Late last year, the Australian Treasury called for 2024–25 Pre-Budget submissions in the lead-up to the next federal budget, expected to be delivered on 14 May 2024. The Royal Australasian College of Physicians (RACP) trains and educates doctors and trainee doctors in Australia and New Zealand and represents a broad range of medical specialties. This article explores the RACP’s Pre-Budget Submission, including its key insights and future funding priorities for the Australian health system and workforce.
Both the Australian government and the RACP are mindful of key factors impacting the Australian economy, population and health system in the coming decades, as outlined in the 2023 Intergenerational Report, and the Department of Health and Aged Care’s recent capability review.
The RACP and the government acknowledge several growing and compounding problems including:
- Population ageing, increased longevity, growing healthcare needs, and the increasing demand for aged care.
- Lower fertility rates.
- Slowing economic growth, a declining revenue base, and the growing costs of hospitalisation.
- The rural and remote healthcare divide.
- Harnessing emergent technologies responsibly.
- The need for better models of chronic care, integrated care, and health prevention.
- Climate-related or future pandemic-related disruptions in the health system.
Key insights and funding priorities from the RACPs’ 2024 Pre-Budget Submission to the Australian Government:
- Strengthening Medicare and involving more specialists in supporting primary care:
- Provide long-term funding for Urgent Care Clinics and with ongoing evaluation and reporting.
- Invest in multidisciplinary ambulatory care and outreach services, including timely care of patients with complex and chronic conditions within their local communities (e.g. ambulatory care and outreach services provided by specialist physicians such as, geriatricians, paediatricians, addiction medicine physicians, or palliative care physicians).
- Expand funding of the Bulk Billing Incentive payments to a broader range of priority groups (e.g., rural, regional, and remote communities, older people, and First Nations people).
- Extend telehealth and other technologies to broaden specialist access to priority patient groups:
- Fund new models of telehealth and remote service delivery, including virtual care and remote monitoring, and the linking of secondary, primary, and urgent care settings (e.g. telehealth hubs in rural, regional, and remote areas; technology packages for patients; permanent funding of a full range of MBS video and telephone-based specialist items that cover all consultant physicians and promote the uptake of telehealth and the delivery of integrated care).
- Address health workforce pressures and burnout, including workforce constraints, maldistribution, the regional health disadvantage, and competing demands (research, supervision, and patient care demands):
- Fully fund the effective implementation of the National Medical Workforce Strategy 2021–2031 as well as a centralised national database of workforce (DWS) shortages for overseas trained practitioners to identify and apply for positions.
- Increase funding for the FATES program to improve long-term planning and effective change.
- Expand and enhance the Specialist Training Program (STP) and increase the number of STP places in rural and regional communities, including in paediatrics, community child health and other sub-specialties in shortage.
- Increase STP incentives and improve flexibility, enable unspent STP Salary Support funds to pay for additional STP posts in areas of need.
- Fund rural specialist training hubs that attract and retain specialist trainees across rural sites.
- Guarantee long term equitable and transparent funding for the Rural Health Outreach Fund.
- Introduce MBS payments to encourage physicians to relocate and remain in rural, regional, and remote practice locations.
- Prevent ill health and chronic disease:
- Fund the interim CDC to prioritise both communicable diseases and non-communicable diseases (including related social, environmental and occupational determinants) and fund an CDC open data policy framework.
- Urgently fund The National Preventive Health Strategy (2021-2030), with 5% of health expenditure dedicated to prevention by 2030.
- Fund The National Obesity Strategy (2022-2032).
- Fund the National Tobacco Strategy (2023-2030).
- Fund The National Diabetes Strategy (2021-2030).
- Increase funding for bariatric surgeries and PBS subsidies for evidence-based obesity weight-loss medicines.
- Raise the baseline rate of social support to increase recipients’ ability to make healthy choices, particularly around positive diet, and lifestyle changes.
- Boost funding for multidisciplinary sub-acute, community, ambulatory and rehabilitation services to address the burden of post-COVID related conditions and fund the development of nationally consistent data collection to inform future policy and strategies.
- Improve health equity across population groups:
- Provide funding for the National Aboriginal and Torres Strait Islander Health Plan 2021-2031 and use NACCHO’s Measuring the Gap in Health Expenditure to guide health funding.
- Increase funding and deliver long-term sustainable funding models for Aboriginal Community Controlled Health Organisations.
- Fund public health information campaigns promoting uptake of MBS Item 715 Health Check for the prevention and management of chronic diseases in First Nations communities, as well as bulk-billed specialist medical services.
- Fully fund and implement the National Children’s Mental Health and Wellbeing Strategy to expand mental health support for children, young people and their families and carers.
- Increase funding for paediatricians in rural, regional, and remote areas.
- Fully fund the implementation of the Safe & Supported: The National Framework for Protecting Australia's Children 2021–2031.
- Urgently fund and implement the recommendations from the Royal Commission into Aged Care Quality and Safety, including supporting employment and training for Aboriginal and Torres Strait Islander aged care workers, and providing access to specialists and other health practitioners through Multidisciplinary Outreach Services.
- Fund medical, pharmacy, and allied health outreach services for people with disability and provide training and support for healthcare providers working in rural and regional areas to expand their capacity to care for people with disability.
- Invest adequately in evidence-based interventions to prevent and treat harms arising from alcohol-use and other drugs, across hospital and community-based care, including services provided by multidisciplinary teams.
- Increase investment in the addiction medicine and addiction psychiatry workforce.
- Fund integrated pain and addiction treatment services across Australia.
- Develop an MBS item number to allow physicians to engage employers, supervisors, workplace regulators and unions to assess hazards and work, health, and safety issues.
