2014 was dominated by discussions about better ways of paying for health care. But for all the talk, little progress was made.
The year began with former Howard government adviser Terry Barnes' proposal to introduce a A$6 co-payment for bulk-billed visits to the GP. This, he said, would save money by reducing unnecessary visits to the doctor. The Commission of Audit swallowed the proposal and spat out a A$15 version (A$5 for concession card holders) ahead of the May budget.
The government initially settled on a A$7 co-payment for all GP visits and follow-up pathology and imaging. This was widely criticised for its potential to hurt the most vulnerable Australians who, according to research by the Grattan Institute, already paid more than their fair share of out-of-pocket health costs.
Modelling for The Conversation also showed the introduction of a GP co-payment could see average emergency department visits increase by between six minutes and three hours, as more patients opt for free hospital care rather than paying to see their local GP.
The impetus for the co-payment was concern that the nation’s health expenditure was rapidly spiralling out of control. But as data released in September revealed, Australia’s recent growth in health expenditure was the lowest since the mid-1980s. Per person spending fell from A$6,447 in 2011-12 to A$6,430 in 2012-13.
After seven months of trying to convince the crossbench Senators of the scheme’s merit, the government announced a compromise earlier this month: cutting GP rebates by $5 and freezing the rates until 2018. As Michelle Grattan wrote, this puts the onus on doctors to send a A$5 price signal to non-concessional patients.
In other key health news, Melbourne’s July AIDS2014 conference put HIV and AIDs back in the spotlight. Reema Rattan led our coverage, which included an In Conversation with Professor Rob Moodie and Nobel Laureate Françoise Barré-Sinoussi and interviews about HIV and the law with the Honourable Michael Kirby and Professor Nick Crofts.
Edwina Wright outlined the five promising steps forward in HIV science, including treatment as prevention, pre-exposure prophylaxis (giving antiretrovial drugs to people at risk of HIV to stop them contracting the disease) and new medications for people with both HIV and hepatitis C infections.
While a cure for HIV is a fair way off, there is reason for hope, wrote AIDS2014 co-chair Sharon Lewin. In August, scientists showed mice could be “cured” of HIV using a combination of four drugs to flush out and kill hidden HIV-infected cells.
AIDS2014 also addressed the human cost of the disease, with Australian experts focusing on three key groups: sex workers, people who inject drugs and men who have sex with men. While we’ve come a long way to reduce HIV in Australia, wrote Marion Pitts, there’s still more to do to reduce the spread of the disease and remove the stigma against people living with HIV.
Internationally, we’re no longer in an era of emergency response, but that doesn’t mean rich countries can stop funding HIV. Instead, David Wilson and Breadon Donald argue, developing countries still need donor assistance to strengthen their health system so they can treat HIV as a chronic disease.
This year Ebola also focused the world’s attention on the challenges of health care in West Africa. The disease spreads through bodily fluids – blood, vomit and feces – so it should, theoretically, have been easy to contain.
In our coverage of almost 100 articles spanning the US, UK and Australian sites, we bought you the basics on Ebola: what it is and how it affects the body; what went wrong in the Ebola respnse; vaccine development; as well as stories on how authorities can reduce “Ebolanoia”, why some people survive Ebola and others don’t, and how the outbreak has affected those left behind.
Other highlights for the year include series on testing alternative therapies, international health systems, biology and blame, domestic violence in Australia, child protection in Australia and our popular ongoing series Health Check.
Finally, this year we also welcomed new a columnist, psychiatrist Steve Ellen, whose Life on the Couch column shines a psychological light on people, culture and society. Next month public health veteran Simon Chapman will also join the ranks, with some plain speaking about public health.
Thanks to all columnists and authors, and of course, to our regular readers. Have a happy and healthy new year.
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