This post offers an overview of health-related news from the Budget and a wrap of reaction.
Here are links to:
• A table giving a quick overview of health spends and cuts
Overview of key announcements
• $55.7 million over four years to expand BreastScreen Australia’s active recruitment of women in the target range of 50-69 years of age to women 50-74 years of age. From 2013-14, all Australian women 70-74 years of age will be actively invited to undertake free breast screening every two years – a first for the program. This will improve the early detection of breast cancer, resulting in more than 145,000 additional women screened every two years from 2016-17, with up to an additional 1,170 breast cancers detected every two years.
• The target age range for the National Bowel Cancer Screening program has also been extended, and from 1 July 2013, people turning 60 will be invited to undertake free bowel cancer screening through the program. This will build on the current program, which invites those turning 50, 55 and 65 years of age to participate in screening. From 1 July 2015, people turning 70 will also be included in the program. Around 5 million Australians will be offered free screening over the next four years. The 2013-14 Budget commits $16.1 million over four years to ensure that the program is available to all eligible Australians.
Bowel Cancer Australia would like to clarify some media reports regarding the budget announcement relating to the Government’s National Bowel Cancer Screening Program (NBCSP).
Additional funding for the National Bowel Cancer Screening Program (NBCSP) in the 2013-14 budget is $3.7 million for program reporting.
No new ages for the National Bowel Cancer Screening Program (NBCSP) were announced in this budget. The addition of 60 and 70 year olds were announced in last year’s budget.
In 2013, the National Bowel Cancer Screening Program (NBCSP) is only relevant to people aged 50, 55, 60 and 65, not all Australians aged over 50. It remains a five yearly screening program despite medical guidelines recommending screening for people aged 50 and over every one to two years.
The $16.1 million allocation to the National Bowel Cancer Screening Program (NBCSP) is over four years and relates to health professional reporting of the program.
A ‘fully implemented’ bowel cancer screening program (two yearly screening for people aged 50-74) is still scheduled for 2034, as per last year’s budget announcement.
(Croakey’s wording was taken from Budget papers.)
• $4.1 billion for a dental reform package, in addition to the $515.3 million investment in dental health made in the 2012-13 Budget.
• From 1 January 2014, around 3.4 million children aged 2-17, in families who meet a means test, will be able to access up to $1,000 worth of basic essential dental treatment capped over a two year period under the Grow Up Smiling program. This replaces the teen dental program. A National Partnership Agreement to expand services for adults in the public dental system will commence on 1 July 2014.
• A Flexible Grants Program will commence in 2014 to provide funding for dental infrastructure in outer metropolitan, rural and regional areas.
• Two industry funded clinical quality registers will also be established with $5.1 million over two years in initial Government funding. These will enhance national post-market surveillance for high risk implantable devices such as pace makers and breast implants, so that potential faults with devices can be detected more quickly and followed up appropriately. There will also be enhanced patient contact arrangements for patients with high-risk implantable medical devices. In the event of a recall of a device, hospitals will follow a new national protocol to contact affected patients.
• A National Antimicrobial Resistance (AMR) Prevention and Containment Strategy will provide national and international leadership on this significant global health priority. The Strategy will also coordinate Australia’s efforts across human and animal health to reduce, monitor and respond to AMR. The Government will expand surveillance of AMR and antibiotic usage; implement infection prevention and control activities to reduce the spread of infection in general and of resistant infections in particular; and implement antimicrobial stewardship programs to provide a systematic approach to optimising the use of antibiotics in primary health care, residential aged care facilities and hospitals.
• There will be a review of the drug and alcohol prevention and treatment services sector to clarify the range of services currently funded; develop common understanding amongst governments and the sector of current and future service needs; and clarify the type and timing of drug and alcohol funding activities undertaken by governments. The review will be concluded in 2014 and its findings will inform the next funding round under the Substance Misuse Service Delivery Grants Fund scheduled to commence in late 2014.
• Reviews of Medicare Benefits Schedule (MBS) items – 16 reviews that are now underway will be progressed, and a further two specialty reviews will be undertaken (does anyone know what they are for??), “to ensure that items listed on the MBS remain clinically relevant and consistent with best practice”.
• This is the one that will have the medical lobby screaming: Changes to MBS indexation so that MBS fees will be indexed on July 1 each year (in line with many other programs) rather than on November 1. The next indexation date will be July 1, 2014. Savings will also come from removal of double billing under Chronic Disease Management , and an increase of the upper (general) threshold of the extended Medicare safety net to $2,000 from 2015. These measures will save $889.4 million over four years. (Update 16 May: For a more detailed explanation of these changes, see the Commonwealth Parliamentary Library’s article.)
• More cuts ($20 million over four years) are to come from the National Rural and Remote Health Infrastructure Program, and $10.8 million will be saved from not proceeding with Katherine and Gove District Hospitals.
• $80 million will be cut from Health Workforce Australia’s budget over four years (you can get a sense of the breadth of HWA’s work here.) HWA sources say that the first $20 million cut next financial year is likely to come from savings in the Clinical Training Funding (CTF) program and the International Health Professionals (IHP) program. Reaction added: Former HWA board member, Professor Andrew Wilson, director of the Menzies Centre for Health Policy, University of Sydney: “It would be very unfortunate if the reduction in HWA funding impacted on its support for initiatives to make the increased number of clinical graduates work ready. It would be unfortunate if it also impacted on the programs to reform health workforce training. However, while this is a large reduction I think the Board will could make changes that will maintain its priority programs.”
• In 2013-14 there will be a new Medicare Locals Accreditation Scheme to support Medicare Locals to meet best practice organisational management and service delivery processes. Accreditation is one aspect of a broader quality framework for Medicare Locals, which will seek to promote transparency, information sharing, and a culture of continuous quality improvement. Work will continue on the National Evaluation of Medicare Locals to assess the extent to which Medicare Locals are progressing toward the five strategic objectives of the program.
• A National Primary Health Care Strategic Framework has been agreed and the Department will work with the states and territories to develop bilateral plans for primary health care by July 2013.
• In 2013-14, the NPS will complete the first phase of the development of the MedicineInsight project and deliver to the Australian Government the first reports from this dataset. The NPS is developing the MedicineInsight project to capture, store and analyse GP data to better inform how medicines are being used in clinical practice.
