Friday, March 06, 2015

This Is An Interesting Discussion On Some Ways Of Saving And Or Improving The Health System.

There was an interesting discussion broadcast last week:

Saving Health

It’s the conversation that doctors and patients want to have, but many politicians are avoiding – how do we create a patient-focused healthcare system?
By SBS Insight
Airdate: Tuesday, February 24, 2015 - 20:30
Channel:  SBS One
Carly Stewart's seven-year-old son Lachlan has cerebral palsy, requiring treatment from up to eight different hospital departments. She says the biggest hurdle for her family is poor communication between doctors across these departments.
Two-year-old James Robins has cystic fibrosis, and requires consistent medical care. His mother, Katherine, prefers to use Hospital in the Home (HITH) wherever possible, because it gives James a sense of normality in his daily routine, and reduces his chances of contracting further infections.
Dr Charlotte Hespe has been in general practice for over 20 years. She says a doctor's primary focus is the patient, but feels their efforts are supremely hampered by an unnecessary amount of red tape.
Terry Barnes, the man who floated the idea of a GP co-payment in recent times, and a former advisor to the Howard government, is frustrated by the current debate. He feels that whilst the co-payment remains on the table, any chance at greater health reform is stymied by both professional and political forces.
The Federal Government's spending on health care was around $30.2 billion in 2012-2013, according to the Productivity Commission's Report, and this is set to rise from 4 per cent of GDP to 7 per cent by 2059.
As the government warns of unsustainable spending, we ask: how efficient could our health system be?
This week, Insight brings together patients, carers, nurses, health professionals, and economists, to discuss the challenges in reforming healthcare.
Saving money and helping patients: can the health system do both?
Presenter: Jenny Brockie
Producer: Paige MacKenzie 
Associate Producer: Saber Baluch 

Insight, Saving Health


JENNY BROCKIE:   Welcome everyone, good to have you with us tonight. Carly, your seven year old son Lachlan has cerebral palsy. How many health professionals would Lachlan see in a year say? 
CARLY STEWART: Oh, I think currently we see about eight or nine different departments at the Children's Hospital in Melbourne mostly doctors, sometimes physios or occupational therapists, occasionally speech therapists but generally doctors at the Children's Hospital.  We don't see our GP all that often except for referrals, we also see our private paediatrician just so that we can have a bit of an overarching view of where we're going with Lachlan, a lot of the paediatricians and doctors at the hospital, though very good, work in one modality. 
JENNY BROCKIE:   So how much do all of these people talk to one another about Lachlan?  
CARLY STEWART: Very little. It is getting better but very little. I'm usually the common thread in terms of making sure that we have, um, a plan that takes into account all of the things that's happening with him health wise and physically.
JENNY BROCKIE:   Isn't there a central record of everything that's happening in the hospital with Lachlan? 
CARLY STEWART: Um, they do have a central record. However, I believe there are still some departments that hold individual records. Um, and often when you see doctors they look at those areas that look to be relevant to them rather than whatever else might be happening in his life medically at that point in time.
Much, much more follows. 
Audio and a very full transcript are available from this link:
There are a lot of interesting view expressed in this program by a range of experts with lots of discussion of the issues around information flows, communication, information sharing and care co-ordination.
E-Health as a generic gets a fair bit of discussion.
I found it interesting that when the audience was asked only two people had a PCEHR record and most had not heard of
Well done guys!

Thursday, March 05, 2015

Review Of The Ongoing Post - Budget Controversy 5th March 2015. Urgent Work Now Underway on 2016 One!

Budget Night was on Tuesday 13th May, 2014 and it is still not finalised by any means.
Both major health and education changes as well as pension changes are still stuck and we have a new Families Package being floated . Also we have only 3 sitting weeks in Parliament before the next Budget - due to be  handed down Tuesday 12th , May 2015.

The big news is the Co-Payment barnacle removal earlier this week. Sadly it seems the Government is still plotting to make many pay more to visit a GP - details yet to come. Watch this space!
Articles this week include.

General Budget Issues.

