Program: A deep dive on Labor's health promises

Preeya Alexander: Are you a good sleeper, Liv?

Olivia Willis: I am a pretty good sleeper. I mean, I think like everyone I have my good nights and my bad nights, but in our house our bad sleeper is our dog, a three-year-old labrador, who from the other side of the wall you would think is an 85-year-old man with serious snoring problems. 

Preeya Alexander: Oh, so the dog is a snorer? 

Olivia Willis: The dog's a snorer. But most of the humans are okay. What about you guys? 

Preeya Alexander: I am not a snorer. Our dogs also snore. But the reason we're even talking about snoring (not in dogs) is yes, obstructive sleep apnoea. And snoring can be one of the features, potentially, of obstructive sleep apnoea. But we're going to explore the diagnosis a little bit further today and how women might present quite differently. 

Olivia Willis: That's coming up on the Health Report. 

Preeya Alexander: I'm Preeya Alexander on Wurundjeri land.

Olivia Willis: And I'm Olivia Willis, also on Wurundjeri land, filling in this week for Norman Swan.

Preeya Alexander: Who is off gallivanting, eating delicious food somewhere wonderful. 

Olivia Willis: Lucky for some. 

Preeya Alexander: Also on the show, about one in seven Australians are on an antidepressant, with more and more people taking them long-term. So what happens when they want to come off the medication?

Olivia Willis: And the first national clinical guidelines for early pregnancy loss have been developed, which experts hope will be used as a benchmark for best-practice care. First though, let's jump into the news. And this week it was, pretty unsurprisingly, all about the federal elections. If you've been under a rock and you haven't heard, the Albanese government has secured a second term. And on the Health Report we've previously covered a bit about the health measures that were in the budget announced in March, but we thought that maybe we'd recap what the Labor government is promising on the health front in this next term of government, and also some of the areas that perhaps have been a little bit overlooked. So Preeya, let's start with what has been promised. What do we know?

Preeya Alexander: There's a lot. So I've picked out some of the big ones. I think a big promise from this government was that nine out of ten GP visits will be bulkbilled by 2030, that was a big promise.

Olivia Willis: Kind of the centrepiece, really.

Preeya Alexander: They're talking about $8.5 billion in additional funding in addition to what already goes into Medicare, and really tripling the incentives to GPs to bulkbill patients. And we did break this down in quite a bit of detail on the Health Report a few weeks ago.

Olivia Willis: And I think since you and Norman spoke about it on the Health Report last time, there was actually some research done by the College of General Practice, and also the ABC did its own research, finding that most GPs aren't intending to bulkbill all their patients despite this kind of budgetary promise.

Preeya Alexander: Because it's not sustainable. The viability of general practice is really, really under fire at the moment, so it's going to be very hard to keep clinic doors open and pay the nurses and the reception staff and keep the machines running and the vaccine fridges if we're going to bulkbill all patients, because of that pay cut. 

But I do think though, Liv, a real positive is in terms of what this government has promised is in the area of women's health. So they've promised menopause health assessments, trying to facilitate people seeing their GP in general practice and getting all the input they need in that transitional phase of life. There's going to be an expansion of the endometriosis and pelvic pain clinics nationally, so that goes from 22 to 33, and we know that when it comes to conditions like endometriosis and adenomyosis, chronic pelvic pain impacts quality of life, sleep, ability to function, work, and so this is hopefully going to see significant improvement for people with those conditions. And the big one that I've already seen translate into clinical practice is there are some medications that have gone onto the PBS in the reproductive space.

Olivia Willis: Have you already started prescribing these? 

Preeya Alexander: I have. I already used to prescribe them, to be fair, but I'm talking about medications like Slinda, people might know it, which is a progesterone-only pill, or the drug name is drospirenone. There are also two combined oral contraceptive pills, Yaz and Yasmin, which have also gone onto the PBS. But a lot of people cannot take a combined oral contraceptive pill with oestrogen and progesterone, it's contraindicated. So someone might have a history of migraines with aura or a higher stroke or clot risk, in which case we ideally want to avoid the oestrogen component. So for a lot of patients who were needing that Slinda or the drospirenone, they were previously paying around $80 to $100 for their pill. And now it's on the PBS, the price has gone down to that capped price of $31.60. And also the Labor government has promised to reduce the price of PBS medications from that $31.60 to $25. 

Olivia Willis: What has been in store for men's health?

Preeya Alexander: So they're going to promise $32 million towards Movember and more Men's Sheds and more male-specific mental health services, which we know that in Australia three out of four suicides occur in Australian men, and so certainly we need more money in that prevention space. So hopefully this is the start of a positive difference. 

Olivia Willis: And I noted in the budget that suicide prevention wasn't actually explicitly given funding, but the Labor government has promised…I think it was a billion dollars for mental health, and that goes to a variety of measures. There's more funding for Headspace. I think there were centres specifically for youth mental health. In addition to that, they've also promised they're either opening or upgrading 31 Medicare mental health centres, which essentially provide free drop-in…it's a free drop-in centre. And then also a substantial number of training places for mental health professionals and peer workers. So mental health is definitely, in addition to women's health and bulkbilling, seems to be another fairly key pillar. 

