A call for clarity in health policy, recommendations for improving access to hospital in the home, a roadmap to improve the health and mental health of autistic people, and the costs of specialist care – these are among the wide-ranging topics covered in this week’s column.
Meanwhile, the Tasmanian Government is offering $15,000 bonuses for midwives interstate or overseas to work in Lutruwita/Tasmania and is considering a fast-track midwifery qualification.
The Government’s pledge to open another 50 Medicare Urgent Care Clinics (reported briefly here at Croakey) will be covered in more depth in The Zap next week.
The quotable?
The AMA called for ‘the establishment of an independent national health workforce planning agency to ensure Australia’s medical workforce is distributed where it’s needed, improving access to healthcare for all Australians’.
The Rudd Government established just such an agency called Health Workforce Australia (HWA) – but it was abolished by then Health Minister Peter Dutton as part of the horror 2014 Budget.”
Charles Maskell-Knight writes:
The major health news in the week covered by this column was the Government’s announcement on 23 February of a package of health measures including extending eligibility for GP bulkbilling incentives to the whole population – followed shortly by the Opposition adopting the same package.
I have summarised reaction to the announcement from a wide range of health sector groups for Croakey here.
In other significant health news, Minister Mark Butler announced that, “after asking [private health] insurers to resubmit their claims three times, and considering their years of record profits”, he had approved premium increases for private health insurers of an average 3.73 percent to come into effect from 1 April.
The table presenting increases by insurer published by the Department of Health and Aged Care shows that for-profit funds had an average increase of 4.5 percent, while not-for-profits averaged 3.4 percent.
It is still not clear to me why not-for-profit insurers with net assets of over six months’ worth of premium revenue require any premium increase – yet all will be increasing their premiums.
Shadow Treasurer Angus Taylor and Shadow Health Minister Anne Ruston lambasted the Government for pushing up the cost of living with the decision.
Ruston said “it was Labor who cut the private health rebate when last in government, which has had a lasting negative impact on the affordability of private health insurance in Australia”.
While it is true that Labor introduced means testing of the rebate, it was Health Minister Peter Dutton who decided to freeze the income thresholds for the rebate in the 2014 Budget, meaning as incomes increased, more and more people received lower rebates. Indexation of the thresholds only resumed under the Labor Government in 2023.
The insurers’ lobby groups (Private Healthcare Australia and Members Health Fund Alliance) both issued statements defending the increase as below the rate of health inflation.
Members Health also took the opportunity to argue that the Government should restore the standard rate of the private health insurance premium rebate to 30 percent from its current 24.3 percent.
Catholic Health Australia (CHA) drew on the December quarter APRA data on private health insurance to claim that insurers “are keeping more of their soaring profits for themselves”. CHA reiterated its calls for the premium setting process to be carried out by “an independent body such as the Independent Health and Aged Care Pricing Authority (IHACPA), to ensure premium increases accurately reflect the cost of delivering care”.
The Australian Private Hospitals Association (APHA) issued a statement focusing on the maternity services issue, claiming that “hospitals are unable to cover the losses in services like maternity due to low birth rates and more privately insured parents opting for public hospital deliveries, because private hospitals are being short-changed by insurance companies across most services”.
Well over 95 percent of private hospital episodes of care are covered by contracts between insurers and hospitals.
Absent any evidence that insurers are breaching the terms of these contracts (and I am sure any evidence would have been produced by now), the “short-changing” translates into poor contracts negotiated by the hospitals.
Ministers and government
Following the announcement by Healthscope last week that it was closing maternity services at the Hobart Private Hospital due to ongoing staffing difficulties, Minister Butler joined with Tasmanian Health Minister Jacquie Petrusma to announce $6 million in funding “for infrastructure and equipment upgrades in the Tasmanian Health Service and at Calvary Lenah Valley [to] ensure that new mothers get the local care they need at this most important time of their lives”.
Minister Petrusma said at a joint press conference that the Tasmanian Government was addressing staffing issues by measures including:
- $15,000 bonuses for midwives interstate or overseas to work in Tasmania
- scholarships from both the Tasmanian and Federal Governments
- consideration of a fast track midwifery qualification
- part-time employment of student midwives.
