[Comment] Offline: Planetary health—gains and challenges

Slowly, planetary health is evolving into a new discipline to complement public and global health. The first professor of planetary health was recently appointed: Anthony Capon, at the School of Public Health in Sydney. A Planetary Health Alliance has been established between universities and non-governmental organisations, led by Sam Myers at the Harvard TH Chan School of Public Health in Boston, Massachusetts. In April, 2017, the first Planetary Health conference will be held. Already, scientific meetings are including planetary health in their programmes.

AMA policy on euthanasia and physician assisted suicide – an update

The issue of euthanasia remains very much to the fore in current media, and attempts to introduce euthanasia laws continue in several states.

In South Australia, a new voluntary euthanasia Bill is currently being considered by Parliament and will be voted on as soon as this month. Pro-euthanasia MPs in Tasmania and Western Australia have indicated they will introduce legislation in the near future. The Victorian Government is due to respond by year’s end to a report on the Inquiry into End of Life Choices in Australia, which recommends the development of a legislative framework for assisted dying.

In the midst of this, the AMA’s review of its own policy on euthanasia and physician assisted suicide continues to progress. The Federal Council held a special policy session on the issue at its meeting in August, where it considered information gained from a very wide-ranging and deliberate process of member consultation, including:

the results of an AMA member survey on euthanasia and physician assisted suicide;
issues raised through this year’s AMA National Conference Q&A session on assisted dying;
member responses to the current AMA policy (undertaken last year through Australian Medicine); and
relevant background information on euthanasia and physician assisted suicide, including national and international legislative initiatives and professional and community attitudes.

At its August meeting, Federal Council recognised the diversity of member views on euthanasia and physician assisted suicide and agreed that there was a need to consult further with State and Territory AMA offices on whether the AMA’s current policy opposing doctor involvement in euthanasia and/or physician assisted suicide should be amended.

There were, however, several issues highlighted at the meeting over which there was no dispute:

access to adequate palliative care and end of life care remains inadequate throughout the country;
regardless of the final policy position, there must be appropriate funding of palliative care and greater clarity regarding legislative protections for doctors providing good end of life care for their patients; and
irrespective of whether or not euthanasia and/or physician assisted suicide become legal in Australia, it is imperative that the medical profession articulates the message that end of life care is a central responsibility of doctors, and that we will always care for patients and the broader community.

The members of Federal Council are acutely aware that this issue is sensitive and controversial, and that any decision will have potential political ramifications and consequences for health care. It is an issue on which some members have very strong views, many of which have been expressed as heart-felt and compelling arguments during the current consultation process.

However, because this is a debate about something that is very much at the core of what it is to be a doctor – that is, whether doctors should be involved in actions with a specific intention to end life – there are times when those with opposing views maybe forget the need to genuinely listen to each other. This is unfortunate when it occurs, because what has become very clear during the consultation process is that all members, whatever their views, have shown a deep dedication to the care of their patients and the welfare of the community as a whole.

So, the Federal Council’s mission is to be respectful of the views of all members, and to be understanding of the passion of those with opposing views, while seeking to find a position which is sensible and justifiable, but also reflects the unbreakable responsibility of doctors to always care for their patients.

Federal Council will continue its deliberations on a euthanasia and physician assisted suicide policy position at its upcoming meeting in November. We will keep members informed of the progress of this issue.

Improving safety and quality of public hospital services – a case of less $$ to do more?

A key focus for Health Financing and Economics Committee (HFE) is the pricing and funding of public hospitals.

This work includes monitoring public hospital funding through the federal Budget and public hospital expenditure as reported by the Australian Institute of Health and Welfare.

HFE also takes a close interest in hospital pricing through the operation of Activity Based Funding (ABF) and the National Efficient Price (NEP), managed by the Independent Hospital Pricing Authority (IHPA). Each year, IHPA publishes a consultation paper to inform the Pricing Framework of ABF and the NEP to apply for the following financial year.

The AMA has a direct and significant interest in the Pricing Framework for public hospital services as a critical element in the overall functioning of our hospital system.

The major new element in the proposed Pricing Framework for 2017-18 relates to options for incorporating safety and quality into the pricing and funding of public hospital services.

For 2017-18, IHPA has been directed by Federal, State and Territory governments to undertake specific work to integrate quality and safety into hospital pricing and funding. IHPA has been tasked to advise on pricing and funding options for sentinel events, preventable hospital acquired conditions, and avoidable hospital readmissions.

