Now we have had time to digest the Budget 2024, here are the wrap-ups for each area of interest.
Strengthening Medicare
The APA advocates for primary care reform that places the patient at the centre to drive better musculoskeletal health through equitable and early access to physiotherapy. Primary care reform must tackle the first touchpoints of care across the different care pathways that exist for patients, particularly for those with musculoskeletal injuries and pain. This means utilising physiotherapy and other disciplines to their full scope of practice and with better use of team-based care. Publicly funded First Contact Physiotherapy will provide better and faster access to diagnosis and treatment of musculoskeletal pain and conditions in primary care.
Strengthening Medicare
The Budget 2024-25 provides $2.8 billion to strengthen Medicare. This encompasses expanding the Medicare Urgent Care Clinics network, measures for older patients to reduce hospital stay durations and care transitions and increasing mental health services within Medicare. The budget also takes important next steps to strengthen Medicare for women and address healthcare inequity.
Specific measures include:
- $227 million to provide a further 29 Medicare UCCs to make urgent health care more accessible and reduce waiting times in emergency departments.
- $882.2 million to ensure that older Australians get the medical support they need in a safe and comfortable environment when they don’t need to stay in hospital, while freeing up beds for other patients who do.
- $361 million for mental health in a stronger Medicare.
- $127.8 million in new services on the MBS. Changes to existing services will ensure patients have access to safe and clinically relevant services with appropriate rebates.
This includes:
- $49.1 million for longer gynaecology consultations for patients who have complex needs, and
- $56.5 million for eligible midwives to provide longer consultations before and after childbirth. - $23.1 million to extend the continuous review of the MBS.
- $69.8 million to increase the number of Medicare eligible magnetic resonance imaging (MRI) machines.
- $92.8 million to increase rebates and reintroduce indexation for nuclear medicine imaging items to ensure these services remain accessible and affordable for patients.
- $174.1 million for labour intensive pathology test indexation.
- $335.7 million for permanent arrangements for COVID-19/respiratory panel tests.
- $57.4 million to continue initiatives under the Health Delivery Modernisation Program and to update My Health Record.
This builds on the $6.1 billion investment to strengthen Medicare in the Budget 2023-24.
Our asks
In the APA’s Pre-Budget submission, the APA called for reform solutions to strengthen Medicare and build new funding models that align with modern healthcare needs.
The APA called for action to place patients at the centre, to empower patients and integrate care, and address barriers to access to care.
The APA called for targeted action to:
- Lift the barriers to direct referrals that would enable physiotherapists to appropriately refer on for specialist consult and imaging.
- Prioritise a publicly funded First Contact Physiotherapy (FFCP) service in Urgent Care Clinics nationally.
- Invest new funded physiotherapy in the form of Medicare-rebated item numbers for primary care, including through multidisciplinary team-based care, to drive better, more connected and more integrated care.
- Digital health solutions including a pilot to extend the MyMedicare patient registration model to the broader primary care team.
Policy advice
Analysis and response
- It comes as no surprise that the Government has once again prioritised strengthening Medicare reform as a key election commitment. While the $2.8 billion package is welcomed, it is not the ‘comprehensive revamp’ promised, nor is there much movement on the broader shifts required to fix an outdated single practitioner, fee-for-service model that continues to hinder reform progress.
- While the budget placed an important emphasis on funding mental health services, this needed to be accompanied by an equal focus on chronic disease and pain. The reform opportunity was in the development of new care pathways to reduce avoidable hospitalisations and assist individuals in better managing their chronic and complex health conditions.
- The cost efficiencies achieved through investment in physiotherapy-led primary care intervention have been overlooked in this budget. These interventions not only keep people healthy and out of hospital, but also optimise patient outcomes during care transitions.
- However, more broadly, the APA see significant reform promise in the $882.2 million investment aimed at better supporting older people and relieving pressure on our public hospitals. This represents a positive reform shift, utilising hospital outreach services in the community and expanding virtual care services. As part of a broader package aimed at strengthening Medicare and improving the care economy, this initiative will help to avoid unnecessary hospital admissions, allow early and safe hospital discharge and improve transition out of hospital of older Australians.