She said “we’re pulling out all the levers to ensure that we do have an increased workforce now and into the future”.
CHA welcomed the announcement, while criticising Healthscope for “cherry-picking the work that suits its bottom line and abandoning communities that rely on these vital services”. The RACGP applauded the decision.
Assistant Minister for Health and Aged Care Ged Kearney commented on the Australian Donation and Transplantation Activity Report for 2024, showing 1,328 patients received organs from 527 deceased organ donors.
She said that while the number of organ donors has increased by three percent in 2023, the consent rate for families had decreased by two percentage points to 53 percent.
Kearney urged Australians to register as an organ and tissue donor and tell their families of their wishes.
The Department of Health and Aged Care released the National Roadmap to Improve the Health and Mental Health of Autistic People 2025-2035, saying it “forms the fourth pillar of Australia’s National Autism Strategy 2025–2031”.
The Australian Institute of Health and Welfare (AIHW) released MBS billing data for January, showing that on average Medicare paid 83 percent of GP fees, but only 49 percent of much higher specialist attendance fees.
The AIHW also released monthly GP bulkbilling data and PBS data.
It also released a report on mental health hospital admissions for the decade 2013-14 to 2022-23.
The report showed some massive differences between states in hospitalisation rates.
For example, in 2022-23 in Queensland the rate of admission to private day hospitals with specialist psychiatric care was 121 per 10,000 population, while in SA it was three per 10,000 population.
And it isn’t as if the public sector in SA is making up for the differential: the rate for all hospitals in Queensland was 136 per 10,000 population, compared with eight in SA.
Ahpra released the report of an “independent rapid review” of the use of the title “oral surgeon”, which found that it has not caused serious physical or financial harm or a loss in confidence in the safety of services provided.
Ahpra said that the report recommended a full public consultation on all specialist dental titles to gauge their suitability, and that the Dental Board would be preparing for this to be undertaken in 2025-26.
The Australian Bureau of Statistics (ABS) released data on excess mortality during the COVID-19 pandemic by ‘remoteness areas’ (major cities, inner regional, outer regional, remote, and very remote parts of Australia).
For the four years 2020 to 2023, “for all remoteness areas, the highest excess mortality was in 2022. This ranged from 3.4 percent in outer regional Australia to 13.4 percent in very remote Australia”.
First Nations health
The National Aboriginal Community Controlled Health Organisation (NACCHO) and the RACGP signed their third Memorandum of Understanding (MOU).
NACCHO CEO Pat Turner said the renewed MOU “reinforces our commitment to strengthening healthcare for Aboriginal and Torres Strait Islander people…”.
“[It]highlights the critical role of ACCHOs in delivering culturally safe, comprehensive care. It also underscores the need for genuine cooperation that prioritises equity, self-determination, and the elimination of racism in healthcare,” she said.
Turner said NACCHO looked forward to continuing the partnership with RACGP to “drive systemic change, shape policies, and create healthier communities”.
Consumer and public health groups
The Conversation published an article by Peter Breadon and Wendy Hu from the Grattan Institute on vaccination. They wrote that in the 25 years from 1995 to 2020 the proportion of one-year-olds fully vaccinated increased from a little over half to the 95 percent needed to limit the spread of diseases such as measles.
However, since 2020 the proportion of children who are fully vaccinated has decreased every year, and there are now over 50 communities where one-year-old vaccination rates are below 90 percent.
Some areas in Australia now have lower measles vaccination rates than Gaines county Texas, the seat of an outbreak which has now grown to several hundred cases and claimed one life.
Breadon and Hu set out an agenda for governments to pursue to address the problem, including addressing the three issues of lack of awareness, lack of trust, and inconvenience. They conclude that “if it commits to a bold national plan, Australia can get back to setting records for child vaccination”.
Mental Health Australia (MHA) urged all political parties to commit to free mental health care for everyone under the age of 25. It said “this ambitious move could change the trajectory for mental health in Australia, by investing in accessible care, earlier in life, during the most critical phase of growth and development”.
