Then there are people who sit for many hours and also get in reasonable amounts of physical activity. For example, someone who has an office job but walks to and from work for 20 minutes each way and runs two to three times a week easily meets the recommended level of physical activity.
While we know moving is better than sitting, what is far less clear is how much of a good thing (moving) can offset the harms of a bad thing (sitting).
That’s what we wanted to find out in our study of almost 150,000 Australian middle-aged and older adults.
We followed people enrolled in the 45 and Up Study for nearly nine years. We looked at links between sitting and physical activity with deaths from any cause, and deaths from cardiovascular disease such as heart disease and stroke, over that time. We then estimated what level of moderate-to-vigorous physical activity might offset the health risks of sitting.
This kind of activity is strenuous enough to get you at least slightly out of breath if sustained for a few minutes. It includes brisk walking, cycling, playing sports or running.
What we found
People who did no physical activity and sat for more than eight hours a day had more than twice (107%) the risk of dying from cardiovascular disease compared to people who did at least one hour of physical activity and sat less than four hours a day (the “optimal group”).
But it wasn’t enough just to sit less. People who did less than 150 minutes of physical activity a week and sat less than four hours a day still had a 44-60% higher risk of dying from cardiovascular disease than the optimal group.
We also calculated the effect of replacing one hour of sitting with standing, walking, and moderate and vigorous physical activity.
Among people who sit a lot (more than six hours a day) replacing one hour of sitting with equal amounts of moderate physical activity like strenuous gardening and housework, but not standing, was associated with a 20% reduction in dying from cardiovascular disease.
Replacing one hour of sitting with one hour of vigorous activity such as swimming, aerobics and tennis, the benefits were much greater, with a 64% reduction in the risk of dying from cardiovascular disease.
What does it all mean?
The great news for people who sit a lot, including sedentary office workers, is that the amount of physical activity needed to offset the health risks of sitting risks was substantially lower than the one hour a day a previous study found.
Even around 20-40 minutes of physical activity a day – the equivalent of meeting the physical activity guidelines of 150 to 300 minutes a week – seemed to eliminate most risks associated with sitting.
For people who sat a lot, replacing sitting with vigorous physical activity was better than replacing it with moderate activity; and replacing sitting with moderate activity or walking was better than replacing it with standing.
What’s the take-home message?
Our study supports the idea that sitting and exercise are two sides of the same health “coin”. In other words, enough physical activity can offset the health risks of sitting.
Should we worry about sitting too much? Yes, because sitting takes up valuable time we could spend moving. So too much sitting is an important part of the physical inactivity problem.
For those who sit a lot, finding ways to reduce sitting would be a good start but it is not enough. The most important lifestyle change would be to look for or create opportunities to include physical activity into our daily routine whenever possible.
How to widen our activity ‘menu’
Not everyone has a supportive environment and the capacity to create opportunities to be active. For example, lack of time and physical activity being low on people’s list of priorities are the main reasons why inactive adults don’t exercise. Also, many do not have the motivation to power through a strenuous workout when they are juggling many other life challenges.
There are no known remedies to a lack of time or low motivation. So, perhaps we need to add new approaches, beyond exercising and playing sport for leisure, to the “menu” of physical activity options.
Incidental physical activity like active transportation – think walking fast or cycling part or all of the way to work – or taking stairs are great ways to become or stay active without taking much extra time.
Eleven years after Australia adopted the Closing the Gap strategy, many pressing First Nations health issues remain unresolved.
The gap between Indigenous and non-Indigenous life expectancy, currently 10.8 years for men and 10.6 years for women, is actually widening.
Similarly, the target to close the gap between Indigenous and non-Indigenous child mortality has not been met. The Indigenous rate of 164 deaths per 100,000 children aged 0-4 years is still 2.4 times the non-Indigenous rate of 68 deaths per 100,000 in this age group.
The causes of Indigenous health inequality are complex. They stem from social determinants such as employment, education, social inclusion, and access to traditional land, rather than strictly biomedical causes.
Government policies have a critical role to play here. But funding cuts, policy incoherence, and governments retaining control over resources and decision-making explain why the gaps between Indigenous and non-Indigenous health outcomes are not closing.
Regardless of who wins the federal election on May 18, these enduring health issues affecting Indigenous Australians will require sustained and concerted policy attention.
A look at the major parties’ policy promises reveals some signs of hope, but also plenty of room for improvement.
The budget did include A$35 million for First Nations solutions to family violence, and A$10 million for the Lowitja Institute for health research.
Indigenous youth suicide remains an urgent policy concern, with Indigenous children five times more likely to die in this way than non-Indigenous children. A coronial inquest recently identified complex causes including intergenerational trauma, poverty, and problems stemming from the home environment.
