1
FEDERAL BUDGET
SUBMISSION
2005-06
Making Indigenous Health the Top Health Priority
AUSTRALIAN MEDICAL ASSOCIATION
JANUARY 2005
AMA FEDERAL BUDGET SUBMISSION 2005-06
Making Indigenous Health the Top Health Priority
In recent months we have seen in the Australian community an amazing display of the spirit of goodwill and the spirit of giving.
Australians from all walks of life and from all socio-economic backgrounds have been generous with care, compassion and cash to help the victims of the tsunami.
Governments and individuals alike have reached out equally to the families and loved ones of Australian victims and to the devastated communities in Asia.
Similar assistance has been given to the people of the Eyre Peninsula hit so dramatically and tragically by bushfires.
Now is the time for our Governments and all Australians to extend this goodwill to the first Australians – the Aborigines and Torres Strait Islanders of this great country of ours.
The health and living conditions of many Indigenous Australians is at Third World level. For some, it is below Third World level. This is unacceptable in 21st Century Australia.
Throughout 2004, an election year, we saw lots of promises and pledges to fix health. Sadly, not a lot of those promises extended to Indigenous Health – at least not to the extent to bring Indigenous Health to a standard enjoyed by other Australians.
Many of the issues and concerns raised by the AMA during the election campaign been wholly or partly responded to by election promises. We will be watching the implementation of these policies to judge whether they will have a positive impact on the access and affordability issues confronting patients.
Against that background, the AMA Federal Budget Submission will this year focus on the neediest in the community – the people least able to advocate directly with Government for funding and policies to help them.
I am talking about Indigenous Australians, people with mental illness, and severely disabled people, including those disabled from medical accidents.
Detailed submissions on our three focus areas – Aboriginal and Torres Strait Islander Health, Mental Health Services, and the Long-Term Care Scheme – are contained in this document.
By focussing on these groups, we are providing the Government with achievable health budget aims - in both the fiscal responsibility sense and the social justice sense.
The AMA is asking the Government to make these areas their health priorities because they are the right things to do.
No Australian would begrudge their Government funding these key sectors. It’s all about the Australian ethos of a ‘fair go’.
Of the three, Indigenous Health must be the Government’s top health priority in the 2005-06 Budget. The reasons are compelling and the rewards would be far-reaching, not just for the Indigenous Australians.
While our Budget submission is priority-focussed, the AMA will not shirk its responsibility on behalf of doctors, patients and the community to keep the Government up to the mark on other important areas of health policy.
Above all, the Government must fund all its election promises on health, and not at the expense of any existing health programs, policies or funding. On the contrary, they must find more money to fund the programs outlined in this submission.
The AMA will continue its advocacy on the following issues, among others, but outside the 2005-06 Budget context:
- The introduction of a fully-funded and indexed 7-tier general practice item structure
- More funding for public hospitals and protection of their teaching and research roles
- A national anti-obesity program
- The funding of all childhood immunisations listed on the Australian Standard Vaccination Schedule and recommended by ATAGI
- Funding for a pilot program for specialist training in private clinical settings an important step in addressing Australia’s chronic shortage of home-grown medical specialists
- Cutting red tape, especially in general practice
- Smoking – education and legislation to stop people smoking
- General practice workforce issues, especially shortages in rural and outer-urban communities.
Australia has a good health system, but we should have a better health system to reflect our sound economic situation. We are in the best possible position in recent history to provide a health system that looks after the poorest and sickest in our community.
As a priority, the AMA calls on the Government to extend its spirit of goodwill in this year’s Budget to do the right thing, for the long term, for the health of all our Aborigines and Torres Strait Islanders.
Let’s give them a leg-up into the 21st Century with proper health care and services.
Dr William Glasson
Federal President
Australian Medical Association
AMA FEDERAL BUDGET SUBMISSION 2005-06
Summary
The AMA is calling on the Government to make the following initiatives their health policy priorities in the 2005-06 Federal Budget.
