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The Federal Government is committed to improving access to health and aged care services for Australians living in regional, rural and remote locations. Since 1996 it has introduced a broad range of initiatives to ensure the best health care is available to everyone no matter where they live, both through its own programmes and through the substantial support it provides to the States and Territories. Successive Budget packages have built on these initiatives, culminating in the 2000-01 Budget's Regional Health Strategy: More Doctors, Better Services - an extensive and integrated package worth more than $560 million over four years.
This year's 2001-02 Budget reinforces the Government's commitment to improving health outcomes for Australians living in regional, rural and remote locations by focusing on filling the gaps that still exist in sustaining a rural health workforce, particularly in the field of nursing.
Measures totalling $117.3 million will enhance rural nursing opportunities. These measures complement the rural health workforce initiatives that are currently being implemented as part of the Regional Health Strategy by providing incentives for doctors to employ nurses within rural practices, and encouraging rural Australians to consider nursing as a career, or to return to nursing through:
This Budget will provide $104.3 million over four years for general practices to employ practice nurses. These arrangements will allow general practitioners in these practices to focus more efficiently on diagnosis and clinical care, while allowing practice nurses to assist in managing chronic diseases such as diabetes and asthma, conducting health assessments, and providing clinical support.
The initiative will be targeted to those areas where patient access to medical services is limited due to an undersupply of general practitioners, such as in rural and remote Australia, and in provincial and outer metropolitan areas. Funds will be provided through the Practice Incentives Programme.
Under this measure, $5.2 million over four years is for re-entry training programmes for rural nurses. This will be provided via a scholarship programme of approximately 400 scholarships per annum, and provision of funding to support the professional development of nurses.
The Government has provided $13 million over four years to improve the access to undergraduate nursing education for rural and regional students.
Under this initiative, $10.9 million over four years will provide greater access to undergraduate nursing degrees for students who are from rural and regional Australia. One hundred rural nursing scholarships of $10,000 per annum will be available for rural students. A further ten scholarships will be available for Indigenous Australian nursing students or Aboriginal health workers who want to upgrade their qualifications.
In addition, $2.1 million over four years will be provided for support measures associated with the scholarship, with a particular emphasis placed on Indigenous nursing students. Funding will be provided to facilitate greater access to mentor/preceptor programmes and financial assistance will be made available to scholarship holders in exceptional circumstances where students suffer financial hardship. Funding will also be provided for culturally appropriate training for rural nurses to assist them in providing care to Indigenous clients.
The Government will invest $43.4 million on improvements to after-hours primary medical care services. Part of this investment will help to reduce the after-hours workload on rural doctors while ensuring that consumers have good access to the advice and services that they need. By relieving some of the pressures on rural doctors, this will in turn assist in recruitment and retention in regional areas.
Alcohol abuse is a major cause of death and hospitalisation in Australia and makes a significant contribution to the total burden of disease. Alcohol misuse can not only shorten people's lives through the disease, it is also a significant factor in road trauma, falls, drowning, suicide, other injuries and mental illness. The financial burden of misuse of alcohol to the community has been estimated at $4.5 billion a year, including lower productivity due to lost work days, road accident costs, legal and court costs, as well as health care costs. [Collins DJ and Lapsley HM (1996) The social costs of drug abuse in Australia in 1988 and 1992 AGPS.]
To help alleviate this burden, the Government is funding the establishment of an independent Alcohol Education and Rehabilitation Foundation in order to prevent alcohol and other licit substance abuse. The aim of the Foundation is to prevent abuse of alcohol and other licit substances, particularly among vulnerable population groups. This measure will provide $115.6 million to the Foundation.
The Foundation will:
The focus of this initiative is on the provision of effective treatment and rehabilitation services and also of health promotion programmes which have been shown to make a significant contribution to the reduction of alcohol misuse.
Mental illness is one of the most serious health issues facing Australia, with 2.4 million Australians - 18 per cent of the population - experiencing a mental health problem each year.
Most people use their general practitioner (GP) as the entry point for help with mental health issues. In recognition of this, the Government will provide $120.4 million over four years to assist GPs to develop their skills in mental health diagnosis, care planning and treatment. The Government will also support doctors in forming effective links with other mental health professionals, including psychologists and psychiatrists.
