The column this week brings many calls for action, including for governments to do better on Closing the Gap, especially in areas such as prevention of incarceration, child protection, and suicide prevention.
There are also calls to crack down on “inflated specialist doctor fees” and the marketing of unhealthy foods, and to ban genetic discrimination in life insurance.
Workforce reforms remain a hot topic, and the health impacts of extreme weather are also in focus.
The quotable?
We can and must stop emitting fossil fuel pollution to safeguard the health of our future generations in the face of the worsening climate crisis.”
Charles Maskell-Knight writes:
In a 10 March media release headed ‘Strengthening Medicare: more doctors and larger Medicare payments for dozens of communities’, Health Minister Mark Butler announced changes to the results of the classification systems underlying bulkbilling incentives and doctor distribution.
While it is appropriate to vary the classifications due to updated census data, the changes have been implemented on a ‘no worse off’ basis. This means that as areas are moved from inner regional to metropolitan, for example, they retain their earlier classification and their higher bulkbilling incentives and Distribution Priority Area (DPA) status that makes it easier to recruit doctors.
However, as the Royal Australian College of GPs (RACGP) pointed out, as more and more areas gain access to DPA status, the benefit of that status is diluted. Once Surfers Paradise and Noosa are as special as Roma, who will go to Roma?
As 19th century sociologist WS Gilbert observed, when everybody’s somebody, then no one’s anybody.
Ministers and government
Minister Butler also announced a range of further measures to combat the illicit tobacco trade.
Assistant Minister for Health and Aged Care Ged Kearney announced grants to three frontline miscarriage support services to deliver care for women and families who have experienced miscarriage.
Most of the funding will flow to the Pink Elephants Support Network, working in partnership with the Stillbirth Centre of Research Excellence (Stillbirth CRE) and Perinatal Anxiety and Depression Australia (PANDA).
The Australian Institute of Health and Welfare (AIHW) released updated data from state and territory suicide registers, and an updated report on Alcohol treatment in Australia: Client characteristics and patterns of service use.
The Australian Commission on Safety and Quality in Health Care released resources to support implementation of the Cosmetic Surgery Standards and the Cosmetic Surgery Module introduced in 2033.
Ahpra said that the revised Registration standard: English language skills (the common ELS standard) and the Nursing and Midwifery Board of Australia’s English language skills registration standard (NMBA ELS standard) were expected to take effect from 18 March.
The current arrangements exempt practitioners from seven recognised English-speaking countries from the requirement to sit an English language test before registration. The new standard removes South Africa from the exempt list, but adds 24 new countries, including many from the Caribbean.
The Australian Bureau of Statistics marked 14 March (Pi day) by reporting that in the 2021 Census, 3.14 percent of all bakers in Australia were women working in SA.
Consumer and public health groups
I have been reporting for some time on the issue of large out-of-pocket costs for specialist services, as each month the AIHW releases data showing that the Medicare Benefits Schedule (MBS) rebate for these services is around half of the fee charged.
Patients Australia (formerly the Australian Patients Association) has now released the results of a survey with almost 5,500 respondents. It found that “over a third of Australians surveyed (37 percent) experienced psychological distress from out-of-pocket medical costs, with one in five patients skipping specialist appointments or declining treatment due to cost”.
(Details of the sampling methodology used in the survey were not included in the statement.)
Dr Nick Coatsworth, Patients Australia’s Ambassador for Health Reform, said “billing practices that are invisible to government need to be banned, and we need to do that because it’s impossible to assess the impact of tax-payer funded Medicare rebate increases unless every doctor is transparent about their out-of-pocket fees”.
Private Healthcare Australia (PHA, the private health insurance lobby group) responded to the report, calling for “urgent action to crack down on inflated specialist doctor fees”.
PHA CEO Dr Rachel David said “while most specialist doctors charge appropriately and fairly, there is increasing evidence that more are charging very high fees and billing inappropriately”.
“Some are taking deliberate steps to avoid billing through Medicare and private health insurance channels so they can get away with charging patients additional ‘hidden’ fees,” she said.
David also argued that patients avoiding specialist consultations due to cost was resulting in reduced private hospital utilisation and contributing to financial pressure on the sector.
