Dr Rhonda Jolly, Amanda Biggs and Dr Matthew Thomas
The 2010–11 Budget acknowledged the importance of technology in delivering better health services into the future. In that Budget, funding of $466.7 million over two years was committed to establish the key components of a Personally Controlled Electronic Health Record (PCEHR) system. At the time the investment in e health was welcomed, but crucially, critics argued that it was insufficient and misdirected.
It may be that figures in 2012–13 confirm that funds were misdirected. Only 500,000 people had opted to register for a PCEHR in that year and it is expected that only 2.8 million will have registered by 2016–17.
Despite the low uptake of this fundamental element of an effective e health system, there is but one mention of e health in the Budget in relation to a savings measure, and no new funding to assist in promoting existing e health projects or initiate new ventures.
Parliamentary Library analysis of health workforce issues in recent Budgets has stressed the importance of adopting policy and funding initiatives that move away from conventional approaches to dealing with problems associated with a shrinking health workforce and increasing demand for health workers. Despite supporting substantial workforce reform, recent funding in this area has been consistently conservative in nature.
Funding has been allocated in this Budget, however, to continue for a ‘workforce redesign activities’ project. While the amount allocated to this project is minimal ($6.0 million in 2013-14), its objective has the potential to deliver greater workforce capabilities and efficiencies.
At the same time, the Government’s workforce body, Health Workforce Australia (HWA), set up specifically to address the many challenges involved in providing a more skilled and flexible workforce, will lose funding of $80.0 million over the next four years. Some of this funding is to be re-directed to the General Practice Rural Incentives Program (GPRIP), which provides relocation incentive payment to encourage medical practitioners to work in rural areas. GPRIP will be provided with $33.8 million in 2013–14; of this funding, $20.0 million will be redirected from HWA.
The GPRIP program is an essential workforce program, calculated to reduce the inequities between health services available in metropolitan and rural areas. However, HWA has produced some valuable work, and it would be unfortunate if its capacity was diminished by the reduction in resources as announced in this Budget.
Victorian local hospital networks funding
The recent controversy between the Victorian and the Australian governments over hospital funding was a stark reminder that the blame game over health funding is far from over. Broadly, the dispute arose after changes to population growth estimates resulted in Commonwealth funding to most states to run their public hospitals being reduced from mid-2013. The impact in Victoria, where local decentralised hospital networks had already budgeted their spending, was considered particularly acute.
While a Senate inquiry was underway, the Health Minister, Tanya Plibersek announced a Victorian hospital rescue package of $107.0 million to be paid directly to Local Hospital Networks, which would distribute funds to hospitals—bypassing the state government. The Health Minister accused the Baillieu Government of ‘savagely’ cutting public hospital funding by $616 million and mismanaging the health system.
Funding for this ‘rescue package’ is committed in this year’s Budget, and is being drawn from a redirection of Victoria’s ‘reward payments’ under the National Partnership Agreement to deliver a Seamless National Economy. Funding is for a transitional period only, to July 2013, when a previously agreed new funding formula will commence.
Registers for high-risk implantable devices and clinical quality
A patient register for high-risk implantable devices and two clinical quality registers for breast implants and cardiac devices will be established with funding of $12.1 million over four years. Funding for the patient register will also support the development of device identifiers, standard labelling, nationally consistent data requirements and national protocols for rapid patient identification. The two clinical quality registers will provide performance information on devices. Over time, costs for operating these registers will be recovered from the medical devices industry—from 1 July 2014 for the patient register and 1 July 2015 for the two clinical quality registers.
The safety and regulation of implantable medical devices has come under scrutiny following a number of device problems and recalls. These include voluntary recalls for the poly implant prostheses (PIP) breast implants and the De Puy ‘metal on metal’ hip replacement system, following a number of safety issues.
The establishment of an opt-out patient register for breast implants was a recommendation of a recent Senate Committee report. A patient register should assist in the rapid and accurate identification of patients in the event of a future recall while the quality registers should help identify emerging safety issues.
