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Health sector wish-lists: a pre-Budget round-up

With less than a week to go before the Federal Budget 2013, the leaks and rumours (and rumours about leaks) are increasing and speculation about possible new funding measures is mounting. The following analysis looks at the main items on the wish-lists of eight peak health groups and identifies key issues on which there is broad health sector agreement.

An increased focus on prevention and the social determinants of health, more action on Indigenous health and a stronger primary care sector are the main areas of agreement in the Budget wish-lists of key health groups.

Croakey analysed a number of pre-Budget submissions from peak health and social welfare bodies and prepared the following summary of the key proposals from the following groups:  Australian Health Care Reform Alliance (AHCRA); Australian Council of Social Services (ACOSS); Australian Healthcare and Hospitals Association (AHHA); Australian Medicare Locals Alliance (AMLA); Australian Medical Association (AMA); Catholic Health Australia (CHA); Consumers Health Forum of Australia (CHF); and the Public Health Association of Australia (PHAA).  The National Rural Health Alliance was also contacted but did not submit a Budget Submission for this year. It will, however, be providing a response to the Budget once it is brought down next Tuesday.  Links to each organisation’s specific submission/policy document are provided below.

Prevention

A number of groups seek increased funding for prevention. The PHAA wants the level of funding for prevention to rise from 2.2% to 4% of health expenditure.  It is also seeking an investment into building the competence and capacity of a national preventative health workforce who understand inequity and the social and economic determinants of health and are skilled to effectively deliver preventive health services at the local level. CHA, AHCRA and the AMA also support a range of measures to increase the focus on preventative health and health promotion.

Social determinants of Health

The need to focus on the social determinants of health was raised by a number of groups, in particular the AHHA, AHCRA and CHA. Among AHHA’s specific proposals are that the Australian Government make a formal statement of  support for the recommendations of the WHO Commission on Social Determinants of Health and in conjunction with the States,  develop an action plan to implement the recommendations of the WHO Commission  on Social Determinants of Health.  AHHA also supports a federal ‘health in all policies’ approach to policy development and legislation and the establishment of an Australian Commission on the Social Determinants of Health to coordinate interagency action and report annually on progress to  address the social determinants and reduce health inequity.

Indigenous Health

There is strong support among the peak health groups for increased action on Indigenous health with a number of submissions making specific suggestions as to how the ‘health gap’ between Indigenous and non—Indigenous Australians could be reduced. The AHHA recommends that National Indigenous Hospital Demonstration and Mentoring Program be funded that focuses on Indigenous heart health.  The PHAA supports retaining and extending funding for the “Close the Gap” measures including additional support for Aboriginal Medical Services and Aboriginal Health Services; and the AMA wants the Federal Government to renew its commitment to a COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes for a further five years from 2013, with the same level of funding allocation as provided in 2008.

Primary Care

The need for a strong primary care sector was the focus of a number of recommendations with groups expressing support for ongoing funding for Medicare Locals. The PHHA suggests maintaining the funding of Medicare Locals, Locals and Women’s Health at a level that will allow comprehensive primary healthcare based on an understanding of the social determinants of health. CHA recommends a number of strategies for strengthening primary and community care and ACOSS seeks an investment in capacity for community health services to engage with key health policies, including the establishment of Medicare Locals and the Partners in Recovery framework, as a key element of building the role of community health services to help reduce inefficiencies in the health budgets from preventable hospital admissions.

Consumer engagement

Unsurprisingly, consumer engagement was a key focus of CHF’s submission which includes a recommendation that the Government recognise the value of consumer and community participation in health and medical research, and reflects this in the allocation of funding. CHF also wants the Government to commit to funding the development and implementation of measures of health outcomes and consumer experience in the Australian health system that will ultimately lead to a more effective and efficient healthcare system.  Action on out-of-pocket costs for health services is another item on CHF’s agenda, along with a commitment that any Government measures that aim to reduce PBS expenditure do not reduce or delay consumer access to essential medicines.  Increased consumer engagement in the health system is also strongly supported by CHA which proposes a number of strategies to facilitate greater consumer empowerment and engagement. 