• Safety and quality initiatives will aim to reduce unnecessary clinical variation in the use of blood products, reduce unnecessary radiation exposure from diagnostic imaging and develop an Annual Atlas that identifies unwarranted clinical variation.
• The Mental Health Nurse Incentive Program, which provides access to coordinated clinical care for patients with severe and persistent mental health disorders in the primary care setting, will continue under existing arrangements pending a restructuring in response to an evaluation published late last year. This will enable community based general practices, private psychiatric practices and other similar organisations to continue existing arrangements with mental health nurses.
• The Budget also includes funding for perinatal depression initiatves, the Partners in Recovery initiative, headspace program for teenagers and young adults, and expansion of the Access to Allied Psychological Services (ATAPS) program, which funds Medicare Locals to broker allied mental health professionals to provide psychological treatment to people with a diagnosed mental disorder. The expansion targets hard to reach groups and communities that are currently underserviced, such as children, Aboriginal and Torres Strait Islander communities and socio-economically disadvantaged communities.
• From 1 July 2013, the My Aged Care website and call centre – key components of the new Aged Care Gateway – will be established. This will provide older people, their families and carers with access to the information they need, and enable them to more easily navigate the aged care system.
• The Closing the Gap release says the Government is investing $6.5 million over three years to 30 June 2016 to continue to support Indigenous communities to participate in the digital economy and access government services online. The agreement supports the ongoing operation and maintenance of public internet facilities delivered under the original agreement and provides training to Indigenous people in the use of online technology
• Funding of $16.5 million over four years will improve eye health for around 20,000 Indigenous Australians. The aim is to eliminate trachoma – an infectious eye disease that can lead to blindness – in affected communities.
• $3.9 million will be spent over four years on mosquito control activities including a program to prevent the spread of mosquito-borne diseases such as dengue fever in the Torres Strait and to the mainland. Funding will also support communication and coordination between Australia and Papua New Guinea to reduce communicable disease risk in the Torres Strait.
• $15 million over three years from 2014-15 to continue funding to the National Congress of Australia’s First Peoples. Joint Select Committee on Constitutional Recognition of Aboriginal and Torres Strait. $1.3 million over two years will be provided to support the work of the Joint Select Committee on Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples to establish a parliamentary and community consensus on referendum proposals.
Wrap of reaction
The Social Determinants of Health Alliance: Health inequity grows as Senate report gathers dust
The Social Determinants of Health Alliance has expressed disappointment at there not being any mention in this year’s Federal Budget about the shame of increasing rates of health inequity in a country that prides itself on giving everyone a “fair go”. Read the full release here.
Public Health Association of Australia: Mixed reaction
The long term plans to underpin Australian children’s education and a National Disability Insurance Scheme are welcomed by the Public Health Association of Australia (PHAA).
Improved health outcomes rely on all Australians having a positive start in life, and that requires a strong and long term government commitment to children’s education. Similarly, people and families living with disabilities need the assurance of a national insurance scheme to meet their daily needs.
Other public health areas also received support in the 2013/14 budget: cancer prevention and screening ($4.5m to CanTeen for youth cancer networks; $3.7m increase for the National Bowel Cancer Screening Program; $55.7m over four years to expand breast screening to a wider age range of women); $16.5 million for trachoma prevention and eye health for Indigenous Australians; $1.7m for an OzFoodNet national partnership; $64.6m for the National Partnership on Preventive health; $11.1m to local government for healthy communities initiatives; $28.9m for healthy children (0-16 years) initiatives; $24.7m for workplace health programs; and $3.9 million to combat dengue fever and tuberculosis.
Associate Professor Heather Yeatman, President of the Public Health Association of Australia (PHAA), supported the Government’s commitment to funding continued compliance and enforcement activities associated with tobacco plain packaging legislation and $155.2m to treat additional public dental patients. “It is important that current public health initiatives are not forgotten when large new programs are announced.”
The PHAA acknowledged other important areas in the budget that will support health outcomes in the long term. These included $777 million for a new National Partnership (NP) on Closing the Gap in Indigenous Health Outcomes, including preventative health checks for Indigenous Australians; funding for key urban public rail projects that will encourage fewer cars on the road; and $300 million over four years to support jobseekers in the transition to work.
The PHAA had suggested that the government could raise much needed funds and achieve improvement in public health through taxes – a volumetric tax on wine, the abolition of the WET rebate and implementation of a tax/levy on selected nutritionally undesirable foods.
“Funds raised by these taxes could be used for preventive programs and to promote and subsidise nutritionally desirable foods for disadvantaged groups” said Professor Yeatman, “but this did not happen.”
Meanwhile, the Treasurer’s announcement of changes to the indexation of tobacco excise (expected to add 7 cents to the price of a pack by the first half of next year) did not impress one public health advocate:
Tonight’s Budget has kept faith with four major initiatives which, over time, will help transform Australian society and contribute to good health, including in rural and remote areas.
As expected, there are some significant new investments in cancer care and treatment, but little else to excite those in the health sector.
And disappointingly, no improvements yet to rural health workforce programs.
The four major initiatives are the Gonski education reforms, DisabilityCare Australia, improvements to public dental health services (initially for children and teenagers) and the National Broadband Network.
Although much of the detail relating to the first two is still in their fine print, foundations have been made which will ensure they become realities and so help lay the basis for good health.
If rural schools can be funded according to educational need it should be possible to equalise educational outcomes in rural areas, making a contribution to greater city-country equity in employment, income and health.
DisabilityCare Australia, with the ongoing support of State and Territory Governments and underpinned by the Medicare levy increase, will end the lottery relating to care for people living with a disability – a lottery which those affected in rural and remote areas win even less frequently than those in major cities.
These two major initiatives have been confirmed tonight as areas for significant investment over the next several years. And GUS is very welcome – Grow Up Smiling – which will see the Commonwealth investing in dental care for 2 to 17 year-olds, starting 1 January 2014, part of the dental reform package announced in August 2012.
The fourth, also confirmed in tonight’s Budget, is the Government’s commitment to the National Broadband Network. Like the education and disability reforms, the NBN is a long-term and high cost project which, when fully delivered, will improve health and wellbeing (including through enhanced business opportunities) for people everywhere and give the same chances in a digital world for people in remote, rural and city areas.
