Undoubtedly the health news story of the past fortnight has been the issue of waste and inefficiency in healthcare. Health Minister Sussan Ley’s launch of the Federal Government’s consultation process for its Medicare Review kickstarted a national debate about healthcare disinvestment, including here at Croakey.
The Review, to be led by Dean of the University of Sydney Medical School Professor Bruce Robinson, will examine all 5700 items on the Medicare Benefits Schedule in a bid to improve safety and accountability.
“Unfortunately the current system is lagging in the last century, with only 3 per cent of all 5700 Medicare items assessed or tested to see whether they actually work, are out-of-date or even harmful,” Ms Ley said.
Professor Robinson wrote in a piece for Croakey that the Review would focus on whether patients were being offered “the right service at the right time for the right reason”.
But this hasn’t satisfied the AMA, which has described the process as a cost cutting exercise. Shadow Health Minister Catherine King also claimed the Review would lead to health cuts.
Although Ley says she’s not interested in warring with doctors, it seems at least some doctors are spoiling for a fight. At this point it’s timely to turn to a bit of Medicare history, which puts some interesting context around both the AMA’s and Labor’s current positions.
As recently as 2009, a Labor Government also found itself in a stoush with doctors over its plans to cut the rebate for cataract surgery due to the surgery becoming cheaper and more efficient to perform. Then Health Minister Nicola Roxon lost that fight, after opthalmologists – supported by the Coalition opposition – mounted a campaign saying the moves would harm patients.
And Professor Peter Brooks reminded us on Croakey this week, of another previous attempt to forensically examine Medicare — the Relative Values Study, which began in the late 90s. This study was jointly designed by the AMA and the Federal Health Department, ran for seven years, cost significant sums of money and went nowhere.
Then Health Minister Michael Wooldridge decided the study “didn’t pass the commonsense test”, and so it was shelved. While the AMA had heavily invested in the study, the government decision to shelve it saw the assosiation escape a tricky political dilemma in not having to confront the potential for funding to move away from some of its members (proceduralists) and towards other parts of its member base (GPs, physicians) .
There was another attempt to review the MBS in 2003 with the establishment of the Attendance Item Restructure Working Group, designed to better reward quality care. This group was also supported by the AMA and it reported to then Health Minister Tony Abbott, proposing adding three new GP items to the schedule and rewarding longer consultations to the tune of $820 million. Its report joined the Relative Values Study on the shelf.
While the Robinson review is more focussed on what tests and treatments are funded rather than the previous reviews’ focus on how the MBS finances consultations, these former unsuccessful attempts to tackle the Medicare behemoth do cast a shadow over new attempts at reform.
But perhaps this is so long overdue that reform will be harder to ignore. Many doctors are in favour of this latest review, including the RACGP, which says it would be disappointing if it were dominated by politics.
Other groups, including the Greens and health funds, have come out in support. And as evidence emerges, such as the AIHW health expenditure report card, to show patients are footing more of the healthcare bill themselves, and a new report from the National Health Performance Authority showing cost is preventing rural and regional patients from accessing GP care, pressure is mounting for every taxpayer dollar spent on health to be better targeted and efficient.
The launch of the Choosing Wisely campaign in Australia has added further momentum to this important issue, and most recently it has been brought into sharp relief with this week’s Four Corners program. The documentary by Dr Norman Swan made a number of arguments, including that $46 billion a year is squandered on unnecessary tests and procedures.
Ray Moynihan, who has been prosecuting similar arguments for a considerable period of time, gave a good overview of the issue for The Conversation, also published here at Croakey.
However, AMA president Dr Brian Owler criticised the program as inaccurate and unfairly targeting GPs.
Meanwhile, the RACGP is pressing on, releasing its Choosing Wisely list of inappropriate treatments GPs should avoid, as well as proposals for a shake-up of Medicare financing based on the concept of a medical home, which it says would increase access, decrease use of inappropriate services and support preventive health.
New movers and shakers
Prime Minister Malcolm Turnbull’s announcement of his new Ministry got the nation’s attention this past fortnight, and of course we all know by now that Sussan Ley remains our Health Minister and belatedly assumed responsibility for ageing, Ken Wyatt, the new Assistant Health Minister, made history in becoming the first Indigenous Minister, rising star Christian Porter became the new Minister for Social Services and Fiona Nash was given the role of Rural Health Minister.
In Labor ranks, new Senator and former ACT Chief Minister Katy Gallagher has been promoted to the Opposition frontbench, and while she says health interests her, she expects to take a role in the outer shadow ministry.
The Turnbull health-related Ministry line-up has been broadly welcomed and if you missed some of the reaction you can catch up with Croakey’s wrap here.
But what will it all mean for health and healthcare? In this Croakey post, Tim Senior, Mark Lock and Keran Howe assess the risks and opportunities. Tim Senior says there will be continued pressure on Ley, Wyatt and Nash to make savings rather than improve health. And Mark Lock notes there will need to be strong connections between the health portfolio and new Minister for Cities Jamie Briggs to promote a whole-of-government approach to creating healthy built environments, particularly for Aboriginal people.
In part one of a Croakey series on health prospects in a Turnbull Government, Jennifer Doggett suggests that those who want to influence healthcare policy should be looking beyond the health portfolio and win the hearts and minds of those who really hold the purse strings – Treasury, Finance and Prime Minister and Cabinet.
Justice and health for Aboriginal people
Australia has redefined hypocrisy in aiming for a seat on the UN Human Rights Council, wrote Sol Bellear in a blog for the Huffington Post. He said Australia’s history on human rights meant allowing it too join the council would be like “putting a fox in charge of the hen house”.
