With the 2015-16 Federal Budget only hours away, Croakey has prepared the following summary of the announcements already made in the health portfolio and compared these against the recommendations made by key organisations in their Federal Budget submissions. While some of the requests from the sector have already fully or partially met (indicated below) through pre-Budget announcements, there remain a number of significant priority areas which have not been addressed by Government. These will be the focus of the health sector tonight as it watches Treasurer Joe Hockey bring down his Government’s mid-term Budget.
Croakey will be post a Budget Wrap tomorrow, including responses from key experts and stakeholder groups.
What we know already
PBS: cuts estimated to be $3 billion over the next five years through changing the funding arrangements for generic drugs and dispensing fees to pharmacists. An additional $1.3 billion over four years for the listing of new medicines and vaccines.
Medicare: no cuts flagged for this year but the Minister has announced a wholesale review of every test, treatment and procedure subsidised under Medicare with a view to rationalising MBS spending in the future.
Mental health: $300 million for a 12-month funding extension to mental health services and organisations, with a priority on frontline services.
Drugs and alcohol: The Government has reversed a planned cut to drug and alcohol treatment services, guaranteeing funding of $87 million to NGOs until June 30 2016.
Natural disasters/terrorism: $100 million over four years to improve Australia’s ability to quickly and effectively respond to a health crisis caused by a natural disaster or terrorist attack at home or abroad
Dental: Just over $200 million in funding for state and territory services to allow for reform work to be undertaken over the next 12 months.
Cancer: more than $600 million over four years including finding for a National Cancer Screening Register, a new test for cervical cancer and the listing of new drug treatments for melanoma and breast cancer on the PBS (includes some funding under PBS above).
ehealth: $485 million over four years to revitalise the national electronic medical records system with an ‘opt-out’ option.
Vaccinations: $26 million over four years for the Immunise Australia programme, including free vaccinations for the shingles virus for older Australians, incentive payments for GPs and a schools vaccination register.
What health groups have asked for – a summary of some peak organisations’ Budget submissions
In its 2015-16 Federal Budget Submission the Consumers Health Forum of Australia (CHF) called on the Government to:
- reverse its decision to reduce Medicare rebates for GP visits and freeze the indexation of Medicare rebates until 2018;
- work with health consumers and professionals to consider mechanisms for addressing waste in health expenditure through reducing overtreatment, unnecessary treatment and inappropriate treatment within the health system; [PARTIALLY ADDRESSED VIA THE MEDICARE REVIEW ALTHOUGH THE ROLE OF CONSUMERS NOT CLEAR]
- more actively engage in international price surveillance and comparisons for devices, medicines and prostheses, in order to ensure Australians aren’t paying more than comparable countries for the same product;
- give a long term commitment with appropriate funding to implement electronic health records [PARTIALLY ADDRESSED VIA EHEALTH FUNDING];
- put in place a pharmacy services funding arrangement that is transparent, accountable, inclusive, consumer-driven and health outcome focused with an inbuilt Independent, public evaluation and mid-term review [PARTIALLY ADDRESSED VIA PBS SAVINGS MEASURES];
- introduce further measures to accelerate price disclosure to ensure the price paid by Australians aligns with the market price of medicines [ADDRESSED VIA PBS SAVINGS MEASURES];
- adequately and transparently fund Home Medication Reviews, with funding quarantined for that purpose with clear criteria for access, better program guidelines and improved monitoring of usage;
- fund the development and implementation of consumer experience measures in the Australian health system via the Australian Commission for Safety and Quality in Healthcare;
- provide funding to ensure access to dental care for children and adults though the public health system; [PARTIALLY ADDRESSED VIA INCREASED DENTAL FUNDING]
- develop and fund a new National Oral Health Promotion Plan;
- develop a National Obesity Prevention Strategy which would include: mandatory health food stars rating, a ban on advertising junk food to children and exploring a tax on sugar;
- restore the $165.8 million it cut from Aboriginal and Torres Strait Islander programs;
- commit to long term funding for Aboriginal Community Controlled Health Services in a partnership which ensures funding genuinely is addressed to Closing the Gap [PARTIALLY ADDRESSED VIA RESTORED FUNDING FOR INDIGENOUS HEALTH ORGANISATIONS];
- merge the Clinical and Consumer Advisory mechanisms and provide funding for structural engagement of consumers in the Primary Health Networks to ensure the proposed consumer and clinical advisory mechanisms are robust and resourced to facilitate discussions with a broad range of consumers; and
- give a reference to the Productivity Commission for an inquiry into private health insurance, prior to any structural reform of private health insurance taking place.
