Subscribe
×

Preference: Government and politics

News briefs

One-handed people point way to new brain theory

In people born with one hand, the brain region that would normally light up with that missing hand’s activity lights up instead with the activity of other body parts — including the arm, foot, and mouth — that fill in for the hand’s lost function, according to an international study published in Current Biology. Scientists from Israel and the UK say that the discovery could change fundamental understanding of how the brain is organised. The researchers studied 17 people who lacked a hand from birth along with 24 matched, two-handed controls. A video of each participant was recorded while they completed five everyday tasks, such as wrapping a present or handling money, to see how they went about it. Participants were also asked to move various parts of their bodies while their brains were scanned using functional magnetic resonance imaging. “We found that the traditional hand area gets used up by a multitude of body parts in congenital one-handers,” said researcher Tamar Makin, from University College London. “Interestingly, these body parts that get to benefit from increased representation in the freed-up brain territory are those used by the one-handers in daily life to substitute for their missing-hand function — say when having to open a bottle of water. In intact participants, all this is carried by the non-dominant hand,” she continued. “But the fact that we see such a strikingly different representation in that area in congenital one-handers may suggest that this is not actually the hand area. If true, this means we’ve been misinterpreting brain organisation based on body part, rather than based on function. The implications, if this interpretation is correct, are massive.” Her hope is to find a way to encourage the brain to represent and control artificial body parts, such as a prosthetic arm, using the brain area that would have controlled the missing hand.

doi: http://dx.doi.org/10.1016/j.cub.2017.03.053

Australian ad linking alcohol with cancer is a winner

Australian-led research published in BMJ Open has found that the effectiveness of alcohol harm reduction campaigns may be improved by directly communicating alcohol’s long term harms to the general adult population of drinkers, along with drinking guidelines. Researchers from the Cancer Council Victoria, Curtin University and Ohio State University in the US, randomly assigned 2174 Australian adult weekly drinkers to view three of 83 English-language alcohol harm reduction ads. Each ad was viewed and rated by a mean of 79 participants. After viewing each ad, participants reported the extent to which they felt motivated to reduce their drinking. Ads were ranked from most to least motivating using predicted means adjusted for demographic characteristics and alcohol consumption. The researchers then compared the characteristics of the top-ranked 15% of ads (most motivating) with the middle 70% and bottom 15%. An Australian ad about the link between alcohol and cancer (“Spread”) was most motivating, whereas an ad that encouraged drinking water instead of beer (“Add nothing”) was least motivating. Top-ranked ads were more likely than other ads to feature a “why change” message and less likely to carry a “how to change” message, more likely to address long term harms, more likely to be aimed at the general adult drinking population and more likely to include drinking guidelines. There was substantial overlap in top-ranked ads for younger versus older adults, men versus women and high risk versus low risk drinker subgroups. With a mean score of 3.77, the highest ranked ad was “Spread”, developed and funded by the Western Australian state government as part of their Alcohol and cancer mass media campaign. The second most effective ad — “What you can’t see” (mean score of 3.62) — was from the same Western Australian campaign. The authors acknowledge that further research is needed to determine whether the motivation measure predicts subsequent reduced alcohol consumption.

doi: http://dx.doi.org/10.1136/bmjopen-2016-014193

[Department of Error] Department of Error

Mahmood S S, Wroe E, Fuller A, Leaning J. The Rohingya people of Myanmar: health, human rights, and identity. Lancet 2016; 389: 1841–50—On page 5 of this Review, the text should have read “A Myanmar Government report 44 noted that, in the Rohingya-predominant northern region of Rakhine State, both Maungdaw and Butheetaung townships have only one physician each (serving 158 000 people combined)…” This correction has been made in the online version as of May 4, 2017, and the printed Review is correct.

Government had to reassure Australians about Medicare

After almost losing last year’s federal election over cuts to Medicare, the Government has used this Budget to display its commitment to the national health scheme.

