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Investing in health: preserving universal health care



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Printed and authorised by Senator Christine Milne, Parliament House Canberra ACT 2600. Page 1 of 5

The cost of health care is being increasingly borne by the health consumer. This is raising a barrier to care for those on limited incomes and undermining the universality of our health system - the principle that all Australians should have a right to health care no matter what their income or situation.

The Greens will reverse this trend and stand up for an efficient and equitable health system. Rather than see Australia go down the road of an American-style, two tiered health system we would invest in Medicare and hospitals. The Greens will put greater emphasis on primary care and preventative health so that healthcare is sustainable for the long term.

> THE GREENS HEALTH PLAN The Greens plan for health will reinvest billions in public health and ensure our health system remains sustainable for the future. Our initiatives include:

 Denticare - bringing dental care into Medicare, so that going to the dentist will be just like going to the doctor.

 Investing in primary care to keep costs to health consumers down.

 Properly funding hospitals so they are there when people need them most.

 Investing in rural health so that country people can access the services the rest of us take for granted.

 Properly funding mental health services including in country Australia.

 Shifting the focus to preventative health so that more of us can stay out of hospital longer and ensure the health system is sustainable in the long term.

> PREVENTATIVE HEALTH The Greens are committed to preventative health. A strong investment in preventative health can keep people healthier longer and bring big savings to the healthcare system. With a looming crisis caused by the obesity epidemic and the rise in chronic disease, the time to make those investments is now. The Greens are strong supporters of plain packaging and of Australia’s right to make laws like this that protect the public health. The Greens succeeded in getting the Future Fund to divest $250m in tobacco shares - and in the next Parliament will force Commonwealth Superannuation schemes to do the same.

The Greens are committed to protecting the Australian National Preventative Health Agency (ANPHA) and expanding their work beyond alcohol, tobacco and obesity. Australia needs urban environments that promote better health including better and more frequent public transport, bike and footpaths that encourage active transport and active lifestyles.

Healthy people need a healthy environment. To protect the air and water that are fundamental to our own health, the Greens will impose a moratorium on coal seam gas, prevent the logging of water catchments and introduce a comprehensive Clean Air Act to cut down on sources of fine particulate pollution that are proven to have serious effects on the health of Australians. The Greens will push for comprehensive health impact assessments for all mining developments that could have an adverse impact on the health of the community.

A focus on targeted prevention for those at risk of chronic diseases such as diabetes and heart disease will be a major Greens priority in the next Parliament. By changing the lifestyle factors of at-risk groups we can lower the burden of disease and save money while improving health outcomes. By putting

INVESTING IN HEALTH PRESERVING UNIVERSAL HEALTH CARE The Greens health plan for now and the future

Australia’s health system was designed to be universal: Everyone has the right to quality health care. But with out-of-pocket costs soaring we are now heading towards a two-tiered, American-style health system. The Greens care about health and are willing to stand up and defend universal health care.

Printed and authorised by Senator Christine Milne, Parliament House Canberra ACT 2600. Page 2 of 5

preventative health back on the agenda with initiatives such as a National Diabetes Prevention Plan, we can reshape our approach to chronic disease and save hospital resources for less preventable emergencies.

Other preventative health initiatives include:

 Mandatory front-of-pack food labeling to enable consumers to more easily make healthy food choices;

 Banning junk food ads to children and closing loopholes that allow alcohol ads in children’s viewing times;

 Introducing warning labels on alcoholic beverages, particularly around pregnancy;

 Tackling the dangers of alcoholic beverages with added stimulants.

 A national ban on sunbeds and extra funding for a SunSmart campaign to reduce the incidence of skin cancer;

 A focus on hearing health to help low income earners access hearing services and care for Aboriginal and Torres Strait Islander hearing health.

> FILLING THE GAP IN DENTAL HEALTH Australia's oral health is poor and getting worse. Less than half of Australians have good oral health and dental visiting patterns. This is largely due to the high cost of dental treatment. 60% of dental care is paid for out-of-pocket by consumers, with the result that a third of people say they can’t afford to go to the dentist or delay going to the dentist because of the expense.

i

Good oral health is important for overall health and wellbeing. Complications from dental disease can make other medical issues worse and lead to life-threatening situations.

The Greens plan, Denticare, adds dental treatment to the Medicare Benefits Schedule, meaning dentists can bulk-bill dental services like doctors do. Our plan for Denticare will:

 Provide dental treatment covered by Medicare. Phased in over five years, Medicare will cover preventative and restorative dental treatment so that everybody can afford to go to the dentist.

 Start with the most disadvantaged. Low income earners, kids and teens, pensioners and concession card holders will be among the first to access dental treatment under Medicare, before rolling out the scheme to everybody.

 Ease pressure on the public system. Because of the Greens, billions of extra dollars are being injected into public dental services. By maintaining this investment, public dental services will be able to treat complex cases and hard-to-reach sectors of the community without sending waiting lists skyrocketing.

