This post compiles rolling reactions to the 2014-15 Federal Budget, handed down tonight, and including major cuts to health, welfare, and education, and a raft of tough measures affecting vulnerable groups – including the much-flagged introduction of a $7 GP co-payment.
Professor Mark Harris (comment)
The $7 co-payment on Medicare services and increases in the PBS co-payments will cause hardship for disadvantaged patients on low incomes. It will also have a chilling effect on efforts to improve continuity of care and prevent presentations to hospital emergency departments (ED). A patient requiring a GP visit which also involves a pathology test and imaging would have at least a $28 co-payment (including a second GP visit to find out and review the results of the tests). This will create a strong incentive for patients present to hospital. Although they will have longer waiting times at hospital (as demand increases thereby reducing ED capacity to deal with emergencies), these disadvantages for low income patients will be offset by the lack of a GP co-payment and the convenience of getting it all done in one place and one time. The only way to reduce this extra demand will be for States to introduce their own co-payments, although it will be costly to establish and operate money collection systems within the ED especially after-hours. The Medicare co-payments will also make it more difficult to shift care of low income patients from the ED or hospital or community health services back to general practice. This will affect referral from ED to GP after-hours services, referral of patients back to general practice on discharge and referral from community health or ambulatory services back to general practice (eg for wound care). The end result of all this is likely to be less fair and less efficient.
National Welfare Rights Network (media release)
“This is a budget that is very harsh on people living on low incomes including people with disabilities, the jobless and young people. Structural changes in the budget will cause financial harm to people on low incomes for years to come. By contrast, people on high incomes face some temporary and short-lived pain”, said Maree O’Halloran of the National Welfare Rights Network. “Most of the heavy lifting in balancing the budget is being achieved off the backs of those who can least afford it.”
“The modest changes targeting high income earners, such as the deficit levy and the freeze to politicians’ wages will be little more than a temporary irritant, but the slug to unemployed people, young people and people with disabilities are permanent and punishing.
Restricting unemployment payments of people under 30 to rolling six monthly spells heralds the beginning of the Americanisation of Australia’s welfare system. Time-limited welfare payments aren’t the way we do things here. This extreme proposal is a recipe for increased homelessness, poverty and social division.
Single parents on Parenting Payment, 90% of whom are women, are again this year the target of harsh budget cuts. Around 220,000 single parents face lower payments due to heartless changes to payment indexation rules. Cuts to Family Tax Benefits will send families to the poorhouse. Many single parents on Newstart will feel betrayed by the counter-productive decision to axe the Pensioner Education Supplement (PES), which is paid to over 41,100 people. This payment provides up to $64 a fortnight to 16,788 single parents and 18,100 people with disabilities with the costs of education and study.
It appears that processes around the Commission of Audit, the Budget, and the McClure Welfare Review are setting the scene to strip away the protections of Australia’s social security safety net.
For over nine months, some sections of the media have created an atmosphere of fear, where the unemployed and people with disabilities have been demonised.
Australia does not have a budget emergency, and compared to other OECD countries, Australia is travelling remarkably well. Australia has had continuous growth since 1991, and avoided the pain of the global financial crisis in 2008.
Our debt to GDP ratio is relatively low compared to other OECD countries and we are a low taxing country. We are also one of the lowest spending counties when it comes to welfare. Australia currently spends 8.6 percent of our national income on income support, compared to an OECD average of 13.2 percent. The share of wages in GDP has also been declining for about two decades with the profit share rising. As a result, we are a more a country that tolerates more and more inequality.
Of course our national budget needs careful managing, and, like many nations we face the challenges of an ageing population. However, it is wrong to manufacture an economic crisis to justify deep and harsh spending cuts which will disproportionately hurt the poor and disadvantaged.
It’s disappointing that the Government is cutting programs rather than undertaking the essential reforms needed to make our tax system fairer. Tackling excessive superannuation tax concessions, which favour high income earners, and reviewing negative gearing, private trust arrangements and other tax loopholes should have been a priority.
The Government has focussed on the capital infrastructure needs of the country, but it has failed to adequately invest in the nation’s human infrastructure. We need adequate investment in employment assistance, training, support for TAFE and programs like Youth Reconnections.
National Welfare Rights will assess this budget by how it affects people on low incomes and vulnerable people and how it equips us for the future ageing of our population. Most importantly, we need to assess whether the changes make us a better society.
The test of the changes to the Disability Support Pension will be if people achieve sustainable paid employment or are just pushed into poverty on a lower payment with a harsher means test. Changes affecting people on the Disability Support Pension aged under 35 must be carefully and sensitively implemented. Activity testing needs to be constructive, should not exacerbate existing medical conditions, and not place people at risk of being penalised.