Trade unions
The Australian College of Midwives (ACM) welcomed the introduction from 1 March of new and updated MBS items for midwifery.
It said that as well as funding midwives to provide postnatal care for “not more than eight weeks” post birth, rather than six, there are new items including:
- a long antenatal appointment up to 90 minutes
- complex care of up to three appointments lasting from 3 hours each that leads to hospital admission
- a final 60-minute postnatal appointment to include mental health and domestic violence screenings and a birth debrief.
The ACM said the number of endorsed midwives able to provide primary maternity care in Australia has doubled in four years to almost 1400, “highlighting the growth in consumer demand for midwifery-led maternity care as well as the appetite from midwives to choose this as a career path”.
The Australian Dental Association and its associated Dental Health Foundation charity invited applications for a number of scholarships, including for First Nations dentistry and dental therapy students.
The AMA called for “the establishment of an independent national health workforce planning agency to ensure Australia’s medical workforce is distributed where it’s needed, improving access to healthcare for all Australians”.
The Rudd Government established just such an agency called Health Workforce Australia (HWA) – but it was abolished by then Health Minister Peter Dutton as part of the horror 2014 Budget.
Its functions were supposed to be taken on by the Department of Health but, as the AMA observed, the Department had too many competing priorities to properly tackle the issue.
AMA President Dr Danielle McMcullen said “the impact of the loss of [HWA] can be seen in the workforce issues we are facing now”.
‘Thorough, evidence-based planning, coordination and policy advice is needed on workforce to ensure the healthcare needs of Australians can be met in the future.”
The AMA also released its annual Public Hospital Report Card.
In her introduction McMullen said there had been some improvements in performance in 2023-24, including in “the percentage of patients triaged as emergency being seen on time; the proportion of category 2 planned surgery patients being seen on time; a drop in the median waiting time for planned surgery; and an increase in the number of public hospital beds available”.
However, in most areas, performance during 2023–24 was markedly worse than it was just five years ago.
Dr McMullen said “while recent investment from the federal government and action to address issues in some states and territories is welcome; the delay to a new National Health Reform Agreement was disappointing’.
“The Federal Government’s promised investment, originally estimated at $13 billion, into our public hospitals is little more than a nice idea if states and territories fail to reach an agreement with the federal government”.
The Pharmaceutical Society of Australia welcomed the ACT Government’s decision to allow more community pharmacies in the ACT to offer treatment for urinary tract infections (UTIs) and re-supply the oral contraceptive pill, following a trial of the expanded scope of practice.
The RACGP joined with Advanced Pharmacy Australia (AdPha) to release a jointly developed Transitions of Care resource kit for doctors, pharmacists and patients.
AdPha President Tom Simpson said “research shows medication-related adverse events occur in approximately 20 percent of patients following discharge, two-thirds of which are considered preventable”.
He said the new resource kit would “promote continuity of care, optimise medication management, and reduce the risk of medication-related issues”.
Industry groups
Ageing Australia (the lobby group for aged care providers) released its position statement on hospital in the home (HITH), arguing for:
- making HITH available at every residential aged care facility
- developing an interface with in-home aged care providers
- exploring the possibility of extending HITH into retirement living
- requiring private health insurers to pay default benefits for HITH care.
PHA issued a statement about the proposal put forward in its pre-budget submission for “midwives, GPs and obstetricians… to offer a total package of private maternity services, including pregnancy care in the lead up to birth, with fixed out-of-pocket costs so families know exactly how much they will pay”.
It proposed that insurers and the Government would each pay a minimum of $3,000 to “lead practitioners who undertake the task of coordinating care and providing a single bill to the patient”.
The National Association of Specialist Obstetrician and Gynaecologists (NASOG) said that the PHA proposal would place “unrealistic financial, legal and administrative burdens on practitioners, while failing to ensure high-quality care for women and their babies”.
NASOG President A/Prof Gino Pecoraro claimed “it is an unfair and unworkable model that would discourage doctors from offering maternity care and ultimately reduce choice for pregnant women”.
Politicians and parliamentary committees
Australian Greens health spokesperson Jordan Steele-John announced that the party would add ADHD and autism assessments to Medicare.
