Health Minister Mark Butler has made it very clear that dental health reform is not on the Albanese Government’s agenda, Charles Maskell-Knight reports this week.
His latest column also covers increasing rates of antimicrobial use in aged care homes, wide-ranging news from the primary care frontlines, and concerns about the use of medical eponyms (terms used in medicine that are named after people or places), including that they may “inadvertently contribute to the persistence of colonialism and intersectional discrimination in medicine”.
The column also covers the widespread concern across the health sector about the Census debacle; meanwhile, Dr Andrew Leigh, Assistant Minister for Competition, Charities and Treasury, released a statement today saying there would be a new topic of ‘sexual orientation and gender’ for inclusion in the 2026 Census.
The quotable?
This milestone gives us a moment to pause and celebrate Aboriginal and Torres Strait Islander Health Practitioners for their incredible sacrifices to care for our families and communities’ health and wellbeing.”
Charles Maskell-Knight writes:
Following Adam Bandt’s National Press Club speech on 28 August, a number of Government backbenchers picked up on his call to extend Medicare to cover dental services.
Health Minister Mark Butler promptly shut the door on these proposals.
Responding to questions on the issue at a press conference, the Minister said: “I know that many of my colleagues are ambitious for Medicare to do more. We’re very proud in Labor of our role in creating and defending and strengthening Medicare.
“I know my colleagues would like to see it do more, but right now my focus is… on strengthening the fundamentals of Medicare, which have been under real pressure after ten years of cuts and neglect.”
A journalist then asked “is there a time frame for Medicare dental rebates, though? Because you’ve previously said Labor’s committed to providing this. So, is there a time frame, or are you sort of just letting it [drift] further down the road?”.
Butler responded: “There’s no work on that in this term of Government… we are working with state governments on developing a new oral health plan, and that’s about practical change that we can make that will make a real difference.
“I know that there is ambition for Medicare in the medium to long term, but right now, we’re focused on the fundamentals of Medicare, as it was envisioned by Hawke 40 years ago and Whitlam 50 years ago, and that particularly is about general practice.”
The only “practical change… that will make a real difference” to oral health is a significant increase in government funding – and that is clearly not going to happen.
The Australian Dental Association (ADA) joined in the debate, arguing that rather than adding dental to Medicare, “it’s far more realistic to start smaller with a dental scheme for our most vulnerable populations, starting with one for seniors”.
The ADA acknowledged “the enormous workforce shortages associated with providing even the most basic care for 26 million Australians”.
Perhaps it will now revisit its policy that “the government must place a cap on the number of dental practitioner students to be trained in Australia”?
Ministers and government
Butler announced that seven existing Victorian Government-funded Priority Primary Care Centres would “transition” to become Urgent Care Clinics funded by the Commonwealth.
Assistant Minister for Indigenous Health Ged Kearney announced Government capital funding for a new Victorian Aboriginal Health Service at South Morang in Melbourne’s north, an area with a growing First Nations population. The project includes funding for two vans to provide primary and dental health outreach services.
The Australian Institute of Health and Welfare released a report assessing state and territory performance against the benchmarks outlined in the Essential Vaccines Schedule for the year ending 31 March 2023. The report notes that “results in this report should be interpreted in the context of the COVID-19 pandemic, which may have led to limited immunisation service access and reduced vaccine demand through the reporting period”.
Having said that, the AIHW website reports that only two jurisdictions met all five performance benchmarks, and then only after “reassessment” – the data included in the actual publication suggests that only South Australia met four of the five benchmarks and partly met the fifth.
The Australian Commission on Safety and Quality in Aged Care released a report on Antimicrobial use in the community 2023, using PBS data.
It found that “despite an encouraging gradual decline in overall antimicrobial use in the community, there was an 11 percent increase in use in residents of aged care homes from 2022 to 2023… antimicrobial use is notably higher for older Australians who reside in aged care homes than for those in the community, with almost three-quarters of aged care home residents receiving at least one antimicrobial prescription last year”.
Ahpra announced that the number of registered Aboriginal and Torres Strait Islander Health Practitioners had climbed over 1,000 for the first time.
