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HomeminewsEyes on Federal Budget to Address ‘Crumbling’ Health System

Eyes on Federal Budget to Address ‘Crumbling’ Health System

The Australian Medical Association (AMA) President, Professor Steve Robson, said the health system requires urgent funding now after being in crisis for years, with cracks starting to show even before the pandemic.

“only three of the 201 Australian public hospitals analysed are delivering care within recommended timeframes”

Expectations are growing that the upcoming May federal budget will be a ‘health budget’ after a slew of reports indicating that the Australian health system is “crumbling beyond repair”.

The Australian Medical Association (AMA) President, Professor Steve Robson, said the health system requires urgent funding now after being in crisis for years, with cracks starting to show even before the pandemic.

He released AMA’s analysis, delivered in a report Australian Public Hospitals in Logjam,1 that reveals only three of the 201 Australian public hospitals analysed are delivering care within recommended timeframes.


The AMA report provided a ‘traffic light’ rating of hospital emergency department and elective surgery performance.

A green rating is given where performance is above 95%, an amber rating is given where performance is unknown or where 85–94% of patients received care within the clinically recommended time.

A red rating is when less than 84% of patients received care within the clinically recommended time. It shows that while Sydney Hospital/Sydney Eye Hospital received a ‘green light’ for emergency and non-urgent cases in its emergency department, urgent cases received a red light, and semi-urgent cases were amber.

For elective surgery performance, the same hospitals received a green light for urgent cases, but semi-urgent and non-urgent cases were well into the red.

The Royal Victorian Eye & Ear Hospital’s emergency department dealt with its non-urgent cases swiftly but received a red rating for its performance in emergency and urgent cases. For elective surgery, the Eye & Ear Hospital was green-lighted for its performance dealing with urgent cases, but semi-urgent and non-urgent cases were ranked red and amber respectively.


Australia’s federal, state and territory health ministers have committed to an independent review of the agreement on public hospital funding. The current agreement runs until 2025. The review will consider whether the objectives of the National Health Reform Agreement (NHRA) are being met, including:

  • the impact of external factors (such as theCOVID-19 pandemic) on the demand for hospital services and the flow-on effects,
  • the performance of small rural and small regional hospitals,
  • the implementation of the long-term reforms and other governance and funding arrangements, and
  • any unintended consequences such as cost-shifting, perverse incentives, or other inefficiencies that impact on patient outcomes.2

While the AMA’s Prof Robson welcomed the review, he said the AMA’s Logjam report was proof that urgent funding was needed. “

… unless something changes soon, by the middle of this year around 500,000 Australians will be stuck waiting for elective surgery, many of them unable to even get in to see a specialist to get onto an official waiting list, many of them in excruciating pain,” he said.

“We need a plan now to tackle the current backlog and get those hundreds and thousands of Australians out of pain. “That plan can’t wait. We need May’s federal budget to be a health budget to address the issues happening now,” Prof Robson said.


The AMA’s report is not the only one to highlight the dire state of the public health system.

Also in February, were two reports: one from the Health Services Union (HSU) by Impact Economics and Policy on the NSW health system, entitled Reform Critical – A Fragmented Health System at Breaking Point;3 the other from independent public policy think-tank The Grattan Institute.4

The HSU report called for a Royal Commission into NSW state’s “chronic misallocation of resources and warped priorities” around health. The Grattan Institute report meanwhile indicated that Australia was “sleepwalking into a sicker future that will condemn millions of Australians to avoidable disease and disability”.

Highlighting the need for the federal Government’s promised Australian Centre for Disease Control (ACDC), the Grattan Institute report said Australian governments have let a trifecta of practical and political challenges hold back chronic disease prevention. It said these challenges were: short-term thinking, vested interests, and lack of collaboration.

“They have resulted in piecemeal investment, stymied regulation efforts, and a leadership void.

“Many prevention initiatives have been shown to cost-effectively reduce rates of chronic disease, but Australia isn’t adopting them. We have lost the leadership position we had in previous decades, with other countries now spending more, and doing more,” the report said.


The federal Government has already signalled a focus on health in the May budget.

Prime Minister Anthony Albanese has insisted health care will be the “first priority issue” of focus for governments this year.

And, releasing the Strengthening Medicare Taskforce Report,5 also in February, Health Minister Mark Butler said its recommendations would guide the deliberations of Government ahead of next month’s Budget “to frame particular investments needed to deliver our commitment to rebuild general practice and, more broadly, strengthen Medicare.“

The Strengthening Medicare report pointed to the need for access to a “world class primary care system that is designed and funded for the 21st century”, and which reflects the requirements of an ageing and more complex chronic disease population.


