more_vertWe read with interest the Article by Mark Barone and colleagues (July 4, p 56).1 These researchers are to be congratulated on doing a randomised trial across Africa in resource-poor hospitals providing services to a group of severely disadvantaged women.
Preference: Statistics, epidemiology and research design
1138
[Editorial] Advancing China’s health and medical science
The Lancet and the Chinese Academy of Medical Sciences (CAMS) held the first of what will become their annual Health Summit in Beijing last week. More than 500 delegates, most from China, participated. 30 research abstracts were selected from among 600 submissions for oral presentation, together with around 100 posters. Four keynote speeches highlighted critical aspects of China’s endeavour to achieve universal health coverage by 2020: Nanshan Zhong spoke about the continuing threat of air pollution and chronic airway diseases; Wang Yu described the neglected challenge of hepatitis B and C; Richard Peto set out a comprehensive strategy to halve premature mortality; and Xuetao Cao presented a manifesto for strengthening the scientific capacity of China to meet the needs of its 1·3 billion people.
[Correspondence] Alzheimergate: neither miscommunication nor sensationalism
In the Editorial “Alzheimergate? When miscommunication met sensationalism” (Sept 19, p 1109),1 I appreciate that The Lancet has acknowledged the critical role press officers play but having lifted the lid on the architecture of these stories it fails to convey the complexity. Far from applying “goodwill and hope”, seasoned press officers at Nature, Medical Research Council, and UCL recognised the potential for alarming headlines and worked hard to ensure the findings were communicated carefully with caveats emphasised.
[Correspondence] Faith-based organisations and health care: invest, don’t proselytise
I am inspired to see The Lancet, one of the world’s most esteemed research journals, focus its attention on the role of faith-based organisations in delivering health care to vulnerable individuals and communities that mainstream health-care professionals find it difficult to penetrate. We, at the American Jewish World Service are deeply involved in this work, supporting more than 500 local grassroots organisations in some of the poorest countries in the world to fund innovative approaches to tackling HIV/AIDS, Ebola, and other public health challenges as part of our focus in the developing world.
Nation’s cut-price health system ‘performs well’: OECD
Australia’s health system has been given a big tick by the Organisation for Economic Co-operation and Development for delivering world-class life expectancy and cancer survival rates despite below-average funding.
In its latest Health at a Glance report, the OECD reported that Australia’s average life expectancy of 82.2 years was the sixth highest among the world’s richest countries, and its record on breast and colorectal cancer survival was “among the best”.
Significantly, given the Federal Government’s claims of unsustainable growth in health spending, the Organisation reported that Australia’s expenditure was 8.8 per cent of gross domestic product, below the OECD average of 8.9 per cent.
“Australia performs well in terms of overall population health status,” the OECD said. “[It] achieves good outcomes relatively efficiently.”
But, echoing AMA arguments for increased investment in general practice, the Organisation said the country could cost-effectively achieve even better outcomes if it cut down on the number of patients with chronic health problems who end up in hospital.
It found that Australia had among the highest rates of avoidable hospitalisations for patients with asthma and chronic obstructive pulmonary disease among its member countries, and recommended a greater emphasis on treatment by family doctors.
“Effective treatment for these conditions can be delivered at a primary care level, negating the need for hospital admissions that are not in the best interests of patients, and are more costly for the health system,” the OECD said. “A well-organised primary health care system emphasises health promotion and prevention, and educating patients about self-management of chronic disease.”
Its comments are in line with AMA calls for greater support for GPs in managing patients with chronic conditions and providing health promotion and preventive care, and came a day after the release of a major report showing there has been a blow-out in the demands faced by GPs from an aging population with increasingly complex health needs.
The Bettering the Evaluation and Care of Health (BEACH) report from Sydney University’s Family Medicine Research Centre found that older patients were seeing their GP more often, and with a wider array of health problems.
Because of this, doctors are having to spend more time with each patient – on average, a little less than 15 minutes – heightening the financial strain caused by the increasingly inadequate Medicare rebate, which has been frozen by the Federal Government until mid-2018.
The BEACH researchers said GPs were playing a crucial ‘gatekeeper’ role in preventing duplication and ensuring the coordination and continuity of care patients receive from hospitals, specialists, allied health professionals and other providers, and recommended greater support for them in carrying out the role.
