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The is an election-year budget. So stakeholders have been pushing their wheelbarrows up the hill to Parliament House to lobby for extra largesse to flow their way.

But while plenty of taxpayers鈥� money was allocated this year to give an ailing government the greatest possible advantage in the upcoming election, health fared poorly.

Although health stakeholders should expect a lean year every now and again, the reform agenda in health is large, and each budget where no progress is made is an opportunity lost.

Small sums for favoured interest groups

A characteristic of all health budgets 鈥� and this one is no exception 鈥� is there are lots of little throwaways for favoured interest groups.

Commonwealth health spending is big: , with aged care spending an additional A$25 billion.

So an extra A$50 million a year 鈥� for programs delivering for psychosis or 鈥� are enough to get headlines, especially when multiplied by four because the spend is over the 鈥渇orward estimates鈥�.

But A$50 million a year is still only an 0.05% increase in funding, colloquially referred to as 鈥渞ats and mice鈥� of the budget.

Announce things you鈥檇 do anyway

Another trick is to announce the ordinary as the extraordinary.

Health Minister of politicising decisions about .

This year鈥檚 budget doesn鈥檛 disappoint. It announced that 鈥� a new life-extending treatment for cystic fibrosis 鈥� has been approved for taxpayer subsidy.

Cue grateful patients and drug manufacturers to explain the wondrous benefits of this generous government.

No thanks to the bureaucrats and advisers who assessed the cost effectiveness of the new drug and back in December 2021.

Nor criticism of the delay between advice to the minister and the approval announcement, a delay which maximised political advantage.

Aged care and mental health

Last year鈥檚 budget was a big one for health, with significant investments in aged care and mental health. In 2021, the government committed more than A$5 billion extra each year to aged care in response to the Royal Commission into Aged Care Quality and Safety, and A$550 million annually for mental health (both amounts are when the initiatives are fully rolled out).

Although the 2021 budget鈥檚 aged care commitment is , it was very welcome and further expansion of services should not have been expected in last night鈥檚 budget.

Last night鈥檚 budget did provide for a to help address contemporary staff shortages in aged care, and to support clinical placements for nursing and other health sciences students in aged care.

But staff shortages will persist until wages are addressed. A significant item of unfinished business is the pending increase in pay for aged care staff .

This will be resolved before the 2023 budget, so the government should have been explicit that it will meet the costs of the increase, and provided an estimate 鈥� even as a range 鈥� as to the expected cost. Unfortunately, there was no mention of this, despite it being for the aged care workforce.

The 2021 mental health initiative is still being implemented, so again, the additional 鈥渞ats and mice鈥� spending here is an unexpected bonus. The 2022 budget includes a raft of 鈥渞ats and mice鈥� initiatives in , , (including A$1.6 million for a youth treatment service in Minister Hunt鈥檚 electorate), mental health support for , and .

But there are still gaps

There鈥檚 plenty of work to do in other areas of health which unfortunately didn鈥檛 attract any attention in this year鈥檚 budget.

In the Grattan Institute鈥檚 pre-election , we argued for a commitment to roll out universal dental coverage. in Australia鈥檚 health system 鈥� an estimated missed out on oral health care in 2020-21 because of cost.

We also called for reform in other areas, such as care by , where people are also missing out on care because of cost.

A short-term funding injection for public hospitals is also needed to help states deal with the care deficit caused by widespread and at the height of the COVID pandemic.

Primary care

The one area where hopes were particularly raised for extra funding in this budget was primary care, especially general practice.

A recent hinted at directions for reform. General practice is under pressure as fewer new medical graduates choose the specialty, preferring higher-paid, narrower specialties.

High out-of-pocket costs for patients when they see is also a cause for concern and should have been addressed in the budget.

General practice reform, including progress on voluntary patient enrolment, is desperately needed and yet this has been put in the too hard 鈥� or maybe too costly 鈥� basket for another year.

Where to next?

Despite the upcoming election, 2022-23 is a standstill year for health and aged care.

The health system adapted well to the pandemic, with innovations such as a pivot to telehealth being implemented remarkably quickly.

These changes need to be embedded and made routine across the health sector 鈥� rural and urban, for hospital outpatients and in primary and specialist care 鈥� and this may require incentives and encouragement, neither of which was forthcoming in the budget.

Australia鈥檚 health-care system is good, but it is not perfect. Evidence of public hospitals being under pressure can be seen in every state, with ambulance ramping and long waits for elective procedures.

The answer is not simply shovelling more money at hospitals, it鈥檚 for the federal government to get its house in order to fix primary care and aged care, areas of its direct responsibility. Fixing both sectors would reduce demand on admissions and beds.

Unfortunately, progress on both sectors was absent in the 2022 budget.

, Honorary Enterprise Professor, School of Population and Global Health, University of Melbourne,

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Image credit: 漏stock.adobe.com/au/RomanR