Britain has introduced plain packaging for tobacco cigarette products sold in that country.
And Oxford’s Cochrane Tobacco Addiction Group says its research involving a review of more than 50 experimental studies, suggests the move will likely have a significant impact on the prevalence of smoking.
Experts from the Cochrane Review say plain packaging appears to diminish the appeal of tobacco and help reduce the practice of smoking.
Some of that evidence comes from observing the Australian experience. In 2012, Australia became the first country in the world to implement standardised packaging of tobacco products, when the then Labor Government successfully enacted plain packaging legislation.
Data collected since then shows the measure has resulted in an extra 0.5 percent a year decline smoking numbers.
“We are not able to say for sure what the impact would be in the UK, but if the same magnitude of decrease was seen as was observed in Australia, this would translate to roughly 300,000 fewer (UK) smokers,” said Jamie Hartmann-Boyce, a Cochrane Review researcher.
British legislation on plain packaging for tobacco came into full effect from May this year.
Cigarette packs must have a uniform colour and font and carry no logos apart from health warnings.
The Cochrane team analysed 51 studies.
“Our evidence suggests standardised packaging can change attitudes and beliefs about smoking,” Mr Hartmann-Boyce said.
“And the evidence we have so far suggests that standardised packaging may reduce smoking prevalence and increase quit attempts.”
AMA President Dr Michael Gannon represented Australian doctors at the 206th World Medical Association Council meeting.
Medical practitioners from national medical associations around the world gathered to debate a number of key issues in Livingstone, Zambia on April 20 to 22. The event was attended by almost 200 delegates from more than 30 national medical associations.
Medical cannabis was one of the key discussions at the meeting. A Position Statement was developed to be presented at the WMA’s General Assembly in October.
A debate also took place on proposals to revise the WMA’s long-held policy on boxing so as to include safety regulations until a ban could be put in place. A recommendation to revise the policy at the General Assembly was agreed.
The Council agreed they needed to update their position on availability and effectiveness of in-flight medical care, along with the idea of allowing physicians to provide emergency care during flights without fear of legal reprisals.
Discussions also took place on bullying and harassment in the medical workplace; updating ethical advice on hunger strikes for doctors; armed conflicts; medical education; alcohol; and water and health.
All new policy proposals will be forwarded to the General Assembly.
WMA leaders heard from the Confederation of Latin American National Medical Associations (CONFEMEL) that restrictions on the professional freedom of physicians to practice medicine was leaving patients without basic medical care. They reported that medical prescriptions and laboratory tests were being restricted, leading to disappointed and sometimes angry patients.
Dr Ketan Desai, President of the WMA, said: ‘We have been told that doctors in Venezuela feel helpless to resolve the situation, which is getting worse day by day. Junior doctors in particular are having to face angry patients and are often suicidal.
“For the sake of patients and physicians in Venezuela this situation cannot be allowed to continue. We urge the Government of Venezuela to allocate the necessary resources to the health care system and to ensure the independence of physicians to allow them to deliver high quality medical care to their patients. At the moment patients’ fundamental rights to health are being violated.”
WMA is now considering sending a delegation to Venezuela to express support to local doctors as well as report on the situation.
Extreme concern was expressed by the WMA as well as calling for the immediate release of a Turkish doctor, Dr Serdar Küni who is jailed in Turkey for providing medical treatment to alleged members of Kurdish armed groups.
Dr Küni, a respected member of the local community, and former chairperson of the Şırnak Medical Chamber was the Human Rights Foundation of Turkey’s representative in Cizre. He has remained detained since his arrest last October and is awaiting trial. Concerns have been raised by human rights organisations regarding his access to a fair trial and fair hearing rights at that trial.
The WMA believe the case of Dr Küni is one example among many of arrests, detentions, and dismissals of physicians and other health professionals in Turkey since July 2015, when unrest broke out in the southeast of the country.
The WMA moved an emergency resolution that condemned such practices that: “Threaten gravely the safety of physicians and the provision of health care services. The protection of health professionals is fundamental, so that they can fulfil their duties to provide care for those in need, without regard to any element of identity, affiliation, or political opinion.”
It added: “The WMA considers that punishing a physician for providing care to a patient constitutes a flagrant breach of international humanitarian and human rights standards as well as medical ethics. Ultimately it contravenes the principle of humanity that includes the imperative to preserve human dignity.”
The United Nations Security Council has declared, states should not punish medical personnel for carrying out medical activities compatible with medical ethics, or compel them to undertake actions that contravene these standards.