The real problem for people under 35 with disabilities is the lack of employment opportunities and the reality that employers – and even the Government – are unwilling to take a chance and give them a start in life. What employer or business will give a person under 35 a go if some elements of the tabloid media have already labelled people on the Disability Support Pensions as lazy shirkers and scroungers?
People reliant on Centrelink support will be bitterly disappointed that this budget contains no measures to address the growing queues at the counter or on the telephone. The missing correspondence and excessive review delays and poor quality letters that the Commonwealth Ombudsman recently highlighted won’t be improved by cutting staff. An austerity budget like this one means that more people need the assistance of experienced and knowledgeable public servants.
Our message to Labor, the Greens and the minor parties in the Senate is that we want them to stop the attacks on welfare recipients, not a tax on high income earners (even if it is only temporary).
Despite some modest positive initiatives, this is a budget that targets people on low incomes who are struggling to make ends meet.
Budget changes that are of concern to NWRN:
- · Increasing to the Age Pension eligibility age to 70 by 2035.
- · Repetitive reviews the medical conditions of DSP recipients under 35
- · Failure to increase $510 pw Newstart Allowance, which will shrink to half the rate of pension by 2040
- · Eligibility age for Newstart and Youth Allowance increased from 22 to 25 years, from 1 January 2015, saving $508 m over 5 years
- · Require unemployed people on Newstart and Youth Allowance aged under 30 to serve a six month waiting period in addition to existing waiting periods. These job seekers might only receive income support for six month per year, and be required to serve six months in Work For The Dole, with various exemptions, saving $2b over 4 years
- · Harsher job seeker compliance rules, saving $20.9m over 4 years
- · Expand Work For The Dole scheme for 18-30 year olds, costing $14.9m over two years
- · Apply a one week waiting period for all ‘working age’ payments from October 2014, saving $231m over five years
- · DSP recipients under 35 face reviews if granted DSP between 1 January 2008 and 31 December 2011, saving $46 m over 5 years
- · Compulsory participation requirements for DSP recipients with some work capacity under 35, costing $29.3m over 5 years from 2014, with financial sanctions for non-compliance
- · Family Tax Benefit B restricted to families on less than $100,000 per year, until the youngest child turns 6. Low income single parents eligible for a $750 a year for each child aged between 2 and 12.
- · FTB A frozen for 2 years and FTB B frozen for 3, large family supplement tightened, with total changes to FTB saving $7.3b over 5 years
- · Restrictions to Jobs, Education and Training Child Care Fee Assistance
- · Pensioner Education Supplement axed from 1 January 2015, costing $281m over 5 years
- · Employment Entry Payment of $208 axed, saving $65m over 4 years
- · Parenting Payment Single indexed to prices instead of wages from 1 July 2014, cutting payments by $70 over a decade
- · Pensions indexed to prices instead of wages from 1 September 2017, cutting payments by $80 over a decade
- · Axing of the National Rental Affordability Scheme, saving $235m over 3 years
- · Curtail portability for students and restrict DSP overseas portability to 4 weeks, saving $153m and $12.3m over 5 years
- · Axing specialist Career Advice for Single Parents Program, saving $5.8 m over 5 years
- · Axe Centrelink Connection Interviews and Job Seeker Workshops, saving $4.4m
- · Restrict access by volunteers to Job Services Australia assistance, saving $52.5m over 5 years
- · Freeze Allowance, Parenting and non-pension payment thresholds from 1 July 2014 and for pension payments from 1 July 2017
- · Income Management to continue in place-based locations, the NT and other sites and expanded into Ceduna from 1 July 2014, for 1 year, costing $101m
- · Termination of certain concessions for pensioners and Seniors Health Care Card Holders, costing $1.3b over 4 years
- · Pharmaceutical Co-payments increased by $0.80 to $6.90 in 2015, and $5, to $42.70 per script, at a cost to sick people of $1.3b over 4 years
- · A $7 co-contribution to visit the doctor, from July 2015
- · Reduction in funds to Financial counselling and some Community Legal Services, including Welfare Rights
- · Removal of funding for the National Congress of Australia’s First Peoples, saving $15m over three years.
Budget announcements that NWRN supports:
- · Introduction of a temporary 2% increase in tax for high income earners
- · Restoring twice-yearly indexation of the fuel excise
- · Axing the Seniors Supplement from September 2014, saving $1.1b over 5 years
- · Including untaxed superannuation income in eligibility assessment for the Commonwealth Seniors Health Card, saving $20.9m over 5 years
- · Providing $301m over 4 years for Restart, a $10,000 incentive for employers who hire older workers who have been on payment for at least six months.