The Coalition’s budget committed A$5 million over four years to address Indigenous youth suicide. This figure has since been increased to A$42 million following criticism from First Nations organisations and advocates.
Meanwhile, the budget directed A$129 million towards the expansion of a cashless welfare card system that operates in a number of Aboriginal communities. The card quarantines 80% of welfare recipients’ income for use in government-approved stores, and on government-approved items, to prevent spending on alcohol, cigarettes and gambling. This decision was taken despite a lack of evidence these cards reduce social harm or public expenditure.
The government also made some pre-budget commitments around Indigenous health. These included:
The Morrison government deserves some credit for its part in reaching an agreement between the Council of Australian Governments and a coalition of Aboriginal and Torres Strait Islander peak organisations in December 2018.
This agreement commits governments and Indigenous peak bodies to shared decision-making and joint accountability in devising and working towards new Closing the Gap targets.
Labor has also promised A$20 million for sexual health promotion in northern Australia, A$13 million to combat vision loss, and A$16.5 million for the “Deadly Choices” initiative, which aims to prevent chronic disease through education.
Further, the opposition has announced a compensation scheme and healing fund for surviving members of the Stolen Generations and their families. This could help manage the effects of intergenerational trauma.
Both parties’ funding commitments must be assessed in the context of the 2014 budget cut of more than A$500 million dollars to Indigenous affairs by the then Coalition government, which only the Greens have committed to restoring.
Impacts have been severe for specific programs, especially those run at the community level. These include youth services in Maningrida (NT) and employment and training programs in Inala (Queensland).
Funding for crucial Indigenous health infrastructure and capital works is also lacking, with the current shortfall estimated at A$500 million. Many Aboriginal Community Controlled Health Services are run from old buildings in desperate need of upgrades to accommodate increasing patient numbers and rising demand for services. The Coalition recently announced an incremental increase to infrastructure funding, but much more is needed.
Neither the Coalition nor Labor has made any substantial commitment to a national Indigenous housing strategy. Inadequate, insecure and poor quality housing worsens physical and mental health through overcrowding, inadequate heating and cooling, injury hazards, and stress.
Similarly, both parties have been silent on reducing poverty in Indigenous communities. Poverty is another social determinant that contributes to Indigenous physical and mental ill-health, as well as high incarceration levels.
As the Close the Gap steering committee’s shadow report emphasised, “when Aboriginal and Torres Strait Islander people are involved in the design of the services they need, we are far more likely to achieve success”.
The Coalition has been silent on the issue of community control, and funding reforms under the Indigenous Advancement Strategy and the Indigenous Australians’ Health Programme have destabilised the position of Aboriginal organisations.
Community control is threatened by the government’s focus on competitive tendering, where First Nations organisations compete with “mainstream” service providers trying to secure contracts to deliver Indigenous health services.
Neither the Coalition nor Labor has outlined a response to these structural issues.
A final verdict
It’s difficult to identify major differences between the two parties’ Indigenous health promises. The likely impact of these polices is also hard to gauge given the significant role played by state and territory governments in service delivery.
Labor has promised to support Aboriginal Community Controlled Organisations but specific details have not been announced. Labor’s significant funding pledge for rheumatic heart disease, though, makes their Indigenous health offering perhaps slightly more likely to achieve health gains than the Coalition’s.
Are you allergic to penicillin? Perhaps you have a friend or relative who is? With about one in ten people reporting a penicillin allergy, that’s not altogether surprising.
Penicillin is the most commonly reported drug allergy. But the key word here is “reported”. Only about 20% of this 10% have a true penicillin allergy – so the figure would be one in 50 rather than one in ten.
People may experience symptoms they think are a result of taking penicillin, but are actually unrelated. If these symptoms are not investigated, they continue with the belief that they should steer clear of penicillin.
This can become a problem if a person is sick and needs to be treated with penicillin. Penicillin and related antibiotics are the most common group of drugs used to treat a broad range of infections, from chest or throat, to urinary tract, to skin and soft tissue infections.
The overestimation of penicillin allergies is also not ideal because it means people are being treated with a broader range of antibiotics than necessary, which contributes to the problem of antibiotic resistance.
Yes, penicillin comes from mould
To understand more about why so many people think they’re allergic to penicillin, we need to look at a brief history of the drug.
Penicillin (benzylpenicillin or Penicillin G) was first discovered in 1928 and first used in 1941.
It was grown from a mould, as it is today. The liquid nutrient broth the mould grew in was drained, and the penicillin purified from it.
In the 1930s and 40s, and even through the 1960s and 70s, purification techniques were not as efficient as they are today. So, many early allergic reactions are thought to be due to impurities in the early penicillin products – especially injections.
Penicillin and the range of antibiotic compounds that followed it revolutionised how we treat bacterial infections.
