In 2023, the number of measles cases reported globally to the World Health Organization increased by 20 percent from the previous year. And that was before the news that President-elect Donald Trump has nominated vaccine-sceptic Robert F Kennedy Jr as Secretary of the Department of Health and Human Services.
Meanwhile in Australia, as the Albanese Government gears up for a pre-election advertising campaign highlighting its healthcare initiatives, this week’s edition of The Zap reminds us of the bipartisan history of self-promotional government-funded advertising.
Our columnist also brings questions about Genomics Australia, news of developments in diabetes, and a “red letter day for health nerds”, as well as a handy list of consultations now open.
The quotables?
So far the Albanese Government has been in power for two and a half years and has done nothing to address the costs of medical specialists. Will anything happen before the election, other than a gaslighting campaign to persuade us that healthcare is affordable?”
and
Given the law and order hysteria that has characterised recent state and territory elections, it is worth noting that the rate of hospitalisations for assault has declined since 2020-21 by over ten percent from 93.9 per 100,000 population to 81.2.”
Charles Maskell-Knight writes:
In the months leading up to an election every opposition rails against government-funded advertising that amounts to a thinly veiled plug for the government of the day.
Every opposition on winning government promptly adopts the same behaviour.
Several years ago the Grattan Institute researched the issue of politicised government advertising, and found that:
Over the past 13 years [to 2022] about $630 million, or a quarter of all federal campaign advertising, was spent on campaigns that spruiked government achievements – and spending spiked on the eve of each federal election.
This is a problem on both sides of politics, and at federal and state level. Of the 10 most expensive politicised federal campaigns in the past 13 years, half were approved by Labor governments and half by Coalition governments.”
Health Minister Mark Butler announced on 10 November that the Government would be launching “a new public information campaign [to] support Australians to know how they can access affordable healthcare”.
The campaign is a “response to recent rises in the number of Australians delaying or deferring healthcare”.
Butler said the campaign will highlight:
- the growing network of Medicare Urgent Care Clinics, where Australians can walk in and get bulk billed urgent care, seven days a week, open early to late, without waiting hours in a busy hospital emergency department.
- enhanced mental health support, including the growing network of Medicare Mental Health Centres that provide free mental health support for everyone who walks in the door, no appointment or referral needed.
- more available bulk billing at your local GP, through the largest investment in bulk billing in the history of Medicare, which has delivered an additional 103,000 free GP visits each week, on average.
These initiatives just happen to have been introduced by the current Government since it was elected in May 2022.
An example of one of the television advertisements can be found here, and a social media post is here.
Ministers and government
Minister Butler announced that the Government would provide pregnant women with free access to the maternal respiratory syncytial virus (RSV) vaccine, Abrysvo, under the National Immunisation Program, and would work with the states to support national access to the monoclonal antibody, Beyfortus, which provides direct protection to newborns and young children.
The national approach follows decisions by most states to implement state-based vaccination programs for at least some at-risk groups.
The Royal Australian College of GPs (RACGP) lauded (their word, not mine!) the announcement, saying that RSV infection rates had skyrocketed from 96,000 in 2022 to almost 166,000 so far this year. Almost half of cases in 2024 have been in children aged under four years.
The Pharmaceutical Society of Australia welcomed the Government announcement, but pointed out that while funding of the administration of the vaccine by community pharmacists would be provided by the Government, “due to an outdated regulatory approach, many states will need to amend their regulations to permit pharmacists to immunise this cohort against RSV”.
The Pharmacy Guild also supported the Government’s announcement, saying the Guild “looks forward to continuing to work with the Government to ensure primary healthcare services, such as vaccine administration, are as accessible as possible for all Australians”.
Butler announced the establishment of Genomics Australia “to provide leadership, coordination and expertise so all Australians can reap the benefits of cutting-edge genomic research and technologies”.
It will be a body within the Department of Health and Aged Care, with a Commissioner who will “provide expert advice to Government on health genomics”.
While this weird model may have been “informed by advice from experts”, I can only assume the experts were knowledgeable about genomics rather than public administration. If this model is followed for every new development in medicine, the vexed problem of policy coordination across the Department will only worsen.
The Minister also announced the appointment of Rosemary Huxtable AO PSM to develop the National Health and Medical Research Strategy, which will “ensure we remain at the forefront of global health and medical innovation [and] help foster a strong and sustainable research workforce, create an environment that attracts investment, and translate research into practical health outcomes”.
