The 2016 Federal Election put health issues front and centre. Now with the Turnbull Government returned but with a reduced margin and some ministerial changes in the health portfolio, NAB Health consultant Dr Barbara Carney reviews the election results, industry reaction and the implications for the future.
After an eight-week election campaign, the longest in Australia since the 1960s, Prime Minister Malcolm Turnbull has claimed victory albeit with a greatly reduced majority. The pundits have been out in force since election night with their reasons for the result, ranging from the electorate’s disaffection with mainstream politics to the pedestrian nature of the election campaign overall.
The Senate also returned the largest crossbench in the country’s history. It means the government will need to negotiate all major legislation with the crossbench, which has significant implications for the implementation of election policies, as well as, crucially, for the 2017 Budget.
As widely expected Sussan Ley has been reappointed Minister for Health and Aged Care. There’s a new appointment for Assistant Minister for Rural Health with Dr David Gillespie, a former physician and gastroenterologist, stepping into the role, replacing Fiona Nash. Ken Wyatt continues as Assistant Minister for Health.
Health and Ageing dominate
According to JWS Research, a company headed by John Scales, probably the best quantitative pollster in the country – “health was the dominant issue for voters in the 2016 Federal election campaign.”
57% of voters surveyed post-election nominated health issues as a key vote influencer, including 39% who nominated hospitals and health care generally and 33% who mentioned Medicare specifically. (JWS Research, Post-Election Survey, July 2016 – survey conducted 3-5July 2016).
This survey also showed the Opposition’s focus on Medicare in the last two weeks of the campaign had a significant effect – 46% of people who voted on election day nominated Medicare as a vote influencer, as did 41% of those who only made up their minds on how to vote on election day. These numbers are higher than normal for a single issue.
Medicare was the dominant issue for ALP voters at 59%. Coalition voters rated the economy and taxation issues higher than healthcare (69%) with healthcare coming in as most important for 32% of Coalition voters.
Greens voters and people who voted for other parties also rated health issues as most important (52%, with hospitals and healthcare most dominant at 36% and Medicare at 31%).
Aged care was singled out by 16% of voters as a significant issue on its own. However, looking at the JWS survey and other post-election reports, it can’t be ruled out that aged care figured in people’s concerns about health and Medicare.
Likely impact on government policies
There have been some statements, or strong hints, by some in government ranks that a clear, even if tiny, majority in the Lower House gives the Government a mandate to implement in full its budget and election policies no matter how unpopular with crossbenchers, or voters. This would include the continuation of the freeze on MBS rebates. Others, however, including members of the government’s backbench have called for a more consultative approach that attempts to make key stakeholders, especially doctors, part of the solution.
Treasurer Scott Morrison, asked whether he would end the rebate freeze, said the Medicare system needed to be sustainable. “You can’t expect Medicare into the future if you can’t fund it. To fund it you have to have a strong economy and to have a strong economy you also need to have your fiscal setting right. These issues are interdependent.” ( The Australian, 7 July 2016).
Some backbenchers, such as Dr Andrew Laming, a former GP and ophthalmologist, Queensland MP Warren Entsch, and West Australian Senator Chris Back, have said the government needs to listen to voters.
Dr Laming suggested a shake-up of the system which could see payments to clinicians based on quality and not quantity. He said this shift would reward doctors who oversaw improvements in patients’ outcomes and not those who saw large volumes of patients without producing results.
“The shift to quality is where the debate needs to go and is going that way in other countries,” said Dr Leming. “The only promising path in health reform is paying for quality. There are plenty of resources for high-quality healthcare if we could remove the waste, duplication and mismanagement. Ultimately we’ve got to pay for outcomes.” (The Australian, 7 July 2016)
Meanwhile, Warren Entsch has said the Government “had to move very quickly to reassure the public that Medicare would not be privatised” and the payments system would be improved. (The Australia, 7 July 2016).
Peak body reaction
The Council on the Ageing (COTA) has called for the modelling for the current $1.6b Aged Care Financing Instrument Budget (ACFI) cuts to be made public. COTA CEO Ian Yates said the measure is unacceptable in its current form and has called for moderation and restoration of funds. COTA has offered the alternate suggestion of a voucher system. COTA acknowledges that the sector is “more viable” than previously, though acknowledging the view that struggling facilities should exit the industry.
