Doctors are calling for the country’s incoming health minister to reset the government’s relationship with the sector by ending a controversial freeze on Medicare payments.
With Malcolm Turnbull expected to announce a new health minister either today or tomorrow, doctor groups say lifting the freeze would restore faith with the sector and ease the path for future reform.”
The Prime Minister is considering a limited reshuffle, with Cabinet Secretary Arthur Sinodinos or Industry Minister Greg Hunt most likely to take on the portfolio.
Australian Medical Association president Michael Gannon said whoever took on the politically sensitive portfolio needed to implement reforms once reviews established by former minister Sussan Ley were completed, including one examining payments made under the Medicare Benefit Schedule.
“I am sure if the government lifted the freeze next week then they would be less likely to have the College of GPs complaining about other elements of government policy.”
President of the Royal Australian College of General Practitioners Bastian Seidel said the organisation wanted to see the government adopt evidence-based policy that would endure regardless of who held the portfolio.
Dr Seidel said the RACGP would be calling for an immediate end to the freeze on Medicare rebates for doctors, saying it would make a “significant difference” to patients.
“The top priority for the RACGP and our members and our patients is to lift the Medicare rebate freeze for general practice,” Dr Seidel said.
He said ending the freeze on payments to doctors would cost $150 million a year, and called for a reprieve over the next two years while a review of the MBS was completed.
Mr Turnbull is understood to be considering whether he reduces the size of cabinet from 23 to 22 ministers, while increasing the outer ministry from seven to eight to maintain the ministry at its current level of 30.
Doing so would likely see the elevation of an assistant minister to the outer ministry, with conservative NSW MP Angus Taylor a frontrunner.
“ I have been invited to launch the second Healthy Futures Report Card that is produced by the Australian Institute of Health and Welfare.
I applaud the National Aboriginal Community Controlled Health Organisation for commissioning this annual report for the benefit of the entire sector.
This report is an invaluable resource because it provides a comprehensive picture of a point in time.
These report cards allow the sector to track progress, celebrate success, and see where improvements need to be made.
This is critical for the continuous improvement of the Aboriginal Community Controlled Health Sector as well as a way to maintain focus and achieve goals.
We need to acknowledge the great system in place that comprises the network of Aboriginal Community Controlled Health Organisations, and recognise the role you play to build culturally responsive services in the mainstream system.
Our people need to feel culturally safe in the mainstream health system; the Aboriginal Community Controlled Health sector must continue to play a centralrole in helping the mainstream services and the sector to be culturally safe “
The Hon Ken Wyatt AM,MP Assistant Minister for Health and Aged care : SPEECH NACCHO MEMBERS CONFERENCE 2016 Launch of the Healthy Futures Report Card 8 December 2016 Melbourne
Before I begin I want to acknowledge the traditional custodians of the land on which we meet – the Wurundjeri people – and pay my respects to Elders past, present and future. I also extend this respect to other Aboriginal and Torres Strait Islander people here today.
I want to thank my hosts Matthew Cooke, Chair, NACCHO; and Patricia Turner, CEO, NACCHO for inviting me to speak and acknowledge NACCHO Board members. Distinguished guests, ladies and gentlemen.
Today I also want to specifically acknowledge Naomi Mayer and Sol Bellear from the Redfern Aboriginal Medical Service. 2016 marks the 45th anniversary of the Redfern Aboriginal Medical Service, the first such service in Australia and spearheaded by Naomi and Sol.
Thank you Naomi and Sol and congratulations on achieving such a significant and important milestone. Your work has improved the lives of countless Aboriginal and Torres Strait Islander Australians because of your leadership and compassionate care.
I have been invited to launch the second Healthy Futures Report Card that is produced by the Australian Institute of Health and Welfare. I applaud the National Aboriginal Community Controlled Health Organisation for commissioning this annual report for the benefit of the entire sector. This report is an invaluable resource because it provides a comprehensive picture of a point in time.
These report cards allow the sector to track progress, celebrate success, and see where improvements need to be made. This is critical for the continuous improvement of the Aboriginal Community Controlled Health Sector as well as a way to maintain focus and achieve goals.
Crucially, this report card is about and for the Aboriginal Community Controlled Health Services sector. It is not something that is happening at and to the sector. It’s yours.
This report card includes information from around 140 Aboriginal Community Controlled Health Services which provide care to Aboriginal and Torres Strait Islander Australians. The services you provide cover around two thirds of the services funded by the Australian Government for primary health care services specifically for Aboriginal and Torres Strait Islander people.
During 2014–15 these services saw about 275,000 of these clients who received almost 2.5 million episodes of care. More than 228,000 Australians were regular clients of the Aboriginal Community Controlled Health Services sector.
I’m pleased that there have been a number of improvements identified since the 2015 report. Improvements include:
Increases in the number of clients and episodes of care for primary health care services provided by Aboriginal Community Controlled Health Services.
A rise in the proportion of clients receiving appropriate processes of care for 10 of the 16 relevant indicators. This includes:
antenatal visits before 13 weeks of pregnancy
birth weight recorded
smoking status or alcohol consumption recorded, and
clients with type 2 diabetes who received a General Practice Management Plan or Team Care Arrangement.
Improved outcomes in three out of the five National Key Performance Indicators. This includes:
improvements in blood pressure for clients with type 2 diabetes, and
reductions in the proportion of clients aged 15 or over who were recorded as current smokers.