Through our work in Parliament, the Greens have already secured the biggest reform to dental health in a generation. It’s time to extend the benefits to all Australians.

> PRIMARY CARE Health care costs are already rising in Australia and we have an obligation to keep our public health system accessible. According to the Australian Institute of Health and Welfare, 19.3% of healthcare costs are now coming straight from the hip pocket of consumers.

ii This is an average of $1075 per person. iii

We know that cost deters people from seeking medical treatment. iv We need to invest in Medicare before this problem

gets any worse.

Our allied health workforce is a crucial but often overlooked part of the health system. Allied health practitioners, such as nurses, podiatrists, physiotherapists and optometrists, are highly skilled professionals who can make a greater contribution to preventative and primary care. The Greens believe that we should review the cost-effectiveness of interventions by allied health practitioners and where good evidence can be found provide more public funding for allied health treatments through Medicare.

The Greens will invest $664m in extra funding for Medicare over the forward estimates. This money is a sorely-needed top-up to the health system that reverses cuts to Medicare made by Labor in the last budget and supported by the Coalition.

Our position is supported by the medical community including the Australian Medical Association. AMA President Steve Hambleton warned that “Families will have to pay more each time they visit their family doctor. The value of the Medicare rebate is dropping, making it harder for doctors to provide care and essentially hitting the hip pocket of patients.”

v

The Greens are also committed to properly funding Medicare Locals so that primary health care services can be better coordinated on a regional level and local authorities can work together to plug local service gaps.

> HOSPITALS THAT WORK An obsession with budget surplus and an unwillingness to take on vested interests and raise revenue have led both levels of government to look for cuts in the hospital system. This has resulted in service cuts by already overloaded hospitals. The Greens will invest and bring funding back to more realistic levels.

 The Greens would invest an extra $1.5 billion in Commonwealth funds into the public hospital system over three years.

Printed and authorised by Senator Christine Milne, Parliament House Canberra ACT 2600. Page 3 of 5

 30% would be allocated to rural and regional hospitals many of whom who are already struggling.

 The Greens commit to transparent and fair Commonwealth funding of hospitals - no tricks or cuts.

State governments, particularly Liberal governments in Victoria and Queensland, have slashed hospital budgets, leaving hospital administrators no choice but to ration care, shed jobs and cut services. The Labor government, in turn, chopped $1.5 billion out of its own contribution to the National Health Funding Pool. The Greens will put this money back into the state Hospital systems as follows:

NSW $345m

Vic $475m

Qld $300m

WA $150m

SA $115m

Tas $45m

ACT $25m

NT $20m

There is more to the health system than just hospitals, but a properly functioning hospital system is crucial for good health. The Greens will invest in making sure our hospitals are there for people when they need them most.

> ACCESS TO MEDICINES The Pharmaceutical Benefits Scheme is a central pillar of our health system, giving Australians timely access to safe and effective medicines. However, in recent years the PBS has become less predictable, with the listing of new medicines delayed by a government in search of a budget surplus.

The Greens will preserve the independence of the Pharmaceutical Benefits Advisory Committee and commit to listing all medicines found to be cost effective in a timely manner. The Greens would ensure that post-market reviews are conducted at arm’s length from government rather than being exploited as a means of achieving short term savings.

The Greens oppose any provisions within the Trans-Pacific Partnership that could undermine the Australian Government’s ability to provide medicines at the lowest possible price.

A Greens-led parliamentary inquiry into out-of-pocket costs will examine the cost of medicines and make recommendations on ways to make drugs more affordable where expense is a barrier to consumers.

The Greens would also pursue industry reforms, ensuring that there is greater transparency regarding the interactions between drug companies and the medical community. Under Greens reforms, all payments to doctors by drug companies would be disclosed.

The Greens would also give the Therapeutic Goods Administration more teeth to pursue manufacturers selling shonky health products and making misleading claims about their health benefits.

> REDUCING THE RURAL HEALTH IMBALANCE Australia has good healthcare, but rural Australians are missing out due to a shortage of medical workforce, a lack of access to services and a lack of infrastructure. The Greens care about the health of all Australians and want a higher priority given to the health of Australians living outside our major cities.

To help bolster health services in regional and rural Australia, the Greens will invest over $1 billion in rural health including:

 $450m earmarked for rural hospitals by boosting federal hospital funding to the states for rural and regional hospitals.

 Maintaining investing in Closing the Gap in indigenous health including our $368 million Hearing health initiative

 $200m in flexible rural infrastructure grants to keep more clinics open longer.

 $20m in grants for doctors to provide training in rural areas.

 Fixing the classification system so rural health professionals are properly remunerated according to level of remoteness

 Funding after hours care through Medicare Locals in rural areas to decrease the inequity in access to services.

 Streamlining the accreditation of overseas doctors until Australia is self-sufficient with the rural health workforce.

