Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697633010048.pdf (Australia)
Senate Community Affairs Committee Inquiry into NATIONAL HOSPITALS AND HEALTH NETWORK BILL 2010 BY AUSTRALIAN SELF-MEDICATION INDUSTRY JULY 2010 Table of contents EXECUTIVE SUMMARY INTRODUCTION THE RECENT HEALTH REFORMS ASMI VIEWS ON THE REFORMS SELF-CARE THE ACSQHC CONCLUSIONS ii 1 1 1 1 2 3 i EXECUTIVE SUMMARY ASMI’s position  This submission is made by Australian Self-Medication Industry (ASMI), which represents the interests of the Australian non-prescription medicines industry.
 ASMI recommends that the Committee support passage of the Bill.

The legislation  The legislation under consideration by the Committee does not deal directly with the title of the Bill –the National Health and Hospitals Network.

 Rather it relates to one aspect of the COAG Agreement of April 2010 –the Australian Commission on Safety and Quality in Health Care.

 The Bill sets up the present ACSQHC as a statutory Commission.
Health reforms  ASMI supports the general direction of the Government’s health and hospital reforms.

We are keen, however, to see further significant reforms in encouraging people to take responsibility for their own health.

Self Care  The Self Care proposal, which ASMI has advocated for some time, will help achieve that objective - - through the encourage of responsible self-medication in treating minor ailments; and thus relieving the pressure on GPs and other senior professionals.
ACSQHC  Regarding the ACSQHC, ASMI supports its work, particularly in relation o promoting the Quality Use of Medicines.

Non-prescription medicines are generally safe if taken in accordance with the dose directions.

Public education encouraging people to do that has ASMI’s support.

Australian Self-Medication Industry ii INTRODUCTION The Australian Self-Medication Industry (ASMI) represents the interests of the sponsors of non-prescription medicines.

It is an industry with turnover of about $3bn/yr.


Further information about ASMI can be provided if the Committee wishes.

THE RECENT HEALTH REFORMS The legislation under reference comes to the Parliament as a consequence of the Government’s hospitals and health reforms.

The intention of these is set out in the COAG agreement of 21 April 2010.
This Bill gives effect to one element of the agreement –the establishment of the already operating Australian Commission on Safety and Quality in Health Care (ACSQHC), as a statutory corporation.

The Bill does not deal with what its title suggests is its subject-matter –the National Health and Hospitals Network.

ASMI understands that details of these arrangements will largely be matters for the States, and are still to be worked out.
ASMI VIEWS ON THE REFORMS ASMI has supported the Government’s initiatives to review the health system.

We made our views known to the various enquiries.

proposals about Self Care –see below.

In particular, we put our It is understood that the areas for initial action have related to the public hospitals system and financial issues that arise from that.
However, ASMI is very keen to see significant reform to encourage people to take more responsibility for their own wellness and, when illness confronts, their responsible self-medication.

We look forward to working with other players in the health industries and professions as the ideas advanced in the reform reports are put into effect.

SELF-CARE ASMI has developed and espoused the “Self-Care” approach over the past several years.

A copy of our position paper is at Attachment 1.


In brief, we see scope for significant cost savings, and more effective use of scarce health professional resources by people taking more, and more direct, responsibility for their own health.

Australian Self-Medication Industry 1 Our studies show that people often consult their GP when they are suffering only a minor ailment.

Such ailments can almost always be treated with over-the- counter medication.
People can consult their community pharmacist, who can recommend medications, or refer them on for medical attention, as needed.

As well, there are now many medicines –vitamins, minerals and herbals –which people take, or can take, to maintain their wellness.

Glucosamine (for healthy joints) and calcium (for osteoporosis) are just two of many medications the public can access.

The Self Care proposal, as advanced by ASMI, has drawn on experience in the United Kingdom.
There, the reforms have shown remarkable cost savings and better health outcomes.

We have no doubt similar outcomes could be achieved in Australia.

ASMI therefore requests the Committee to note that health reforms are possible, and desirable, in a way that does better than simply putting up more cash to public hospitals.