NWRN will make further analysis of the Budget in the coming days.”
Australian and New Zealand College of Psychiatrists (media release)
The Royal Australian and New Zealand College of Psychiatrists has welcomed several announcements relating to specific initiatives and new research priorities in this year’s Federal budget, however it has also expressed concern around the potential negative impacts on the most vulnerable members of our community. Changes to the Disability Support Pension and the introduction of co-payments for GP visits and accessing prescription medications may have a disproportionate impact on those who can least afford it.
It is pleasing to see funding extended for the Mental Health Nurse Incentive Program (MHNIP) for another year. RANZCP President Dr Murray Patton says this extra funding supports a valuable program which ensures coordination between psychiatrists, general practitioners, and mental health nurses, and which is crucial to the delivery of good patient care, and the College would like to see this continued in future years.
“An evaluation of the MHNIP in 2012 found that it had the potential to reduce mental health related hospital admissions by approximately three days per patient with severe mental illness and would be associated with a cost saving per patient of around $2600,” Dr Patton says.
Dr Patton has also welcomed the establishment of a Medical Research Future Fund and news that investment in dementia research will be increased.
Mental illness is a major health and social issue, with one in five Australians experiencing a mental illness in any one year. Almost half of all Australian adults (45%) are affected by mental illness at some time in their life. Disorders of the brain and mind impose the greatest burden on Australian health of any disease group, contributing over 22% of the aggregate losses, well ahead of cancer at 11.3% or heart disease at 9.9%.
“The new Medical Research Fund must ensure that research into mental illness is funded according to the burden of disease attributable to mental health, to prepare Australia for the mental health challenges facing us in the coming years. This must include research into the causes of mental illness and its distribution in the community, effective treatments and therapies and research into the metabolic effects of many psychotropic drugs.”
Dr Patton says a commitment to increase funding for youth mental health services is also good news.
“Recent statistics show an increase in the prevalence of suicide, particularly among young children. Prevention of these tragedies should be a major Australian priority.”
Dr Patton says there are concerns around some areas of the budget such as changes to the Disability Support Pension, an increase to Pharmaceutical Benefits Scheme co-payments for subscription medicines, and health funding arrangements to states.
“The College is worried about the possible impacts that increased fees to see a doctor, and then to get medication, may have on a person’s willingness to seek treatment or on their eventual recovery.” “Also of concern is the lower rate that the Disability Support Pension will be paid out, this too could affect people living with mental illness.”
Dr Patton says there is also a lack of clarity around issues like hospital funding and the College will be commenting further after it undertakes an in-depth analysis into the implications of the budget on mental health.
Catholic Health Australia
Martin Laverty, CEO of Catholic Health Australia, got up early this morning to video his response to the Budget in front of an impossibly blue Canberra sky. His broad analysis of the impact of the Budget covers all areas of CHA’s operations, including public and private hospitals and aged care and in particular focusses on the impact of the $200m cut to public hospitals. As one of the few stakeholders with an interest spanning the public/private, health/aged care and Commonwealth/State divides, his take on the impact of the Budget is worth watching.
Vern Hughes: Why do politicians in Australia not get health reform? (commentary)
There is no policy area with a tighter bi-partisan commitment from Liberal and Labor to avoid structural reform than health policy. In almost every other portfolio area, there is at least some semblance of a reform agenda. But in health, we have unanimity from Labor, Liberal (and the Greens) that no structural reform is needed in health care, and that financial bandaids applied here and there are enough.
Joe Hockey’s medical research future fund is not health reform, any more than rationalisations in federal and state responsibilities in health care under Labor was health reform. The notion that health care costs can be reined in by curing cancer, dementia, and neurological disorders through medical research, is farcical, and is not public policy at all, let alone good policy. It is simply wishful thinking of the worst kind – holding out hope for people with these conditions that a cure is imminent. It perpetuates a faith in the efficacy of medical research and technology to deliver better health outcomes which diverts all of us from the structural reforms needed in moving towards a consumer-centred, rather than a provider and illness-centred, health system.
The introduction of a $5 levy on GP visits to fund this promise of hope (while allowing GPs to retain the other $2) makes no sense as a budget repair measure – it makes no contribution to repairing the budget, since its revenue will not find its way into the budget revenue column. While the impact of this $7 levy on health equity has been wildly exaggerated by the public health lobby, the levy itself is a pointless exercise, and will make no contribution to the re-organisation of primary care away from system gate-keeping towards illness prevention.
Medicare Locals are a thorough waste of public expenditure, and have been another major diversion from real reform. Scrapping them simply stops some of the industry-driven waste in health care, it does not lead us towards structural reform.
