Eat your vegetables – studies show plant-based diets are good for immunity



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We’ve been told there are many benefits of eating our veggies. Could they improve our immune system too?
From shutterstock.com

Yasmine Probst, University of Wollongong and Joel Craddock, University of Wollongong

The number of people in Australia who follow vegetarian or plant-based diets is growing rapidly. People might choose to be vegetarian for ethical, cultural or health-related reasons.

While not all vegetarians are necessarily following a healthy diet, research shows vegetarianism can have many benefits for health. One we’re learning more about is its potential to strengthen our immune systems.

We’re still working out what aspects of a vegetarian diet may be responsible for this – whether it’s the lack of meat or the emphasis on plant-based foods.

But we think the higher volume of foods including fruits, vegetables and legumes seen in vegetarian diets is likely to have a lot to do with any associated health benefits.




Read more:
We asked five experts: is vegetarianism healthier?


What do vegetarians eat?

Vegetarian diets are comprised of combinations of fruit, vegetables, whole grains, nuts and seeds, legumes and, for some, dairy and eggs.

There are many types of vegetarian eating patterns, from vegan (no animal products) through to lacto-ovo (some animal products such as eggs and dairy). But each avoids eating meat.

There are also a few semi-vegetarian approaches which include eating small amounts of some meats. People who primarily follow a vegetarian diet but include fish are referred to as pescetarian, while those who occasionally eat other forms of meat are considered flexitarian.

Importantly, not all vegetarians follow a healthy and balanced diet. Many won’t eat the recommended daily servings of fruit and vegetables, and will consume too much junk food.

But studies show that balanced vegetarian eating patterns could be good for our immune system and the related response of the body.

Defending from attack

Our bodies are faced with daily challenges such as getting rid of toxic chemicals and defending against nasty viruses. The immune system is “switched on” in response to these attacks.

Having a healthy immune system is important, as it prevents us from becoming sick. A healthy immune system can be supported by a number of lifestyle factors including adequate sleep, healthy body weight and regular physical activity. It can also be substantially affected by the foods we eat and drink.

Some research has found following a vegetarian diet could improve our immune systems.
From shutterstock.com

People following vegetarian diets tend to have lowered levels of white blood cells, our natural defender cells. This is the case for vegetarian diets including vegan, lacto-vegetarian and lacto-ovo vegetarian.

Having very low levels of these cells is not ideal as it can affect the body’s ability to fight infection. However, having just the right number of white cells within a healthy range may reduce your chances of getting sick.

An added shield of protection

As well as helping the immune system, vegetarian diets may also help our body with a related process called inflammation. Vegetarian diets have been shown to prevent inflammation due to the antioxidant components within the foods.

Inflammation occurs when the body releases cells to attack unwanted pathogens or respond to injury. It may result in redness to an area of the body or the release of certain chemicals inside our bodies. Inflammation is a protective measure that the body uses to stay as healthy as it can.




Read more:
Five life lessons from your immune system


People who follow vegetarian diets have lower levels of some of these chemicals (called C-reactive protein and fibrinogen) compared to people following a non-vegetarian diet.

This means people maintaining a vegetarian diet long-term are at a lower risk of getting type 2 diabetes, heart disease or even some cancers. Each of these chronic diseases is associated with increased inflammation in the body. This is shown in blood tests by increased levels of C-reactive protein, as this is a signal of systemic inflammation.

The reason why vegetarians have lowered levels of inflammation remains to be fully understood.

We suspect the high amount of fruits, vegetables, whole grains, nuts and seeds are helping. These foods are full of important nutrients including fibres, vitamins, minerals and compounds called phytochemicals.

All of these nutrients have been shown to improve levels of inflammation in the long term and may influence the body’s immune response as an added bonus.

Should I switch to a vegetarian diet?

Going vegetarian may not be for everyone.

And it’s unwise to start a new eating pattern without understanding the potential impacts it can have on your health.

Vegetarian diets that are inappropriately balanced can lead to an increased risk of iron, zinc and vitamin B12 deficiencies. This can be detrimental to overall health, particularly if followed for extended periods of time.

The risks may be greater for certain groups of people who have added nutrient needs due to life stage, gender or for another health-related reason.

So vegetarian eating should always be undertaken carefully and under professional guidance, preferably that of a dietitian, to minimise these risks.




Read more:
Love meat too much to be vegetarian? Go ‘flexitarian’


But importantly, only 5.1% of the Australian population eat the recommended amount of fruit and vegetables – five serves of vegetables and two serves of fruit each day.

So whether you’re vegetarian or not, focusing on incorporating more plant-based foods into your diet is worthwhile. We’re constantly learning more ways this is good for your health.The Conversation

Yasmine Probst, Senior lecturer, School of Medicine, University of Wollongong and Joel Craddock, PhD Candidate, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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We need more than a website to stop Australians paying exorbitant out-of-pocket health costs



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For some people, high out-of-pocket costs makes it difficult to see a doctor or fill a prescription.
From shutterstock.com

Anthony Scott, University of Melbourne and Peter Brooks, University of Melbourne

In an attempt to crack down on specialists charging exorbitant fees, the Morrison government has pledged to create a website listing individual specialists’ fees.