Vision 2020 called for increased consultation with the eye health sector as the federal Government works through recommendations to review Medicare and the health system.

“We would like to see sector representation and consultation with Vision2020 Australia and its members in the next phase,” Vision2020 Chief Executive Officer Carly Iles told mivision.

“Obviously, we want to see government policy that provides access to eye care services for all Australians when they need it and practical actions for achieving this,” she said.

Optometry Australia said recommendations in the Strengthening Medicare report “broadly align” with its vision for eye health, however the inadequacy of Medicare rebates for optometric care must be addressed.

The peak body for optometrists welcomed the commitment by Mr Butler to ensure best use of Australia’s skilled health workforce.

Optometry Australia also stated its commitment to working with governments and stakeholders to explore how the contribution of optometry can be maximised to improve health outcomes of all Australians.

“The recommendations in the report broadly align with our vision to support optometrists practising to their fullest scope and to enhance local integration of specialists and hospitals with primary care,” OA Interim CEO Skye Cappuccio said.

“Any change needs to be implemented alongside appropriate indexation of Medicare funding to enable a system that sustainably serves the needs of the community.”

Quarterly Medicare statistics, released in February for the December quarter, show the rate of bulkbilled optometry services remained high at 94.5%.6

“Optometry is a vital component of the healthcare system. As outlined in our Working Together for Better Eye Care policy platform, central to addressing Australia’s looming eye health crisis is supporting optometrists to practise to their full scope to enhance patient access and increase the efficiency of Australia’s eye health system,” Ms Cappuccio said.

The Strengthening Medicare report highlighted the importance of new locally relevant funding models for rural and remote communities, the significance of enabling multidisciplinary team care, enhancing digital access, and sharing patient health information.

“Vision 2020 and its members also recognise that rural and remote communities require rural and remote solutions,” Ms Iles said.

“What we’d like to see is a partnership between the health and vision care sector, Aboriginal and Torres Strait Islander health organisations, federal and state governments, and other key stakeholders – which includes local communities – to deliver a more sustainable eye care system that also optimises the use of all available workforces and also draws on the strengths of local models and pathways to address some of these inequities.”

Macular Disease Foundation Australia (MDFA) CEO Kathy Chapman said the Strengthening Medicare Taskforce Report was welcome and had great potential.

“Absolutely it is high level, and I know we shouldn’t be surprised about that. What’s missing is the actual detail about how all of these things apply, and how they apply to eye health models. Where is the rubber going to hit the road?

“We need to make sure that as things are being considered… that it goes beyond just thinking about GP reimbursements but thinking about… other allied health services.

“In the case of people with eye conditions, we really need to make sure that Medicare fees are going to be an advantage for people accessing optometrists. We know that optometrists absolutely have to be at the heart of helping people with their eye health.”

Dr Chapman said MDFA would be “very keen” to see funding for a national audit of eye health services announced in the federal Budget “to understand the gaps in services for people that require vital eye health services” including sight saving intravitreal injections for diseases such as age-related macular degeneration and diabetic macular oedema.

“We know there are very few places where people can access either (ophthalmology) clinics that bulk bill or access clinics through public hospitals. That would be a really good first step to work out where there’s the most need,” Dr Chapman said.


  1. Australian Medical Association, Australian Public Hospitals in Logjam 2023, (report), available at www.ama.com.au/articles/australian-public-hospitals-logjam [accessed 27 Feb 2023].
  2. The Hon Mark Butler MP, Review of National Hospital Funding (media release), available at health.gov.au/ministers/the-hon-mark-butler-mp/media/review-of-national-hospital-funding-agreement [accessed 27 Feb 2023].
  3. Impact Economics and Policy, Reform Critical: A fragmented health system at breaking point, Feb 2023, available at: drive.google.com/file/d/15FL664KWx-SlyTE33gOhyzBwMyf_6plG/view [accessed 27 Feb 2023].
  4. Breadon, P., Fox, L., and Emslie, O., The Australian Centre for Disease Control (ACDC): Highway to health (report), available at grattan.edu.au/report/acdc-highway-to-health/ [accessed 27 Feb 2023].
  5. Australian Government, Strengthening Medicare (report) available at health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf [accessed 27 Feb 2023].
  6. Department of Health and Aged Care, Medicare quarterly statistics – bulk billing by Primary Health Network (December quarter 2022-23), available at: health.gov.au/resources/publications/medicare-quarterly-statistics-bulk-billing-by-primary-health-network-december-quarter-2022-23?language=en [accessed 27 Feb 2023].