This year’s Government budget documents and the Opposition’s response are budgetary in name only – they should be seen as election campaign commitments. As such, they provide a telling story about the parties’ focus on health and healthcare and the underlying political ideologies.
The Morrison Government’s 2019-20 Budget reprises their health mantra that places the focus of their healthcare commitments on biomedical research, new medicines listed on the Pharmaceutical Benefits Scheme, and more money for public hospitals. This is echoed in the media release accompanying the Budget and the rhetoric that surrounds it. No-one would deny that these are not important aspects of healthcare, but they represent a focus on illness, treatment and acute care. There is little or nothing in the Budget to address prevention and population health – areas where effective initiatives could help to limit downstream health impacts and healthcare costs.
An examination of the pre-Budget submissions from health groups highlights a growing consensus about what is needed to ensure all Australians have affordable access to healthcare and improved health outcomes. Key issues include:
- Tackling obesity and its consequences;
- Addressing disparities (in particular, Closing the Gap on Indigenous disadvantage);
- Ensuring affordable and coordinated care for people living with multiple co-morbidities;
- Better integration of physical, mental and dental services; and
- Support services for those who provide care in the community to the sick, frail and disabled.
Solving these “wicked” problems will require:
- New models for delivering and paying for healthcare services;
- An appropriately trained and supported workforce;
- Better integration of health and social welfare sectors, of primary, acute, rehabilitation and residential care, and of federal and state and territory responsibilities;
- Visionary leadership, sustained investments and meaningful consultation with all stakeholders.
How far does the 2019-20 Budget go towards these goals? The general agreement from health and healthcare advocacy groups is that there are some very small, tentative steps in what might be the right directions, if only more details were available. These issues are summarised succinctly by a panel of experts for The Conversation.
There is funding to support more community-based services for mental health (but nothing to address their integration with physical health) and the beginnings of a new approach for the management and financing of the care of patients with chronic conditions (this appears to be Health Care Homes version 2.0 but details currently are few). There is recognition that the failure to index Medicare reimbursements for doctors and diagnostic imaging contributes to out-of-pocket costs but, in reality, the only redress for this growing problem is the establishment of a website to provide information about doctors’ fees. The Child Dental Benefits program is extended for three years but with no increase in funding.
There is nothing to tackle obesity beyond $1.1 million for the Health Star Rating system – that can is kicked down the road and we will all pay the price if it is not addressed. There is very little to boost the efforts towards Closing the Gap. There is a real failure to recognise that having the appropriate workforce is essential for the implementation of new programs in mental health and primary care. The past two budgets have taken savings of $774 million by limiting the intake of overseas doctors and where they can practice. These are only “savings” if the doctors’ visits not delivered were not necessary, otherwise they result in costs elsewhere in the system. The Government’s largesse with the distribution of healthcare infrastructure seems to be targeted more to winning votes than addressing need.
Opposition Leader Bill Shorten’s Budget reply made it clear that health will be a major issue in the upcoming election. His focus was on addressing out-of-pocket costs for patients with cancer. The details are not yet clear, but hopefully the bulk billing arrangements for diagnostic imaging and out-of-hospital specialist consultations will be developed to ensure that there is no ability to game the system or to inflate fees. If this expansion of Medicare can be demonstrated to deliver value to the healthcare system and to patients, then perhaps it could be expanded to cover other costly and long-term conditions such as cardiac disease, diabetes and chronic pain.
Like the Treasurer, Shorten has already been criticised for what was not in his speech. In the election campaign days ahead, voters and stakeholders in the health care system will be monitoring and evaluating every health commitment. We must hope for moves away from bidding wars on hospital funding and the latest new technology to a focus on more affordable and expansive primary care delivered in settings that are tailored for and with the communities served. We must look for leadership and vision, appropriate resourcing and sustainability, and for a willingness to tackle the hard problems like obesity, the health impacts of climate change, health disparities, and the social and economic determinants of health.
Ultimately, what is needed for this to happen is a recognition (by politicians and voters alike) that delivering improved health outcomes and better, more affordable healthcare is not a budget impost but an investment in the future of the nation.
Dr Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney.