As the health sector waits to hear the outcome of Federal Budget 2018/19, Croakey editor Jennifer Doggett takes another look at the proposals made by from peak health organisations in their pre-Budget submissions.
As previously reported in Croakey, there was overwhelming agreement that prevention is the number one issues needing to be addressed in the Budget with widespread support for the creation of a national preventive health body. Other proposals widely supported by the health sector are a review of private health insurance, a sugar tax and action on Indigenous, mental and oral health.
However, apart from these priority issues, health groups made a number of interesting suggestions and observations, articulated some impressive visions for the future of health care and (in some cases) made some curious claims about the status quo. These are covered in Croakey’s second Federal Budget preview below.
Jennifer Doggett writes:
Health is a complex and diverse area and summarising a vision for the future of health care into a cohesive, overall message can be difficult. The Australian Healthcare and Hospitals Association (AHHA) articulated this well in calling for a ‘Nationally unified, person-centred, regionally controlled health system.’
PHAA took a broad approach to health by emphasising the importance of broader environmental and societal factors in articulating its vision for: A healthy region, a healthy nation, healthy people: living in an equitable society underpinned by a well-functioning ecosystem and a healthy environment, improving and promoting health for all.
Consumers Health Forum (CHF) also clearly communicated a complex (but crucial) point about our siloed, portfolio-based approach to funding and policy making noting that: ‘Healthcare that works independently of housing, disability and social services will always be less effective than when these systems work together.’
The Royal Australasian College of Physicians (RACP), the Australian Medical Association (AMA) and the Australian Medical Students Association (AMSA) were among the few submissions that addressed climate change as a health issue, with the AMA calling on the Government to develop and fund a National Strategy for Health and Climate Change, including a broad reaching adaptation plan to reduce the health impacts of climate change.
RACP called for the Government to establish a national Healthcare Sustainability Unit to draw on local best practice as well as leading international models, such as the Sustainable Development Unit (SDU) in the UK.
Private patients in public hospitals
The issue of private patients in public hospitals was a focus of a number submissions from groups directly affected by this issue, including Catholic Health Australia (CHA), Private Healthcare Australia (PHA), AHHA and the Victorian Healthcare Association.
CHA called for enforcement of compliance with the Medicare principles so that private patients do not receive quicker treatment or other preferential treatment to public patients. They also want to remove hospitals’ ability to offer inducements or to actively compel consumers to declare their private health insurance status.
Private Healthcare Australia (PHA) called for an end to the ‘harvesting of private patients in emergency departments, a practice which is clearly inappropriate.’
Out-of-pocket (OOP) health care costs were another issue highlighted in multiple submissions.
CHF called for a comprehensive review from the consumer perspective ‘with modelling that outlines the real OOP costs associated with healthcare facing consumers.’
The PHA called for a ‘carrot and stick’ approach…‘which both incentivises GPs to make referrals which consider the cost to the patient as well as quality of the specialist, and which permits sanctions of providers who fail to provide consumers with informed financial consent in advance of treatment.‘
Health workforce issues were a focus of a number of submissions with the National Rural Health Alliance (NRHA) noting the maldistribution of the health workforce across a range of professional health disciplines.
As one strategy to address this, the NRHA called for more support for rural generalist pathways and strategies and opportunities for enhancing access to multi-professional practitioners.
The VHA also highlighted the need to support the role of nurse practitioners (NPs), calling on the government to change MBS claiming rules to allow NPs to claim under more MBS items, to support rural communities where there are shortages of doctors.
AMSA was the only group to include refugee and asylum health within its submission, calling on the Government:
1. To establish an independent, national, preventive body with power to investigate and advise on the health status of refugees and asylum seekers living in the community and held in detention
2. To minimise the proven detrimental health impacts of detention
3. To develop and implement national strategies that minimise inequities experienced by refugees and asylum seekers in the healthcare sector.
Connect Health and Community (CHM) called for a national commission for the regulation of online gambling and a national regulatory framework to ensure a consistent application of Australian online gambling legislation.
PHAA noted the widespread cost of gambling on the community and recommended that a code of conduct be developed for all gambling venues in Australia, including measures addressing media advertising, and requiring regulators to adopt uniform standards which emphasise product safety and consumer protection as priorities for regulatory activity.
Surprisingly, despite concerns raised about the over-representation of doctors on Government-appointed committees, the AMA appeared worried that peak medical groups may be losing their influence as it called for the Government to ensure the membership of Clinical Committees and Working Groups includes leaders from the Colleges, Associations, and Societies.
Also scoring high on the hypocrisy scale was the PHA which complained about an ‘inflexible regulatory environment’ and called for the removal of legislative ‘shackles’ while also asking the Government to increase penalties for people who choose not to take out private health insurance.
It also argued against any reduction in the $7 billion public subsidy provided each year to the private health insurance industry while simultaneously complaining about having to fund the care of members who choose to receive treatment in public hospitals, on the basis that this represents ‘cost shifting’ between the public and private sectors.