This week the column covers the importance of place-based approaches for tackling health inequalities, a smouldering dispute between the private hospital sector and the private health insurance sector, a survey of the palliative care workforce, and trends in multidrug-resistant tuberculosis.
Our columnist also examines lack of progress in national mental health reform and the Federal Government’s delay in establishing the Centre for Disease Control, and lists a stack of consultations now open.
The quotable?
On 30 October the Department opened consultations on the draft Public Health (Tobacco and Other Products) Amendment (On‑Product Health Messages and Other Measures) Regulations 2024 – with a closing date for submissions of 8 November.
It’s almost as though the Department doesn’t want any comments!”
Charles Maskell-Knight writes:
The major health story of the week was the release of the report of the Commonwealth COVID-19 response inquiry, and the associated announcement about a permanent Centre for Disease Control (CDC).
There was extensive media coverage of the report and the announcement. Croakey colleagues Dr Melissa Sweet and Alison Barrett have written about equity issues arising from the report, and about the agenda it sets out for the CDC.
The Conversation published an article by Michelle Grattan on the report, and an article by Dr Jocelyn Basseal and Professor Ben Marais from the University of Sydney on the key findings and the potential impact a CDC could have on pandemic management.
A range of health groups reacted to the report and announcement, including the Australian Medical Association (AMA) here and here, the Consumers Health Forum (CHF), the Pharmaceutical Society of Australia (PSA), the Pharmacy Guild, and the Public Health Association of Australia (PHAA).
Health Minister Mark Butler said in the media release about the CDC that “in October 2020, Labor committed to establishing a transparent, trusted and independent CDC. In January 2023, we established the interim Australian CDC to immediately improve the way we prepare for and respond to health emergencies”. (The Department has since confirmed this was a typo, as the interim CDC was established in January 2024.)
The Government is now promising to have the permanent CDC operational from 1 January 2026, pending passage of legislation.
It is not clear why the legislation could not have been introduced at any time since Labor won Government in May 2022. We can only hope there isn’t another pandemic in the next few years before the CDC is established and fully operational.
Ministers and government
Minister Butler also released the Private Hospital Sector Financial Health Check on 1 November, over two months after its projected completion in late August.
The Department of Health and Aged Care asked hospitals to provide financial data as part of the process. Unfortunately the hospitals that responded only made up a little under 60 percent of the market by volume of activity, meaning as the report observes “potential selection bias exists due to the incomplete submission of financial data across the private hospital sector”.
Having said that, the Department “estimates that the sector’s weighted average EBITDA [earnings before interest, taxes, depreciation, and amortization] margin is likely to have been between seven percent and eight percent in 2022-23”.
Butler announced the establishment of a Private Health CEO Forum, which “will bring together leaders from private hospitals, private health insurers, medical groups and independent experts to develop short term options for government consideration and to commence work on long-term reforms to strengthen the sector’s financial viability”.
My past experience of such committees suggests that expecting substantive results from it is a little like expecting the turkeys and the poulterers to agree on a date for Christmas.
Butler was at pains to emphasise that “there will be no silver bullet from Canberra or funding solution from taxpayers to deal with what are essentially private pressures in this system”.
Private health insurer and private hospital groups reacted to the report in such different ways I had to check that there was in fact only one version of the report.
Private Healthcare Australia (PHA, the peak private health insurer lobby group) said on LinkedIn that “the Government’s ‘health check’ found private hospitals experienced healthy profit margins in 2022-23, and that health insurance premium increases closely matched rising health fund payments to hospitals”. The Members Health Fund Alliance (the lobby group for not-for-profit health insurers) stressed the estimated EBITDA rate of seven percent to eight percent, as well as recent growth in the private hospital sector.
On the other hand, Catholic Health Australia (CHA) said that the “report confirms what we have been saying for a long time – that the private health sector is under severe and unprecedented funding pressure”.
