whole of person approaches to health and wellbeing.
Recommendation
CHF calls on the Federal Government to move away from the current budgetary requirement for all new health expenditures to be offset by savings in the health portfolio.
National Rural Health Alliance
Key points from NRHA’s Pre-Budget Submission
Australia is fortunate to have a number of Australian data base entities that collect and report on data for the health sector (such as ABS and AIHW). Other data agencies include the Independent Hospital Pricing Authority (IHPA), National Health Funding Body and the Australian Health Practitioner Regulation Agency (AHPRA).
However, the Alliance has identified previously that what is missing is a single, overarching long term plan clearly identifying the range of health data needs, the rationale underpinning data gathered by whom, how and why, and how data is stored and disseminated and shared.
Investment in this initiative would deliver the analysis required to a provide a clear picture of both disadvantage in rural Australia and where governments and policy makers could get the best return on the health investment. The funds will resource the data analytics, health economic analysis and governance design and development to ensure privacy and data protection mechanisms are in place.
This initiative is possibly the most powerful tool available for health policy and health funding decision-making. Its release and use would have a profound impact on health outcomes in Australia. A similar facility is in operation in New Zealand and Canada.
Recommendation
The creation of a linked data set on rural health to enable:
- The assessment of different levels of access to health care for different conditions and in different geographic locations.
- An assessment of the degree to which best practice is being employed across disease groups and how different populations interact with the health system to address their needs
- The provision of near real time evidence to assist decision-making and better inform policy makers, researchers and funders about the current relationship between health service provision and the health outcomes achieved.
- More accurate commissioning of research activity to address health inequity and the measurement of the effectiveness of research translation into practice.
