After writing 49 editions of The Zap during 2024, providing in-depth coverage of health and aged care policy, Charles Maskell-Knight shared reflections from the experience at the end of last year, including frustrations about the Department of Health and Aged Care’s approach to managing information on its website.
These frustrations continue, he reports in the first edition of The Zap for 2025. The column also covers developments in mental health, awards recognising “the worst examples of profiteering and dysfunction in healthcare”, and a list of consultations and inquiries to kickstart your year.
The quotable?
Anyone who believes that private health insurers can provide increased funding for private hospitals without putting pressure on premiums must also believe in the Magic Pudding.”
Charles Maskell-Knight writes:
The last weekly edition of this column for 2024 included events up to 13 December.
During the following week, on 18 December, the Government released the Mid-Year Economic and Fiscal Outlook (MYEFO), which included the fiscal impact of the revised aged care funding arrangements agreed with the Opposition in September last year.
According to MYEFO, the “new framework for participant co‑contributions [will] create a fairer, more equitable and sustainable aged care system for older Australians [and] will save $3.0 billion over four years from 2024–25 (and $15.8 billion from 2028–29 to 2033–34)”.
It is not clear how reduced Government spending will increase the sustainability of the sector.
MYEFO contained a number of aged care decisions that had not previously been announced, including one to “link care minute funding to the delivery of care minutes from 1 October 2025 for residential aged care providers in metropolitan areas”.
A fact sheet released by the Department of Health and Aged Care provided more information on the change.
The basic daily rate of care under the AN-ACC classification will be reduced by almost $32, and this amount will then be returned to providers in the form of a “care minutes supplement” at a rate linked to their performance against the care minute targets.
A provider meeting the targets will have all the funding returned to them, while undershooting total care minutes by 7.5 to 10 percent will result in a funding reduction of about $13 per resident per day.
Ministers and government
While Aged Care Minister Anika Wells did not issue a statement on the change in care minutes funding, she did announce expenditure of $440 million under two recent grant rounds intended to “improve access to domestic assistance, allied health and therapy, community transport and home maintenance and expand culturally appropriate Commonwealth Home Support Program [CHSP] services for older First Nations people”.
COTA Australia responded, welcoming the announcement, but “urging the Government to do more for the tens of thousands who still need support”.
Acting COTA CEO Corey Irlam said that while the funding “ensures thousands more older Australians will be supported to live independently in their homes… it won’t be enough to clear the decks of the more than 58,000 Australians waiting for a home care package that look to CHSP for interim support while waiting for any supports”.
It is worth remembering at this point that the Government’s new “rights-based Aged Care Act” does not include a right to timely access to care, despite the Aged Care Royal Commission’s recommendation that such a right should be included in the new legislation.
Health Minister Mark Butler announced that co-payments under the PBS would not be increased in line with inflation on 1 January, for the first time in 25 years. This decision averted increases of 90 cents in the general co-payment and 20 cents in the concessional co-payment, and the Government estimates it will save consumers half a billion dollars over an unspecified period.
The Consumers Health Forum welcomed the announcement.
Butler also announced on 5 January (the third and – as it turned out – final day of the “Pink Test” cricket match, which raises funds for the McGrath Foundation) extra funding of $2.3 million for the McGrath Foundation to expand its “Find my Nurse” online tool to cover more cancer nurses.
The Department of Health and Aged Care started a number of consultation processes during the last days of 2024 and early in the new year.
On 20 December it opened a consultation on the draft service delivery model for the National Early Intervention Service (NEIS) which will provide free digital mental health support for people at risk of, or experiencing, mild mental ill-health or transient distress. Submissions close on 20 January – effectively providing two working weeks for a response – even though the service will not begin until the start of 2026.
Then on 23 December the Department opened a consultation on definitions and descriptors in the private health insurance prostheses list (now unhelpfully called the ‘Prescribed List’) with a closing date of 24 January. Perhaps it believes data nerds don’t take holidays?
In the new year the Department began consultation on a proposal to collect annual financial data from the private hospital sector. This follows the Private Hospital Sector Financial Health Check, which collected data from less than 40 percent of private hospitals, and comes seven years after the Department stopped engaging the Australian Bureau of Statistics (ABS) to collect and publish private hospital data including financial information.
On 13 December last year Minister Butler released a “a substantial package of reform proposals for consideration by the first meeting of the Private Health CEO Forum”.
On 7 January the Department issued a consultation paper setting out six options that “can contribute to alleviating financial pressures on private hospitals and improve the value of private health insurance without putting pressure on policyholders’ premiums”, and could be immediately agreed to by Government and fully implemented within six months. The options include several identified by Butler, as well as several new ones.
Anyone who believes that private health insurers can provide increased funding for private hospitals without putting pressure on premiums must also believe in the Magic Pudding.
Comments are due by 31 January.
The Department released the results of a survey of Medical Research Future Fund grant recipients “revealing strong consumer and clinician involvement and progress towards impact in health and medical research”.
In one of the oddest statements ever to be included on its “news” page, the Department announced that updated versions of “program forms” for the Hearing Services program were now available for use.
The announcement concluded “providers must use the updated forms from 1 July 2025. Please ensure you update your systems to use the new forms from this date… No new forms have been created”.
Perhaps Erwin Schrödinger designed the forms to be “new” and “not new” at the same time?
The Department also released (without any reference on its “news” page) the report of an evaluation of the aged care star ratings system, carried out by Allen and Clarke Consulting at a cost of just under $580,000.
The evaluation’s findings included that “some consumers believe that Star Ratings do not sufficiently assess and communicate important factors relating to the quality of residential aged care”.
“This is particularly the case in relation to Staffing and Compliance ratings. Some residential aged care homes receive high ratings despite not meeting staffing benchmarks or failing to comply with Aged Care Quality Standards. This has eroded trust in the accuracy of Star Ratings and led to calls for improvements in the assessment and communication of Staffing and Compliance ratings.”
I have already told the Department that for free.
Ahpra announced the ongoing expansion of the scope of the fast track registration pathway for international medical graduates, with anaesthetists and psychiatrists eligible to apply from 23 December.
On 19 December the ACCC issued a draft determination refusing an application from a number of Catholic and other religious healthcare providers seeking authorisation to collectively bargain with funding organisations and to “agree to collectively boycott [the five largest] private health insurers while collective negotiations are underway, where the private health insurers have agreed to participate in joint negotiation”.
The determination proposed to re-authorise collective bargaining with providers of goods and services, as well as data sharing for benchmarking purposes.
The ACCC invited submissions on the draft determination by 24 January.
Based on recent health surveys, the Australian Bureau of Statistics (ABS) released its first “experimental estimates” of LGBTI+ populations, reporting that 900,000 people or about 4.5 per cent of all Australians 16 years and older are LGBTI+. The rate is higher among younger age cohorts.
Trade unions
The Australian Medical Association (AMA) released its submission on the future of the National Mental Health Commission, calling for a strengthened commission to “drive collaboration and coordination between governments”.
The AMA submission said that Mental Health Ministers should meet more regularly, and data should be reported to allow patient wait times to be tracked and programs to be adjusted to respond to need.
The AMA also released its submission on the Fifth National Sexually Transmissible Infections Strategy, arguing for more support for First Nations communities and older Australians.
The Royal Australian College of GPs (RACGP) endorsed the Government’s National Action Plan for LGBTIQA+ health, and issued an eve of Christmas Eve statement “urging Australians to look after themselves and their loved ones this holiday season”, saying that “reaching out and helping others can make all the difference”.
The RACGP and the Pharmacy Guild welcomed the Crisafulli Government’s announcement to continue the program of free influenza vaccines for all Queenslanders introduced in 2024.
The RACGP also provided advice on New Year’s resolutions: slip, slop, slap, and see your GP for a skin check; make small but sustainable changes to diet and exercise routines; prioritise mental health; and “find yourself a regular GP if you don’t already have one”.
This last action is easier said than done in those regions where GPs have closed their books to new patients.
