NACCHO Aboriginal #HealthBudget17 : #Budget2017 Are we investing enough in #healthyfutures to #closethegap ?

‘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 re‑commitment 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”

 AHHA Health Budget 2017

 ” 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.”

PHAA Press release

” There are no real funding commitments in this Budget to Close the Gap of Indigenous disadvantage. This is a disgrace. In fact there is a decrease of $16 million in National Partnership for Remote Housing funding to the NT.”

NT Federal Labor politicians

 ” Reconciliation Australia is concerned with the lack of a clear plan to close the gap, and to take the next steps toward constitutional recognition and treaty.

The Prime Minister’s latest Closing the Gap report, which revealed six of seven targets are not on track, is clear proof that targeted and sustained resources are needed to address Aboriginal and Torres Strait Islander health, education and employment disparities.”

Justin Mohamed CEO Reconciliation Australia and former NACCHO chair

 Picture above from Government Budget Brochure Page 15  Investing in a healthy Australia but does not mention Aboriginal /Indigenous Health.

“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 Michael Gannon AMA president  

“We are also particularly pleased that the Government has listened closely to RDAA and opted not to include the Indigenous Health Incentive and Procedural GP Practice Incentive as part of the Practice Incentives Program (PIP) Quality Improvement Incentive measure.

“This will mean that only general practices that are actively providing Indigenous healthcare and/or procedural GP services to their communities will continue to have access to the important funding support provided under these specific areas of the PIP.”

Rural Doctors Press Release rural doctors health Budget2017

 ” Prioritising Mental Health, Preventive Health and Sport

Significantly, the 2017-18 Budget puts a strong focus on mental health and preventive health-key elements of our Long-Term National Health Plan.

The Turnbull Government is building on its mental health reforms by delivering another boost of more than $170 million for mental health support, treatment and research.

This includes $80.0 million of additional funding, contingent on matched commitments from the states and territories, to maintain community psychosocial services for people with mental illness who do not qualify for assistance through the National Disability Insurance Scheme.

People living in rural and remote regions of Australia will now receive significantly improved access to psychologists, under a new $9 .1 million telehealth initiative set to roll-out later this year.

And we are providing $11.1 million to prevent suicide in specific locations – hotspots – where suicide incidents repeatedly occur. Crisis help signage and infrastructure such as barriers will deter suicide attempts, and the capacity of existing crisis line services to respond to cries for help will be improved.”

The Hon. Greg Hunt MP Minister for Health Full Press Release

The Hon. Greg Hunt MP Budget 2017 Press Release

Health Budget 2017–18

This page provides access to stakeholder information on the Health Portfolio’s 2017-18 Budget measures

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 Australia is lagging considerably compared to places like Canada and New Zealand where over 5% of the health budget is committed to prevention”.

Michael Moore, CEO of the PHAA.Statement from the Public Health Association of Australia

Preventive health 

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.

Tobacco

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.

Budget 2017 sees Medicare rebate freeze slowly lifted and more funding for the NDIS: experts respond Via The Conversation

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,’

As expected, the government has announced a progressive lifting of the Medicare rebate freeze. Together with removing the bulk-billing incentive for diagnostic imaging and pathology services, as well as an increase in the PBS co-payment and related changes, this will cost a total of A$2.2 billion over the forward estimates.

Other announcements include:

  • From July 1, 2019, an increase in the Medicare levy from 2% to 2.5% of taxable income, with the extra half a percent directed towards the NDIS
  • $1.2 billion for new and amended listings on the PBS, including more than $510 million for a new medicine for patients with chronic heart failure
  • a A$2.8 billion increase in hospitals funding over forward estimates
  • $115 million for mental health, including funding for rural tele-health psychological services, mental health research and suicide prevention
  • $1.4 billion for health research, including $65.9 million this year to help research into children’s cancer.

All up, these commitments equate to A$10 billion.

Medicare rebate freeze

Stephen Duckett, Health Program Director, Grattan Institute

As foreshadowed in pre-budget leaks, the government is slowly unthawing the Medicare rebate freeze, but at a snail’s pace. At a cost of A$1 billion over the forward estimates, indexation for Medicare items will be introduced in four stages, starting with bulk-billing incentives from July 1, 2017.

General practitioners and specialists will wait another year – until July 1, 2018 – for indexation to start up again for consultations, which make up the vast bulk of general practice revenue. Indexation for specialist and allied health consultations is slated to start from July 1, 2019.

Certain diagnostic imaging items (such as x-rays) will be the last cab off the rank. Indexation will start up again from July 1, 2020.

