Minister takes on health funds as election looms

Health Minister Sussan Ley has stepped up her pressure on the private health insurance industry, demanding all 35 funds reduce planned premium increases or justify higher charges.

Positioning herself as a strong advocate for consumers ahead of the federal election due later this year, Ms Ley has written to all insurers asking them to re-submit their applications for premiums increases due to come into effect from 1 April.

“Consumers have strong concerns about the affordability of their premiums; hardly surprising given premiums have increased at a rate of around 6 per cent per year for the past five years,” the Health Minister said. “It is important I am armed with the full picture before approving any premium increase, particularly as consumers are telling me they are finding it increasingly difficult to simply shop around for a better deal.”

Under current arrangements, health insurers receive around $6 billion a year from the Federal Government each year and, in return, have to get proposed premium increases approved by the Health Minister.

For the last two years, premiums have increased by an average 6.2 per cent, even as a proliferation of policies with multiple exclusions and large excess has undermined the value of cover on offer.

Ms Ley said health funds would need to lower their planned premium increases or provide evidence as to why they cannot do it.

But there are suggestions that the Minister is grandstanding on the issue for short-term political gain rather than trying to achieve sustained reform.

The funds lodged their proposed premium increases with the Health Department late last year, but Ms Ley made her announcement just a week before the Government traditionally notifies insurers of its decision.

Peak industry body Private Healthcare Australia told The Australian health funds undertook months of research and taking actuarial advice in coming up with their premium proposals, and for the Minister to make her request so late in the process was “quite challenging for the funds to comply with”.

Leading industry figures including PHA Chief Executive Dr Rachel David and NIB Managing Director Mark Fitzgibbon said premiums were being driven up systemic pressures including the rising cost of prostheses and hospital care.

Dr David told The Australian a “one-off discount on pricing is unlikely to address the fundamental problems”.

Jumping the gun

But the nation’s largest insurer, Medibank Private, pre-empted Ms Ley’s move by a week when it announced it was re-submitting its proposed premium increases for 2016.

While Medibank has not disclosed what size of premium increase it is proposing, a financial update from the fund suggests it is likely to be below the industry-wide average rise of 6.2 per cent approved last year.

In the financial update, which coincided with the premium announcement, Medibank reported that it had revised its premium revenue growth projections down from “above 5.5 per cent” to between 4.5 and 5 per cent.

Managing Director George Savvides said the recently-privatised fund was passing the benefits of cost-cutting measures on to its customers through lower premiums.

“Medibank has been working hard to address private health insurance affordability issues at their source by working in partnership with hospitals and other providers to reduce waste and inefficiency in the healthcare system,” Mr Savvides said. “Medibank members will directly benefit from the savings achieved as we invest in delivering more value to our members through more competitive pricing and enhanced product benefits.”

Medibank announced its move after releasing preliminary figures showing an operating profit in the first half of the financial year of $270 million and a $100 million boost to its full-year profit outlook from above $370 million to in excess of $470 million.

The improved financial performance has been underpinned by a crackdown on benefit payouts and a series of tough deals struck with private hospitals involving shifting the financial burden of medical complications away from the insurer onto providers.

Medibank’s decision to resubmit its proposed premiums for 2016 was hailed by Ms Ley, who said any move to cut costs was welcome.

The price of war

But AMA President Professor Brian Owler warned patients could be the losers in any price war that breaks out between the major health funds.

Professor Owler told Channel Seven he was concerned that people lured into taking out a health insurance policy by cut-price premiums might later find it does not provide the cover they expected, leaving them out-of-pocket for important medical care.

Without accompanying regulatory measures to buttress the quality of health insurance cover, the AMA is concerned any premium price war could result in even more policies riddled with multiple exclusions and hefty excess charges.

In its submission to the Federal Government’s Private Health Insurance Review, the peak medical group 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 Owler said there were several emerging trends in private health insurance that were alarming, most notably a steady downgrading in the quality of cover on offer.

He said that in the last 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.

Adrian Rollins

Australia Day honours

Former AMA President Dr Brendan Nelson and former Treasurer Peter Ford are among almost 30 AMA members recognised for their outstanding service to medicine and the community in the 2016 Australia Day honours.

Dr Nelson, who led the AMA between 1993 and 1995 before entering federal politics and rising to become Defence Minister in the Howard Government and Opposition leader after the Coalition’s defeat in 2007, served as Australia’s ambassador to the European Union before returning to Australia to become Director of the Australian War Memorial.