The savings measures necessary for underpinning these initiatives include a halving of the allocation to the National Rural and Remote Health Infrastructure program from $10 to $5 million a year. The smaller amount will be focused on remote Indigenous communities and places under 20,000 people.
Those who went to the 12th National Rural Health Conference will be delighted about continued investment in Indigenous eye health. And in what is a credit to its advocates, funding has been uncapped and new money provided for a year for the Mental Health Nurse Incentive Program while it is being redesigned. Major new investments in screening and services for breast, prostate, lung and bowel cancer are also very welcome.
ACOSS: Budget secures landmark disability and education reforms, but gaping hole for poorest on allowances remains
ACOSS warmly welcomes the Federal Government’s vision to secure disability care and dental and schools reform and the strengthening of public revenue to secure funding for these and other services, but cannot believe that there is no income relief for the people who are the poorest,” said ACOSS CEO Dr Cassandra Goldie.
“We praise the move by the Treasurer to lock in government expenditure on crucial social reforms such as education and disability care, in some cases for a decade. We have also been strong supporters of the more equitable and effective system for dental care in Australia and that begins with two-thirds of all children in this Budget. These are not only visionary reforms but long overdue,” Dr Goldie said.
“However, we remain deeply concerned at the failure to reduce the rate of poverty in Australia by increasing the single rate of Newstart and other allowances. While we welcome the modest easing of income rates for people on Newstart and other allowances, the Government has failed to assist the four-fifths of Allowance recipients who are unable to obtain paid work. Each year we fail to act, this gaping hole in our safety net grows. One in eight people, including one in six children, are living in poverty and an increase in the lowest social security payments would have the most immediate and direct impact in reducing it.
“On the savings side, there are some incredibly important measures in this Budget. In addition to the welcome increase in the Medicare levy to fund DisabilityCare Australia, we are pleased that the Budget makes significant inroads into closing tax loopholes and inefficient tax arrangements. With tax receipts down by over $20 billion from the pre-GFC period, we must pull back from generous tax breaks that are not delivering on policy outcomes and eroding our tax base. ACOSS advocated the extension of the Medicare Safety Net threshold, the abolition of the medical expenses tax offset, the capping of self-education expense deductions and the tightening of the thin capitalisation rules, all of which we welcome in this Budget.
“We are also pleased that there is greater investment in tackling tax evasion through trusts. We would have liked to have seen changes to tax rules as well, but hope this commences the reforms needed to close this glaring tax loophole.
“We welcome the integrating of the baby bonus into the family payments system so that it is better targeted but remain concerned about reductions in payments for the poorest families.
“The next step to secure our economic and social progress must be to strengthen revenue. Otherwise we face painful cuts to essential expenditure down the track. Australia is the 5th lowest taxing country in the OECD. If we want a decent safety net, and universal health education and dental services, as well as the housing and infrastructure for present and future generations, we need a sustainable tax base,” Dr Goldie said.
The Government’s failure to increase Newstart allowance has been widely condemned, by the UnitingCare Australia and others:
The Gillard Government’s latest broken promise on growing the overseas aid program will have a devastating impact on the world’s poorest people, reducing Australia’s aid commitment by $1.9 billion, Oxfam Australia said today.
In response to tonight’s federal budget, the international aid agency also said it was deeply disappointing to see the government plunder another $375 million from the overseas aid program to pay for its domestic asylum seeker policy.
Oxfam Australia Chief Executive Dr Helen Szoke said that the good news this year with aid levels rising from 0.35 to 0.37 per cent was overshadowed by the government’s decision to again delay, by one year, its pledge to grow the overseas aid budget to 0.5 per cent of national income.
“This decision will cost approximately 1.9 billion to our fight against global poverty,” said Dr Szoke.
“That’s $1.9 billion that would otherwise have been spent in some of the world’s poorest countries, making sure children can go to school, that families have enough food to eat, and communities can access safe drinking water.”
On top of previous delays to meeting the 0.5 per cent aid spending target, Australia’s aid effort has been reduced by a total of approximately $4.8 billion since the 2011-12 federal budget.
“This government has failed the world’s poorest people. Every dollar denied has real impacts for people living in poverty,” Dr Szoke said.
“We know Australian aid helps to save lives and improve opportunities for some of the world’s most vulnerable people.
“Last financial year, Australian aid helped more than one million people in Africa access safe water and ensured more than 135,000 pregnant women in East Asia gave birth with the support of a skilled birth attendant.
Dr Szoke also said the diversion of $375 million from the overseas aid program to pay for onshore asylum seeker costs meant Australia would be the third largest recipient of its own aid, behind Indonesia and Papua New Guinea.
“We are fortunate in Australia that we can afford to help those in need at home, as well as provide life-saving aid to those beyond our borders. Australians expect our overseas aid to be focused on helping poor people overseas, not to prop up the funding of domestic asylum seeker policies.
“The government’s continued raid on the overseas aid program will mean more farmers won’t get the help they need to grow food, more children won’t get the education they need for better jobs, and too many women won’t get the support they need to deliver healthy babies.”
Oxfam is urging the government to show leadership on this issue and ensure investment in the overseas aid program gets back on track as soon as possible, with no funds diverted to pay for domestic programs.
“Millions of people around the world are depending on Australia’s promise to step up its fight against global hunger and poverty, and with one in eight people still going hungry every day, we cannot afford to wait,” Dr Szoke said.
“Oxfam is now looking to the Coalition to show leadership on this issue and commit to a timeline to increase aid to 0.5 per cent of national income.”
Consumers Health Forum: Budget for medicines and cancer but no hip pocket relief
Patients with cancer or needing new medicines will benefit but there is little relief from hip pocket pain in tonight’s budget, says Carol Bennett, CEO of the Consumers Health Forum.
“The heavier costs consumers now face are fuelling the emergence of a two-tiered health system — one for those who can afford to pay and one for those who cannot. Unfortunately, there is a growing number of Australians, particularly the aged and the chronically ill, who are struggling to afford necessary medical treatment,” Ms Bennett said.
