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Health and the Federal Budget: a wrap of links, news and reaction

Many of the Budget’s health measures have been announced or leaked in recent weeks, as previewed in this previous post.

Below are links to key Budget papers, some of the health spends and cuts, details of the foreign aid cuts and disability reforms, and a compilation of some of the health-related reaction (more reaction added on May 9, 10, 11).

***

KEY LINKS

• Budget papers

• Budget paper number 2 has details of spends and cuts, with the health section starting here.

Department of Health and Ageing budget papers

• This table gives a quick overview of health spends and cuts

• Ministerial press releases

• Ministerial press releases on Closing the Gap

Portfolio statements

Transcript of Treasurer’s speech “Strong economy and fair Australia”

***

SOME OF THE HEALTH SPENDS AND CUTS

This table shows the cuts to funding for:

  • multipurpose services
  • lead clinician groups
  • GP super clinics (savings of $44.0 million over four years)
  • health workforce programs (savings of $67.9 million over three years)
  • the Practice Incentives Program ($83.5 million over four years)
  • national Health Call Centre Network
  • Medicare Safety Net.

Savings are also projected from the PBS, and the Government will also tighten regulations around diagnostic radiology services so imaging is carried out by appropriately qualified practitioners.

$75 million over four years will also be redirected from Indigenous health infrastructure (“to support other Government priorities in Indigenous health”), and funds will also be redirected from Telehealth and National Health Information Network.

The details below are taken from Budget paper 2.

PIP program:

The Government will improve the efficiency of the Practice Incentives Program (PIP) by more effectively targeting incentives to medical practitioners. The Government will:

  • include a requirement for general practices to participate in the Personally Controlled Electronic Health Record System to receive the eHealth PIP incentive;
  • increase the targets for general practices to receive incentives for the PIP Cervical Screening Incentive, from 65 per cent to 70 per cent of eligible female patients;
  • increase the targets for general practices to receive incentives for the PIP Diabetes Incentive, from 40 per cent to 50 per cent of eligible diabetics; and
  • discontinue the GP Immunisation Incentives Scheme, in light of requirements introduced on FTB A supplements in the Mid‑Year Economic and Fiscal Outlook 2011‑12.

Change of plans re Lead Clinician Groups – local ones not going ahead

The Government will establish a National Collaborative Clinicians Network. The network will promote clinical leadership and multidisciplinary models of integrated care and engage clinicians across Australia in health reform, providing opportunities for clinicians to identify, inform and deliver service improvements. The Australian Medicare Local Network will be provided with $3.4 million over four years to work with Medicare Locals to enhance clinical leadership and engagement across health settings.

At the same time the Government will streamline program management and better use available resources working within existing state structures and not proceed with funding for the Local Lead Clinicians Groups. This measure will provide savings of $60.7 million over five years from 2011‑12. Savings from this measure will be redirected to support other Government priorities.

Telehealth changes

The Government will better target incentives and payments to encourage early adoption of telehealth initiatives to ensure that they are targeted towards meeting the Government’s e‑Health priorities.

The Government will cease funding for the Telehealth Support Initiative, which was introduced as part of the measure titled Connecting Health Services to the Future in the Mid‑Year Economic and Fiscal Outlook 2010‑11, from 1 July 2013. The Government will also restructure telehealth incentives for medical practitioners to supply telehealth services, and cease funding for these incentives from 1 July 2014.

In addition, the Government will introduce minimum distance requirements for telehealth consultations. These rules will focus services toward those patients without close access to specialists, and ensure more effective usage and distribution of these services.

This measure will generate savings of $183.9 million over five years, which will be reinvested in the related expense measure titled National e‑Health Program‑continuation.

Driving competition and other changes for private health insurance industry

The Government will provide $2.3 million over four years to the Private Health Insurance Administration Council (PHIAC) to establish the Private Health Insurance Premiums and Competition Unit (PACU).

The PACU will improve the advice provided to the Government on private health insurance industry pricing, industry cost drivers and insurance premiums. It will also enhance the capacity of PHIAC to encourage competition within the private health insurance industry for the benefit of consumers.

The cost of this measure will be met through an increase to the levy collected under the Private Health Insurance (Council Administration Levy) Rules 2007.

The Government will undertake a review of the private health insurance rebate for natural therapies. The review, which will be overseen by the Chief Medical Officer, will examine the evidence of clinical efficacy, cost effectiveness and safety and quality of these natural therapies.

Following the completion of the review, the Government will introduce through regulation a list of natural therapies that will continue to receive the private health insurance rebate. Natural therapy treatments not included on this list will no longer be eligible for the rebate.

Funding of $1.0 million will be provided to the Department of Health and Ageing in 2012‑13 to undertake the review. The savings for this measure are not for publication until the completion of the review.

Food policy

The Government will provide $3.9 million over four years to implement initiatives responding to recommendations from the Review of Food Labelling Law and Policy.

These initiatives support the Government’s commitment to refocus the health system towards prevention, including by developing a comprehensive National Nutrition Policy. This measure also includes funding for awareness and education activities, consumer and economic research activities, and the development and implementation of an interpretative front‑of‑pack labelling system.

Tobacco

The Government will provide $3.1 million in 2012‑13 for compliance and enforcement activities associated with tobacco plain packaging legislation.

Compliance activities will include a communications campaign to raise awareness among retailers of their responsibilities under the legislation, while enforcement activities will include inspections of general retail outlets such as supermarkets, and specialist outlets such as tobacconists and wholesalers.

The Government will reduce the duty free allowance on tobacco to 50 cigarettes or 50 grams of other tobacco product. For more background on this, see Professor Simon Chapman’s previous analysis. And his tweet tonight:

Research

The NHMRC has welcomed an increase in funding for medical research, through the appropriation to the NHMRC’s Medical Research Endowment Account, from $746.1 million in 2011-12 to $760.5 million in 2012-13.

Indigenous health

Budget papers say:

The Government will provide $11.8 million over two years to extend the Cape York Welfare Reform Trial in the communities of Aurukun, Coen, Hope Vale and Mossman Gorge until 31 December 2013.

The trial will continue initiatives focussing on rebuilding social norms, improving education, and encouraging engagement in the real economy.

Extension of income management

The Government will provide $19.1 million to continue income management trial measures. These include extending the BasicsCard and a one year extension of income management in Western Australia.

Funding of $5.6 million will also be provided from 2012‑13 to 2014‑15 to continue the provision of BasicsCards to income support recipients. Existing BasicsCards, introduced in 2008, are due to expire on 30 June 2013. BasicsCards are the primary payment mechanism used under income management for clients to access their income managed money for the purchase of certain priority goods and services.

The Western Australian Trial, which provides Child Protection Income Management and Voluntary Income Management services to people in metropolitan Perth and the Kimberley Region of Western Australia, will continue until 30 June 2013 at a cost of $13.5 million. This trial commenced in November 2008. The measure includes the continuation of incentive payments and matched savings payments, as well as $5.0 million to continue Commonwealth financial counselling and money management services. These services are available to income management clients and to the broader community, with priority given to vulnerable people.

An overview of cuts to Indigenous literacy and numeracy programs.

The Australian Indigenous Health Bulletin has compiled a collection of Budget papers relevant to Indigenous health.

***

Global health/aid

From the aid budget papers:

The Government will continue to grow Australia’s aid budget to 0.5 per cent of Gross National Income (GNI) but defer the target date by one year, from 2015‑16 to 2016‑17.

This measure will achieve $2.9 billion in savings over four years while still growing aid spending by 50.0 per cent over the period 2012‑13 to 2015‑16. These savings will be achieved by a $2.7 billion reduction in the provision for expanded aid funding held in the Contingency Reserve and a reduction of $212.5 million to existing AusAID resources.

Under the new growth profile, ODA spending will have doubled from 2007‑08 levels by 2014‑15. Additionally, based on current projections of ODA contributions by the 23 members of the Development Assistance Committee of the Organisation for Economic Co‑operation and Development (OECD), this growth path could see Australia rank sixth in the ODA donor rankings by 2015‑16. Currently, Australia is ranked tenth.

