In this post Croakey will provide rolling coverage of reactions to the health related measures of the 2017-18 Budget.
Readers can also follow reactions at #HealthElection17, #Budget2017 and #PeoplesBudget on Twitter.
Statement from the Consumers Health Forum
Medicare thaws, now time to take health reforms off ice
“The staged lifting of the freeze in the Budget does mean that many families on average incomes still face the risk of co-payment increases they can ill afford for at least another year.
The retention of bulk billing incentives for diagnostic imaging and pathology is welcomed.
“A strong and equitable health system that delivers for all Australians is THE top priority for voters. As the Essential poll showed last week, nearly two thirds of Australians think funding should be increased in health care.
Government also needs to exploit the longer term benefits available to Australians by strengthening and modernising Medicare so it can respond to the rise we have seen in complex chronic disease.
”We welcome the Government’s modest investment for further development of a future patient-focused system through its Health Care Homes initiatives, including a role for community pharmacy. These are developments which could be impeded if GPs faced continued freeze on all of their Medicare payments.
“We must get the right approach to this fundamental development but much more is needed in terms of Government resourcing, local leadership and consumer involvement. A staged implementation of Health Care Homes is prudent.
“While we will always need high quality hospitals, we would like to see future hospital funding arrangements to include deals with the States that shift the focus to integrated care outside hospitals, particularly for those who are at risk of repeated costly visits to hospital.
“The Government in this Budget will generate significant savings by reducing further the price of medicines once they come off patent. A separate measure to make generic medicines the automatic choice for prescriptions will also contribute to much-needed savings.
“That is very welcome because the savings will enable PBS to subsidise new drugs. Also welcome is the removal from the budget figuring of the “zombie” $5 increase to prescription co-payments that was first proposed in the 2014 Budget but has been blocked in the Senate.
“Private health insurance will continue to be a source of widespread consumer dissatisfaction prompting possible declines in membership without the consumer-friendly reforms advocated by CHF and others which would oblige health funds to implement or lose eligibility for the health insurance rebate.
“We need a 21st century response to the health hazards of today: obesity, poor diet and sedentary lifestyle.
“The Budget includes a modest down payment in preventive health but we still lack a comprehensive obesity prevention plan. The hiatus in preventive health commitments has failed to recognise the huge dividends available in the future improved health outcomes. And the cost is small relative to the $75 billion the Commonwealth pays out in health costs each year.
“We are disappointed the Government is putting the interests of business before the health of the nation in not pursuing a tax on sugar-sweetened drinks which other countries like the United Kingdom have seen fit to introduce.
“We welcome the national rollout of the opt-out model for MyHealthRecord. This will reinvigorate our health care system which is currently stuck in a pre-internet world.
We welcome the mental health measures including tele mental health and suicide hotspots, and the $350 million to target suicide prevention and mental health of war veterans.
CHF supports the minister’s announcement that he is developing a National Health Plan.
“Overall this health budget is a commendable attempt to rebalance priorities while seeking to establish a platform that provides hope for a future more effective health system that is both responsive to consumer needs but also delivers best bang for the buck,” Ms Wells said.
Statement from National Congress of Australia’s First Peoples
The National Congress of Australia’s First Peoples coordinated a meeting with over 30 representatives from key Aboriginal and Torres Strait Islander organisations in Canberra tonight (Tuesday) to discuss our response to the 2017 budget and the implications it will have for First Peoples.
The urgent needs of our peoples are almost invisible in the budget. We are concerned by the lack of specific measures for Aboriginal and Torres Strait Islander peoples, particularly given
six of the seven Closing the Gap targets are not being met.
We welcome the $52.9 million allocation over four years for research associated with Closing the Gap provided it produces effective and efficient programs that make a tangible difference
to the lives of our peoples.
We support the appointment of a Productivity Commissioner dedicated to Aboriginal and Torres Strait Islander services but believe that the funds for the position should not come
from the Indigenous Advancement Strategy.
Insufficient funds have been allocated for frontline services, which will have a negative effect on health, justice, education and other targets, and increase the burden on these services,
many of which are already over-stretched.
At around $10 000 per participant, the administrative overheads for the cashless welfare card, make the program shockingly inefficient. The outcomes of this program are questionable. In
spite of this, the Government plans to expand the program to include two new sites without having announced the locations.