This led to widespread, and sometimes inappropriate, use of these medicines. Antibiotics do not work against viruses, but are sometimes prescribed for bacterial infections that occur while people have viral infections such as glandular fever.
We know using penicillin while a person has glandular fever can cause a rash that looks like penicillin allergy but is not related.
People may report symptoms to their health professionals that seem like a reaction to penicillin. Perhaps these symptoms are not fully investigated because it takes time and can be expensive – they’re just put down to the common penicillin allergy.
Further, some people perceive other side effects of a penicillin antibiotic such as nausea or diarrhoea as an allergy, when these are not, in fact, allergy symptoms.
From this point, the penicillin family will not be used to treat these patients.
An allergy to penicillin can also limit the use of some other antibiotics which may cross-react with the allergy.
Cross reaction occurs when the chemical structure of another antibiotic is so similar to the structure of penicillin that the immune system gets confused and recognises it as the same thing.
To avoid this, doctors need to look to antibiotics from other medication classes when prescribing patients with a documented penicillin allergy.
But we need to be careful when drawing on a wider range of antibiotics. This is because the more bacteria are exposed to antibiotics, the more likely they are to develop resistance to these antibiotics.
To address the growing problem of antibiotic resistance, we now try to restrict antibiotics as much as possible to the lowest level one that will kill the specific bacteria.
We don’t kill tiny ants in our gardens with a sledgehammer, so likewise, we use a narrow-spectrum antibiotic wherever possible to keep the broad-spectrum antibiotics for severe and complex infections.
The penicillin family contains both narrow and broad-spectrum antibiotics. Ruling out this family and its “cousins” when we don’t need to can limit the choice of antibiotics and increase the chance of making other antibiotics less useful.
Can I get tested?
Studies show penicillin allergy reduces over time. So even if you did have a true penicillin allergy, it may have gone away over several years.
Under the guidance of your doctor, it is possible to be tested to see if you’re allergic – or still allergic – to penicillin.
A skin “scratch” test involves injecting a small amount of penicillin and monitoring for a reaction. Rescue medications will be on hand in case you do have a severe reaction. Your GP will probably refer you to an allergy specialist to get this done.
Often during the day I feel the need to have a bit of a lie-down. Whether it’s been a busy day, I didn’t sleep well the night before, or for no particular reason I know of. But some will warn that you’ll be ruined for sleep that night if you nap during the day.
We asked five experts if we should nap during the day.
Four out of five experts said yes
Here are their detailed responses:
If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: firstname.lastname@example.org
None of the authors have any interests or affiliations to declare.
Bill Shorten has promised his government would introduce a A$2.3 billion four year package to slash cancer patients’ out-of-pocket costs, and has committed $1 billion to give extra tax relief for low income earners, above what they would get from Tuesday’s budget.
In his budget reply on Thursday night, the opposition leader pitched to voters on a Labor strength – health – declaring his cancer care plan would be the “most important investment in Medicare since Bob Hawke created it”.
Shorten rejected the government’s second and third tranches of tax cuts, due to start in 2022-23 and 2024-25 and worth about $143 billion of the $158 billion ten year package. The last stage was a “radical, right-wing, flat tax experiment”, far off in time and skewed disproportionately to a relative few, he said.
Stressing Labor’s economic responsibility, Shorten recommitted to delivering “stronger surpluses, paying down debt faster” than the government.
“What we need is a fighting fund for the country, a strong surplus to protect us from international shocks”, he said.
He attacked the government – which has a $7.1 billion surplus in its budget for next financial year – for “shortchanging the NDIS [National Disability Insurance Scheme] by $1.6 billion, to prop up a flimsy surplus forecast”.
Shorten – who in his speech referred to his late mother Ann’s battle with breast cancer – said the cancer care plan would provide for millions of free scans and consultations, and cheaper medicines.
Cancer “is frightening, it’s isolating, it’s exhausting”. And all too often, it was impoverishing, he said.
“For so many people, cancer makes you sick and then paying for the treatment makes you poor. And that’s a fact that I think a lot of Australians would be surprised to learn.
“Because if you haven’t been through it yourself, you might not realise that all those vital scans and tests and consultations with specialists aren’t fully covered by Medicare. Instead, they cost hundreds of dollars, adding up to thousands, out of your own pocket,” he said.
One in four women with breast cancer paid more than $10,000 for two years of scans and tests, he said. Some men with prostate cancer were paying more than $18,000. Most people with skin cancer – and Australia has the highest rates of this cancer in the world – paid more than $5000 for the first two years of treatment.
Each year 300,000 people who needed radiology did not get it, because they couldn’t afford it.