And some reaction:

***

Details of the National Disability Insurance Scheme

The Australian, state and territory governments have committed to working towards a National Disability Insurance Scheme (NDIS) and agreed their shared responsibility for this important reform.

The Australian Government will provide $1.0 billion over four years for the first stage of an NDIS. This will deliver personalised care and support for up to 10,000 people with significant and permanent disability from 2013‑14 and expand to support up to 20,000 people from 2014‑15. Eligible individuals will be entitled to reasonable and necessary care and support that reflects their individual circumstances. The Government will provide funding of $342.5 million over three years from 2013‑14 for this purpose.

This first stage of an NDIS will occur in up to four launch locations, to be announced following negotiations with state and territory governments. The Government will be seeking to share the costs with state and territory governments of individual care and support for people with a significant and permanent disability, and will bear the full remaining costs of this initiative.

The Government will provide funding of:

$240.3 million over four years from 2012‑13 to build and operate the information technology system required to collect and analyse data to monitor client outcomes and measure the performance of the new arrangements;

$154.8 million over three years from 2013‑14 to employ Local Area Coordinators to provide a more individually focused approach to delivering assistance to people with a disability;

$122.6 million over four years from 2012‑13 to prepare the disability sector for the new way of delivering disability services with a focus on launch locations;

$58.6 million over three years from 2013‑14 to conduct assessments of people with a disability in launch locations to determine their eligibility and the appropriate level of individual care and support;

$53.0 million over four years from 2012‑13 to establish a new National Disability Transition Agency to coordinate the implementation and manage the delivery of care and support to people with a disability in the launch locations from 2013‑14;

$18.3 million over four years from 2012‑13 to continue the Commonwealth Taskforce responsible for providing policy advice to the government on the design, governance and funding of an NDIS;

$11.7 million over four years from 2012‑13 to undertake research into early interventions to improve support for people with a disability and to support the implementation of an NDIS, and provide training of Local Area Coordinators; and

$5.2 million over three years from 2013‑14 to evaluate the outcomes being achieved in launch locations to inform further decision making.

This builds on the $19.5 million announced by the Government in December 2011 to design the launch of an NDIS.

Lessons learned in proceeding with the launch and negotiations with the states and territories will inform when and how the Government proceeds to a full scheme.

****

REACTION

(from the Public Health Association of Australia, Australian General Practice Network, Rural Doctors Association of Australia, Catholic Health Australia, St Vincent de Paul Society, ACOSS, UnitingCare Australia, Consumers Health Forum, AMA, Australian College of Mental Health Nurses, Australians for Native Title and Reconciliation, Early Childhood Australia, AHHA, The Australian Diagnostic Imaging Association, Carers Australia, Pharmaceutical Society of Australia, Services for Australian Rural and Remote Allied Health, Foundation for Alcohol Research and Education).

PHAA: Health Budget 2012: firm but fair

The Public Health Association of Australia (PHAA) has welcomed key initiatives in the areas of dental health, rural health and aged care in the 2012-13 Health Budget.  Other highlights include additional expenditure on bowel cancer screening and measures to Close the Gap in health outcomes for Indigenous Australians.

“Additional expenditure in these key areas is being offset by some thrifty savings to be achieved by cracking down on Medicare rorts, tightening the Private Health Insurance Rebate applied to natural therapies and cutting Medicare rebates for cosmetic surgery.  The budget measures should ensure that expenditure is better targeted to provide access to essential services for those who need them most,” explained Professor Helen Keleher, President of the PHAA.

“The centrepiece of the health budget is a $515.3 million investment over 4 years in oral health for disadvantaged Australians.  This funding will cut waiting lists, build the dental health workforce and provide improve facilities in rural and remote areas.

“$475 million will also be spent on 76 health and hospital infrastructure projects in rural and regional areas.  This includes projects such as hospital and community health centre development, multi-purpose services, dental facilities and training and accommodation for health professionals in rural, regional and remote locations across the country.

“$3.7 billion will be spent over 5 years on aged care system reforms focused on supporting people to stay in their own homes if they so choose, and enhancing aged care facilities for those who do choose, or continue to require, residential care.  An additional $49.7 million will also be spent over 4 years on expanding the National Bowel Cancer Screening Program to people aged 60 and 70, with a view to phasing in biennial screening for all people between 50 and 74 years of age by 2017-18.  A further $233.7 million will be spent to progress the roll-out of the national electronic health records system,” said Professor Keleher.

“$713.5 million will be spent over 10 years under the Stronger Futures in the Northern Territory initiative for better primary health care and better access to allied health services for Aboriginal people living in rural and remote areas.  A further $40.9 million will be spent on improving food security and $694.9 million will go towards community safety initiatives, including measures to address alcohol misuse.  There are also additional measures designed to provide more aged care places and improve regional and remote health care facilities.  These measures should make a significant difference to health outcomes for Indigenous Australians,” said Michael Moore, PHAA Chief Executive Officer.

“The Government has also committed to raising the low-income thresholds for the Medicare Levy and Medicare Levy Surcharge, in line with changes to the consumer price index.  Tighter limits will also be applied to the amount of duty-free tobacco that can be brought into Australia.  On the whole, it looks like some sensible savings and thoughtful changes to current health expenditure have been used by the Government to ensure that money is spent on those who need it the most,” said Mr Moore.

****

Primary health care the ‘poor cousin’ this time round Federal Budget 2012-2013

In response to this evening’s Federal Budget 2012-2012, Australian General Practice Network (AGPN) Chair, Dr Emil Djakic said that the general practice and primary health care sector has been given the ‘poor cousin’ treatment limiting the potential for developing Australia’s Medicare Local program.

“AGPN welcomes the community care slant that’s been given to the aged care reforms but tonight is a missed opportunity for primary health care. We need the same commitment to community- based care for health programs,” Dr Djakic said.

“The divisions of general practice advocacy for primary health care reform in line with World Health Organisation principles, has seen Medicare Locals (MLs) established as regional primary health care enterprises to drive better health,” he said.

“In establishing MLs, the divisions network has vested its considerable capacity and community trust in this structural change. The Federal Government now needs to think ahead about how it is going to give MLs the tools, which includes flexible funding and a diversity of programs, to not only meet their obligations under a COAG performance and accountability framework, but more importantly to deliver safe, equitable and accessible health care for communities Australia-wide.

“By the end of 2012, MLs will be solidly bedded down with the weight of clinical and community leadership behind them. Expectations will be that expenditure in this sector is ramped up significantly come May 2013,” Dr Djakic said.

“Overall, this health budget is extremely modest even though there is spending on infrastructure projects like measures to support the adoption and steady roll-out of the Personally Controlled Electronic Health Record (PCEHR).

“AGPN acknowledges that a shared health record will reap dividends for the community when this investment is translated through an uptake by patients and clinicians across Australia and MLs must be funded appropriately to promote the benefits of this initiative to patients, practices and the efficiency and effectiveness of the health system.

AGPN welcomes:

  • $3.7 billion for aged care reform
  • $161.6 million over 2 years for the PCEHR
  • $515.3 million over 4 years to dental health including oral health promotion activities
  • $17.6 million over 2 years for maintenance of anticipated service levels under the Mental

Health Nurse Incentive Program

  • · $49.7 million over 4 years to expand the National Bowel Cancer Screening Program

“In light of the Government’s commitment to deliver a surplus, cutbacks were definitely on the cards tonight and health was not spared.

“Affected primary health care programs included savings of $83.5 million over 5 years to the Practice Incentive Program achieved through raising cervical screening and diabetes targets and cessation of practice payments for immunisation,” Dr Djakic said.

 ***

Budget again fails the bush:  More doctors to walk away.

The Rural Doctors Association of Australia (RDAA) says the federal budget has again ignored the medical workforce crisis in rural and remote communities.

“The Government just doesn’t get it. It has failed to listen and engage in any meaningful discussion on fixing the problems in rural health. Doctors and other health workers are losing hope that there is light at the end of the tunnel and will simply drop out of services or even leave their towns” RDAA President, Dr Paul Mara, said.

