Finding someone with high expectations of the Federal health budget is about as difficult as scoring a dental appointment in the bush anytime before 2010.

The general view is that if the Government is going to make bold health announcements, it won’t be in this budget. There are still too many outstanding reviews and reports, from the National Health and Hospitals Reform Commission and others.

As one source puts it: “Indications are that they will take major reforms from the papers under development to the next election and continue to try and hold the current arrangements up for the time being. I hope I am wrong.”

Rather than expecting any grand new plans, the most fervent wish around the traps is that the additional $5 billion promised for the Health Infrastructure Fund will be forthcoming, and that plans for a National Prevention Agency are fleshed out.

Meanwhile, the many critics of the multi-billion-dollar public subsidy of private health insurance are hoping that these knife-wielding times will suit them. They are hoping for the introduction of a cap or means testing of the subsidy, at the very least.

In an effort to add a pinch of spice to dull pre-budget deliberations, Crikey has asked an assortment of public health and health policy types for the sort of budget announcements they’d like to hear next week.

You can read their comments in full at Croakey, but here is a sampling:

  • Pay pharmacists less for dispensing prescriptions, take action to limit overcharging by doctors, and tackle pharmaceutical pricing. Mr Robert Wells, Director Menzies Centre for Health Policy, ANU (clearly a brave man — why upset only one lot of power-brokers at a time…)
  • Reduce the costs of pathology and imaging services, and fees for procedural doctors. Professor Peter Brooks, Executive Dean, Health Sciences, University of Queensland (another one who’s not afraid to speak truth to power…)
  • Increase tobacco taxes and move towards volumetric taxation of alcohol, with a special emphasis on the products that are targeted to kids and at-risk drinkers. Professor Mike Daube, president, Public Health Association.
  • A costed long-term strategy for closing the gap in Aboriginal health. “What has been announced so far is pathetic.” Health economist Professor Gavin Mooney.
  • Capital and recurrent funding for multi-disciplinary community health centres with salaried medical and other health professional staff (instead of super clinics). Fran Baum, professor of public health, Flinders University.
  • A national centre for disease prevention and healthy living funded by Treasury and run through the office of PM&C. Professor Glenn Salkeld, University of Sydney.

The storyline that links these seemingly disparate suggestions belongs to Robin Hood. Helping the poor (whether in community health, prevention or remote Australia) necessarily means robbing from the rich and powerful (for which, read the high-profit end of health).

This requires a major shakeup of the current incentives and disincentives that drive the system, not simply a tinkering at the edges — as is likely with the proposed changes to the safety net for specialists’ fees. The safety net has been a shining example of how a policy intended to increase equity has actually had the opposite effect, by entrenching the privileged position of specialists. So much for all the rhetoric about the need to strengthen primary care.

For those who prefer a more contemporary tale to Mr Hood’s, there’s the “Biggest Loser” approach.

First, consider who deserves to be the biggest loser in cost-cutting times like these, and then vote on who will actually end up as the biggest losers.

If history is any guide, Salkeld’s entry is likely to be on the money.

In the first category for deserving losers, he nominates: “Services/procedures/drugs that provide no gain (health) for a lot of pain (cost)”.

And in the second category for those likely to end up the actual losers: “Ironically and perhaps sadly I think the losers will be average folk trying to cope with chronic disease, and/or who have a family member with a disability and/or who live in wrong post code that find access to help, services and support so hard to find. In hard financial times it is so often those who have the least who are asked to sacrifice so much.

“On this I would be delighted to be proved completely wrong!”

Maybe we will all be proven wrong, and the budget will help usher in a new, fairer era in health. And maybe those who have the most to gain from dental care will be able to find the appointments they need, at a price they can afford.Finding someone with high expectations of the Federal health budget is about as difficult as scoring a dental appointment in the bush anytime before 2010.