“Medicare is already under strain. We expect to see GP bulk billing drop and even greater pressure on doctors to speed up patient consultations..
“CHF has demonstrated the growing burden health care places on families with our recent “Hip Pocket Pain” campaign, showing that Australians pay among the highest out-of-pocket costs in the world, averaging over $1,000 a year..
“The ballooning expense to government and individuals underlines the need for fresh approaches to pay for health care that will result in more effective, targeted treatment and reduced out-of-pockets. We have an ageing population, increased demand and government revenue slowing and to pay simply for patient throughput no longer makes sense, ” Ms Bennett said..
Tonight’s Budget largely insulated health from major cuts in spending and provided a welcome boost to cancer services, but it failed to plug gaps in public hospital funding – a gap that risks coming back to haunt the Government in the lead-up to the Federal election.
Catholic Health Australia CEO Martin Laverty said Government efforts to fund important reforms in education and disability care could, in time, improve social determinants of health in a country that is currently burdened by unacceptable levels of health inequity. Thankfully, fears that funding those services could have resulted in larger health funding cuts have not been realised.
“Not too many who work in the health system expected new spending announcements tonight. Funding increases in cancer screening, research and support is welcomed. Expanded funding for prostate cancer programs at the Kinghorn Cancer Centre at Sydney’s St Vincent’s Hospital campus is most welcome,” Mr Laverty said.
“There is also relief that in an effort to avoid a larger Budget deficit and fund education and disability care, cuts to health programs have not gone deeper. Tonight really could have been a lot worse than it is.”
Mr Laverty said three main health program funding cuts detailed in tonight’s Budget papers will need further attention in the lead up to the election.
“The first funding cut was announced late last year, when the Federal Government clawed back $1.6 billion in public hospital funding over the next four years. Tonight’s Budget only affirms the restoration of this year’s $107 million in funding for Victoria, ignoring need in other states.
“In the coming weeks, public hospitals across every state will have to start announcing service cuts in response to the $1.6 billion public hospital clawback, which a Senate Inquiry called ‘extraordinary and indefensible’. Tonight was a lost opportunity, and this funding should have been restored.
“No one should underestimate how problematic this public hospital funding cut is likely to be in the years ahead. As state and territory governments announce their budgets in coming weeks, we can expect to see public hospital services starting to be wound back.
“Tonight’s second cut involves changes to the Medicare Benefit Schedule that will see a freeze in Medicare payments to doctors. The Department of Health and Ageing confirmed tonight no modelling had been done on how this might impact consumer out-of-pocket costs.
“The third cut will see $80 million taken from Health Workforce Australia over the next four years. The Department of Health and Ageing again confirmed tonight that it’s not known what health workforce programs will be cut as a result of a funding clawback, but we do know that severe health workforce shortages are predicted in the years ahead,” Mr Laverty concluded.
The Australian College of Mental Health Nurses (ACMHN) welcomes the modest increase to the Mental Health Nurse Incentive Program (MHNIP). The Federal Budget 2013-14 provided $23.8 million in additional funding for the MHNIP.
Minister Butler also re-affirmed the Government’s commitment to working with stakeholders to improve the Program and provide better support to this vulnerable client group.
“It is clear our calls have not fallen on deaf ears and we are delighted with this modest increase in funding”, said Adj Associate Professor Kim Ryan, CEO of the Australian College of Mental Health Nurses. “I look forward to meeting with the Minister to find out how that increase will be implemented”.
And some more mental health reaction:
The Rural Doctors Association of Australia (RDAA) says, for rural Australians and particularly rural patients, this year’s federal budget is firmly a case of the good, the bad and the ugly. RDAA President, Dr Sheilagh Cronin, said:
On the good side, we are pleased to see:
- additional funding for Indigenous healthcare under the Close the Gap initiative
- funding for breast screening for women aged 70-74 years
- significantly more funding for cancer research, treatment and support
- a commitment from the Federal Government that funding under the National Rural and Remote Health Infrastructure Program, while being reduced in actual terms, will see remote areas and Indigenous communities being the priority areas for the remaining funding
- a $20 million increase in funding for the General Practice Rural Incentives Program (GPRIP), however whether this additional funding is allocated to doctors moving to small rural and remote towns is, RDAA believes, dependent on adjustments being made to the ASGC-RA classification scheme.
On the bad side, we are very disappointed that:
- there has been no commitment from the Government to fix the troubled Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) scheme in consultation with key rural stakeholders, despite the fact that the current system is making it very difficult to attract and retain doctors in many small rural towns
- there has been no commitment to introduce a National Advanced Rural Training Program or additional supports to provide a ‘pipeline to rural practice’ for the many young doctors now graduating from Australia’s universities
- there has been no commitment to reverse the $2000 / year tax deduction cap on work-related self education expenses, given a $2000 limit makes it extremely difficult for rural doctors to afford continuing medical education given the costs of course registration, travel, accommodation and locums
- the Medicare Safety Net has been increased to $2000.
And on the ugly side…
- The Federal Government’s decision to cut Medicare rebate funding over four years by $664.3 million (through realignment of Medicare indexation) is of serious concern.
Dr Cronin said: “It will discourage more rural Australians to seek preventative healthcare and health checks, despite the fact this healthcare would save the Government significant future expenditure by reducing chronic disease and hospitalisations.
“And we are significantly concerned that the aged, frail, disabled and those with chronic disease will be worst hit by the rebate funding cut, given they regularly need to access healthcare, as well as low-income rural Australians who simply cannot afford additional healthcare costs…..
“Medicare rebates are, in reality, a subsidy to the patient, not the doctor. If these subsidies to patients don’t keep up with the CPI, then practices will have no choice but to pass on these costs to the majority of their patients, and/or limit the amount of bulk-billing they do. These are the harsh economic realities.”
AMA President, Dr Steve Hambleton, said tonight that the Government will force sick people to pay more for their health care to help address the Budget deficit.
Dr Hambleton said that the decision to delay indexation of the Medicare Benefits Schedule (MBS) from 1 November 2013 to 1 July 2014 – which is effectively a freeze on MBS indexation – will rip $664.3 million out of primary health care services.
