Friday, October 09, 2015

Now Here Is The Approach We Should Be Adopting To Move Forward In E-Health.

This appeared a little while ago.

NHS developing PHR adoption strategy

9 July 2015   Thomas Meek
NHS England is working on an adoption strategy to support the use of personal health records.
The strategy is intended to enable the NHS to develop an understanding of “what do we need to do at centre to help health economies and patients adopt PHRs,” according to Lenore Ogilvy, a commercial specialist at the commissioning board.
Ogilvy, who was speaking at a Future of Personal Health Records event this week organised by Sitekit, the co-creator of the eRedbook, said the plan is part of the National Information Board’s ‘Personalised Health and Care 2020’ framework to drive improved use of digital technology in healthcare.
The work on PHRs comes under workstream 1.1 of the framework, which is focused on enabling patients and the public to use digital tools to access health and care information and make informed choices.
Tim Kelsey, director of patients and information at NHS England and chair of the NIB, has previously said this strand of the framework, which also encompasses the development of an app endorsement model, could achieve up to £3.4 billion in annual efficiency savings by 2020.
In order to develop the PHR strategy Ogilvy said that NHS England is engaging in a “landscape review” to get an insight into what local NHS organisations and commercial companies are developing innovative approaches to using and implementing PHRs.
The use of PHRs has expanded in recent years, as both central and local NHS services have pushed the benefits of tools that can complement electronic medical records by allowing patients access to view and update their own healthcare information.
Examples include Emis Health’s PHR, which links to Apple’s HealthKit, and the More Independent Programme in Liverpool, which links health and social care information to support older people to live more healthily in their own home.
NHS England’s own work in the area includes giving patients access to their Summary Care Record online, and enabling patients to book appointments and order repeat prescriptions online, by giving GPs incentives to switch on the parts of their systems that enable patients to do this.
More here:
How refreshing! Actually planning to research and then trial approaches to Personal Health Records to find out what works for consumers before actually committing to major expenses.
Pity this was not done when we kicked off the PCEHR!

Thursday, October 08, 2015

The Macro View - General And Health News Relevant To E-Health And Health In General.

October 8 Edition
This post tries to understand the economics and drivers behind the General and Health Budgets that will determine what gets spent on Health and e-Health specifically.
Politics and policy inevitably get mixed up in all this so a wide range of views get canvassed.
Here is some other of the recent other news and analysis.

The Political Scene.

Govt attacked medical profession: AMA

  • Lucy Hughes Jones
  • AAP
  • September 27, 2015 2:05PM
THE federal government has attacked the integrity of doctors while announcing a review of Medicare, the Australian Medical Association says.
THE Turnbull government has launched a "long overdue" review of Medicare services to bring the system into the 21st century.
While AMA president Professor Brian Owler agreed the Medicare Benefits Schedule (MBS) was outdated, he said Health Minister Sussan Ley had indicated doctors were using it to perform unsafe and unnecessary procedures, harming patients for financial gain.
"This is a direct attack on the integrity of the medical profession.
28 Sep 2015 - 9:55am

I'm not attacking doctors: Ley

The federal government has promised it will have evidence before making any changes to taxpayer-funded medical procedures.
AAP  28 Sep 2015 - 8:46 AM 
Health Minister Sussan Ley insists she's not attacking doctors by asking Australians if they've undergone inefficient and unsafe medical procedures.
The federal government wants to update the 5700-strong list of subsidised services and tests in the Medicare Benefits Schedule and has asked for public feedback.
But the Australian Medical Association has taken umbrage with the assumption doctors are performing unnecessary procedures for financial gain.

Morrison and Ley’s health misstep is a gift for Shorten

New Treasurer Scott Morrison and Health Minister Sussan Ley have made their first fundamental mistake and unless they learn from their initial error it will leave the way open for Bill Shorten to have a better chance to be the next prime minister.
Morrison and Ley have correctly worked out that they must find a way to reduce the $150 billion we are spending on health, or at least stop it growing to $200bn.
They went to Treasury and health department officials to try and cut back or rationalise on various services provided to the public, and those officials trotted out their favourite cost-cutting schemes. And immediately the Australian Medical Association declared war and, of course, we will get nowhere going down this route.
28 Sep 2015 - 10:20am

All tax reforms on the table: Morrison

Treasurer Scott Morrison says the government will consider every possible tax reform to improve Australia's budget challenges.
Source:  AAP
28 Sep 2015 - 9:53 AM  UPDATED YESTERDAY 10:20 AM
Treasurer Scott Morrison is open to any tax reform proposal that will reduce reliance on federal government handouts.
"It's not about cuts, it's about control," Mr Morrison told 3AW on Monday.
"Anything that is going to help Australians work, save and invest, I am open to."
In a separate interview, the treasurer hinted at changes in the marginal tax rate to encourage people to work more.

