Australian Health Care Reform Alliance

02/09/2026

Cutting the cigarette tax risks undoing a health win

The Coalition has proposed cutting the to***co excise by 80 per cent — from about $30 to $6 on a standard pack — arguing with little evidence, that closing the price gap with illicit to***co will starve organised crime of its profits. https://www.abc.net.au/news/2026-09-03/coalition-unveils-plan-to-slash-to***co-excise/107109642

Illicit to***co is a real problem: illicit product is etimated to now makes up more than half of ci******es sold, and around 80 per cent of to***co, vapes and pouches combined. (3 Sep)

But the numbers don't add up. Even after an 80 per cent cut, a legal pack would still cost roughly $18–21. That's barely below, and maybe still above, the $15–20 illicit price, with nothing stopping illicit sellers from undercutting the price further.

Not surprisingly, fifteen public health bodies, including Cancer Council, Heart Foundation and the Public Health Association of Australia, warn that the cut would make ci******es more affordable, lift smoking rates, and hand billions in profit to multinational to***co companies while barely touching the black market it's supposed to kill. https://www.cancer.org.au/about-us/news-and-media/media-releases/health-bodies-unite-to-expose-big-to***cos-push-for-tax-cuts

Here's the part that should make everyone pause: the evidence is that the excise is working.

AIHW's 2025 National Drug Strategy Household Survey found daily smoking has fallen to a record-low of 5.6 per cent. That’s down from 8.3 per cent just two years earlier, and down from 19.5 per cent in 2001. So the raw smoking rate has diminished significantly with the increased excise and other initiatives to reduce smoking. That’s a real health bonus that also has economic benefits.

The decline in smaking rates has held steady right through the years that illicit trade has exploded. What did spike is illicit purchasing among smokers. That's up from 16.7 per cent to 34 per cent in the same survey. That's a customs, retail-licensing and organised-crime enforcement failure. It is not evidence the health policy and excise tax have failed.

The ABS's separate experimental ni****ne-consumption series (not the AIHW survey) found total ni****ne consumption up about 30 per cent since late 2021 (the figure Mr Taylor has quoted) but the ABS itself cautioned the estimate is experimental, and the data does not establish that the excise caused overall consumption to rise. The Coalition's "consumption is up 30 per cent, therefore the excise has failed" claim conflates two different, non-equivalent datasets.

The overall picture: on the health outcome the excise was designed to modify i.e. smoking prevalence, has worked quite effectively. The problem that has emerged is a supply-chain/enforcement/retail-regulation failure, not a health-policy failure, and the AIHW and ABS data don't support treating them as the same problem.

Treating a border-security and retail-regulation problem as if the fix is a single number on a tax schedule is exactly the kind of siloed policymaking that AHCRA warns against and populist political advocates use.

What's actually needed is a “Health in All Policies” approach. That means customs, retail licensing, criminal enforcement, health promotion and taxation working as a coordinated strategy, each part doing the job it's good at, instead of suggesting the excise will solve a problem it didn't create and dismantling a ground-breaking public health success in the process.

The $200 million enforcement surge and $60 million awareness campaign in the Coalition's package are policy moves worth having on their own merits. Bolting an 80 per cent tax cut onto them isn't positive as a health policy, it's a bet that the fastest way to beat the black market is to make legal ci******es cheap enough that the market stops worrying. And it’s a bet against better health and wellbeing that twenty-five years of falling smoking rates say would be a bad move.

AHCRA calls for to***co control policy to be developed jointly across health, customs, law enforcement and retail regulation portfolios, not through a focus on excise settings alone.

A future Coalition government would slash the to***co excise by 80 per cent, legalise and tax vapes and ni****ne pouches, and bolster law enforcement to shut down the illicit trade.

31/08/2026

New national AI roadmap released.

The Australian Alliance for Artificial Intelligence in Healthcare (AAAiH) has launched its Third National Policy Roadmap for Healthcare AI, "Don't Walk. Run."