The website is voluntary and doctors will post their own fees. Patients will be able to compare doctors whose fees are listed, and the searchable website will have a special focus on the high fees in gynaecology, obstetrics and cancer services.

The announcement, made on Saturday, follows the release of a ministerial advisory committee’s report on out-of-pocket costs, which the government has had since November.

But while the website is a good first step, transparency alone is unlikely to be enough to ensure Australians aren’t forgoing care because of high costs.




Read more:
More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up


What’s the problem?

A central problem is the lack of transparency around out-of-pocket costs. Patients are typically unaware of the full out-of-pocket costs they might incur at the time of referral and admission.

The Consumers Health Forum’s recent report found Australian consumers face higher than average out-of-pocket costs compared to most countries. This translates into people often avoiding visiting a GP or specialist and failing to fill scripts due to cost.

A report from the Grattan Institute using data from the Australian Bureau of Statistics shows many people already miss out on health care because of cost: 5% skip GP visits, 8% don’t go to a specialist, 8% don’t fill their prescription and 18% don’t go to the dentist. This will happen more if fees go up.

Those who avoid care because of cost are often those most in need, leading to concerns about equity of access. Delaying or foregoing care means when people do visit their doctor, their condition may be much worse than if they had presented earlier. This can affect long-term health outcomes and lead to higher costs over time.




Read more:
Many Australians pay too much for health care – here’s what the government needs to do


“Value” is also about providing information on the various options for care, including the evidence base of the treatments offered, waiting times for various providers, and how the quality of care might vary between the options.

Consumers, with the help of GPs where necessary, should be able to assess these trade-offs to arrive at a decision that works best for them.

But patients know little about the quality of care provided when they are offered treatment or even whether they will really get better as a result.

Significant numbers of procedures and treatments performed on patients in Australia are considered “low value care” – when treatments have little effect on health outcomes, and may even cause harm. Recent estimates for New South Wales public hospitals suggest that between 11% and 20% of treatments involve low-value care.

These issues are being tackled through the Choosing Wisely campaign which is increasing awareness of tests and treatments that are of low value and may cause harm.

The Medicare Benefits Schedule Review Taskforce is also reviewing how these procedures are funded through Medicare.

This website will make specialist fees publicly available to consumers – but only if the specialists choose to list their fees.
From shutterstock.com

Your right to know the costs of care

What are your rights as a patient in relation to the costs of medical treatment?
At present, it seems consumers have very few.

There are no consistent enforceable guidelines on health-care providers to provide information on costs. Voluntary codes of practice are in place to encourage fee transparency but cannot be enforced.

The Commonwealth Ombudsman’s website provides guidelines on informed financial consent in health care. Unfortunately these place the onus to gather the relevant information on the costs of care on consumers:

You should ask your doctor, your health fund, and your hospital about any extra money you may have to pay out of your own pocket, commonly known as a “gap” payment.

Health professionals should be required to provide information that will assist consumers make informed decisions.

Why we need more than a website

Gathering information on specialists’ fees and making sense of it is an enormous burden to place on vulnerable patients. This is especially the case for the elderly and those with little education who are reluctant to appear to question their trusted doctor.

We don’t know how effective a website of usually charged fees will be and who will use it. It’s possible it will advantage the rich by increasing their access to information, while not increasing access for poorer consumers.

Published fees may also be used by other doctors to set fees, and could potentially increase fees, if they see their prices are lower than others.

The onus should be on clinicians, and the system, to give patients easily accessible and digestible information as part of the service they provide.




Read more:
Specialists are free to set their fees, but there are ways to ensure patients don’t get ripped off


If health professionals cannot provide and interpret these costs to patients, we need to consider other trained workers – health “cost navigators” – who could advise patients as to how to decide on the best treatment for the best price.

The issues of out-of-pocket expenses are serious. They threaten the sustainability of our health system and adversely influence health. We need to ensure patients don’t face prohibitive costs that discourage them from treatment or force them into debilitating financial straits.The Conversation

Anthony Scott, Professor, University of Melbourne and Peter Brooks, Professor, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Doctors may be prescribing antibiotics for longer than needed



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Most recommended courses last between three and seven days.
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Allen Cheng, Monash University

For most infections, the long-standing advice is to take a full course of antibiotics.

The rationale for not simply stopping antibiotics as soon as you start to feel better is that antibiotics don’t kill the bacteria instantly. If stopped too early, the remaining bacteria, which are exposed to low concentrations of antibiotics, tend to be more resistant. These can then re-grow, causing recurrent infection, or spread to other people.

The recommended length of the course depends on the type of infection, the likely cause, and how effective the antibiotics are at killing the bacterium and penetrating to the site of infection.

For infections commonly seen in general practice, most recommended courses last between three and seven days. For more serious infections requiring hospitalisation, the recommendations are generally a little longer.




