Women’s health, inequalities in access to medical specialists, and the impact of heat upon physical and psychological health for people on low incomes are among the topics covered in The Zap this week.
Health policy analyst Charles Maskell-Knight also reports researchers’ concerns that provision of adequate healthcare to Northern Queensland rural and remote communities is being hindered by restrictions on public access to information about health service delivery, combined with reliance on health data sources that are not fit for purpose.
Our columnist raises questions about research grants that appear to be promoting the role of private health insurance in general practice, and also laments the closure of the Health Issues Centre, established in Melbourne in 1985, which advocated for consumers in the health system for almost 40 years.
The quotable?
“This column is dedicated to reporting announcements and statements in the health and aged care areas, but every so often non-announcements are just as interesting:
- for the 12th week since the Aged Care Taskforce held its final meeting on 15 December, Aged Care Minister Anika Wells did not release its final report; and
- the Government is now a week late in responding to the report of the Senate select committee inquiry into dental services, which was due on 29 February.”
Charles Maskell-Knight writes:
I have always wondered if there was a United Nations committee somewhere which decided on how to allocate days of the year to different causes, and if so, which criteria it uses. Anyway, last Monday, 4 March was both International HPV Awareness Day, and World Obesity Day.
And of course, Friday, 8 March was International Women’s Day.
Assistant Minister Ged Kearney marked the first of these with a media release about the success of the self-collection option for cervical cancer screening introduced in July 2022. So far 315,000 Australian women have used the option, and 27 percent of all screening tests are now done this way.
Kearney said: “The increase in testing rates in the Northern Territory and among First Nations Australians is a big success story. It puts us closer to closing the gap on First Nations testing rates so we can drive down the rate of cervical cancer in these communities”.
Kearney also did a series of radio interviews associated with International Women’s Day, discussing women’s health and the End Gender Bias survey commissioned by the National Women’s Health Advisory Council. Talking to ABC Radio Perth, Kearney said she had been told that the health system was designed for a fifty-year-old white man from Pennsylvania, and that it often let down women.
She is convening a women’s health summit on Thursday, 14 March to discuss how to improve how the health system works for women.
While World Obesity Day saw a plethora of media stories about Australians’ expanding waistlines, there was no Government acknowledgement of the day.
Ministers and government
Minister Mark Butler announced that on 1 March a further 94 medicines were added to the list of drugs available under a 60 days prescription, including treatments for diabetes, epilepsy and breast cancer. He said that Australians had already saved $11.7 million on almost three million scripts since the policy began in September last year, and foreshadowed adding a further 100 medicines to the list on 1 September this year.
The announcement was welcomed by many groups including the Australian Medical Association (AMA), the Royal Australian College of General Practitioners (RACGP), Diabetes Australia, and the Breast Cancer Network Australia. The Pharmacy Guild, which vociferously opposed the initial change, did not comment.
Butler also announced he had approved private health insurance premium increases averaging 3.03 percent to apply from 1 April. He noted that the increase was below the rate of increases in wages and inflation, and “much lower than the increase to the cost of other insurance products, which rose by around 17 percent in 2023”.
All very true, but I still don’t see why the five insurers who had net reserves greater than a year’s worth of premium income at the end of last year need to have any premium increase.
Shadow Health Minister Anne Ruston criticised the Government for delaying the announcement until after the Dunkley by-election. I’m sure she’s right, but is it any worse than announcing a premium increase on Thursday, 23 December when the national media have already checked out for the holidays?
This column is dedicated to reporting announcements and statements in the health and aged care areas, but every so often non-announcements are just as interesting:
- for the 12th week since the Aged Care Taskforce held its final meeting on 15 December, Aged Care Minister Anika Wells did not release its final report
- the Government is now a week late in responding to the report of the Senate select committee inquiry into dental services, which was due on 29 February.
The Australian Institute of Health and Welfare (AIHW) released a number of new reports, including:
- access to and spending on general practice, allied health and other primary care services
- Medicare-subsidised GP, allied health and specialist health care by local areas for 2022-23
- emergency department attendances and hospitalisations for spinal injuries in Australia 2020-21.