Accordingly, we ask the Committee to recommend that the alternative approach set out in our Self Care position paper be adopted by the Government.

“pilot” or trial basis.


Initially this could be done on a THE ACSQHC ASMI supports the setting-up of the Commission.

achieve better quality and safety in our health care system.

In our view, there is scope to ASMI has always supported the objectives of Quality Use of Medicines (QUM), as set out in “The National Strategy for Quality Use of Medicines”1.

ASMI will support, and participate in, any work the Commission conducts to enhance QUM.
The present (non-statutory) Commission’s website says this about the Medication Safety Program: “The Australian Commission on Safety and Quality in Health Care has identified medication safety as one of its priorities.

Reducing error and harm from medicines through safe and quality use of medicines is an important element of our work and is helping us to achieve our objective of leading and coordinating national safety and quality improvements in health care.
1 http://www.health.gov.au/internet/main/publishing.nsf/Content/CA777524C860DFF2CA256F1800468B61 /$File/natstrateng.pdf Australian Self-Medication Industry 2 The Medication Safety Program aims to improve the safety of medication usage in Australia.
Effective and safe use of medication is an area of great potential improvement in the safety and quality of health care.” Non-prescription, or over-the-counter medicines have market authorisation which does not need a prescription, precisely because they are recognised as safe.

Safe, that is, if they are responsibly used and as directed by the label.

Likewise, most non-prescription medicines may be advertised to enable the public to be kept informed of their options.
ASMI will be very happy to work with the ACSQHC to further ensure that Australian self-medication products remain safe and effective.

CONCLUSIONS It is recommended that the Committee support passage of the legislation.

Australian Self-Medication Industry 3 Attachment 1 Self Care in Australia A roadmap toward greater personal responsibility in managing health March 2009.
Prepared by the Australian Self-Medication Industry Australian Self-Medication Industry Self Care in Australia A roadmap toward greater personal responsibility in managing health March 2009.

Prepared by the Australian Self-Medication Industry.

Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.

What is Self Care?
What is Self Care?

Self Care describes the activities undertaken by individuals and the wider community in order to improve health, prevent disease and manage illness.

It encompasses a broad spectrum of activities and decisions that people make for themselves so that they maintain a good level of physical and mental health.

This can include physical exercise and sound nutrition in order to maintain good health and prevent disease, as well as using self- health after discharge from hospital.
Self Care may be used by an individual, for instance to treat a mild headache, or may be used in collaboration with a healthcare professional.

In that sense, Self Care may encompass a partnership between the individual and a healthcare professional such as a doctor, pharmacist, naturopath or physiotherapist.

Self Care embraces both curative and preventative health.
Treatments may involve Western mainstream medicine, complementary and alternative remedies, or, as is increasingly the case, some combination of these.

The World Health Organization (WHO) provides the following definition of Self Care: Self Care refers to activities individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness and restoring health.
These activities are derived from knowledge and skills from the pool of both professional and lay experience.

They are undertaken by lay people on their own behalf either separately or in participative collaboration with professionals.

Seeking professional advice in Self Care is part of the continuum of trying to maintain good health and prevent disease.
The notion of Self Care has gained wider acceptance in health systems in several countries and is recognised in a number of recent official Australian health publications1.

1Towards a National Primary Health Care Strategy: A Discussion Paper from the Australian Government, Commonwealth of Australia 2008.

March 2009 Page 2 Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.

Why the interest in Self Care?


The take-up of Self Care coincides with a growing interest in personal health and wellbeing, increased access to a wide range of health information, and government funded public health promotions that have targeted smoking, obesity and consumption of alcohol.

It also comes at a time when Australia faces a growing rate of chronic conditions such as cardiovascular disease and diabetes, often associated with excessive weight and obesity.
In the 15 years to 2004-05, the prevalence of diabetes more than doubled and chronic diseases in Australia caused 9 out of every 10 deaths2.

The idea that individuals should take greater responsibility for their health also fits with a growing trend of consumer empowerment, aided by increased availability of information, remedies and medicines that can improve and prolong quality of life.
Government health budgets simply cannot be sustained at current levels without significant increases in taxation to fund mounting health bills.