- The APA disagree with others that the Urgent Care Clinics are a ‘misguided’ investment, but the models would be enhanced through the inclusion of physiotherapy. Medicare Urgent Care Clinics represent a key piece of reform and hold the potential to reduce the burden on the healthcare system. However, this requires policy leadership to drive the required funding models to address the barriers to successful implementation of integrated care to strengthen the service model.
- Opportunities to leverage the full health workforce to their full scope of practice and bringing the required system enablers to drive better use of team-based care were clearly missed.
- Investment to update My Health Record is welcomed provided this includes significant measures to integrate physiotherapy and allied health more broadly. For too long allied health has been neglected developing digital initiatives that promote connected care. See separate Women’s Health and Aged Care budget overviews for further information on these measures.
Call to action
- The APA’s strength is in membership and call on you to get behind campaigns that advocate for measures placing the patient at the centre, driving better musculoskeletal health through equitable and early access to physiotherapy.
Aged Care
The APA advocates for reform that delivers comprehensive clinical assessment and targeted funding for physiotherapy across settings to prolong independence and manage the physical and cognitive symptoms of disease. In addition, the APA calls for investment in a falls-related fractures and hospitalisation prevention program through physiotherapy-led care in the community.
Strengthening Medicare and the care economy
The federal government has committed $882.2 million over five years to supporting states and territories free up hospital capacity by supporting older Australians to avoid hospital admission, be discharged from hospital earlier and improve their transition out of hospital to other appropriate care.
Specific measures include:
- $610.4 million over 4 years from 2024-2025 for states and territories to invest in initiatives that address long stay older patients, unique to each jurisdiction.
- $190 million over three years from 2025–26 for the extension and redesign of the Commonwealth’s Transition Care Programme to provide short-term care of up to 12 weeks for older people after a hospital stay.
Improving aged care support
The Australian Government will provide $2.2 billion over five years from 2023–24 to deliver aged care reforms and to continue to implement recommendations from the Royal Commission into Aged Care Quality and Safety.
Specific measures include:
- $531.4 million in 2024–25 to release 24,100 additional home care packages in 2024–25.
- $110.9 million over four years from 2024–25 to increase the regulatory capability of the Aged Care Quality and Safety Commission as part of the government’s response to the Final Report - Independent Capability Review of the Aged Care Quality and Safety Commission, and to implement a new aged care regulatory framework from 1 July 2025.
- $65.6 million over four years from 2024–25 to attract and retain aged care workers, and collect more reliable data.
- $10.8 million over two years from 2024–25 to extend the Palliative Aged Care Outcomes Program and the Program of Experience in the Palliative Approach program to continue to upskill the aged care and primary care workforce to further embed palliative care capacity in the aged care workforce.
The APA's asks
In the APA's 2024–25 Pre-Budget submission, the APA called for reform to provide better care and outcomes for its care priorities.
The APA called for:
- Immediate action to address the consequences of recent policy reforms for a rapidly diminishing physiotherapy workforce in residential aged care.
- Comprehensive clinical assessment and targeted funding for physiotherapy across settings to prolong independence and manage the physical and cognitive symptoms of chronic disease.
- The incorporation of adequate clinical assessment to ensure that healthcare needs are met at home and in the community. Investment in the assessment, prevention and non-surgical management of women’s health conditions including birth trauma and the conditions and symptoms associated with the genitourinary syndrome of menopause.
Policy advice
Analysis and response
- The government’s aged care budget measures do nothing to allay the APA's workforce concerns in residential aged care and shift responsibility for care to hospitals without addressing access issues in primary care. While efforts to reduce hospital admissions and stays and improve transitional care appear positive, the APA awaits the detail of a number of initiatives to get a clearer picture. The reprioritisation of unspent Commonwealth Home Support Program funds needs clarification as it could result in unintended policy consequences that may negatively impact on the health outcomes for older people living at home.
- At first glance, the government’s $610.4 million investment initiatives supporting states and jurisdictions to address long stay older patients and a further $190 million in the Transition Care Programme are steps in the right direction.
- The APA supports efforts to improve health outcomes of hospitalised older patients by reducing hospital stays and providing appropriate transitional and in-home or in-facility care, all of which are dependent on physiotherapy-led rehabilitation.