IHPA’s options are set out in its consultation paper on the Pricing Framework 2017-18.

The options involve reducing pricing and funding for services that do not meet safety and quality standards, for example, services that involve a preventable hospital acquired condition. The ‘logic’ appears to be that improved safety and quality will be achieved by imposing financial penalties and reducing hospital funding for poor safety and quality services.

At its October meeting, HFE was briefed by IHPA Chief Executive James Downie on hospital pricing issues and IHPA’s safety and quality options. HFE drew on this discussion to consider and make input to the AMA’s submission on the Pricing Framework.

The AMA has consistently advocated for the appropriate recognition of safety and quality in the ABF and NEP framework.

However, the AMA has significant concerns with how this longstanding gap in the framework is now to be addressed. Any approach that sets out to improve safety and quality by financially penalising hospitals that are already under-resourced to achieve safety and quality standards is misconceived.

Improving the safety and quality of public hospital services requires a framework of positive incentives for the achievement of relevant targets, supported by the full range of quality and safety mechanisms in place and available to public hospital system operators, doctors, nurses and other hospital staff.

These include improvements in data quality and information available to inform clinician practice, whole‑of‑system efforts to deliver improved patient outcomes, and incentives that work to the level of the clinical department to focus efforts and effect change, with local implementation, monitoring and information sharing needed.

An essential pre-condition for all such improvements is adequate funding for public hospitals.

Overall funding for public hospitals under the NEP has been, and continues to be, inadequate. This has direct consequences for the performance of public hospitals in key areas against the targets set by governments, as tracked and reported in the AMA Public Hospital Report Card.

Health Care Homes must be tailored to Indigenous needs

I am continuing the important tradition of chairing the Taskforce on Indigenous Health as AMA President. The taskforce acts to identify and recommend Indigenous health policy strategies for the AMA.

On 8 October 2016, it was my privilege to chair my first meeting of the Taskforce. A number of important issues were discussed, including the AMA’s election priorities relating to Aboriginal and Torres Strait Islander health, the AMA’s support for the establishment of an Academic Health Science Centre in Central Australia, as proposed by Baker IDI Heart and Diabetes Institute and its partners, and the Indigenous health focus of the Medicare Benefits Schedule (MBS) Review.

One issue that was raised as being of particular concern was how the proposed Health Care Homes initiative will affect health care for Aboriginal and Torres Strait Islander peoples. The AMA supports the concept of Health Care Homes – a policy announcement made by the Coalition prior to the 2016 election, and we are pleased that the Australian Government has committed to an extended trial of the concept.

The AMA has concerns about the Health Care Homes model in relation to Indigenous health, and we assert that the specific health needs of Aboriginal and Torres Strait Islander people must be addressed through the scheme.

The concept of the medical home is not new in Australia. For many Australians, their local general practice is already their Health Care Home, and their GP, their primary carer. Patients whose care is well managed and co-ordinated by their GP are likely to have a better quality of life and to make a positive contribution to the economy through improved workforce participation. Health Care Homes should mean more expensive downstream costs can be avoided. Chronic conditions, if treated early and effectively managed, are less likely to result in the patient requiring hospital care for the condition or any complications.

The Health Care Home model has worked overseas and the evidence is of significant reductions in avoidable hospital admissions, emergency department use, and overall costs.

The AMA sees Health Care Homes as potentially one of the biggest reforms to Medicare in decades.

However, we know that, for the Health Care Home model to succeed, the Government needs to engage with and win the support of general practice. We also need to see greater detail about how the Health Care Home model will operate in remote and Indigenous communities.

Indigenous communities face a range of unique health problems and chronic diseases uncommon in our cities. A high turnover of medical practitioners and support services in these areas means continuity of care and follow up treatment can be difficult to maintain.

Trust is a vital component of health care, especially for Aboriginal and Torres Strait Islander peoples, and knowing and trusting a GP is critical in the management of chronic conditions. How the Health Care Home model will deliver consistent, ongoing GP care and management of chronic health conditions is not known, and the AMA has been urging the Government to provide greater details about funding and operation.

There is a degree of anxiety among the Aboriginal Community Controlled Health Organisation (ACCHO) sector that any announcements made by the current Government will result in cuts to Indigenous health. There is a strong view that building up the ACCHO sector is the best model of care for Aboriginal and Torres Strait Islander peoples, particularly as ACCHOs are the preferred provider of Indigenous health services.

