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Jun 13, 2014

The Health Wrap: Co-payments, COAG and cutting costs; racism is unhealthy; health-environment ties; tobacco tussles


By Kellie Bisset


Co-payments, COAG and cutting costs

The release of the COAG Reform Council’s final health report could not have been more timely, given the ongoing Budget fallout and debate around the proposed $7 co-payment.

Newly elected AMA president Dr Brian Owler said the report, which showed that 12% of people in disadvantaged areas delayed or did not fill a prescription due to cost, highlighted the impact the co-payment policy would have on the vulnerable. Medical Observer reported that the AMA is currently developing an alternative co-payment model, though it didn’t outline the details.

Croakey co-ordinator Melissa Sweet also addressed the issue of entrenching disadvantage in a piece that takes a look at the COAG’s report’s main findings. The report identified six emerging areas of health concern, including diabetes and obesity, elective surgery waiting times, and an increase in potentially preventable hospitalisations for vaccine preventable and acute conditions. This ABC news story from Sophie Scott also gives an overview.

And as Sweet argues in this post, the report’s findings are just part of the story. What impact will the council’s axing have on keeping governments accountable for health outcomes, she asks. Professor Stephen Duckett also tackled the issue of Commonwealth-State relations on health in the wake of the Budget, which he argues has taken a wrecking ball to collaborative health reform efforts.

The risk of the budget measures having a disproportionate impact on the poor and disadvantaged was a prominent theme at Croakey this fortnight. Another piece from Melissa Sweet highlighted the opposition from both ends of the political spectrum, with John Hewson at one end and the Doctors’ Reform Society’s Dr Tim Woodruff at the other.

Dr Tim Senior’s first crowdfunded Wonky Health column looked at why co-payments will increase the health gap and Dr Justin Coleman added his voice to the debate, pointing out that not touching the primary care bucket of money is an evidence-based way to improve health outcomes and save long-term dollars – no matter what country you come from. Jennifer Doggett looked at whether the opposition to the co-payment was related to the delivery of the message or the message itself.

And mental health researcher Dr Vanessa Rose highlighted that while much attention has focussed on the co-payment, Government welfare reforms will also have significant impact, particularly on young people.

Senate Estimates meanwhile, heard that the Government had done no modelling to ascertain the impact of the GP co-payment and the Australian Healthcare and Hospitals Association released a statement saying a Freedom of Information request for details on the number of people bulkbilled (as opposed to the number of services) was refused.

Former Tony Abbott policy adviser Terry Barnes told Medical Observer  that he supported the idea of the FOI application in the interests of public debate and getting more data into the public domain.

According to Professor Kim Oates, if we want to have a debate about cutting healthcare costs, we should take a more visionary approach than introducing a co-payment. And former Labor health minister Brian Howe has argued that his version of a co-payment, introduced in 1991, was different to this one because the savings were to be redirected towards preventive health.

This article in The Age says that as Medicare turns 40 this year, it (like the rest of us?) potentially faces its own decline.


Budget fallout for Aboriginal health 

In the immediate Budget aftermath it was pointed out by many that the impact on disadvantaged Australians has particular resonance for Aboriginal people, and this past fortnight the issue has been teased apart even further.

Croakey reports the issue was pursued by Senator Penny Wong in Senate Estimates, and Julie Tongs, CEO of the Winnunga Nimmityjah Aboriginal health service in Canberra, said the co-payment was a human rights issue. Some of the service’s clients had trouble affording milk and bread, let alone a visit to the doctor, she said.

Deputy Chair of the Government’s Indigenous Advisory Council Dr Ngaire Brown told the Australian Financial Review that the Budget would be a mess for Indigenous communities, given one of the main barriers to poor Indigenous health outcomes was lack of access to services.

The council’s chair, Warren Mundine, told The Australian that the budget cuts to Indigenous services were related to inefficiencies and should be reinvested into education, employment and community safety. However, this World Today report also quotes Dr Brown, who says the detail on the Budget cuts is not yet known, so it’s premature to suggest they are targeting waste.

“In theory, absolutely everybody wants to spend better, but in order for us to be able to overcome disadvantage, and disparity, we can’t spend less,” she told the program.