Indexation of tobacco excise
A substantial body of research evidence demonstrates that increases in the price of tobacco result in a reduction in tobacco use, especially among price-sensitive young people. Raising tobacco taxes has thus been found to be one of the most effective means for governments to reduce tobacco use, along with its negative health impacts. If tobacco taxes are to prove effective in reducing tobacco consumption then this demands that they should keep pace with inflation and increases in real income.
Tobacco excise rates are currently indexed to the Consumer Price Index (CPI) which has historically, on average, been lower than the growth in average weekly ordinary time earnings (AWOTE). Based on this trajectory, current indexation arrangements will result in tobacco excise falling in relation to wages over time, thereby reducing the health protective effects associated with higher tobacco prices. In light of this finding, the Henry Review of the taxation system recommended that tobacco excise should be indexed to wages rather than the CPI, a recommendation taken up by the Government. The Government has indicated that the change in indexation arrangements should result in a packet of 25 cigarettes increasing in price by seven cents from the first half of 2014. The change is thus in line with the Government’s strategy to ‘continue to implement regular staged increases in tobacco excise as appropriate, to reduce demand for tobacco’.
Supporting leave for living organ donors
Australia’s organ donation rate has increased in recent years. At 15.6 donors per million people (dpmp) in 2012, the rate is at its highest level since national records were first kept. This improvement is likely to have been in large part a result of the Government’s substantial reforms to the nation’s organ donation system, introduced from 1 July 2008. While there are marked signs of improvement in Australia’s organ donation rate, it nevertheless remains one of the lowest in the developed world. The waiting list for organs is substantial, with 1,536 Australians awaiting transplant as at December 2012. A vast majority of people on the waiting list (1,080 people) were waiting for kidneys, which are able to be donated by a living donor.
According to Transplant Australia, international research shows that 24 per cent of potential living organ donors choose not to donate because of anticipated financial hardship, and some 45 per cent of living donors do experience some financial hardship as a result of their donation. This measure provides for a pilot study in which a payment up to the national minimum wage is paid to donors (via their employers) to help cover their costs while they recover from surgery. As such, the measure seeks to provide support to those living donors who do provide an organ (in 2012 there were 237 live kidney donors) and encourage others to do so, thereby increasing the number of organ donations. Transplant Australia chief executive officer, Chris Thomas is reported as having estimated that the scheme could result in over 100 extra live donors per year.
It is worth noting that some aspects of the Supporting Leave for Living Organ Donors pilot have changed between the time of the joint press release of 7 April 2013 announcing the measure and the release of the 2013–14 Budget. Initially, the Government was to provide $1.3 million over two years towards the pilot but Budget Paper No. 2 provides for $2.6 million over three years.
The main concerns that might be raised in relation to any scheme that provides financial or in-kind support for living organ donors are that this should neither result in poor people being exploited for their body parts nor undermine the altruism that is assumed to underpin organ donation. Given that most live donors are friends or relatives of the person requiring an organ, the scheme is restricted to people who are employed, payments are made to employers and not directly to donors, and that the scheme only provides for payment up to the minimum wage for a limited period, the scope for exploitation of the poor is minimal. Similarly, the scheme is unlikely to compromise the altruism of donors or would-be donors. In any case, it is debatable whether or not such an emphasis should be placed on altruism as a necessary component of organ donation.
. The measure is the National Health Information Network, savings of $31.2 million to be achieved by ceasing funding. The budget figures in this brief have been taken from the following document unless otherwise sourced: Australian Government, ‘Part 2: Expense measures’, Budget measures: budget paper no. 2: 2010–11, p. 179, accessed 16 May 2013.
. R Jolly, ‘Health workforce’, Budget Review 2010–11, Parliamentary Library, Research paper, 17, pp. 192–95, accessed 16 May 2013.
. Under the National Health Reform agreement a new funding formula based on an activity basis, rather than on population estimates, is being introduced.
. See M Thomas and M Klapdor, The future of organ donation in Australia: moving beyond the ‘gift of life’, Research paper, 11, 2007–08, Parliamentary Library, Canberra, 2008, accessed 20 May 2013; G Moorlock, J Ives and H Draper, ‘Altruism in organ donation: an unnecessary requirement?’, Journal of Medical Ethics, 28 March 2013, accessed 20 May 2013.
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