Women's Health Summit Must Broaden Focus Beyond High-Cost Care

Discrimination and bias against women in health care occurs across the health sector not only in medical settings.

Massage & Myotherapy Australia CEO Ann Davey, said that in the past, bias against women in complementary health has gone well under the radar and can appear to be openly discriminatory.

'We hope the Women's Health Summit will not only focus on gender-bias in medical health but acknowledge and discuss these issues in complementary health.'

Massage therapy is the most used care therapy with women accessing massage services at a ratio of 2:1 to men. The massage sector is also a female dominated sector of health with a ratio of 4:1 to men.

Health policy and funding around the country has not kept pace with the needs of Australian women or the education and skills of professional qualified massage therapists.

Consequently, discrimination and bias against women in complementary health and women that access these services are very evident.

Access bias in women's health

Medicare does not cover massage and hence State and Federal health policy limits universal access to professional massage therapists to women who can afford to pay for access privately:

• Women accessing professional massage therapist services at a ratio of 2:1 to men^[1]
• Females experiencing a higher proportion of osteoarthritis compared with males (66% females/34% males), rheumatoid arthritis (64% females/36% males) and 'other musculoskeletal conditions' (52% females/48% males)^[2].
• In peri-natal and post-natal care, specialised massage care has been shown to help maintain mobility, manage pain and stress, and reduce complications during birth^[3].
• Anxiety, depression, and lower back pain are common during pregnancy and the postpartum period. Non-pharmacologic treatments for these mental health symptoms are critically important during these periods. Massage therapy has been shown to effectively reduce lower back pain[4] while also reducing anxiety, depression, and cortisol levels throughout the pregnant and post-partum periods. As a secondary effect to these improvements, massage has also been shown to reduce premature birth and low birth-weight[5]^,[6].

Age discrimination

No funding for services from remedial massage therapists is available for older women unless they are in the NDIS, or Aged Care Home Package

• Older women are heavily dependent on massage therapy, with 50% having visited a massage therapist in the previous 12 months. Women with lower quality of life scores in terms of bodily pain and/or emotional health are more likely to consult a massage therapist than those with higher scores^[7].

Professional discrimination and bias

Medicare funding arrangements limit funding for massage to physiotherapists or other allied and registered health practitioners, even if they are not trained in remedial massage therapy:

• When massage is administered under the current Medicare funding arrangements it is unnecessarily more expensive, not as effective or beneficial with little or no data collection.
• The use of massage in Medicare, is an unnecessary burden on time-constrained Registered Health Practitioners, who can provide massage despite their qualifications providing no hands-on manipulation or massage therapy training.
• This is evidenced in the Medicare Benefits Schedule – Item 10960 for physiotherapy where a fee of $64.20 with a benefit of 85% or equal to $58.30, is provided but only requiring a minimum of 20 minutes for a combined physiotherapy and massage treatment. In this regard massage therapies may be delivered for as little as 10 minutes, as a pleasant adjunct to the consultation and other allied health therapies.

• Qualified professional massage therapists undertake training ranging from 1 to 3 years and 1000 hours of supervised hands-on training to attain qualifications recognised under the Australian Qualifications Framework.
• A confused and disparaged reputation of female massage therapists is prevalent within Governments such the Victorian Department of Consumer Affairs equating sex workers to massage therapists and the Victorian and Queensland Law Reform Commissions not recognising the vast differences in the two profession as detailed in their recent sex work decriminalisation reports enabling sex work to be advertised as massage services.

Low wages and income

• Within Australia's health care system, professional massage therapists are still regarded as pleasant optional extras, made available as supervised and often low-paid hand maidens to allied health or medical therapy.
• Incomes for female massage therapists, and massage therapists in general, are close to 30% below the average. According to JobOutlook,^[8] , a full-time worker on an adult wage in the massage sector is around $1,038 per week compared to the average of $1,460.
• During the 10 years to end of 2019, less than a third of the people employed in the massage sector were working full-time (29.9%), which compares poorly to the national average of 40.2%.^[9]

Mrs Davey said there is now significant evidence to show that it is time to redress these issues in Government Health Policy.

'There is a significant growing body of evidence attesting to the efficacy of massage therapy on the health and well-being of patients when administered by a qualified professional massage therapist.

'The professional standards and development requirements of massage therapists are now similar to those of Registered Health Practitioners.

Professional massage services are now well integrated in private health settings overseen or supported by Government, such as the Private Health Insurance Rebate Scheme, Workers Compensation and some motor accident rehabilitation insurance, and the Aged Care Home Package.

All provide substantive argument for change if we are to achieve the fair and equitable outcomes for women that access massage therapy and female massage therapists,' Mrs Davey said.

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