more_vertWorldwide, a disproportionate burden of HIV, tuberculosis, and hepatitis is present among current and former prisoners. This problem results from laws, policies, and policing practices that unjustly and discriminatorily detain individuals and fail to ensure continuity of prevention, care, and treatment upon detention, throughout imprisonment, and upon release. These government actions, and the failure to ensure humane prison conditions, constitute violations of human rights to be free of discrimination and cruel and inhuman treatment, to due process of law, and to health.
Preference: Government and politics
TGA presentation: Complementary Medicines Australia Annual Conference, 15 September 2016
This presentation provides an overview of the Government’s response to the Expert Panel Review of Medicines and Medical Devices, with an emphasis on complementary medicines changes
[Comment] Replenishment of the Global Fund: global solidarity needed
On Sept 16–17, 2016, in Montréal, Canada hosts the Fifth Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund is a partnership of governments, civil society, the private sector, and people affected by the diseases that works to accelerate the end of these epidemics. It raises and invests funds to support programmes run by local experts in countries and communities most in need. The Global Fund works to maximise efforts against these diseases, mobilise increased resources, build sustainable and resilient health systems, and promote and protect human rights and gender equality.
Rebate freeze threatening quality GP care
The nation’s GP leaders have warned the Federal Government’s Medicare rebate freeze is undermining the quality of care and will have “serious repercussions” for patients.
The nation’s peak general practice representative group United General Practice Australia (UGPA), which includes the AMA, the Royal Australian College of General Practitioners, the Rural Doctors’ Association of Australia and several other doctor organisations, has told the Government that financial pressure caused by the Medicare rebate freeze was threatening the kind of services general practices could provide.
“Modern general practice relies on sophisticated infrastructure to support quality care. The Government’s policies are eroding this infrastructure,” UGPA said in a statement. “It is challenging for practices to even maintain the status quo as the impact of the Medicare freeze compounds year on year.”
The peak group said GPs were being caught in a financial squeeze between increasing patient demands and rising running costs on one side, and stagnant income from Medicare on the other.
“Like all small businesses, general practices must cover many costs, including for staff, equipment, technology, building, insurance, and medical indemnity,”. “Many general practices are reviewing their practice costs and business operations in order to remain viable. The ongoing freeze is eroding the ability of practices to continue to meet demand and maintain the highest possible levels of primary care.”
The warning follows the release of data showing that patient out-of-pocket costs have surged as struggling practices have moved to offset the relative loss of income caused by the rebate freeze.
Medicare figures show that GP patient fees jumped 6.5 per cent last financial year, the biggest rise in four years, to reach an average $34.25, underlining AMA warnings that Government policies were pushing many general practices to the financial breaking point, with serious consequences for patients and access to quality care.
“GPs are caught in a diabolical squeeze,” AMA President Dr Michael Gannon said recently. “They are caring for increasingly sick patients while the Government tightens the financial screws in the name of budget repair. GPs are now at breaking point. Many patients who are currently bulk billed will face out-of-pocket costs well over $20.”
Health Minister Sussan Ley has claimed the record high bulk billing rate of 85.1 per cent showed that patients continued to get ready access to care.
But UGPA said this ignored the enormous pressure being placed on GPs and the increased costs imposed on patients.
“With an ageing population and a dramatic increase in the number of patients with complex and chronic conditions, the demand on quality health care from GPs is growing significantly and quickly,” the peak general practice coalition said. “The Medicare rebate freeze is squeezing general practice. It will have serious repercussions for our patients, especially the most vulnerable, and the health of the economy.
The group has added its voice to AMA calls for the Government to immediately scrap the rebate freeze.
Adrian Rollins
Many living a long but not-so-healthy life
Australia’s latest check-up shows that although we are living longer than ever before poor diets, excessive drinking and inadequate exercise are undermining our health and almost half have a chronic illness.