It is setting up a Medicare Guarantee Fund and from July this year money from the Medicare Levy as well as from personal tax receipts, will be poured into the fund to cover the costs of Medicare and the Pharmaceutical Benefits Scheme.

(A 0.5 percentage point Medicare Levy rise in 2019 will help fund the National Disability Insurance Scheme.)

Labor hammered the Coalition during the 2016 election with its so-called Mediscare campaign, requiring a clear message on Budget night from the Government.

“Tonight, we put to rest any doubts about Medicare and the Pharmaceutical Benefits Scheme,” Treasurer Scott Morrison said in his Budget address.

“We are lifting the freeze on the indexation of the Medicare Benefits Schedule. We are also reversing the removal of the bulk billing incentive for diagnostic imaging and pathology services and the increase in the PBS co-payment and related changes.

“The cost of reversing these measures is $2.2 billion over the next four years

“Tonight, I also announce we will legislate to guarantee Medicare and the PBS with a Medicare Guarantee Bill.

“This new law will set up a Medicare Guarantee Fund to pay for all expenses on the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme.

“Proceeds from the Medicare Levy will be paid into the fund. An additional contribution from income tax revenue will also be paid into the Medicare Guarantee Fund to make up the difference.

“The Bill will provide transparency about what it really costs to run Medicare and the PBS and a clear guarantee on how we pay for it.”

But Shadow Health Minister Catherine King said the Budget was an insult directly from Prime Minister Malcolm Turnbull to every Australian who relies on Medicare.

She said instead of a staggered lifting of the rebate freeze, it should have been removed across the board immediately.

“When it comes to health, the Liberals haven’t learned a thing. The Turnbull Medicare freeze remains in place across the health system for years to come,” Ms King said.

“The failure to drop the freeze immediately will impact on many of Australia’s most vulnerable patients – such as those needing critical oncology treatment, obstetric services, and paediatric treatment.

“Australians will have to wait more than 12 months for relief and will be left waiting more than two years for the freeze on specialist procedures and allied health to be lifted.”

Greens leader Richard Di Natale described the Budget as a missed opportunity for health.

“The Medicare Guarantee Fund is a glorified bank account and ending the Medicare freeze just undoes a bad decision,” Senator Di Natale said.

“We should be investing more in prevention and redirecting the Private Health Insurance rebate into the public health system.”

Health Minister Greg Hunt said all Australians can be assured Medicare was not only here to stay, but will be strengthened into the future.

“This Budget includes a $2.4 billion additional investment in Medicare over the next four years,” he said.

“Partnerships have been struck with the nation’s GPs, specialists, pharmacists and the medicines sector. These are key to the Turnbull Government’s initiatives that will support the long-term future of Australia’s health system.

“As part of our compacts with Australia’s GPs and specialists, the 2017-18 Budget restores indexation of the Medicare rebate at a cost of $1 billion, starting with GP bulk-billing incentives from 1 July 2017.

“With GP bulk-billing at a record high 85.4 per cent, more Australians are visiting the doctor without having to reach into their pockets. This Budget will help ensure that continues with our indexation commitment to GPs alone worth $543.1 million over 4 years and around $2.2 billion over ten years.

“Indexation of standard GP and specialist consultations will resume on 1 July 2018, and specialist procedures and allied health from 1 July 2019.”

Chris Johnson

 

Budget 2017-18 from a public health perspective

Analyses of federal budgets are typically couched in clichés. Government’s talk about jobs and growth, initiatives, priorities and investments; while oppositions and minor parties respond with the language of not enough, missed opportunities, disappointments and failures.

In regard to public health and health prevention, the 2017-18 Coalition Budget is all of these things.

There are many welcome and positive public health initiatives in the Budget. The Government has listened to the AMA and is investing $5.5 million into an immunisation awareness campaign. There is a further $14 million to expand the National Immunisation Plan to provide catch-up vaccinations to 10-19 year-olds who missed out on childhood vaccinations. These are measures the AMA has been advocating directly with the Government for.