- The APA have long known that the lack of access to post-acute physiotherapy-led rehabilitation in the community and in residential care has kept older patients in hospital far longer than required or resulted in deterioration following discharge.
- However, these measures in isolation do little to address the APA's concerns about diminishing access to physiotherapy for older people in residential care and the potential impact on access of the Single Assessment System in home care that begins on 1 July this year.
- While the APA support the expansion of outreach services to avoid unnecessary hospital admissions and facilitate earlier discharges, these measures should not be seen as a substitute for the provision of clinically assessed comprehensive and ongoing care for older people. In reinforcing the foundations that underpin quality in aged care, it is crucial that a broader reform lens is applied and one that encompasses physiotherapy.
- The APA calls on the government to ensure:
- The health outcomes of the older person are at the forefront of the new initiatives.
- Older people have access to physiotherapy-led rehabilitation during their hospital stay to enable safe discharge.
- Physiotherapy rehabilitation services are provided to older people once discharged into the community or residential aged care facilities based on individual clinical assessment and need.
- Access to physiotherapy-funded home care packages or the Australian National Aged Care Classification in residential care continues unaffected by the new measures. - The APA is also awaiting further detail on the plan to shift unspent Commonwealth Home Support Program (CHSP) funds to other parts of the aged care system.
- The announcement of 21,400 new home care packages is positive but does not touch the sides of current demand for these packages. These packages will also be assessed using the new Single Assessment System, which does not incorporate clinical assessment when determining the level of package to be assigned.
- Comprehensive clinical assessment and targeted funding for physiotherapy across settings to prolong independence and manage the physical and cognitive symptoms of chronic disease.
Call to action
If you have strong examples of effective in-hospital, transitional care or short-term in-RACF provision of physiotherapy-led rehabilitation or virtual physiotherapy outreach services, please email our Policy Department.
NDIS
The APA advocates for reform that supports those living with a disability to access physiotherapy to support them in maintaining the highest level of function, independence and mobility. Reform to the NDIS is needed to allow all participants access to physiotherapy and indexation of NDIS price limits are needed to allow physiotherapists to continue to provide services. There is also a need to increase public funding for those not eligible for the NDIS.
Getting the NDIS back on track
In this budget, the government’s focus was on ensuring NDIS funding goes to those who need it most.
Measures include:
- $160.7 million to upgrade the NDIS Quality and Safeguards Commission’s information technology systems, to better protect the safety of NDIS participants, reduce regulatory burden on NDIS providers, and improve cyber security.
- $129.8 million for design and consultation work to respond to the findings of the Independent NDIS Review.
- $83.9 million to boost fraud detecting information technology systems at the National Disability Insurance Agency (NDIA), to further safeguard the integrity of the NDIS.
- $45.5 million establish a NDIS Evidence Advisory Committee, to provide independent and transparent advice to government on the efficacy and cost-benefits of types of supports funded by the NDIS.
- $23.5 million for Services Australia to continue fraud investigation and response activities as part of the Fraud Fusion Taskforce.
- $20.0 million for initial design and consultation work on reforms to help participants and people with disability navigate services.
- $5.3 million for the Independent Health and Aged Care Pricing Authority to work with the Department of Social Services and the NDIA to undertake initial work to reform NDIS pricing arrangements, including reviewing existing pricing approaches and developing a pricing data strategy.
Our asks
In the APA’s 2024-25 Pre-Budget submission, the APA called for:
- Immediate indexation with the Wage Price Index and Consumer Price Index of NDIS price limits for physiotherapy supports.
- Strengthened funding for access to physiotherapy early intervention services and treatments under Medicare for children and adults living with disability.
Policy advice
Analysis and response
- As the cost of the NDIS continues to grow, the APA supports measures that will enable the Scheme to remain viable. However, these measures should not limit access for participants to vital health services such as physiotherapy. It is important to ensure that there is a NDIS workforce available to work with those on the Scheme.
- The APA welcomes a review of current NDIS pricing arrangements and reiterates its pre-budget ask of indexation with the Wage Price Index and Consumer Price Index.
- The APA is pleased to see investment targeted at consumers and welcomes the funding allocated to assist NDIS participants and those with a disability navigation service.