The National Health and Medical Research Council Act 1992 provides that one of the objects of the Act is to make provision for a national body “to pursue activities designed to foster medical research and training and public health research and training throughout Australia”.
In other words, developing a health and medical research strategy should be bread and butter business for the National Health and Medical Research Council, and should not require a separate process.
Anybody interested in the development of the strategy can register to join a webinar with Huxtable on 5 December.
Butler was not having a good week on radio.
He carried out an interview on Adelaide radio, where he was pressed on the new aged care legislation and financial framework. Asked if it was true that there would be specific caps on cleaning and gardening services under the new regime, he was unable to answer definitively, ultimately resorting to “I haven’t got the bill in front of me”.
The Minister also went on Radio National, where Patricia Karvelas pointed to the inherent contradiction in running an anti-vaping social media campaign directed at teenagers while trying to ban teenagers from social media.
On 11 November the Department of Health and Aged Care opened consultation on the draft national standards for counsellors and psychotherapists, with responses due by 13 December. The standards were developed following an initial public consultation process which was open for less than three weeks from 19 June to 5 July.
The Australian Institute of Health and Welfare (AIHW) released the latest updated data on suicide and intentional self-harm.
It also released a suite of reports on injury, accidental poisoning, assault and homicide, falls, transport accidents, and other causes of injury.
Given the law and order hysteria that has characterised recent state and territory elections, it is worth noting that the rate of hospitalisations for assault has declined since 2020-21 by over ten percent from 93.9 per 100,000 population to 81.2.
On 13 November (a red letter day for health data nerds across the country), the AIHW released hospital data cubes for principal diagnosis, AR-DRG, and procedures covering 2022-23.
The AIHW also released a report, Exploring how transitional aged care supports older people leaving hospital. The report provides an optimistic assessment of the program, concluding that “three in five people who used transition care returned to the community, and almost all of these people (86 percent) experienced an increase in their functional independence on leaving the program”.
“Fewer than one in seven people who returned to the community went on to enter permanent residential aged care by the end of the following year,” said the report.
While the National Perinatal Mental Health Guideline prepared by the Centre of Perinatal Excellence recommends that all women are screened for signs, symptoms and risk factors of mental health conditions during the perinatal period, there is no nationally consistent data collection covering screening, subsequent service use, and outcomes.
The AIHW released a report presenting some data for four jurisdictions (NSW, Queensland, Tasmania and the ACT). The high-level findings are that over 70 percent of mothers in Queensland, Tasmania and the ACT were screened in 2022, and that they were more likely to be screened if they were aged under 25, First Nations people, or gave birth in a public hospital.
The Australian Commission on Safety and Quality in Health Care invited registrations for the National Medicines Symposium to be held on Tuesday 19 November, with the theme Ageing Well: Safe Medicines, Better Lives.
The Commission said that speakers would “share their insights on key topics such as person-centred deprescribing, deprescribing high-risk medications and leveraging digital health tools… [and provide] valuable knowledge about how to tackle the complexities of medication management in an ageing population and drive sustainable healthcare practices”.
The Aged Care Quality and Safety Commission (ACQSC) released its latest Compliance Management Insight, focussing on non-compliance with residential care minutes targets.
It said that “there are providers with residential services that are a long way from meeting their minimum care minutes targets… [and] aren’t able to show that issues with workforce availability or financial viability are major contributing factors to their continued non-compliance”.
These providers will be subject to “active supervision”, meaning the ACQSC “will actively case manage the provider with regular engagement to ensure that the required actions are being taken”.
All very well, but unless the ACQSC takes compliance action, such as issuing a Non-Compliance Notice, the failure to meet the targets need not affect a provider’s aged care star ratings.
Ahpra released its annual report, which showed that the number of registered health practitioners has exceeded 900,000 for the first time.
Ahpra said it “continues to work hard to get more international practitioners registered faster and safely by implementing changes in response to the Kruk review. Improvements to Ahpra’s registration processes have almost halved the time to finalise international applications, cutting the previous 60-day average to just 33 days”.
It identified as a priority “maintaining a balance between access to needed healthcare and the risk posed by some emerging models of care… amid the acceleration of telehealth, online prescribing and direct-to-consumer health services”.
First Nations peoples’ health
NACCHO announced that more than 500 new Aboriginal and Torres Strait Islander Health Workers will receive diabetes prevention training as part of a new partnership with the Bupa Foundation.