New mental health funding is also welcome. There is $9 million for a telehealth initiative to improve access to psychologists for people living in rural and remote areas, and an extra $15 million for mental health research initiatives. The big ticket item is $80 million of additional funding to maintain community psychosocial services for people with mental illness who do not qualify for the NDIS. This is a very good measure and shows that Health Minister Greg Hunt has taken on-board concerns the AMA and others raised about people falling through the cracks that exist between the NDIS and State and Territory community services.

However, this funding is contingent on the States and Territories matching the Commonwealth’s commitment. The Government said it will allocate the entire $80 million, even if some States or Territories do not sign up to the matched funding offer. In other words, the money will only go to those jurisdictions who offer a matched dollar-for-dollar commitment. What we don’t know is how these funds will be allocated and what happens if a State or Territory does not sign up or provide new money for psychosocial services. Will the people in those jurisdictions be left with no psychosocial supports? I suspect that the Australian Health Ministers’ Advisory Council (AHMAC), the advisory and support body to the COAG Health Council, may be the entity that negotiates this funding measure.

The mental health sector has been encouraged by this Budget and Minister Hunt’s dedication to mental health reform. Preventative health didn’t get the same attention as mental health in this budget. The Prime Minister told the National Press Club in February: “In 2017, a new focus on preventive health will give people the right tools and information to live active and healthy lives.”

There was, therefore, an expectation that this Budget would deliver in key areas of preventative health, most importantly in tackling obesity. The AMA has been calling for a range of initiatives and measures that are urgently needed to address the rise in obesity, and in this respect the cliché of ‘missed opportunity’ is applicable.

There is a $10 million initiative to establish a Prime Minister’s Walk for Life Challenge and a further $5 million for a GPs Healthy Heart partnership with the RACGP to support GPs to encourage patients to lead a healthy lifestyle. These are small but good measures. The AMA has been calling for a national obesity prevention strategy that recognises obesity as a complex problem that can only be addressed through a broad range of measures. The measures announced in the Budget are a start, but fall well short of the funding for community-based initiatives and restrictions on the marketing of junk food and sugary drinks to children that we say are needed to address obesity.

There was no National Alcohol Strategy or any measures that help Australians manage the misuse and abuse of alcohol, and the alcohol-fuelled violence that emergency department staff know all too well.

There were no measures or initiatives that address climate change and health.

The Government has indicated that there will be a ‘third wave’ of preventative health measures, possibly in the next budget. We hope so, because investment in preventative and public health initiatives is smart, cost-efficient and a benefit to future generations.

Simon Tatz 
Director, Public Health

 

Budget at a glance

Significant health measures in the Budget

  1. Lifting the freeze on the indexation of the Medical Benefits Schedule.
  2. National Disability Insurance Scheme to be fully-funded by a 0.5 percentage point Medicare Levy increase from 2019.
  3. Legislation to guarantee Medicare and the PBS.
  4. Hospital funding increased by $2.8 billion over four years.
  5. $1.4 billion to be invested in health research over four years.
  6. $1.2 billion in new medicines to be made available

 

Other big measures in the Budget

  1. Levy on big banks’ liabilities to raise $6.2b.
  2. Negative gearing and depreciation changes to raise $2.1b.
  3. First home buyers can get a deposit by salary sacrificing into super.
  4. $300m to the Australian Federal Police to fight terrorism.
  5. $10b to establish a National Rail Program.
  6. Foreign worker levy to raise $1.2b over four years.
  7. $18.6b for Gonski education funding.
  8. $5.3b over 10 years for Western Sydney Airport Corp.
  9. $8.4b for Melbourne to Brisbane Inland Rail Project.
  10.  $4b tax crackdown on multinationals.
  11.  $1b National Housing Infrastructure Facility for new homes
  12.  Federal Government to take control of Snowy Hydro
  13.  $90m to secure gas resources for domestic use

 

The Budget deficit is $29.4 billion in 2017-18, with the Government forecasting a return to surplus by 2020-21.

