What the Federal Government hasn’t mentioned about public hospital financing, a warm welcome for the new Chief Medical Officer, Professor Michael Kidd AO, and health reform advice for the next Australian Government are among topics covered in this week’s column.
The Zap also brings a wrap from Close the Gap Day, news from near and far on social prescribing, and a positive update from Ireland in honour of St Patrick’s Day.
The quotable?
The Government has chosen to spend about $200 million a year making medicines 16 percent cheaper.
For the same amount of money, it could have almost doubled the assistance it provides to the states for public dental services, or provided an extra 4,000 or so home care packages to help address the waiting list, which now includes tens of thousands of people.”
Charles Maskell-Knight writes:
On 19 March the Independent Hospital and Aged Care Pricing Authority released the national efficient price (NEP) and national efficient cost determinations to apply to public hospital funding in 2025-26.
The media statement accompanying the determinations focussed on a number of technical issues, including the transition to activity based funding for community mental healthcare.
It also discussed “implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), the Australian Classification of Health Interventions (ACHI) and the Australian Coding Standards (ACS), collectively known as ICD-10-AM/ACHI/ACS Thirteenth Edition, including cluster coding”.
It also said that the NEP for 2025-26 is $7,258.
What it didn’t say is that $7,258 is an increase of over 12 percent on the $6,465 applying in 2024-25.
However, after applying backcasting to 2024-25 (using the new classification on old activity), the effective price increase for public hospital funding purposes is 5.9 percent.
The Government in February announced a one-year deal to fund public hospitals in 2025-26, with the Commonwealth contribution growing by 12 percent.
After allowing for price growth of 5.9 percent and the impact of population growth and ageing, total growth of 12 percent does not seem so very generous.
Ministers and government
I don’t usually report on announcements by Ministers of new Pharmaceutical Benefits Scheme (PBS) listings, because they should be seen as part of business as usual.
However, the Health Minister Mark Butler made a big splash on 16 March with the announcement of new PBS listings for an oral contraceptive and an endometriosis medication, and an amended listing for an IVF medication.
As well as a media release, Butler held a press conference with a local Labor councillor at an Adelaide IVF clinic, and appeared on Weekend Sunrise.
Anybody thinking there was an election coming would have had their suspicions confirmed when the Government announced later in the week that if re-elected it would reduce the general PBS copayment to $25 from 1 January next year, at an annual cost to Government of $200 million. (The Opposition immediately said it would match the policy.)
As Greg Jericho points out in this Guardian article, budgets are all about choices. The Government has chosen to spend about $200 million a year making medicines 16 percent cheaper.
For the same amount of money, it could have almost doubled the assistance it provides to the states for public dental services, or provided an extra 4,000 or so home care packages to help address the waiting list, which now includes tens of thousands of people.
The Rural Doctors Association of Australia (RDAA) said “further cuts to the price of PBS medicines would save many patients money, but lack of access to care remains the big issue for those in rural and remote areas”.
Other groups such as the medicines sector (Pharmacy Guild, the Pharmaceutical Society of Australia (PSA), Advanced Pharmacy Australia, and Medicines Australia) and various health consumer groups welcomed the announcement.
However, the Government does not appear to have decided to reduce the general PBS safety net threshold from its current $1,647.90, meaning a person will have to pay for 65 scripts before qualifying for access to the concessional PBS.
Minister Butler also announced that a re-elected Labor Government would act to fix “the former Government’s failed price disclosure tool, Medical Costs Finder”.
The website is supposed to assist patients by showing the average fee charged for a particular medical service, as well as the fee charged by particular doctors.
However, it relies on doctors uploading their data, and after six years only 70 out of a potential 11,000 doctors in specialities covered by the website have done so.
Butler said that the Government will analyse Medicare and private health insurance data to calculate average fees for individual doctors and present that information on the website.
He added that the website “will also include data from private health insurers showing their financial arrangements with specialists and how often patients pay out-of-pocket for services that aren’t fully covered by their insurance policy”, noting that so far only three insurers have voluntarily added their data to the website.
In a media conference covering the issue, Butler said “I’ve now given up on the expectation that we can rely upon specialists to upload their own fees”.
“We are now going to do it for them,” he said.
Dr Rachel David, CEO of Private Healthcare Australia (the private health insurance lobby group), said “this a massive win for consumers who have been crying out for more information and competition between specialist doctors, so they don’t get hit by unexpected fees”.
The Australian Medical Association (AMA) said it “welcomed the Government’s commitment to increase transparency on consumer out-of-pocket costs for private healthcare, including placing stronger obligations on insurers to reveal data showing how much they contribute to the cost of care and how often patients pay out-of-pocket costs that are not fully covered by their insurance policy”.