If I had to pull one striking headline statistic from these reports, it would be this: the rate of specialist attendances for people living in the North Sydney Primary Health Network is almost three times the rate for people living in the Northern Territory. Another example of the inverse care law?
The AIHW also released a massive dataset covering “up to 20 years of weekly health service use data by Statistical Area Level 4 geography…includ[ing] data relevant to respiratory, cardiovascular, and mental health conditions, as well as other health conditions”. The dataset was developed to support “research on the impact of environmental events (in particular, bushfire) on health service use”.
Finally, the AIHW published a report about the COVID-19 Register linkage project as a resource for researchers wanting to use the data, setting out the linkage method and process, and comparing high level linkage results for previous and current versions of the COVID-19 Register.
The ABS released data on multiple job-holders. As at November 2023, 10.3 percent of people who were a “community and personal service worker” in their main job also held another job. This was the highest percentage for any main occupation, possibly reflecting the prevalence of part-time shift work in the caring sector, not to mention low rates of pay.
First Nations health
The Australian Indigenous HealthInfoNet at Edith Cowan University released its Overview of Aboriginal and Torres Islander Health Status 2023, containing detailed information against a wide range of performance indicators. The overall picture is consistent with the Closing the Gap report and the data on First Nations health in the Productivity Commission Report on Government Services: First Nations peoples have worse health than the non-indigenous population, and across many indicators the difference is not reducing.
The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) issued a statement condemning the Victorian Department of Justice for dismissing testimony given by Aboriginal people about their experience of health services in prison.
Although an investigation by the Victorian Ombudsman found “common themes of inadequate mental health, delays in accessing healthcare, and harmful attitudes held by custodial and healthcare staff”, the Department of Justice’s response was “to question the veracity of experiences shared by Aboriginal people”. [Read more about this investigation in a previous Croakey article by Professor Megan Williams and Jack Bulman].
Consumer and public health groups
The Consumers Health Forum expressed concern that the boom in demand for Ozempic as a weight loss product meant that “suddenly people living with conditions, like diabetes, who need the drug for medical purposes can’t get it”. CHF said while it understood the reasons for the TGA’s proposed ban on compounding pharmacists preparing Ozempic-like products, action was need to address supply issues.
It called on the Government to continue its efforts to get more Ozempic into Australia, noting that this is a global supply issue; and “convene a roundtable of consumers, industry and clinicians to see how we can work together to find solutions to medication supply and use issues”.
CHOICE published an article on the private health insurance premium increases, pointing out that in many cases it was possible to avoid the increase on 1 April by prepayment for a year. Good advice for families with a lazy $5,000 lying round not earning interest. However, if the money would otherwise be sitting in a mortgage offset account, or a term deposit earning interest, it would be better left there. (This is not to be taken as financial or investment advice!)
ACOSS reported on a survey of over 1,000 people experiencing financial and social disadvantage, which found 80 percent of them were living in homes “that are too hot in summer” and made them unwell. Fourteen percent of respondents (25 percent of First Nations respondents) had sought medical attention for heat stress.
CEO Dr Cassandra Goldie said that “due to skyrocketing energy costs, inefficient homes and the glaring inadequacy of income support, people on low incomes cannot keep themselves cool, badly impacting their physical and psychological health. In the May budget, the Government must invest further in energy efficiency, electrification and rooftop solar across all low-income housing types, incentivise minimum energy efficiency rental standards, and raise the rate of JobSeeker and related payments”.
The Australian Institute of Tropical Health and Medicine at James Cook University published an article about the difficulty of accessing and combining health data sets. It found that “restrictions on public access to information about health service delivery, combined with reliance on health data sources that are not fit for purpose, are hindering the provision of adequate healthcare to Northern Queensland rural and remote communities”.