The package will also see GPs better remunerated for providing best practice care for mental health clients. This will include financial incentives for GPs to provide formal diagnosis, care planning and review activities. A new Medicare Benefits Schedule item will be introduced to enable appropriately trained GPs to provide a limited range of non-medication based therapies. To complement these measures, GPs will have access to support from both allied mental health professionals and consultant psychiatrists.
The Government will spend $5 million to promote ongoing care for aged care residents in rural and urban fringe areas. Grants will be provided to smaller aged care homes facing particular challenges in improving their business processes and infrastructure so that they continue to meet accreditation requirements. Funding will continue the restructuring programme, and includes:
The Government is extending the Community Visitors Scheme, which organises volunteers to provide companionship and social support to people in residential aged care.
Funding of $5.3 million over four years will allow for an additional 1,000 visitors, 400 of whom will be in rural areas.
The Regional Health Strategy comprises a range of initiatives designed to provide more doctors and better health services for rural Australia.
The Strategy aims to increase the number of general practitioners and specialists working in rural and regional Australia in the short term, and provide for this increase to continue into the future. Incentives were also provided for medical graduates to undertake their vocational training in rural and regional Australia, immediately increasing the supply of qualified medical practitioners working in these areas.
Better services are available in rural and regional areas through a new focus on allied health professionals, chronic disease, and increased health and aged care infrastructure, with more regional health services and support to ensure the ongoing viability of bush nursing, small community and other small regional non-government hospitals.
The Regional Health Strategy provided for the establishment of three additional university departments of rural health and nine new rural clinical schools.
This initiative enhances support mechanisms for a range of health professionals, nurses and allied health workers, offers more training and career development opportunities and facilitates greater collaboration and integration of service delivery.
In February 2001, the locations for the new clinical schools and university departments of rural health were announced. Clinical schools will be located in Coffs Harbour, Dubbo, Rockhampton, Toowoomba, Kalgoorlie, Bairnsdale, Shepparton, Burnie, Whyalla and the Riverland district of South Australia with an expansion of the Northern Territory Clinical School. Two university departments of rural health will be located in Tamworth and Lismore, which will join the newest university department of rural health established in Warrnambool, Victoria.
The Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme provides financial assistance to enable medical students from a rural background to enter and complete their study of medicine. Since it was announced in the 1999-2000 Budget, additional funding has been provided, bringing the total funding for the scheme to $12 million over five years.
A total of $32.4 million was allocated in the 2000-01 Budget to fund the Commonwealth Medical Rural Bonded Scholarship Scheme over the next four years. Under the scheme, 100 new medical school places are offered every year, with students receiving $20,000 annually while studying, in return for a commitment to work in rural areas for at least six years once they complete their fellowship as a general practitioner or specialist. One hundred new medical students have already signed up for the scholarships, with the Commonwealth to spend $6.2 million on the scheme in the 2001-02 financial year.
The Higher Education Contribution Scheme (HECS) reimbursement scheme provides financial incentives to graduating medical students to attract them to careers in rural medicine by offering them the opportunity to 'work off` their HECS debt in designated rural areas. The first payments under the scheme will commence on schedule in July 2001. During 2001-02, approximately 200 doctors will be assisted under this scheme.
To increase the number of general practice registrars in Australia, $102.1 million over four years was provided in the 2000-01 Budget.
The initiative restructured vocational training for general practitioners by introducing the dedicated 200-place Rural Training Pathway from 1 January 2001. Fifty new vocational training places per annum are to be made available for the next three years. These places, and 150 of the annual 400 quota for the Vocational Training Programme, will be reserved for registrars keen to undertake rural training, bringing the total number of registrar places to 450 per annum.
The General Practice Registrars Rural Incentive Payments Scheme was established as an integral component of the Rural Training Pathway. Under this scheme, significant financial incentives have been established to encourage registrars to take up the Rural Training Pathway.
The Workforce Support for Rural General Practitioners Programme allocated $10.2 million over four years from 2000-01 to provide additional support to the general practice workforce in rural areas.