Catholic Health Australia and the Consumers Health Forum also supported the announcement.
I suspect that while everybody can sign up for the notion of transparency, when it comes to implementation, everybody will have a different idea about what should be transparent.
The Department of Health and Aged Care announced that aged care providers could apply for verification of their claims to provide specialised aged care services for people who have diverse experiences, backgrounds and characteristics.
Some sort of verification process is sorely needed – during the Aged Care Royal Commission I came across one nursing home in a small regional centre with a My Aged Care entry claiming proficiency in every language from Afrikaans to Zulu and every faith from Albanian Orthodox to Zoroastrianism.
The Department also announced the appointment of Professor Michael Kidd AO, past President of the Royal Australian College of GPs (RACGP), as Australia’s Chief Medical Officer from 1 June 2025.
Kidd is the first GP to hold the role (which has previously been held since 1996 by three kidney specialists, a gastroenterologist, an oncologist, an emergency medicine physician, and a public health physician).
His appointment was greeted with enthusiasm by GP groups including the RACGP and the Rural Doctors Association of Australia, RDAA.
The Australian Institute of Health and Welfare (AIHW) released a report on General practice, allied health and other primary care services, examining trends in service use over the period 2017–18 to 2023–24.
The rate of GP services per capita per year peaked at 7.4 in 2020-21 but has since declined to 6.1, while the rate of allied health services provided under Medicare has been relatively stable for a number of years at around one service per capita annually.
The AIHW also released data on Medicare-subsidised GP, allied health and specialist healthcare across local areas. At a high level, the differences in service provision rates between metropolitan and regional Primary Health Networks (PHNs) are generally not large.
There is a difference for services provided by nurses and Aboriginal and Torres Strait Islander health workers, where a higher proportion of people living in regional PHN areas accessed services than those in metropolitan areas.
Another difference is the proportion of people accessing after hours GP services, which in 2023-24 was 18.9 percent compared with 9.2 percent in regional areas. However, both areas have seen a substantial decline over time, from 28.1 percent and 15.8 percent respectively in 2017-18.
The Australian Bureau of Statistics released microdata from the 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), which collects information on the health and wellbeing of Aboriginal and Torres Strait Islander people, including the prevalence of chronic and long-term health conditions, self-reported health status, and some health risk factors. (The summary results are available at National Aboriginal and Torres Strait Islander Health Survey, 2022–23.)
First Nations health
Close the Gap Day on 20 March saw the release by the Lowitja Institute of the Close the Gap Campaign Report 2025, covered for Croakey in this article by Marie McInerney.
Many health sector organisations marked the day and responded to the report, including the Australian College of Rural and Remote Medicine (ACRRM), the National Rural Health Alliance (NHRA), the PSA, and the RDAA.
The NHRA acknowledged the crucial importance of Aboriginal and Torres Strait Islander-led solutions to achieving meaningful and lasting improvements in health outcomes.
NHRA Chief Executive Susi Tegen said “aligning with the National Agreement on Closing the Gap’s four Priority Reform Areas, it is the responsibility of any government elected this year to prioritise the full implementation”.
“In addition, long-term funding and policy levers need to be implemented by working with state and territory governments and communities,” she said.
“These, as well as the recommendations of the Productivity Commission’s 2024 Closing the Gap Review would ensure the gap becoming smaller”.
ACRRM President Dr Rod Martin said the college was “proud to have seen a consistent rise in the number of members identifying as Aboriginal and Torres Strait Islander over the past decade, including an almost 50 percent increase in Aboriginal and Torres Strait Islander registrars in the past year [and] proud to be part of a movement that is striving for equality in healthcare for Aboriginal and Torres Strait Islander communities”.
The RDAA said a number of key areas needed further, targeted investment to Close the Gap for people living in rural and remote Australia, including: additional rural-focused GP training places; grant funding for small rural and remote hospitals and general practices to support birthing, dialysis and palliative care; and “a National Rural Health Strategy to coordinate the outcomes from recent reviews to be considered through a rural lens so recommendations can be progressed appropriately for the rural and remote context”.
The PSA urged the Government to “fund Aboriginal and Torres Strait Islander Primary Health Services to employ pharmacists”.
“Evidence supporting this model of care was captured in the Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC) project” led by PSA in partnership with the National Aboriginal Community Controlled Health Organisation (NACCHO) and James Cook University.
In related news, Thirilli issued a media release warning that suicide rates among First Nations peoples are at crisis levels.