The Royal Australasian College of Physicians (RACP) told Governments, alcohol retailers, advertisers and sporting bodies to “step up” to prevent problem drinking and the violence against women that often comes with it.
The RACP said “violence against women spikes around holidays and major sporting matches due to harmful levels of alcohol consumption”, and called for an end to “dirt-cheap alcohol, alcohol sponsorships in sport and other forms of irresponsible advertising”.
Professor Adrian Dunlop, President of the College’s Chapter of Addiction Medicine, said that the NT introduced a floor price for alcohol of $1.30 per standard drink three years ago, and that there had been a subsequent “documented decrease in alcohol-related assaults and emergency department presentations”.
Despite this measure’s success, the new NT Government plans to repeal the policy.
Elsewhere in Australia, alcohol can currently be purchased for as little as 54 cents per standard drink.
Dunlop said that “continuing to allow the sale of dirt-cheap grog – or in the case of the NT, planning to repeal a policy that is successfully preventing violence – is completely out of step with supporting the health and welfare of Australians”.
The RACP reacted to reports that Queensland Health Director-General David Rosengren is “exploring the possibility of bringing in more Physician Assistants (PAs) to further support the healthcare workforce”, urging “thorough consultations with medical experts” before any changes are made.
The RACP and the Australian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) released new low-value care guidelines urging “medical professionals to re-evaluate prescribing medications that offer no benefits to patients and risk unintentional harm”.
RACP President Professor Jennifer Martin said many patients experience a ‘prescribing cascade,’ where the side effects of one medicine can be misdiagnosed as a new condition, which may in turn lead to further unnecessary prescriptions.
“We’re calling on medical professionals to rethink how and when they prescribe medications to patients,” she said.
The RACP and the Pharmaceutical Society of Australia welcomed the NSW Government’s announcement of a trial of pill checking at summer music festivals; and the RACP and the AMA supported the SA Government’s decision to ban junk food advertising on public transport, and urged other jurisdictions to adopt the measure.
The Rural Doctors Association of Australia encouraged safe driving on rural roads, caution when swimming in inland waterways, and common sense partying on New Year’s Eve.
Industry groups
Catholic Health Australia issued a statement bemoaning the past increases in premiums for private health insurance “gold” (comprehensive) products, and calling for reforms to the premium-setting process such as:
- entrusting premium increases to an independent body, such as the Independent Health and Aged Care Pricing Authority, with a formalised approach to incorporating hospital cost data
- linking premium increases with the level of benefits paid in order to incentivise insurers to give back more to patients
- implementing a national private price, which would align price growth with the real costs of delivering care — similar to what occurs in the public sector
- capping the capital reserve requirements for private health insurers to increase the flow of funding into the system.
The Australian Private Hospitals Association (APHA) issued a statement describing the Government’s Private Health CEO Forum as a “sham process” and “a dud that will not deliver much-needed action before next year’s election”.
As far as I can see, such a group will never deliver any concrete outcomes, irrespective of election dates.
Politicians and parliamentary committees
The last weekly edition of The Zap for 2024 reported on the poor reception accorded to the Government’s tardy and underwhelming response to the report of the Senate inquiry into assessment and support services for people with attention deficit hyperactivity disorder (ADHD).
Since that column was published, ADHD Australia, the peak lobby group for people living with the condition, has released its reaction to the Government’s response.
It says that “the 15 recommendations [by the Senate committee] strongly illustrated that the ADHD community is chronically underfunded, needs additional access to diagnosis and treatment, and requires additional research. This response does little to address these key issues other than provide additional justification for existing programs and funding”.
The only positive comment on the response I have found came from the RACGP, which welcomed the Government’s support for nationally consistent rules for prescribing ADHD medication.
Of course, as the Government’s response observes, the rules are made by state and territory governments, and all the Commonwealth Government has done is “commit to raising this issue through a Health Ministers’ Meeting for its consideration”.
Shadow Health Minister Anne Ruston called on the Government to release the approved latest private health insurance premiums as soon as possible “to ensure that Australians with private health have time to plan for this additional cost hike”.
