All medical specialists’ fees would be added to the Government’s Medical Cost Finder website under an opt-out system under a proposal examined in The Zap this week.
The proposal also recommends an independent website for dentists’ fees so consumers can shop around, and mandatory price displays for individual dental clinics, with fees for common services published on their websites and windows.
The column also reports on illuminating research into the real reason behind variation in medical fees, and covers efforts to reduce the environmental impact of healthcare through hospital pharmacy practice.
Also making news is an expansion of the Deadly Choices program, and the official opening of the new Jabiru Health Centre in the Northern Territory, which is expected to “drastically improve access to primary health services for Aboriginal families and communities in the remote West Arnhem region”.
Among the long list of consultations compiled by our columnist is an opportunity for Croakey readers to comment on a Federal bill to tackle misinformation and disinformation. But get in quick… the deadline is tomorrow (30 September).
The quotable?
It’s shocking to think that so many Australians are in a situation where they must choose between accessing essential medical care and sacrificing a dignified retirement.”
Charles Maskell-Knight writes:
The Australian Taxation Office (ATO) recently published data for 2022-23 on applications from people to access superannuation accounts to pay for health costs, showing that a total of $730 million was released in response to 39,500 applications.
The amount released had increased by 88 percent compared with 2018-19, while the number of successful applications had increased by 51 percent.
In an article in The Conversation, Associate Professor Neera Bhatia discussed the background to the early release of superannuation scheme, and highlighted the potential conflicts of interest from health professionals promoting the scheme to a patient, writing a report to the ATO supporting early release, and then benefiting from providing health services.
She suggested mandatory financial counselling, a tightening of the criteria for access, and establishment of an independent body of practitioners to assess and recommend applications.
The ATO data also prompted a reaction from COTA Australia, which said “reports that Australians are being forced to dig into their superannuation funds to pay for essential healthcare could mean they’re sacrificing a dignified retirement down the track”.
CEO Patricia Sparrow said: “It’s shocking to think that so many Australians are in a situation where they must choose between accessing essential medical care and sacrificing a dignified retirement.”
Private Healthcare Australia (PHA, the private health insurance lobby group) said that “allowing tens of thousands of people to drain their superannuation for medical and dental treatment each year is driving up costs for all consumers and should be stopped”.
PHA said its data on insured services showed “surges” of 70 to 90 percent over the past four years in out-of-pocket cost for procedures, often funded by superannuation withdrawals, compared with a 14 percent increase in health inflation.
It called for:
- all medical specialists’ fees to be added to the Government’s Medical Cost Finder website under an opt-out system (it is currently voluntary for doctors to add their fees)
- an independent website for dentists’ fees so consumers can shop around
- mandatory price displays for individual dental clinics, with fees for common services published on their websites and windows.
PHA also argued that the Government should restrict early access to superannuation to people with “terminal and life-threatening conditions”, and that there should be stronger measures to ensure independent advice and restrict conflicts of interest.
While the Consumers Health Forum did not make a formal statement, CEO Dr Elizabeth Deveny posted a comment on LinkedIn arguing for:
- more funding for public hospital services, particularly in areas where stigma or under-funding creates affordability barriers and unfairly limits access
- lots more consumer education on navigating both healthcare and financial systems during these challenging times, so people feel empowered and informed when making hard decisions
- a greater focus on preventative care, “so we’re not pushing people into desperate choices”.
Ministers and government
Health Minister Mark Butler and Minister for Indigenous Health Ged Kearney announced an expansion of the Deadly Choices program delivered by the Queensland-based Institute of Urban Indigenous Health.
The program is “proudly Aboriginal and Torres Strait Islander operated and consists of a wide range of community-focussed activities [with] a strong focus on Healthy Lifestyle and Tackling Indigenous Smoking”.
A major focus is encouraging First Nations people to obtain an annual comprehensive health assessment (MBS item 715) from an Aboriginal and Community Controlled Health Service.
The take-up rate for the health assessment fell sharply during the COVID-19 pandemic and, while it is now trending upwards, it has still to return to 2018-19 levels.
The Australian Institute of Health and Welfare (AIHW) issued a number of reports and updates, including the seventh annual update monitoring suicides among current and former Australian Defence Force (ADF) members.
It found “permanent and reserve male ADF members die by suicide at about half the rate of Australians of similar age, while ex-serving male ADF members have a higher rate than Australian males”. However, the higher rate among veterans is driven by higher rates among those who left the ADF involuntarily.
The AIHW also released an updated version of Australia’s mothers and babies, including data from the National Perinatal Data Collection (NPDC) for the 2022 calendar year.
After a spike in 2021, the birth rate in 2022 returned to the 2020 level of 56 per 1,000 women. Long term trends of an increase in the average age of mothers and of the proportion of births through caesarean section continued.