The latest Productivity Commission Closing the Gap Targets dashboard shows that the 2023 age-standardised suicide rate for Aboriginal and Torres Strait Islander people was 30.8 per 100,000 people, a substantial increase over the 2018 baseline of 23.6 per 100,000 people, and more than double the rate among the rest of the population.
Associate Professor Summer May Finlay, Thirilli Chair (and a member of Croakey Health Media), welcomed the recent release of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy in 2024, saying “for too long, suicide prevention programs and policies have been developed and coordinated in ways that do not reflect the needs of the communities they aim to support”.
Thirilli said that successful solutions must be designed and led by First Nations people and “incorporate cultural knowledge and place-based approaches that prioritise healing and connection to Country rather than solely relying on Western mental health frameworks”.
Consumer and public health groups
The Grattan Institute released its Orange Book briefing setting out the policies that should be on the agenda of whoever wins the 2025 federal election.
It calls on the next Government “to stay the course on many necessary but difficult reforms, and tackle others that have been in the too-hard basket for too long”.
The health chapter says that the foundations for reform have been laid, and that the next Government “must build on this foundation, moving from commitments, planning, and experimentation to systemic reform”.
Grattan identifies four areas of focus in health.
The first is chronic disease prevention, where it suggests the Government should strike a national prevention funding deal with the states to increase spending on prevention initiatives supported by strong evidence and endorsed by an independent Centre for Disease Control.
The second is general practice and chronic disease. The Government should implement the Scope of Practice Review recommendations, and reform general practice funding to move away from fee-for-service.
The third is fixing the holes in the safety net: addressing GP deserts, phasing in universal coverage for dental care, and increasing the supply of specialists and expanding public specialist clinics.
Fourthly, the Government should drive efficiency and productivity by targeting the greatest need, paying for value, and increasing accountability for impact.
The Orange Book also identifies some “quick wins”, including: improving food regulation with mandatory labelling and advertising restrictions; boosting vaccination rates; enabling GPs to get rapid advice from specialists; and revamping pathology remuneration.
These are all sensible suggestions with a robust evidence base, and many of them have been recommended or endorsed by reviews established by the Government.
Let’s hope whichever party wins Government in May has the courage to pursue them.
Trade unions
ACRRM called for urgent investment in rural healthcare infrastructure, pointing out that workforce retention is directly linked to access to essential services such as housing and childcare.
It suggested a Rural Health Service Providers’ Infrastructure Support Fund “to help close critical service gaps, making it easier to attract and retain healthcare professionals in areas of greatest need”.
The Australian Dental Association (ADA) said the “Government’s refusal to fund basic dental care for older Australians is costing them dearly in good oral health, while also wasting millions of taxpayer dollars from unnecessary hospitalisations of seniors”.
Extrapolating from past trends, the ADA forecast that preventable hospital admissions for people aged over 65 to receive dental care were likely to reach 23,000 in 2027-28.
The ADA urged the next Government to “fund a Seniors Dental Benefits Schedule up to specified limits for holders of Commonwealth seniors’ health cards, pensioner concession cards and health care cards who are 65 years or older; and include an oral health component to GP checkups of over 75s so that problems can be identified earlier”.
COTA Australia supported the proposal. CEO Patricia Sparrow said “the introduction of a Seniors Dental Benefits Scheme would ensure older Australians get access to the quality, affordable dental care they need which will keep us healthier for longer, decreasing the burden on our public health care system and freeing it up for those who need it most”.
The AMA reiterated its call for “a tax on selected sugar-sweetened beverages at a rate of 50 cents per 100g of sugar, which would raise the price of an average 375mL can of soft drink by 20 cents”.
President Dr Danielle McMullen said while the obesity crisis would cost the health system $38 billion over the next four years, a sugar tax was “a tried, tested and easily implemented policy that can significantly curb the prevalence of obesity, type 2 diabetes, heart disease and stroke”.
McMullen said the AMA had been pushing for a tax on sugary drinks for years, but Governments “keep kicking the can down the road” as our problems with obesity and chronic disease worsen.
Occupational Therapy Australia (OTA) circulated its pre-budget submission, with a range of policy suggestions including:
- implementing the recommendations of the Scope of Practice Review, extending access to the Practice Payment program to occupational therapy students, and funding the implementation of the National Allied Health Workforce Strategy
- expanding the range of service occupational therapists can provide under the Medicare Better Access program and increasing the rebate
- developing new models to fund occupational therapy services for individuals with complex mental ill-health and psychosocial disability outside the NDIS as part of the development of targeted foundational supports
- increasing access to occupational therapy in residential aged care
- increasing Department of Veterans’ Affairs fee rates
- amending the MBS Chronic Disease Management program to increase annual service limits and introduce time-tiered rebates and additional loadings for home-based care.
