12 May 2022

Rheums for improvement

Medicare PBAC PBS Political Research Rural Telehealth

To the relief of many, the 2022 federal election campaign will soon be over. But amid the usual cash splashes and pork barrelling, the health offerings thus far have failed to impress.

The Coalition has proposed $146 million for expanded rural training programs and a raft of workforce incentives for rural doctors. Labor, in turn, has agreed to match it, and to also increase telehealth mental health rebates for people in rural and regional areas.

Labor launched its health campaign with the promise of $135 million over four years for 50 urgent care bulk-billing clinics across Australia, though doctor groups are unimpressed. Labor also says it will review the NPS funding cut announced in the last budget.

At the consumer level, both parties have agreed to slash PBS co-payments, though neither are looking to address other out-of-pocket costs.

We asked rheumatology professionals and patients what policies and initiatives they want to see on the table.

On our panel we had:

  • Dr Claire Barrett – rheumatologist and incoming ARA president
  • Linda Bradbury – rheumatology nurse practitioner and Rheumatology Republic editorial board member
  • Seth Ginsberg – co-founder and president of the Global Healthy Living Foundation patient advocate organisation
  • Professor Steve Hall – rheumatologist and Rheumatology Republic editorial board member
  • Professor Catherine Hill – rheumatologist and current ARA president
  • Dr Benjamin Sutu – first year rheumatology trainee

Unsurprisingly there was a lot of overlap in their wishlists, and several key themes emerged. Here’s what they said.

Telehealth and video consults

“The issue of credibility in politics has been thrown into focus on the medical side by the offer to maintain telehealth, which most of us see as a given – the most popular change to health care since Medicare itself,” said Professor Hall.

While the continuation of telehealth was nevertheless a good thing, our panel said more needed to be done – especially for video consultations.

“Reinstate funding for regional video consultations,” said Dr Claire Barrett. “The removal of Medicare item 112 for specialists and the associated GP/AHP item numbers has resulted in significant challenges to those who offered a bulk billing service for regional patients.”

Paediatric rheumatology resources

Most of the panel mentioned that they want to see funding for and implementation of the recommendations of the parliamentary inquiry into childhood rheumatic diseases.

Rheumatology training and workforce

We need more rheumatologists and rheumatology nurses, especially in paediatric rheumatology, said Mr Ginsberg.

Dr Barrett wants to see an “increase in dedicated funding for additional training positions to future proof the medical workforce shortage in specialist rheumatology service – but also primary care.”

Professor Hill asked for “consistent long-term funding of both adult and paediatric rheumatology advanced training positions in line with appropriate workforce needs analysis.”

Nursing and allied health

Ms Bradbury pointed out the need for improved access to allied health services and rheumatology nurses.

“At the moment, patients can only access five free services per year for allied health via the chronic care management plan,” she explained.

“If you have someone that is diabetic and needs to see a podiatrist, this will take up all of the free sessions! As you know, physiotherapy or exercise physiology is vital for many of our patients and so we need more than five fully funded sessions per year,” Ms Bradbury said.

“And more funding is required to allow patients access to rheumatology nurses … irrespective of where they live or if they are public or private,” she added.

Professor Hill raised the importance of funding of rheumatology nurses to support people with arthritis in both rural and metropolitan areas, “consistent with international standards”.

Research funding

Dr Barrett and Professor Hill called for more research funding for musculoskeletal disease.

Medication

Several of the panel asked for improved and timely access to medicines.

Dr Barrett mentioned addressing the untimely delays between a PBAC recommendation and a change in the PBS, “with the rituximab September 2021 recommendations being an example”.

In addition to reducing the time for PBAC-recommended medicines to hit the PBS, Mr Ginsberg sought an increase in the number of biologics patients can try/fail to allow for new products on the market, earlier access to biologics/biosimilars for people newly diagnosed and reduced time for biologic prescriptions to be approved.

Equity and accessibility

“Accessible healthcare should be something available to all Australians,” said Dr Sutu.

“We’re lucky in this country to have the foundations for universal healthcare, but we should strive to make sure it continues to be safe, equitable and accessible by all, regardless of background.”

More culturally and linguistically diverse patient information (pamphlets, booklets, media resources) about rheumatic conditions and treatments, as well as improved rural and regional access to public rheumatology services and more funding for more allied health sessions would ensure greater equity, said Dr Sutu.

State and territory health services had to be provided with adequate funding in conjunction with mandatory obligation to ensure nationwide affordable access to specialist rheumatology care, Dr Barrett said.

“For many patients, cost is prohibitive for many services – so, for example, we have patients waiting 3-4 years for a knee replacement,” said Ms Bradbury. 

“This has a knock-on effect as they potentially have difficulty exercising, so they gain weight, have an increase in pain, become unable to exercise, gain more weight, get more pressure on other joints, more pain, then that leads to depression … and so on.”

In addition to restructuring Medicare funding models to make health appointments more affordable and accessible, Mr Ginsberg wanted to increase access to in-home medical services for people with limited mobility.