 Delivering on rural mental health by investing heavily in prevention and properly funding more mental health services in rural areas.

> PROPERLY FUNDING MENTAL HEALTH Almost 50% of people will experience mental health problems at some stage in their lives, but our mental health system is suffering from decades of under-investment.

After extensive consultation, the Greens have committed to a huge investment in mental health services including $550m for more mental health nurses, suicide prevention and a program to grow the mental health community sector in addition to $550m specifically for rural mental health services.

By supporting community mental health programs, we can look after everyone and keep them leading full, healthy lives. For more information, see our Mental Health policies.

Printed and authorised by Senator Christine Milne, Parliament House Canberra ACT 2600. Page 4 of 5

> A SUSTAINABLE HEALTH SYSTEM

As the population ages, as the burden of chronic disease grows, as we face the health challenges of climate change and as new and ever-more-expensive therapies become available, our health system will come under enormous pressure. It is important to start acting now to reform our health system so it can meet the challenges of the future.

Some of our initiatives in sustainability include:

 An inquiry into rising out-of-pocket costs and expanding the role of Medicare  Exploring new ways to realise savings on the PBS, while providing more certainty about listing to consumers

and industry  A national Centre for Disease Control to prepare for and manage outbreaks of infectious disease and the

health effects of climate change, and to lead the way on managing the threat of antibiotic resistance  A Health Sustainability Unit tasked with finding system-wide savings and efficiencies and reducing the

environmental footprint of health infrastructure

Over the course of the next Parliament, the Greens will focus on well-resourced national strategies for preventing and treating chronic disease such as diabetes, heart disease and chronic kidney disease.

By continuing to support Medicare Locals, we will properly resource measures that will help people get more targeted care from their GP and other primary care providers. This will help avoid unnecessary hospitalisation and let more people stay in their homes with assistance to manage their health problems.

> CLOSING THE GAP Aboriginal and Torres Strait Islander peoples are among the most disadvantaged Australians, with the worst health outcomes. The gap in life expectancy is still over 10 years.

The Greens have supported the Close the Gap campaign since its inception - which calls for equality of access to essential services within a decade, and equality of outcomes on all major indicators of health, education and opportunities within 25 years. As part of this support, the Greens have advocated for great community control and ownership over the health programs. The Greens also have worked for years to stop petrol sniffing and in 2013 the Greens’ Low Aromatic Fuel Bill became law. Other Greens achievements include: greater availability of dialysis services, and more resources for mental health and suicide prevention. We have also been strong advocates for more effective alcohol policies.

As well as supporting the Close the Gap campaign and advocating for all levels of Government to adequately fund

aboriginal health initiatives through the National Health Partnership Agreement, the Greens initiatives have focused on hearing health as a key area with a $47 million package that includes an integrated approach to tackling otitis media (glue idea).

The Greens will have also introduced an initiative to tackle the preventable vision loss because blindness in aboriginal communities is six times higher than the average Australian rate.

> SOCIAL DETERMINANTS OF HEALTH Health is about more than just access to healthcare. Where you live, your access to education and your employment opportunities all play an enormous role in determining your present and future health.

The Greens policies on Newstart, education reform, payments to single parents and tackling rising income inequality aren’t just important social justice measures - they will improve the health outcomes of millions of people.

The Greens are committed to improving people’s health not just by improving access to the health system, but by addressing inequalities in society that are important determinants of people’s health.

> MAKING HEALTH A PRIORITY The Greens believe health is a top priority of government. We are the only party willing to stand up and raise the revenue needed to pay for services that will keep Australians healthy and ensure the health system can cope into the future.

The Greens Health Plan has been fully costed by the independent Parliamentary Budget Office. We would invest an extra $9 billion in the nation’s health over a three year period. This includes:

 $4.87b for Denticare  $1.5b in new hospital funding including $450m for rural and regional hospitals  $1.1b for mental health, including $550m for rural

mental health services  $664m in extra funding for Medicare  $554m for Mental Health services  $368m to improve hearing health  $200m for rural health infrastructure grants

In addition, our $2.5 billion plan for research in Australia will bolster our place as a leading centre of medical research and help Australians get access to the cutting-edge therapies of the future.

Printed and authorised by Senator Christine Milne, Parliament House Canberra ACT 2600. Page 5 of 5

Our expenditures are fully offset by new savings and revenue measures which will be released in keeping with the Charter of Budget Honesty.

> MORE INFORMATION Detailed information about our costed health initiatives and other Greens policies can be found at the Greens web site, including:

 Denticare  Funding for Hospitals  Investing in Medicare  Rural Health  Mental Health and Rural Mental Health  Focus on Hearing Health  Clean Air Act

i AIHW, Dental attendance patterns and oral health status (2011) ii AIHW Health Expenditure 2010-2011 iii

AIHW iv ABS figures, cited by COAG Reform Council, 2012 v

https://ama.com.au/media/ama-calls-proper-indexation-medicare-patient-rebates