The Government has released a Q&A document on Indigenous health in the budget. Does it answer your questions or are there others you would like asked? Croakey is interested to know.

Two new Australian reports on Indigenous health were released this fortnight. Updated results from the Australian Aboriginal and Torres Strait Islander Health Survey show that Aboriginal and Torres Strait Islander people aged 15 years and over are about half as likely as non-Indigenous people to report excellent or very good health. Less than 40% rate their health as excellent or very good. The COAG Reform Council’s report Indigenous Reform 2012-13: five years of performance, shows that over five years, the national gap to non-Indigenous life expectancy narrowed by 0.8 years for men and just 0.1 years for women.

A new resource to support those working to reduce the harms associated with substance misuse in Aboriginal and Torres Strait Islander communities has been launched by the National Indigenous Drug and Alcohol Committee. Assistant Health Minister Fiona Nash, who gave the opening address at the committee’s recent national conference, and said the service would particularly benefit health workers. 

The initiative is undoubtedly a positive one, and without taking away from its importance, The Health Wrap will take this opportunity to reiterate Croakey’s recent post, which reminded us that Aboriginal people in general are more likely to abstain from alcohol than non-Indigenous Australians. This CBC News piece says  the stereotype that Aboriginal people have a genetic intolerance to alcohol persists in Canada and around the world. But Manitoba’s former chief public health officer Dr Joel Kettner says the evidence points to social conditions such as poverty, not genetics, as a driver of alcoholism, and this is where we should be focusing our attention, he argues.


Racism is unhealthy

In some good news welcomed by NACCHO, the Government has announced that by the end of the year it will develop an implementation plan for the National Aboriginal and Torres Strait Islander Health Plan.

While reiterating concerns over budget cuts to Indigenous services, NACCHO Chair Justin Mohammed said he welcomed “the long-sought acknowledgement that racism continues to have a negative impact on the health and wellbeing of Aboriginal and Torres Strait Islander people.”

This issue was highlighted by a new MJA study, which found that a third of Aboriginal Australians had experienced racism in healthcare settings in the previous year and that this was directly contributing to levels of psychological distress. It also received some international attention, with comments from Canadian public health physician Janet Smylie that racism towards Aboriginal people seeking emergency department treatment is still an uncomfortable issue in Canada.

And it will be dealt with in-depth at a symposium in Melbourne later this month, as this Croakey post from Marie McInerny discusses.


Does the medical research fund have a future?

As the NHMRC celebrated its 200th meeting  controversy continued to surround the Federal Government’s $20 billion Medical Research Future Fund and whether it does, in fact, have a future. This Lateline piece looks at just that question. In an address to the National Press Club, CSIRO Chairman Simon McKeon said the health and research community was “quietly hopingthat Canberra would sort out the opposing views over the fund. McKeon, who chaired the Strategic  Review of Health and Medical Research said he was hoping the Government could devise a funding peace package.

The Opposition has drawn parallels between the fund and an episode of The Hollowmen – an ABC TV series that satirised the workings of government. Labor said the fund sounded a little like  the $150 billion National Perpetual Endowment Fund which featured in an episode of the program.

Meanwhile the SMH reported that neither NHMRC chairman Warwick Anderson nor Chief Scientist Ian Chubb had any input into the fund plan. The Australian’s Niki Savva wrote that the fund should be debated on its own merits and not destroyed by politics. And if it did happen to go ahead, this is how it could work, according to this SMH piece from Nicky Phillips.


Health, environment and the ties that bind 

The Obama Administration has put public health front  and centre in the latest phase of its Climate Action plan, which focuses on reducing carbon emissions from power stations. The New York Times reports estimates that the measures will prevent 100,000 asthma attacks and 2100 heart attacks in its first year of operation. The Amercian Public health Association has released this storify on the EPA plan for those who want an at-a-glance overview.

In this Croakey post, Professor of Climate and Environmental Law at University of Sydney Rosemary Lyster, says its significant that Obama has chosen to make the connection between health and climate change, a connection that has gained little traction in Australia.

The connection between transport and health might be gaining gradual momentum here, though this University of Colorado study says the link is often ignored in transportation planning in the US.

