What the budget means for our health and aged care sectors – five ideas to start reform: opinion

After the challenges of funding significant spending on COVID-19, 2021’s $17.7bn aged care reform package and the additional $2.1bn for mental health, it was not unreasonable to expect that 2022’s pre-election budget would be less exciting for health than previous years. Nevertheless there are some notable areas of spending:

• Further confirmation of the scale of cost related to an ongoing COVID-19 pandemic, with $4.2 billion covering supply and access to vaccines, treatments and support for our health workforce in primary care, aged care and hospitals.
• Establishing Australia’s own onshore manufacturing plant for mRNA vaccines (for an undisclosed amount) which will secure supply not just for vaccines related to this pandemic but for a range of future vaccines and therapeutics.
• $522m added to the aged care reform package, with $345m of this focused upon improving medication management in residential aged care through on site pharmacists and community pharmacy services. This could play a significant role in better management of the health of residents as medication management delivered as part of multidisciplinary teamwork improves the safety and quality of aged care.
• A further $547m for mental health, with a focus upon suicide prevention – an area where access to care on a timely basis, wherever and whenever it is required, is vital. Separately, there is also a commitment of $60m related to the national mental health workforce strategy, with a major focus ($28m) on growth in the psychiatry workforce.
• $296.5 million over 4 years added to the government’s investment in improving regional, rural and remote health. This includes a focus on workforce with almost $100m for training and education opportunities in rural areas.

In addition to these health portfolio investments, the health and wellbeing of Australians was also supported by significant additional funding projected for the NDIS (over $40bn over the forward estimates). These investments illustrate a continued focus upon sustaining our health – all Australians benefit from a health system that is high-quality, accessible and relatively cost-effective.

The challenge, however, is that to truly invest in the things that matter, we need to do more.

Where could we prioritise doing more?
There is always a healthy debate about where Australia should do better in healthcare. A good example is dental care: should all Australians have medicare-style coverage for dental care preventive and community based dental services? Further, there is always a desire to make sure that healthcare spending is targeted and effective – there are many competing demands for Commonwealth government expenditure (such as helping families with the cost of living, defence and national security, and infrastructure investments).

There are, however, some areas that may be difficult to address (for a range of reasons) but it is hard to argue that they should not be. These are not new, but significant reform is a challenge. With this in mind, we’ve turned our attention to some specific ideas that could be discussed through the 2022 election campaign and form the basis of initiatives adopted by a returned or incoming government.

We believe that in each of these areas, specific changes can have lasting and significant impact:

• Improving our ability to attract, train, support and retain the workforces needed to deliver health and aged care services.
• Equitable and timely access to specialist services across all of Australia, particularly in mental health.
• Dramatically improving the way that Australians receive (and pay) for treatment of complex and chronic conditions, including as they age.
• Truly embracing digital health service delivery to improve access and efficiency of services, as well as to enable new ways of delivering care.
• Further promoting Australia’s sovereign health industry.

Australia’s healthcare workforce
Australia has a health workforce problem: we are not keeping up with the growth of the sector and needs of the population. This goes beyond the medical workforce (where a major issue is equitable access and geographic coverage, as well as continued reliance on migration - as recognised by this budget’s rural health workforce investments) to issues with the broader workforce in most clinical contexts, including nursing, aged care, allied health, and carers.

Whilst exacerbated by the COVID-19 pandemic, our heavy reliance on overseas migration for some workforces is only part of the problem.

At a national level, there is no specialist accountable body for this issue. Having a small, specialist organisation with accountability and responsibility for working across sub-sectors and with all jurisdictions to close the gaps in our workforce across all areas – training, incentives, practice improvements, new workforce models, overseas migration, re-entry to work pathways, opportunities for diverse work locations amongst many others – would demonstrate our commitment to addressing the problem.

An analogy exists in aged care: when Australia identified a major issue with quality and safety, a specialist agency with clear and independent responsibility was created. Why not for our health workforce: a sector that accounts for over 600,000 professionals nationwide?

Improving access to mental health services
Almost half of all Australians will experience a mental health condition at some point in their lives. Demand for mental health services continues to grow, compounded by the impacts of bushfires and COVID-19. And this budget continues to invest to address this issue. And yet, Australia is experiencing workforce shortages in mental health service delivery, and there are significant waitlists for psychiatrists, clinical psychologists and other specialist support services. Addressing these workforce shortages is only part of the solution (and investments like in the psychiatry workforce in this budget will take time to take effect): we need to find ways to consistently deliver the right care at the right time with teams of service providers working together to care for someone with a mental illness.

We have the ability to do this today, harnessing evidence-based digital solutions to coordinate care and enable support. This can allow a range of professionals (including those with lived experience) to remotely and locally provide support and care, allows the use of predictive analytics to improve decision making, and empowers individuals with tools that help them manage their own mental health journey. Australia can harness an existing range of mental health providers and solutions to deliver – empowering this through a major investment to incentivise, operate, measure and confirm the impact. This offers a real chance to deliver the mental health services all Australians deserve, and to do this sooner rather than later.

