PBS-like framework for health prevention programs?

Should Australia consider developing a framework like the Pharmaceutical Benefits Scheme (PBS) for health prevention programs to ensure consistent and effective funding?

A new study, providing insights into the allocation of federal government spending on public health initiatives — such as infectious and chronic disease prevention, protection and promotion — suggests so.

Funded by The Australian Prevention Partnership Centre — a research, policy and practice collaboration and Centre of the Sax Institute — the study reports that in 2019–20, only 1.8% of overall health spending, equivalent to $140 per person, was allocated to public health initiatives. The spending varied across states; for example, Victoria spent $110 per person, while the Northern Territory spent $527 per person.

Some variation can probably be explained by differences in responsibilities between states and territories, but a lack of transparency regarding what this money was spent on makes it difficult to draw conclusions, the study authors said.

Lead author Emeritus Professor Alan Shiell, from La Trobe University, said the effectiveness of public health funding is not solely determined by the amount allocated but also by how it is distributed; that is, the channels through which funds flow and the mechanisms used to pay service providers.

“Our research revealed a complex and piecemeal [public health] funding system. The system delegates responsibility for a lot of the funding decisions to the states and territories, which is advantageous as it allows local expertise to identify need. But much of the system is also hidden from view, which makes it difficult to track where the money is being spent or understand its impact,” Shiell said.

How the funding mechanism influences outcomes

The key insight from the work, according to the researchers, is not just about the amount spent on prevention but also about how the funding mechanisms influence outcomes.

Emeritus Professor Penny Hawe, from the Sydney School of Public Health at The University of Sydney, said the way funding is allocated can significantly affect what outcomes are achieved.

“I don’t just mean the difference between allocating to programs with high versus low return on investment. That principle is already well known. I am talking about whether the funding is bundled up and allocated by a population block grant or given over to categorical funding, or separate funding for cancer, alcohol, mental health, etc,” Hawe said.

“Block grants allow more flexibility to address the way problems cluster and the way we know that frontline practitioners ‘multisolve’ in the field and build ‘soft infrastructure’ or the ability for communities to take positive steps with regards to their health.

“Most of us spend our time looking at the behaviours of healthcare providers or at the behaviours of consumers or people in cities, towns, workplaces or schools.

“But funding mechanisms are the missing third lever for health improvement. This is the sixth paper in our series examining various aspects of funding. It’s not just about the amount of funds, but the conditions, timing, decision-latitude and reporting around it that deliver stronger benefits.”

Nadia Mastersson, Head of the Prevention Centre, said, “We hope this study stimulates a crucial conversation about how we can improve public health funding mechanisms in Australia.

“We need to consider how we can better track and allocate these resources to ensure they make a meaningful difference to the health of Australians.”

Re-evaluating funding models

Australia has a well-established system for evaluating investments in medicines through the PBS, said Shiell, noting that it is time a similar framework was developed for prevention programs to ensure consistent and effective funding.

“This was first considered 25 years ago,” he said. “We probably did not have enough data to make good decisions then or the methods required. But we do now.”

The research advocates for re-evaluating public health funding models, proposing a system akin to the PBS for prevention to ensure more consistent and impactful health spending.

Mastersson said there are many critical functions included within the public health system, including food safety, environmental health and infectious disease control, and that chronic disease prevention and health promotion are just one part of what is funded within just 1.8% of the total health system funding.

“Our investment in this study highlights our ongoing commitment to enhancing public health outcomes,” Mastersson said. “By identifying and addressing gaps and inefficiencies in how these funds are allocated, we aim to support more effective and impactful policies and action.”

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