Two recent Senate committee reports have raised concerns that federal policies are exacerbating health inequities (an interim report from the Senate Select Committee on Health, and another report, Bridging our growing divide: inequality in Australia).
Such concerns are particularly acute in Tasmania, as was made clear in submissions to the Senate Select Committee on Health.
Thanks to Miriam Herzfeld of the Social Determinants of Health Advocacy Network in Tasmania for summarising below some of the key areas of concern, including the impact of federal budget cutbacks upon the most vulnerable and high-need members of the community.
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Key points of concern for Tasmania’s health
When hearings for the Senate Select Committee on Health were held in Tasmania in November, a number of Tasmanian organisations, groups and individuals were united in their concerns about recent budget cuts and policy decisions that will have direct impacts on the health and wellbeing of Tasmanians.
Some of the main points included:
1. The need to protect our most vulnerable populations
A commitment to social justice and equity, and the enactment of what Sir Michael Marmot refers to as proportionate universalism were at the heart of points raised with Senators.
Proportionate universalism recognises that focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage.
Ms Neroli Ellis of the Australian Nursing and Midwifery Federation (Tasmanian Branch) stated that: “The GP co-payment, the dissolution of the National Preventative Health Agency, the shifting of funding from downstream to upstream services combine to further reduce access to primary health services for those most disadvantaged in the community, who in Tasmania are over represented.”
Ms Elida Meadows from the Mental Health Council of Tasmania (MHCT) identified that people living with mental illness and their carers are one such group that will be hardest hit: “…the MHCT would like to stress the issue of the vulnerability of people living with mental illness and their carers being adversely affected by additional medical costs, reduction in benefits and added insecurity in their access to health care..”
Dr Bastian Seidel from the Royal Australian College of General Practitioners (RACGP) pointed out that equitable access to quality general practice was key to addressing rural health disparities.
Ms Miriam Herzfeld from the Social Determinants of Health Advocacy Network (Tasmania) (SDOHAN) drew attention to the five recommendations of the Senate Standing Committee on Community Affairs’ 2013 Inquiry report on Australia’s domestic response to the World Health Organization’s (WHO) Commission on Social Determinants of Health report, Closing the gap within a generation and urged the Government to enact these recommendations.
2. The need for a greater focus on health promotion
Presenters spoke about the need to broaden the Government’s understanding of primary health beyond a clinical care model, and about the importance of incorporating health promotion, prevention and early intervention into health systems.
Mr Darren Mathewson from Aged & Community Services Tasmania said that in order to effectively deal with our rapidly ageing population we need a “population health, prevention focused, wellness driven, collaborative primary health care driven system including greater capability for aged services to play a broader role.”
Ms Miriam Herzfeld (SDOAH) and Mr Phil Edmondson from Tasmania Medicare Local (TML) expressed concern about the axing of the National Partnership Agreement on Preventive Health from 1 July 2014, which amounts to up to $8.5 million loss of revenue to Tasmania over the next four years.
Professor Tim Greenaway from the Australian Medical Association (AMA Tas Branch) outlined that: “Commonwealth Government investment in health promotion, prevention and early intervention is essential to supporting population health and economic productivity, reducing downstream healthcare costs and improving the sustainability of healthcare spending.”
A number of presenters expressed concern about the dissolution of Medicare Locals and the establishment of new Primary Health Networks. Mr Phil Edmondson (TML) argued, “The logic of throwing everything out and recreating primary health organisations from foundation up is not evident.”
3. We have a stretched, inefficient system that has been further hampered by budget cuts
Ms Neroli Ellis from the ANMF (Tas Branch) stated: “We are committed to publicly funded universal healthcare. Australia’s health system is siloed and fragmented, leading to service gaps, duplication, and wasted resources. This is very evident in the Tasmanian context. The Federal reduction in funding will and has had significant impacts on the ability of Tasmania to receive quality health care and this will compound with the reduction to primary care and ongoing long lasting effects on health.”
A number of presenters also raised concerns about the health workforce, forward planning and capacity building.
4. Unfair policy: the proposed Medicare co-payments
Adding their voices to many others around the country, Tasmanian witnesses to the Committee expressed their concerns about the proposed Medicare co-payments.
Mr Martyn Goddard stated, “The proposed Medicare co-payments will add substantially to the numbers of people avoiding needed GP-level care. This avoided care is likely to add more to state public hospital costs than it saves for the Commonwealth through increased co-payments.”
Dr Pauline Marsh (Tasmanian Council of Social Service – TasCOSS) said: “Cost already deters people on low incomes from visiting the GP. Saving money by not visiting the GP is a proven false economy.”
Professor Tim Greenaway (AMA Tas Branch) said: “International research has repeatedly demonstrated that the impact of increasing co-payments is greatest on those most vulnerable in our population (the elderly, the chronically ill, the unemployed, the ‘working poor’, Indigenous peoples).”
• Contributions from Ms Miriam Herzfeld (Social Determinants of Health Advocacy Network), Dr Pauline Marsh (Tasmanian Council of Social Service), Mr Phil Edmondson (Tasmania Medicare Local), Ms Neroli Ellis (Australian Nursing and Midwifery Federation (Tasmanian Branch), Mr Martyn Goddard (presenting as an individual), Professor Tim Greenaway (Australian Medical Association (Tasmanian Branch), Mr Darren Mathewson (Aged & Community Services Tasmania), Ms Elida Meadows (Mental Health Council of Tasmania) and Dr Bastian Seidel (Royal Australian College of General Practitioners).
• For full submissions from the organisations, groups and individuals listed in this article and associated references please visit: APH website.