In a comprehensive snapshot of the nation’s health, the Australian Institute of Health and Welfare reported that a baby boy born between 2012 and 2014 will, on average, live for 80.3 years and a baby girl born at the same time will live even longer, to an average 84.4 years.
However, more than 11 million Australians had at least one of eight chronic conditions, including about 1.2 million identified with diabetes – 85 per cent of whom had the largely preventable type 2 version of the condition.
In addition, 13 in every 100 smoke daily, 18 drink alcohol at risky levels and 95 do not eat the recommended servings of fruit and vegetables. Despite 55 out of 100 completing daily recommended physical activity levels, 63 per cent of Australians are overweight or obese.
The long-term decline in smoking rates has continued. The proportion of people aged 14 years and older who report never smoking rose from 58 per cent in 2010 to 60 per cent in 2013.
What kills us is changing. Cancer has overtaken heart disease for the first time as Australia’s biggest overall killer. It is predicted that 46,900 Australians will succumb to cancer this year – slightly more than 128 people a day. Nonetheless, survival rates for cancer are increasing.
More than 45 per cent of Australians aged 16 to 85 will experience a common mental disorder such as depression or anxiety, and one in seven will have suicidal thoughts in their lifetime.
Indigenous Australians continue to have a lower life expectancy and higher rates of many diseases, including diabetes, end-stage kidney disease and coronary heart disease.
AMA Vice President Dr Tony Bartone told ABC Radio National’s PM program that it was good news that Australians were living longer and that cancer survival rates were increasing, but lamented that around half of Australians had a chronic disease that was mainly caused by lifestyle choices.
“We still need to ensure the lifestyle prescription is the cornerstone of good preventative health care,” Dr Bartone said.
“Good preventative care is worth exceedingly more than the cost of the consultation, in terms of improved outcomes.
“Thirty-one per cent of the burden could have been prevented by reducing risk factors such as smoking or excess weight, and that’s a significant amount of suffering, morbidity, and of course health care.”
In 2013-14, $2.2 billion or 1.4 per cent of total health expenditure went to public health activities, which included prevention and health promotion. This proportion has fallen from 2.2 per cent in 2007-08.
AMA President Dr Michael Gannon recently urged the Government to invest in preventive health measures to improve the health and wellbeing of all Australians.
“The lack of investment, coupled with the freeze on Medicare patient rebates and cuts to bulk billing incentives for pathology tests and x-rays, is affecting GPs’ ability to provide primary health care,” Dr Gannon said
“Preventive health is not only an investment in the health of our nation, it is an investment in Australia’s economic productivity.
“When risk factors for chronic diseases and conditions are detected early and addressed, it reduces the need for more expensive hospital admissions.
“Australia spends significantly less on prevention and public health than comparable countries including New Zealand, Finland, and Canada.
“With the exception of tobacco control, there has been little or no progress against the national targets for preventing and controlling risk factors for chronic disease.”
The AMA calls on the Government to commit to:
- fund prevention and early intervention as a sound and fiscally responsible investment in Australia’s health system;
- increase investment to properly resource evidence-based approaches to preventive health; and
- deliver sustainable funding for non-government organisations (NGOs) that advocate, educate and provide services to those affected by chronic diseases and health problems, including alcohol and substance abuse, domestic violence, blood-borne viruses, aged care, mental health and public health awareness.
The AIHW report is available at http://www.aihw.gov.au/publication-detail/?id=60129555544
Kirsty Waterford
Suicide prevention trial for Kimberley region
The Government has announced a landmark suicide prevention trial site in the remote Kimberley region of Western Australia, where suicide rates are more than six times the national average.
It will be one of 12 trial sites around the nation and is part of a $192 million suicide prevention package promised before the July Federal election.
Minister for Health, Sussan Ley, said the trial would help develop a model of suicide prevention which could be tailored to the unique and often culturally sensitive requirements of communities.
“We must, as a nation, address the tragic over-representation of suicide rates in remote and indigenous communities such as the Kimberley,” Ms Ley said.