Dr Nelson has been made an Officer (AO) in the general division of the Order of Australia, in recognition of distinguished service to Federal Parliament, the advancement of Australia’s international relations and service to major cultural institutions.

Several other AMA members were similarly honoured, including Monash University Pro Vice Chancellor Professor David Copolov, anaesthetist Professor Kate Leslie, clinical immunologist Professor Robyn O’Hehir, ophthalmologist Professor Minas Coroneo and gastroenterologist Professor Finlay Macrae.

Adelaide GP Dr Ford, who served in several senior roles within the AMA including as Federal Treasurer, was awarded an Order of Australia (AM) for his work representing the medical profession and promoting the delivery of health care for the elderly.

Another GP, Dr Vlasis Efstathis, was also awarded an AM for services to community health and medicine. Dr Efstathis has been a GP since 1972 and was team leader of the tsunami relief effort in Banda Aceh in 2004.

Former Royal Australian and New Zealand College of Obstetricians and Gynaecologists President Dr Ted Weaver, was awarded a Medal in the general division of the Order of Australia, as was Australian National University Adjunct Associate Professor Rashmi Sharma, who told Medical Observer the honour showed that “little GPs in the suburbs can sometimes be recognised”.

The following AMA members were recognised in the Australia Day honours:

Officer (AO) in the general division

Professor David Copolov
Professor Minas Coroneo
Professor Katherine Leslie
Professor Finlay Macrae
The Honourable Dr Brendan Nelson
Professor Robyn O’Hehir

Member (AM) in the general division

Mr Ian Carlisle
Dr Jay Chandra
Dr Timothy Cooper
Dr Vlasis Efstathis
Dr Peter Ford
Professor Mark Frydenberg
Dr Michael Gardner
Dr Myrle Gray
Dr Paul Mara
Dr Peter Pratten
Dr Lyon Robinson
Dr Brian Spain
Dr Roderic Sutherland
Dr John Vorrath
Associate Professor David Watson
Associate Professor Julian White

Medal (OAM) in the general division

Dr Creston Magasdi
Dr John Paradice
Adjunct Associate Professor Rashmi Sharma
Dr John Tucker
Dr Edward Weaver

Adrian Rollins

WHO declares Zika virus a threat of ‘alarming proportions’

Health authorities are on high alert to prevent a mosquito-borne virus linked to thousands of birth defects in South America getting a toehold in Australia.

Though there is no evidence the Zika virus, which health experts suspect has infected millions in Brazil and surrounding countries in recent months, has been transmitted in Australia, authorities are concerned about the possibility someone infected with the disease overseas may travel to central and northern Queensland, where mosquitos capable of carrying the disease are found.

“There is very low risk of transmission of Zika virus in Australia, due to the absence of mosquito vectors in most parts of the country,” the Health Department said, but added that “there is continuing risk of Zika virus being imported into Australia…with the risk of local transmission in areas of central and north Queensland where the mosquito vector is present”.

Australia’s preparations come amid mounting international alarm over the rapid spread of the virus and fears it is linked to an increased incidence of serious birth defects including abnormally small heads and paralysis.

World Health Organisation Director-General Dr Margaret Chan said the virus was “spreading explosively” in South and Central America since being first detected in the region last year, and the WHO’s Emergency Committee has been convened to consider declaring the outbreak a Public Health Emergency of International Concern.

The virus, which is closely related to the dengue virus, was first detected in 1947, and there have only ever been 20 confirmed cases in Australia – six of them in 2015 alone, and all of them involving infection overseas.

Only about 20 per cent of those infected with the Zika virus show symptoms, and the disease itself is considered to be relatively mild and only lasts a few days.

But there is no vaccine or treatment, apart from rest, plenty of fluids and analgesics, and Dr Chan said the speed of the virus’s spread and its possible link to serious birth defects meant the threat it posed had been elevated form mild “to one of alarming proportions”.

“The level of alarm is extremely high,” Dr Chan said. “Arrival of the virus in some places has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barre syndrome.

A causal relationship between Zika virus infection and birth malformations and neurological syndromes has not yet been established, but is strongly suspected.”

But there are concerns, yet to be scientifically verified, that the virus may cause microcephaly (small or under-developed brain) in unborn infants.

