Budget Review 2022–23 Index
Emma Vines
Key figures and trends
Total spending on health in 2022–23 is estimated at $105.8
billion, representing 16.8% of the Australian Government’s total expenditure (Budget
strategy and outlook: budget paper no. 1: 2022–23, pp. 141–143).
Table 1 below outlines health expenses by sub-function (nominal terms). In real
terms, total expenses are expected to decrease by 8.3% between 2021–22 and 2022–23
and decrease by 4.4% between 2022–23 and 2025–26, primarily due to the cessation
of COVID-19 related payments.
Table 1 Health function
expenses, 2021–22 to 2025–26
|
2021–22 $m |
2022–23 $m |
2023–24 $m |
2024–25 $m |
2025–26 $m |
Medical services and benefits |
38,980 |
39,471 |
40,317 |
42,115 |
43,998 |
Pharmaceutical benefits and services |
16,443 |
17,229 |
17,101 |
17,226 |
17,281 |
Assistance to the states for public hospitals |
25,013 |
27,333 |
28,717 |
30,659 |
32,653 |
Hospital services |
1,105 |
1,062 |
1,058 |
1,055 |
1,059 |
Health services |
24,133 |
15,290 |
10,552 |
10,403 |
10,244 |
General administration |
4,801 |
4,227 |
3,684 |
3,595 |
3,560 |
Aboriginal and Torres Strait Islander health |
992 |
1,142 |
1,145 |
1,172 |
1,137 |
Total |
111,467 |
105,754 |
102,575 |
106,225 |
109,932 |
Note: totals may not sum due to rounding.
Source: Australian Government,
Budget strategy and outlook: budget paper no. 1: 2022–23, (Canberra: Australian
Government, 2022), 151.
Budget
paper no. 1 details expenses by sub-function (pp. 151–154):
- Medical services and benefits, consisting primarily of Medicare
and Private Health Insurance Rebate expenses, will account for $39.5 billion,
or 37.3% of total health expenses in 2022–23.
- Spending
is expected to increase by 2.5% in real terms from 2022–23 to 2025–26, driven
primarily by growing Medicare expenses.
- Pharmaceutical benefits and services, consisting largely of Australian
Government subsidies for Pharmaceutical Benefits Scheme (PBS) medicines, will
account for $17.2 billion, or 16.3% of total health expenses in 2022–23.
- Expenses
are expected to decrease slightly in real terms over the forward estimates,
primarily due to the impact of existing pricing policies.
- Assistance to the states and territories, comprising the
Australian Government’s contribution to public hospital funding, will account
for $27.3 billion, or 25.8% of total health expenses in 2022–23 (excluding
National Partnership payments).
- In
real terms spending is expected to increase by 5.6% from 2021–22 to 2022–23,
largely due to an anticipated growth in the volume of services, then increase
by 9.9% between 2022–23 and 2025–26.
- A
breakdown of Commonwealth National Health Reform funding to each state and
territory can be found in Federal
financial relations: budget paper no. 3: 2022–23 (pp. 19–21).
- Hospital services, consisting primarily of payments to the states
and territories for veterans’ hospital services, will account for $1.1 billion,
or 1.0% of total health expenses in 2022–23.
- Expenses
are projected to decrease by 7.1% in real terms between 2021–22 and 2022–23,
then decrease by 8.2% between 2022–23 and 2025–26, reflecting a reduced
number of older veterans.
-
Health services, covering Australian Government expenses
associated with the delivery of population health, medical research, mental
health, blood and blood products, other allied health services, health
infrastructure and disbursements from the Medical Research Future Fund (MRFF),
account for $15.3 billion, or 14.5% of total health expenses in 2022–23.
- Expenses
are expected to decrease by 38.7% in real terms between 2021–22 and 2022–23, then
decrease by 38.4% between 2022–23 and 2025–26, with the change attributed to reduced
COVID-19 measures.
-
General administration, consisting of administrative costs,
investment in health workforce measures and support for rural health
initiatives, will account for $4.2 billion, or 4.0% of total health expenses in
2022–23.
