Friday, May 22, 2015

An Expert View Of Just How Off The Rails E-Health Seems To Be At Present And How It Might Be Fixed.

This appeared last week in response to the E-Health Announcements last week and seemed to me to put a sound view of what we are seeing and to be trying to suggest the level of thought being applied to e-Health globally my need to be improved. More people need to read it!

A modest e-health proposal to government

Enrico Coiera
May 12, 2015
Dear [insert country name] Government,
E-health is hard. I think we can all agree on that by now. You have spent [insert currency] [insert number] billion on e-health programs of one form or another over the last decade, and no one knows better than you how hard it is to demonstrate that you are making a difference to the quality, safety or efficiency of health care.
You also know that so much of e-health needs to happen in the public domain that, irrespective of your desire to privatise the problem, you will end up holding the can for much of what happens. E-health is your responsibility, and your citizens will, rightly or wrongly, hold you accountable.
It is so hard to get good strategic advice on e-health. You recently commissioned [insert large international consultancy firm] to prepare a new national e-health strategy, and it didn’t come cheap at [insert currency] [insert number] million. In the end it told you nothing you didn’t really already know, but at least you can say you tried.
You also commissioned [insert large international consultancy firm] to prepare a business case to back up that strategy, and it didn’t come cheaply either at [insert currency] [insert number] million. The numbers they came up with were big enough to convince Treasury to fund the national strategy, but deep in your heart of hearts you know you’ll never see a fraction of the [insert currency] promised.
It’s also really hard to find organisations that can deliver nation-scale e-health to time, to budget and of a quality that the professions and the voters all agree it’s a good thing. You want the IT folks who build these systems to understand health care, its needs and challenges, deeply. Just because they can build a great payroll system or website does not qualify them to jump in and manage an e-health project. Do you remember how [insert large IT company] ended up crashing and burning when they took on the [insert now legendary e-health project disaster]? We can all agree that didn’t go as planned, and that you didn’t exactly enjoy the coverage in the press and social media.
What you really want firstly is impartial, cheap and informed expert advice because you are in the end driven to do the right thing. Given the heated and partisan nature of politics, that advice needs to come from safe and trusted individuals. That often means the advice comes from within the tent of government, or from paid consultancies where legal contracts and the promise of future work secure your trust. You also want the IT folks who build your systems to be deeply trained in the complexities of implementing systems for e-health. The health professions, and indeed the voters, also need to be sophisticated enough to understand how to use these systems, and their limitations. That’s going to maximise your chances of success, as well as blunt the uninformed chatter that so often derails otherwise good policy.
Our proposal is a simple one. We suggest you set aside 10% of the E-health budget to train the next generation of e-health designers, builders, and users. Use the funds to resource training programs at the Masters level for future e-health policy leaders, as well as system designers, builders and implementers. Let us provide incentives to include e-health in health profession training both at primary degree and for continuing education. Let us also invest in training the public in the safe and effective use of e-health. Investing in creating a critical mass of skilled people over 5 years will be your best insurance that, when you are again faced with e-health, you have a real chance of doing the right thing.
Given how little outcome you have had for your e-health investments over the last decade, and the harsh reality that little will change over the next, this is a chance to rewrite the script. Invest in people and skills, and you might find that with time e-health isn’t so hard after all.
[insert name of concerned citizen, NGO, or professional association]
[insert date]
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Here is the link:
I like the idea - but we need to pause the spending and doing things until we get these experts in place!
David.

Thursday, May 21, 2015

2016 Budget - Articles Covering The Big Changes And Impact! It Is Amazing To See The Level Of Change In One Year.

Budget Night was May 12, 2015.
I think it is fair to say we have had the switch from austerity to generosity and stimulus in just one year - doubtless due the  ‘political near-death experience’ of the present Government leader a few months ago!
The bottom line with all this is that other than the extra support for small business there has already seemingly been some mis-steps in the way all the rest of the of the changes have been designed and sold. ( Accusing  ordinary Mum’s who acted honestly to be fraudsters is not a good look). It’ s not clear again - sadly - just how much of the ideas on health, childcare etc. will make it through the Senate! Back to the future?
Here are the articles I found helpful this week (excluding e-Health).
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General Budget Issues.