Read more:
Use them and lose them: finding alternatives to antibiotics to preserve their usefulness


A recent study from the United Kingdom found a substantial proportion of antibiotic prescriptions in general practice were for longer than these recommendations. While for each prescription this may have only been a few days longer, for the UK as a whole this amounted to about 1.3 million days of antibiotics more that would have been necessary.

Researchers are currently investigating how much of a problem this is in Australia.

There’s little evidence to suggest longer courses of antibiotics benefit patients. In fact, even the recommended lengths could be too long for many infections.

Why are courses longer than recommended?

The most important determinant of duration in primary care is probably the size of the pack the antibiotics come in.

But the number of tablets in a pack is rarely the same as the length of a course. One Australian study looked at 32 common prescribing scenarios and found that the pack size only matched the recommended duration of antibiotics in four cases.

Other reasons antibiotics may be prescribed for longer than recommended is when patients are given “repeats” and taking a second course of antibiotics. Often, the doctor isn’t actively prescribing a second course, but their medical prescribing software is printing a “repeat” on their prescription by default.




Read more:
FactCheck: Is Australia’s use of antibiotics in general practice 20% above the OECD average?


In hospitals, clinical uncertainty plays a large role. It is sometimes suggested that antibiotics are used for the benefit of the patient, but at other times to allay the treating doctor’s anxiety.

While the motivation to make sure infections are properly treated is understandable and well-intentioned, particularly in patients who might still be critically unwell for other reasons, continuing antibiotics for too long increases the risk of side effects and antibiotic resistance.

Do we even need a full course?

We may be able to stop antibiotics before we reach the end of our course. The body has the capacity of “mop up” small numbers of bacteria, so at least for milder infections, it may not be necessary to kill them all.

This is important because using antibiotics for too long can be a problem in causing antibiotic resistance. This can occur within individual patients by exposing bacteria elsewhere in the body to antibiotics, but also because antibiotics are eliminated from the body and can contaminate the environment.

We didn’t always standardise the duration of antibiotics. Harry Dowling, one of the pioneers of early antibiotic use, once said

The duration of treatment just evolved. There was no rationale for any single length of time. We saw how long it took for the temperature to come down and gave antibiotics until it did, and then some.

The durations recommended in guidelines often come from arbitrary decisions made in early studies, which have translated into some odd “rules” about antibiotics:

  • prime numbers for durations of up to a week (three, five or seven days)
  • even numbers for more serious infections that take weeks to eradicate (two, four or six weeks)
  • multiples of three for really tenacious infections such as bone infections (three months) or TB (six months).

In writing guidelines for doctors, we often wrestle with whether to set a fixed duration (such as seven days), a range (five to ten days), a minimum (at least five days), a maximum (up to ten days) or wordy qualifications (usually five days, or ten days for severe illness or where there is a slow response).




Read more:
We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?


What about serious infections?

For deep or severe infections, we want to be sure the infection won’t return. Recent research has focused on defining the shortest effective duration of treatments.

A recent trial compared whether seven days or 14 days of antibiotics were required for some types of bloodstream infection, and found outcomes to be similar.

Researchers have also been testing the use of oral antibiotics for two of the most difficult infections to treat – endocarditis (infection of the heart valves) and ostemyelitis (infection of bone) – which have needed intravenous antibiotics for six weeks or longer. These trials have shown a shorter course of intravenous antibiotics with an early switch to oral antibiotics may be adequate.

Shortening the duration of antibiotics is one important way to reduce antibiotic use, the key driver of antibiotic resistance.




Read more:
Health Check: should kids be given antibiotics in their first year?


The Conversation


Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up



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The number of Medicare claims Australians make in a year doubled between 1984 and 2018.
By Sopotnick

Jane Hall, University of Technology Sydney and Kees Van Gool, University of Technology Sydney

This is part of a major series called Advancing Australia, in which leading academics examine the key issues facing Australia in the lead-up to the 2019 federal election and beyond. Read the other pieces in the series here.


Over the last 35 years, Medicare has given Australians access to high-quality health care at a reasonable cost. But, despite our justifiable pride in Medicare, it’s time to reconsider the way we pay for health care.

Australia’s Medicare system is a A$20 billion-a-year program. It subsidises most of our out-of-hospital doctor consultations, blood tests, X-rays and scans, physio appointments, eye tests and many other health services. It’s based on a long list of items and each time an item is provided, Medicare pays a benefit.

But paying doctors and other health providers a set fee for each service they deliver is not delivering optimal value for the health dollar. There are two reasons for this.

First, it encourages a higher volume of services, but not necessarily better-value services.

Second, it constrains doctors into delivering the care based on the items in the schedule, which often don’t meet the needs of complex patients.




Read more:
Explainer: what is Medicare and how does it work?


One promising alternative is “bundled payments”. Rather than paying doctors a “fee for service”, they would be paid a prospective lump sum to care for the patient’s medical problem, over a specified period.

The lump sum would be a pooled payment for all services provided to treat the condition. The provider’s role would be to coordinate the patient’s care across different parts of the health system and work with a range of health professionals to deliver high-quality care.

This would give doctors greater flexibility to manage the care patients need. At the same time, doctors would be held accountable via measurements of the quality of their care.

