more_vert2015 was a landmark year in the USA for lesbian, gay, bisexual, transgender, and queer (LGBTQ) civil rights. In June, the US Supreme Court Obergefell vs Hodges decision upheld marriage equality for same-sex couples, suggesting a nationwide move toward the rejection of stigma associated with LGBTQ sexuality. In December, the US Department of Health and Human Services (HHS) released their annual report—Advancing LGBT Health & Well-being—which highlights substantial advances in health initiatives for LGBTQ people and their families, as well as outlining HHS objectives in LGBTQ health care for 2016.
Preference: Administration and Health Services
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Govt faces storm over cuts to pap smear payments
Women face being charged to get their pap smear results under Federal Government plans to axe bulk billing incentives for pathology services.
Calculations by the AMA show the Government’s contribution to the cost of a pap smear will be cut by 12 per cent to $23.55 from 1 July, a $3.20 reduction. There were almost 1.8 million pap smears conducted in 2014-15, suggesting the cut will save the Government around $5.7 million a year.
Pathology providers, who have had no increase in the Medicare rebate for their services for almost two decades, have warned that many labs will not be able to absorb the cut and will instead have to pass it on to their patients.
The amount charged to patients is likely to increase above $3.20 to account for the additional administrative costs of billing individuals, including processing payments and chasing up amounts owing.
Royal College of Pathologists of Australasia Chief Executive Debra Graves told Sydney radio station 2SER FM that most pathology labs would have to reduce the rate at which they bulk bill patients, meaning many will be forced to make a co-payment.
The issue has alarmed doctors and pathologists because of concerns that out-of-pocket costs will convince many patients to forego a pap smear, reducing the chances of early detection of cervical cancer.
AMA President Professor Brian Owler condemned the bulk billing incentive cuts at the time they were announced, describing them as “a co-payment by stealth”.
“Cutting Medicare patient rebates for important pathology and imaging services is another example of putting the Budget bottom line ahead of good health policy,” Professor Owler said. “These services are critical to early diagnosis and management of health conditions to allow people to remain productive in their jobs for the good of the economy.”
Health Minister Sussan Ley has tried to head off a social media campaign on the issue by arguing that the Government has not touched the Medicare rebate it pays for pap smear tests, and the bulk billing incentive was an “inefficient” payment to pathology companies.
In its Mid-Year Economic and Fiscal Outlook statement, the Government estimated that axing the incentive for pathology services and reducing it for diagnostic imaging would save $650 million over four years.
But the AMA said that the bulk billing incentive had been used by successive governments to help offset the fact that the Medicare rebate for pathology services including pap smears had not been increased in 17 years, and the net effect of axing the incentive was a cut in the Government’s contribution to the cost of a pap smear.
An online petition objecting to the change, which is due to come into effect from 1 July this year, has so far collected almost 34,000 signatures.
Those signing the petition claim the cuts are unfair and will lead to the late detection of illness, which would end up costing the health system more.
Professor Owler said the AMA strongly opposed the changes and would be working to convince the Senate to disallow them.
Adrian Rollins
[Series] Pre-hospital emergency medicine
Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes.
Government rethinks kick in the guts for patients
Patients have been saved from being left with huge unexpected out-of-pocket expenses after the AMA intervened to secure a delay in major changes to Medicare benefits for abdominal surgery.
The AMA acted after the Health Department, in a letter sent to AMA President Professor Brian Owler on 17 December, gave just 14 days’ notice of significant amendments to Medicare items for lipectomy services, which involve the removal of large flaps of skin left hanging from the gut following rapid weight loss.
Increasingly, lipectomies have been performed on people who have lost significant weight following lap band surgery or other medical interventions.
A review of Medicare Benefits Schedule items for lipectomy services conducted in 2013 found a large increase in the number of claims made in the previous decade. Most of the procedures were carried out on women between 35 and 54 years of age.
