Counter-terror powers could extend to mental health records

The Federal Government is considering whether to allow security authorities access to mental health records as part of efforts to prevent so-called ‘lone wolf’ terror attacks.

In what he admitted would be a “huge step”, Prime Minister Malcolm Turnbull has asked Counter-Terrorism Coordinator Greg Moriarty to examine the possibility of police and intelligence service access to the mental health records of terrorist suspects as part of a review of the nation’s defences.

“It is important this be looked at carefully. Let me come to another point, you’ve got a number of important interests to balance here. Mental health alone, leaving aside issues of terrorism, is a gigantic challenge,” Mr Turnbull said. “But my most important obligation, my most important responsibility to Australia, is to keep the people of Australia safe, and so that is why we are constantly improving, upgrading our legislation – that is why we provide additional resources to our police and security services.”

The Prime Minister said a change in approach was necessary because of a recent spate of attacks, including in Orlando, Nice and Germany, suggested the terrorist threat was evolving to include individuals not previously considered to be a threat but who were socially, emotionally or mentally unstable and were susceptible to rapid radicalisation.

“What we are seeing at the moment is people being radicalised or adopting Islamist, murderous Islamist ideology very, very quickly. So that you have people that are not on the counter terrorism radar screen who then often, as a result of mental illness, will then attach themselves to this murderous ideology and then act very quickly,” Mr Turnbull said on radio 3AW. “They appear to be drawn to Islamist extremism very late and very fast, not necessarily because of a long-term religious or ideological belief, but as a means of filling a void and providing meaning or rationalisation. The Lindt Café attacker, who converted from Shia to Sunni in the days leading into the siege, might also fit this profile.”

But he admitted giving the security services access to mental health records would involve overriding “very significant privacy protections”.

There are also doubts about whether the breach of doctor-patient confidentiality involved would necessarily achieve much in detecting or heading off potential terror attacks.

Even if those contemplating undertaking a ‘lone wolf’ terror attack have a mental illness, they may not necessarily have sought treatment. Furthermore, they might be deterred from seeking care if they thought their health records could be accessed by the police or intelligence services, exacerbating their illness and potentially making them more of a threat to themselves and others.

Mr Turnbull admitted that there would need to be a balance struck between patient confidentiality and the possibility of being alerted to a terror attack.

Adrian Rollins

Doctors must have health say

Caption: AMA President Dr Michael Gannon meets with Helath Minister Sussan Ley at Parliament House, 21 July 2016

Doctors must have a central and active role in Government decisions on health funding and the allocation of resources within the health system, AMA President Dr Michael Gannon has said.

Just days after Prime Minister Malcolm Turnbull highlighted the need for a “better working relationship with the AMA and its GP membership”, the AMA has sharpened its pitch for a greater say in the financing of health care and the deployment of resources.

Dr Gannon said recent policy failures and poor decisions such as the Abbott Government’s hamfisted GP co-payments, the extended Medicare rebate indexation freeze and cuts to public hospital funding showed the need for much greater involvement of doctors in the formulation of policy.

“When major health decisions are taken without clinical involvement, the results are often sub-optimal and unsustainable,” Dr Gannon said. “Doctors bring a practical and informed perspective from the real world of their clinical practice to health financing and funding decisions [and] must have an active role in the operation of healthcare financing and funding processes, and be involved in decisions on the allocation of resources at the health system level.”

As the Federal Government digests the lessons of its narrow victory in an election where health was a leading issue, there are signs it will seek out the counsel of the AMA more attentively and frequently.

Mr Turnbull and reappointed Health Minster Sussan Ley have both met with Dr Gannon since the election, and at the announcement of his new Ministry on 18 July the Prime Minster said he was “confident we will have a better working relationship with the AMA and its general practitioner membership”.

Dr Gannon said doctors, individually and as a profession, had a direct interest in the overall resourcing, performance and sustainability of health care, and their role as stewards of healthcare financing and funding must be explicitly recognised by governments.

The specific role to be played by doctors and the medical profession in the stewardship of health care resources was detailed in two Position Statements released on 21 July.

The first, AMA Position Statement on the Doctor’s Role in Stewardship of Health Care Resources 2016, set out the obligation on individual practitioners to eliminate wasteful practices, minimise diagnostic errors and ensure patients receive the most appropriate treatment.

