Objective

To enhance Medicare-supported services in the Spence electorate by boosting funding for general practitioners (GPs), mental health professionals, autism-specific supports, paediatric psychology, and palliative care. This initiative aims to ensure equitable, affordable access to high-quality healthcare, reduce out of pocket costs for individuals and families, and address critical service gaps, particularly for neurodivergent individuals and those requiring end-of-life support.

Scope

This policy focuses on the Spence electorate in South Australia (population ~130,000), encompassing urban, suburban, and semi-rural communities. It supports a broad range of healthcare

services, including:

• General practitioners (GPs) and mental health providers, both public and private, including psychologists, psychiatrists, mental health nurses, and social workers.
• Autism-specific services such as diagnostic assessment centres and coaching or early intervention programs.
• Paediatric psychology services, addressing the mental health and developmental needs of children.
• Enhanced palliative care accessibility through integrated in-home and telehealth pathways, reducing service gaps and supporting family-based care.

Policy Components

1. Enhanced Medicare Funding for Providers

• Bulk Billing Incentive Increase: Triple the existing Medicare bulk billing incentives for GPs, mental health providers, and pediatric psychologists in Spence who commit to bulk billing at least 80% of patients.
• Mental Health and Autism Rebates: Introduce tiered Medicare rebates for mental health and autism-related services, with a 20% uplift for providers in Spence. Include higher rebates for extended consultations (60+ minutes) for complex mental health and autism assessments.
• Service Establishment Grants: Provide one-time grants of up to $50,000 for new or expanding private practices, public clinics, autism assessment centers, and palliative care providers in Spence to cover setup costs (e.g., equipment, staffing, premises).

2. Service Establishment and Expansion

• Medicare Urgent Care Clinics (MUCCs): Establish two fully bulk-billed MUCCs within the Spence electorate. These clinics will be staffed by GPs, mental health professionals, and paediatric psychologists, with referral pathways to autism services and palliative care. Estimated cost: $5 million over three years.
• Head to Health Centre: Establish a Medicare Mental Health Centre in Spence, incorporating paediatric psychology and autism behavior coaching programs. Estimated cost: $3 million for establishment, $1.5 million annually for operations.
• Mobile Mental Health Units: Deploy two mobile units staffed by mental health nurses, social workers, and autism coaches to reach semi-rural areas, integrated with telehealth capabilities for palliative care consultations. Estimated cost: $1 million initial investment, $500,000 annually.
• Autism Assessment and Support Hubs:
  • Establish two dedicated autism assessment centers in Spence, staffed by multidisciplinary teams (psychologists, speech pathologists, occupational therapists) to reduce wait times for diagnosis (currently 6-18 months in many regions).
  • Offer autism and behavior coaching programs for parents and caregivers, including group workshops and one-on-one sessions to support behavior management and skill development.
  • Estimated cost: $2 million for establishment, $1 million annually for operations.
• Paediatric Psychology Services:
  • Integrate pediatric psychologists into MUCCs, the Head to Health Centre, and autism hubs to provide tailored mental health support for children, including those with autism or developmental challenges.
  • Estimated cost: $500,000 annually for staffing and training.
• In-Home and Telehealth Palliative Care:
  • Fund in-home palliative care services delivered by nurses, GPs, and social workers, with a focus on patient comfort and family support.
  • Develop a telehealth palliative care platform for Spence, offering 24/7 virtual consultations with palliative care specialists, counselors, and pain management experts.
  • Estimated cost: $1.5 million for establishment, $1 million annually for operations.

3. Workforce Support

• Training Incentives: Provide annual subsidies of $10,000 per year for GPs, mental health providers, paediatric, psychologists, and autism specialists in Spence who undertake additional approved professional development in key areas such as trauma informed care, youth and adolescent mental health, autism assessment, suicide prevention, palliative care and culturally responsive practice.
• Recruitment Bonuses: Introduce a $20,000 sign-on bonus for GPs, mental health professionals, autism specialists, and palliative care providers who commit to practicing in Spence for a minimum of three years.
• Specialist Retention Program: Offer annual retention bonuses of $5,000 for autism assessors and palliative care nurses to address workforce shortages.

4. Funding Sources

To ensure long-term viability, this policy will draw from a blend of federal health funding streams and strategic reallocations focused on maximising impact without creating unnecessary burden on average taxpayers:

• Reallocation of Existing Health Budget: Redirect $12 million annually from the existing federal health budget ($146.1 billion in 2024-25), prioritising Spence as a priority region due to its documented socioeconomic disadvantage, autism prevalence, and palliative care demand data.
• Pharmaceutical Benefits Scheme (PBS) Savings: Utilize $6 million annually from PBS savings (e.g., $4.3 billion committed in 2024-25) to fund autism and palliative care initiatives.
• National Health Reform Agreement (NHRA): Increase Spence’s allocation of federal contribution to public hospitals in South Australia set to rise by 45% from 2025-2030. $4 million annually will be earmarked specifically for autism hubs, paediatric psychology, and palliative care integration.
• Federal Mental Health and NDIS Block Grants: Allocate $3 million annually from federal Mental Health and National Disability Insurance Scheme (NDIS) block grants to South Australia, with the funding ring-fenced for autism and paediatric psychology services in Spence.
• Medicare Levy Surcharge Adjustment: Introduce a 0.15% increase to the Medicare Levy Surcharge for high-income earners (earning over $180,000). This adjustment is projected to generate approximately $75 million nationally, with $7 million earmarked for health and mental health initiatives in Spence over five years.
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• Palliative Care Innovation Fund: Invest $5 million nationally to enhance in-home and telehealth palliative care, with $1 million directed to Spence each year to improve end-of-life outcomes, funded through Aged Care Reform underspend.