In its letter to Professor Owler, the Department said that the review had found little strong evidence regarding the effectiveness, safety and quality of lipectomies.
“But [the review] concluded that patients with a major abdominal apron following massive weight loss due to bariatric surgery or other weight loss measures were the most likely patient population for clinically relevant lipectomy, with personal hygiene and ulceration as the main clinical issues,” the Department said.
In April, the Medical Services Advisory Committee, which oversees the listing of services on the MBS, supported changes to Medicare items for lipectomies recommended by an expert working group.
But the Government did not act on this advice until deciding to implement the changes as part of its Mid Year Economic and Fiscal Outlook deliberations, and it announced they were to come into effect from 1 January 2016.
In her letter to Professor Owler, Health Department Assistant Secretary Natasha Ryan admitted that the rapid implementation of the changes meant there was little time to give doctors and patients notice. But she argued the nature of the changes meant they were likely to cause “only minimal inconvenience”.
But the AMA told the Department patients already booked in for a lipectomy, particularly those undergoing the procedure in January, were likely to be left badly out-of-pocket as a result of the extremely tight timeframe.
“There may be cases where patients are booked for services in January, who will now not be eligible for Medicare rebates and, therefore, private health insurance rebates,” the AMA warned. “Without proper notice to the relevant medical practitioners, the Department may be exposing some individuals to having to pay the full costs of treatment, [including both] the medical and hospital costs”.
The AMA said the period of notice given by the Department was “unacceptable”, and urged for a delay.
It said there was no material reason why the changes had to be implemented so quickly, and the decision showed “a lack of insight by the Department in how the health system works and how changes need to be planned for.
Following strong representations from the AMA, the Department has announced that the changes will be deferred until 1 April 2016.
Adrian Rollins
Advertising health services with medical devices
Information to consider when advertising health services that involve medical devices and IVDs
‘Why does this Government have it in for sick people?’
AMA President Professor Brian Owler has accused the Federal Government of ‘having it in’ for the ill over its plan to scrap bulk billing incentives for pathology services and downgrade them for diagnostic imaging.
As Health Minister Sussan Ley admitted some patients “may be worse off” as a result of the changes announced in the Mid Year Economic and Fiscal Outlook, Professor Owler warned they would increase expenses for patients and amounted to a “co-payment by stealth”.
“I really don’t understand why this Government has it in for sick people,” he told Channel Nine.
The AMA President said the Government’s decision to save around $300 million by axing bulk billing incentives for pathology services would force many providers, who haven’t had their Medicare rebate indexed for 17 years, to introduce a charge for patients.
“That is why it is a co-payment by stealth,” Professor Owler told ABC radio. “It’s about forcing providers to actually pass on those costs to their patients.
“So, while Tony Abbott might have said that the co-payments plans was dead, buried and cremated, it seems to have made a miraculous recovery and it’s reaching out from beyond the grave – or, at least, components of it are.”
Treasurer Scott Morrison has denied the claim, and Health Minister Sussan Ley said competition in the pathology industry would ensure increased costs were absorbed by providers rather than being passed on to patients.
In an interview on ABC radio she initially claimed there were 5000 providers operating in a “highly corporatised and highly competitive” environment.
She later clarified her comments, admitting that there were 5000 collection centres rather than individual operators, and most were owned by “two very large corporate entities and they’re doing very nicely.”
Ms Ley said the charging practices of providers was a commercial decision and “we can’t dictate what they charge patients”.
But Professor Owler said it was “completely ridiculous” for the Government to pretend its cuts would not result in charges for patients.
“You can’t take out what is essentially over $300 million from pathology and not expect that there’s going to be some sort of effect on patients,” he said. “Without that money being supplied to those providers, of course they’re going to have to charge the patients and so you’re going to see more patients with more out of pocket expenditure.
“And that is the plan of this Government – to pass more expense on to the pockets of the patients, and that is going to affect the sick and the most vulnerable in our community.”