The Roadmap sets out 28 recommendations across eight priority areas, drawn from submissions by more than 90 member organisations and tested against 20 focus groups and interviews with state and federal officials over nearly a year of development. (22 Jul)https://aihealthalliance.org/wp-content/uploads/2026/07/AAAiH_3rdNationalPolicyRoadmap_FINAL.pdf

Paramedics absent from the text.
The Roadmap discusses AI professional guidance for general practitioners, radiologists, physiotherapists and nurses by name. It does not mention paramedics or ambulance services despite their role in healthcare.

That's an oversight given the extent of AI support being developed for dispatch triage algorithms, secondary triage, automated ECG interpretation and deterioration-prediction decision support that are already in use across Australian ambulance services.

Automation bias risk flagged.
A related piece in MJA InSight+ this month warned that over-reliance on AI risks "automation bias" — clinicians accepting unsafe AI outputs — and a deskilling effect on core diagnostic reasoning, "particularly for students and trainees who have not yet fully developed these core competencies."

AHCRA notes that risk is highest for any clinical workforce making high-stakes calls without on-site senior backup, which fits paramedics working solo at the roadside as much as any other frontline clinician. (Aug 2026) https://insightplus.mja.com.au/2026/31/when-your-patient-arrives-with-an-ai-self-diagnosis

System "unprepared," Croakey warns.
Croakey Health Media's assessment of the Roadmap was blunt: Australia's healthcare system is unprepared for AI disruption. AHCRA's position is that national AI governance needs to name every clinical workforce it intends to cover, including paramedicine, rather than leaving gaps for individual sectors to fill in after the fact. (22 Jul) https://www.croakey.org/australian-healthcare-system-is-unprepared-for-ai-disruption-new-report/

AHCRA will be watching how the Roadmap's recommendations are implemented as the role of AI is further developed across health.

The Australian healthcare system is unprepared to maximise the opportunities and manage the risks of artificial intelligence (AI), according to a new report putting forward dozens of recommendations for change.

13/08/2026

A public health crisis with global ripples

The executive order signed by US President Donald Trump on August 10, 2026, marks a significant and deeply concerning shift in American childhood vaccination policy. By slashing the number of routinely recommended vaccines from 18 to 11, calling for the separation of the combined MMR vaccine, and encouraging states to relax school-entry requirements, the order undermines decades of established scientific evidence and public health practice. https://theconversation.com/why-trumps-mmr-vaccine-order-is-the-latest-public-health-disaster-with-effects-set-to-last-years-289479?utm_source=twitter&utm_medium=bylinetwitterbutton

While the order does not ban vaccines, it lends credibility to scientifically unfounded notions of vaccine risk, including the debunked link to autism. Public health experts, including the World Health Organisation, have voiced alarm, warning that such changes could lead to delays in vaccination, reduce overall coverage, and trigger outbreaks of preventable diseases like measles, which is already on the rise in the US and globally.

The potential for damage extends far beyond America's borders, threatening global health security through the disruption of international aid and the weakening of key health institutions.

Ramifications for Australia
For Australia, the consequences of this order are both direct and indirect:

One impact is potential increased exposure to infectious diseases. As a nation heavily reliant on international travel, Australia is directly exposed to global disease outbreaks. The resurgence of measles in the US and other regions creates a higher risk of imported cases, a threat Australia is already grappling with as 2026 cases have surpassed those of the same period in 2025. A less vaccinated global population increases the probability of travellers introducing the virus, putting pressure on Australia's own vaccination coverage, which is already slipping below the 95% herd immunity threshold.

Another impact is weakening of health and medicine supply chains. Australia has long relied on US health institutions like the FDA and NIH for drug approvals and biomedical research. The hollowing out of these agencies threatens the pipeline for new medicines and could disrupt access to vital therapies. Furthermore, the Trump administration's "most favoured nation" pricing policies and 100% tariffs on pharmaceuticals directly target Australia's Pharmaceutical Benefits Scheme (PBS), placing pressure on affordability and availability of medicines. This creates significant uncertainty for the Australian health system's ability to provide equitable access to essential drugs.