People needing treatment for cancer were often not well enough to work, so they were already under massive financial strain, Shorten said. Those living in regional areas had the extra costs of travel and accommodation.
invest $600 million towards eliminating all out-of-pocket costs for diagnostic imaging, with up to six million free cancer scans funded through Medicare – reducing out-of-pocket costs from hundreds of dollars to zero. This would include MRIs too. At present only half the MRI machines were covered by Medicare, and regional patients often had to drive for hours or pay thousands of dollars. “If we win the election, not only will we provide more MRI machines to communities where they are needed most, but Labor will guarantee that every single MRI machine in Australia that meets a national quality standard is covered by Medicare for cancer scans.”
invest $433 million to fund three million free consultations with oncologists and surgeons. Over four years this would mean an extra three million appointments were bulk billed, reducing costs of hundreds of dollars to nothing
guarantee that every drug recommended by independent experts would be listed on the Pharmaceutical Benefits Scheme.
On tax, Shorten said people earning between $48,000 and $126,000, no matter who they voted for in May, would get the same tax refund.
But the Liberal plan did not do enough for the 2.9 million people who earned less than $40,000 – about 57% of whom were women.
In Labor’s first budget Labor would provide a bigger tax refund for low earners than the Liberals proposed.
“6.4 million working people will pay the same amount of income tax under Labor as the Liberals – and another 3.6 million will pay less tax under Labor,” he said. “All told, an extra billion dollars, for low income earners”.
Under further details provided by Labor, it said workers earning up to $37,000 a year would receive a tax cut of up to $350. For workers earning between $37,000 and $48,000 the value of the tax offset would increase up to the maximum tax offset of $1,080.
A worker on $35,000 would get a tax cut of $255 a year under the Liberals, compared to $350 under Labor. A worker on $40,000 would receive a cut of $480 under the Liberals compared to $549 under Labor.
On TAFE Shorten promised to double the size of Labor’s rebuilding TAFE program – up to $200 million – to renovate campuses.
Labor is committed to paying the upfront fees for 100,000 TAFE places to get more Australians in high priority courses. “I am proud to announce that 20,000 of these places will be allocated to a new generation of aged care workers and paid carers for the NDIS,” Shorten said.
Finance minister Mathias Cormann said Shorten had put forward an agenda for $200 billion in higher taxes that would weaken the economy and bring higher unemployment.
This year’s budget includes $448.5 to modernise Australia’s Medicare system, by encouraging people with diabetes to sign up to a GP clinic for their care. The clinic will receive a lump sum payment to care for the person over time, rather than a fee each time they see their GP.
The indexation freeze on all GP services on the Medicare Benefits Schedule (MBS) will lift from July 1, 2019, at a cost of $187.2 million. The freeze will be lifted on various X-ray and ultrasound MBS rebates from July 1, 2020.
The budget announces $461 million for youth mental health, including 30 new headspace centres, some of which will be in regional areas. But it does little to address the underlying structural reforms that make it difficult for Australians to access quality and timely mental health care.
In aged care, the government will fund 10,000 home care packages, which have been previously announced, at a cost of $282 million over five years, and will allocate $84 million for carer respite. But long wait times for home care packages remain.
Other announcements include:
$62.2 million over five years to train new rural GPs
$309 million for diagnostic imaging services, including 23 new MRI licences
$331 million over five years for new pharmaceuticals, including high-cost cancer treatments
$107.8 million over seven years for hospitals and facilities including Redland Hospital, Bowen Hospital, Bass Coast Health and Ronald McDonald House
$70.8 million over seven years for regional cancer diagnosis, treatment and therapy centres
$114.5 million from 2020-21 to trial eight mental health facilities for adults
$43.9 million for mental health services for expectant and new parents
$35.7 million over five years for increased dementia and veterans’ home care supplements
$320 million this year as a one-off increase to the basic subsidy for residential aged-care recipients.
Here’s what our health policy experts thought of tonight’s budget announcements.
A hesitant step forward for Medicare
Stephen Duckett, Director, Health Program, Grattan Institute
Medicare funding is slowly creeping into the 21st century. The 19th-century model of individual fees for individual services – suitable for an era when medicine was essentially dealing with episodic conditions – is being supplemented with a new fee to better manage the care of people with diabetes.
The precise details of the new fee – including the annual amount and any descriptors – have not yet been released. But it should encourage practices to move towards a more prevention-oriented approach to chronic disease management, including using practice nurses to call patients to check up on their condition, and using remote monitoring technology.
The budget announcement contained no evaluation strategy for the initiative. The government should produce such a strategy soon.
Support for aged and disability care
Hal Swerissen, Emeritus Professor, La Trobe University, and Fellow, Health Program, Grattan Institute
The budget has short-term measures to address major issues in aged care and disability while we wait for the royal commissions to fix the long-term problems.
