This post continues Croakey’s coverage of the 2017-18 Federal Budget, with links to detailed information and analysis on measures from services, sectors, academics, media and others on health related measures.
It comes amid uncertainty over one critical measure – secured funding for the NDIS through a rise in the Medicare levy to 2.5 per cent, with Opposition Bill Shorten saying Labor will limit its support for an increase in the levy to those in the top two tax brackets, despite the urging of leading disability groups to “not compromise the bipartisanship” on full NDIS funding.
As was also revealed in immediate responses to the Budget last week, there is strong support for the NDIS commitment, the lifting (albeit in slow stages) of the Medicare rebate freeze, and for Gonski 2.0, needs-based school funding.
But there are deep concerns that the Budget seeks more to partially restore what the Coalition has already cut in a bid to head off another “MediScare” election, worries about a failure to invest in rural and regional health and Indigenous health, and climate change, and dire warnings about further cuts to foreign aid and more punitive measures for welfare recipients.
Thanks to the National Rural Health Alliance for the link to the Budget lock up presentation by Health Minister Greg Hunt detailing his first, second and third waves of reform, which make it clear why there is disappointment on Indigenous health funding, particularly given the poor Close the Gap report card earlier this year, and on prevention.
This is also a useful quick guide to the Budget from the Parliamentary Library.
Dealing with ‘Mediscare’
In a statement, the Doctors Reform Society says almost all of the health measures in the Budget are “partial restorations of funding which has previously been slashed” and that it is “designed simply to move health off the political agenda as much as possible”.
The DRS welcomes extra funding for mental health and for research in primary health, but says the “paltry” three per cent increase in hospital funding is less than inflation, the Medicare rebate freeze will remain in part for three years, and that it lacks proper investment for preventive health, Primary Health Care networks, dental care or community based programs axed by the 2014 cut to flexible funding.
Writing for Eureka Street, Croakey editor, freelance journalist and medical student Amy Coopes reports that the Budget has been touted as a signal moment for health and a principled exercise in fairness, but that it promises much while delivering little.
Most telling, she says, are the conspicuous absences in the government’s calculus, with climate change, Indigenous health, prevention (particularly obesity, tobacco and alcohol) and aid for our vulnerable regional partners all failing to register.
This Macquarie Uni overview quotes ancient Chinese military strategist Sun Tzu as saying ‘the supreme art of war is to subdue the enemy without fighting’. Author Dr Henry Cutler from Macquarie’s Centre for the Health Economy says: “The 2017-18 Budget has firmed up the coalition party flank against future health care attacks by the Labor government, after the Medi-Scare campaign nearly lost it an election.
The Parliamentary Library has published this helpful guide to Medicare related measures, as part of its annual Budget review. It provides details on the phased lifting of the indexation freeze on Medicare rebates and says the allocation of $44.5 million over four years for the ongoing operation of the Medical Services Advisory Committee (MSAC) appears to address stakeholder (particularly Australian Medical Association) concerns over the faster process of removing items from the MBS.
The Library’s Budget review of Pharmaceutical Benefits Scheme says it delivers a number of positives for patients, including the scrapping of the long-term “zombie” proposal to increase co-payments and safety net thresholds and the expansion of existing programs such as medicine reviews in the patient’s home and dose administration aids to help patients manage multiple medicines.
It also details $1.8 billion in savings to be achieved over five years under a new five-year agreement with Medicines Australia (MA) and two-year extension to the agreement with the Generic and Biosimilar Medicines Association (GBMA). Both include measures to encourage (but not mandate) prescribing of lower-cost generic and biosimilar medicines, including changes to doctor’s prescribing software.
You can also read the Library’s review of family payments, including details on the extension of the No Jab, No Pay measure from the 2015–16 Budget to reduce the fortnightly payment rates of Family Tax Benefits A recipients whose children do not meet immunisation requirements.
The National Aboriginal Community Controlled Health Organisation (NACCHO) says the 2017 Budget “is a missed opportunity to put Aboriginal led solutions at the centre of efforts to close the gap in Indigenous health”. Chair Matthew Cooke welcomed the lifting of the Medicare rebate freeze, restoration of bulk billing incentives for diagnostic imaging and pathology services, increased funding for the Indigenous Australians’ Health Program, expansion of support for community pharmacies and the decision to fully fund the NDIS via an increase in the Medicare Levy.
However Cooke said too much funding aimed at improving Aboriginal health is still administered by mainstream health providers and there is great concern with “silence on a number of key issues relating to Aboriginal health”, failure to fully fund the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, and lack of commitment to a national strategy to address the social determinants of health, such as early childhood education for the under 5s, appropriate housing and meaningful employment. .
He said it is disappointing the Government has not acted on the Prime Minister’s pledge to begin a new partnership with Aboriginal and Torres Straight Islander people by supporting indigenous led solutions outlined by Aboriginal peaks in the Redfern Statement.
The National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) says the Budget held “few echoes of the urgency” felt from Prime Minister Malcolm Turnbull in February when he revealed the failure to be on track for most targets in the latest Close the Gap report.
NATSIHWA says it was heartened by the Budget media statement from Indigenous Health Minister Ken Wyatt and welcomed funding for the Indigenous Australians’ Health Program, to reduce and prevent rheumatic heart fever, and the strong representation of Aboriginal Community Controlled Health Organisations (ACCHOs) in rolling out Health Care Homes. But it said what is needed is a serious and system-wide focus on prevention and to increase the number of Aboriginal and Torres Strait Islander health professionals.
SBS reported from the post-Budget media conference by Aboriginal and Torres Strait Islander organisations, including the National Congress of Australia’s First People which said Indigenous people are largely “invisible” in the Budget.
