Our drivers deserve the best: Owler

AMA President Professor Brian Owler has called for tougher vehicle safety standards, improved road user education and the development of a national road trauma database as part of efforts to reduce death and injury on the country’s roads.

Professor Owler told a Senate inquiry into road safety that there was much that can and should be done to reduce traffic trauma, including the adoption of world-leading design rules and technologies, such as autonomous emergency braking.

“I do not see why an Australian life should be worth any less than the life of a European or US or Japanese citizen,” he said. “I think our vehicles should be rated to the highest standards. It makes good sense.”

Cars equipped with autonomous emergency braking can detect the threat of an imminent collision and apply the brakes, either avoiding an accident or significantly reducing its severity.

Professor Owler said it was not just about preventing fatalities. He said people involved in simple accidents like rear-end collisions can suffer injuries such as whiplash that can have serious lifelong consequences.

He told the committee he had seen “many young people” who had lost their job and their partner after suffering whiplash and subsequently developing a dependence on opioids while trying to manage the pain.

Often, calls to tighten design and safety standards are resisted on the grounds that will add to production costs.

But Professor Owler said the marginal increase to the cost of a vehicle was more than offset by the huge savings to be made from preventing deaths and injuries that, over a lifetime, might cost millions of dollars in care.

One of the biggest blank spots in efforts to cut down the road toll was the lack of a national road trauma database, he said.

Though road deaths were recorded and shared across state borders, this did not extend to traffic accident injuries, hampering efforts to come to grips with the scale of the issue and how it could best be tackled.

“The number of deaths is only a fraction of the number of injuries that occur,” Professor Owler said. “While some of those injuries might heal…there are many injuries that are very devastating or at least result in significant time off work, loss of income, disruption to families. Being able to record that information is a very basic step that we need to take in order to be able to assess how we are going to make roads and cars safer.”

“It would provide a platform for being able to assess any investment [in road safety] that is made. But it will also allow us to determine where the problems are occurring”.

Professor Owler said while this was important, the most significant action governments should take would be to improve driver behaviour through education – particularly aimed at young people learning how to drive.

He said there was “a lot of positive feedback” regarding programs that aimed to educate those about to get their driver’s licences about speed, driving conditions, distractions and the role of passengers.

“People will make mistakes, and that is why education is so important, particularly for young drivers,” the AMA President said.

Adrian Rollins

Health on the Hill – briefs

Dying with dignity

Laws legalising euthanasia in the ACT and the Northern Territory would be reinstated under a Bill introduced to the Senate with the support of a group of MPs drawn from across the major parties.

In a rare display of cross-party action, Labor MPs including Alannah Mactiernan, Katy Gallagher and Nova Peris have joined with Liberal MP Sharman Stone and Australian Greens leader Richard Di Natale in backing legislation which would restore to the ACT and the NT the right to legislate around euthanasia.

The new laws would roll back a Private Member’s Bill, introduced by Liberal MP Kevin Andrews in 1996, that nullified NT euthanasia legislation and stripped the ACT of the power to legislate for euthanasia.

The issue is politically divisive, and the Labor caucus last month decided to allow ALP MPs a conscience vote on the matter.

The push to allow for euthanasia has gathered momentum in recent months and has the backing of several high-profile advocates including broadcaster Andrew Denton.

But even if the legislation is passed by the Senate, there are doubts it will attract sufficient support in the Lower House to become law.

Indecent disclosure

Health care providers are set to come under scrutiny over the adequacy of their information disclosure as the consumer watchdog vows to crack down on confusing and misleading conduct.

Australian Competition and Consumer Commission Chair Rod Sims said the agency had “important investigations underway” into the disclosure practices of health care providers amid concerns some were in breach of Australian Consumer Law.

Flushed with success after forcing Canberra’s Calvary Private Hospital to provide patients with more information about potential out-of-pocket costs, Mr Sims said the ACCC would focus on shortcomings in disclosure to consumers.

He said the Commission’s scathing report on the behaviour of the private health insurance industry, released last year, would provide a springboard for greater scrutiny regarding the provision of incomplete information that was not only confusing but potentially misleading.

Research boost

Research to develop an AIDS vaccine and reduce the incidence of over-diagnosis are among 96 projects sharing $130 million of funding in the latest round of grants from the nation’s peak medical research organisation.

Health Minister Sussan Ley said the money was part of $850 million that will be disbursed by the National Health and Medical Research Council to fund a wide range of projects.

