This week’s column unpicks the latest news on bulk billing and safety and quality in aged care, and underscores the adage that every crisis presents an opportunity for someone or other.
Meanwhile, at a time when there are real questions about the stability of the World Health Organization in the era of Trump, the world is experiencing 42 ongoing health emergencies largely arising from climate change, conflict, displacement and disease outbreaks.
The quotable?
To summarise, the alternative government has no policy on primary care, and a potential minority government partner has completely fantastic ones.”
Charles Maskell-Knight writes:
Cleanbill operates a service helping patients locate doctors and provides information on their billing practices.
For several years it has produced a Blue Report presenting what it calls a “GP national bulk billing rate”. This does not measure how many GP services are bulk billed, but rather the percentage of GP practices who have told Cleanbill that they will “bulk bill a new adult patient without concessions who attends for a standard consultation (MBS Item 23) during regular, weekday business hours”.
This year’s edition of the report claimed that “the national bulk billing rate has fallen by almost 15 percentage points in the last two years to 20.7 percent”.
Health Minister Mark Butler said that the Cleanbill report amounted to a “ring around [which] effectively asks general practices, whoever happens to pick up the phone, whether they have a policy of bulk billing every single person, every single time that person walks in the front door, whether it’s an age pensioner or whether it’s Gina Rinehart or James Packer. That is no substitute at the end of the day for the transparent reporting we now conduct about MBS data”.
The Royal Australian College of GPs (RACGP) also reacted to the release of the report.
While acknowledging that almost 78 percent of GP consultations are bulk billed, RACGP President Dr Michael Wright said that patients who weren’t eligible for GP bulk billing incentives were missing out and paying higher out of pocket costs. He reiterated the RACGP’s call for higher Medicare rebates.
Of course, the availability of bulk billing or not only becomes an issue if GPs are available to provide services. In the last few weeks in Tasmania alone, one practice has closed permanently and one has warned of service restrictions due to GP shortages.
The Pharmacy Guild issued a statement prompted by the Cleanbill report urging patients to “Think Pharmacy First”, saying “community pharmacies offer accessible care often with longer weekday and weekend openings for a range everyday health conditions and long-term health management”.
Guild President Trent Twomey said “highly trained community pharmacists provide an important service to patients with non-complex everyday health conditions. State and federal governments can also make a difference by increasing the range of conditions that can be treated in a pharmacy – and making this consistent across the country”.
Ministers and government
In the Ministerial reshuffle prompted by Bill Shorten’s retirement, Aged Care Minister Anika Wells was promoted to Cabinet, but retained her current responsibilities. She issued a statement on her appointment here.
The Aged Care Quality and Safety Commission (ACQSC) announced it was “cracking down” on residential aged care providers that have “persistently failed to meet their mandatory care minutes targets”. The ACQSC said it had entered into enforceable undertakings with 11 providers operating 27 homes that have fallen well short of delivering their care minutes targets across successive quarters.
The Department’s care minutes dashboard (updated on 20 December last year) shows that in the September quarter 2024, over a thousand homes failed to meet the total care minutes target, 900 failed to meet the registered nurse care minutes target, and almost 1,400 failed to meet both targets.
While not all of the failing homes would be persistent offenders, I am sure there are more than 27 of them, suggesting the ACQSC has a lot more work to do.
And, of course, virtually all of the homes missing the targets are still receiving three or more stars under the aged care star ratings system, meaning they are classed as delivering an appropriate standard of care.
The ACQSC also released its Sector Performance Report for the July quarter last year, with a mass of useful data.
Just over 80 percent of audited residential services met all quality standards, consistent with the last 12 months. While only 73 percent of audited home care services met all quality standards, this was an improvement from the 63 to 66 percent apparent over the previous four quarters. Poor compliance with the Governance standard continues to be an issue for both residential and home care services.
The rate of notifications under the Serious Incident Reporting Scheme increased by over five percent compared with the corresponding quarter in 2023, driven by a 24 percent increase in the rate of notifications of neglect.
The Weekly Source reported on the departure from office of acting Inspector-General of Aged Care Ian Yates AM. In a statement to the publication Yates “reiterated his disappointment that the Government has retained a rationed approach to aged care, rather than introducing a needs-based system as recommended by the Royal Commission into Aged Care Quality and Safety”.
Yates also said that the Office of the Inspector-General “is severely under-resourced … [and] not sufficiently funded to sustainably undertake all its statutory functions”.
Natalie Siegel-Brown has begun work as the first permanent Inspector-General.
Consumer and public health groups
The Australian and New Zealand Journal of Public Health said it was “working to ensure that the studies we publish provide the evidence and insights we need to tackle our most pressing public health challenges”, and invited public health researchers, health professionals, and community members to complete a prioritisation survey.
A number of organisations including the Lung Foundation Australia, Asthma Australia, the Stroke Foundation, the National Rural Health Alliance, and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) have released their pre-Budget submissions, reported on by my colleague Alison Barrett here.
Submissions are due to the Treasury by the end of January.
Trade unions
The ABC reported on data analysed by the Australasian College for Emergency Medicine on waiting times in emergency departments before admission to hospital. The analysis showed that “90 percent of people who required admission at a metro hospital spent 15 hours and 36 minutes on average waiting in the emergency department”.
The Australian Dental Association announced that World Oral Health Day, an oral health awareness raising event promoted by the FDI World Dental Federation, will take place on 20 March this year. With the theme “A Happy Mouth is…A Happy Mind’’, this year’s event “is asking everyone around the world to raise awareness about the importance of good oral health”.
The Health Services Union (HSU) issued a statement saying research it had commissioned from the Bankwest Curtin Economics Centre had found “Australia’s lack of reproductive leave is costing the economy $26.6 billion a year in lost productivity” as the result of “of people missing work days, working through pain and sickness and retiring early due to reproductive conditions”.
The HSU called for 12 days of reproductive leave for all Australians, which it said would only cost employers $920 million a year.
The RACGP reacted to the imminent resignation of many psychiatrists in the NSW public sector, calling on the state Government to allow all GPs “to initiate and prescribe medications for people living with ADHD, and manage their care”. (Currently in NSW, only GPs working in rural or remote communities or practising predominantly in paediatrics can be approved to prescribe stimulants.)
State RACGP Dr Rebekah Hoffman said “people in NSW face significant barriers to ADHD care – they often have to wait months and pay hundreds of dollars for psychiatrists to confirm their diagnosis and get scripts that could be easily and safely prescribed by their GP. Now the situation is even worse”.
The RANZCP also issued a statement on the dispute, imploring the State Government to work with the doctors’ union to solve the issue.
The Rural Doctors Association of Australia (RDAA) noted that the “annual junior doctor rural migration is under way” as hundreds of doctors moved to take up placements in rural areas.
RDAA President Dr RT Lewandowski said he hoped that “all of the junior doctors heading bush really embrace the experience, get to know their patients, their communities, and the joys and opportunities available in rural medicine”.
He urged rural communities to do everything they could to make the doctors welcome.
Industry groups
The Members Health Fund Alliance (the industry group for private health insurers which don’t distribute profits) used the Cleanbill report as the reason to call for private health insurance to be allowed to cover copayments for GP services.
As the premiums for any such product would need to be set at a level to cover the12 percent management costs of insurers as well as the benefits, they would on average cost policyholders more than the copayments.
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston appeared on ABC Adelaide radio, criticising the Government’s performance on GP bulk billing. Asked what she would do, she said she would be honest about the problem, and (somehow) address a shortfall of 8,000 doctors.
Greens health spokesperson Senator Jordon Steele-John used the Cleanbill report as the occasion to remind everyone of the Green’s policy to triple the GP bulk billing incentive for everyone, and establish 1,000 free healthcare centres across Australia.
To summarise, the alternative government has no policy on primary care, and a potential minority government partner has completely fantastic ones.
Submissions to the Senate inquiry into access to diagnosis and treatment for people in Australia with tick-borne diseases closed on 17 January, and the committee is planning a public hearing in Canberra on 29 January.
International organisations
The World Health Organization (WHO) launched a $US1.5 billion Heath Emergency Appeal.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said the resources were needed to address 42 ongoing health emergencies largely arising from climate change, conflict, displacement and disease outbreaks.
The appeal came four days before Donald Trump was inaugurated for his second term as US President.
Trump attempted to withdraw the US from WHO in his first presidency, and experts believe he may do so again. This would present a major challenge to WHO’s ability to fund ongoing operations, far less respond to crises.
Finally
The Guardian reported on a Cochrane evaluation of Calorie (energy) labelling for changing selection and consumption of food or alcohol taking into account 25 studies.
The findings “suggest that, for an average meal of 600 kcal, adults exposed to calorie labelling would select 11 kcal less (equivalent to a 1.8% reduction) and consume 35 kcal less (equivalent to a 5.9% reduction)”.
However, the evidence relating to consumption is of lower quality than that related to selection, and the very limited evidence related to alcohol labelling did not support any conclusion.
The authors concluded that “calorie labelling of food could lead to potentially meaningful impacts on population health when applied at scale, but we need more high‐quality studies for consumption and for alcohol products”.
While the Guardian noted that the 11 calories equated to a single Pringles chip (or two almonds), any measures that will help address the obesity epidemic deserve serious consideration by policymakers. Did someone mention a sugar tax?
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
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
Australian and New Zealand Journal of Public Health
Research publication prioritisation survey
27 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
Therapeutic Goods Administration
Proposed amendments to the Poisons Standard
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
Department of Health and Aged Care
Consultation on PHI Rules sunsetting in October 2025
31 March
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.