A third issues is erosion of the global health framework. The US withdrawal from the World Health Organisation and the disruption of its foreign aid programs will cripple global efforts to control diseases like HIV, tuberculosis, and malaria. The breakdown of the international health surveillance and response network, which has been a cornerstone for protecting Australia from emerging global health threats, leaves Australia more vulnerable and potentially forces a more costly, independent response in the future.

Trump’s latest executive order is set to lead to delayed vaccinations, falling coverage and a resurgence of diseases once brought under control.

12/08/2026

The Fauci case: Science, Politics and Accountability

Writing in Pearls and Irritations, Professor John Dwyer offers a personal and professional defence of Dr. Anthony Fauci, reflecting on their decades-long acquaintance and Fauci's contributions to HIV/AIDS and COVID-19 research.
https://pearlsandirritations.com/post/2026/08/vindictiveness-is-fuelling-the-fauci-fiasco/

Dwyer addresses recent political attacks on Fauci regarding mask guidance, gain-of-function research funding, and rejected treatments, framing them as politically motivated rather than genuine accountability.

While Dwyer argues strongly for Fauci's integrity and scientific track record, the piece also raises broader questions about the balance between supporting scientific researchers and ensuring transparent oversight.

The letter responses to the article highlight differing views—some readers endorse Dwyer's assessment, while others argue that Fauci still has questions to answer, particularly around pandemic origins and decision-making processes.

The article and its responses underscore ongoing tensions between the need to back scientific expertise and the imperative for evidence-based, accountable public health governance, free from ideological or personal agendas.

The attacks on Tony Fauci over COVID-19 advice, masks, gain-of-function research and rejected treatments are vindictive politics dressed up as accountability.

10/08/2026

Healthy Starts - the first 2000 days explored

A new report from the Centre for Policy Development (CPD), Healthy Starts, maps what actually happens to families from pregnancy confirmation through to a child's fifth birthday — and finds a child and family health system that is nominally universal but functionally a postcode lottery. https://cpd.org.au/work/healthy-starts/

AHCRA's stated position is that the health system needs to be built on a social determinants of health perspective, and that inequalities in those determinants, not just direct access to care, drive inequalities in health outcomes. Healthy Starts maps onto that almost point for point.

Ten systemic barriers are identified: patchy access and workforce shortages, out-of-pocket costs that delay first contact, inconsistent cultural safety, rigid "eligible or not" service design, fragmented digital records, and — perhaps most tellingly — no national oversight body holding any of it to a consistent standard.

Compare that to maternity care, which has strong national clinical guidelines tied to funding and hospital accreditation. Child and Family Health services have eleven different guideline documents and none of that authority.

What makes this report worth reading is how squarely it lands on the case AHCRA has been making for years: that health outcomes are shaped far more by the social determinants — housing, income, transport, cultural safety, parental mental health — than by clinical care alone, and that no single sector can fix that on its own.

Healthy Starts finds those determinants are "rarely considered in service design, eligibility criteria or care pathways," and that there's no whole-of-government mechanism bringing health, education, disability and family services together around shared outcomes for this age group. That's a textbook Health in All Policies (HiAP) gap — the kind of siloed, sector-by-sector blindness a commitment to HiAP exists to correct.

It's also a sustainability question, not just an equity one. Early underfunded prevention shows up later as avoidable acute healthcare, justice system contact and income support costs. CPD's own Avoidable Costs work and the Front Project's Cost of Late Intervention report both make this case. A system built on progressive universalism — universal in reach, flexible in intensity by need — isn't just fairer, it's the more fiscally sustainable design over the life course.

The stakes are real: children in the most disadvantaged communities are developmentally on track at less than half the rate of those in the least disadvantaged (41.2% vs 61.1%), and around half of children identified as developmentally vulnerable never catch up.

Worth the read for anyone working across health and early years or social policy. CPD's recommendations report is still to come, but the mapping here is a solid, evidence-based foundation.