Call to action
- The APA’s strength is in membership and call on you to get behind campaigns that advocate for measures placing the patient at the centre, driving better musculoskeletal health through equitable and early access to physiotherapy.
- Get behind our campaigns to ensure we have a strong voice in building the future NDIS together.
Veterans' health
The APA advocates for reform that enables veterans to access the vital healthcare provided by a physiotherapist. Veterans often present with complex and comorbid physical ill-health, and every veteran deserves access to physiotherapy. Unfortunately, barriers within the Department of Veterans’ Affairs (DVA) funding scheme significantly impact the sustainability of physiotherapy under the scheme. Reform is needed to deliver a pricing framework that encourages earlier intervention and drives value-based healthcare through new physio-led models of care. The APA advocates that the government must address the price disparity in DVA fees to ensure that physios can continue to provide essential services to veterans.
Continuing veterans’ access to health and support programs
The Government will provide $59.6 million over three years from 2024-25 to continue access to health and support services for veterans and their families. Specific measures include:
- $48.4 million to provide viability payments to providers to maintain the short-term viability of Veterans’ Home Care and Community Nursing programs.
- $10.2 million to extend access to the Provisional Access to Medical Treatment program, which provides access to funded medical treatment for ill and injured veterans who are awaiting a liability determination on the claim they have submitted.
- $1.0 million to extend the Veterans’ Chaplaincy Pilot Program for one year, which will provide additional time to complete the evaluation of the program.
APA asks
The APA’s Pre-Budget submission called for an urgent fee increase to the fee for physiotherapy to enable viability of access to physiotherapy health service to veterans.
The APA called for targeted budgetary measures to:
- Address the price disparity by adopting an urgent fee increase for initial physiotherapy in-rooms consultations to at least $118.55 (parity with occupational therapy) and subsequent consultations to at least $85.65 (parity with podiatry).
- Co-design of pilot models of care recommended by DVA’s alternative funding models for allied health services for veterans to implement Model 1a which recommended a physiotherapist be utilised to coordinate allied healthcare within musculoskeletal management.
Policy advice
Analysis and response
- The APA acknowledges the important investment of $48.4 million to support viability of Veterans’ Home Care and Community Nursing Programs. This measure may enable physiotherapists involved in the Veterans’ Home Care program to continue to provide home-based care to veterans, and this may in turn allow veterans to remain at home and may assist them to continue to live their life outside of aged care settings.
- However, the APA is deeply concerned about the lack of action in addressing access to physiotherapy for veterans. Physiotherapists continue to report that veterans’ care under the Department of Veterans’ Affairs (DVA) is not viable and that barriers to care provision, worsened by fee discrepancies within the scheme, have a significant impact on veterans’ access to healthcare.
- APA data shows that approximately 92 per cent of physiotherapists report that they cannot sustain services for veterans, with physiotherapist facing a loss of approximately $50 to $74 per service when they treat a veteran under the DVA scheme. These fee discrepancies take advantage of physiotherapists and significantly limit the number of physiotherapists able to provide continuity of service to veterans. APA data also shows 25 per cent of physiotherapists reporting that they have been forced to limit their provision of service under DVA because of the limited subsidisation under DVA.
- The APA has called for urgent measures to sustain the viability of physiotherapy for veterans but there has been a continued lapse in budgetary acknowledgement of the complex and comorbid physical health needs of veterans by the government.
- Opportunities to support veterans to access the best health care to support their osteoarthritis, pain, physical impairment and injury and falls risk have been missed. Opportunities to give veterans a fighting chance to avoid unnecessary or low-value surgery for musculoskeletal conditions have been missed.
- The continued paucity of funding for physiotherapy in veterans care signals a lack of value by the government for quality healthcare for veterans.
- The shortfall in funding will seemingly rely on the goodwill of physiotherapists to take on the deficit in funding and unfortunately, this is not a viable funding model within healthcare and calls into question whether the government prioritise veterans' healthcare.
- Veterans deserve more from the government than healthcare reliant on physiotherapists sustaining a loss to accommodate the shortfall in the underfunded services under DVA.
Workforce measures
The APA advocates for a sustainable and adequately distributed health workforce, with targeted incentives for physiotherapists in building workforce capability now and in the future. Prioritising strategies for mobilising the physiotherapy workforce is essential. This includes implementing policies to financially incentivise physiotherapists to undertake training and practice in areas where they are most needed.