“Individual doctors affect health care expenditure through their clinical recommendations and decisions regarding patient treatment,” Dr Gannon said.

“Doctors can reduce wasteful expenditure by applying responsible stewardship to their everyday practices through, for example, appropriate clinical decision-making, minimising diagnostic error, and eliminating tests, treatments or procedures that are unnecessary, inappropriate, or unwanted by the patient.”
The AMA President said this should not be confused with rationing, which limits the amount of care a patient receives because of financial constraints.

“Doctors must retain their clinical independence and professional autonomy so they can make health care decisions based on the best interests of the patient, and not the interests of third parties such as insurers, governments or employers,” he said.

The second Position Statement, The Role of Doctors in Stewardship of Healthcare Financing and Funding Arrangements 2016, details how the stewardship obligation on individual doctors extends to encompass of the medical profession as a whole.

“The primary ethical duty of the doctor is to care for, and protect the healthcare interests of, the individual patient,” the Position Statement said, adding that there was a secondary ethical duty on doctors “to protect the interests of other patients and the wider community”.

“This secondary duty involves ensuring healthcare financing, funding and expenditure are managed to ensure resources are available for health needs currently and into the future,” the Statement said. “Doctors must have an active role in the operation of healthcare financing and funding processes and be involved in decisions on the allocation of resources at the health system level.”

To achieve this, doctors and their representatives “should seek opportunities to formally engage in healthcare financing and funding processes”.

Together, the Position Statements make the case for doctors and the AMA to be at the centre of decisions affecting health financing and the allocation of resources, for the sake of patients – something that so far the Government seems to be open to.

The AMA Position Statement on the Role of Doctors in Stewardship of Healthcare Financing and Funding Arrangements 2016 is available at position-statement/role-doctors-stewardship-health-fi…

This Position Statement complements the AMA Position Statement on the Doctor’s Role in Stewardship of Health Care Resources 2016, which is available at position-statement/doctors-role-stewardship-health-ca…

Adrian Rollins

Gannon ‘gobsmacked’ if Govt persists with Medicare rebate freeze

Caption: AMA President Dr Michael Gannon speaks to the media following his first post-election meeting with Health Minster Sussan Ley

AMA President Dr Michael Gannon has declared he would be “gobsmacked” if the Federal Government took the Medicare rebate freeze to the next election, and has called for a “firm timeline” for its end.

Speaking following his first meeting with Health Minister Sussan Ley since the knife-edge Federal election, Dr Gannon said unwinding the freeze would be a good start to Government efforts to rebuild trust with the public on health policy.

“I would be gobsmacked if the Government took an ongoing freeze to the next election,” the AMA President said. “They got the scare of their life on health, and that was probably the policy which hurt them the most.”

While Federal Cabinet is yet to meet and Ms Ley did not make any commitments, Dr Gannon said the meeting, which he hoped become a regular occurrence, established common ground, including an acknowledgement that health was not the area of the Budget in need of “repair”.

“It is true that the Government should try and find ways of balancing its books, but it’s not true to say that health spending is out of control,” Dr Gannon said. “Our discussions did focus on the fact that health is not the problem with the Budget…health should not be the focus of Budget repair in this Turnbull Government.”

The AMA campaigned hard during the election on the Medicare rebate freeze amid warnings it would force many GPs to stop bulk billing, increasing the risk that the sickest and poorest would defer seeing their family doctor until they needed much more expensive hospital care.

Both Labor and the Greens promised to reinstate rebate indexation from 1 January next year, and before the 2 July poll the AMA called on the Coalition to match the commitment.

At her meeting with Dr Gannon, Ms Ley was non-committal on the issue, and the AMA President said it would be the subject of further discussions.

But he said the end of the freeze should be a priority for the Government.

“Unravelling the freeze would be a great start, a good sign of good faith from the new Government…and the sooner the better. I will be looking for serious undertakings and a firm timeline from the Government,” he said.

After springing surprise savage cuts in the health sector in its 2014 Budget, the Coalition has struggled to gain traction in the policy area ever since, and Prime Minister Malcolm Turnbull has admitted those policies, which included two failed attempts to introduce a GP co-payment and massive cuts to public hospital spending, had laid “fertile ground” for a Labor scare campaign over the future of Medicare.