With the incidence of patients with multiple complex and chronic health complaints set to increase as the population ages, AMA President Professor Brian Olwer said the Government needed to lift its investment in general practice.
Out-of-pocket costs among highest
AMA concerns that the Government is increasingly abrogating its health responsibilities and dumping more of the cost of care on to patients, the OECD found that Australians face above average out-of-pocket costs.
It reported that 20 per cent of health spending comes directly from the pockets of patients – much more than is faced by patients in other countries with Government-funded health systems like the United Kingdom, Canada and New Zealand – and jumped by 1 percentage point between 2008 and 2012.
The OECD warned that in such an environment, there was a heightened risk that increasing the barriers to access to care could “unduly affect” the sickest and most vulnerable.
In conclusions that that endorse the AMA’s successful campaign last year and early this year against Coalition Government proposals for an up-front patient charge to see their GP, the OECD said that “co-payments remain a blunt policy instrument that can have many unintended consequences, particularly when the prevailing economic conditions are simultaneously reducing incomes for many citizens”.
“The risk remains that citizens forego needed care that can have long-term adverse health outcomes,” it said.
“Given the current level of out-of-pocket payments in Australia, there is a need to ensure that policy options aimed at improving the appropriate use of care do not unduly affect the most vulnerable, and the overall burden of out-of-pocket payment I the community more generally.”
The OECD report can be viewed at: http://www.oecd.org/health/health-at-a-glance-19991312.htm
An interactive chart comparing Australian and OECD helath spending can be viewed at the folling link:
Adrian Rollins
[Perspectives] Avraham Steinberg: leading light in faith-based medical ethics
Avraham Steinberg seems to fit the description of multitasker, for even at 67 years of age he juggles prominent and diverging areas of work in Jerusalem: as consultant paediatric neurologist at the Shaare Zedek Medical Center, as co-Chair of Israel’s National Bioethics Council, as researcher and consultant on Jewish medical ethics, and as an expert witness in court for personal injury and malpractice suits. “I’ve always loved working, and am lucky in being able to turn my mind from one project to another fairly quickly; I often set aside minutes, rather than hours, to do tasks, but am in bed by 11pm.
Cost-effective GPs a health saving
A major study has found that the nation’s GPs are playing a vital role in holding health costs down, calling into question the Federal Government’s push to gouge money out of primary care to boost the Budget bottom line.
Sydney University health researchers have found that GPs are playing a crucial role in caring for aging patients with multiple and complex health problems, helping them lead longer and healthier lives at a fraction of the cost of other health systems, particularly the United States.
The conclusion is politically awkward for the Federal Government, which has targeted the health budget for cuts, claiming that Medicare expenditure is out of control.
The Government has imposed a four-year freeze on Medicare rebates, and Health Minister Sussan Ley has directed a review of the Medicare Benefits Schedule to achieve savings that can be ploughed back into general revenue.
The Minister has sought to justify the cuts by accusing doctors of manipulating and exploiting the Medicare system for personal financial gain – a line of attack that AMA President Professor Brian Owler has condemned as deeply offensive.
The latest report from the long-running Bettering the Evaluation and Care of Health (BEACH) study being undertaken by the Family Medicine Research Centre backs AMA warnings that the Government’s attack on primary health care funding is misguided and will cost both patients and the country dearly.
The BEACH report found that the aging of the population is imposing an increasing burden on the health system.
While less than 15 per cent of all Australians are aged 65 years or older, they are twice as likely to see a GP, have a pathology test, see a specialist and be on medication as the rest of the population.
This is due, to a large extent, to the fact that they tend to have multiple chronic health complaints – the study found 60 per cent of them had three or more health problems, and a quarter had five or more.
And the health demands of older Australians are growing quickly – their use of GP time, diagnostic tests, medicines and referrals is expanding much more rapidly than their numbers would imply.
But, despite this, Australia’s total health spending as a proportion of GDP is on a par with countries such as Britain, Canada and New Zealand while achieving among the longest life expectancies in the world – and is far better than the United States, which spends double the amount but whose life expectancy is four years shorter.
The BEACH researchers attributed this world-class result to the work of the nation’s GPs and central role they play in the health system.
“One of the biggest differences between the health care systems in Australia and the United States is that primary care is the core of Australia’s system, with GPs acting as ‘gatekeepers’ to more expensive care,” they said. “If general practice wasn’t at the core of our health care system, it is likely the overall cost of health care would be far higher.”