“This budget continues the trend of punitive measures on welfare recipients,” said Rod Little, Congress co-chair. “This further stigmatises the most vulnerable members of society and is
counterproductive to social cohesion,” added Congress co-chair Jackie Huggins.
We call on the Governments to work collaboratively with us, by implementing Aboriginal and Torres Strait Islander led-solutions, as outlined in the Redfern Statement.
See also the statement from the Close the Gap Campaign.
Statement from Royal Australian College of GPs
Lifting of the Medicare rebate freeze first step towards reinvesting in preventative health
The peak body for Australia’s GPs The Royal Australian College of General Practitioners (RACGP) has welcomed the lifting of the Medicare rebate freeze as the first step towards a commitment to reinvesting in preventative health.
RACGP President Dr Bastian Seidel said more than 85% of Australians receive preventative health care services from their GP every year – and that’s not only a great decision by these patients – it’s also a great decision for all taxpayers.
“If you see your GP early you’ll save the whole community money by staying out of hospital – and receive GP health services that can cost up to ten times less,” Dr Seidel said.
“The patient rebate had been frozen since 2013 putting pressure on patients and their GPs as out of pocket fees increased.
“The lifting of the freeze was exactly what the RACGP’s #youvebeentargeted campaign was aiming for.
“We’re also pleased Minister for Health Greg Hunt, has extended the Medicare Benefits Review.
“If we are serious about focusing on a preventative GP health care we need to end the inequality of GP Medicare rebates compared to other clinical specialties.
“It’s also pleasing to see the Federal Government make a genuine commitment to funding practice based research networks.
“The initial $5 million funding to kick start these networks signals a pivot towards preventative health research that will build a knowledge base for the profession and help us build a healthy Australia.”
Statement from the Public Health Association of Australia
‘Medicine’ budget – not a health budget: Where is the investment on tackling obesity, tobacco and alcohol?
The Prime Minister’s rhetoric on prevention falls way short when looking at the expenditure in the budget. In February the Prime Minister announced a focus on prevention and was followed shortly after by the Health Minister commitment to “tackling obesity”. The three most significant causes of ill health in Australia are tobacco, alcohol and poor nutrition – yet these barely receive a mention in the health budget.
The Public Health Association of Australia (PHAA) expressed disappointment in the lack of investment in prevention. “Expenditure on prevention is likely to remain close to 1.5% of the health budget while the major issues of tobacco, obesity and alcohol remain with minimal increases in funding compared to the investment to remove the freeze on the Medicare rebate,” said Michael Moore, CEO of the PHAA. He added, “Australia is lagging considerably compared to places like Canada and New Zealand where over 5% of the health budget is committed to prevention”.
And now the Minister asks the community to wait another two years for the “third wave of reform”. “Two years is too long” responded Michael Moore.
Removing freeze on Medicare rebate
The lifting of the four-year freeze on Medicare rebates is a positive step toward establishing universal healthcare for Australians, as it will initially facilitate lower out-of-pocket costs for patients visiting their GPs, as well as specialist medical services, such as pathology and medical imaging, and other procedures.
“The freeze on rebates combined with rising consultation fees has made it more difficult for Australians to visit their doctors and therefore prevented them from receiving the basic level of healthcare which should be their entitlement. A strong public health system means the affordable and efficient provision of healthcare services, which starts with general consultations being accessible and within the means of the Australian public.” Mr Moore added.
There is good news in the decision to equalise the tax treatment of roll your own tobacco and cigarettes. It should help to ensure that smokers worried about price quit rather than switch to equally lethal roll your own products and this budget maintains tobacco tax increases.
Immunisation and Vaccines
A commitment of $19.2m into improving immunisation rates along with stockpiling of essential medicines and vaccines costing around $85million is a strong commitment to protecting the health of all Australians.
Announcement on heart health
The PHAA welcomes the Government’s commitment to heart health with the announcement of $10m over two years to the Heart Foundation for walking interventions and further funding $5 million into material to enable better GP interventions for patients presenting with obesity.
Mental health and suicide prevention
The PHAA welcomes investment into mental health and suicide prevention.
THE GLARING OMISSIONS
It is disappointing to see that there will effectively be no increase to the percentage of funding for preventive health in the Budget. This is particularly disappointing considering the announcement by the Prime Minister and the Health Minister in February that there would be a new focus by Government on prevention.
