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: email@example.com
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.
The claim appeared to gain traction with voters, so we should expect to see a re-run of this tactic in this election. This started with Bill Shorten highlighting the issue in his budget reply speech, promising to “put back every single dollar that the Liberals have cut from public schools and public hospitals”.
Despite bribes and threats, the federal government has failed to negotiate hospital funding agreements with Victoria and Queensland, together covering 46% of the population. As a result, those states are at risk of being left in a funding limbo when the current arrangements expire on June 30, 2020.
Increased transparency is all well and good, but it puts the burden of reducing out-of-pocket costs on consumers, who generally do not have enough information to make informed choices. The complication rates of different specialists, and other measures of quality, are not yet routinely available to patients, or even GPs.
Left unaddressed is the need to reform the pathology market to recognise that pathology provision (such as blood and tissue tests) is a big business and needs to be treated as such, by procuring via tenders rather than fee-for-service.
Although the details are still to be fleshed out, this will probably allow general practitioners to introduce remote consultations – such as advice by email for those who want it – and have practice staff reach out to people with chronic illness to track how they are going to reduce future problems.
Pharmaceutical prices have come down, so the prices paid by Pharmaceutical Benefits Scheme (PBS) for drugs are now closer to international best practice. But anti-competitive restrictions on pharmacy location remain, to the benefit of pharmacy owners.
All were worthy, and most were designed to placate vocal sectoral interests. Most have been implemented, but few will change the fundamentals of the health system or improve integration of the system’s many disparate elements.
Scattered like programmatic confetti, each of these funding dollops will yield a minor benefit, but together they will lead to more funding silos, less policy integration, and more confusion about the roles of the Commonwealth government and the states.
What’s more, they will give more heart to vested interests, and undermine rational national health policy.
Labor has also set out a longer-term vision for reform of the health system, including a proposal for an ongoing “reform commission”.
The centrepiece and most expensive was a massive “cancer plan” commitment to address out-of-pocket costs for people with cancer. This includes expanded Medicare rebates for MRI scans for cancer patients, a new rebate for bulk-billed visits to oncologists, and a guarantee that all new drugs recommended for listing on the PBS will be listed.
The federal government has just promised to increase spending on public hospitals from A$21.7 billion in 2018 to A$26.2 billion by 2023. Expect more hospital promises in coming weeks. There is a long history of parties at both state and federal level pledging new hospitals during election campaigns.
Building new hospitals may at first seem sensible, especially as the population grows. But it will not cure the health system’s most pressing ailment. Instead, our research shows it’s more effective to focus health policy on people and prevention.
A problem of demand
It is true that hospitals in Australia aren’t keeping up with demand. Though supply of beds has increased, the population is growing while also ageing. This is increasing demand for all health-care services, including hospital beds.
The following graph shows the change in the number of beds per 1,000 people in all states and territories since 2006. Only in the Australian Capital Territory has the ratio improved.
State and federal governments thus feel a lot of pressure to spend more on hospitals. In 2016-2017 it was $69 billion Australia-wide – $2 billion more than the previous year. The following graph shows expenditure on public hospitals by state over the past two decades.
Queensland shows the greatest growth over the past two decades. In Western Australia, where we did our research, the proportion of government health budgets spent on public hospitals rose from 26% to 31%.
We looked at why the hospital care is growing faster than the overall health sector, and what can be done about this.
Our conclusion: there needs to be more focus on the “unsexy” parts of the health-care system that treat people before they get sick enough to need a hospital. Prevention is cheaper and more effective than cure.
For example, it is estimated that A$9 million invested in anti-smoking campaigns between 1997 and 2007 saved A$740 million on smoking-related illnesses like lung cancer.
Yet our breakdown of health spending in Western Australia shows just 1.7% is spent on preventive measures – called “public health spending”. Australia-wide the average percentage is even less, according to research from La Trobe University and the Australian Preventative Partnership Centre.
Early medical attention is another way to reduce the need for hospitals. In analysing data from around Western Australia between 2009 and 2016, we generally found that increasing visits to general practitioners reduced the incidence of avoidable deaths (deaths that could have been avoided with better treatment or prevention).
Limited prevention and early detection comes back to the way we fund health care.
Australia’s health system is funded using a “hospital-centred” rather than “people-centred” approach.
This means hospitals are funded by the number of patients cared for and the type of procedures done. Hospital and GPs are funded separately. There is no incentive to cooperate and keep people out of hospitals.
A people-centred approach, on the other hand, would give funds based on patients’ health outcomes, rather than their particular treatments. GPs would be paid to manage patients, with the goal of keeping them out of hospital.
This system would particularly help people living in remote and rural regions, including Indigenous Australians, who are disadvantaged by the relative lack of resources being spent on local and preventive health.
The Canterbury model
The best example of such a people-centred system is New Zealand’s Canterbury model – named after the Canterbury region on New Zealand’s South Island (which includes Christchurch).