In Brazil, a four-fold increase in the number of cases of microcephaly last year coincided with widespread outbreaks of the Zika virus, increasing suspicions of a link.

An investigation by the Brazil Ministry of Health found that of 35 cases of microcephaly recorded in a registry established to investigate the outbreak, 74 per cent of mothers reported a rash illness during their pregnancy. More than 70 per cent of the babies were found to have severe microcephaly, and all 27 that underwent neuroimaging were found to be abnormal.

“The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions,” Dr Chan said. “The increased incidence of microcephaly is particularly alarming, as it places a heart-breaking burden on families and communities.”

The Department of Foreign Affairs and Trade has issued a travel advisory recommending that pregnant women considering travelling to countries where the Zika virus is present to defer their plans.

“Given possible transmission of the disease to unborn babies, and taking a very cautious approach, pregnant women should consider postponing travel to Brazil or talk to their doctor about implications,” the Department said.

The Brazil outbreak has drawn particular attention given that hundreds of thousands of athletes, government officials and tourists are expected to travel to the country later this year for the Olympic Games.

DFAT has issued similar travel advice for all 23 countries where the virus has been identified – almost all of them in Southern or Central America, except for the Pacific island nation of Samoa and Cape Verde, off the north-west African coast.

All other travellers are advised to take precautions to avoid being bitten by mosquitos, including wearing repellent, wearing long sleeves, and using buildings equipped with insect screens and air conditioning.

The Health Department has issued advice for clinicians to consider the possibility of Zika virus infection in patients returning from affected areas, and said authorities were ready to act if it appeared in areas where mosquitos capable of transmitting it were present.

“In the event of an imported case in areas of Queensland where the mosquito vector is present, health authorities will respond urgently to prevent transmission, as they do for dengue,” the Department said.

Adrian Rollins

Look no further than GPs for Medical Home

GPs already perform many of the functions of a Medical Home, and should be at the centre of any move to formalise such an arrangement in Australia, the AMA has said.

As Health Minister Sussan Ley contemplates the findings and recommendations of the primary health review led by former AMA President Dr Steve Hambleton, the AMA has issued a Position Statement advising that any proposal to adopt a Medical Home approach in Australia must have GPs at its core.

Internationally, the term Medical Home is used to refer to a model of primary care that is patient-centred, comprehensive, team-based, coordinated, accessible and focused on quality and safety.

AMA Vice President Dr Stephen Parnis said in Australia these attributes were already embodied in general practice.

“The concept of the Medical Home already exists in Australia, to some extent, in the form of a patient’s usual GP,” Dr Parnis said. “If there is to be a formalised Medical Home concept in Australia, it must be general practice. GPs are the only primary health practitioners with the skills and training to provide holistic care for patients.”

Evidence suggest patients with a usual GP or Medical Home have better health outcomes, and 93 per cent of Australians have a usual general practice, and 66 per cent have a family doctor.

Dr Parnis said the Medical Home concept had the potential to deliver improved support for GPs in providing well-coordinated and integrated multi-disciplinary care for patients with chronic and complex disease, and it made sense for this to be the focus of Government thinking on adopting the Medical Home idea in Australia.

“You can’t just transplant models of health care from other countries without acknowledgement of local conditions and what is already working well,” he said.

“Australia needs to build on what works, and ensure that a local version of the Medical Home is well-designed and relevant.”

The AMA said this should involve additional funding to enable GPs to deliver comprehensive and ongoing care, including patient education, improved coordination and targeting of services, and activity that does not require face-to-face contact.

Establishing a Medical Home arrangement in Australia was likely to involve formally linking a patient with their nominated GP or medical practice through registration, and the AMA said this should be voluntary for both patients and doctors.

In addition, the peak medical group said fee-for-service must remain the predominant funding mechanism for doctors, though it acknowledged that the Medical Home could also involve a blended funding model that rewarded the delivery of services over a period of time.

The AMA Position Statement on the Medical Home can be viewed at: position-statement/ama-position-statement-medical-home

Adrian Rollins

AMA in the News – 2 February 2016

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

Timing of Medicare cuts announcement criticised, The Age, 29 December 2015
Doctors have criticised the Turnbull government for using the Christmas-New Year holiday period to reveal the first tranche of items to be dropped from the government-subsidised Medicare Benefits Schedule. AMA President Professor Brian Owler said the proposed cuts would make the common tonsillectomy procedure marginally more expensive due to fewer individual parts of the operation being funded by Medicare.