By directing health funding toward the root causes of diseases, particularly those which are largely attributable to environmental factors such as obesity, alcohol and tobacco the general health of the population will increase significantly. This is why the PHAA proposes that preventive health should compare favourably to countries like Canada and New Zealand with prevention at 5% of the Health Budget.
Although there was some good news on tobacco the failure to provide adequate funding for public education on tobacco is deeply disappointing. This is an area where the government has dropped the ball in recent years. They receive around $10bn p.a. from tobacco revenue, but have failed to restore funding for the crucial media campaigns needed to underpin smoking prevention, especially for people in vulnerable and lower socio-economic groups where smokers are concentrated”.
Obesity – a missed opportunity
“Obesity is currently the second highest contributor to the burden of disease in Australia which costs billions to the public and private sectors annually, and it’s time we seek a proactive solution,” according to Michael Moore.
However, PHAA cautions that these are not the types of structural interventions required to fully address the problem, which are necessary if the Government is genuinely committed to tackling obesity as was announced by the Prime Minister in February this year.
“A levy on sugary drinks has proven benefits which we’ve seen in other nations like Mexico which have adopted this approach, therefore it is an essential preliminary step toward controlling the obesity epidemic”, Mr Moore said.
The introduction of a sugar levy would also have delivered additional funds which would have allowed further investment in prevention around obesity and other diet related disease.
The PHAA strongly advocates for a national, coordinated plan to tackle the problem of obesity in Australia, which has become a leading issue due to its high prevalence and severe associated health and social impacts.
It is disappointing that Indigenous health interventions must also wait for the “third wave” of reform in another two years. However, the Closing the Gap falls within the Prime Minister’s portfolio.
The budget has some positives and negatives. However, the big omission is prevention and it makes no sense to wait another for another two budget cycles to begin on this “third wave” of reform when action taken now will save in the long term.
Statement from the Australian Council of Social Service (ACOSS)
Welcome change of tack in health education and housing, but vilification of people who are unemployed continues
ACOSS welcomes the change of tack to invest in health, education and housing, but the 2014 Budget mindset to demonise and impoverish the most disadvantaged continues.
“The government is trying to put the 2014 horror budget behind it, securing the National Disability Insurance Scheme and putting housing affordability on the agenda but the government still neglects, blames and targets the most disadvantaged in the social security system”, said ACOSS CEO Dr Cassandra Goldie.
“The government’s significant change of tack on Medicare and schools funding is welcome, recognising that people value essential services. The challenge is to properly fund them. The government has begun to strengthen the revenue side, by increasing the Medicare levy and taking further steps to stem tax avoidance by international businesses. But securing funds for essential services like Medicare while restoring the budget is not just an accounting exercise: it will require major reform to make sure that every individual and businesses pays tax according to their ability to do so.
“ACOSS welcomes the first steps to address housing affordability, including key elements to encourage private investment in affordable housing and secure funding for homelessness services. This start will only deliver for those on the lowest incomes if the next step is taken: new public investment in social housing and improved rent assistance for tenants. On the other hand, the extension of super tax breaks to people buying a first home or downsizing is a backward step that will increase house prices and waste public revenue.
“But in social security, the government remains stuck in the 2014 budget mindset that demonises and impoverishes people who are unemployed. Access to their payments is restricted by the continuation of income management and extension of the ‘cashless debit card’. The wasteful Work for the Dole scheme continues, and the government is having another go at cutting the Pensioner Education Supplement.
“It speaks volumes for the government’s approach to social security that unemployed people are denied the one-off $75 Energy Supplement and it proposes to drug-test recipients and deny the Disability Support Pension to people if their disability is drug-related. New waiting periods are proposed for Age Pensions for people who are migrants and have had to rely on income support during working life.
“A major restructure of penalties for unemployed people saving more than $200 million a year is proposed without convincing evidence the system is widely abused, or discussion with the community sector. Given the severe impact that penalties have, the system should not be restructured without a public review.
“It’s time the government invested in jobs and unemployed people instead of penalising people for poverty. The modest investment in career counselling for older people who are unemployed, and linking of employment assistance with infrastructure projects shows the way forward but with unemployment projected to remain above 5% for four years, there’s much more to be done.”