There has been criticism that scientists starting their research career have often been unfairly overlooked in the race for funding, but NHMRC Chief Executive Officer Professor Anne Kelso said grants were awarded to a mix of both “outstanding new talent and experienced and internationally recognised researchers”.

TPP

Drug companies may effectively hold at least an eight-year monopoly on the supply of expensive biologic medicines under the terms of the controversial Trans Pacific Partnership trade deal, activists have warned.

Trade watchers have seized on remarks made by Australia’s Special Trade Envoy, Andrew Robb, during a visit to Washington DC late last month to claim the Government was looking at using administrative delays and other bureaucratic processes to effectively extend monopoly protection for biologic medicine manufacturers to eight years – three years longer than stipulated under the treaty.

The Washing-based Politico news service reported assurances from Mr Robb, who was visiting the US capital to help rally US Congress support for the TPP, that the trade agreement would effectively provide at least eight years market protection for biologic makers, as possibly as long as 17 years.

During negotiations for the TPP, Australia and other countries resisted US demands for at least 12 years of data protection for biologic manufacturers, and there was eventual agreement on a “five-plus” approach guaranteeing makers a minimum of five years’ monopoly on supply.

Though Mr Robb told Politico Australia would not be “a party to anything that would imply that we’ve changed our position”, he emphasised the importance of providing drug companies similar protection to that they received in the US: “We’ve got a very burgeoning biologics sector in Australia, [and] if they weren’t getting the protection that they could get in the United States, they wouldn’t be setting up in Australia”.

Health advocates warn this would effectively mean at least eight years before cheaper generic versions of expensive biologic medicines – gene and cellular-based therapies that are being developed to treat diseases long-considered intractable, such as cancer, HIV/AIDS, rheumatoid arthritis, diabetes, hepatitis B and multiple sclerosis – would become available.

Get moving

Teenage girls are being urged to ‘make your move’ following findings that they are, on average, only half as physically active as their male counterparts.

Health Minister Sussan Ley has launched the #girlsmakeyourmove campaign to encourage young women to play sport and engage in other activities amid concerns many are heading for a life of poor health.

Ms Ley said research showed almost 60 per cent of girls aged between 15 and 17 years undertook little or no exercise, compared with a third of boys in the same age group.

The Minister said such sedentary habits, particularly during the formative teenage years, could lead to a lifetime of chronic disease.

“[This campaign] aims to tackle this sliding door moment in a young woman’s life when they actually are laying down the foundation for the rest of their lives,” Ms Ley said. “Physical activity in the teenage years lays down the muscle and bone you need for the rest of your life.”

Many girls get put off playing sport or engaging in physical activity because of a lack of confidence, fear of being judged or a bad experience, and the campaign uses television ads and social media to feature girls enjoying playing sport and being active.

The sick will pay heavy price for Govt cuts

Patients are likely to face blow outs in emergency care and elective surgery waiting times from next year, and may even miss out on care altogether, unless the Federal Government acts immediately to unwind massive Commonwealth public hospital spending cuts.

AMA analysis shows a huge shortfall in Federal funding for hospitals will rapidly open up from mid-2017 as a lower indexation arrangement kicks in, creating a gap in resourcing that State and Territory governments are unlikely to be able to cover.

AMA President Professor Owler said the states and territories were facing an “economic disaster” unless the Federal Government urgently restored its funding, and warned patients would be forced to wait longer for vital health care and may, in some cases, miss out altogether.

“As hospital capacity shrinks, doctors won’t be able to get their patients into hospital or keep them there to receive the critical care they require,” Professor Owler said. “Doctors will always do the best they can by their patients, but these cuts mean the system as a whole simply won’t be able to meet the demand.”

His warnings came amid mounting speculation the Commonwealth will provide emergency funds to avert a pre-election crunch in public hospital finances – though it is expected to make little dent in the long-term shortfall, which is projected to reach $57 billion by the middle of next decade.

Expectations are increasing that Prime Minister Malcolm Turnbull will use a rare joint meeting with the nation’s premiers and treasurers scheduled for 1 April to clear the decks on a range of contentious issues in the lead-up to the Federal election, not least massive cuts to Commonwealth support for public hospitals unveiled in the Government’s disastrous 2014-15 Budget.

The Prime Minister has reportedly already offered New South Wales Premier Mike Baird an emergency $7 billion cash injection to tide the State’s public hospital and education systems through till after the election, which could come as early as July or as late as November, and other premiers are now lining up to demand similar assistance.

