In the latest edition of The Health Wrap, Associate Professor Lesley Russell looks at two important reports on family, domestic and sexual violence released in the leadup to International Women’s Day, big developments in private health insurance, and the lack of focus on public and preventive health policies on the eve of the South Australian election.
Beneath her column are some links to other recommended reading and resources from the Croakey team, and some “tweets of note”.
Some thoughts on International Women’s Day 2018
Thursday March 8 was International Women’s Day. In its honour, I’m persuaded to stray from my health policy beat to look at several reports that highlight how much more needs to be done to improve the safety and wellbeing of Australian females of all ages.
But first, on a frivolous note, Ultra-Violet has been declared the 2018 Pantone Color of the Year (American spelling for an American sales pitch) and this fits in nicely with the fact that purple is historically associated with efforts to achieve gender equality. It was originally used alongside green and white as the colours of the Women’s Social and Political Union, the organisation that led Britain’s women’s suffrage movement in the early 20th century. For suffragettes, purple represented “the royal blood that flows in the veins of every suffragette”, white represented purity and green represented hope.
On a much more serious note, women today might be more inclined to see red than wear purple at the findings of several recent reports:
AIHW report: Family, domestic and sexual violence in Australia 2018.
The report looks at these issues for both sexes, but finds women (especially those who are Indigenous, young, pregnant, separating from their partners, disabled and struggling financially) are at greatest risk. This is because women are most likely to experience violence in their home at the hands of someone they know, often their current or a previous partner) while men are more likely to experience violence from strangers in a public place.
This violence exacts a substantial toll on individuals, families and society: it is the leading cause of homelessness for women and children and has a significant impact on physical and mental health. The report highlights where there are gaps in the data needed to understand, address and target these problems. In particular, there is a paucity of information about programs and interventions that work.
The numbers are so shocking it’s hard to understand how they have been ignored for so long – or to imagine that they could be ignored into the future. For example, at the tip of the iceberg, on average one women a week and one man a month is killed by a current or former partner – and so many more lives are permanently damaged.
Yet to date, progress to address family and domestic has been so painfully slow. Small wonder former Australian of the Year Rosie Batty, who has been such a public face for this work, now feels she must withdraw from the public arena after what she describes as a “gruelling and unrelenting four years”.
Towards the end of Rosie’s term as Australian of the Year, in November 2015, the Australian Parliamentary Library released an excellent summary of where actions, policies and funding on domestic violence issues stood at that time.
In April 2016 the COAG Advisory Panel on Reducing Violence against Women and their Children released its final report which was designed to inform the implementation of the National Plan to Reduce Violence against Women and their Children 2010-2022. A national summit was held in October 2016 at which the Prime Minister launched the Third Action Plan (2016-19).
The evaluation of the Second Action Plan, undertaken by consultants and delivered in 2017, found that not enough has been done to account for the needs of high risk groups like Indigenous women, women from culturally and linguistically diverse backgrounds, and women with a disability. These failings are not adequately addressed in the Third Action Plan.
Unfortunately it is not possible to track funding for anti-violence initiatives in the annual federal budgets, although the National Foundation for Australian Women has made an effort to do this in their Gender Lens on the Budget series – see 2015-16, 2016-17, 2017-18 analyses.
The Red Zone
As the 2018 university year begins and new students commence their academic studies, The Red Zone Report, undertaken by a student advocacy group End Rape on Campus Australia, has found that the first week of semester one at university is the most dangerous time of the year to be a woman on campus. Research has found that 1 in 8 sexual assaults at University of Sydney colleges happen during Orientation Week. Reports of students of both sexes experiencing hazing and unpleasant college rituals also spike. O week is the “red zone”.
Like domestic violence, this is an issue that has been on the radar for some time, with little apparent change. The 2017 report from the Australian Human Rights Commission Change the course: National report on sexual harassment at Australian universities (conducted at the request of Australia’s 39 universities) found disturbing levels of sexual violence and violence against women in universities. Residential colleges were particular areas of concern, with women four times as likely as men to have been sexually assaulted in this setting.
Universities argue they are hindered in their ability to act by the organisational independence of some colleges, but the fact is their responses to date have been inadequate. Deputy Labor Leader Tanya Plibersek has said that universities must go further to force their associated colleges to provide a safe environment – and if they can’t, “they should sever links with them”. She also committed that a Labor government would compel university colleges to fulfil their duty of care through measures such as financial penalties directed at residential colleges or universities which breach the rules.
What are the Private Health Insurance funds up to?
There have been some major changes proposed to private health insurance (PHI) over the past two weeks. Australia has never had a coherent policy around role of PHI in healthcare system and these recent announcements don’t help – arguably they make it more difficult for consumers.