See also this statement from the Brotherhood of St Laurence which welcomes some measures but has deep concerns about the new tiered welfare demerit system and random drug testing for new welfare recipients.
Statement from the Disabled People’s Organisations Australia (DPO Australia)
Great NDIS and job support wins, but harsh welfare measures for people with disability
Statement from Australian Healthcare and Hospitals Association
Doctors, industry groups entrusted with the keys for a healthy Australia
‘Tonight’s Budget is a winner for doctors and pharmacy interests as the Medicare rebate freeze is lifted and a new collaborative approach is embedded in a series of compacts with industry groups, but time will tell whether this will contribute to building a healthy Australia,’ says Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven.
‘Health Minister Greg Hunt has placed substantial trust through formal compacts with five professional groups – the Australian Medical Association, the Royal Australian College of General Practitioners, the Pharmacy Guild, Medicines Australia and the Generic and Biosimilar Medicines Association – in a budget which partly overturns horror budgets of the past.
‘It is now up to these groups and the Minister to ensure that this trust, and the funds being directed towards their interests, are well-invested for a healthy Australia.
‘There is a very real risk that tonight’s Budget will reward an increased volume of services and products, rather than incentivising a shift to greater value-based care and better health outcomes, particularly for the most vulnerable members of our community.
‘We commend the Minister’s pursuit of a more strategic approach to health policy, but the four pillars must be expanded to include primary care, aged care, Indigenous health, and better health outcomes.
‘The Minister’s three waves of reform are a guide for the remaining years of this Government’s term, but it is most disappointing that hospitals, primary care, prevention and Indigenous health are in the last wave of priorities.
‘The reform agenda needed across these areas is substantial, and won’t be put to bed solely by the formation of compacts with doctors and pharmacy industry groups.
‘The progressive lifting of the freeze on Medicare payments for GP and specialist consultations and procedures may assist in shoring up Medicare, but risks continuing to drive volume in use of health services at the expense of value.
‘We hope that doctors – and particularly specialists – will play their side of their bargain and commit to bulk-billing for the many services which currently have large out-of-pocket costs associated with them,’ says Ms Verhoeven.
‘Higher out-of-pocket costs lead to less use of primary health care by people who cannot afford any kind of co-payment, which in turn leads to increased public hospital attendances and higher health costs down the track.
‘The Minister has proposed the Medicare Guarantee Fund as a measure to provide certainty for health funding, but it appears to be an exercise in compartmentalising health funding which could lead to longer term jeopardy should the coffers not be full enough.
‘AHHA welcomes the Commonwealth’s ongoing commitment to its previously announced Health Care Homes trial as the beginning of a much-needed reform journey for primary health care in Australia. The funding for pharmacists to play a role in the trial is welcomed – Health Care Homes must be more than just a new way to fund care, and must focus on the most efficient and effective ways to provide care to people with high burdens of disease.
‘The development of a national minimum data set for primary care was flagged last year by the Primary Health Care Advisory Group as critical infrastructure for Health Care Homes, but there appears to be limited action. Data provision should be a trade-off with doctors for the Medicare rebate thaw.
‘Moving to an opt-out mechanism for the My Health Record, and ensuring substantial investment for this is commendable.
‘While growth funding for public hospitals is settled until 2021 with just over $2 billion in additional funding, there remains considerable uncertainty over post-2020 hospital funding and the method of indexation for future years. Hospital funding requires a sustainable, long-term solution that is part of an overall strategy to shift from volume to value-based care, and that leverages the investments being made in primary care and in Primary Health Networks.
‘It is disappointing that the Prime Minister’s interest in preventive health, announced in a National Press Club speech earlier this year, has not been a greater focus of this budget. Preventive health requires long-term national leadership and sustained investment to reduce illness, prevent disease and promote wellness. This in turn reduces individual, intergenerational and health system burden, improves health system resource use and boosts productivity through greater economic participation and productivity. Australia spends less on public health and prevention than most other OECD countries.
‘It is time to make prevention a more prominent part of the Commonwealth’s health agenda, and acknowledge that more is needed than just spending on sports and exercise programs —you can’t have a healthy economy or healthy budgets if you don’t support a healthy population.