The Guardian reported that Brett Heffernan, the CEO of the Australian Private Hospitals Association (APHA), said private hospital finances were suffering at the same time as insurers’ profits and premiums keep rising. Heffernan went on to say that structural reform of the relationship between funders and providers of private healthcare is needed.
In other news, the Minister announced that “the Australian health system added one new doctor every hour last year, on average, with more doctors joining in the last two years than at any time in the past decade”.
He claimed that “the sharp growth in the number of doctors joining the health system is one of several positive indicators of a turnaround in sentiment among Australia’s doctors”.
The Department announced that aged care providers could “express interest in a free onsite menu and mealtime review by an accredited practising dietitian” under the Menu and Mealtime Review Program. Applications close on 4 December.
On 30 October the Department opened consultations on the draft Public Health (Tobacco and Other Products) Amendment (On‑Product Health Messages and Other Measures) Regulations 2024 – with a closing date for submissions of 8 November. It’s almost as though the Department doesn’t want any comments!
The Pharmaceutical Benefits Advisory Committee (PBAC) announced that “the number of submissions requiring clinical and economic evaluation expected to be presented for the March 2025 PBAC meeting cycle significantly exceeds the capacity available to undertake the technical evaluations necessary for PBAC preparations and progression to Committee considerations”, and that some submissions would be deferred to the subsequent July meeting.
Medicines Australia met with the Department of Health and Aged Care to discuss the issue, and agreed on steps to expedite consideration of all submissions at the March or July meetings, as well as agreeing to work together on longer-term solutions to avoid a repetition of the problem.
The Therapeutic Goods Administration announced it had seized 200,000 illicit vapes with a value of $8 million in a joint operation with Victorian police. Since the start of the year the TGA has been involved in operations leading to the seizure of over 6.5 million vaping products valued at more than $195.5 million.
The Australian Institute of Health and Welfare (AIHW) released data for the June quarter on younger people living in residential aged care, showing continued reductions in the number of new admissions and ongoing residents.
However, the Government targets of no people under the age of 65 entering residential aged care by 2022 and no people under the age of 45 living in residential aged care by 2022 have both been missed, while the target of no people under the age of 65 living in residential aged care by 2025 is unlikely to be met.
The AIHW also released the latest MBS billing data, showing 85 percent of the cost of GP attendances was met by Medicare, up from 83 percent at the start of the year; a report on the health of veterans; and updated data on palliative care.
The Aged Care Quality and Safety Commission released a report on complaints against aged care services for the 2023-24 financial year. There were just over 5,400 complaints against residential aged care providers, an increase of 6.9 percent on the previous year. The top reasons for complaints were medication administration and management, personal and oral hygiene, and personnel numbers.
There were just over 4,000 complaints against home care services, almost exactly the same number as the previous year, with lack of consultation/communication, fees and charges, and management of finances the main reasons for complaints.
The Commonwealth Ombudsman released a statement on the aged care star ratings system, saying that “in my view, while noting the department’s advice about steps it has taken and is intending to take to improve the star ratings system, currently star ratings are not sufficiently meaningful to help people make informed decisions about their aged care”.
(The statement referred to media reports since January 2024 “that aged care star ratings may not be providing meaningful information about residential aged care services’ quality of care”. Croakey was way ahead of the curve, first reporting on the issue in January 2023.)
Consumer and public health groups
The Alcohol and Drug Foundation (ADF) released the results of a report it had commissioned from the National Drug and Alcohol Research Centre at UNSW on the serious and increasing levels of harm older Australians face from alcohol and other drugs.
ADF CEO Dr Erin Lalor AM said “older people were dying from alcohol and other drug related causes at a rate almost two times higher than other ages, proving urgent action was needed”, and that there was a need to target older Australians with tailored information about the risks of alcohol and other drug use.
The CHF responded to media reports of consumer concerns about osteoporosis drug Prolia® (denosumab), emphasising the need for consumers to be made aware of the side-effects and potential risks associated with the medicine.