Morrison seeks common ground on childcare

By Colin Brinsden, AAP Economics Correspondent
February 22, 2015, 2:18 pm
Scott Morrison hopes to find common ground with Labor this week over childcare reforms that will be part of the Abbott government's families package.
But the social services minister has dismissed a report the government had considered kicking millionaires off the aged pension last year, describing it as a "beat up".
Mr Morrison will meet with Labor's early childhood spokeswoman Kate Ellis this week following the release of the Productivity Commission's childcare report on Friday.
"I hope we can agree ... on a package as we did when we were in opposition and we dealt with the NDIS," Mr Morrison told ABC television.

Key reports due before budget: Hockey

February 26, 2015, 1:24 pm
The federal government will release its intergenerational report and tax white paper before the May budget.
The intergenerational report is a five-yearly review by Treasury which looks at the impact of demographic change on economic growth, the financial implications of policies and trends over the next four decades.
Treasurer Joe Hockey said the report, which he described as "an exciting document", would be released on March 5.
This would be followed by "extensive consultation" with the public and a discussion paper on tax reform, before the release of the May budget and a white paper on reform of the federation.

Political Instability.

Tony Abbott's leadership enters the death zone

Date February 27, 2015 - 1:22PM

Mark Kenny

Chief political correspondent

Tony Abbott's beleaguered leadership has entered the phase where even baseless rumours tend to have a locomotive force. Such are the shadowy dynamics of leadership crises.
Momentum is running away from Abbott with the danger to his leadership being clear and present. 
Colleagues are coming to the pragmatic conclusion that irrespective of the justice of it all, the sheer distraction of leadership instability may warrant a change.

Tony Abbott stakes survival on policy reset

Dennis Shanahan

David Crowe

TONY  Abbott will seek backbench approval for a recovery plan for his government, including a likely move within days to dump the Medicare co-payment, as he stares down attempts to panic Liberal MPs into another leadership showdown.
The Prime Minister’s fightback strategy will be to refocus the budget, cement his national ­security credentials and show he is listening to the concerns of the Liberal partyroom.
Conscious of consulting his colleagues, Mr Abbott wants to discuss options with MPs before any decisions are finalised, but he is considering making a health policy statement to quell concerns about the future of Medicare. He also, as a courtesy, plans to take ­announcements on a further troop commitment in Iraq to the partyroom.
Following a meeting with New Zealand Prime Minister John Key, Mr Abbott last night said that when some “final processes have been completed” he would, within days, be able to announce that Australia would be joining New Zealand in the training of Iraqi forces.
The Intergenerational Report, to be released on Thursday, will be used to reset the campaign to fix the budget, making it clear to voters that difficult reforms will be needed to ensure the nation’s ­finances are sustainable.

Samantha Maiden: Turnbull and Morrison are dating again — and this time it’s serious

  • Samantha Maiden
  • The Sunday Telegraph
  • March 01, 2015 12:00AM
LIBERAL MP Malcolm Turnbull’s penchant for intriguing dinner companions was once dubbed “chopstick diplomacy” after he wined and dined Clive Palmer over a $17 banana split.
Just weeks after the Budget, the pair was captured laughing as they emerged from Wild Duck to a mob of photographers. To his critics, the dinner was evidence Turnbull still dreamt of becoming prime minister and was courting the millionaire MP.
Broadcaster Alan Jones pointed out Palmer had described the PM as “WTF”: Worse Than (Malcolm) Fraser.
“You have no hope of ever becoming leader,’’ Jones told Turnbull.

Health Budget Issues.

Medibank Private promises to lean hard on hospital providers

By Greg Roberts
5:00 AM Monday Feb 23, 2015
The newly privatised Australian firm Medibank Private has started flexing its muscles, leaning on hospital providers to lower their charges in a tough market for insurers.
The insurer has also begun trials with GPs to expand their services beyond basic consultations to offer more sophisticated treatment, in the hope of keeping patients out of hospital and therefore cutting the insurers' costs.
The moves come as Medibank missed its revenue growth and revenue per customer forecasts in its half year earnings, the first released since it listed on the share market.

