Health policy
Covid-19 is still kicking around
Covid-19 hasn’t gone away, and probably won’t ever go away, but as Amy Coopes explains in the Saturday Paper, government policy has changed: Covid-19: Inside the shifting vaccine strategy. By now almost everyone – 99.6 percent of the population according to Health Department estimates – has some level of immunity resulting from vaccination or past infection – “hybrid immunity”. Immunity wanes of course, but provided a reasonably high level of immunity is sustained, and those most at risk are vaccinated, Covid-19 will have successfully made a transition from pandemic to endemic status.
Coopes points out that the consequences from contracting Covid-19 are becoming less severe. When Covid-19 first broke out, 1 in every 3 aged care residents who contracted Covid-19 died from it: now the figure is closer to 1 in 40.
The quality of publicly-available data has deteriorated. Although the Department of Health publishes data on cases, case numbers are probably vastly under-reported. The same data set records deaths and hospitalizations, but those death numbers seem to be low when compared with data from individual states. The latest New South Wales Respiratory Surveillance Report records that there were 28 deaths of people with Covid-19 in the week to April 8, which, with a little rough calculation, suggests that about 3000 Australians a year are dying from Covid.[1]
These are rough numbers, only to give an impression of the order of magnitude. It indicates that Covid-19 is a serious disease, ranking near breast cancer and suicide as a cause of death. Also Covid-19 can cause debilitating conditions (“long Covid”) and there is evidence that it may reduce immunity to other diseases.
The Commonwealth and state reports confirm that Covid-19 is continuing to come in waves, each successive wave being a little smaller. Also, the New South Wales report shows that after two years (2020 and 2021) influenza has re-established its seasonal pattern – a small summer peak and a larger peak mid-year.
Catherine Bennett of Deakin University, writing in The Conversation, warns that Covid-19 could see a winter rise in Covid-19: Another COVID winter is coming. Is this the calm before another peak?. She provides some data on hospitalization, noting that recorded cases of hospitalization are fairly volatile, and that most people with Covid-19 admitted to hospital have been admitted for other conditions.
1. By a rough calculation that suggests there are 4 deaths a day in NSW, or 12 nationally assuming the death rate is the same in all states. That’s around 4500 people a year dying with Cpvid-19. Assuming only two thirds of those deaths are caused by Covid-19, that suggests that Covid-19 is resulting in around 3000 deaths a year. ↩
Is Medicare still fit for purpose?
In an ABC Rear Vision program three health policy experts – Jennifer Doggett of Croakey, Stephen Duckett now at the University of Melbourne, and Jim Gillespie of the University of Sydney – are interviewed on the question Is Medicare still fit for purpose?.
In the 30-minute discussion the participants cover the history of Medicare, going back to its roots in the Whitlam government’s Medibank, the first program of universal tax-funded health insurance. The Fraser government, in a number of steps, abolished Medibank entirely. Then the Hawke-Keating government resurrected it under the name Medicare, as part of the Prices and Income Accord – an inflation-breaking deal that increased the social wage in return for a cap on monetary wages. The Howard government rescued private health insurance through a series of expensive subsidies and incentives, most of which are still in operation, but accepted that Medicare is politically established. Subsequent governments, Coalition and Labor, have tended to neglect health care reform, opting for minor tweaks. While universalism was a core principle of Medibank and of Medicare in its early days, Labor seems to be less committed to universalism than it was in the past.
On the question of its fitness for purpose, the participants pointed out that it was designed when the health care task was mainly for short-term acute conditions. Now that task is mainly about long-term chronic conditions, but the remuneration systems and institutional arrangements of Medicare do not cope well with these more recently emerged needs.
The participants acknowledge the government’s Strengthening Medicare commitments, but they note that the amount of money committed is small in relation to the scope of change that is needed in Medicare. Maybe there is so much waste in our health care arrangements that extra funding is not needed, but the modesty of the government’s spending suggests that it is not up to fundamental reform.
Notably no one on the panel suggested that private health insurance should take a stronger role in financing health care.
Specialist wait times
Before reunification the Germans had an old joke about East Germany:
It is January, 1980, and Comrade Schmidt gets a call from the Ministry of Transport to give him the joyful news that his Trabant car, for which he has paid a deposit, will be ready for collection on 22 September, 1984. Comrade Schmidt is grateful for the news, but he asks whether it will be in the morning or afternoon, because that’s when the plumber is scheduled to come.
There is nothing funny, however, in knowing that if one is on the waiting list for neurosurgery in Hobart, it too will take 4.8 years.
That’s one of the worst cases exposed in an ABC research project: Specialist wait times blow out to greater than six years, sparking renewed calls for change, reported by Stephanie Dalzell. It covers only four states and she points out that it is biased to understating wait times.
She identifies two drivers of this huge expansion in specialist wait times. One is that an ageing population has an increasing incidence of chronic disease requiring specialist attention. The other, on the supply side, is that there have been too few places in the postgraduate courses for specialists.
In times past medical specialists were renowned for their cartel-like behaviour, in deliberately restricting numbers in postgraduate courses. In this article Dalzell suggests that this attitude may be changing: some specialist colleges are now acknowledging that more places need to made available, but that takes time.