Amanda Biggs
The Government has announced a number of measures relating
to Medicare in this Budget. Expenditure on Medicare is estimated to be $24.1
billion in 2018–19, an increase in real terms of 1.1 per cent on 2017–18.[1]
Funding for Medicare is now through a special account, the Medicare
Guarantee Fund, which was established as a result of last year’s Budget.[2]
New Medicare Benefits Schedule
listings
A number of new and amended listings will be added to the
Medicare Benefits Schedule (MBS) as a result of recommendations made by the independent
Medical Services Advisory Council (MSAC). Among the new items to be funded are:
-
a new pathology test for patients with a cystic fibrosis gene
mutation
-
treatment for patients with idiopathic (of unknown cause) overactive
bladder
-
magnetic resonance imaging (MRI) prostate scans for diagnosing
prostate cancer and for monitoring diagnosed patients.[3]
The total cost over four years from 2018–19 is estimated to be $25.4
million.[4]
In addition, the Budget includes $49.4 million in funding
over four years for a raft of new and amended listings as a result of
recommendations made by the clinician-led MBS Review Taskforce which has been considering
how to align the more than 5,700 items on the MBS with contemporary clinical
evidence and practice. The first tranche of recommendations made by the
Taskforce resulted in the removal of 24 obsolete items from the MBS in the
2016–17 Budget.[5] Net savings of $189.7
million from the Review have been ‘re-invested by the Government in Medicare’.[6]
Recently, the Chair of the Taskforce announced that the Government had accepted
38 of its most recent recommendations which included a number of additions and
amendments to the MBS.[7] New items to be funded
include:
-
renal medicine items to support dialysis services in rural and
remote regions, which will improve access for Aboriginal and Torres Strait
Islander people with kidney disease. Aboriginal and Torres Strait Islander
people experience kidney disease at 7.3 times the rate of other Australians[8]
-
three dimensional (3D) breast tomosynthesis—a form of high
resolution imaging for breast cancer detection.
Amendments include restricting GP referrals for some MRI
scans for knees, and restructuring the schedule for spinal surgery services.[9]
New listings and amendments to the MBS do not require
legislation, but are enacted through legislative instrument.
Modernising the health and aged
care payments system
Last year’s Budget included funding of $67.3 million (over
one year) to modernise the health and aged care payments ICT systems. This
budget includes an additional $106.8 million over four years to progress this
work.[10]
Low income thresholds
The Budget includes the annual adjustment to the Medicare
levy low income thresholds, in line with movements in the Consumer Price Index
(CPI). These annual adjustments ensure that those on incomes below these
thresholds are exempt from paying the Medicare levy. The low income thresholds
will be increased to $21,980 for singles, $37,089 for families and $48,385 for
seniors and pensioners.[11] The cost to the Budget
over the forward estimates is $230.0 million. These threshold adjustments will require
legislation.
Medicare levy
As expected, the Budget confirmed that the Government will
not proceed with the planned 0.5 percentage point increase to the Medicare levy
which was to be used to help fund the National Disability Insurance Scheme
(NDIS).[12] The levy will remain at
2.0 per cent. The implications of this decision are briefly discussed in the Library
Flagpost article, ‘‘Fighting for funding’: where to next for the NDIS?’.[13]
Compliance
$9.5 million over five years from 2017–18 is provided to
improve compliance and debt recovery arrangements for doctors. The measure
includes ‘better targeting investigations into fraud, inappropriate practice
and incorrect claiming’.[14] Legislation will be
introduced to support these measures.[15]
Stakeholder reaction
Stakeholder reaction to individual Medicare measures has varied.
For example, the Australian Healthcare and Hospitals Association (AHHA)
welcomed the continuing work of the MBS Review Taskforce[16]
and the Consumers Health Forum welcomed the ‘additional funding for hospitals,
Medicare, aged care and medicines’.[17] However, some in the
diagnostic imaging sector have criticised the government for failing to
immediately end the freeze on indexation of diagnostic imaging fees, and for
restricting GP-referred MRI scans on knees.[18] A number of disability
and social sector stakeholders have expressed disappointment over the decision
to not proceed with the Medicare levy increase.[19]
Hospital funding
All but two states (Victoria and Queensland) have signed up
to a new five-year public hospital funding agreement from 2020–21.[20]
Under the agreement, the Government has committed to providing $130.2 billion
over five years from 2020–21, based on funding 45 per cent of the efficient
growth in hospital activity, with total funding growth capped at 6.5 per cent a
year.[21] These parameters are the
same as those operating under the current agreement. Estimated allocations to
individual states and territories to 2021–22 are provided in the Budget,[22]
but final entitlements will be subject to reported hospital activity levels and
the determination of the national efficient price for hospital services by the
Independent Hospital Pricing Authority.