Healthy Starts is a report from the Centre for Policy Development that maps the experiences of families accessing health services across the first 2000 days, from pregnancy to age 5.

31/07/2026

Closing the Gap 2026

The Productivity Commission's 2026 Closing the Gap Annual Data Compilation Report records one national target met, several improving, and four deteriorating: childhood development, out-of-home care, adult imprisonment and su***de.https://assets.pc.gov.au/2026-07/closing-the-gap-annual-data-compilation-july-2026.pdf

Preschool enrolment for Aboriginal and Torres Strait Islander children passed the 95 per cent benchmark nationally in 2025 — the first target formally achieved since the National Agreement was signed. The Commission called it evidence that sustained investment in early childhood education delivers results.

Developmental outcomes tell a different story. Only 33.9 per cent of Aboriginal and Torres Strait Islander children starting school in 2024 were assessed as developmentally on track across all five Australian Early Development Census domains, down from 35.2 per cent in 2018. The target is 55 per cent by 2031. In very remote areas, the figure drops to 16.5 per cent.

The su***de rate rose from 23.6 deaths per 100,000 in 2018 to 33.9 per 100,000 in 2024 — 298 deaths across reporting jurisdictions, up from 196. The Commission found this target not on track.

Adult imprisonment reached 2,500.2 per 100,000 in 2025, well above the 2019 baseline. Children in out-of-home care reached 52.2 per 1,000 in 2025. Both targets are moving away from, not toward, their goals.

Employment (55.7 per cent for those aged 25–64 in 2021) and appropriately sized housing (81.4 per cent in 2021) are improving, though housing remains off track. Life expectancy is narrowing against historical baselines — 71.9 years for males and 75.6 for females born 2020–22 — but too slowly to close the gap by 2031.

Commissioner Selwyn Button pointed to the four Priority Reforms — shared decision-making, the community-controlled sector, government transformation, and shared data access — as the mechanism through which progress happens, not a side issue to outcomes.

Central Australian Aboriginal Congress Chair Paul Ah Chee and Chief Medical Officer Dr John Boffa cited their own region's results as proof that community-controlled primary health care changes outcomes when governments back it with sustained investment.

21/07/2026

Record Profits for Insurers, Closed Wards for Patients. This Isn't Working.

Canberra Private Hospital is the latest casualty in a string of hospital closures across the country. It's a devastating trend with more than 80 lost in the last five years. Patients are losing access to care, and healthcare professionals are bearing the brunt of the human and financial costs.

National operator Nexus Hospitals has said it would close the financially struggling hospital at the Equinox Business Park in September. https://tinyurl.com/3nv7tx2f

For more than two years, the Federal Government has hosted "talkfests" about the viability crisis. Eighteen months ago, they promised "immediate solutions" for mental health, maternity, and regional services. That deadline lapsed a year ago. Fifteen months ago, the Health Minister publicly rebuked insurers for their record profits and demanded they pay hospitals fairly. Yet, we are still waiting for action.

The Australian Private Hospitals Association (APHA) would not comment directly on the Canberra Private Hospital’s situation but said it had been raising issues about the viability of private hospitals for several years. CEO Brett Heffernan warned that more hospitals would close and blamed the sector’s troubles on health insurers not passing on the premium increases they’d been getting every year to healthcare providers.

According to CEO Heffernan, the figures tell a story:
- Insurers are making record after-tax profits of over $2 Billion a year. (2024-25)
- They are spending $3.4 Billion on "management expenses."
- Meanwhile, they are short-changing private hospitals for the care they provide.

The payout ratio is highly variable while the government’s own expectation is 90%. Insurers are pocketing premium hikes while hospitals close and services are cut. https://tinyurl.com/2v7sdsn3
This isn't a complex problem—it is a market failure that requires leadership and the APHA says it is time for the Government to act.