‘AHHA supports the Commonwealth’s move to encourage doctors and patients to choose generic medications when appropriate over the more expensive brand name drugs. There must be a firm commitment to put savings from the shift to generic medicines back into the Pharmaceutical Benefits Scheme.
Private health insurance
‘AHHA is disappointed by the lack of progress in reforming private health insurance as part of tonight’s Federal Budget. This is a major let-down for policy holders who have been hit with substantial rises in health insurance premiums – and who remain very concerned about the value and transparency of their policies.
‘Tonight’s Budget was a lost opportunity for greater equity in dental care by not restoring funding previously agreed to under the National Partnership Agreement for public dental services to adults. Last December the Commonwealth provided less than a fortnight’s notice to the states and territories of a significant cut to public dental funding—from $155 million in calendar year 2016 down to $128 million in calendar year 2017. The real pain is being felt by vulnerable population groups unable to afford private dental care.
‘AHHA welcomes the $80 million investment for community psychosocial services for people who do not qualify for the National Disability Insurance Scheme. We note this is contingent on matched commitments from the states and territories.
‘Investment in mental health services for veterans is also welcome – although we note that much of the $350 million allocated is for improvements to IT systems for claims processing, rather than for direct service provision.
Aboriginal and Torres Strait Islander health
‘We welcome the commitment of $7.6 million over 4 years for a National Partnership Agreement on Rheumatic Fever Strategy.
‘It is unacceptable that Aboriginal and Torres Strait Islander peoples continue to have poorer health and a much lower life expectancy than the general population, and that this Budget has overlooked that massive inequity. COAG’s recent recommitment to prioritising improving outcomes for Australia’s First Peoples should have been supported by appropriate funding and support for locally developed responses.
‘A commitment should have been made to appropriately fund the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 and its Implementation Plan.
Proton beam therapy
‘AHHA welcomes the Commonwealth’s first investment in supporting proton beam therapy in Australia through the establishment of a world-leading facility at the South Australian Health and Medical Research Institute. This collaborative approach to novel technology and treatment will lead to better health outcomes for Australian patients and is a significant boost for Australia’s health and medical research community. Patients from other states must be financially supported to access this care if needed.
Statement from the Australian Medical Association
Farewell freeze: government wins back goodwill with positive health measures
AMA President, Dr Michael Gannon, said tonight that the Government has begun to win back much of the goodwill it lost with the disastrous 2014 Health Budget with the announcement of a number of positive health measures, most notably an early lifting of the freeze on Medicare patient rebates.
The Medicare rebate freeze will be lifted from bulk billing incentives for GP consultations from 1 July 2017, from standard GP consultations and other specialist consultations from 1 July 2018, from procedures from 1 July 2019, and targeted diagnostic imaging services from 1 July 2020. The lifting of the freeze on Medicare rebates will cost the Government around $1 billion.
Dr Gannon said that the policy breakthroughs in the 2017 Health Budget are the direct result of the consultative approach of Health Minister, Greg Hunt, with the hands-on input and support of the Prime Minister.
“Minister Hunt said from day one in the job that he would listen and learn from the people who work in the health system every day about what is best for patients, and he has delivered tonight,” Dr Gannon said.
“The AMA would have preferred to see the Medicare freeze lifted across the board from 1 July 2017, but we acknowledge that the three-stage process will provide GPs and other specialists with certainty and security about their practices, and will help address rising out-of-pocket costs for patients.
“Lifting the Medicare rebate freeze is overdue, but we welcome it.”
Dr Gannon said that the Government has also responded to AMA advocacy by:
- reversing proposed cuts to bulk billing incentives for diagnostic imaging and pathology services;
- scrapping proposed changes to the Medicare Safety Net that would have penalised vulnerable patients;
- delaying the introduction of the Health Care Homes trial until October to allow fine-tuning of the details;
- moving to an opt-out approach for participation in the My Health Record; and
- recognising the importance of diagnostic imaging to clinical decision-making.
Dr Gannon said the AMA supports the Government’s measures to increase the prescribing of generic medicines, when it is safe and appropriate and discussed with the patient, and preserves doctors’ clinical and prescribing independence, with savings to be invested back into the Pharmaceutical Benefits Scheme (PBS).