ACCHOs, like Health Care Homes, need to be built on existing relationships and investment in models that work. The Government must not rush the Health Care Homes trial and, if it is to be successful, it must be adequately funded.

As a model, it has the potential to help close the gaps in health outcomes between Aboriginal and Torres Strait Islanders and non-indigenous Australians. The AMA’s position will be to closely monitor what works and what does not work, and work constructively with Government to ensure the necessary changes are made.

Govt’s dodgy deal with big pathology ‘not the answer’: Gannon

AMA President Dr Michael Gannon has told pathologists that capping pathology collection centre rents is “simply not the answer” to the challenge the sector faces from almost 20 years of frozen Medicare rebates.

In a message to AMA pathologist members, Dr Gannon said the surprise deal struck between the Federal Government and Pathology Australia during the Federal election to impose a rent ceiling was a “poorly targeted” policy that would deliver a massive windfall for the big pathology companies at the expense of medical practices, and did nothing for individual pathologists.

“The Government’s proposal goes too far, interfering with legitimate commercial arrangements that have been entered into by willing parties,” he said. “It will unfairly damage medical practices that have made business decisions based on projected rental streams, including investment in infrastructure and staffing.”

The AMA President said there was no guarantee from Pathology Australia, whose biggest member is Sonic Healthcare (which holds 43 per cent of the market), that any money pathology companies saved by cutting their collection centre rents would be re-invested in pathology services or the pathology workforce.

Instead, the rents deal controversy was overshadowing important issues such as the impact of the near 20-year rebate freeze for pathology services and the need for a much more sustainable funding base, he said.

In striking his deal with Pathology Australia, Prime Minister Malcolm Turnbull blindsided groups including the AMA and the Royal College of Pathologists of Australasia, who had been involved in discussions with the Government earlier this year on ways to improve transparency and strengthen compliance within the existing regulatory framework governing pathology collection centre (ACC) rents.

ACC rents have risen strongly since their deregulation in 2010, and there have been fears of a nexus between leases and the number of pathology tests a practice orders.

But the Health Department has reported in several different forums that it has not detected any such link, and told a roundtable meeting of stakeholders attended by the AMA on 27 April that it had found no evidence that rents were substantially above market value.

Instead, rents are being driven higher by intense competition for market share. Consolidation in the industry has intensified since deregulation, and the two big pathology companies, Sonic and Primary Health Care, between them now hold about 77 per cent of the market – a 12 per cent increase in five years.

Instead of addressing issues around the structure of the industry and how that was affecting competition and rents, Dr Gannon said the Government’s unilateral move to cap rents was simply a “knee jerk reaction” to head-off a politically damaging campaign.

The Government struck the deal in the early days of the Federal election in order to get Pathology Australia to drop its threat to axe the bulk billing of pathology services following the abolition of the pathology bulk billing incentive.

The terms of the agreement were laid out in a Senate Estimates hearing last month by Health Department Deputy Secretary Andrew Stuart, who said the “nature of the deal between the Government and Pathology Australia is to work to bring rents down to a more reasonable level and, at the same time or in some relationship to that, to continue with the Government’s proposal to remove the bulk billing incentive”.

Government Minister Senator Fiona Nash told the Estimates hearing the Coalition had received assurances from the pathology industry that “it is going to keep the bulk billing levels at its rates [and] we are taking it in good faith that that is exactly what they meant, and we expect they will do that”.

Dr Gannon said that in rushing to strike its deal with Pathology Australia, the Government had failed to take into account the consequences for GPs.

The Government’s plan went well beyond the intent of existing laws and gave pathology providers an unfair advantage in commercial negotiations with medical practices, he warned.

His concerns were borne out by the testimony of Mr Stuart, who admitted that the Department had not modelled the likely effect of the pathology rents cap on general practices, particularly when combined with the Medicare rebate freeze.

The senior health official, who made pointed reference to the fact the deal was “a Government negotiation, not a departmental negotiation”, said details of the arrangement, especially regarding its implementation, were still being finalised.

Significantly, the deal leaves the contentious issue of what should be defined as ‘market value’ unresolved – something admitted by Health Department First Assistant Secretary Maria Jolly in her testimony to the Senate committee.

She said how the new arrangement would be introduced was also yet to be determined, including how existing leases would be treated, and how the new deal would relate to the current regime governing prohibited practices.