Importantly, this would give patients greater access to a broader range of services and make it easier to navigate our complicated health system.

Why health costs are rising

Between 1984 and 2018, Australian government spending on services outside of hospitals has increased from A$426 to A$818 per person, after adjusting for inflation.

This increase is almost entirely due to service volume. Back in 1984, the average Australian made 7.25 out-of-hospital Medicare claims a year. By 2018, this had escalated to 15.34; a doubling in the average number of claims.

The biggest growth has been in the number of pathology claims for blood and tissue tests (1.4 in 1984 to 5.2 in 2018), followed by GP consultations (4.2 compared to 6.3) and diagnostic imaging, including X-rays and other types of scans (0.3 versus 1.0).

This is not just the result of population ageing. At every age, we are making more Medicare claims. In 1985, people aged between 75 and 84 made 16.1 Medicare claims per year. In 2018, this number had grown to 44.6 claims per person per year.

Medicare prices have been very steady. For GP consultations, for example, the benefit paid per service has increased by 72% over the 35-year period, and mostly as a direct result of policy initiatives such as the Strengthening Medicare reforms introduced in 2004-05.

In fact, since 2005, the benefit per service has declined by 6% in real terms. This is a result, in part, of the Medicare freeze imposed by government between 2012 and 2018.

So price control is only one part of constraining expenditure growth. The other is the volume of services.




Read more:
FactCheck: has Medicare spending more than doubled in the last decade?


The medical care market has undergone considerable corporatisation. Corporate entities now own around 10% to 15% of all GP practices in Australia.

Corporate entities can own and run primary care practices as well as pathology laboratories, diagnostic imaging services and even pharmacies. This creates more incentive to refer patients to their own businesses for blood tests and imaging to increase the volume of claims, and therefore increase profits.

Greater spending doesn’t mean better care

The second critique of Medicare is that current funding arrangements create disincentives for delivering optimum care over a longer period, particularly for complex patients who require multiple services from multiple providers. They might have cancer, for instance, or multiple chronic diseases such as heart disease and diabetes or dementia.

Currently, Medicare makes a payment for every claim made within what we call an “episode of care” – a set of services to treat a condition, or a procedure. Each provider in that episode has an incentive to increase their own volume of care, but there are virtually no incentives to coordinate or deliver an optimum pathway of care for the patient.

Further, there are too few opportunities and rewards in this system to give doctors flexibility to offer different types of care for patients. This includes care provided by nurses, physiotherapists or dietitians; email or telephone consultations; patient education; and coordination services.

Instead, pay doctors a lump sum

The main feature of a good payment system is that it creates the right incentives for providers and patients to use health care resources effectively, efficiently and equitably.

Bundling payment involves working out the best care pathways for each condition. Cancer, for example, is a complex disease that requires ongoing care from primary, specialist and hospital services.

Under a bundled payment, the patient’s GP clinic would be paid a lump sum to ensure the patient receives all the services they need. This includes consultations, health checks, blood tests, physiotherapy, dietetics, patient education, and so on. The GP would have more control over how each of those services is delivered.

Sometimes will be best cared for by a physiotherapist.
Africa Studio/Shutterstock

If viable, the GP could bring some of these services into their practice, or they could subcontract them to other organisations.

The practice would be held accountable for providing high-quality care through various performance measures. These could range from patient satisfaction measures to objective measures such as timeliness of care or fewer avoidable complications. Payments could, in part, be made conditional on meeting performance targets.

Ultimately, because we are giving the provider more say over how care is delivered, the model of care can be more easily adapted to the needs of the patient.

Health reform must be based on evidence

In the small number of countries where bundled payments have been piloted, they are associated with improved quality, financial savings and increased patient satisfaction.

A bundled payment for hip-fracture patients in England, for example, resulted in more patients receiving surgery within 48 hours after admission and lower death rates.




Read more:
Creating a better health system: lessons from England


Although these studies show promise, the evidence base is still in its infancy.

Successful reform in this area will require careful design of the bundles, the payment levels and patient selection process, as well as how best to monitor quality care. In particular it requires robust evidence to determine:

  • what constitutes an optimal bundle of care for a particular condition
  • the cost of delivering those services
  • how the payment should be adjusted for the specific characteristics of a patient
  • the role performance targets may play in motivating health providers to deliver high-quality care.



Read more:
Is it time to ditch the private health insurance rebate? It’s a question Labor can’t ignore


The Conversation


Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney and Kees Van Gool, Health economist, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Is it time to ditch the private health insurance rebate? It’s a question Labor can’t ignore



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Premium subsidies encourage Australians to take out and keep private health insurance.
Shutterstock

Stephen Duckett, Grattan Institute

This is part of a major series called Advancing Australia, in which leading academics examine the key issues facing Australia in the lead-up to the 2019 federal election and beyond. Read the other pieces in the series here.


This election campaign, Labor’s health focus is expected to be on Medicare, which it regards as one of its defining achievements. But with almost half the population covered by private health insurance, Labor needs to tread carefully on this vexed topic.