Health system issues

Broad health system issues were addressed in a number of submissions, including the AHHA’s which proposes a comprehensive research and evaluation of the National  Health Reforms.   The AHHA is also seeking a National Health System Coordination and Integration Program and a National Discharge Planning and Referral Program. The CHA supports the need for improved integration and transition with a number of proposals to take health care ‘from silos to a system’ and also wants to reform health system governance.

Ambulance Services

Both AHHA and CHF support a national program funded by the Commonwealth to provide universal access to ambulance services for all Australians.

Research and evidence

CHF highlighted the need to increase the evidence base for health care in its submission, including proposing that the Government commits to funding at least a proportion of the costs for the establishment and implementation of clinical registers, following the conclusion of consultations to identify the most appropriate model or models.  It also supported a commitment to funding the implementation of the recommendations of the McKeon Review.

Chronic disease

A new approach to chronic disease management was proposed by AMLA involving Medicare Locals implementing a national network of chronic disease care coordinators to help people with chronic disease to access tailored prevention and/or management programs and to establish local health provider networks to ensure better access to the multidisciplinary care required for this. In contrast, CHF focussed on a different approach to chronic disease management suggesting that the Government fund a pilot of personal health budgets for people with chronic and complex conditions, with a view to widespread implementation.

Early childhood

Early childhood development was a key focus of the AMLA submission with a comprehensive proposal for Medicare Locals to work in partnership with relevant agencies to develop early childhood ‘masterplans’ for each ML community. The initiative would draw on the Partners in Recovery (PIR) model to develop and implement pathways that link multi-sectoral services to systematically address early childhood outcomes.  

Oral health

The AHHA submission recognises the funding already allocated to public dental services and recommends that this be built on with additional funding, in order to establish a Universal Oral and Dental Health Scheme for all Australians within five year

Workforce

The AHHA and the AMA both focussed on workforce issues in their submissions. The AHHA is seeking an evidence based graduate nurse program for all nurses in Australia. This would include a national Nurse Graduate Support Teams program to provide for all new graduates to have access to a team dedicated to supporting them as they begin their career. The AHHA also is proposing an innovative program for supporting the employment of refugees and migrants in health services. This would provide benefits to the individual as it facilitates social inclusion and social cohesion and also to health services which would be able to fill skill and labour shortages and develop staff profiles that reflect the cultural diversity of the wider community. In contrast the AMA is requesting increases in GP and specialist training places and funded intern places in private hospitals. It also wants to increase the payment to GPs of teaching medical students.

Non-health measures

ACOSS focussed on a range of non-health measures, including raising the level of payments for Newstart Allowance, Youth Allowance and other Allowance payments for single adults and young people living independently of their parents; doubling the number of wage subsidies available for very long term unemployed people to 20,000 places per year and substantially boosting the resources available to Job Service Australia providers to work intensively with this group from present inadequate levels. It also proposed establishing an Affordable Housing Growth Fund to expand the stock of affordable housing and investing in the capacity of the community sector to deliver services and engage in national industry initiatives. 

Savings measures

Many of the submissions included suggestions for funding the new initiatives proposed. These included the PHAA’s proposals to increase excise duty by ten cents per cigarette and introduce a volumetric tax for wine (an abolition of the current WET rebate). PHAA also suggested a new tax/levy on selected nutritionally undesirable foods.   ACOSS suggested  a removal of both the 30% private health insurance rebate for ancillary cover and the Medical Expenses Tax Offset.

Submissions

The following are links to the submissions from each group – in some cases groups provided a recent policy document to Government in lieu of a forma Budget submission.