“The Government is getting sick people to help fix the Budget black hole,” Dr Hambleton said. “People will pay more for their health care every time they visit the doctor. The sicker you are, the more you will pay. Even veterans will be hit. The freeze will hit health services provided by the Department of Veterans Affairs.
“Many families will face further increases to their health care costs through the increase of the upper Medicare Safety Net threshold to $2000. At a time when many Australians are facing huge cost of living pressures, it is going to get harder for people to cover their health care costs. Some people may choose to put off seeing their doctor.”
Dr Hambleton said it is surprising that a day after the Government announced record bulk billing figures, it hands down a package that will force bulk billing rates down.
The AMA welcomes funding in key areas, including:
· $777 million for Closing the Gap in Indigenous Health Outcomes;
· the World Leading Cancer Care Package; and
· a national patient register for high risk implantable devices.
The AMA will closely examine the Budget Papers before making a comprehensive response to the overall Budget across portfolios.
A particular focus will be on the Government’s changes to taxation of work-related self-education expenses, which make it harder for doctors to improve their skills to the benefit of patients.
Hal Swerissen, Professor of Health Policy, La Trobe University, says:
The budget delivers on funding for the NDIS, the government’s major policy initiative. It also includes funding for dental health reform and has there is money for cancer prevention, new pharmaceutical listings, rural incentives program for GPs, and aged care reform.
The budget makes sensible savings by removing double dipping on Medicare by GPs, removing the net medical expense tax offset, increasing the general threshold of extended Medicare Safety Net and realigning of Medicare Benefits Schedule indexation arrangements.
Overall, apart from the NDIS, the budget continues health policy directions already in place. As with social services, significant real growth in the health budget is projected over the forward estimates to deal with population growth, population ageing and health inflation.
Stephen Duckett, Director, Health Program at the Grattan Institute, says:
This budget contains mostly small changes here and there from a health perspective. The funding of DisabilityCare is a major initiative and represents a significant step forward for equity.
The slower indexation of Medicare rebates could result in access problems for consumers if doctors increase their fees ahead of the rebate changes.
This budget does not future proof Australia. A number of decisions have not been taken to eliminate waste from the system, such as addressing the excess prices in the Pharmaceutical Benefits Scheme
There are small increases in highly targeted research programs in cancer and aged care research. The McKeon proposals to prioritise relevant health services research have not been pursued, which is a disappointment.
Also at The Conversation: health equity and the budget.
Meanwhile, the Get Up review of the budget notes that over $5 billion in fossil fuel subsidies remain in place.
It is striking that the health portfolio budget statements under “population health” and “biosecurity and emergency response” outcomes do not even mention climate change…
Updates added on 15 May, 2013
The $777 million commitment to Close the Gap initiatives in the 2013 Federal Budget is welcome, however the Aboriginal health Community Controlled sector remains concerned about the lack of detail on how and where the money will be spent.
National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Justin Mohamed, said it was critical that adequate funding was dedicated to support and grow Aboriginal Community Controlled Health services where the biggest gains were being made in improving Aboriginal health.
Download the Aboriginal Health Budget here also see executive summary below
“The lack of clarity in the Budget around how funding will flow to Aboriginal primary Community Controlled Health services is very concerning,” Mr Mohamed said.
“Aboriginal Community Controlled Health services need to be at the forefront of any comprehensive primary health care model.
“It is these services – run by Aboriginal people, for Aboriginal people – that are making the biggest improvements to the health of their communities.
“The Federal Government also needs to put greater effort into getting the states and territories to re-commit to the National Partnership Agreement – due to expire in just over a month.
“It is simply not OK to leave the fate of Aboriginal health hanging while everyone plays politics up to the 11th hour.”
Mr Mohamed said NACCHO was disappointed that the Budget did not spell out how the upcoming National Aboriginal and Torres Strait Islander Health Plan would be funded.
“The Health Plan will not work unless it is properly resourced and after yesterday we are no clearer on how much of the $777 million will be directed to this critical initiative.
“It is also disappointing to again see the focus on Medicare Locals in the Budget. Medicare Locals are yet to prove their effectiveness in the Aboriginal health space where the community controlled model has made positive health gains.
“If we’re serious about closing the appalling gap in life expectancy between Aboriginal and non-Aboriginal Australians, then Aboriginal health needs to be given the attention it deserves and community controlled services better supported.”
Mr Mohamed said NACCHO would be consulting widely with the Aboriginal Community Controlled sector and providing further comment upon further analysis of the budget papers in the coming days.
Australian Healthcare and Hospitals Association: Some gains but fails to address key issues
The AHHA acknowledges the balanced approach taken by the Government in this year’s Health Budget given the difficult fiscal environment.
The Association welcomes the investment in the suite of initiatives comprising the new cancer package – World Leading Cancer Care – and the further investment in mental health.
However, the Government has failed to address some of the most important issues facing the Australian people.
The Gillard Government has claimed credit for reduced waiting times in emergency departments arising from its investment in sub-acute services. However with no ongoing commitment to the sub-acute programs the gains achieved will quickly evaporate and pressure will again be directed back onto acute hospitals leading to longer waiting times and poorer outcomes.
The Government has overlooked the opportunity to make a significant commitment to addressing the social determinants of health. The Senate Standing Committee on Community Affairs recently recommended that the Government commit to addressing the social determinants of health and give consideration of the social determinants of health in all relevant policy development activities. This Budget has done nothing to implement those recommendations which are critical to addressing the inequities that exist in health outcomes.
It is extremely disappointing that the Budget includes savings measures that will result in higher out-of-pocket costs for medical services, such as delaying Medicare rebate increases and tightening criteria for the Medicare safety-net. Australians already face higher out of pocket costs when accessing health care than people in most comparable countries and these measures may widen the disparity. Despite current high rates of bulk-billing, this will adversely impact on people in areas with poor access to bulk-billed services, particularly those in rural and remote areas who already disadvantaged.
National Primary Health Care Partnership: A sensible approach to health spending
The National Primary Health Care Partnership (NPHCP) welcomes what it believes is a sensible approach to health spending in last night’s Federal Budget.
NPHCP Chair Damian Mitsch stated that “We largely commend the Government on its health budget announcements. It could have taken a slash and burn approach to help deal with its ominous fiscal outlook, but instead it demonstrated a commitment to addressing some of Australia’s most pressing health needs; maintaining or increasing funding in a number of important areas.”
