ALTHOUGH a healthy population and a healthy economy go hand in hand, the 2022 federal budget makes no commitment to much-needed health sector reform.
Healthy workers will be the backbone of our economic rebound from the ongoing COVID-19 pandemic. And Australia’s health workforce must be healthy to achieve economic productivity.
Hospitals will remain under pressure
Funding for hospitals will continue as planned with no future increases, despite hospitals facing backlogs of patient appointments and postponements interrupted by waves of COVID-19. Although hospital funding is partly a Commonwealth responsibility, hospital outcomes are the responsibility of the states. The budget states that the Commonwealth will cover 45% of usual hospital costs and that the 6.5% cap on hospital funding growth will remain. Yet every state is seeing emergency departments full, ambulances springing up, and waiting lists skyrocketing (here and here). This was before the COVID-19 pandemic.
The rising costs of providing public hospital care are uncovered and unsustainable. Better decisions need to be made on how to prioritize delivering patient-centered, high-quality, and financially sustainable care in hospitals and primary care.
When one jurisdiction (Western Australia) conducted an external review looking at the sustainability of its healthcare system, the reviewers’ first conclusion was to recommend that public and preventative health spending be increased to a minimum of 5% of its health budget by 2029.
A missed opportunity to invest in the public health workforce
The delivery of health services in Australia is complicated by multiple levels of government and the separation of primary care from hospitals and other services; essentially, the Commonwealth pays the bills and the states provide the hospital services. COVID-19 has revealed and aggravated pressures on health workers and seen the exodus of highly skilled cadres. The loss of trained personnel is a ‘brain drain’, affects the next generation of health workers and is expensive to replace.
Add to that Australia’s aging population, growing number of people with chronic conditions, increasingly expensive medical technologies and healthcare inflation, and we have a perfect storm of pressure on an already tired of COVID-19.
To help improve the demand on our healthcare system and healthcare workers, we need to redouble our efforts to tackle preventable diseases, keep people out of hospitals and ensure resources are directed where they are most likely to have the greatest advantage. We urgently need major improvements in how we attract, educate, train, deploy and retain a much larger public health workforce (i.e. those working on prevention, promotion of health and population response, and epidemic preparedness and response) than before the pandemic hit.
Last week’s budget announced several funding items for specific groups (particularly Women’s Cancers), mental health programs, and maintaining telehealth services. Yet the majority of funding has gone to high-cost pharmaceutical treatments ($878.7 million over 5 years), which occur during routine health technology assessments and funding decisions, regardless of any budgetary measures. . While welcome, small incremental expenditures for very specific groups represent a missed opportunity for real reform and population-wide health gains. Significant gaps exist for dental health care funding, hospital funding to manage patient deferrals created by COVID-19, general practice incentives/reforms, and out-of-pocket fees.
The cost of living takes center stage, but where is the relief in out-of-pocket healthcare costs?
The centerpiece of the budget was temporary cost-of-living payments. But the very real medical financial pressures for patients that can affect household finances and clinical care received no attention in the budget. While doctor-patient conversations about the cost of care are important, doctors and nurses should not bear the brunt of finding ways to reduce out-of-pocket expenses for their patients as has happened in the United States. Dealing with financial pressures is not their primary role and healthcare workers often do not have the time, training, knowledge or support services to do so effectively.
High medical expenses arise from medications, tests and investigations, paramedical care, unplanned hospitalizations and prolonged treatments as well as travel, parking and time off from work. Australians are very concerned about the affordability of care and medicine. Those who cannot afford medical bills are the poorest and sickest, and health inequalities will continue to grow unless action is taken (here and here). To reduce out-of-pocket expenses, it has been suggested that the federal government fund wholesale-charged specialist services in private clinics, particularly in poorer parts of Australia, while state governments expand outpatient services to reduce waiting times. The federal government could also reduce referrals to specialists by paying specialists to give GPs telephone advice on patients. For direct pharmaceutical expenditure, they could reduce co-payments, especially for people with chronic conditions.
The social, economic and commercial drivers of chronic disease are ignored
Chronic illnesses, while common among older Australians, are increasing among young people of working age (and here), those in their prime. Where is the new funding in the budget to address major preventable diseases caused by structural determinants of health, environmental factors, including corporate influences?
Everyone knows that prevention is better than cure, but the government continually ignores it as we face huge problems with obesity, diabetes, cancer, and alcohol-related injuries. The National Prevention Strategy (NPHS) calls for an investment in preventive health of 5% of total federal and state government health expenditures by 2030. We are currently well below that. The Australian Institute of Health and Welfare’s Health Expenditure Reports consistently estimate public and preventative investment in health at less than 2% of total health expenditure, and lower than in other countries such as the UK, Canada and New Zealand. The budget allocation of $30.1 million for the ENSP is purely symbolic.
With a high national debt on the back of pandemic emergency spending, defence, elderly care and National Disability Insurance Scheme spending commitments, the government has missed an opportunity to increase revenue through significant taxes on alcohol and sugar-sweetened beverages that target key business determinants of health. These measures are the low-hanging fruits of taxation, are supported in Australian communities and are implemented in more than 50 countries around the world. Raising the price of sugary and alcoholic beverages is a win-win situation for government, effectively raising incomes and improving health and social outcomes (here, here, and here). The largest government health expenditure for a single condition is $5 billion for dental caries, largely attributable to the consumption of sugary drinks.
Counting the costs of inaction
The National Health Survey for 2017-2018 reports that two-thirds (67.0%) of Australians are overweight or obese, and around a quarter (24.9%) of children aged 5-17 are underweight. overweight or obese. From a health perspective, these numbers mean that a large portion of the population is at increased risk of chronic diseases, including cardiovascular disease, type 2 diabetes and certain cancers. In 2021, the Australian Medical Association estimated that:
“…if no action is taken to stem the obesity crisis, by 2025 taxpayers will have paid an additional $29.5 billion (over four years [to 2024–25]) for the direct health costs of obesity.
The federal government has once again missed an opportunity to make important structural improvements to the health care system and expand preventive multisectoral action in health. This happened despite the launch of the NPHS in December 2021, a blueprint to address Australia’s health and prevent the onslaught of chronic disease costs and burdens. Australia must not continue to fail to invest in preventative health to achieve a healthier population while protecting our health system and workforce.
Associate Professor Louisa Gordon is a health economist and health economics group leader at QIMR Berghofer. It is also affiliated with Queensland University of Technology and the University of Queensland.
Terry Slevin is the chief executive of the Public Health Association of Australia. It is also affiliated with Australian National University, College of Health and Medicine and Curtin University, National Institute for Drug Research.
Malcolm Baalman is Senior Policy Officer at the Public Health Association of Australia.
Statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of WADA, the MJA Where Preview+ unless otherwise stated.