The National Disability Insurance Agency (NDIA) is struggling with the huge task of putting the National Disability Insurance Scheme (NDIS) in place.
There has been a major under-spend on the on the scheme. Price caps for services such as therapy and personal care are too low and nearly one-third of services are operating at a loss. The under-spend would have been more if there hadn’t been a last-minute budget decision to significantly increase service caps, at a cost of $850 million.
$528 million dollars has also been announced for a royal commission to look at violence, neglect and abuse of people with disabilities – the most expensive royal commission to date.
There is more funding for aged care. Currently, 130,000 older people are waiting for home care packages – often for a year or more. Nearly half of residential care services are losing money and there are major concerns about quality of care.
The short-term fix is to give residential care $320 million to try to prevent services going under. The budget includes 10,000 previously announced home care packages, at a cost of $282 million, but that still leaves more than 100,000 people waiting.
Little for prevention, Indigenous health and to address disparities
Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney
Preventable diseases and conditions are a key factor in health inequalities and rising health-care costs. The two issues looming large are obesity and its consequences, and the health impacts of climate change.
There is $5.5 million for 2018-19 and 2019-20 for mental health services in areas affected by natural disasters, and $1.1 million over two years for the Health Star rating system – otherwise nothing for primary prevention.
The Treasurer did not mention Closing the Gap in his budget speech, and there is little in the budget for Indigenous health.
Just $5 million over four years is provided in the budget for suicide-prevention initiatives. And the Lowitja Institute receives $10 million for health and medical research.
$6.3 million to continue the development of the Health Data Portal for services funded under the Indigenous Australians Health Program.
Inequalities and disparities
Disadvantaged rural and remote communities will (ultimately) benefit from efforts to boost National Rural Generalist Training Pathway, with $62.2 million provided over four years. This was a 2016 election commitment.
Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University
There are no major changes to public hospital funding arrangements in this year’s budget.
Funding for public hospitals is predicted to increase at between 3.7% and 5.6% over the forward estimates. However, these figures are contingent on the new COAG agreement on health funding between the Commonwealth and states, which is due to be finalised before the end of 2019.
The states will be hoping to wring some more dollars from the federal government given their soaring public hospital admissions and pressure on waiting times.
Government spending on the private health insurance rebate is projected to increase more slowly than premiums at between 1.8% and 3.2% because of indexation arrangements which are gradually reducing the rebate over time.
Smaller targets for mental health
Ian Hickie, Co-Director, Brain and Mind Institute, University of Sydney
Numerous reports and accounts from within the community have noted the flaws in Australia’s mental health system: poor access to quality services, the uneven roll-out of the NDIS, and the lack of accountability for reforming the system.
The next federal government faces major structural challenges in mental health and suicide prevention.
Not surprisingly, this pre-election budget does not directly address these issues. Instead, it focuses on less challenging but worthy targets such as:
continued support for expansion of headspace services for young people ($263m over the next seven years) and additional support for early psychosis services ($110m over four years)
support for workplace-based mental health programs ($15m)
support for new residential care centres for eating disorders ($63m).
A more challenging experiment is the $114.5 committed to eight new walk-in community mental health centres, recognising that access to coordinated, high-quality care that delivers better outcomes remains a national challenge.
Despite the commitment of health minister Greg Hunt to enhanced mental health investments, the total increased spend on these initiatives ($736.6m) is dwarfed by the big new expenditures in Medicare ($6b), improved access to medicines ($40b), public hospitals ($5b) and aged care ($7b).
It will be interesting to see whether mental health reform now receives greater attention during the election campaign. At this stage, neither of the major parties has made it clear that it is ready to deal directly with the complex challenges in mental health and suicide prevention that are unresolved.
New funding for research, but who decides the priorities?
Philip Clarke, Professor of Health Economics, University of Melbourne
The budget contains several funding announcements for research.
The government will establish a Health and Medical Research Office, to help allocate money from the Medical Research Future Fund (MRFF). This will be needed, as the budget papers commit to a further $931 million from the MRFF for:
Clinical trials for rare cancers and rare diseases
Emerging priorities and consumer-driven research
Global health research to tackle antimicrobial resistance and drug-resistant tuberculosis.
In addition, the budget includes:
$70 million for research into type 1 diabetes
a large investment for genomics (although that is a re-announcement of $500 million promised in last year’s budget)
a series of infrastructure grants to individual universities and institutions, such as $10 million to establish the Curtin University Dementia Centre of Excellence.
The government appears to be moving away from allocating medical research funding through existing funding bodies, such as the National Health and Medical Research Council (NHMRC), towards allocating research funds to specific disease areas, and even to individual institutions.
This is a much more direct approach to research funding, but it raises a few important questions. On what basis are these funding decisions being made? And why are some diseases considered priorities to receive funding? There is very little detail to answer these questions.