Government subsidies for private health insurance premiums cost over A$6 billion a year. Is it time to scrap the rebate and redirect these funds elsewhere in the health system?

If Labor sees private health insurance as a system that provides unnecessary extravagances that Medicare won’t cover, it can’t justify this type of subsidy.

But picking a fight with the private health insurance industry would be politically foolhardy. And families have factored the subsidies into their budgets, so cutting or eliminating the subsidies would put further pressure on family finances at a time of wage stagnation.




Read more:
Do you really need private health insurance? Here’s what you need to know before deciding


We’re unlikely to see much of a discussion about private health insurance during the election campaign. But the party that wins government must commit to reforming the ailing private health insurance system.

How did we get here?

Private health insurance has been a contested policy zone for more than 50 years.

Gough Whitlam prompted a bitter debate over whether government health insurance should be for everyone (universal) or just for the poor (residual), when in 1968 he committed Labor to a universal scheme to replace the then residual model. The new universal model eventually became Medibank in 1975, then Medicare in 1984.

It wasn’t until the 1996 election that then opposition leader John Howard formally conceded defeat on this issue, acknowledging that Medicare should be for all. However, Liberal governments keep returning to “residual” rhetoric, arguing wealthy people should pay directly for health care rather than use the universal scheme, Medicare.

After winning the 1996 election, Howard opened a second front in the health-care war by reinstituting government subsidies for private health insurance.

The cost of the first subsidy scheme – known as the Private Health Insurance Incentive Scheme – was estimated at A$600 million a year. Two decades later, the private health insurance subsidy has increased ten-fold to more than A$6 billion a year.

Getting people to sign up and stay

Liberal governments offer carrots to encourage people to take out insurance – subsidies for premiums – but also use two sticks to penalise people for not taking out insurance. The sticks have proved to be more effective than the carrots in increasing insurance enrolment.

The first stick penalises the rich if they don’t have private health insurance. It is based on the “residual” ideology, that those who can afford to pay their own way should take out private health insurance and not use public hospitals. This stick takes the form of a Medicare Levy surcharge, starting at 1% of income to be paid by singles who earn more than A$90,000 a year, or families on more than A$180,000 a year. People who have private health insurance are exempt from the surcharge.




Read more:
Private health insurance premium increases explained in 14 charts


The second stick penalises people who do not take out private health insurance before turning 31. They have to pay higher premiums if they join later in life. When introduced in 2000 this scheme – known as Lifetime Healthcover – increased coverage from about 30% to around 45% of the population.

What is private health for?

Neither side of politics has confronted the fundamental question: what is the role of private health care and private health insurance, given we have universal health coverage?

Private health insurance can complement universal health insurance, providing insurance for services not covered by Medicare. Dental insurance is a good example.

Private health insurance can also be a substitute, where it overlaps with or replaces the public scheme, such as insurance for private hospital care for hip replacements. More than half of all hip replacements are done in private hospitals.

The Liberal approach is simple: private health insurance is both an essential substitute for the universal public hospital system (“it takes pressure off the public hospital system”) and a complement (“it gives people choice of doctor”).

Labor approaches private health insurance a bit like one might approach a dead cat on the table – as an issue that has to be dealt with, but that everybody wishes would just go away.

But private health insurance won’t go away. If Labor sees it solely as a complement, providing unnecessary extravagances not covered by Medicare, then the argument for any public subsidy is weak.

But if Labor sees private care primarily as a substitute, then the A$6 billion of subsidy to private care through the rebate may be better value for money than further support for public hospitals. If that is the case, Labor will have to confront the issue of whether to continue some combination of carrots and sticks, and what can be done to make the industry more efficient.

Time for real reform

Private health insurance premiums have risen dramatically, faster than average weekly earnings, as have consumer complaints.

Labor is seeking to exploit public outrage at high private health insurance premiums by promising to establish a Productivity Commission review into the sector.

In the meantime, Labor would freeze private health insurance premium increases – in effect, kicking the policy can two years down the road.

Whichever party wins the election, it ought to revisit our nation’s history with failing industries. Over recent decades we have learnt that propping up industries in the face of consumers turning away from their products is not a long-term proposition.

Private health insurance is no car industry, but it’s not a sunrise industry either. Yet it receives a greater subsidy than manufacturing at its subsidised peak at the end of the 1960s.

The government has to decide why it’s subsidising the private health care industry. If it decides it doesn’t want to in future, it needs a carefully managed transition.




Read more:
Private health insurance rebates don’t serve their purpose. Let’s talk about scrapping them


Even if private care is seen primarily as a substitute for the public sector – and a way to take some demand off – subsidies for private care may be counter-productive.

Doctors earn more for each hour worked in the private sector, which makes it harder for public hospitals to attract staff. So subsidies may end up undermining access to care in the public system.

Australians feel pressured to take out private health insurance because of the sticks, but the product is only sustainable with its current level of coverage because of the carrots: the hefty public subsidies. Without the carrots and sticks, coverage would probably return to the pre-1996 levels of around one-third of the population.