The BEACH researchers said that the early diagnosis of health complaints and increasing life spans meant people were living longer with complex conditions, adding greatly to health costs: “This is the price Australia pays for good health, but we would argue this price is very reasonable”.
GPs are central to holding costs down, in large part because of the work they do in co-ordinating the care provided by hospitals, specialists, allied health professionals and community and aged care services.
The BEACH researchers said this coordinating role was crucial because it cut down on duplication of tests and helped ensure continuity of care – both considered vital in sustaining health and holding down costs.
They found that 98.6 of older patients had a general practice they usually attended – a de facto ‘medical home’.
“If our Government wants to make our health care system sustainable, it should invest in primary care to improve the integration of, and communication between, these different parts of the health system,” the researchers said.
“Further strengthening the role of general practitioners will reduce unnecessary interventions in the secondary and tertiary health sectors.”
Adrian Rollins
[Comment] Respiratory medicine and critical care: a call for papers
As health care becomes ever more complex and the approach to treatment more personalised, research is a vital component in our mission to help improve the lives of patients living with respiratory diseases. From understanding the genetic links to disease to cutting-edge treatments, high-quality research helps us to navigate the intricate path to optimum care for patients.
Dementia ‘flying squads’
Mobile ‘flying squads’ of clinical experts will soon be on-call nationwide to help aged care homes confronting crisis situations because of the violent or extreme behaviour of residents with dementia.
Health Minister Sussan Ley has announced $54.5 million will be used to establish Severe Behaviour Response Teams which can be called in on four hours’ notice to help aged care providers trying to cope with residents posing a significant risk to either themselves or others.
The Minister said the initiative was intended to help minimise the number of times aged care home residents with dementia are “unnecessarily” transferred to higher security or acute facilities.
“Like all of us, aged care residents are most comfortable in a familiar environment and this program will provide that helping hand to better manage people in their current community who exhibit severe behaviour because of their dementia,” Ms Ley said.
“This initiative will provide additional support in a crisis situation to residents, who may be hitting out at people around them, and manage their behaviour so they can remain in their familiar aged care home.”
Under the program the teams, to operate between 7am to 7pm seven days a week, will contact the aged care within four hours of receiving a call to discuss interim action, and within 48 hours will hold either a face-to-face or telehealth conference to work on immediate and longer-term care plans.
The support from the teams is in addition to the work done by the existing Dementia Behaviour Management Advisory Services, and is intended to focus solely on residents that pose a threat to themselves or others, such as hitting out at other patients or staff, breaking furniture or windows, ongoing aggressive behaviour and a history of attempting to leave.
The service, which will cover all Commonwealth-funded residential aged care facilities, will be established and operated by HammondCare, which Ms Ley said had a successful history of providing dementia care to high-need residents.
Under the contract, HammondCare is required to provide the same level of service across the country, regardless of location.
Despite the company’s expertise, the Government has emphasised that the teams will not be a substitute for existing emergency and mental health services.
“As is currently the case, all emergencies will be referred to the appropriate state-based paramedic service, who are responsible for providing an immediate emergency response,” the Health Department said.
More information about the Severe Behaviour Response Teams can be found at: https://www.dss.gov.au/ageing-and-aged-care/older-people-their-families-and-carers/dementia/severe-behaviour-response-teams-information-pack
Dementia research boost
The Federal Government has announced a second round of grants worth $43 million to fund research into the causes, effects, treatment and prevention of dementia.
Health Minister Sussan Ley said the grants, shared among 76 researchers, would help keep Australia at the forefront of international efforts to understand and tackle the devastating disease, which currently afflicts about 330,000 Australians.
Ms Ley said the $43 million was in addition to $35 million already committed to dementia research in August, and was jointly funded by the National Health and Medical Research Council and the Australian Research Council.
The Shadow Minister for Ageing, Shayne Neumann, said the research funding boost was welcome, but called on the Government to release the results of a review into publicly-funded dementia programs that was due to report in June.
Mr Neumann said that, in addition to funding research, the Government should also be investing more into supporting those currently living with dementia and their carers.
Adrian Rollins
AMA in the News
Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.
Print/Online
Baby shaking on par with road toll, The Australian, 10 September 2015
New research shows shaking kills as many Australian babies and toddlers as car crashes. AMA President Professor Brian Owler said The Children’s Hospital at Westmead in Sydney was treating a case every month.