Australian Health Care Reform Alliance

Australian Council of Social Services

Australian Healthcare and Hospitals Association

Australian Medicare Locals Alliance

Australian Medical Association

Catholic Health Australia

Consumers Health Forum of Australia

Public Health Association of Australia

  

 

 

Comments 1

  1. Elllsee says:

    NRHA MEDIA RELEASE: 13 May 2013
    Rural health expectations of the Budget

    National purse strings may be tight but people in rural and remote areas are holding out for things they have been promised that they trust they will not lose, and for some modest new spending to improve access and equity for rural people.

    Non-negotiable promises include funding according to need for rural schools as part of the Gonski reforms; funding for DisabilityCare Australia; ongoing funding for enhanced public dental health services for children and people with special need; and a ‘fix’ to the current system used for the classification of rurality.

    In addition, new and better directed expenditure is expected as a result of the Mason Report into health workforce programs. Augmentation and rationalisation of successful health workforce programs is expected along the ‘life course’ of recruitment, education, training and support for health professionals in rural and remote areas.

    For many years governments have invested in training greater numbers of health professionals, and now the emphasis needs to turn to their spatial distribution.

    Despite these initiatives relating to supply, Health Workforce Australia has predicted shortages of 80,000 registered nurses and 30,000 enrolled nurses by 2025. The Mason Report should therefore propose specific new initiatives for the nursing workforce, in particular in rural and remote areas.

    In general, rural health workforce programs must build the integrated health care team, and so encompass health service managers, medicine (GPs and specialists), nursing and midwifery, all allied health (including optometry and exercise science), oral health (including dentists), pharmacy, chiropractic and paramedicine.

    Other important rural expectations of the Budget include high speed broadband, reduced smoking rates, telehealth, and crush protection devices on quad bikes.

    Further details of these expectations are in the Alliance’s media release.

    Attachment: Rural health expectations of the Budget

    DisabilityCare Australia
    Ongoing bipartisan commitment and secure funding are critical to ensure that DisabilityCare Australia unfolds in ways that can deliver fully on the entitlements of people living with disability in rural and remote areas, as well as their carers and clinicians.

    Public dental health services
    The Budget must continue to underwrite joint Federal-State improvements in public dental services, particularly for those in special need. These include people in rural and remote areas, Indigenous Australians, the aged and those who are socio-economically disadvantaged.

    The legislated Grow Up Smiling (GUS) program for eligible young Australians is a good start in moving oral health care into the mainstream and should be seen as the first step towards ensuring regular, appropriate oral health care is available to all Australians on the basis of need.

    Health workforce programs
    The increased numbers of health professionals in training come from a new generation with different values and expectations. So now is a good time to refurbish and re-focus health workforce programs. The Budget should indicate where new and existing investments will be made and how the targeting of rural incentives will be improved.

    The system should begin in local High Schools in order to enable local communities to ‘grow their own’ doctor, allied health professional, nurse, midwife or dentist. Universities should be required to have a minimum of 30 per cent of their intake from rural, regional and remote areas – with better inter-university and inter-agency means of collaboration and information exchange on issues relating to rural placements.

    Additional investments must ensure that all health students have access to rural placements that are well-supported with appropriate educational infrastructure and clinical teachers. Students must also have access to affordable accommodation and appropriate financial support while on placements. Additionally, HECS reimbursement options should be extended to nurses, midwives, allied health professionals and dentists who are willing and able to practise in rural and remote areas.

    It is anticipated that the current restrictions on access to the Mental Health Nurse Incentive Program through MBS will be removed to allow all nurses with the appropriate postgraduate mental health qualifications access to the MBS-funded MHNIP.

    There should be funding for newly-graduated nurses, midwives, nurse practitioners and allied health professionals to undertake transition to practice programs in rural and remote areas. These programs should be inter-professional, thus modelling and preparing for the integrated multi-disciplinary teams that have to be the reality in rural and remote areas.

    Later on down the life course support system, with the goodwill and support of the range of regulatory bodies and organisations engaged, vocational training settings will be expanded to permit a greater proportion of vocational training to be undertaken in rural areas. The home base for vocational training will then more frequently be in regional centres, with rotations in the cities being necessary mainly for more specialised content.

