Patients’ ability to use private cover in public hospitals must not be curtailed

The AMA is advising the Federal Government to reject any policy proposals that limit patients’ ability to use their private health insurance for treatment in a public hospital, warning that such a move would restrict patient choice and further disadvantage public hospitals.

In its submission to the Government’s paper, Options to reduce pressure on private health insurance premiums by addressing the growth in private patients in public hospitals, the AMA strongly rejects all of the options proposed.

AMA President Dr Michael Gannon said the options would have a negative impact on the health system and should be dismissed out of hand.

“The options raised in this paper would simply reduce the level of funding available to public hospitals in favour of private health insurers, and significantly reduce the health care choices available to privately insured patients,” Dr Gannon said.

“Patient choice is a fundamental feature of our health system, which includes the option for patients to use their private health insurance in a public hospital.

“There are very good reasons why a patient may choose to use their private health insurance for treatment in a public hospital.

“In regional and rural areas, there may be no other option available due to the lack of private sector services.

“Public hospitals are also equipped to handle the most complex of cases and, in many cases, may represent the most appropriate clinical setting for treatment.

“It may also be the most cost effective option for a patient, particularly in light of the growing number of private health insurance policies with exclusionary features or excesses and co-payments.

“A patient may also wish to be able choose to be treated by a doctor who they have previously seen or know.

“There are also significant benefits that flow to public hospitals.

“In a constrained funding environment, the supplementary revenue generated from private patients makes an important contribution towards the recruitment and retention of medical practitioners, improved staffing, teaching, training, and research, and the purchase of modern new equipment.

“All these resources support and enhance the delivery of high quality care to public and private patients alike.”

Dr Gannon said the private health insurance lobby was guilty of blatant hypocrisy.

“On the one hand, the industry is offering and promoting public hospital-only private insurance policies, but at the same time objecting to more and more of their members opting to use their insurance in a public hospital,” he said.

“Insurers and governments only have themselves to blame for patients increasingly choosing to be treated as a private patient in a public hospital.

“The private health insurers offer a bewildering array of products, with varying levels of cover and many exclusions, which often leave patients confused and shocked when they find out that common medical procedures are not covered by their expensive insurance policy.

“This is compounded by the stagnation of the indexation of the Commonwealth Medicare Benefits Schedule (MBS) and medical fee schedules offered by the private health insurers.

“On top of this, public hospital funding has failed to keep up with community demand for services, with the Commonwealth and the States and Territories guilty of under-delivering in this area for many years.

“If the Government and the private health insurers want to see fewer patients opt to use their private health insurance in a public hospital, we will need to see significantly improved long-term funding for public hospitals, private health insurance policies that meet the common medical needs of consumers, and clear articulation of the different levels of coverage so that they are easily understood by consumers.

“If there is evidence of cost shifting, or concerns that private patients are jumping the queue in public hospitals, this needs to be addressed through stronger provisions and improved compliance arrangements in future COAG Hospital Funding Agreements.

“The development of a durable solution to this issue needs to be proportionate, and considered in the context of broader private health insurance reforms and future public hospital funding arrangements.

“This will require extensive consultation, including with the States and Territories which, in relation to private patients in public hospitals, appear to have had very limited input to date.”

The AMA submission is as submission/private-patients-public-hospitals

MARIA HAWTHORNE

Medical Students call for clearer pathways for reporting sexual assault

The Australian Medical Students’ Association (AMSA) has raised serious concerns about recent incidents of two medical students falling victim to alleged sexual assaults at Royal Darwin Hospital.

AMSA, the peak representative body for Australia’s 17,000 medical students, believes that both the historical institutional culture of dominance in medicine and lack of clear reporting pathways are to blame for the ongoing problem of sexual harassment and assault.

While two doctors have been stood down over the separate incidents at Royal Darwin Hospital and clinical placements have been suspended in the department, AMSA says there is a desperate need for wider action to see an end to this behaviour.

“Unfortunately we continue to hear of stories of sexual harassment and assault of students on clinical placements. It is not uncommon; however, more often than not, it goes unreported. The stories we see in the news are only scraping the surface of a much larger systemic problem,” AMSA President Rob Thomas said.

Rob Thomas believes that there are many reasons that students feel they are better off not reporting experiences of sexual harassment and stems from: a lack of satisfactory mechanisms of addressing inappropriate behavior; fear of reprisal; and a negative impact on their studies.

Recently at the request of Australia’s 39 universities, the Australian Human Rights Commission has conducted a national, independent survey of university students to gain greater insight into the nature, prevalence and reporting of sexual assault and sexual harassment at Australian universities.

The Australian Human Rights Commission found that across all university settings, the Commission found that women were three times as likely as men to be sexually assaulted in 2015 or 2016 and almost twice as likely to have been sexually harassed in a university setting in 2016.

The Commission’s research also revealed that most students who were sexually assaulted or sexually harassed at university in 2015 and 2016 did not make a formal report or complaint to their university.

Rob Thomas says the problems associated with medical students reporting sexual assault is exacerbated because they: “exist in an awkward interim space between the university where their degrees are accredited and hospitals where they undertake their clinical placements.”

