A significant saving announced in this Budget
is the $962.8 million over five years expected to be achieved by changes to a
range of health programs. Programs to be targeted
for savings include: the Department of Health’s Flexible Funds, workforce and
research programs, the GP Super Clinics program, a program for special foods
and medicines and a medical aids appliance program.
In 2011, 18 Flexible Funds were established as
a result of the consolidation of 159 separate funding programs—consolidation
was intended to reduce red tape, improve flexibility and more efficiently fund
health priorities. Following machinery of
government changes after the 2013 federal election, 16 Flexible Funds remained in
the Health portfolio. Under the Flexible Funds,
non-government organisations are funded to deliver a range of health and
community services. Flexible Funds cover a diversity of health priority areas,
including: chronic disease prevention, substance misuse prevention, rural
health outreach, health workforce, communicable disease prevention, Aboriginal
and Torres Strait Islander chronic disease, quality use of diagnostics and
therapeutics, and primary care incentives.
The Budget does not detail if all or only some
of these Flexible Funds will be affected, or the precise level of savings to be
realised from rationalising this particular program, although media reports
suggest a figure of $500 million. Last year’s Budget included
a pause in indexation for the Flexible Funds over three years, with $197.1
million in savings forecast. The flow-on effects of this
pause in indexation remain unclear as the measure was not to apply to all funds
and, in any case, is not due to commence until the 2015–16 financial year.
Michael Moore of the Public Health Association of Australia has raised concerns
about the cuts to the Flexible Funds, stating: ‘If these drastic cuts go ahead
it could decimate NGO sector responses to many of the key challenges in public
health and leave Australian families and communities without the support they
need’. Others worry that funding
for organisations that treat drug and alcohol abuse will be cut.
Unspecified savings from rationalising and
streamlining other programs include: not proceeding with GP Super Clinics that
have not commenced construction; redesigning some dental workforce programs,
including incentives to encourage dentists to relocate to smaller rural centres;
ceasing funding for the Inborn Error of Metabolism program as key
medicines are subsidised through the Pharmaceutical Benefits Scheme (PBS) and
low-protein foods are more readily available at lower cost; piloting
competitive tendering in the Stoma Appliance Scheme and rationalising preventative
health research funding.
In addition, savings of $113.1 million over
five years are forecast from the Smaller Government – Health Portfolio
measure. This aims to create
operational efficiencies in the Department by merging certain corporate
functions across agencies, ceasing departmental activities in areas already
performed by a number of other agencies (including agencies that were
previously slated for merger in last year’s Budget), ceasing a Lead Clinicians
Group, rationalising departmental structures and business functions,
consolidating staffing and reducing contracting arrangements.
The combined savings from these two measures
total over $1.0 billion, which will be redirected to fund other health
priorities and the proposed Medical Research Future Fund (MRRF).
Savings of $7.6 million over four years are also
forecast from changes to items that are listed on the Stoma Appliance
Scheme. This scheme
provides free products to people who require either a temporary or permanent
stoma to remove body waste (for example, following a colostomy). From 1 July
2015, two new items will be listed on the Stoma Schedule, one will be removed
and prices for a further 21 products will be amended (presumably including
price reductions), consistent with recommendations of the Stoma Product
Assessment Panel (SPAP).
After hours primary care
The Budget also seeks to shift funding for after hours
primary care away from the After Hours GP Helpline (AHGPH) and the Medicare
Locals After Hours Programme to a new Practice Incentives Programme (PIP) After
Hours Payment from 1 July 2015. This measure is intended
to encourage General Practitioners (GPs) to provide after hours care and
follows recommendations of a review into after hours primary care by GP,
educator and researcher, Professor Claire Jackson.
The AHGPH was established in 2011 by the Gillard Government.
Callers are first triaged by a nurse through the National Health Call Centre
Network who assesses their medical condition before transferring the caller to
a GP if appropriate. More than 208,000 calls
were transferred to the AHGPH in 2013–14. Between July 2011 and
June 2014, the AHGPH dealt with over 407,000 calls. Of these, around 63.1 per
cent of callers were advised to either self-care or see a doctor within normal
The Jackson review reported that the AHGPH had received a
‘mixed evaluation from many respondents’. A number of issues were
identified, including: incomplete awareness of local services, suitability of some
conditions referred to the Helpline, anecdotal evidence of unnecessary
presentations to emergency departments, accountability and transparency issues,
cost and communication arrangements with a patient’s regular GP.
However, the review acknowledged that a full cost-benefit analysis of the
Helpline had not been conducted.
Medicare Locals (MLs) are due to be replaced with new
Primary Health Networks (PHNs) from July 2015. One of the key tasks of MLs was
to improve access to after hours primary care. However, concerns were expressed
to the Jackson review that the transition to these new organisations should not
disrupt effective after hours programs. The National Rural Health Alliance (NRHA)
submission cautioned: ‘The impending transition from MLs to PHNs may stifle
opportunities for collaboration in the establishment or expansion of
after-hours services’. The NRHA further advised
that ‘PHNs should consider the full range of models by which after-hours care
might be delivered in their respective area’. Whether this advice will
be heeded by the new PHNs remains to be seen.
Australian Government, Budget
measures: budget paper no. 2: 2015–16, p. 110.
Department of Health (DoH), ‘Flexible
funds’, DoH website.
Two moved to the Department of Social Services. Ibid.
Ibid. Others cover indemnity insurance, health surveillance, health
protection, health information, and health system capacity.
M Koziol, ‘Budget
leaves ice addicts in the cold’, The Canberra Times, 15 May 2015, p.
Australian Government, Budget
measures: budget paper no. 2: 2014–15, p. 131.
Officials quizzed at Senate Estimates indicated that five funds would
be exempt from indexation. Senate Community Affairs Committee, Official
Committee Hansard, 25 February 2015, p. 129.
M Moore (Chief Executive Officer, Public Health Association of
Budget 2015: death by 1000 cuts, media release, 12 May 2015.
M Koziol, op. cit.
measures: budget paper no. 2: 2015–16, op. cit., p. 110. The Inborn Error of Metabolism program
provides financial assistance to patients with rare genetic disorders in which
the body cannot properly turn food into energy.
Ibid., p. 111.
Ibid., p. 112.
A review to assess the clinical effectiveness of products is being
undertaken by the Department of Health in conjunction with the Stoma Product
Assessment Panel (SPAP) and an expert group. Department of Health, ‘Stoma
Appliance Scheme – Group 9 Review’, DoH website.
measures: budget paper no. 2: 2015–16, op. cit., p. 109.
C Jackson, Review
of after hours primary health care: report to the Minister for Health and
Minister for Sport, 2014, p. ix.
J Gillard (Prime Minister) and N Roxon (Minister for Health and Ageing), GP
care a phone call away for families, media release, 30 June
Callers from Tasmania are transferred to the GP Assist service in that
report 2013–2014, (vol. 1) p. 80.
Jackson, op. cit., pp. 20–1.
Ibid., p. 39.
Ibid., p. 40. Conducting a cost/benefit analysis was considered beyond
the scope and timeframe of the review.
National Rural Health Alliance, Submission
to the Review of After-Hours Service Delivery, 2014, p. 4.
All online articles accessed May 2015.
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