Senator Nick Xenophon has promised to delay the ACFI cuts in the Senate until the government reveals the full analysis. (Australian Financial Review, 14 July 2016).
Soon after congratulating the government on its election win, the Australian Medical Association (AMA) called for a complete review of the Coalition’s health platform.
In a media release on July 11 AMA President Dr Michael Gannon said the government should “immediately lift the freeze on Medicare patient rebates, scrap changes to bulk billing incentives for pathology and medical imaging, and increase public hospital funding”.
“The AMA agrees health funding must be sustainable well into the future and this will require a sector wide examination of approaches to prevention, public health, the ageing population and the significant increase in the incidence of chronic and complex disease,” he said.
“This will require investing more, not less, in primary health care, and keeping people out of more expensive hospital care where possible. We need to find a way to sustainably fund the health system but, at the same time, we must protect the health of the most vulnerable in our community.”
Dr Gannon said the AMA wants the Health Minister to have “a very strong voice in Cabinet” to ensure health policy is not dominated by the “considerations of the Department of Treasury or Finance”.
In an ABC Sydney radio interview on 15 July Dr Gannon said: “What we have seen in the past going back to the 2014 Budget was a desire by the Coalition to introduce a co-payment to try and work out ways those who can afford it can contribute more to the cost of their healthcare. The reason that proposal failed so badly is because it didn’t give the opportunity for individual GPs to make a judgement, knowing their patients well, who can and can’t afford a modest amount of money. We need to be open to all different conversations and that should be part of the conversation in unravelling the freeze.”
There’s been a beat up in some sections of the media that this comment amounts to advocacy of a GP co-payment. However, as can be seen, Dr Gannon is calling for a consultative discussion on sources of savings within the health portfolio, mindful of the difficulty of the task .
Pharmacy Guild CEO David Quilty has pledged the Guild’s commitment to “working closely” with the Government and other stakeholders, as well as stressing the importance of maintaining the sector’s profile.
“With some 50 new Members and Senators there is significant turnover in the 45th Federal Parliament making it critical that the Guild and our grassroots members around Australia are visibly demonstrating the unique and vital contribution of community pharmacies to patient care and the wider health system,” he said in the Guild’s fortnightly e-newsletter.
Quilty identified the launch of the rollout of the Pharmacy Trail Program (PTP) as one of the most important priorities for the sector. “In terms of outstanding policy issues first and foremost it is vital that the benefits of the Sixth Community Pharmacy Agreement (6CFA) are delivered in full and on time,” he said. “Due to the late signing of the 6CPA and the early Federal Election the rollout of the PTP is behind schedule and needs to be fast-tracked.
“The Guild is committed to working with pharmacy organisations, patient groups, health professional bodies and research organisations to ensure these community pharmacy-based trials are of the highest calibre and rolled out as expeditiously as possible.
Quilty said the Guild would continue to work closely with the Pharmaceutical Society of Australia (PSA) to ensure the work they jointly undertook in the run-up to the 6CPA negotiation “comes to fruition in the PTP”.
“To that end, the Guild has submitted proposals to the Call for Ideas for the second tranche of the PTP that reflect this joint Guild/PSA work in the areas of prescription renewal, minor ailments, and anti-coagulation monitoring. In the coming weeks it is likely that the discussion paper for the Pharmacy Remuneration and Regulation Review will be released. The Guild will make a comprehensive submission to the Review and encourage our members and with their patients to do likewise, as well as attending the community meetings being held around the country.”
Overall the position of medical and other health practitioners, pharmacists, hospitals, insurers and consumers in the health care system has changed little since the Federal Budget in May.
Major reviews into Medicare, General Practice, Private Health Insurance and Pharmacy Remunerations and Locations are ongoing. All are due to be concluded this year, certainly in time for any outcomes to be factored into the 2017 Budget. But how this factoring is done depends very much on how soon and how well the government learns to get on with the new Senate crossbenchers. And all this with the savings from the 2016 Budget still not legislated.
Yet again, it will be a period for “vigilance and valour” in the health care arena.
Disclaimer: Pulse Check is a weekly/fortnightly article prepared for use by NAB by an independent consultant. It contains information about issues related to the health and aged care industry and Federal Parliament and politics. The information is not advice, and should not be treated as such. Any opinions expressed are those of the author only, not of NAB. Please contact firstname.lastname@example.org with any queries or comments.
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