Funding1.Aboriginal and Torres Strait Islander Health
In its 2004 landmark report, Healing Hands, the AMA identified an annual shortfall of $400 million in spending on Aboriginal and Torres Islander Health. The AMA calls upon the government to fund this shortfall in the 2005-06 Budget. / $400 million
2.Mental Health Services
The AMA calls upon the government to commit a recurrent increase of $200 million for Mental Health Services over the next four years. This would cost the government $2 billion over the four years and would help bring Australia’s mental health spending performance towards the 12 per cent level of other OECD countries. / $200 million
(in 2005-06)
3.Long-Term Care Scheme
The AMA supports a national or nationally coordinated scheme for the long term care of severely disabled people, including those disabled from medical accidents. The initial cost to the Australian Government is estimated at $120 million a year. The AMA believes that a properly structured long-term care scheme will reduce litigation costs and provide for better lives and quality of life for the disabled. / $120 million
(estimate)
AMA FEDERAL BUDGET SUBMISSION 2005-06
1.Aboriginal and Torres Strait Islander Health
The Problem
Like Indigenous peoples in other countries, Aboriginal peoples and Torres Strait Islanders suffer a disproportionate burden of illness and social disadvantage when compared with the general population. However, the situation in Australia is much worse than other countries. Life expectancy at birth remains 20 years less than that for non-indigenous Australians and the gap has not closed over the past decade. The percentage of the Aboriginal population expected to live to age 65 is less than in many developing countries.
The Aboriginal population has reduced access to a range of health services relative to other Australians. Reduced access by the Aboriginal population to the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Breast screen Program, cervical screening, Commonwealth Hearing Services Program, renal transplants, cardiac rehabilitation programs, immunisation, hospital emergency thrombolysis therapy, Practice Incentive Programs for asthma and diabetes, elderly health assessments, have all been documented.
The AMA recognises that income and social status; social support networks; education and literacy; employment and working conditions; social environments; physical environments, housing and nutrition; personal health practices and coping skills; healthy child development; biology; health services; gender and culture all a have significant impact on health and well-being. Therefore Aboriginal peoples and Torres Strait Islanders will not achieve equal health outcomes with the rest of the Australian population until their economic, educational and social disadvantages have been eliminated. Nevertheless, while social disadvantage continues, Aboriginal people and Torres Strait Islanders should not be doubly disadvantaged by the neglect of potential medical solutions arising from health sector inequities. It is upon these inequalities we wish to focus.
The Solution
The AMA has calculated in 2003/2004 the annual shortfall of spending on Aboriginal and Torres Islander Health to be $400 million in the primary care sector. The AMA calls upon the government to make a serious commitment in its 2005/06 budget to significantly reducing this shortfall. The aim should be to have recurrently increased the spending by $400 million annually by 2008/09. We suggest a number of investments to achieve this.
The AMA calls upon the government to instigate programs to increase an Aboriginal and Torres Strait Islander individual’s access to mainstream health funding and programmes such as PBS/MBS and preventative screening programs.
This should be delivered through comprehensive integrated primary health care services most of which should be provided specifically for Aboriginal peoples and Torres Strait Islanders.
The AMA calls for improved access to PBS either through the implementation of its joint proposal with NACCHO and the PGA, which would cost the government $7 million over three years to implement and would increase annual spending through PBS by $50-100 million.
This could be financed through the recently announced $280 million generic drugs savings. Or, if this proposal is unacceptable, the AMA challenges the Government to fund and implement in 2005/06 an alternative program to increase access to PBS by the Indigenous population to at least the level of the non-indigenous population.
To increase access to MBS the AMA calls on the government to undertake educational and promotional activities with both GPs and the Aboriginal and Torres Strait Islander population to increase the at present low up take of the ATSI Adult Health Check MBS item. In addition the AMA calls on the government to extend this Health Check to Aboriginal and Torres Strait Islander children.
The AMA calls on the government to provide support to those providing services specifically to Aboriginal individuals and Torres Strait Islanders to claim through MBS and for the development of further MBS item numbers specific to Aboriginal and Torres Strait Islander Primary Care Services (eg activities undertaken by Aboriginal Health Workers to improve the implementation of GP initiated treatment and long term follow up).
The AMA calls upon the government to increase the remuneration rates, to the equivalent in the non-indigenous sector, of all health professionals and support staff providing services specifically for Aboriginal individuals and Torres Strait Islanders. At present these individuals work in some of the most challenging environments and yet are paid less than those working in mainstream services.