Affordable medicines could be at risk as US seeks to firm up protections

Date February 23, 2015 - 12:15AM

Gareth Hutchens

Access to affordable medicines could be under threat in Australia if the United States gets its way in secretive negotiations over a massive trade deal involving 12 Pacific-region countries, academics have warned.
If Australian negotiators give the US what it wants in these negotiations they will also put at risk the financial sustainability of Australia's Pharmaceutical Benefits Scheme, they say.
Dr Deborah Gleeson, from Melbourne's La Trobe University, has warned in the Medical Journal of Australia that pharmaceutical monopoly protections already cost the Australian health system hundreds of millions of dollars a year, and new US ambitions for intellectual property protections would "expand and entrench" those monopolies, making it even costlier.

Hospitals forced to raise hundreds of millions from outside sources: Australian Medical Association NSW

Date February 24, 2015 - 12:15AM

Amy Corderoy

Health Editor, Sydney Morning Herald

Hospitals are being forced to cover severe funding shortfalls in NSW by raising hundreds of millions of dollars in external revenue, the state's doctors say.
They have called on the state government to urgently freeze so-called "revenue targets", which are growing at a faster pace than overall health funding.
The call is part of a broad platform of election priorities to be released by the NSW arm of the Australian Medical Association on Tuesday.
The doctors say that, particularly in western Sydney, hospitals are becoming swamped with increasing numbers of people suffering serious conditions, at the same time as federal health cuts are creating chaos and uncertainty.

Hundreds of thousands to pay much more to see GP, Senate hearing told

Date February 25, 2015 - 6:19PM

Dan Harrison

Health and Indigenous Affairs Correspondent

Hundreds of thousands of Australians who currently pay nothing to see their doctor could face having to pay the full cost of their visit upfront as a result of the Abbott government's Medicare changes, a Senate committee has heard.
Health department officials told an estimates hearing late on Wednesday that it expects about 5 per cent of services to non-concessional patients which are currently bulk-billed would be privately billed following the changes, which are due to come into effect in July.
This would mean that these patients would have to pay the full cost of the visit upfront, and make their own claim for a rebate from Medicare.
From July, the government is proposing to cut the Medicare rebate for GP visits for non-concessional patients by $5, and allow doctors to recoup the loss by charging patients a fee of up to $5.

Concerns mount for future of Medicare Local

By Kate Ramien
Feb. 26, 2015, midnight
There are growing fears for the future of health services in Gunnedah, following plans by the federal government to axe the Medicare Local network. 
Medicare Locals were set up to fill gaps in health services, with Gunnedah providing programs with a focus on Aboriginal health, as well as services like psychology, physiotherapy and podiatry.
From June 30, Australia’s 61 Medicare Locals, including the New England service which takes in 
Gunnedah, will be cut and replaced with 30 Primary Health Networks (PHNs).

Private health insurance premiums face big price hikes

Sarah Danckert

PRIVATE health insurance heavyweight Medibank Private will slug policyholders with a 6.59 per cent increase in premiums – well above the 6.18 per cent rise approved by the federal government.
Rival insurer Nib Holdings, which is primarily focussed on the under 40s market, will also increase its premiums by an average of 6.55 per cent across all products.
The changes will be effective April 1.
The increase follows on from a government-approved 6.2 per cent increase in premiums in 2014. Medibank Private, which was government owned up until its listing on the Australian Securities Exchange last year, and Nib Holdings said they had received approval from Federal Health Minister Sussan Ley to increase their premiums at above the prescribed rate.
Medibank surprised the market last week in its first set of results in private ownership with the company posting a 5.2 per cent lift in premium revenue for six months to Decemer 31 – well below the 6.2 per cent growth it promised investors it would deliver in its prospectus.

Government approves health premiums to rise 6.2pc

Sean Parnell

HEALTH  insurance premiums will rise 6.2 per cent on average for the second year running after the Abbott government approved another request from insurers to slug members more.
The increases from April 1 — including a 6.59 per cent increase for Medibank Private, its first since being privatised — will be higher in real terms for some members because the insurance rebate increases only in line with inflation.
Successive governments have approved premium increases above inflation despite warnings that rising costs are forcing members to scale back their cover.
Health Minister Sussan Ley yesterday sought to emphasise how the benefits paid to members had grown by more than $1 billion — or 7.4 per cent — to about $17.3bn in the year to December.

Medicare Co-payment Issues.

