Author: MIL-OSI Publisher

Source: Public Service Association Te Pūkenga Here Tikanga Mahi

Analysis shows pay equity settlements over four years would have:

• Created 13,000 jobs
• Grown GDP by $13.5 billion or 0.6%
• Increased tax revenue by $5 billion

Fresh analysis by the PSA of Treasury’s own modelling shows the Government’s decision to cancel pay equity claims under urgency in May 2025 was an economic own goal, one that has cost the country billions of dollars in lost growth, lost jobs and lost tax revenue.

The analysis, based on Treasury’s own MATAI macro-economic model, shows that reinstating pay equity would grow the economy by $13.5 billion over four years and create around 13,000 jobs. It would also generate an extra $5 billion in tax revenue, reducing the net fiscal cost of pay equity to $6 billion over four years, or $1.5 billion a year.

“Low paid women workers have paid the price for a decision that was all about making the Budget numbers work, without a considered assessment of the economic upside from the significant income boost that would flow from pay equity settlements,” said Fleur Fitzsimons, National Secretary for the Public Service Association Te Pūkenga Here Tikanga Mahi.

“Our analysis shows the Government had a genuine opportunity to grow the economy, create jobs and boost tax revenue by continuing with pay equity settlements, and it walked away from it.

“This was short sighted economic management, plain and simple, depriving over 150,000 women of the pay rise they need and deserved.”

Treasury’s own figures show pay equity delivers a return of $2.25 for every dollar of net government spending, a stronger return than other major Budget initiatives.

The 0.6% increase in GDP from pay equity outperforms other less effective Government growth policies. By comparison, Treasury modelling shows the Government’s Investment Boost policy generates just $6.4 billion in GDP growth (0.3%) from a $4 billion net spend; a return of just $1.6 for every dollar spent.

“Pay equity isn’t just the right thing to do for women who have been underpaid for years, it’s also better value for the taxpayer than some of the Government’s own flagship policies,” Fitzsimons said.

“The actions of the Government in cancelling pay equity claims and gutting the Equal Pay Act 1972 were an act of constitutional vandalism and wage theft which must be overcome. We will leave no stone unturned until New Zealand women receive pay equity starting with care and support workers many of whom are now back on the minimum wage.

“We need to see clear commitments from opposition parties to pay equity which means and properly accounting for it in their fiscal plans and fixing the Equal Pay Act 1972.

“Low- and middle-income workers spend the money they earn in their local communities. That spending supports local businesses and creates local jobs. This Government keeps choosing policies that don’t deliver anywhere near the same bang for buck, simply because it prioritised tax cuts for landlords over our nation’s working women.”

With unemployment rising to a decade high and the economy struggling, the analysis is a reminder of the cost of the Government’s decision.

“The Government says growing the economy is its top priority, but it turned down a $2.25 return on every dollar. That’s not economic management; it’s an own goal.”

The Public Service Association Te Pūkenga Here Tikanga Mahi is Aotearoa New Zealand's largest trade union, representing and supporting more than 95,000 workers across central government, state-owned enterprises, local councils, health boards and community groups.

Source: Amnesty International

21 August 2026

Responding to the convictions of activists who organized Tiananmen vigils in Hong Kong, Amnesty International Hong Kong Overseas spokesperson Fernando Cheung said:

“This dismaying verdict underlines how Hong Kong’s National Security Law is being used to punish people for peacefully remembering one of the darkest chapters in recent Chinese history.

“For decades, Hong Kong was the only place on Chinese soil where large-scale public remembrance of the Tiananmen crackdown could take place. Today’s decision marks another grim milestone in the government’s deliberate campaign to erase that legacy and silence those who seek truth, justice and accountability.

Amnesty International’s Deputy Regional Director Sarah Brooks said:

“Chow Hang-tung and Lee Cheuk-yan have not committed any recognizable crime; they have been convicted solely for their role in organizing peaceful commemorations of the people killed by the Chinese authorities on 4 June 1989.

“The Hong Kong authorities should quash these convictions and end the ongoing persecution of people seeking to keep the memory of Tiananmen alive.

“Chow Hang-tung and Lee Cheuk-yan are prisoners of conscience who should never have been prosecuted in the first place. They must be released immediately and unconditionally.”