The rate of caesarean section in Australia has long been high by international standards and has now reached 39 percent.
The proportion of First Nations mothers who attended an antenatal visit in the first trimester continues to increase and is now at 71 percent, while the proportion who reported smoking at any time during pregnancy has decreased.
The AIHW also released updated data on younger people in residential aged care, showing that in the March quarter this year, 61 people aged under 65 (excluding First Nations people aged 50-64) entered permanent residential aged care, an increase from 42 in the December quarter last year.
However, the total number of under 65s continues to trend downwards, from 1,959 at the end of March 2023 to 1,381 at the end of March this year.
The AIHW also released the latest monthly data on the PBS scripts and MBS services.
The Australian Commission on Safety and Quality in Health Care released a report Medication without harm, Australia’s response to the World Health Organization Global Patient Safety Challenge.
While there have been significant achievements (a reduction in dispensing rates of antipsychotic medicines for people aged over 65 years, a decrease in the rate of hospitalisations for insulin-related adverse events and poisonings since a peak in 2021-22, and a fall in unintentional drug-induced deaths involving opioids), the Commission notes there are “areas requiring further attention”, set out in a Priority Action Status Summary.
The Aged Care Quality and Safety Commission released its Sector Compliance Report for the June quarter.
Residential care compliance in the June quarter was 81 percent – that is to say, 19 percent of services were noncompliant.
While this is a considerable improvement on the September 2022 quarter when 42 percent of services were noncompliant, it is still really hard to reconcile this level of noncompliance with the results of the aged care star ratings showing over 95 percent of services are providing an acceptable level of care.
Home care sector compliance was 65 percent.
Consumer and public health groups
The Public Health Association of Australia (PHAA) announced the publication of a study showing “that less than two percent of total government health spending in Australia goes towards public health efforts like infectious and chronic disease protection, prevention and health promotion”.
Lead author Emeritus Professor Alan Shiell said that the public health funding system was “complex and piece-meal”, and that “it leaves the public in the dark about exactly where the money is going and exactly how much is being spent on public health”.
PHAA CEO Adjunct Professor Terry Slevin said there was a need for a new Government funding model for prevention to ensure that public health expenditure was cost-effective.
PHAA also congratulated the South Australian Government for enacting legislation to create a new agency, Preventive Health SA.
National Seniors Australia released a report (produced in conjunction with investment management firm Challenger) on Older people’s financial wellbeing and preferences based on a survey conducted earlier in the year.
High level issues included the inadequacy of the aged pension, barriers to obtaining financial advice, and concerns about the financial impact of aged care costs.
The National Rural Health Alliance (NRHA) reiterated its earlier call for people to support a petition calling for a 10-year National Rural Health Strategy to “ensure federal and state governments and territories make an agreement to ensure rural Australia receives better healthcare access”.
The NRHA also welcomed the Government’s commitment as part of the aged care announcement to spending an additional $900 million on aged care services in rural and remote areas.
First Nations health
The Aboriginal Medical Services Alliance Northern Territory (AMSANT) welcomed the official opening of the new Jabiru Health Centre, “marking the successful transition from Northern Territory Health management to the Red Lily Health Board”.
AMSANT CEO Dr John Paterson said the new health centre will “drastically improve access to primary health services for Aboriginal families and communities in the remote West Arnhem region”, and “paves the way for the future of Aboriginal community-controlled primary healthcare in the Northern Territory”.
Trade unions
The Australian College of Rural and Remote Medicine (ACCRM) released its submission to the Government’s Review of General Practice Incentives.
The submission argued that the review’s recommendations should include “include explicit recognition of the importance of General Practitioners as a critical workforce that should be sustained and strengthened…[and] explicit recognition that rural people deserve access to a doctor with whom they can have continuity of relationship and reasonable access to in-person interactions”.
ACCRM also said that the success of any reforms “will be contingent on additional funding being made available to the General Practice sector through the implemented programs including specifically to rural General Practitioners and Rural Generalists”.
The Australian Nursing and Midwifery Federation (ANMF) marked International Day of Peace on September 21 by “expressing its support for nurses, midwives and all aid and healthcare workers, and the people they care for, in war zones and conflicts across the world”.
In the budget in May the Government announced a system of means-tested financial support for some social workers, nurses and teachers undertaking mandatory placements as part of their training. However, the scheme did not extend to allied health professionals.
The Health Services Union’s (HSU) submission to the Senate inquiry into the legislation points out that “most allied health students also endure severe placement hardship [with] some courses requiring up to 2,300 hours of compulsory practicum”.
HSU National Secretary Lloyd Williams said “the Universities Accord said that there should be paid placements in the care sector. Occupational therapists, physiotherapists, speech pathologists and psychologists are some of the largest tertiary-qualified professions within it. Why exclude them?”
