The Health Wrap: RIP copayment; choice vs culture; future proofing research infrastructure; on matters of evidence

By Kellie Bisset

RIP copayment

As Prime Minister Tony Abbott ended ongoing criticisms of the government’s GP copayment proposal by  declaring it “dead, buried and cremated”, health groups warned that the sting might just be in the tail. A Medicare rebate freeze until 2018 might save $1.3 billion but it would have negative consequences they said, including increasing out-of-pocket costs for patients as GPs were forced to increase their fees to keep pace with inflation.

Health Minister Susan Ley said the government had listened to the people who had made it clear they did not support the reform, the SMH said. And the AFR and ABC reported her flagging other potential funding models such as lump sum payments for doctors covering episodes of care and removing restrictions on bulk billing doctors from charging their own gap payments. The story even made the Wall Street Journal (paywalled).

The SMH reported a Cabinet leak suggesting the PM had made a veiled rebuke of former Health Minister Peter Dutton, saying the copayment issue had been mishandled. But a spokesperson for Mr Abbott’s office said that suggestion was inaccurate.

In the commentary that followed, further discussion was had around whether in fact there really was a Medicare sustainability crisis – a premise used to justify the need for the policy. This piece in The Age says not, arguing that far from being unsustainable, Medicare costs have remained remarkably stable. The Conversation conducted a fact check on the issue, and found that while spending on Medicare had doubled in the past decade as Susan Ley suggests, the message had been framed in such a way that overstated the impression of rising healthcare expenditure because the costs had not been deflated.

Writing for Croakey, Dr Tim Senior said that if anyone wanted to talk about increasing healthcare costs, they need look no further than the cost of private health insurance, for which the government recently approved a 6.2% increase. And this article from Amanda Biggs from the Parliamentary Library, republished on Croakey, looked at the policy implications of introducing private health insurance into primary healthcare.

Terry Barnes, who wrote the thinktank paper that re-ignited the copayment concept, wrote in the SMH that a debate was still needed on Medicare reform but it should be held in a depoliticised framework. Perhaps Croakey could offer a pot of gold for anyone who can make that happen?

For anyone who wants to revisit the chain of events, The Conversation produced this handy timeline. And for a handy dose of irony, try this Reuters story reporting on the French Government’s attempt to increase low-income earners’ access to doctors, but being attacked by elements of the medical profession concerned about the impact it would have on their fees.

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Choice vs culture

Prime Minister Tony Abbott’s comments this week around the merits of funding services for Indigenous Australians who made the “lifestyle choice” of living in remote communities caused much discussion and attracted strong criticism.

Croakey’s compilation of coverage included statements from a number of key bodies, including NACCHO, whose chairperson Matthew Cooke said : “Time and again we see evidence showing that when you remove Aboriginal people from their land, they lose their sense of identity which has profound impacts on their health and wellbeing.”

And this from Public Health Association of Australia CEO Michael Moore: “If governments are seeking to save money by closing remote communities they are wrong.  The legacy of ill-health and social problems will be vastly more expensive to deal with than the current costs of providing vital services.”

Writing in The Age, Pat Dodson said the remarks meant the PM “didn’t get it” and highlighted the critical need for “Aboriginal values, priorities and concerns to be better understood by the whole nation, and by our leaders in particular”.

Fred Chaney, former Fraser Government Minister for Aboriginal Affairs, was quoted in The Australian (paywalled) as saying that taking Aboriginal people off country in the 1960s was socially catastrophic and the government could not wipe its hands of responsibility in policies like these.

The Government’s chief adviser on Indigenous Affairs, Warren Mundine, said it was wrong to equate thousands of years of connection to the land with a ‘sea change’ or retirement move.

On RN Drive, Cape York Indigenous leader Noel Pearson said the comments lacked historical perspective and reflected the ‘dismal’ state of national Indigenous policy. And Croakey coordinator Melissa Sweet called on researchers to document the health impacts of chaos in Indigenous affairs policy, which she said was impacting the wellbeing of individuals and communities. Concerns about the process and outcomes of the Indigenous Advancement Strategy led to a Twitter hashtag #IASLottery.