The National Aboriginal and Torres Strait Islander Legal Services (NATSILS) welcomed the reversal of $16.7 million in cuts to community legal centres but called again for a Close the Gap justice target and said continuing unmet need for civil and family law services is “a major catalyst for involvement with child protection systems and experiences of violence that result in increased contact with the criminal justice system.”
The Victorian Aboriginal Community Controlled Health Organisations (VACCHO) welcomed the unfreezing of Medicare rebates which had put pressure on ACCHOs (although said it was still too slow a process) and investment in mental health and the NDIS, given high rates of disability and intergenerational trauma experienced in Indigenous communities.
But it also said the lack of targeted investment in Aboriginal health is disappointing. particularly no new funding allocated to the implementation of the National Aboriginal and Torres Strait Islander Health Plan and limited reference to Indigenous Health in relation to Strengthening Preventive Care.
See also this full list of Budget information with relevance to Aboriginal and Torres Strait Islander health compiled by the Australian Indigenous HealthInfoNet.
Rural and remote health
In its statement, the National Rural Health Alliance says rural health, including Aboriginal and Torres Strait Islander health, “gets almost no attention in the Budget”, which it describes as a “glaring omission”.
It says some measures will benefit people living in rural and remote Australia and their service providers, including the staged removal of the Medicare freeze and significant investment in regional infrastructure. It also details welcome moves in mental health funding.
The Alliance also points out one of the less publicised initiatives in the Budget, the announcement of the first disbursements of $65.9 million from the Medical Research Future Fund (MRFF), which will be provided for eight strategic programs, with a particular focus on regional Australia, including $20 million for preventive health and research translation projects.
But it says a long-term commitment is still needed for a national rural and remote health plan.
Social determinants of health
Australia21 Chair, Paul Barratt, says in this review that the Budget does little, if anything, to tackle the serious social and economic problem of inequality.
He welcomes the government’s belated embrace of needs-based funding, but says raising uni student costs and demanding earlier repayment do not help and that imposing the extra Medicare levy while relieving high income earners of the budget repair levy makes inequality a little worse. He finds it also “remarkable” that there is nothing about climate change.
See also Australia21 director Dr Alex Wodak’s view of the Budget decision to introduce random drug testing of welfare recipients, which he says is “set to be another sorry chapter in Australia’s failed and futile attempt to solve our drug problems by relying on punishment. ”
Jesuit Social Services also welcome the securing of funding for the NDIS, the ‘Gonski 2.0’ commitment to needs-based school funding, the commitment of $55.7 million over five years to boost Indigenous employment and $17.6 million for employment assistance for Indigenous people exiting prison.
But CEO Julie Edwards says the Budget “again seeks to vilify welfare recipients”, through the demerit point system where welfare recipients can have payments cut for missing appointments or other breaches, and also ‘random’ drug testing for new welfare recipients.
This analysis at The Conversation by Australian National University Public Policy Professor Peter Whiteford says it is worrying that the budget papers do not identify the costs of the drug testing proposal nor the expected savings, concluding that the proposal is symbolic, rather than designed to have a positive impact.
Whiteford outlines other punitive welfare measures, and questions their need when, he says, there is little current evidence of an unsustainable growth in spending on social security and welfare.
Good Shepherd’s Kathy Landvogt said highly discriminatory proposals such as where people will no longer be able to qualify for the Disability Support Pension on the basis of their substance abuse alone (estimated by Whiteford to affect fewer than 450 people each year, saving about A$22 million over five years) ignore the connection between mental illness and drug addiction, and threaten to breach basic human rights and that drug testing welfare recipients “comes dangerously close to criminalising poverty.”
In this post at Power to Persuade, Landvogt also says the extension of the cashless welfare card into new locations ignores evidence from trial evaluations that nearly half of the cardholders felt it made life worse for them, while the threat to put those who fail drug tests on the card demonstrates it is “a means of exercising punitive control “.
The Parliamentary Library provides more information on Budget measures on job seeker compliance and workforce participation in this review, including tightening of activity requirements for job seekers aged 30 to 49 and 55 to 59.
The Australian Council for International Development (ACFID), the peak body for Australia’s aid groups, has published a detailed analysis, saying Australia’s aid contribution as a share of gross national income in 2017-18 will be 0.22 per cent, “once again plunging aid to new all-time low levels of generosity” and failing to match-up to the reality of global challenges, like climate change, food crises and the insecurity faced by displaced people.
ACFID has welcomed an increase in total humanitarian funding by $60m (AUD) over the next year, as well as the prioritisation of child protection in humanitarian programs. Health has also received an increase, up $22.4 million to $495.7, with a commitment to $9.5m over three years for sexual and reproductive health programs in crises also welcomed.
Disappointingly, ACFID says, there is no additional funding for climate change action.
The George Institute welcomes a range of measures: Health Care Homes, cheaper medicines, NDIS funding, removing the Medicare freeze, tackling obesity through the Healthy Heart initiative and ensuring the highest standard of care through the Medicare Benefits Schedule Review.
But it warns that the freeze on aid spending will have a “dire impact on global health and national security”.
“Our neighbouring nations, particularly in the Pacific, bear some of the highest burdens of chronic disease in the world. Investments in programs in the region have significant humanitarian and strategic value for Australia,” it says.
The ABC reported that veterans exposed to nuclear bomb tests welcomed the Budget decision to grant Gold Card access. Gold Cards have also finally been promised to Indigenous people present at or near Maralinga, Emu Fields or the Monte Bello Islands at the time of the British nuclear tests in the 1950s or 1960s.
Eye health and vision care
In a comprehensive snapshot, Vision 2020 says the eye health and vision care sector should be encouraged by the Budget, although it says there are concerns about significant cuts again handed down to the international development sector and a lack of targeted focus on Closing the Gap for Aboriginal and Torres Strait Islander people.