JENNIFER DOGGETT. Health Budget Gaps.

Prevention, out-of-pocket costs, and oral health. 

Prevention

Despite prevention being nominated as the highest priority for the Budget by a number of key health groups prior to the Budget, the actual Budget measures were very light on preventive health.  In fact, prevention was not even given its own section in the briefing documents prepared by the Department of Health, but was grouped together with sport and mental health as a single item.

There were some individual initiatives announced which have a preventive health focus, such as funding for whooping cough vaccines for pregnant women, a National Injury Prevention Strategy and hearing assessments for pre-school Indigenous children. These measures in themselves seem sensible and were generally well received by the health sector. 

However, there was no attempt to link these initiatives together into a broader approach to prevention or to articulate an overall approach to addressing the key determinants of illness and disability throughout the health system. 

Specific proposals, made repeatedly by health organisations and advocates, for a tax on sugary drinks and junk food advertising restrictions were ignored, despite evidence that these measures have succeeded in other countries. 

With around two-thirds of all Australians now classed as overweight or obese, and therefore at a higher risk of a range of serious chronic diseases, this is a problem that can no longer be ignored. Of course, it is a complex and challenging issue which could not be solved by one Budget. 

However, disappointingly the Government failed to even signal that this was on their radar as a high priority. Since the abolition of the Australian National Preventive Health Agency in 2014, there is a lack of national leadership and coordination on preventive health and this Budget did nothing to fill this gap. 

Out-of-pocket costs

Out-of-pocket (OOP) health care costs are a major source of health funding in the Australian health system. OOPs can have a major impact on consumers’ access to health care, influencing both the types of services they access and when they access them. Yet despite their influence and despite the fact that they contribute a larger share of health funding than private health insurance, OOPs are not addressed through any national policies or overseen by any level of government. This is a major problem as there is widespread evidence that OOPs are creating barriers to access and causing financial hardship for many Australians. 

The Consumers Health Forum of Australia recently undertook a comprehensive survey on OOPs relating to health care and found that many respondents reported struggling to afford basic and essential health care, such as filling prescriptions, routine dental visits and tests recommended by GPs. Some reported having to delay or forgo care due to unaffordable OOPs and others made financial sacrifices to afford the care, sometimes going into debt with costs of $10 000 and higher. 

This Budget would have been an ideal opportunity for the Government to draw on the information on consumer experience of OOPs to announce a measure targeted at minimising their impact on the most vulnerable groups, typically people on low incomes with chronic illnesses and disabilities. At the very least, the Government could have supported calls from consumer groups for greater transparency around medical fees and charges to enable consumers to make more informed choices about their health care use. 

However, the Government did not address OOPs or any related issues, such as fee transparency or informed financial consent, in the Budget. This is a short-sighted omission as problems caused by OOPs risk undermining the aims of some of the other Budget initiatives, such as additional funding for PBS medicines and rural allied health, which rely on people being able to pay upfront fees and charges. 

Oral Health

A country as wealthy Australia should be able to afford dental care for all its citizens. Many countries with fewer resources than Australia provide much more in the way of subsidised dental care for their citizens and have better dental health overall to show for it. 

We know from surveys that 30% of Australians currently go without regular dental care due to cost, unavailability of services and other barriers. More than one in three Australians delay or avoid dental treatment because they can’t afford the cost. This problem is even worse in disadvantaged communities, including among people on low incomes, people living in rural and remote areas, Indigenous people, aged care facility residents and people with disabilities.

Despite this widespread problem, the only funding for dental services in the Budget was for the Royal Flying Doctor Service to provide oral health (and other) health services to people in remote areas where no private services are available. This sends a message to the community that the Government supports the current model of private mainstream dental services and does not want the public sector to play a greater role. 

There is no good physiological reason for excluding teeth from Medicare – they are just as much as body part as any other and oral health is inextricably linked to overall health and well-being. People with untreated dental problems are at higher risk of a number of serious illnesses, such as heart disease, diabetes and some forms of cancer. They also can experience social isolation and difficulties in participating in employment and other aspects of life. 

Including dental services in Medicare would be expensive but the cost of ignoring untreated dental problems is much larger. We do already subsidise some private dental services but unfortunately, this occurs via the inefficient and inequitable private health insurance rebate. A much more effective model would be to use the funding currently going into the rebate (around $7-$9 billion depending on how it is calculated) to support an expansion of Medicare to include basic, preventive dental care.

While passing over this issue in the Budget, the Coalition can commit to addressing this issue in its pre-election policy platform either through diverting funding from the private health insurance rebate or allocating additional funding to Medicare to incorporate an entitlement to oral health care. 

Jennifer Doggett is the Chair of AHCRA, a Fellow of the Centre for Policy Development a member of the Croakey Collective and a consultant working in the health sector. 

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