WA Premier Colin Barnett, whose government plans to close up to 150 of WA’s 274 remote Indigenous communities following a federal government announcement it would remove funding from essential services, said he believed the PM was committed to Indigenous issues even though the choice of words was “unfortunate”.

Christopher Pyne defended the PM, saying in The Australian (paywalled) that the calls for him to apologise were “hysterical”.

The University of SA’s Professor Peter Buckskin said Aboriginal identity was so closely connected to the land that a policy of forced removal would see an increase in mental illness within Indigenous communities.

This SMH editorial said the ‘lifestyle choices’ comment could also apply to white people living on remote farms who also demanded community services, and the West Australian argued that while it was not a lifestyle choice to wish to continue a tradition which for some stretches back tens of thousands of years, governments did in fact, “currently subsidise all manner of lifestyle choices, mostly in cities, including education, health and sports facilities, libraries, arts activities and public transport”.

A piece in The Conversation argued that using the term ‘lifestyle choice’ was a common tactic of governments when they wanted to distance themselves from funding responsibilities – a recent and obvious example being the important public health issues of obesity and chronic disease.

On other important Indigenous health issues, Croakey covered the launch of the Lowitja Institute’s ‘Recognise health’ initiative, a project that supports constitutional recognition as a pathway to better health and wellbeing for Aboriginal people. The initiative, which has the support of Australia’s leading medical groups, was also covered by the ABC here.

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Future proofing research infrastructure

Scientists and academics came out swinging this past fortnight on the potential for Australia to lose critical research infrastructure if the future of funding for the National ­Collaborative Research Infrastructure Strategy (NCRIS) remained tied to the fate of the Government’s higher education reform package, which may not pass the Senate.

Vice Chancellors at the Group of Eight Universities took out newspaper advertisements saying a government decision to pull NCRIS funding if the reforms were not passed would be “dumb”. The SMH reported this was the first time the Group of Eight had used paid advertising as a protest since it was formed 16 years ago.

Writing in The Australian (paywalled), Andrew Trounson reported on one of the projects facing an uncertain future – a new migraine treatment being produced by researchers at the Institute of Health and Biomedical Innovation at QUT.

And in The Conversation, The ANU’s Professor Brian Schmidt wrote that just as roads, bridges and rail were critical infrastructure that underpinned Australia’s development, research infrastructure was just as critical to the nation’s economy, as it underpinned our scientific research and development. Examples included telescopes, leading edge imaging devices and the integrated marine observing system.

Another example, funded by NCRIS and developed by the Sax Institute, is the Secure Unified Research Environment (SURE), which allows sensitive human data to be used in linked data research projects without compromising privacy. SURE works as a remote computing environment for researchers – who can access this sensitive data securely from anywhere in the world without having to store it on their own devices. The technology provides a way to capture Australia’s untapped potential to answer important research questions using ‘big science’ while simultaneously addressing the critically important issue of data privacy and security.

On matters of evidence

Homoeopathy doesn’t work, says the NHMRC – its final word on the issue after a fair amount of deliberation. The recently released statement received widespread coverage across Australia and internationally. Writing in The Australian (paywalled), Sean Parnell said taxpayers continued to fund the cost of the treatment but Health Minister Susan Ley said it wasn’t a simple matter to turn off the tap for a single treatment and broader considerations had to be taken into account. 

In other evidence news, this UK article looked at the impact of spending cuts that aren’t based on evidence, and this piece from the European Public Health Alliance said the principle of using science advice in health policy was still “a work in progress”.

A paper in the New England Journal of Medicine found that the vast majority of clinical trials have failed to find their way onto the main US federal registry Clinicaltrials.gov within a year of completion – as required by law. And this alarming article from Dr Justin Coleman on Croakey looked at the level of research misconduct that is detected but goes largely unreported and manages to find its way into the scientific literature.

Experts have warned the public about a new book by a celebrity chef, a blogger and a naturopath promoting a paleo diet for babies that promotes a DIY baby milk formula made from liver and bone broth with 10 times the maximum recommended daily intake of vitamin A for babies. The release of the book has been delayed. A temporary victory for evidence?