Take care morning after the big night, Adelaide Advertiser, 1 January 2016
Health and safety experts are urging people to be careful embracing life the morning after a big night. AMA President Professor Brian Owler urged people to take it easy with water sports and even sunbaking over summer if they have consumed alcohol.

Anti-vax nuts try to cheat jab laws, The Sunday Telegraph, 3 January 2016
Anti-vaxers are trying to manipulate the new “no jab no pay” laws in a bid to gain taxpayer-funded rebates available only to those who vaccinate their children. AMA President Professor Brian Owler said the attempt is hurting only the child involved.

Threats to handouts prompts jab boosts, The Sunday Telegraph, 17 January 2016
Doctors have noticed a significant boost in the number of parents bringing their children in for vaccinations as the new “No Jab, No Play” laws start to bite. AMA President Professor Brian Owler said the laws were already having a beneficial effect on immunisation numbers.

Warning over autism doctor shopping, The Australian, 19 January 2016
GPs should be given stronger guidance about how to diagnose autism. AMA President Brian Owler said that having consistent guidelines would make things easier for doctors during diagnosis, but added that the emphasis should remain on assessing children early.

Doctors warn of busy emergency facilities, Australian Financial Review, 28 January 2016
The AMA Public Hospital Report Card found the performance of the public hospital system has stagnated, and even declined in some areas. AMA President Professor Brian Owler placed the blame for the declining public hospital performance firmly on the Federal Government’s reduced rate of health funding which would lead to a funding “black hole” in 2017.

Hospitals faced with funding ‘black hole’, Sydney Morning Herald, 28 January 2016
The Federal Government is under pressure to reform taxes following a report card on public hospitals that shows the most urgent patients are waiting longer at emergency departments. AMA President Professor Brian Owler said hospitals would be insufficiently funded to meet the rising demands from 2017, when the states and territories were facing a “black hole”.

State looks sick, Herald Sun, 29 January 2016
Victorian emergency patients are paying the price for a “funding crisis” in the nation’s public hospitals, and doctors warn the worst is yet to come. The AMA warned that a further $57 billion of Commonwealth funding was expected to be lost from hospital coffers over seven years starting next year, by indexing funding growth to CPI and population expansion.

Radio

Professor Brian Owler, 774 ABC Melbourne, 29 December 2015
AMA President Professor Brian Owler discussed recent cuts to the Medicare Benefits Scheme. Professor Owler said it was clearly a cost saving exercise by the Federal Government.

Professor Brian Owler, Radio National, 29 December 2015
AMA President Professor Brian Owler talked about new cuts to the MBS. Professor Owler said the AMA has supported the Medicare Benefits Schedule review from the outset, on the basis there were no cuts to access to patient services.

Dr Stephen Parnis, 4BC Brisbane, 7 January 2016
AMA Vice President Dr Stephen Parnis dismissed claims that pap smears would cost women $30. Dr Parnis said cuts to Medicare have resulted in reports of overpriced pap smears.

Dr Stephen Parnis, Tipple J Sydney, 25 January 2016
AMA Vice President Dr Stephen Parnis discussed the use of so-called “hangover clinics”. Dr Parnis said the treatments they offered were a placebo, and he questioned whether their operations were ethical.

Professor Brian Owler, Radio National, 28 January 2016
AMA President Professor Brian Owler discussed the latest AMA Public Hospital Report Card which revealed a public hospital funding ‘black hole’ as Commonwealth funding cuts hit the States and Territories.

Professor Brian Owler, 2GB Sydney, 28 January 2016
AMA President Professor Brian Owler talked about a report from the AMA showing emergency department waiting times has worsened for the first time in seven years.

Professor Brian Owler, 774 ABC Melbourne, 28 January 2016
AMA President Professor Brian Owler talked about the AMA Public Hospital Report Card and said longer waits for elective surgery and emergency rooms often resulted in more health problems.

Television

Professor Brian Owler, ABC News 24, 28 December 2015
AMA President Professor Brian Owler talked about Health Minister Sussan Ley’s proposed removal of 23 items from the Medicare Benefits Schedule.

Dr Stephen Parnis, ABC News 24, 1 January 2016
AMA Vice President Dr Stephen Parnis talked about how parents who refused to vaccinate their children would be stripped of childcare benefits by the Federal Government under new laws. Dr Parnis said public health was a major government responsibility, and vaccination rates were not as high as health experts would like them to be.