- Expenses
are expected to decrease by 14.9% in real terms between 2021–22 and 2022–23,
then decrease by 22.5% between 2022–23 and 2025–26, largely due to the
cessation of COVID-19 measures.
- Aboriginal and Torres Strait Islander health, reflecting health
portfolio Indigenous-specific services, will account for $1.1 billion, or 1.1%
of total health expenses in 2022–23.
- Expenses
are expected to increase by 11.3% in real terms from 2021–22 to 2022–23, due
primarily to COVID-19 responses and utilisation of the Indigenous Australians
Health Program. Expenditure is then expected to decrease by 8.4% in real terms
between 2022–23 and 2025–26, due to the cessation of COVID-19 measures and
reduced payments to states and territories for an expiring national partnership
agreement.
Significant policy measures
Selected Health portfolio measures from Budget
measures: budget paper no. 2: 2022–23 are outlined below. Measures
related to mental health and public health are discussed in separate articles.
Medicare and medicines
Changes to the Medicare Benefits
Schedule
The Budget includes $131.3 million over 5 years for new and
amended Medicare Benefits Schedule (MBS) listings (Budget
paper no. 2, p. 95). The Health
portfolio 2022–23 budget stakeholder pack states that the Government
is investing $170.6 million over 4 years on this measure (p. 68),
and Budget paper no. 2 notes that partial funding for the measure has
already been provided. The measure includes $81.2 million over 4 years from
2022–23 for newly subsidised genetic testing items for cystic fibrosis, spinal
muscular atrophy and fragile X syndrome. It is unclear whether these new items
will support counselling through genetic counsellors or health professionals. The
inclusion of these items comes following an
application by the Royal College of Pathologists and the Medical
Services Advisory Committee recommendation in 2020 that they be funded.
There are also responses to the MBS
Review Taskforce (Budget
paper no. 2, pp. 95–96), with the Government’s implementation
timeframe suggesting that all changes will be complete by 2023. Changes are
being made to otolaryngology, head and neck surgery, paediatric surgery,
thoracic surgery, acupuncture, and cleft and craniofacial services (Health
portfolio budget stakeholder pack, pp. 69–70). In addition, $7.5
million in 2022–23 is provided for the MBS Continuous Review (Budget
paper no. 2, p. 97).
Changes to the Pharmaceutical Benefits
Scheme safety net
The Government has committed $525.3 million over 4 years from
1 July 2022 to lower the PBS safety net thresholds (Budget
paper no. 2, p. 105). The
thresholds will drop to $244.80 for concession card holders and $1,457.10
for general patients—a decrease of $81.60 for concessional patients and $85.00
for general patients. The thresholds are indexed on 1 January each year, as
specified in the National
Health Act 1953 (section 99G).
Stakeholder response has been mixed. The Pharmacy
Guild of Australia said lowering the threshold would not mitigate rising
prescription prices. The Consumers
Health Forum of Australia welcomed the measure, despite disappointment that
a national social prescribing scheme was not announced.
Primary health
The Australian Government recently released Australia’s
Primary Health Care 10 Year Plan 2022–2032, committing $632.8
million over 4 years (Portfolio
budget statements 2022–23, budget related paper no. 1.7: health portfolio,
p. 16).
The Royal
Australian College of General Practitioners warned that major components of
the Plan remain unfunded and that workforce shortages must be addressed and
Medicare rebates reformed. The Consumers
Health Forum of Australia expressed similar disappointment at the ‘lost
opportunity’ for transformational reform.
Budget
paper no. 2 (pp. 97–98) commits $230.7 million over 5 years from
2021–22 to improve access to primary health care, including:
- $108.5 million over 2 years from 2022–23 to extend the Federation
Funding Agreement of Public Dental Services for Adults to support the states
and territories in providing public dental health services and to fund the next
National Child Oral Health Study—this is the fourth
extension to the Agreement
- $56.0 million in 2022–23 to support Primary Health
Networks to address after-hours healthcare demand
- $7.5 million over 3 years for the Palliative Care Service
Navigation Pilot to trial models for improved coordination of palliative
care
- $4.4 million over 4 years to improve access to allied health
services for deaf and non-English speaking Australians
- $3.0 million to expand Street Side Medics’ service
delivery within homeless communities
- $0.2 million to extend the Patient Pathways
Program pilot to connect patients with rare diseases with health
services.
