Federal Budget Submission

Transcription

1 Federal Budget Submission Simple Steps To A Healthier Population AUSTRALIAN MEDICAL ASSOCIATION - NOVEMBER 2005

2 Introduction Australians generally enjoy a pretty good health system by international standards and standards of health in the population are on average up there with the world s best. But as the latest OECD data shows we are a nation that is becoming overweight and too many Australians still smoke despite significant numbers quitting. Not enough is being done to improve Indigenous health by the quantum leap that is required and our public hospitals are constantly crying out for more funding and resources. Our medical workforce shortage continues and it will take years to produce locally sourced doctors in the required numbers. On the positive side, more Australians are being immunised than ever before and we are living longer. While good, our health system can always be improved and, as we all know, too much health funding is never enough. The first step to making the system better is to realise that it does have very considerable strengths and to build on them. These strengths include a high quality system for training health professionals that, in turn, sustains a high quality and very productive health workforce. We can be very proud of what our doctors, nurses and other health professionals achieve with the resources they are given. Australia is facing some interesting challenges in the years ahead as it seeks to reconcile available health resources with high and rising expectations, an ageing population and a growing burden of chronic disease. But we still need to build on our strengths if the health system is to properly serve patients and communities into the future beyond the budget year. We must invest in the future health of all Australians. In this submission, the AMA points to the opportunities in the Federal Budget to make strategic new investments in health workforce and health programs that will lift our performance in preventative health, make our national health spending more effective, and improve health outcomes. They are achievable and affordable, especially in an environment of a $13.5 billion budget surplus. The proposals put forward by the AMA in this submission are simple steps to a healthier population. Dr Mukesh Haikerwal AMA Federal President 2

3 Mental health Strategic investment in mental health care would bring a significant improvement in the care and treatment of people with mental illness. The current National Mental Health Strategy has failed. It is time to seek new directions. With 62 per cent of people with mental health disorders not utilising mental health services, as a community we are bound to do more. The Report, Out of Hospital, Out of Mind, by the Mental Health Council of Australia, concluded that the proportion of the health budget spent on mental health needs to increase from seven per cent to 12 per cent over the next five years. It has called for leadership by Government and a commitment to innovation and investment in mental health. A shared Commonwealth/State responsibility. Both need to pull their weight. The Commonwealth and the States need to commit to lift the level of mental health expenditure over the next five years. A minimum Federal kick-start of $100 million per year is essential. Mr John O Dea Director, Medical Practice Telephone: jodea@ama.com.au Aboriginal and Torres Strait Islander health More appropriate primary and preventive health care for Aboriginal peoples and Torres Strait Islanders could significantly improve the health of the most disadvantaged Australians while reducing, in real terms, the high burden of tertiary health care. Well-evidenced primary health care interventions that have considerable potential are areas such as mothers and babies, better access to the PBS, and better support and training for staff. A key element will be to train more Indigenous people as health professionals. $400 million per year for primary health care $10 million per year for primary and secondary school mentoring programs Dr Margaret Chirgwin Director, Public Health and Ethics Telephone: mchirgwin@ama.com.au 3

4 Public hospitals The performance of public hospitals could improve markedly if we avoided the inefficiencies that arise from excessive rationing of care and resource starvation. The drive for efficiency is actually making our public hospitals inefficient. Access needs to be improved across the board if the Government wants to be able to truly claim that free public hospital care is available to all Australians who want it, as opposed to who can afford it. The level of indexation contained in the current Australian Health Care Agreements (five per cent) barely covers the cost increase in public hospitals, let alone activity increases, which are inevitable. The AMA supports all Federal Government initiatives to combat the cost shifting and service closure activities of State and Territory Governments and looks for strategic tied Federal funding to create incentives for a stronger State/Territory effort. A shared Commonwealth/State responsibility - both need to pull their weight. The Federal Government needs to take a lead by lifting the level of indexation to more realistic levels. The States would then be required to follow. Suggested Federal kick-start of a minimum of $100 million per year. Mr John O Dea Director, Medical Practice Telephone: jodea@ama.com.au Seven-tier GP consultation structure The current structure of GP consultation items actively works against high quality care. A new structure, combined with a sustainable system of indexation, will improve incentives for high quality, patient-centred care. Adopt the recommendations arising from the attendance item review to achieve an appropriately priced and superior structure, and hold this system in place with a workable indexation system. $100 million per year (assuming that current GP blended payments are re-invested as Medicare patient rebates) Ms Julia Nesbitt Director, General Practice and ehealth Telephone jnesbitt@ama.com.au 4