Professor Brian Owler, The Today Show, 14 January 2016
AMA President Professor Brian Owler discussed the importance of safe work environments for emergency workers after a police officer was allegedly shot by a patient with a history of ice addiction at a Sydney hospital.

Professor Brian Owler, Channel 7 Melbourne, 26 January 2016
Medibank says it is passing savings onto its members, but there are concerns more affordable premiums might mean cuts in benefits. AMA President Professor Brian Owler said doctors did not want to see people taking out cheaper premiums and policies and then realising that their private health insurance was not worth it.

Professor Brian Owler, The Today Show, 28 January 2016
The AMA Public Hospital Report Card 2016 showed that, against key measures, the performance of public hospitals is virtually stagnant, and even declining in key areas. AMA President Brian Owler said unless the Government looked at the way it funded public hospitals, people were likely to wait longer in emergency departments and for elective surgery.

Professor Brian Owler and Dr Stephen Parnis, Channel 9, 28 January 2016
The AMA released its new Public Hospital Report Card and the figures revealed that scores of patients were not being treated within recommended times. Doctors fear the situation is only going to get worse.

Professor Brian Owler, ABC News 24, 28 January 2016
The AMA has warned that public hospitals are facing a funding crisis. AMA President Professor Brian Owler said hospitals faced a crisis due to the funding fight between Federal and State governments.

Anti-vax dodge dismissed by Commonwealth

The Federal Government has confirmed that a form being circulated by anti-vaccination campaigners attempting to circumvent new ‘No Jab, No Pay’ laws has no legal standing, backing AMA advice that doctors are under no obligation to sign it.

Social Services Minister Christian Porter has written to AMA President Brian Owler confirming that medical practitioners were under no obligation to sign the form, which asks doctors to acknowledge the ‘involuntary consent’ of a parent to the vaccination of their children, and which is deemed to be ineffective in any case.

“I am able to advise you that under the No Jab, No Pay Act, immunisation providers are not obligated to sign such declarations,” Mr Porter wrote. “This statutory declaration is not relevant evidence for the purposes of family assistance payments, [so that] even if such a form were signed by a doctor…it would not in any circumstances make the relevant parent eligible for payments that would otherwise be suspended.”

The form has been circulated by anti-vaccination campaigners following Federal Government welfare changes aimed at denying certain welfare payments to parents who refuse to vaccinate their child.

Under the No Jab, No Pay laws, from 1 January this year parents of children whose vaccination is not up-to-date are no longer eligible for the Family Tax Benefit Part A end-of-year supplement, or for Child Care Benefit and Child Care Rebate payments. The only exemption will be for children who cannot be vaccinated for medical reasons.

The new laws were introduced amid mounting concern that vaccination rates in some areas were slipping to dangerously low levels, increasing the risk of a sustained outbreak of potentially deadly diseases such as measles.

The Australian Childhood Immunisation Register shows there has been a sharp increase in the proportion of parents registering a conscientious objection to the vaccination of their child, from just 0.23 per cent in late 1999 to 1.77 per cent by the end of 2014.

In all, around a fifth of all young children who are not fully immunised are that way because of the conscientious objection of their parents.

The form being circulated by anti-vaccination groups, headed “Acknowledgement of involuntary consent to vaccination”, is intended to circumvent the No Jab, No Pay laws and allow conscientious objectors to receive Government benefits without allowing the vaccination of their children.

But Mr Porter said the aim of the new laws was to boost immunisation rates “by providing a level of encouragement and incentive for families to more thoroughly inform themselves about the importance of immunising their children”.

The Minster said the Government recognised the right of parents to decide not to vaccinate their children, but the new laws meant there would be consequences.

“An individual is not prohibited in any way from maintaining their vaccination objection; it is simply the case they will not receive some of their family assistance,” he said. “This is a relatively small financial cost, particularly when compared to the cost that the spread of crippling, debilitating and deadly diseases has on our health system and community.”

“It is the Government’s view that when an individual decides not to vaccinate their child, they are putting their child and the community at risk of infectious diseases.”

Last month, the AMA’s senior legal adviser John Alati advised that, where there was no medical reason for vaccination exemption, the doctor’s job was to outline the relevant facts about immunisation and to provide vaccination where consent was given. Where it was withheld, “the doctor should not perform the procedure as it might constitute trespass to the person”.

