Federal Budget 2018
Dr Ayman Shenouda
Expectations around this year’s Federal Budget were high. The Government certainly worked hard in its lead up trying to lower expectations promising an economically responsible and fair budget.
We knew we would see an election budget here and with that, we expected a strong focus on some key areas important to the majority of Australians.
Voters wanted to see a focus on cost of living pressures and improving the health system and these two items came out on top in earlier polling.
A budget for a healthier Australia?
So, what is the verdict - is this a budget for a healthier Australia?
There were certainly strong gains in rural health, aged care, mental health and medical research.
There are some really positive initiatives in this budget but at a time of record inequality, more wellness measures through formalising a preventative health strategy would have made this a great budget.
This is required to help drive a strategy forward to really address some of those causes of ill health.
Spending measures in countering the high numbers of our population who are overweight or obese, for example, are needed and it would have been good to see some strategy around this.
We all know to get to the bottom of the causes of health disparities then the focus needs to be on those social determinants of health.
The investment is beyond health and an overall policy approach to protect those factors which stretch a range of personal, social, economic and environmental factors.
Primary prevention focus
A strong and broad primary prevention focus is needed to counter those health risks factors and improve health outcomes for all Australians.
This budget does pick up a number of these issues, including for women’s health and wellbeing and more broadly through its More Choices for a Longer Life Package.
Mental Health funding of $338 million and priority on suicide prevention clearly goes a long way towards addressing the system gap around crisis support.
The allocation for older Australians which includes $83 million for more services within the RACF, again addressing a significant gap, is a really positive step forward.
While short on detail, the new primary care funding model for the Indigenous Australians’ Health Program is another key area which required focus.
The increases for PBS and new funding for medical research, development of diagnostic tools and medical technologies, and clinical trials of new drugs all represent a significant health investment.
The standout here in terms of addressing disparities and ensuring a primary prevention focus is the rural investment and the Government has certainly delivered here.
Equity for rural Australians
The key rural health workforce measures are provided through the $83.3 million new Stronger Rural Health Strategy which includes some solid measures to secure more GPs for rural Australia.
This is a 10-year plan and a $550 million commitment which promises 3000 more doctors, 3000 nurses and hundreds of allied health professionals to our regions.
The plan provides an unprecedented level of funding and commitment for rural Australia and its packed with measures that show the Government has listened on addressing rural health need.
The workforce component will see integration through the entire training continuum as well as measures to support the existing rural workforce with an important focus on retention.
Stronger targeting of rural bulk billing incentives and key focus on accessing rural services particularly for older Australians with $40 million towards rural aged care infrastructure another positive shift.
For Aboriginal and Torres Strait Islander communities, there is a $105 million boost towards access to services which are culturally appropriate and closer to home.
There is a new MBS item to deliver dialysis services to remote areas representing a $35 million investment.
We have some great leadership here at the moment in our Rural Health Minister, Senator the Hon Bridget McKenzie and Commissioner Professor Paul Worley and it shows in the budget.
Rural pathway package
The rural workforce package is certainly comprehensive and a significant step forward in securing a stable rural workforce with a number of the key components to this strategy covered in earlier blogs.
There is a priority placed on establishing a homegrown rural medical workforce with an important emphasis on skills.
Many of the placement gaps that make it harder to remain in a rural area have been addressed.
More intern placements in general practice and an additional 100 vocational training places are committed. The latter committed from 2021 as part of the National Rural Generalist Pathway.
New training facilities to help rural students aspiring to become rural doctors study closer to home is also welcomed.
The $95.4 million new Murray-Darling Medical Schools Network will help universities work together to support medical teaching in our regions.
It’s also great to see that the new Workforce Incentive Program will extend to supporting general practices to employ more allied health workers.
Strong IMG focus
It’s great to see strong action to ensure we retain the rural workforce in this package of measures which extends to providing incentives for IMGs to progress towards Fellowship.
Those working in rural areas know the huge contribution IMGs make and it is great to see the shift here towards IMG retention. These doctors play a vital role in rural and remote communities and they deserve some support.
The rural strategy outlined in this budget invests in the next generation through domestic recruitment to rural areas but shows a commitment to the existing workforce through investment in skills and retention with an important focus on IMG retention.
In Aged Care, reduced waiting lists and incentives to stay in the home longer sees another important policy shift.
Measures which keep older patients in their homes longer is welcomed policy with this initiative providing $1.6 billion for 14,000 new places for home-care recipients.
This is a good start but not nearly enough with more than 100,000 people on the waiting list. However, the policy is certainly headed in the right direction towards an integrated care at home program.
Some of these measures will restore some of the cuts to the aged care sector of recent years. But it is unclear if they will provide for the targeted supports needed to deliver the complex care required which needs more focus on enabling more GP-led care.
A healthier future
There are some major challenges in funding and delivery of healthcare in securing a healthier future and for this budget, we’re seeing shifts in the right direction.
Health is so integral to our nation’s prosperity and the Government through its investment particularly in rural Australia shows that it understands the value of general practice and primary care.
This budget will certainly improve the lives of the seven million people living in rural and remote Australia.
The rural health measures will help to address disparities and important gains will be realised through this investment and this is a clear win for the sector.
The mental health and aged care gains are also significant and it is great to see those more vulnerable Australians being prioritised.
Dr Ayman Shenouda