The PSA announced it had launched a comprehensive training program for pharmacists practising to an expanded scope.
It said “pharmacists who complete both components of the program will be able to provide clinical services as part of the Queensland Community Pharmacy Scope of Practice Pilot… the training program will form the basis for pharmacist training in other states and territories pending other jurisdictional legislation changes”.
The Royal Australasian College of Physicians (RACP) said Australians are facing longer waits for specialist medical care, widespread medicine shortages, and increasing health impacts from climate events, and warned that these problems would worsen without concrete action during the next term of government.
The RACP also called for a total ban on engineered stone and a national framework to monitor the health and exposure of workers.
The RACGP called for “effective obesity-management medication to be subsidised on the PBS to reduce health inequity”.
RACGP Specific Interest Obesity Management Chair Dr Terri-Lynne South said: “If a medicine is effective and safe, and the cost of a condition to the health system outweighs the cost of treating it with a medicine, there’s a strong case to subsidise that medicine.
“The evidence for semaglutide and similar GLP-1 receptor agonists as effective weight loss medicines is if not at, then approaching, that point.”
The RACGP marked Neurodiversity Celebration Week by “calling for nationally uniform rules to ensure equitable access to attention deficit hyperactivity disorder (ADHD) treatment and medicines for the estimated one million plus Australians with ADHD”.
RACGP President Dr Michael Wright said “currently, different states have different rules for prescribing stimulant medications”.
“In some states, people can get treatment for ADHD from their GP, which means less frequent visits to the psychiatrist or paediatrician, while those living in other states experience delayed care due to long specialist waitlists… access to timely medical care shouldn’t be a postcode lottery.”
“We welcomed the Government’s support for nationally consistent rules for ADHD prescribing last year… [and] we’re calling for all political parties to commit to increasing the number of medicines GPs can prescribe, including essential medicines for people with ADHD.”
As reported by Croakey, the RACGP also marked Social Prescribing Day by asking Government and health providers to boost social prescribing in Australia, particularly in rural and remote areas.
The RACGP relaunched its Australian General Practice Research Foundation “with a new focus on innovation and impact to improve patient care and health outcomes”.
RACGP President Dr Michael Wright said the College also called on “all political parties to commit to funding a national practice-based research network in Australia and research into multidisciplinary practice teams – which will improve access to care and reduce costs for patients”.
The RACGP marked the International Day for the Elimination of Racial Discrimination by releasing a position statement on Racism in the Healthcare System “affirming [its] zero-tolerance approach to any form of racism and commitment to measure, challenge and address racism in general practice, GP training and the broader healthcare system”.
The RDAA marked National Advance Care Planning Week (17-23 March 2025) with a statement urging rural and remote Australians “to talk with their family and doctor about setting up an Advance Care Plan – or to revisit their existing Advance Care Plan in case it needs any changes – so their care preferences are fully understood should they become seriously ill or injured and unable to communicate themselves”.
Industry groups
The Australian Healthcare and Hospitals Association released its AHHA Federal Election Statement 2025, calling for reforms to measure and report what matters; build a sustainable, resilient, person centred health workforce able to meet need; provide stewardship that enables regional innovation and reform; and use funding models that incentivise improved health outcomes for people and communities.
Day Hospitals Australia (DHA) finally entered the debate on private hospital viability, calling on Minister Mark Butler and Shadow Health Minister Anne Ruston “to take immediate action to reduce health insurance costs for consumers, prevent the closure of day hospitals and improve the financial sustainability of all private hospitals”.
DHA suggested three reforms.
The first is to “introduce equitable pricing for hospital procedures”, to avoid the situation where some overnight hospitals are paid substantially more than day hospitals for the same procedure. (Of course, these rates are the subject of agreements between insurers and hospitals, not regulation by Government.)
The second is to regulate to require some procedures to be performed only in a day hospital setting. (The Government already regulates to provide that some procedures must be provided on a day admission basis rather than an overnight basis unless there are good clinical reasons otherwise, and it is hard to see it would want to go further than that.)
Finally, DHA supports the AMA and the Australian Private Hospitals Association in calling for an “independent regulatory body to oversee the implementation of these reforms and ensure fairness and accountability in private hospital funding”.
The Pharmacy Guild held its annual shindig (aka the Australian Pharmacy Professional Conference and Trade Exhibition) on the Gold Coast.