Bardi and Jabirr Jabirr woman Ms Iris Raye, Chair of the Aboriginal and Torres Strait Islander Health Practice Board of Australia, said “this milestone gives us a moment to pause and celebrate Aboriginal and Torres Strait Islander Health Practitioners for their incredible sacrifices to care for our families and communities’ health and wellbeing”.
The Australian Bureau of Statistics (ABS) released the July Monthly household spending indicator, showing growth in health spending in the year to July of 6.8 percent – well above the total 1.8 percent, and the second highest of any category behind “miscellaneous goods and services”.
First Nations health
The Lowitja Institute released a discussion paper, ‘Cultural safety in Australia’, highlighting “the critical need to improve access to quality healthcare, addressing the social determinants of health, and elevating the importance of the cultural determinants of health for Aboriginal and Torres Strait Islander peoples”.
Consumer and public health groups
The Burnet Institute announced the publication of a paper, ‘Changes in Australians’ attitudes towards supervised injecting facilities’, which found that “between 2001 and 2019, support for supervised injecting facilities increased modestly by 3.3 percent, those who ‘don’t know’ by 7.4 percent, whereas opposition decreased by 11.7 percent”.
“Between 2001 and 2019, support for supervised injecting facilities increased in NSW and Queensland, whereas opposition decreased in all jurisdictions,” the researchers reported.
Lead author Zachary Lloyd said that “addressing public stigma about supervised injecting facilities is key to building support for the introduction of more facilities and helping to reduce the rates of overdoses in Australia”.
Burnet researchers also published a paper on COVID-19 infection control in hospitals, concluding that “simple infection control measures could save lives and reduce costs for hospitals”.
National Seniors Association (NSA) published an article on the private hospitals’ financial situation. (There is a lot more on this issue in the Industry groups section below.)
NSA suggests that the Productivity Commission should “review the private health system, with an emphasis on identifying ways to improve its value proposition to policy holders in general and older policy holders in particular”.
The policy of private health insurance community rating, and the system of risk equalisation that underpins it, means older policy holders as a group receive billions of dollars more in benefits than they pay in premiums.
Private health insurance is already incredibly good value for older people – and conversely, terrible value for younger people who see most of their premiums go to cross-subsidise their parents and grandparents.
The Public Health Association of Australia (PHAA) joined with the Thoracic Society of Australia and New Zealand (TSANZ) in criticising the acquisition of medicine and vape manufacturer Vectura by tobacco giant Philip Morris International. They said that earlier this year Vectura partnered with Mundipharma to reformulate the asthma medication Flutiform.
TSANZ President Professor Anne Holland said “this disturbing alliance undermines public health initiatives and perpetuates a destructive cycle where Big Tobacco profits from selling harmful products like cigarettes and e-cigarettes, only to profit again from selling treatments for the damage they cause”.
PHAA and TSANZ “strongly urged all medical societies and health-related organisations to back their efforts to cease partnerships with Mundipharma”.
Trade unions
The Australian College of Nursing called for “every school-aged child in Australia [to] have ready access to a suitably qualified registered nurse to provide care and guidance to ensure the maintenance of healthy weight”. Their call has been widely criticised on social media and in mainstream media because of concerns about fat-shaming, stigma and a focus on individual behaviours rather than creating healthy environments.
As reported in Croakey, LGBTIQ+ Health Australia released a joint statement from a wide range of organisations calling on the Government “to end the current uncertainty and unhelpful discourse about the introduction of three new topics on gender, innate variations of sex characteristics and sexual orientation into the 2026 Census and allow the Australian Bureau of Statistics to do its job and complete its processes”.
The Primary Health Care Alliance, made up of eight organisations including Allied Health Professions Australia, the Australian Nursing and Midwifery Federation, and the Australian Primary Health Care Nurses Association, issued a consensus statement on primary healthcare reform.
The organisations agreed that:
- funding should be needs-based, flexible enough to support multi-disciplinary care across health systems, and sufficient to enable pro-active preventative care
- interconnectivity between primary healthcare, private and tertiary providers was essential
- there should be a consistent national data and evaluation framework to inform health policies and interventions, along with a strategic research agenda
- primary healthcare training should be embedded in the undergraduate curriculum across all professions to grow an interdisciplinary primary healthcare workforce.