Next week’s column will report more on the news today that the Government will ensure all specialists fees are available on the Medical Costs Finder website. Minister Butler said that when he took on the portfolio, of the 11,000 specialists covered by the scheme, only seven had registered to disclose their fees.
The Public Health Association of Australia (PHAA) commented on research released in the Australian and New Zealand Journal of Public Health using Australian dietary data from the period 2015 to 2023 to track current diets and model future trends.
The authors predict that by 2030:
- adult fruit intake will drop by almost 10 percent
- adult discretionary/unhealthy dietary intake (including sugary drinks and ultra-processed foods) will rise by 18 percent
- vegetable intake will remain stable, but well below government targets.
PHAA said the National Preventive Health Strategy aims to ensure adults meet health recommendations, including consuming two serves of fruit and five serves of vegetables every day, while only getting 20 percent of their daily energy from unhealthy, discretionary foods.
PHAA CEO Adjunct Professor Terry Slevin said the “study shows that without action we are going to fall woefully short of this target”.
PHAA called on “all political candidates to commit to comprehensive action, including improving unhealthy food marketing regulation, implementing mandatory Health Star Ratings on packaged foods, and funding ongoing public health education campaigns to promote healthy food choices”.
First Nations health
The Productivity Commission released the latest Closing the Gap dashboard, showing that only four of the 17 socioeconomic targets are on track to be met.
In many areas, such as child removal, adult imprisonment, and suicide, the situation is worsening. For example, there was a 15 percent increase in the imprisonment rate of First Nations adults in 2024.
The Victorian Government’s reactionary proposals to tighten bail laws (covered here by Croakey) will only exacerbate this trend.
Productivity Commissioner and Gungarri man Selwyn Button called the continuation of business-as-usual by governments “the definition of insanity”.
Catherine Liddle, deputy convenor for the Coalition of Peaks, which represents more than 80 Aboriginal and Torres Strait Islander community-controlled peak bodies, said all levels of government must deliver on their commitments under the 2020 National Agreement.
Liddle also said “the data is beyond serious…what we need is governments of all colours to step up”.
“We’re seeing areas that need critical and urgent attention, like incarceration, child protection, suicide targets. Those things are interlinked, and they’re moving too slow,” she said.
NACCHO CEO Pat Turner discussed the results in Croakey, arguing that “we need action, accountability, and unwavering commitment to closing the gap”.
The Australian Medical Association (AMA) also commented, with President Dr Danielle McMullen saying “it is crucial for all government departments and mainstream organisations to enable and embed First Nations leadership in the design of policies and programs aimed at improving outcomes for Aboriginal and Torres Strait Islander peoples”.
“We are disappointed to see progress going backwards in many areas of the National Agreement on Closing the Gap, which shows the current approach simply isn’t working,” McMullen said.
The Australian Healthcare and Hospitals Association (AHHA) announced that the Australian Health Review has released a new collection of articles focused on the health and wellbeing of First Nations Australians, Beyond Closing the Gap.
AHHA said that the Policy Reflection from Dr Alicia Veasey, a proud Torres Strait Islander woman, obstetrician and gynaecologist, “reasons that Australia’s failure to address social and political determinants of health stems from short-term political interests and a reluctance to share power with communities – particularly Aboriginal and Torres Strait Islander peoples – hindering progress towards health equity”.
Trade unions
Advanced Pharmacy Australia (AdPha) marked the start of MedsAware Deprescribing Action Week.
AdPha said that as pharmaceuticals accounted for 20 percent of health sector greenhouse emissions, MedsAware this year would also “shine a light on how deprescribing can also positively impact the environment”.
In the wake of Cyclone Alfred, the Australian Association of Psychologists (AAP) reiterated its call for the specific Medicare item numbers for disaster counselling – under which people could self-refer to a psychologist – to be reinstated and to include any large-scale disaster. The measure was originally introduced after the Black Summer bushfires in 2020.
Executive Director Tegan Carrison said “we cannot keep our heads in the sand and be unprepared when the next, inevitable, tragedy strikes”.
“It would be a mark of care and compassion to make these Medicare item numbers permanent, together with self-referral, which means a client would not have to wait for a GP to be available to request the psychological help they need following a disaster,” Carrison said.