In addition to axing and downgrading bulk billing for pathology and diagnostic imaging services, the Government expects a further $595 million will be saved by “streamlining” health workforce funding, including dumping several programs including the Clinical Training Fund (which was originally intended to fund up to 12,000 clinical training places across a range of disciplines), the Rural Health Continuing Education Program, the Aged Care Education and Training Initiative and the Aged Care Vocational Education and Training professional development program.
The Federal Government is also tapping the aged care sector for significant savings. It plans to cut more than $480 million by improving the compliance of aged care providers and making revisions to the Aged Care Funding Instrument Complex Health Care Domain.
The Government also expects to realise $146 million in savings from improving the efficiency of health programs, and plans to extract $78 million from the Independent Hospital Pricing Authority and $104 million from the National Health Performance Authority.
A further $31 million will be withdrawn from public hospital funding over the next four years.
Professor Owler said the health sector needed more detail and explanation from the Government regarding the MYEFO cuts.
“All up, MYEFO has delivered another significant hit to the health budget with services and programs cut, and more costs being shifted on to patients,” he said.
The health savings have been announced as part of measures to help improve the Budget, which has been rocked by a plunge in revenues caused by soft economic activity and falling commodity prices.
Since May, the Budget deficit has swelled by more than $2 billion to $37.4 billion, and is expected to be $26 billion bigger than anticipated over the next four years. Mr Morrison has targeted social services and health to deliver the bulk of spending cuts needed to put the Budget on the path to a surplus, which has been pushed back to 2020-21.
But the tenuous nature of this goal has been underlined by the fact that the Government is relying on savings measures that have little prospect of being implemented to help achieve the surplus.
In particular, proposed changes to the Medicare Safety Net worth $267 million were withdrawn by Ms Ley earlier this month after failing to garner sufficient support in the Senate, but still included in the Budget.
While the Government targeted health for major cuts, it did announce some initiatives welcomed by the AMA, including $131 million to expand the Rural Health Multidisciplinary Training Program and establish grants for private healthcare providers to support undergraduate medical places, and a further $93.8 million to develop an integrated prevocational medical training pathway in rural and regional areas – a measure the AMA has long been advocating for.
The Government has also introduced new MBS items for sexual health and addiction medicine services.
Adrian Rollins
[Comment] India’s health: more practical solutions needed
Vikram Patel and colleagues1 are to be congratulated for their comprehensive review of India’s health conditions, programmes, and policies. Despite many shortcomings, there has been substantial progress. India’s high infant, child, and maternal mortality rates show sustained decline and life expectancy is increasing.1 Some credit is due to increased national support since 2005, under the umbrella of the National Rural Health Mission (NRHM)/National Health Mission (NHM). States have accelerated efforts to generate demand for and strengthen supply of health services.
5 hospital presentations that GPs could help prevent
New research suggests over half a million hospitalisations could be avoided if patients had visited their doctor earlier.
The National Health Performance Authority’s report found there were 22 conditions for which hospitalisation was considered to be potentially preventable.
They found that 600,267 hospitalisations in 2013-14 could have potentially been prevented and five conditions specifically account for almost half (47%) of all potentially preventable hospitalisations.
The five conditions are:
- Chronic obstructive pulmonary disease (COPD) –10.4% of potentially preventable hospitalisations.
- Diabetes complications – 6.8% of potentially preventable hospitalisations.
- Heart failure – 8.9% of potentially preventable hospitalisations.
- Cellulitis – 9.7% of potentially preventable hospitalisations.
- Kidney and urinary tract infections (UTIs) – 10.4% of potentially preventable hospitalisations.
The report found that among the 300 local areas, age standardised rates of potentially preventable hospitalisations were nine time higher in some areas compared to others, “ranging from 1,406 per 100,000 people in Pennant Hills-Epping (NSW) to 12,705 hospitalisations per 100,000 in Barkly (NT).”