“The Government’s announcement that it will allocate additional funding to the primary health care nursing, Indigenous health, and rural and remote health workforce sectors, in particular, demonstrates its commitment to reorienting our health system to one that focuses more on prevention and health promotion, and on delivering services closer to where people want them – in their communities.”
The NPHCP believes that in addition to consumer preference, the cost savings associated with strong primary health care cannot be ignored by governments; particularly in the constrained fiscal environment we find ourselves in. “We know that hospital care is the most significant cost burden on our system, and knowing that primary health care works to keep people well and out of hospital, such as through preventative measures and better self-management, then surely investing in it to do its job is smart fiscal policy for any government,” Mr Mitsch said.
The NPHCP is a strong supporter of Medicare Locals in helping to drive this change. “Medicare Locals are providing a much-needed vehicle through which this system reorientation can occur. Many of them are already doing some great things, but more needs to be done, and they must be adequately supported by government to do so. That is why we strongly support the Government’s continued investment in them, and its decision to implement a Medicare Locals Accreditation Scheme. This will help promote value for money by ensuring Medicare Locals are employing best-practice organisational management and service delivery processes when serving their communities”.
“The budget announcement that there will be a freeze on rebates for GP services confirms that this Government is not concerned that many Australians delay or don’t see their doctor when they are sick because it costs too much,” said Dr Tracy Schrader, president, Doctors Reform Society.
“Last week Minister Plibersek claimed that the Government’s reforms had led to improved access to GPs and increased bulk billing rates”, said Dr Schrader.
“Now that they are freezing the rebates, doctors will once again move away from bulk billing and patients will pay extra or go without. This hypocritical position by the Government, firstly claiming it is great that bulk billing rates are up and then imposing a freeze on rebates which will make rates go down, needs to be exposed.
“It indicates that the prevailing view of the Government is that the poorest and most disadvantaged Australians should bear the burden for the delayed effects of the global financial crisis”.
“Doctors who want to bulk bill patients because they know that it means patients can afford to see them, will now have to either face an income cut (whilst politicians pay rises continue unchecked despite tough times}, or stop bulk billing and run the risk of dissuading patients who are struggling”.
“Whilst funding for the NDIS, the Gonski reforms, the dental scheme and other smaller but also important projects will all be important for the general health of Australians, the great health reform agenda of this Government has not included any major reforms to address the problem of cost barriers to seeing doctors”, said Dr Schrader.
“Despite the two party consensus that these are economically constrained times the truth is otherwise as we see the gap between rich and poor increase and Australians taxed at lower rates than most western nations.”
“This budget measure is a cynical and hypocritical decision by the party which introduced Medicare nearly 30 years ago. It is hard to recognise as the same party”
Mental Health Council of Australia: “A stronger economy, a smarter nation and a fairer society” needs a longer term investment in mental health reform
The Mental Health Council of Australia has described the federal budget as a missed opportunity to continue to build on much needed investment in mental health reform.
“If Australia hopes to achieve the Treasurer’s goal of building “a stronger economy, a smarter nation and a fairer society” then we need a longer term funded plan for investing in mental health reform,” Mental Health Council of Australia CEO Frank Quinlan said.
“We understand that we are living in a tight fiscal environment, but this just underscores the need for a longer term plan for investment and reform. Real fiscal discipline requires spending on the things that matter in the lean years as well as the bountiful years.
“Spending on mental health reform is too important to be dependent on the short term rise and fall of international financial markets and political fortunes.
“The Mental Health Council of Australia is pleased to see that there have been no real cuts to mental health spending, but it is difficult to see how mental health reforms will be sustained without substantial investment every year for the next decade.
“We welcome the inclusion of mental health spending within the NDIS. This investment is genuinely transformative, substantially because it is sustained over such a long period of time.”
“Investments in the Mental Health Nurse Incentive Program, Veteran’s Mental Health, victims of forced adoptions practices, and perinatal mental health are also welcome.”
Following the Budget, the Council asks all sides of politics to commit to long term mental health reform, ensuring a sustained approach for at least the next ten years.
“Australia has not forgotten the optimism and the heady commitments to mental health that were made by both sides of politics in 2010,” Mr Quinlan said. “Australians living with mental illness are still experiencing stigma, are still struggling to find appropriate services and are still falling through the cracks.”
Palliative Care Australia: A missed opportunity to support Australians at the end of life
Despite predicted growth in the numbers of Australians dying annually, the 2013 Federal Budget has failed to recognise the integral role of palliative care in the health system.
“In the context of the recommendations made in the recent Senate Inquiry into Palliative Care in Australia this Budget is simply disappointing”, said Professor Patsy Yates, President of Palliative Care Australia (PCA). “This has been a missed opportunity to make real improvements in people’s experience of death and dying.”
PCA has long advocated for advance care plans to be included in the Personally Controlled Electronic Health Record (PCEHR) and welcomed last Thursday’s announcement that this work would be funded. This is a significant move forward to ensure that people’s wishes are recorded and recognised, but does not in itself improve end of life care.
“Across the nation health care staff delivering palliative care are losing their jobs. Services are being decimated. Yet there is no money at all for the palliative care workforce in this Budget,” commented Dr Yvonne Luxford, Chief Executive Officer of PCA. “As rates of complex chronic disease increase, the need for a comprehensive palliative care workforce strategy is essential.”
Specialist palliative care is delivered by a multidisciplinary team comprising medical, nursing and allied health staff, working alongside pastoral carers, pharmacists and volunteers.
“If we don’t fund specialist palliative care workforce development now Australians will die without access to the services we need”, warned Dr Luxford. “To be blunt, that means without access to the level of pain management and symptom control that we all expect.”
“Of course, not all people require access to specialist palliative care, but they do need their primary care team to understand the palliative approach. It is simply essential that a significant education program be funded both for the community and all health professionals to ensure that all Australians are well supported as they move towards the end of their life.”