Workforce measures
The 2024-25 Budget includes a range of measures to support the health workforce.
Specific measures include:
- $90.0 million to fund the implementation of the health-related recommendations of the independent review of Australia’s regulatory settings relating to overseas health practitioners (the Kruk Review) to grow and support the health workforce.
- $427.4 million over four years for a new Commonwealth Prac Payment as part of the cost-of-living measures.
- Nursing, teaching, midwifery and social work students will be eligible for $320 per week when undertaking mandatory practical units (delayed until July 2025). - The government will cut $3 billion in student debt for more than 3 million Australians, reducing revenue by $239.7 million from 2023-24 to 2027-28.
- This will provide relief for everyone with Higher Education Loan Program (HELP) and other student loan debt. - $88.4 million to continue to attract and retain the aged care workforce and provide better staffing solutions as part of the Ensuring dignity and choice in aged care package.
- $17.4 million to boost the supply of health care in areas of shortage.
- Primary Health Networks and Rural Workforce Agencies will work with local communities to support people to get the care they need, close to home. - $7.1 million for a new national peer workforce association will help to mobilise, professionalise and unlock the potential of mental health workforce as part of the Better Access initiative.
- $24.6 million for Charles Darwin University to establish a new medical school in the Northern Territory from 2026.
- $4.7 million to grow the Northern Territory Medical Program by six places with a total of 36 students a year to start from 2024.
The budget also includes measures to grow and support the First Nations health workforce as part of the First Nations people package.
- Lowitja O’Donoghue Foundation scholarships in enrolled nursing and for postgraduate and undergraduate nursing students.
- To ensure people receive the latest clinically and culturally appropriate care, the HIV workforce will get up-to-date training and education through continued funding for the HIV Online Learning Australia program and the HIV Prevention Workforce Development pilot.
Our asks
In the 2024-25 Pre-Budget submission, the APA called for reform solutions to strengthen and futureproof the physiotherapy profession. This included targeted measures to support future generations of physiotherapists, such as incentives for training and teaching.
The APA called for targeted action to:
- Extension of the HELP for Rural Doctors and Nurse Practitioners initiative to rural physiotherapists (as per rural ask).
- Investment in a training pipeline to support successful adaptation to practice through a flexible framework of support and training that can be applied at any career stage.
- Development of physiotherapist teaching capacity and the provision of a more supportive training pathway through funded supports for clinical placements via teaching incentives.
- Legislative change to address the barriers that prevent physiotherapists from billing against MBS items for supervising a student to treating eligible patients.
- A funded trial to embed appropriated trained, culturally safe physiotherapists within Aboriginal Community Controlled Health Services.
- Immediate action to address the consequences of recent policy reforms for a rapidly diminishing physiotherapy workforce in residential aged care (as per aged care ask).
Policy advice
Analysis and response
- The APA supports the new Commonwealth Prac Payment Incentive as a means of developing a sustainable pipeline in critical workforce areas. This new payment will be provided to an estimated 68,000 students studying nursing, teaching and social work a $320 weekly payment for undertaking mandatory work placements at university. As physiotherapy is one of the top 20 professions in demand, the APA hopes physiotherapy is prioritised as this measure expands in future years.
- Capping the HELP indexation rate will be a welcome relief for many physiotherapists. The APA is calling for further HELP debt relief to support the physiotherapy workforce in areas of need, such as those who work in rural and remote areas.
- The budget measures to grow and support the First Nations health workforce are particularly welcomed. These will ensure First Nations people will be supported to choose a career in nursing and medicine and deliver high-quality care to patients. The APA hopes these initiatives are expanded to support the careers of Aboriginal and Torres Strait Islander physiotherapists.
- This budget also announced the government’s intention to explore the introduction of a psychology assistant role. Alongside others in the sector, the APA is concerned that there is an increasing reliance toward utilisation of the assistant workforce without sufficient focus on quality and safety. Instead, the policy focus needs to be on investing in the development of physiotherapists to take pressure off the high costs parts of the system. This will need a broader focus on skill retention and a level of policy and planning alignment, to fully examine the changing profiles through a national workforce plan.