The Country WA Primary Health Network will commission the trial, which has been welcomed by Black Rainbow, the newly-formed peak body tackling suicide in the Indigenous lesbian, gay, bisexual, queer, transgender and intersex (LGBQTI) community.
Black Rainbow CEO Dameyon Bonson, who is based in Broome, said that for far too long the Kimberley had weathered the high rates of Indigenous suicide.
“What we know nationally is that Indigenous Australians are 2.5 times more likely to die by suicide, and LGBQTI Australians are up to 14 times more likely to do so,” Mr Bonson said.
“These figures place Indigenous LGBQTI people at an astronomically heightened risk of suicide and self harm – we are talking up to 35 times more likely.
“It is hoped that all of the 12 selected sites are responsive to the needs of Indigenous LGBQTI people.”
Maria Hawthorne
Recruit local to relieve rural doctor shortage
The AMA has intensified its calls for the Federal Government to boost its investment in rural GP education amid mounting evidence that doctors who grow up and train in the bush are far more likely to practice there.
A study published in the latest edition of the Medical Journal of Australia found there is up to a 90 per cent chance that doctors who have a rural background and train in a rural area will still be practising in the bush five years later.
The result lends weight to AMA proposals for increased training opportunities for aspiring GPs and other specialists interested in practising in the country.
AMA President Dr Michael Gannon said the findings showed that the right investments by Government could make a real difference to access to care for rural communities.
“This study provides some important lessons for policy makers looking at how we can ensure that Australians living in rural areas have access to medical care,” Dr Gannon said.
While there has been an explosion in the number of medical school graduates in the past decade, relatively few are opting to train and practice in the bush, which remains chronically under-served.
Governments continue to recruit doctors from overseas to help fill the gap – the Herald Sun has revealed they sponsored 2268 health professionals to enter the country on 457 visas last year, including 1692 GPs and registered medical officers, 228 registered nurses, 35 specialists, 38 psychiatrists,28 surgeons and 19 anaesthetists.
Dr Gannon said proposals to build more medical schools were misguided.
“The problem isn’t a shortage of medical graduates. With medical school intakes now at record levels, we don’t need more medical students or any new medical schools.
“What we need are more and better opportunities for doctors, particularly those who come from the bush, to live and train in rural areas. The evidence shows that they are the most likely to stay on and serve their rural community once that qualify.”
The MJA study, Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce, found “a strong association between rural training pathways and subsequent rural practice”.
“[The] findings suggest that the periods leading up to and immediately following the vocational training are critically important windows of opportunity for ensuring that appropriate policies optimise recruitment of GPs for rural practice and their subsequent retention,” the study’s authors said.
Dr Gannon said these conclusions backed a number of policy proposals developed by the AMA to boost access to care in rural areas, including:
• for the targeted intake of medical students from rural areas to be increased from a quarter to a third of all new enrolments;
• the establishment of a Community Residency Program to give prevocational doctors, particularly those in rural areas, with access to three-month general practice placements;
• an increase in the GP training program intake to 1700 places by 2018;
• an expansion of the Specialist Training Program to 1400 places by 2018, with priority given to rural settings, under-supplied specialties and generalist roles; and
• access to regional training networks to support doctors to train and remain in rural areas.
“The Federal Government has a wonderful opportunity to make a real and lasting difference by adopting these sensible, effective, evidence-based measures,” Dr Gannon said.
The Government has promised to appoint a Rural Health Commissioner to champion rural health issues, including developing a National Rural Generalist Pathway to help address the shortage of rural medical practitioners.
Adrian Rollins
AMA in the News
Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.
Print/Online
Lift freeze on Medicare rebate, AMA tells Libs, The Australian, 18 August 2016
Australian Medical Association President Dr Michael Gannon has called on Malcolm Turnbull and Health Minister Sussan Ley to “stare down” their cabinet colleagues and restore funding to the sector.
