Is the number of media releases issued about any given topic a reliable indicator for the importance of an issue?
Is “once in a generation” the most abused cliché in the political lexicon?
These and other questions are raised in the latest edition of The Zap, which traverses health and medical research announcements, safety and quality matters, the latest bulk billing figures, road accident data, and a long list of consultations that may be of interest/use for Croakey readers.
Columnist Charles Maskell-Knight also reminds readers that the Senate inquiry into the Government’s anti-vaping legislation is due to report very soon: 8 May.
The quotable comes courtesy of POTUS:
Charles Maskell-Knight writes:
The biggest story in the Australian health sector last week (judged by number of media releases it prompted) was the decision by Health Minister Mark Butler to maintain the requirement for private health insurers to pay for so-called “general use items” through the prostheses list.
The prostheses list was originally intended to cover surgically implanted spare parts or devices, such as artificial joints, pacemakers, and (more recently and controversially) spinal cord stimulators.
But over time, medical supply companies managed to get the list expanded to include a wide range of what are essentially consumables – glue, staples, sutures, and even feeding tubes.
An independent review of the prostheses list arrangements in 2007 recommended that these items should be removed from the list, and the costs covered as part of contracts between hospital and insurers.
In 2021 the then Government agreed to remove the general use items, with effect from 1 July 2023. Minister Butler decided last year to defer implementation by twelve months, and has now decided to drop the measure altogether.
Reaction to the news has been predictable.
The private health insurers were “disappointed” (the Australian Health Service Alliance and the Members Health Fund Alliance) or “extremely disappointed” (Private Healthcare Australia).
Other groups were a lot happier.
The Medical Technology Association of Australia (MTAA, representing the medical technology sector) welcomed the decision as “putting patients first”, and the Australian Medical Association (AMA) claimed that “Australian patients will be protected from another cost-of-living blow after the Federal Government announced health insurers must continue funding essential surgical items”.
The hospital sector agreed, with Catholic Health Australia (CHA) calling the decision “a victory for hospital patients”, and the Australian Private Hospitals Association (APHA) claiming that removal of the items would have endangered “bariatric surgery, knee replacements, and cardiothoracic surgery” in the private sector.
The Royal Australasian College of Surgeons (RACS) said the decision was “a major victory for patients” that would maintain patient choice. Call me a cynic, but I am pretty sure that the next patient to choose the glue or sutures they want used in their operation will be the first.
The Consumers Health Forum of Australia described the decision as “a victory for consumers and common sense”.
Common sense?
I’m not so sure. If I agree with a builder to construct a house, it is reasonable for the contract to itemise and cost separately the air conditioning system, hot water supply, and built-in appliances. However, it would be insanity for the contract to require itemisation and separate payment for every screw, nail, bracket, and tube of Liquid Nails.
Yet that is effectively the system that Butler’s decision has locked in.
Last week Butler also announced a “once in a generation transformation of health and medical research in Australia”.
There is a case to be made that “once in a generation” is the most abused cliché in the political lexicon, and this announcement adds strength to that case.
Essentially the Government intends to spend an additional $1.89 billion on medical research, including priorities such as “women’s health, reducing health system inequality, and cancers with low survival rates”.
It will also support clinical trials through a so-called National One Stop Shop that will “harmonise and nationalise the administration and regulation of health and medical research, including through establishing an easy-to-use website which will help patients, researchers and industry find, conduct and participate in clinical trials and research”.
Finally, the Government will develop a National Health and Medical Research Strategy. It seems to me that spending an extra $1.9 billion on medical research should have been informed by a strategy, rather than precede it.
Ministers and government
In other ministerial news, Butler claimed that “five months of official Medicare billing data shows after a decade of cuts and neglect from the Liberals, the slide in the GP bulk billing rate has stopped and bulk billing has now stabilised, since the Albanese Government tripled the bulk billing incentive”.