These are commendable results from services in some of the most diverse and challenging environments in Australia.
I echo the report’s authors when they say that the findings in this Report Card will assist Services in their continuous quality improvement activities, in identifying areas where service delivery and accessibility issues need to be addressed, and in supporting the goals of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.
We are all united in our determination to close the gap in health outcomes for Aboriginal and Torres Strait Islander people, so they live longer and have a better quality of life. A critical means to close the gap is the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
The Implementation Plan has seven domains that focus on both community-controlled and mainstream services.
It is a huge step forward to have racism recognised in the Implementation Plan – this is a critical issue for the social and emotional wellbeing of Aboriginal and Torres Strait Islander Australians.
Domain seven of the Implementation Plan is about the social and cultural determinants of health. These determinants impact on everything that we do and contribute to at least 31 per cent of the gap in life expectancy between Indigenous and non-Indigenous Australians.
As we all know, health departments and health providers are only part of the solution. We need an integrated approach to Aboriginal and Torres Strait Islander health.
To have strong healthy children and strong communities we need to have effective early childhood education, employment, housing and economic development where people live. These issues can only be addressed through whole-of-Government action. Whole-of-Government action across departments and across jurisdictions.
However, it is not only about governments coordinating their actions because governments alone cannot progress this agenda and action. This can only be done working with Aboriginal and Torres Strait Islander people.
The Implementation Plan Advisory Group, established to drive the next iteration of the Implementation Plan, comprises representatives from the Departments of Health, Prime Minister and Cabinet and the Australian Institute of Health and Welfare.
I’m pleased that this Advisory Group also includes respected and experienced members such as:
Richard Weston from the National Health Leadership Forum and the Healing Foundation, who is Co-Chair.
Pat Turner from the National Aboriginal Community Controlled Health Organisation.
Donna Ah Chee , Julie Tongs and Mark Wenitong who are experts on, among other things, Indigenous early childhood; comprehensive primary health care; and acute care.
The Group also includes jurisdictional members of the National Aboriginal and Torres Strait Islander Health Standing Committee from South Australia and Western Australia.
I believe that the next iteration of the Implementation Plan, due in 2018, will be stronger because of these ongoing—and new—collaborations and partnerships.
It is clear that you all work extremely hard on behalf of the communities you serve. You are delivering excellence in primary health care and I congratulate you on the delivery of comprehensive, holistic models of care.
At the end of the day, we share the ultimate goal of Closing the Gap in health outcomes for our people so that they live longer and experience a better quality of life.
But we also have a health system under pressure. There are frontline pressures on the whole health system from our hospitals, to rural health to remote Indigenous communities. And the pressures are mounting. There is a growth in demand for services, increasing costs and growing expectations.
Expenditure on health services accounts for approximately one-sixth of the Australian Government’s total expenses—estimated at more than $71 billion for the current financial year. This figure is projected to increase to more than $79 billion by 2019-20.
There is enormous pressure on the health and aged care sectors to do more, with less. This is why there is a clear expectation that all Government-funded organisations provide the evidence basis for what they do, and show the difference their programs are making on the ground. All of us—governments and organisations—need to ask ourselves how can we do better and continue to reform within this tight fiscal environment.
I am sure many of you will be aware of the Nous Review of the Roles and Functions of the Aboriginal and Torres Strait Islander Health Peak Bodies and some of you, of course, participated in the Review consultations. I thank you.
The Government has not published a formal response to the Review because we recognise that what happens now is a discussion that we need to have together.
I know that NACCHO, as well as State and Territory Peak Bodies, are working with the Department of Health to chart a way forward that takes into consideration the findings of the Review.
The Nous Review provided a clear message: Peak Bodies need to play a role in supporting the Aboriginal Community Controlled Health Sector AND mainstream health care providers to deliver appropriate and responsive health care services.
Governance reform for the Peak Bodies is a central element of the way forward. I know this is being driven by NACCHO in close cooperation with affiliate organisations and I applaud your initiative and commitment. I understand that Bobbi Campbell spoke with you yesterday on this matter, so I will keep my remarks brief.
I do want to say that it is important to Government to see the sector positioned as a key component of the overall health system with a clear unified voice.
The Government looks at the health system as a whole and expects collaboration that delivers effectiveness, efficiency and quality. We need a truly linked up, integrated, affordable and sustainable system.
We need to acknowledge the great system in place that comprises the network of Aboriginal Community Controlled Health Organisations, and recognise the role you play to build culturally responsive services in the mainstream system.
Our people need to feel culturally safe in the mainstream health system; the Aboriginal Community Controlled Health sector must continue to play a central role in helping the mainstream services and the sector to be culturally safe.
Australia has come a long way in improving the health of Aboriginal and Torres Strait Islander people but there is still a long, hard road ahead. I know that if we continue to work together, to collaborate and to talk about the issues and opportunities for the sector then the next Healthy Futures Report Card will have an even longer list of achievements.
I thank you for the work you do for the benefit of all Aboriginal and Torres Strait Islander people and wish you only the best now, and into the future.
Photo Above Some in the health industry name Indigenous health as the top area worthy of investment. Photo: Michael Amendolia
The growing cost of health – powered by an ageing population and more expensive technology – presents an ongoing challenge to the federal government, but there is no shortage of people willing to offer Health Minister Sussan Ley some unsolicited advice on how to better spend her portion of the budget.