Trade unions
The AMA used the announcement of increased private health insurance premiums to call for a “new independent body to oversee the sector to ensure patients get value for money”. President Professor Steve Robson said a new “referee” was in the best interests of patients, hospitals, prostheses suppliers, and doctors. He went on: “We are currently seeing patients wading through unexpected out-of-pocket costs, restricted choice, and additional complexity”.
The most likely source of unexpected out-of-pocket costs is, of course, gap fees resulting from specialists charging more than insurers will pay. The AMA want a rule compelling insurers to return 90 percent of premiums in the form of benefits. A rule forbidding doctors from charging fees greater than insurers will pay would be just as beneficial for patients.
The RACGP announced that applications had opened for a range of research grants under the auspices of the RACGP Foundation and funded in conjunction with other bodies such as the nib foundation (a charitable trust established by nib health funds “in pursuit of its purpose of better health and wellbeing”).
The College said that: “the nib foundation/RACGP Foundation Healthcare Systems & Sustainability Grant will fund up to two general practice research projects focused on one or both of the following themes:
- The financial sustainability of general practice and the potential role of private health insurers.
- Collaborative approaches to non-pharmacological interventions within the broader health ecosystem, including the potential role of private health insurers. Interventions may include social prescribing, health promotion, and/or illness prevention”.
The nib foundation’s three purposes are to promote prevention, enable equality, and empower communities. It isn’t clear to me how a role for private health insurance in funding general practice will “enable equality”.
The RACGP asked for the Government to fund “living guidelines” for general practice care. College President Dr Nicole Higgins said “health research and evidence changes so rapidly that guidelines quickly become outdated, and GPs need to spend a lot of time looking at new research to keep up to date. Funding for GP-led living guidelines will mean Australians can get the latest evidence-based care – this will make Australia healthier and reduce costs to the health system”.
The College also issued a media release on International Women’s Day, reiterating earlier calls for funding in the next Budget to provide conditions for GP registrars comparable with their hospital-based specialist trainee peers, together with an increase in the MBS fee for longer GP consultations.
The Australian Physiotherapy Association released a position statement on Physiotherapy and Birth Trauma to mark International Women’s Day. It proposed Medicare-funded obstetric pelvic health physiotherapy consultations to support birthing parents before and after childbirth; encouraging investment in the non-surgical management of physical birth trauma; research to understand the impacts of physical birth trauma and inform policy and funding decisions; and government funding for the Australasian Birth Trauma Association to assist it in providing education and support for those affected by birth trauma.
The Rural Doctors Association of Australia marked International Women’s Day with a release calling for funded child care centres on the grounds of smaller rural hospitals to help allow parents who are doctors get back into the workplace.
The Australian College of Nursing issued a media release picking up on the #InspireInclusion theme for International Women’s Day, saying that it “reflects the values, practices, and objectives of ACN and the nursing profession”.
Writing on LInkedIn, Dr Elizabeth Deveny, CEO of the Consumers Health Forum, raised concerns about a company that has been pushing #InspireInclusion for International Women’s Day, and misquoting the UN’s actual theme of: Invest in Women: Accelerate progress.
“This co-opting of International Womens Day, especially changing the UN themes to slogans promoting passivity, by a nameless for profit marketing company has made me cranky!” Deveny wrote. “Inspire inclusion – give me a break. I’d prefer “include me” – or as the UN put it, count me in.”
The Australian Nursing and Midwifery Federation welcomed the Government’s announcement that it would pay 12 percent superannuation for workers taking Commonwealth paid parental leave from 1 July next year. ANMF Assistant Secretary Lori-Anne Sharp, said the decision was “very welcome news as women should not be penalised for taking time out of the workforce to have children”.
The Australian College of Rural and Remote Medicine published an update on its work on climate and health, arguing health organisations should be equipped to “develop systems to anticipate, recognise and respond to changes in climate-based health demands; build resilient systems to plan for adapt to climate threats, and use available resources, while minimising waste; reduce the provision of low value care; and develop a workforce with the capacity to understand and interpret risks to sustainable healthcare, as well as build and apply these systems in the workplace”.