Background

Hong Kong’s High Court today convicted Tiananmen activists Chow Hang-tung and Lee Cheuk-yan of “inciting subversion of state power” under the city’s National Security Law. Chow and Lee, along with Albert Ho Chun-yan, who previously pleaded guilty to the same charge, will be sentenced at a later date and face up to 10 years’ imprisonment.

Chow and Lee were among seven members of the Hong Kong Alliance in Support of Patriotic Democratic Movements of China (Hong Kong Alliance) charged with different offences under the Beijing-imposed law in September 2021. Both have been held in pre-trial detention ever since, having been repeatedly denied bail. They have been designated prisoners of conscience by Amnesty International.

Amnesty International has repeatedly raised concerns that the National Security Law, enacted in June 2020, is being used to target civil society groups, journalists, political activists and academics for actions that are fully protected under international human rights law.

The Tiananmen vigils commemorated the events of 4 June 1989, when Chinese troops opened fire on students and workers who had been peacefully protesting for political reforms in and around Beijing’s Tiananmen Square. Hundreds – possibly thousands – of people were killed. Tens of thousands more were arrested across China in the suppression that followed.

In the 37 years since the crackdown, all discussion of the incident has been heavily censored in China, and authorities have effectively erased it from their version of history.

From the beginning, commemorating the Tiananmen crackdown was forbidden in mainland China. But in Hong Kong, crowds reaching hundreds of thousands of people would gather annually in centrally located Victoria Park to peacefully remember those killed. The vigil participants regularly called on the Chinese authorities to reveal the truth about what happened and accept accountability for the atrocity; for thirty years, local government did not, in practice, interfere or object.

The last major vigil organized by the Hong Kong Alliance was held in 2019. The Hong Kong vigil was banned in 2020 and 2021, ostensibly on COVID-19 grounds. Since then, the National Security Law has effectively criminalized peaceful protest in the city – including Tiananmen commemorations.

Source: FreshChoice

21 August 2026

The magic is far from over at FreshChoice. To keep the excitement going and help Kiwis finish their collections, FreshChoice is excited to share that our stores still have Disney OOSHIES™ in stock.

To help collectors of all ages track down those final elusive characters and complete their 40-figure sets, selected FreshChoice stores are running a Double OOSHIES™ giveaway from today, Friday, 21 August to Sunday, 23 August.

Since launching on 13 July, the 10th anniversary Disney OOSHIES™ featuring beloved characters from Disney, Pixar, Marvel, and Star Wars, has swept across Aotearoa, bringing excitement to millions of people nationwide.

To mark the final stretch of the campaign, there is also one last surprise for Kiwi collectors. From 24 to 30 August, 100 rare Platinum Buzz Lightyear OOSHIES™ will be up for grabs at FreshChoice. Everyday Rewards members who Boost the offer in the app and spend $30 or more in an eligible transaction at FreshChoice will automatically enter the draw to win one of these limited-edition figures.

Tim Cartwright, Executive General Manager FreshChoice, says the response to the Disney OOSHIES™ programme has been outstanding.

“The enthusiasm from our customers has been incredible. As our second collectible campaign since joining Everyday Rewards last year, it’s been fantastic to see the excitement it brings to families shopping at their local FreshChoice store,” says Cartwright.

“The OOSHIES™ magic continues in full force at FreshChoice. Having stock still available in our stores and hosting a double giveaway weekend at select locations is a fun way to bring local communities together and help collectors complete their 40-figure sets.”

About the Campaign

FreshChoice customers receive one Disney OOSHIE™ for every $30 spent in-store or online, while stocks last.

Stock is currently available at FreshChoice stores nationwide (except FreshChoice Queenstown). The Double OOSHIES™ offer (2 x OOSHIES™ for every $30 spent in-store or online) is available at the following participating stores, while stock lasts: Hauraki Corner, Greerton, Geraldine, Barrington, Roslyn, Oxford, Otautau, Mandeville, Leeston, Merivale, Lake Hawea, Sumner, Renwick, Prebbleton, Leamington, Te Awamutu, Otahuhu, and Waiuku.

