Following on from Part 1 of the Budget analysis, this part addresses the impact of the Budget measures on hospitals, dental, public health, rural health, mental health, regulatory issues and private health insurance.
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Jennifer Doggett writes:
Hospitals
Public hospitals were one of the brighter spots of the Health Budget with stakeholders welcoming the announcement of an additional $2.9 billion over three years in public hospital funding. Although AHHA CEO Alison Verhoeven noted that “this returns less than half of the expected funding that was initially removed by the Government in the 2014 Budget.’
Ms Verhoeven added that the AHHA strongly supports the ongoing commitment to activity-based funding, particularly given the National Health Performance Authority’s recent report has shown such funding improves hospital efficiency.
Catholic Health Australia also supported the additional funding and the move towards activity-based funding agreeing that this would drive greater efficiencies in the public hospital sector.
Dental
The Government’s new dental program had been announced prior to the Budget and, as Croakey has previously reported, it was widely criticised by stakeholders. This trend continued on Budget night with a number of groups criticising the initiative as not being accessible to many in the community.
Catholic Health Australia said the program was “a backward step for those millions of Australians who can’t afford to see the dentist.”
CHA spokesperson Toby Hall added that “The Government’s announcement last month of plans to shift dental services back to state governments, and save an estimated $1 billion in forecast spending, is a retrograde step given the many Australian children and adults for whom dental care is unaffordable.”
Public health
Public health was not a major focus on the Budget and the Government was strongly criticised by peak public health body the Public Health Association of Australia for ignoring prevention.
Public Health Association of Australia (PHAA) Vice President David Templeman said that the Budget “ shows a fundamental misunderstanding of the importance of prevention for the economy and the health of the Australian population.” He argued that “After tonight’s budget release, it is clear the Government is not prioritising prevention and has missed a significant opportunity to invest in the health and wellbeing of Australians.”
Key public health measures not included in the Budget were a tax on sugar which had been hotly debated in the media. PHAA supports this proposal with Mr Templemann saying “A sugar tax on soft drinks would not only improve the health of Australians but it would inject money back into the economy. The funds can be reinvested back into prevention initiatives and research.”
However, the few relatively modest public health spending announcements did receive support from the PHAA and other stakeholders. These included a National Cancer Screening Register, a program to reduce Fetal Alcohol Spectrum Disorder and funding to reduce the impact of anti-biotic resistance in Australia.
Most stakeholders also supported the plan to increase tobacco tax, on the basis that it would reduce smoking rates in the community.
Rural health
Rural health was not a focus of the Budget and the Government was criticised by rural health groups, such as the National Rural Health Alliance, for failing to address the under-expenditure on rural health, which is in the order of $2 billion per year.
While the sector acknowledged that some of the smaller initiatives that will assist rural and remote patients, and Aboriginal and Torres Strait Islander patients, the Budget overall was criticised for not providing a comprehensive plan to reduce the discrepancy in health outcomes, and access to healthcare, between rural and remote Australians and their urban counterparts.
The National Rural Health Alliance urged the Government to also include rural and remote areas in its national agenda, saying that the Smart Cities approach could be used to invest in the health and wellbeing of the almost 7 million people who live in rural and remote Australia.
The Rural Doctors Association of Australia warned that the MBS freeze will continue to bite hard on many rural and remote practices that are already struggling financially, and will further increase the barriers for rural and remote Australians in accessing local primary care. “The continuation of the Medicare freeze is going to send more rural and remote patients to the healthcare equivalent of deepest, darkest Siberia” RDAA President, Dr Ewen McPhee, said.
However, both the RDAA and ACRRM were pleased to see that GP registrars training through the Australian College of Rural and Remote Medicine’s (ACRRM) Independent Pathway will be given the same access to GP-related Medicare benefits for the services they provide while training.
Mental health
Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre, University of Sydney, has prepared the following analysis of the mental health content in the Budget.
Even by recent standards, tonight’s budget was a non-event for mental health. It was almost entirely devoid of any new initiatives, barring some welcome funding for veteran’s facing mental illness. This spending is overdue, with the future pipeline of people needing help waxing not waning.
The government has also flagged a hunt for malingerers, targeting 90,000 Disability Support Pension recipients for review over the coming three years. This will undoubtedly affect many with a mental illness. New funding for youth internships as an employment pathway is most welcome though the extent to which these will engage with young people affected by mental illness is not clear. Similarly, new funding for ‘medical homes’ seems to suggest holistic care but their application to mental health is unclear.
It was put to me recently that elections were excellent opportunities for issues like mental health to receive some public attention they may struggle to elicit under normal circumstances. Let’s hope this is the case because tonight’s budget left the colossal challenge facing Australia in relation to mental health largely untouched.
The one curious element for me was the repeated reference to hospital avoidance – in the Treasurer’s speech, in the Health portfolio statements. We know that just under half of all the beds in the acute psychiatric wards of public general hospitals are occupied by people who would be better off in other settings, if suitable services were available.
I cannot find any engine or policy initiative which looks to address this massive embedded waste in Australia’s health system. There is little merit in a new digital gateway that can more effectively direct people to non-existent services. The NDIS may manage some aspects of psycho-social support for the lucky few who may qualify for a package of mental health support, but it will not deal with their health issues. Primary health networks will hopefully start to better organise primary care, including managing the physical health of people with a mental illness and addressing suicidality.
But where is ‘secondary care’? Who is building the blended models of clinical and non-clinical mental health care necessary to obviate the requirement for hospital admission? Who is investing in supported accommodation and employment?
Who is fostering development of new online mental health services so as to reallocate demand to the most cost effective and appropriate modality for the need? Who is taking responsibility for planning and delivering a 21st century mental health workforce? Reading this Budget – nobody.
This failure is all the more poignant given we already know a great deal about how to address all these things.
Private Health Insurance
There were two main measures targeting private health insurance. One was to pause indexation of the Medicare Level Surcharge and Private Health Insurance Rebate thresholds. A Departmental spokesperson said that on their modelling only about 27% of members should be affected by these measures and there was no way to know what the impact will be on membership numbers.
Another PHI measure was the establishment of a new private health peak committee called Private Healthcare Australia. The Departmental officer informed Croakey the group would focus on both PHI and non-PHI funded services in the private health sector and would include consumer representation.
Regulatory issues
There were some largely sensible and unexpected changes to the regulation of therapeutic goods, most of which arose from recent reviews and inquiries. From the recent Review of the Prostheses List, the Government has accepted recommendations to broaden the membership of the Prostheses List Advisory Committee to include other relevant expertise, such as experts in health economics and epidemiology.
From the Review of Medical Device Regulation came the ongoing commitment to streamline the regulatory process through measures such as greater recognition of overseas approvals processes.