Since the election, the Government has sought to reclaim some of the ground it lost by engaging more closely with the health sector, particularly the AMA.

Mr Turnbull has already met with Dr Gannon and, in his speech unveiling his new Ministry on 18 July, made special mention of his hopes for a closer working relationship with the AMA.

Dr Gannon said it was gratifying that Ms Ley had made meeting with the AMA “her first order of business” since being reaffirmed in the Health portfolio.

“The Government has shown a willingness to listen to the AMA and a willingness to engage more closely on health policy,” the AMA President said. “[From] very early preliminary discussions with the Minister today, [there] was a willingness to listen…and when governments talk to doctors, when doctors talk to government, we’ve got a really good chance of coming up with the best health policy.”

“I don’t think it’s smart to get doctors offside, and I think it’s smart to listen to all stakeholders in the health industry. I think that the Government will make good policy if they talk to doctors, if they talk to nurses, if they talk to other people at the coal-face, dealing with patients everyday, whether that’s in the community, or in hospitals. Good health policy is listening to those people who deal with patients every day.”

Mr Gannon met with Ms Ley soon after the AMA released Position Statements detailing the important role played by doctors as stewards of the health system, helping minimise waste and making best use of the available resources.

For more detail, visit: ausmed/doctors-must-have-health-say

Adrian Rollins

Co-payment is ‘poison’

AMA President Dr Michael Gannon has declared that the idea of a patient co-payment is dead, with no desire on the part of the Government or the AMA to see it resurrected.

Speaking following a meeting with Health Minister Sussan Ley, Dr Gannon told ABC News 24 that he thought there was no chance the Coalition Government would try to introduce some form of GP co-payment after two earlier versions were shot down amid a fierce backlash from the AMA and patients.

“I think that the co-payment word is poison to Government, and it’s poison to the AMA,” Dr Gannon said. “We opposed both versions of the co-payment back in 2014…[and] I don’t think that there’s any desire from either the Government or the AMA or anyone else in the health sphere to see the co-payments introduced.”

The AMA President said the evidence showed that even nominal out-of-pocket expenses would deter some patients from seeing their doctor, causing health problems to deteriorate and need more expensive hospital care later on.

The Abbott Government initially proposed a $7 co-payment for all doctor visits, which was watered down to $5 cut to Medicare rebates that doctors could pass on to patients. But both ideas were withdrawn following a massive public backlash and staunch opposition in the Senate.

Instead, the Government has extended a freeze on Medicare rebate indexation to 2020, which has been described as a co-payment by stealth because it will force an increasing number of GPs to abandon bulk billing.

Dr Gannon is pushing the Government to unfreeze Medicare rebates, and expects the policy to be gone by the next Federal election.

He said the tight result of the election just fought sent a clear message to the Coalition about how much the people valued access to health care.

“I think that the Australian people want their affordable access to see their GP, access to public hospitals. They’ve spoken. They’ve said that they are absolutely key things that they expect from their Government. They regard them as absolutely core services and I think the post polling, the exit polling, the private polling has told the Government that,” he said.

Instead of a co-payment, Dr Gannon said the AMA supported GPs privately billing those patients who could afford to pay, while ensuring there were robust safeguards in place to give the neediest and most vulnerable ready access to care.

“The reason the co-payment models of 2014 were so wrong is that they didn’t give individual doctors the ability to make those judgements. They also didn’t give the system the ability to protect the neediest in the community and we know that even small $5, $6, $7 out of pocket expenses are enough to stop some people from going to see the doctor,” he said.

Adrian Rollins

What to tell your patients who are travelling to Brazil

With the Olympic Games in Brazil starting in less than a month, Australia’s retiring Chief Medical Officer, Professor Chris Baggoley has released some important health messages for spectators travelling to the Games.

Brazil is experiencing a Zika virus outbreak and there is also the presence of other mosquito-borne diseases including yellow fever, dengue and chikungunya.

The vaccine for yellow fever should be given at least 10 days before travellers arrive in Brazil. Travellers should be aware that many countries, including Australia, need proof of yellow fever vaccination before they allow entry so they should ensure they have their yellow fever certificate when they travel.