Amidst the confected fury about GP co-payments, the demise of Medicare Locals, and the folly of seeking policy panaceas in scientific research, there will be no public debate arising from this budget about real structural reform and its fundamental pre-requisite – the development of associations of health consumers to act as demand aggregators and purchasers of integrated care in an otherwise fragmented, excessively costly, provider-driven, illness-oriented health system.
The Climate and Health Alliance (media release)
The first federal budget from the Abbott government has failed to set a course for a healthy prosperous and sustainable future, the Climate and Health Alliance (CAHA) said today.
While the federal Treasurer Joe Hockey has claimed all Australians have to do some ‘heavy lifting’ to get the budget back into surplus, CAHA is alarmed at the removal of important policies with health, social and environmental benefits, while corporate subsidies for polluting industries are retained or expanded. CAHA President Dr Liz Hanna said: “The budget would be better served if the federal government reversed its decision to scrap policies such as a price on carbon pollution, or by taxing the profits of mining companies.”
“The real sources of wealth in a community are the health and wellbeing of people and the health of the natural systems that support human life. By walking away from climate action, and scrapping important environmental initiatives, this government is imposing enormous economic, social and environmental burdens on the community. These will compromise those that already suffer ill-health or are less well off, as well as impose unjustified and avoidable burdens on future generations.”
The abolition of the Australian Renewable Energy Agency (ARENA), established to boost the rollout of affordable renewable energy; scrapping of $10 billion Clean Energy Finance Corporation; and plans to remove the carbon price are all working in the opposite direction to what is needed for future health and wealth of Australians. These policies will actively worsen the health of Australians, Dr Hanna said.
“There is billions of dollars worth of subsidies being provided to companies that produce large quantities of pollution, including carbon emissions, that pose health risks to people now and harm the prospects of future generations by promoting further climate change.”
Large cuts to health and aid budgets are being made to direct revenue to big carbon polluters from the Emissions Reduction Fund, in which high emitting companies will be paid to cut emissions.
“This is a very perverse approach to delivering necessary and urgent emissions reductions – harmful emissions should carry a financial penalty, not an incentive,” Dr Hanna said. “Instead of investing in clean renewable energy which can provide thousands of jobs in struggling rural and regional areas, lower the nation’s carbon footprint and reduce health risks associated with air pollution, the federal government is offering handouts to polluting industries, subsidising fossil fuel use, adding new subsidies for exploration, and cutting funds for science, innovation and health care services.”
“This budget is a missed opportunity in a rapidly closing window of time to prepare Australia for a strong healthy and sustainable economic future.”
Public Health Association of Australia (PHAA): media release
The PHAA described the Budget as both regressive and short-sighted, with low income and disadvantaged Australians being slugged with cost-saving measures while the fortunes of the wealthy go untouched.
“This Budget is dominated by cuts to spending in key areas that will effectively kick people while they are down and result in an increasing burden on the health system over time. Many of the funding cuts appear to be short sighted approaches that do not recognise the health and economic costs associated with the growing burden of chronic disease. Almost $8.6 billion will be cut from the Health Budget over 4 years,” said Michael Moore, PHAA CEO.
“We vehemently oppose the introduction of a $7 co-payment for GP visits, out-of-hospital pathology and diagnostic imaging services – a regressive measure that will invariably create barriers to accessing primary care for disadvantaged Australians and ultimately lead to larger burdens on hospitals. The longer term impact will be compounded by a $5 co-payment for PBS-listed medicines and the abolition of the National Preventive Health Agency, General Practice Education and Training Limited and the Australian Medical Local Alliance.
“These agencies focused on promoting preventive health approaches and primary health care designed specifically to reduce pressure and costs in hospital and acute settings. It is vital that there are agencies at the national level to protect and progress the national interest in key areas such as primary health care and preventive health.
“It has long been said that prevention is better than cure – certainly prevention is cheaper than treatment – and it’s false economy to cut funding in these areas to achieve short term savings. As it stands, only about 2% of the health budget is spent on prevention – if the Government wants to reduce pressure on the health budget over time, they should actually be looking to increase that figure. Instead, expenditure on prevention is reduced dramatically.
“Cuts in funding to Indigenous Affairs Programs (over $121 million over 4 yrs), dental health programs ($635 million over 4 yrs) and the National Partnership Agreement on Preventive Health (over $367 million over 4 yrs) are similarly counter-productive and are likely to be particularly expensive over time. It certainly flies in the face of the Government’s purported commitment to prevention and Closing the Gap in health outcomes for Indigenous Australians.