The incoming government should look at the effectiveness and efficiency of the carrots and sticks, whether consumers and taxpayers get value for money from private health insurance, and how to address rising out-of-pocket costs.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Royal commission on the abuse of disabled people to be announced soon


Michelle Grattan, University of Canberra

The Morrison government is about to establish a royal commission into violence and abuse of people with a disability.

The aim is to have the terms of reference finalised before the
election. The disability area is a shared one, so the royal commission would be set up jointly with the states and territories.

As of late Wednesday, Queensland, Victoria, NSW, South Australia and Tasmania had agreed to the inquiry; Western Australia and the two territories are expected to do so soon.

Scott Morrison, campaigning in Tasmania, flagged a very extensive
scope for the commission.

“I think it will be a royal commission of a similar size and standing as what we saw with institutional child sexual abuse. Let’s remember that went for four years. It had five commissioners,” he said.

There is no cost for the royal commission as yet and the federal
government wants the other governments to contribute. The child sexual abuse commission cost about A$500 million; the banking inquiry was around $75 million; the aged care one is set to cost about $100 million.

The disability sector has been pressing for the inquiry. Greens
senator Jordon Steele-John, who has a disability, has been one of the loudest voices. The opposition has promised a royal commission, and earlier this month parliament passed a motion calling for one. The Coalition opposed that motion in the Senate but voted for it in the lower house.

In a letter to state and territory leaders Morrison said the scope of the inquiry being proposed by disabled people and advocates “is broad, including mainstream services that are regulated by state and territory governments such as health, mental health and education services provided prior to the establishment of the NDIS.

“The cooperation and support of state and territory governments is therefore essential”.

Morrison said he was seeking views from the states and territories on the “most appropriate consultation pathways to progress” the commission, including through the Council of Australian Governments. This process should also consider cost sharing. “I am also seeking views on options to undertake meaningful consultation with the disability sector, to ensure that the perspectives of people with disability are incorporated and they are provided with appropriate support”.

The opposition accused Morrison of haggling with the states over the funding of the royal commission, saying that “Labor committed to a separate, dedicated and fully federally funded royal commission in May 2017”.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our culture of overtime is costing us dearly



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About 13% of Australian worker are working 50 hours or more a week, putting themselves, and others, at greater risk.
Shutterstock

Joshua Krook, University of Adelaide

The story of Yumiko Kadota, whose gruelling schedule as a Sydney hospital registrar included clocking up more than 100 hours of overtime in her first month, has highlighted the punishing work schedules required in the medical profession.

Research indicates working more than 48 hours a week is associated with significant declines in productivity, more mistakes and more mental health problems. Yet the Royal Australasian College of Surgeons reckons working up to 65 hours a week “is appropriate for trainees to gain the knowledge and experience required”.

It’s an attitude that explains why a 2017 audit found more than 70% of surgeons in public hospitals were working unsafe hours. And it’s symptomatic of many areas where pushing the hours envelope is seen as part of the job.




Read more:
Working long and hard? It may do more harm than good


Last month, for example, a study by the Australian Transport Safety Bureau found almost one in four long-haul pilots reported working on less than five hours of sleep in the previous 24 hours – putting them in the risk zone where fatigue leads to impaired performance.

Meanwhile, two of Australia’s largest law firms are being investigated for overworking staff. At King & Wood Mallesons in Melbourne, lawyers working on the banking royal commission were reportedly sleeping in their offices overnight, too tired to go home. At Gilbert + Tobin Lawyers in Sydney, it is alleged lawyers were resorting to drugs and other supplements to cope with fatigue.

Other areas in which long hours are common are in mining, farming and construction. All up about 13% of the workforce – 19% of men and 6% of women – are working 50 hours or more, putting themselves, and others, at risk.

What’s the damage

After a century of “scientific management” you might think that more attention would be paid to the scientific studies on working long hours.

The relationship between work hours and productivity follows the economic law of diminishing returns. Productivity peaks at a certain point and then declines. Work too long and you get to the point where you’re achieving nothing; or are even doing damage.

Diminishing returns: author Mark Manson decided to chart his productivity over hours in the day in this fashion.
The Observer

This is what the research literature tells us:

  • After working 39 hours a week, mental health tends to decline.
  • After 48 hours, job performance begins to rapidly decrease. There are more signs of depression and anxiety, and worse sleep quality associated with long-term health risks such as cardiovascular disease, type 2 diabetes and cancer.
  • Working more than 10 hours a day increases the risk of workplace injury by 40%, and more than 12 hours a day doubles it.
  • Longer working hours harm relationships, erode job satisfaction and contribute to depression, including increased suicidal thoughts.

A rule made to be broken

All of this research shows there’s good sense in Australia’s federal Fair Work Act (s. 62) capping the standard work week at a maximum of 38 hours.

But that maximum is easy to flout. The act also says an employer can require an employee to work “reasonable” extra hours. Determining whether they are unreasonable depends on 10 factors, including a risk to health and safety, family circumstances, the needs of the business, compensation, the usual patterns of work in the industry and “any other relevant matter”.

The law says an employee can refuse to work more than 38 hours a week, but in practice that rarely happens.

