High Level Budget Summary

The 2023-24 Federal Budget was handed down by the Treasurer, the Hon Dr Jim Chalmers on 9 May 2023.  This Budget estimates the first surplus in fifteen years off the back of surging revenue (from a rise of commodity prices and increased taxes due to low employment levels).  However the $4.2 billion surplus is for this financial year, with deficits to follow in subsequent years.  It represents an improvement of $125.9 billion over 5 years however.  Total Australian Government payments will be 26.5% of GDP (higher than during the global financial crisis stimulus).  The Treasurer also forecast headline inflation to fall from 7% earlier this year to 3.25% by the middle of next year. 

The main elements of the Budget were a $14.6 billion cost of living package and a strengthening Medicare package. The Health Portfolio has a budget of $139.2 billion next financial year, an increase of $5.6 billion compared with the March 2022-23 budget.  The significant measures in the Health and Aged Care Portfolio were framed around themes of: 

• building a stronger Medicare
• delivering the largest ever pay rise to aged care workers  
• tackling smoking and vaping, and improving cancer outcomes  
• laying the groundwork for mental health and suicide prevention system reform, and
• health protection, preventive health and sport.

The Treasurer’s speech noted a tripling of the GP Bulk Billing Incentives of $3.5 billion; keeping downward pressure on the cost of medicines (including the double dispensing measure), increasing vaccination via pharmacies, establishing eight more urgent GP care clinics in regional communities, investing in multidisciplinary team measures and the My Health Record.  The health portfolio pre-budget announcements were measures aimed at supporting workforces to work at top of scope, improving access to after-hours primary care, introducing new blended payment models, providing flexible funding for multi-disciplinary team-based models and investing in digital health infrastructure.

 

Health Portfolio
Public Pathology Australia participated in the Australian Health Portfolio Budget Briefing today where presentations were made by the Hon Mark Butler MP, the Hon Anika Wells MP, the Hon Ged Kearney MP, the Hon Emma McBride MP and Senator the Hon Malarndirri McCarthy.  Significant announcements are below.

Expenditure Overview
Expenditure on health and aged care in the May budget will be $139.2 billion for 2023-24, an increase of $5.6 billion compared with the March 2022-23 budget. Total health and aged care spending over the next four years will be $589 billion, an increase of $42 billion from the March 2022-23 budget allocation of $547 billion.

The following are selected elements of the budget.  For full budget papers, click on the links at the end of this e-alert.

Australian Centre for Disease Control and Prevention
$91.1 million has been allocated over two years from 2023–24 (including $0.2 million in capital) to commence the establishment of the Australian Centre for Disease Control (the ACDC) which aims to better prepare Australia for future pandemics and health threats.  The ACDC will be located within the Health Department in Canberra until otherwise agreed between States/Territories.  Its main focus will be on data and infectious disease, noting that the longer term vision is to take preventative action and deal with chronic disease. 

The National Medical Stockpile will be replenished and begin transitioning into the ACDC. The Government will provide additional funding of $0.7 million in 2023– 24 to ensure the National Medical Stockpile can sustain its stock and procure additional chemical, biological, radioactive and nuclear countermeasures, store surplus consumables and develop long term strategies.The Therapeutic Goods Administration (TGA) will receive long term funding for activities aimed at protecting public health ($61m).

COVID-19
Continued funding over 5 years from 2022–23 to expand the COVID-19 vaccine strategy and provide Australians with COVID-19 treatments, including:

• $285.5 million over two years from 2022–23 to protect priority groups from COVID-19, by providing states and territories 50 per cent of the cost for Polymerase Chain Reaction (PCR) testing and agreed price per COVID-19 vaccination dose delivered for Australians most at risk of severe COVID-19 and death.

• $250.5 million over two years from 2022–23 to extend Medicare Benefits Schedule (MBS) items for PCR pathology testing for COVID-19 and other respiratory pathogens to 31 December 2023.

• $41.3 million over two years from 2022–23 to extend access to in-reach PCR testing in residential aged care homes to 31 December 2023.