- A priority must be placed on the professionally qualified clinical and regulated staff groups, which includes physiotherapy, the fourth largest group of registered primary health care professionals—now in urgent need of nationally directed interventions. Greater focus also needs to be on the improved utilisation of skills through advanced scope of practice roles to address current and future need. In addition, reform must tackle the existing system complexities including removing barriers to integrated care.
- To ensure a sustainable physiotherapy workforce, the profession needs the same training incentives as that of GPs, this includes a funded training pathway. A robust policy for both recruitment and retention planning is crucial to ensure a sustainable pipeline through a training pathway from early career to advanced practice roles. Legislative change is also required to eliminate barriers associated with supervised clinical placements, alongside further policy to fund physiotherapy prac placements.
- Physiotherapy is a feminised profession, and the APA commends the government's extension of superannuation to paid parental leave.
Call to action
Get behind the Scope of Practice Review, as allowing physiotherapists to work to their full scope of practice will support these policy aims.
Rural health
The APA advocates for reform that improves access to physiotherapy for those living in rural communities. Further investment beyond medicine is needed to ensure the healthcare needs of those living in rural Australia are met. This includes redirection of the Workforce Incentive Program (WIP), reform to support practice viability and incentives to support physiotherapy training.
The 2024–25 Budget provides $17.4 million to boost the supply of healthcare in areas of shortage. PHNs and rural workforce agencies will work with local communities to support people to get the care they need, close to home. This is new funding for the existing Workforce Incentive Program.
The APA's asks
In the APA's 2024–25 Pre-Budget submission, the APA called for reform solutions to improve access to physiotherapy for Australians in rural and remote locations through both workforce and care solutions.
The APA called for targeted action to:
- Support the growth of the rural physiotherapy workforce through training and practice incentives. For example, expanding existing measures such as the HELP for Rural Doctors and Nurse Practitioners initiative.
- Ensure the viability of existing rural physiotherapy services, this includes redirecting the Workforce Incentive Program.
- Develop integrated care models to increase access and address local needs.
Policy advice
Analysis and response
- Overall, the APA is disappointed in the lack of investment in rural health in this year’s budget.
- Specifically, the APA are frustrated there were no initiatives for physiotherapy, or allied health more broadly. Improvements in rural health outcomes cannot be achieved without investment in team-based care initiatives. Opportunities to leverage the full health workforce to their full scope of practice and bringing the required system enablers to drive better use of team-base care were clearly missed.
- PHNs are positioned to support team-based care to address their community’s need. The APA is disappointed in the lack of national funding to allow PHNs to fund allied health to address unmet needs.
- This budget provided the opportunity to reassess current rural workforce polices. An opportunity which has been missed and will result in an ongoing maldistribution of the physiotherapy workforce.
- Capping the HELP indexation rate will be a welcome relief for many physiotherapists. The APA is calling for further HELP debt relief to support the physiotherapy workforce in areas of need, such as those who work in rural and remote areas.
Call to action
- The APA's strength is in its membership and the APA calls for members to get behind its campaigns as it continues to advocate for measures that place the patient at the centre to drive better musculoskeletal health through equitable and early access to physiotherapy.
- Get behind the APA's Scope of Practice Review submission as allowing physiotherapists to work to their full scope of practice will support rural areas.
Women's health
The APA advocates for reform that provides targeted Medicare funding to increase access to women’s pelvic health physiotherapy across the lifespan when and where they need it, including pre-and postpartum, during perimenopause and menopause and to address pelvic pain.
Strengthening Medicare
The Australian Government will provide $8.5 billion in health which includes an investment of $3 billion to strengthen the Medicare system as part of its strengthening Medicare reform package.
Specific measures include:
- $49.1 million over four years from 2024-25 for gynaecology consultations of 45 minutes or longer with patients who have complex conditions such as endometriosis and pelvic pain.
- $56.5 million over four years from 2024-25 to promote high-quality and tailored maternity care by implementing recommendations from the MBS Review Taskforce, for participating midwives.
- $23.1 million over two years from 2024-25 to extend the MBS Continuous Review program to ensure the MBS remains clinically appropriate including the appropriateness of a number of MBS items to ensure that they support equitable and affordable access for Australian women.