Funding under the programme is being distributed to rural divisions of general practice. Each division will receive between approximately $20,000 and $50,000 in 2000-01, and $26,000 to $62,000 per annum in future years.
The Multipurpose Services Programme is continuing to expand. Too often, small communities cannot support separate aged care and health facilities. This programme promotes integration of services and the Commonwealth funding enables residential and community aged care services to be provided in these rural areas.
This initiative enables additional specialist services to be delivered in regional communities, thereby reducing the need for rural Australians to travel for medical treatment. Around $14 million per annum is available for the programme in 2001-02 and subsequent years.
Advisory groups have been established in each State and the Northern Territory to assist in identifying areas of need and developing appropriate models of service delivery. These groups are currently considering priorities and new outreach services will become operational early in 2001-02.
The More Allied Health Services Initiative is providing $49.5 million over four years from 2000-01 to assist with the employment of allied health professionals in line with locally identified needs.
Funding is being managed by rural divisions of general practice, which are currently recruiting a range of allied health professionals, including mental health workers, registered nurses, podiatrists, physiotherapists and dieticians, and are commencing service provision. Estimates indicate that there will eventually be more than 130 full-time equivalent health positions funded nationally.
Pharmacies play a key role in improving health outcomes for Australians. Last year, the Enhanced Rural and Remote Pharmacy Package introduced a range of measures for rural pharmacy, including:
To meet demand and suitable care standards for the frail aged, the Government has substantially increased funding for aged care. The outlay in the 2001-02 financial year is budgeted to be $5.4 billion - an increase of around $400 million on 2000-01. A substantial proportion of this funding is delivered in rural and regional areas.
Over a third of aged care places are located in rural and regional Australia, in conjunction with the proportion of older people living there. In the 2000 Aged Care Approvals round, which were announced in January 2001, more than 6,200 additional places were directed to regional, rural and remote areas, representing 44 per cent of the new places in the round.
The Rural Chronic Disease Initiative aims to assist people in rural Australia, particularly small rural communities, to prevent and manage chronic disease and injury better.
During 2001, a small number of pilot sites across Australia will be established to develop local processes and models for implementing chronic disease and injury prevention and management programmes in rural communities.
Up to 100 rural communities will receive one-off funding over the next three years to develop and implement chronic disease and injury prevention and management programmes in their local area. Also included is the establishment of a special projects funding pool to provide grants to individuals and organisations for new and innovative chronic disease/injury prevention and management ideas.
Funding of $30.3 million over four years was committed in the 2000-01 Budget to be spent on revitalising bush nursing, community and other small, regional private hospitals.
Through this initiative the Commonwealth provides funding for the engagement of service planners to assess both the health service and business administration aspects of the hospital and put forward strategies for improving viability. In many cases further funding will be available to support the implementation of identified strategies.
There are approximately 59 targeted hospitals throughout regional Australia. These are all at various stages of the initiative. The second phase, the implementation of recommendations arising from the service planning phase, is set to begin from June 2001.
Many regional and rural Aboriginal and Torres Strait Islander communities do not have access to primary health care services.
In 1999-2000 the Government provided $78.8 million to improve Indigenous Australians' access to primary care through the Primary Health Care Access Programme, a significant amount of which was directed into regional and rural areas. This Budget provides around $20 million per annum in further funding from 2003-04.
The Government has agreed to provide an extra $43.8 million over four years to assist not-for-profit Indigenous organisations to adjust to the introduction of new fringe benefits tax (FBT) arrangements. Aboriginal and Torres Strait Islander organisations providing essential health, housing, employment, education and legal services have made considerable use of fringe benefit concessions in the past to attract and retain professional staff and extend service delivery. Around two thirds of primary health care services are provided in rural and remote areas, where salary packaging has become an essential component of remuneration.
The Rural Undergraduate Support and Coordination (RUSC) Programme was developed as part of the Rural Incentives Programme as a strategic long-term initiative to increase the number of medical graduates adopting a career in rural and remote practice.
In 2001-02, $4.3 million has been allocated to the RUSC Programme. The funding is distributed to individual medical schools, coordination agencies involved with liaison between medical schools, rural practitioners and communities. It is also used to support a series of special projects of national significance.