• $160.2 million over two years from 2022–23 for additional COVID-19 vaccine procurement and logistic arrangements, and to extend the Essential Vaccines Schedule.

• $757.4 million over two years from 2022–23 to ensure access to a range of vaccine administration channels, including community pharmacies, Primary Health Networks and the Vaccine Administration Partnership Program.

• $61.6 million over two years from 2022–23 to continue resourcing for the National COVID-19 Vaccine Program.

• $57.3 million over two years from 2022–23 to extend support for First Nations Australians to access COVID-19 testing and vaccinations to 30 June 2024.

• $43.0 million over two years from 2022–23 to invest in ICT infrastructure to prepare for future pandemic events and extend existing COVID-19 programs.

• $14.3 million over two years from 2022–23 to extend Commonwealth funding for Healthdirect’s Living with COVID service to 31 December 2023.

• $14.2 million over two years from 2022–23 to extend MBS items for general practitioners (GPs) to undertake telehealth consultations to evaluate eligible COVID-positive patients’ suitability for oral antivirals.

• $12.7 million over 5 years from 2022–23 to establish and maintain a scalable GP-led Respiratory Clinic Panel, to be activated in response to another COVID-19 wave or other major health emergency.

• $3.9 million over two years from 2022–23 to support COVID-19 expert advisory groups and rapid health technology assessments to provide advice on COVID-19 vaccines and treatments.

• $0.8 million over two years from 2022–23 to support cardiac magnetic resonance imaging for mRNA COVID-19 vaccine-associated myocarditis.

• $536.6 million over two years from 2022–23 to reimburse aged care providers for additional costs incurred due to COVID-19 outbreaks that occur on or before 31 December 2023.

• $14.1 million over two years from 2022–23 for targeted financial support for disability workers who deliver personal support to National Disability Insurance Scheme participants, contract COVID-19, and do not have access to leave entitlements.

• $4.7 million in 2023–24 to partner with culturally and linguistically diverse communities to boost COVID-19 vaccination rates.

• $0.7 million over two years from 2023–24 to improve the detection of COVID-19 in wastewater samples from selected inbound Qantas flights, and to test incoming passengers from China, Hong Kong and Macau.

• $13.4 million in 2023–24 to reimburse aged care providers for the cost of leave entitlements for casual staff and those who have no other access to leave payments where staff cannot attend work due to being COVID-19 positive.

MBS Items
The Budget allocates:

• $10.9 million for one year for the MBS Continuous Review program to ensure the MBS remains clinically appropriate.

• $125.6 million over 5 years to improve clinical practice through amendments to the MBS, including:
  
  • $18.5 million for testing genetic variants in patients suspected of having myeloid or lymphoid haematological malignancy.
  • $16.8 million to introduce a new MBS item for gene expression profiling test to determine a patient’s risk of recurrent breast cancer.
  • $13.1 million to introduce genetic testing for hearing loss in children.
  • $23.6 million to remedy previous changes to orthopaedic items which have impeded patient access to orthopaedic procedures.

PPA has been issued with the following further details from the Health Department.

1 July 2023 new and amended pathology MBS changes:

• Amendment to 17p chromosomal deletion testing for patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL).

1 November new and amended pathology MBS changes:

• Amendment to genetic testing for cardiac arrhythmia to align with genetic testing for cardiomyopathy (MSAC Executive Dec 2022).
• Genetic testing for childhood hearing impairment (MSAC application1680).
• Gene panel testing for variants associated with haematological malignancies (MSAC application1684).
• Small gene panel testing for non-small cell lung carcinoma (MSAC application1721).
• Quantification of NT-proBNP in patients with systemic sclerosis (MSAC application1689).
• Amendments to prostate specific antigen testing to align with guidelines (MSAC Executive August 2022).
• Targeted carrier testing for severe monogenic conditions (MSAC application1671).
• Detection of measurable residual disease in patients with acute lymphoblastic leukaemia (MSAC application1707).
• A prognostic RT-qcPCR test for prediction of risk of distant recurrence of breast cancer under endocrine treatment (MSAC application1408.1).
• Whole genome sequencing for the diagnosis of mitochondrial disease (MSAC application1675).
• Improved access to pathology testing for breast, ovarian, fallopian tube or primary peritoneal cancer (MSAC Executive Dec 2021).