Lewis Kaplan CEO General Practice NSW
An issue which will cause annoyance is the new rule that a GP can’t bill Medicare for a standard consult on the same day they bill a chronic disease management plan. This is not helpful to patients who may have difficulty accessing a doctor and need e.g. a small procedure which is not connected to the CDMP and don’t want to have to attend the surgery a second time. It’s also not helpful to GPs who could have more efficiently seen a patient for more than one reason. I’d be very surprised if this item is being rorted, rather it’s a good use of GP and patient time. An example of a decision taken in the interests of a backroom Treasury person rather than a front-line health service provider.
Modest steps in the right direction on ageing and aged care: Hal Kendig, Professor of Ageing and Social Policy, Australian National University
An initial reading of the 2013-2014 Budget suggests that the Government is moving ahead, albeit slowly, with resources for the Living Longer, Living Better (LLLB) reforms and for innovative new directions forthcoming from the Advisory Panel on Positive Ageing.
After the Government launched its LLLB aged care reforms last year, its 2012-2013 budget provided modest initial resources with outlays committed mainly towards building community care towards the end of the four year forward estimates.
The current year budget slowly advances these plans, mainly for expanded home care packages and the My Aged Care website, although later years reduce the previously anticipated growth apparently as part of overall budget trimming.
Valuable but small initiatives related to the Advisory Panel on Positive Ageing include a pilot program to facilitate pensioners downsizing their homes without financial penalties; increased access to broadband internet access; a scoping study on wound management; and a translational research and policy centre to apply evidence to the positive ageing agenda.
These initiatives are on top of significant pension increases mainly for single pensioners over recent years; ongoing increases of health expenditure for all age groups; and initiatives to enable people to work longer.
Overall, major initiatives in ageing, as with other areas, are being left on hold until the years after the Election in a likely difficult fiscal context. It will be challenging to advance plans for consumer-directed care reforms and entitlement-based care in what already are heavily rationed allocations.
User pays is foreshadowed as part of the answer and this will require careful policy work to ensure equitable access and fair treatment for those with few resources of their own.
In the aftermath of this Budget the Business Council released a well-publicised statement warning about the costs of population ageing ahead.
That is the big picture issue but it is by no means clear that the spectre of ageing can be fairly raised as the major cause of increasing health care and income support costs.
On the contrary, the Positive Ageing Panel raises promising directions for older people to contribute more to the nation’s productivity and to their own support in the context of living longer and an ageing Australia.
Leading Age Services Australia
Budget 2013 has no real surprises for the age services industry or for health generally. It has been pitched as balancing structural spending with structural saving to support the government reform agenda in a tight fiscal environment.
LASA welcomes a budget with no surprises but laments a lost opportunity to further enhance the reform process by ensuring that funding matches the cost of care for older Australians.
LASA notes that $60.2 million was removed from the workforce compact in line with the 5 March launch of the supplement. $60.2 million removed from direct care of older Australians.
LASA looks forward to being a participant in the research from the Andrew Fisher Applied Policy Research initiative ($4.6M) to enhance positive ageing for all Australians and to enhance the ability of the age services sector to meet the increasing demands of an ageing population.
The removal of $80 million from Health Workforce Australia may adversely affect age services which will need to recruit almost 600,000 workers in the next 30 years.
Some disappointments from nursing perspectives: Professor Mary Chiarella, Sydney Nursing School, University of Sydney
From a personal big picture perspective: great news about the NDIS, the education funding, the terrific focus on preventive health screening for cancer.
From a nursing perspective, I’m disappointed that they didn’t follow up on the need to boost nursing retention and productivity – the HW2025 study showed that a 20% increase in retention would address the 2025 shortfall almost completely. There are decades of research that demonstrate nurses leave the profession for 2 reasons – 1. because they don’t feel valued or respected and 2. because they are unable to delver the quality of care they were educated to deliver.
Enabling increased productivity has occurred on a minor scale through projects like the MHN scheme, but there were huge opportunities to assist nurses and midwives to work to the full scope of their practice through added MBS support for Nurse Practitioners (NPs) in private practice.
Currently NPs in Australia receive 85% reimbursement of fee for service from Medicare, compared to the 100% received by physicians. NPs in private practice in Australia have access to a limited number of Medicare Benefit Schedule (MBS) items, only four items, compared with physicians who can access many more (Medicare 2010).
These four items are characterised by their length of consultation. For example, a short patient consultation with limited examination and management is valued at $9.20, of which the NP may receive 85%, $7.85. A 40-minute consultation involving extensive history taking and examination and management is valued at $56.30, of which the NP receives $47.90 reimbursement from Medicare (MBS 2013).
For the provision of comparable services, the scheduled fees for General Practitioners are $16.60 and $103.50 respectively, over double the reimbursement of an NP. Greater MBS support for NP services would have been a valuable message for nurses both in terms of recognising their value and increasing their productivity.
COTA Australia: Welcome initiatives for older Australians but the most vulnerable left wanting
Older Australians will welcome initiatives to improve internet skills, increased action on breast, prostate and bowel cancer screening, and continued commitment to pension indexing and major aged care reform, said leading seniors advocacy body COTA Australia.
However they will be disappointed the 2013 Federal Budget does little to support the most vulnerable older Australians.
COTA Chief Executive Ian Yates said it was disappointing an increase to the Newstart allowance was not included in this Budget given the fact that a third of long term Newstart beneficiaries are over 55.
“These people struggle for years on Newstart, with many failing to find employment, until they qualify for the Age Pension. The result is many older Australians spiraling below the poverty line,” Mr Yates said.
COTA welcomes the ‘Housing help for older Australians’ pilot which supports pensioners who want to downsize to a more suitable home. Under the scheme they can put up to $200,000 of the excess sale proceeds from the family home into a special account and the capital and interest will not be counted under the pension income and assets test.
“While a positive step forward the scheme has its limitations,” Ian Yates said “ We welcome any initiative that gives older Australians more freedom to make appropriate lifestyle choices but the pilot scheme has some limitations which will significantly reduce eligibility, so we will be talking to the government about that.
“We would like to see pensioners being able to draw income from these funds to meet the costs of aged care and health services, which is not permitted as the scheme currently stands.
“The scheme doesn’t address one of the most vulnerable group of pensioners, those in the private rental market and at risk of homelessness. COTA has repeatedly called for an increase in rent assistance and the establishment of a Social Housing Growth Fund to support older Australians in the private rental market many of whom, especially single women, are experiencing significant housing stress.”