GPs are being urged to ensure patients are made aware of the risks involved in visiting Brazil, particularly women who are pregnant or seeking to become pregnancy as Zika virus can cause severe birth defects, including microcephaly.

Women who are pregnant or seeking to become pregnant should defer travel to Zika affected areas including Brazil.

Related: Protection of Olympian proportions

For those who aren’t pregnant or seeking pregnancy, they should take these precautions to avoid mosquito bites:

Use insect repellent containing DEET or picaridin.
Wear light-coloured clothing that covers as much skin as possible.
Ensure there are fly screens or air conditioning at accommodation.
If the accommodation doesn’t have those options, sleep under a mosquito net.

Regarding the sexual transmission of Zika virus, travellers should be advised:

Men who travel to Brazil and who have a pregnant partner should abstain from sex or use condoms for the duration of the pregnancy.
For couples planning pregnancy and travelling to the Games, it’s recommended women wait at least 8 weeks for attempting pregnancy. If the woman’s partner travelled with her and contracts Zika, they might have to wait 6 months before trying for pregnancy.
Men travelling to a Zika affected area should avoid unprotected sex for 8 weeks after returning.

GPs are encouraged to display this poster in their practice and give this brochure to patients travelling to the Games. This information is designed to inform travellers on how they can reduce the risks of contracting Zika virus, get travellers thinking about yellow fever vaccination, and instruct travellers on how they can protect themselves from mosquito-borne illness.

To obtain hard copies of either the brochure or the poster, please email humanquarantine@health.gov.au with your details and quantity needed and they will be mailed out. More information is available on the Department’s website at health.gov.au/rio2016 or email humanquarantine@health.gov.au.

Latest news:

Photo: lazyllama / Shutterstock.com

Health policy in play as Coalition licks wounds

AMA President Dr Michael Gannon has intensified his calls on the Government to dump its Medicare rebate freeze policy and reverse other health cuts amid mounting pressure within the Coalition for changes to health policy following the narrow Federal election result.

Seizing on admissions from Prime Minister Malcolm Turnbull that health policy concerns swayed many voters away from his party, Dr Gannon has called on the Coalition to change course and treat health as an investment, rather than a cost.

“The Prime Minister, the Coalition, have had the scare of their life,” Dr Gannon said. “It’s very clear that Australians value their health, and many of them voted on the grounds that they were worried about their health care.”

Last week the Coalition secured the 76 seats needed to form Government in its own right after suffering a national swing of 3.4 per cent against it. The narrow victory (the ABC predicts Labor will hold 68 seats, the Greens and Xenophon Team one each, and three independents) prompted a wave of finger-pointing and recriminations within conservative party ranks, including calls to revisit health cuts made in the 2014 and 2016 budgets.

Rancour over the close election result extended to include speculation that Health Minister Sussan Ley would be dumped amid complaints she had not done enough to counter Labor’s attack lines on the Government over Medicare. Her supporters, though, revealed that she had been muzzled from speaking out during the campaign by Liberal strategists, and Dr Gannon said that, from afar, it seemed “that the Coalition didn’t want to talk about health in the campaign, and that they had silenced Minister Ley”.

Dr Gannon said the big lesson for the Government from the election was that the public valued the health system highly, and in post-election talks with the Prime Minister he had reinforced the need to invest in general practice, increase public hospital funding and reverse cuts to bulk billing incentives for pathology and diagnostic imaging services.

The AMA President said Mr Turnbull understood the AMA’s concerns.

“I think that in an ideal world he would unravel the freeze tomorrow,” he told ABC radio. “What we have seen in the past, going back to the 2014 Budget, was a desire by the Coalition to introduce a co-payment to try and work out ways that those who can afford it can contribute more to the cost of their health care.

“Now, the reason that proposal failed so badly is because it didn’t give the opportunity for individual GPs to make a judgement, knowing their patients well, who can and can’t afford even a modest amount of money.”

Asked if he would re-visit the idea of a patient co-payment, Dr Gannon said he was not seeking “a re-energisation” of the co-payment debate, but instead wanted a serious discussion about the future funding of Medicare.

“My comments…are about being able to have conversations about why those two [co-payment] proposals from two years ago were not good policy, being able to have a conversation about how we fund Medicare, 15, 20 years in advance,” he said on radio station 2GB.

