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The Zap: renovating Medicare, wishlists for Jim “Santa” Chalmers, and the rights of aged care residents

The Zap is a newish column at Croakey providing a weekly summary of health-related reports, announcements and media releases from Commonwealth government agencies, Health and Aged Care Ministers and other politicians, national health sector organisations, and some international bodies.

Below is the fourth edition, compiled by health policy analyst Charles Maskell-Knight. Bookmark this link to follow the series.

The quotable?

The key points were that the new Act should provide that aged care residents must have an absolute right to visitors at all times, and that the rights of aged care residents must be enforceable. The Act should also enshrine an independent and effective system for dealing with complaints from residents and their families.”


Charles Maskell-Knight writes:

This week’s edition of The Zap begins with a collection of announcements and articles prompted by the 40th anniversary of the establishment of Medicare by the Hawke Government on 1 February 1984.

There was lots of other news, including pre-budget submissions from various groups setting out wish-lists for consideration by Treasurer Jim “Santa” Chalmers as he ponders Christmas in May. If he is to meet even a tenth of these wishes, he will need a much bigger sleigh.

Happy birthday, dear Medicare

On 29 January Ministers Mark Butler and Bill Shorten announced the release of a special edition Medicare card to “commemorate the 40th anniversary of Australia’s world class universal health insurance scheme”. Any replacement or new card issued from 1 February to the end of the year will be in the special format.

Butler and Shorten joined with the Prime Minister in a joint media release on 1 February to mark the day. Also on the day, Butler spoke at Deakin University. Croakey published his speech here.

When announcing the commemorative cards Butler said that “Medicare is the foundation of our health system, ensuring all Australians have equitable access to healthcare when they need it, regardless of where they live or their ability to pay”. As many commentators are observing, after 40 years Medicare needs renovation to ensure that this aspiration is achieved.

The Guardian collected some views on what is needed now, and Alison Barrett published more in an article on this site. Elsewhere Professor Anthony Scott from Monash University concluded that “the future of Medicare needs to involve supporting the provision of high-value healthcare (and defunding low-value healthcare) through the serious introduction of value-based payment models, systematic investment in research, rethinking aspects of medical education, and the measurement of health outcomes and patient experience”.

Professor Stephen Duckett AM in an article in The Conversation suggested three major reforms: independent fee-setting; contracting with corporate providers of technology intensive services; and coverage of dental care.

Other organisations to mark the occasion included AHHA, AMA, CHF, NRHA, and PHA.

For those seeking another trip down nostalgia lane to 1984, here is an extract from Liberal leader Andrew Peacock’s campaign launch before that year’s federal election:

We will restore individual choice of doctor, [and] end the Medicare cost spiral…

You will get a choice about Medicare – you can stay in or opt out. You can choose the private health insurance best suited to your needs and the needs of your family.”

Ministers and government

Minister Butler chose 1 February to announce new GP bulkbilling data, showing an increase in the proportion of GP consultations that were bulkbilled following the increase in the bulkbilling incentives that came into effect on 1 November 2023. The RACGP welcomed the upturn. While the increase may be good news, if current trends continue each extra bulkbilled service will cost of the order of $200 – because of the huge cost of the additional incentive paid for services that were already bulkbilled.

The Minister also suggested that people should “vote with their feet” and “ring around” to find a general practice that would bulkbill them. I’m sure that got a Bronx cheer from people like me, living in a region where GPs have mostly closed their doors to new patients. Michael McCormack, National Party member for Riverina, said Butler’s comment was “cold comfort for those in the Riverina and Central West who may only have access to one GP or have to travel many kilometres to even see a doctor, let alone have the luxury of choice”.

Butler also announced a $7.3 million joint campaign between the Government and Cancer Council Australia to dissuade younger adults from sunbaking. The campaign will “bring together content creators, a music festival, fashion, beauty and lifestyle brands and publishers to ‘End the Trend’ of suntanning”. Judging from the behaviour of the hordes of young beachgoers who flood the Yuin coast every summer, it cannot come too soon.

The Minister announced the seizure of 13 tonnes of disposable vapes (worth $4.5 million) in air freight consignments in Adelaide.

Aged Care Minister Anika Wells announced that Dementia Australia would be funded to deliver an online course to first responders to build their skills to assist people with dementia in emergency situations. Seven organisations, including police, ambulance and health services across five jurisdictions, have already agreed to take part in the training. Here’s hoping not using Tasers on the frail elderly is part of the course.

The AIHW released a report on First Nations primary care services, including data on services (staffing, client contacts), performance indicators, and health status indicators. It also released the latest monthly report on MBS-funded services.

The Productivity Commission released part E of the 2024 Report on Government Services, with separate sections on primary and community health, ambulance services, public hospitals, and mental health. Including 40 general demographic and workforce tables, the report comprises 248 tables.