“Many doctors in small country towns are hanging on by the skin of their teeth, are overworked, and are getting burnt out from extended hours combined with high levels of responsibility.

“Doctors working in rural settings have completely different training and practice needs to those in the cities, and their patients also have different needs. Put simply, a ‘one size fits all’ approach just doesn’t work.

“This is a key point that the Federal Government doesn’t appear to be grasping.

“Nothing in this budget addresses the key issues of concern that have been raised time and again by RDAA:

*  The Government has done nothing to fix the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system policy wreck that continues to bleed small rural towns of much-needed additional doctors and encourages them instead to move to large regional cities.

*  The Government has done nothing to reverse its disastrous decision to cut after-hours incentives from the Practice Incentives Program from July next year—a decision that threatens the very existence of the excellent after-hours care services provided by rural practices in small rural towns for decades.

*  The Government has done nothing to ensure better supervision and support for the many overseas trained doctors practising in rural Australia, nor better support for their families.

*  The Government has done nothing to amend the misguided Districts of Workforce Shortage (DWS) regime so it better reflects the reality of doctor shortages in rural Australia.

*  The Government refuses to accept that its incentives program is now driving doctors into regional centres rather than smaller country towns.

“RDAA also continues to call on the Government to invest in a much-needed National Advanced Rural Training Program to deliver the next generation of well-trained rural generalist doctors to thebush—doctors who can provide not only general practice-based care but also the advanced care that rural patients need, like accident and emergency, obstetrics, anaesthetics, surgery, acute mental health, advanced paediatrics and Indigenous health. Queensland already has a state-based program up and running, and other states are close behind…it’s now time for the Federal Government to back this winning horse and put a national training program in place.

“The irony in this time of economic uncertainty is that many of the measures we have been calling for would make a big impact for very little increase in cost.

“As it is, this budget—like those before it—has been way off the mark when it comes to rural healthcare.

“And as a consequence of the Federal Government’s continuing under-investment in rural health, we run the risk of more long-serving doctors leaving small rural towns with no new doctors willing to replace them.”

***

Budget delivers surplus by cutting hospital beds

The Gillard Government has fulfilled its promise of a Budget surplus by slashing spending on sub-acute hospital beds.

Last month, Catholic Health Australia gave its support to the aged care reforms announced by Prime Minister Julia Gillard and Minister for Ageing Mark Butler, and the Budget tonight confirmed the funding mechanisms for those reforms.

“What we saw tonight was confirmation of the modest $55.2 million next year in new spending to improve an aged care system that is under immense strain,” CHA chief executive officer Martin Laverty said.

“One of the great disappointments of this Budget was a $120 million cut from multi purpose services, which will mean more than 200 sub-acute beds promised as part of the Council of Australian Governments health reform agreement will now not be built.”

There was also disappointment about the lack of any policy – and associated funding – to address the expected shortfall of 110,000 nurses across Australia by 2025, as a Health Workforce Australia report predicted less than two weeks ago. In fact, the Budget cut workforce spending by $68 million.

Hospitals are also concerned about the impact of the implementation of the Government’s carbon tax, with both public and private hospitals expected to be adversely affected by the carbon tax and not compensated for the rising costs they will incur.

“Not-for-profit hospitals will see operating costs increase as a result of the carbon tax, but the Government has not committed to ensuring hospitals can cover those costs,” Mr Laverty said. “We have no view on the merits of the tax, but we do not want to constrain health services because of a new tax.”

Despite the fiscal constraints the Government placed on itself, there were some important funding injections announced tonight, including $1 billion in initial funding for the National Disability Insurance Scheme, starting in 2014, and the increase in funding for dental care, aimed at improving the oral health of lower-income Australians.

“Oral health is closely related to general health, and CHA has been pushing for a greater emphasis on improving the health of poor, vulnerable and marginalised Australians, so additional money for dental care should go some way to achieving that,” Mr Laverty said.

CHA welcomed a funding boost of $50 million over four years to improve access to free bowel cancer screening for older Australians and an additional $162 million for the implementation of the personally controlled electronic health record (PCEHR) system.

Mr Laverty also welcomed Health and Hospital Fund grants to St Vincent’s Hospital Lismore ($2.5 million), Mater Health Services North Queensland ($10m) and Calvary Port Augusta ($700,000), saying the investment will improve the quality of care those facilities can deliver.

***

Vinnies: Surplus on the back of sole parents and the unemployed

St Vincent de Paul Society Chief Executive, Dr John Falzon, has sharply criticised the failure of the 2012 Budget to deliver relief for people who are outside the labour market. He said:

“Tonight’s Budget confirms one thing that both sides of politics agree on. And that’s their belief in the existence of an undeserving poor. Their message is that if you’re poor it’s because you’re just not trying hard enough. So the unemployed are left below the poverty line. Newstart has not received its much-needed boost of $50 a week. And a $700 million chunk of the surplus has been skimmed from the pockets of sole parents and their children.

“You don’t build people up by putting them down. You don’t help them get work by forcing them into poverty.

“There’s nothing wrong with bringing home the bacon for middle Australia. But the people living at the rough end of Struggle Street are trying to get by on baked beans.

“The young unemployed bloke scraping by on $35 a day and we wonder why we he doesn’t get a haircut before going for a job interview, or the single mum who has just been forced down to $38 a day on Newstart. They remain unheard.

“The middle-aged mum or dad on low wages or no wages as they battle to re-enter a workforce from which they have been dumped like so much human garbage. They remain unheard.”

St Vincent de Paul Society National President, Mr Anthony Thornton, added:

“A good Budget should at least be a step in the direction of putting a charity like ours out of business. Sadly, this is not the case tonight. We will always be there to give our fellow Australians a bit of a hand-up. But people don’t want charity. They want dignity whether they are in the low end of the labour market or outside the labour market door, trying to get in. At a time when they increasingly have to turn to charity, it is not charity they long for. It is justice.”

Dr Falzon welcomed Government initiatives such as the National Disability Insurance Scheme and other measures that would help reduce inequality but was scathing of the Government’s treatment of the people who continue to be left out. He said: “The forgotten and excluded have not been heard. They’ve been answered, not with hope, but with a bucket-full of austerity.”

***

Robin Hood comes good, except for single parent families

The Australian Council of Social Service has welcomed the overall approach in the Federal Budget, which makes the tax system fairer and will improve the lives of people on low incomes – except for 100,000 of our poorest families.

“This Budget reduces supports and tax breaks for those that need them least, and strengthens them for those that need them the most, except for the poorest sole parents, who are left up to $60 a week worse off,” said ACOSS CEO Dr Cassandra Goldie.

“We are delighted that a number of our recommendations to make the Budget more equitable and sustainable have finally been taken up, such as rolling back superannuation tax concessions for high earners; tightening the living away from home allowance; targeting tax breaks for golden handshakes; and phasing out the inefficient mature age worker tax offset. It begins important work on tax reform, which must now be extended, building consensus along the road.

“As well as achieving a surplus the Budget redirects some of that wasteful spending to begin the work on some of our most pressing social issues, including dental health reform, reductions in carbon emissions, the NDIS, and the adequacy of allowances and family tax payments (including the liquid assets test for people claiming income support).

“We welcome the commitment to work towards a national dental scheme from next year. The $500 million investment (over half of which is new money) will be welcome relief to the 400,000 people on public dental waiting lists.

“ACOSS is also pleased to see funding set aside in this year’s budget to launch a national disability insurance scheme a year ahead of schedule. This is long overdue and great news for the great many people in Australia with disability, and their families and carers.

“The new Supplementary Allowance of around $4 per week is welcome though it is no substitute for raising Newstart to a decent liveable level and indexed to wages like Pensions instead of CPI but it is the first real increase in the Newstart Allowance payment for twenty years. Further increases to these Allowance payments are essential to reduce poverty and put people in a better position to find paid work. We take it as a sign of good faith that recognises this payment is inadequate, with a much more substantial increase to be achieved around the corner.