As Labor frontbenchers Catherine King and Andrew Leigh recently wrote: It’s no wonder we’re questioning the value of private health care. Consumer concerns are reflected in a 30 per cent rise in complaints to the Private Health Insurance Ombudsman in 2016-17 compared with 2015-16.
Last week Australia’s largest health fund Bupa (having presaged average premium increases of 3.9 per cent, effective April 1) announced that from July it would switch restricted cover (paying minimal benefits) for certain services to an outright exclusion. This would affect more than a third of Bupa’s members (some 700,000 people) for services usually expected as part of PHI cover, including hip and knee replacements, pregnancy, IVF, cataract procedures and obesity surgery.
Bupa also announced that from August, it would restrict eligibility for no gap or known gap services by requiring doctor and patient to use only Bupa-contracted facilities. (Doctors participating in medical gap schemes like Bupa’s and their insured patients currently have a choice of hospital and day surgery facilities).
At the same time HBF (in discussions to merge with HCF) will remove some services, including obesity surgery, cochlear implants, dialysis and insulin pumps, from its less expensive policies and reduce some mental health payments.
The Australian Medical Association characterised these moves as “one big leap towards US-style managed care”. The PHI funds argue these changes, made ahead of a government proposal to categorise policies as bronze, silver of gold based on cover and cost, are about keeping costs down, improving transparency, and “to remove any confusion over who pays”.
But the reality is patients will have to do more homework to make sure they are not hit with large out-of-pocket costs and their choice of doctor and hospital may be limited. Not surprisingly, consumers with affected policies have been quick to look elsewhere for PHI cover.
However after Health Minister Greg Hunt requested the PHI Ombudsman to investigate the fund, Bupa had a sudden change of heart. Bupa has agreed to keep the scheme open to elective, pre-booked procedures in public hospitals, but will still limit the benefits it pays for services in uncontracted private facilities. It is also still pushing ahead with plans to downgrade the cover of more than a third of its members.
Using PHI in public hospitals
A Heads of Agreement put forward by the Federal Government last month (so far signed only by NSW and Western Australia) will allow public hospitals to continue to bill patients’ health insurers for treatment costs but will restrict some practices. Again, it seems that these changes are more in the interests of the PHI funds (which have complained this practice is forcing up costs and therefore the price of premiums) than patients (many of whom have no access to private hospitals even though they may have PHI).
The new agreement will require that public patients treated free of charge are prioritised according to clinical need and not PHI status (this reinforces an established Medicare principle). Reform talks by governments around the agreement are likely to focus on whether patients should be asked about their insurance status in emergency departments.
Where to from here?
All this begs the question/s of what are the issues that must be resolved around PHI? Bupa’s Managing Director could only say that “thoughtful” feedback, especially from those in regional areas, had made him realise the change to the medical gap scheme was “catching the wrong thing” – but what are these “wrong things” and what are the “right things” that must be promoted?
Here is a partial list of what PHI funds (and doctors) must deliver to ensure value to consumers:
- The ability to know accurately total out-of-pocket costs before surgery or treatment. This may require a firm contract between funds and providers (hospitals and doctors).
- Publicly available information about specialists who charge exorbitant fees (name and shame) and, ideally, a mechanism to reel these in.
- Clear transparency at the time of purchase about what PHI policies cover. This may be delivered by the government proposal to categorise policies, but this is yet to eventuate.
- An examination of the extent to which day surgeries are currently (or could in the future) provide appropriate treatment at reduced costs and to which converting rooms to day surgeries is merely a mechanism to enable doctors to chase extra fees.
Doctors on the frontline can be effective partners in reform – they see the consequences for their patients when PHI is not cost effective. This article from Dr Ranjana Srivastava makes the case perfectly: From a frontline clinician: here’s what’s wrong with private health insurance.
Readers who are concerned about what these changes might mean for them will find some clear explanations and advice on the Choice website.
And finally: there is a push from consumer organisations for an inquiry by the Productivity Commission into the effectiveness of government assistance to PHI. As far as I can tell, the last one was in 1998. The time for that inquiry is now.
Health vs healthcare in SA election
South Australia goes to the polls on Saturday, with Labor, under Premier Jay Weatherill, trying for a fifth term in office. Energy prices, the brain drain, job creation, education and access to affordable healthcare have solidified as the key issues.
An examination of the health and aged care policies from Labor, Liberal and the SA Best (Xenophon) parties reveals the inevitable focus on hospitals. Labor has committed $480 million to new and upgraded facilities, $30 million for a health hub linked to the Royal Adelaide Hospital, and $70 million over 5 years for a mental health package. Liberal commitments include $40 million to reduce elective surgery waiting lists, over $20 million for hospitals, and $20 million to increase the rural medical workforce. SA Best would provide $150 million to address the health capital works backlog.