The second Intergenerational Report predicts that expenditure on health by the Australian Government will, with no change in approach, almost double from 3.8% of GDP in 2006-07 to 7.3% in 2046-473.
All this means that there needs to be fundamental change to entrench a powerful preventative health culture in the community, including the role of Self Care for those who are able to take greater responsibility for personal health.
Benefits of Self Care There is growing evidence to support the notion that promoting Self Care leads to a number of benefits for individuals, the community and government through: improved general health and quality of life; prevention of disease; improved management and control of existing conditions; increased productive life of the individual; increased patient satisfaction; more appropriate use of GP and hospital services; and reduced resource burden on government health and welfare services.
2Nicola Roxon MP, The Case for Change, Speech to the National Press Club, Canberra 13 August 2008.

3Intergenerational Report 2007, Commonwealth of Australia, April 2007 March 2009 Page 3 Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.
Already, many Australians engage in some form of Self Care; sustaining a physically active, health conscious regime to maintain or restore good health; or using non-prescription medicines, nutritional supplements or treatments to address minor ailments and chronic conditions.

Even though they may be willing to embrace Self Care, most consumers will still seek the support and expertise of a general practitioner (GP), pharmacist, naturopath or other healthcare practitioner.
This idea of collaboration between the individual and healthcare professional is pivotal to effective Self Care.

On the one hand it involves equipping consumers with the choices, skills and tools necessary to make their own healthcare decisions.

On the other, it means giving industry and training and support necessary to assist all Australians healthcare providers the tools, appropriately.
Self Care internationally a health-conscious lifestyle, take precautionary health measures in good time, and actively participate in treatment and rehabilitation in order to prevent the onset of illness and disability Perhaps the most extensive manifestation of Self Care has occurred in the United Kingdom, healthcare including the prevention and care of illness, symptom relief and chronic illness.

It is strongly supported by the UK government.


In 2004, the UK Department of Health issued the report, Self Care for the future and committing to increase the availability of medicines over-the-counter.

A Real Choice, outlining a plan In many countries, the impact of ageing population, chronic preventable diseases and ballooning health budgets means that individuals are being given the tools and incentives to take greater responsibility for personal health.
The major stakeholders in Self Care Fundamental to the success of Self Care is the formation of strong partnerships between stakeholders.

Self Care does not mean consumers are left on their own; nor does it translate into "no care".
It requires informed consumers, the expertise of pharmacists, GPs and other practitioners, provision by the healthcare industry of evidence based-products and remedies, the creation by government of a regulatory environment conducive to Self Care, and innovative approaches from private health insurers.

March 2009 Page 4 Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.
Consumers Consumers, at large, cannot simply be expected to take on greater responsibility for personal health and wellbeing without guidance and leadership.

This means greater encouragement and support, as well as the essential knowledge, skills and tools to undertake the task.

A lack of information and knowledge can be a barrier to Self Care.
Health literacy is a critical element, not only in enabling people to make the correct health decisions, but in reducing inequalities in health outcomes, particularly in remote and indigenous communities.

For many consumers, the GP is the first point of call, yet not all ailments need the attention of a GP.

Recent research has outlined the significant impact that minor ailments impose on GP workload.
The study found that 15% of all GP consultations in Australia involve the treatment of minor ailments, and 7% involve the treatment of minor ailments alone4.

When projected nationally, the study indicates a total of 25 million GP consultations annually, or approximately 96,000 consultations per day involve the treatment of a minor ailment.

Also, approximately 59% of minor ailments resulted in a prescription, suggesting almost 15 million prescriptions being provided for minor ailments.
It raises the need to examine alternatives to GP consultations for minor ailments and other conditions that can be more appropriately managed once diagnosed.

Government A major responsibility of government is to create a policy environment in which Self Care forms an integral part of a national health policy and where all stakeholders work to develop strategies to give effect to these policies.

