Budget Review 2009-10 Index

Budget 2009 10: Health and ageing


Dr Rhonda Jolly

Health workforce initiatives in the Government’s first budget reflected that it had had little time to develop a comprehensive strategy to begin to address structural problems relating to the supply and distribution of health workers in Australia. Nevertheless, the 2008–09 Budget increased the number of training places for health professionals and further funding increases for training have been delivered since that time.[1]

According to the 2009–10 Budget papers, the Government has developed an agenda for reform which will make the health system ‘more responsive, coherent and efficient’ by using the skills of all health workers better.[2] Despite this claim, while there are some workforce innovations in the Budget, it appears that many of the measures announced are about rearranging or continuing with current programs, sometimes in different guises.         

The major workforce measure, the Rural Health Strategy for example, mostly involves either consolidation or reorganisation. The Registrars Rural Incentive Payments Scheme (RRIPS) and the Rural Retention Program (RRP) for general practitioners are to be consolidated into a General Practice Rural Incentives Program. The Budget papers claim this new program will provide incentives for relocation and retention—but these are already available under the existing schemes.[3] Almost $100 million has already been spent on the RRP in the last five years. The $64.3 million planned for the next four years is a continuation of this funding.  Similarly, other measures in this package, such as the commitment to increase locum relief to doctors in rural and remote areas, are not substantially different to existing arrangements.

The other significant workforce initiative in the Budget extends access to the Medicare Benefits Schedule and Schedule of Pharmaceutical Benefits for nurse practitioners and midwives. From one perspective, it can be argued that this measure will be of great benefit to rural and remote communities, which often cannot access the services of medical practitioners. From this perspective, the measure not only reflects the reality that nurses and midwives are integral to the birthing experience; it is also an innovative use of alternative medical practitioners. It could be seen as indeed a first step in a structural reform of the health workforce, and as such, it could be argued that it is the most far-sighted health workforce measure in this Budget; one which one of the health professions considers a landmark reform.[4] 

On the other hand, this measure raises a number of questions about what will be defined as the appropriate range of services for which Medicare benefits will be paid to nurse practitioners. Questions can also be asked about what will constitute subsidised medical indemnity for eligible midwives,  how will eligibility be defined, what will the advanced midwifery credentialing framework noted in the Portfolio Budget Statements entail, and how will it differ from existing assessments.[5]

The nursing measure has been criticised in some quarters. For example, the Royal Australian College of General Practitioners (RACGP) has argued that, unlike funding for practice nurses, the $59.7 million provided to support the expansion of the role of specialist nurse practitioners ‘does not meet the workforce needs of Australian general practice’.[6] This criticism is most likely based on the fact these practitioners work in independent practice and not as part of a team supervised by medical practitioners.  This view illustrates one obstacle to any substantial health workforce reform. That is, that each of the health professions is protective of its traditional boundaries and reluctant to concede that alternative approaches may deliver more efficient and effective health outcomes. 

There is little attention paid to the allied health workforce in this Budget. Announcements specifically related to the allied health workforce are targeted at rural areas. Dental students will receive $4.1 million over four years for clinical training in rural areas and $6.8 million will be provided under the University Departments of Rural Health program to encourage students in other health professions (including medicine) to practise in rural areas. Incentives offered to allied health workers (and to nurses) to work in rural and remote settings, however, are significantly less in comparison with those offered to medical practitioners.  

The Budget allocates funding to the training of Indigenous health workers. This includes funding for 160 new Indigenous Outreach Workers and 75 allied health workers and practice managers to work in Indigenous health services and for the development of a National Indigenous Health Workforce Training Plan. In addition, the Government will continue to support the Puggy Hunter Memorial Scholarship Scheme to encourage more Aboriginal and Torres Strait Islander people to enter health professions.

A long-awaited and needed review of the Rural Remote and Metropolitan Area (RRMA) classification scheme, upon which qualification for a number of health programs has been based, took place before the Budget. This review appears to have influenced the Government to commit to moving qualification requirements to reflect the Australian Standard Geographical Classification, which is based on 2006 Census data. The Budget papers indicate that this move will deliver a bonus for medical practitioners, as 2400 more doctors will be eligible for rebates under the scheme. However, it remains unclear what advantages this change in program administrative arrangements will have for workforce outcomes. In addition, there is no guarantee that that there will not be losers, in terms of rebates or qualification requirements.

Overall, this Budget does not provide a comprehensive health workforce reform package. However, it could be argued that the first steps towards such a package have been put in place and are currently being taken by bodies such as the National Health and Hospitals Reform Commission.  This process will be advanced further by new agencies to be established as a result of the Council of Australian Government’s various national partnership agreements—the outcomes of the process may deliver more comprehensive health workforce funding announcements in subsequent Budgets. [7]           

[1].    J Gillard (Deputy Prime Minister) and N Roxon (Minister for Health and Ageing), COAG to deliver up to 50 000 more frontline health workers, media release, 28 March 2008, viewed 13 May 2009, and Council of Australian Governments meeting 29 November 2008, attachments to  Communiqué, Attachment A, viewed 13 May 2009,

[2].    Australian Government, Portfolio budget statements 2009–10: budget related paper no. 1.10: Health and Ageing Portfolio, Commonwealth of Australia, Canberra, 2008, p. 301.

[3].    Department of Health and Ageing, ‘Rural Retention Program’, viewed 13 May 2009, and Department of Health and Ageing, ‘Registrars Rural Incentive Payment Scheme’, viewed 13 May 2009, Note: the Registrars scheme only provides incentives for undertaking training in rural areas.

[4].    Australian Nursing Federation, Patients and the community are the big winners in ground breaking health reform budget, media release, 12 May 2009, viewed 14 May 2009,

[5].    The Australian Nursing and Midwifery Council currently works in conjunction with state and territory nursing and midwifery regulatory authorities to produce national standards which are an integral component of the regulatory framework to assist nurses and midwives to deliver safe and competent care. Standards include national competency standards for registered nurses, enrolled nurses, midwives and nurse practitioners and codes of professional conduct and ethics. These are available on the Council website, viewed 14 May 2009,

[6].    Royal Australian College of General Practitioners, Budget lacks recognition of the role of primary care, media release, 12 May 2009, viewed 14 May 2009,

[7].    Council of Australian Governments, National Partnership Agreement on Health and Hospital Reform, December 2009, viewed 14 May 2009,

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