The Australian College of Nursing and eight other nursing organisations put forward “seven nursing-led reforms to improve care, reduce waiting times, and deliver better health outcomes with minimal impact on the budget”.
These were to:
- enable Nurse Practitioners and Endorsed Midwives to directly refer patients to relevant specialists
- introduce funding and regulatory reforms that support nurse and midwife-led clinics and innovative care models
- change Commonwealth and state law to allow qualified Registered Nurses across Australia to prescribe approved medications under the Pharmaceutical Benefits Scheme
- increase the Workforce Incentive Payment Practice Stream to cover up to seven healthcare professionals, and tie payments to higher scope clinical care
- authorise Nurse Practitioners, Endorsed Midwives and qualified Registered Nurses to order diagnostic tests such as mammograms, X-rays and DEXA scans
- amend the Medicare Benefit Schedule items to allow Endorsed Midwives to support pre-conception counselling, primary sexual and reproductive health, intrapartum care outside of a hospital setting (homebirth), and a general consult item for women’s health
- implement a primary healthcare workforce development strategy to unlock 15,000 extra education and training places for Registered Nurses, Nurse Practitioners and midwives.
The Australian College of Rural and Remote Medicine (ACCRM) said it was “pushing for Rural Generalist-specific MBS item numbers to strengthen rural healthcare”.
President Dr Rod Martin said the additional cost of the new items could be funded through the $6.5 billion annual budget underspend on healthcare services in rural and remote communities.
The AMA called on the Government to expand the Workforce Incentive Program (WIP) by $400 million over four years to enable more nurses and allied health professionals to work in general practice.
AMA President Dr Danielle McMullen said “the WIP has been a real success story, supporting general practices around the county to employ nurses and allied health professionals as part of a GP-led team to improve access to care for patients and further investment in this proven model would enable general practices to do even more”.
The AMA joined over 100 other organisations in a joint submission to the Government’s consultation process on banning genetic discrimination in life insurance.
McMullen said “we need a ban to give consumers absolute certainty that their genetic status won’t be used by insurers to freeze them out of certain levels of cover”.
“A partial ban or a vague moratorium only leads to more uncertainty and deters patients from having life-saving genetic testing and participating in genomic research.”
The Australian Physiotherapy Association (APA) said a partnership between it and the University of Sydney had received a National Health and Medical Research Council grant to carry out research to “explore the effectiveness, cost-effectiveness, and implementation of a publicly funded direct access physiotherapy pathway for musculoskeletal pain in Australia”.
As a clue to the APA’s view of the likely results of the research, the media release was headed “Research project to strengthen the case for First Contact Physiotherapy in primary care”.
The following day APA issued another release calling for direct access to publicly funded First Contact Physiotherapy, which would provide funding for patients to access physiotherapists for diagnosis and treatment without needing a GP referral.
APA National President Dr Rik Dawson said “physiotherapy is the missing link in our healthcare system”.
“By allowing patients to directly access physiotherapy services, we can reduce the need for unnecessary GP appointments, cut down emergency wait times and hospital admissions and save millions in healthcare costs,” Dawson said.
The Pharmaceutical Society of Australia (PSA) issued a statement marking Thank Your Pharmacist Day, calling on “policymakers to recognise and invest in the essential role pharmacists play in our health system”.
“With a federal election on the horizon, now is the time for meaningful reform to recognise and support pharmacists to practise to their full and top of scope.”
AdPha and the PSA also welcomed the re-election of the Cook Labor Government in WA.
The PSA welcomed the Government’s commitment “to enhancing the role of pharmacists as frontline healthcare professionals, ensuring that Western Australians can access essential care when and where they need it”.
AdPha called on the Government “to commit to the statewide roll out of Partnered Pharmacist Medication Prescribing and a $67.7 million investment into strengthening the WA Health hospital pharmacy workforce to boost the ailing health system”.
The RACGP said it was a member of a new National Multidisciplinary Primary Care Research, Policy and Advocacy Consortium, involving 100 primary care researchers from 20 universities from across the country, which is a positive step forward to improve patient care.
President Dr Michael Wright said “research in general practice is vastly underrepresented and underfunded… [and] receives less than two percent of our national medical research funding”.