If the $160 million was diverted to health, here is where some health advocates believe it could be better invested, in no particular order.
The latest Australian Institute of Health and Welfare report showed the proportion of health expenditure devoted to prevention had decreased to 1.4 per cent in 2013-14, down from 2.2 per cent in 2007-2008.
Although much of the preventative health dollar in that peak year went towards introducing the HPV vaccine, other evidence suggests a disinvestment in preventative health, including the termination of funding to the Australian National Preventative Health Agency [ANPHA].
Michael Moore said the re-opening of that agency and all the programs that it ran would be one good use of the funds, or campaigns on the harms associated with tobacco, alcohol or obesity.
“You could easily spend all of the money on this as we cannot hope to compete with industry bombardment,” he said.
The Heart Foundation has called for $35 million to be spent annually on addressing physical inactivity, which is estimated to cause 14,000 deaths every year.
General manager advocacy Rohan Greenland said Australia was in the bottom third of OECD nations in terms of the amount it spent on preventative health.
“While we are doing well on tobacco control, we should be putting the same, sustained effort into preventing obesity, tackling physical inactivity and addressing poor nutrition,” Mr Greenland said.
A Department of Health spokeswoman said the activities of ANPHA had been taken over by the department.
Preventative programs included projects centred on chronic conditions, a National Asthma Strategy, a National Diabetes Strategy, activities addressing healthy eating, physical activity, obesity, tobacco, alcohol, research, immunisation, mental health initiatives and cancer screening, she said.
Nurses nominate aged care as the sector in most dire requirement of funding.
Aged care providers have long been predicting a shortage of places and qualified nurses as baby boomers move into their dotage, with lack of staffing blamed on an increase in violent incidents.
The Australian Nursing and Midwifery Federation federal secretary Lee Thomas said $160 million could replace some of the money that has been taken out of the sector in recent years.
“Currently, there is a shortage of 20,000 nurses in aged care,” Ms Thomas said.
“This needs to be fixed as a matter of urgency, given Australia’s rapidly ageing population.
“The restoration of funding for the health sector would also go toward supporting public hospitals in the states and Territories and allowing more graduate nurses to be employed.”
Australian Healthcare and Hospitals Association chief executive Alison Verhoeven has a wishlist that lasts pages (“Oh there’s so much you could do”) but indigenous health tops her list.
As a start, the money could be invested in closing the gap in diseases such as rheumatic heart disease and trachoma or addressing the high rates of suicide, drug and alcohol abuse.
“We could be looking beyond that at things like how we incorporate investment in safe housing and safe food supplies and ensure that kids growing up in indigenous, particularly remote and rural, communities actually get a good start in life,” Ms Verhoeven said.
The Heart Foundation has argued that there is an economic and social argument to address chronic disease, which cause 90 per cent of all deaths and 85 per cent of the burden of disease.
“The health minister has rightly said that chronic disease is our greatest health challenge,” Mr Greenland said.
“We need to be better at early detection of those at risk of having heart attacks, strokes or developing diabetes and kidney disease.”
The federal government unveiled in March a trial of “Health Care Homes”, whereby people with chronic disease would have all their care managed from a single GP practice, but Ms Verhoeven says the $21 million package would only cover education and training.
“It’s not enough to make a real change across Australia in the way we deliver primary care.”
A Department of Health spokeswoman said the $21 million was in addition to $93 million that would be redirected from the Medicare Benefits Schedule in 2017-18 and 2018-19 to support the management of patients with chronic conditions.
Many in the health sector are concerned that the angst caused by the plebiscite could actually contribute to its overall cost.
Michael Moore said the mental health impact of the plebiscite was estimated to cost $20 million and already there was more demand for counselling services.
The Royal Australian and New Zealand College of Psychiatrists has called for employment support for people with mental illness and improved services for people with borderline personality disorder, aged care residents, children and adolescents and Aboriginal and Torres Strait Islanders.
” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.
Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.
Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.
However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.
The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.
This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “
The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.
The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.
The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.
The gap for women was slightly lower at 9.5 years.
Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.
The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.
Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.
Indigenous sobriety rate higher than non-Indigenous Australians
While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.
The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.
However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.
This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.
Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.
This was 10 per cent more than their non-Indigenous counterparts.
Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.
According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).
The single leading cause of death in Australia is coronary heart disease, followed by:
Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.
The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):
Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.
Fron Jackson-Webb, Health + Medicine Editor, The Conversation
The good news is Australians are less likely to smoke and drink at risky levels than in the past.
Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).
The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.
Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).
Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).
The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.
Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.
Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.
Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.
Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.
Proportion of the burden attributable to the top five risk factors
Preventing chronic disease
Rob Moodie, Professor of Public Health, University of Melbourne
This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.
If we took prevention and health promotion far more seriously, we could do a lot better.
The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.
Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.
However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.
We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.
Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.
Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University
Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.
Deaths by socioeconomic group: 1 = lowest; 5 = highest
The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.
Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.
Compared with the non-Indigenous population, Indigenous Australians are:
3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
five times as likely to have end-stage kidney disease
twice as likely to die from an injury
twice as likely to have heart disease.
Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.
The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.
Coverage with private health insurance and government health-care cards
Cost of care
Professor Stephen Duckett, Director of the Health Program at Grattan Institute
Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.
Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.
But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.
