The Lancet, Volume 373, Issue 9677, Page 1736, 23 May 2009

Nicola Roxon—Australia’s Minister for Health and Ageing—has taken some pioneering steps in announcing the country’s health budget. Midwives in Australia will, from 2010, be able to prescribe subsidised drugs and bill their services to Medicare, the nation’s health safety net. Nurse practitioners will also be granted further prescribing rights and Medicare access. These changes represent a big step towards reducing the now blurred boundaries between doctors and nurses. Diversifying the workforce and getting better value for money can only, argues Roxon, improve patient care. Other winners in the budget include rural health, with funding to attract doctors extended to 500 additional remote communities. Maximum retention bonuses for doctors in the most remote locations will be nearly doubled. And Indigenous health services will receive a AUD$200 million (US$151 million) boost, to help close the health inequity gap.

The budget has been criticised by the Australian Medical Association (AMA) President, Rosanna Capolingua, who says that more prescribing powers for nurses could be costly and ineff ective. The AMA also attacks the lack of provision for the unemployed. Rising unemployment could, it says, cause people to drop private health cover and turn to the overburdened public hospital system. More affl uent families have seen their private health insurance rebates cut. Medicare rebates off ered to private obstetricians have been reduced. And perhaps the least popular measure is to reduce rebates for fertility (IVF) treatment, with concerns that women will attempt more multiple embryo implantations to reduce their out-ofpocket expenses—leading to more multiple pregnancies 
with the risks they entail.

Roxon has shown her mettle in expanding the role of midwives and nurses, which will cost AUD$126 million (US$95 million) over 4 years. She may not win many popularity contests with doctors after these changes. But with this budget, the Australian Government has shown its genuine commitment to real change.