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The Health Wrap: A big Budget wrap; a global shared challenge; reframing Indigenous health conversations

 

By Kellie Bisset

 

A big Budget wrap

Budget night has come and gone but the impact is still reverberating. There has been much written already about the potential effects of some of the budget measures and no doubt there will be more, as protests take place across the country, and unhappy state and territory leaders meet to discuss how they will manage their funding shortfall and the Government grapples with getting some of its more controversial measures through the Senate.

The measures that have attracted the most attention are the $20 billion Medical Research Future Fund (with questions raised about both the sources of this funding from healthcare cuts, as well as what appears to be its narrow focus), savings from axing the National Partnerships Agreement and National Health Reform Agreement with the states, revising the public hospitals funding arrangements, the introduction of a $7 GP co-payment and increased Pharmaceutical Benefits Scheme co-payments.

Croakey has covered the budget extensively, and also summarised Health Minister Peter Dutton’s post budget speech, in which he said individuals needed to take more responsibility for their own health, and state and territories must take more responsibility for managing their health budgets. The SMH quotes the Minister saying the payment will improve patient outcomes. However, he hasn’t ruled out negotiating to appease the Senate, according to the Australian Financial Review.

At least two grassroots campaigns are opposing the $7 co-payment. The #CoPayNoWay campaign has the backing of the Royal Australian College of General Practitioners, Medical Observer reports, while the CoPayStories website aims to document stories from patients, carers, health professionals and others of the impact of co-payments. The AMA is also opposed to the co-payment – see the Australian Financial Review’s interview with President Steve Hambleton here

Meanwhile, Labor and the minor parties are lining up to oppose the co-payment in the Senate. Opposition Leader Bill Shorten says the measures are akin to a two-tier US system “where your wealth determines your health”.

And the ABC reports that state and territory leaders are holding an emergency meeting in NSW Premier Mike Baird’s office today to discuss their response to the Budget cuts. NSW Health Minister Jillian Skinner told the ABC the government had made “an admission they are sending patients to the emergency department” by introducing a co-payment and telling the States they could charge for GP-like attendances if they wished.

There is evidence from the US to support the argument that charging a GP co-payment will result in extra costs to the states down the track via the hospital system, writes Martyn Goddard for Croakey. He says these measures, designed to make the system more sustainable, will actually make it less so.

Much of the Budget criticism has centred on the impact the changes will have on those with the least capacity to pay. Professor Sharon Friel says the Budget measures – including education changes, will worsen health inequities; Professor Fran Baum concurs. Jennifer Doggett also outlines some equity issues and this compilation of reactions gives a good overview of how people in the health sector responded. Croakey’s wrap of reactions from the health Twittersphere is also worth a read.

Many have raised concerns about paying for the Medical Research Future Fund with cuts to Medicare, PBS and hospital payments, including Professor Fiona Stanley, who described the situation as unpalatable. And Croakey co-ordinator Melissa Sweet asks why some in the medical research sector have ignored the elephant in the room.

Pharmacist academic Lindy Swain writes about how rural areas will be particularly affected by the cuts. And Indigenous patients will be particularly hard hit by the co-payment, says the National Congress of Australia’s First Peoples, which will have its funding removed by July as part of Budget savings measures. And while NACCHO welcomed the quarantining of Aboriginal Community Controlled Health Organisations from Budget cuts, it also raised concerns about the impact the co-payment would have on Indigenous Australians’ access to healthcare. Canberra University Chancellor Dr Tom Calma went further, saying the co-payment should be waived until Indigenous Australians achieved health equity.

A level of uncertainty over the cuts earmarked for Indigenous health programs over the next five years is causing anxiety, the ABC reports. The Government will make savings of about $550 million by rationalising Indigenous programs, including health, but the full detail is yet to emerge. This article in The Guardian points out that at the same time as  Aboriginal legal aid funding has been cut, $54 million has been earmarked for boosting police infrastructure in remote communities.

The Grattan Institute’s Professor Stephen Duckett has written a number of analyses pre and post Budget, including this in-depth look at the recent history of hospital financing and the likely ramifications of turfing out recent reforms. An overview from Duckett and other health experts originally published in The Conversation also gives a good summary.

