The week in five desks: 2 November 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: what the NDIS reviews added and took away

The National Disability Insurance Agency gave Senate estimates its latest figures on 29 October, as reported by Health Services Daily. The scheme had 782,013 participants at 30 June. Over the past year 119,976 plan reviews raised participants' budgets by a combined $5.56 billion, and 72,018 reassessments cut them by $2.09 billion. The agency also projected how many children will leave the scheme under Thriving Kids, which moves children with mild to moderate developmental delay or autism to supports outside the NDIS: about 21,000 by June 2028, rising to 155,000 by June 2031. The chief executive confirmed that two current staff were the subject of adverse findings in a Victorian anti-corruption report; neither is on duty.

United Kingdom: who gains and who loses from the Budget

The Resolution Foundation's analysis of last week's Budget, Spread thin, finds that the measures announced in this Parliament leave the poorest fifth of households about £320 a year better off by 2029–30 and the richest fifth about £2,000 worse off. One of the measures pulling the other way is the freeze on Local Housing Allowance, the rate that caps housing support for private renters on benefits, now extended into 2027–28; the Foundation says more than a million families will be worse off as a result. The Government Actuary's technical note confirms the full new state pension at £13,036.40 a year from April, and the new uprating rule from 2030.

United States: open enrollment without the extra subsidies

Sign-up for 2027 marketplace health insurance opened on 1 November and runs to 15 January. It is the first full season since the enhanced pandemic-era tax credits expired: people earning more than four times the federal poverty level no longer get any help with premiums, and credits are restricted for some lawfully present immigrants. KFF puts the average rise in benchmark premiums at about 13%, after 26% for 2026, and counts 11 insurers leaving at least one state's marketplace. Federal regulators say most HealthCare.gov users can still find a plan for $50 a month or less after subsidies. Plan selections fell by 1.2 million last season.

Europe: Germany's care insurance bill reaches the Bundestag

The government's care reform bill went to the Bundestag for its first reading this week and on to the health committee. It raises money and slows benefits. The surcharge for people without children rises by 0.3 points to 0.9%, the earnings ceiling for contributions rises by €300 a month, minijobs become liable, and from 2028 spouses now covered free would pay 0.52%. The benefit increase planned for 2028 is dropped; from 2029 benefits rise each year with inflation. In the lowest care grade, a small cash allowance is replaced by a right to advice, and the thresholds for a care grade rise slightly, with current recipients protected.

China: what joining late costs

Collection for the 2027 residents' medical insurance is under way, and provinces are setting out the rules. Hunan's, published on 2 November, are typical: a personal premium of 400 yuan, unchanged, paid between 1 October and 31 January. Anyone who joins outside the window pays 1,124 yuan, the full premium plus the state subsidy they would otherwise have received, and waits before cover starts. From 1 January joining is also a legal duty under the new Medical Security Law. The national list of drugs the scheme pays for, negotiated in September, is expected later this month and takes effect on 1 January.

Also this week

A federal court in Massachusetts on 29 October struck down the definition of "medically frail" that US states must use to exempt people from Medicaid's new work requirements, for 25 states and the District of Columbia; the requirements still start on 1 January, and the administration says it will appeal. Germany set the average supplementary health insurance contribution for 2027 at 2.9%, unchanged (30 Oct). Australia's Aged Care Act turned one on 1 November. France's Senate takes up the social security budget from 9 November, and Dutch insurers must publish their 2027 premiums by 12 November.

Sources: Health Services Daily on NDIA evidence to Senate Community Affairs estimates, 29 Oct 2026; Resolution Foundation, Spread thin (Oct 2026); Government Actuary's Department, Budget 2026 technical bulletin; HM Treasury, Budget 2026; AP and KFF via WECT and KMPH, 1 Nov 2026; Health Management Associates weekly roundup, 4 Nov 2026; Deutscher Bundestag, Pflegeneuordnungsgesetz (Drucksache 21/8869), Nov 2026; Hunan provincial medical insurance notice via The Paper, 2 Nov 2026; Massachusetts Attorney General, 29 Oct 2026; Federal Ministry of Health, 30 Oct 2026; Department of Health, Disability and Ageing, 1 Nov 2026; Légisocial; Zorgwijzer.