In his 2013 election campaign, Tony Abbott promised his government would build a world-class “five pillar economy”, encompassing manufacturing, agriculture, services, education and mining. On the eve of his government’s second budget, Michael Woods argues that health should have been one of those pillars.
Australia’s health system is both important and big: as a proportion of the economy, as an employer and as a cost to taxpayers. It’s big business, and it’s only going to get bigger, so governments need to play close attention to creating a sustainable health system.
The country spent A$147 billion on health in 2012-13, which is just under 10% of the country’s Gross Domestic Product (GDP). Only a decade ago, this figure was much lower at 8.6% of GDP.
Countries such as the United Kingdom and Norway spend a similar proportion of their GDP on health, and Canada and France spend a little more. The United States is in a class of its own, at 16.9% of GDP. In 2002, the OECD median in health spending was 8.2%, and it had grown to 9.2% a decade later.
A large chunk
The health workforce is large and diverse. In Australia, approximately 600,000 workers are registered as health practitioners, of whom more than half are nurses and midwives. Added to that are many more who provide support services. In fact, health care and social assistance is now one of the top three employers in the economy, along with retail and construction.
But the health workforce needs reforming. High-cost professionals are performing procedures that could be safely undertaken by other health workers. The demand for nurses is outstripping the supply of those skilled and willing to work in the health sector. And the shortage of many health services in rural and remote Australia is an ongoing concern.
Health care and social assistance is now one of the top three employers in the economy, along with retail and construction.
Somewhat ironically, the agency that led research and funding into workforce reform, Health Workforce Australia – was itself a victim of the 2014-15 federal budget.
The health system is also at the heart of some of the country’s strongest fiscal pressures. Of the A$147 billion spent on health in 2012–13, more than two thirds was funded by federal and state taxpayers.
The federal government spends over 40%, with the big ticket items being the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme and payments to the states (and territories). It’s not surprising then that these items are in its sights come budget time.
The states spend a further quarter of the total, mainly to meet the costs of their public hospitals. And, of the rest, households directly spend nearly 20%, and indirectly meet another 8% through health insurance premiums.
Growing share