The Coalition has delivered its eighth and biggest spending Federal Budget since its election in 2013. But will the record $503 billion (over four years) health spending deliver record benefits for consumers?
Croakey editor Jennifer Doggett investigates.
Jennifer Doggett writes:
The Budget’s focus on aged care, mental health and COVID-19 recovery will be welcomed by the electorate but implementation challenges, workforce shortages and a failure to address structural problems in the health system and address the social determinants of health will make it difficult for many of the measures announced tonight to achieve their goals.
This Budget is clearly designed to take the Coalition to the next federal election, due later this year or early 2022. It carefully dodges contentious reform issues and avoids making any major policy and funding changes which might upset vested interest groups.
With so many measures across the portfolio, it can be hard to identify what is missing. However, despite the record levels of spending, some of Australia’s most pressing health challenges barely rated mention.
There was little on climate change, social determinants and only modest new funding for Aboriginal and Torres Strait Islander health. As outlined earlier today, the women’s health package failed to address some of the most significant barriers to accessing health care for many Australian women.
On a purely political level, the Coalition’s big spending budget will make it difficult for Labor to gain traction for its Budget-in-reply on Thursday.
After being burnt last election, the Opposition will want to avoid an ambitious policy agenda. But it also needs to differentiate itself from the Government, which can be hard without outspending the Coalition on health and social policy.
The focus on aged care, mental health and COVID-19 recovery was no surprise but the lack of detail provided in the Budget papers raised a number of questions about implementation of measures in these areas.
The $17.7 billion (over five years) aged care package is the biggest ticket item in the health budget, although still less than the $9 billion per year in additional spending that economists have estimated is required to fully implement the recommendations of the Royal Commission into Aged Care Quality and Safety.
This substantial package targets a range of areas, including funding for 80,000 extra home care packages to reduce the current waiting list of 100,000.
Other measures include $630.2 million to improve access to quality aged care services for consumers in regional, rural and remote areas including those with Indigenous backgrounds and special needs groups.
Minister for Health, Greg Hunt, described the package as “once in a generation, transformative change” but provided little detail of any major structural reforms, apart from some governance changes, including $21.1 million over four years from 1 July 2021 to establish the National Aged Care Advisory Council and a Council of Elders to provide advice to Government on quality and safety in the aged care sector.
Workforce is a key feature of the package, including $91.8 million over two years from 2021-22 to support the training of 13,000 new home care workers and incentives for registered nurses to work in aged care.
There is also $798.3 million to provide greater access to respite care services and payments to support carers.
There was little detail provided in the Budget papers about increased accountability within the aged care sector to ensure the increased funding was spent efficiently and delivered tangible outcomes to consumers.
See here for reactions to the Budget aged care package.
Aboriginal and Torres Strait Islander health
The Coalition has significant ground to make up on Aboriginal and Torres Strait Islander health, as the sector is still recovering from the 2014-15 Federal Budget when $534 million was cut from Indigenous programs run by the Department of the Prime Minister and Cabinet, and the Department of Health.
The $781 million package for Aboriginal and Torres Strait Islander health falls far short of what is required to close the gap in health outcomes, particularly when the burden of disease for Aboriginal and Torres Strait Islander people is 2.3 times higher than for other Australians.
Some positives in the package include a focus on Aboriginal and Torres Strait Islander people in a number of the initiatives, including aged care and mental health. The $9.6 million for the ACCHOs to access telehealth is also a welcome move.
The $31.1 million (over four years) for Agreements on improving trachoma control services and rheumatic fever strategy targets important areas of need but is not new money and has already been allocated.
There was nothing in the health budget to address some of the main drivers of poorer health outcomes for Aboriginal and Torres Strait Islanders, including systemic racism within the health, social care and justice system.
See here for stakeholder reactions to Aboriginal and Torres Strait Islander health Budget measures.
The $2.3 billion mental health package focuses on suicide prevention ($298 million) and services for vulnerable Australians ($107 million). There is also $500 million for Primary Health Networks to commission services.
These priorities reflect the recommendations of the Productivity Commission’s Inquiry into mental health, although they do not address the Commission’s call for major reforms within the mental health sector.
Some positives of the package include the focus on digital mental health services and targeting of services for those in rural areas and people on low incomes.