In its 2015-16 Federal Budget Submission the National Association of Community Controlled Health Organisations (NACCHO) reminded the Government that:
Aboriginal and Torres Strait Islander People fare much worse than other Australians against all health indicators. Life expectancy is estimated to be ten to seventeen years less than the Australian national average.
The incidence of preventable illnesses such as diabetes, heart disease and kidney disease is considerably higher. Suicide rates have increased due to high levels of psychological distress, where hospitalisations due to self-harming have increased forty-eight percent in less than a decade. Child and maternal health outcomes are poorer, with birth weights lower and infant mortality higher.
These facts highlights the importance of making primary health care as culturally appropriate and accessible as possible.
NACCHO also specifically recommended the following measures:
- Re-distribution of mainstream health funding to Aboriginal Community Controlled Health Services
- Sustainable and targeted funding for Closing the Gap initiatives
- Retain Funding to the Aboriginal Community Controlled Health Sector [PARTIALLY ADDRESSED VIA RESTORED FUNDING FOR INDIGENOUS HEALTH ORGANISATIONS];
- Retain funding for Aboriginal Community Controlled Health Services Peak Bodies
- Improving access through Capital Works programs
- Demand-driven Employment Framework
In its 2015-16 Federal Budget Submission the Australian Healthcare and Hospitals Association (AHHA) stated that:
The 2015-16 Budget must instead present effective solutions that compromise neither the short term nor long term health of Australians or our health system. By implementing sensible changes in health policy, more can be achieved with our existing health system without having to commit additional resources.
The proposals presented in this submission all represent the more effective and efficient use of existing resources and health infrastructure, not simply a call for additional public funding. Fiscal sustainability within the health sector requires a more nuanced approach with a holistic view across both the sector and over generations.
The AHHA specifically requested the following:
- increased federal government support for the Choosing Wisely campaign;
- an Medical Services Advisory Committee (MSAC) review of existing MBS item numbers; [PARTIALLY ADDRESSED VIA MEDICARE REVIEW]
- a review of existing PBS products for their continued appropriateness and efficient cost; [PARTIALLY ADDRESSED VIA PBS SAVINGS MEASURES]
- measures to reduce unnecessary GP presentations, for example through encouraging employers to require medical certificates for sick leave only where there is prolonged use of leave;
- better planning for end of life care needs and intentions into both health and aged care practices;
- support for the States and Territories to implement and fund a range of Hospital in the Home (HITH) or community based acute and sub-acute care programs by removing current perverse funding disincentives;
- a recommitment to the allocation of funding to support the implementation of the National Oral Health Promotion Plan, and to ensure continuation of the Child Dental Benefits Schedule beyond 30 June 2015; [PARTIALLY ADDRESSED VIA INCREASED DENTAL FUNDING]
- support for greater use and entrenchment of personal electronic health records; and
- an increased focus on prevention and Indigenous health [PARTIALLY ADDRESSED VIA RESTORED FUNDING FOR INDIGENOUS HEALTH ORGANISATIONS AND IMMUNISATION INITIATIVES].
Catholic Health Australia (CHA) focussed on aged care in its Federal Budget Submission stating that:
CHA’s submission concerns the care of the increasing number of older Australians due to the ageing of our population. It calls for a clear statement that it is the Government’s intention to transition to a contestable market-based aged care system so that providers, financiers and equity investors, who are making long term investments, and consumers have certainty about the Government’s policy intentions. The submission also identifies the care of older people with severe behavioural and psychological symptoms of dementia as an immediate priority.
Mental Health Australia’s submission drew from its Blueprint for Action on Mental Health., the fourth and final submission to the National Mental Health Commission’s (NMHC) Review of Mental Health Services and Programmes. It is based around Mental Health Australia’s Seven Point Plan and included the following specific recommendations for the Federal Government:
adopt national, long-term, whole-of-life targets for improving mental health outcomes, backed up with indicators to demonstrate the pace of improvements; and
- develop a National Mental Health Agreement which acknowledges cross-portfolio and inter-governmental linkages, boosts development of the community mental health sector, and defines optimal roles and responsibilities for Commonwealth, state and territory governments, as well as for community-managed and private-sector organisations.