“However, it is disappointing that the Budget does not strengthen investment in employment services for long term unemployed people, who still only get an interview every two months and $500 worth of other help. The Budget cuts to Job Services Australia are unsustainable and underscore the need for a major review of the system.

“The Schoolkids bonus is a vast improvement on the Education Tax Refund, which we have called to be abolished. This bonus will make it easier for low income families to claim but could still be better targeted to those families who really need it. The separate family payment increases of up to $600 a year are better targeted and very welcome.

“The major blight on this year’s Budget is the unnecessary attack on 100,000 single parents who’ll be left worse off. The surplus could have been achieved without leaving some of the most disadvantaged families and their children in deficit.

“People on Parenting Payments will be left around $60 a week poorer by being forced off their current payment ($324 a week) onto the lower paying Newstart Allowance ($265 per week) when their youngest child turns eight.

“This measure goes against the grain of an otherwise balanced and fair Budget and we urge the Government to reconsider. This will drive many more families into poverty and ACOSS will be calling on parliamentarians to reject any legislation to bring this into affect.

“This is not a work incentive measure – in fact the financial returns from employment are less than those available under Parenting Payment.

“Such a proposal further underscores the urgent need for an increase to the Newstart Allowance which has widespread support in the community, among union groups, and business.

“Overall this budget begins the work we need: securing a more sustainable revenue base, whilst funding important national priorities. We must make sure that the 100,000 sole parents are not collateral damage along the way,” Dr Goldie said.

***

BUDGET DELIVERS FOR LOW WAGED FAMILIES

UnitingCare Australia said tonight’s Federal Budget is fiscally responsible and fair overall. It will deliver a decent chance at a decent life for more Australians.

National Director, Lin Hatfield Dodds said the suite of Budget initiatives promises a brighter future for families and unemployed Australians.

“Reducing executive tax perks and golden hand-shakes, better targeting superannuation concessions, and deferring defence spending have enabled the Government to spend more on the things that matter.

“Investment in aged care reform, rolling out the National Disability Insurance Scheme, and better access to dental services for low income and disadvantaged Australians are particularly welcome initiatives.

“Previously mooted company tax cuts of $4.5 billion have been shelved and the revenue saved largely redirected to families and unemployed Australians through the new Benefits of the Boom package.

“This package boosts support for families by $1.8 billion, and includes a new supplementary allowance worth $1.1 billion for people receiving Newstart, Youth Allowance and Parenting Payment. While this very modest allowance falls well short of the $50 a week increase we called for, it’s a trend in the right direction.

“We hope it’s a down-payment on a decent increase in unemployment benefits in next year’s budget.

“It’s disappointing to see the Government has proceeded with plans to cut parenting support for single parents whose children are older than eight years, an effective drop in income of almost $120 a fortnight.

“However increases to the Jobs Education and Training program and more childcare for unemployed single parents will assist people as they move into jobs and provide a better start for vulnerable children.

“The new Schoolkids Bonus cashes out an inefficient and ineffective tax refund system that failed to deliver the full education benefit to nearly 80 per cent of eligible households.

“Budgets are all about choices. They expose our values as a nation. This Federal Budget overall delivers a better deal for many Australians,” Ms Hatfield Dodds said.

The UnitingCare network provides social services to over 2 million people each year in 1,300 sites in remote, rural and metropolitan Australia. UnitingCare employs 35,000 staff and 24,000 volunteers.

***

More reaction added on 9 May

Less plastic – more teeth: a healthy Budget outcome!

“This Budget has delivered on key promises in critical areas of health such as dental ($515.3m), disability ($1bn) and aged care ($3.7bn) without painful cuts,” said CHF CEO Carol Bennett.

Cuts to health expenditure have been restricted to better targeting services through means- testing the medical expenses tax offset and capping higher cost procedures – mainly cosmetic and out of hospital items from the Extended Medicare Safety Net.

Ms Bennett said, “We can’t expect wrinkle reduction, eye lifts, nose and ear jobs to be subsidised by tax payers. We would much prefer the money was directed to addressing the pain and suffering of the hundreds of thousands of Australians on public dental waiting lists. We also applaud the Government for putting new money into aged care, disability and the roll out of eHealth measures despite the tight fiscal circumstances.”

Welcome measures include:

  • $515.3m to target better dental services;
  • $233.7m over two years for eHealth to ensure roll out of the system;
  • $475m investment in new regional health infrastructure projects through the National

Health and Hospital Fund;

  • $49.7m funding for bowel cancer screening for 60 and 70-year-olds every five years;
  • $5.2bn for (Closing the Gap) indigenous measures;
  • $1.4m to increase transparency in medicines promotion;
  • A review of natural therapies to ensure private health insurance rebates target evidence-based care.

Limits on current medical benefits:

  • Tightening up of funding for some cosmetic procedures covered under the Extended Medicare Safety Net where excessive fees can be many times the average;
  • Means-testing of the medical expenses tax offset ($84,000 threshold for singles, $168,000 for couples);
  • Removal of benefits for some out of hospital procedures that should be delivered in hospital.

“It is reasonable to constantly review Medicare payments to ensure equity and make certain we are directing resources to those who most need healthcare,” said Ms Bennett.

“This Budget has ensured that access to necessary healthcare is not compromised by major cuts. We have achieved significant new funding for critical parts of healthcare in a very tight budget. The new health expenditure will pay a real dividend for all of us by promoting a healthier and more productive Australia,” Ms Bennett concluded.

***

AMA

AMA President Dr Steven Hambleton said tonight that the government had done the right thing by sparing health from broad funding cuts to provide a budget for tough economic times and to fund a budget surplus.

“Health has generally been sheltered from the budget cuts,” Dr Hambleton said.

“This budget means that health costs should not add further pressure to the cost of living for Australian families.

“The AMA welcomes new funding for aged care, bowel cancer screening, dental services, health infrastructure, and electronic health initiatives,” the AMA President said.

“The changes to the Extended Medicare Safety Net (EMSN) appear to have been based on clinical and economic evidence and do not involve services or procedures that are regularly required by families.

“We have strong objections to changes to Practice Incentive Payments (PIP).

“The General Practice Immunisation Incentive has ceased. This has serious public health implications.

“And GPs will only be eligible for the electronic PIP if they participate in the PCEHR. We will challenge this decision. This will be a roadblock to the system working properly.

“We also see problems with the cessation of Local Lead Clinician Groups. This may have a downside for the better management of hospitals.

“More broadly, we support funding for the National Disability Insurance Scheme (NDIS) and key health services for Indigenous Australians under the Stronger Futures program. We still have concerns about the lack of medical care programs or funding in the aged care package, and the lack of incentives for doctors to embrace the personally controlled electronic health record (PCEHR).

“With the budget returning to surplus, we encourage the Government to look to the future by bringing forward investments in medical research and medical training.

“As always, there may be devil in the detail. We will be looking at the fine print over coming days.”

 ***

More reaction added on May 10

The National Rural Health Alliance has compiled a detailed overview of reactions to the health budget.

NRHA: Improvement in three key areas is foreshadowed

For people who live in rural and remote areas, tonight’s Federal Budget promises good news on three fronts: dental care, aged care and disability services. For the news to be confirmed there will need to be ongoing Government commitment, wide ranging consultation, and the allocation of substantial extra resources as soon as fiscal conditions permit.

People in rural and remote communities should welcome the major shifts initiated. They should stay engaged and keep the pressure on to ensure that the policy journeys foreshadowed today are successfully completed tomorrow. With universal, national, fully-funded schemes for dental health, healthy ageing and aged care, and disability support, several of the gross inequities currently experienced by the people of rural and remote areas can be addressed.

These are three social policy areas in which it is better to arrive than to travel.

On dental health, the National Rural Health Alliance and others have recognised for a long time that positive change in dental care in rural and remote areas must start with workforce. The Government’s dental scheme, with incentives for up to 300 dentists to shift to rural and remote communities and (later) grants to help with purchase and fit-out of dental facilities, provides a good start. Extra support for the Voluntary Dental Graduate Year program, introduction of a similar graduate program for Oral Health Therapists from 2014, and oral health promotion are also useful building blocks. It is to be hoped that progress towards universal coverage can begin next year.