More health measures in the Budget

The following is extracted from the Government’s Budget overview document

Budget 2017-18 Guaranteeing the essentials for Australians

 A healthy Australia

Providing affordable medicines and investing in mental health and public hospitals. Continuing to provide access to new medicines. Australians will continue to have affordable access to new medicines, with the Government meeting its commitment to list cost-effective medicines on the PBS. In this Budget, $1.2 billion will be provided for new and amended listings on the PBS, including more than $510 million for Sacubitril with valsartan (Entresto®).

Since 2013, the Government has listed more than 1400 new or amended medicines on the PBS averaging 32 new and amended listings a month. These new listings include breakthrough medicines to treat breast cancer, Hepatitis C, cystic fibrosis and severe asthma. Investing in mental health More than $115 million will be invested in mental health, including $80 million for psychosocial services, $9.1 million in funding for rural telehealth psychological services, $15.0 million for priority mental health research and $11.1 million to address suicide hotspots. The Government is providing further mental health support for veterans and their families, by investing $9.8 million to fund pilot programs to improve mental health services and support suicide prevention efforts for veterans.

The Government will also provide $33.5 million to ensure anyone who has served a single day in the fulltime Australian Defence Force can seek treatment for mental health conditions and $8.5 million to expand access to counselling services for veterans’ families. Funding public hospitals Record levels of financial assistance will be provided to State Governments to deliver the public hospital services Australians need. Commonwealth payments to the States for public hospitals continue to grow strongly, from $13.8 billion in 2013-14 to an estimated $22.7 billion in 2020-21. On current Budget forecasts, an additional $7.7 billion will be provided to the States and Territories from 2016-17 to 2020-21 giving effect to the Heads of Agreement on public hospital funding signed by COAG on 1 April 2016. Medical Research In this Budget the Government has committed new funding for medical research, $65.9 million will be provided from the Medical Research Future Fund to support preventative health research, clinical trials and breakthrough research investments. In addition, $5.8 million will be provided for research into childhood cancer.

Full and sustainable funding for the National Disability Insurance Scheme

The Commonwealth will fully fund its contribution to the National Disability Insurance Scheme, giving Australians with permanent and significant disability, and their families and carers, certainty that this vital service will be there for them into the future. To help fund the scheme, the Government is asking Australians to contribute, with the Medicare levy to be increased by half a percentage point from 2 to 2.5 per cent of taxable income. This means that one-fifth of the revenue raised by the Medicare levy, along with any underspends within the NDIS, will be directed to the NDIS Savings Fund. The Government’s decision to increase the Medicare levy from 1 July 2019 reflects the fact that Australians have a role to play, in accordance with their capacity, to ensure this important program is secure for current and future generations. The NDIS is on track to be fully rolled out from 2020. States and Territories will be expected to maintain their commitment and contribution to the NDIS and continue to support mainstream services for people with disability. More than $200 million will be provided to establish an independent NDIS Quality and Safeguards Commission to oversee the delivery of quality and safe services for all participants of the NDIS. The Commission will support NDIS participants to exercise choice and control, ensure appropriate safeguards are in place, and establish expectations for providers and their staff to deliver quality supports. The Commission will perform three core functions: regulation and registration of providers; complaints handling; and reviewing and reporting on restrictive practices.

The Government will also invest $33 million over three years to help existing service providers in the disability and aged care sectors grow their workforce. This package will deliver jobs for Australians in rural, regional and outer suburban areas that require strong workforce growth as a result of the NDIS roll out. The scheme’s cost sustainability is being examined in the Productivity Commission’s review of NDIS costs. Due to be released in September 2017, it will examine factors affecting costs and will help inform the final design of the full scheme.

Indigenous health measures welcomed, but more needed

The AMA welcomes many of the Indigenous health measures in the Federal Budget, while recognising that there is still more to be done.