5 Consultant Physicians Of all the medical groups, Consultant Physicians have not received any benefit from recent government actions and budgetary measures to increase the level of bulk billing (General Practice) or to increase the level of participation in private health insurance (Surgeons and Anaesthetists). There are serious shortages of Consultant Physicians particularly in those areas supplying services to the aged where long consultations are necessary. There is a need to refine the MBS Item numbers applicable to Consultant Physicians to ensure that the structure does not discriminate against those Consultant Physicians who provide longer consultations, especially for the aged. There is also a need for new items to cover case conferencing and complex care situations, as has been done already in General Practice. The effect of these measures will be to ensure adequate access to high quality Consultant Physician services. It is estimated that an additional $70 million per annum is necessary to implement this measure in a way not disadvantageous to any of the specialty craft groups and to enable the new money to be properly targeted to consultation services. Mr John O Dea Director, Medical Practice Telephone: jodea@ama.com.au Rural retention program Generally successful rural retention programs are losing their effectiveness as the real value of incentives falls behind living costs and costs of medical practice. Restore the value of these payments and adopt a more sustainable indexation arrangement for future years. $42 million over four years. Mr Warwick Hough Director, Workplace Policy Telephone whough@ama.com.au 5

6 Support for procedural GPs Commonwealth support for training of rural procedural GPs is being impaired by closure of rural hospitals, withdrawal of specialist services, and lack of opportunities for hands-on experience. There is a significant opportunity cost in terms of the skills base. Greatest need is for Commonwealth/State cooperation with a view to a more rational framework for assessing hospital closures - one that addresses workforce needs as well as budgetary considerations. $8 million over four years. Mr Warwick Hough Director, Workplace Policy Telephone whough@ama.com.au Training and support of Temporary Resident Overseas Trained Doctors We are not making best use of the 2,500 temporary resident overseas trained doctors who come to Australia each year due to lack of proper assessment, training and professional support. Better programs and support services will lift productivity as well as the safety and quality of practice. Better assessment (rapid assessment units), orientation and ongoing professional support, and better support for the families of temporary resident overseas trained doctors (Medicare, PBS and public hospital entitlements). $8 million over four years (assuming costs shared with States) for training $9 million over four years for Medicare and other entitlements $4 million over four years for rapid assessment units Mr Warwick Hough Director, Workplace Policy Telephone whough@ama.com.au 6

7 Training and support of Permanent Resident Overseas Trained Doctors We could do more to help permanent resident overseas trained doctors achieve the standards for practice in Australia. This would be an astute and timely workforce measure. A HECS-type scheme for bridging courses would help lift AMC pass rates and allow the health system to maximise the potential of a valuable workforce resource. $8 million over four years initially, working up to $4 million per year - long term cost neutral. Mr Warwick Hough Director, Workplace Policy Telephone whough@ama.com.au Training support for practice nurses The value added from the funding of general practice nurse items could be increased further by supporting training of general practice nurses (GPNs) this is an opportunity to build human capital/workforce capacity. A system of grants to support GPN access to training programs. $16 million per year. Ms Julia Nesbitt Director, General Practice and ehealth Telephone jnesbitt@ama.com.au 7

8 Specialist training in private clinical settings Since the future capacity of teaching hospitals to provide enough avenues for training is in doubt, it is vital to immediately start some pilot programs to extend specialist training into private sector settings. Establish Commonwealth-funded pilot training programs with a longer-run target of 200 FTE positions in private clinical settings. $150 million over four years Mr Warwick Hough Director, Workplace Policy Telephone whough@ama.com.au More action on obesity Obesity is a costly, yet preventable, public health issue, with now alarming rates among Australian adults and children. There is scope to achieve much in nutrition if action is well-informed. There are obvious target areas (children, jails and residential aged care facilities). A National Nutrition Centre would provide the proper policy focus as well as conduct independent nutrition surveys to inform action and to manage action plans and educational efforts. $10 million per year for a National Nutrition Centre $10 million for a fully independent national nutrition survey Plus increased funding for the Healthy School Communities component of the Healthy, Active Australia program - $5000 per school, childcare centre, aged care facility and prison/ correctional facility. Dr Margaret Chirgwin Director, Public Health and Ethics Telephone: mchirgwin@ama.com.au 8

9 Preventative Health Assessment Item There is ample evidence that early intervention gives better health outcomes and saves lives. This requires people to have more regular preventative health checks. A strategic, affordable approach would facilitate health assessments for people in higher risk cohorts. Programs of this nature are most efficiently operated through the provision of Medicare benefits. Cost not known, will depend on proper evaluation of the number of people now missing out on appropriate health assessments. Ms Julia Nesbitt Director, General Practice and ehealth Telephone jnesbitt@ama.com.au Health assessments for intellectually disabled patients There is the opportunity to implement strategically targeted health assessments for high-risk minorities who would not be encompassed within the more general health assessment program. The intellectually disabled are one such group. Programs of this nature are most efficiently operated through the provision of carefully targeted Medicare benefits. $12 million per year. Ms Julia Nesbitt Director, General Practice and ehealth Telephone jnesbitt@ama.com.au 9

10 Health assessments for refugees There is the opportunity to implement strategically targeted health assessments for high-risk minorities who would not be encompassed within the more general health assessment program. Refugees are one such group. Programs of this nature are most efficiently operated through the provision of carefully targeted Medicare benefits. $1 million per year. Ms Julia Nesbitt Director, General Practice and ehealth Telephone