By Helen Dickinson. Associate Professor, Public Governance, University of Melbourne
Health is always a key factor in deciding which way to vote.
A recent survey found health is the most important issue for over-50s this federal election, moving past economic management for the first time.
One-third of respondents believe Labor is best placed to manage health care, with 14% preferencing the Coalition and just 8% favouring the Greens.
So what have the major parties promised in health? And what could these changes mean for consumers?
Labor claims that under the Coalition, Medicare will be “sold off”. Opposition leader Bill Shorten reminded the electorate that one of the first activities of the Abbott government was to privatise Medibank Private.
Don’t listen to what they say, look at what they do. The Liberals want to tear down Medicare, brick by brick. #ausvotes— Bill Shorten (@billshortenmp) June 20, 2016
Prime Minister Turnbull has accused Labor of running a scare campaign, saying:
Medicare will never be privatised. It is a core government service.
Beyond Medicare remaining a public entity, there are some key differences in the parties' election promises.
The Coalition has committed to extending the Medicare rebate freeze to 2020 and abolishing the bulk-billing incentives for pathology (blood and tissue tests) and radiology (X-rays and MRIs).
Extending the rebate freeze means doctors will be paid the same for consultations in 2020 as they were in 2014. They’re likely to eventually pass the difference on to patients.
Removing bulk-billing incentives may mean patients have to pay a co-payment and some providers have stated this could amount to around A$30 per patient.
Labor has committed to ending the rebate freeze in early 2017 and will continue to fund bulk billing incentives for pathology and radiology. Ending the freeze is anticipated to cost A$2.4 billion in forward estimates and keeping bulk-billing incentives a further A$884 million over the next four years.
But Labor argues this is important to stop patients being charged co-payments and to encourage people to seek scans and tests to diagnose illnesses such as cervical cancer.
What do the Medicare promises mean for voters?
Under the Coalition, GPs, pathologists and radiologists may pass on some of the reductions in funding to the consumer. This could result in lower rates of bulk billing and higher co-payments.
Under Labor, costs of visits to the GP, blood tests and X-rays are less likely to rise, but these come with a significant cost to the public purse.
Private health insurance
Private health insurance is one of the few areas in health in which Labor has announced funding cuts, projecting A$3 billion in savings by freezing the private health insurance rebate for another five years and removing the rebate for natural therapies.
The Coalition argues Labor’s plans amount to charging those who use private health insurance to pay for the opposition’s other health commitments. The Coalition says private health insurance is a fundamental element of the health system, which is important to offer consumers greater choice over their care and take pressure off the public system.
The Coalition’s election promises for private health insurance focus on creating a more simplified scheme that it is easier to navigate and understand which company provides best value for money.
Rules will be introduced for plain English disclosures and there will be gold, silver and bronze categories of cover so that policies are easy to compare. Simplified billing will be developed, as will standard definitions for procedures so they are easily comparable.
What do the private health insurance promises mean for voters?
Under Labor, people with health insurance will face rising costs and some therapies that are currently covered will be removed.
Under the Coalition, private health insurance will become easier to navigate and use.
Hospital funding has long been the focus of funding disputes between state and federal governments. Following the 2014 budget, when the Abbott government cut A$80 billion in health and education funding, hospitals argued they were significantly underfunded and that this would have implications for the quality of care.
The recent Council of Australian Governments (COAG) agreement to give the states additional funding for public hospitals has been welcomed, but hospitals have maintained it’s not enough to guard against increased waiting times for emergency and elective care.
Given this history, it’s no surprise to see both parties promise more funding to hospitals. The Coalition has pledged an extra A$2.9 billion to states for hospital funding and committed to fund 45% of the growth in costs. Labor has promised an additional A$2 billion – on top of the Coalition’s A$2.9 billion – and will fund 50% of the growth in costs.
What do the hospital funding promises mean for voters?
Around A$42 billion is spent on Australian public hospitals each year. Although the extra funding promised by both parties may seem like it should improve access to emergence and elective care, the additional funds are a drop in the ocean.
There is also a growing case to suggest more money for hospitals won’t necessarily fix the challenges they face. Instead, hospitals need to work in a smarter way.
Chronic disease management through strengthening primary care
One in five Australians has a chronic and complex disease such as diabetes, heart disease, asthma, or cancer. All the major parties have recognised the need to do more to allow these people to stay in their own homes for longer and prevent unnecessary hospital admissions.
The Coalition has committed A$21million to trial Health Care Homes. These will introduce a more flexible payment structure for general practitioners, with the aim of better supporting the chronically ill to stay out of hospital.
Labor has committed A$100 million to trial a new primary care model known as Your Family Doctor. As with the Coalition’s Health Care Homes, these focus on improving the relationship between GPs and patients, providing more integrated and preventative services, and developing more innovative ways to deliver primary care.
The Greens have also made significant commitments in this space, arguing that primary care in Australia does not sufficiently meet the needs of those with multiple chronic diseases. The party has promised A$4.3 billon over four years.
Central to this plan is bolstering the role of Primary Health Networks (PHNs) to give them primary responsibility for improving chronic disease management. Of the $4.3 billion:
- A$1.5 billion has been earmarked to give GPs A$1,000 per patient with a chronic disease to provide high quality care for one year
- A$2.8 billion is to give patients access to allied health practitioners via PHNs
- A$11.9 million will be used to develop standardised models of chronic disease management which will be used across the country.
These promises to strengthen primary care are in line with the international literature, which suggests this is the bedrock of high quality health services.
What do the chronic disease management promises mean for voters?
Although it may look like Labor and the Coalition are promising significant funds to improve chronic disease management and primary care, these pale next to the amounts promised to hospitals.
It’s unclear whether Your Family Doctor and Health Care Home will be able to make a significant difference to people with chronic disease. They have broadly similar visions for changes to payment structures, preventing hospital admission and making greater use of a range of professionals in the care of individuals.
Only the Greens have promised a significant injection of cash and seem to have developed a comprehensive vision for the future of primary care.
Long-term reform is still missing
All parties argue they are committed to maintaining universal health services. Labor, and to some extent the Greens, plans to do this through a cash injection to the system and making savings on private health insurance. The Coalition is committed to more limited investments but with a desire to better use existing resources – including the private health system.
But none of the election commitments will deliver the level of reform needed to ensure the health system performs as well in the future as it does now.
This article was originally published on the Conversation.