In his President’s address Trent Twomey said that “empowering pharmacists to practise to full scope will be transformational for Australian healthcare”, claiming that “when Medicare was created, it changed how everyday health conditions were treated. Unintentionally, it directed patients away from their community pharmacist”.
Twomey envisages a world in which “full scope will restore 6,000 community pharmacies to triage and treatment units, akin to urgent care clinics. It means patients will be ‘thinking pharmacy first’”.
Unlike Twomey, I am old enough to remember the world before Medicare – and I never thought of seeking health advice from a pharmacist.
Twomey’s speech came the day before the Queensland Government announced that the Queensland Community Pharmacy Pilot, enabling pharmacists who undertake specialised training to prescribe for a range of acute conditions, would become a permanent feature of Queensland’s health system.
The announcement was welcomed by the Pharmacy Guild and the PSA, and criticised by the RACGP as “prioritising retail politics and pharmacy owners over patient health and safety”.
International organisations
UK health policy think tank The Kings Fund marked Social Prescribing Day with an article by Loreen Chikwira and Nurjahan Ali Arobi celebrating the impact of social prescribing on the health and wellbeing of people and communities.
Since 2019 3,500 “link workers” to enable social prescribing have been recruited across the NHS, and by March last year three million people had received support.
Chikwira and Ali Arobi argue that “there is increasing evidence about the benefits of social prescribing in tackling health inequalities at local levels”.
“Social prescribing supports the most disadvantaged people, such as racially minoritised communities and those living in the most deprived areas, as well as having a positive impact on long-term conditions,” they said.
Finally
The columnists’ vade mecum provides that every article covering the week that includes St Patrick’s Day must contain an item relating to Ireland.
This year there is good news to relate.
The Irish version of ambulance ramping is trolley waiting – measured by the number of people in ED lying on a trolley awaiting transfer to a bed in a ward.
Following the St Brigid’s Day long weekend in early February, there were 617 such patients at 8am on Tuesday morning.
This was regarded as unacceptable, and Health Minister Jennifer Carroll MacNeill “requested the Health Service Executive (HSE) to provide a deeper analysis of hospital consultant rostering in all acute hospitals, to cover a focused analysis of future periods’ rostering of senior decision makers in the evenings, on weekends and public holidays, initially covering St Patrick’s weekend”.
Following the weekend Carroll MacNeill was able to announce that only 230 patients were waiting on a trolley on the morning of Tuesday 18 March, a reduction of 63 percent compared with the St Brigid’s weekend.
Carroll MacNeill said “this level of performance needs to be achieved every weekend to benefit our patients and our healthcare staff”.
“I am determined to work with the HSE to make sure this momentum continues and to deliver sustained improvements in the provision of safe and timely access to emergency and urgent care for the people of Ireland,” she said.
As the Minister’s statement said, “fundamental to this is ensuring sufficient Senior Decision Makers are rostered to discharge patients throughout the entire week, including evenings, weekends and public holidays”.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Department of Health and Aged Care
Consultation on Assignment of Medicare Benefits for Simplified Billing Services
28 March
Department of Health and Aged Care
Consultation on PHI Rules sunsetting in October 2025
31 March
Aged Care Quality and Safety Commission
Consultation on cost recovery arrangements
1 April
Australian Commission on Safety and Quality in Health Care
Public consultation on potential changes to the accreditation of general practices
4 April
Department of Health and Aged Care
Emerging Mental Health Curriculum Framework for Undergraduate Health Degrees
4 April
Food Standards Australia New Zealand
Caffeine in sports foods and general foods
15 April
Coalition of Peaks
Independent Aboriginal and Torres Strait Islander-Led Review of the Closing the Gap agreement
16 April
Department of Health and Aged Care
Design of a national registration scheme to support personal care workers employed in aged care
17 April
Department of Health and Aged Care
Draft Quality Standards for Human Research Ethics Committees and their Host Institutions
17 April
Department of Health and Aged Care – Gene Technology Regulator
Invitation to comment on a field trial of genetically modified canola
17 April
National Health and Medical Research Council
Scoping survey on clinical practice guidelines on the diagnosis and management of myalgic encephalomyelitis / chronic fatigue syndrome
27 April
Department of Health and Aged Care – Gene Technology Regulator
Trial of a genetically modified (GM) vaccine for the prevention of respiratory disease in horses
28 April
Food Standards Australia New Zealand
Permitting small dogs and cats in aircraft cabins
30 April
Therapeutic Goods Administration
Proposed changes to the IVD medical device classifications and definitions
8 May
Department of Health and Aged Care
Updating clinical guidelines for dementia care
31 December
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
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