Preeya Alexander: And the urgent care clinics, they've pledged $644 million to increase the number of urgent care clinics. Whether or not that is the right place…

Olivia Willis: I was going to say, the jury is still kind of out on whether those are a cost-effective measure, whether they're taking people out of…you know, reducing the burden on hospitals, on GPs and so on. I guess that remains to be seen, what the evidence is. So there was undoubtedly a really strong focus on health, I think, for both parties or both major parties. But it obviously goes without saying that there's a bucket of money that's not never-ending, and there's always going to be things that miss out. But I do think it's useful sometimes to look at the areas of health that haven't necessarily received funding or don't appear to be in the major parties' priorities. 

A really big one, I think, is dental, which we did actually hear a little bit about during the federal election campaign because of the Greens, so getting dental onto Medicare was a really central policy platform for them, and it's something I think they've been campaigning on for a long time, and that's because improving oral health, making dental care more affordable is an issue that a number of health bodies and advocates have called for as one that needs fairly urgently addressing. We know that Australians are delaying getting oral care.

Preeya Alexander: It's expensive. And it can impact your other physical well-being…so having good oral health can actually impact cardiovascular health and other things, so it's very important.

Olivia Willis: Absolutely. And there's thousands of people who are hospitalised with dental conditions every year that research tells us could have potentially been avoided. So Labor, like the coalition, didn't want to get drawn too much on dental during the election because as an issue it was kind of absent from their policy platform. They have however said for some time that they have an ambition to bring dental into Medicare, but they haven't really given a time frame on that. And during the election the federal health minister Mark Butler said it wasn't something they had capacity to do in the immediate future. He did however talk about a recommendation for a senior dental benefits scheme, which is essentially a proposal for a capped scheme for Australians over 65 that would operate in a very similar way to the child dental benefit scheme. And basically Mark Butler said that it was very expensive, but an interesting proposal to look at. So I think it's going to be interesting to see what happens with dental.

Preeya Alexander: So there's no timeline for that?

Olivia Willis: No timeline. But I will say that Labor, unlike the coalition, has said that that's kind of a long-term goal, it seems, to bring dental into Medicare.

Preeya Alexander: Watch this space. All right.

Olivia Willis: Another area that I think didn't receive a whole lot of attention in the budget (or during the election probably more so) was investment in preventative health; how we're actually going to keep people out of your waiting rooms and out of hospital EDs, and really reduce pressure on the health system. Australia spends about $250 billion a year on health, and less than 3% of that goes to preventative health, and, by international standards, that's fairly low. And one of the reasons why I guess that's a problem and advocates want that to change is because, as you would well know, we have an enormous and growing tide or burden of chronic disease, and that's obviously putting more and more pressure on the health system. 

One thing I think that's worth noting is the Labor government, a real focus for them is primary care. We saw that through the focus on GPs and bulkbilling, and I think that will definitely go some way to helping address chronic disease and improving management for chronic disease. But what we haven't really seen is funding promises or discussion about some of those bigger preventative health measures that health and policy experts have been advocating for quite a long time.

Preeya Alexander: Which is really lacking, and, I have to say, giving people the really simple nuts and bolts that can yield benefits for the body and the brain, there's not a lot of support in terms of public health campaigning, nor an item number that a GP can actually use to spend a long period of time with a patient to actually implement the preventative health stuff that people need, that takes time. It's not currently an item number, and often gets lost in the midst of a really busy, full consult. And of course people are waiting to see their GP, they've got their issues piled up, and there's not much time to fit prevention in. 

Olivia Willis: And I think in addition to that, some of those regulatory and tax measures that help create healthier environments, encourage and support people to make healthier choices, so things that we've heard a lot about in the last few years, like the introduction of a sugar tax, better food labelling, restrictions around junk food advertising, there definitely are investments in measures around…I think we've seen that in smoking and vaping and trying to reduce that, in cancer screening and so on. 

One thing when it comes to the preventative health space that I think is going to be important to keep an eye on in this next term of government is the newly established Australian Centre for Disease Control, which I don't…are we going with ACDC as the acronym there? Let's go with it…the ACDC or the Australian CDC…

Preeya Alexander: It makes it sound cool.

Olivia Willis: It does make it sound very cool. That was a really big 2022 election promise from Labor, and it was originally proposed as a centre that would focus on both communicable and non-communicable or chronic diseases. At this stage we're not exactly sure what form the centre will take or what its scope or priorities will be. At the moment we have an interim CDC, and that's operating as part of the Department of Health, and its focus is really on communicable diseases right now, so things like biosecurity, disease surveillance and so on. And the actual official CDC is expected to be launched in January next year, pending some legislation through federal parliament this year, and I guess at that point we'll probably get a better sense of what its remit will be. But I think certainly amongst public health advocates the hope is that non-communicable diseases are a really important part of its focus.

Preeya Alexander: And maybe the prevention slips in there.

Olivia Willis: Exactly.