The Indigenous Health Budget line for the next financial year has increased to $881 million, an $83 million increase that the Close the Gap Campaign, of which the AMA is a proud member, attributes mostly to population increases and indexation increases in the Indigenous Australians’ Health Program. There was also a $2.4 billion increase in funding allocated to Medicare over the next four years, and a much welcomed early lifting on the freeze on Medicare rebates.

In particular, the AMA supports the Government’s measures to strengthen and expand their commitment to address Rheumatic Heart Disease (RHD), something we have been strongly calling for. Last year the AMA released its 2016 Report Card on Indigenous Health that focused on the devastating effects of RHD, an entirely preventable disease that affects hundreds of Indigenous Australians each year. In our Budget Submission, the AMA called on the Government to commit to eradicating new cases of RHD, and we are pleased to see the Government heed these calls.

It is unacceptable that Indigenous Australians are still 20 times more likely to die from RHD than their non-Indigenous peers. This measure provides $7.6 million in new funding in addition to the $11.2 million already provisioned by the Government, and focuses on improving clinical care, and using education and training for health care providers, patients and their families to raise awareness to improve the prevention and treatment of RHD. The measure also includes funding for focused prevention activities in high-risk communities.

We also welcome the Government’s allocation of $9.1 million to improve telehealth arrangements for psychological services in regional, rural and remote areas of Australia. Nearly one-third of Aboriginal and Torres Strait Islander adults report high levels of psychological distress in their lives – this is two and a half times the rate reported by other Australians. The AMA believes the mental health and social and emotional wellbeing of Aboriginal peoples should be given greater priority in the nation’s health policy agenda.

As the Government has said, this measure will help remove significant barriers faced by those people unable to access psychological services because of where they live. They will no longer have the inconvenience, time and expense of having to travel to large regional centres to receive the help that they need.

The Budget also commits $400,000 over four years to ensure that eligible pharmacists continue to be appropriately renumerated for supplying medicines under the Pharmaceutical Benefits Scheme (PBS) for individual clients of Remote Area Aboriginal Health Services. This measures ensures that pharmacists will be paid the regular PBS dispensing fee for each item provided, instead of the lower bulk handling fee.

While the AMA welcomes much of these measures, the budget remained quiet on many other important areas in Indigenous health. The gap in health and life expectancy between Aboriginal and Torres Strait Islander peoples and other Australians is still considerable, despite existing commitments to close the gap. However, Health Minister Greg Hunt indicated at the Health Budget Lock-up that there is going to be a ‘third wave’ of reform, which will include Indigenous health. The AMA looks forward to working with the Government in this process.

Alyce Merritt
Indigenous Policy Adviser, AMA

 

Medical Students say Budget missed opportunity for workforce investment

The Australian Medical Students’ Association (AMSA) welcomes certain elements of the federal budget, but is concerned by the Government’s lack of investment in medical education.

While the Budget will continue to fund the Specialist Training Program and support rural background recruitment, cuts to funding will impact quality of medical education.

AMSA President Rob Thomas said he was pleased to see there will be no increases in medical student places from new medical schools, and also that funding will continue for the Commonwealth Medical Internships Program.

“However, this Budget was a real opportunity for the Government to contribute to the future health workforce by increasing specialist training in regional and rural areas and ensuring medical schools are adequately funded,” he said.

“AMSA has called for more places in the Specialist Training Program to be delivered in rural and regional areas, as this is required to ensure a sustainable rural medical workforce.

“The Budget delivers no net increase overall, and a marginally increased proportion from 39 per cent rural places currently to 45 per cent by 2021.

“This means that those who want to work rurally will continue to have to undertake the majority of their training in metropolitan areas, decreasing the likelihood that they will be rural doctors in the long-term.”

Mr Thomas said AMSA was relieved university fee deregulation is off the table, but that the higher education reform announcement posed new concerns.

“According to the Medical Deans of Australia and New Zealand, funding for medical education falls short by $23,500 per student per year. This discrepancy places major strains on the training of future doctors in Australia,” he said.