His advice was backed by Mr Porter, who said that “the appropriate path for a doctor or medical profession who may be requested to sign [the form being circulated by anti-vaccination campaigners] is simply to vaccinate where there is consent, and decline where consent is absent”.

Adrian Rollins

Obituary – Professor Tess Cramond

Medical pioneer and former AMA Queensland President Professor Tess Cramond, credited with saving thousands of lives, has died.

Professor Cramond, who helped blaze a trail for women in anaesthetics and medical politics, and whose lifetime of achievement included establishing and heading Royal Brisbane Hospital’s Multidisciplinary Pain Clinic and becoming Dean of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons, passed away on 26 December, aged 89.

She drew national and international accolades for her work advancing anaesthesia and pain medicine. Among her many awards, she received an Order of the British Empire, she was made an Officer of the Order of Australia, and she was presented with the AMA Women in Medicine Award, the Advance Australia Award and a Red Cross Long Service Award.

Hundreds gathered at Brisbane’s Cathedral of St Stephen on 8 January for her funeral, where many paid tribute to her work as medical adviser to Surf Lifesaving Australia in introducing and promoting the teaching of CPR.

She was also recognised for helping pioneer the advancement of women in medicine.

Born in Maryborough, Queensland, in 1926 as one of four daughters, Professor Cramond entered medical school in the post-war years and graduated in 1955.

She told her friend Dr John Hains in an interview in 2012 that she was drawn to anaesthesia because, “I love the panorama of medicine that anaesthetics provided”.

Professor Cramond was initially reluctant to get involved in medical politics, but eventually agreed to become State Secretary of the Australian Society of Anaesthetists.

Several years later, in 1978, AMA Queensland approached her to become State President – an offer she turned down at the time.

“I had just been appointed Professor of Anaesthetics, and I wanted to get the Anaesthetics Department established properly, so I knocked them back,” Professor Cramond recalled.

But that was not an end to it. AMA Queensland approached her again to become President in 1982.

“When I was asked a second time I thought, ‘If I knock them back again, they will never ask another woman’, so I said yes.”

But Professor Cramond made it clear that one of her proudest achievements was the establishment of the Multidisciplinary Pain Clinic.

The idea for such a clinic came to her during a visit to the United States, where she saw a similar establishment.

When she returned to Brisbane she got to work, and in 1967 the Clinic, which was to become the centrepoint of her career, was established at the Royal Brisbane. She was to serve as its Director for 42 years.

In her 2012 interview, Professor Cramond noted that one of the clinic’s major contributions was to have trained 35 pain specialists since 2000, and was gratified that the Australian and New Zealand College of Anaesthetists had established a Faculty of Pain Medicine.

Adrian Rollins

News briefs

Harvey named to Friends of Science in Medicine board

Associate Professor Ken Harvey, from Monash University’s School of Public Health and Preventive Medicine, has been appointed to the executive of Friends of Science in Medicine (FSM). He has been an influential member of the Commonwealth Pharmaceutical Health and Rational Use of Medicines Committee and most recently served on the Federal Government’s Natural Therapies Review Committee, which found no evidence for the effectiveness of any of the 18 common taxpayer-supported alternative treatments reviewed. Dr Harvey was a member of the expert group that drafted the World Health Organization’s Ethical Criteria for Medicinal Drug Promotion. FSM was established in 2011 and is supported by almost 1200 leading Australian scientists and clinicians. “No one has done more to protect consumers from the unethical marketing of prescription and ‘alternative’ medicines in our country,” said FSM president, Professor John Dwyer, AO.

Anatomy bestseller from 1613 published online

Columbia University in New York has digitised the 1661 translation of an anatomy “flapbook”, first published in 1613, and which remained a bestseller for 150 years. Catoptrum Microcosmicum, originally in Latin, “explains the human body, using movable flaps to take people down through successive layers”, reports Gizmodo. “The first layer was the person delicately draped in a way that preserved their modesty. The layer of drapery came off first. The book features a female figure and a male figure, both shown from the front and the back. Each figure is drawn with one foot standing on a skull.” Also featured is a pregnant female torso, which Gizmodo described as “the creepiest experience imaginable” and includes a “crotch-demon”. Available online at https://archive.org/details/ldpd_11497246_000.