As summer approaches, the Royal Australian College of GPs urged patients to organise a skin cancer check with their GP. The call coincided with the release of the latest edition of the Australian Journal of General Practice, focussed on skin cancer topics.
The College also called on all parties standing in the ACT election on 19 October to “follow other jurisdictions, including Victoria and Queensland, in providing an incentive for doctors to train as GPs in Canberra”.
The College reacted to the announcement by the NSW Government of a further extension of the permitted scope of practice of pharmacists “to treat ear infections, wound management, nausea, gastro-oesophageal reflux disease, acne, and muscle and joint pain”.
According to College NSW Chair Dr Rebekah Hoffman, “the NSW Government is kidding itself if it thinks this move will do anything to reduce pressure on the state’s overflowing hospitals. If anything, it will have the opposite effect”.
She went on to say that “NSW is on a trajectory towards a two-tier healthcare system” in which those who can afford GP care can receive it, while everyone else will have to settle for ‘cheaper’ services at a retail pharmacy.
The Rural Doctors Association of Tasmania joined with the Australian College of Rural and Remote Medicine in welcoming Tasmanian Premier Jeremy Rockcliff’s announcement that Rural Generalists could practise in hospitals in the State’s northwest.
Industry groups
The Medical Technology Association of Australia (MTAA) released a statement “New analysis shows billion door [sic] health insurance profits” commenting on APRA’s March quarter private health insurance statistics. (These were released on 22 May – the June quarter data were released on 27 August, but have not yet been subject to the MTAA’s forensic scrutiny.)
According to the MTAA, the “corporate health insurance industry [was] profiteering as families do it tough during the cost-of-living crisis”.
MTAA said that private health insurer claims that growth in prostheses benefits was behind increased premiums had “been resoundingly refuted by… analysis showing the average benefit payments insurers pay for medical devices has decreased by 17 percent since 2016”. (This analysis is based on price per unit, and ignores the volume of prostheses supplied, which is increasing far faster than hospital episodes.)
MTAA CEO Ian Burgess said “the facts and the analysis show where the money is really going – into health insurers’ own pockets”.
The Australian Private Hospitals Association issued a more timely statement on the June quarter APRA data, claiming that it showed a real decline in insurance benefits per episode since 2019 that “lagged significantly behind the rate of inflation over time”.
However, this analysis does not reflect changes in case mix or the level of excesses or front-end deductibles and other copayments made by patients.
Boston Consulting Group (BCG) released a paper on the outlook for the private hospital sector, which concluded that after adjusting for an ongoing case mix shift, unit level pricing is now growing faster than CPI. Indeed, BCG suggested that despite recent pressures, “we remain cautiously optimistic about the longer-term prospects of the Australian private hospital sector”.
Against this background, private hospital group Healthscope launched a “Protect your hospitals” campaign, claiming that “some health insurers like big-profit Bupa and Australian Unity are bleeding local private hospitals dry – and we are all paying for it”.
Healthscope hospitals were acquired in 2019 by Canada-based Brookfield, which describes itself as “a business services and industrials company focused on owning and operating high-quality businesses that benefit from barriers to entry and/or low production costs”. At that time, Brookfield claimed to have more than US$365 billion of assets under management.
Private Healthcare Australia (PHA, the main private health insurers’ lobby) responded, with a statement claiming that the Brookfield campaign was “designed to pressure Australian health funds and the Australian Government into bailing out Brookfield from bad business decisions, including the underpayment of Australian staff”.
PHA went on “Brookfield is managing more than $1.4 trillion in assets. It can afford to bail itself out. Australian health funds won’t let their members foot the bill through their health insurance premiums”.
PHA also claimed that “Brookfield has already returned more than $2.5 billion in profits from the sale of Healthscope hospitals to its North American owners”.
The Guardian has reported that the Private Hospital Sector Financial Health Check being conducted by the Department of Health and Aged Care is now overdue. It was supposed to have been completed in late August, but on 2 September the Department said it was “still being finalised”.
Until this is resolved, we can enjoy the irony of a Canadian company (Brookfield) that wants to continue to transfer profits from hospital care back to Toronto complaining that it is being underpaid by a British company (Bupa) that is transferring profits from private health insurance back to London.