The Foundation for Alcohol Research and Education drew attention to an invitation for comment on a revised Commercial Television Industry Code of Practice, which would extend the times that alcoholic products can be advertised by about 800 hours each year. Comments are due by 11 November.
Palliative Care Australia (PCA) released some results from a survey of the palliative care workforce highlighting the intersection between palliative care and Voluntary Assisted Dying (VAD).
The results included:
- only 43 percent of those working in specialist palliative care agreed that the VAD system is easy to navigate
- just six percent of respondents in primary care felt that their work with VAD is appropriately compensated, while 46 percent disagreed
- 18 percent of respondents said that the introduction of VAD has resulted in an increased demand for palliative care
- only 57 percent of health staff working in private or nonprofit health services feel supported by their employer in facilitating VAD as a choice of patients – much lower than the 73 percent among those working in public health settings.
This last result presumably reflects the number of faith-based organisations providing palliative care with an institutional ethos opposed to VAD.
PCA said a full written report from the survey will be released in the near future.
Victoria University launched the latest Australia’s health tracker: chronic conditions by socioeconomic status, showing that “the 10 million Australians living in the communities which make up the two most disadvantaged quintiles are at significantly greater risk of preventable chronic disease and poor health… [with] higher rates of heart disease, cancer, diabetes, chronic obstructive pulmonary disease and mental illness…”
“These chronic health conditions affect employment, education and community participation, leading to fewer opportunities to improve socioeconomic factors.”
The two most disadvantaged quintiles also have the highest rates of suicide nationally.
Lead author Professor Rosemary Calder AM said “this situation is getting worse and we must do something about it”.
“The best way is to take a place-based approach and start tailoring what governments and organisations do for the specific needs and strengths of local communities,” she said.
Trade unions
The Australian Nursing and Midwifery Federation (ANMF), the Australian College of Nursing, and the Australian College of Midwives welcomed the termination from 1 November of the need for nurse practitioners and midwives to enter into a “collaborative arrangement” with a doctor in order to access Medicare rebates.
ANMF federal secretary Annie Butler said “the requirement for a ‘collaborative arrangement’ was never about clinical supervision or clinical collaboration, but access to payments and funding under the PBS and Medicare…”
“Removing these barriers will finally allow highly-qualified nurse practitioners and endorsed midwives to work autonomously to their full scope, providing people with better access to quality care without the need to visit a GP surgery or wait in a crowded hospital ED,” she said.
The Pharmacy Guild also supported the changed arrangements, saying it “looked forward to further reform to empower other health professionals to work to the full range of their training, expanding the scope of services on offer”.
The Guild also issued a statement noting that from 28 October “Australian women in every state and territory can access treatment for uncomplicated urinary tract infections at a community pharmacy, without a prescription”.
The Australian Dental Association (ADA) released a statement headed “Fangs for the memory”, saying that “the scariest thing about Halloween is likely to be your child’s monstrous consumption of sugar – with wizards worse than witches”.
The ADA set out a series of tips for reducing the potential damage from exposure to sweets.
The AMA released its Public hospital report card: mental health edition, showing “the length of time spent in ED for patients presenting with mental health-related conditions was the highest on record in 2022–23”.
It also showed that “the number of Australians presenting to ED with a mental illness triaged as emergency has more than doubled from 9 to 21 per 10,000 people since 2010–11, while the number of urgent presentations has grown from 37 to 57 per 10,000 people”.
AMA President Dr Danielle McMullen said there was a need for “additional resourcing and real reform to the delivery and availability of mental health support at all levels”.
Judging by the feeble outcomes from the joint meeting of Mental Health and Health Ministers from all jurisdictions in August, additional resources and real reform are a long way off.
The Australian Association of Psychologists (AAP) joined with eight other groups (including the Australian Clinical Psychology Association, the Australian Psychological Society, the Institute of Clinical Psychologists, the Institute of Private Practicing Psychologists, and the Association of Counselling Psychologists) to launch a petition calling on the Government to remove the ten-session annual cap on the number of Medicare-funded services.