As was announced on 20 April, Government policy in a second key area is starting to move in a positive direction with the rebalancing of the aged care system. It is a greater challenge in rural and, especially, remote areas to keep people in their own homes as they become less independent. But the changes foreshadowed last month recognise the need to provide this choice wherever and whenever possible.

There is to be a focus on the early diagnosis of dementia, and extra resources for in-home care. The re-balancing of resources for low and high care will benefit rural areas, where there is a higher proportion of community aged care, compared with residential facilities. Particularly welcome is the promised focus of the new Workforce Compact on workforce pressures in rural and remote areas.

In the third major area, the Government will commit $1billion over four years to the first stage of a National Disability Insurance Scheme (NDIS). Starting in July 2013, 10,000 people will start to be assessed in ‘launch locations’ – hopefully including the sorts of pathways, from place to place, that rural people with a disability usually have to traverse.

 ***

RACGP: 2012/13 Budget – little new for general practice

The Royal Australian College of General Practitioners (RACGP) is disappointed that tonight’s Budget failed to address most of the issues raised in the College’s 2012/13 pre-budget submission.

Professor Claire Jackson, RACGP President, said as expected the Budget provided $3.7 billion for aged care, $515.3 million for dental health services, $49.7 million for bowel cancer screening, $475 million for new and improved health facilities for rural, regional and remote communities and $5.2 billion for Indigenous health initiatives.

“The College cautiously welcomes the $233.7 million e-health investment, which includes over $161 million to operate the personally controlled electronic health record (PCEHR) system for the next two years. The College notes the continuation of an ePIP for practices participating in a PCEHR.

“The College will be seeking further detail regarding individual general practices payments and GP funding to assist in the smooth implementation of the PCEHR.

“The College is disappointed with the loss of the General Practice Immunisation PIP and we will be seeking clarification regarding changes to the Cervical Screening and Diabetes PIPs over the coming days.

“The College will also seek further detail regarding radiology budget saving measures, which limit Medicare rebates to accredited providers in accredited premises. This has implications for our essential rural and remote GP workforce.

“The College also notes the $44 million saving on GP Super Clinics and the removal of funding for Local Lead Clinician Groups.

“Finally, the College supports the large reduction in cigarette duty free allowance,” Professor Jackson said.

Over the coming days, the RACGP will be analysing the budget papers in detail and will provide members with a briefing document, which will be available soon at www.racgp.org.au/reports.

The College is committed to continue working with all levels of government to improve access to high quality care to better meet the needs of our local communities.

***

• A compilation of the reaction from the not for profit sector 

***

Meanwhile, the Power Index has judged public health a winner from the budget, nominating a public health advocate, a disability reform advocate, and a dental leader as among the “five people who won the federal budget lobbying game”.

***

More reaction added on May 11 

• Minister Tanya Plibersek’s post budget briefing says:

In drafting the 2012-13 health and ageing Budget, our guiding principles have been –

to build health, hospitals and aged care systems for a modern Australia that are truly centred on the patient and individual

to get maximum value for the taxpayers’ dollars

to advance the health and wellbeing of all Australians; and

to ensure that those least able to look after themselves are, in fact, looked after.

***

Australian College of Mental Health Nurses

The Government has delivered an unconscionable freeze on funding for the Mental Health Nurse Incentive Program (MHNIP) in the 2012-13 Budget. This highlights that having a budget in surplus is more important to the Gillard Government than the needs of some of the country’s most vulnerable people.

The Treasurer says the surplus years are here, yet the Budget Papers allocate just $17 million in additional funding to the MHNIP for 2012-13. This means that no new nurses and no new organisations will be able to deliver vital services to thousands of people with complex and serious mental illness.

Through this program, people with severe and persistent mental illness receive specialist nursing support and care coordination through the Medicare system. The services are provided in a range of settings, including patients’ homes or clinics, at little cost to the patient.

“This program is about supporting people with complex conditions. Mental health nurses working under MHNIP keep people connected and stop them falling through the gaps of the health system” says Adjunct Associate Professor Kim Ryan, CEO of the Australian College of Mental Health Nurses.

“The program supports GPs and psychiatrists to provide more effective and targeted mental health care to their clients, and helps keep people from hospitalisation – which saves money throughout the health system”.

“Mr Swan says this is a budget for battlers, yet it stigmatises and marginalises some of Australia’s most vulnerable – those living with complex mental illnesses”.

“How can you deliver a mental health services without access to mental health nurses? They are the backbone of the mental health system. This government is ignoring mental health nurses and the vital role they play in assisting those with mental illness in Australia”.

Adj. Assoc. Professor Ryan is appalled by the decision to recklessly freeze MHNIP funding before a full evaluation of the program has even been completed. “We know the program is working, we know from nurses and we know from clients. We know from the National Advisory Council on Mental Health’s case studies project report, which highlighted its effectiveness”.

“We’re not going to sit idly by and accept this freeze. We’re going to fight for funding to be reinstated so that mental health nurses working under MHNIP can continue to provide vital services to those with mental illnesses”. Ms Ryan said.

***

Australians for Native Title and Reconciliation

ANTaR has welcomed long-term funding delivered by the Budget for essential services in remote communities, along with new governance and leadership programs.

“ANTaR has welcomed long-term funding of more the $3.4 billion over 10 years to fund health, education, justice and homelands services in the NT as a significant development. This offers funding security for remote communities and will enable local community organisations to plan for the future,” said Jacqueline Phillips, National Director.

“The announcement of funds to employ Indigenous Engagement Officers in remote communities and programs to support governance and leadership are also welcomed as positive developments.”

“ANTaR hopes this will facilitate increased local Aboriginal participation in the coordination and delivery of services and build governance and leadership capacity in communities.”

“However, these initiatives sit uneasily with the Government’s Stronger Futures bills which are listed for debate in the Senate today. Should these bills pass without major changes, ANTaR fears further long-term damage to relationships between many NT Aboriginal communities and governments.”

With the 20th anniversary of the Mabo decision next month, ANTaR is disappointed that the Government has not delivered much needed funding to native title bodies. Native Title Representative Bodies and Prescribed Bodies Corporate are central to the recognition, management and administration of native title claims yet are chronically under-funded.

“The best way to improve native title outcomes is to level the playing field. Adequate funding for native title bodies would support this objective and should be considered a high priority for the Government.”

•••

Early Childhood Australia: Budget initiatives continue support for quality early education and care for children

The Federal Budget’s commitments to provide additional funding to JETCCFA (jobs and education training childcare fees assistance) and to assist in attracting Early Childhood Teachers into remote/regional areas are important steps towards implementing the national quality reform agenda in early childhood education and care, according to Early Childhood Australia (ECA).

The peak advocacy organisation for young children said the commitment of an additional $225.1m over 4 years to the JETCCFA program would provide for growth in early childhood education and care services.

“The JETCCFA program has already been highly successful in supporting parents and providing children with access to high quality early childhood education and care,” said ECA Chief Executive Officer Pam Cahir.

“Providing an additional 130 000 families with access to this assistance is great for low income parents and their children.

“Children’s exposure to high quality early childhood education and care at a young age underpins the development of confidence and self esteem and provides a platform for all future learning.

“Children and the nation have much to gain from this.

Ms Cahir said ECA also welcomed the broadened eligibility criteria for the HECS HELP Benefit for early childhood education teachers by doubling the number of postcode areas that teachers can be in, on order to be access the assistance.

“This is an important initiative if early childhood teachers are to be attracted to services in remote and regional Australia.

“It is essential that we have a specialised, professional and qualified workforce delivering quality education and care to babies and young children – no matter where you are in Australia.

“Initiatives like this bring us closer to ensuring that all Australian children are getting the education and opportunities they deserve.”