“Cutting nearly $54 million over the next two years from the Partners in Recovery mental health initiative is also likely to increase the burden on families, communities and the acute care sector. It is essential that there are comprehensive and cross-portfolio approaches to key health issues – like mental health – at the national level.
“This budget effectively puts the boot into disadvantaged, marginalised and low income Australians in a way that will invariably result in greater costs to the health system in the long term. It’s long term pain for short term gain – these spending cuts will cost a lot more over time. It’s not fair, it’s not right and it’s certainly not smart from an economic perspective. The creation of a new Medical Research Fund will do nothing to mitigate a diminished focus on preventive health at the national level.
“This really is a killer Budget in more ways than one,” he said.
Australian Council of Social Service (ACOSS): media release
ACOSS said it was deeply concerned that those in our nation who carry the greatest burden from spending cuts in the Budget are those who can least afford it.
“The Budget divides rather than mends. It entrenches divisions between those with decent incomes, housing and health care and those without them. It undermines the fabric of our social safety net with severe cuts to health, disability support, income support, community services and housing programs,” said ACOSS CEO Dr Cassandra Goldie.
“A few measures are in the right direction, targeting those for whom the age of entitlement should be coming to an end: Abolishing the Seniors Supplement, Capping Family Tax benefit part B at $100 000, introducing a levy for people earning over $180,000, and taking super payments into account in assessing eligibility for the Senior’s Health Card. Corporate welfare is also shaved. However, most of these measures will inflict little damage or will only be felt for a short time.
“The real pain of this budget – crushing and permanent – will be felt by people on low incomes, young people, single parents, those with illness or disability, and those struggling to keep a roof over their heads. These are the groups doing the ‘heavy lifting’ for the Budget repair job.
“One of the most disturbing targets of this budget are our young people. The new rules will deny income support to young people up to 29 years, for six months of every year, unless exempted, and then force them into work for the dole. It will deny them Newstart Allowance until 24 (a loss of $48 per week), and move more young people on DSP to Newstart or Youth Allowance, a cut of at least $166 per week. We are excited about the investment for older workers who lose their jobs, but why treat the young and the old so differently?
“Poorer families will also be worse off as a result of the freezing of family payments for 2 years, the $7 co-payments for doctor’s visits and other services, the fuel excise, and the increasing costs of PBS medicines. And no investment in lifting the abysmally low unemployment benefit (Newstart Allowance) for the individuals and families living the most meagre lives, in an otherwise wealthy country.
“For people on low incomes, housing is the biggest cost of living problem. Yet, this Budget offers no guarantee of future funding for homelessness services, and cuts funding to the NRAS, the one bright light for creating new affordable housing.
“To then cut funding for community services, including financial counselling and emergency relief – small amounts in big budget terms – just seems a cruel blow.
“We were told on election night that the new government would not leave anyone behind, now we find its first Budget places the most vulnerable directly in the firing line,” Dr Goldie said.
“The Government managed to find room in the budget to deliver a $4 billion tax cut for business, and major investments in infrastructure and defence.
“For a decent society, we need a budget that brings us together, rather than pulls us apart,” Dr Goldie said.
Stephen Leeder, Emeritus Professor of Public Health and Community Medicine at the School of Public Health and Menzies Centre for Health Policy, Editor-in-Chief, Medical Journal of Australia
The GP GST (which is what it is) will hit the poor, the chronically ill who already scrape. They will go to public hospitals to be paid for by an increase in STATE GST or lotteries or whatever. What on earth is going on?
The GP GST reminds me of the early days of hypothecation of the tobacco tax to pay for the opera! Probably need to rethink the linkage of that tax with the support of medical research.
By tradition Treasury HATES hypothecated taxes! Whole bunch of them in this budget – medical research, roads and so on. How sustainable?
Australian Healthcare and Hospitals Association (AHHA)
“Minister Dutton’s first health budget looks like a magician’s sleight of hand, with the cost burden shifted to the states and consumers; GPs given some sweeteners to manage co-payments; and a medical research fund which is big on promises but small on detail.
The AHHA says the introduction of co-payments will hurt those who require care the most – the elderly and those with chronic disease, and result in them delaying or avoiding seeking care, or being driven to public hospital emergency departments that are already stretched.
Of even greater concern to states and territories, it said, will be the lack of clarity around funding for hospitals beyond the next two financial years, with health and hospital funding swept up into the broader review of Commonwealth-state funding relations.
The AHHA welcomed investments in bowel cancer screening, youth mental health, some rural workforce initiatives, dementia research and ongoing support for e-health, but said the lack of focus on preventive health is “very short-sighted” and the medical research fund will be limited both by lack of funding clarity and its very narrow view of health.