The letter from Anthony Costello and colleagues1 shows the tangled web that has been woven by WHO to prevent food industry involvement in infant feeding policy and practice. This is despite the core statement within the International Code of Marketing of Breast-milk Substitutes, “affirming the need for governments, organisations of the United Nations system, non-governmental organisations, experts in various related disciplines, consumer groups, and industry to cooperate in activities aimed at the improvement of maternal, infant, and young child health and nutrition”.
As a working GP, I’ve seen the impact that medication misadventures can bring. It is especially frustrating and upsetting when patients, unfamiliar with a generic medication dispensed to them have accidentally become confused – believing it was medication for something else because it was a different colour or shape – and taken it together with their regular brand name drug. As a result double dose is taken, which depending on the medication, can be disastrous.
It was in this light that I recently commented on speculation regarding a policy change on generics and biosimilars.
The AMA is a strong supporter of using generic medications, when it is safe and appropriate and discussed with the patient. This is clearly outlined in our Medicines Position Statement (2014), which can be found here: position-statement/medicines-2014
As stewards of the health system, we’ve advocated strongly for the effective and efficient use of health funds, with a strong view that savings should be reinvested in the health system. It’s why we’ve supported the vision of the MBS Review, it’s why we’re at the table as part of the current Private Health Ministerial Advisory Committee and it’s why we’ve advocated tirelessly for the lifting of the Medicare Freeze. We need a sustainable health system, supported by responsible behaviour by all medical practitioners.
When it comes to generics, the story is no different. It’s pleasing that Australian university training courses encourage trainee doctors to use the generic name of a medicine, and that Australian studies examining pharmacist dispensing behaviour consistently indicate that only 3% or fewer doctors marked the prescription ‘do not substitute’.
But the ongoing drive for cost savings can never come at the expense of patient safety and doctor autonomy. Recently there was high level reporting that a change was going to be made to generic and biosimilar policy. That reporting included speculation that there would be mandatory prescribing included as part of the change – potentially even of biosimilars, which as you know are not identical to the originator.
It was in this vein, and against these issues, which I spoke out. These mooted changes and the questions we fielded were disturbing news, to say the least. Furthermore, and perhaps most disappointedly; there had been no consultation with the AMA on such a potentially dramatic prescribing policy shift. And, as these changes related to speculation of potential budget measures, there was understandably no formal announcement and detail from Government on exactly what the changes were.
As doctors, our first, most critical thought is for the welfare of our patients. And some – especially those with multiple medications, the elderly, those who might have cognitive or vision impairment – rely on the look and feel of their medications in managing their daily doses.
So the AMA spoke out to make clear that mandatory prescribing – be it of biosimilars or generics –or any other radical changes would be very problematic. It could in some instances lead to medical misadventure and adverse events resulting in hospital admissions which could significant impact on health system costs, rather than save funds as intended. Some generics can have filler ingredients that may be contraindicated for patients, and there are variations inherent in biosimilars which also need to be accounted for.
Our point was that any Government measures to increase the take-up of generics or biosimilars needs to include protocols to support the use of originator medicines where the generic/biosimilar alternatives are contraindicated or fail to provide the desired therapeutic outcome. And of course, any new arrangement where software changes are made cannot add to the burden and time it takes for a doctor – every extra minute navigating software is one less minute talking with the patient.
To be clear, the AMA’s concerns were about the exceptions, when a doctor may determine that a brand medicine may be best for the patient, and not the general rule, which is about supporting generics and the efficient use of health funding.
I am pleased that as a result of the AMA’s comments around the importance of being able to prescribe the right medication for a particular patient, we have received confirmation that these changes will not result in mandatory prescribing, while still encouraging the greater uptake of generics where appropriate. We are told the changes in software to default to generics will not be time consuming either.
As you would have seen in media reporting, there may be substantial savings from the increased use of generics in appropriate circumstances, and the AMA therefore strongly supports these savings being invested back into the PBS, and the health system more broadly, to ensure that much needed medications and services are made available to the Australian public.
While the remaining detail will not be released until Budget night, these changes would appear to be in line with the AMA’s existing medicines policy. I am therefore hopeful we can have confidence, based on these reassurances received, that when our patients go to the pharmacy in the future, they get just what the doctor ordered.
Almost 20 years after the 30% subsidy for private health insurance was introduced, premiums continue to rise every year. This comes at a cost to the federal budget – which was forecast at A$6.5 billion in the 2016 federal budget from the subsidy alone.
