Introduction by Croakey: As has been widely reported, Labor has announced plans for “the single largest investment in Medicare since its creation over 40 years ago, with $8.5 billion to deliver an additional 18 million bulk billed GP visits each year, hundreds of nursing scholarships and thousands more doctors in the largest GP training program ever”.
This news will be covered in depth in The Zap next week (as well as by other upcoming articles at Croakey); in the column below Charles Maskell-Knight reports on mental health policy developments and an Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement.
He also reports on delays in the development of a national registration scheme to support personal care workers employed in aged care, and gaps in the evidence base around nutrition and health, as well as sharing a personal story about the importance of resisting United States-driven misinformation and disinformation undermining vaccination.
Meanwhile, the Royal Australasian College of Physicians is keeping up pressure on all governments to transition away from fossil fuels and invest in climate-resilient health systems.
The quotable?
Safe healthcare relies on trust between patients and practitioners. Discrimination and racism erode that trust and put lives at risk. There is no place for discrimination, racism or intolerance in healthcare.”
Charles Maskell-Knight writes:
Health Minister Mark Butler and Assistant Minister Emme McBride announced grants totalling $135 million to 12 mental health services under the Digital Mental Health Program to “provide Australians access to digital and online mental health support at a time and place that suits them”.
The Ministers said that the spending “is part of the Government’s commitment to a whole-of-system approach to mental health reform”.
Nothing says “whole-of-system” like providing three-year service delivery grants to twelve disparate organisations.
Butler and McBride also released the National Suicide Prevention Strategy 2025-2035, the day after Croakey published an article by Suicide Prevention Australia CEO Nieves Murray calling for its release.
If only Croakey articles were always as influential!
In other mental health news, the Australian Association of Psychologists said it had joined with eight other mental health peak bodies to present a petition to Minister Butler with more than 25,000 signatures calling for “an end to the 10 session cap on Medicare-rebated psychology sessions, a policy the government has remained steadfast on, despite announcements from other major parties that they support more care for patients and will remove the cap if elected”.
It is now over two years since the Government decided not to extend the temporary COVID-19 expanded cap of 20 sessions of Medicare rebated sessions, following an evaluation by the University of Melbourne.
At that time Butler said the Government would convene an expert forum to advise it on how to “support access to higher levels of treatment for those who need it, while supporting equitable access for vulnerable and marginalised Australians”.
While the Mental Health Equity and Access Forum met on 30 January 2023, nothing substantive emerged from the forum.
Asked about the issue on ABC Radio on 10 February, Butler justified the reduction to ten sessions on the basis that “it has meant a whole lot more people have got access to important psychological therapy, so I’m not inclined to lift the number back up to 20 without expanding the psychology workforce, which is what we’ve been focused on over the last couple of Budgets”.
He also referred to the rollout of Medicare Mental Health Centres, and said the Government was “building a national early intervention service that will take pressure off our psychology therapy”.
Associate Professor Sebastian Rosenberg from the University of Sydney has reviewed the Government’s performance on mental health for Croakey.
He argues that “only [the Government] can provide the incentives or sanctions required to drive better, more integrated mental healthcare in Australia. This is a task still facing the next Government, whoever wins”.
Ministers and government
Aged Care Minister Anika Wells announced that the Government “is seeking views on the design of a national registration scheme to support personal care workers employed in aged care, including new training and mandatory minimum qualification requirements”.
Submissions responding to the consultation paper are due by 17 April.
Aged Care Royal Commission recommendation 77 was that the Government should establish such as scheme – but by 1 July 2022.
More than two-and-a-half years after the recommended implementation date, the Government is only now embarking on a consultation process about how a scheme might be designed. Policy development should not take this long.
Assistant Minister for Indigenous Health Ged Kearney announced the establishment of a dedicated social and emotional wellbeing centre designed for their needs of First Nations people in South Australia.
It will be jointly funded by the Commonwealth and SA Governments under the National Mental Health and Suicide Prevention Agreement, and an interim service will open by the end of the year.
On the My Aged Care website, the ‘Finance & operations’ tab of the Find a provider tool shows what aged care homes and Home Care Package providers spend on care, staffing, food, and other expenses. The Department of Health and Aged Care announced that this tab had been updated for the first time since the information was published in February 2024.
This information may assist people trying to select a service. From a policy analysis perspective, what would be much more helpful is presenting the data for all providers and services in a format that can be sorted by characteristics such as location, size of facility, and not-for-profit versus for-profit status.
The Australian Institute of Health and Welfare released a report on Health checks and follow-ups for Aboriginal and Torres Strait Islander people focussing on utilisation of specific Medicare items.