Australia’s allocation of research funding through the MRFF is diverging from long-held traditions in other countries, such as the United Kingdom, which apply the “Haldane principle”. This involves researchers deciding where research funding is spent, rather than politicians.
* This article has been updated since publication to clarify the 10,000 home care packages have been previously announced.
Private health insurance premiums will increase by an average of 3.25% in 2019. These increases are relatively modest, as premiums have been rising at between 4% and 6% per annum for more than 10 years.
But in the current environment, above-inflation premium rises are not unexpected.
For comparison, consider the public health system, where spending increased at nearly 7% per year in the decade to 2017.
Out-of-pocket spending by patients also had an above-inflation trend of 5.1% per year over the past decade.
So both public and private expenditure on health are increasing substantially. Driving this is the increased usage and price of health care. Hospital visits are growing at 4% a year, and health price inflation is a further 2% per year.
Many hospital procedures such as cardiothoracic surgery, colonoscopies, hip and knee replacements, are increasing in volume by over 5% a year. So as patients use their health insurance more, it’s reasonable for the price to rise.
Most Australians with private health insurance receive a rebate from the Australian government to help cover the cost of premiums.
Means testing of rebates along income tiers was introduced in 2012. This sees individuals and households with higher incomes receive lower subsidies.
From 2014, the government began indexing rebates every year, using a formula that is calculated as a difference between the consumer price index, and the industry weighted average increase in premiums.
For example, this means in 2013/14, a person aged 65 or below earning less than $88,000 (base tier) would have received a 30% rebate. Today, a person of the same age in the base tier would receive a rebate of just over 25%.
For a typical family policy that covers both hospital and extras (with premiums approximately A$140 a fortnight), the decrease in the rebate translates to a very small rise in premiums of A$1 a fortnight.
Basic, bronze, silver or gold?
One key initiative starting on April 1 is the introduction of four tiers of private health insurance coverage: basic, bronze, silver, and gold. This is distinct to the income tiers we talked about above.
In this case, each tier mandates the minimum set of treatments (defined by clinical categories) that insurers must cover.
For instance, policies in the “basic” tier are required to cover rehabilitation services, hospital psychiatric services, and palliative care.
Insurers can include other types of treatments which are not mandatory under the basic tier, if they choose to do so. Each additional tier covers a wider range of treatments, in addition to services mandated in lower tiers.
This simplified categorisation of policies is designed to help consumers understand how comprehensive their cover is, and enable them to more easily compare products offered by different health funds.
While this initiative provides consumers with greater clarity on the types of services covered by each type of health insurance product, it still does not standardise care completely.
Health funds can offer to cover, in lower tier products, treatments that are mandated only in higher tiered policies (such as providing coverage for pregnancy in a basic policy).
This may confuse patients if they assume their policy covering pregnancy will also cover other costly private procedures such as joint reconstructions (bronze), or back, neck and spinal surgery (silver).
From April 1, health funds will be able to offer discounts on premiums of 2% for each year a person is under the age of 30 when he or she takes up private health insurance. Premium discounts are capped at a maximum of 10%. The discount is retained until the person reaches the age of 41, after which it will be gradually phased out.
This initiative is being introduced to encourage young Australians to purchase private health cover and to stem the decline in private health insurance ownership among younger people. From September to December 2018, the largest net decrease in insured persons was recorded in people aged 25 to 29.
These discounts on premiums for young people complement the Lifetime Health Cover policy introduced in 2000, which was designed to encourage Australians to take up private hospital insurance earlier, and also to maintain cover.
Under the Lifetime Health Cover policy, which is still in force, people above the age of 30 without private cover are required to pay a 2% loading on premiums for each year they are over 30, if they choose to take up private cover later on.
Another key change is that health funds are permitted to offer private hospital policies with a higher excess, in return for lower premiums. The maximum permitted excess is increasing from A$500 to A$750 for singles, and A$1,000 to A$1,500 for families.
Travel and accommodation benefits will be allowed to be included in hospital insurance plans for customers living in regional and rural parts of Australia. This will assist patients and their carers to meet the additional costs of having to travel to urban centres or capital cities to receive specialised treatment.
Natural therapies such as yoga, naturopathy, pilates and reflexology will no longer be covered under a general treatment policy. A total of 16 natural therapies are excluded. A review undertaken by the National Health and Medical Research Council concluded there is no clear evidence of the efficacy of these therapies.
Finally, to strengthen consumer protection, the role of the private health insurance ombudsman will be expanded, giving the agency new powers and greater capabilities to address issues and complaints.