It also found that people in regional and remote areas and from a lower socioeconomic status often have higher rates of potentially preventable hospitalisation.
“This may be due to poorer health among people living in these areas and, potentially, poorer access to health care services provided in the community,” the report suggests.
Authors of the report say focusing on these five conditions can help PHNs target efforts on areas where there can be potential for great improvement.
The RACGP declined to comment on the report.
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Mental health services—in brief 2015
Mental health services—in brief 2015 provides an overview of data about the national response of the health and welfare system to the mental health care needs of Australians. It is designed to accompany the more comprehensive data on Australia’s mental health services available online at .
Women stopped from getting to the top
Women are struggling to make it into the upper echelons of the medical profession despite comprising an increasing majority of those embarking on a medical career.
Australian Institute of Health and Welfare figures show that last year women made up 40 per cent of the medical workforce and 53 per cent of early-career practitioners, including just over half of all specialists in training.
But, despite this, researchers have found that they are failing to progress through to senior positions in representative numbers, comprising less than a third of specialist college board members and medical school deans, 33 per cent of state Chief Medical Officers and just 12.5 per cent of large hospital CEOs.
A study of medical leadership in Australia, published in BMJ Open, has found that women are under-represented in medical leadership roles due to a combination of ill-informed attitudes and inflexible work and career demands.
Through detailed interviews with a sample of 30 medical leaders (22 of whom were men), a team of researchers from Melbourne University, Monash Health and Deakin University found although some thought the representation of women at senior levels would increase because of the pipeline of females entering the profession, the majority – both men and women – identified a series of barriers that prevented women from advancing.
“Most interviewees believed that gender-related barriers were impeding women’s ability to achieve and thrive in medical leadership roles,” the researchers said, and identified three broad impediments – perceptions of capacity, organisational arrangements and professional culture.
The most commonly-cited barrier was parenthood, with several medical leaders referring to an inherent incompatibility between high-level leadership and motherhood.
But several remarked on the tendency of managers, and women themselves, to underestimate their capabilities.
A number of leaders interviewed for the study, Reasons and remedies for under-representation of women in medical leadership roles, reported that women were often “not taken really seriously”, and were consider to be “too feminine” to be an effective leader.
In their findings, the researchers said that, as in other professions, the lack of women in senior leadership positions was justified by a range of explanations including it was “too soon” to see women in these roles, they were too busy with their families, or were not natural leaders.
The researchers said the basis for these explanations was thin, pointing out that women have made up a sizeable proportion of the medical workforce for decades and are still not moving into leadership roles in numbers consistent with their representation in the workforce.
On the career-limiting impact of parenting, they said that “cultural assumptions that childrearing and household responsibilities impede women from entering leadership roles is, at least in part, based on discriminatory social norms”.
They pointed out that inflexible work arrangements made this a structural, rather than inherently biological, barrier. Some of those interviewed for the study suggested that, rather than following a standard linear path, medical careers could be structured to follow a more M-shaped trajectory that would support women to enter, or re-enter, leadership roles at an older age “if that suited their life-course”.
The researchers cited cultural norms and unconscious biases in the medical profession about what a leader should look like, and how they should behave, as another impediment faced by women.
They also identified other institutional impediments. For example, because the responsibilities for childrearing and maintain a household continue to fall disproportionately on women, they tend to gravitate towards specialties that give them the time and flexibility to fulfil these roles, such as general practice and public health medicine.
But these specialties, the report said, tended to have a less influential presence in large health services compared with traditional male-dominated specialities, such as surgery.
“Achieving meaningful change will require us to move beyond ‘fixing the women’ to a systemic, institutional approach that acknowledges and addresses the impact of unconscious, gender-linked biases,” the researchers said. “Revisiting rigid career structures, providing flexible working hours, offering peer support, and ensuring appropriate development opportunities, may all assist women to enter leadership roles.”
Adrian Rollins