However, negatives include the failure to address the structural problems with the Medicare-based Better Access program and a reliance on existing services, such as Headspace, which exclude many consumers with mental health concerns.
Health Minister Greg Hunt stated that the package was the “start of a revolution in mental health” but there was no mention of any major reforms which would integrate the Budget measures into a coherent mental health system.
Major problems with the current mental health sector, such as the “missing middle” and the high number of hospital emergency department presentations are unlikely to be addressed by this package.
There was also nothing to support the involvement of other sectors essential to mental health, including housing, education, policing and justice.
See here for expert and stakeholder reactions to the mental health Budget package.
The women’s health package was announced at the weekend and includes $353.9 million over four years to support women’s health, including funding for cervical and breast cancer, endometriosis and reproductive health.
While many of the measures address important health concerns, as outlined in Croakey the package fails to address some of the most significant barriers to accessing health care, including out-of-pocket costs and access to specialist outpatient services.
The COVID-19 package was one of the Budget’s centrepieces with funding for COVID-related health services, including testing and tracing, respiratory clinics and telehealth.
The vaccine rollout is a major focus of the package with an additional $1.9 billion (over five years) for the program including $777.8 million (over two years) for surge workforce, general practitioners and community pharmacies to administer vaccines and $510.8 million (over two years) for the National Partnership on the COVID-19 Response for the states and territories to administer vaccines.
An undisclosed sum has been allocated for advance purchase agreements for an additional 30 million doses of the Pfizer BioNTech vaccine.
Communications associated with the vaccine program will also be bolstered by an additional $6.7 million (over two years).
Other funding under this package is directed towards a continuation of the temporary Medicare Benefits Schedule (MBS) pathology items for the testing and detection of COVID-19 and the (already announced) extension of temporary telehealth MBS services from 1 April 2021 to 31 December 2021.
Along with these measures there is $11.2 million to continue the remote response to COVID-19 to support regional and remote Indigenous communities throughout Australia and $7.1million to extend the Beyond Blue COVID-19 Mental Wellbeing Support Service.
The preventive health package was disappointingly narrow with a strong focus on cancer screening and the women’s health initiative already announced as part of the women’s heath package.
There was just under $2 million for a “platform” to support the National Preventive Health Strategy – no details were provided on what this platform entails.
Additional funding was also allocated to expand existing BreastScreen services to women aged 70-74 and explore the feasibility of implementing a national lung cancer screening program.
A $74.1 million package was targeted to drug and alcohol misuse but the bulk of this was the continuation of existing spending measures, including funding for drug and alcohol treatment services and for sporting clubs to develop and implement alcohol, illicit drugs, mental health and healthy eating policies.
Rural and remote health
The main rural health spending measures is the $65.8 million package to increase the value of the Rural Bulk Billing Incentive (RBBI), which had already been announced prior to the Budget.
Tonight the government added an additional $9.6 million to expand the Allied Health Rural Generalist Pathway and $3.8 million to continue development of the Bonded Return of Service System to support implementation of the Bonded Medical Program.
There are also rural health components in the major health funding measures, including aged care and mental health.
As noted above, a major challenge for the implementation of these measures will be workforce shortages, particularly in the current environment when attracting health professionals from overseas is not an option.
Also a negative for rural communities is the failure to address climate change and social determinants of health (see below).
Major gaps and omissions
Despite the record levels of spending there were some major gaps and omissions in the Budget health package, including no action to reduce the health impacts of climate change.
Yet again the government has ignored calls from the health sector for a national strategy on climate, health and well-being.
The social determinants of health were only minimally addressed in some of the measures targeting disadvantaged and marginalised groups. There was no coherent attempt to address the broader structural barriers to health, such as poverty, racism, housing insecurity and unemployment.
Given the clear public health benefits of accurate reporting on COVID-19 issues, it was disappointing that there was no mention of public interest journalism initiatives as a determinant of health.
There was also nothing new for oral health apart from the (already allocated) funding for a one year continuation of the National Partnership Agreement on Public Dental Services for Adults and ongoing funding for children under the age of two to access the Child Dental Benefit Schedule.
Join the discussion
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Join our #CroakeyLIVE discussing the health impacts of the Budget on Friday, May 14 from 1.30pm-2.30pm AEST.
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