Professor Owler said such handouts would help relieve pressure on hard-pressed public hospitals in the short-term, but if a financial crisis for the nation’s public hospitals was to be averted there needed to be an overhaul of Commonwealth-State arrangements to ensure hospitals were supported by a reliable long-term source of funding that grew in step with the increase in demand for their services.

“It is clear there is a crisis in public hospital funding and an immediate commitment is required, but a quick fix will not solve the long-term capacity problems for public hospitals or ease the economic burden on State budgets,” he said.

There is mounting evidence that the performance of hospitals is already being hurt by a squeeze on their finances, even before massive cuts detailed in the controversial 2014-15 Budget come into effect.

The human cost

The AMA’s annual Public Hospital Report Card, released earlier this year, showed that hospital performance is already beginning to suffer as the flow of Commonwealth funds slows.

In emergency departments, the proportion of urgent Category 3 patients seen within the clinically recommended 30 minutes fell back to 68 per cent in 2014-15 – a two percentage point decline from the previous year, ending four years of unbroken improvement.

Meanwhile, improvements in elective surgery waiting times have stalled – the median delay in 2014-15 was 35 days, six days longer than a decade earlier.

Professor Owler said there was a real human cost to be paid for such a deterioration in performance.

“For a patient requiring urgent attention for abdominal pain, this could mean they are seen one to two hours after they present to the ED,” he said. “Their symptoms could be consistent with indigestion, or could be a perforated bowel. The quicker a doctor can see them and make a diagnosis, then the quicker they can receive relief from their pain, and their condition can be prevented from deteriorating, potentially to a very serious situation.”

In the Budget, the Coalition announced it would renege on hospital funding guarantees to the states, saving $1.8 billion over four years, while a further $57 billion would be would be saved by 2024-25 by downgrading the indexation of Commonwealth hospital funding to inflation plus population growth.

Increasing the squeeze, the Independent Hospital Pricing Authority has set the National Efficient Price – which determines how much the Commonwealth pays for hospital services – at 1.8 per cent lower than the amount that was set last year, locking in hospital underfunding.

States under pressure

The massive Commonwealth cuts have outraged the states, which have warned of a significant reduction in hospital services unless another stream of funding is found.

The savings appeared to be part of a broader Commonwealth strategy to dump most of the funding responsibility for health services onto the states and directly on to patients, and occurred in the context of a renewed debate about taxation and the structure of the Federation.

Two premiers, Mr Baird and South Australia’s Jay Weatherill, had championed changes to the GST and income tax arrangements to give states access to a more robust stream of revenue to fund hospitals and schools, but they were undercut when Mr Turnbull dismissed any talk of changing the consumption tax.

The resistance of Canberra to calls for more funds has been stiffened by the fact that all the states are currently in surplus, while the Commonwealth expects a deficit of $37.4 billion this financial year, and no return to surplus over the next four years.

But, while Treasurer Scott Morrison has continued to talk tough, telling the states to sort out their hospital funding problems themselves, behind the scenes Mr Turnbull has reportedly been approaching some premiers to discuss a possible deal.

Professor Owler discussed the looming crisis in a meeting with Mr Weatherill earlier this month, and the SA Premier echoed his concerns.

Any short-term deal offered by Mr Turnbull would only “kick the can down the road”, he told ABC radio.

But he indicated the states were likely to accept any injection of funds offered.

“Mike Baird and I have been pushing for a much bigger solution – a 15-year solution – but we have to be realistic, we’re on the shadows of an election, and it’s an urgent problem,” Mr Weatherill said.

Adrian Rollins

[Editorial] Iran: promises and prospects for health

Feb 26 marked a landmark election for Iranian Parliament and the top clerical body, the Assembly of Experts, coming only weeks after the historic lifting of sanctions. Health will continue to be important under President Rouhani’s Government who launched the national health transformation plan in May, 2014, in an effort to address the 52% out-of-pocket payments for health care. Last week, The Lancet was welcomed to Kish Island, Iran, to review progress in health research and to attend a collaborative research meeting led by University College London and Tehran University of Medical Sciences.

Premium hike could drive cover downgrade

There are fears a surge in private health insurance premiums will drive more patients into downgrading or dumping their policies, leaving many with inadequate cover and increasing the pressure on stretched public hospitals.

The Federal Government has approved an average 5.59 per cent increase in premiums from 1 April – more than double the rate of inflation.

Health Minster Sussan Ley has claimed a victory of sorts after convincing 20 of the nation’s 33 private health funds to resubmit lower increases than originally planned, a move she said had saved consumers $125 million.

But the latest round of premium hikes, which range from 3.76 per cent to 8.95 per cent, are likely to feed mounting consumer dissatisfaction with the value of private health insurance, leading to more downgrading or dumping their insurance.