Improving the way we manage chronic and complex conditions

For most Australians who are healthy and well, a health care system that is focused on the activity they need (and paying for that activity where applicable) works well. This might involve a visit to the GP, obtaining vital medicines, an unplanned trip to the emergency department or access to world-class surgery.

The problem arises when navigating chronic and complex conditions. Too often, people don’t get the care they need and/or struggle to understand how to do so. This is particularly acute in older Australians, but is not a unique issue to them. This often leads to needing to deliver an avoidable healthcare treatment because prevention and in-home support isn’t provided or sought or healthcare events are not followed up well enough.

Further, in residential aged care, initiatives like last budget’s support for GP in-reach services and this budget’s improved medication management are to be welcomed, but these may not consistently support the multi-disciplinary clinical care that is optimal for some of our most vulnerable citizens. And this is just in aged care: the core issue is that across our system we don’t sufficiently encourage and incentivise care teams employed by different organisations to work together to deliver higher quality and more cost effective outcomes.

Many world-class healthcare systems similar to ours are much more advanced in supporting bundled and integrated care; organising the funding and governance of care where different healthcare organisations and professionals are motivated and organised to deliver care together, delivering better healthcare outcomes and experiences for patients.

This is something that ideally would include different levels of government working together, but it is also something that can be done within the parts of Australia’s primary and aged care systems: providers working together to keep people well. It’s time we chose some significant parts of our system to get this working.

Digital and virtual healthcare to make healthcare more person-centric
Having embraced telehealth as part of delivering Medicare services during the COVID-19 pandemic, this budget confirms the Australian Government’s recent extension to allow GPs, specialists and allied health professionals to continue to consult with their regular patients by phone or video conferencing.

This is a meaningful step forward in providing flexibility in how Australians seek and receive primary healthcare services – recent PwC research reinforces that as we move beyond the pandemic a desire to use some virtual health services goes beyond the tech-savvy – for those with dependents (who can be time-poor, often trying to manage multiple competing work and care priorities and juggling the money and opportunity cost of having to take time out to attend a physical appointment) virtual attendance is a welcome option.

Going beyond this reform, a next step would combine virtual health with face-to-face support for specialised services. Using remote monitoring, in-home visits, telephone or video consultations and home deliveries (eg of pharmaceuticals), it would be possible to help many more Australians manage their own health or aged care at home and achieve better outcomes with less use of health services. We should select some specific diagnoses, recovery pathways and aged care circumstances where we assume and expect virtual healthcare models to be used, and ask the question as to whether appropriate practice is being delivered if it is not.

Further enhancing Australia’s sovereign health industry
COVID-19 increased the awareness of all Australians of the reliance we have upon worldwide logistics and supply chains. In healthcare, Australia sits at the end of a long and complex supply chain for the majority of its medical supplies. Onshore vaccine manufacturing helped, and this will continue to be enhanced with this year’s announcement of new mRNA vaccine manufacturing capability. And whilst it may surprise many that the majority of our finished drug products come from the United States and Europe, they in turn rely upon India and China for most of their underlying active pharmaceutical ingredients.

The Reserve Bank highlights that Health and Education is the largest single industry sector of the Australian economy. Health is an economic driver for Australia and there is much we are doing to harness this in innovative ways that go beyond delivery of healthcare services:

• Our national Medical Research Future fund is designed to create jobs, strengthen industry, and support world-leading medical research, and bolster our global connections through initiatives such as the International Clinical Trial Collaboration (ICTC).
• Our investment in mRNA vaccine production confirms our desire to have world leading manufacturing capability.
• This budget announced a biotechnology in Australia strategic plan, that articulates the range of Australian Government initiatives that support the entire biotechnology ecosystem.

The big question, though, is how can we further harness our world-class investments into our own high-priority sovereign medical and pharmaceutical manufacturing industries? Where else would it make a difference to us and our neighbours to be able to service our own needs for medical supplies? This, alongside investments in roads, rail, water and freight, is critical infrastructure that can help secure Australia’s healthy future.

In conclusion, reading this year’s budget and seeing the ongoing commitment to fund our universal healthcare system really does remind us we are “the lucky country”. However, without a focus on the sorts of priorities we outline above, our luck could run out: we may not be able to afford the costs inherent to our current approach, or achieve consistent high quality in our healthcare. It is critical to the future of our health system that we keep moving towards a value-based healthcare system – one where we are achieving better health outcomes and experiences whilst at the same time reducing costs and removing waste. This way, the healthcare innovations of tomorrow can remain affordable and accessible to all Australians.

Stuart Babbage is Partner - Health, Public Policy & Economics at PwC Australia.

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