The RACGP called for “all political parties to commit to funding a national practice-based research network, like they have in Canada and the United Kingdom”.
The RACGP also released its 2025–29 Strategy setting out its long-term strategic goals for improving general practice over the next five years.
RACGP Board Chair Dr Sian Goodson said the four areas of focus were:
- an outstanding Fellowship underpinned by compelling member support
- a flourishing GP workforce thriving with the help of flexible and outcome-based education and training
- a profession prepared for a changing future ready to embrace new, innovative technologies
- general practice getting the support needed from government, including adequate funding, to be at the heart of our health system through impactful advocacy.
Following Cyclone Alfred, the RACGP also called on all political parties to commit to fully fund implementation of the National Health and Climate Strategy. (Read more on related in this recent Croakey article.)
RACGP Climate and Environmental Medicine Specific Interests Chair Dr Catherine Pendrey said “the World Health Organization has called climate change the greatest threat to public health in the 21st Century”.
“We cannot ignore the impacts [of extreme weather events] on our communities in Australia. We can and must stop emitting fossil fuel pollution to safeguard the health of our future generations in the face of the worsening climate crisis.”
Industry groups
The Association of Australian Medical Research Institutes (AAMRI) reiterated its call for the Government to fund the indirect costs of medical research.
AAMRI President Professor Elizabeth Hartland AM said unless this was done “we run the risk of losing our future research leaders and our competitive edge in biomedical innovation”.
AAMRI also wants the Government to increase annual funding to the NHMRC for competitive research grants by $120 million to cover the full costs of researchers’ salaries, and lift Australia’s investment in research and development to three percent of GDP.
The Pharmacy Guild assembled an odd miscellany of other lobby groups to support a media release “calling for bipartisan support to reduce the maximum out-of-pocket cost of prescription medicine to $19 – saving more than 12 million Australians $12.60 on each prescription they fill”.
As well as the Pharmaceutical Society of Australia and Advanced Pharmacy Australia, the release was supported by Parents & Citizens Queensland.
The Guild estimates the measure would save patients $440 million in the first year. Unless the Guild is volunteering its members to meet this cost (and there is no sign of that), the $440 million will come from Government.
I suspect there are many better uses for $440 million a year in the health budget – such as expanding Commonwealth assistance for public dental services to alleviate waiting times stretching into years in many states.
As I reported last week, PHA put forward a proposal to provide “a hardship package… to hospitals that open their books and can demonstrate a genuine need for short-term funding assistance in areas where there are no other private hospital services nearby”.
However, the proposal was conditional on “the Government agreeing to implement promised reforms to bring the cost of medical devices and surgical supplies in the private sector down to match the prices for public hospitals”.
Australian Private Hospital Association (APHA) CEO Brett Heffernan responded, saying “this short-term sugar hit proposed by insurers is dripping with desperation”.
“It’s a nonsense that, even if it were ever raised in any setting, would be rejected outright,” he said.
“The need for funding ratio reform is paramount. Mandating at least 88 cents in the dollar be returned to hospitals is a serious solution that costs taxpayers and patients nothing. It simply makes the insurers pay their way.”
APHA joined with the Medical Technology Association of Australia (MTAA) and Catholic Health Australia to issue a joint media release that “slammed the proposal of a ‘hardship package’ by the corporate health insurance industry as a ‘nonsense’ plan that fails to address the serious viability challenges of Australia’s private health system”.
It is amusing to see MTAA raising the bogeyman of the “corporate health insurance industry”.
MTAA members include some of the largest medical technology countries in the world, such as Johnson and Johnson, which has a market capitalisation of about $US400 billion, and last year alone made a profit of $US17.4 billion, more than the net assets of the entire Australian “corporate health insurance industry”.
The media release called for the Government to:
- establish an independent body to oversee insurer practices threatening the system’s viability and the value of private health insurance
- cap capital requirements to compel insurers to release excessive reserves to support the struggling health system
- include rising care delivery costs and factors like insurer profits and management expenses in future premium round processes.
Members Health Fund Alliance CEO Matthew Koce wrote a piece for the Daily Telegraph saying proposals for a minimum benefit payout ratio “should be ringing alarm bells”.
He said “the Government’s recent study into the viability of private hospitals revealed a massive blind spot – it lacks data on hospital operators”.