Medicare co-payments: Health Minister Sussan Ley stands firm

Date February 24, 2015 - 12:15AM

Julia Medew

Health Editor

The federal government is committed to making non-concession patients pay more to see their GP, Health Minister Sussan Ley has warned ahead of her next meeting with health and consumer groups on Tuesday.
On the eve of a meeting in Canberra with eight organisations believed to be opposed to any new GP fees, Ms Ley reiterated her view that people who can afford to pay more for healthcare should pay more.
"We're committed to maintaining high-quality care and treatment and protecting bulk-billing for concession card holders and the vulnerable and both will be high on my agenda today," she said on Monday.

Medicare: Coalition remains committed to making non-concession patients pay more

Health minister Sussan Ley vows to press ahead with plans to cut doctors’ rebates by $5 for non-concession card holders
The Australian government remains committed to reducing doctors’ rebates for non-concession card holders as consultations on Medicare continue.
Health minister Sussan Ley met community and consumer groups to discuss proposed changes to healthcare payments at their request in Canberra on Tuesday.
The minister had announced a wide-ranging consultation process to discuss future changes to Medicare, after two previous attempts at reform failed.

Medicare co-payment still on agenda

Paul Osborne, AAP Senior Political Writer
February 25, 2015, 4:40 am
Health groups say the government remains set on bringing in a Medicare co-payment, despite public and backbench MP concern.
Federal Health Minister Sussan Ley met key health consumer and community groups in Canberra on Tuesday to discuss a way forward on changes to Medicare.
Facing a public and internal party backlash, Prime Minister Tony Abbott declared the co-payment - originally proposed in last year's budget - "off the table" pending Ms Ley's consultation program.

What is the value of a Medicare price signal?

Jennifer Doggett | Feb 25, 2015 11:02PM | EMAIL | PRINT
Health Minister Sussan Ley has re-affirmed the Government’s commitment to the GP co-payment, arguing that it is necessary so that people ‘value’ the health care they receive.  In the following piece, the Consumers Health Forum CEO, Adam Stankevicius, questions the Government’s association of price signals with value, given the fact that Medicare has provided Australians with some of the best health outcomes and longest life expectancies in the world.   He writes:  
When the Government began its ill-considered attempt to cut Medicare funding last year, it should have known that provoking the doctors can turn out to be a very expensive business.
What began as a surprise measure to slug patients $7 per GP, pathology and diagnostic imaging visit, sling the doctors a couple of dollars and fund an ambitious $20 billion medical research future fund has transmogrified several times. The idea of generating more money from doctors’ visits to finance something other than doctors’ incomes was always naively ambitious.

Tony Abbott hints at dropping Medicare co-payment policy

Date February 28, 2015 - 11:45AM

Dan Harrison

Health and Indigenous Affairs Correspondent

Prime Minister Tony Abbott has given his clearest signal yet that he may be preparing to dump his controversial plan for a fee to see a GP.
Mr Abbott also promised to appear regularly with NSW Premier Mike Baird during the state campaign in a move that could unnerve some Liberal MPs concerned that an "Abbott factor" could damage the popular Premier's election prospects.
Appearing at a press conference in Auckland following talks with his New Zealand counterpart John Key, Mr Abbott was asked about media reports that he would abandon the unpopular policy.
28 Feb 2015 - 12:44pm

Government flags changes to GP plan

The federal government has indicated it will make significant changes to its proposed levy on GP visits after consultation with doctors.
Source: AAP
Assistant Treasurer Josh Frydenberg has flagged big changes to the government's proposed GP co-payment plan after consultation with health professionals on the issue.
Health Minister Sussan Ley has been consulting with doctors and health groups over plans for a $5 co-payment, which would be charged by GPs for all non-concessional patients.

Party room appears to have already decided Tony Abbott's fate

Date March 1, 2015 - 7:37AM

Tony Wright

National affairs editor of The Age

Many Coalition MPs seem to accept a change in leadership is inevitable, but are unwilling to trigger it themselves.
Bruce Billson, the Small Business Minister in Tony Abbott's government, inadvertently dropped a stink bomb among his tense colleagues during the last day of Parliament last week.
Answering a benign question about petrol prices, he took a swipe at the previous Labor government's attitude to the price watchdog, the ACCC.
"What we've found under the previous Labor Government, while they're changing leaders, changing ministers, five in 15 months, they actually forgot to actually give the resources to the ACCC to do its job properly," he said, though much of the tortured sentence was quite drowned out.