The AMA has raised the alarm on these and other developments in the private health insurance market that undermine the quality of cover and could disturb the important balance between private and public health systems.

AMA President Professor Brian Owler said in the past six years the proportion of people with policies that had exclusions had jumped from 10 to 35 per cent, often with serious consequences.

The AMA President said it had become virtually a daily occurrence for patients booked in for common treatments to discover upon arrival that they were not covered by their insurance.

He said all too often insurers made changes to a policy after it had been bought without informing policyholders, leaving many unexpectedly stranded.

“People are shocked to make this discovery only when they need a particular treatment, and doctors are seeing this happen on a daily basis,” Professor Owler said.

The AMA’s criticisms were echoed in an Australian Competition and Consumer Commission report highly critical of the quality and accuracy of information provided by the health funds, which the watchdog said served to confuse consumers about what they were covered for and hampered their ability to make informed choices.

Ms Ley has launched a review into the private health insurance industry to examine regulation of the sector, including the setting of premiums, as well as other issues including the industry’s push into primary health care; a possible relaxation of community rating principles; and a proposal to replace health insurance rebates with Medicare-style payments for hospital care.

The Health Minister said the review had received more than 40,000 submissions from the public, and flagged there would be “broader structural overhauls” made to current industry regulation.

Part of the Government’s focus is on the cost of medical devices in the private health sector, and the Minister has launched a separate review of the Prostheses List.

Ms Ley said the process for approving premium increases also need to change.

“The current premium approvals process isn’t providing the right checks and balances to ensure consumers get the best deal every year, and there are clearly significant additional costs and barriers blocking larger premium savings from being passed on,” she said.

But whereas the Health Minister has put the focus on industry regulation as much of the cause of the problem, Professor Owler put much of the blame on the hunger for profit.

Since the privatisation of Medibank Private, the market share of for-profit insurers has surged to 63 per cent, something AMA Medical Practice Committee Chair Professor Robyn Langham said had been a “game-changer”.

“We now have an industry dominated by the interests of for-profit health insurers rather than not-for-profits, with a subsequent shift of focus from providing patient benefits to increasing profits for shareholders,” Professor Langham said.

In its submission to the Government’s review, the AMA warned that industry practices including downgrading existing policies, habitually rejecting claims, lumbering patients with bigger out-of-pocket costs, pressuring policyholders into reducing their cover and selling people cover they don’t need, were badly compromising the value of private health cover and could eventually upset the delicate balance between the public and private health systems.

“On their own, these activities reduce the value of the private health insurance product,” the AMA said in its submission to the Review. “Collectively, they are having a destabilising effect on privately insured in-hospital patient care and treatment.”

Professor Langham said the AMA was planning to produce an annual report card to given consumers clear and simple information regarding the health insurance policies on offer.

She said consumers would be able to check differences in benefits paid for a sample of common procedures, and identify exclusions and restrictions (including junk ‘public hospital-only’ insurance policies). Professor Langham said the report card would also help doctors to compare the gap arrangements of different insurers in order to work out who provided better cover for health costs.

The AMA’s submission to the Government private health insurance review can be viewed at: submission/ama-submission-private-health-insurance-consultations-2015-16

The only way is up

Health fund premium increases to take effect from 1 April

Insurer	Average Increase with rate protection
ACA Health Benefits Fund Ltd	6.19%
Australian Unity Health Ltd	5.05%
BUPA Australia Pty Ltd	5.69%
CBHS Health Fund Ltd	5.92%
Cessnock District Health Benefits Fund Ltd	6.19%
CUA Health Fund Ltd	8.95%
Defence Health Ltd	5.48%
Doctor’s Health Fund Pty Ltd, The	3.76%
GMHBA Ltd	5.44%
Grand United Corporate Health Ltd	4.26%
HBF Health Ltd	4.94%
Health Care Insurance Ltd	6.90%
Health Insurance Fund of Australia Ltd	6.55%
Health Partners Ltd	7.14%
Health.com.au Pty Ltd	8.81%
Hospitals Contribution Fund of Australia Ltd, The	5.42%
Latrobe Health Services Ltd	5.52%
Lysaght Peoplecare Ltd	4.38%
Medibank Private Ltd	5.64%
Mildura District Hospital Fund Ltd	6.74%
National Health Benefits Australia Pty Ltd	5.28%
Navy Health Ltd	5.50%
NIB Health Funds Ltd	5.55%
Phoenix Health Fund Ltd	5.72%
Police Health Ltd	4.81%
Queensland Country Health Fund Ltd	4.91%
Queensland Teachers’ Union Health Fund Ltd	7.15%
Railway & Transport Health Fund Ltd	5.61%
Reserve Bank Health Society Ltd	5.37%
St Luke’s Medical & Hospital Benefits Association Ltd	5.89%
Teachers Federation Health Ltd	4.97%
Transport Health Pty Ltd	6.49%
Westfund Ltd	5.94%
INDUSTRY WEIGHTED AVERAGE	5.59%