The Society of Hospital Pharmacists of Australia marked International Women’s Day with “a strong statement on inclusion”, and announced the opening of consultation on its first Diversity, Equity and Inclusion Strategy.
Industry groups
Private Healthcare Australia (the main private health insurance lobby group) issued a statement seeking to justify the premium increases approved by the Minister, and calling for further action to reduce costs and pressure on premiums, such as:
- further reductions in the cost of generic medical implants and surgical supplies to bring them back in line with global market prices
- removing low value care and harmful medical devices and services from the market as soon as clinical evidence reveals a problem
- allowing health insurers to pay for evidence-based out-of-hospital models of care
- stamping out fraud through continuous monitoring of bulk billing rates and out-of-pocket fees for GP and specialist medical care
- introducing US-style ‘Surprise Billing’ legislation to ensure consumers are not liable for fees they have not agreed to before a procedure.
Members Health (the lobby group for insurers which make profits but can’t distribute them) also issued a release, boasting that its 24 member insurers had an average premium increase of only 2.82 percent, compared with the industry average 3.03.
The Australian Private Hospitals Association published a statement from CEO Michel Roff, complaining that insurers were still issuing “junk” policies with very low levels of cover. Calls to abolish junk policies ignore the billions of dollars in subsidies these policies provide to policies offering full cover through the private health insurance risk equalisation mechanism.
The Australian Healthcare and Hospitals Association released a brief prepared by its Deeble Institute on operationalising value-based health care. AHHA CEO Kylie Woodcock said that value-based health care “provides a framework to support all parts of the health system to come together with the people and communities they serve. It fosters transparent decisions about where and how resources should be deployed in order to drive the greatest improvements in health outcomes”.
Catholic Health Australia called on the Government to support an increase in pay for aged care workers, including non-clinical workers.
CEO Jason Kara said “right now we have 60,000 care and nursing vacancies and this is projected to hit 110,000 in six years’ time. If the government does nothing, more services will be forced to close because they can’t get qualified staff at currently funded rates…with most aged care services operating at a loss, and demand increasing as our population ages, the government must support and fund this essential investment in skilled aged care staff.”
International organisations
The Commonwealth Fund (US health policy think-tank) published a report with a ranking of the health systems across all 50 US states and Washington DC.
Of the state with above average performance, only five voted for Trump in 2020; while among the below average states, only four voted for Biden. Diving into the more detailed data confirms this pattern: conservative states with a long history of Republican administrations perform poorly on just about every reported indicator.
In relation to women’s reproductive health, the report concludes that: “in many states that have imposed abortion restrictions, women had poor health outcomes even prior to the 2022 Supreme Court ruling. Twelve of the 15 states that rank lowest on our measures of reproductive care and women’s health have restrictive abortion laws… The trends are particularly pronounced for all-cause mortality and for maternal and infant deaths. States with abortion restrictions also had fewer maternal care providers before 2022. The additional limitations on reproductive care in states with these poor outcomes raise concern that existing gaps could widen in the coming years”.
Finally
To end this week’s column, some sad news – the Health Issues Centre closed its doors on 7 March. Established in Melbourne in 1985, the HIC had advocated for consumers in the health system for almost 40 years.
As the Board said when announcing the closure: “our training has enabled healthcare providers across the country to advance their practice in engaging consumers in designing and improving services, and enhanced the leadership capabilities of hundreds of consumer advisors. [Our] work has not only highlighted the many issues affecting consumers, but advocated for consumers to be valued and respected as equal and active partners in their own healthcare and in health system transformation”.
The Board said that it was exploring options to “transition the legacy of the HIC to a like-minded organisation” which shares its values of authenticity, partnership, equity and accountability.
Have we missed anything? Let Charles Maskell-Knight know using ‘The Zap’ in the subject line: info@croakey.org
The Zap column launched in early 2024, to provide a weekly summary of health-related reports, announcements and media releases from Commonwealth government agencies, Health and Aged Care Ministers and other politicians, national health sector organisations, and some international bodies.
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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