The 2026 lineup celebrates 10 years of OOSHIES™ with 40 unique characters, including fan favorites from Disney’s Moana, Disney and Pixar’s Toy Story 5, Spider-Man: Brand New Day, and Star Wars: The Mandalorian and Grogu.

Made from 97% recycled materials, we encourage customers to drop off any unwanted OOSHIES™ into dedicated in-store recycling bins.

For more information, including store locations and terms and conditions, visit FreshChoice Disney OOSHIES.

About FreshChoice

FreshChoice is a leading supermarket brand in New Zealand, dedicated to providing fresh, high-quality products tailored to the needs of local communities, and actively supporting those in the community. Focusing on supporting local suppliers and employing local residents, FreshChoice is committed to enhancing the shopping experience for customers. FreshChoice is currently undertaking a brand expansion with SuperValue stores being converted to FreshChoice.

Source: Civil Aviation Authority of New Zealand

Please save the date for an upcoming webinar on the Civil Aviation Authority's Business Transformation programme.

We'll share more about why we're undertaking Business Transformation, what it could mean for aviation participants, and how we'll work with industry as the programme develops.

The session will be led by CAA Chief Executive Kane Patena, alongside members of the Executive Leadership Team, and there will be an opportunity to ask questions.

Webinar details

Date: Monday 31 August 2026
Time: 11.00am to 12.00pm
Platform: Microsoft Teams Webinar

A formal invitation, including registration details, will be sent next week. In the meantime, please hold the time in your calendar.

Source: Médecins Sans Frontières/Doctors Without Borders (MSF)

21 August

Médecins Sans Frontières/Doctors Without Borders (MSF) strongly condemns the decision by the Israeli Military Advocate General (MAG) to close, without opening a criminal investigation, the cases MSF itself submitted for review: the multiple attacks on an MSF convoy in Gaza City in November 2023 that killed two, and the February 2024 strike on an MSF shelter in Khan Younis that killed two and injured six.

Unfortunately, this does not come as a surprise. These responses come nearly two years after MSF's request was submitted, which was followed by a submission to the Israeli High Court of Justice challenging the MAG's failure to provide any answer to our formal requests.

This is not justice. Two years of silence, followed by closures that raise more questions than they answer, is unacceptable. However, it is the predictable output of a military apparatus investigating itself: a system which has demonstrated itself unwilling to respond to the extent of violations that may amount to war crimes emerging from Gaza.

MSF staff and their family members are dead. Their names are known. Their locations were shared. Their vehicles were identified. We have always maintained that all elements point to a clear responsibility of the Israeli army for the deadly attacks. And yet, those responsible for their deaths have declined to pursue any criminal investigation.

With this decision, the MAG has made clear that there is no prospect of accountability within the Israeli legal system for the killing of our staff, just as there has been no accountability for Israel's ongoing genocide against Palestinians.

A total of 15 MSF staff members have been killed in Gaza by Israeli forces since October 2023. This is just a fraction of the 1,700 healthcare workers who have been killed in that time. Israeli forces continue to kill civilians with impunity, something these decisions by the MAG, make clear.

The decision to 'close' these incidents must be understood in their proper context: in Gaza, tens of thousands of Palestinians have been killed. Healthcare facilities have been destroyed. Humanitarian convoys have been struck. Journalists, medical personnel, UN personnel, and aid workers have been killed in numbers unprecedented in any recent conflict.

MSF reaffirms what it has stated since the beginning of this violence: there is no military objective that justifies the wholesale sacrifice of civilians. And there is no internal military review that can substitute for genuine, independent, and impartial accountability.

We demand that the cases involving our colleagues be reviewed by an impartial investigative body.

To our colleagues we have lost, and to the countless civilians and humanitarian workers who have perished in Gaza: we will not let your deaths be filed away as procedural inevitabilities. You deserved protection. You deserve justice.