Labor’s 2016 “Mediscare” has entered political memory as a campaign tactic that almost changed the game in that election. Using robocalls and text messages purporting to come from Medicare, government proposals to outsource management of back-office business became inflated into an all-out “privatisation” of Medicare.
Both the Whitlam government’s Medibank and Hawke’s Medicare faced withering hostility from Australian conservatives.
Australia became one of the only nations to introduce universal health coverage in 1975. This aimed to ensure all Australians had access to a wide range of health services at little or no cost, no matter where you lived or how much money you earned.
After three years of debate about the role of private health insurance, and indivuals’ responsibility to pay for their own health care, universal health care was re-established in 1984 by the Hawke Labor government, under the new name: Medicare.
I want to say with all the frankness I can muster, the Liberal and National Parties do not have a particularly good track record in health, and you don’t need me to remind you of our last period in government.
Howard’s 1996 electoral success relied on defusing the Medicare issue. He assured voters that “Medicare will remain totally in place under a Coalition government”.
However, he retained some of his ambivalence. Howard supported Medicare’s role as a “safety net” to support people with few financial resources. But the Coalition believed those who could afford it should pay their own way, through private health insurance.
The Abbott government’s 2014 Commission of Audit report restated this call for a two-tier health system:
Higher-income earners should be required to insure for basic health services in place of Medicare.
The incoming Turnbull government rejected this advice. But the debate reinforced an image of a reluctant and half-hearted convert.
When the Coalition extended the Medicare benefit freeze, which was originally introduced by Gillard’s Labor government, the extension hurt the Coalition far more than it had Labor.
The Coalition has been determined to avoid this trap again. The Turnbull and Morrison governments have underlined support for Medicare. The 2019-20 Budget documents are punctuated with statements about “guaranteeing” and “strengthening” Medicare. It also declares: “The government’s commitment to Medicare is rock solid.”
The Medicare Guarantee Fund was established in 2017 to emphasise this commitment. Tax dollars generated by the Medicare levy (minus the portion set aside for the National Disability Insurance Scheme), go into the fund. These are topped up with enough personal income tax receipts to meet the combined cost of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS).
But the fund has been criticised as mere rebadging and an “accounting trick”. It offered no new funding or new policies; it simply changed the name of existing policies, and extended the definition of “Medicare” from payments of medical benefits to include pharmaceuticals.
But the “Medicare guarantee” wasn’t extended to guarantee adequate federal funding for public hospitals, which remains a problem.
Labor’s new attempt at scare tactics over Medicare uses well established themes. It will test how far the Coalition has been able to inoculate itself.
The attack has again focused on the out-of-pocket costs from declining bulk-billing levels, especially in cancer treatment.
Despite the Gillard government’s Medicare rebate freeze, Labor has held the high ground in this cost debate. Its cancer package focuses on extending bulk billing to minimise out-of-pocket payments.
In the field of hospital funding, Labor’s “Mediscare 2.0” focuses on a A$2.8 billion “cut” in funding to the states to pay for public hospitals.
In 2011, the Rudd/Gillard government pledged to share the cost of public hospital funding growth with the states with a 50-50 split to end the “blame game”. The Abbott government abandoned this policy in the 2014 budget.
The Coalition, under Turnbull, offered to return to funding 45% of the cost of public hospitals. The Labor-held states rejected this, and Shorten has now promised to restore this to 50%. Labor has made traction with these attacks, though much of the detail has been lost or confused in media soundbites.
Election campaigning in health has forced the Coalition to accept how much Australians value Medicare and the principle of universal health coverage. As the common ground between Labor and the Coalition expands, we may be able to have a more rational debate over Medicare’s virtues and deficiencies. But not in the partisan heat of an election.
The election contest continues to focus on tax and health, with the government setting out the tax benefit people in particular occupations would get in the long term under its plan, and Labor announcing funding for pathology from its cancer package.
The government says teachers, nurses, police officers and tradesmen would pay significantly more income tax under Labor.
According to its figures a NSW nurse manager earning $199,029 in 2024-25 would pay $11,740 less tax than under Labor; a Queensland public school principal on $183,201 would pay $9049 less tax than under Labor, and a Victorian public school classroom teacher on $115,745 would be $3699 better off.
Labor has rejected the later stages of the government’s income tax plan, saying it is not fiscally responsible to produce details at this stage. It however has left the way open for a Shorten government to give tax cuts – beyond those promised to be delivered within weeks of the election – when budget circumstances allow.
Treasurer Josh Frydenberg said: “Anyone earning more than $40,000 will better off under our plan. It means school teachers, nurses, bus drivers and emergency service workers right across the country will have more money in their pocket.
“This is more money to spend as they see fit. Our plan provides greater reward for effort while ensuring top earners continue to pay their fair share.”
“Our tax system will maintain its progressive nature under our reforms, with the top 5% of the taxpayers paying around one third of all income tax.”