“We’re not far off the balance in Australia, it just needs some tinkering around the edges. And I’m really keen to, in this next Parliament, with a knife-edge result in the Lower House and a very interesting Senate…I’m just hopeful we can have these conversations that make sure that Medicare is there to protect people in 20 years’ time, and have more than that two- or three-year view of it.”

The Government appears receptive to calls to re-visit its health policies.

As the Coalition took stock of the extremely tight Federal election result, Mr Turnbull said it was clear that Labor’s message that the Coalition posed a threat to Medicare had fallen on “some fertile ground”.

“What we have to recognise is that many Australians were troubled by it. They believed it, or at least had anxieties raised with it. It is very clear – it is very, very clear – that [Deputy Prime Minister] Barnaby [Joyce] and I and our colleagues have to work harder to rebuild or strengthen the trust of the Australian people in our side of politics when it comes to health. There is no question about that,” Mr Turnbull said.

“We have to recognise that there is a real issue for us if people voted Labor because they genuinely believed or they feared that we were not committed to Medicare, because that is not the case. So that is why Barnaby and I, as we reflect on this and our colleagues reflect on this, that is something that is an issue we have to address,” Mr Turnbull said.

Dr Gannon told ABC radio the election result had shown just how important health policy was for voters, and it was clear that the Medicare rebate freeze, combined with earlier polices such as the GP co-payment, meant Labor’s scare campaign on Medicare had resonated with voters.

“If we go back to the first co-payment model in 2014, which came out of the much-maligned Budget that year, if we look at Co-payment Mark II which came out later that year, it possibly showed that health policy was being run out of Treasury,” Dr Gannon said. “The Coalition has realised maybe too late…that people do worry about their health, they do vote on it, they do regard it as one of the major issues when they decide how to vote.”

Adrian Rollins

Health safety net ‘a must’

AMA President Dr Michael Gannon has declared that the poor, vulnerable and disadvantaged must continue to have ready access to care, whatever changes are made to Medicare and health funding.

While acknowledging that the Federal Government was facing funding constraints, Dr Gannon said the AMA would fight to protect universal access to quality primary health care and make sure health care remained affordable.

“When we talk about universal healthcare, what we mean is that everyone gets treatment, and we must have that,” Dr Gannon told radio 2GB. “We must have that safety net so that people of limited means are looked after, and people even of means, people who have money in the bank, when they face serious health problems, that they don’t go bankrupt having them dealt with.”

Though the Federal Government shows no signs of backing down from its controversial policy to extend the freeze of Medicare rebates to 2020, the AMA President warned that it needed to preserve those aspects of Australia’s health system that made it among the best in the world.

“We do have a health system that’s the envy of many other parts of the world,” he said. “We’re better than the American system, where tens of millions of people literally can’t access health care. And we’re better than systems in many countries in Europe which are basically bankrupt because they’ve promised for too long that you can have everything for free.”

Dr Gannon said the balance between public and private systems was a major strength of Australia’s health care.

“I can tell you that we’re miles in front, especially of the British health system. One of the things which works really well, it’s not perfect, but we’ve got a private system where people then spend more of their post-tax dollars in the health system. What that does is increases the total value of the health system,” he said. “It is very easy to point to failures of public hospitals, they’re not perfect; but…I think we do pretty well, and I think that both sides of politics are not far off the health system that’s the envy of the rest of the world.”

Adrian Rollins

Cancer success more than skin deep

Advances in the detection and treatment of melanoma have meant those diagnosed with the potentially deadly disease have far greater chances of survival than for most other forms of cancer.

While Australia has an unwelcome record for having the second-highest rates of melanoma in the world, the Australian Institute of Health and Welfare (AIHW) has reported that those with melanoma have a five-year survival rate that is 90 per cent of their counterparts in the general population – well in excess of the 67 per cent five-year survival rate for all types of cancers combined.

In further good news, the Institute has found that although skin cancer is a major cause of illness, its prevalence among younger people is declining. After peaking at 13 cases per 100,000 in 2002, the incidence of melanoma in people aged 39 years or younger has since declined to 9.4 cases per 100,000.

The result has been seen by some as a sign that young people are heeding sun-safe messages, and has spurred calls from public health advocates for greater Government investment in campaigns encouraging people to protect their skin.

The Cancer Council Australia said this was much more cost-effective than the huge expense of treating skin cancer once it develops.