AMA urges surgeons to cut bullying, The Age, 11 September 2015
A Sydney senior surgeon whose comments on sexual harassment helped draw attention to widespread bullying in the profession has warned that it will be difficult to fix the problem. AMA President Professor Owler said it would be up to the current generation of surgeons to ‘‘break the cycle’’ of bullying, harassment, and discrimination in the profession.
Calling for review of health fund crisis, The Daily Telegraph, 12 September 2015
Health bodies are demanding a radical review of the private health system as health fund premiums skyrocket, hospital price gouge, and funds slash benefits. AMA President Professor Brian Owler demanded Federal Government intervention as he revealed NIB had removed more than 225 items from its schedule of medical benefits.
Boxer dies after title fight at RSL club, Sydney Morning Herald, 16 September 2015
A 28-year-old Australian boxer has died in a Sydney hospital after being knocked out in an IBF regional title fight. The AMA has released a position statement calling on boxing to be banned from the Olympic Games and the Commonwealth Games.
Medicare review placates AMA by agreeing to stagger changes, The Australian, 17 September 2015
The powerful AMA has won an early concession out of much-anticipated Medicare reforms, with the head of a review taskforce agreeing that recommend changes should be staggered to protect doctor and practice incomes.
‘Junk policies’: the private health cover ripoff, Sydney Morning Herald, 24 September 2015
Fewer than half of all private health insurance policies offer adequate cover for private hospital care, and many patients have no idea what their insurance includes, new figures show. AMA President Professor Brian Owler said policies that insured private patients in only public hospitals were junk policies and should not be allowed.
$20bn addiction to Medicare, Adelaide Advertiser, 28 September 2015
The cost of procedures covered by the Medicare Benefits Schedule has more than doubled to $20 billion a year over the past decade despite much smaller increases to Australia’s population. AMA President Professor Brian Owler said he agreed that Medicare needed to be modernised.
Authorisation to sedate ice addicts welcomed by the AMA, The Age, 28 September 2015
The AMA has welcomed new powers for emergency doctors and nurses to subdue violent ice addicts. AMA president Professor Brian Owler said doctors had already called for all hospitals to have appropriate security to deal with the increasing number of patients affected by ice.
BUPA, nib, Medibank back health review, Australian Financial Review, 29 September 2015
Health Minister Sussan Ley has dismissed the doctors’ lobby’s objections to a review of Medicare, saying the health care system is plagued by ineffective and unnecessary medical procedures and desperately needs reform. AMA President Professor Brian Owler accused Ms Ley of using the review to “cut health funding and health services” and “publicly attack the medical profession”.
Playing doctors and curses, Courier Mail, 29 September 2015
The Turnbull Government has cautioned patients against diagnosing themselves on “Dr Google” and then demanding unnecessary and costly treatments from medicos. AMA president Professor Brian Owler said it was wrong to attack doctors to try to justify cuts to Medicare.
Fees for all finished as uni plan gets the third degree, Adelaide Advertiser, 2 October 2015
Tony Abbott and Christopher Pyne’s controversial plan to allow universities to set their own fees has been dumped, in one of the first major policy shifts of the new Turnball Government. AMA president Professor Brian Owler welcomed the decision, and called on the Government to give students more certainty that degrees will not be priced out of reach.
Backing for RCH doctors, The Herald Sun, 12 October 2015
Victoria’s Health Minister Jill Hennessy has led a resounding show of support for the Royal Children’s Hospital’s demands that children be removed from immigration detention centres. AMA President, Professor Brian Owler, urged Mr Turnbull and Immigration Minister Peter Dutton to intervene.
Surgeon’s road safety plea, The Daily Telegraph, 17 October 2015
AMA President Professor Brian Owler said every new car should by law have autonomous emergency braking to stop rear-end car crashes.
Brain-injury teen stranded by beds deficit, Canberra Times, 23 October 2015
A teenage boy with a critical brain injury was blocked access to the Sydney Children’s Hospital for four days because there were not enough beds, his family was told. AMA President Professor Brian Owler said the incident highlighted that there was an issue with capacity in paediatric hospitals, both at Westmead and the Sydney Children’s Hospital.