QUPP
Starting from 1 July 2023, minor changes will be made to the Quality Use of Pathology Program (QUPP) without consultation of the sector.

From 1 July 2023, a modest reduction in funding will be applied to the Quality Use of Pathology Program (QUPP) totalling $0.9 million over four years from 2023-24. The QUPP will be also integrated into a re-designed Quality Use of Diagnostics, Therapeutics and Pathology (QUDTP) Program from 1 July 2024. Consolidating QUPP with the QUDTP Program, a grant program that also has a focus on the safety and quality of health care, will provide some minor administrative efficiencies for the administration of project grants.

The redesigned QUDTP Program will include a dedicated quality use of pathology project stream to be administered alongside the two existing QUDTP streams, the Health Professional Education Stream and the Consumer Health Literacy Stream. The quality use of pathology project stream will continue to support innovative pathology practice and contribute to the evidence base of the national pathology accreditation program.

Currently funded QUPP projects will not be affected by these changes.

Other MBS Changes
The Budget allocates:

• $6.8 million over 4 years for changes including:
  
  • Introduction of testing for people with systemic sclerosis to assess risk of pulmonary arterial hypertension.
  • Amendments to Plastic and Reconstructive Surgery items and hospital requirements for patient safety.
  • Clarifying co-claiming restrictions to ensure patients receiving the same benefits for the same services and improve billing practices.

• Efficiencies of $461.3 million over 5 years including:
  
  • Saving $301.9 million over 3 years by changes to Chronic Disease Management planning items and associated regulations, in order to implement the recommendations of the Medicare Review Taskforce.
  • Saving $151.7 million over 5 years by reforming time-tiered general attendance items for general practice, through introducing a minimum consultation time for Level B items and establishing a new item for a longer consultation of 60 minutes for people with chronic conditions and complex needs. Improving integrity.

• $29.8 million over 4 years to respond to recommendations of the Independent Review into Medicare Integrity and Compliance (Philip review), including:
  
  • A taskforce established in the Department of Health and Aged Care to identify and disrupt instances of fraud and serious non-compliance before they occur.
  • Limiting duration of backdated patient-billed claims.
  • Appropriate data sharing with Services Australia permitted.
  • Removal of requirements to consult with peak bodies prior to issuing a notice to produce in audits of providers.

• $46.8 million over 4 years to enable nurse practitioners and midwives to deliver health care services.

• $34.6 million over two years to enable non-vocationally recognised doctors to receive MBS rebates under the Other Medical Practitioner Program.

Digital Health
A $951.2 million digital health package will improve digital systems to build a more efficient, connected and collaborative healthcare system. The Intergovernmental Agreement on National Digital Health will be renewed for 4 years to progress the secure, safe and efficient sharing of information across the health system.

• $429.0 million over two years from 2023–24 to modernise My Health Record (MHR) including by creating a new National Repository platform which supports easier, more secure data sharing across all healthcare settings, investment to improve the sharing of pathology and diagnostic imaging information, and targeted investment to increase allied health professionals’ connection to MHR.

• $325.7 million over 4 years (and approximately $79.9 million per year ongoing), to establish the Australian Digital Health Agency (ADHA) as an ongoing entity. This measure will also fund a review of the ADHA’s enabling legislation to ensure the agency remains fit for purpose.

• $69.7 million over 4 years (and $4.2 million per year ongoing) to respond to recommendations made in the Strengthening Medicare Taskforce Report, and the Independent Review into Medicare Integrity and Compliance to digitise additional health services, and better connect health data to improve access to services for customers and health professionals. Funding has also been provisioned to support the Commonwealth’s contribution to the Intergovernmental Agreement on National Digital Health with the states and territories.