Meanwhile, consumers continue to view private health insurance as poor value for money. It would be sensible for the government to face evidence the subsidy is bad and costly policy, as health bureaucrats and commentators predicted long ago.
Why was private cover subsidised?
The 30% subsidy for private health insurance premiums was introduced in 1999, driven more by media coverage than evidence. Following Medicare’s introduction in 1984, private health coverage had fallen from about 50% of the population in 1985 to just more than 30% in 1998.
The media portrayed this decline as a death spiral that would put unbearable pressure on public hospitals. The public system would no longer be sustainable, the narrative went, as healthy people dropped their private insurance while a pool of sick older individuals with high hospital needs flooded the system.
Evidence for this narrative was flimsy at best, and largely anecdotal. Later analysis demonstrated the insured population was actually a healthier (and richer) subgroup. So, healthier people were maintaining cover, while sicker individuals still relied on the public hospital system.
Yet health ministers under both Labor and Liberal governments became champions of the policy to subsidise private cover. Michael Wooldridge, as health minister in the Howard government between 1996 and 2000, introduced a 30% premium subsidy to those already insured and new entrants.
The subsidy was accompanied by a Medicare Levy Surcharge of 1% of taxable income for higher-income earners (singles with income above A$50,000 and couples above A$100,000) without private cover.
Did premiums fall?
When evidence on private cover emerged, it revealed that the 30% subsidy had a negligible impact on declining levels of coverage. Around 70% of the population preferred to rely on the public system.
Yet the government didn’t question the subsidy, which was already costing A$2.1 billion in 2000-01. Instead it further propped up the private health sector by introducing the lifetime health cover (LHC) policy in 2001.
This was a financial loading that increased by 2% for each year the cover owner was older than 30. It was payable in addition to the base rate premium for any private health insurance hospital cover. Those who purchased before the strict deadline of July 1 avoided the age loading irrespective of their age at entry. After the deadline, only those aged 30 or younger could avoid the loading.
Again the media had a major role. The government funded an advertising blitz across print and electronic media – the Run for Cover campaign – in the lead-up to the deadline in July 2000.
Just days before the deadline, private insurance coverage jumped from 30% to about 45% of the population. Subsequent evidence demonstrated the 50% increase was driven by the scare campaign, not the premiums.
Wooldridge was confident there would be downward pressure on premiums because, under LHC, the pool of insured people were younger, healthier and less likely to make claims on their insurance.
Those taking up private health insurance continued to use the public system. from shutterstock.com
But premiums did not fall. Average private insurance benefits for a hospital episode increased. This was driven by a combination of higher medical fees per service and more services per day in hospital.
What about easing pressure on public hospitals?
While 50% more people had private cover by the end of 2000, public hospitals were largely unaffected. Surgery waiting times remained steady. There were long waits for elective procedures like cataract surgery and knee and hip replacements – as before lifetime health cover was introduced.
For most people, the choice of hospital does not depend solely on private cover, and young adults make few claims. Those who took up private health insurance for financial reasons, such as to avoid the Medicare Levy Surcharge, continued to use the public system much as before. Only a small percentage of the population report they are motivated to buy private hospital cover because they anticipate high health needs.
There is considerable churning, particularly as the young drop their cover. But others approaching the LHC age penalty continue to join, again with media encouragement. Promotion of private cover by the funds focus on extras (renamed “general”) cover (such as dental, optical and chiropractic services) rather than private hospital cover.
The advertising focus is also on younger adults, a group unlikely to claim much in hospital benefits, but more likely to claim for dental, optical and other extras.
But extras cover is more profitable for the funds than hospital cover. For most people, losses exceed benefits. Almost all people with hospital cover combine it with extras. Yet the government subsidy is applied to both hospital and extras cover.
Face the facts
The level of private health coverage remains high; premiums continue to grow driven by higher fees, more services and technology costs; and the budget cost of the subsidy increases with premiums. Insurers claim they cannot control health costs, and the state of the public hospital system is much as before.
Restoring the budget to surplus supports cutting the subsidy, but it seems the political realities place this in the too-hard basket for both government and opposition. Several changes suggest some ambivalence about the policy from government.
Indexation of the rate of subsidy was modified in 2014 and the level of subsidy was income-tested. The effect is to slowly reduce the cost to the public purse.
In addition, the Medicare Levy Surcharge was increased for those on higher incomes, and the LHC loading removed for people who had paid it for ten consecutive years. This was because it was discouraging private cover take-up by older and uninsured consumers.
Some extras items (gym memberships, running shoes) have been removed, and subsidies for natural therapies have been questioned.