The merger of the Australian Institute of Health and Welfare (AIHW) Australian Commission on Safety and Quality in Health Care, Independent Hospitals Pricing Authority, National Health Funding Body, National Health Funding Pool Administrator and National Health Performance Authority into a newly created Health Productivity and Performance Commission, had been flagged previously.

This Croakey longread from anonymous health policy analyst ‘William Foggin’ looks at the implications of this and other cuts such as disbanding General Practice Education and Training. And Australian Ageing Agenda ran this article about fears for data quality as a result of the merger. And of course, the Australian National Preventive Health Agency (ANPHA) has been abolished as predicted. This piece from Professor Stephen Leeder was written before the Budget, and explains why ANPHA was a good idea.

***

Commission of Audit – a lifetime ago?

In the wake of the Budget news blitz, coverage of the National Commission of Audit report seems like a world away. And while the last Health Wrap covered the report’s release, there have been several Croakey posts since then if you’d like to catch up on some reading.

And of course, many of the views expressed remain relevant to the budget debate we continue to have. Dr Andrew Weatherall writes that the CoA lost the plot on health; these three views from Dr Tim Woodruff, Martyn Goddard and Dr David Briggs cover various issues raised in the report, but include some particularly interesting comments about co-payments.

Professor Stephen Duckett looks at the evidence around co-payments, and Sebastian Rosenberg from Sydney’s Brain and Mind Research Institute writes that the proposals on mental health and homelessness are without context and understanding.

Chairman of the Australian Medicare Locals Alliance Dr Arn Sprogis, contends that the CoA has its head in the sand about primary care and its potential to keep the entire system healthy. And Professor Jim Hyde, from Deakin University laments a lack of evidence to underpin the report’s recommendations on health.

A combined response to the report from bodies such as the Public Health Association of Australia and the Australian Healthcare Reform Alliance can be found at this Croakey post. There is also a detailed statement from the National Congress of Australia’s First Peoples, which expresses deep concern over what it describes as a focus on cost at the expense of people. And anonymous health policy analyst ‘William Foggin’ focuses on the likely impact on private health insurance proposals.

***

Public health is a global shared challenge

Many of the health issues being debated as a result of the Federal Budget also feature heavily on the international stage.

Central to the discussion we’re having about the value of prevention and early intervention, versus dealing with the expensive consequences of unchecked disease and poor health, is a US paper recently published in the journal Science on latest findings from the long-term Carolina Abecedarian Project. It found that high-quality early childhood programs can have long-lasting adult health benefits. This article in the Stevens Point journal gives a good summary of the issue.

In China, health authorities are also grappling with issues around healthy behaviours, and have released a six-year plan to promote health literacy. And in India, the Times of India has contributed to the discussion about funding and developing new health technology at the expense of giving access to basic healthcare to those who need it most. Sound familiar?

The UK’s Office of National Statistics has just released figures showing more than 100,000 deaths a year could be avoided by better healthcare and healthier lifestyles.

Back to the US, and there has been significant coverage this past fortnight, of a study showing that the death rate in Massachusetts experiences a significant drop after it adopted mandatory healthcare coverage in 2006. The state’s healthcare model is considered to be the country’s first experiment with universal healthcare coverage and the model for President Barack Obama’s healthcare reforms. This New York Times article says health economists say the Massachusetts model has saved lives. 

And a paper just released from the Henry J. Kaiser Family Foundation has found more than a quarter of women surveyed in a health reform study said cost was the primary reason they delayed or went without healthcare in the months leading up to US Patient Protection and Affordable Care Act being fully implemented to include expanded coverage. This Modern Healthcare story gives an overview.

Meanwhile, at the American Planning Association’s national conference, building healthy communities was a central theme. This American Public Health Association blog post gives an overview of the conference, which featured a ‘Health Day’ to discuss key issues around building healthy environments.

And a development that might interest Croakey readers and contributors is a new aggregated news email designed to reach the global health community. Launched by the Johns Hopkins Bloomberg School of Public Health, Global Health NOW, will be delivered each weekday and summarises news articles and commentaries from around the world. The service is also building an expert network to contribute commentaries and anyone interested can contact Brian Simpson at bsimpso1@jhu.edu.