It found that in 2023-24, 28 percent of the First Nations population had a health check (returning to pre-pandemic levels); while among First Nations people who had a health check in 2022–23, 45 percent had a follow-up service in the 12 months following their health check.
The National Health and Medical Research Council (NHMRC) announced that, as part of its review of the Australian Dietary Guidelines, it had commissioned four reviews to address identified gaps in the existing evidence base.
The reviews will cover dietary patterns and the incidence of anxiety or depression; the links between consumption of ultra-processed food (UPF) in children and adolescents and various health conditions; the impact of dietary patterns, source of protein or UPF consumption during pregnancy and breastfeeding on maternal and birth outcomes; and the impact of UPF consumption adults on mortality and the various health conditions.
The NHMRC invited people to submit “primary study citations that answer the research questions” by 14 March for consideration in the reviews.
The NHMRC also opened a scoping survey as part of its work to develop clinical practice guidelines on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) within primary care.
The NHMRC said it “recognises there are other conditions (such as long-COVID, postural orthostatic tachycardia syndrome (POTS) and fibromyalgia) that share common symptoms with ME/CFS, and we will make reference to these conditions where appropriate”.
The survey closes on 27 April.
Ahpra and the National Boards issued a joint statement, which mentioned the suspension of the ‘Bankstown nurses’, and declared that discrimination and racism will not be tolerated in the provision of healthcare services.
The statement said that practitioners had the right “to communicate, including advocating for causes via social media, provided their activities do not involve abuse or discrimination against others, or present a risk to the public”.
However, the Boards may consider regulatory action if the way a practitioner expresses their views presents a risk to public safety; provides false or misleading information; breaches privacy or confidentiality; risks the public’s confidence in their profession; or requires action to maintain professional standards.
“Safe healthcare relies on trust between patients and practitioners,” the statement said. “Discrimination and racism erode that trust and put lives at risk. There is no place for discrimination, racism or intolerance in healthcare.”
First Nations health
The Coalition of Peaks initiated the Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement, a national initiative that captures the perspectives and experiences of Aboriginal and Torres Strait Islander people involved in the implementation of the agreement.
It said the “process is about understanding lived experiences, celebrating successes, and identifying where to build momentum in relation to the National Agreement”.
The review is being carried out by the Jumbunna Institute for Indigenous Education and Research at UTS, and submissions are sought by 16 April.
Consumer and public health groups
The National Rural Health Alliance (NRHA) released the Rural Health in Australia Snapshot 2025, which “paints a grim picture of health inequities between rural and metropolitan areas”.
NRHA Chief Executive Susi Tegen said the data “highlights the shameful failure to adequately provide funding and services to rural Australians, who contribute so much to our economy”.
“Why are they treated like second-class citizens, with a staggering $848 less spent per person per year on healthcare?” she asked.
Tegen reiterated the NRHA’s call for a National Rural Health Strategy to coordinate Commonwealth, State, and Territory policy, investment and service delivery to ensure tailored, sustainable solutions.
The National Seniors Association released its pre-budget submission, including recommendations to:
- increase the Medicare rebate by 40 percent for GP consultations longer than 20 minutes to reduce out-of-pocket health costs
- direct the Productivity Commission to conduct a full review of the private health system
- increase the value of the private health insurance premium rebate for people on low incomes
- create a targeted Seniors Dental Benefits Scheme to help seniors access essential dental care.
Palliative Care Australia (PCA) issued a statement about the ongoing shortage of essential palliative care medicines. It said that despite continued representations to the Minister, the Department of Health and Aged Care, and the Therapeutic Goods Administration, and despite a joint letter from seven patient and clinical groups to parliamentarians in December, the situation has not changed.
PCA reiterated the importance of its 11-point plan (first released in November last year) to address the problem. In relation to long-term supply risks, the plan suggests “expanding incentives for domestic pharmaceutical manufacturing to essential medicines in common clinical use, including opioid analgesics; and commissioning an objective assessment of the factors contributing to the longer-term decline in the availability of opioid analgesics in Australia”.
Given Tasmania produces over half of the world’s legal opium poppy supply, it is hard to imagine Australia couldn’t manufacture opioid analgesics domestically.
The Public Health Association of Australia (PHAA) reported on a study published in the Australian and New Zealand Journal of Public Health which found that locally grown produce in regional Victoria doesn’t necessarily cost more than fruit and vegetables grown outside of the region.
It said “the findings are good news for household budgets, local communities, local farmers and retailers, as well as the environment”.
Trade unions
The pre-budget submission from the Australian College of Rural and Remote Medicine called for the Government to spend $100 million over four years to expand the flagship Rural Generalist pathway, aiming to increase training positions to 500 registrars per year; and $30 million annually to support prevocational training in rural communities, helping medical graduates transition into careers as rural GPs and RGs.