Removing the subsidy from extras cover would be a positive move, with significant budget implications. But the case is also clear for going further. While it has been possible to remove subsidies from the car industry (for example), with 45% of the population having private health insurance, removing the flawed subsidy is proving a political challenge.
Prime Minister Malcolm Turnbull will address the Saturday morning session of the AMA National conference, as the event’s keynote speaker.
The 2017 AMA National Conference will take place at the Sofitel on Collins, Canberra, from 27-29 May.
National political and medical leaders and experts will present at this year’s conference to cover a diverse range of issues central to AMA members.
The 2017 AMA National Conference Program will discuss and debate topical medical, political and ethical issues affecting health and care in Australia.
Tackling Obesity – will deliver opinion from a range of experts into the global obesity epidemic, including how AMA policy can help shape an effective and informed method of address by the Australian Government.
Threats Beyond Borders – is an interactive panel discussion on potential infectious diseases that could cross Australian borders and will explore the role of a National Centre for Disease Control (CDC).
Improving Australia’s organ donation rate – will examine ethical and practical considerations in how to match Australia’s leading global role of successful organ transplant outcomes with our need to increase organ donation rate.
Doctors’ Health and Wellbeing – will discuss emerging issues relating looking after doctors’ health during medical training and throughout their professional careers. The session will explore the success and otherwise of initiatives being implemented in this area.
Pre-conference masterclass on offer – Limited places only
In conjunction with the 2017 AMA National Conference, the Pam McLean Centre and will provide a pre-conference masterclass open to all doctors on Thursday 25 May, also held at the Sofitel on Collins, Melbourne.
The masterclass on ‘Dealing with Bad health News’ will be an interactive, evidence based full-day masterclass designed to provide a safe learning environment for participants to explore different communication approaches to help patients deal with bad health news.
Under the guidance of an expert facilitator, Professor Stewart Dunn (Director, Pam McLean Centre), participants will develop skills in interpreting human behaviour by improving the way they recognise, identify and respond to emotional reactions.
This is an accredited activity for RACGP Category 1 and ACRRM Core PDP points.
The AMA joined the inaugural meeting of the Close the Gap Parliamentary Friendship Group, held on March 30 at Parliament House.
Convened by Greens Senator Rachel Siewart, ALP Senator Malarndirri McCarthy, and Liberal MP Lucy Wicks, the meeting aimed to raise awareness among key decision makers about the scourge of Rheumatic Heart Disease (RHD) on Aboriginal and Torres Strait Islander peoples.
Worldwide, RHD affects more than 30 million people, with Australia’s Aboriginal and Torres Strait Islander people having among the highest rates of this debilitating disease.
The fact that RHD is occurring in Australia, and the fact that we need to reinforce to our political leaders that they need to do something about it, is symptomatic of consecutive government failures to listen and act. RHD is a disease of poverty and it should not be seen in Australia.
Yet Aboriginal and Torres Strait Islander people, particularly children, continue to suffer from RHD every day. Penny, a young patient advocate from Oenpelli in Arnhem Land, is one of those children. Penny was diagnosed with RHD at around ten years of age, and many of her family members are living with RHD as well – her mother, uncle, aunty, and cousin. While it is unacceptable that RHD is even occurring in Australia, it is intolerable that it is affecting whole families.
RHD can be usually resolved if it is detected early, but people are being treated for the condition when it is too late. Dr Bo Remenyi, a paediatric cardiologist in the Northern Territory described how she sees a new case of RHD being diagnosed among Indigenous children every second day – this is about 150 new cases per year.
RHD is no longer a public health problem in Australia. This issue was solved for the majority of Australians about 50 or 60 years ago with the introduction of penicillin and better living conditions. RHD is now a political problem.
In the words of Dr Remenyi: “We have a surgical solution for a political problem. Australia needs a paradigm shift – we need to move away from surgical solutions.” We need to invest in prevention, and double the number of doctors and health workers on the ground – Aboriginal and Torres Strait Islander communities have the smallest health workforce in Australia. This is highly disproportionate, particularly when the health needs of Aboriginal and Torres Strait Islander people are two to three times higher than their non-Indigenous peers.
Part of the solution to addressing RHD is educating members of the community about skin infections, and how they can lead to Acute Rheumatic Fever, and then to RHD if they are not quickly treated. But most of all, there needs to be a strong will to put RHD in the history books.