The Australian Association of Psychologists also commented on the hearings, saying “for reasons only clear to the Federal Government, a selection of health skills has been included [in eligibility for the prac payment] but one we desperately need, psychology, has been frightfully overlooked”.
Executive Director Tegan Carrison said “according to the 2023 Skills Priority List, in both 2022 and 2023, every state in Australia had a shortage of psychologists”.
“Exclusion from this scheme will further entrench this shortage, setting our nation’s mental health workforce dangerously further back.”
The Pharmaceutical Society of Australia (PSA) issued a media release marking World Pharmacists Day on 25 September, reiterating its vision for pharmacy into the future.
PSA National President Associate Professor Fei Sim FPS said that “by 2030, we see community pharmacy formally recognised as a preventive and primary healthcare hub where pharmacists are appropriately funded to practise to full and top of scope and play a greater role in preventive health care, treatment of acute illnesses and management of chronic health conditions – particularly through an increased prescribing role”.
I think that vision will only be achieved in the face of determined resistance from groups representing doctors!
Advanced Pharmacy Australia (AdPha) announced on World Pharmacy Day that it had established a specialty practice group committed to examining and reducing the environmental impact of healthcare through hospital pharmacy practice. It also announced that its MedsAware campaign scheduled for March next year will centre on the themes of sustainability and deprescribing.
The Royal Australian College of GPs (RACGP) called for an overhaul of My Health Record, after the College’s “health of the nation” survey found that about a third of GPs rarely or never use it.
RACGP President Dr Nicole Higgins said the system “needs to capture more information for patients and be easier for GPs to search [and] share information with GP practice software and notify GPs when patients records are updated to support patient care and safety… [It should include] automatic data capture from GP records when patients consent”.
Higgins also said that Government should take steps to increase take-up by other health professionals and health services.
The same survey showed 71 percent of GPs reported mental health in their top reasons for patient consultations, up from 61 percent when the survey started in 2017.
Higgins said “GPs from across Australia have told us they’re seeing more patients with multiple, complex health issues including mental health, and many can’t afford to see specialists or allied health professionals privately”.
The RACGP called for “a 20 percent increase in patients’ Medicare rebates for GP mental health and longer consults to cover the cost of providing this care – so patients will pay less out-of-pocket”.
The RACGP also said that the survey “found a significant increase in GPs concern about their administrative workload – from 60 percent in 2023 to 70 percent in 2024”.
According to the survey, it is “the top reason GPs gave for why they were planning on stopping practising in the next five years. Sixty-six percent said a reduction in compliance would encourage them to stay working as a GP for longer”.
I’m not sure how to square these findings with the recent Commonwealth Fund report which ranks Australia lowest out of ten countries in the number of “primary care doctors [who] report time spent on administrative issues related to reporting clinical or quality data to government or other agencies is a major problem”, and second lowest in the number of “primary care doctors [who] report time spent on administrative issues related to insurance or claims or time spent getting patients needed medications or treatment because of coverage restrictions is a major problem”.
The College welcomed the Government’s decision to delay changes to MBS funding for chronic disease items due to begin on 1 November to 1 July next year.
Diving into state and territory policy, the RACGP attacked the South Australian Government’s expansion of the range of conditions pharmacists can prescribe for as “a risky move… driven by political lobbying and the state’s stretched health system rather than patient needs”.
By contrast, the College applauded commitments by the Liberal party in the ACT election “to expand access to general practice care in the ACT with a range of measures, including exempting GPs from payroll tax and enabling GPs to prescribe and diagnose ADHD”.
The Rural Doctors Association of Australia (RDAA) reported that “nearly 70 percent of the healthcare workers that responded [to a recent survey] made choices about their work location based on the availability of child care in their community”.
Dr Sue Harrison, Chair of RDAA’s Female Doctors Group, said “many of our doctors have had to turn down positions, particularly in rural towns, as they simply cannot find options for child care to cover their work hours”.
The RDAA’s 2024 pre-budget submission recommended “establishing rural childcare centres in the grounds of rural or remote hospitals in places which are accessible to health care workers (state and privately employed) or other critical community workers such as police”.
Industry groups
Medicines Australia issued a position statement on associations between tobacco companies and pharmaceutical entities engaged in healthcare.
The statement recognises “the negative role that tobacco/vaping play in respiratory health”, and opposes “tobacco companies assuming control of companies that provide technologies to treat respiratory and other health conditions” and “associations between healthcare companies and organisations that act in a way to undermine the health of populations and individuals”.
It then goes on: “Medicines Australia… acknowledges the freedom and independence of research-based pharmaceutical companies to make their own commercial decisions, in the best interests of their organisations and customers, and act in a manner which complies with competition laws”.
