Issue 18 / 18 May 2015

IN delivering last week’s federal Budget speech Treasurer Joe Hockey barely made mention of health.

In fact, throughout the speech, media commentators appeared to be gathered in the cold outside Parliament House with little to talk about. One commentator, Alan Kohler, said later that the whole event appeared to be “a long, grovelling apology for last year’s stuff up”.

Delivery aside, as the detail of the Budget began to emerge in the latter half of last week it became clear that there were some important planned changes in health funding. However, as outlined in a comprehensive wrap by health policy expert Jennifer Doggett in a post for the Croakey blog, the three biggest areas of health spending (public hospitals, Medicare and the Pharmaceutical Benefits Scheme) were not extensively addressed in the Budget because all three are currently subject to ongoing government negotiation and review.

Overall, this seems like a good thing, and far preferable to top-down or “thought bubble” policy deliberations that the government has been accused of in the past.

So while some things have been decided and others are still being debated, I offer some snippets of advice from this week’s MJA InSight.

Effective comprehensive primary care is possible — even in remote Australia

One of our news stories takes us to the Fitzroy Valley in the remote Kimberley region of Western Australia, where 3500 people are dispersed between 44 communities in a 30 000 square kilometre area. Over the past 6 years, a formal collaboration between an Aboriginal community-controlled health service, a hospital and a community health service has seen amazing increases in access to health services and some promising shifts in outcomes, outlined in a research report in the MJA.

It’s a good news story but, as MJA research lead author Dr Carole Reeve told MJA InSight, health service improvement can only do so much, and “the biggest factor in determining health outcomes is actually socioeconomic and environmental circumstances”.

Carrots and sticks are complex

Carrots and sticks are health policy staples as motivators for both doctors and patients but they can have unpredictable effects. A trial comparing the effect of incentive payments for smoking cessation with a reward or a deposit scheme (in which the deposit was surrendered on failure or returned with a premium on success) is reported in our News in brief. It found smokers much preferred the reward scheme but were more likely to succeed if they had forked out a deposit, leaving the question of which scheme was preferable open to interpretation.

On carrots for doctors, another news story about an MJA study found less than enthusiastic uptake of some components of the Practice Incentives Program (PIP) for general practice. Experts commenting for InSight blamed inflation, economies of scale and administrative burden for the slight downward trend in claims over time.

With this in mind, it will be interesting to see how GPs respond to the PIP after-hours payment announced in the Budget as a way to encourage eligible GPs to provide after-hours care for their patients, which comes into effect on 1 July.

A big stick being factored into the Budget is the “no jab, no pay” policy, under which families with under-immunised children will forgo childcare and taxation subsidies.

Last week, vaccination expert Associate Professor Julie Leask pointed out that, if the government expects to save more than $500 million over 4 years by withholding payments, it is counting on failing in its primary objective of having every child fully immunised.

It’s a policy that has left public health commentators divided, although most are willing to give it a try to meet the goal of eradicating vaccine-preventable diseases for Australian children.

Surely this policy can only be declared successful when there are no Budget savings because parents are deterred by the stick and participate fully in childhood immunisation programs.

My final snippet of advice is for the government. The aim of health policy is to improve health.


Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight


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