“The taskforce reviewing the $21 billion Medicare Benefits Schedule is finalising the most sweeping changes in more than a decade to crack down on rebate rorts and protect patients, including restricting GPs ordering powerful scans for back pain and reducing the number of colonoscopies and sleep tests.
The MBS Review Taskforce has called for feedback on a series of landmark recommendations from specialist clinical committees established to examine areas as diverse as diagnostic imaging and maternity care.”
The new proposals include a requirement for mandatory health testing for pregnant women and new mothers, restrictions on GPs ordering expensive service such as low back scans, and a strict limit on surgeons ordering multiple MBS items for a single service.
But perhaps the most significant changes foreshadowed by the taskforce come from its 11-member MBS principles and rules committee, headed by former Royal Australasian College of Surgeons president Michael Grigg and including various specialists and a consumer representative.
The committee, tasked with safeguarding Medicare rebates and improving compliance, has called for medical professionals to be required to pass a test on their knowledge of MBS rules and billing requirements before gaining their Medicare provider numbers.
“Many providers have limited awareness of the rules and procedures involved in billing for MBS services, and may adopt questionable practices on the advice of colleagues,” the committee warns.
The committee has also seized on the problem of Medicare being billed for up to 18 MBS items for a single service, with flow-on costs to patients.
It recommends a three-item limit, which would almost certainly trigger separate examinations of the cost of providing a service.
While most services attract three or fewer MBS item number claims, surgical specialties in particular bill more frequently: 39 per cent of cardiothoracic surgery benefits, amounting to almost $10 million in 2014-15, involved four or more MBS items; as did 36 per cent of neurosurgery benefits ($15m), 26 per cent of urogynaecology ($402,019), 17 per cent of ear, nose and throat cases ($17m) and 13 per cent of plastic and reconstructive surgery ($9m).
“This practice is not transparent, (is) potentially unfair and appears to be a misuse of the intention behind the multiple operation rule, although it is partly a symptom of the out-of-date nature of many items and their descriptors,” the committee found.
It also concluded that — contrary to the argument that patients gained from a higher total of Medicare benefits being claimed — their out-of-pocket expenses were usually higher. It cautioned that “gaming of the MBS for any purpose, even the ostensible benefit of patients, is inappropriate”.
While the review was commissioned after the failure of the GP co-payment policy, there is no indication of the scale of potential savings to government. The recommendations are yet to be costed.
Health Minister Sussan Ley, however, continues to talk of making Medicare sustainable and the head of her department, Martin Bowles, told the taskforce it needed to help government “bend the cost curve”.
More patients are seeing more doctors, more often, and getting more referrals. Between 2004-05 and 2014-15, MBS benefits per capita rose from $492 to $843.
The Australian revealed last week that the taskforce’s interim report, delivered to government in January but not released publicly, showed health professionals nominated largely routine or administrative consultations as the most “low-value patient care”.
With medical professions questioning the value of seeing patients in person for repeat referrals or prescriptions and signing time-off-work certificates, the review was told other staff could play that role and communication with patients could be by email or text messages.
But the renewed focus on primary care sparked an unexpected social media campaign against government cuts to general practice and perceived devaluing of the profession.
Ms Ley apparently felt compelled to respond on Twitter, where, over the weekend, she said health practitioners had nominated the low-value tasks to the review, not the government.
When the interim report was released, including data on Medicare expenditure growth, the Royal Australian College of General Practitioners said it “vastly overstates the waste and inefficiency in general practice” and was being used to fuel a government campaign against GPs.
The committee also sought to maintain the role of GPs as gatekeepers of the system, although recommending changes to time periods and criteria for referrals to specialists, ostensibly to reduce the opportunities for specialists to charge higher fees.
The committee also found fault with clinicians claiming for a consultation when also claiming for a procedure, despite little talking being done.
Taskforce head Bruce Robinson, the former dean of the Sydney Medical School, said health practitioners and consumers were invited to comment on the proposals. He hopes to make recommendations to the government by the end of the year.
“What we hope — what all the people who are taking part in this hope — is that by being more sensible about how healthcare dollars are spent we are able to spend them on services that are better value for patients and on more patients who need them,” he said.
Ms Ley previously promised to consider lifting the contentious freeze on Medicare rebate indexation if sufficient savings could be identified by the review and elsewhere, but no time frame was set.
Medicare items review backed by health professionals, patients
The majority of health professionals and patients support the Turnbull Government’s commitment to ensure every taxpayer dollar invested in Medicare delivers clinically-relevant, up-to-date and safe care, a new study has found.
Minister for Health and Aged Care Sussan Ley will today release the interim report of the Turnbull Government’s clinician-led review of all 5700 items on the Medicare Benefit Schedule (MBS), which included consultation with over 2000 health professionals and patients across stakeholder forums, written submissions and an online survey.
Ms Ley said 93 per cent of health professionals surveyed considered parts of the MBS out-of-date and a review was required, while one-in-two nominated specific Medicare items they believed were used for “low-value purposes”.
“The Turnbull Government continues to demonstrate a commitment to working with doctors and patients to build a healthier Medicare and our MBS Review is a perfect example of that,” Ms Ley said.
“We are increasing our investment in Medicare by $4 billion over the next four years as part of our commitment to delivering affordable, universal healthcare for all Australians.
“We appreciate and understand Australians consider Medicare essential, however our consultations also show health professionals and the public understands changes need to be made from time-to-time to keep it healthy and up-to-date with modern medical practices.”