You may be happy to put in more hours because you are compensated. You may even do it “voluntarily”, because you see it as a path to promotion, or the way to keep your job. You may be enmeshed in a “first in, last out” culture, where it’s a competition to show your devotion to your job through the number of hours you work.

As a result, Australians work an average six hours of unpaid overtime a week.

Gaming the system

Management practices can promote an overtime culture without explicitly flouting the law.

One way is to scrutinise an employee’s working hours, such as using a billable hours system. This is common in law firms and other professional services. Clients are charged by the hour (or six-minute increments, as is the case in law firms) for the time an employee spends working on a matter. It puts pressure on a conscientious employee to do any work not related to a client in their own time. An employee may also under-report hours so as not look slow or unproductive to a manager.




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Another way is through using casual or contract workers. Such employment can result in workers doing more hours than what they are paid for, either because they have underquoted to get the job, or are working on a fixed contract where the employer has defined how long it should take, or they feel the need to prove their worth to ensure they get more work.

Changing attitudes

State and federal government agencies, including the Fair Work Ombudsman and Safe Work Australia have broad powers to investigate worker health and safety (including overtime).

But for those powers to make a difference, these agencies need more resources to actually do investigations and greater powers to issue fines and corrective measures to companies where overtime is endemic. There’s no reason hours auditing couldn’t be a more routine procedure, much like food health and safety regulators inspect restaurants.

But more than that we need a change in the cultural attitudes that promote long hours as necessary, acceptable or heroic – even when someone doing their job while overtired and fatigued, such as a surgeon or pilot, is downright scary.The Conversation

Joshua Krook, Doctoral Candidate in Law, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Everyone can be an effective advocate for vaccination: here’s how


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Listening to people’s concerns is important when talking to someone who is hesitant about vaccination.
From shutterstock.com

Jessica Kaufman, Murdoch Children’s Research Institute and Margie Danchin, Murdoch Children’s Research Institute

The World Health Organisation (WHO) has named vaccine hesitancy as one of their top 10 threats to global health for 2019.

Last week, the wife of an NRL footballer made national headlines after posting on Instagram that the couple did not plan to vaccinate their children.

Indeed, there’s rarely a time vaccination isn’t a hot topic of public debate. What’s important to note is that anyone can use evidence-based communication techniques to be an advocate for vaccination – you don’t need to be an expert in the field.

Conversations between peers can be very influential, because our behaviours are shaped by social norms, or what other people in our network value and do.




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Who do we need to talk to?

While the current measles outbreaks in the United States and Europe are concerning, much of the reporting has over-simplified the issue, with sensationalised headlines placing the blame almost solely on “anti-vax” parents.

In reality, the vast majority of people whose children are missing some or all doses of the recommended vaccines are not “anti-vaxxers”, and labelling them as such is unhelpful.

The ability to register for vaccination exemption based on conscientious objection was removed in 2016, but it was last recorded in December 2015 as affecting only 1.34% of eligible children.

Current childhood vaccination coverage in Australia is between 90.75-94.67%, depending on age.

This suggests that missed opportunities and access barriers, such as parents being unable to get to the GP or a council immunisation session, are much more substantial contributors to under-vaccination.

Under-vaccination is regarded as a threat to global health.
From shutterstock.com

Communication about vaccines is unlikely to impact the behaviour of firm refusers and those facing access barriers. However, communication has enormous influence when it comes to the 43% of parents who have some questions or concerns about vaccines.

Aggressive or dismissive language can make people less likely to vaccinate, while open, respectful discussion with a trusted individual can encourage hesitant parents towards vaccination.




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Tips for discussing vaccination

Many people struggle with how to discuss vaccination when confronted with a friend, relative or acquaintance who expresses hesitancy.

Simply providing lots of facts or dismissing their views is not effective.

Instead, these are some tips everyone can use when talking about vaccines, drawing from evidence-based communication techniques. Studies in the United States and Canada have trained healthcare providers to use techniques like these to increase uptake of adolescent HPV vaccination and infant vaccines, and more studies are currently underway.

Ask about, and listen to, people’s concerns: not everyone is driven by the same issues or experiences. Find out what specifically is concerning the person. Is it safety? Effectiveness? Side effects?

Acknowledge their concerns: remember, everyone loves their children. No one is refusing to vaccinate because they want their child to get sick, or because they wilfully hope other children will get sick. Acknowledging that you see where someone is coming from can go a long way in establishing trust.

Provide information to respond to their concerns: share what you know, and try to provide reliable sources for your information. Be careful not to debunk myths too aggressively, as this can actually backfire.

Share personal stories: emotive stories tend to have more impact than facts. This is one reason stories of rare vaccine adverse events can seem to carry more weight than overwhelming safety figures. Share your own stories of positive experiences with vaccines, or better yet, discuss your experience with the diseases they prevent.

Don’t pass judgment: people may discuss vaccination many times with many different people before they decide to vaccinate, especially if they are very hesitant. Your goal should be to establish yourself as a trusted, non-judgmental person with whom they can share their questions and concerns. Berating them won’t convince them to vaccinate, but it will convince them never to speak to you about vaccines again.




