Fresh on the heels of the State election we now move into the annual State Budget cycle. It is expected that the election commitments made by the Government will provide the main focus for this and future budgets, however AMA Victoria will continue to lobby for funding where there is a need or a gap in services.
You may recall that some of the key election promises reflected AMA Victoria priorities including:
- funding of public hospital outpatient clinics
- more acute hospital & mental health beds
- more resources for patients with serious mental illness presenting to Emergency Departments
- improved access to adolescent and youth mental health services, and
- increased on-call payments for rural GPs and other retention strategies
Other areas that need to be addressed in the coming budget include:
Critical care services
A large and persistent gap in public hospital services is the lack of access to critical care services, which is due both to infrastructure and workforce problems. For instance Victoria has about a quarter less intensive care beds compared to the national average. A recent report from the UK NHS Surgical Outcomes Group posits that critical care bed availability in that country, which is comparable to Victoria, but less than one seventh the per capita number of beds in the USA, which leads to under use of critical care services after major surgery which in one risk adjusted comparison between a UK and a US hospital showed a four fold increase in post-operative mortality.
Victorians need better access to properly staffed, critical care services. The urgent attention of government is needed to this pressing problem.
Availability of health services in rural and regional areas
While it is acknowledged that the Department has been working on its strategic directions framework for rural and regional health services, the practical benefit has yet to be realised on the ground. Specific funding programs are needed to support doctors, both general practitioners and specialists, working in rural areas. To ensure access to high quality care through team-based care, other health professionals must also be supported to work and remain in rural areas.
Access to mental health and community support services
The attention of the State Government through successive budgets and also recent CoAG initiatives has begun to address deep-seated, chronic problems in the mental health system. However much more needs to be done, including improved treatment and support for patients and their families in the community; and statewide access to earlier intervention services.
Equitable funding of DRGs
A review of WIES 13 Diagnosis Related Group (DRG) weights demonstrates that some DRGs were significantly discounted compared to the previous year. A number of these changes related to illnesses that especially effect elderly patients, which will lead to pressure on hospitals to reduce length of stay and to discharge patients earlier than otherwise would have been the case. The government has to be able to guarantee the community that particular patient cohorts are not discriminated against by the casemix formula.
Equipment and infrastructure replacement
Recent investigations and studies by the Victorian Healthcare Association and the Auditor-General confirm what clinicians know from day-to-day experience, the funding of planned replacement of equipment and infrastructure is insufficient to keep pace with the needs of patients, clinicians and hospitals. The government should implement a rolling program of equipment replacement and renewal.
Education and training support for the health workforce
The massive increase in medical student numbers, with a concomitant increase in prospective specialist trainees, necessitates the government carefully reviewing the capacity of the health system to provide the needed education and training and to rectify funding shortfalls where they are identified.
Assistance for general practitioners managing the burden of chronic disease
The Premier’s Third Wave Reform project correctly identifies the burden of chronic disease as the major challenge facing our health care system. Whilst the Commonwealth-State funding split militates against easy answers, the State needs to actively work with the Commonwealth to sort out mechanisms which share the costs and benefits of a comprehensive and aggressive response and which assist our general practitioners and other primary health care workers to help manage the community impact of this challenge.