Chromium in the spotlight

Gizmodo reports that University of New South Wales and University of Sydney researchers have found that popular chromium supplements are partially converted into a carcinogenic form when they enter cells. The National Health and Medical Research Council recommends 25–35 micrograms of chromium daily as the adequate adult intake. A maximum of 200 micrograms per day is considered safe by the US National Academy of Sciences. Over-the-counter supplement tablets, available in Australia and most commonly used for weight management, body building and type 2 diabetes, have been found to contain up to 500 micrograms each. The research, originally published in the chemistry journal Angewandte Chemie, was conducted on animal fat cells, which were x-rayed to allow scientists to observe the behaviour of chromium in the cell. The researchers say more study is needed to conclusively say whether the supplements significantly alter cancer risk.

Zika joins list of mosquito-borne nasties

A rare mosquito-borne virus called Zika is spreading from its African home through Asia and the Americas, with the United States Centers for Disease Control issuing its first travel advisory for the disease, for travellers through Puerto Rico, Wired reports. “In Brazil, the number of infants born with shrunken, malformed brains has gone up by a factor of 10 since Zika entered the country, and scientists there are trying to establish a causal link to the virus.” Closely related to dengue fever and yellow fever, Zika is hard to detect because “the classic test for Zika — checking a person’s blood for antibodies that bind to the Zika virus — spikes a false positive when it sees antibodies for those other two diseases”. Complicating the issue is that Zika also appears to be spread through sexual contact.

Hospitals face funding ‘black hole’

Almost a third of Emergency Department patients in need of urgent treatment are being forced to wait more than 30 minutes to be seen, while thousands of others face months-long delays for elective surgery as under-resourced public hospitals struggle to cope with increasing demand.

The AMA’s latest snapshot of the health of the nation’s public hospital system shows that improvements in performance have stalled following a sharp slowdown in Federal Government funding, underlining doctor concerns that patients are paying a high price for Budget austerity.

“By any measure, we have reached a crisis point in public hospital funding,” AMA President Professor Brian Owler said. “The states and territories are facing public hospital funding black hole from 2017 when growth in Federal funding slows to a trickle.”

The Federal Government will have slashed $454 million from hospital funding by 2017-18, and a downshift in the indexation of spending from mid-2018 will reduce its contribution by a further $57 billion by 2024-25.

Professor Owler said the consequences of Commonwealth cutbacks were already showing up in hospital performance, and the steep slowdown in funding growth in coming years will further exacerbate the situation.

“Public hospital funding is about to become the single biggest challenge facing State and Territory finances, and the dire consequences are already starting to show,” the AMA President said. “Without sufficient funding to increase capacity, public hospitals will never meet the targets set by governments, and patients will wait longer for treatment.”

The AMA’s Report Card, drawing on information from the Australian Institute of Health and Welfare, the Council of Australian Governments Reform Council and Treasury, shows the performance of public hospitals against several key indicators has plateaued and, by some measures, is declining.

In terms of hospital capacity, the long-term trend toward fewer beds per capita is continuing. The decline is even more marked when measured in terms of the number of beds for every 1000 people aged 65 years of older – a fast growing age group with the highest demand for hospital services.

In 1993 there were almost 30 beds for every 1000 older people, but by 2013-14 that had virtually halved to around 17 beds.

Alongside a relative decline in capacity, there are signs the hospitals are struggling under the pressure of growing demand.

Emergency departments, often seen as the coal face of hospital care, 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, and a result that ended four years of unbroken improvement.

The national goal that 80 per cent of all ED patients are seen within clinically recommended times appears increasingly unlikely, as does the COAG target that 90 per cent of all ED patients be admitted, referred or discharged within four hours. For the last two years, the ratio has been stuck at 73 per cent.

The outlook for patients needing elective surgery is similarly discouraging.

The AMA report found that although there was slight reduction in waiting times for elective surgery in 2014-15, patients still faced a median delay of 35 days, compared with 29 days a decade earlier.

It appears very unlikely the goal that by 2016 all elective surgery patients be treated within clinically recommended times will be achieved. Less than 80 per cent of Category 2 elective surgery patients were admitted within 90 days in 2014-15 – a figure that has barely budged in 12 years.

The Commonwealth argues it has had to wind back hospital spending because of unsustainable growth in the health budget.

But Professor Owler said the evidence showed the opposite was the case.

