Staring into the abyss Public hospitals at ‘crisis point’, AMA warns, p3 INSIDE Are we headed for $100 x-rays? p5 Australia on Zika alert, p7 AMA members honoured on Australia Day, p9 How’s your PSA? New GP advice, p10 ED violence – guns not the answer, p15 Brit doctors suspend strike, p27 ISSUE 28.00A - FEBRUARY 3 2016 AUSTRALIAN MEDICINE - 28.00 JANUARY 13 2016 1 In this issue National news 3 Hospitals: staring into financial abyss Managing Editor: John Flannery 5 $100 x-rays? Bulk billing incentive cuts to bite Editor: Adrian Rollins 7 Outbreak: Zika a threat of ‘alarming proportions’ Production Coordinator: Kirsty Waterford 9 Honoured: AMA members prominent in Australia Contributors: Sanja Novakovic Day awards Odette Visser 10 Prostate: new GP guide aims to end confusion Streamline Creative, Canberra Graphic Design: 11 Under-pay: Medical practices targeted in crackdown 12 Rural health: Govt accused of mixed signals on Advertising enquiries training Streamline Creative 13 Medicine: is de-listing Panadol Osteo a mistake? Tel: (02) 6260 5100 14 GP: look no further for Medical Home Australian Medicine is the na tion al news publication of the 15 Safety: guns in hospitals ‘a very bad idea’ Australian Medical Association Limited. 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World News AMA LEADERSHIP TEAM 27 NHS: Brit doctors suspend strike action 28 Ebola: virus makes a comeback 29 Abduction: West African militants seize Australian couple 30 Clinical trials: tragedy raises safety questions 31 Donor: UK changes to respect donor wishes President Vice President 32 AMA member benefits Associate Professor Dr Stephen Parnis Brian Owler NEWS Hospitals struggle as Govt applies funding brakes “The states and territories are facing a public hospital funding black hole from 2017 when growth in Federal funding slows to a trickle.” – Brian Owler Almost a third of Emergency Department patients in need of Professor Owler said the consequences of Commonwealth urgent treatment are being forced to wait more than 30 minutes cutbacks were already showing up in hospital performance, to be seen, while thousands of others face months-long delays and the steep slowdown in funding growth in coming years will for elective surgery as under-resourced public hospitals struggle further exacerbate the situation. to cope with increasing demand. “Public hospital funding is about to become the single biggest The AMA’s latest snapshot of the health of the nation’s public challenge facing State and Territory finances, and the dire hospital system shows that improvements in performance have consequences are already starting to show,” the AMA President stalled following a sharp slowdown in Federal Government said. “Without sufficient funding to increase capacity, public hospitals will never meet the targets set by governments, and funding, underlining doctor concerns that patients are paying a patients will wait longer for treatment.” high price for Budget austerity. The AMA’s Report Card, drawing on information from the “By any measure, we have reached a crisis point in public Australian Institute of Health and Welfare, the Council of hospital funding,” AMA President Professor Brian Owler said. Australian Governments Reform Council and Treasury, shows the “The states and territories are facing a public hospital funding performance of public hospitals against several key indicators black hole from 2017 when growth in Federal funding slows to a has plateaued and, by some measures, is declining. trickle.” In terms of hospital capacity, the long-term trend toward fewer The Federal Government will have slashed $454 million from beds per capita is continuing. The decline is even more marked hospital funding by 2017-18, and a downshift in the indexation when measured in terms of the number of beds for every 1000 of spending from mid-2018 will reduce its contribution by a people aged 65 years of older – a fast growing age group with further $57 billion by 2024-25. the highest demand for hospital services. Continued on 4 ... AUSTRALIAN MEDICINE - 28.00 JANUARY 13 2016 3 NEWS Hospitals struggle as Govt applies funding brakes ... from p3 Percentage of Triage Category 3 (urgent) Emergency Department patients seen within Sources: The State of our recommended time (<30 minutes) – Australia Public Hospitals (DoHA, 2004 – 2010); AIHW Australian Hospital Statistics: Emergency 100% department care (2010-11 – Performance worsened in 2014-15) 90% 2014-15. Now further below the 80% target set for 2012-13 Target 80% 70% 60% 50% 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 In 1993, there were almost 30 beds for every 1000 older people, But Professor Owler said the evidence showed the opposite was but by 2013-14 that had virtually halved to around 17 beds. the case. Alongside a relative decline in capacity, there are signs the The Government’s own Budget Papers show total health hospitals are struggling under the pressure of growing demand. expenditure grew 1.1 per cent in 2012-13 and 3.1 per cent the following year – well below long-term average annual growth of 5 In emergency departments, often seen as the coalface of per cent. hospital care, the proportion of urgent Category 3 patients seen within the clinically recommended 30 minutes fell back to 68 Furthermore, health is claiming a shrinking share of the total per cent in 2014-15 – a two percentage point decline from the Budget. In 2015-16, it accounted for less than 16 per cent of the previous year, and a result that ended four years of unbroken Budget, down from more than 18 per cent a decade ago. improvement (see graph above). “Clearly, total health spending is not out of control,” Professor The national goal that 80 per cent of all ED patients are seen Owler said, and criticised what he described as a retreat by the within clinically recommended times appears increasingly Commonwealth Government from its responsibility for public unlikely, as does the COAG target that 90 per cent of all ED hospital funding. patients be admitted, referred or discharged within four hours. “There is no greater role for governments than protecting the health For the last two years, the ratio has been stuck at 73 per cent. of the population,” he said. “Public hospitals are the foundation The outlook for patients needing elective surgery is similarly of our health care system. Public hospital funding and improving discouraging. hospital performance must be a priority for all governments.” The AMA report found that, although there was slight reduction The issue of hospital funding is set to loom large when the nation’s in waiting times for elective surgery in 2014-15, patients still leaders meet in March to discuss reform of the Federation. faced a median delay of 35 days, compared with 29 days a Already, several premiers are pushing for an overhaul of taxation decade earlier. arrangements to provide the states with a better growth revenue It appears very unlikely the goal that by 2016 all elective surgery stream than the Goods and Services Tax. patients be treated within clinically recommended times will be NSW Premier Mike Baird and South Australian Premier Jay achieved. Less than 80 per cent of Category 2 elective surgery Weatherill have proposed an increase in the GST with revenue patients were admitted within 90 days in 2014-15 – a figure that raised used to help compensate low income families, cut direct has barely budged in 12 years. taxes and increase health funding. The Commonwealth argues it has had to wind back hospital spending because of unsustainable growth in the health budget. ADRIAN ROLLINS 4 4 AUSTRALIAN MEDICINE - 28.00 JANUARY 13 2016 NEWS Patients face $100 x-rays The Federal Government is coming under pressure over His concerns have been borne out by the ADIA’s analysis, which concerns its cuts to bulk billing incentives will leave patients shows the Medicare rebate for an x-ray will be cut by $6 under needing x-rays, ultrasounds, MRIs and other diagnostic imaging the changes, while the rebate for an ultrasound will be $12 services hundreds of dollars out-of-pocket. less, that for a CT scan will be $34 lower, $43 less for a nuclear Estimates by the Australian Diagnostic Imaging Association medicine service, and $62 less for an MRI.