The AAP said that after halving the cap from twenty to ten sessions in 2022 the Government “has failed to provide a care plan for vulnerable people who need more sessions”. I would add that the Government so far has not even revealed the concepts of a plan.
The Australian Psychology Society marked Psychology Week (28 October-3 November), which this year focusses on psychology and the environment. It said members could “host local activities to understand how environmental factors influence behaviour and wellbeing, to promote sustainable practices, and address the psychological impacts of climate change”.
The PSA congratulated the ACT Government on its re-election, and welcomed its commitment to expanding the scope of practice for pharmacists.
It also welcomed the incoming Queensland Government, and urged it “to continue support for the Queensland Scope of Practice Pilot and the Hormonal Contraception Pilot, both of which are showing positive outcomes for accessible, timely healthcare”.
The Royal Australian College of GPs (RACGP) was also quick out of the blocks to congratulate the LNP on its win in the Queensland state election.
RACGP Queensland Chair Dr Cath Hester welcomed the new Government’s commitment to “delivering real-time health data for the state’s hospitals within 100 days of coming to government”, and said the RACGP looked forward to “working with the Government to remove the ‘patient tax’”.
Hester said “we want to help the government empower general practice to reduce the strain on our emergency departments, make healthcare more affordable, and keep more Queenslanders out of hospital in the long term”.
“Reducing the number of preventable hospitalisations could save taxpayers more than $1 billion,” she said.
(Croakey’s coverage of the Queensland election is compiled here.)
Industry groups
The Aged Care and Community Providers Association (ACCPA) called for “realistic timelines to implement a raft of historic reforms as part of the new Aged Care Act”.
ACCPA CEO Tom Symondson argued for a phased implementation of the reforms, saying that “we need certainty, and we need time”.
“Everyone wants this reform to succeed, but that means a staged approach to implementation should be adopted,” he said. “We only get one chance to get this right”.
The ongoing smouldering dispute between the private hospital sector and the private health insurance sector burst into flame on a new front, as Healthscope announced a “facility fee” for privately insured patients with policies issued by Bupa or the Australian Health Service Alliance group of insurers. Around six million insured people will face a $50 fee for day-only admissions and a $100 for overnight admissions.
According to the Protect your hospitals website (actually a Healthscope site), the fee is needed because the insurers “are not properly funding local Healthscope hospitals”.
PHA was outraged, accusing Healthscope of an “unethical new low to extort money from Australians with health insurance”.
Dr Rachel David, CEO of PHA, said the health insurers being targeted by Healthscope already have legal contracts in place for services and that the fees could be illegal.
She went on “this is a deeply unethical move from a $1 trillion North American private equity firm holding patients hostage and trying to bully health funds into paying them more so they can increase profits”.
“Brookfield… is trying to squeeze out as much profit as possible before it abandons Healthscope hospitals, potentially making private healthcare unaffordable in the process,” she said.
The Australian Medical Association (AMA) also bought into the issue, urging Healthscope and the insurers to “return to the negotiating table” to resolve the dispute.
President Dr Danielle McMullen said the dispute reinforced the need for a “Private Health System Authority… [to] drive long-term reform and ensure the sector is appropriately regulated and patients get real value for money from their private health insurance”.
She added that such an authority could have “a crucial role in helping solve disputes like these between Healthscope and each of Bupa and the AHSA”.
Perhaps the authority could also have a role in regulating the level of out-of-pocket costs charged by doctors?
Another dispute flared arising from reform of the prostheses list to remove from the list of goods for which private health insurers must pay separately a range of medicines including fibrin sealants.
CHA called on the Government to defer the change, “warning it could severely disrupt essential surgical procedures and increase costs for patients and hospitals”.
PHA responded that suggestions insurers would “not pay for fibrin sealant medicines from 1 November in private hospitals are completely false”.
