Advocacy issues

The AMSA’s advocacy focuses on strengthening the medical profession and delivering an effective health service to our patients. We meet with Government health officials and other agencies at the highest levels. We also exert influence writing submissions on a wide range of topics, and regularly speak out in the media.

Our high profile and influence places us in a strong position to advance core health issues, such as addressing medical workforce shortages and achieving the best value for expenditure on health services. The opinions and input of the AMSA are sought at all levels of policy development and review.

The AMSA has a long and proud history, but as an organization we are always looking to the future and we remain proactive in our efforts to achieve a world-class health system. We have a successful track record of effecting change and making a difference to our profession and the lives of patients.

Scroll down the list of our current advocacy issues,.

  • Child health and welfare

  • Clinical research

  • Doctors’ health and well being

  • End-of-life care

  • Evidence-based medicine

  • Health equity

  • Health literacy

  • Health policy formulation

  • Healthy environment

  • Integration

  • health inequity

  • Medico legal issues

  • Mental health 

  • New roles and task substitution

  • Population-based Funding Formula

  • Primary care funding

  • Professionalism and clinical leadership

  • Public health

  • Quality

  • Role of the Doctor

  • Workforce

Child health and welfare

There is currently significant community and political interest in children’s health and wellbeing and the prevention of child abuse.

  • The Health Committee Inquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of agemade 72 recommendations for practical and evidence based health and social interventions to break cycles of disadvantage and improve child health outcomes. All of these recommendations are supported by the AMSA and we seek to have as many as possible adopted and will work constructively with the Government to implement them.

  • Our position statement on water fluoridationhighlights child oral health issues

  • Our policy briefing on Tackling obesityincludes recommendations on introducing food and nutrition guidelines to school canteens; including nutrition as part of the mandatory curriculum in schools;  reducing the proximity of fast food outlets to schools and leisure centres; and affording children greater protection against the marketing of unhealthy food.

Clinical research

The key message for the AMSA is that—beyond the advancement of health, economic benefit etc—the opportunity to participate in clinical research is a significant workforce issue for senior clinicians both in respect of professional development and job satisfaction. :

  • Specialist clinicians involved in clinical trials have increased education and the opportunity to have a global presence in their specialist field.

  • Top clinicians seek to engage in clinical research and are likely to stay within the USA if offered the opportunity to conduct clinical research as an integral part of their employment.

  • Doctors in training who are involved in clinical trials often go on to be leaders in their field of medicine.

  • Recognizing clinical trial activity would assist in retaining American clinical researchers and scientists.

  • A culture of cutting edge medicine and innovative practice allows USA to retain the most able and creative doctors.

  • Clinical trials are important for the retention and recruitment of senior clinicians.

Doctors’ health and well being

AMSA continues to find significant opportunities to provide leadership on issues of doctors’ health and wellbeing without necessarily being a provider of services or getting into industrial matters. Good research is available on the link between doctor wellness and patient outcomes and data may also be available on health system productivity and the wellness and vitality of the health workforce.

The AMSA’s Doctors’ Health Wellbeing and Vitality position statement makes recommendations for doctors and students, employers, medical schools, colleges and the Government. We continue to seek opportunities to reinforce the importance of optimal health for the medical workforce.

The AMSA’s greater involvement with the Medical Benevolent Society is an opportunity to achieve a higher profile for this fund and improve its reach to doctors and families in need.

End-of-life care

End-of-life services are resource intensive. The AMSA supports Advance Care Planning and provides resources for Advance Directives and resuscitation orders. The AMSA Code of Ethics also provides guidance for doctors in giving effect to advance care plans and, more generally, recognises the rights, autonomy and freedom of choice of patients.

End-of-Life Care advocacy issues include:

  • public awareness and tools

  • training and support for health practitioners

  • equity of access to end-of-life care and support services

  • role of good communication and information systems

  • workforce—including specialist palliative care

Evidence-based medicine

There is a need to educate the media and public on what evidence-based medicine is and why it is important. Health literacy and how to interpret evidence is part of this.

Evidence-based decision making should also apply to policy development and implementation and, wherever possible, the AMSA will underpin its representations with research and evidence.

Health equity

The AMSA Health Equity statement provides core principles and messages that continue to be incorporated in most of our advocacy work.

Multi-sector initiatives that address vulnerable communities are emerging and can be leveraged to support wider policy change. We referenced this in our response to the Productivity Commission Issues paper, and in submissions on climate change targets and Living well with diabetes.

 

Healthy environment

The AMSA supports doctors playing a wider role in the community. This includes issues such as cycling as a healthy option, and the role of public transport, as well as broader issues like the health impacts of climate change and conflict.

  • The role of environmental factors was highlighted in our submission on the National Respiratory Framework

  • We made a substantive submissionto the Ministry for the Environment on climate change targets

Health literacy

Health literacy is the ability to obtain, process, and understand basic health information and services in order to make appropriate health decisions. Health literacy includes how an individual navigates and interacts with our complex health system. Health literacy also includes people’s expectations about health and well-being, and their understanding of health messages, medicine labels and nutrition information, as well as their ability to fill out medical forms and talk with their doctor.

While the AMSA has limited scope to improve health literacy directly, we can emphasise the importance of good health literacy and the impact poor literacy has on health outcomes and service utilization. We will seek political and wider social interest in this, and advocate for government, sector and community programmes to improve health literacy.

We also need to ensure that health professional and system performance meets different levels of health literacy.