There is no mention of reintroducing indexation for pathology items. This may be due to the recognition that there is money to be saved in pathology.

Regardless of the reaction of medical lobby groups, it is too early to tell whether this glacially slow reintroduction of indexation will be enough to keep bulk-billing rates at their current levels. Practice costs and income expectations of staff have not increased dramatically over the freeze period as the Consumer Price Index has been moving slowly. But each additional day of a freeze means costs and revenues fall further out of alignment.

The jury will be out for a while on whether reintroduction of indexation is enough to restore the Coalition’s tarnished Medicare credentials with voters.

Certainly, the slow phase-in may attract cynicism, with a legitimate perception the government is doing the minimum necessary and at the slowest pace to ensure the issue is off the agenda before a 2019 election.

There is no sign in the budget that the government has sought any trade-offs from the medical profession in exchange for the reintroduction of indexation, so we will have to wait to put in place better foundations for primary care reform.

National Disability Insurance Scheme (NDIS)

Helen Dickinson, Associate Professor, Public Service Research Group, UNSW

Since its inception, a number of bitter political battles have been fought over how the National Disability Insurance Scheme should be funded. Many have been nervous the current Productivity Commission review of the costs of the scheme could lead to a scaling back of the NDIS before it is fully operational.

The NDIS operates under a complex funding arrangement split between federal, state and territory governments. Until now it has been unclear where the federal component of this commitment will come from, and a significant gap was emerging from the middle of 2019.

Today’s budget promises to fill this funding gap, in part through an increase by half a percentage point in the Medicare levy from 2% to 2.5% of taxable income. Of the revenue raised, one-fifth will be directed into the NDIS Savings Fund (a special account that will ensure federal cost commitments are met).

A commitment has also been made to provide funding to establish an independent NDIS quality and safeguards commission to oversee the delivery of quality and safe services for all NDIS participants.

This will have three core functions: regulation and registration of providers; complaints handling; and reviewing and reporting on restrictive practices. While such an agency will be welcomed by many, the devil will be in the detail as to whether it is possible to deliver this in practice.

But how has the Government prioritised Indigenous spending?

NITV Report

The Indigenous Affairs Minister, Nigel Scullion, said in a statement that his department’s major focus is to drive jobs, growth and investment of Aboriginal and Torres Strait Islander people by supporting them into employment and growing the Indigenous business sector.

Here’s how Indigenous Affairs measured up.

INDIGENOUS BUSINESS

The government will redirect $146.9 million over four years from Indigenous Business Australia to the Department of the Prime Minister to facilitate the delivery of innovative and effective support for Indigenous businesses and entrepreneurs.

Services will include workshops, business planning and training. The measure will also provide tailored loan products, including capital assistance for Indigenous entrepreneurs who would like to establish or grow their business

CASHLESS DEBIT CARD

The government will also extend and expand  cashless debit card trials.

The two trial sites in Ceduna, South Australia, and the East Kimberley, in Western Australia, will be extended for a further 12 months, until 30 June 2018.

Another two new locations will be trialled from 1 September 2017

CLOSING THE GAP

To help close the employment gap, the government says it will inject $55.7 million over the next five years to reach the employment target.

The government will provide $55.7 million over five years from 2016-17 to help meet their Closing the Gap employment targets for Indigenous Australians. This measure will enable stronger engagement by employment service providers with Indigenous communities and provide enhanced support for Indigenous participants.

This measure includes:

• $33.2 million over five years from 2016-17 to deliver pre-employment training and mentoring for Indigenous participants, and to expand access to the Transition to Work program to all Indigenous job seekers aged 21 years or under;

• $17.6 million over five years from 2016-17 to trial additional employment assistance to Indigenous prisoners, to ensure they are provided with better preparation and assistance to transition from prison to an employment assistance program after their release. The measure includes additional support in the immediate post-release period, as part of the government’s response to COAG’s 2016 Prison to Work Report;

• $5.0 million over four years from 2017-18 to support the implementation of community-designed and delivered employment services in Yarrabah, Queensland.

• Immediate access to increased wage subsidies (from $6,500 to $10,000) for Indigenous participants to better support their employment outcomes, with funding to be met from within the existing Wage Subsidies Funding Pool.

To help close the gap in literacy achievement, the government will provide $5.9 million over four years from 2017-18 to trial the use of digital applications to improve English literacy outcomes for Aboriginal and Torres Strait Islander children. The trial will be undertaken over two years, 2019 and 2020, in 20 preschools around Australia.

POLICIES & PROGRAMS

The government will provide $52.9 million over four years to implement a whole-of-government research and evaluation strategy for policies and programs affecting Indigenous Australians, including the establishment of an Indigenous Research Fund.