Aged care: Health Minister Sussan Ley to pick up extra portfolio

Date September 30, 2015 - 3:06PM

Jane Lee

Legal affairs, industrial relations and science correspondent

Five women in first Turnbull cabinet

Malcolm Turnbull announces Marise Payne, Michaelia Cash and Kelly O'Dwyer will join Julie Bishop and Sussan Ley in cabinet.
One more minister will be added to Prime Minister Malcolm Turnbull's new cabinet this afternoon, a week after the first one was appointed, with Health Minister Sussan Ley also being sworn in as the minister for Aged Care.
The aged care system was until Wednesday part of the portfolio of newly appointed Social Services Minister Christian Porter.

General Budget Issues.

ALP ‘faces $57bn hit to budget’

  • The Australian
  • September 28, 2015 12:00AM

Sarah Martin

Treasurer Scott Morrison says government spending of 26 per cent of GDP was not sustainable, and vowed to address the country’s ‘spending problem’.
The Coalition will today step up its attack on Labor over more than $10 billion in new spending measures announced since the budget, claiming that the opposition now faces a $57bn budget black hole and a raft of unfunded policies.
But as the government seeks to capitalise on a lead in the polls sparked by the leadership change to Malcolm Turnbull and turns its attack to Labor’s economic credibility, Scott Morrison faces calls to further tighten government spending and pursue wide-ranging tax reform that increases revenue.
In his first interviews as Treasurer, Mr Morrison said government spending of 26 per cent of GDP was not sustainable, and vowed to address the country’s “spending problem”. He also pledged to consider any reforms that helped Australians “work, save and invest’’.
Analysts warn that the government will have to raise revenue as well as cut spending, and any ­retreat on savings measures will further expose Australia to economic shocks. This echoes warnings from former treasurer Peter Costello that the outlook for Australia was “dangerous”, particularly if China’s economy slowed.

Morrison must overcome his deficit of sense on the budget

Callam Pickering

Federal Treasurer Scott Morrison’s first week on the job started poorly but by the end of the week he was beginning to make sense on a range of important issues. The Turnbull Government isn’t the revolution that many were hoping for, but it is slowly distancing itself from its failed predecessor.
Few positions within the government are more difficult than that of federal treasurer. A significant share of the portfolio (Australia’s economic performance) is almost completely outside the control of the Treasurer or even the government.
Peter Costello is often lauded as perhaps Australia’s greatest treasurer but his success was largely a product of remarkable luck as he rode the Chinese-driven commodity boom towards record tax revenue and budget surpluses.

Scott Morrison off to a jittery start as Treasurer

Date September 29, 2015 - 6:20AM

Peter Martin

The Treasurer must accept we have a revenue problem as well as a spending problem. We want intelligent debate now, not more slogans.

Morrison says priority is tax system

Scott Morrison's first outings as Treasurer were woeful.
On the night of the spill, Malcolm Turnbull promised something different: "a style of leadership that respects the people's intelligence, that explains these complex issues and then sets out the course of action we believe we should take, and makes a case for it".
We are entitled to an open and honest conversation about how much we are prepared to pay for our services, as well as how much spending on them should be cut. 
Turnbull promised "advocacy, not slogans".

Government spending should be eventually reduced to 24% of GDP: Cormann

September 28, 2015 9.56pm AEST
Author Michelle Grattan - Professorial Fellow, University of Canberra
Finance Minister Mathias Cormann says government spending needs to be reduced over time to an average of around 24% of GDP “at the most”, and warns that sustainable budget reform cannot be delivered without continuing structural reform of programs.
Speaking at the Sydney Institute, Cormann said there was “no easy way to repair the budget, as suggested by some, just by slashing the public service”.
Spending was expected this year to come in around 26% of GDP, and was projected to come down to 25.3% by 2018-19. “But to ensure federal government expenditure is affordable in our economy and doesn’t force us into higher taxes overall, over time we need to get back to an average level of government expenditure of about 24% as a share of GDP at the most and stabilise it at that level.”