Tax and health have dominated the first days of the campaign, with the government using numbers from the Treasury to butress its argument about Labor as high taxers and figures from the Health department to claim Labor’s plan to slash costs for cancer sufferers was massively under-costed.
Both Treasury and the Health department distanced themselves from the exercises, saying they had responded to government requests rather than costed opposition policies.
In the case of the attack on the cancer package the government’s attack was based on a false assumption about rebates.
In its latest slicing and dicing of its $2.3 billion cancer package Labor says it would invest $200 million to keep pathology tests free for older people and people with cancer.
“Bulk billing for blood tests is at breaking point – cancer patients will either have to pay, or there will be a reducation in services,” Bill Shorten and health spokeswoman Catherine King say in a statement.
A Labor government would work with the sector and lift the bulk billing incentive. Older people will have about 20 million pathology tests a year; people with cancer have about three million.
The CEO of Australian Pathology, Leisel Well, said that “without adequate funding, pathology services will be forced to stop bulk billing.
“This will impact unfairly on poorer Australians, including pensioners. Many will simply not be able to afford tests, which means diseases will get diagnosed later at a greater cost to taxpayers, and most importantly with a greater impact on the health outcomes of Australians”.
When most of us get the flu, we spend three or four days on the couch feeling miserable, then we bounce back pretty quickly. But others have more severe symptoms and need to be hospitalised because they’re at risk of life-threatening complications. Some people even die from the flu.
The size and impact of influenza seasons varies from year to year. In 2017, Australia had its worst flu season for 20 years, with at least 1,255 lives lost. The 2018 season was relatively mild, but it doesn’t seem to have ever ended – cases have been reported throughout summer and into autumn 2019.
Protection often will have begun to wane four or five months later, so getting vaccinated in mid to late May, or even early June, will give you better protection at the height of the flu season. But there are number of factors to consider before deciding when to get your flu shot.
Remind me, why get a flu shot each year?
Influenza viruses change each year and the vaccine is updated to keep up with these changes. This year, for example, the vaccine protects against two different strains than the 2018 vaccine.
Our body’s immune response to the vaccine also wanes over time. So even if you were vaccinated last winter, you may no longer be fully protected 18 months later, depending on your age and your response to the last vaccination.
When does the flu vax become available?
Influenza vaccines are usually available in early April, or even in March; though you’ll generally have to pay full price for early access, even if you’re eligible for a free flu vaccine later.
In mid-April, stock starts arriving at GP clinics and pharmacies for the government’s immunisation program, which offers free flu vaccines for those most at risk of complications from influenza. This includes:
all Aboriginal and Torres Strait Islander people aged six months and over
pregnant women (during any stage of pregnancy)
all people aged 65 years and over
people aged six months and over with medical conditions which increase the risk of complications following influenza infections.
In addition, most states in Australia offer free vaccination to all other children from six months of age to five years of age.
For those not eligible for the free vaccine, influenza vaccines are available through pharmacies and GPs for between A$10 and A$25 (plus the cost of a consultation if your GP doesn’t bulk bill), or via workplace programs.
Is it good to get in early?
Getting a vaccine immediately after it becomes available will ensure you don’t miss out if there’s a vaccine shortage. And it will protect against the “summer flus” we’ve been seeing over the last few months, which are circulating earlier than normal.
But there is a potential downside. Protection against influenza peaks one to two months after you have your vaccine, and then declines. This rate of decline varies from person to person, by age, and by influenza strain.
The flu season usually reaches its peak in August or sometimes even September. So if you’re vaccinated in early April, four to five months will have passed by the time you reach the peak virus months, and you will have lower levels of protection.
There are few good quality studies across all ages to measure this rate of decline accurately, although a study from 2015 showed that the measurable antibody responses to the influenza vaccine components reduced slowly.
Another study from 2014 showed the vaccine was less effective in people vaccinated three or more months earlier, adding to the evidence that protection wanes over time.
When is too late for the flu shot?
If you delay your decision to be vaccinated until July or August, when the flu season is well underway, your chance of becoming infected will significantly increase.
Mid to late May or early in June is the sweet spot between trying to maximise your protective levels of antibodies generated by vaccination and getting vaccinated before there are significant levels of influenza virus circulating.
Remember, it takes seven to ten days from the time of your flu shot for the vaccine to begin to be fully effective.
Getting vaccinated in late May or early June should provide good levels of protection during the peak of the influenza season and may even last through to November, by which time the influenza season has usually finished.
Vaccinate kids a month earlier
Vaccination timing is a little different for children. Those aged six months to nine years who haven’t been vaccinated against influenza before need two doses of vaccine, four weeks apart. So they will need to start their vaccination program a month earlier than adults and the elderly.