The data showed that the national average bulk billing rate for GP attendances in March had increased to 77.7 percent, a 2.1 percentage point increase since the GP bulk billing incentives were trebled on 1 November last year.
Detailed figures in Butler’s media release reveal that the rate actually hit 77.7 percent in December last year, falling away a little in January and February before again reaching 77.7 percent in March. In five states and territories the March figure is still lower than the December one.
The Medical Board of Australia reported on progress in developing a new process “to safely fast-track urgently needed internationally trained medical specialists into the Australian health system”.
Initial priority groups are GPs, anaesthetists, obstetricians and gynaecologists, and psychiatrists, and the Board is holding discussions with the relevant colleges to “determine which qualifications have consistently been assessed as comparable in existing college approval processes, as the basis of the new expedited process”.
The Australian Institute of Health and Welfare (AIHW) released a number of reports and data updates.
As well as the latest MBS monthly billing data, these included reports on:
- mental health (the planning framework, social isolation and loneliness, and service utilisation)
- use of health services by younger people in residential aged care
- aged care (quality indicators, spending, service providers and places, and people using aged care)
- rural and remote health.
Even a cursory summary of these reports would take up the rest of this column, so I will only mention several points.
Mental health presentations made up about three percent or almost 300,000 emergency department presentations in 2022-23. Over a quarter of these were for drug overdoses (“Mental and behavioural disorders due to psychoactive substance use”), but 13 percent or almost 40,000 were for schizophrenia, schizotypal and delusional disorders.
Some of these will undoubtedly be initial contacts with the health system, but many others will be people with a history of the illness attending an ED when other treatment options are not available.
The report on aged care quality indicators for the period ending with the December quarter last year shows that “over time there has been a statistically significant decrease in the proportion of residents experiencing polypharmacy, antipsychotic medication use, falls that resulted in major injury, use of physical restraint, physical restraint exclusively through the use of a secure area, significant unplanned weight loss and consecutive unplanned weight loss”.
Great news – except that the rates for many of these indicators are still very high. For example, 6,800 residents (3.8 percent) were subject to physical restraint other than through use of a secure area. Some 16,500 residents (9.1 percent) without a diagnosis of psychosis were given antipsychotic medication.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) issued some new educational resources to mark World Hand Hygiene Day on 5 May.
The Commission will be holding a webinar on the new Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard on 9 May – registrations are still open here.
The Aged Care Quality and Safety Commission (ACQSC) announced that it was extending the public consultation period for the strengthened Aged Care Quality Standards draft guidance documents from 30 April to 19 May 2024.
Consumer and public health groups
The National Rural Health Alliance used the release of the AIHW report on rural and remote health to reiterate its demand for Governments to address the funding gulf between health spending in the cities and health spending in the regions.
Trade unions
The Australian College of Rural and Remote Medicine announced that from 1 May all Queensland ACRRM registrars on the Australian General Practice Training program would be directly trained by the College. This follows a decision by James Cook University that it would no longer be able to deliver the training.
The AMA gave evidence to the Senate inquiry into the Government’s anti-vaping legislation, urging the Senate to resist industry pressure and support the reforms.
President Professor Steve Robson said in a media release that:
“Tobacco companies want to continue to profit from young people getting addicted to vaping through ease of access, misinformation about safety, and sneaky marketing that entices young people to vape through flavouring and packaging.
“We must resist industry lobbying and keep pushing to implement a consistent, robust framework to reduce rates of vaping and prevent long-term adverse health effects on population health.”
The AMA commended Transport Minister Catherine King for announcing that she intended to include “a requirement for all states and territories to start sharing data on road accidents in the next five-year road funding deal”.
Apparently so far only Queensland has committed to sharing data with the Commonwealth Government.
Seven nursing organisations (the Australian College of Nurse Practitioners, the Australian Primary Health Care Nurses Association, the Australian College of Nursing, the Australian College of Mental Health Nurses, Australian College of Midwives, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and the Council of Deans of Nursing and Midwifery) joined with the Australian Nursing and Midwifery Federation (ANMF) in a joint statement welcoming the Scope of Practice Review Issues Paper 2.