“If Government is serious about meaningful reform it should focus on obtaining better data on hospital operations to build a sound evidence base for change,” Koce said.
As I wrote a few weeks ago, it is premature to discuss treatment options in advance of a clear diagnosis.
In other private hospital news, it was reported that Healthscope hospitals has appointed Korda Mentha to prepare a contingency plan in case the hospitals are placed into voluntary administration.
Politicians and parliamentary committees
The Senate inquiry into PFAS held a hearing in Launceston on 12 March.
International
Reuters reported that “the US Centers for Disease Control and Prevention is planning a large study into potential connections between vaccines and autism”.
(The CDC website still includes a page on autism and vaccines, stating unambiguously that “studies have shown that there is no link between receiving vaccines and developing autism spectrum disorder (ASD) [and] no links have been found between any vaccine ingredients and ASD”.)
There is now a large number of studies examining the “potential connection” first suggested by British researcher Andrew Wakefield in 1998 in an article in The Lancet that was later retracted.
The overwhelming weight of evidence strongly suggests that there is no connection (see, for example, this 2014 meta-analysis).
However, according to Dr Wilbur Chen, a professor at the University of Maryland School of Medicine and former member of the CDC’s vaccine advisory panel, the problem is that the existence of such a study conducted by the US Government is itself enough to raise doubts about vaccines among some in the general public.
Chen said “it sends the signal that there is something there that is worth investigating, so that means there must be something going on between vaccines and autism”.
Dr Susan Kressly, president of the American Academy of Pediatrics, said “devoting more research dollars to answer a question that is already known does not add to our knowledge about the safety of vaccines”.
“It does a disservice to individuals with autism and their families by diverting funding that is needed to learn more about autism and how we can strengthen supportive communities,” she said.
Read more about these issues in the latest edition of The Health Wrap.
In other vaccine news, the US National Institutes of Health cancelled grants funding research into vaccine hesitancy and effective vaccine promotion.
A memo to grant recipients said “it is the policy of NIH not to prioritise research activities that focuses on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment”.
“NIH is obligated to carefully steward grant awards to ensure taxpayer dollars are used in ways that benefit the American people and improve their quality of life. Your project does not satisfy these criteria”.
The measles outbreak in west Texas and New Mexico continues to grow, and has now spread to Oklahoma.
Finally
I have spent the last week accompanying a family member receiving treatment in a Healthscope hospital.
They have generally received excellent care from all involved, including nursing and catering staff and four specialists (who have managed not to trip over each other’s feet more than once).
What is really striking is the occupancy pattern. A walk around the floor on Sunday afternoon showed only 27 percent of beds were occupied. By Tuesday elective procedures were in full swing, and occupancy was approaching 90 percent, but by Friday evening more and more rooms were in darkness with beds stripped as patients were discharged for the weekend.
I can’t help thinking this is not a very efficient use of capital.
Perhaps hospitals could supplement their revenue by renting rooms to visiting sports fans at the weekend? Or offering romantic getaways to couples with a taste for doctor-nurse role play?
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Department of Health and Aged Care
Consultation on Assignment of Medicare Benefits for Simplified Billing Services
28 March
Department of Health and Aged Care
Consultation on PHI Rules sunsetting in October 2025
31 March
Aged Care Quality and Safety Commission
Consultation on cost recovery arrangements
1 April
Australian Commission on Safety and Quality in Health Care
Public consultation on potential changes to the accreditation of general practices
4 April
Food Standards Australia New Zealand
Caffeine in sports foods and general foods
15 April
Coalition of Peaks
Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement
16 April
Department of Health and Aged Care
Design of a national registration scheme to support personal care workers employed in aged care
17 April
Department of Health and Aged Care
Draft Quality Standards for Human Research Ethics Committees and their Host Institutions
17 April
Department of Health and Aged Care – Gene Technology Regulator
Invitation to comment on a field trial of genetically modified canola
17 April
National Health and Medical Research Council
Scoping survey on clinical practice guidelines on the diagnosis and management of myalgic encephalomyelitis / chronic fatigue syndrome
27 April
Department of Health and Aged Care
Updating clinical guidelines for dementia care
31 December
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
Bookmark this link to follow The Zap