It also welcomed moves to “reduce the alphabet soup of agencies” that have emerged over recent years and resulted significant duplication in data collection, analysis and reporting, although it would have preferred to have seen the retention of the Australian Commission on Safety and Quality Health Care as a separate agency with a broader role. But it said the redesign of the consolidated agencies should ensure that their objectives and structures are “fit for purpose”, and for leaders of the new agencies to be equipped with the knowledge, experience and skills to initiate major organisational change.
Finally, the AHHA said the decision to delay negotiations on the new National Partnership Agreement for additional Adult Public Dental Services threatens to reverse the recent improvements in waiting times for public dental care.
“There is still no sign of the National Oral Health Promotion Plan that has languished on the desk of the current and previous Health Minister for over 12 months. This, together with the latest cuts, raises concerns about the Government’s understanding of the importance of oral heath to overall health and its links with chronic disease.”
The National Aboriginal Community Controlled Health Organisation (NACCHO) welcomed continued funding for the 150 Aboriginal Community Controlled Health Services around Australia announced/confirmed in the Budget, saying it means “we can continue to provide high quality, culturally appropriate health care to our people for another year”.
“However, we also need long-term planning and budget resources to build on recent health gains and create lasting improvements to the health of Aboriginal people.”
NACCHO said there was also a great risk that the $7 GP co-payment “will create new barriers to healthcare for many Aboriginal and Torres Strait Islander Australians, including additional red tape for Community Controlled Health Organisations. Most Aboriginal and Torres Strait Islander Australians are low income earners and suffer the highest level of chronic disease, requiring regular GP visits.”
Giving States and territories the green light to charge for hospital emergency visits also created “a dangerous situation where people may not present for serious medical treatment for fear of the cost. “We will get the most benefit from policy that encourages Aboriginal people to seek medical attention and seek it early, not make it even harder for them to get the care they need.
NACCHO said the Federal Government should guarantee the $80-90 million cut across Aboriginal Health does not impact on-ground services and Aboriginal health outcomes.
“Aboriginal Community Controlled Health Organisations have a proven track record in providing a range of quality employment and education opportunities for Aboriginal people and boosting local economies. “Given cuts to Aboriginal health and employment budgets they are even more valuable – providing employment and training opportunities to our people which in turn boost local economies and tackle some of the huge barriers to Aboriginal people achieving economic independence and quality of life.”
Australian Medicare Local Alliance (AML Alliance): media release
The coordination of primary health care has been severely disrupted following the Federal Government’s decision to scrap the Medicare Locals’ national body, the AML Alliance.
AML Alliance Chair, Dr Arn Sprogis said the Government’s plan for primary health care is to destroy what’s already there only to re-establish another primary health care system – effectively primary health care 2.0.
“Between now and July 2015 as the Medicare Locals come to an end, it will be every Medicare Local for itself and any coordination will be via the health bureaucracy which is ill prepared and incapable of delivery,” Dr Sprogis said.
“Health services at the frontline will be in disarray beyond 2015 as another primary health care system is re-built and re-established,” he said.
“The losers tonight are patients, carers, health professionals and other Australians who need health services coordinated and supported now and not when they are re-arranged. Medicare Locals and the AML Alliance comprise the only national network that has the capacity to work with communities and health care providers to coordinate prevention, care improvement and cross sector initiatives and to find the gaps in services that are needed today, not after July 2015.
“Through its national-local structure of the AML Alliance, State Coordinators and 61 regional Medicare Locals, the Medicare Local network can think nationally, act locally and work quickly at the grassroots. This network structure provides government with national infrastructure to implement change initiatives at the health care coalface with clinicians, practices and other health care organisations while also linking with and attaining input from relevant national agencies.
“As of June 2014 there will be minimal coordination or primary health care nationally as what’s left of the Medicare Local network will now rely on bureaucrats embedded in Canberra to manage the system without AML Alliance,” Dr Sprogis said.
The Mental Health Council of Australia (MHCA) said it was encouraged to see the Federal Government meet its pre-election commitments to mental health, as well as provide certainty for the Review of Mental Health Services and Programs by the National Mental Health Commission.
MHCA CEO Frank Quinlan welcomed the expected funding commitment to youth mental health, headspace, the Mental Health Nurse Incentive Program, and the 12 month extension of funding to the Personal Helpers and Mentors Program.
However he said the MHCA was concerned about some Budget measures and the long term impact they may have on the mental wellbeing of the nation – especially young people.
“For example, a GP co-payment may discourage people with early signs of mental illness from seeking help quickly. We know that 70% of people with a mental illness do not currently seek help, but we also know the earlier we intervene the better.