Health funds put profits first, Australian Financial Review, 18 August 2016
Dr Gannon wants the Federal Government and regulators to check private health insurers’ increasingly aggressive behaviour that he says puts profits above patients.
Show us the money, Adelaide Advertiser, 18 August 2016
Doctors will boycott the Federal Government’s Health Care Homes program unless it is better funded, the Australian Medical Association warns. Dr Gannon, in his first address to the National Press Club, listed primary prevention as one of the key priorities of the doctors’ group.
Health insurance fee crisis put down to prostheses costs, The Australian, 22 August 2016
Dr Gannon talked about claims by health insurers that the price of pacemakers and replacement hips and knees is the cause of Australia’s rising health insurance premiums. Dr Gannon said that he did not believe that Australia’s healthcare costs were out of control.
Australia produces more specialists, not enough GPs, The Age, 25 August 2016
The Australian Institute of Health and Welfare reported that while the number of registered medical practitioners overall has increased by 3.4 per cent a year, the ratio of general practitioners has remained steady. AMA Vice President Dr Tony Bartone, said the increase in specialists was needed, but the number of GPs remained too low, especially in rural and remote areas.
Doc drug spruiking revealed, Adelaide Advertiser, 1 September 2016
Drug companies have revealed they are paying Australian doctors up to $19,000 for overseas trips, and more than $18,000 in speaking and consultancy fees to spruik and critique their medicines. Dr Gannon said some of the payments helped doctors attend medical conferences to keep up to date with developments in their field.
Radio
Dr Michael Gannon, ABC 666 Canberra, 17 August 2016
Dr Gannon speaks about his upcoming National Press Club Address. He says health is not the problem in the Federal Budget and there will be inevitable increases in health spending due to the aging population.
Dr Michael Gannon, 2CC Breakfast, 17 August 2016
Dr Gannon talks about his upcoming address to the National press Club. He says the AMA is a voice independent from Government.
Dr Michael Gannon, ABC North West, 22 August 2016
Dr Gannon talks about a body representing private health insurance called “For Government Reforms” which they say will make private health insurance cheaper.
Dr Michael Gannon, 702 ABC Perth, 24 August 2016
Dr Gannon talks about a GP who has admitted assisting in hastening the death of a patient. Dr Gannon says that doctors have to act within the limits of the law and ethical code.
Dr Michael Gannon, 6PR Perth, 6 September 2016
Dr Gannon says the Federal Government is looking to drop the requirement for a doctor to issue medical certificates for sickness, dismissing Medicare costs and reducing the cost of the country’s medical services. Dr Gannon says doctors would miss out on health promotion opportunities.
Dr Michael Gannon, ABC 666 Canberra, 6 September 2016
Dr Gannon accused the Federal Government of unfairly blaming GPs for ballooning health costs after an interim report for the MBS Review was released.
Dr Michael Gannon, 2UE, 12 September 2016
Dr Gannon talks about a review into the Medicare Benefits Schedule. Dr Gannon said primary care lacks funding, which creates problems.
Dr Michael Gannon, Radio National, 13 September 2016
Dr Gannon talks about the warning signs of stillbirths, saying decreased foetal movement is not normal. Dr Gannon says decreased foetal movement is a sign that the baby is at risk due to placental deficiency and pregnant women who think that their babies are being quiet should take the time to rest and assess the foetal movement.
Dr Tony Bartone, Radio National, 13 September 2016
AMA Vice President Dr Tony Bartone commented about the latest report on Australian health which found alarming rates of chronic disease caused by lifestyle choices. Dr Tony Bartone said good preventive care is worth much more than the cost of consultation as many cases of chronic disease could have been avoided by preventive measures such as quitting smoking or reducing alcohol consumption.
Television
Dr Michael Gannon, ABC News 24, 17 August 2016
Address to the National Press Club by AMA President Dr Michael Gannon.
Dr Michael Gannon, Sky News, 2 September 2016
Dr Gannon discusses ethical implications from a court ruling that a child with brain cancer does not have to undergo treatment. Dr Gannon also discusses same sex marriage and foetal alcohol syndrome.