Instead of separate budgets for GPs and hospitals, Canterbury created a “one system, one budget” approach. This led to new programs that weren’t possible under the old system. An example is Healthpathways, which brought together GPs and specialists to decide on treatement programs for individual patients.
In working to make hospitals the last resort, more time and resources have gone to GPs. There are now more 24-hour clinics, for example, making it easier to get treated by a local doctor when needed.
A study of the Canterbury system showed that between 2007 and 2014 the number of people being hospitalised declined from 6.59 to 5.83 per 1,000. While an 11% decline may not seem huge, it represents a significant financial saving, given the high cost of hospitalisation.
Canterbury shows what can be achieved by rethinking how health care funding works. Australia has the opportunity to reimagine its health care system in a similar way.
New hospitals get a lot of attention. Politicians can point to them as concrete evidence they’re doing something to help. But emphasising hospitals as the most important part of the health system comes at a cost, and will only get more so as the population ages.
It’s time to discuss alternatives. Putting more resources into prevention and people is the right medicine for our future health needs.
The Opposition’s A$2.3 billion cancer care plan – announced in Bill Shorten’s budget reply speech on Thursday night – aims to ensure cancer treatment costs for scans, specialists and drugs are bulk billed or subsidised under the Pharmaceutical Benefits Scheme (PBS). It would be a hard heart indeed that did not welcome such a move.
Maybe even better than avoiding the out-of-pocket costs of treatment is preventing future cases of cancer. Around one-third of all cancers are preventable by not smoking, staying at a healthy weight, eating healthy food, being physically active, minimising alcohol consumption, and avoiding excessive sun exposure.
But apart from a small commitment to tobacco control in the 2019 budget, neither the government or opposition has made even the vaguest commitment to, or investment in, cancer prevention.
So far we have heard virtually nothing from either party on efforts to tackle obesity, promote healthy eating, encourage more physical activity, reduce alcohol consumption, promote sun protection, or boost efforts to increase participation in cancer screening and vaccination programs.
The government currently spends around A$2 billion a year on “public health”, which includes monitoring, regulation, as well as prevention and vaccination. This amounts to less than 2% of the nation’s total health expenditure of A$170 billion. That is about half of what we spend on patient transport.
A boost to 5% – or closer to A$8.5 billion – could make enormous strides in better prevention programs, driven by high-quality research.
Poor track record
When it comes to investment in disease prevention, the story is not strong for the Coalition.
The Rudd Labor government established the Australian National Preventive Health Agency (ANPHA) in 2009, with funding of around A$60 million a year. The agency ran national programs focusing on tobacco, alcohol, healthy eating and reducing alcohol consumption.
But the new Abbott government axed the agency in 2014, after drafting legislation to expunge it from the books.
Programs such as Live Lighter and Foodcents, for example, provided evidenced-based and practical help for people to live healthy lives. Other programs improved the availability of nutritious foods, and ensured walking and cycling were safe and viable components of transport planning.
In 2012, the then Labor government committed to the continuation of the NPAPH to 2018, but it was axed by the Abbott government in the 2014 federal budget.
This took hundreds of millions of dollars otherwise committed to prevention efforts out of the federal budget calculations.
All of these discontinued efforts were likely to have had a major effect on reducing future generations of Australians from hearing those awful words: you have cancer.
Like any human endeavour that aims for big changes in systems and behaviours, stopping and starting the programs that lead these changes diminishes the prospect of success.
So why is it hard to get governments to invest in prevention?
Strong and influential industries consistently lobby governments to protect their commercial interests. That’s what happens in a market economy democracy. The alcohol, processed food and even tobacco industries continue to exercise an influential voice in the halls of power.
Unsurprisingly, industry aggressively opposes higher taxes on these products (“sin taxes”) and programs discouraging their use.
It is common to hear politicians tell stories of individuals, “real people” who benefit from a new treatment or access to new life-saving medical care or drugs. We all connect with these heart-warming stories and they illustrate the importance of the public funding investment.
Such stories are harder to tell in prevention. How do we find the 64-year-old enjoying his granddaughter’s first day at school, largely because he did not die of a smoking-related disease in his 50s because tobacco control efforts in his youth meant he did not take up smoking?
Effective prevention policies, such as putting a minimum floor price on alcohol, work to reduce alcohol-related harm. But making it more difficult to reduce the price of alcohol is politically unpopular.
Finally, the benefits of prevention often take many years, even decades, to arrive. Political timeframes are often linked to election cycles of three or four years.
A long-term view is vital. Each dollar invested in skin cancer prevention, for example, returns about A$2.20 in cost saving in avoiding cost of treating the disease. But there are decades between reducing kids’ sun exposure and avoiding treatment when those kids reach their 50s and 60s.
As the election campaign unfolds, let’s hope both aspiring Australian governments continue to show a genuine interest in the health of Australians and commit to preventing disease. Is 5% of the health budget too much to ask for that?