The community, health professionals, people working laboratories, public servants and most of all, governments, are all responsible for helping to make this a reality. Our political leaders need to show leadership and take action to work with health professionals and communities to rid Australia of RHD.
A second stage of a major vaccination campaign to halt the spread of cholera got underway in March and April in three drought-ravaged regions of Somalia.
Gavi, the Vaccine Alliance, delivered 953,000 doses of Oral Cholera Vaccine to the country to protect more than 450,000 people from the disease.
The campaign took place in three of the worst-hit regions, Banadir, Kismayo and Beledweyne, with the vaccine being given in two doses to everyone over the age of one. The first round ran from 15-19 March and the second from 18-22 April.
The vaccines were procured, transported and stored at the appropriate temperature by UNICEF. They are being administered by the Government of Somalia with the support of World Health Organisation (WHO) and UNICEF; while UNICEF and others continue to improve water and sanitation infrastructure and promote behaviour change. As well as providing the vaccines, Gavi has provided US$550,000 to support the campaign.
Seth Berkley, CEO of Gavi, said the people of Somalia are going through unimaginable suffering.
“After years of conflict, a severe drought has brought the country to the brink of famine and now a suspected cholera outbreak threatens to become a nationwide epidemic,” he said.
“These lifesaving vaccines will play a vital role in slowing the spread of the disease, buying valuable time to put the right water, sanitation and hygiene infrastructure in place to stop the root causes of this outbreak.”
Dr Ghulam Popal, WHO Representative in Somalia, said cholera was a major health issue in Somalia.
“The current drought has worsened the situation for many. Therefore we’re very glad to have the support of Gavi to implement the first OCV campaign in Somalia,” Dr Popal said.
“We are very hopeful that the vaccination campaign will control outbreaks, and eventually save lives.”
The current severe drought in Somalia has forced communities to use contaminated water, helping cholera to spread. A total of 25,000 cases of Acute Watery Diarrhoea/cholera have been reported since the beginning of 2017, causing at least 524 deaths. Surveillance reports indicate that the epidemic is now spreading to areas inaccessible to aid workers.
UNICEF Somalia Representative, Steven Lauwerier said the vaccination campaign was an emergency measure.
“We need to continue to tackle the main cause of such outbreaks,” he said.
“UNICEF, donors, government and other stakeholders are making some progress in improving access to safe water and promoting good sanitation and hygiene practices and this needs to be scaled up urgently.”
Gavi, the Vaccine Alliance is a public-private partnership committed to saving children’s lives and protecting people’s health by increasing equitable use of vaccines in lower-income countries.
The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners.
Gavi uses innovative finance mechanisms, including co-financing by recipient countries, to secure sustainable funding and adequate supply of quality vaccines. Since 2000, Gavi has contributed to the immunisation of nearly 580 million children and the prevention of approximately 8 million future deaths.
A recent survey of some AMA members has highlighted the impact of the Government’s ongoing indexation freeze on access to Department of Veterans’ Affairs (DVA) funded specialist services for veterans.
The DVA Repatriation Medical Fee Schedule (RMFS) has been frozen since 2012.
The AMA conducted the survey following anecdotal feedback from GP and other specialist members that veterans were facing increasing barriers to accessing specialist medical care.
Running between March 3 and 10, the survey was sent to AMA specialist members (excluding general practice) across the country.
It attracted interest from most specialties, although surgery, medicine, anaesthesia, psychiatry and ophthalmology dominated the responses.
More than 98 per cent of the 557 participants said they treat or have treated veterans under DVA funded health care arrangements.
For the small number of members who said they did not, inadequate fees under the RMFS was nominated as the primary reason for refusing to accept DVA cards.
When asked, 79 per cent of respondents said they considered veteran patients generally had a higher level of co-morbidity or, for other reasons, required more time, attention and effort than other private patients.
According to the survey results, the indexation freeze is clearly having an impact on access to care for veterans and this will only get worse over time.
Table 1 highlights that only 71.3 per cent of specialists are currently continuing to treat all veterans under the DVA RMFS, with the remainder adopting a range of approaches including closing their books to new DVA funded patients or treating some as fully private or public patients.
If the indexation freeze continues, the survey confirmed that the access to care for veterans with a DVA card will become even more difficult.
Table 2 shows that less than 45 per cent of specialists will continue to treat all veterans under the DVA RMFS while the remainder will reconsider their participation, either dropping out altogether or limiting the services provided to veterans under the RMFS.
In 2006, a similar AMA survey found that 59 per cent of specialists would continue to treat all veteran patients under the RMFS.
