Australian Medical Association

The AMA strongly believes that strong support for health and medical research is necessary to ensure that the best and most efficient health care is available to all Australians. Australia has been falling behind other countries in its funding and strategic long-term commitments to health and medical research. This submission to the McKeon Review outlines how Australia can regain its position as a world leader in health and medical innovation.

The AMA submission to the Australian Institute of Health and Welfare and the Royal Australasian College of Surgeons highlights that: urgency categories should facilitate patients being prioritised for surgery fairly and equitably; category definitions should take account of all the factors relevant to a patient's requirement for surgery; the primary driver for surgeons to categorise elective surgery will always be clinical urgency; and elective surgery waiting time should be counted from the time the patient is referred by a general practitioner to a surgeon for assessment until the time surgery is performed.

Achieving high quality supervision and assessment of trainees must be a high priority for the health system. The AMA position statement on Supervision and assessment of hospital based postgraduate medical trainees (2012) outlines the key requirements for effective supervision and assessment of trainees to ensure the quality of medical education and training /remains of a high standard.

The AMA's submission to the Independent Hospital Pricing Authority on a pricing framework for public hospital services calls for hospital services to be funded on the basis of an 'effective' rather than an 'efficient' price. An effective price is one that provides sustainable and equitable access to high quality hospital services. The submission details the AMA's support for appropriate funding of post-hospital care; investment in teaching, training and research; and small and medium sized hospitals.

In September 2011, the AMA hosted a summit of public health and police stakeholders to consider advice to the Australian Government on reform of alcohol taxation and pricing. A Communique was issued which outlined a consensus view on options for reform.

The provision of out-of-hours care is a key part of general practice. The AMA Out-of-Hours Primary Medical Care 2011 position statement has been developed to guide the design of these services, outlining the essential feature of a successful model of out-of-hours primary medical care.

The AMA Public Hospital Report Card 2011 has found that there has been little improvement in public hospital capacity and performance across Australia in 2009-10, despite extra Commonwealth funding.

It has been very much business as usual as public hospitals struggle to meet demand.

The AMA's submission to the Senate Finance and Public Administration Committee on the National Health Reform Amendment (Independent Hospital Pricing Authority) Bill 2011 highlights the importance of the Pricing Authority, the Australian Commission on Safety and Quality in Health Care, and the National Health Performance Authority collaborating on their roles and responsibilities, for example, on data collection requirements.

It also points out that the Pricing Authority should consider the standards set by the Performance Authority when calculating the national 'efficient' price, that is, it must take into account the performance that must be achieved. In addition, the National Health Reform Agreement allows states to pay hospitals less than the determined efficient price, therefore, we recommend that the actual payments made to hospitals are reported to Parliament so that it is clear when poor performance is linked to insufficient funding.

Overall the Bill before Parliament responds to the AMA's lobbying last year to ensure the Pricing Authority considers the range of variables affecting the actual costs of providing health care services when calculating the national efficient price. However we recommend that the Authority is explicitly required to ensure hospitals can fulfil their teaching and research obligations.

On 2 August 2011, the Commonwealth, State and Territory governments finalised the National Health Reform Agreement. A summary of the Agreement's key points can be found here.

The AMA opposes Government decisions to defer listing of medicines on the PBS that have been recommended by the independent Pharmaceutical Benefits Advisory Committee (PBAC). The Government is leaving itself open to accusations of political interference by ignoring the PBAC assessment and pricing process which is fair, equitable, evidence-based and transparent.

Second Submission

The AMA submission to the Department of Health and Ageing position paper on the role and governance of Lead Clinician Groups released on 20 May 2011 emphasises that the Commonwealth Government's attempts to provide doctors with a meaningful role in how local hospitals are run has failed.

First Submission  - 17 February 2011

The AMA submission to the Department of Health and Ageing discussion paper on the role and governance of Lead Clinician Groups released on 25 January 2011 strongly opposes the limited role for doctors proposed. The AMA submission provides a model for Lead Clinician Groups that ensures doctors are involved in decisions made at the local hospital level about resource allocation, service planning and provision, and patient care.

The AMA has made an additional submission to the Department of Health and Ageing to raise concerns identified by AMA member junior doctors. This submission:

• emphasises the need to ensure that time-based targets do not impact on the ability of public hospitals to provide quality clinical education and training;
• calls for ongoing resources to support the ability of emergency departments, the hospital and community providers to fulfil education and training obligations; and
• recommends that the monitoring and evaluation of the impact of targets also includes the impact on education, training and junior doctor experiences.

This submission supplements the submission lodged by the AMA on 25 May 2011.

The AMA has made a submission to the Department of Health and Ageing, on the implementation of elective surgery and emergency department targets, which strongly advocates for an evidence-based approach to implementation. The AMA supports measures to improve the timeliness and quality of patient care in public hospitals but cautions against imposing arbitrary time-based targets that may carry more risks than potential benefits if they are not slowly, carefully and cautiously implemented.

Aboriginal and Torres Strait Islander Health Report Cards

Medicare Locals have the potential to impact on a wide range of health care services.  The AMA believes they should be introduced in a manner consistent with the AMA's overall health vision and which is respectful of the exisitng role of the General Practitioner and other community based specialists.   This position statement includes details of the AMA position on the governance, functionality, accountability, fundholding and boundaries of Medicare Locals.