Continued “cashing out” and setting up of Primacy Health Care Access Programs (PHCAPs) is an important way to increase the efficiency and effectiveness of primary health care services through streamlining the financial management systems and increasing community control. It is important that all these “cashed out” funds be committed recurrently and not on project type terms for limited periods. The AMA calls upon the Government to ensure all PHCAPs are funded to meet the defined needs of the communities they service and not artificially capped at present levels of use or at arbitrary population numbers.
To provide the increased services a larger workforce is required. In this time of a nationwide shortage in all health professions it will be necessary for the government to continue to develop and fund programs specifically targeted at attracting suitable individuals to work in health services providing mainly for Indigenous patients. The AMA calls upon the government to allocate $36 million annually to this program. This could include creating specifically funded bonded training places or bonding recent graduates by paying off their HECS fees in return for a period of work in a health service providing services to Aboriginal and Torres Strait Islander individuals.
The AMA calls upon the government to commit to increasing the number of Aboriginal individuals and Torres Strait Islanders in all health professions to parity within 10 years. The main difficulty in meeting such a dead line is the lack of students applying for training places.
Therefore the AMA calls on the government to commit significant funds to develop a school mentoring program which would support health professionals to visit schools, create enthusiasm for their profession and then allow them to support interested students to aspire to and ultimately achieve entry.
The program should be active in primary and secondary schools. This program should start immediately in all states and territories. Funding of $10 million a year would give this program a significant start. The beginnings of success of the program would be at least 3-5 years down the track so we call upon the government to make a 5year commitment to such a program.
To achieve the 10-year target the support of students at the point of entry and throughout their time in training is essential. Therefore the AMA calls upon the government to commit funds to the development of pre-medicine programs, such as at the University of NSW, and support units, such as that at the University of Newcastle, in all universities providing medical and other health professional training.
AMA FEDERAL BUDGET SUBMISSION 2005-06
2.Mental Health Services
The Problem
Over two million people in Australia experience a mental illness each year.
- 3-4 per cent of people in Australia experience severe mental disorders, which significantly interfere with their mental well-being and reduce their capacity to participate fully in community life
- 1 in 5 people (20 per cent) in Australia 18 years or older meet some criteria for a mental disorder
- 62 per cent of people with a mental illness receive no assistance at all or depend on informal support - usually from unpaid carers and families.
Children and adolescents younger than 18 years make up 25 per cent of the Australian population. In any 6-month period, 15-20 per cent of this group may have a mental health problem.
Since the Richmond report in 1983 recommended the closing of the long stay mental institutions and reinvestment of funds into providing services in the community, there has in fact been little increase in the percentage of total health spending spent on Mental Health Services.
The promised replacement of long-term institutional care with long term care in the community has not materialised. Many with long-term mental health problems can now be found in prisons or among the homeless. Others simply receive no treatment at all. The negative impact of this upon national productivity and individual wellbeing is huge.
What is the benchmark of success in mental health services? How well is Australia doing? Unfortunately at this time there is no good way to compare the effectiveness of the Mental Health Services in different OECD countries. In October 2004 an expert committee representing 21 OECD countries agreed upon a set of 12 indicators to be used to compare their Mental Health Services. Only when these have been collected and compiled will Australia know where it sits compared to these other nations.
At present we spend significantly less than the comparator OECD countries. Do we need to spend more? The AMA believes there is plenty of evidence on the ground that would indicate that we are not doing well enough. The numbers of homeless people with significant mental health diagnoses and the reports from our psychiatrist members that they are often asked to admit individuals at high risk of suicide but are unable to find a suitable bed are evidence that the system is under-funded. The exact level of under-funding could be debated but we would suggest it is massive, particularly in the area of acute services and in primary care where the vast majority of individuals are not getting the support they need through general practice simply because there are not enough support services available.
The Solution
With the most recent National Mental Health Strategy (the 3rd 5 year plan) signed in 2003 there is general consensus of what needs to be done but the necessary financial backing has not been given.
The AMA calls upon the government to commit a recurrent increase of $200 million recurrent in each of the next 4 years. This would cost the government $2 billion over the four years. A similar increase over the following four years would bring the percentage of health spending spent on mental health services up to the 12 per cent level of other OECD countries.
Service development must include input from past and present users of the service and carers. Only they really know what it is like to need and provide support and their input into the design of services will increase the likelihood of success. Although service development and increasing the number of practitioners in all the health professions working with individuals with mental health problems is necessary, the development of appropriate physical infrastructure must be a priority.