COTA Australia supports encouraging older Australians to become more confident with internet technology. “The additional $9.9m for new technology and training grants in the Broadband for Seniors program will encourage further internet use but there should also be help for lower income older Australians to connect the internet to their home, especially with the roll out of the NBN,” Mr Yates said.
“Many pensioners are challenged to afford internet access, not just the initial set up costs but the ongoing service charges. We have been advocating for a broadband supplement for pensioners for some time.”
COTA Australia welcomes investment in collaborative and integrated academic research. “We hope that the establishment of the $4.6m Andrew Fisher Applied Policy Institute for Ageing will provide the opportunity to do just that.
“We want to see research activity that connects the community, the corporate sector and the government with academia to deliver meaningful advice that works for older Australians in the real world beyond their immediate health and aged care needs.”
Mr Yates said older people would also welcome the additional commitments to cancer research and treatment.
“COTA Australia has been advocating for an extension to the age limit of the Breastscreen program for years and we’re delighted that this has been taken up.
“We are also pleased that other cancers that affect mostly older people have been given a priority in the Budget with funding for a new Australian Prostrate Cancer Research Centre and additional funding for the Bowel Screening program which saves many thousands of lives.”
COTA Australia considers the change to the Pension Bonus Scheme as an inevitable part of the winding down of that scheme.
“The Pension Bonus Scheme closed on 20 September 2009 and this change ends the grandfathering arrangements whereby people who qualified before that date have been able to enter scheme. Even then the scheme doesn’t close to these individuals until 1 March 2014.
“We urge everyone who is eligible to enter the scheme to do so in the next nine months.
“COTA welcomes the fact that the Government’s major social policy initiatives for older people have emerged unscathed from a difficult Budget.
“The age pension reforms continue to provide pensioners with unprecedented increases through indexation on top of the major increase in 2009.
“The Living Longer Living Stronger aged care reforms – for which crucial legislation is now before Parliament – will provide older Australians with more care in the home, more choice and control over services, and a fairer and more sustainable system.”
Community Services and Health Industry Skills Council: workforce concerns need attention
A driving issue facing the community services and health industry at this time is its capacity to overcome constraints in delivering care, says CEO of Community Services and Health Industry Skills Council (CS&HISC), Rod Cooke.
“And we don’t believe this has been addressed in the 2013 Budget,” Rod Cooke said.
CS&HISC welcomes the Budget’s aged care spending inclusions, and the locked-in commitment to DisabilityCare Australia.
“Both should bring genuine benefits to people across Australia, but the question of who will be providing this support and care continues to go unaddressed,” Mr Cooke said
“The strength of DisabilityCare Australia is undermined by the omission of funding for current and future vocational education and training (VET) qualifications, required to meet the ever expanding and changing Aged Care and Disability services workforce need.
“We’re concerned that the importance of the VET workforce and unpaid carers, that is, the people who will provide the bulk of care, are being undervalued by a decision to not pay more attention to workforce issues,” said Mr Cooke.
“All the good work that’s been put into getting the NDIS and the Aged Care reforms might come undone if the workforce issues associated with the scheme are not integrated now.
Aged care providers and trade unions have been saying for a while now, there’s no way we can enable that sector to cope with the increased pressures of an ageing population unless we undertake a true assessment of how much it actually costs to deliver care now and in a reformed sector,” said Mr Cooke.
“In Aged Care, a nationwide cost of care study would determine what kind of funding figures providers will need to be able to deliver care, sustainably. This is also true for Disability care and support.
“Any cost of care study must take into account all the costs involved with the provision of care, including the true cost of labour – wages, expected pay increases, adjustments in the workforce supplement, and the cost of workforce development, and vocational educating and training.”
The care workforce is predicted to continue to grow faster than any other industry. National data from the Australian Workforce and Productivity Agency (AWPA) states that the health care and social assistance workforce employed almost 1.3 million employees in 2011.
Modest predictions estimate an increase to 1.6 million workers (35 per cent rise) while generous estimates predict a rise to almost 2.1 million (77 per cent) by 2025.
Over 60% of care is delivered by Vocationally Educated and Trained (VET) qualified workers (up to 83% in Aged Care), yet there has been no information released in the Budget as to how Australia will recruit, train and retain a qualified workforce to deliver this care and support.
Despite these figures, Mr Cooke continued, there has been no extra funding allocated to enable the industry’s future workers access to VET qualifications.
“Funding has been earmarked to support up-skilling existing workers and apprenticeships, but there has been nothing mentioned about training new workers to this industry.”
The Australian Medical Students’ Association (AMSA) believes the Federal Budget has failed to set out a long-term vision for quality medical education in Australia or for tertiary education generally.
AMSA President, Ben Veness, said the NDIS and the Gonski school reforms are admirable and worthy long-term goals for the Government and the country, but university education should be afforded the same status and support.
“There was some welcome new funding for the university sector in the Budget but nothing of the magnitude to offset the recent huge cuts to higher education,” Mr Veness said.
“The Government has ignored two reviews, that it initiated, which both recommended increased funding for universities, and medical education in particular.
“The Review of Australian Higher Education recommended increased funding for universities. The Higher Education Base Funding Review Panel Report of 2011 found that medical schools were particularly underfunded.
“Medical schools remain underfunded by around $20,000 per student, per year.
“The Government needs to better support universities to provide secure and affordable learning environments for future generations of students, including for medical education.”
“Health Minister Tanya Plibersek has been active in solving medical training pipeline issues through COAG and Health Workforce Australia but she has had to act on a year-by-year and State-by-State basis because of funding uncertainty into the future.
Mr Veness said AMSA welcomes funding for Closing the Gap, cancer care, and DisabilityCare.
“We are disappointed, however, with the delayed increases to foreign aid and failure of the Budget to provide greater support for university students.
“Youth Allowance payments remain well below the Henderson Poverty Line and Start-up Scholarships have been turned into loans that add to student debt and may discourage participation, especially from low socio-economic background students.
“Universities Australia data, released last week, showed that 17 per cent of university students regularly miss meals because they can’t afford them.”
AMSA’s Pre-Budget Submission can be found on its website.
Some SMH Budget stories that may be of interest