“We also welcome the Government’s allocation of $350 million to help prevent suicide among war veterans; the expansion of the Supporting Leave for Living Organ Donors Program, which allows donors to claim back out-of-pocket expenses and receive up to nine weeks paid leave while recovering; measures to increase the vaccination rate; and the ban on gambling ads during live sporting broadcasts before 8.30pm.
“We acknowledge extra funding for the Rheumatic Fever Strategy, in response to calls in the 2016 AMA Indigenous Health Report Card.”
Dr Gannon said that tonight’s Health Budget effectively ends the era of disastrous co-payment and Medicare freeze policies, and creates an environment for informed and genuine debate about the numerous other areas of unfinished business in the health portfolio.
“We now need to shift our attention to gaining positive outcomes for public hospitals, prevention, Indigenous health, mental health, aged care, rural health, private health insurance, palliative care, and the medical workforce,” Dr Gannon said.
Dr Gannon said that the lifting of the Medicare freeze and the other positive measures in the Budget have come about through open discussion and engagement with the Government, and the AMA intends to build on this positive relationship with the Health Minister and the Prime Minister to achieve further benefits for patients and the health system.
Dr Gannon said that the AMA is committed to working collaboratively with the Government on:
- the Medicare Benefits Schedule (MBS) Review process;
- an improved system of after-hours care;
- uptake of the My Health Record;
- the Health Care Homes concept and trial;
- pathology sector arrangements, including approved collection centre (ACC) rents; and
- MBS compliance.
See also a separate statement from the AMA Western Australia welcoming the Budget as a “significant step forward for health”.
Statement from Oxfam Australia
Federal Budget fails on fairness
After desperately gouging the aid budget to bring it to its lowest ever level in previous years, the Government has dealt aid another blow by reneging on its promise to keep spending in line with inflation, Oxfam Australia said tonight.
“The Government has refused to lift aid funding out of historically low levels, while at the same time pushing ahead with corporate tax cuts for the top end of town,” Oxfam Australia Chief Executive Helen Szoke said.
“Repeated cuts to aid funding that is crucial to tackling poverty have been used to balance the books – and this Budget has done nothing to rectify this unconscionable failing of our responsibility as a wealthy nation.”
Dr Szoke said tonight’s Budget had pegged next year’s aid funding at $3.9 billion, which was in line with the growth in the consumer price index, but completely out of step with global need and Australia’s international commitments. She said over the next four years of the forward estimates, the aid budget would be cut by $303 million.
“Aid spending now equates to about just 22 cents in every $100 of gross national income, a new historic low,” Dr Szoke said.
“Long-term aid programs have already had to be scaled back, most significantly across sub-Saharan Africa. These programs make communities resilient and able to cope when disasters strike. Aid is an essential part of Australia’s contribution to a more peaceful, stable and sustainable world – both for our own citizens and our neighbours.
Dr Szoke said tonight’s disappointing Budget could not come at a worse time as the world grappled with multiple humanitarian crises. About 30 million people in four countries – South Sudan, Somalia, Nigeria and Yemen –are experiencing alarming hunger. An unprecedented 65 million people have been forced to flee their homes because of conflict and persecution.
“The $20 million increase in the Humanitarian Emergency Fund is a small step in the right direction, but is simply not enough,” she said. “The Government needs to at least double its spending on the emergency fund to $260 million to meet urgent need and save more lives.
“At a time when our neighbours are grappling with the escalating realities of climate change, the Budget also shows no increase in Australia’s $200 million a year contribution to international climate finance, which is drawn from the general aid budget.”
Dr Szoke said tonight’s tax integrity measures, including new tightening up on tax avoidance by multinationals, were another move in the right direction. However, it was concerning that there were no revenue estimates attached to the new measures.
She said that with one in three companies reported on by the Australian Tax Office paying zero corporate tax in 2015, more needed to be done. Oxfam estimates Australia loses up to $6 billion a year – and developing countries miss out on $3 billion annually – because of corporate tax dodging by the use of tax havens.
“In a world where just eight men have the same amount of wealth as the 3.6 billion poorest people, and the richest 1 per cent of Australians own more wealth than the poorest 70 per cent combined, the Budget has been a squandered chance to act on soaring inequality at home and abroad.
Links to other statements
St Vincent’s Health Australia: An encouraging health budget makes up for lost ground
Australian Medical Students’ Association (AMSA): Budget a missed opportunity for investment in medical workforce.