“In addition, while we are keen to find ways to encourage people with mental illness, including those with a psychosocial disability, to seek employment, implementation of any new system should not see people removed from the Disability Support Pension without an achievable plan for their transition into work – including mental health treatment and support programs, skills development and training, and workplace reform.”
Reconcilation Australia says the Budget outlines a total of $549.4 million of savings from Indigenous programs, including $15m from Congress and $534.4m from program consolidation within Prime Minister & Cabinet (PM&C) which will see a new “Indigenous Advancement Strategy” comprised of five programs within PM&C:
- Jobs, land and the economy – focused on jobs, business and the use of land for economic development.
- Children and schooling – focused on school attendance, improving education outcomes, early childhood and families.
- Safety and wellbeing – focused on health and social and emotional wellbeing.
- Culture and capability – focused on maintaining culture, social and economic participation and that organisations are capable of delivering quality services.
- Remote Australia Strategies- focused on strategic investment in local, flexible solutions based on communities priorities and remote housing and infrastructure.
However Reconciliation Australia says it is not clear from the Budget what programs will be cut or consolidated as part of the changes within PM&C, apart from the confirmation of funding cuts to the National Congress of Australia’s First Peoples. Also missing, it says, is mention of funding for a further national partnership agreement on Indigenous health or investment for the National Aboriginal and Torres Strait Islander Health Plan.
In short, there are lots of questions yet to be answered about a range of Indigenous health, education, justice, housing and other programs: see its early reaction.
The Rural Doctors Association of Australia (RDAA) said it is pleased that the rural health sector has been spared substantial funding cuts amidst a wider healthcare budget of dramatic cost-cutting, but the introduction of a $7 Medicare patient co-payment for GP consults is of serious concern to rural patients and rural doctors.
“The new arrangements will only make it much more difficult for rural Australians, who are among Australia’s poorest people, to afford healthcare. It will also put additional pressure on rural practices and doctors, not only in terms of additional red-tape but also in terms of them having to cut already low consult fees for patients who simply cannot afford the co-payments.
“In many cases, patients unable to afford a GP consult will seek treatment at their local hospital. Because many rural doctors work at both their local general practice and the local hospital, they will experience an increasing number of hospital call-outs, including after-hours call-outs.
The RDAA welcomed a number of initiatives:
- the doubling of the Practice Incentives Program teaching payment for doctors and practices that are providing training to medical students and young doctors—at a cost of $238.4 million
- the introduction of a new $52.5 million program of infrastructure funding for rural and remote practices, to enable the practices to build the facilities required to take on more trainee doctors
- an additional 300 GP training places and 500 new nursing and allied health scholarships with a focus on boosting the regional and rural health workforce
But it was very disappointed that the “highly successful” Prevocational General Practice Placements Program (PGPPP) will be abolished, given its success in attracting doctors to general practice and ultimately rural general practice.
It welcomed reform of the existing Medicare Locals system, to be replaced by Primary Health Networks, but is concerned about the difficulties for rural PHNs in delivering services following the increase in geographic areas they will be given under the new arrangements.
See its full media release.
The Council for Older Australians (COTA) said older Australians have fared poorly in the Budget, with hits to the age pension, introduction of co-payments for health care, changes to aged care and the abolition of measures to improve housing affordability.
“Reducing pensioners living standards is a poor substitute for a comprehensive strategy for an ageing Australia,” said Chief Executive Ian Yates.
Yates said the changes to pension indexing arrangements meant pensioners would be $100 a week worse off in 10 years – a massive cut that would see many older people slip back below the poverty line.
COTA welcomed the introduction of $10,000 incentives to employ older workers, but said the Budget was missing measures which provide retraining to older workers or address the need for more flexible working arrangements as people age.
On health, COTA said $7 co-payments for GP visits, pathology and diagnostics, and 80 cents for medicines would put basic health care “out of reach” for many seniors. “Older people are in fact being hit with a triple whammy as large users of health care and medicines, getting slugged for visiting a doctor, having a blood test, and filling their prescriptions.”
In aged care, COTA’s biggest concern was the projected cut to the rate of real growth in the Commonwealth Home Support Program, and the axing of the Aged Care Payroll Tax Supplement that would see aged care providers pass on more than $650 million over the next four years to residents.
The decision not to continue the National Rental Affordability Scheme (NRAS) would put older, single women particularly at risk and was likely to force more older people into homelessness, it said.
Cancer Council Australia: media release
At least 35,000 Australian bowel cancer deaths will be prevented thanks to a $95.9 million, four-year plan to finalise Australia’s National Bowel Cancer Screening Program in the 2014-15 budget.
