Health policy expert Dr Yvonne Luxford writes:

Nobody expected a generous budget, and at first blush the health budget is definitely not generous.

However, the good news is that the vital area of Indigenous health has received a strong influx of funding (apparently not to be distributed via the jurisdictions), and the programs to incentivise a rural and remote workforce will give an additional boost, as will the establishment of a medical school in the NT. It is unclear why the incentive scheme is lmited to GPs – the bush needs nurses, specialists and allied health care professionals as well. And the opposite applies to dentists – there is funding for Indigenous dental services in rural and remote Australia, but nothing for urban settings.

My dream that the budget would fund the much needed Prevention/Public Health Agency has not come to fruition, in fact the budget is a bit light on the ground on direct prevention initiatives. The funding around cancer is definitely welcome, and of course there is also the potential for hypothecation of a comprehensive alcohol tax package when that makes it through parliament (I am an optimist).

There is a significant amount of money for upgrading hospital infrastructure, much of it directed at regional locations.

Providing MBS and PBS access to nurse practitioners is clearly a sensible move, as is the introduction of access to midwives – although this will be restricted to ‘advanced’ eligibile midwives, which has yet to be clearly defined.

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The Consumers Health Forum press release says:

The 2009-10 Health Budget will provide better access to health care, particularly for rural and remote communities, Indigenous Australians and those seeking maternity services, the Executive Director of the Consumers Health Forum of Australia, Carol Bennett, said tonight.

‘This budget is a step towards real health care reform in these areas, but does not provide for implementation of the significant reform agenda commissioned by Government,’ she said.

‘We are very pleased that midwives and nurse practitioners will have access to Medicare and PBS, which is an important reform consumers have been advocating for. We are also pleased with the significant expansion of rural health and Indigenous measures which will improve access for consumers,’ she said.

‘We welcome changes to the extended safety net which will reduce perverse incentives for some practitioners rather than penalising consumers. These measures should tighten the system to create better efficiencies.

‘CHF is looking forward to working with Government to deliver on these new measures.

Disappointments

‘We are disappointed there is no new money to implement the recommendations of the reform committees that will be reporting soon, including the NHHRC and Preventative Health Taskforce. We can’t afford to lose sight of the reform agenda even during this economic crisis as it will deliver better health outcomes and cut health spending into the future.

‘We are also disappointed that there is no new funding for important e-health activities. Consumers see e-health, particularly e-health records, as crucial for better safety and quality of health care.  It’s also cost effective – a classic example of how spending now will reap cost benefits.

Private health

‘The health insurance rebate cuts were expected, but consumers want those savings to be fed back into health care to improve the public hospital system, particularly if it needs to cater for those who drop their insurance.’

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Michele Kosky, Health Consumers Council WA, writes:

Health consumers Council welcomes the initiatives in the 2009-2010 Budget particularly the initiatves for Nurse Practitioners and Midwives. Great benefit to consumers and the begining of real reform in the health workforce and hopefully the end of the tribal warfare that plagues the health professions in Australia.Means testing the Private Health Insurance Rebate seems reasonable in the face of the the GFC as long as benefits evident in public hospital system.
We are particularly pleased that there is continual investment in Aboriginal health in the Close the Gap campaign.
Overall pretty good we think!!
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A joint statement from nursing groups says:

Royal College of Nursing, Australia (RCNA) and the College of Nursing (CoN) applauds the Rudd Government on its pragmatic decision to provide nurse practitioners access to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS).

The Federal Government tonight allocated $59.7 million over four years to provide access to MBS and PBS for nurse practitioners. RCNA has lobbied for over a decade for this breakthrough.

“This is a practical decision acknowledging the untapped potential of the nursing workforce,” said Debra Cerasa FRCNA, Chief Executive Officer, RCNA.

Nurse practitioners are already legislated and regulated to safely prescribe medications, but until now, clients have had to pay the full cost of prescriptions.

“Nurse practitioners have the flexibility to reach a range of communities, including those often marginalised and under serviced. Tonight’s announcement will provide greater equity in access to the health system reducing bottlenecks in GP clinics and hospital emergency
departments,” Ms Cerasa said.

“The role of the nurse practitioner complements and sits alongside other health professionals, this step will simply enhance the capacity of the health system to meet community health demands,” said Tracey Osmond, Chief Executive, CoN.

“People currently do not have timely access to appropriate health services. Nurse practitioners will now be better able to meet the community needs within their defined scope of practice.”

“The Budget demonstrates good policy. It will result in making better use of our available health workforce,” said Ms Osmond.

The Budget decision challenges conventional health care funding arrangements. It is a positive sign that the Government is committed to a sustainable, equitable and efficient health system. RCNA and CoN are encouraged by the investment in the role of the nurse
practitioner, and look forward to future decisions that support fundamental structural reform of Australia’s health care system.

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It’s not all smiles from the Australian Healthcare & Hospitals Association (AHHA). Its statement says:

The AHHA has welcomed the Federal Government’s announcement of much-needed health infrastructure projects.  However the Association’s members are disappointed that the funding for hospitals and health service facilities appears to fall short of the promised $5 billion from the 2008-09 Budget.

The AHHA is the peak national body representing public hospitals, area health services, community health centres and public aged care providers.

“The AHHA is also disappointed that the Federal Government has made the decision to remove the commitment of the additional $5 billion in expected funding to the Health and Hospitals Infrastructure Fund.  This is undermining the future of the health system and threatens the Government’s goals for health reform,” Ms Prue Power, Executive Director, said.

“The community will share our concern that Australia’s strained hospital and health service infrastructure has not been given the much-needed attention that was promised in the last Budget. The health needs of the population do not slow down even when the economy does.

“The funding saved through the means testing of the inefficient Private Health Insurance (PHI) Rebate Scheme should be used to make up the funding shortfall for the Health and Hospitals Infrastructure Fund.  As the Department of the Treasury stated previously in advice to the Government, direct funding to hospitals is much more effective, rather than via the PHI rebate.  The AHHA does not accept that the funds should be lost from the health system as a savings measure.

“The AHHA welcomes some Budget measures, such as the reform of the Medicare safety-net to target benefits more directly to those in need and to reduce the opportunities for private providers to manipulate the system. The AHHA also strongly supports funding to hospitals for elective surgery and subacute care, two key issues identified in the AHHA’s Service Integration policy released in 2008.

“We also support health workforce initiatives announced, specifically incentives to increase the number of doctors in rural and remote areas, and the expansion of MBS and PBS for some nurse practitioners and midwives.  The announcement of infrastructure funding for research and clinical training is also a welcome investment in the future.

“However, the effectiveness of these initiatives will be undermined if our hospitals and health services do not have the infrastructure required to support high quality care.   Unless we want the next generation of Australians to inherit a health system that is not physically equipped to meet the needs of the community and lags behind that of other countries, the Government must increase funding for health infrastructure,” Ms Power said.

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