- Telehealth services by general practitioners and prescribed medical practitioners specifically for blood borne virus and sexual and reproductive health services will transition from temporary to permanent MBS items from 1 July 2024.
- Telehealth services for sexual and reproductive health to address unmet clinical need, support vulnerable populations and enable access to time-critical treatment such as medical termination.
There are some welcomed measures that see an expansion of Medicare coverage for priority populations, including in women’s health, specifically for those suffering from endometriosis and complex gynaecological conditions.
The $49.1 million investment for longer specialist consultations and the investment in midwifery are positive steps but have failed to bridge the care gap in addressing pain which often depends on access to pelvic health physiotherapy services.
Women’s health package
The Federal Government will provide $56.1 million over four years from 2024-25 (and $0.4 million per year ongoing) to improve access to sexual and reproductive healthcare for women in Australia across the life-course, including support for women’s health services on miscarriages, pre-term or early-term births, stillbirths, early pregnancy and menopause. This measure was informed by the National Women’s Health Strategy 2020–2030, Working for Women: A Strategy for Gender Equality and the Commonwealth’s #EndGenderBias survey.
Specific measures include:
- $1.2 million over two years to support placements for health practitioners to enrol in the professional development accredited course, Managing Menopause.
- $8.0 million over three years from 2024-25 to support the development of datasets on miscarriages and sexual and reproductive health, and evaluation activities for early pregnancy assessment services, including $5.5 million over three years for the Australian Institute of Health and Welfare to develop a dataset on sexual and reproductive health.
Updated Medical Research Future Fund 10-year Investment Plan
The Federal Government is allocating $53.6 million over four years from 2024-25 for research into health priorities such as women’s health including menopause, pregnancy loss and infertility.
The APA welcome this significant investment in better understanding the physiological processes causing often-debilitating symptoms in different populations of women, including modelling on the economic, health and social impact of these symptoms in Australia.
APA asks
The APA called for investment in the assessment, prevention and non-surgical management of women’s health conditions including birth trauma and the conditions and symptoms associated with the genitourinary syndrome of menopause.
The APA called for reform to:
- Prevent physical birth trauma by providing expert pelvic health physiotherapy care during pregnancy and postpartum.
- Medicare-funded obstetric pelvic health physiotherapy at five individualised antenatal and postnatal pelvic health physiotherapy consultations to enable antenatal screening and education, prevention and early treatment of physical birth trauma and referral to diagnostic imaging.
- Investment in the assessment, prevention and non-surgical management of physical birth trauma—a systemic reform combining better health outcomes for patients with a reduction in costly surgeries and associated out-of-pocket costs for families and increased productivity and available workforce.
- Modelling on the economic, health and social impact of physical birth trauma in Australia.
- Funding for the Australasian Birth Trauma Association (ABTA) to support those with lived experience of birth trauma and to develop appropriate educational consumer-facing information and necessary materials.
Policy advice
Analysis and response
- The Australian Government is to be congratulated for delivering a budget with women at its centre from a number of perspectives – cost of living, domestic violence, workforce gender equity and health.
- With such a wide-ranging and ambitious agenda, there is a lack of cohesion in some of the wide-ranging suite of measures. From a health perspective this budget can be viewed as laying the foundations for a more comprehensive women’s health care system in the future.
- The APA supports measures to improve access to much-needed, evidence-based care and other supports and welcomes the Women’s Health Package and related MBS reform measures.
- While there are no direct measures improving access to physiotherapy in this budget, it delivers many patient-first initiatives that will make positive impacts on health and quality of life, including for First Nations’ women. These include:
- funded 45-minute consultations for gynaecology for pelvic pain and endometriosis
- a substantial package to increase access to midwives in maternity care
- investment in menopause training for health professionals
- investment in advancing research into women’s health priorities including menopause. - The APA is still awaiting conclusion of commonwealth and state inquiries into birth trauma, menopause and women’s pain and therefore would not expect many measures to pre-empt the findings of these inquiries.
- As such, the APA expect to see Budget 2024-2025 measures built upon to enable referral to multidisciplinary, preventive and non-operative treatment pathways in the future.