The project will involve “the development of a specialist diabetes prevention training pathway that includes developing culturally safe training and assessment resources, delivery of face-to-face training sessions and integration into existing local Aboriginal Community Controlled Health Organisations”.
NACCHO CEO Pat Turner said “culturally informed, Aboriginal and Torres Strait Islander-led training is essential to reversing the impact of diabetes and improving health outcomes”.
“By working with Bupa, we’re building a pathway to strengthen our healthcare workforce and bring us closer to closing the health gap in our communities,” she said.
Consumer and public health groups
14 November was World Diabetes Day. Diabetes Australia released data from a survey showing that 75 percent of people living with diabetes were worried that managing their disease will become unaffordable in the future.
The organisation reported that “half of survey respondents said cost of living pressures were negatively impacting their ability to manage their diabetes, which includes attending GP appointments, undertaking pathology tests and purchasing syringes to administer insulin”.
CEO Justine Cain said Diabetes Australia was launching “Diabetes YOUnited – a free national membership program to provide trusted support and information that is easy to access and will help people, no matter what their financial situation, to live well with diabetes”.
Other groups to acknowledge World Diabetes Day included the Royal Australian College of GPs (RACGP) and Rural Doctors Association Australia (RDAA).
The RACGP released the latest edition of the Management of type 2 diabetes: A handbook for general practice guidelines, prepared in partnership with Diabetes Australia.
RACGP Diabetes Specific Interest Group Chair Dr Gary Deed said that as well as new sections on medication shortages, sleep and diabetes management with disability, dementia, cognitive decline and hearing impairment, the new handbook included a section on “remission” of type 2 diabetes.
Deed said “research has shown some people with type 2 diabetes, particularly when it’s diagnosed early, can reduce their average glucose level to achieve an HbA1c of under 6.5 percent and sustain it there, without glucose-lowering medication”.
“It’s a best-case scenario, and the new section will help GPs and patients achieve it where possible,” he said.
The RDAA urged rural and remote Australians living with diabetes to reach out to their rural doctor and local health team for ongoing support. President Dr RT Lewandowski said “the relentless 24/7 nature of managing diabetes can have a huge impact on the mental and physical wellbeing of those living with it”.
“Rural and remote Australians with any type of diabetes, however, need to know that they are not alone and help is at hand to ensure they can live well,” he said.
The Food for Health Alliance’s Brands off our kids! campaign launched an open letter appealing to the Government to “introduce regulation to stop sinister marketing tactics of the processed food industry relentlessly targeting children”.
Alliance Executive Director Jane Martin said “we are heartened by incredible progress in places like the UK, where government action has resulted in a ban on junk food ads on TV before 9pm and paid junk food advertising online which will come into force in 2025”.
“It’s time for Australia to put our children’s health ahead of corporate profits and for us to follow suit with regulation,” she said.
The Australian Dental Association supported the letter.
In February-March this year the Government held a public consultation on a feasibility study on options to limit unhealthy food marketing to children. So far, no results have been released.
National Seniors Australia lent its weight to the RACGP’s campaign for a 20 percent increase in the MBS rebate for GP consultations lasting more than 20 minutes.
The National Rural Health Alliance (NHRA) said that the audit of the Australian health and medical research workforce by the Department of Health and Aged Care “throws light on the importance of supporting rural, regional and remote health workforce and researchers through strategic and targeted measures to ensure rural Australians enjoy the same health benefits as their city counterparts”.
Trade unions
The Australian Physiotherapy Association issued a statement encouraging Australians to support the Stroke Foundation’s Stride4Stroke initiative intended to help raise awareness and funds for stroke recovery.
In a submission to the Government’s review of the Medicare safety nets, the RACGP called for the thresholds to be lowered so people across all income brackets can benefit.
RACGP President Dr Nicole Higgins said “as it stands, people can’t benefit from the Medicare Safety Net if they can’t afford the upfront out-of-pocket cost of seeing their GP – this means the most vulnerable Australians, those on low incomes are being left behind”.
Industry groups
The Australian Private Hospitals Association (APHA) called for the Victorian Government to address its public hospital elective surgery waiting lists by commissioning services from private hospitals.
APHA CEO Brett Heffernan said more than 144,000 Victorians were treated in the public system as private patients in 2022-23. “These are patients who should be treated in private hospitals,” he said.