Adrian Rollins

Pathology rent cap will cost patients, doctors

The AMA has warned that Federal Government proposals to cap pathology collection centre rents will likely drive up patient out-of-pocket costs and could force some medical practices out of business.

In a strongly worded letter, AMA President Dr Michael Gannon has appealed to the Small Business and Family Enterprise Ombudsman, Kate Carnell, to intervene and help try to convince the Government to drop its plan.

Dr Gannon said the proposal, announced during the Federal election, to change provisions in the Health Insurance Act would allow the two major pathology companies that dominate the market to unilaterally cut the rents they paid to medical practices for co-located collection centres (ACCs), delivering a big financial blow to small business already reeling under the effects of the Medicare rebate freeze.

“The proposed changes fundamentally alter the intent of the existing law…by imposing a blunt cap on the commercial rents that GPs and other specialists can receive for co-located ACCs,” the AMA President said. “It delivers two major listed companies with an unwarranted and unfair advantage…estimated to save [them] between $100 million and $150 million per annum.”

Under the deal, which was sprung on the medical profession without warning, the Government has promised to bring down rents in exchange for a promise from pathology companies that they will sustain bulk billing rates despite the loss of the bulk billing incentive.

Dr Gannon warned that the Government’s proposed changes would have “a big impact” on medical practices.

“Medical practices are [already] feeling the impact of the current MBS indexation freeze, and policy changes like this will simply have a further negative impact on their cash flow and on practice viability,” he said. “For those practices that have used this source of rental income to help keep them viable during the current extended freeze, it may it may mean higher costs to patients or simply selling their business.”

Many, the AMA President said, had made decisions about hiring staff and purchasing equipment based on anticipated revenue streams from ACC rents, and the policy would put their finances under strain.

Dr Gannon said it was unlikely the Government comprehended the full impact of the “poorly targeted” policy when announcing it, including the massive windfall it would deliver to the big pathology providers and the hefty financial blow it would deliver to many medical practices.

Adrian Rollins

Health ‘prime target’ for cybercrime

The increasing adoption of electronic medical records and billing systems has made the health sector a prime soft target for cybercriminals, the World Medical Association has warned.

Delegates at the WMA’s General Assembly in Taipei were told that cybercrime had become “a real threat”, with some hospitals already being hacked on a regular basis – including, on occasion, being blackmailed for money.

“Cyber security threats are an unfortunate reality in an age of digital information and communication,” the WMA said in a statement adopted by the Assembly. “Attacks on critical infrastructure and vital assets of public interest…are on the rise and pose a serious threat to the health and wellbeing of the general public.”

It warned that the proliferation of electronic health records and billing systems meant the health sector was “especially susceptible to cyber intrusions and has become a prime soft target for cybercriminals”.

Hospital information and practice management systems could become “gateways” for cybercriminals, putting the electronic medical and financial records of patients at risk and even opening the way to “increasingly sophisticated system breaches that could jeopardise the ability to provide care for patients and respond to health emergencies”.

The WMA’s warning echoes concerns about information security identified by the AMA in its Position Statement on Shared Electronic Medical Records issued earlier this year.

In the Position Statement, the AMA warned that the adoption of electronic medical records needed to be accompanied by measures to ensure their safety and security.

The WMA said current security procedures and strategies in the health sector had generally had not kept pace with the volume and magnitude of cyberattacks.

Despite the scale of the threat, many health care providers were devoting insufficient money and resources to the problem, and many lacked the expertise to detect a cyberattack, let alone prevent or address it.

The Association called on governments, policymakers and health providers to work with national cyber security authorities and collaborate internationally to anticipate and defend against such attacks.

It said providers should develop comprehensive systems to detect and prevent security breaches and, where they occurred, have a prepared and robust system of response that includes notification, remedial action and insurance.

Acknowledging that such an investment of time and resources may be beyond many smaller operators, the WMA said governments and provide bodies should provide support to overcome these limitations.

The AMA Position Statement on Shared Electronic Medical Records can be viewed at: position-statement/shared-electronic-medical-records-…

The WMA statement can be viewed at: http://www.wma.net/en/30publications/10policies/c15/index.html

Adrian Rollins

Government targets quality in proposed PIP overhaul

The AMA has expressed concern that a proposed major shake-up of the Practice Incentives Program is not being supported by increased investment in general practice.