MSF is an international, medical, humanitarian organisation that delivers medical care to people in need, regardless of their origin, religion, or political affiliation. MSF Australia was established in 1995 and is one of 24 international MSF sections committed to delivering medical humanitarian assistance to people in crisis. Every year more than 120 Australians and New Zealanders go on assignment with Médecins Sans Frontières working as: doctors, midwives, psychologists, laboratory technicians, human resource/finance coordinators, pharmacists, mental health specialists and logisticians. MSF delivers medical care based on need alone and operates independently of government, religion or economic influence and irrespective of race, religion or gender.

https://msf.org.au

Source: Workforce Hub Northern Region

21 August 2026

A new regional Workforce Hub designed to simplify workforce development, expand training opportunities and strengthen primary and community care across the Northern Region was officially launched yesterday by Health Minister Hon Simeon Brown.

Delivered by ProCare and Total Healthcare on behalf of all 11 Primary Health Organisations (PHOs) across Te Tai Tokerau and Tāmaki Makaurau, the Workforce Hub – Northern Region provides a single, co-ordinated point of access for workforce development across primary care.

The Workforce Hub supports more than 400 general practices and a wide range of primary and community care providers, helping connect healthcare professionals with training, placements and funding opportunities while reducing complexity for busy practices.

Danny Wu, Regional Planning, Funding & Outcomes Director for the Northern Region said the Workforce Hub would help strengthen New Zealand's health workforce and improve access to care closer to home.

“Improving access to timely care and building a workforce that can meet patient demand is imperative to the future of primary care. The Workforce Hub – Northern Region is an important step towards creating stronger workforce pathways and supporting more services to be delivered closer to where people live. It is also a practical example of how we can make training, development and career pathways easier to access, while supporting more care to be delivered in the community.”

The Workforce Hub has been established with Health New Zealand funding as one of four regional workforce development hubs across the country.

Initially, it will support programmes including Community-Based Attachments for junior doctors, training and support for graduate nurses entering primary care, planned care training, PRIME training (primary response in a medical emergency), cyber risk education and other workforce development initiatives.

Mark Vella, Chief Executive at Total Healthcare said the Workforce Hub's goal was simple: make workforce development easier for practices and practitioners while ensuring investment is directed where it can have the greatest impact.

“There is no shortage of commitment to growing the primary care workforce, but navigating training pathways, funding streams and placement opportunities can be complicated. The Workforce Hub brings these together in one place, making it easier for practices and providers to access the support available to them.

“By reducing administrative barriers and providing a coordinated regional approach, we're making it easier for practices to participate in training, easier for clinicians to develop their careers in primary care and ultimately helping communities access the care they need. When we remove complexity from the system, everyone benefits, from learners and trainers through to the patients they serve,” continues Vella.

Bindi Norwell, Group Chief Executive at ProCare, said the Workforce Hub was an investment not only in today's workforce, but in the future sustainability of primary and community care.

“Every healthcare professional deserves a clear pathway into and through primary care. By connecting people with opportunities and removing unnecessary complexity, the Workforce Hub will help create a workforce that is not only larger, but better supported, better connected and more likely to stay in primary care for the long term.

“This initiative is about much more than training programmes and funding. It's about building a stronger workforce pipeline, supporting career development at every stage, and ensuring primary care remains an attractive and rewarding career choice. Ultimately, that means better access to care, more services delivered closer to home, and healthier communities across the Northern Region,” concludes Norwell.

The Workforce Hub will co-ordinate support across four key areas:

1. Practice-based placements
2. Expanding clinical scope and capability
3. Skills development within existing roles
4. Training pathways into new roles.

The Workforce Hub's long-term vision is to create a stronger, more sustainable primary and community care workforce by improving access to training, supporting career development and helping workforce investment deliver better outcomes for communities across the Northern Region.

https://www.workforcehub.co.nz

Source: Commonwealth Bank of Australia (CBA)

Friday, 21 August 2026

Australian household spending lifted by 0.6 per cent in July, with discretionary spending on experiences helping fuel the jump.

Key stats:

• The strongest spending categories in July were insurance (1.2%), recreation (1.1%) and hospitality (1.0%).
• Discretionary spending lifted from 0.3% in June to 0.8% in July.
• On a monthly basis, discretionary spending accelerated to 0.8%, while essential spending held at 0.4 per cent.

Household spending rose 0.6 per cent in July, with households continuing to prioritise spending on experiences and discretionary categories despite downward pressure on incomes and housing prices.