 ***
Australian Healthcare and Hospitals Association : The 2012 -2013 Health Budget NEW MEASURES AT A GLANCE

$515 million dental health package, focused on tackling public dental waiting lists

$233.7 million for the continuation of the national e-health program $49.7 million for the staged expansion of the National Bowel Cancer Screening Program

$475 million for 76 health infrastructure projects in rural and regional areas

A $3.7 billion aged care package, including a big emphasis on providing more options for older Australians to stay in their own homes

IN DETAIL

1. Overall Budget context

The Government has fulfilled its pledge to return the Budget to surplus, projecting a small surplus of $1.5 billion for 2012-13, and surpluses in each year of the forward estimates thereafter.

Given the tight fiscal discipline required to produce a Budget surplus, Health was a Budget night winner – with funding provided for investments in critical areas like dental care and e- health, and no real savings nasties.

2. Major new areas of health spending

Dental health

The AHHA strongly welcomes the $515 million dental health package included in the Budget. A majority of this funding ($345.9 million) will be dedicated to ‘blitzing’ public dental waiting lists – which will be important relief to the hundreds of thousands of low-income Australians on these waiting lists who have been waiting months, and often years, for dental care.

Funding will be provided to boost the public dental workforce – by doubling the number of places in the Voluntary Dental Graduate Year Program (announced in the 2011 Budget), which commences next year, from 50 to 100 by 2016; and by introducing a similar program for Oral Health Therapists, commencing in 2014. The latter is particularly important as therapists are a very important part of the public dental workforce.

The package also includes:

a new grants program to encourage and help dentists relocate to regional, rural and remote areas – similar to existing programs for GPs;

capital funding for dental health infrastructure in rural and regional areas, provided through the regional priority round of the Health and Hospitals Fund;

$10.5 million for a national oral health promotion activities, recommended as a key activity in the report of the National Advisory Council on Dental Health; and a small amount of funding ($450,000 over three years) to non-government organisations to coordinate the provision of pro-bono dental health services for those in greatest need.

These investments are funded in part by redirecting $290 million that the Government allocated to the Commonwealth Dental Health Program in the 2008 Budget, which has not been spent because of the long-running stand-off in the Senate over the closure of the Chronic Disease Dental Scheme.

This is a much needed funding boost, though it falls a long way short of universal access to dental treatment that the AHHA and other groups have long campaigned for. The Government itself acknowledges there is more to do, stating in the Budget papers that “the next phase of significant dental reform will be addressed in the 2013-14 Budget”, in line with the Government’s agreement with the Australian Greens.

e-health records

The Budget includes $233.7 million for the continuation of funding for the national e-health program and the rollout of the personally controlled e-health record (PCEHR) from 1 July this year. This will help promote more coordinated and integrated health care for consumers, and reduce inefficiencies and duplication (for example, in diagnostic testing) in the system.

This commitment builds on the $466.7 million provided in the 2010 Budget to build the national infrastructure for the PCEHR system – which was due to run out at the end of this current financial year.

The e-health spending in the 2012-13 Budget includes:

$161.6 million to operate the PCEHR system for the next two years, including registration and customer support, adoption support, and monitoring and evaluation;

$67.4 million as the Commonwealth’s share of joint funding with the states and territories for the National E-Health Transition Authority (NEHTA) work program for the next two years, including for continued work on standards for the secure electronic exchange of health information; and

$4.6 million for the implementation of privacy safeguards.

Bowel cancer screening

The Budget includes $49.7 million for the staged expansion of the National Bowel Cancer Screening Program to biennial screening, in line with best practice and international evidence, as recommended by the NHMRC.

Currently, bowel cancer screening is provided free to people aged 50, 55 and 65. With the new funding provided in the Budget, this will be expanded to people turning 60 from 2013 and 70 from 2015. The program will then be further extended in 2017-18, when a phased implementation of biennial screening will commence, beginning with 72 year olds.

While it is disappointing that biennial screening will be phased in for another five years, it is good news that the Government has been able to fund this expansion at all in the current budget environment. Once fully implemented, biennial bowel cancer screening for at risk age groups will result in earlier detection of bowel cancer, preventing as many as 500 deaths from this disease in Australia every year.

Rural and regional health infrastructure

Funding of $475 million for health infrastructure in rural and regional areas was included in the Budget. This is the final drawdown from the $5 billion Health and Hospitals Fund (HHF) established by the Labor Government in the 2008 Budget, as well as the last installment of the $1.8 billion HHF Regional Priority Round that formed part of the Government’s agreements with the rural independents, Tony Windsor and Rob Oakeshott, following the 2010 election.

The 76 projects funded under this measure range from big and small hospital capital upgrades, to investments in primary and community health care infrastructure, to e-health infrastructure investments in regional and remote Queensland, to investment in Indigenous health services in the Northern Territory, as well as some much-needed investments in dental infrastructure (as noted above).

Aged care

The Budget includes funding for the $3.7 billion aged care reform package that had been previously announced by the Prime Minister and Minister Butler. This package responds to the Productivity Commission report on aged care commissioned by the Government in its first term.

The aged care package has an emphasis on expanding aged care services, and in particular, providing more options for older Australians to stay in their own homes.

The expansion in community care options will be achieved by:

a big boost to the number of Home Care Packages – from 59,876 currently to almost 100,000 over the next 10 years;
providing more tailored care packages to people receiving home care.

Other important elements of the package include:

more funding for residential care places;

$1.2 billion to attract, retain and train aged care workers, and ensure that they receive competitive wages, through a Workforce Compact with government, unions, and aged care providers;

more respite care and counselling support for carers;

better support for older Australians from diverse backgrounds to access aged care services;

significant investments to better support people, families and carers living with dementia;

an emphasis on improving the experience of the system for consumers and their carers and families – through the establishment of a single ‘gateway’ to all aged care services, initially via the establishment of a new My Aged Care website and national call centre; and

funding for building stronger connections between the health and aged care systems – including through grants to develop innovative models of service, and more funding for palliative care.

The large-scale expansion in services is partly funded by the introduction of new means- testing arrangements for both residential and community care, so that older people with a greater capacity to contribute to the costs of their own care will be required to do so. The Government will still remain the majority funder of care for most care recipients.

Indigenous health

The Government will provide $254.4 million over four years ($713.5 million over ten years) for the continued delivery of specialist and allied health services to Indigenous Australians in the Northern Territory under the Government’s Stronger Futures in the Northern Territory package.

This includes funding for:

primary health care services and primary health care reform, to establish regional health boards with strong local leadership and support;

specialist and allied health services for conditions of very high disease burden — oral health, hearing health, substance misuse, social and emotional wellbeing and therapeutic services for children; and

skilled medical practitioners through the Remote Area Health Corps to meet workforce shortages in remote locations.

The Budget also includes $48.6 million for 10 Indigenous health infrastructure projects, through the HHF Regional Priority Round; and $1.1 million to provide around 6,000 Aboriginal and Torres Strait Islander children each year access to an additional dose of the pneumococcal conjugate vaccine preventing pneumococcal disease (Prevenar 13) under the National Immunisation Program.

Other spending

Other spending initiatives in the Health Budget include:

mental health: additional funding for the Mental Health Nurse Incentive Program to maintain anticipated service levels under the Mental Health Nurse Incentive Program ($17.6 million over 2 years);

food labeling: funding for the implementation of the Government’s response to the Blewett Review of Food Labelling announced last year ($3.9 million over 4 years);

private health: increased funding to boost the Private Health Insurance Ombudsman capacity to manage complaints and respond to consumer enquiries ($1.4 million over 4 years); and

tobacco: funding for compliance and enforcement activities associated with tobacco plain packaging legislation ($3.1 million in 2012-13).

3. Health savings

The budget includes some modest, targeted savings proposals and sensible redirections of existing funding. By and large, the Health portfolio has escaped the razor gang’s scalpel – again, which is noteworthy given the overall fiscal circumstances in which the Budget was framed.

Extended Medicare Safety Net

The Government will achieve savings of $96.5 million by further tightening the Extended Medicare Safety Net – extending existing capping rules to a wider range of procedural items, including to prevent people from misusing Medicare to pay for cosmetic surgery, and introducing an upper limit on the amount of EMSN benefits payable for all consultation items (to prevent ‘item shift’, where doctors shift claims for particular procedures onto items which are uncapped).