For example, Ms Ley said one in every four patients surveyed believed they, or an acquaintance, had received or been recommended a consultation, medical procedure or test that they believed to be unnecessary.
“We are having a genuine conversation with the Australian people and health professionals about what they want and expect from Medicare and we appreciate the time and effort taken by the thousands of participants in this important consultation.
“We recognise the important role clinicians undertake in keeping Australians happy, healthy and out-hospital and this work is about delivering the right balance for health professionals, patients, taxpayers and the future of Medicare in general.”
Ms Ley said the MBS Taskforce’s interim report was designed to give an update on consultations and what Australian patients and health professionals thought about current Medicare-funded health services, with further consultation to be undertaken as individual MBS items were identified for removal or rule changes.
Ms Ley said the MBS Review, combined with rolling out the Turnbull Government’s Medicare Health Care Homes and the revamped My Health Record, aimed to cut down on low-value use of MBS items through a greater focus on integrated care and stronger rules, education and compliance.
“For example, our Medicare Health Care Homes will see a patient with chronic illness sign up with one GP who will manage all of their integrated health care needs, cutting down on the potential for duplicate tests and procedures.
“The same goes with having an electronic health record that patients can use to share information with their GP, specialist, pharmacist, psychologist, practice nurse and emergency department doctor to ensure they’re all on the same page regarding everything from medical history through to recent tests, scans, prescriptions and allergies.
“In return, our work on Health Care Homes and the My Health Record will help the clinicians working on the MBS Review to ensure rules around Medicare items reflect modern, integrated clinical practice.”
Ms Ley said the results also supported the Government’s intention that the review was not just about removing low-value or outdated items from the MBS altogether, but equally ensuring the rules around a common item’s usage reflected best clinical practice targeted at the appropriate patient cohorts, with the report finding:
“Reported ‘low-value services’ were very rarely inappropriate for all patient groups; more commonly the complaint concerned the provision of services in circumstances where for that particular type of patient the benefits did not outweigh the risk or costs.”
Ms Ley said the Taskforce’s work on the removal or amendment of specific MBS items was an ongoing process and each item put forward was subject to further consultation before changes were made.
“This independent clinician-led Taskforce is committed to ensuring the right patient gets the right test at the right time.
“That’s why it has established around 40 Clinical Committees and working groups, with more than 300 clinicians actively involved in examining the MBS items they use on a daily basis to ensure we get this right first time.”
“Doctors having to write sick certificates and repeat scripts, as well as provide patients with routine test results, have emerged as priority areas for reform of the $21 billion Medicare Benefits Schedule.
The Turnbull government has been told health professionals question the value of largely routine or administrative consultations, raising the potential for funding and workforce changes to make better use of limited resources.”
An interim report from a government-commissioned MBS review has also highlighted unnecessary diagnostic imaging as a concern, with a quarter of all patients consulted claiming to have been sent off for tests and scans they felt they didn’t need. The increase in referrals has caused Medicare expenditure to surge in recent years.
Health Minister Sussan Ley commissioned the review after the Coalition ditched the concept of a Medicare co-payment. The review, headed by former Sydney Medical School dean Bruce Robinson, is examining the evidence base and usage of about 5700 MBS items.
When health professionals were asked to identify areas of “low-value patient care” that should be prioritised as part of the review, administrative GP consultations were mentioned the most, and 50 per cent more than the second most mentioned area (the range of allied health providers covered by the MBS).
The burden of administrative tasks and paperwork, which could be reduced or given to non-medical staff, included providing certificates for patients to take time off work, repeat scripts for those on medication, and extended referrals for those being treated by a specialist. The review heard emails and text messages could be a more efficient way of dealing with such matters.
An increase in chronic illness — and of consumers, especially older people, seeking to take better care of themselves — has raised the risk of over-servicing. In 2013-14, for every 100 patient encounters, there were 49.1 pathology referrals (an increase from 36.7 in 2004-05) and 10.9 referrals for diagnostic imaging (an increase from 8.3 in 2004-05).
Inappropriate diagnostic imaging was the third most often cited area of low-value care by health professionals — four times the rate for pathology — and 24 per cent of consumers reported themselves, or their acquaintances, being referred for unnecessary care. One consumer reported having multiple blood tests ordered by different doctors due to a breakdown in communication between clinics and the laboratory, while a parent said “my son has had an X-ray for a chest infection four times (and) also had four hip X-rays — he is only 20 months old”.
The government still plans to remove bulk-billing incentives from diagnostic imaging and pathology services next year as it seeks savings across portfolios.
Despite initial scepticism from the Australian Medical Association, a survey found 93 per cent of health professionals believed parts of the MBS were outdated and changes were necessary.
Ms Ley has promised to consider lifting the contentious freeze on Medicare rebate indexation if sufficient savings could be identified through the review and elsewhere.
Despite a torrid election campaign, the Coalition has avoided giving a timeframe for the freeze being lifted, and the interim review demonstrates line-by-line spending reviews are complex. While the review has identified obsolete MBS items, bringing savings of $5.1m over four years, the Department of Health has had to spend $4.95m hiring management consulting firm McKinsey to assist the review.
In stakeholder forums, the issue most raised was “factoring in the costs of delivering a service” — rebates too high or low, depending on the circumstances — with “outcomes-based reimbursement” the third most commonly raised issue.