“By reducing Commonwealth base funding for medical education by 2.5 per cent in each of 2018 and 2019, this figure will only expand, impacting the quality of basic medical education.”

AMSA welcomes the Government’s commitment of $5 million over the next two years to Orygen, the National Centre of Excellence in Youth Mental Health, and a further $10 million to the Black Dog Institute and Sunshine Coast Mind and Neuroscience.

“With medical students facing a disproportionate burden of mental illness, the Government’s increased funding for mental health research is to be applauded,” Mr Thomas said

“We are hopeful that a proportion of this funding will be devoted to the research of university student mental health.”

Chris Johnson

What the budget means for healthcare

Medical bodies have lined up to welcome new health measures announced in the 2017 budget this week, as the government seems determined to put its “Mediscare” problems behind it.

AMA President Michael Gannon said that with the new measures, notably the lifting of the freeze on Medicare patient rebates, the government has begun to win back the goodwill it lost with its disastrous 2014 health budget.

“Lifting the Medicare rebate freeze is overdue, but we welcome it,” Dr Gannon said.

Much the same message came from the RACGP, which described the lifting of the freeze as “the first step towards a commitment to reinvesting in preventative health”.

RACGP President Dr Bastian Seidel said the college was also pleased that the Medicare Benefits Review had been extended and that the government was committing to funding practice-based research networks.

The RACP also fell into line, welcoming the end of the rebate freeze as “a good outcome for the Australian health system as it will better support patients in accessing the care they need”.

The government has said it will be spending an extra $1billion on health in the next financial year compared with the previous one. Below are some of the key changes related to healthcare announced on Tuesday:

Medicare Rebate unfrozen

The government has announced an end to the freeze on indexing Medicare rebates, but it will be done slowly and in stages.

The rebate will be indexed from July 2018 for GP consultations and specialist attendances, and then from July 2019 for specialist procedures and allied health services. Payments for diagnostic imaging services will be indexed from July 2020 for the first time in 16 years.

These measures have been costed at around $1 billion over four years.

Medicare levy raised

Medicare levy will be increased by 0.5% to 2.5%, in a measure that should raise $8.3 billion for the government over four years. Low-income earners will continue to be exempt, with the threshold for the levy raised to incomes of $21,655 and over.

Medicare Guarantee Fund to be set up

The government will legislate for a Medicare Guarantee Fund to ensure funding for Medicare rebates and the PBS. Proceeds from the 0.5% increase in the Medicare levy will be paid into the fund, once NDIS funding costs are deducted. Some income tax revenue will also be diverted into the fund.

Cheaper medicines on the PBS

An overhaul of the Pharmaceutical Benefits Scheme will make an extra $1.2 billion available for new medicines, the government has said.

It said it has reached agreements with Medicines Australia, the Pharmacy Guild and Generic and Biosimilar Medicines Australia to bring down costs of some medicines.

This would include drugs such Entresto (Sacubitril/Valsartan) for chronic heart failure, which will now be PBS listed at a cost of $515 million.

A five-year agreement with Medicines Australia will also boost prescribing of generics and biosimilars, with savings of $1.3 billion.

More money for mental health

Mental health is a big winner in the budget, with the government committing to a range of mental health and preventive health services and strategies.

This includes $80 million for services to people with severe mental illness but who don’t qualify for NDIS or who haven’t yet transitioned to it. It will cover people with severe eating disorders, schizophrenia and severe post-natal depression.

And it also includes $9.1 million to improve access to psychologists for people in remote and rural areas via telehealth services.

Suicide prevention gets $11.1 million, with a particular focus on locations with high suicide rates. That includes money to build fences, barriers and lighting at notorious suicide spots, plus extra funding for Lifeline.

There’s also $15 million over two years for research into mental health, including funding for the Black Dog and Thompson Institutes.

Hospitals

Commonwealth funding to states and territories for hospitals is set to increase by $2.8 billion, including $736 million for hospital services in Tasmania.