Cancer Council Australia CEO, Professor Ian Olver, applauded the Minister for Health, Peter Dutton, for committing to the completion of the program, which was introduced 10 federal budgets ago.
“Bowel cancer is the second-largest cause of cancer death in Australia, yet most cases can be cured if detected early,” Professor Olver said.
“Our research shows the Government’s commitment to bring the program’s full implementation date forward by 14 years will prevent at least 35,000 bowel cancer deaths over the next 40 years. By filling in additional gaps in the bowel cancer screening program from July next year, the benefit in lives saved will be maximised while full roll-out occurs.”
Professor Olver also commended the Government for its unprecedented commitment to medical research investment through its proposed $20 billion futures fund.
“Minister Dutton was always adamant that the Government would be guided by the evidence when it came to major investments in cancer care,” he said. “We are seeing that tonight with the $95.9 million for bowel cancer screening. Importantly, the new funding shows the Government’s preparedness to invest in programs that will realise their full health and economic potential over the longer term.
“We look forward to working closely with the Abbott Government on its research program to help ensure that future investments are also based on the best available evidence.
“The renewed commitment to medical research should put the Government in a position to collect and disseminate independent evidence to address the changing needs of an ageing population and challenges such as obesity.”
The Australian Academy of Science said the Budget is mixed for science; investing in some areas while pulling funding from others.
“While the new Medical Research Future Fund provides a positive vision, the rest of Australian science is left substantially weakened,” said Academy President, Professor Suzanne Cory in a media statement.
The Budget cuts at least $420 million over the forward estimates to five vital science agencies — the Australian Research Council (ARC) ($74.9 million), the CSIRO ($111.4 million), the Defence Science and Technology Organisation (DSTO) ($120 million), Australian Nuclear Science and Technology Organisation (ANSTO) ($27.6 million), and Australian Institute of Marine Science (AIMS) ($7.8 million) – as well as Cooperative Research Centres (CRCs) program ($80 million).
These cuts come after an overall decline in the science budget of $470 million since 2011.
The Academy welcomes the target to double National Health and Medical Research Council (NHMRC) spending by 2022, new spending on the Future Fellowships program for mid-career researchers, additional support for the Agricultural R&D Corporations, the continuation of the National Collaborative Research Infrastructure (NCRIS), and a new commitment to the Academy’s education programs Primary Connections and Science by Doing.
“Funding for research infrastructure is vital and we hope this is just the first stage of a longer term vision to support major infrastructure,” Professor Cory said. “But the introduction of tuition fees for research students in PhD programs is of great concern as these students are the engine for our nation’s research.”
“We need to increase our science investment now and grow it for decades to come. The commitment to medical research needs to be matched in the rest of the science sector or we will not be able to meet Australia’s big challenges.”
The National Aboriginal Community Controlled Health Organisation (NACCHO) has welcomed continued funding for the 150 Aboriginal Community Controlled Health Services around Australia announced/confirmed in Budget 2014.
Justin Mohamed, Chair of the National Aboriginal Community Controlled Health Organisation, said the Aboriginal population is growing and demand for services is increasing at more than 6% per year.
“The 2014 Budget funding means we can continue to provide high quality, culturally appropriate health care to our people for another year,” Mr Mohamed said today.
“However, we also need long-term planning and budget resources to build on recent health gains and create lasting improvements to the health of Aboriginal people.
“There is great risk that the introduction of a $7 co-payment for doctor’s visits will create new barriers to healthcare for many Aboriginal and Torres Strait Islander Australians, including additional red tape for Community Controlled Health Organisations.
“Most Aboriginal and Torres Strait Islander Australians are low income earners and suffer the highest level of chronic disease, requiring regular GP visits.
“State and territories have also been given the green light to charge for hospital emergency visits, creating a dangerous situation where people may not present for serious medical treatment for fear of the cost.
“We will get the most benefit from policy that encourages Aboriginal people to seek medical attention and seek it early, not make it even harder for them to get the care they need.
“It is also vital that the Federal Government guarantees the $80-90 million cut across Aboriginal Health does not impact on-ground services and Aboriginal health outcomes.
“Aboriginal Community Controlled Health Organisations have a proven track record in providing a range of quality employment and education opportunities for Aboriginal people and boosting local economies.
“Given cuts to Aboriginal health and employment budgets they are even more valuable – providing employment and training opportunities to our people which in turn boost local economies and tackle some of the huge barriers to Aboriginal people achieving economic independence and quality of life.
“Healthy communities keep our kids in school, keep our adults in the workforce and allow great opportunities for Aboriginal contributions to the economy and broader community,” Mr Mohamed said.