Adrian Rollins

[World Report] Profile: Burnet Institute, Melbourne, Australia

Burnet Institute in Australia is an unusual organisation; it is a medical research institute that is also designated as an accredited non-governmental overseas development organisation. Formed in 1986, the institute—now under the direction of Brendan Crabb—has close to 250 researchers and public health professionals in Melbourne and more than 160 across the Asia Pacific region and in east Africa. Burnet’s ethos includes its primary aim to sustainably improve the health of poor and vulnerable people.

[Health Policy] Moving towards universal health coverage: lessons from 11 country studies

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts.

[Comment] Oil prices, climate change—health challenges in Saudi Arabia

In December, 2015, Saudi Arabia reported a US$98 billion budget deficit (about 15% of gross domestic product [GDP]) in 2015 with no improvement projected for 2016.1 Saudi Arabia has been resilient during oil price fluctuations in the past, so the new government budget came as a surprise. The new spending plan reflects several measures to curb subsidies, raise revenue, and improve healthy lifestyles.2

[Correspondence] Implementing health policy and systems research in Myanmar

We agree with Karen Eggleston and colleagues’ (Nov 21, p 2053)1 assertion that one of the greatest challenges facing Myanmar is the optimum allocation of scarce resources, and add that evidence to inform this is needed urgently. We started working to generate such evidence shortly after the move to a nominally civilian government in 2011 opened the country up to more international collaborations. Here, we summarise the insights gained while doing one of the first multidisciplinary research programmes on the health system and tuberculosis control in Myanmar, which included two literature reviews, a mixed-methods situational assessment, a case-control study of risk factors for emergence of drug resistance, a qualitative study of barriers to accessing health services, and an economic analysis of patient costs.

Medicinal cannabis hits jack-pot

Medicinal cannabis will be bracketed with morphine and other restricted medicines under changes to the Poisons Schedule being made following the passage of legislation legalising and regulating its cultivation and supply.

Health Minister Sussan Ley said the Health Department and the Therapeutic Goods Administration were “well advanced” in changing the categorisation of medicinal cannabis to a Schedule 8 substance.

Ms Ley said the change would simplify arrangements regarding the legal possession of medicinal cannabis products, “placing them in the same category as restricted medicines such as morphine, rather than an illicit drug”.

The TGA is due to make an interim decision on the change in March, which will then be subject to further consultation.

The change is part of a suite of measures being undertaken after Parliament approved amendments to the Narcotic Drugs Act making it legal to cultivate and manufacture medicinal cannabis.

The legislation was passed in rapid order and without amendment, aided by support from the major political parties and across the political spectrum.

“This is an historic day for Australia and the many advocates who have fought long and hard to challenge the stigma around medicinal cannabis products so genuine patients are no longer treated as criminals,” Ms Ley said. “This is the missing piece in a patient’s treatment journey, and will now see seamless access to locally-produced medicinal cannabis products from farm to pharmacy.”

Medicinal cannabis is currently imported by individuals from overseas to treat a range of conditions including severe epilepsy and nausea and loss of appetite associated with chemotherapy.

AMA President Professor Brian Owler has said medicinal cannabis should be subject to the same sort of scrutiny and testing as any other medicine.

The Government’s legislation provides for the creation of a single, national body to regulate the cultivation and supply of medicinal cannabis.

Those wanting to cultivate cannabis for medical or research purposes will have to show that they are a “fit and proper person”, do not have ties to criminal activity, and be able to demonstrate they have the capacity to ensure the physical security of the crop before being granted a licence.

The quantities and strains of cannabis produced will be tightly controlled, and a system of permits will be used to ensure that amounts to be manufactured are planned in advance, and are in proportion to demand.

Ms Ley said the Government, through the national regulator, would closely track the development of medicinal cannabis products “from cultivation to supply, and curtail any attempts by criminals to get involved”.

Initially, the focus of the scheme will be production for domestic consumption, with any provision for exports “to be addressed at a later date”.

Adrian Rollins