This is a sensible measure, which will help ensure spending on this program is targeted at those with genuine health care needs.

Private Health Insurance

The Government will undertake a review of the private health insurance rebate for natural therapies, following which, the Private Health Insurance Rebate will cease to be paid for services which are not clinically effective. The Government will provide funding of $1.0 million for the review (but will not publish the savings estimated to come from this measure until the review is complete, though these are likely to run into the tens of millions).

Multi-Purpose services

The aged care package has in part been funded by redirecting existing expenditure, including capital funding allocated for Multi-Purpose Services (MPSs) in the 2010 Budget as part of the National Health Reform agreement.

Negotiations between the Commonwealth and the States and Territories over the National Partnership Agreement under which it will be administered have been protracted. Accordingly, the Government has decided to redirect this funding ($120.7 million) to the broader aged care package.

The Government also committed $1.6 billion to the States and Territories to deliver and operate over 1,300 new sub-acute care beds in hospital and community settings as part of National Health Reform. This funding is not affected by the redirection of the MPS funding.

Health Workforce

Funding of $67.9 million over three years will be redirected from health workforce programs into other government priorities, including through streamlining and improving delivery of the Rural Education Infrastructure Development Pool, Health Workforce Australia programs and the Health Workforce Flexible Fund.

The Government is also redirecting funding from Health Workforce Australia and other health workforce capacity programs to fund the extension of the General Practice Rural Incentives Program (which provides relocation and retention incentive payments for medical practitioners to work in rural areas), for which demand had outstripped previously allocated funding.

Reduction in health workforce funding is of some concern, given projected workforce shortfalls outlined in the recently released Health Workforce Australia report, in particular in the nursing workforce where a shortage of 110,000 nurses across Australia by 2025 is predicted.

Local Lead Clinician Groups

As part of National Health Reform the Government had previously announced funding for a National Lead Clinicians Group, and for Lead Clinician Groups in local LHN and Medicare Local regions.

Local Lead Clinicians Groups have not gotten off the ground, partly because they had been contentious in some States given their potential to duplicate existing clinical structures. Accordingly, instead of proceeding with the local Lead Clinicians Groups, the Government will establish a National Collaborative Clinicians Network to promote clinical leadership and multidisciplinary models of integrated care, engage clinicians across Australia in health reform, and provide opportunities for clinicians to identify, inform and deliver service improvements. The Australian Medicare Local Network will also be provided with $3.4 million over four years to work with Medicare Locals to enhance clinical leadership and engagement across health settings.

This is a sensible reallocation of resources, which will provide a saving of $60.7 million over five years.

Other savings

Other savings proposals contained in the Budget include:

Medicare: changes to Medicare listings, including through tightening of the provisions for Medicare funded diagnostic radiology services to ensure providers meet minimum qualifications, and removal of subsidies for Hyperbaric Oxygen Therapy (HBOT) for the treatment of non-diabetic chronic wounds, following a recommendation from the Medical Services Advisory Committee ($43.9 million saving in total). The AHHA is concerned about the removal of the HBOT MBS item and will be following up on this issue;

PBS: changes to prices paid by Government for certain drugs provided under the PBS ($104.6 million saving);
GP Super Clinics: the Government will not proceed with currently uncommitted funding for some GP Super Clinic support activities, which will be undertaken through the Medicare Local Network instead ($44.0 million saving). This will not impact on the construction of any GP Super Clinics or primary care infrastructure grants;

Practice Incentives Program (PIP): the Government will tighten requirements for receiving the PIP, including by introducing a requirement for general practices to participate in the Personally Controlled Electronic Health Record System to receive the eHealth PIP incentive; increasing targets for the cervical screening and diabetes incentives; and discontinuing the GP Immunisation Incentives Scheme in light of immunization requirements introduced on FTB A supplements announced by the Government last year ($83.5 million saving);

Telehealth: the Government will restructure some existing telehealth incentive payments, and introduce minimum distance requirements for telehealth consultations (other than in aged care). Savings from this measure ($183.9 million) are being redirected to the e-health investments announced in the Budget;

National Health Call Centre Network (NHCCN): the Government will cease provisioning for the operational costs of the Queensland and Victorian components of the NHCCN as these States have not agreed to join the Network ($32.4 million saving);

Australian Commission on Safety and Quality in Health Care: the Government has agreed with the States and Territories on a slower than originally planned expansion of the ACSQHC ($15.5 million saving in total).

4. Beyond the health portfolio

There are two areas outside the health portfolio which will be of interest to members.

National Disability Insurance Scheme

Funding of $1 billion has been committed to the first stage of the National Disability Insurance Scheme – a very important, nation-building social reform for Australia.

The first stage of the NDIS will begin in mid-2013 by providing care and support to around 10,000 people with significant and permanent disabilities in up to four locations across the country. This number will increase to 20,000 in mid-2014.

Funding in the Budget includes:

$342.5 million for individually funded packages for people with significant and permanent disability;

$154.8 million for Local Area Coordinators to provide an individualised approach to delivering care and support to people with a disability;

$58.6 million for needs assessments in the launch locations;

$122.6 million for building the capacity of the disability sector to deliver services in new ways;

$240.3 million over four years to build and operate an NDIS information technology system; and

$53 million to establish a new National Disability Launch Transition Agency to coordinate implementation of the NDIS.

Tobacco

The Government continues its strong commitment to tobacco control, reducing the inbound duty free allowance for cigarettes and tobacco for international travellers, which will produce a saving of $600.0 million – which no doubt helped to fund some of the important new spending measures outlined above.

***

Budget backs radiographers and highlights importance of medical imaging: The Australian Diagnostic Imaging Association (ADIA)

A Budget measure that will ensure critical radiology services are delivered to the highest standards has been described as both ‘sensible and responsible’ by the peak body representing private medical imaging practices across Australia.

The Australian Diagnostic Imaging Association (ADIA) has welcomed last night’s announcement of a Medicare Benefits Schedule requirement that all x-rays, fluoroscopies and angiograms are performed by a qualified radiographer.

“ADIA agrees with the Federal Health Minister that Medicare eligible x-rays must be performed by radiographers or other health professionals with equivalent qualifications,” said President of ADIA, Dr Sue Ulreich.

“It is essential that x-rays are carried out by appropriately qualified professionals who have the training to produce high quality medical images with as low a dose of radiation as possible,” Dr Ulreich said.

Dr Ulreich described the budget measure requiring minimum qualifications as “sensible and responsible”.

Dr Ulreich said that while there remains an urgent need for indexation of Medicare rebates for diagnostic and medical imaging services, “the measures announced last night were fair and well- targeted.”

Medicare rebates for diagnostic imaging services have not been indexed for 14 years and are 20 to 30 per cent below actual private practice costs.

“The sickest members of the community pay the most, with gap payments made by patients now exceeding $300 million a year. The chronic underfunding of radiology and the need for indexation of Medicare rebates for medical imaging must be addressed in next year’s Budget,” Dr Ulreich said.

ADIA represents private diagnostic imaging practices in Australia. They diagnose and treat 50,000 patients every day and operate 80% of the comprehensive practices providing services to patients in rural and regional Australia. ADIA members are both for-profit and charitable and operate practices in the community and in public and private hospitals in Australia.

***

At last – the beginning of transformational social reform: Carers Australia

The Government’s commitment of $1 billion over four years to the launch of the National Disability Insurance Scheme represents the beginning of transformational reform to the lives of hundreds of thousands of Australians. This reform is a quantum leap forward. It has the potential to provide equal opportunity for people with disability, their families and carers.

Mr Moore said, ‘combined with the reforms to aged care, the NDIS will have a positive flow on effect for many of Australia’s 2.6 million carers. Government investment in aged care, the National Disability Insurance Scheme, the Personally Controlled Electronic Health Record and better access to dental services for low income and disadvantaged Australians are much needed and welcome initiatives.’

Mr Moore said, ‘carers of people with disability and those who are frail aged need to be recognised not only as key players in the disability and aged care systems but also as those needing support in their own right. For too long, carers have held together failing aged care and disability systems, at great physical, emotional, social and financial cost Carers Australia calls on the Australian Government to recognise the needs of carers as well as the needs of those they care for in the implementation of these much needed reforms.