The second most common area raised was “transparency surrounding usage, variation and fees”, which corresponds with the Health Department’s push for better data collections and analysis to allow officials to identify trends and potential concerns. Asked about MBS rules and regulations, 37 per cent of health professionals believed the entire list, and 60 per cent of individual items, needed attention.
With Malcolm Turnbull in China for G20 talks, Bill Shorten yesterday sought to reignite the Medicare debate, repeating his claim that Labor would protect Medicare but the Coalition would destroy it.
Ms Ley said last night said the review demonstrated that “Labor’s insistence on blocking any changes to Medicare is out-of-date and will only harm Medicare in the long run”.
” An extra 17 million GP services were bulk billed under the Coalition last year compared with Labor following another year of record Medicare investment by the Turnbull Government, as Bill Shorten’s Mediscare lies “crumble around him” and leave the credibility of his leadership in tatters.
Minister for Health and Aged Care Sussan Ley today revealed a record 123 million out of 145 million GP services were fully-funded by the Turnbull Government at no cost to patients through Medicare during 2015-16.”
“Record bulk billing as Shorten’s Mediscare lies crumble ” Minister for Health and Aged Care Sussan Ley
“The Government’s triumphalism about today’s bulk billing figures shows how out of touch they are on Medicare.
As the Royal Australian College of General Practitioners has said previously, the statistics the Government is using are “misleading” and “should be rejected”.
That’s because they measure the number of services that are bulk billed, not the number of patients. So they hide the fact that millions of Australians are no longer bulk billed.
Malcolm Turnbull has confirmed that his Government remains committed to its six year freeze on Medicare rebates.”
“Government out of touch on Medicare ” Catherine King Opposition spokesperson Health and Medicaresee Part 2 Below
“Labor is in damage control over their Mediscare lies, this morning caught out claiming official bulk billing figures they trumpeted in Government now don’t apply because they are in opposition, in another major gaffe.
Bill Shorten and Labor made their bed with Mediscare. The question is whether they can stop lying in it.”
Gaffe-prone King in Mediscare damage controlLey Press Release Part 3 Below
This saw GP bulk billing hit a historic high of 85.1 per cent under the Turnbull Government – up from 84.3 per cent in 2014-15 – and follows the Coalition’s record $7.1 billion investment in general practice via Medicare last year.
The number of Australians accessing Medicare-funded GP services was also up by nearly half-a-million to 20.9 million last year, while the average number of services and spend per GP patient grew to 6.9 and $344 respectively.
The figures are a far cry from Labor’s Mediscare lies over the past year and raise serious questions for Mr Shorten:
‘Just weeks after it was introduced that freeze is already wreaking havoc on patients, with doctors forced to raise fees, cut bulk billing…” – Catherine King – 15 September 2015 – Media Release
Ms Ley said the figures were “good news for Australians and bad news for Labor”.
“Last year the Turnbull Government invested over $21 billion into Medicare as part of our commitment to ensuring all Australians have access to affordable universal healthcare – that’s about $60 million every day,” Ms Ley said.
“Across Australia, there were 17 million more bulk billed GP attendances in the last 12 months under the Turnbull Government compared to Labor’s last full year in office.
“These figures expose the blatant and remorseless Mediscare lies Labor – under Mr Shorten’s leadership – have been telling the Australian public over the past 12 months.
“There’s no doubt we still have work to do, but Australians should take assurance from the fact no government has invested more into Medicare than the Turnbull Government.
“And no Government has consistently overseen higher bulk billing rates than the Turnbull Government.”
Ms Ley said the Turnbull Government would increase investment in Medicare by another $4 billion over four years.
“And we’re backing that up with nearly $120 million to begin rollout out our GP-focused Health Care Homes – a better way of delivering Medicare for Australians with chronic illness.”
Overall, the number of Medicare services increased to 384 million in 2015-16 – more than one million per day – at a total cost of $21,107,750,246 – an increase of nearly $1 billion on 2014-15 – with the overall Medicare bulk billing rate also increasing to 78.2 per cent in 2015-16 from 77.6 per cent the year before.
Neither the Rudd-Gillard, nor Hawke-Keating, Labor Governments have ever delivered higher rates of Medicare investment or bulk billing than the Turnbull Coalition Government, Ms Ley said.
“This is possible because the Turnbull Government is committed to delivering a strong budget and economy that ensures we can also afford to continue investing in services important to Australians like Medicare.
“We will continue to work closely with health professionals across the board to ensure we deliver a health and Medicare system that is not only fair and focussed on quality, but efficient and sustainable for generations to come.
“In contrast, Bill Shorten’s Mediscare lies have left Labor exposed by a Leader whose credibility is now terminally damaged with the public and has weighed down his party with billions of dollars of promises they cannot afford.
“Labor is now going to have to make some tough savings decisions if they want to match the Turnbull Government’s record investment in Medicare, while at the same time building a strong economy and repairing the budget.”
” The Government’s triumphalism about today’s bulk billing figures shows how out of touch they are on Medicare. ” King
As the Royal Australian College of General Practitioners has said previously, the statistics the Government is using are “misleading” and “should be rejected”.
That’s because they measure the number of services that are bulk billed, not the number of patients. So they hide the fact that millions of Australians are no longer bulk billed.
These statistics also ignore the fact that out-of-pocket costs have more than doubled.