They are seeking:
- Restore the benefits ratio to 90% immediately.
- A mandatory Code of Conduct for contracting between insurers and hospitals.
- Price transparency with the ACCC as the independent umpire.
The government has a key role by awarding premium increases but also provides a Private Health Insurance Rebate which is a major healthcare expenditure item. As the government considers solutions to the private hospital crisis, it may need to balance the cost of these rebates against the need to bail out the hospital sector or impose stricter conditions on insurers.

When Medibank Private was still government-owned, its benefit payout ratio figures available from the 2000s showed a decline from 91.5% in 2003-04 to 88.4% in 2004-05. By comparison, recent data shows Medibank's current payout ratio is around 82.9%. https://tinyurl.com/ys36u2wt

The government is proposing to modernise the rebate to remove the higher rates for older Australians, stating this would make the subsidy more equitable. Given past experience the government operated Medibank was more effective than the private insurers.

APHA is calling for action to bring the health insurance industry into line. If insurers think their tactics are fair, they should have nothing to hide from an independent umpire.

Read the APHA article: https://tinyurl.com/4wzmhdkh

What do you think? Should the government force insurers to pay their fair share?

06/07/2026

Australia's health system: universal access, but is access equitable?

A recent article in theTimes.com.au examines the pressures facing Australia's health system: Medicare and bulk billing, hospital waiting lists, the PBS, the dental care gap, and the divide between Commonwealth and state responsibility. It's a useful overview of where funding and accountability sit, and where the lines blur.

One area not covered, but worth noting within the same picture: ambulance services. In 2024/25 the jurisdictional ambulance services in Australia responded 5.864 million time to 4.266 million patients. That's separate from the private paramedic services at indusrial sites, events,, Search and Rescue, Aeromedical Retrieval and other activities. (ABS Report on Government Services 2026)

It also might surprise some to learn that fewer than half of ambulance service responses are emergency, and that 695,897 patients were treated by service personnel (principally paramedics) and not transported.

Ambulance care in Australia is delivered through a mix of state-operated and contracted private providers, and increasingly extends beyond emergency response into primary and community-based care. Unlike Medicare or the PBS, the cost to patients for this care varies by jurisdiction, with no consistent national approach.

This is a clear example of the fragmentation the article describes, where responsibility is divided between levels of government and patients are left uncertain about who is accountable for what. Ambulance services are funded through a mixture of government funding, transport fees and 'other' income. South Australians and Western Australians are clearly disadvanteged by having the highest transport fees per capita.

AHCRA's view is that as ambulance services take on a broader role in primary and community healthcare, there is a stronger case for the Commonwealth to support state funding in this area, to help ensure more consistent and equitable access to care regardless of jurisdiction.

Read the full Times article: https://thetimes.com.au/world/51276-australias-health-system-billions-spent-but-are-patients-better-off

30/06/2026

Specialist Fees and Medicare

Australians are told we have universal health care, yet seeing a medical specialist is becoming increasingly unaffordable for many. https://pearlsandirritations.com/post/2026/06/medicare-needs-substantial-reform-not-more-and-more-band-aids/

Specialist fees have been rising far faster than Medicare rebates, leaving patients with growing out-of-pocket costs. For those who can't afford private treatment, the alternative is often a place on a public waiting list—sometimes for years.

This isn't just about individual doctors' fees. It's about how we fund specialist care, regulate pricing, and ensure equitable access to treatment.

The Minister for Health, Mark Butler, has acknowledged that specialist fees are "getting out of control." The question is whether meaningful reform will follow.

This thoughtful article examines why specialist fees have escalated, the impact on patients and the health system, and the policy changes needed to restore affordability and fairness.

What do you think? Should governments have a stronger role in regulating specialist fees where Medicare and public funding are involved?

Medical specialist fees have been rising far beyond Medicare support, leaving patients with heavy out-of-pocket costs, long public waiting lists and a health system that needs stronger public controls.

22/06/2026

Understanding sugar-sweetened beverage tax implementation

An international perspective that shows Australia lags behind many nations.

From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%).

Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Details here: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00093-8/fulltext