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The Zap: delays in aged care reform, Urgent Care Clinics, health workforce inequities and private health insurance premiums

Will the delayed introduction of the new Aged Care Act be an opportunity to ensure that high quality care becomes one of the objects of the new Act, as the Aged Care Royal Commission recommended?

Will the Australia National Audit Office’s draft 2024-25 work program raise some embarrassing questions for the Department of Health and Aged Care?

These and other questions are addressed in this week’s edition of The Zap.

Columnist Charles Maskell-Knight also brings these quotables:

Private health insurance – a great product until you use it.”

AND

Does anybody outside the [private health insurance] sector seriously believe insurers need to increase premiums at all at this point?”


Charles Maskell-Knight writes:

The Government finally bowed to the inevitable on 3 April, when Aged Care Minister Anika Wells acknowledged that the new Aged Care Act would not take effect on 1 July this year.

Her statement was apparently prompted by leaked Departmental documents suggesting that 1 January or 1 July next year were more likely commencement dates.

The Minister said that the Government had “heard strong feedback that the proposed new Aged Care Act is a once in a generation opportunity for systemic reform that we must get right”.

Did the Government really need to get public feedback to understand that?

Wells said that the Government had “a mission to lift the standard of aged care in Australia and deliver a high quality, person-centred service”.

If that is really so, I have a hot tip for her: make the provision of high quality care one of the objects of the new Act, as the Aged Care Royal Commission recommended.

COTA Australia and Older Persons Advocacy Network (OPAN) greeted the news with dismay.

COTA CEO Patricia Sparrow said while it was important to get the new Act right, “it doesn’t mean we need to move at a glacial pace”.

Craig Gear OAM, CEO of OPAN, said: “Older people cannot wait another 15 months for their rights to be enshrined in legislation. While work is required to incorporate the extensive feedback… into the new Aged Care Act, we believe the time frame being suggested by aged care providers to be overly conservative if not excessive.”

The Aged & Community Care Providers Association (ACCPA) – the provider lobby group – took a different view, with CEO Tom Symondson saying “we need to make sure that the legislation, which will likely govern the aged care sector for the next 30 years, is not rushed”.

“We need to get this right… It is far more important that the legislation and associated requirements be passed when it is ready, than passed to meet the 1 July date,” he said.

Catholic Health Australia also supported the deferral, and “encouraged the Government to set up a working group to provide expert input on the new laws”. Apparently a Ministerially-led taskforce with sector representation and almost half a dozen public consultation processes over the last several years have not allowed enough opportunities for “expert input”.

CEO Jason Kara said: “The Government has shown determination to act on the recommendations of the Royal Commission and we strongly support moves to ensure the rights of older Australians are enshrined in legislation as soon as possible.”

All I can say is that the exposure draft of the new Act may have received a better reception if the Government had acted on the recommendations of the Royal Commission, rather than distorting or ignoring them.

Shadow Minister Anne Ruston spoke to at least one media outlet, saying “it is [a] failure of the Minister to be having this conversation in the media, instead of showing respect to the sector, older Australians, and the broader community by telling them first of the Government’s plans to delay the Aged Care Act”.

It isn’t clear to me how you can tell the broader community of your plans as a Minister other than by issuing a media release… should Ruston ever become a Minister again, I look forward to a demonstration.

Leaving that aside, Ruston is right in saying that the process for preparing the new Act has been a mess. Soon after taking office Wells promised a new Act by July 2023, and is now clearly going to miss that deadline by eighteen months at the least.

But let’s not forget that in May 2021 concurrent Health Ministers Scott Morrison and Greg Hunt also promised a new Act by July 2023.

By the time they lost office a year later the only progress was a concept paper released by the Department.

Ministers and government

Minister Mark Butler held a media conference on 4 April to announce that 250,000 patients had now attended Urgent Care Clinics (UCCs), and the number was growing by 10,000 a week.

It sounds impressive, until you look at the Australian Institute of Health and Welfare (AIHW) data showing 8.8 million ED presentations last year, or 170,000 a week.

Even if every UCC patient would otherwise have attended ED, that means a reduction in ED demand of just under six percent. Given some patients probably attended a UCC rather than a GP, that is likely to be an overestimate.

Butler said that “We’ve only got 58 clinics so far across the country. That doesn’t provide national coverage even though it is delivering care to hundreds of thousands of patients every single year. We’re determined to scale this up, to evaluate how it’s working. If there are improvements that we can make, we will make those improvements”.

Best practice would involve evaluating first, and then scaling up – or not.

The Australian Commission on Safety and Quality in Health Care announced that Minister Butler had made a number of appointments to the Commission’s board. Professor Christine Kilpatrick AO, who had been a board member since July last year, was appointed as board chair. She will replace foundation chair Professor Villis Marshall AC, who had served since 2013.

