Professor John Wakerman, Director, Centre for Remote Health, A joint Centre of Flinders University & Charles Darwin University, writes:

1. Hospitals have done well.

2. Indigenous health: continuing support for closing the gap is wellreceived. Continuing support for the Expanded Health Services Delivery
Initiative in NT is welcome. We need this strategic approach toimproving PHC services nationally, not just NT. The big money is in the COAG initiative. I question the ‘organ specific approach to ears, mouth & eyes. We really need the primary health care services up to scratch in a well planned way first.

3. Rural health: some bureaucratic streamlining of the many programs. The devil will be in the detail – the implications for the actual
programs are unclear. It is also unclear what the move from RRAMA to ASGC means for services in re-classified areas. The associated press
release sounds like everybody will benefit with increased incentives for doctors. But will there be losers as feared pre-budget? There are increased cash incentives for doctors in remote areas & thoserelocating from metro. There is no evidence to suggest these are effective. There is increased support for international medical graduates, more GP registrar places, increased funding to support medical clinical placements. Nurse practitioners access to MBS welcome. Not much (if anything) for allied health – a big need in the bush.  There is a commitment to a strategic national plan for rural health. Given Healthy Horizons is long expired, action on a national rural health plan is overdue.

4. Health, training & research infrastructure: a number of ruralinfrastructure programs have been funded. That’s great. It’s not clear
what proportion of infrastructure funding has gone to rural locations compared to metro. Looks like bulk of infrastructure funding has gone to
capital cities for major hospital, education & research centre building projects. Basic infrastructure still lacking in the bush.

5. Changes to private insurance rebate overdue. Many of us would be happy with its abolition

In summary, the budget has some big ticket infrastructure items, more for acute care and then its tinkering around the edges with increased cash incentives for doctors in the bush and not many obvious losers on the face of it. Where is the pain? The big unanswered question, especially for remote & rural areas with poor health outcomes and poorer access to services, relates to overall system reform.  After many decades of incremental change, we have high expectations of our political leaders to bite the bullet with fundamental structural reform.

Watch this space as the major policy reports – NHHRC, Preventative Health Taskforce, Primary Care Policy – land on the Minister’s desk mid
year.

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