Coinciding with the release of the December quarter CPI, the ABS released a report on price movements in Australian Dietary Guidelines (ADG) groups. While over the decade to 2023 the overall food group in the CPI increased by 29.0 percent, meat prices increased by 42.2 percent, fruit by 35.9 percent, and milk by 35.4 percent. Prices in the ADG “discretionary” group (for example, snack foods, biscuits, chocolate) increased by only 25.7 percent. No wonder obesity is a growing problem.

Consumer and public health groups

COTA acknowledged the 2024 Senior Australian of the Year, Yalmay Yunupiŋu. CEO Pat Sparrow praised Ms Yunupiŋu for “her tireless work and invaluable contribution to her community, inspiring and guiding our next generations and forging a bilingual teaching approach to make young people strong in their Yolŋu language and culture”.

COTA and Older Persons Advocacy Network (OPAN) released a response to the exposure draft of the new Aged Care Act drawn up by a group of 12 advocacy organisations. The key points were that the new Act should provide that aged care residents must have an absolute right to visitors at all times, and that the rights of aged care residents must be enforceable. The Act should also enshrine an independent and effective system for dealing with complaints from residents and their families.

The Consumers Health Forum (CHF) called on the Government “to fund a public education campaign that fully explains the Medicare system to the general public” and “give consumers the health literacy tools to help them save money, navigate the health system and improve their health”. The proposed campaign was part of the CHF’s budget submission, which also included recommendations about improving access to dental care and allied health.

Trade unions

The RACGP released its pre-budget submission, asking inter alia for funding for universal annual children’s health checks for the first 2,000 days; a 20 percent increase to patients’ rebates for longer consults and mental health, with extra support for rural patients; support for practices to employ more nurses, nurse practitioners, pharmacists, and allied health professionals; and funding for people to see their GP after an unplanned hospital visit.

The Rural Doctors Association of Australia also published its pre-budget submission, outlining “common sense initiatives that will attract and retain doctors into rural and remote Australia” such as simplifying and expanding supervision payments for GPs training in rural areas.

Optometry Australia released its pre-budget submission, calling for a fee review as well as a number of measures to improve access, including increased funding for the Visiting Optometrists Scheme “to support the delivery of 29,000 additional eye examinations to First Nations people annually, to provide population parity with non-Indigenous Australians”, and support for the First Nations Eye Health Alliance to lead the development of identified sector priorities for First Nations eye health.

In a clever piece of spin the Australian Physiotherapy Association linked its pre-budget submission to Medicare’s 40th birthday: “the crossroads we are currently at with Medicare is very reminiscent of a mid-life crisis”. The Association wants funded access to physiotherapy for all Australians. No biggie, just a lazy $3 billion or thereabouts.

Australian Association of Psychologists (AAP) director Carly Dober suggested the Government should introduce an incentive program to encourage allied health professionals to work in rural and remote areas. The AAP’s pre-budget submission asked for a one-tier Medicare rebate for the clients of all registered psychologists in Australia; an increase in the Medicare rebate to $150 per session and an increase to 40 rebated sessions per year; and a rebate for provisionally registered psychologists.

Allied Health Professions Australia’s (APHA) pre-budget submission called on the Government to build a sustainable allied health workforce; facilitate interoperable sharing of allied health information; promote excellence in residential aged care allied health data, analysis and evaluation; and ensure best practice provision of allied health supports to NDIS participants.

APHA also sent out a release responding to the Scope of Practice Review Issues Paper, welcoming some elements but expressing concern at the suggestion of greater regulation for the “self-regulated” professions (such as speech pathology or dietetics).

The Pharmaceutical Society of Australia also welcomed the release of the Issues Paper, and looked forward to “a future where community pharmacies are supported and funded to fulfil their primary care role as urgent care clinics where pharmacists can triage, manage and consult on a range of acute common ailments”. Who needs GPs?

Industry groups

Medicines Australia must be confident of the as yet unannounced outcomes of the Health Technology Assessment Policy and Methods Review, because its pre-budget submission called for the Government to “commit to funding the reforms that will come out of the HTA Review to give Australians faster access to new medicines”.

Private Healthcare Australia (the private health insurance lobby group) released data on the growth in out-of-pocket costs for in-hospital medical services, and called for legislation to protect patients from liability for costs which were not fully disclosed beforehand. CEO Dr Rachel David said “if we can [provide an up-front quote with all likely costs] for car and home repairs, there is simply no valid reason why this can’t happen for medical treatment”.

Politicians and parliamentary committees

Shadow Minister Anne Ruston castigated the Government for the slow delivery of Shingrix vaccine to GPs. It appears that the Department has learned nothing from the COVID-19 vaccine stroll-out. While Minister Butler announced on 8 October last year that the shingles vaccine would be available free of charge to almost 5 million people from 1 November, the Department had clearly not put in place arrangements to make sure the vaccine would be available in doctors’ practices in anything like the required volumes.

The Commonwealth Chief Medical Officer issued a statement on 2 February noting that 487,000 doses of Shingrix had been administered in the firs