Australian Medical Association (AMA) President Dr Danielle McMullen called on organisations in the health sector to commit to the Every Doctor, Every Setting Framework and action plan, intended to protect the mental health of Australia’s healthcare professionals.
The Pharmaceutical Society of Australia (PSA) announced that members had approved the necessary constitutional changes to allow the acquisition of the Australasian College of Pharmacy to proceed.
The Royal Australian College of GPs went for a whole week without issuing a media release.
The Royal Australasian College of Physicians (RACP) released its pre-budget submission, focused on the divide in access to specialist medical care between metropolitan and rural Australia.
It called for:
- expanding rural and regional specialist training pathways;
- introducing new incentives for medical specialists to work in regional communities;
- increasing funding for telehealth hubs in regional hospitals;
- reinstating Medicare rebates for specialist telehealth consultations; and
- supporting international medical graduates with dedicated rural training arrangements.
The RACP also reiterated its call for all governments to transition away from fossil fuels and invest in climate-resilient health systems.
RACP President, Professor Jennifer Martin, said “from heatwaves that increase the risk for hospitalisations to floods and cyclones that can cause serious injuries – extreme weather events are wreaking havoc on our communities. Without decisive and urgent action, the health and well-being of Australians remains at great risk from extreme weather events. The need for transitioning away from fossil fuels and investing in a climate-resilient healthcare system has never been greater”.
The Rural Doctors Association of Australia (RDAA) called for ongoing funding for training an extra 200 rural doctors per year to start addressing the shortage of doctors in rural and remote communities.
RDAA President Dr RT Lewandowski said “over the past two years the number of Rural Generalist training positions funded by the Commonwealth has actually been oversubscribed and the Colleges providing the training have been permitted to fund additional positions on a temporary basis”.
“To build on this momentum we need to lock in these training places with secure funding over the next three years to ensure the security and sustainability of these training numbers.”
Industry groups
Catholic Health Australia released its pre-budget submission with a strong focus on a range of measures intended to support private hospital viability.
As well as endorsing the ill-thought-out concepts proposed by the Department of Health and Aged Care in its recent consultation paper (which I discussed in a recent article), CHA came up with some additional ideas.
These include the truly weird notion that the private health insurance premium rebate should apply only to patient benefits and not to management expenses.
If policyholders are not to be worse off under such an arrangement, the rate of the rebate would need to increase. This means the element of the premium notionally allocated to paying benefits would decrease.
However, insurers would need to increase (by an exactly offsetting amount) the element of the premium notionally allocated to paying management expenses to make up for the lost premium rebate revenue.
Such a move may have symbolic significance, but it is unlikely to have any practical impact on private hospital viability.
CHA is also proposing various direct Government subsidies to private hospitals.
Former Medibank executive Marc Miller summed up the CHA submission by saying that the options “involve other actors in the sector taking an ice bath to inflate the declining profitability of private hospitals”.
By the way, I am always struck by the language groups opposed to the private health insurers use.
In their submission CHA refers to “corporate insurers”, with the adjective “corporate” clearly intended as a term of disparagement.
Most private hospitals are now run by corporate providers out to make a profit, such as Brookfield, an investment management company with assets under management of $US900 billion. Perhaps these are “corporate hospitals”?
Healthscope announced it was closing maternity services at the Hobart Private Hospital and the Darwin Private Hospital, due to staffing difficulties in Hobart and service volumes in Darwin.
The AMA responded, expressing “deep concern” at the closures, and claiming that they “further emphasised the urgent need for reform to the private health sector”.
AMA President Dr Danielle McMullen said in its response to the recent Government consultation on private health insurance reform, the AMA had “proposed a range of policy options to improve access to private maternity cover, including reviewing the tier level that includes maternity cover and options for patients to access maternity cover without a 12-month wait if it is not included in their cover level”.
CHA claimed the closures were “yet another example of the for-profit healthcare model’s failure to deliver essential health services to underserved communities” and showed a “for-profit healthcare provider cherry-picking the work that suits its bottom line and abandoning communities that rely on these vital services”.
Speaking to ABC radio in Hobart before the closures were announced, the CEO of Private Healthcare Australia (PHA, the private health insurers’ lobby group), Dr Rachel David, made the point that private health insurance benefit levels weren’t the only factor affecting the viability of private hospital maternity services.
She said “it’s a bit more complicated than that”.
“Money won’t actually solve this problem. The issue is that there are fewer births now because the economy is not as good as it was,” David said.
“There is a workforce shortage of skilled obstetricians, midwives and nurses, which is affecting [the Hobart] Healthscope hospital, as well as hospitals all around the country. And the out-of-pocket that are charged by obstetricians can be… between $5,000 and $10,000, and, in a cost of living crisis that just completely puts people off.