GPs have the best interests of their patients at heart, and many continued to bulk bill in 2015-16. They had been assured the freeze would be lifted in the Budget, and were watching the outcome of the election.
But now that it’s clear that Malcolm Turnbull’s Medicare freeze is an ice age, practices around Australia are abandoning bulk billing.
For example, the only practice on Magnetic Island in Queensland has advised the Island’s residents that it is abandoning bulk billing due to “Medicare restrictions and cuts”.
Similarly, the Collins and Grosvenor Street General Practices in Hobart have scrapped bulk billing due to the freeze.
Australians know that Malcolm Turnbull’s six year freeze on Medicare rebates is driving bulk billing down and out-of-pocket costs up.
The Government’s insistence otherwise only shows how out of touch they are.
GOVERNMENT REMAINS COMMITTED TO MEDICARE FREEZE
Malcolm Turnbull has confirmed that his Government remains committed to its six year freeze on Medicare rebates.
In an interview in today’s Australian, Mr Turnbull said the Government had “not decided to change the policy”.
This is in spite of Mr Turnbull’s comments, in the same interview, that “what we have to do this term is categorically reassure Australians about our commitment to universal health and Medicare”.
Mr Turnbull’s comments echo his claim, made immediately after the election, that he would learn the lessons of the election and address Australians’ concerns about his deep cuts to health.
But two months later, nothing has changed. As Mr Turnbull has confirmed today, the Government remains committed to:
Driving bulk billing down and co-payments up via the freeze on Medicare rebates, a GP Tax by stealth;
Cutting Medicare bulk billing incentives for vital tests and scans;
Increasing the price of prescription medicines by up to $5, even for concession card holders; and
Cutting hundreds of millions from Medicare via changes to the Medicare Safety Net.
Softer rhetoric won’t change the harsh reality of these cuts. Mr Turnbull’s “reassurance” is worth as much as Tony Abbott’s promise of “no cuts to health” – nothing.
In contrast, during the election campaign Labor committed to ending Mr Turnbull’s Medicare freeze, scrapping his cuts to vital tests and scans, reversing his price hikes to Medicines, and protecting the Medicare Safety Nets.
On health, look at what Mr Turnbull does, not what he says.
Gaffe-prone King in Mediscare damage controlLey Press Release
Labor is in damage control over their Mediscare lies, this morning caught out claiming official bulk billing figures they trumpeted in Government now don’t apply because they are in opposition, in another major gaffe.
Annual Medicare figures today show that an extra 17 million GP services were bulk billed under the Coalition last year compared with Labor following another year of record Medicare investment by the Turnbull Government.
This saw GP bulk billing rates hit a record high of 85.1 per cent in 2015-16, higher than both the Rudd-Gillard or Hawke-Keating Labor Governments.
Yet it’s clear Labor’s Mediscare know no bounds, with Shadow Labor Health Spokesperson Catherine King now trying to spin the Australian public that “the statistics the Government is using are “misleading” and “should be rejected”.
Except Ms King clearly forgot to check with her Deputy Labor Leader Tanya Plibersek, who was more than happy to stand by the official bulk billing statistics when she was Health Minister during the Rudd-Gillard Government.
And in a double blow for Ms King, Ms Plibersek’s media release is another reminder that GP bulk billing rates were lower under Labor than the 85.1 per cent recorded under the Turnbull Government today.
Ms King’s gaffe today will only continue to fuel concerns in Labor’s party room that Bill Shorten’s Mediscare lies will hurt the party’s trust with the Australian people in the long run.
Particularly after it was Ms King herself who, during the election campaign, was forced to admit Medicare bulk billing rates were higher under the Turnbull Coalition than under Labor:
KELLY: Bill Shorten is saying we want to campaign about bulk billing but in actual fact the Government’s performance is better than Labor’s.
KING: Well certainly. Well I’d welcome that. I’d welcome that bulk billing remains high – that’s a good thing, we want to preserve that.
And let’s not forget what Ms Plibersek had to say when Labor first introduced the Medicare pause on indexation, which runs completely counter to Bill Shorten’s Mediscare lies today:
Doctors earn enough money to bear the Federal Government’s controversial freeze on MBS rebates, Health Minister Tanya Plibersek says.
Ms Plibersek dismissed concerns that the freeze — which will remove $664 million from the MBS over four years — will pressure doctors to compromise care.
“I understand that GPs have all sorts of expenses in running their surgeries and employing staff and so on, but the average billing from Medicare is more than $350,000 a year.”
Bill Shorten’s Mediscare lies have left Labor exposed by a Leader whose credibility is now terminally damaged with the public and has weighed down his party with billions of dollars of promises they cannot afford.
Bill Shorten and Labor made their bed with Mediscare. The question is whether they can stop lying in it.
On 22 April 2015, the Minister of Health and Sport Sussan Ley announced a programme of work to deliver a Healthier Medicare and announced that a Medicare Benefits Schedule (MBS) Review Taskforce would be established.
The taskforce is considering how the more than 5,700 items on the MBS can be aligned with contemporary clinical evidence and practice and improve health outcomes for patients. The review is clinician-led and there are no targets for savings attached to the review. The taskforce recommendations will be made to the Minister.
About the review – includes Terms of Reference, indicative timeline and scope of the review
You do not have to wait to be invited to make a submission on a particular issue. Make a submission at any time to the Review by email to the MBS Review team.