- The APA look forward to opportunities to contribute to measures to improve knowledge of multidisciplinary referral pathways among all health care professionals to ensure women have access to existing high-value care such as pelvic health physiotherapy.
- The APA are calling on the government to expand measures to recognise and provide affordable access to pelvic health physiotherapy in pre-and post-partum care, during perimenopause and menopause and to address pelvic pain. The APA are also calling for funded telehealth pelvic health physiotherapy for priority populations and women in rural and remote regional areas.
Call to action
The APA will be ramping up its campaign to improve access to women's pelvic health physiotherapy and need your help. The campaign needs strong patient case studies told by clinicians and women themselves to help amplify the message that women's pelvic health physiotherapy changes lives, families and communities. Please email Policy Department with case studies.
Pain
The APA advocates for reform that funds and prioritises physiotherapy pain management, to enable access to early intervention and primary care for people living with chronic pain and pain-related ill-health.
Initiatives which may assist people living with chronic pain
While the budget did not specifically allocate measures for chronic pain or the musculoskeletal burden of pain, it did include initiatives that build to support these areas. These initiatives target research in preventative health, access to medicines and pelvic pain, all of which contribute to the the promotion of health outcomes for individuals living with chronic pain.
These include:
- $49.1 million over four years from 2024–25 for gynaecology consultations of 45 minutes or longer with patients who have complex conditions such as endometriosis and pelvic pain.
- $480.2 million over five years from 2023–24 to reduce patient costs and improve access to medicines.
- $22.1 million over two years from 2024–25 to continue support for preventive health and chronic disease research including patient and clinician services for Australians with chronic conditions, in support of the National Preventive Health Strategy 2021–2030.
The APA's asks
In the APA's 2024-25 Pre-Budget submission, the APA called for specific physiotherapy measures to promote access to non-pharmaceutical management of chronic pain in primary care settings.
The APA called for targeted action via:
- New chronic disease management item numbers for chronic pain and pain-related prevention and early intervention physiotherapy.
- MBS funded physiotherapy management plan for patients diagnosed with rotator cuff-related shoulder pain to reduce reliance on low value or unnecessary surgical procedures.
- New PHN commissioned models to direct a range of prevention and early intervention services for people at risk of persistent pain.
- An MBS item to provide an alternative pathway for physiotherapy and pain management, reducing opioid dependence by limiting the default towards an ineffective opioid pathway.
Policy advice
Analysis and response
- The APA welcomes the budgetary initiatives intended to improve access to care for people living with chronic pain, such as initiatives which support gynaecology consultations for pelvic pain and medicines for those in need of pharmaceutical management. The APA also support funding for research into preventative health and chronic disease.
- However, the APA is disappointed in the lack of specific funding for musculoskeletal conditions and that there has been none targeted specifically for people diagnosed with chronic pain.
- Opportunities to enable multidisciplinary primary care have been neglected, and there seems to have been no appetite from the government to enable non-pharmaceutical pain management such as physiotherapy.
- The government’s own Medical Services Advisory Committee report into the funding for subacromial decompression surgery found that funding of physiotherapy for patients with subacromial pain, a highly prevalent shoulder pain diagnosis would reduce surgery by 39 per cent and save the government $4,823 per patient. The APA strongly supports funding of a physiotherapy management plan for patients with this highly prevalent, painful condition and again implore the government to operationalise these evidence-based, cost-saving and best practice pathways within primary care by budgetary measures which promote access.
- The APA urge the government to recognise chronic pain as a primary condition in its own right, which requires targeted and earmarked action. The APA advocate for designated chronic disease management item numbers to facilitate the implementation of evidence-based care models in the primary care setting.
- Failure to improve access to physiotherapy means it is available only to those who are able to self-fund care, with those unable to afford care limited to costly and avoidable operative and pharmaceutical options.
- The commitment to reform Medicare into a modern system that provides healthcare beyond drugs and surgery is crucial to truly support and address the chronic disease burden for people living with pain. This could be facilitated by improving access to physiotherapy, rather than forcing patients to pay out-of-pocket for this evidenced-based first-line treatment option.
- PHNs are positioned to support team-based care to address their community’s needs. The APA is disappointed in the lack of national funding to allow PHNs to fund multidisciplinary pain programs.