    In all of this activity there should be positive discrimination for Aboriginal and Torres Strait Islander people to help to build up and sustain their numbers in the health professions.

    Maximum value should be obtained from older health professionals who may want to retire from full-time practice but still have much to offer by way of teaching, mentoring and supporting others.

    The Federal Government should more actively promote the elements of its refurbished rural health workforce program from schools through to retirement to make sure there is widespread knowledge of what is available.

    High speed broadband
    The Budget (and the Budget Reply speech from the Leader of the Opposition) should confirm the Government’s commitment to the delivery of high speed broadband to all families, services, businesses and communities in rural and remote areas.

    The broadband infrastructure provided must be robust and adaptable enough to accommodate future information technology developments, and to provide high speed connectivity and the coalescing of various media. The costs to the consumer must not discriminate against people in rural and remote areas but facilitate availability to all who need it, and both the rollout schedule and costs that apply must be widely publicised.

    High broadband speeds are crucial for ensuring that the people who live and work in rural and remote communities are connected to the world as well as the rest of Australia. New and emerging best practice models of health care rely more and more on high speed broadband, and include those which incorporate high definition videoconferences, data exchange and high resolution image transfer,

    People most in need of broadband, including those who are isolated, on low incomes, or with disabilities, should have special assistance to enable their access as soon as possible.

    Smoking reduction and health promotion
    Health promotion activity has not been as effective in rural and remote areas and health risk factors remain worse, on top of there being poorer access to health services.

    Rates of smoking provide an important and well-evidenced example. In 2008-09, whereas 17.6 per cent of people in the Major cities were smokers, the figures were 27 per cent for Outer Regional areas and up to 35 per cent for Remote and Very remote areas.

    Funding must continue for successful work to reduce rates of smoking, particularly among Aboriginal and Torres Strait Islander people. Given the particular challenge of health promotion in rural and remote areas, and the relative extent of health need, health promotion allocations (including to the Australian National Preventive Health Agency) should be increased and appropriate amounts spent in rural areas.

    The Government should also foreshadow new investments in health promotion activities targeted at other key determinants such as obesity, physical activity and alcohol consumption.

    Some of these additional investments should be targeted through Medicare Locals so they can be genuine primary health care agencies with the capacity to improve the social determinants of health in rural areas.

    The Budget should provide support for a coordinated national approach to Indigenous eye health, in which eye health checks are integrated with routine screening such as for hearing and diabetes, as well as for general health and wellbeing. Funding must be available for an increased number of Aboriginal Health Workers and Regional Eye Health Coordinators based in Aboriginal Community Controlled Health Services. The feasibility of a national spectacle scheme for Aboriginal and Torres Strait Islander Australians should be considered.

    Telehealth
    The Budget should maintain the current momentum and map out increased support for the development of telehealth, including for store-and-forward services as well as real-time consultations. To ensure that telehealth serves the front line health professionals and their patients in more remote communities, this support should be provided through new or expanded MBS items and with appropriate training and support for those involved, including doctors, nurses, midwives, allied health professionals and Aboriginal Health Workers.

    There needs to be block funding for telehealth for rural and remote area nurses, midwives and allied health professionals working where there are no GPs. This would allow for the expansion of telehealth consultations between a broader range of health professionals involved in care and help reduce the need for busy GPs to be the gatekeepers for access.

    Legitimate and potentially valuable telehealth transactions can involve a range of pairings, such as allied health to nurse; allied health to allied health; or nurse to nurse, as well as the pairings that are currently more familiar, such as GP to specialist. And the applications of telehealth are numerous: health monitoring, video consults, interim reviews between consultations, aged care services and professional supervision sessions.

    Quad bikes
    Consideration should be given to legislation relating to the manufacture and sale of quad bikes, to require both the mandated inclusion of crush protection devices, and the education of those who sell and purchase such machines.

    NRHA
    12 May 2013

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