Treasurer Scott Morrison hints at changes to superannuation to make system fairer to seniors saving for retirement

Morrison flags income tax cuts

SCOTT Morrison has hinted at a superannuation overhaul to make the system fairer to seniors saving for retirement.
Mr Morrison, who with the Prime Minister will meet unions, social service groups, business lobbyists and seniors at Parliament House tomorrow to build reform consensus, said yesterday there was a policy opening under Malcolm Turnbull’s leadership.
Mr Morrison said changes to the tax system needed to be fairer and explained better to the general public.
But he said Australia needed to be resilient, especially to growth downgrades and transitioning Australian economies. The stock market fell almost 4 per cent yesterday, further worrying self-funded retirees.

Savings from Medicare review to help budget repair: Health Minister Sussan Ley

By Debleena Sarkar on September 29 2015 5:08 PM
Australian Foreign Minister Julie Bishop touches the baby of Minister for Small Business Kelly O'Dwyer as they pose for an official photograph with Prime Minister Malcolm Turnbull and the other female members of his cabinet Defence Minister Marise Payne (L), Minister for Health Sussan Ley (3rd L), and Minister for Employment Michaelia Cash (R) and other officials after a swearing in ceremony at Government House in Canberra, Australia, September 21, 2015. Australia got its fifth prime minister in as many years on Monday after the ruling Liberal Party voted to replace Abbott with former investment banker Malcolm Turnbull, following months of infighting and crumbling voter support. Reuters/David Gray
The Medicare review launched by the Turnbull government on Sunday not only aims at assessing a list of 5,700 services on the Medicare Benefits Schedule, but will also help with the budget repair, said Health Minister Sussan Ley. Her confirmation of the intention of the government is in line with the warning by Treasurer Scott Morrison that Australia suffers from a spending problem. 

Our bold budget was too gutsy for parliament we had: Tony Abbott

  • The Australian
  • October 2, 2015 12:00AM

Rosie Lewis

Dennis Shanahan

Tony Abbott says not enough backers of reform supported his government’s controversial budget last year, as he declared the economic blueprint “bold” and “too gutsy” for the parliament.
The former prime minister said he was “disappointed” the Turnbull government had decided to put the Coalition’s twice-rejected higher education reforms on hold, saying they had been the “centrepiece of a brave” budget.
“Given the realities of the situation in the Senate, I can understand it, but I am disappointed by it and frankly I’m a little dis­appointed that more of the people who keep saying we need reform, we need cuts in government spending, we need long-term structural change, did not get behind the 2014 budget,” Mr Abbott told radio 3AW.

Health Budget Issues.

Medicare: review into 5700 items on Benefits Schedule slammed as ‘deeply alarming’ by Labor

  • The Australian
  • September 27, 2015 12:26PM

Rosie Lewis

The Turnbull government’s new Medicare review into all 5700 items on the Medicare Benefits Schedule has been slammed as “deeply alarming”, after Health Minister Sussan Ley called on Australians to let her know about any “unnecessary, out-dated or unsafe medical services”.
Ms Ley officially launched the start of consultations today and said the “long overdue” review was the “first of its kind” since Medicare was established in the 1980s.
Tonsillectomy surgery for kids, scans for lower back pain and bone density tests for seniors will be among the thousands of items facing a shakeup, according to a report in News Corp Australia papers.

'Long overdue' Medicare review launched

Updated: 3:07 pm, Sunday, 27 September 2015
The Turnbull government has launched a 'long overdue' review of Medicare services to bring the system into the 21st century.
There are about 5700 items on the Medicare Benefits Schedule, 70 per cent of which have not changed since since Medicare began in 1984.
'The current system is lagging in the last century, with only three per cent of all 5700 Medicare items assessed or tested to see whether they actually work, are out-of-date or even harmful,' Health Minister Sussan Ley said in a statement on Sunday.
The minister wants to hear from health professionals and patients about any services, tests or procedures they have come across in the Medicare system that are unnecessary or unsafe.