Other new board appointments included: Professor Jeffrey Braithwaite, health services and systems researcher; Dr Alicia Veasey, a Torres Strait Islander obstetrician and gynaecologist; and Leanne Wells, former longstanding CEO of the Consumers Health Forum of Australia.

The Independent Hospital and Aged Care Pricing Authority announced two webinars on 10 April and 24 April to explain cost data collection to the aged care provider community.

The Commonwealth Ombudsman (aka the Private Health Insurance Ombudsman) made available the State of the Health Funds Report for 2023. Its summary of the year began by noting a 26.8 percent increase in complaints between 2021-22 and 2022-23. It went on:

“The increase in complaints resulted from several factors including Medibank’s data breach and members accessing (and complaining about) health insurance more consistently following lower rates of access during the COVID-19 pandemic”.

Private health insurance – a great product until you use it.

The Australia National Audit Office released its draft 2024-25 work program, foreshadowing possible audits for the Department of Health and Aged Care including administration of the Commonwealth Home Support Program, the coordination and targeting of mental health funding, the effectiveness of the Professional Services Review Scheme, and Urgent Care Clinics.

Lots of scope for potential embarrassment for the Department in that selection.

Trade unions

The Royal Australian College of General Practitioners (RACGP) launched a new definition of general practice for accreditation purposes, “with the aim to inclusively accredit innovative models of general practice care”.

The Aged Care Royal Commission heard that the previous definition and accreditation standards could act as a barrier to general practices geared towards providing services to people in nursing homes or in their own homes, rather than at a physical practice. It recommended (R. 57) that the RACGP should amend its standards by 31 December 2021 to allow such practices to be accredited.

The College noted that the new definition retained the requirement for a practice be comprehensive, continuous, and GP-led, and would not cover practices “focusing on one body system or disease or telehealth services that cannot offer in-person consultations”.

The RACGP joined the calls from other groups reported here several weeks ago for the Government to restore Medicare rebates for GPs interpreting electrocardiograms.

The Australian Dental Association tweeted (X’d?) welcoming the decision by the SA Government to exempt dentists from past payroll tax liabilities, and called for other states to follow suit.

The Australian Association of Psychologists called for the Government to introduce HECS debt relief for psychology graduates located in rural and regional areas. According to the Association almost two-thirds of graduates have a HECS debt of $80,000 or more, with over a quarter owing more than $100,000.

Executive director Tegan Carrison said “there is a massive workforce shortage of mental health professionals in rural and regional areas, but if the Government could offer psychologists incentives [on the same basis as] GPs…, it would be a win-win for the mental wellbeing of both the provider and the client.”

The Pharmaceutical Society of Australia welcomed the announcement by the WA Government of free influenza vaccinations for all state residents, following the example set by Queensland.

The Australian College of Rural and Remote Medicine (ACRRM) called for the Government to attract regional students to a career in medicine by spending “$7.5 million over three years to enable the College to design and implement an awareness program for rural and remote secondary school students, and $17.25 million over three years for a scholarship scheme to support rural and remote students commencing a medical degree”.

Industry groups

Medicines Australia issued a media release warning of the risks of compounded medicines, without once mentioning the words Ozempic or weight loss.

Politicians and parliamentary committees

Greens health spokesperson Senator Jordon Steele-John broke a four month media silence on health issues with a media release welcoming the referral of the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Bill 2024 to an inquiry by the Senate Community Affairs Committee.

The committee is calling for submissions by Friday 12 April, with a view to reporting on 8 May, the week before Parliament resumes.

International organisations

The week ending 7 April was World Health Worker Week. The World Health Organization marked it by releasing guidance on the fair and ethical management of health worker migration.

WHO said that while health workers are crucial to the health system, “many countries with unmet needs for health services also have the lowest density of health workers”.

“Continuous large-scale migration of health workers from these countries can widen health inequities and present risks to global health security. In contrast, properly managed international migration of health workers has the potential to strengthen health systems.”

As a major importer of health workers, Australian policymakers should be aware of the issues this can cause in workers’ home countries.

Finally

In case you missed it while suffering from a surfeit of chocolate, private health insurance premiums increased on 1 April.

When the increase was announced on 5 March, the Members Health Fund Alliance (“our trusted health insurance funds put people before profits”) was quick to announce its members had only increased premiums by an average 2.82 percent, compared with the sector average of 3.03 percent.

APRA data for 2022-23 show Alliance insurers made a profit of $725 million, or almost seven percent of premium revenue. Even if benefits had been 10 percent higher, and administration costs five percent higher, the insurers would still have made over $200 million in profit to add to their reserves – which equal about seven months of premium income.

Does anybody outside the sector seriously believe insurers need to increase premiums at all at this point?


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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