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5. Implementation Plan

• Year 1 (2025-2026):
  • Launch MUCCs, Head to Health Centre, and autism assessment hubs.
  • Begin in-home palliative care services and telehealth platform development.
  • Distribute establishment grants, recruitment bonuses, and training subsidies.
  • Deploy mobile units with autism and palliative care capabilities.
• Year 2 (2026-2027):
  • Expand autism coaching programs and pediatric psychology services.
  • Evaluate the effectiveness and uptake of bulk billing incentives, autism assessment wait times, and palliative care access.
  • Scale telehealth palliative care services in response to local demand.
• Year 3 (2027-2028):
  • Evaluate health outcomes including reduced autism diagnosis wait times, improved paediatric mental health, and increased satisfaction with palliative care.
  • Ensure long-term funding sustainability through NHRA contributions, NDIS allocations, and targeted innovation grants.

6. Oversight and Evaluation

• Governance: Establish a Spence Healthcare Taskforce, comprising federal and South Australian health officials, local health providers inclusive of autism specialists, paediatric psychologists, and palliative care experts and community stakeholders. This taskforce will oversee rollout, provide strategic guidance, and ensure alignment with local health priorities.
• Performance Metrics: Monitor and publicly report on key indicators, including bulk billing rates, autism diagnosis wait times (target: <3 months), pediatric psychology session uptake, palliative care patient satisfaction, and hospital admission reductions.
• Community Feedback: Conduct biannual surveys and focus groups with Spence residents, particularly families of autistic children and those receiving palliative care needs, to ensure services remain responsive to community needs.

Estimated Costs

• Total Initial Investment (Years 1-3): $33 million ($25 million + $8 million for autism, pediatric psychology, and palliative care).
• Annual Operational Costs (Post-Year 3): $14 million ($10 million + $4 million for new services).
• Funding: Fully covered through federal budget reallocation, PBS savings, NHRA, NDIS grants, minor Medicare Levy Surcharge, and innovation funds, minimizing new large scale federal borrowing.

Community Benefits

• Autism Support:
  • Reduced diagnosis wait times (from 6-18 months to <3 months) enable earlier interventions, improving developmental outcomes for children.
  • Behavior coaching supports parents, easing family stress and fostering greater independence for children.
  • Integrated pediatric psychology services address co-occurring mental health challenges, improving school performance and social development.
• Palliative Care:
  • In-home and telehealth services allow patients to remain in familiar environments, improving quality of life and reducing hospital admissions.
  • 24/7 telehealth access ensures timely pain management and emotional support for families.
• Equity and Access:
  • Bulk billing and mobile units ensure low-income and rural families access specialized care without financial burden.
  • Tailored services address Spence’s diverse needs, including high autism prevalence and aging populations.
• Economic and Social Impact:
  • Reduced healthcare disparities improve workforce participation and strengthen overall community wellbeing.
  • Early autism interventions and palliative care reduce long-term NDIS and hospital costs.

Comparison to Previous Government Approaches

Federal policies from 2013-2023 often relied on fragmented funding for autism (via NDIS) and palliative care (via Aged Care), with minimal integration into Medicare or primary care. Key limitations included:

• Prolonged Autism Diagnosis Delays: NDIS-funded assessments were constrained by workforce shortages and regional inequities, with wait times exceeding 12 months in areas like Spence.
• Underinvestment Palliative Care: In-home and telehealth options received limited funding, leading to over-reliance on hospitals and reducing patient automy.
• Restricted Mental Health Access: Medicare’s Better Access initiative capped psychology sessions, excluding many children and families from ongoing care.
• Centralized Funding Models: Block grants to states lacked electorate-specific targeting, neglecting Spence’s unique needs.

Why This Approach is More Effective:

• Electorate-Specific Targeting: Focusing on Spence ensures responses tailored to its demographic geographic realities, such as a high autism prevalence and limited rural access unlike one-size-fits-all national programs.
• Medicare-Based Integration: Embedding autism, paediatric psychology, and palliative care services within Medicare facilitates seamless access through bulk billing and reduces out-of-pocket costs, avoiding the fragmentation seen under NDIS or private care models.
• Multidisciplinary Hubs: Co-located autism hubs and MUCCs streamline service delivery by integrating diagnosis, coaching, and therapy, offering a more cohesive alternative to disconnected state and NDIS services.
• Innovative Palliative Care: Investment in In-home and telehealth delivery improves access, dignity and patient choice, addressing critical gaps hospital-centric approaches.
• Sustainable, Diversified Funding: This model leverages reallocations, efficiency savings, and modest tax adjustments, offering a more stable funding base compared to short-term grants or one-off initiatives.