Medicare Benefits Schedule Review Taskforce

The Medicare Benefits Schedule (MBS) Review Taskforce will consider how services can be aligned with contemporary clinical evidence and improve health outcomes for patients.
Page last updated: 27 September 2015

About the Review

On 22 April 2015, the Minister of Health and Sport Sussan Ley announced a programme of work to deliver a Healthier Medicare and announced that a Medicare Benefits Schedule (MBS) Review Taskforce (Taskforce) would be established. The Taskforce will consider how the more than 5,500 items on the MBS (as of 1 April 2015) can be aligned with contemporary clinical evidence and practice and improve health outcomes for patients. The Review will be clinician-led and there are no targets for savings attached to the Review.

Medicare review ‘deeply alarming’: Labor

8:42pm, Sep 27, 2015
Emma Manser Reporter
Doctors and Labor warn the government could erode the integrity of the nation’s health system.
Health experts and Labor have slammed a review of the Medicare Benefits Schedule (MBS), saying it may see restrictions placed on medical tests and procedures.
The ALP labelled the review “deeply alarming”, while the Australian Medical Association said it was an “attack on the integrity of Medicare and the medical profession”.
The MBS sets out the services subsidised by the Australian Government under the Medicare program.
Health Minister Sussan Ley said in a statement on Sunday many of them were “out-of-date or even harmful”.

Australian Medical Association accuses government of attack on doctors' integrity

Date September 28, 2015 - 5:40AM

Lucy Hughes Jones

The federal government has attacked the integrity of doctors while announcing a review of Medicare, the Australian Medical Association says.
The Turnbull government has launched a "long overdue" review of Medicare services to bring the system into the 21st century.
While AMA president Professor Brian Owler​ agreed the Medicare Benefits Schedule (MBS) was outdated, he said Health Minister Sussan Ley had indicated doctors were using it to perform unsafe and unnecessary procedures, harming patients for financial gain.
"This is a direct attack on the integrity of the medical profession," he said.
"It's an approach that undermines the confidence that patients have in their doctors; it's unacceptable."

Doctors group condemns Medicare review as an attack on GP integrity

Australian Medical Association says reviewing every item on the Medicare benefits scheme on safety grounds suggests doctors use it as a cash cow
The federal minister for health, Sussan Ley, has announced the government will review the entire Medicare benefits schedule. Photograph: Mick Tsikas/AAP
The Australian Medical Association (AMA) has condemned suggestions that a review into Medicare would improve patients’ safety, saying the consultation is a “direct attack on the integrity of the medical profession”.
The health minister, Sussan Ley, on Sunday announced that the government would review all of the nearly 5,800 items on the Medicare benefits schedule (MBS) as part of a consultation process aimed at weeding out unnecessary, unsafe and outdated procedures.

Shake-up to tackle doctor’s windfall

  • Renee Viellaris
  • The Courier-Mail
  • September 28, 2015 12:00AM
DOCTORS are charging taxpayers twice or even three times in one day to treat a patient’s condition during the same consultation.
The windfall — particularly for obstetricians and oncologists — looks set to be on the Turnbull Government’s chopping block as the Medicare Benefits Schedule undergoes one of its biggest overhauls.
The Government is reviewing all 5700 items on the MBS.
When billing the Commonwealth, medicos cite an eligible item number. But some of the items are old and also more expensive than safer and newer alternative treatments.
Yesterday Labor attacked the Government for trying to make health more expensive for families, while Health Minister Sussan Ley criticised the Opposition for not engaging in meaningful reform.

Doctors slam Sussan Ley’s MBS review as an ‘attack on integrity’

  • The Australian
  • September 28, 2015 12:00AM

Sarah Martin

Doctors have attacked the government for its proposed review of almost 6000 Medicare rebates, saying the profession is being unfairly accused of providing unnecessary, outdated and unsafe medical services.
Launching a review of the Medicare Benefits Schedule yesterday, Health Minister Sussan Ley said the “challenging but necessary” update was needed to reflect modern clinical practice.
About 70 per cent of the 5700 MBS items charged to government by doctors have not changed since 1984. “What we have in the MBS is a large number of items that have not been renewed or refreshed since the early 80s when it began,” Ms Ley said.
“It doesn’t reflect clinical practice, it needs to be updated.”