Yes, states are responsible for public hospitals and yes, public hospitals need more funding. But building a healthy population requires so much more. That’s why, in the lead-up to the election, a consortium of state-based public health and social service organisations has been strongly advocating for the prioritisation of public health, health promotion and disease prevention and making the case for a substantial, long-term commitment to health and wellbeing (#healthySA). You can read more about their work in a recent Croakey article.
The consortium can claim some success. Labor has pledged $15 million for a preventive health package (although it should be noted that this does not cover any of the three key public health priorities of the consortium – to appoint a full-time Chief Public Health Officer, establish a statewide community health promotion and disease prevention strategy, and establish and evaluate two non-government primary health care centres.). This funding includes:
- $7.2 million for a childhood obesity and lifestyle program
- $4.5 million for a 4 years trials to better manage asthma
- $1.35 million to the Heart Foundation to provide screening checks via a mobile health bus
- $1.0 million for an awareness campaign to reduce sugar consumption by children.
Both major parties have responded to the recent ICAC report on the abuse of elderly residents at the Oakden residential aged care facility. Premier Weatherill, who must ultimately take responsibility for this scandal, has said that Labor will accept and implement all 13 recommendations of the report; the Liberals will commit $14 million to shift Oakden patients to a new facility.
- Previous editions of The Health Wrap can be read here.
- Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow on Twitter: @LRussellWolpe
ICYMI: Reading and resources recommended by the Croakey team
- Australian Indigenous Doctors’ Association Student Representative Committee member Kathryn Dalmer, a Wirradjuri woman, is conducting the first Australian national study, looking at the experiences of GPs with Indigenous cultural training. If you are a GP, please take this short online survey.
- IndigenousX is running a series of articles from Australian Indigenous women to mark International Women’s Day 2018. In one, Buzzfeed journalist Amy McQuire writes how white feminists can be often complicit in myths and misrepresentations of violence in Indigenous communities, in an environment where “blaming both Aboriginal men for violence, and Aboriginal women for parental neglect, is not just unhelpful, but dangerous.”
- In light of the AIHW report (above), ABC radio’s Background Briefing provides this shocking insight into the murder three years ago of a Canberra woman by her former partner, asking: Could Tara Costigan’s murder have been prevented? Meanwhile, the Women’s Legal Service Victoria has published the Small Claims, Large Battles research report. As this story in The Age noted, many disadvantaged women simply walk away from their entitlement to a fair division of property when relationships end because of a lack of quick, affordable ways to resolve family law disputes.
- UN Special Rapporteur on human rights and the environment John Knox has released a much under-reported report on human rights obligations relating to the enjoyment of a safe, clean, healthy and sustainable environment, with a particular focus on protecting children’s rights.
- Here’s a call to action for our times. UN prosecutor and human rights scholar Payam Akhavan delivered the 2017 CBC Massey Lectures, In Search of a Better World: A Human Rights Odyssey. If you have the time, you can listen back here:
- The Disability Discrimination Act came into effect 25 years ago this month. Disability Discrimination Commissioner Alastair McEwin looks back at what it’s meant, and where action is still urgently needed, notably with employment and violence in institutional settings.
- The Australia and New Zealand Communication Association (ANZCA) annual conference last year featured an Indigenous media plenary session: Deterritorialising Media: resilience and Activism. Chair Professor Bronwyn Carlson, Head of Indigenous Studies at Macquarie University was joined by media practitioners from Australia and Aotearoa/New Zealand, including Croakey contributing editor Summer May Finlay. It’s now published an edited transcript of their discussion (paywall).
- As news breaks of plans for a summit between US President Donald Trump and Kim Jong-un on North Korea’s nuclear and missile program, the 2018 Don’t Bank on the Bomb report (produced by Pax and the International Campaign to Abolish Nuclear Weapons) details international investments in nuclear arms, plus a Hall of Fame (with one Australian entry) for those financial institutions with policies against such investments (hint: not the big four).
- Detained on Nauru: ‘This is the most painful part of my story – when you realise no one cares’. In this excerpt from the book They Cannot Take the Sky, Benjamin talks about his years detained on Nauru, and his undying hopes for the future.
- Via Race Discrimination Commissioner Tim Soutphommasane, the story of Mak Sai Ying, who arrived in Australia 200 years ago last month, and is believed to have been Australia’s first Chinese immigrant. Today 1.2 million Australians claim Chinese ancestry.
- The stop sign and one-way street might seem benign, but they shape our lives in ways we sometimes don’t even realise, writes Johnny Miller, the founder of africanDRONE in this important Guardian article on how infrastructure built on American inequality.