Other funding included under this measure is discussed in
the MBS and Digital health sections of this article.
Rural health
The Budget provides $296.5 million as part of the 10
Year Stronger Rural Health Strategy (Portfolio
budget statements 2022–23: health portfolio, p. 17), with the Australian
College of Rural and Remote Medicine welcoming the continued commitment to
the Strategy, despite calling for ‘reform of primary care funding models’ to
ensure rural practice remains sustainable.
Rural health measures include:
- $66.0 million over 4 years to remove the restriction on the
number of magnetic resonance imaging machines eligible for Medicare in
regional, rural and remote Australia (Budget
paper no. 2, pp. 94–95)
- $224.4 million over 4 years (Budget
paper no. 2, pp. 98–99) to improve access to health services and
support doctors working in rural and remote areas, through:
- $99.3
million to increase the number of medical students studying in rural and remote
locations
- $36.2
million to fund 2 new University Departments of Rural Health in Western
Australia
- $33.3
million to the Royal Flying Doctor Service as part of a new 10
year Strategic Agreement—this forms part of a $1
billion 10-year partnership
- $22.1
million to increase CareFlight’s and Little Wing’s service capacity
- $17.2
million to fund Heart of Australia’s
provision of specialist medical support in regional and remote Queensland
- $14.8
million to support Charles Sturt University to deliver a Rural Clinical School
- $4.2 million over 5 years from 2021–22 to encourage general
practitioners’ work in rural and remote headspace
centres (Budget
paper no. 2, p. 111).
Digital health
Measures related to digital health include:
- $71.9 million over 4 years to support Phase
Three of the Health Delivery Modernisation Program, with the primary focus being
to improve claim timeframes for patients and medical providers for Medicare
services, the PBS and other health related payments. Investment in this Program
totals $96.8 million (and $2.2 million per year ongoing) and is expected to
achieve departmental efficiencies from Services Australia of $24.9 million (and
$13.3 million ongoing) (Budget
paper no. 2, p. 168)
- $12.0 million over 2 years from 2022–23 for healthdirect Australia (Budget
paper no. 2, p. 97)
- $23.8 million over 4 years to improve measures in general
practice accreditation, improve linkages with My Health Record and provide
additional funding to accredited practices for the provision of temporary
telehealth services during the pandemic and for areas affected by natural
disasters (Budget
paper no. 2, p. 97)
- $35.2 million over 4 years (Budget
paper no. 2, p. 94) through the Guaranteeing Medicare—Digital
Health measure, including:
- $32.2
million in 2022–23 to extend the Intergovernmental
Agreement on Digital Health, which supports My Health Record and the Health
Care Identifiers Service
- $2.9
million over 4 years from 2022–23 to transition the Australian Institute of
Health and Welfare’s data holding to cloud-based services and off-site data
centres.
Research
The Budget commits $28.1 million over 4 years from 2022–23
to establish a new agency, Genomics Australia, from 1 January 2024 (Budget
paper no. 2, p. 93).
The Budget also commits $6.8 billion over 4 years (Health
portfolio budget stakeholder pack, p. 16) for medical research, provided
through 3 funding sources:
- $3.7 billion for the National Health and Medical Research Council
- $2.6 billion for the MRFF
- $0.5 billion for the Biomedical
Translation Fund.
Additional funding of $1.3 billion (Health
portfolio budget stakeholder pack, p. 16) brings investment in the
updated Medical Research
Future Fund 10-year investment plan to $6.3 billion from 2022–23
to 2032–33 (Budget
paper no. 2, p. 103). This includes:
-
$384.2 million to assist early to mid-career researchers
- $478.0 million for preventative and public health research
- $374.4 million for clinical trials
- $240.0 million for medical research commercialisation
- $70.0 million for primary health care research.
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