There was significant pressure on DVA funded health care at the time, with many examples of veterans being forced interstate to seek treatment or being put on to public hospital waiting lists.
The Government was forced to respond in late 2006 with a $600m funding package to increase fees paid under the RMFS and, while the AMA welcomed the package at the time, it warned that inadequate fee indexation would quickly erode its value and undermine access to care.
In this latest survey, this figure appears likely to fall to 43.8 per cent – underlining the AMA’s earlier warnings. The continuation of the indexation freeze puts a significant question mark over the future viability of the DVA funding arrangements and the continued access to quality specialist care for veterans.
The AMA continues to lobby strongly for the lifting of the indexation freeze across the Medicare Benefits Schedule and the RMFS, with these survey results provided to both DVA and the Health Minister’s offices. The Government promotes the DVA health care arrangements as providing eligible veterans with access to free high quality health care and, if it is to keep this promise to the veterans’ community, the AMA’s latest survey shows that it clearly needs to address this issue with some urgency.
Chris Johnson
Table 1
Which of the following statements best describes your response to the Government’s freeze on fees for specialists providing medical services to veterans under the Repatriation Medical Fee Schedule (RMFS):
Answer Options
Response Percent
I am continuing to treat all veterans under the RMFS
71.3%
I am continuing to treat existing patients under the RMFS, but refuse to accept any more patients under the RMFS
9.9%
I am treating some veterans under the RMFS and the remainder either as fully private patients or public patients depending on an assessment of their circumstances
10.8%
I am providing some services to veterans under the RMFS (e.g. consultations) but not others (e.g. procedures)
5.6%
I no longer treat any veterans under the RMFS
2.4%
Table 2
Which of the following statements best describes your likely response if the Government continues its freeze on fees for specialists providing medical services to veterans under the RMFS:
Answer Options
Response Percent
I will continue to treat all veterans under the RMFS
43.8%
I will continue to treat existing patients under the RMFS, but refuse to accept any more patients under the RMFS
15.5%
I will treat some veterans under the RMFS and the remainder either as fully private patients or public patients depending on an assessment of their circumstances
21.1%
I will provide some services to veterans under the RMFS (e.g. consultations) but not others (e.g. procedures)
8.4%
I will no longer treat any veterans under the RMFS
DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE
Readers will need to pardon the pun, but the ban on charging for consumables like dressings when bulk billing a patient is an open wound that GPs and general practices have been struggling with for over a decade. It is estimated that more than 400,000 patients at any one time are suffering from hard-to-heal wounds. Venous leg ulcers, which are prevalent in the older population, for example, affect around 43,000 people. KPMG, as far back as 2003, estimated that $166 million a year could be saved by treating these patients with compression bandages and stockings.
The high incidence of chronic wounds produces a heavy burden on the Australian health care system. And a study on wound care costs in general practice conducted in 2011 showed that, in most cases, general practices are not recouping the costs of wound care. In providing this critical service for patients, GPs and practices typically incur a loss.
Before the introduction of the Practice Nurse Incentive Scheme, the practice nurse item for wound management helped offset the cost of wound care. Bandages and dressings generally cost anywhere from between $4 and $21 with the median just under $10. However some, such as a four-layer compression bandage, can be around $50.
As you know, many of the patients who need wound care are vulnerable. They are often aged and suffering from multiple conditions. GPs are faced with a difficult choice and tend to bulk bill them out of compassion. The GP/practice then is left with carrying the cost of the dressings, which in the context of an inadequate Medicare rebate is not a trivial sum.
Of course GPs could raise a charge for the bandage and just bill the patient the MBS fee for the attendance, which they can then claim on Medicare, but in doing this lose access to any bulk billing incentive. For GPs it is a lose-lose.
The Government’s freeze on Medicare rebates has made this situation even more intolerable.
As is so often the case when it comes to supporting best practice, the Department of Veterans’ Affairs is at the forefront, providing veterans with access to subsidised dressings for treating a range of wounds. While the Government may not want to pursue this model for non-DVA funded patients, it is time for a conversation about the potential for cost recovery on consumables like dressings, while still being able to bulk bill a patient. This is a conversation the AMA is now starting with the Government.
Ideally, the same arrangements that apply to vaccines should apply to consumables. Proper wound care is essential to managing patients in the community and keeping them out of hospital. It’s a classic situation where prevention is better than the cure and, from a patient’s perspective, a much better alternative than asking them to pop down to the pharmacy to purchase dressings (with a retail mark-up) and then having to return to the practice to have the dressing applied.
more_vert
