In this post-Budget analysis, Jennifer Doggett awards Health Minister Greg Hunt an A+ for public relations but finds that, despite significant spending, this Budget fails to address key areas, such as prevention, primary health care and oral health.
Jennifer Doggett writes:
The 2018/19 Federal Budget scores an A+ for public relations but only rates a C for policy, due to its lack of an overall vision, key funding gaps and a failure to address the underlying causes of poor health and chronic disease.
Health Minister Greg Hunt’s brief on taking on the health portfolio was to neutralise health as an issue for the Coalition and repair the damage done to relationships with powerful peak groups after the disastrous 2014/15 Budget in which the Abbott Government walked away from commitments on public hospitals, introduced unpopular co-payments and was accused of trying to dismantle universal health care.
This public relations disaster for the Coalition paved the way for Labor’s Mediscare campaign, almost costing the Coalition the 2016 Federal election. With another election looming, Greg Hunt has delivered on his promise to turn around the hostile health sector and do whatever it takes to keep Labor from ‘owning’ Medicare as an issue. This he has achieved in spades, with almost every peak health group leading with a positive message in their responses to the Budget, despite the widespread criticism it received from many social welfare groups and commentators for increasing inequalities and failing to address major social problems, such as housing affordability.
After tonight, it’s safe to say that the next Federal election won’t be won or lost in the health portfolio.
A public relations masterpiece
When assessed against this politically motivated goal, the 2018/19 Budget is a public relations masterpiece.
It covers more territory than any Budget in living memory, ticking all the required boxes (powerful stakeholder group issues, media friendly items and human interest stories) in a dazzling line-up of funding commitments. In fact, there are so many different spending measures that for the first time ever, it required all three of the portfolio’s ministers to brief the attendees at the Health Department briefing.
On closer inspection some of the new funding measures did not seem quite as promising as they had initially. Some of the initiatives seemed inadequately funded for the scale of the issue they addressed ($5m for better care for people with dementia) and some seemed overly ambitious ($500m to establish Australia as a world leader in genomics research and ‘transform the lives of 200, 000 Australians’).
But to be fair, it’s not all spin and rhetoric. There is some serious money being spent in areas that few would question, including $30 billion on public hospitals, $4.8 billion on Medicare and $2.4 billion on the PBS. These measures alone should be enough to quash any thoughts Labor has of attempting another Mediscare-type campaign at the next election.
No reform agenda
Within these core programs, the new funding has been largely allocated along conventional lines with little attempt at the reforms required to ensure our health system can meet future health challenges.
For example, the additional Medicare funding is going to unfreeze the indexation of the rebate – a welcome move in itself – but one which does nothing to change the fee-for-service funding system which prevents more effective management of chronic and complex conditions.
While we hardly need any more confirmation, this Budget sends the clear message that the current government has exactly zero interest in any health reform agenda that might upset the powerful vested interest groups that dominate the health portfolio (which is to say any health reform agenda at all).
Despite this, the Government’s commitments to the programs which underpin universal health care will be welcomed by the health sector even if their execution is less than perfect.
Similarly, there was general support for the Government’s focus on mental health, aged care, rural health and Indigenous health but some questioning of the Government’s priorities and overall approach to spending new money without addressing some of the underlying structural problems in these areas.
For example, the rural health initiatives were welcomed by the sector, which acknowledged the Government’s response to its call for support for a rural generalist pathway and the need for more doctors and nurses in rural areas. However, the Budget did not address any of the workforce reform measures suggested by groups in their pre-budget submissions.
The Indigenous health measures were largely well received and clearly the Government had consulted with the community controlled health sector on their priorities and preferred funding mechanisms.
Initiatives addressing specific health conditions, such as crusted scabies and remote area dialysis, targeted priority areas within Indigenous health. Unfortunately, the potential gains of these programs could be undermined by the failure to address some of the other determinants of health, such as the cost of fresh food in rural and remote areas.
Despite the broad range of issues covered by this Budget, there remain some glaring gaps.
Prevention – the number one issue nominated by health groups in their pre-Budget submissions – barely rates a mention. In fact, it didn’t even receive its own section in the briefing documents but was lumped together with mental health and sport in an awkward attempt to force the Budget neatly into five priority areas.
Of course, among the array of spending measures there were some isolated and sensible preventive health initiatives, such as funding for whooping cough vaccines for pregnant women, a National Injury Prevention Strategy and hearing assessments for pre-school Indigenous children.
What was lacking was an overall approach to preventive health which addresses the determinants of ill-health and, in particular, focuses on Australia’s growing burden of preventable chronic disease.
Two other issues missing in action were primary health care (outside of the Medicare funding measure) and dental care. Given the crucial role these areas play in the prevention and management of chronic disease the lack of focus on these areas means that, overall, the Budget is unlikely to result in any significant population health benefits.
In fact, when coupled with the Government’s failure to address broader social determinants of health, such as increasing housing costs, the health impact of climate change and poverty, it is likely that despite support for public health care, this Budget could increase, rather than decrease, the ‘health gap’ between best and worst off in Australia.