News in brief

Monday, 28 September, 2015

Health expenditure continues to grow

HEALTH expenditure in Australia in 2013‒2014 grew relatively slowly to an estimated total of $154.6 billion, up 3.1% on 2012‒2013 in real terms (after adjusting for inflation), according to a report released last week by the Australian Institute of Health and Welfare. The report said an estimated $6639 was spent on health per person in 2013–2014, up by $94 on the previous year — a 1.4% growth rate, which was less than half the 3.3% average annual growth over the past decade. Health represented 9.8% of Australia’s gross domestic product (GDP) in 2013‒2014, a 0.1% rise from 2012‒2013. Government revenue totalled $104.8 billion (67.8% of total health expenditure) but the federal government’s share of total health expenditure declined from 43.8% in 2008‒2009 to 41.2% in 2013‒2014. State, territory and local government share of expenditure has been around 26.6% since 2009‒2010, the report said. In the past decade out-of-pocket payments by individuals was the fastest growing area of non-government spending on health, growing to an average of 6.2% a year. The proportion of total health funding from private health insurance funds had declined steadily since 2003‒2004 from 8.1% to 7.4% in 2011‒2012, before rising to 8.3% in 2013‒2014, when the changes to income testing for the government’s private health insurance premium rebates were introduced, reducing the government’s contribution. When compared with taxation revenue, government health spending represented the same proportion of taxation revenue (24.7%) as the previous year, the report said.

Primary Health to take Medicare review hit, analysts warn

Sarah-Jane Tasker

Primary Health Care will be hit by the government’s review of the Medicare benefits schedule, analysts warn.
The government review, coupled with the current freeze on GP-fee indexation puts Primary (PRY) directly in the firing line given its bulk-billing focused business model, Morningstar’s healthcare analyst Chris Kallos said.
“Primary’s value proposition to doctors is based on providing a total infrastructure package allowing GPs to focus on clinical practice rather business administration,” he said.
Primary is the second-largest pathology and diagnostic imaging provider in Australia after Sonic Healthcare but unlike Sonic, Mr Kallos said Primary was reliant on the domestic market.

Tests and treatments which achieve nothing could be on the way out to reduce wasted spending

September 28, 201511:46am
There are 150 MRI scans on knees each year, with Dr Swan suggesting many of these won’t lead to any pain relief.
YOU might have to get used to your wonky knees, back twinges and even chest pains because tests for these ailments could soon be rationed.
There is a mounting argument these tests and any subsequent operations do little or nothing — and might even be harmful — and they are massively expensive.
They keep pumping up the nation’s health bill, now at $155 billion a year, and in some cases patients don’t actually get better.
“We’ve been trained to expect as a community that there are all these marvellous tests and procedures and we should have access to them because it’s going to answer our questions,” the ABC’s health reporter Dr Norman Swan said today.

Greens, health funds back Medicare rebate review

Sid Maher

Sarah-Jane Tasker

The Greens and key health funds have backed the Turnbull government’s review of almost 6000 Medicare rebates that has drawn fire from doctors and Labor.
Greens leader Richard Di ­Natale said procedures such as knee arthroscopies for osteoporosis, vitamin D tests and hysterectomies were among procedures that needed review.
The row over the Medicare Benefits Schedule review came as the ABC’s Four Corners reported last night that about one-third of health spending — about $46 billion — was being wasted.
Senator Di Natale said the Greens would support the review as long as the savings were reinvested into procedures that more accurately reflected modern practice or preventive health measures such as chronic disease management plans.

Dr Google ‘choking Medicare’

  • Renee Viellaris
  • The Courier-Mail
  • September 29, 2015 12:00AM
THE Turnbull Government has cautioned patients against diagnosing themselves on “Dr Google’’ and then demanding unnecessary and costly treatments from medicos.
The health budget is being strained by online DIY diagnoses and doctors who order redundant tests.
Health Minster Sussan Ley, who is being attacked by the Australian Medical Association for reviewing the relevance of almost 6000 item numbers subsidised on the Medicare Benefits Schedule, said Dr Google was one of the reasons why clinical criteria needed to be strengthened.