In reality, many of those patients would have been admitted through an emergency department, and then persuaded to use their private insurance “to help the hospital”. They would not have been crowding out public elective surgery patients.
And in most of rural Victoria (just like the rest of the country) there are hardly any private hospitals for privately insured people to attend, meaning they too would be admitted to a public hospital.
Medicines Australia issued a statement stressing the need for improved horizon scanning as recommended by the Health Technology Assessment review to “provide greater visibility to the Pharmaceutical Benefits Advisory Committee of new treatments coming to the market, and ultimately reduce delays to patient access”.
Following reports in The Age of “double-dipping” by specialists, Private Healthcare Australia (PHA, the private health insurers lobby group) issued a statement “urging people who have had surgery in private hospitals to check if they have been billed incorrectly under ‘no gap fee’ arrangements”.
It is alleged that doctors are charging patients directly as much as $5,000 for “booking fees” or “administrative fees”, and then receiving a payment above the MBS schedule fee under a “no-gap” arrangement with an insurer.
PHA said that insurers “will do everything they can to resolve proven cases of fraud”.
It also said that a survey of policyholders by one large insurer had found that over 30 percent of respondents who received medical treatment under a “no gap” fee arrangement were charged a fee, and almost a quarter of those covered by a “known gap fee” arrangement paid more than the maximum $500 out-of-pocket specified in the agreement with the insurer.
Politicians and parliamentary committees
The Senate Select Committee on PFAS held its first public hearing in Canberra, with witnesses from CSIRO, a group of Government departments, and a panel of PFAS remediation experts.
Graeme Barden, Executive Director of the Australian Industrial Chemicals Introduction Scheme, told the hearing that 99 of the 522 PFAS chemicals in its inventory were yet to be assessed.
On the provision of abortion services, the Greens promised funding of $100 million a year to “end the postcode lottery” and ensure all public hospitals provide these services.
In announcing the commitment, Senator Larissa Waters noted that the Government was more than a year late in responding to the 36 recommendations in the report of the Senate inquiry into universal access to reproductive healthcare.
International organisations
The World Health Organization announced that there were an estimated 10.3 million cases of measles worldwide in 2023, a 20 percent increase from 2022. It said the surge in cases was being driven by inadequate immunisation coverage globally.
The WHO report coincided with the announcement by US President-elect Trump that he would appoint vaccine-sceptic Robert F Kennedy Jr as Secretary for Health and Human Services.
Kennedy’s support for groups opposed to measles vaccination has been associated with a major outbreak of measles in Samoa in 2019, which saw an estimated three percent of the population infected, and resulted in over 80 deaths, nearly all among children.
As CNN host Jake Tapper commented following news of the Kennedy appointment, “well, America, I hope you like measles”.
Finally
The Government’s information campaign telling Australians “how they can access affordable healthcare” will be greeted with a Bronx cheer by many of the over eight million people who see a specialist in the community each year.
AIHW data shows that the Medicare rebate for these attendances now covers on average just over half of the fee charged.
Given that many specialists offer reduced fees for pensioners and other concession cardholders, the average rebate for other groups must be considerably lower.
Several days ago a family member saw an ear, nose and throat specialist who charged $600 for an initial specialist consultation and a nasendoscopy. The Medicare rebate was $203 or 33.8 percent of the fee charged, leaving an out-of-pocket of $397.
So far the Albanese Government has been in power for two and a half years and has done nothing to address the costs of medical specialists.
Will anything happen before the election, other than a gaslighting campaign to persuade us that healthcare is affordable?
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.
Australian Commission on Safety and Quality in Health Care
Updated Falls Guidelines Consultation
20 November
Office of the Gene Technology Regulator
Online Services Portal Survey
22 November
National Health and Medical Research Council
Updated Australian Drinking Water Guidelines
22 November
National Health and Medical Research Council
Proposed updates to the Investigator and Synergy Grant assessment framework
4 December
Office of the Gene Technology Regulator
Proposed minor and technical amendments to the Gene Technology Regulations 2001
8 December
Department of Health and Aged Care
Draft national standards for counsellors and psychotherapists
13 December
Department of Health and Aged Care
Medical Research Future Fund Australian Brain Cancer Mission – consultation on the refreshed Roadmap and Implementation Plan|
20 December
House of Representatives Standing Committee on Health, Aged Care and Sport
Inquiry into the health impacts of alcohol and other drugs in Australia
31 December
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
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.