“My people today are not only the most jailed people in Australia … we are also one of the most jailed people in the world,” he wrote.
His comments followed news that the Human Rights Law Centre has requested a UN investigation into the mistreatment of young people at the Northern Territory’s Don Dale Detention Centre. As reported on Croakey, an NT Children’s Commissioner report into an alleged 2014 riot by six juvenile detainees detailed appalling treatment at the Centre, including hooding and cuffing as restraint practices.
In Canada, there was also discussion about incarceration rates of First Peoples. At a panel event titled ‘Injust justice’, researchers said incarceration rates of Aboriginal people in Canada had jumped by 47% in the past decade.
Canada, along with New Zealand, joined the National Health and Medical Research Council recently to publish a series of special collections on Indigenous health. This was to mark the United Nations International Day of the World’s Indigenous Peoples held in August. An MJA article on the special collection can be found here.
And as Australia watches to see what move the Turnbull Government will make next, there have been calls from Indigenous leaders for it to abandon its controversial Indigenous Advancement Strategy, which is threatening the future of many child welfare and family centres.
The issue of racism and health featured this past fortnight with the Australian Indigenous Doctors’ Association calling for more cultural awareness training in the medical profession. Attitudes created so many barriers, both for patients using healthcare services and Aboriginal people who wanted to become doctors, the association told the ABC.
The Conversation also addressed racism, with authors Nicholas Biddle and Naomi Priest from ANU arguing that Closing the Gap initiatives on education ignored racism, which was a driver of school attendance rates and educational attainment.
Drug use and how it is affecting Indigenous communities was also an issue of discussion this past fortnight. In the WA town of Kununurra, the community is struggling with social problems to such an extent a group of locals formally asked if the town could trial the ‘healthy welfare card’ proposed by Andrew Forrest, the SMH reported.
Not all in Kununurra back the move, however, and the town is divided over how to address alcohol-related violence and drug use. This SBS article looked at how Indigenous communities in Queensland are preparing to confront the looming threat of ice addiction.
Gun control – more of the same
The latest mass shooting in the US has once again focused attention on gun control, with a visibly frustrated and angry President Barack Obama saying it was terrifying as a parent to live in a country where events like this had “become the norm”.
“Our thoughts and prayers are not enough. It does nothing to prevent this carnage from being inflicted some place else in America next week or a couple of months from now. And what’s become routine, of course, is the response of those who oppose any kind of common-sense gun legislation. “Right now, I can imagine the press releases being cranked out. ‘We need more guns,’ they’ll argue. ‘Fewer gun-safety laws.’ “Does anybody really believe that?”
Former Australian deputy prime minister Tim Fischer was reported as saying it was time for Mr Obama to use his last 15 months in office to make headway on gun laws. And this blog post on Forbes.com reiterates the call to treat gun violence like the public health problem it is, if the US is to make any progress on gun law reform.
Tragically, Sydney was dealing with a shooting of its own after it was reported that a 15 year-old boy murdered NSW Police finance worker Curtis Cheng outside NSW Police headquarters at Parramatta in what Police Commissioner Andrew Scipione described as a terrorist attack. He said investigations had begun into how the boy had obtained the gun.
Public health in the spotlight
As the Population Health Congress in Hobart wrapped up, Croakey asked some of the participants for their thoughts on what they would take away. Renewed focus on advocacy and importance of a joint approach from researchers and practitioners were just a few. Read more about the highlights here or go to the full conference coverage.
We ought to celebrate the achievements of public health practitioners whose work isn’t often lauded, wrote Associate Professor Julie Leask in this Croakey blog post reflecting on her recent success at the Sax Institute’s Research Action Awards. The awards are designed to recognise researchers whose work makes a real-world impact on healthcare delivery and Leask says it’s important to be able to celebrate public health success in this way.
In the US, Surgeon-General Vivek H. Murthy told the Yale School of Public Health that a “Golden Age” of public health was within our reach – “an epoch marked by fairness and equality, where different sectors unite in the common cause of promoting health for all citizens”. Nice to hear such a positive assessment.
More pharma sagas
He’s been described as healthcare’s Gordon Gekko and he has created a social and mainstream media storm. Martin Shkreli’s company Turing Pharmaceuticals, raised the price of of its antimalarial drug Daraprim from US$18 to US $750 per pill because he openly says it just wanted to make more money. This Washington Post article is a good, yet depressing read.
Wired.com looked at how prescription drugs in the US got to be so expensive – also interesting reading in light of the current negotiations over the Trans Pacific Partnership, which have seen the US bringing pressure to bear on Australia to increase IP protection for biologic pharmaceuticals beyond the current five years.
The SMH reported Trade Minister Andrew Robb as saying Australia would not do anything to undermine the health system or increase the price of medicines. And Sussan Ley meanwhile, said something needed to be done about delay in US pharma companies bringing their drugs to the Australian market.
“Unfortunately Australia is disadvantaged because drug companies often delay bringing new medicines down under – sometimes by up to 15 months – in favour of making applications in more-lucrative markets such as the US and Europe first,” the Australian Journal of Pharmacy reported her as saying.
At the same time as US pressure was being brought to bear over the TPP, Democrat presidential candidate Hilary Clinton was talking about the need for measures to reduce out-of-pocket healthcare costs for patients, particularly in the area of prescription drugs.
Her prescription drugs plan would include, among other things, capping out-of-pocket prescription costs.
Other Croakey reading you may have missed this fortnight:
Kellie Bisset is the Sax Institute’s Communications Director. Follow her on Twitter @medicalmedia.