How could the 2023 Australian federal budget impact EDs?

In early May, the Australian government released the 2023 federal budget. While there was little in it that directly resourced EDs, it included large investments into primary care, aged care, NDIS and Medicare.

Deficits in access to primary care contribute significantly to poorer health outcomes, which can lead to increased presentations to emergency departments (EDs). Deficits in aged care, NDIS and Medicare are key contributors to access block, particularly by delaying discharge from hospital. Therefore, improvements in these areas should have a positive impact on EDs – but in ways that may not be immediately obvious.

Bulk-billing and primary care

Without accessible, affordable primary care, conditions that are initially manageable can deteriorate, turning into more complex or acute ailments that require emergency care.

The $5.7 billion funding package resourced a new Medicare item for longer consultations lasting more than 60 minutes, tripled the bulk-billing incentive, lifted Medicare rebates and increased the Workforce Incentive Payment.

RACGP welcomed the budget as a “ground-breaking investment in the health of all Australians” and the Doctors Reform Society said that the budget will bring relief to patients and doctors and that it had “saved Medicare”.

Most importantly, this initiative is good for patients, their carers, and their communities. From a health system perspective, improved primary health care reduces unnecessary hospital presentations. This may include reducing the number, and acuity, of emergency presentations in the medium-term.

We know that access block, the situation where a patient who needs a hospital bed is delayed for more than eight hours in the ED, significantly contributes to the pressure EDs face.

While there are many complex issues that contribute to access block, requiring reform on a systems level, actions that can reduce the number of people deteriorating and requiring admission to hospital will have an impact over time, as distinct from changes to access to care for low acuity patients.

Support for aged care workers

Deficits in aged care is a key contributor of access block that leads to delays in care, for all patients, and the College has long advocated for better investments in this area to improve ED flow and give more older persons the care they need, faster.

The budget has committed a significant investment in the aged care sector, with $11.3 billion committed to paying a historic wage increase for aged care workers, and aged care spending being redirected to support in-home care for an aging population that have a preference for remaining in their homes.

There have been long-term and ongoing discussions about the ageing of the Australian population and the implications that this will have for accessing health care. Those changes are no longer something we can talk about in the future, as we can see in just about every ED, the change is here now.

Improving care for older Australians in the community, and in residential aged care facilities, is an imperative. It will always be the role of EDs to work with older Australians, but on a daily basis FACEMs will be treating some older patients who could have been managed effectively in the community with the appropriately resourced support from General Practice, aged care nurses and other allied health staff.

Support for nurse practitioners

The nursing workforce provides a vital component of ED care, and the budget contained a commitment to reduce some of the restrictions on nurse practitioners and $47 million to increase relevant Medicare rebates.

EDs are struggling to retain experienced nursing staff, and efforts to enhance career opportunities for nurses are welcome and could help retain these vital clinicians across the health system.

Other key initiatives

The budget contained dozens of other measures, some of which may also have a positive impact on EDs, if indirectly.

Some of these include $25.4m to establish a homelessness support program, $98.9m to support frequent hospital users to connect to a general practice, and $511.1m over four years on vaping regulation reform and smoking cessation.

The full detail is contained in the budget papers (Health and Aged Care runs from pages 123-154).

Where to next?

Given the breadth of patient groups and conditions that EDs treat every day, along with the challenges in getting patients into definitive care, FACEMs have an excellent view of the challenges that are being experienced right across the health system.

With a system view in mind, this budget could be seen as an important first step in reforming access to primary care and it is likely that the Strengthening Medicare Taskforce report released earlier this year will provide the broad blueprint for the next steps.

Budgets are a vitally important part of health system reform – where the money goes is the strongest signal of a government’s priorities. However, it is not the be-all and end-all.

In terms of hospital-based reform, ACEM is engaging in the current review of the National Health Reform Agreement.

This is a mechanism agreed between the Commonwealth and the States and Territories to prioritise reform across the health system, but with a strong focus on the funding of the public hospital system. ACEM is primarily focusing on patient flow initiatives, as well as appropriately resourcing the interface between the hospital system, primary care, and other community-based care.