“So, there’s multiple factors that are playing into this and hospitals, private or public, have to be able to do a certain number of births every year to be considered a safe place to give birth.”
Let’s hope the Government considers these factors before adopting crazy regulatory options intended to rescue private maternity services.
After the closures had been announced, PHA said insurers were “working with governments in the Northern Territory and Tasmania, as well as health professionals, and other private hospital services to ensure affected [women] have maternity care options”.
The Pharmacy Guild called on the Government to “act now to make medicines more affordable by reducing the PBS general co-payment. This non-inflationary measure would reduce out-of-pocket prescription costs for patients”.
I checked carefully, but the Guild statement was released on 17 February this year – just over two years after the Government reduced the general co-payment by almost 30 percent from $42.50 to $30.00, as acknowledged by the Guild at the time in this statement.
Of course, further extending the range of medicines available under a 60-day script would reduce the number of times patients have to make the co-payment, but that does not seem to be on the Guild’s wish list.
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston called on Minister Butler to announce the private health insurance premium increase before the federal election is announced.
International organisations
The OECD released the results from its Patient-Reported Indicator Surveys (PaRIS), intended to “provide a unique set of indicators that unveil how people of 45 years and older who live with chronic conditions experience healthcare and how this impacts their lives”.
The high-level findings of the Australian country report include:
- 74 percent of people with chronic conditions report good physical health and 81 percent report good mental health, broadly in line with the OECD averages
- more than nine out of ten people with chronic conditions in Australia report good person-centred care and quality of care, significantly above the OECD average
- just under a quarter of the people with two or more chronic conditions are managed in primary care practices that offer follow-up and regular consultations of more than 15 minutes in Australia, more than 20 percentage points lower than the OECD average of 47 percent.
Finally
I reported last week on the resurgence of vaccine-preventable illnesses in the US, a trend which is likely to worsen now that vaccine opponent Robert Kennedy junior has been confirmed as Secretary for Health and Human Services.
This week paediatrician Professor Scott Krugman from the George Washington University posted on LinkedIn information on “how to recognise vaccine preventable illnesses, because they are all coming back as our public health infrastructure is unravelling and very few people under the age of 60 have seen any of these illnesses”.
He covered a disease a day for a week: measles, Hib, whooping cough, polio, rubella, mumps, and diphtheria.
On a personal note my mother, brought up in north-east England during the Great Depression in a household reliant on meagre unemployment relief, had at least four of these diseases including diphtheria, which nearly killed her.
I was born in the late 1950s, and vaccinated against diphtheria, pertussis and polio. However, I was a few years too soon for early childhood vaccination for measles, mumps and rubella. I duly caught measles aged three, but through good luck avoided the others.
My generation’s children (Gen Y) and grandchildren have had access to childhood vaccination against all these diseases including (since the mid-1980s) Hib.
Asa result, outbreaks of these diseases in wealthy countries like the US should be rare and easily contained.
However, the measles outbreak in west Texas/east New Mexico is now up to 99 confirmed cases (effectively doubling in a week), and at least one local expert thinks this is “the tip of the iceberg”.
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
National Health and Medical Research Strategy – Webinar Survey
28 February
Senate Community Affairs Committee
Inquiry into the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025
28 February
Department of Health and Aged Care
Draft National Allied Health Workforce Strategy
3 March
Aged Care Quality and Safety Commission
Consultation on the new Financial and Prudential Standards
7 March
Australian Commission on Safety and Quality in Health Care
Comments on the home page of the Australian Register of Clinical Registries
9 March
The Treasury
Consultation – ban on the use of adverse genetic testing results in life insurance
12 March
Inspector-General of Aged Care
Consultation on the Australian Government’s implementation of the Aged Care Royal Commission recommendations
14 March
The National Health and Medical Research Council
Call for citations addressing research question as part of the review of the Australian Dietary Guidelines
14 March
Department of Health and Aged Care
Consultation on Assignment of Medicare Benefits for Simplified Billing Services
28 March
Department of Health and Aged Care
Consultation on PHI Rules sunsetting in October 2025
31 March
Australian Commission on Safety and Quality in Health Care
Public consultation on potential changes to the accreditation of general practices
4 April 2025
Coalition of Peaks
Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement
16 April
Department of Health and Aged Care
Design of a national registration scheme to support personal care workers employed in aged care
17 April
National Health and Medical Research Council
Scoping survey on clinical practice guidelines on the diagnosis and management of myalgic encephalomyelitis / chronic fatigue syndrome
27 April
Department of Health and Aged Care
Updating clinical guidelines for dementia care
|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, and on Bluesky at: @charlesmk.bsky.social.
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