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24 Jun 2014

Major declines in infant mortality, heart attacks, rates of smoking and lung cancer cases have helped ensure Australian life expectancy is among the highest in the world.

But the AMA has warned the Federal Budget could undermine recent progress and exacerbate the threat posed to the nation’s health by rising rates of obesity, diabetes and other chronic conditions by making it more expensive to see a doctor, obtain medicine or undergo a diagnostic test and by reducing the focus on preventive health measures.

In its final update on the state of the nation’s health, the soon-to-be-disbanded COAG Reform Council reported that average life expectancy increased almost a year between 2007 and 2012 to reach 79.9 years, supported by a 22 per cent fall in the child death rate, a 21 per cent decline in deaths from heart attack and stroke, and a 6.4 per cent fall in deaths from cancer.

Cancer has overtaken circulatory diseases to be the leading cause of death.

The increase in life expectancy has been underpinned to considerable extent by the success of anti-smoking policies and campaigns, with little more than 16 per cent of adults lighting up daily – down from 19.1 per cent in 200708.

Aspects of health care have also improved – more than 70 per cent of emergency department patients receive timely treatment, rates of hospital-acquired infections have fallen, fewer people with chronic diseases are ending up in hospital unexpectedly and access to mental health care has improved.

But AMA President Associate Professor Brian Owler said the COAG report also revealed worrying signs of stress in the health system, particularly public hospitals, and highlighted the risk that increasing the cost of seeing a GP, getting medicine or having a pathology or radiology test could undo recent health gains – especially given the nation’s increasing weight problem.

“The report shows that public hospitals are already stretched to meet demand,” A/Professor Owler said. “Waiting times in emergency departments have improved, access to important surgery varies significantly by levels of disadvantage.”

Indicating the price sensitivity of a small by significant proportion of the population, COAG reported that 5.8 per cent of patients either delayed or avoided altogether seeing a doctor because of cost (more than 7 per cent outside the major cities), while 8.5 per cent did not have a prescription filled for the same reason – a proportion that rose one in every eight people in the most disadvantaged areas.

A/Professor Owler said these findings reinforced the AMA’s concern that the Government’s decision to impose a $7 co-payment on GP, pathology and diagnostic imaging services would cause an increasing number of people with health problems to delay seeking treatment, potentially turning a condition that could be readily treated into much more serious and expensive issue later on.

“Our worries about co-payments is not about co-payments, per se,” he told radio 4BC. “Many doctors already charge them for those that can afford it. But we are worried about those most vulnerable in our society, those in aged care, the young, and those that are the working poor for which these sorts of costs are a significant barrier to them accessing healthcare.”

A/Professor Owler said the Government’s “poorly-designed” co-payment model would hit patients with a rapidly accumulating medical bill if they were referred for diagnostic tests or prescribed medication.

“The rates for not filling scripts in the COAG report can be expected to increase significantly with increased co-payments for PBS medicines,” he said. “This would have serious consequences for downstream health care costs. A similar impact will occur with co-payments for pathology and diagnostic imaging services.”

Preventive health measures such as vaccinations and measures to improve physical activity and diet have been a focus of health policy through COAG in recent years, but the results have so far been disappointing, and Associate Professor Owler expressed concern that the Abbott Government’s Budget would further undermine progress.

The COAG report found hospitalisation rates for vaccine-preventable conditions surged 16 per cent between 2007 and 2012, while the nation’s waistline has expanded to the extent that 62.7 per cent of adults are overweight or obese, and more than 4 per cent of people have type 2 diabetes – a chronic disease associated with poor diet and sedentary lifestyles.

“In the future, Australia’s high obesity rates suggest a possible increase in the incidence of type 2 diabetes, given the well-established link between the two,” the report said.
Of particular concern, according to the COAG report virtually half of all those with type 2 diabetes – which is most prevalent in disadvantaged areas - were not managing the condition effectively, and only around 10 per cent who knew they had the disease maintained a health body weight.

A/Professor Owler said increasing the cost of seeing a doctor would lower vaccination rates, increasing the number of people with vaccine-preventable health problems who end up in hospital, and would likely undermine the diagnosis and effective management of type 2 diabetes, leading to greater health costs in the longer-term.

“The good news in the report about improved health outcomes is overshadowed by the risks of the Government co-payment model,” he said. “The rest of the world is lowering barriers to primary care to improve overall health outcomes and make their health systems sustainable. But Australia is moving in the opposite direction.”

Adrian Rollins

Published: 24 Jun 2014