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.
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.
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.
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.
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.
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.
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 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.
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
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.
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.
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.
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.