Budget Review 2020–21 Index
Amanda Biggs and Alex Grove
The Budget provides $93.8 billion for the health function in
2020–21 (p. 6-7), representing 14.0
per cent of total expenditure (Budget
Strategy and Outlook: Budget Paper No. 1: 2020–21, p. 6-9). A priority is
funding the ongoing health response to COVID-19 with commitments now
totalling more than $16 billion. Funding for the COVID-19 response in this Budget
is in addition to the $9.4 billion in health funding committed in the Economic
and Fiscal Update released in July 2020 (p. 5).
The major components of the COVID-19
Response Package announced in this Budget total around $4.9 billion in
new commitments (Budget
Measures: Budget Paper No. 2: 2020–21, pp. 92–97). Other than the aged care
and mental health responses (dealt with in separate Budget Review
articles), the key measures comprise:
- $1.9 billion over two years to secure access to two dedicated
COVID-19 vaccines and related consumables, and to facilitate access to
alternative vaccines that are being developed globally
- $1.1 billion in 2020–21 to support the COVID-19 responses of
public and private hospitals
- $1.1 billion to support access to Medicare services including
extension of temporary telehealth services, continued pathology testing and extending
the operation of dedicated respiratory clinics and
- $42.5 million to continue support for emergency measures
including the National Incident Room, national communication activities and a
central patient triage hotline.
More details are provided below.
Vaccines
The Budget includes $1.9 billion for access to COVID-19
vaccines, needles and syringes. $1.7 billion of this is for domestic
manufacturing agreements for two vaccines
currently in clinical trials: the University of Oxford/AstraZeneca vaccine
and the University of Queensland/CSL vaccine. The agreements are for more than
84.8 million doses, with early access to 3.8 million doses of the University of
Oxford/AstraZeneca vaccine expected in January and February 2021.
As
noted by Prime Minister Morrison, there are ‘no guarantees that these
vaccines will prove successful’, and ‘both vaccines would need to be proven
safe and effective, and meet all necessary regulatory requirements, prior to
being made available to the public’. However, the Government is planning to
provide free access to a COVID-19 vaccine in 2021 if clinical trials prove
successful. Because there are a number
of other candidate vaccines currently in trials, the Budget also includes
$123.2 million to join the COVID-19
Vaccines Global Access (COVAX) Facility. This initial investment means
Australia is part of a purchasing mechanism and can receive offers to purchase
other vaccines if they become available.
As noted in Budget
Paper No. 1, how the pandemic will play out is ‘highly uncertain’ (p. 2-15).
The Budget assumes that a vaccination program will be ‘fully in place by late
2021’ (p. 2-6), but Treasury has also considered an alternate ‘upside scenario’
in which there is ‘an earlier roll-out of a vaccine from 1 July 2021’
and an alternate ‘downside scenario’ in which rolling outbreaks necessitating
severe containment measures continue until June 2022 (p. 2-15).
Hospitals
The Budget provides an additional
$1.1 billion in funding to support public hospital activity during the
COVID-19 pandemic (p. 97).
Public hospital services are jointly
funded by the federal and state and territory governments under the National
Health Reform Agreement (NHRA, as amended). The hospital response to
the COVID-19 pandemic is guided by the National
Partnership on COVID-19 Response which complements the NHRA and recognises
the additional costs incurred by state and territory governments in managing
and controlling the pandemic. The National Partnership Agreement, signed
in March 2020, provides an upfront payment of $100 million to the states (paid
on a population share basis) and specifies that the Australian Government will
meet, through monthly payments, 50 per cent of the costs incurred by state
governments in diagnosing and treating COVID-19 patients.
Under the National Partnership Agreement the states
and territories entered
into separate agreements with private hospitals in their jurisdictions to
ensure they have access to sufficient hospital capacity (that is, beds and
workforce) to meet higher demand for hospital services during the pandemic. The
Australian Government has sought to ensure the on-going viability of private
hospitals by agreeing to meet the cost to the sector of making private hospital
beds and its workforce available to work with public hospitals in addressing
COVID-19, underwriting the sector with a $1.7
billion private hospital guarantee (p. 56).
In addition, the Australian Government is supporting the
states and territories to deliver public health activities associated with
addressing the pandemic. This includes the cost of care outside of hospitals,
paramedic services, personal protective equipment, community health services,
staffing support in aged care, transport costs and minor capital expenditure.
This brings their total
commitment to the COVID-19 state and territory public health and hospitals response
to $1.8 billion (p. 16).
The funding under these measures is in addition to NHRA
funding for public hospital activity which totals almost $23.2 billion in 2020–21
(p. 16).
Medicare
Access to essential medical services during the pandemic is
being supported in the Budget through the extension of a
number of temporary items on the Medicare Benefits Schedule (MBS) and related
measures (pp. 95–96). It builds on the Guaranteeing
Medicare and access to medicines measures in the Economic and Fiscal
Update (pp. 134–5).
Telehealth
$111.6 million is provided to extend temporary
Medicare-funded telehealth consultations to March 2021. Since March 2020,
general practitioners (GPs), specialists, nurse practitioners, midwives and
allied and mental health service providers have been able to offer video or
phone consultations to patients in order to reduce the risk of spreading COVID-19.
Generally, patients accessing GP telehealth services must have an established
relationship with their GP or medical practice (that is, have visited face-to-face
at least once in the previous year), although exemptions apply. As of 30 September
2020 32.8
million telehealth services had been accessed. Incentives for GPs to bulk
bill telehealth consultations—meaning no out‑of‑pocket cost to the
patient—ceased
on 30 September. $18.6 million is provided to develop
ICT systems to support telehealth services reform (p. 20).
Respiratory clinics and pathology
$711.7 million is provided to extend MBS pathology items for
the detection of COVID-19, including among freight workers and aged care staff,
for a further six months. $42.0 million is provided for dedicated pathology and
collection centres in aged care facilities. More than 7.6
million COVID-19 tests have been conducted since the commencement of the
pandemic (p. 22). Funding of $170.8 million is provided for dedicated GP-led respiratory
clinics to continue operating to March 2021. These clinics operate as one-stop
shops where patients can be isolated and tested for COVID-19, thus reducing the
risk of community transmission. Funding for up to 100
respiratory clinics was initially provided in March 2020. By August, 146
clinics had been established and had undertaken more than half a million
consultations.
Emergency response
$42.5 million is provided for the continued
operation of a number of emergency response measures (p. 92). This
includes $15.4 million for the National Incident Room, $6.8 million for a
centralised patient triage hotline, and $20.3 million for national
communication activities related to COVID-19. Funding of $1.9
billion for the urgent procurement of emergency health equipment such as
masks was provided under a number of Appropriation Acts in March and April 2020
(p. 56).
Stakeholder reaction
The peak doctors’ body, the Australian
Medical Association, has commended
a number of health measures including continued funding to support the COVID-19
response in hospitals, pathology testing services, GP respiratory clinics and temporary
COVID-19 telehealth services, but warned that a safe, effective vaccine is not
guaranteed for next year. The Rural
Doctors Association of Australia also acknowledged the ‘significant
investment’ in the COVID-19 response, including the expansion of telehealth
items and respiratory clinics. The Australian
Healthcare and Hospitals Association, representing public and
not-for-profit hospitals, Primary Health Networks, and community and primary
healthcare services, expressed disappointment that telehealth consultations
were no longer required to be bulk billed and called for ‘long-term vision for
these services in the interests of patients’. The Consumers
Health Forum commended the Budget for giving ‘comfort that adequate
provision has been made for the manufacture and supply of a COVID-19 vaccine
should one become available’.
All online articles accessed October 2020
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