This should include emphasis on, and investment in, health promotion and disease prevention.
Authorities responsible for the availability of medicines, such as the Therapeutic Goods Administration in Australia, need to encourage an environment that supports access to evidence- based non-prescription medicines and complementary and alternative medicines.
There is a case for wider access to prescription medicines with an extended, safe record of use by switching these to non-prescription status, particularly those targeting the treatment and prevention of preventable conditions identified in the National Health Priority areas.

Improved partnerships between government and other stakeholders, including industry, have the capacity to generate positive outcomes through sharing of resources, personnel and data.
4Minor ailment workload in general practice, IMS Australia and New Zealand, November 2008 March 2009 Page 5 Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.

Healthcare professionals The move towards greater Self Care will necessitate a cultural change in the relationships between healthcare professionals and patients and between the different healthcare professions - GPs and pharmacists in particular - towards sharing clinical management of patients.
GPs will remain the first option for many with more serious ailments but many minor ailments do respond to effective Self Care in consultation with a pharmacist, natural healthcare provider or treatment by a nurse practitioner.

If professionals are to play an active role in Self Care, new policies are needed to define these roles.
Skills training is critical because Self Care involves a cultural shift from professionals being the principal providers of care (and patients as passive recipients) towards more emphasis on shared care, preventive care, healthy lifestyle and patient involvement in their own care of minor, acute and long-term conditions.

Self Care opens up the choice of a range of health professionals as consumers exercise choice based on enhanced knowledge and empowerment.
This includes GPs, pharmacists, naturopaths, nurses, psychologists, physiotherapists and dieticians, among others.

Healthcare Industry timely access to medicines that are affordable and meet appropriate standards of quality, safety and efficacy.

The National Medicines Policy and any new policies underpinning Self Care will help define Industry will be required to continue to provide timely access to medicines that are safe, efficacious and of a high quality at affordable prices.
The expansion of Self Care will increase the demand for a broader range of solutions - demand that should be met through product innovation and wider access to safe, effective treatments.

The healthcare industry will need to work with healthcare professionals, relevant professional bodies and patient groups to ensure consistency of message and information.

As patients become more involved in the management of their conditions, there will be a need for new and different types of consumer information.
Responsible advertising and communication will be central to the goal of raising disease awareness and encouraging self-management.

Training for health professionals will become a significantly bigger issue for industry.

Product- specific treatment guidelines will need to be proactively developed in cooperation with the professional bodies for use by pharmacists and other healthcare professionals as well as by consumers.
The wider industry will also be required to demonstrate that consumers have the necessary information and access to advice to ensure that products can be used appropriately without close medical supervision.

March 2009 Page 6 Self Care in Australia: A roadmap toward greater personal responsibility in managing national health.
Private health insurers The private health insurance industry has a key role to play in helping to develop a system architecture that contains the right mix of incentives to alter behaviour in favour of Self Care.

Already there are a range of payments and rewards available in Australia for people who avoid certain risk-taking behaviour such as quitting smoking, and who make positive lifestyle changes.
More evidence is emerging that simple and cheaper prevention strategies can be at least as cost- efficient as more expensive interventions, for example the use of Calcium and Vitamin D in the prevention of fractures in osteoporosis.

As healthcare costs escalate, there must, of necessity, be an increased focus on innovative ways of encouraging individuals and families to adopt healthy alternatives in order to prevent longer term, costly and often traumatic medical interventions.
Self Care a pathway to improved national health an ageing population, policy makers seek solutions that are affordable, practical and will have lasting impact.

One thing is clear; the current system design is not financially sustainable.
Self Care has the capacity, based on its spread elsewhere, to form part of a broad sweep of reforms that can ease the pressures falling on GPs, hospitals and government resources, at the same time providing better health, enhanced wellbeing and greater satisfaction for all Australians.
About ASMI The Australian Self-Medication Industry (ASMI) is the peak industry body for the Australian Self Care industry representing consumer healthcare products including over-the-counter medicines and complementary medicines.

This means ensuring that safe and effective Self Care products are readily available to all Australians at a reasonable cost.
ASMI works to encourage responsible use by consumers and an increasing role for cost-effective self-medication products as part of the broad national health strategy.

www.asmi.com.au March 2009 Page 7