‘In aged care and disability reform there is need for significant consultation over policy detail and implementation,’ said Mr Moore. ‘Carers Australia is particularly interested in ensuring that carers and their families are fully involved in these processes.’

Carers Australia believes that these intiatitives have the potential to shift the social landscape. The intiatives full implemenation depends on continuing government commitment and budget priority.

***

Pharmacists welcome an e Health future: Pharmaceutical Society of Australia (PSA)

The commitment of funding in the Budget to continue the rollout of a national eHealth system has been welcomed by the Pharmaceutical Society of Australia.

Acting President of the PSA, Claire O’Reilly, said the $233.7 million investment for eHealth would deliver practical benefits to all Australians which in turn would result in much improved health outcomes.

“eHealth has been one of the missing links in enabling collaborative primary health-care teams to work effectively together to improve the wellbeing of all Australians,” Dr O’Reilly said.

“This funding will help to ensure delivery of a system that will give pharmacists access to essential patient health information to allow better outcomes to be delivered by the pharmacy profession.

“PSA has been a very strong supporter of the development and implementation of national eHealth initiatives and has been closely involved in providing constructive input to National eHealth Transition Authority (NEHTA) via its representatives on key committees and through submissions and consultations.

“PSA is presently working with NEHTA and its Change and Adoption Partner McKinsey & Co, providing the perspectives of pharmacists to assist in the implementation of a key eHealth initiative, the Personally Controlled Electronic Health Record. PSA is specifically helping to build awareness of adoption of PCEHRs.”

The Government announced in the Budget that the spending would include $161.6 million to operate personally controlled electronic health records, including registration and customer support, adoption and support as well as monitoring and evaluation.

A further $4.6 million will be used to maintain safeguards for privacy-related aspects of PCEHRs, to ensure Australians are confident that the privacy of their personal health information is fully protected.

$67.4 million will be the Commonwealth’s share of joint funding for the NEHTA work program.

Dr O’Reilly said the focus on security of the system would facilitate implementation of eHealth.

“Australians can be confident their records are secure and the information will be used to improve their health and wellbeing,” she said.

***

SARRAH supports the Budget but more needs to be done in the bush: Services for Australian Rural and Remote Allied Health (SARRAH)

Despite the current fiscal challenges, tonight’s Federal Budget has seen growth in forward expenditure on health in the areas of aged care and oral health services.

Rod Wellington, Chief Executive Officer of Services for Australian Rural and Remote Allied Health (SARRAH) said that people living in rural and remote Australia will welcome the Federal Government’s plan for aged care through a five year $3.7 billion package, with its emphasis on greater choice and equity.

“However in rural and remote areas, the challenge remains how the plan will be delivered close to where people live. The aged care plan is a move in the right direction, assuming that sufficient resources are devoted to the plan in coming years and that emphasis is placed on the groups in greatest need”, Mr Wellington said.

“The Government’s announcement of a $515.3 million Budget dental health package targeting those most in need of dental care is a significant investment. This will greatly help improve both dental health and quality of life for some of the most marginalised people in the community as well as improving productivity and reducing hospital admissions.

“Improving dental health services in the bush is also a welcome focus of this package with funding for relocation grants and dental health infrastructure in rural and regional areas. These measures will help address the gap between the dental health status of Australians who live in the bush and those in urban areas.

“The Stronger Futures in the Northern Territory package in particular, $713.5 million over 10 years for better primary health care and better access to allied health services for Aboriginal people in regional and remote areas is well targetted.

“The announcement that the phasing in of Australia’s long-awaited National Disability Insurance Scheme will begin in 2013 is also a major initiative. This is a significant step in improving the long neglected disability sector but of course expanding the workforce is essential if disability reform is to be effective and sustainable.

“In general, whilst SARRAH supports the current range of programs for Allied Health Professionals and students wishing to practise in rural and remote Australian communities, we are concerned over the lack of equity, when these strategies are compared against the range and volume of programs available to doctors and nurses in the bush”, Mr Wellington said.

 ***

Budget Inaction: the Foundation for Alcohol Research and Education’s Michael Thorne

(Cross-posted from Drink Tank)

With the Federal Budget put to bed for another year, exhausted Treasury officials, and political staffers headed to their local watering holes and favourite eateries to unwind and relax. After long days and nights under intense pressure to help Wayne wring a surplus from the budget, it’s a night to kick back and let off steam.

For a few golden hours, the only number they need to pay any attention to is the number of drinks they are putting away. No doubt a few lost count and woke up in the morning a little worse for wear, sleep deprived, and nursing a hangover.

The good news is; their hangover would be gone before the day is out. The bad news; Wayne Swan failed to introduce one single meaningful alcohol reform measure in the 2012-13 Budget.  As a result, the nation’s collective hangover is set to continue into 2013 and beyond.

And that’s a problem, because unlike the hungover public servant from Treasury, our nation’s problems with alcohol cannot be solved simply with a Barocca and a burger.

Alcohol use and misuse is the cause of substantial harms to the Australian community. You might have heard these sobering stats before. But I’d ask you not to tune out. Don’t just skim over the next few lines.  Because this is not someone else’s issue. Unfortunately, this is an issue that impacts dramatically upon all of us.  60 Australians die and a further 1500 are hospitalised every single week. Alcohol misuse contributes significantly to crime and violence, and chronic diseases. In fact the total cost of alcohol use and misuse is put at $36 billion each and every year – $20 billion of which can be attributed to alcohol’s harms to others.

The good news is that it’s not a problem without a solution. There are measures government can take; evidence-based approaches that are proven to be effective.  And with the cost of alcohol misuse so high, there is even a financial incentive for governments to introduce such policies.

This makes Wayne Swan’s scant budget announcements concerning alcohol so disappointing because they amount to little more than tinkering around the edges, and are not even motivated by the need to improve public health.

Let’s take a look at what was announced.  Unfortunately this won’t take long.

Leading health groups have lobbied long and hard for government to replace the current wine equalisation tax (WET) which taxes wine according to its value, with a volumetric alcohol tax, a system that taxes products based on the volume of alcohol. Such a move would have boosted Wayne Swan’s surplus by $1.5bn and done much to remove cheap wine from bottle shop shelves.

Eight separate government reviews have recommended overhauling the WET.

Instead, the Government announced a Band-Aid solution aimed at improving the integrity of the wine producer rebate by ensuring that wine producers cannot claim multiple rebates where wine is blended or further manufactured.

While the move will begin to address the widely acknowledged rorting of the WET, it doesn’t go nearly far enough.  With the WET still in place, we are still left with a system that results in cheap wine selling for less than bottled water.

That’s not just absurd; it’s a real concern. Why? It’s a problem because children and young people are drinking earlier and at dangerous levels and we know that they are influenced by price.

If further proof was needed that this Government measure really is just a temporary solution that fails to deal with the problem, the announcement was enthusiastically endorsed by the Wine Federation of Australia.

And that’s it for alcohol policy measures…oh sure, the Government also announced some tax concessions for micro brewers, news which was welcomed by the Australian Real Craft Breweries Association and the Greens; because it promotes job creation and that’s always a good thing. It’s just a shame that some of that extra work will be created in our hospital emergency departments.

But when it came to announcements of meaningful alcohol reform measures, this Federal Government came up empty handed.

No tax reform, no funding increases for preventative health measures, no public education campaign to promote the national drinking guidelines, and no funding for the completion and piloting of the Fetal Alcohol Spectrum Disorder diagnostic tool.

In short, nothing. The Government has missed another opportunity to contribute to the prevention of one of the leading causes of preventable deaths in Australia.

We know that Australians are keen for change and that they believe that more needs to be done to address alcohol-related harms.

FARE’s Annual Alcohol Poll again showed that over 76% of Australians believe Australia has a problem with excess drinking and alcohol abuse, and 75% of Australians say they want something done about it.

Unfortunately, those calls fell on deaf ears this time around.

 

 

 

 

 

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