The latest data showed monthly gains across 10 of the 12 categories, led by insurance, recreation and hospitality. Education saw the largest decline in July, followed by utilities, likely the result of warmer-than usual weather in recent months.

Spending on recreation rose 1.1 per cent in July, with spending on hospitality increasing by 1.0 per cent. Spending on the football World Cup, which ended on 19 July, and The Odyssey movie likely supported the increase in spending over the month.

“Spending indicators have been choppy lately, though the annual rate of growth remains below late 2025, suggesting that spending has slowed over 2026,” CommBank’s Senior Economist, Ashwin Clarke said.

Annual growth ticks up as discretionary spending strengthens

Household spending growth has so far been weaker in 2026 compared to 2025, but the gap is narrowing.

The average monthly increase over 2026 has ticked up slightly to 0.4% from 0.3% in the previous month, compared to the 0.5% increase over 2025.

Discretionary items make up for three of the top four contributors to overall annual growth, in particular spending in hospitality and recreation. Household goods spend was also strong, supported by promotional activity at online marketplaces.

“The discretionary strength on the face of it suggests households are not in a saving mindset,” Clarke said.

“However, we have seen some listed companies report that value conscious behaviour is on the rise as part of recent earnings outlooks. In addition, the weakness in essentials, in particular utilities and the temporary respite in fuel costs in previous months, may have made it easier for household budgets to accommodate this spending.”

On a monthly basis, discretionary spending accelerated to 0.8%, while essential spending held at 0.4 per cent.

“The data has been quite uneven over the year. Financial conditions for households have tightened, following three interest rate hikes, higher fuel prices and declining housing prices.

“The key question is whether households will be willing to use their financial buffers to shrug off these headwinds and continue to spend like the better times in 2025,” Clarke said.

“As we have been highlighting for some time now, there remains a risk that household spending does not slow as we expect it to. The pick-up in the pace of growth this month may point to the possibility that weakness in earlier months was temporary, driven by the Middle East conflict. If spending does not continue to slow, this would make the RBA uncomfortable that inflation will not moderate from here.

“Our expectation is that spending slows in coming months in line with the lagged impact of rate hikes, the wealth effect and slow household income growth.”

Official release: https://www.commbank.com.au/articles/newsroom/2026/08/household-spending-rises-in-july.html

Commonwealth Bank of Australia | 244/2026

Source: Billo

August 21, 2026

Data from marketing platform Billo dated June to December 2025 shows Meta ad competition rose 40% between August and the November peak. Billo, which connects brands with creators to produce social video ads, says the brands that win Black Friday test their creative already in August.

New Billo data shows Meta ad competition rising about 40% and the cost to reach 1,000 impressions climbing roughly 18% between August and the November Black Friday peak. Brands that wait until fall to plan their campaigns enter an auction that is already crowded and expensive, with the outcome largely shaped by creative built weeks earlier. Black Friday and Cyber Monday together make up the single largest ecommerce advertising event of the year, and the brands that prepare earliest tend to capture a disproportionate share of that spending.

Billo, which connects brands with creators to produce social video ads for platforms including TikTok, Meta and YouTube, has tracked the same pattern in its own client data. Donatas Smailys, co-founder and CEO of Billo, said brands that enter Black Friday without tested creative end up paying more for weaker results, regardless of how much they spend.

“Everyone treats Black Friday as a fourth-quarter problem, so everyone ends up competing for the same ad space at the same time,” Smailys said. “Brands that create their ads early and test them in August get better results than brands that wait until October or November. By the time November comes, the brands that tested early already know what works, while the brands that waited are launching untested ads during the most expensive weeks of the year.”

Why August Is the Right Time to Start

September and October are when brands learn which ads actually convert, and that testing takes weeks. August gives brands exactly enough time to brief creators, film several options, and get results back before Black Friday begins.

“You don't need a media budget to find out if an ad works,” Smailys said. “In August, we tell our clients to post a few short variants organically, each with a different hook and a different creator. A small, specific audience responds within days, and that tells you which version actually lands. The trick is picking the right audience for that test: people who already care about the product. Once you know what they respond to, you know exactly what to put the budget behind in November.”

Brands that follow this approach typically produce three to five short variants per product, each testing a different angle: a different opening line, a different creator, or a different pain point. The variants that perform best organically become the ads brands scale with paid budget once Q4 begins.