Blood Borne Viruses And Sexually Transmissible Infections
There is funding to enhance efforts to end HIV transmission in Australia by 2030, including access to treatment for people who are ineligible for Medicare ($10m), and increased access to testing, treatment and information ($3.2m). The Blood Borne Virus (BBV) and Sexually Transmissible Infection (STI) National Response will be continued ($6.6m).

National Gene Technology Scheme
$3.2 million in 2023–24 (including $1.1 million in capital funding in 2023–24) has been allocated to support legislative amendments to the National Gene Technology Scheme to ensure regulation is fit for purpose.

Access To Care
Measures under this theme include $1.5 billion over 4 years to increase indexation in the MBS (further details pending) and a $3.5 billion investment to triple bulk billing incentives. Minster Butler claims this is the largest increase to MBS in the 40-year history of Medicare. The latter aims to benefit 11.6 million Australians for face-to-face and telehealth GP consultations.From 1 November, a GP who bulk bills an eligible patient for a standard consultation in a metropolitan area will receive a bulk billing incentive benefit of $20.65 instead of $6.85. In remote areas, the bulk billing incentive for a standard consultation will increase from $13.15 to $39.65. This will address the sharp decline in bulk billing rates and doctor availability over recent years and make healthcare more affordable for about 5.1 million children under 16, and 7.9 million pensioners and concession card holders.

Additional elements include:

• $143.9 million over 2 years to improve access to after-hours primary care through:
  
  • $77.9 million to extend the Primary Health Network (PHN) After Hours programs.
  • $25.4 million to establish a Homelessness Support program to support homes less people’s access to primary care.
  • $15.3 million to establish a PHN Multicultural Access program to support multicultural communities access to primary care.
  • $14.8 million to support PHNs implement and support these after-hours programs.
  • $7 million to support Healthdirect’s after-hours GP helpline.
  • $3.5 million to the Department of Health and Aged Care to implement and monitor the measure.

• $98.9 million over 4 years to connect frequent hospital users to a general practice to receive comprehensive, multidisciplinary care in the community, which will reduce the likelihood of hospital re-admission.

• $79.4 million over 4 years to support PHNs to commission allied health services to improve access to multidisciplinary care for people with chronic conditions in under-serviced communities.

• $445.1 million over 5 years to increase funding for the Workforce Incentive Program–Practice Stream, to both increase the maximum incentive payment to $130,000 per practice, per annum and make more general practices eligible for the maximum payment. This funding will support practices to expand multidisciplinary teams and employ more nurses, allied health and other health professionals in practices.

• $60.2 million to extend Practice Incentive Program–Quality Improvement payments for an additional year to 30 June 2024, and to undertake an intensive review of all general practice incentive programs.

• $47.8 million over 5 years (and $12.3 million per year ongoing) to improve the treatment of chronic wounds by establishing a Chronic Wound Consumables Scheme for people with diabetes aged 65 years and First Nations people aged 50 years and over to provide eligible people with subsidised wound consumables. The measure will also provide health care professionals with education and training on chronic wound management.

• $29.1 million over two years to support the Royal Flying Doctor Service to deliver essential services to people living in remote communities through additional primary care visits and increased aeromedical evacuations.

• The Government will provide $29.5 million over 4 years from 2023–24 to design, implement and maintain a range of cost recovery arrangements to support affordable health care and ensure services provided to commercial entities are consistent with the Australian Government Charging Framework.

MyMedicare
The Budget allocates:

• $19.7 million over 4 years (and $3.2 million per year ongoing) to implement MyMedicare to formalise the relationship between patients and their primary care providers to improve patient care and health outcomes. This is the voluntary enrolment program for general practice.

• $5.9 million over 5 years to enable access to longer telehealth consultations through the MBS for patients and general practices under MyMedicare from 1 November 2023 (including additional bulk billing incentives applied as above). Investments in trials.