It said the review offered a “once in a generation opportunity” (there’s that phrase again!) to: realise the full value of using every health profession; enable modern models of health delivery; and embed evidence-based workforce decisions in Australia’s health system.
The statement concluded: “It’s time for change. It’s time to be bold. Australia’s health depends on it.”
The Pharmaceutical Society of Australia noted that Queensland had now joined NSW and Victoria in allowing pharmacists to administer respiratory syncytial virus (RSV) vaccination, and called on residents aged over 60 to make an appointment with their pharmacists to receive the shot.
The Royal Australian College of General Practitioners (RACGP) welcomed the latest bulk billing figures, but warned the Government more needed to be done, in a media release which put forward the same solutions as its release from last week. The College’s PR team clearly subscribe to the notion that you should repeat the message until you are sick of hearing it…
Another repeated message from the College is the workload faced by GPs. However, it called for more work for GPs by recommending to a Senate inquiry into NDIS legislation that GPs should be involved in the NDIS planning process.
The Rural Doctors Association of Australia (RDAA) noted that the increase in the bulk billing incentive had been a huge change, with a positive effect for patients in rural and remote areas.
President Dr RT Lewandowski said that “there also needed to be a significant overhaul of funding models for general practice, particularly with consideration to supporting a multidisciplinary team approach in [rural and remote] communities”.
Industry groups
Medicines Australia welcomed the Government’s announcement about medical research, especially the One Stop Shop for clinical trials.
CEO Liz de Somer said: “Currently there are different processes and systems for clinical trials in each state and territory and within area health services. This creates inefficiencies and makes it difficult for patients and doctors to know what options are available, which is why a national approach is needed.”
Politicians and parliamentary committees
The Senate inquiry into the Government’s anti-vaping legislation completed one and a half days of hearings on 1 and 2 May. The programs and transcript of the hearings can be found here; the report is due on 8 May.
Shadow Health Minister Anne Ruston responded to Minister Butler’s media release about bulk billing rates, pointing out that the rate for March was the same as the rate in December, and that the average proportion of GP fees paid by government had fallen to 84 percent, the lowest ever.
She said the Government should “start taking real action to increase the affordability of primary care”.
International organisations
The World Health Organization (WHO) announced that member states were close to agreeing on changes to the International Health Regulations “to strengthen the international community’s ability to detect and respond to pandemic threats”.
Subject to agreement at a working group meeting in mid-May, the amendments will be considered by the World Health Assembly at the end of the month.
And, finally
Finally this week, some insight from US President Joe Biden, who posted a six-word message on X (formerly Twitter): “It’s simple: Mental health is health.”
Improving access to quality mental health services would be a lot easier if policymakers bore the President’s message in mind.
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.
TGA
Clinical decision support system software regulation
6 May
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Aged Care Infection Prevention and Control Guide
15 May
Senate Community Affairs References Committee
Inquiry into Excess Mortality in 2021, 2022, and 2023.
17 May
Department of Health and Aged Care
Minimum stockholding requirements for PBS drugs
17 May
Aged Care Quality and Safety Commission
Aged Care Quality Standards draft guidance documents
19 May (previously 30 April)
TGA
Amendments to the Poisons Schedule
22 May
Scope of Practice review
Issues paper 2
26 May
TGA
Instructions for Use for Medical Devices
28 May
NHMRC and CHF
Review of the 2016 Statement on Consumer and Community Involvement in Health and Medical Research
31 May
Office of the National Rural Health Commissioner
Awareness of the National Rural and Remote Nursing Generalist Framework 2023-2027
31 May
Department of Social Services
Developing the National Autism Strategy
31 May
Chinese Medicine Board of Australia
Patient health records guidelines
5 June
TGA
Proposed changes to the regulation of exempt medical devices and exempt other therapeutic goods
9 June
TGA
Companion diagnostics guidance update
17 June
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.
