The Rudd Government's first
budget indicates its
commitment to a leadership
role in the partnership with
the states and territories to address
the needed reforms in the provision
of acute-care services through public
hospitals.
Over the next 12 months, while
funding and performance
agreements for the new Australian
Health Care Agreements are
negotiated, the states and territories
will have an immediate boost of
$1billion in additional funds to
public hospitals, plus $150million to
conduct an immediate national blitz
to clear the backlog of people who
have been waiting for elective
surgery, and $142million for
improvements and upgrades in
health-care facilities and more
advanced medical technologies such
as magnetic resonance imaging
machines.
Over the four years 2008-09 to
2011-12 in addition to the funding
provided through the Health Care
Agreements, there will be a further
$247.5million for health
infrastructure and new technologies
and $150million for hospital
improvements such as new day-care
facilities that will help the states and
territories continue to meet elective
surgery waiting-list reduction
targets.
There is $300million available for
incentive payments to those states
and territories which meet these
targets.
Most importantly, the interest and
the principal from the Health and
Hospitals Fund, which has an initial
allocation of $10billion, will finance
health infrastructure and medical
research so that these priorities do
not need to compete with patient
services for funding.
However, the benefits of the
reforms which the National Health
and Hospitals Reform Commission
will generate, and this new funding
will support, will only fully eventuate
when the Government also
implements promised reforms in
prevention and primary care.
Clearly major policy changes and
investments in this area must await
the deliberations of the National
Preventative Health Taskforce, the
funding bonanza that will result from
the application of higher taxes to
alcopops, and the development of
the National Primary Health Care
Strategy.
But it is disappointing to see some
lost opportunities in this budget to
progress the agenda on prevention
and primary care reform.
Budget and earlier
announcements provide
$53.3million to tackle binge
drinking, $29.5million for anti-
tobacco programs and $21.9million
for obesity and healthy nutrition
initiatives, but this is a puny
response when the annual direct and
indirect costs of obesity and obesity-
related diseases, smoking and
alcohol abuse total almost
$70billion, equivalent to the total
cost of the health system.
Even when the costs of child health
checks and continuation and
expansion of the bowel cancer
screening program are included, the
Commonwealth's new commitment
to prevention amounts to only
$54million a year over the next four
years.
Tackling these lifestyle diseases
that take such a toll on our health
and our health-care system requires
a multi-faceted approach that must
extend well beyond the health
portfolio.
The inclusion of sport and
recreation in the health and ageing
budget provides an opportunity in
this regard that has been missed this
year. Of $117.5million to be spent
over the next five years, only
$22.2million could be described as
going to community recreational
activities, and the remainder is for
elite sports.
In primary care, the growing
concern is that a Medicare system
that only pays GPs for services
delivered if and when the patient
visits their practice will not deliver in
terms of better prevention, early
intervention and management of
chronic illnesses.
The incentive payments that were
introduced a decade ago to
encourage GPs to do more in these
areas have not had a huge take-up,
and this budget sensibly cuts these
incentives but does nothing about
replacing them with incentives that
will work. The fact that the new GP
superclinics will continue to use this
fee-for-service reimbursement to
GPs for their services and those of the
nurses and allied health
professionals they employ has the
potential to undermine the ability of
superclinics to deliver better
preventive health care and chronic
illness management.
Changing the focus of the health-
care system and the way in which
services to keep people healthy and
treat their illnesses are delivered
cannot happen overnight, and needs
a cohesive strategy which involves all
stakeholders. So we should not
expect miracles in this first budget in
the first six months of government.
But we should expect a consistent
focus on these new imperatives that
will deliver the required new
strategies, action plans and funding
as soon as possible. The target time
line should be the 2009-10 budget.
Dr Lesley Russell is the Menzies
Foundation Fellow at the Menzies Centre
for Health Policy, University of Sydney/
Australian National University.
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