Clearly the Mid-Year Economic and Fiscal Outlook (MYEFO) is not primarily focused on trying to improve the nation’s health or healthcare. If it was, it would look quite different to the document released today (you can find the 305-pages here).
Instead, for the health, aged and welfare sectors, most of the focus is on yet more cuts – to the tune of $3.7 billion according to the ABC’s calculations (though of course these are described in the MYEFO papers as “savings”).
The Government has also maintained its track record of cutting funding to Indigenous programs, with a continuation of the existing indexation pause on the Indigenous Advancement Strategy for one year to “provide” $17.8 million in 2018-19. (“Provide” in this instance being something of a weasel word.)
Meanwhile, areas such as counter-terror and border protection have gained additional funding.
In the wake of the COP21 agreement, it is nothing short of remarkable (in polite speak) that the Government can find $2.5 million over four years to establish a National Wind Farm Commissioner and the Independent Scientific Committee on Wind Turbines (with some of these dollars coming from the existing resources of the Clean Energy Regulator).
Was Paris just a dream? On what planet does it make sense to subsidise fossil fuels – the cause of so many health problems – while cutting health and social spending?
As the reaction towards the end of this post illustrates, the Turnbull Government is following in the footsteps of the Abbott Government in uniting the health sector’s often competing stakeholders in a chorus of complaint. The AMA, the Doctors Reform Society and the Consumers Health Forum are not impressed.
While there is no doubt considerable room to reduce unnecessary testing and treatments, blunt measures like those in the MYEFO are just as likely to mean that people will miss out on tests and treatments that might have helped – perhaps even have kept them “agile and innovative” in the workforce or the community.
Below is a summary of key announcements and some reaction.
- A program to improve cancer patients’ access to treatment will stop, with $26.6 million in savings over four years from the end of the Better Access to Radiation Oncology Programme. Currently committed projects will continue until completion in 2016-17.
- Savings of $650.4 million over four years from 2015-16 by: removing bulk-billing incentives for pathology services; aligning bulk-billing incentives for diagnostic imaging services with those that apply to General Practitioner services; and, reducing the bulk-billing incentive for Magnetic Resonance Imaging (MRI) services from 15 per cent to 10 per cent of the Medicare Benefits Schedule fee, aligning it with other diagnostic imaging services. Bulk-billing incentives for diagnostic imaging services will continue to apply for patients with concession cards and children under 16 years of age. These changes to pathology and diagnostic imaging bulk-billing incentives apply from 1 July 2016.
- Under the title “more efficient health programs”, there will be savings of $146 million over four years by redesigning 24 health programmes to operate more efficiently, including programmes associated with population health, medical services, eHealth, and health workforce. Following the axing of the Australian National Preventive Health Agency, this doesn’t augur well for population health initiatives.
- Cuts to a range of health workforce programs, which is expected to reduce cash payments by $178 million in 2015-16 ($595 million over four years to 2018-19). On the chopping block are the Clinical Training Fund; the Rural Health Continuing Education Programme; the Aged Care Education and Training Initiative; and the Aged Care Vocational Education and Training professional development programmes. However, the Government will redirect a further $225.0 million from these measures to support current health workforce priorities, including $131.2 million over four years to expand the Rural Health Multidisciplinary Training Programme and establish grants to private healthcare providers to support undergraduate medical places; and $93.8 million over four years to develop an integrated prevocational, postgraduate medical training pathway in rural and regional areas.
- $70 million will be saved over four years from 2015-16 by further reducing the number of government bodies in the Health Portfolio. The Government will rationalise the functions of six agencies by: abolishing the National Health Performance Agency from 30 June 2016, and transferring its functions to the Australian Institute of Health and Welfare, the Australian Commission on Safety and Quality in Health Care, and the Department of Health. (Here is an example of the type work done by NHPA.) The operational functions of the Independent Hospitals Pricing Authority will be transferred to the Department of Health from 1 July 2016, with the Board, Chief Executive Officer and functions retained. The National Health Funding Body and the Administrator of the National Health Funding Pool will be abolished from 31 March 2018 in line with the scheduled end of activity based funding payments from the Commonwealth.
(This is a shift from the Budget announcement in 2014 that a Health Performance and Productivity Commission would be created by merging the Australian Institute of Health and Welfare, the National Health Performance Authority, the Independent Hospital Pricing Authority, the National Health Funding Body, the Administrator of the National Health Funding Pool, and the Safety and Quality Commission. Presumably the States and Territories dug in against the initial proposal.) Meanwhile, the Government will no longer proceed with the merger of the National Blood Authority and the Organ and Tissue Donation and Transplantation Authority, as announced in the 2014-15 Budget.
- Interestingly, the Department of Health is going to have to find funds for the scheme to regulate cannabis for medicinal and scientific use: “The cost of this measure will be met from within the existing resources of the Department of Health.”
- Search the MYEFO papers for details of new PBS listings and new MBS items, including for addiction medicine and sexual health care.
• Shadow Health Minister Catherine King: Different leader, more health cuts
• Doctors Reform Society: Patients will suffer
• AMA: another significant hit to the health budget, with more costs being shifted on to patients. AMA president Professor Brian Owler said: “The Government is continuing to retreat from its core responsibilities in providing access to affordable, quality health services for the Australian people.
• At The Conversation, Professor Stephen Duckett, Director of the Health Program, Grattan Institute, notes that consumers have little power to bargain or price-shop for pathology and diagnostic imaging services. He said:
“Given the corporatisation of pathology and diagnostic imaging services, it may now be time to move away from an open-ended fee-for-service reimbursement system that was developed for the old era of professional, rather than corporate, practice. A tender arrangement might generate more savings for government at the same time as protecting consumers.”
While the MYEFO statement does not provide details of the workforce cuts, it appears aged care workforce programs may be particularly hit, he says, and this would be unfortunate, as the number of older people who need care (at home or in an aged care facility) is increasing.
• Consumers Health Forum of Australia: “Cuts to Medicare payments for pathology raise the prospect of a fresh cost barrier that could dissuade patients from undergoing important tests”.
CEO Leanne Wells said:
“Australia needs to be strengthening its primary care services, as shown in a recent international survey and as canvassed widely by the Government’s Primary Health Care Advisory Group’s recent consultations on how we can better respond to people with complex and chronic conditions. Introducing a new price for pathology will not help improve primary care services and will discourage early diagnosis.”
• AHHA statement: Vulnerable people, such as low and middle income earners and patients suffering chronic health conditions, should be protected.
Chief executive Alison Verhoeven said:
“The Government has a number of options for raising revenue such as increasing or broadening the GST, minimising or removing Private Health Insurance rebates, and increasing the Medicare Levy. But they would need to be offset by adequate protections to the most vulnerable members of our society.
The health sector must take the opportunity to move towards integrated care and address the fragmentation between primary and acute care services, to reduce waste and inefficiency, and to improve patient care. The regional focus of Primary Health Networks will assist in moving this work forwardCuts to government funding are not the answer, and healthcare must remain a priority for the Government as it is for its citizens.”