International organisations
The US-based Lown Institute released its annual Shkreli awards, its top ten list of “the worst examples of profiteering and dysfunction in healthcare”.
The awards are named after Martin Shkreli, who gained notoriety after raising the price of antiparasitic Daraprim (pyrimethamine) from $13.50 to $750 per pill.
Tenth place for 2024 went to a Texas medical school which “allegedly neglects to notify next of kin before selling body parts of deceased”. A hard act to follow – yet there were nine even more egregious cases.
It is hard to go past pharma company Amgen, which obtained accelerated FDA approval for cancer drug Lumakras® (sotorasib) at a daily dose of 960 mg. Even though “a subsequent trial indicated that…a lower 240 mg dose offers similar efficacy with reduced toxicity [and reductions in side effects such as] diarrhea, nausea, vomiting, and mouth sores”, Amgen is continuing to market the higher dose and is seeking permanent regulatory approval for it.
The lower dose would reduce Amgen’s revenue by around $180,000 per patient year.
However, first place went to Dr Ralph de la Torre, CEO of Steward Health Care, who “allegedly orchestrated a dramatic healthcare debacle by prioritising private equity profits over patient care”.
“Fuelled by debt and sale-leaseback schemes, Steward’s expansion and subsequent fall into bankruptcy left hospitals gutted, employees laid off, and communities underserved.”
De la Torre was paid over $250 million in the last four years before the company went bankrupt.
Finally
Finally, a reflection that what goes around, comes around.
Following the release of MYEFO, Mental Health Australia (MHA) welcomed the inclusion in MYEFO of various mental health related expenditures, but noted that “much of the investment announced today is short term, spanning only one financial year”.
MHA promised it would “continue to advocate strongly for multi-year budget outcomes, which provide better certainty and continuity of service for the community and service providers”.
Just under two years ago Finance Minister Katy Gallagher told a media conference before the 2023 Budget that through the Budget process the Government had found over $9 billion in “unfunded and terminating programs that actually have ongoing impacts”. She said “these are programs that are ongoing”.
“These are agencies that need funding, these are services that people expect and rely on,” she said. “They need ongoing funding and really the decision to treat them another way or the way the previous Government did was dishonest and dodgy, in my view, in terms of Budget transparency and honesty.”
Indeed.
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.
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia
16 January
Senate Community Affairs Committee
Access to diagnosis and treatment for people in Australia with tick-borne diseases
17 January
Department of Health and Aged Care
Healthy Food Partnership Reformulation Program: Wave 3 Category Definitions and Targets
17 January
Food Standards Australia and New Zealand
Nutrition Labelling – Health Star Rating and Nutrition Information Panel
17 January
Department of Health and Aged Care
Residential Care Service List (explaining what care and services aged care homes must provide to all permanent residents and residential respite recipients).
20 January
Department of Health and Aged Care
Draft service delivery model for the National Early Intervention Service (digital mental health service)
20 January
Department of Health and Aged Care
Review of Primary Health Network Business Model and Mental Health Flexible Funding Model
22 January
Department of Health and Aged Care
Definitions and descriptors in the private health insurance prostheses list
24 January
Australian Consumer and Competition Commission
Catholic Health Australia application on collective negotiations with insurers and providers
24 January
Department of Health and Aged Care
Private Health Reform Options
31 January
Australian Commission on Safety and Quality in Health Care
National Hand Hygiene Initiative (NHHI) auditor training pathways
31 January
The Treasury
Pre-budget submissions
31 January
Department of Health and Aged Care
Medical Research Future Fund Traumatic Brain Injury Mission – refreshed Roadmap and Implementation Plan
10 February
Department of Health and Aged Care
Private Hospital Financial Data Collection Framework
14 February
National Health and Medical Research Council
Investigator Grants peer review process
14 February
Therapeutic Goods Administration
Draft guidance documents – audit framework for medical devices
17 February
Attorney General’s Department
Draft National Plan to End the Abuse and Mistreatment of Older People 2024-2034.
17 February
Department of Health and Aged Care
National Health and Medical Research Strategy – Webinar Survey
28 February
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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