The Health Department has unveiled plans to “refresh” the 18-year-old PIP system by slashing the number of incentive payment categories on offer, reducing the administrative burden on practices and intensifying the focus on quality.

Under the proposal, outlined in a discussion paper released by the Department, seven existing payments covering asthma, cervical screening, diabetes, aged care access, prescribing, Indigenous health and procedural GP incentives would be axed; four existing payments, covering rural loading, after hours services, teaching and e-health – would be maintained; and a new Quality Improvement Incentive payment would be introduced.

The AMA has welcomed the increased focus on quality, and is in consultation with the Department over the proposal to collapse the PIP payment categories.

But it voiced concern that the changes were not being supported by an increase in financial support for GPs, particularly given that many practices are being pushed to the financial brink by the Medicare rebate freeze and the prospect of cuts to pathology collection centre rents.

The Department has indicated that there will be no extra money injected in the PIP scheme.

It said the quality incentive payment would be used to “give general practices increased flexibility to improve their detection and management of a range of chronic conditions, and to focus on issues specific to their practice population”.

The push to overhaul the PIP system comes at the same time the Government is launching the initial stage of its Health Care Home model of care and undertaking a comprehensive review of the 5700 services listed on the MBS.

The Department said the initiatives together would “take the health system towards services that are aligned with contemporary practice”.

The case for changes to the PIP has been mounting in recent years, with a number of organisations including the Australian National Audit Office, the Organisation for Economic Co-operation and Development and the Grattan Institute all raising concerns that the system imposed an unduly heavy administrative burden on practices and was failing to keep up with evolving health needs and priorities.

The Department said the evidence showed that many existing incentives might be no longer appropriate, and that the more could be achieved by intensifying the focus on quality, including by making better use of data.

“Redesigning the PIP would enable it to move away from process-focused funding towards a simpler system that encourages quality improvement and innovation, and allows practices to see improvements in measures that are important to them,” it said.

Precisely how this could be achieved was up for consultation and debate, the Department added.

It suggested two options. One would be to merge all five PIP items (including the new Quality Improvement Incentive) into a single payment administered by the Department of Humans Services – essentially building on and adapting existing arrangements. Eligible practices would receive sign-on and quarterly payments, to be used to make quality improvements of their choosing.

Under the second option, the Department would no longer directly fund practices. Instead, practices would use PIP funds to engage third-party providers to support their quality improvement work.

Whatever the option chosen, practices would be required to regularly share data to map quality improvements, individually, locally and nationally.

The Government is inviting submissions on the proposed PIP overhaul. The deadline is 30 November.

The Department’s consultation paper can be downloaded here.

Latest news

Gene tests on ‘don’t do’ list

Medical experts have taken aim at ‘direct to consumer’ genetic testing services amid concerns that they are causing unnecessary expense and alarm.

Medical experts have warned that patients should not initiate genetic tests on their own, particularly for coeliac disease and for the genes MTHFR and APOE, which are, respectively, associated with levels of folate and susceptibility to Alzheimer’s disease.

The Gastroenterological Society of Australia has recommended against genetic tests for coeliac disease because the relevant gene is present in about a third of the population and “a positive result does not make coeliac disease a certainty”.

Similarly, Human Genetics Society of Australasia Clinical Professor Jack Goldblatt said variants of the MTHFR gene were “very common in the general population [and] having a variant in the gene does not generally cause health problems”.

Additionally, Professor Goldblatt said that although the APOE gene was considered a risk factor for Alzheimer’s, “having a test only shows a probability, so people undertaking [the test] can also risk being falsely reassured”.

“Unnecessary genetic testing can lead to further unnecessary investigations, worry, ethical, social and legal issues,” he said. “In particular, we caution people to not initiate testing on their own. Genetic tests are best performed in a clinical setting with the provision of personalised genetic counselling and professional interpretation of test results.”

The recommendations are among 20 made by the Gastroenterological Society of Australia (GESA), the Royal Australian and New Zealand College of Radiologists (RANZCR), the Human Genetics Society of Australasia and the Australasian Chapter of Sexual Health Medicine, as part of program being coordinating by the Choosing Wisely Australia campaign to improve the use of medical tests and treatments.

The advice includes cautioning women against self-medicating for thrush, improved use of radiation therapy to treat cancer, and careful use of colonoscopies.

