Senate Estimates, Sugar Tax and Health Care Homes

Sunday, 19 March 2017

The Senate Estimates process and what we learnt about some specific health issues

Senate Estimates is a time for political journalists and policy junkies to rub their hands in delight and try to pick through the evidence for startling bits of news.  There are two rounds of Estimates every year – the main sessions following the Budget, where the proposed expenditure and policy settings are dissected and questioned. Then the Supplementary Estimates, which happen in February or March each year, look at changes that have been identified following the Mid-Year Economic and Fiscal Outlook (MYEFO).

Many organisations, including the National Rural Health Alliance, are in contact with parliamentarians and their staff, seeking answers to questions about issues relevant to their core responsibilities.  This is different to political journalists who might look for information to trip Ministers up - a headline news story. Rather, policy organisations like the Alliance seek information on the progress of new policies, or on current programs and funding implications arising from MYEFO.

Following the release of the most recent MYEFO update in December 2016, the Supplementary Estimates sessions in 2017 were the first opportunity to dissect any changes and find out more about how implementation of a range of new programs announced in the 2016 Budget was progressing.

Two of the issues the Alliance has been following closely are food security, obesity and sugar and Health Care Homes. 

Food security, obesity and sugar are closely linked, as obesity is one of the outcomes of poor food security, and sugar rich foods are often consumed by people on limited budgets because they may be cheaper than healthier food choices.

The cost of fresh food was explored, with Department of Health officials asked whether price increases were an incentive to people to choose cheaper, less healthy options.  Chief Medical Officer, Professor Brendan Murphy, agreed that price is indeed recognised internationally as a factor in food choice. 

The questioning at Estimates can sometimes raise areas where the Department and Minister do not wish to engage, and one such area was with regard to a Sugar Tax and whether it had been demonstrated as being beneficial to health outcomes overseas.

While the Department indicated it was aware of the literature on this issue, it also indicated that it was not undertaking any work on this issue.  The Department also indicated it had not been consulted by the ATO, which it would expect if a taxation measure such as this was being considered.

Questions about the Implementation of the Health Care Homes initiative provided somewhat more complete information.  Some of the key points to emerge during the hearings were:

  • 462 applications were received from practices and Aboriginal Medical Services and these are currently being assessed. Only 200 practices/medical services will participate in the trial.
  • Implementation from 1 July 2017 may be delayed.  One of the reasons for a possible delay in implementation is because the Department is “fundamentally rethinking the model, particularly for patients with chronic and complex disease. It is very, very evident that we can do this better over time. We are leading the world in some of these things. We are the first to try a range of things in this context and we do not apologise for trying to push the boundaries on some of these issues. We will continue, as I said, to work with the sector to get this right, over and above any time frame, because it is important for patients that we get this right. It is important for the sector more broadly. It is a major reform”.
  • Health Policy Analysis has been contracted to manage the Evaluation of the trial “and they will look at all aspects of the program. The felt experience by consumers, the impacts that it has on practices, the effectiveness of the new payment arrangements, the education and training that needs to be undertaken to change management—they will look at all of those aspects. We are just working through with that company at the moment. We have been on board for a little while now to shape up the format of the evaluation”.   Measuring hospitalisations avoided will be included in the evaluation.
  • The patient will be able to access unlimited MBS rebates for visits not relating to their chronic condition(s).

We will continue to bring you more information on other issues explored through the Estimates process.