The Government is also providing $100 million for a new Health
Innovation Fund—$50 million in 2018–19 and $50 million in 2020–21—for ‘trials
that support preventive health innovations and better use of health data’.[23]
The Fund is conditional on all states and territories signing the hospital
funding agreement.[24]
In addition to funding for public hospital activities, the
Budget includes $188.9 million to support the expansion of the Joondalup Health
Campus and Osborne Parks Hospital, and refurbishment of Royal Perth Hospital.[25]
The funding is being provided in the form of a GST top-up payment to Western
Australia for 2017–18.[26]
Stakeholder reaction
Stakeholder reaction has been varied. The CHF has welcomed
the ‘record funding for hospitals’ and the proposed Health Innovation Fund,
which will ‘look at models of care that involve specialist hospital providers
working in innovative ways outside of the hospital walls and better integrating
with primary and community health services’.[27] The Australian Medical
Association has argued that ‘more [hospital] funding will be needed over the
long term’.[28] Meanwhile, Victorian
Minister for Health, Jill Hennessy has criticised the Government for not
increasing the Commonwealth’s contribution to 50 per cent of the efficient
growth of hospital activity and was also critical of the lack of funding for
health infrastructure projects in Victoria.[29]
[1].
Australian Government, Budget
strategy and outlook: budget paper no. 1: 2018–19, p. 6-19.
[2].
The Medicare
Guarantee Act 2017 received Royal Assent on 26 June 2017.
[3].
Department of Health (DoH), ‘Guaranteeing
Medicare – Medicare Benefits Schedule – new and amended listings’, Budget
2018–19 Fact Sheet, 8 May 2018.
[4].
Australian Government, Budget
measures: budget paper no. 2: 2018–19, p. 109.
[5].
DoH, ‘Healthier
Medicare – removing obsolete services from the Medicare Benefits Schedule’,
Budget 2016–17 Fact Sheet, 3 May 2016.
[6].
Budget
measures: budget paper no. 2: 2018–19, p. 110.
[7].
B Robinson (Chair of the MBS Review Taskforce), ‘Latest
recommendations accepted by Government’, media release, 29 April 2018.
[8].
DoH, ‘Indigenous
Health – investment in remote renal services and infrastructure’, Budget
2018–19 Fact Sheet, 8 May 2018.
[9].
DoH, ‘Guaranteeing
Medicare –Medicare Benefits Schedule Review – response to Taskforce
recommendations’, Budget 2018–19 Fact Sheet, 8 May 2018.
[10].
Budget
measures: budget paper no. 2: 2018–19, pp. 110–111.
[11].
Ibid., p. 32.
[12].
Ibid.
[13].
L Buckmaster, ’Fighting
for funding’: where to next for the NDIS?’,FlagPost, Parliamentary
Library blog, 27 April 2018.
[14].
Budget
measures: budget paper no. 2: 2018–19, p.109.
[15].
DoH, ‘Guaranteeing
Medicare – improving safety and quality through stronger compliance’, Budget
2018–19 Fact Sheet, 8 May 2018.
[16].
Australian Healthcare and Hospitals Association (AHHA) ‘Health
data boost right step on the road to reform’, media release, 8 May
2018.
[17].
Consumers Health Forum (CHF), ‘Health
budget includes welcome consumer focus’, media release, 8 May 2018.
[18].
Australian Diagnostic Imaging Association, ‘Budget:
Government is “miles short” on Medicare’, media release, 8 May 2018.
[19].
L Buckmaster, op. cit.
[20].
G Hunt (Minister for Health), ‘Northern
Territory and Tasmania sign onto record hospital funding agreement’,
media release, 23 April 2018.
[21].
Budget
measures: budget paper no. 2: 2018–19, p. 126.
[22].
Australian Government, Federal
financial relations: budget paper no. 3: 2018–19, p. 15.
[23].
Budget
measures: budget paper no. 2: 2018–19, p. 126.
[24].
DoH, ‘Record
Hospital Investment – National Health Agreement 2020–21 to 2024–25’, Budget
2018–19 Fact Sheet, 8 May 2018.
[25].
Federal
financial relations: budget paper no. 3: 2018–19, p. 23.
[26].
Budget
measures: budget paper no. 2: 2018–19, p. 144.
[27].
CHF, op. cit.
[28].
Australian Medical Association (AMA), ‘Safe
and steady health budget, but bigger reforms are still to come’, media
release, 9 May 2018.
[29].
J Hennessy (Victorian Minister for Health), ‘Patients
suffer as Turnbull gives big business a tax cut’, media release, 8 May
2018.
All online articles accessed May 2018.
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