***

Reframing conversations about Indigenous health 

While much of the focus on Indigenous health this past fortnight has been around the potential impact of the budget (detailed above), there is much else to report.

The first ever #IHMayDay – a national day of Twitter action focusing on Indigenous health – was a great success, trending nationally more than once. Important conversations were had – from the impact of racism on health, to challenging the notion that Aboriginality equals sickness and the importance of a strength-based approach to Indigenous health.

Marie McInerny’s summary of the day shows who the influencers were and highlights some of the exchanges. Kudos to James Cook University nursing academic Dr Lynore Geia who came up with the #IHMayDay idea, and who is already looking at ways to build on the initiative.

Following on from the #IHMayDay discussions around changing the stories told about Aboriginal people, Mikaela Jade and Ruth Mirams wrote this inspiring Croakey post about reframing the conversation around closing the gap.

“If we let people define the health problems in our communities as ‘Indigenous problems’, we let them put us in a box, and we don’t hold them to account for the difference in health outcomes between Indigenous and non-Indigenous Australians,” they write. They talk about four transformative questions that have an important role to play in taking a new approach to closing the gap.

On the subject of framing conversations, this Croakey post by Summer May Finlay looks at media portrayal of Indigenous people. For example there is  little acknowledgement in the media, she says, that more Aboriginal and Torres Strait Islander people abstain from alcohol (37%) than other Australians.

“The way Aboriginal and Torres Strait Islander people are portrayed in the media has a very real impact on their lives. The media often relies on stereotyping which can lead to racism,” she writes. “Racism has links to poorer health outcomes for Aboriginal and Torres Strait Islander people.”

The Australian Institute of Health and Welfare (AIHW) released the first report on National Key Performance Indicators for Aboriginal and Torres Strait Islander primary healthcare. The purpose of the national KPIs is to support continuous quality improvement and ultimately improve the delivery of healthcare services. The report says improvements have occurred across most of the indicators and the data will give service providers insight into guide their quality improvement activities.

Research published in the MJA meanwhile, says that culturally appropriate screening tools are essential to address concerning dementia rates among Indigenous populations, which are more affected by dementia than non-Indigenous people.

***

Infectious disease: threats new and old

In only the second time since the introduction of rules allowing the WHO to declare a global health emergency, the organisation has issued just such a declaration on the re-emergence of polio. This New York Times article says that despite being close to eradication two years ago after a 25-year campaign that vaccinated billions, several countries have allowed the disease to spread and extraordinary measures are needed to stop it.

While closely monitoring Middle East Respiratory Syndrome (MERS), which is attracting international headlines, the WHO says it is not yet a public health emergency. The SARS-like virus seems to be more prevalent in hospitals than in the community but the WHO is still taking the increasing number of cases very seriously, CBC News reports.

The WHO is facing a decision in coming weeks about whether to destroy the last living samples of the virus that causes Smallpox. This interesting article on Smithsonian.com looks at the issues, including the view of some researchers that we don’t yet know enough about the disease to protect ourselves from future outbreaks should the disease re-emerge.

On to pertussis, and a large study presented at the Pediatric Academic Societies meeting in Vancouver has found that vaccination rates did not rise during a pertussis outbreak in Washington State between 2011 and 2012. The results are discouraging for public health experts who might hope that disease outbreaks could spur non-vaccinating parents into action, writes HealthDay.

The last word in this week’s Health Wrap goes to a study in PLOS ONE by US anthropologist Sharon DeWitte, which looked at how the medieval bubonic plague has shaped public health. Her study suggests that people who survived the Black Death lived longer and were healthier than those who lived before the 1347 epidemic.

“Knowing how strongly diseases can actually shape human biology can give us tools to work with in the future to understand disease and how it might affect us,” she said in a statement.

***

Other Croakey reading you may have missed this fortnight:

Do you have something you’d like to see highlighted on The Health Wrap? Contact us on Twitter @medicalmedia or @FrancesGilham.

You can find previous editions of the Health Wrap here.

* Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.

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