Renewed focus the common denominator

Renewed focus the common denominator


Dr Andrew Miller
AMA (WA) President

Monday 2 December 2019

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I am pleased to report that Dr Bennie Ng has already made inroads in his new role as CEO of the Australian Medical Association (WA). As he works with the Board to take stock of our current activity and businesses and to consider future strategy, it is worth reminding members that our commercial arms underpin our success in advocacy.

 

The AMA (WA) has good businesses supplying medical products (online growing rapidly), providing financial services and insurance brokerage, health training (including a new Joondalup campus) and other apprenticeships.

 

In parallel, the Federal AMA has welcomed a new CEO in Martin Laverty, who most recently headed the Royal Flying Doctor Service, another federated health organisation. Under his leadership, the RFDS established a strong Canberra advocacy presence, and expanded its range of offerings.

 

Having just returned from the AMA Federal Council meeting, I can confidently reassure members that we have in Bennie and Martin, a respected and effective team overseeing state and federal issues with renewed focus.

 

Voluntary Assisted Dying

 

Frequent meetings continue even this week, with Members of Parliament and their advisers as we discuss the views of the profession gleaned from our recent successful survey on the Voluntary Assisted Dying Bill. The AMA (WA) Council has asked me to continue to work towards sensible amendments in the Upper House that will contribute to the safety, workability and equity of the Bill.

 

Along with most commentators, we do expect the legislation will be passed in some form. Accordingly, we are keeping an eye over the horizon to the implementation phase where the guidelines and information for patients and practitioners will be developed.

 

The AMA (WA) stands ready to assist the profession, the Minister for Health and the community in order that VAD finds its place in end-of-life care, throughout our immense State, in the most compassionate and effective form possible regardless of patient and doctor views.

 

Most patients will never ask for it; of those who do, many will never use it. We will, of course, be watching all the other available care and resources at end of life closely. The findings of the Aged Care Royal Commission and the interaction with end-of-life care are other issues under active consideration as we consult with our partners in the sector.

 

Private Health Insurance

 

Much media discussion about the lack of uptake of private health insurance (PHI) and rising premiums and gaps has turned the spotlight on the balance of public and private systems. Australia enjoys some of the best health outcomes seen among OECD countries[1] with our current systems working in tandem successfully. So overseas perspectives, while interesting, do not help us much in our unique environment.

 

Yet upward pressure on premiums is building because:

 

  • Ageing is pushing up premiums by 0.6 per cent pa;
  • PHI participation is declining in younger groups; and
  • Those over 65 years of age are taking up policies.

 

Only the latter two can be influenced by policy settings, and the Federal AMA is conducting important economic modelling on the behaviour of consumers, which is unstable in the sense that people are moving in and out at times we do not expect them to. How they respond to government encouragement to take up PHI cover – such as through the Lifetime Health Cover scheme relating Medicare levy to PHI years of cover and rebates – will be better determined to enable us to advocate for government policy settings that mitigate the rise in premiums and the drop in cover of those younger people who can afford it.

 

Medical gaps, aside from occasional egregious nonsense, do not contribute to costs in any way that is out of proportion. The June 2018 ACCC report[2] is a useful resource, which shows that:

 

  • since 2015, “no gap” in hospital services has increased to 88 per cent; and
  • the average gap where there is one, is flat at $300.

 

Recently the Commonwealth Chief Medical Officer Professor Brendan Murphy met with AMA (WA) members and we had the opportunity to ask him about the plans to build a Fuel-Watch style website for doctor fees (see page 16 for more on that meeting). Prof Murphy clearly understands that the AMA will not see this as a useful tool unless detailed information about PHI rebates and products accompanies individual doctor charges. We will watch that space closely.

 

Medicinal Cannabis

 

I had the distinction of becoming the television show Flashpoint ’s first repeat guest last week, when the topic of medicinal cannabis was discussed.[3] This is an acknowledgement, I believe, of the central role the AMA plays in health literacy in this State.

Health Minister Roger Cook announced some changes that make prescription by GPs easier, and my point was that like all drugs, medicinal cannabis should be made to earn its place in our pharmacopoeia.

 

I tried to emphasise that while pharmaceutical companies have an important role, they are understandably optimistic on behalf of their shareholders, while doctors remain healthily cynical about new drugs. We know that in the end, all new drugs will disappoint. I am sure doctors will maintain a scientific view and while some patients might benefit, there is much more to cost benefit, and “number to treat” analysis than the anecdotes of individual success that drive consumer demand.

 

Good luck with the pre-Christmas rush that hits us all about this time – and as always should you have comments or queries, please feel free to contact me directly at drajm@me.com on 0419 941 274 or on twitter @drajm.

 

References

1) http://www.oecd.org/els/health-systems/health-data.htm

2) https://www.accc.gov.au/publications/ private-health-insurance-reports/private-health-insurance-report-2017-18

3) https://7plus.com.au/flashpoint?episode-id=FLAS01-011

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