“There is no need for patients to be concerned about accessing these medicines if they require them in future,” PHA said.
APHA CEO Brett Heffernan responded to a recent KPMG report commissioned by Medibank arguing for an expansion of hospital care in the home (HITH).
The KPMG report said that wider use of HITH could substitute up to 1.2 million physical bed days and save up to $1 billion in healthcare costs in 2030, as well as saving up to $6.4 billion in capital expenditure on new physical hospital infrastructure.
Heffernan warned that currently “[HITH] services are almost exclusively delivered by the insurers themselves, who seldom recognise or pay for any other providers”.
He said that “patients ‘should be alarmed’ when insurance companies seek to justify their forays into clinical service provision based on cost-savings”.
Politicians and parliamentary committees
The Senate inquiry into the Aged Care Bill was due to report on 31 October. On that day it produced a “progress report”, which consisted of a request for an extension of time to report until 4 November 2024.
Greens health spokesperson Jordon Steele-John joined leader Adam Bandt in announcing a plan to “put mental health into Medicare”. This will doubtless come as a shock to the tens of thousands of health professionals who are already providing mental health services under Medicare.
The plan involves:
- removing the annual limit on the number of Medicare-subsidised psychology consultations
- increasing the Medicare rebate for these sessions to $150
- making Medicare rebates available for serviced provided by provisionally registered psychologists
- increasing by 1000 the number of peer workers.
These measures are in addition to the provision of free psychologist sessions at the 1,000 free Local Healthcare Clinics across Australia announced by the Greens last month.
According to the Greens, on the basis of costings by the Parliamentary Budget Office (PBO), these policies will cost $5.9 billion over a decade. (As of Saturday 2 November, these costings were not available on the PBO website.)
International organisations
The World Health Organization (WHO) released the latest report on tuberculosis (TB), showing that approximately 8.2 million people were newly diagnosed in 2023, the highest number since WHO began global monitoring in 1995, and a substantial increase on the 7.5 million reported in 2022.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said “the fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it”.
The WHO said that multidrug-resistant TB remains a public health crisis. While successful treatment rates for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) have now reached 68 percent, less than half of the 400,000 people estimated to have developed MDR/RR-TB were diagnosed and treated in 2023.
Finally
Having read the WHO statement on TB, I thought it would be interesting to see how rates in Australia have been trending in recent years.
A Google search for TB notifications in Australia finds a Department of Health and Aged Care website page, which claims to “contain links to annual reports on tuberculosis notifications in Australia and reports on bacteriologically confirmed cases and drug resistance, produced by the Australian Mycobacterium Laboratory Reference Network from 1994”.
However, the page was last updated on 9 August 2022, and the most recent report linked on the page is for Tuberculosis notifications in Australia, 2015-2018.
Further Google searching to find out what has happened since 2018 eventually located a page for the National Notifiable Disease Surveillance System, which links to a data visualisation tool that allows access to TB notifications over time.
That shows TB cases so far this year of 1,302, compared with 1,432 for all of last year. However, this is a decline from a two-decade peak of 1,618 in 2020.
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
Proposed amendments to the Gene Technology Act 2000
8 November
Podiatry Board of Australia
Proposed change to the protected title for the specialty of podiatric surgery
8 November
Department of Health and Aged Care
Medical Research Future Fund Genomic Health Futures Mission – National Consultation on the refreshed Roadmap and Implementation Plan
8 November
Department of Health and Aged Care
Public Health (Tobacco and Other Products) Amendment (On-Product Health Messages and Other Measures) Regulations 2024
8 November
Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November
Free TV Australia
Revised Commercial Television Industry Code of Practice
11 November
Therapeutic Goods Administration
Medical Devices – Essential Principles for Safety and Performance
13 November (extended from 16 October)
Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November
Department of Health and Aged Care
Potential reforms to the Medicare safety nets
15 November
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
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
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.
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