This measure includes three components:

• $40.0 million over four years from 2017-18 to strengthen evaluation of the Indigenous Advancement Strategy.

• $10.0 million over three years from 2017-18 to establish an Indigenous Research Fund that will add to the Indigenous policy evidence base.

• $2.9 million over four years from 2017-18 for the Productivity Commission to enhance its role in Indigenous policy evaluation and to expand the Commission to include an additional Commissioner with relevant experience in Indigenous policy.

While the government will continue to sell its budget, time will only tell its true effect on Indigenous Australians.

Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven.

Download Press Release AHHA Health Budget 2017

‘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.

Medicare

‘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.

Primary care

‘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.

Hospitals

‘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.

Preventive health

‘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.

Medicines

‘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.

Oral health

‘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.

Mental health

‘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.

Download press release Mental Health Budget 2017

Download Press Release Lifeline health Budget2017

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 re‑commitment 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.

Health sector feels the warmth in Budget 2017, but rural health still needs some extra layers

The Rural Doctors Association of Australia (RDAA) has welcomed key elements of tonight’s Federal Budget, saying it shows recognition by the Federal Government of key concerns of RDAA and other medical groups, as well as recognition of the importance of the primary health sector in keeping Australians healthy and out of hospital.

“Overall, and certainly compared with previous federal budgets, this is a good budget for the health sector” RDAA President, Dr Ewen McPhee, said.

“Having said that, more work is required to fully address rural health issues, and we look forward to working with the Government to achieve this.

“We strongly welcome the Government’s decision to lift the indexation freeze onMedicare patient rebates, commencing with bulkbilled incentives for GP consultations from 1 July this year; standard GP consultations and other specialist attendances from 1 July 2018; specialist procedures and allied health from 1 July 2019; and targeted diagnostic imaging services from 1 July 2020.

“We would have preferred the freeze to be lifted in full immediately, but we accept the approach of the Government in lifting it incremently over forthcoming years.

“The lifting of the freeze on bulkbilled incentives for GP consultations will particularly benefit many rural and remote patients who rely strongly on bulkbilled consultations to afford their medical care.

“We are also particularly pleased that the Government has listened closely to RDAA and opted not to include the Indigenous Health Incentive and Procedural GP Practice Incentive as part of the Practice Incentives Program (PIP) Quality Improvement Incentive measure.

“This will mean that only general practices that are actively providing Indigenous healthcare and/or procedural GP services to their communities will continue to have access to the important funding support provided under these specific areas of the PIP.

“We also welcome some added support for the Health Care Homes initiative, through delaying the introduction of the initiative until 1 October 2017 for a first tranche of practices and until 1 December 2017 for a second tranche. A general practice research pilot will also support practices to provide continuity of care for their patients across the health system. It is also good to see funding support for community pharmacies to participate in the Health Care Homes initiative.

“We believe, however, that additional funding support for practices will be required to ensure the Health Care Homes initiative is fully successful.

“We welcome acknowledgement by the Federal Health Minister, Greg Hunt MP, that as part of a forthcoming second wave of the Government’s National Health Plan, there will be (amongst other things) a focus on addressing health workforce maldistribution between urban and rural areas.

“As part of this focus, and in line with a major initial focus of the National Rural Health Commissioner role (the legislation for which is anticipated to soon be passed by the Senate), we will be keen to see significant funding committed in future federal budgets to the development and rollout of the Government’s promised National Rural Generalist Program.

“This Program will be essential in delivering to rural and remote Australia the next generation of doctors with advanced medical skills — including in obstetrics, anaesthetics, general surgery, emergency medicine, advanced mental healthcare and Indigenous healthcare.

“We welcome funding already announced by the Government that will ensure rural and remote patients benefit from increased access to psychology services via Medicare funded video consults with distant psychologists.

“Additionally, we welcome significant additional funding in the areas of both Aboriginal and Torres Strait Islander health, and mental health.

“It was great to see Minister Hunt attend tonight’s Health Budget lockup to address health sector stakeholders — it underlines the consultative approach that he, along with the Federal Assistant Minister for Health, Dr David Gillespie MP, and the Federal Minister for Aged Care and Indigenous Health, Ken Wyatt AM MP, have been adopting in developing an holistic plan to take healthcare in Australia into the future.

“Rebalancing the distribution of doctors and other health professionals between urban and rural Australia will continue to be a key challenge, and we look forward to working with the Government to deliver a vibrant and sustainable rural health workforce for the years to come.”

 

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