Doctors resist camp return of asylum pair, The Age, 12 October 2015
Doctors at Melbourne’s Royal Children’s Hospital refused to discharge an asylum seeker and her child because the immigration department would have sent them back to detention at the expense of their health. AMA Vice President Dr Stephen Parnis said the association had a fundamental problem with keeping children in detention, and had been urging governments to look for any alternative to it for years.
Codeine medicines to be prescription-only next year, The Age, 2 October 2015
Common painkillers such as Nurofen Plus and Panadeine could soon require a doctor’s prescription after a shock decision by Australia’s drug regulator. AMA Vice President Dr Stephen Parnis backed the TGA’s judgement.
Radio
Professor Brian Owler, 2UE Sydney, 10 September 2015
AMA President Professor Brian Owler discussed new research which indicated that shaking kills as many Australian babies and toddlers as car crashes. Professor Owler said the Westmead Children’s’ Hospital treated a case every month.
Professor Brian Owler, 2UE Sydney, 28 September 2015
AMA President Professor Brian Owler talked through his concerns about the upcoming Medicare review and the approach that the Government was taking. Professor Owler believed it would lead to a cut to the number of services patients can access.
Professor Brian Owler, Radio National, 1 October 2015
AMA President Professor Brian Owler talked about the Turnbull Government shaking up the Medicare Benefits Schedule, with Health Minister Sussan Ley launching consultations on a review of nearly 6000 taxpayer-subsidised items on the schedule
Dr Stephen Parnis, 774 ABC Melbourne, 2 October 2015
AMA Vice President Dr Stephen Parnis talked about the rules changing around getting codeine from the chemists. Dr Parnis said the TGA, which determines what things need to put on prescription, has had an inquiry about over-the-counter medications which contain codeine.
Dr Brian Morton, ABC Gippsland, 7 October
AMA Chair of General Practice Dr Brian Morton talked about Mental Health Day and said that all employees were allowed to have ten sick days per year. Dr Morton said but it will still depend on the reason and what you will do with the sick days you will take.
Dr Stephen Parnis, 612 ABC Brisbane, 9 October 2015
AMA Vice President Dr Stephen Parnis discussed calls from health academics to ban energy drinks for people younger than 18 years of age. Dr Parnis said stimulants in the products could cause heart rates to reach dangerously high levels, arrhythmias, problems to blood vessels, difficulties sleeping or anxiety.
Dr Stephen Parnis, 3AW Melbourne, 11 October 2015
AMA Vice President Dr Stephen Parnis talked about Royal Children’s Hospital doctors protesting the detention of children in Australian detention centre. Dr Parnis said the AMA is very supportive of getting all children out of immigration detention and says they can’t see any good coming out of the situation.
Dr Brian Morton, Radio National. 21 October 2015
AMA Chair of General Practice Dr Brian Morton talked about the idea of shared doctor appointments. Dr Morton said privacy could be an issue in shared appointments.
Professor Brian Owler, ABC NewsRadio, 23 October 2015
AMA President Professor Brian Owler talked about a new domestic violence campaign being launched by the AMA. Professor Owler said doctors are being encouraged to report domestic violence.
Professor Brian Owler, 2UE Sydney, 23 October 2015
AMA President Professor Brian Owler discussed the Sydney Children’s Hospital turning away a teenage boy with a brain injury because there were not enough beds.
Television
Professor Brian Owler, Sky News Sydney, 27 September 2015
AMA President Professor Brian Owler talked about the Federal Government reviewing the Medicare system. Dr Owler said the AMA were willing to engage with the Federal Government, but says their discussion paper does not allow new procedures to be added.
Professor Brian Owler, Channel 9, 12 October 2015
AMA President Professor Brian Owler speaks to the Today Show about the Royal Children’s Hospital in Melbourne remaining locked in a bitter dispute with the Federal Government over their refusal to discharge asylum seeker children.
Professor Brian Owler, ABC News 24, 23 October 2015
AMA President Professor Brian Owler talked about the AMA launching a new domestic violence campaign, including a video encouraging patients to confide in their GPs. Professor Owler said there were “far too many” cases of domestic violence, affecting both women and children.
Dr Stephen Parnis, ABC News 24, 28 September 2015
AMA Vice President Dr Stephen Parnis discussed a Four Corners investigation that claimed the medical profession was over-servicing patients and ordering wasteful and potentially dangerous scans. Dr Parnis denied that doctors were over-servicing, but said there was a lot the AMA agrees with when it comes to more judicious care.