Methodology

Figures are based on Billo client Meta ad data, tracked monthly from June through December 2025. Comparisons reflect August 2025 against the November 2025 peak, and where noted, December. Cost per 1,000 impressions reached is a derived figure, calculated as total spend divided by total impressions, multiplied by 1,000; it is not a reported column in the underlying data.

About Billo

Billo is the leading UGC marketplace founded in 2019 that connects brands with creators to produce high-performing social video ads. It is based in Lithuania, built for US needs, and led by co-founder and CEO Donatas Smailys. The platform combines the power of UGC content with a streamlined production process, helping brands increase brand awareness, drive traffic, and boost conversions with authentic creator videos on TikTok, Meta, YouTube, and other platforms.

Source: University of Sydney, Business School and Chartered Accountants Australia and New Zealand

21 August 2026

Two reports highlight growing capability and valuable lessons for entities preparing for future reporting obligations.

Australia's largest organisations are shaping good practice in mandatory climate reporting, according to two new research reports from the University of Sydney Business School and Chartered Accountants Australia and New Zealand.

The reports found significant climate reporting capability has been developed among large Group 1 entities¹ and their assurance providers, with more than half engaging external expertise as part of their climate reporting preparations. This finding highlights both the complexity of implementation and the significant investment organisations have made to build reporting capability.

Smaller Group 2 and Group 3 entities continue to build the systems, governance arrangements and processes needed to meet future reporting requirements. The report also suggests some later reporters may be underestimating the scale of preparation required to produce the sustainability report soon to be required by law.

Under Australia's phased implementation timetable, Group 2 entities will generally commence reporting for financial years beginning on or after 1 July 2026, followed by Group 3 entities from 1 July 2027.

Lead researcher Associate Professor Shan Zhou from the University of Sydney Business School said the findings reinforced the value of starting early.

“Climate reporting and assurance require new systems, governance arrangements, skills and data collection processes,” Associate Professor Zhou said.

“The entities that appear most prepared are those that began building these capabilities well before their reporting deadlines.”

The research initiative was led by the University of Sydney, Monash University and the Australian National University in partnership with Chartered Accountants Australia and New Zealand (CA ANZ). The separate assurance report was also developed in partnership with the Auditing and Assurance Standards Board (AUASB).

CA ANZ Sustainability Leader, Karen McWilliams, said the research highlights the importance of maintaining momentum as more entities enter the reporting regime.

“As the next wave of Group 1 reporters lodge their climate-related disclosures, the experience of early reporters is providing valuable insights into what effective climate reporting looks like in practice,” Ms McWilliams said.

“The opportunity now is to build on those lessons and ensure the whole market is ready for what's next.”

Most entities indicated a preference to use the same provider for both financial statement audits and sustainability assurance engagements, highlighting the importance of early engagement between reporting entities and assurance providers.

The reports identified several technically complex areas that will require ongoing attention, including forward-looking disclosures, scenario analysis and Scope 3 emissions.

Assurance providers also highlighted challenges associated with assessing climate-related risks – including physical, weather-related risks and transition-related risks – and ensuring consistency between sustainability disclosures and financial statements.

The University of Sydney Business School's Sydney Executive Plus launched the Net Zero sprint in April 2024 to train executives in how to account, report and act on business' carbon emissions and make the transition to net zero.

CA ANZ continues to support its members and reporting entities through climate reporting and assurance resources, professional development opportunities and broader capacity-building initiatives to help the profession prepare for the expanding reporting regime.

¹Organisations are classified as Group 1, 2 or 3 entities based on legislative thresholds such as revenue, assets and employee numbers. Group 1 entities entered the regime first, followed by Group 2 entities and then Group 3 entities.

Research

Preparedness of Australian Entities for AASB S2 Climate-related Reporting: https://doi.org/10.25910/j95n-g420

Preparedness of Australian Auditors for Assuring Climate-related Disclosures: https://doi.org/10.25910/fyqe-cn26

Declaration

This research was supported by the Auditing and Assurance Standards Board and Chartered Accountants Australia and New Zealand. AUASB and CA ANZ respect the independence of the researchers and have not attempted to influence the research or findings in any way.

