Funding debate: Who pays for nursing

The ceaseless topic of who should pay for nursing continues to be argued in the halls of power. By Louis White

The dual questions of how should we fund our health services and who should pay for nursing are being asked of our politicians and policymakers every day.

After all, the medical profession offers invaluable services that seemed, especially in the area of nursing, to have a less than handsome price.

But it is a complex issue that involves federal and state governments, private health insurance companies, with the basis of the health system being encompassed by the National Health Act (see breakout box over page).

The system constantly sees both federal and state governments in conflict over funding and treatments. Both triumph their spending feats, but ignore the areas that are too difficult to deal with happily blaming the other.

Health expenditure, though, is increasing at a steady rate.

According to the Australia Institute for Health and Welfare report Health Expenditure Australia 20100-11, Australia spent $130.3 billion in 20100-11. This was a steady increase from $77.5 billion spent in 2000-1.

In 20100-11, health expenditure as a percentage of Australia’s GDP was 9.3 per cent. (It was 8.2 per cent in 2000-1).

In 20100-11, the estimated national average level of recurrent expenditure on health was $5,796 per person. In that year, expenditure in New South Wales ($5,356 per person) was 2.7 per cent below the national average, while the Northern Territory’s average spending ($7,339 per person) was 33.4 per cent higher than the national average.

Governments funded 69.1 per cent of total health expenditure during 20100-11, with the Australian government contributing 42.7 per cent and the respective state governments spending 26.4 per cent.

Spending on public hospital services in 20100-11 was estimated at $38.9 billion or 31.5 per cent of recurrent expenditure. Expenditure on medical services ($22.5 billion or 18.2 per cent) and medications ($18.4 billion or 14.9 per cent) were the other major contributors.
The Australian government’s share of public hospital funding was 40.3 per cent in 20100-11 with the state’s and territory government’s share of public hospital funding at 49.5 per cent in the same year.

It is public hospital funding where most disputes occur, especially when it comes to salaries and conditions. There was a series of strikes before the recent WA state election by the Australian Nursing Federation resulting in a 14.5 per cent pay increase over three years. A year earlier, Victorian nurses won a 14–21 per cent pay rise over four years after nine months of fighting with the Victorian state government.

“As part of our national ‘Stop passing the buck, Australia’s nursing grads need jobs’ campaign, the ANF is calling on federal, state and territory governments to stop the blame game over health funding,” ANF federal secretary Ms Lee Thomas says.

“This ongoing wrangling has resulted in billions of dollars being slashed from public health systems across the country in order to achieve so-called budget savings.

“Cuts to health budgets have seen highly-educated nurses and midwives lose their jobs with the continued underemployment of Australian-trained nursing and midwifery graduates.

“We’re urging federal, state and territory governments to work together to find funding solutions to fix critical issues, such as the country’s growing shortage of nurses and midwives, to ensure safe patient care across the community.”

The federal government cut $107 million from the Victorian government’s health budget last year, which was – according to a senate inquiry – based on “dodgy”, out-dated population data.

After a public outcry, they reversed the decision earlier this year to reinstate the money, bypassing the state government and directly allocating it to hospital boards.

“Without a doubt, government funding must be injected straight into workforce strategies and policies which will deliver quality, frontline care,” Thomas says.

“Australia continues to suffer a shortfall of highly-educated nursing and midwifery staff, with a predicted shortage of 109,000 nurses and midwives by 20105.

“In the aged care sector alone, the country urgently needs 20,000 nurses to cope with a rapidly ageing population.

“As a matter of urgency, governments must work together to start funding a future nursing and midwifery workforce to replace the current staff who will be retiring over the next 15 to 20 years.”

The ANF is campaigning hard to create greater employment opportunities for locally-elected graduate nurses and midwives to meet the challenges of this nursing and midwifery workforce shortage and the provision of the right staffing levels to ensure the delivery of safe patient care.

“The ANF is calling on the Gillard government, the coalition and key independents to commit to making health and aged care a funding priority in their election campaigning,” Thomas says.

“At a time of ever-growing demand for health services, we believe there must be a COAG-led process to address the country’s significant healthcare issues, irrespective of political persuasion.

“As part of the ANF’s election health platform, we have identified four areas of concern that must be addressed by all of our politicians, irrespective of political persuasion, including Australia’s shortage of nurses and midwives; experienced nurses and midwives losing their jobs due to health budget cuts; providing the right staffing levels for nurses and midwives to ensure the delivery of safe patient care, and delivering on funding for aged care reforms.”

The NSW state government has recently publicised the fact that 4,000 extra nurses are working across the state – both in rural and regional hospitals – since they won office. (They had made an election pledge to recruit 2,475 nurses).

For the first time in the state’s history there are 47,500 nurses working in NSW. “Nurses are at the very heart of our hospitals and more nurses means better experiences for patients and their families,” Jillian Skinner, NSW Health minister says.

The Australian Practice Nurse Association (APNA) is a big advocate of funding for nurses in primary health care being maintained.

“APNA supports and represents nurses working in primary health care, which is primarily funded by the federal government,” Kathy Bell, chief executive officer, says.

“Financing for primary health care, including general practice, needs to be structured in a way that supports quality, holistic team care. Primary health care nurses make up an increasingly significant proportion of the workforce, and play a key role in delivering care to our ageing community with its growing burden of chronic disease.”

APNA is the peak professional body for nurses working in primary health care including general practice. It has more than 3000 members.

“It is critical that financing systems support the recruitment and retention of nurses in primary health care, and support the optimal use of the nurse’s skills in the delivery of care by the team,” Bell says.

“It is also critical to develop and put in place an education and career framework that ensures we have an adequate workforce of skilled primary health care nurses into the future. We hope that the federal government will address these issues in the forthcoming budget.”

But problems will always remain no matter what political party is in charge at a federal and/or state level due to funding and what is a priority for that particular government at the time to win an election.

It is a basic truth that the general public are very aware of.

“We need one government to take overall responsibility for health,” professor Julie Considine, chair in nursing at Deakin University Nursing and Midwifery Research Centre, says. “As long as health is co-funded by state and federal governments, there will always be blame shifting and buck passing.

“If healthcare was truly patient-centred, then the flow-on effect would be efficient hospitals and happy staff. We need to look at more creative systems that deliver care not only in hospitals but a range of other settings including patient’s homes and also systems that better involve families and significant others in care delivery.

“Healthcare funding needs to benefit patients rather than a craft group of clinicians although we know that if nurses’ workloads and work environments are good then patients are safer. I think we also need to have high levels of engagement in evidence-based practice so we can be sure that we are using healthcare funding for the most effective interventions and models of care.”

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