The result is that the dual reporting structures of each institution’s sexual harassment policies are often either inaccessible or difficult to enforce. AMSA believes that the solution requires a cooperative and independent process between Universities and health services.

An important part of changing this side to the culture of medicine will be improved knowledge, access and effect of incident reporting structures and mechanisms for dealing with inappropriate behaviour.

According to current statistics, one in three Australian women over the age of 15 will experience physical violence, and almost one in five will experience sexual violence. Living safe and free from violence is everyone’s right; reducing violence is everyone’s responsibility.

The National Sexual Assault, Family & Domestic Violence Counselling Line for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault is: 1800RESPECT (1800 737 732).

MEREDITH HORNE

Nation-first pill testing trial at Canberra music festival

Australia’s first pill testing trial will be held at a music festival in Canberra later this year, prompting applause from drug reform advocates but concern from the Federal Government.

Revellers at the Spilt Milk festival in November will be able to have their illicit substances tested for purity and authenticity, and will have the option of safely disposing of the pills if they turn out to be not what they thought they had purchased.

ACT Health Minister Meegan Fitzharris said the testing would be provided free by the Safety Testing and Advisory Service at Festivals and Events (STA-SAFE), which is led by Harm Reduction Australia, Australian Drug Observatory, Noffs Foundation, DanceWize and Students for Sensible Drug Policy.

A similar proposal for another festival in May was denied.

Ms Fitzharris said the decision had been made after careful assessment of the STA-SAFE proposal, and of pill testing schemes in New Zealand and Canada.

“We need to find the right balance between letting young people know it’s illegal to take drugs, they can be very harmful, but also being realistic because we’ve seen deaths at festivals, five in 2015 alone, so if that helps to keep people safe, it’s worth doing,” Ms Fitzharris said.

“Pill testing means young people who are considering taking drugs can be informed about what’s really in their pills, and how potent they are, and it creates an opportunity to remind them of the risks before they make the final decision to take a drug.”

While the AMA has always supported a range of drug harm minimisation measures, AMA President Dr Michael Gannon raised concerns that the trial might send the wrong message.

“We do need to do better but we also need real evidence that something works,” Dr Gannon told The Project.

“And the last thing we would want to do is give people a false sense of security about taking illegal drugs cooked up in someone’s bath tub.”

The AMA is concerned that pill testing does not entirely remove the risks associated with taking illicit drugs, as people react to drugs differently, and may also be influenced by the amount of drug consumed, gender, age, weight and other substances consumed such as alcohol.

The announcement coincided with the launch of a new national TV and online advertising campaign cracking down on ice and party drugs, aimed at school leavers who are preparing to celebrate the end of their school education.

Federal Health Minister Greg Hunt said while the pill testing trial was a matter for the ACT Government, the Federal Government did not support it “as a matter of principle”.

“Saying that any drug is okay is not okay,” Mr Hunt told Weekend Sunrise.

“People can have a reaction to any drug. There are no safe illicit drugs, and I think that’s a very important message.”

Festival goers will be able to attend a medical tent and provide a sample of a drug to be tested using laboratory grade equipment for free.

After receiving the results, the person will have the option of keeping the pill or discarding it in an amnesty bin containing bleach.

Regardless of the test outcome, trained drug counsellors will warn festival goers about the health risks of illegal drugs.

Dr David Caldicott, an emergency medicine specialist and advocate for Harm Reduction Australia, said the move would stop people taking drugs and prevent deaths.

Research from overseas programs showed up to 60 per cent of people who had their pills tested went on to throw them away, he said.

ACT Chief Police Officer Justine Saunders said ACT Policing supported the program and had been actively working with ACT Government and stakeholders.

“ACT Policing will be patrolling the festival to ensure patrons enjoy the event in a safe environment,” she said.

“Police will not enter the health facility that contains the pill testing station unless requested to do so by festival organisers, security staff or emergency services or in response to an emergency situation.”

MARIA HAWTHORNE

Calls for internet addiction to recognised as a medical condition

Pathological internet addiction that triggers deviant behaviour on social networking sites (SNS) should be recognised as a disorder needing treatment, according to Dr Mubarak Rahamathulla, from Flinders University.

Dr Rahamathulla, a senior lecturer in social work at Flinders University has also called for more research into intervention therapies.

In Australia internet addiction is currently not recognised as a clinical disorder.

In 2008, China became the first country to declare internet addiction a clinical disorder, Internet Addiction Disorder (IAD).

Dr Rahamathulla believes that because individuals with the condition will not be clinically diagnosed, they are not offered support and treatment, which causes enormous additional psychological strain, and can lead to problematic deviant behaviours in cyberspace.

His research into general strain theory, where negative experiences in life can result in problem behaviours and deviance, finds a very high likelihood that internet addiction sufferers will vent their frustrations through problematic online behaviours. He says this can be expressed in an anonymous way through SNS, creating social and psychological problems for other internet users and the wider community, and lead to possible crimes.

“Our research argues that individuals with internet addiction may feel victimised and so will feel compelled to engage in a range of deviant behaviours in SNS to vent their emotional strains,” Dr Rahamathulla said.