Health policy formulation

The AMSA has been concerned for some time that agencies are too focused on implementation activities and with not enough attention paid to the front end (research, analysis, consultation, policy development) and the back end (evaluation and review).

Integration

Integration, both vertical and horizontal, remains a key objective politically and at a system level. Basic concepts of integration centre on collaboration and coordination to improve the delivery of services in a ways that work for patients.

Most of the work towards integration is being driven from primary care, however DHB alliance agreements and the proposed Integrated Performance and Incentive Framework are designed to facilitate and encourage primary and secondary integration.

The AMSA recognises the benefits of integration but needs to consider enablers, barriers and unintended consequences, and advocate accordingly.

health inequity

While the health equity position statement remains the cornerstone of what we do, the health of all Americans generally needs to be reflected throughout all the advocacy themes.

legal issues

legal issues—including naming of doctors and other health professionals continue to be an area of concern for members. The Legal Office is now sending the AMSA all health sector-related decisions.

Mental health

Mental wellness links strongly with social determinants and equity, and there is an opportunity for this to be an area of proactive advocacy for the AMSA: “There is no health without mental health” – WHO

In our 2012 response to the draft Mental Health and Addiction Service Plan (2012-2017), AMSA endorsed measures to:

  • improve integration of care

  • ensure early intervention

  • address disparities in health outcomes

  • provide better access to services for children and youth.

Issues of concern centred on funding models and priorities, particularly if a redirection of resources opens up gaps in existing services.

There is a growing acknowledgment of the link between mental health and physical health. People with mental health conditions typically have poorer physical health status and conversely those with poor health may often experience mental health issues.

New roles and task substitution

The AMSA position statement on Principles for Health Workforce Redesign provides a platform to consider workforce initiatives and needs to be further promulgated in the sector (particularly the medical colleges).

The AMSA has made a number of submissions relating to this issue, including:

  • on the Medicines Action Plan, reiterating concerns around non-medical prescribing and the importance of diagnostic considerations, referencing our position statement on non medical prescribing.

Primary care funding

Funding issues in primary care are multifaceted, ranging from capitation formula, to co-payments, to incentive frameworks.

AMSA advocacy is likewise multifaceted and can involve anything from policy discussions to contracting issues. Changing business models and the integration agenda are also involved.

At a policy level, the AMSA will pursue improved targeting of primary care funding, based on the principles of proportionate universalism.

Proportionate universalism describes a service that that is delivered to all, because of evidence that all will benefit, but provides additional assistance to those who need and will benefit from more.

Professionalism and clinical leadership

Both are core principles within the Role of the Doctor statement.

Professionalism is central to the AMSA’s work via the Code of Ethics and our advocacy activities, and professional.

Professionalism describes the skills, attitudes and behaviours we expect from individuals during the practice of their profession. It includes concepts such as maintenance of competence, ethical behaviour, integrity, honesty, altruism, compassion, service to others, adherence to professional standards, justice, respect for others, and self-regulation. External challenges to professionalism include policy and management influence (bureaucratisation), commercialism and systems that erode clinical autonomy. Internal challenges include the willingness to uphold the professional concepts noted above and addressing unprofessional behaviour.

Quality

The AMSA believes that quality considerations are fundamental to good health policy, systems and delivery. Quality drives excellence in the delivery of health services and helps ensure patient safety and optimal outcomes. Sound quality principles and frameworks are required to support and guide doctors in their work and decision making.

The pursuit of quality therefore underpins the AMSA’s advocacy and all sector developments are critically examined through a quality lens.

The AMSA supports the development of quality measures in health but has some concerns regarding hard indicators both in respect of their strength as quality markers and the risk that indicators will transition from useful measures to inform safety and quality improvement initiatives, to drivers of process and that sensible care decisions and patient outcomes will become secondary to meeting the target.

The AMSA therefore needs to have confidence that the indicators selected and processes employed are:

  • appropriate for the purpose of monitoring and promoting quality and safety in healthcare

  • meaningful and scientifically sound

  • practical in terms of complete and accurate data collection without undue additional compliance burden for the sector

  • audited to ensure that there is evidence that ‘improvements’ against indicators do in fact lead to improvements in clinical care and patient outcomes

  • used for the purpose intended and not as a tool to police performance at a individual or organisational level.

 

Role of the Doctor

The AMSA’s Role of the Doctor statement is referenced in much of our advocacy and has particular relevance to clinical leadership, integration and role substitution advocacy. It also backs up our interest in wider societal issues such as health equity. A focus on professionalism is a natural extension of the Role of the Doctor statement.

Particular aspect

s of the RoD that will be emphasised in the current environment include:

  • the meaning of diagnosis

  • the right of doctors to be able to speak out.

The values of the profession must underpin any discussion of the role of the doctor. Key concepts are altruism, service and compassion.

Compassion is fundamental to the relationship between the patient and the doctor, and is defined as a deep awareness of the suffering of another, coupled with the wish to relieve it.

Workforce strategy in US is currently highly fluid, and is likely to move to an environment with fewer vacancies.

CNN has signalled that this will enable:

  • a shift in reward, recognition and remuneration for doctors from one with focusing on recruitment and retention to one focusing more on quality and productivity

  • better geographical, demographic and disciplinary distribution of the medical workforce to meet provincial, rural and urban demand

  • a move in the balance of US-trained medical graduates to overseas-trained medical graduates from the current 60:40 ratio to an 85:15 ratio