He said the items “could be billed by a paediatrician, psychiatrist, psychologist, nurse practitioner or general practitioner… and the rebate would be set at the average cost of a diagnosis which would allow health practitioners to bulk bill”.
Steele-John cited submissions to Senate inquiries suggesting some professionals were charging as much as $5,000 for diagnoses.
If that is what the market will bear, there is no reason to expect those providers will start bulkbilling Medicare.
International organisations
UK health policy think tank The King’s Fund published an article by senior researcher Luca Tiratelli on what German political economist Albert Hirschman called the synergy illusion – the notion that good ideas will always work alongside and reinforce other things that are also generally considered to be good.
Tiratelli argues that “everything, it seems, is now part of a big bucket of ‘good things’ that right-minded health policy folks want to see happen”.
He suggests that the illusion “prevents us from being able to dig into the substance of the kind of ‘how’ conversations that are needed to fix the myriad problems facing the health system”.
He also argues that “the most important issue that comes from seeing all good things as inherently synonymous and synergistic is that it prevents you from getting into a conversation about choices… just because [things are] good, doesn’t mean that that the good stuff can’t be contradictory”.
Tiratelli uses as an example fixing acute care while also seeking to address the balance of investment between acute care on the one hand and primary and community care on the other.
This is only possible with massive investment on both sides of the equation, and governments and political parties are virtually united in arguing that investment isn’t possible.
He concludes “in the end government and policy-makers have to be absolutely clear about what they want to do, and equally clear about what they are regrettably going to have to come back to later”.
“Without this clarity of vision, we will end up with the worst of all worlds – achieving nothing because we were never able to decide on what we wanted in the first place.”
Finally
Several weeks ago, it was reported that following the Trump Administration’s decision to leave the World Health Organization (WHO), the US Centers for Disease Control (CDC) was not taking part in international expert group discussions on the makeup of flu vaccine for the 2025-26 northern winter.
However, it appears that personnel from the CDC did eventually participate in the meeting that led to the WHO recommendations released on 28 February.
This week CNN reported that the US Food and Drug Administration (FDA) had cancelled the planned 13 March meeting of the Vaccines and Related Biological Products Advisory Committee (VRBPAC), which was to have discussed the composition of the US flu vaccine for release in September.
According to CNN, VRBPAC member Dr Paul Offit said it wasn’t clear who directed the meeting to be cancelled or why, and said it’s also not clear now how flu vaccine manufacturers will get guidance on the composition of seasonal flu vaccines.
The FDA subsequently issued a statement saying “the FDA will make public its recommendations to manufacturers in time for updated vaccines to be available for the 2025-2026 influenza season” – but apparently without the benefit of expert advice.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Department of Health and Aged Care
Draft National Allied Health Workforce Strategy
3 March
Aged Care Quality and Safety Commission
Consultation on the new Financial and Prudential Standards
7 March
Australian Commission on Safety and Quality in Health Care
Comments on the home page of the Australian Register of Clinical Registries
9 March
The Treasury
Consultation – ban on the use of adverse genetic testing results in life insurance
12 March
Inspector-General of Aged Care
Consultation on the Australian Government’s implementation of the Aged Care Royal Commission recommendations
14 March
The National Health and Medical Research Council
Call for citations addressing research question as part of the review of the Australian Dietary Guidelines
14 March
Department of Health and Aged Care
Consultation on Assignment of Medicare Benefits for Simplified Billing Services
28 March
Department of Health and Aged Care
Consultation on PHI Rules sunsetting in October 2025
31 March
Australian Commission on Safety and Quality in Health Care
Public consultation on potential changes to the accreditation of general practices
4 April 2025
Coalition of Peaks
Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement
16 April
Department of Health and Aged Care
Design of a national registration scheme to support personal care workers employed in aged care
17 April
National Health and Medical Research Council
Scoping survey on clinical practice guidelines on the diagnosis and management of myalgic encephalomyelitis / chronic fatigue syndrome
27 April
Department of Health and Aged Care
Updating clinical guidelines for dementia care
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