• $27 million over 4 years to improve the provision of, and access to, primary care and support services in thin markets by trialling integrated services and joint commissioning across primary health, First Nations health services, disability, aged care, and veterans’ care sectors in up to 10 locations.

• $20.6 million over two years from 2022-23 through National Partnership payments to support the states to trial models of multidisciplinary outreach care for aged care facilities.

• $100 million over two years from 2022-23 through National Partnership payments to fund the states to co-develop and pilot innovative models (Primary Care Pilots) that reduce pressure on emergency departments. Awareness-raising, codesign and evaluation of initiatives.

• $21.9 million over two years to raise awareness of Medicare Urgent Care Clinics and MyMedicare.

• $13.0 million over 4 years to strengthen consumer and community representation in the design and delivery of primary care policy.

• $6.1 million over 4 years to develop and implement a monitoring and evaluation framework and establish an Implementation Oversight Committee as an advisory body to the Department of Health and Aged Care.

Rural Health
The Budget allocates:

• $31.6 million over two years to trial enhanced training arrangements to support international medical students working in rural and remote locations.

• $4.5 million over 5 years to increase rural generalist trainees by expanding the single employer model trials by a further 10 trial sites from 1 July 2023.

Workforce Support And Development
There are a range of workforce measures that have been announced in the Budget.National Cabinet has also agreed to a broad scope of practice review for workers in the health sector. 

To improve the accessibility and affordability of general practice in rural areas, a new pre-fellowship program for non-vocational doctors will be established to support international medical graduates to work in primary care and remain in rural communities ($30.5m).

Changes to scholarship arrangements – with a focus on nursing, midwifery and First Nations health workers – will boost the workforce in primary care, aged care, regional and rural areas and other areas of workforce shortage ($50.2m).

GP registrars in regional, rural and remote locations will be able to deliver services in community-based medical practices without losing employment benefits as they move between employers, through an extension of the Single Employer Model trials ($4.5m).

The Budget will significantly increase workforce incentives for primary care practices to employ various health professionals, to provide team-based, patient-centred, high-quality primary care ($445.1m).

A one year extension of the Practice Incentives Program Quality Improvement and a review of workforce incentive programs will be undertaken, to ensure incentive payments appropriately support primary care practices to deliver the care Australians expect ($60.2m).

• $515 million over 5 years to increase award wages by 15% from 30 June 2023 for many aged care workers including registered nurses, enrolled nurses, assistants in nursing, personal care workers, home care workers, recreational activity officers and some head chefs and cooks.

• $50.2 million over 4 years to establish the Primary Care and Midwifery Scholarships program to support registered nurses and midwives to undertake post-graduate study and improve their skills.

• $17.5 million over two years to extend the General Practice Incentive Fund until 30 June 2024 and to expand its eligibility to all PHNs to improve access to primary care in thin markets.

• $10.7 million over 4 years to boost the primary care nursing workforce by creating 6,000 primary care clinical placements and providing incentives to clinics employing returning nurses. The measure will also fund a scope of practice review to examine current models of primary care.

• $4.2 million over two years from 2022–23 to support James Cook University to deliver the Australian General Practice Training program.

• Increases to the Temporary Skilled Migration Income Threshold to attract skilled migrants.

• Savings across the Employment and Workplace Relations portfolio (not specific to health) include:
  
  • $27.5 million over 4 years by reducing uncommitted Industry Workforce Training program funding.
  • $20 million over 4 years by reducing uncommitted funding to support Jobs and Skills Councils.
  • $3.9 million over two years by rescoping the Skills Assessments Pilots.

