The week in five desks: 26 October 2026

Five things that happened in the systems we follow, one per desk, with the number and the mechanism. No argument; the leaders do that.

Australia: the algorithm behind home-care budgets

On 26 October the Commonwealth Ombudsman published a review of the Integrated Assessment Tool, the software that sets which funding level an older person receives for care at home, across programs used by about 1.1 million people. It found that the tool's fairness and consistency "could not be assured". The law gives assessors no power to override it, nothing is published about how it decides, and only 0.6 per cent of assessments between December 2024 and March 2026 were audited or reviewed. The Ombudsman asked whether the arrangements meet two recommendations of the Robodebt royal commission and made ten of its own, including a change to the law to allow a human override. The health department disputed several findings; ministers said they accept the rest in full or in principle.

United Kingdom: the Budget leaves disability benefits for 2027

John Healey's first Budget, on 28 October, made no change to Personal Independence Payment. The Red Book accepts the Timms Review's interim finding that the benefit is "no longer fit for purpose" and promises a response before the end of the year, a White Paper early in 2027 and legislation later that year. The welfare cap was neither reset nor tested: the OBR will assess it at the first fiscal event of the next Parliament. The full new state pension rises 3.9 per cent in April, to £250.70 a week, and the triple lock stays until 2029. From April 2030 the pension will rise by the highest of 2.5 per cent, inflation, or whatever keeps its April 2029 value relative to earnings. The Treasury puts the saving at £15 billion a year by the late 2030s and says it will help build the National Care Service, for which no sum or start date was given.

United States: what a work requirement looks like from the inside

Michigan's health department launched an online screener on 23 October for the 625,000 people in its Medicaid expansion plan, ahead of federal work requirements that start on 1 January. To keep cover, a member must earn at least $580 a month or log 80 hours of work, study or volunteering. Exempt groups include parents of children aged 13 or under, pregnant and postpartum people, some disabled people and veterans rated totally disabled. The state checks its own records first and asks for documents only when they fall short. Renewals move from yearly to six-monthly, so each member faces the check twice a year. Current members are first tested at renewals from 1 March 2027.

Europe: France's deputies reject the social security budget

The Assemblée nationale voted down the 2027 social security financing bill (PLFSS) at first reading on 23 October, after its social affairs committee had already rejected it. None of the bill's measures can take effect until a final text is agreed. It now goes to the Senate, and a joint committee follows if the two chambers disagree. According to summaries of the bill, it revises the 2026 deficit up to €21.8 billion, sets 2027 health spending growth at 2 per cent with €5.1 billion of savings, and extends a 2.05 per cent levy on the mutuelles. The annual caps on patient co-payments, the franchises médicales, were already raised from €50 to €70 by regulation, which needs no vote.

China: the residents' fund spends 87 per cent of what it collects

The National Healthcare Security Administration published fund figures for January to September on 21 October. The basic medical insurance funds took in ¥2.30 trillion and paid out ¥1.75 trillion. The two schemes are not alike. The employees' scheme, funded by payroll contributions, took in ¥1.45 trillion and spent ¥1.00 trillion. The residents' scheme, funded by flat personal premiums plus state subsidy, took in ¥855.5 billion and spent ¥747.1 billion, about 87 per cent of its income. Collection for 2027 is now open. The minimum personal premium is held at ¥400 for a third year and the state subsidy rises by ¥24 to at least ¥724. Anyone who misses the window waits at least three months for cover. From 1 January, enrolment becomes a legal duty under the new Medical Security Law.

Also this week

Australia's health and ageing minister said on 23 October that the country needs an average-sized aged-care home "every three days or so for the next 20 years", as providers report 3,000 planned beds shelved. Downing Street confirmed on 22 October that free personal care under the National Care Service will cover only people over 65. Missouri expects about 360,000 adults to face Medicaid work requirements from January (26 Oct). France's Senate takes up the social security bill from 9 November. The Netherlands' first 2027 health insurance premium, from DSW, rises a record €14.75 to €173.25 a month (21 Oct). US marketplace premiums are expected to rise about 15 per cent for 2027 as open enrollment begins on 1 November.

Sources: Commonwealth Ombudsman, Automation and Oversight in Aged Care (26 Oct 2026), via SBS News and The Weekly Source; HM Treasury, Budget 2026 (28 Oct 2026), paras 1.23, 1.29, 5.20–5.24; MoneyWeek, Budget live, 28 Oct 2026 (pension rates); Michigan Department of Health and Human Services via Oakland County Times, 23 Oct 2026; Assemblée nationale, commission des affaires sociales; Kohen Avocats and Ouillade summaries of the PLFSS 2027 vote, 23–24 Oct 2026; MandaPro, 25 Oct 2026; NHSA fund figures via China News Service and Guangming Daily, 21–22 Oct 2026; NHSA briefing, 9 Oct 2026; Minister for Health and Ageing, press conference transcript, Adelaide, 23 Oct 2026; Disability News Service, 22 Oct 2026; KCUR, 26 Oct 2026; Zorgwijzer and TPO, 21 Oct 2026; KFF Health News, 23 Oct 2026.