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These communication tips can help support discussions about vaccines with someone who is hesitant, but open to discussing their position. If, however, you find yourself publicly debating a “vocal vaccine denier”, the WHO has developed a toolkit to help guide your responses.

In such a situation, your intended audience is not the vaccine denier themselves, but the public who may be watching or reading your debate.

The techniques used by a vaccine denier could include referring to conspiracies, fake experts, selective or misrepresented evidence, or impossible expectations (such as 100% safety). The WHO recommends you identify the techniques the denier uses and then correct their content.

If you’re a strong supporter of vaccination, you can become a powerful ally in the effort to sustain high coverage rates in your community. Listen and share your views respectfully, build and maintain open and trusting relationships, and yours may be the words that encourage another person to vaccinate.The Conversation

Jessica Kaufman, Postdoctoral researcher in vaccine acceptance and communication, Murdoch Children’s Research Institute and Margie Danchin, Senior Research Fellow and General Paediatrician, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health check: will eating nuts make you gain weight?



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Nuts contain “good” fats.
From shutterstock.com

Elizabeth Neale, University of Wollongong; Sze-Yen Tan, Deakin University, and Yasmine Probst, University of Wollongong

The Australian Dietary Guidelines recommend we eat 30g of nuts – a small handful – each day. But many of us know nuts are high in calories and fat.

So should we be eating nuts or will they make us gain weight?

In short, the answer is yes, we should eat them, and no, they won’t make us gain weight if eaten in moderate amounts. The fats in nuts are mostly the “good” fats. And aside from that, our bodies don’t actually absorb all the fat found in nuts. But we do absorb the nutrients they provide.




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Dietary fat: friend or foe?

Nuts do contain fat, and the amount of fat varies between nut types. For example, a 30g serving of raw cashews or pistachios contains around 15g of fat, whereas the same amount of raw macadamias contains around 22g of fat.

There are different kinds of fats in our diet and some are better for us than others. Nuts contain mainly monounsaturated and polyunsaturated fats. These types of fats are known as “good fats”. They can help lower cholesterol when we eat them in place of saturated fats.

The type of fats present varies between nuts. For example, walnuts are rich in polyunsaturated fats, whereas other types of nuts such as hazelnuts and macadamias have more monounsaturated fat.

What the evidence says

Even if the type of fat in nuts is good for us, they are still high in fat and calories. But this doesn’t mean we should be avoiding them to manage our weight.

Studies that looked at people’s eating habits and body weight over a long period have found people who regularly eat nuts tend to gain less weight over time than people who don’t.

Nuts are a healthier option for a snack than many processed alternatives.
From shutterstock.com

We see a similar pattern in clinical studies that asked people to include nuts in their diets and then looked at the effects on body weight.

A review of more than 30 studies examined the effects of eating nuts on body weight. It did not find people who ate nuts had increased their body weight, body mass index (BMI), or waist circumference, compared to a control group of people who did not eat nuts.

In fact, one study found that when people ate a pattern of food aimed at weight loss, the group of people who ate nuts lost more body fat than those who didn’t eat nuts.




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Let’s nut this out

There are several possible explanations for why eating nuts doesn’t seem to lead to weight gain.

  1. We don’t absorb all of the fat in nuts: The fat in nuts is stored in the nut’s cell walls, which don’t easily break down during digestion. As a result, when we eat nuts, we don’t absorb all of the fat. Some of the fat instead is passed out in our faeces. The amount of calories we absorb from eating nuts might be between 5% and 30% less that what we had previously thought.

  2. Nuts increase the amount of calories we burn: Not only do we not absorb all the calories in nuts, but eating nuts may also increase the amount of energy and fat we burn. It’s thought this may partially be explained by the protein and unsaturated fats in nuts, although we don’t yet know exactly how this occurs. Increases in the number of calories burnt can help us maintain or lose weight.

  3. Nuts help us feel full for longer: As well as fat, nuts are rich in protein and fibre. So, nuts help to keep us feeling full after we eat them, meaning we’re likely to eat less at later meals. Recent studies have also suggested providing people with nuts helps improve the overall quality of the types of foods they eat. This may be because nuts replace “junk foods” as snacks.

  4. People who eat nuts have healthier lifestyles in general: We can’t rule out the idea that eating nuts is just a sign of a healthier lifestyle. However, randomised controlled trials, which can control for lifestyle factors like eating habits, still find no negative effect on body weight when people eat nuts. This means the favourable effects of nuts are not just the result of nut eaters having healthier lifestyles – the nuts themselves play a role.




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Overall, the evidence suggests nuts are a healthy snack that can provide us with many of the nutrients our bodies need. We can confidently include the recommended 30g of nuts a day in a healthy diet, without worrying about the effect they will have on our waistlines.The Conversation

Elizabeth Neale, Career Development Fellow (Lecturer), University of Wollongong; Sze-Yen Tan, Senior Lecturer in Nutrition Science, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, and Yasmine Probst, Senior lecturer, School of Medicine, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.