First Nations Health
The Budget allocates:

• $77.3 million over 4 years from 2023–24 to improve outcomes for Aboriginal and Torres Strait Islander people in aged care, including:
  • $52.1 million over two years from 2023–24 to increase the funding available to aged care providers in very remote areas under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program by calculating funding levels for residential care services using the Australian National Aged Care Classification price.
  • $8.1 million over 3 years from 2023–24 to support providers transition to new accountability measures and obligations under the proposed new Aged Care Act.
  •  $7.6 million over two years from 2023–24 to fund capacity building of Aboriginal Community Controlled Organisations to potentially provide aged care services.
  • $4.1 million over 4 years from 2023–24 to develop mandatory cultural awareness training for aged care staff.
  • $3.8 million over 4 years from 2023–24 to support project and program assurance activities.
  • $1.7 million in 2023–24 to appoint an interim First Nations Aged Care Commissioner.

• $28.2 million over 3 years from 2023–24 for workforce accommodation to support the delivery of 30 dialysis units for First Nations peoples in regional and remote Australia with end-stage kidney disease.

• $239 million will be invested to ensure mainstream cancer care services are culturally safe and accessible to First Nations people and help build the capacity and capability of the Aboriginal Community Controlled Health Services sector to support cancer care needs on the ground.

• $16.7 million over 4 years from 2023–24 to:
  
  • develop a national campaign to promote increased uptake of First Nations Australians’ health assessments and improve administration and coordination of health assessments and linkages with allied health services.
  • update eligibility for outcome payments under the Practice Incentives Program.
  • Indigenous Health Incentive to include all Medicare Benefits Schedule items for the preparation and review of a Mental Health Treatment Plan.

• $0.9 million in 2023–24 to the Australian Indigenous Doctors’ Association to continue to support Aboriginal and Torres Strait Islander doctors and medical students.

Medicines and Related Community Pharmacy Services
More than 300 common medicines will be cheaper for 6 million Australians who will be able to buy 2 months’ worth of medicine with a single prescription. This will halve patients’ visits to the GP and pharmacy. It will save patients up to $180 per year for each eligible medicine they take. Commonwealth concession card holders will save up to $43.80 a year per medicine. Medicines, including to treat COVID-19 and cystic fibrosis, are being expanded or added to the PBS, saving patients thousands of dollars a year ($2.2b).

• $2.2 billion over 5 years for new and amended listings on the PBS, the RPBS, the Life Saving Drugs Program, the National Epidermolysis Bullosa Dressing Scheme and the Stoma Appliance Scheme. Plus additional funding for the Opioid Dependence Treatment program and administering National Immunisation Program vaccines.

• $654.9 million over 4 years (and $168.4 million ongoing) for community pharmacy programs under the Seventh Community Pharmacy Agreement.

• $111.8 million over 4 years (and $24.2 million ongoing) to provide electronic-prescription delivery infrastructure and services, including mandating the use of e-prescribing for high risk and high cost medicines subsidised under the PBS.

• Efficiencies of $1.3 billion over 4 years of $1.2 billion over 5 years (and $438.7 million ongoing) by allowing 2 months’ worth of certain PBS medicines to be dispensed by pharmacies from 1 September 2023. Per year, per medicine, concession card holders may save up to $43.80 and general patients may save up to $180.

• $73.5 million over 4 years (and $3.6 million ongoing) by revising the estimated uptake and changing the medication management arrangements for residential aged care homes previously announced in the 2022-23 March Budget. Improved medication safety and quality use of medicines for residential aged care residents will continue to be led by community pharmacy.

Climate Change
$83.2 million over 4 years from 2023–24 to establish a national Net Zero Authority, of which $23 million is allocated for 2023-24.

Clinical Quality Registries
$40 million over 4 years to establish the National Clinical Quality Registry Program for tracking the safety and performance of treatments and devices, thereby improving performance reporting for clinicians and hospitals.  This aims to ensure patients are receiving the best quality medical procedures and treatments, including those for dementia, cystic fibrosis, and pelvic floor disorders.

Other Measures
There are also significant aged care measures including a pay rise for aged care workers, and other measures.  There is also a new national lung cancer screening program that is predicted to prevent over 4,000 deaths from lung cancer through early diagnosis and treatment ($263.8m).

For a comparison with the 2022-23 Budget (MARCH) commitments, see the AHHA’s summary below.