How will Health fare in the May Federal Budget this year after some pretty disastrous outings in the past two years?
The signs are not good, with continued focus by Ministers on cutting “spending” rather than seeing health as an investment and news that the government is (once again) considering the possibility of privatising the payment services associated with Medicare – see the Minister’s statement. (What DID happen to those expressions of interest?)
The deadline for submissions to the 2016-17 Federal Budget closed last Friday. Treasury doesn’t publish them, but this post compiles links to submissions from key players in the public health space. Croakey will add to these if organisations can provide them in the coming weeks.
A big message, for example from the Australian Healthcare and Hospitals Association and the Australian Medical Association, is that health expenditure is not out of control. The Australian Institute for Health and Welfare has this week released a helpful guide to that assessment: 25 years of health expenditure in Australia: 1989–90 to 2013–14, that says:
It is likely that population factors such as population growth and population ageing have had an important influence on the demand for health goods and services. The development of new technologies and community expectations regarding their availability and use also appear to have a large impact on this demand. Increased demand for health goods and services does not automatically translate into increased health expenditure though. The information presented in this report suggests that a combination of factors, including increased wealth and government policies, have determined if, how and when demand for services are met and, ultimately, how much is spent.
Consumers Health Forum of Australia submission
The CHF says the big challenge facing the framing of the Health budget this year is illustrated by the numerous reviews looking to reform systemic failings and frailties, namely:
- Primary Health Care Advisory Group examining models for improving care for people with complex and chronic conditions.
- Medical Benefits Schedule Review Taskforce looking to modernise Medicare.
- Review of Pharmacy Remuneration and Regulation.
- Private Health Insurance Review.
- Reform of Federation White Paper which will examine how all Australian governments can better structure administration and funding in health.
All of the reviews in their own context are needed and timely. Although some of the reviews have already reported and we know some are providing input into the Budget deliberations we have not had access to the recommendations. Our concern is that they have different timelines and we are looking for some reassurance through the Budget process and beyond that they fit together as a coherent whole and actually move us towards achieving a modern sustainable health system.
Some of its recommendations include to:
- remove the freeze on Medicare Benefits Schedule rebate for primary health care consultations and services
- reverse the proposed $57 billion cut from hospital funding over the next 10 years
fund Primary Health Networks to introduce integrated stepped care arrangements and fill identified gaps for people with complex and chronic conditions
- develop a 10 year National Preventive Health Program and National Oral Health Plan
restore the $793 million cut out of the Health flexible funds in the 2014 Budget
create a suite of nationally standardised (or default), basic private healthinsurance packages for Hospital Cover.
Australian Healthcare and Hospitals Association (AHHA) submission.
The AHHA urges no further cuts to health expenditure until current review processes are completed, adequate funding for Primary Health Networks, and sustainable funding for hospitals – “growth funding based on population and CPI increases to be implemented from 2017-18 is significantly short of requirements, as demonstrated in the Productivity Commission’s Report on Government Services.”
Its submission notes that most of its recommended budget measures and policy directions do not call for extra funding, but rather more efficient and better targeted use of current funding. They also include:
- ensure that ehealth tools and resources are at the forefront of any system change
- align the interfaces between health, aged care and disability services
- fund Phase Three of the Lighthouse Hospital Project to improve the treatment of acute coronary syndrome conditions among Aboriginal and Torres Strait Islander people
- link the Medicare Benefits Schedule Review with work separately being undertaken by the Commonwealth funded National Prescribing Service (NPS) on the Choosing Wisely initiative
- extend eligibility for public dental services beyond concession card holders to lower income Australians
- appoint an Australian Chief Dental Officer to coordinate oral health policy
- prioritise developing and implementing preventive health strategies.
Royal Australian College of General Practitioners (RACGP) submission
The RACGP presents four strategies for investing in patient healthcare through better supporting general practice:
- reversing the freeze on MBS indexation
- establishing Learning hubs for general practice training with 200 additional community training places
- piloting a voluntary patient enrolment and coordination of care program
- prioritising general practice research.
Australian Medical Association submission
The AMA also calls for an end to the Medicare patient rebate freeze, the reversal of cuts to pathology and radiology, and restoration of public hospital funding “to proper levels”. The comprehensive submission also includes recommendations on Federation reform, efficient Medicare claiming, Indigenous health, medical workforce and training, chronic disease, pharmacists in general practice, rural GP infrastructure grants, medical care for demential, palliative care and aged care patients, climate change and health, prevention, methamphetamine (ice), alcohol, obesity, physical activity and immunisation.
Its preamble looks back over the past year, and warns the landscape is not looking good:
We have seen active demonising of doctors in the MBS review process, and a clear plan to cut costs.
We have seen a willingness for PHIs to play a more active role in all areas of the health system – despite inappropriate behaviour and lower value products for patients.
We have seen strong indicators of a Government pursuing a US-style managed care system.
And we have seen signs of the Commonwealth retreating from its core responsibilities in funding public hospitals and other health services.
The Government is on a path of funding cuts and shifting costs to patients. This is not good for the Australian health system or the health of Australians.
Royal Australian and New Zealand College of Psychiatrists (RANZCP) submission
The RANZCP submission identifies eight priorities for spending:
- enhancing employment support and opportunities for people with mental health issues
- addressing the physical health of people with mental illness
- improving the accessibility of evidence-based clinical care for children and adolescents
- making quality mental healthcare available to Australia’s ageing population
- addressing the maldistribution of the mental healthcare via the Specialist Training Program (STP)
- supporting Aboriginal and Torres Strait Islander mental health workers
- establishing ongoing national funding for consultation liaison psychiatry services
- facilitating better links between the mental health sector and the National Disability Insurance Scheme (NDIS).
Rural Doctors Association of Australia submission
The RDAA identifies 5 priority areas:
- realistic funding targeting improved primary health care and general practice in rural and remote areas including immediate discontinuation of the MBS indexation freeze
- coordinated, innovative and flexible approach to rural health funding: incentives for public-private partnership investment, funds for e-health, inclusion and appropriate remuneration of telehealth items on the MBS
- support rural generalist services including establishment of a national training program
- flexible rural training pathways to support rural recruitment and retention and workforce sustainability in the longer term
- improved funding and service delivery between federal and state/territory governments
Please forward your budget submissions to us at email@example.com or via Twitter to @croakeyblog or @croakeynews.