The AIHW said Medicare benefits worth almost $137 million were spent on skin cancer services in 2014, and the Cancer Council has estimated that treating the disease costs the country more than $1 billion a year.

Those costs appear likely to escalate.

While the incidence of melanoma in young people is declining, it is rising strongly in the broader population.

Australia’s melanoma rate has doubled in the last 34 years from 27 to 49 cases per 100,000, according to the AIHW, and its incidence (35 new cases a year per 100,000) is now second only to New Zealand (36 per 100,000) in the world.

The Institute estimates that almost 13,300 people will be diagnosed with melanoma this year and 1770 will die, while further 560 will be killed by other forms of skin cancer, and almost 140,000 will be hospitalised.

Even though the prognosis for many is good, the distress for individuals and families, and the costs to the health system, are substantial.

The hospitalisation rate for patients with melanoma surged 63 per cent between 2002-03 and 2013-14, while the number of surgical procedures undertaken to treat melanoma jumped almost 54 per cent over the same period and the number of chemotherapy treatments more than doubled.

Though the hospitalisation rate for those diagnosed with other forms of skin cancer did not increase as sharply over this period (up 39 per cent between 2002-03 and 2013-14), surgical procedures increased 40 per cent and chemotherapy treatments were up 65 per cent.

In addition, effective but hugely expensive drugs are being used to treat melanoma. In the latest development, Melanoma Institute Australia is reporting promising results from the use of two immunotherapy medicines, Yervoy and Keytruda, in combination to treat advanced melanoma. The two drugs, which can cost up to $120,000, are available at a reduced price through the Pharmaceutical Benefits Scheme, but have so far been denied full listing.

The AIHW findings have fuelled a backlash against celebrity chef Pete Evans, who last week described sunscreens as “poisonous chemicals” that gave people the illusion of protection from the sun’s harmful rays.

Cancer Council Chief Executive Professor Sanchia Aranda said skin cancer was the most preventable form of cancer, and the AIHW data underlined the need for campaigns to encourage people to take steps to protect themselves from sun damage.

“Given the rapid growth in skin cancer treatment costs, and mounting pressures on the health system as our population ages, there is an urgent need to get skin cancer prevention back on the federal agenda,” Professor Aranda said. “We need a mass media campaign, this summer and the next.”

Adrian Rollins

Aged care sector calls for cuts to be deferred

The aged care sector has called for a taskforce to review the sector’s funding process, as new analysis shows the 2016-17 Budget would strip funding to older people in care by 11 per cent per resident each year.

The Turnbull Government announced $1.2 billion in cuts to aged care funding in the May Budget, largely through reductions in the complex care component of the Aged Care Funding Instrument.

The Government argued that providers were overclaiming by wrongly classifying residents as high complex care patients.

“There’s no hiding away from the fact that the residential aged care budget will blow out by a further $3.8 billion over the next four years without action to address inconsistencies in the way claims are made, with as many as one in five ruled to be too high,” Minister for Health Sussan Ley said in June.

Ms Ley’s comments were borne out by a Health Department response to a Freedom of Information request by the Australian Financial Review.

The Department rejected the request, saying that there were more than 26,000 pages detailing non-compliance in relation to claims for Government funding from aged care providers.

Making public such a significant volume of related information would be too time-consuming, the Department said.

“A preliminary search has identified that there are approximately 1100 emails, 430 documents and 800 page reports, comprising over 26,000 pages that may fall within the scope of the request,” it told the newspaper in July.

The Labor Opposition has also refused to reverse the cuts.

But a coalition of service providers said, while the sector understood the need to manage growth in health care spending, the cuts went too far.

UnitingCare Australia (UCA), Aged and Community Services Australia (ACSA), and Catholic Health Australia (CHA) commissioned Ansell Strategic to undertake a review of 501 aged care homes and almost 39,000 residents around the country.

The modelling indicated that the actual impact of the cuts would be more than $2.5 billion over the next four years alone, nearly $840 million more than the Government’s forward estimates.

“The 2016-17 Budget was particularly harsh as it targeted people with complex health care needs and those receiving treatment for severe pain and chronic diseases like heart disease, diabetes, and dementia,” UCA Chair Steve Teulan said.