“In my view, there’s a very real possibility that a baby may die if this book goes ahead,” Public Health Association of Australia President Heather Yeatman told the Women’s Weekly.

Apple’s new foray into medical research, with its new ResearchKit software platform, which gathers information from users that can be fed into medical research studies, has raised concerns among privacy advocates. On Croakey, Michelle Hughes wrote the move could be a game changer for research. Stanford researchers found 11,000 people had signed up to their study in a 24-hour period. This piece on the Mayo Clinic’s Social Media Health Network blog says the software will change research in ways we haven’t even thought of yet.

Apple also released it’s smartwatch, and while much has been written on this latest piece of technology, this article in Forbes said the device might have an unexpected health benefit – getting its wearers to stand up more. On the issue of standing vs sitting, the SMH’s Daisy Dumas looked at the growing body of evidence around the perils of too much time spent sitting. And a new study to be presented at American College of Cardiology (ACC) 2015 Scientific Sessions found each added hour spent sitting was associated with a 14% increase in coronary artery calcium score.

What can data tell us about the way we use and design health systems? A lot, writes Dr Lesley Russell, if only we could make more and better use of it. Croakey featured recent work by Dr Russell that analysed publicly available data on Medicare obstetric services and costs. Rosie Williams furthers this theme with her Croakey piece on the brave new world of open data and all of the benefits it can hold for a country and its citizens.

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A spoonful of sugar

The WHO released its guideline on sugar consumption this fortnight recommending that adults and children reduce their daily intake of added sugars to less than 10% of their total energy intake. The Heart Foundation’s Sam Byfield covers the issue for Croakey here.

Burger King can see the writing on the wall it seems, quietly dropping soft drinks from its children’s menu and following similar moves from rivals McDonalds and Wendys, The Guardian reported. Another Guardian article claimed that taxing sugary drinks could save the NHS £15 million a year.

Some very interesting new research in PLoS Medicine shows that the sugar industry in the US influenced the National Institute of Health’s attempts to reduce dental cavities up to 50 years ago. USA Today reported on the study, which relied on internal industry documents to show “the industry knew sugar caused tooth decay as early as 1950 but pushed government researchers to focus on prevention strategies other than reducing sugar consumption”.

“The industry funded research on enzymes to break up dental plaque and vaccines against tooth decay as a way to deflect attention from the simpler strategy of telling Americans to cut back on sugary drinks and snacks,” the article said.

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A word for women

Vascular surgeon Dr Gabrielle McMullin sparked heated debate with her comments that it was safer for women surgical trainees to comply with requests for sex from their senior male colleagues than make a claim for sexual harassment if they wanted to protect their careers.

The Royal Australasian College of Surgeons criticised the comments and has since established an expert advisory group to deal with concerns of bullying, harassment and discrimination in the health sector, Medical Observer reported. And AMA president Dr Brian Owler wrote to AMA members urging them to speak up if they had experienced sexual harrassment.

Dr Caroline Tan spoke out about her experience in the wake of Dr McMullin’s comments and said the College should create an independent body to hear complaints about misconduct.

“This not going away. They need to face the music. I’m sure that’s going to be uncomfortable for them, but it’s going to be for the better,”  Dr Tan told The Age.

According to the UN, violence against women and girls “persists at alarmingly high levels”. The New York Times reported that more than one in three women worldwide said they had experienced physical violence in their lifetime, and one in 10 girls under 18 was forced to have sex.

The Conversation reported that one in six Australian women experienced physical or sexual violence by someone they know at some point in their adult life. Kathleen Baird and Deborah K Creedy from Griffith University wrote that midwives were ideally placed to identify women at risk of violence given that more than 300,000 women sought antenatal care in Australia each year.

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Other Croakey reading you may have missed this fortnight

• FactCheck: can you change a violent drinking culture by changing how people drink?
• Organ donation numbers suggest time for change
• Dental Care in Australia: We truly live on a very uneven continent
• Measuring what matters: the consumer experience of health care

You can read previous Health Wraps here. Got an idea for The Health Wrap? Contact me on Twitter @medicalmedia.

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.