The Rural and Remote General Practice Programme was introduced in 1998 to deliver a range of incentives and supports to increase the number of medical graduates adopting a career in rural and remote practice. State and Northern Territory-based rural workforce agencies are administering this programme, for which $68 million was allocated over four years.
As part of the General Practice Memorandum of Understanding, the Government is currently funding the Australian College of Rural and Remote Medicine to administer the Rural and Remote Area Placement Programme. This programme is a pilot that aims to increase the exposure of recent medical graduates undertaking hospital internships to rural general practice.
In addition to the operating consortia in various regional locations, applications for placements are currently being considered for new sites in 2002.
The Rural Other Medical Practitioners Programme provides around $32 million over four years (commencing in 2000-01) to ensure that people in rural and remote areas have enhanced access to primary health care services.
Under this programme, all consumers who receive services from Other Medical Practitioners (OMPs) in rural and remote areas of Australia have been able to access a higher Medicare rebate from 1 January 2001.
The Federal Government has funded the Royal Flying Doctor Service (RFDS) for more than 40 years. In 2001-02, about $18 million will be provided to ensure that the people of rural and remote Australia have access to the best aeromedical emergency retrieval system in the world, as well as to a broad range of clinical services.
In the 1999-2000 Budget, the Rural Women's GP Service was allocated $8.2 million over four years. The service provides regular female general practitioner visits to over 50 communities nationwide, with more targeted communities coming on line every month.
Water supplies that do not meet modern water quality standards have been identified in many rural and remote communities, particularly Indigenous communities. The Rural and Remote Potable Water Project addresses this problem by identifying and ranking the important health impact associated with these sub-standard supplies and developing specific approaches for improving the supplies. The Project is worth $500,000 over three years.
The first part of the project, a national audit of the current status (quality, availability and access) of rural and remote community potable water supplies, began in late 2000. Work on the next step, the health risk assessments, is expected to begin in the latter half of 2001.
Thirty-one per cent of entitled veterans and war widows live in rural, remote and regional Australia. Improving their health status continues to be of prime importance to the Department of Veterans' Affairs.
The Government will continue the current programme of agency arrangements in rural and remote areas. Agency arrangements use other Commonwealth, State and local organisations to deliver information and assistance to the veteran community in regional areas. These arrangements allow veterans to access information and services in areas where the Department of Veterans' Affairs is unable to directly provide the service.
The Government will extend full access to the Repatriation Pharmaceutical Benefits Scheme (RPBS) to all British, Commonwealth and Allied Veterans aged 70 years and over with World War II qualifying service (consistent with requirements for the service pension). This initiative will give these veterans access to pharmaceutical items at the concessional rate including the additional items which are on the RPBS and not on the Pharmaceutical Benefits Scheme.
The Government launched a new plan for sport in April 2001. Backing Australia's Sporting Ability - A More Active Australia, outlines a two-fold policy objective - to assist our best athletes to reach new peaks of excellence and to increase the pool of talent from which our future world champions will emerge.
A fresh approach to grassroots participation in sport will be supported by the Government to see greater numbers of Australians participating in sport, particularly young people. This approach will involve partnerships between the Federal Government, national sporting organisations, local sporting clubs, schools and the business community.
These measures include an additional allocation of $32 million for the More Active Australia initiative, including $4 million for the new Olympic Youth Programme. The additional funding means that total federal government funding for A More Active Australia will be worth approximately $82 million over the four year period beginning 2001-02.
The new Sports Excellence Programme will provide funding for high-performance sport and cover sports that were not included in the Olympic Athlete Programme. The programme includes an additional allocation of $122.2 million over four years for Australian athletes. Total federal government funding for Sports Excellence to support Australian athletes will be approximately $402 million over the four-year period beginning 2001-02. This includes approximately $15 million specifically for Paralympic Games sport and sport for people with disabilities.
Backing Australia's Sporting Ability includes an additional allocation of $7.4 million for new anti-drugs research, additional testing and to meet international obligations.
Total funding for the Tough on Drugs in Sport Strategy will be nearly $24 million over the four years beginning 2001-02.