Professor Anne Duggan from GESA said colonoscopies had a “small but not insignificant risk of complications”, and those undertaken for surveillance placed “a significant burden on endoscopy services”.

Professor Duggan said surveillance colonoscopies should be targeted “at those most likely to benefit, at the minimum frequency required to provide adequate protection against the development of cancer”.

The RANZCR said radiation treatment was “a powerful weapon” in the treatment of cancer, and half of those diagnosed with the disease would undergo radiation therapy.

But the College advised that such treatment should be provided within clinical decision-making guidelines, “where they exist”.

In particular, it has recommended sparing use of radiation to treat prostate cancer.

Dean of the College’s Faculty of Radiation Oncology, Dr Dion Forstner, radiation oncology might not be immediately required where prostate cancer is diagnosed.

“Patients with prostate cancer have options including radiation therapy and surgery, as well as monitoring without therapy in some cases,” Dr Forstner said.

The College also advised that while whole-breast radiation therapy decreased the local recurrence of breast cancer and improved survival rates, recent research had shown that shorter four-week courses of therapy could be equally effective “in specific patient populations”. It said patients and doctors should review such options.

The Chapter of Sexual Health Medicine made several recommendations, including advising against tests including herpes serology and ureaplasma in asymptomatic patients, and the use of serological tests to screen for chlamydia, because of frequent inaccuracy and the possibility of false-positive results.

In addition, it flagged concerns about the treatment of thrush.

Chapter President Dr Graham Neilsen said it was concerning that many women with recurrent and persistent yeast infections self-administered treatment, or were prescribed topical and oral anti-fungal treatments.

Dr Neilsen said it was important that patients had “good conversations” with clinicians about appropriate care.

“It is important to rule out other causes…such as genital herpes or bacterial vaginosis, so that other infection are not left untreated,” he said. “As well as the importance of ruling out other causes before commencing anti-fungal agents, inappropriate use of antifungal drugs can lead to increased fungal resistance.”

The 20 recommendations are the latest instalment in an ongoing program, coordinated by Choosing Wisely, in which 23 medical colleges and societies are working to improve the use of tests and treatments based on the latest evidence.

The process is separate from the Federal Government’s MBS Review, which is examining all 5000 items on the Medicare Benefits Schedule.

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AMA at the table on health insurance reforms

The Federal Government continues with its reforms to health care, shifting focus to the private health sector.

Health Minister Sussan Ley has recently established a Private Health Ministerial Advisory Committee (PHMAC) to develop recommendations across a range of policy areas relevant to private health.

The PHMAC follows on the work earlier in the year of an industry working group on reforms to the Prostheses List. The Prostheses List sets out the reimbursement amounts for thousands of prostheses used in the private health system.

The Minister has announced reductions in the benefit amounts for some prostheses to support a reduction in cost to private health insurers and a consequential reduction in private health insurance premiums for consumers.

The benefits for a small number of prostheses will be reduced from February 2017, including a:

10 per cent reduction across the cardiac devices category;
10 per cent reduction to the ophthalmic (intraocular lenses) category;
7.5 per cent reduction across the hip product category; and
7.5 per cent reduction across the knee product category.

In total, these reductions are expected to deliver savings of $86 million to health funds in the first year, and $394 million over five years. The Minister has also announced moves towards a more transparent pricing model with open disclosure.

The work of the PHMAC is now underway as the second part of the reforms.

The Committee’s terms of reference include a closer examination of private health insurance (PHI) product design with simplified consumer products; standard product categories; the role of exclusions and restrictions; appropriate excess levels; and the scope of services covered by PHI.

The Committee will also look at consumer information; premium setting; second tier default benefits; risk equalization; single billing; lifetime health cover; and providing better value for rural and remote consumers.

The first meeting of the PHMAC considered some early thinking from the private health insurers on product design and a potential ‘Gold/Silver/Bronze’ product classification model.

These are all important areas for review.

The AMA has a strong interest in the work of the Committee and its outcomes.

The AMA has a commitment to a viable private health sector and sees the work of the Committee as key to strengthening the sector and maintaining its relevance and attractiveness to patients into the future.

I am representing the AMA on the PHMAC, using a reference group of senior clinicians to provide advice in the lead in to each meeting.

The AMA will make available on its website the outcomes from each meeting (which are circulated for publication).

I welcome comment and input from members. The work of PHMAC will inform the shape of private health care funding for years to come. It is important that the AMA voice is heard.