How to rein in healthcare spending

Over the past quarter century, healthcare expenditure has grown more quickly than economic growth in almost every OECD country. With the ‘baby boomers’ entering retirement, the existing projects for public healthcare expenditure appear unsustainable in the long term. What can advanced economies do when reducing service quality is not an option?
Spending on healthcare services -- of which around three-quarters is accounted for by the public sector -- has become a significant issue for most advanced economies. Recent work by the OECD shows that “going over budget on health spending remains endemic in most OECD countries”.
Across the OECD, private and public spending on healthcare accounted for 9.2 per cent of GDP in 2012. Expenditure took a hit in the aftermath of the global financial crisis as countries across the eurozone were forced to scale back budgets. As a result, healthcare spending is slightly below its peak as a share of GDP.

Give the AMA a bypass and privatise public hospitals

The Australian Medical Association’s pre-emptive political strike on the Medicare services review shows that some members of the medical profession believe only the doctor’s union should make health policy in this country.
Given the evident sense of entitlement, and the self-serving belief that no savings can be made from the health system, it beggars belief some are suggesting taxes should be raised principally to feed the beast that is Medicare.
Many budget experts are calling for a range of tax increases to close the fiscal gap between government revenue and expenditure. But before allowing the nation to be dragged over the cliff of higher tax and spend policies, we should stop, think and understand how acting on this advice would be the antithesis of true economic reform.

Future-proofing healthcare - press the reset button

Date September 30, 2015 - 9:00PM

Jeffrey Braithwaite

About a third of spending is wasted on tests and procedures that do little to improve a patient’s condition.
One in every 10 patients in our hospitals is actually harmed by our healthcare system through errors, omissions or miscommunication. Photo: Nicolas Walker
The tens of billions of dollars spent on unnecessary or inappropriate medical tests and treatments in Australia every year is not just a phenomenal waste of tight healthcare budgets. It shows modern healthcare systems needs more than just a spring clean to ensure we can meet future demands and keep up with advances in biomedical technology.
The challenge is not insurmountable. We can reset the way our system works. Much of the research we need to sort this out is already under way. 
First, the negative headlines. Australians receive care in line with the latest evidence in only 57 per cent of cases. And delivery of care is uneven. For some conditions, like coronary artery disease, most Australians receive excellent care, but for others such as obesity, antibiotic use and alcohol dependence, more than two-thirds of care isn’t up to scratch. On top of this about a third of spending is wasted on tests and procedures that do little to improve a patient’s condition, as Four Corners detailed this week.
1 Oct 2015 - 8:34am

Many Australians can't afford to fill their prescriptions, new data reveals

More than 10 per cent of Australians in some areas can't afford to fill their prescriptions, meaning their medical conditions cannot be properly managed, new data reveals.
30 Sep 2015 - 5:48 PM  UPDATED 6 HOURS AGO
Many Australian adults cannot afford to fill prescriptions, with rates as high as 13 per cent in some parts of the country.
The situation is worst in the Darling Downs and West Moreton (DDWM) Primary Health Network, according to new health survey data released on Thursday.
The first analysis of its kind from the National Health Performance Authority reveals 13 per cent of adults in the DDWM health network in south-east Queensland could not afford to fill their prescriptions in 2013-14.
Brisbane had relatively high rates of people who could not afford their prescriptions – 10 per cent for Brisbane North and 12 per cent for Brisbane South PHNs.

Health Insurance Issues.

Means testing to start stampede: HBF

Health insurer HBF has called on the federal government to meet its pre-election commitment and remove the means test on the health insurance rebate, warning of a 300 per cent increase in the number of its members downgrading their policies.
Managing director Rob Bransby said the government, when in opposition, had committed to remove the means test, which he said was urgently needed to ­address a system that was becoming unsustainable.
Over the past couple of years, HBF has seen a significant number of members downgrade policies and a 400 per cent increase in the number of people taking out exclusionary products.
“We are seeing that our sales mix has shifted so what was about 8 per cent of our sales in exclusionary or downgraded product is probably now around 14 to 15 per cent,” Mr Bransby said.
“Even those new to market are taking out a product they can afford as distinct to what they need.”
New national research done by HBF shows that many health fund members believe they will be forced to drop or downgrade their cover in the future unless issues of affordability are addressed.
It has been an interesting time with the new Government settling in and all sorts of options now back on the table. Health is also clearly under review as far as its budget is concerned. Lots to keep up with here!