Pharmacy Issues:

Pharmacists converge on parliament

24 February, 2015 Christie Moffat
A delegation of community pharmacists has met with politicians at Parliament House to discuss the upcoming Sixth Community Pharmacy Agreement.
The Pharmacy Guild of Australia said that 55 of its members had attended meetings in Canberra over a two-day period to press for a positive outcome in the 6CPA negotiations.

6CPA in the spotlight

A Guild delegation of around 60 pharmacy owners spent two days in Canberra this week telling politicians how vital and urgent it is that a new Community Pharmacy Agreement is put in place.
The great thing about this big group was that it meant pharmacy owners were able to tell their stories of the difficulties they are facing directly to their MPs and Senators – and the stories are compelling and real.
Our message at over 70 meetings across the two days was that the threat to the viability of local pharmacies, the jobs of their staff and their services to patients is real and must be addressed as a matter of urgency.

Who should be involved in 6CPA negotiations?

24 February, 2015 Christie Moffat
A wide range of health professional groups are being consulted in preparation for the upcoming Sixth Community Pharmacy Agreement negotiations. But should they have a place at the table?
As reported earlier in February, Health Minister Sussan Ley met with a number of different health interest groups in Canberra to discuss their views on the 6CPA.
The Guild said it had met with the Minister multiple times since the start of the year to discuss the 6CPA, and that it “welcomed the government consulting with other stakeholders”.

Pharmacy civil war over advertising practices

26 February, 2015 Chris Brooker
Pharmacy is in a state of civil war over advertising guidelines and regulations, a Senate committee has heard.
Speaking at the Senate Estimates Committee additional expenses hearing, Senator Sean Edwards (SA, Lib) said there is “a civil war going on” in pharmacy regarding advertising practices and regulations.
“Practices [we] are being made aware of, I believe, warrant further investigation,” he said.
Senator Edwards, the committee chair, was referring to an ongoing investigation by the Australian Competition and Consumer Commission into claims Chemist Warehouse had misled customers over the discounts available on its products.
I also have to say reading all the articles I still have no idea what is actually going to happen with the 2015 (or the 2016) Budget (or the Government) at the end of the day. Will the Medicare Co-payment go this week I wonder?
One wonders for how much longer all this will go on and just what impact a apparently almost inevitable change of leader might have?

Wednesday, March 04, 2015

My View Is That Providing ASIO Access To Patient Records Is Going A Zillion Miles Just Too Far.

This appeared a few days ago:

Push for ASIO to be given better access to patient records

23 February, 2015 Michael Woodhead 34 comments
Photo: AAP
Security services should be given enhanced access to patients' medical records and personal Medicare and PBS data, the inquiry into Sydney's Martin Place siege has recommended.
The inquiry report, released on Sunday, found there was no indication from the medical records of Lindt Chocolate Café attacker Man Haron Monis (pictured) that he posed a risk of violence,
However it went on to conclude that current health privacy legislation "has the potential to inhibit the flow of important information in future cases" and should be reviewed by states and territories "to ensure appropriate access by ASIO [the Australian Security Intelligence Organisation]".
The joint review into the Martin Place siege conducted by the federal and NSW governments also urged for healthcare providers to take on a wider role in screening for potential extremism, and to report it to authorities.
Reviewing the actions that preceded the siege, the inquiry found that Monis had multiple interactions with healthcare providers and agencies.
But "at no time in his multiple encounters with mental health professionals was there evidence that Monis represented a potential risk to others or to himself".
The review noted there was "transactional" information showing Monis' interactions with agencies such as Medicare and the PBS, but none of this information would have changed the security assessment of him and it was not requested or shared with ASIO.
However, despite the lack of relevance in the Monis case, the review identified "legislative impediments" to the sharing of health-related information that should be addressed.
"The Review recommends all States and Territories review relevant legislation, in particular with respect to privacy and health, to ensure appropriate access by ASIO, with a report back to the Council of Australian Governments by mid-2015," it concluded.
The ultimate aim was to encourage "proactive sharing of threat information in a timely way to enable agencies to take preventative action", it said.
The Martin Place siege review also flagged a role for healthcare providers in early recognition of would-be extremists, noting that "susceptible (including perhaps mentally unstable) individuals can quickly become radicalised and rapidly move from intent to action".
More here:

Sorry, but this is simply not on unless the access is agreed to by a judge who issues a specific warrant. If there is real need for the information then obtaining a warrant will not be an issue, but unless a judge can be persuaded the confidentiality of all clinical information should be preserved under pain of severe penalty for breach.

At present in NSW there is a reasonable barrier - i.e. a real need to know - to the sharing of health information - but laws vary at Commonwealth and different state levels. My strong preference is that there be a national, consistent and pretty tough regime in place. As far as I can see there is presently no reference to health information held by medical practices in the report but it seems that all hospital encounter records are fair game.
My 2 cents. The excuse of terrorism is causing just too much erosion of our personal freedoms and privacy IMVHO.

(In passing I note the article provoked 34 mostly very annoyed comments!)


Tuesday, March 03, 2015

Surely, After This Much Has Been Spent, And All We Have Is This Set Of Numbers, The Time Has Come To Pull The Pin!

This appeared late last week.

Taxpayers have spent more than $1 billion on a digital health record that doctors won’t use

  • February 27, 2015 12:00AM
  • Sue Dunlevy National Health Reporter
  • Herald Sun
AUSTRALIANS could have had a hip replacement, a knee replacement or a brain tumour removed for the money it has cost to create the shared health summaries on their e-health records.
The botched Personally Controlled e-Health Record has been operating for nearly three years but less than one in ten Australians (2.1 million people) currently has one.
And doctors have uploaded just 41,998 shared health summaries onto these records, which means most of the more than 2 million e-health records are empty.
The scheme has so far cost taxpayers more than $1 billion to develop, or almost $24,000 per shared health summary.
Launched by the previous Labor Government in July 2012, the Personally Controlled Electronic Health Record was meant to bring medical records into the digital age and contain an electronic patient health summary, a list of allergies and medications and eventually X-rays and test results.
The Abbott Government commissioned a review of the system just after winning office, but has failed to respond to its recommendations for more than 14 months.
The review called for the system to switch from an opt in to an opt out model to speed up the toll out.
If the $1 billion spent so far is to be salvaged and the scheme fully rolled out the government needs to provide direction and funding by June 30.
Health Minster Sussan Ley said she had been listening to doctors about their experiences with Labor’s e-health system as part of her national Medicare consultations and “the prognosis isn’t good for the previous government”.
“Unfortunately Labor’s rush for glory has ended up with a false start costing taxpayers and doctors in the long run due to poor implementation and take up,” Ms Ley said.
“Labor has left a complex, expensive mess behind and this is not an easy overnight fix, but we’re continuing to put the time and effort into getting the right outcome for all involved.”
Following the release of the review report, which found significant flaws in the system, the Government has been consulting widely with key stakeholders including consumers, healthcare providers, software vendors, professional associations and peak bodies.
Opposition health spokeswoman Catherine King said the government’s review found e-health could save the health system $7 billion a year through fewer diagnoses, treatment and prescription errors, and in the process avoid thousands of unnecessary hospital admissions.
“This was clearly not the outcome the government was looking for, given its failure to act on the report for 14 months,” she said.
The committee was told only 7,645 of the 57,000 health provider organisations have so far registered to use the e-health record.
And just 274 of the 1,338 public and private hospitals around the country are connected to the e-health system.
A review of e-health by IT expert Karen Dearne notes there are an average 36 million GP consultations per day, but the PCEHR System Operator Annual Report found only a paltry 72 attempts by doctors to access e-health records each day.
The rollout of e-health records was growing strongly until late 2013 when the number of new records taken out each month began to slow considerably.
Lots more here:
There is very little to add as far as I am concerned - and surely before we waste any more money on a clear cut failure - we need to cancel the whole thing. As the Americans say - ‘this dog simply will not hunt’ and a dog it surely is!