The Government’s own Budget Papers show total health expenditure grew 1.1 per cent in 2012-13 and 3.1 per cent the following year – well below long-term average annual growth of 5 per cent.

Furthermore, health is claiming a shrinking share of the total Budget. In 2015-16, it accounted for less than 16 per cent of the Budget, down from more than 18 per cent a decade ago.

“Clearly, total health spending is not out of control,” Professor Owler said, and criticised what he described as a retreat by the Commonwealth Government from its responsibility for public hospital funding.

“There is no greater role for governments than protecting the health of the population,” he said. “Public hospitals are the foundation of our health care system. Public hospital funding and improving hospital performance must be a priority for all governments.”

In a statement to Fairfax Media, Health Minister Sussan Ley declined to specifically address the issues raised in the AMA Report Card.

Instead, the Minister pointed out that Commonwealth funding for hospitals was increasing on an annual basis, and there had been no policy anouncements in last year’s Budget or MYEFO affecting that. While technically correct, the Minister’s comments brush over the big changes announced in the first Hockey BUdget in 2014-15, including a massvie slowdown in the growth of Federal funding for hospitals.

The issue of hospital funding is set to loom large when the nation’s leaders meet in March to discuss reform of the Federation.

Already, several premiers are pushing for an overhaul of taxation arrangements to provide the states with a better growth revenue stream than the Goods and Services Tax.

South Australian Premier Jay Weatherill has proposed that the Commonwealth hold on to GST revenue and, in return, give the states and territories a slice of income tax receipts.

Adrian Rollins

Public hospital performance stagnating due to lack of funding: AMA

The Australian Medical Association has launched its Public Hospital Report Card 2016, and says results point to an imminent crisis.

The report card shows key performance measures such as emergency department waiting times, elective surgery waiting time and bed number ratios have either deteriorated or are stagnant.

AMA President Professor Brian Owler said these results are a direct consequence of reduced funding from the Commonwealth.

“The States and Territories are facing a public hospital funding ‘black hole’ from 2017 when growth in Federal funding slows to a trickle,” Professor Owler said.

“From July 2017, the Commonwealth will strictly limit its contribution to public hospital costs.

“Growth in Commonwealth funding will be restricted to indexation using the Consumer Price Index (CPI) and population growth only.

“Treasury advised the Senate Economics Committee that this change will reduce Commonwealth public hospital funding by $57 billion over the period, 2017-18 to 2024-25.

“As a result, hospitals will have insufficient funding to meet the increasing demand for services,” Professor Owler said.

The current report card shows that:

Hospital bed to population numbers have remained constant despite there being an increased demand for hospital services
68% of emergency department patients classified as urgent were seen within the recommended 30 minutes. The target for this is 80%
Under the National Emergency Access Target (NEAT), 90% of patients should be treated within four hours of presentation to an Emergency Department. In 2014/15, only 73% were treated in this time frame.
Under the National Elective Surgery Target (NEST), 100% of all urgency category patients waiting for surgery should be treated within the clinically recommended time however in 2014-15, 78% of elective surgery category 2 patients were admitted within the clinically recommended time (within 90 days).

Professor Owler believes it’s a lack of focus on public hospitals since the 2014 budget that has led to poorer outcomes.

He told ABC Breakfast: “The incentives and funding was there for infrastructure and [indistinct] ward funding was all taken away. And, naturally enough, we’ve seen these performances stripped backwards.”

He also said emergency departments are under increased stress with an increase of patients.

“We’re seeing more and more patients present to emergency, and they’re not GP-type patients; these are higher triage category patients, they’re sicker patients. These are the patients that are actually – represent the growth in the presentations to our hospitals.”

Related: Hospital cuts cloud reform outlook

Opposition health spokeswoman Catherine King said the government’s decision to walk away from Labor’s funding agreement with the states and territories would lead to further increase in emergency department wait times and big increases in elective surgery wait times.

“Patently, the current arrangements are inadequate and demonstrate that this government has no interest in health reform or ensuring every Australian has access to high quality hospital care,” she said in a statement.

Health Minister Sussan Ley has previously denied the AMA’s claims that multi-billion dollar “black hole” for hospitals.

“What we are focused on in the Federal Government — and what all governments should be — is efficiency,” she said in April 2015.

“Let’s get the best bang for our dollar, wherever it goes.”

The AMA Public Hospital Report Card 2016 is available at https://ama.com.au/ama-public-hospital-report-card-2016

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