The Pharmacy Guild marked World Pharmacy Day with a media release “[reminding] Australians to ‘think pharmacy first’ for the treatment of everyday health conditions, as pharmacists across the country, upskill to deliver more for patients”.
National President Professor Trent Twomey said “pharmacists are a critical part of a holistic health system”.
“We are putting our hands up to do more, to take the pressure off GPs and, more importantly, to keep Australians out of emergency departments,” he said.
Politicians and parliamentary committees
The ridiculously short two-week period for providing submissions to the Senate inquiry into the 544-page Aged Care Bill expires on Monday 30 September.
So does the even shorter period for submissions to the inquiry into the Combatting Misinformation and Disinformation Bill.
Submissions to the House of Representatives inquiry into the health impacts of alcohol and other drugs in Australia also close on that day.
Shadow Health Minister Anne Ruston issued a media release claiming that since the change of government, the amount patients paid for GP services had increased by 45 percent, and that GP bulk billing rates had decreased by 11 percent.
International organisations
The World Health Organization (WHO) and TikTok announced “a year-long collaboration aimed at providing people with reliable, science-based health information”.
Of course, if the Government’s ban on young people accessing social media is successful, young Australians will be unable to access it.
Finally
Whenever I’ve asked doctors to explain the differentials in the fees they and their colleagues charge for the same procedure, I am usually told it has to do with the complexity of particular cases.
Researchers at the Melbourne Institute have now examined whether variation in specialist fees can be attributed “to patient risk factors, variation between [doctors], medical specialties, or other factors”.
Using claims data from a major private health insurer, they found that “[doctor]-specific variation accounts for close to 65 percent of the total variance in total fees and 72 percent of out-of-pocket payments”.
“Observed patient characteristics and risk factors, such as patient health conditions, case complexity, procedure-specific factors, age, gender, location, etc helped explain away little of the variation in fees and out-of-pocket payments, by approximately four percent and six percent respectively.”
In other words, doctors’ fees vary because of the doctor, not the patient.
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.
Senate standing committee on community affairs
Aged care bill
30 September
Senate standing committee on environment and communications
Communications Legislation Amendment (Combatting Misinformation and Disinformation) Bill
30 September
Department of Health and Aged Care
Review of MBS health assessment items
30 September
Department of Health and Aged Care
How the Australian CDC plans to use data
30 September
House of Representatives Standing Committee on Health, Aged Care and Sport
The health impacts of alcohol and other drugs in Australia
30 September
Therapeutic Goods Administration
Consultation on temporary labelling exemptions for paracetamol
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Department of Health and Aged Care
Review of the Stoma Appliance Scheme Schedule
6 October
Therapeutic Goods Administration
Draft guidance on the new regulatory requirements and transition arrangements for medical devices containing medicinal substances or materials of animal, microbial, or recombinant origin
9 October
Senate Legal and Constitutional Affairs References Committee inquiry
Australia’s youth justice and incarceration system
10 October
Department of Health and Aged Care
Survey on the functionality and user experience of MBS Online
11 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Therapeutic Goods Administration
Clarifying and strengthening the regulation of Artificial Intelligence (AI)
13 October
Department of Health and Aged Care
Safe and Responsible Artificial Intelligence in Health Care – Legislation and Regulation Review (See also the Joint Committee on Public Accounts and Audit Inquiry into the use and governance of artificial intelligence systems by public sector entities.)
14 October
Independent review of complexity in the National Registration and Accreditation Scheme (NRAS)
Consultation paper
14 October
Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 October
Ahpra Accreditation Committee
Guidance on developing professional capabilities
18 October
Department of Health and Aged Care
Draft 24-hour movement recommendations for adults and older Australians
18 October
Therapeutic Goods Administration
Public consultation on interim decisions to amend the Poisons Standard
18 October
Department of Health and Aged Care
Draft National Nursing Workforce Strategy
20 October
Therapeutic Goods Administration
Proposed amendments to the Poisons Standard
22 October
Independent Health and Aged Care Pricing Authority
Pricing Approach for the Support at Home Service List
25 October
National Mental Health Commission (National Suicide Prevention Office)
Draft National Suicide Prevention Strategy
27 October
Australian Commission on Safety and Quality in Health Care
Draft Medication Management at Transitions of Care Stewardship Framework
27 October
National Health and Medical Research Council
Draft Procedures and Requirements for Meeting the NHMRC Standards for Clinical Practice Guidelines
27 October
Food Standards Australia and New Zealand
Varying maximum residue limits (MRLs) for residues of specific agricultural and veterinary chemicals that may occur in food commodities
29 October
Department of Health and Aged Care
Proposed amendments to the Gene Technology Act 2000
8 November
Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November
Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November
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.