Dr Michael Gannon, Channel 7 Perth, 3 September 2016
Dr Gannon comments on swabs taken on hand rails, doors and ticket machines that revealed the presence of a range of germs responsible for many common respiratory and stomach infections.
Dr Michael Gannon, ABC News 24, 5 September 2016
Dr Gannon comments on the interim report of the Medical Benefits Schedule Review, which found patients visiting doctors for sick certificates, repeat scripts and routine test results cause costs to surge. He said patients who present for repeat prescriptions provided doctors with a health promotion opportunity. He says bashing GP as inefficient or expensive is not right.
Dr Michael Gannon, Channel 9 The Today Show, 10 September 2016
Dr Gannon talks about the MBS Review interim report, saying the current situation, with doctors prescribing medicines and pharmacists dispensing them, is working well and avoids ethical conundrums.
AMA in Action
Picture: AMA President Dr Michael Gannon with Sir Michael Marmot, President of the World Medical Association
AMA President Dr Michael Gannon has been clocking plenty of air miles this month travelling around the country and internationally representing the AMA in meetings with politicians, regulators, Federal Government officials, advisers and other health advocates – even squeezing in some karaoke at the Confederation of Medical Associations in Asia and Oceanic in Thailand.
Dr Gannon met with the Medical Board of Australia and the Australian Health Practitioner Regulation Authority as part of a quarterly meeting. He flew to Sydney and spoke with Ramsay Health Care CEO Danny Sims and, while in town, caught up with Professor Bruce Robinson to discuss the MBS Review Interim Report.
In Melbourne, Dr Gannon caught up with Greens Leader Senator Richard Di Natale, before flying to Canberra to meet with Independent Hospital Pricing Authority CEO James Downie, CEO of Palliative Care Australia Liz Callaghan, and Chief Medical Officer and the inaugural Surgeon General of the Australian Border Force Dr John Brayley.
Dr Gannon finished the month spending a few days in Thailand with other Asia and Oceanic Medical Associations to talk about issues and directions in global health policy.
Kirsty Waterford
Billions start flowing for medical research
Almost $1.3 billion of funds stripped from the Health portfolio have been funnelled to the Medical Research Future Fund as the Federal Government makes good on its controversial plan to divert billions of dollars from other areas of health to support research.
Late last month the Government, with little fanfare, transferred $1.277 billion to the MRFF’s Special Account, the first instalment of what is expected to be $20 billion injected into the Fund in coming years.
Prime Minister Malcolm Turnbull is persisting with the Medicare rebate freeze, reduced public hospital funding and cuts to bulk billing incentives in pathology and diagnostic imaging, with a share of the savings being directed to the MRFF.
The plan, unveiled in the 2014 Budget, was heavily criticised at the time by the AMA, which argued that although increased investment in medical research was welcome, it should not come at the expense of medical services and other areas of health.
But the $1.2 billion transfer is the clearest demonstration yet that the Government has no intention to abandon or scale back its plan, which has the backing of parts of the medical research community.
The Research Australia alliance, which claims to have 160 members and supporters, welcomed the initial investment as a “significant step to secure Australia’s health and medical research future”.
Research Australia Chief Executive Officer Nadia Levin said the transfer of the money to the MRFF Special Account was “words in action”.
“This is Prime Minister Turnbull and Health Minister Ley doing exactly what they said they would do – build our health system and build an innovation nation,” Ms Levin said. “This is not just words. It’s action and it’s money, and it is going to make an enormous difference to the health of Australians and the health of the economy.”
Following months of consultation, the MRFF is developing a document setting out the strategy and principles which will guide its investment in research projects.
Initially, the Fund intends to direct $61 million toward health and medical research project this financial year.
Under the Government’s plan, the Fund will expand rapidly in the next few years to reach $20 billion in the early 2020s, enabling it to invest around $1 billion a year in research.
Adrian Rollins