“We wanted to fully assess the impact of the funding reductions so we commissioned modelling that looked at the potential impact on nearly 39,000 people in aged care homes.

“The results are stark. The cuts far exceed the amounts stated by Government and will reduce funding to support older people in care by $6,655 – or 11 per cent – per resident each year.”

Under these arrangements, the funding would not cover the costs of services currently provided to residents with complex needs, meaning many older people in care might miss out on vital treatments including physiotherapy, pain management, and skin care, Mr Teulan said.

“If these cuts are implemented as stated, by 2017 service providers will be forced to seriously consider both turning away sick old people who are seeking admission from hospital and reducing services, particularly allied health,” Mr Teulan said.

The providers called on the Government to defer the proposed cuts until it undertook proper analysis of their impact, and an evaluation of the relative costs of providing care to frail aged people in nursing homes.

They also called for a taskforce to review the funding process for aged care, with a view to establishing a more sustainable model which provides certainty to providers, residents, their families and carers, and long-term affordability for taxpayers.

Maria Hawthorne

More funding needed for Health Care Homes trial

GPs are still waiting for clarity on whether appropriate funding will be offered for services to patients under the Government’s $21 million Health Care Homes trial.

Under the model, also known as the Medical Home, patients suffering from complex and chronic health problems will be able to voluntarily enrol with a preferred general practice, with a particular GP to coordinate all care delivered.

The Government announced the model in March, with $21 million to allow about 65,000 Australians to participate in initial two-year trials in up to 200 medical practices from 1 July 2017.

The trial was one of the recommendations of the report of the 2015 Primary Health Care Advisory Group, headed by former AMA President Dr Steve Hambleton.

It was hailed as a step in the right direction for chronic disease management, with the Labor Opposition announcing plans for a similar trial.

However, the Labor proposal came with $100 million of funding, while under the Government model, the funding is not directed at services for patients, but rather on clinical need.

Professor Jane Gunn, the head of the General Practice Department at the University of Melbourne’s medical school, said the outcomes of similar trials, such as the 1994 coordinated care trials and the more recent diabetes care project, highlighted the difficulty in driving health delivery reform.

“The coordinated care trials showed some promise but were costly to implement and too costly to scale up,” Professor Gunn wrote on The Conversation website.

“They were difficult to replicate and few were sustained outside the trial environment.

“The impact of the diabetes care project was also disappointing. The diabetes care project included many of the elements of [the advisory group’s] report, such as bundled payments, yet only small gains were made in health outcomes and the cost-effectiveness of the model was not proven.

“The bundled payment used in the diabetes care project was viewed as inadequate.”

Making improvements in chronic disease management would require strong buy-in from all stakeholders, but it would be a challenge to get eligible practices and patients to sign on for the trial, she said.

“One of the biggest challenges will be to work out exactly how much the Government should pay a practice for providing a person with all their chronic disease care in a year,” Professor Gunn said.

“Working out how an individual GP will get their fair share of the chronic disease payment is likely to make for interesting negotiations and new ways of working for practice managers.

“Female GPs will be vulnerable to further pay inequities as they are less likely to be practice owners and more likely to work part-time.

“It is also not clear whether the recommended ‘bundled payment’ would include more radical models where the practice has to fund payment for pathology, imaging and medications from the ‘bundled payment’.”

AMA President, Dr Michael Gannon, said the AMA was keen to work with the Government to make the trial a success, but appropriate funding would be a critical test.

“The Medical Home is fundamental to the concept of the family doctor who can provide holistic and longitudinal care and, in leading the multidisciplinary care team, safeguard the appropriateness and continuity of care,” Dr Gannon said.

“BEACH data shows that GPs are managing more chronic disease. But they are under substantial financial pressure due to the Medicare freeze and a range of other funding cuts.

“GPs cannot afford to deliver enhanced care to patients with no extra support. If the funding model is not right, GPs will not engage with the trial and the model will struggle to succeed.”

With the right support, GPs can provide more preventive care services and greater management and coordination of care, keeping patients healthier and out of hospital, he said.

“Health played a major part in the Federal Election and the Government must now demonstrate that it has heard the people’s concern regarding the ongoing affordability of their health care,” Dr Gannon said.

“The Medical Home must be appropriately funded to succeed.”

Maria Hawthorne