“Air pollution, crime and numerous traffic hazards … point to a serious and persistent gap between public health and planning,” a university statement said.

Those interested in climate change and health research might like this web story from the US National Institute of Environmental Health Sciences, highlighting work from two of its scientists who are developing methods to assess and quantify the role of climate change on health.

This Triple Pundit article looks at the contradiction of most Americans supporting the need to address climate change – even at the cost of the economy – while ranking it lower than other concerns.


Budget blues in the bush

Returning to the Budget, the National Rural Health Alliance has raised concerns over the gloomy prognosis the measures will have for regional, rural and remote Australians.

Meanwhile, rural doctors have described as a ‘disaster’ and a ‘false economy’ the Government’s decision to scrap the Prevocational General Practice Placements Program, which they say has attracted doctors to rural medicine by giving them a taste of what it was all about.

John Menadue offers a controversial ‘pearl’ on the subject of country doctors with the suggestion that auctioning doctor provider numbers by postcode might help the medical workforce maldistribution.

“Why can we send teachers to areas of need but not doctors?” he asks.


Tobacco tussles

As we observed World No Tobacco day, a stoush took place over disputed claims raised in The Australian over evidence of the value of plain packaging, Assistant health Minister Fiona Nash launched a new $4.6million anti-tobacco advertising campaign and what to do about e-cigarettes continued to occupy our attention.

Professor Simon Chapman’s article in The Conversation critiquing a new study published in the journal Addiction, said claims that e-cigarettes could assist quitting or reduce smoking-related harm were premature and “may be all smoke and mirrors”.

Internationally, the US Food and Drug Administration is still considering its position on the products, this video interview on Medscape looked at the issue of nicotine poisoning in kids using e-cigarettes, and a study in Pediatrics showed that e-cigarette manufacturers had substantially increased their advertising, resulting in much greater exposure of the products to teenagers and young adults.

UK pop star Lily Allen has come under fire from health experts after being paid to plug e-cigarettes in her latest music video and the BBC reports that 50 researchers and public health specialists have written an open letter to the WHO, urging the organization to resist the urge to control and suppress e-cigarettes, which they say could be a ‘significant health innovation’. According to one of the speakers at Wales’ first summit on e-cigarettes, there is no evidence they will lure young people into taking up smoking.

On the issue of tobacco regulation, Russia has banned smoking in restaurants and bars, and the American Medical Association has upped its pressure on retailers who sell health products to follow the lead of the CVS chain and halt the sale of cigarettes. Jamaican health officials said recent increased tobacco regulation has already shown public health benefits, and this Huffington Post article to mark World No Tobacco Day points out the tsunami of illness facing China as a a result of smoking.


Social determinants – the last word

It seems fitting, given we began this week’s wrap with a series of links on health and disadvantage, to look at some news on this subject internationally, and a couple of local offerings.

This blog post on Kevin MD says political conversations about health tend to fall into familiar traps but in order to properly move what we know about the social determinants of health into the broader public discourse, we need to avoid being trapped by the “holy trinity” of smoking, diet and exercise.

The always excellent Reporting on Health blog asks: we know toxic stress is damaging to kids but how do we fight it? And the UK Royal College of General Practitioners has released research showing that people living in the most deprived communities face the longest waiting times for care.

The Scotland Herald quotes researchers saying shaming campaigns that target smokers and drinkers do not work and just end up alienating their target audience. And on the issue of drugs, Professor Jeanette Kennett writes in a piece for The Conversation that victim blaming in the area of drug addiction means there is a legal inconsistency whereby addicts are considered responsible for their crimes but others compelled to harmful behaviours are not.

Also at The Conversation, Professor Karen Charlton looks at the health implications of living on $2 a day.

And finally, a new report released by The Australian Institute of Health and Welfare and the National Centre for Social and Economic Modelling (NATSEM) which looked at the link between social exclusion and the risk of poor health outcomes, found that children living in areas with a higher risk of social exclusion had poorer health than those who lived in other areas.


Other Croakey reading you may have missed this fortnight:

Do you have something you’d like to see highlighted on The Health Wrap? Contact us on Twitter @medicalmedia or @FrancesGilham.
You can find previous editions of the Health Wrap here.

Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.


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