Nominations to participate in a clinical committee
To nominate yourself or someone else to a clinical committee, please email the MBS Review team and provide the following information: name, position/title, organisation, email, and clinical interest/expertise.
Nominees should be committed to interpreting evidence/research and being productive team members, and have current knowledge of practice in their clinical discipline, and preferably contemporary experience of the MBS.
You do not have to wait for the announcement of the establishment of a clinical committee or to be invited to submit nominations. Submit a nomination at any time to the Review by email to the MBS Review team.
MBS REVIEW – CONSUMER REPRESENTATIVES – ROLE DESCRIPTION
What is the Medicare Benefits Schedule (MBS)?
Medicare is Australia’s universal health scheme. It is a Commonwealth government program that guarantees all citizens (and some overseas visitors) have access to a wide range of health services at little or no cost.
What is the MBS Review Taskforce?
The government has established a Medicare Review Taskforce to review all of the 5700 Medicare items to ensure they are aligned with contemporary clinical evidence and practice and improve health outcomes for patients.
The Goals of the Taskforce are over the page.
What is a Clinical Committee?
Clinical Committees are established by the Taskforce to review allocated parts of the MBS.
Members are appointed in their individual capacity, not as representatives of their professional or other organisations.
Committees will typically include medical specialists from relevant discipline groups, other clinicians (including those in related disciplines and generalists), experts in evidence evaluation, and consumer representatives.
The membership structure is intended to ensure that a broad range of skills and perspectives are considered including specific content knowledge, wider content and practice knowledge and expertise in evidence appraisal.
What is a clinical committee consumer representative?
Consumer representatives are not expected to have clinical expertise: they bring an essential community perspective to committee deliberations, and do so in accordance with the evidence regarding the imperative for co-design in health policy and research.
Consumer representatives are appointed as individuals, not representatives of their professional group or other organisations.
What does a consumer representative do? You will support the Clinical Committee in achieving the goals of the MBS taskforce by:
Participating in committee meetings and deliberations to identify where changes are required to MBS items.
Providing consumer perspective and engage in the committee’s decision-making and formation of recommendations to the Taskforce.
Providing input into the clinical committee reports to ensure they are in plain English and reflect the consumers’ perspective on the services funded under the MBS. These views will be included in final reports to the MBS Review Taskforce and recommendations to the Health Minister.
Evaluating MBS items in the scope of the clinical committee, including the findings from working groups and articulate consumer perspectives via the clinical committee to the Taskforce.
What will be required of the consumer representative as a member of a Clinical Committee? You will:
Be involved throughout the duration of the clinical committee – approximately 4 – 5 months.
Participate in a face to face induction meeting.
Participate in two face to face meetings of 4-8 hours at the beginning and end of the committee process.
Participate in four to five teleconferences – approximately two to three hours per teleconference (once a month) over the period of the Clinical Committee.
Undertake to read the agenda papers and research reports to understand the committee’s deliberations.
Be paid sitting fees for the time you spend attending clinical committee as per Specified Professional Committees in Table 4 of Determination 2015/20 and as determined by the Remuneration Tribunal.
The Goals of the MBS Taskforce
The Taskforce is committed to providing recommendations to the Minister that will allow the MBS to deliver on each of these four key goals:
Affordable and universal access—The evidence demonstrates that the MBS supports very good access to primary care services for most Australians, particularly in urban Australia. However, despite increases in the specialist workforce over the last decade, access to many specialist services remains problematic with some rural patients being particularly under-serviced.
Best practice health services—One of the core objectives of the Review is to modernise the MBS, ensuring that individual items and their descriptors are consistent with contemporary best practice and the evidence base where possible. Although the Medical Services Advisory Committee (MSAC) plays a crucial role in thoroughly evaluating new services, the vast majority of existing MBS items pre-date this process and have never been reviewed.
Value for the individual patient—Another core objective of the Review is to have a MBS that supports the delivery of services that are appropriate to the patient’s needs, provide real clinical value and do not expose the patient to unnecessary risk or expense.
Value for the health system—Achieving the above elements of the vision will go a long way to achieving improved value for the health system overall. Reducing the volume of services that provide little or no clinical benefit will enable resources to be redirected to new and existing services that have proven benefit and are underused, particularly for patients who cannot readily access those services currently.
Broadly, the Taskforce’s focus is on reviewing the existing MBS items, with an initial emphasis on ensuring that individual items and usage meet the definition of best practice.
Within the Taskforce’s brief there is considerable scope to review and advise on all aspects which would contribute to a modern, transparent and responsive system. This includes not only making recommendations about new items or services being added to the MBS, but also about a MBS structure that could better accommodate changing health service models.
The Taskforce has made a conscious decision to be ambitious in its approach and seize this unique opportunity to recommend changes to modernise the MBS on all levels, from the clinical detail of individual items, to administrative rules and mechanisms, to structural, whole-of-MBS issues.
Another key project for the Taskforce will be the development of a mechanism for the ongoing review of the MBS once the current Review is concluded.
Medicare services for Indigenous health – what you need to know
The Federal Department of Human Services has an online eLearning program and education guides to help you when providing health services to your Aboriginal and Torres Strait Islander patients.
Our eLearning program, Indigenous Health Services, is a comprehensive overview of Medicare services for Aboriginal and Torres Strait Islander patients, including the health items available and subsequent requirements.