Source: Royal Australasian College of Surgeons (RACS)

Friday 21 August 2026

The Royal Australasian College of Surgeons (RACS) calls for focus on what sits behind the patient gap.

More than 700 surgeons have identified pressures across Medicare, private health insurance, public hospital capacity and the distribution of the surgical workforce as barriers to Australians accessing affordable surgical care.

The findings come from a survey of RACS Fellows across Australia, informing the College's submission to the House of Representatives Inquiry into Access to and Affordability of Medical Specialists.

RACS welcomes the broad terms of reference of the Inquiry as an important opportunity to look comprehensively at all of the factors contributing to access and affordability.

RACS President Dr Philip Morreau said the focus needs to be on what creates the patient gap.

“When a patient faces out-of-pocket costs, we need to understand what has created that gap.

“A specialist sets their professional fee, but they don't set the Medicare rebate or the benefit a patient's private health insurer will pay.

“When Medicare and insurer contributions don't keep pace with the cost and complexity of delivering care, more of that cost can fall to the patient.

“Focusing only on the most visible part of the patient's bill risks treating the symptom rather than the underlying problem.”

More than 70 per cent of Fellows identified inadequate public hospital funding as a major barrier to accessing surgical services. Theatre closures, limited operating lists and private health insurance settings were each identified by 50.9 per cent of Fellows, while 46.5 per cent identified a lack of hospital beds.

The survey also highlights the increasing cost of providing surgical care. Medical indemnity insurance was identified by 65.9 per cent of Fellows as a major contributor to private practice costs, followed by administrative staffing at 63.9 per cent and practice infrastructure and consulting rooms at 60 per cent. These costs form part of the underlying cost of delivering private surgical care and have increased over time.

When asked which reform would most improve access to surgical care, 67 per cent of Fellows nominated modernising Medicare rebates so they better reflect the time, complexity, expertise and resources required to provide contemporary surgical services.

Dr Morreau said Australia's public and private surgical systems are interdependent.

“If capacity is lost from the private system, the need for surgery doesn't disappear. It moves elsewhere, including into already stretched public hospitals.”

RACS is calling for reforms across the health system, including:

• modernising Medicare patient rebates so they better reflect the cost and complexity of contemporary surgical care, with appropriate ongoing indexation.
• reforming private health insurance settings to improve affordability and transparency, including reviewing and appropriately indexing the $500 known-gap threshold, ensuring insurer benefits and gap arrangements keep pace with the cost of care, and clearer disclosure of what insurers will contribute.
• increasing public hospital surgical capacity, including outpatient services, operating theatres, theatre utilisation, beds and workforce, with better reporting of waiting times across the patient journey and theatre utilisation.
• strengthening national workforce planning, with specialty- and region-specific planning informed by specialist medical colleges and health services, and targeted support for training and services in areas of greatest need.

RACS supports informed financial consent and appropriate transparency so patients have clear information about the expected costs of their care.

“But genuine transparency means understanding the whole equation – the specialist's fee, the Medicare rebate and what the insurer will actually contribute,” Dr Morreau said.

“Transparency alone won't increase a Medicare rebate, improve an insurance benefit or create additional hospital capacity.

“If we want to make surgical care more affordable and accessible, we need to address the system that sits behind the patient's bill.”

RACS has offered its workforce data, analysis and surgical expertise to support the Inquiry and assist governments and health services to develop practical reforms to improve access to surgical care.

About the Royal Australasian College of Surgeons (RACS)

RACS is the leading advocate for surgical standards, professionalism and surgical education in Australia and Aotearoa New Zealand. The College is a not-for-profit organisation that represents more than 8000 surgeons and 1300 surgical Trainees and Specialist International Medical Graduates. RACS also supports healthcare and surgical education in the Asia-Pacific region and is a substantial funder of surgical research. There are nine surgical specialties in Australasia being: Cardiothoracic Surgery, General Surgery, Neurosurgery, Orthopaedic Surgery, Otolaryngology Head and Neck Surgery, Paediatric Surgery, Plastic and Reconstructive Surgery, Urology and Vascular Surgery.

https://www.surgeons.org/