An odd pill for a sick in­dus­try

Bud­get changes to the health sys­tem have left the in­dus­try less than im­pressed, writes Siob­hain Ryan

The Weekend Australian - Travel - - Health -

ON bud­get night, the Rudd Gov­ern­ment got to work on Aus­tralia’s health sys­tem. It de­liv­ered a dose of good news with its $10 bil­lion fund to fi­nance fu­ture health and hospi­tal in­fra­struc­ture, be­fore sur­gi­cally re­mov­ing a few hun­dred mil­lion dol­lars from gen­eral prac­tice, pathol­ogy, drug whole­salers and dis­pensers.

Then it did some­thing dras­tic, that hadn’t been tried in over a decade. It cut one of the ar­ter­ies to the private health in­dus­try.

The change was a sim­ple one. From July 1, the gov­ern­ment will lift the in­come thresh­old where the Medi­care levy sur­charge cuts in from $50,000 to $100,000 a year for sin­gles and from $100,000 to $150,000 for fam­i­lies.

It will forgo $660 mil­lion over four years from the re­form — the amount the penalty for fail­ing to hold private health cover would have raised. But it will save even more — $960 mil­lion in to­tal — be­cause it won’t have to shoul­der 30 per cent or more of the cost of health cover through the re­bate sys­tem.

The Aus­tralian Med­i­cal As­so­ci­a­tion, Aus­tralian Health In­sur­ance As­so­ci­a­tion and in­di­vid­ual in­sur­ers this week pre­dicted dire re­sults from the move.

First 400,000, then 600,000 and even as many as one mil­lion peo­ple could dump their health cover, ac­cord­ing to the es­ti­mates rolled out over the week.

Those Aus­tralians forced to wait longer on pub­lic hospi­tal queues and those Aus­tralians who will pay more for their private health in­sur­ance must won­der why the Gov­ern­ment has made such a blink­ered de­ci­sion,’’ the AHIA said.

Trea­sury set­tled on an ex­o­dus of 485,000 peo­ple as the ba­sis for its bud­get cost­ing — still an alarm­ing enough num­ber for health in­sur­ers, rep­re­sent­ing about 5 per cent of peo­ple they cover for hospi­tal treat­ment.

Wayne Swan sought to pla­cate the in­dus­try the day af­ter the bud­get, at a Na­tional Press Club ad­dress, say­ing La­bor re­mained a

sup­porter of private health in­sur­ance’’, as well as of the 30 per cent re­bate for private cover. But the fact the new Rudd Gov­ern­ment clawed back more in a sin­gle mea­sure from one health sec­tor than it did from any other in its first health budge says some­thing pro­found about its pri­or­i­ties. Those pri­or­i­ties aren’t just about Swan’s work­ing fam­i­lies’’ — the ones he says were un­fairly hit by a thresh­old that hasn’t been ad­justed since its in­tro­duc­tion more than a decade ago. They’re also about shift­ing the bal­ance be­tween the private and pub­lic health sec­tors.

The ALP’s pol­icy plat­form may be more con­cil­ia­tory than it once was to­wards the Howard Gov­ern­ment’s health fund in­cen­tives, but it still rates Medi­care and free pub­lic hos­pi­tals as the cor­ner­stones of Aus­tralia’s health sys­tem. So it’s not sur­pris­ing that just as money is be­ing with­drawn from private health, more is be­ing fun­nelled into pub­lic hos­pi­tals.

In the bud­get the Gov­ern­ment scrapped the Coali­tion’s $2.5 bil­lion Heath and Med­i­cal In­fra­struc­ture Fund — which was to be sup­ple­mented by the pri­vati­sa­tion of pub­lic health fund Med­ibank Private — for its $10 bil­lion ver­sion drawn from bud­get sur­pluses.

The fund, the big­gest sin­gle in­vest­ment in health in­fra­struc­ture ever made by an Aus­tralian gov­ern­ment, is part of the Gov­ern­ment’s re­form agenda to equip Aus- tralia’s health and hospi­tal sys­tem for the fu­ture’’, Health Min­is­ter Ni­cola Roxon says.

It’s also a way of qui­eten­ing the con­cerns of the states and ter­ri­to­ries about for­mer health fund mem­bers adding to the queues at their pub­lic hos­pi­tals. But it will only buy their si­lence for so long. The Rudd Gov­ern­ment has al­ready post­poned new fed­eral-state health fund­ing agree­ments once, push­ing the dead­line for strik­ing a new deal till the end of the year. Fur­ther, the long and of­ten bit­ter ne­go­ti­a­tions will only fo­cus at­ten­tion on the de­lay be­tween when Kevin Rudd first promised real im­prove­ments and fund­ing boosts to pub­lic hos­pi­tals, and when they will be de­liv­ered.

The prob­lem he and Roxon face in health is that they’re deal­ing with more im­me­di­ate, in­ter-re­lated prob­lems than any one bud­get or flag­ship long-term in­vest­ment fund can solve.

They want, for ex­am­ple, to move away from six-minute medicine’’ but will have to re­vamp the com­plex 700-plus page Medi­care sched­ule of ser­vices billed by doc­tors and other health work­ers to do so.

They want to make health­care more ac­ces­si­ble in the bush, but must boost and re­dis­tribute the health work­force first. And they want to co-or­di­nate care for the chron­i­cally ill, but will have to take on pro­fes­sional si­los be­tween doc­tors, nurses and other health work­ers to achieve that end.

Th­ese changes may come, yet the start made in this week’s bud­get was a mod­est one. Even the Rudd Gov­ern­ment’s much-vaunted pre­ven­tive health strat­egy — sell­ing the sim­ple mes­sages of nu­tri­tion, ex­er­cise and health screen­ing — won’t be de­liv­ered be­fore June next year, wait­ing as it is on yet an­other task­force re­port.

As a re­sult, the bud­get mea­sures fed­eral La­bor rolls out ahead of its broader re­forms risk ap­pear­ing ad hoc, out of con­text or, at worst, down­right op­por­tunis­tic.

Last month’s 70 per cent hike in the tax on al­copops, for in­stance, won’t, as Ni­cola Roxon first im­plied, re­sult in a cut to cur­rent con­sump­tion lev­els of the flavoured pre­mixed drinks.

Trea­sury modelling has since shown the $3.1 bil­lion tax will not re­verse growth in the vol­ume of al­copops drunk, leav­ing her ex­posed her to Op­po­si­tion at­tack. Op­po­si­tion health spokesman Joe Hockey asked this week: How can the Rudd Gov­ern­ment claim they are ini­ti­at­ing a new health mea­sure when they pre­dict an in­crease in al­co­hol con­sump­tion?’’

The tax will re­turn rev­enue to the Gov­ern­ment’s con­tin­gency re­serve for over a year be­fore Roxon’s prom­ise that it will help fund Aus­tralia’s big­gest pre­ven­tive health push is re­alised.

Lit­tle won­der Hockey claims the pub­lic ex­pects more of a legacy from the health bud­get than higher taxes and more pres­sure on pub­lic hos­pi­tals from fall­ing private health mem­ber­ship: The Rudd Gov­ern­ment’s first bud­get has failed its health check’’.


Am­bu­lances queue: The Rudd Gov­ern­ment has al­lo­cated $10 bil­lion for ail­ing hospi­tal in­fra­struc­ture

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