Catholic Health Australia (CHA) announced that the ACCC had decided on an interim extension to an existing authorisation to allow CHA members “to collectively negotiate with suppliers of medical goods and services … collectively negotiate hospital and healthcare related funding arrangements with funding organisations, including health insurers; and exchange data for benchmarking purposes”.
CHA’s statement did not say that it had also applied to expand the scope of the authorisation to allow its members “to engage in a further limited collective boycott of the five largest health insurers”.
The ACCC’s final decision is due in December.
Remember the Pharmacy Guild’s campaign last year against 60-day dispensing?
It commissioned a report which found that under the policy “as many as 20,818 jobs will go, 665 pharmacies will close with a further 900 community pharmacies will be placed under financial stress”.
The Guild has now released a statement on the benefits of the reductions in PBS copayments, saying that Government data shows the policy has saved consumers $346 million. The Guild is claiming credit for the policy change.
The statement also identifies the savings to consumers from 60-day scripts as $30 million – which works out as an average of $5,000 per pharmacy.
I find it hard to believe that a revenue reduction of that magnitude will lead to any job losses, far less pharmacy closures.
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston joined with several female colleagues to convene a women’s health round table to mark Women’s Health Week.
Ruston said that the Opposition “remained focused on developing policy to ensure the health needs of Australian women are met by our healthcare system”.
“This work builds on our proud record of funding important women’s health initiatives, including our leadership on endometriosis research and support,” she said.
International organisations
As the United States election campaign proceeds, the Commonwealth Fund published an article spelling out the consequences of repealing the Affordable Care Act, as ex-President Donald Trump still seems keen to do.
It estimates that “a full repeal of the ACA would increase the number of uninsured Americans by up to 24 million, while healthcare providers’ uncompensated care costs over a decade would rise by hundreds of billions of dollars”.
Finally
Jane Austen is presumed to have died from Addison’s disease, and Neil Diamond retired from touring because of Parkinson’s disease. Most of us would know somebody who has suffered from either a Smith’s fracture or a Colles fracture of the wrist.
These conditions are all medical eponyms, named after the (usually male European) doctor or scientist involved in first diagnosing or describing it – in these cases Thomas Addison, James Parkinson, Robert William Smith, and Abraham Colles.
An article in The Medical Journal of Australia suggests that the ongoing use of medical eponyms “without reflective deliberation may be detrimental”.
Dr Leya Nedumannil and Dr Diana Lewis argue that:
- medical eponyms may “falsely promote medical discoveries as the product of a single individual’s efforts while neglecting the broader team that contributed”
- eponyms may “reinforce the enduring issue of representation of women in medicine, or lack thereof”
- eponyms may “potentially glorify the memory of individuals complicit in unethical methods of research historically veiled under the guise of scientific progress”, and may “inadvertently contribute to the persistence of colonialism and intersectional discrimination in medicine”
- may lead to confusion when a person’s name is used in different contexts – for example, Jean‐Martin Charcot, who gave his name to the Charcot joint, Charcot disease, and Charcot triad of acute cholangitis.
The authors conclude that “the use of eponyms particularly in highly specialised fields comes at the risk of interdisciplinary disconnect and misleading jargon when communicating with patients”.
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.
Food Standards Australia and New Zealand
Amend the definitions in the Australia New Zealand Food Standards Code (the Code) for ‘food produced using gene technology’ and ‘gene technology’
10 September
Department of Health and Aged Care
Improving commercial foods for infants and young children
13 September
Therapeutic Goods Administration
Proposed changes to the Permissible Ingredients Determination
13 September
The Joint Standing Committee on Aboriginal and Torres Strait Islander Affairs
Parliamentary inquiry into the Truth and Justice Commission Bill 2024
20 September
Independent Health and Aged Care Pricing Authority
Pricing Framework for Australian Residential Aged Care Services
20 September
Department of Health and Aged Care
Prostheses list – General Use Items utilisation, expenditure and integrity
20 September
Australian Commission on Safety and Quality in Health Care
National Safety and Quality Medical Imaging Standards (to replace the Diagnostic Imaging Accreditation Scheme Standards).
27 September
Department of Health and Aged Care
Draft of the National Roadmap to Improve the Health and Mental Health of Autistic People
27 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
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
Therapeutic Goods Administration
Future regulation of assistive technologies
13 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
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.