Adult respondents in the study also reported that their online sexual correspondence through SNS are adversely affecting their real-life relationships.

While monitoring and blocking deviant behaviour is possible on such social networking sites as Facebook, Instagram, Youtube and Twitter, anti-social activity can go unhindered on private mobile messaging applications such as Facebook Messaging, WhatsApp and Google Play.

AC Nielsen estimates that in 2016 Facebook subscriptions have grown to near 2 billion people, and mobile messaging applications came second to Facebook in 2015 and are still expanding. Dr Rahamathulla’s study suggests these more private one-on-one communication channels present increased opportunities for aberrant behaviour, or trigger addictions that generate negative expression.

“The rapid shift from more public social networking to private mobile messaging communications increase the frequency of SNS use, bringing with it possible psycho-social consequences of heavy use of SNS,” Dr Rahamathulla says in his latest research paper.

However, rather than blaming the internet, he says the process that leads to pathological internet needs closer examination, identification and acknowledgement as a condition needing attention.

Dr Rahamathulla reports in his research there is currently no reliable data available to deeply analyse the nature of internet addiction.

General strain theory of Internet addiction and its association with deviant behaviours in social networking sites (SNS), by Dr Rahamathulla has been accepted for publication in the Journal of Information, Communication and Ethics in Society.

MEREDITH HORNE

The world is running out of antibiotics

The World Health Organization has confirmed in a new report that there is a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

The report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, reveals there is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli).

This is alarming because these pathogens can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

Most of the drugs currently being developed are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections. This includes drug-resistant tuberculosis which kills around 250,000 people each year.

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, believes antimicrobial resistance is a global health emergency.

“There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery,” Dr Tedros cautioned.

WHO has also identified 12 classes of priority pathogens which can cause common infections such as pneumonia or urinary tract infections but are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only eight are classed by WHO as innovative treatments. There are also very few new oral antibiotics being developed, despite these being essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” explained Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic Research and Development Partnership (known as GARDP), with Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust recently pledging more than €56 million.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme said.

WHO believes that new treatments alone will not be sufficient to combat the threat of antimicrobial resistance, and is developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

The AMA believes the over-prescribing of antibiotics is a threat to the wellbeing of Australians as we remain one of the highest consumers of antibiotics in the industrialised world. The AMA also encourages antibiotics to be responsibly prescribed.

MEREDITH HORNE

[Essay] Russian medicine: trying to catch up on scientific evidence and human values

At the beginning of the 20th century, medicine as an academic discipline and a vocational training was quite similar in Russia and in western Europe. Most professors in Russian medical faculties had some international training. Pirogov, Sechenov, Mechnikoff, and Pavlov, just to name a few, were not only exceptional scientists but typical with their international training and research experience. Yet medicine as a service to the public was underdeveloped. The access to a nurse or doctor was very limited, as described depressingly clearly in Anton Checkhov’s short stories.

[Comment] In search of global governance for research in epidemics

The west African epidemic of Ebola virus disease in 2014–15 became a major tragedy because the global system under the International Health Regulations and the governance of research related to epidemics both failed to function as needed. Research started too late and yielded only one vaccine candidate with probable effectiveness.1 Today, the international framework for epidemic preparedness and response still does not include a role for research.2 Future cross-national epidemics and Public Health Emergencies of International Concern are likely to involve pathogens that have no proven effective vaccines or specific therapeutics.

[Correspondence] Tranexamic acid for post-partum haemorrhage in the WOMAN trial

As clinicians and researchers of post-partum haemorrhage, we appreciate the clinical trial of tranexamic acid1 and applaud the researchers and results. We want to emphasise the importance of the addition of tranexamic acid to other technologies and strategies to form a complete comprehensive package for post-partum haemorrhage (or emergency post-partum haemorrhage bundle),2 which begins at the community level and proceeds, with attention to context, through primary health care to the referral-hospital level.

[Correspondence] Tranexamic acid for post-partum haemorrhage in the WOMAN trial

As one of the many collaborators who contributed to the WOMAN trial1 our team’s involvement in research that will improve maternal outcomes globally has been gratifying. 1 g of intravenous tranexamic acid given within 3 h of post-partum haemorrhage significantly reduced maternal death and the need for surgery (laparotomy). The fact that post-partum haemorrhage was defined as 500 mL or more for vaginal deliveries but 1000 mL or more for caesarean section is important to note. This difference should be considered when clinicians update local guidelines for post-partum haemorrhage.

[Perspectives] Design for life

Mention the name John Snow in conversation, and the odds are that discussion would not revolve around a 19th-century physician. Yet this particular John Snow was responsible for saving many lives after he mapped cholera cases during an 1854 epidemic in London. Snow’s map, regarded as a foundation of modern epidemiology, sits without fanfare next to another pioneering work—Florence Nightingale’s polar area diagram of causes of death in the Crimean War—in a new Wellcome Collection exhibition, Can Graphic Design Save Your Life? It’s refreshing to see these items in the limelight, alongside a collection of objects ranging from cigarette packets to drug packaging and posters to hospital spaces and signs.