Medical practitioners (doctors involved in patient care) have long held concerns that decisions about how health services are delivered and resources for health services are allocated, are made without proper advice from the medical profession. Over time, decisions about the allocation and use of health resources have shifted away from doctors, and away from where care is delivered.  Consequently, Australia’s health system is not responsive to local needs, and opportunities to improve clinical safety and quality are lost.

The establishment of Lead Clinician Groups will ensure medical practitioners have a role in the stewardship of health care resources.

This position statement focuses on how Lead Clinician Groups will operate at a local level. AMA policy on national Lead Clinician Groups will be developed when more detail is available on their proposed role and interaction with other national guideline development bodies.

The structure of Lead Clinician Groups, the governance arrangements underpinning them and their relationship with government decision-making bodies will be critical to their effectiveness in supporting and guiding policy and decision makers in shaping the future of the Australian health system.

The AMA Public Hospital Report Card 2010 is an analysis of the most recent publicly available national data on public hospital performance plus more recent feedback from doctors working in public hospitals in all States and Territories.

There has been little improvement in public hospital capacity and performance despite significant extra Commonwealth funding as part of the National Healthcare Agreement and specific funding for an elective surgery ‘blitz’.

This position statement sets out the principles the AMA considers should underpin the national introduction of time-based targets for public hospital emergency departments (EDs) in order that patient safety and outcomes, quality of care and the training of doctors are not compromised.

The Council of Australian Governments (COAG) Agreement 2010 outlines the agreement reached by all jurisdictions, except Western Australia, to establish a National Health and Hospitals Network (NHHN). The NHHN Agreement incorporates structural reforms as well as additional investments in hospital, primary and aged care services, and preventive care in mental health and diabetes health care.

Further initiatives announced in the Commonwealth Government’s Budget on 12 May 2010 include support for practice nurses, improved primary care infrastructure and the roll-out of electronic health records, bringing the total new health investment over the next five years to $7.3 billion.

The Commonwealth Government plans to introduce this Bill to make amendments to the legislation that underpins the Professional Services Review (PSR) scheme.

The Department of Health and Aging has recently met with the AMA to discuss and explain the current proposed amendments.

The AMA has made a submission to the Department of Health and Ageing on the exposure draft of the Bill.

Medical practitioners (doctors involved in patient care) can make a significant contribution to the effective and efficient management of public and private hospitals. Doctors can contribute to better management of health costs while ensuring quality patient care and outcomes by being involved in decisions about resource allocation and the purchasing of services for the provision of patient care.

The management of hospitals works best when doctors are engaged in clinical and corporate governance.

This position statement outlines the measures the AMA considers appropriate for the prevention and treatment of obesity in Australia.

In November 2008 the Council of Australian Governments' agreed to introduce a nationally-consistent approach to activity-based funding for public hospital services to allow comparisons of efficiency across public hospitals.

Subsequently, the Australian Government asked the Productivity Commission to examine and report on the relative performance of the public and private hospital systems. In June 2009, the Productivity Commission released a paper seeking information and feedback on a range of issues including treatment costs, including out-of-pocket patient expenses and rates of fully-informed financial consent, rates of hospital-acquired infections and other relevant performance indicators.

Below are the two submissions the AMA made to the Productivity Commission on the Performance of public and private hospital systems. The AMA submissions also address the Commission's term of reference on informed financial consent.

The AMA Public Hospital Report Card 2009 is an analysis of the most up-to-date national data on public hospital performance plus more recent feedback from doctors working in public hospitals in all States and Territories.

It shows that Australia’s public hospitals continue to be seriously under-funded and are struggling to meet growing public demand for their services.

People still experience excessive waits in emergency departments and excessive waits for admission to a hospital bed. Waiting times for elective surgery have been getting longer.

The growing number of Australians at risk of serious chronic diseases from obesity, smoking and excess alcohol use is a major health challenge facing Australia. This AMA Policy Brief, Preventing Obesity, Smoking and Excess Alcohol Use, summarises some key measures that the AMA believes should be given priority in a National Preventative Health Strategy, including support for the preventative role of doctors and implementation of a number of targeted community-level measures.

The AMA President, Dr Rosanna Capolingua, has written to the Minister for Health and Ageing to seek assurances that there will be sufficient clinical training positions for interns and specialist trainees in the public sector.

AMA's views on rural health care delivery to the Department of Health and Ageing.

The AMA highlights that the major shortfall in current rural health programs is the overall lack of funding.

The AMA also calls for the Rural, Remote and Metropolitan Areas (RRMA) classification system that is used by the department to target many of its rural workforce programs to be retained and enhanced.

AMA Position Statement: Clinical support time for public hospital doctors - 2009

The AMA defines clinical support time as protected time for duties that are not directly related to individual patient care. Clinical support duties encompass most aspects of the teaching, continuing professional development, clinical governance, administration and research activities undertaken by clinicians in the public health sector.

The purpose of this position statement is to specify a minimum benchmark of remunerated time for clinical support duties for senior and junior clinicians. It includes a comprehensive list of the roles and responsibilities that constitute clinical support time to assist with developing job descriptions and work schedules.

The AMA's response to Matter number AM 2008/13.

The AMA has made a submission in response to the draft national awards and also appeared before AIRC hearings in Sydney. The AMA has argued that the new awards may result in cost increases for some private medical practices as they prescribe, in some cases, more generous working conditions than those contained in existing awards. The AMA submission called on the AIRC to bring working conditions in the proposed awards back into line with current awards so that medical practices are not hit with increases in costs.

AMA Public Hospital Report Card 2008

An AMA analysis of Australia's public hospital system.