Federal budget 2015: Landing on a wing and a prayer

Date May 12, 2015 - 12:00AM

Peter Martin

With a deficit that is growing by the day, a strong budget has never been more necessary or less likely.
There's been something odd about the lead-up to tonight's budget. Time and time again Joe Hockey has floated ideas only to have them knocked down. He suggested what he would soon be doing about negative gearing only to have Morrison and Abbott slap him down. He suggested he would look at super tax concessions, only to have just about the entire party slap him down.
Tony Abbott, not Hockey, chaired every one of the expenditure review committee meetings. The last time around he let Hockey deputise for him when he was away. Scott Morrison, not Hockey has been fronting budget press conferences. One of the cruelest photos on  The Age's website shows Hockey posing for pre-budget photos in his inner office while in the outer one Scott Morrison is on the TV announcing the childcare package.
Doing no harm is now the top priority. 
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Budget puts Hockey in same bracket as Swan

Oh dear, oh dear, let’s hope Joe Hockey’s second budget doesn’t prove to be his, ahem, fiscal “Swan song”.
It’s passed largely unnoticed or unremarked how excruciatingly similar Tuesday’s effort was to Wayne Swan’s ignominious 2012 budget. Indeed, the — in both cases, unheralded — centrepiece was all but exactly the same.
Swan built his budget and his infamous, ill-fated, if all-too-characteristic claim of the “four years of surpluses I announce tonight” on a projected $109 billion a year of extra revenue by the fourth “out” year of the budget projections.
The single biggest contribution was going to be an extra $52bn a year from personal income tax, with a big chunk of that coming as a result of bracket creep.
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Budget 2015: Federal spending on social services per person to fall

Date May 16, 2015 - 12:15AM

Matt Wade

Senior writer

EXCLUSIVE
Federal government spending per person on key services will shrink over the next four years even though the amount allocated to them is forecast to reach record highs.
Australia's robust population growth rate means federal health spending per capita will be $104 lower in real terms by 2018-19 than this financial year, analysis of the budget by the Australia Institute shows. Per capita spending on education will fall by $74 in real terms over the budget's four year forward estimates.
The institute's analysis also reveals that overall federal government spending per person is set to fall from $17,893 per person this financial year to $17,611 in 2017-18.
The projected fall in spending per person will put more stress on social services.
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Controversial Announcements.

Double-dipping new mothers won’t get any Government money

  • Ellen Whinnett
  • Herald Sun
  • May 11, 2015 6:51AM
TENS of thousands of new mums who claim government-funded paid parental leave as well as employer parental leave will be hit in a move by Treasurer Joe Hockey to shave $1 billion off the Budget bottom line.
Mr Hockey said on Sunday “double-dipping’’ parents would be stopped from accessing the Government’s paid parental leave scheme if their employer’s scheme was more generous.
 “At the moment, people can claim parental leave payments from both the Government and their employers so they are effectively double dipping. We’re going to stop that,’’ Mr Hockey said.
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Federal budget 2015: How Christopher Pyne 'fixed' research funding

Date May 13, 2015 - 11:12AM

Matthew Knott

Communications and education correspondent

He fixed it. 
Now the surprise has been revealed 
In March, Education Minister Christopher Pyne was accused by crossbench senators of playing "undergraduate politics" by linking continued funding for world-renowned scientific research facilities to the passage of university fee deregulation through the Senate.
A day after saying the two issues were "inextricably linked", Mr Pyne announced he had found $150 million to continue to fund the National Research Infrastructure Strategy (NCRIS), regardless of whether his reforms flew or flopped.
It was a major relief for the scientific research community, given NCRIS helps fund ocean monitoring facilities, has led to major health breakthroughs and supports advances in high-end manufacturing. But there were fears the government would slash other important research programs to pay for it. 
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‘Dull budget’ doesn’t please all

11:45am, May 13, 2015
Dan Moss AM News Reporter
Industry leaders have given their verdict, and they are by no means a universally happy bunch.
The nation has reacted with head-scratching to the Federal Budget as it proves the ideological battles of the Abbott Government — climate change, ending the age of entitlement, budget emergencies — are in a holding pattern or have been sacrificed on the altar of the gods of opinion polls.
Commentators have had their say, and here are some of the vital assessments from community leaders after the budget finally showed the way the government was to fund their sectors.
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  • Updated May 13 2015 at 4:41 PM

Federal Budget 2015: Stakes alarmingly high in Joe Hockey's economic gamble

by Warwick McKibbin
The 2015 Australian budget is a political budget which postpones the medium term fiscal adjustment that the Australian economy needs. It is a reflection of the state of Australian politics today.
It is easy to argue that the Treasurer had no choice but to come up with a reasonable budget, given clear political constraints. The federal budget does little economic damage and has some good aspects especially for small business which is a key driver of growth in the Australian economy. But like Labor budgets in previous years, this budget takes a big bet on a future that might not eventuate. Labor lost that bet every year to leave Australia with a problematic fiscal legacy. There is every chance that this budget will expose Australia even more to the many risks in the global economy.
Rather than focus on the winners and losers which is what a political budget encourages, the budget should be evaluated relative to the type of fiscal policy that Australia needs to sustain economic growth and maintain social cohesion.
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Joe blasts ‘welfare rich’ who have more money to spend than workers

  • Samantha Maiden National Political Editor
  • The Sunday Telegraph
  • May 17, 2015 12:00AM
TAXPAYERS have a right to know how much welfare they are really paying for, Treasurer Joe Hockey said.
In an exclusive interview with The Sunday Telegraph, Mr Hockey said he had insisted that the federal Budget papers reveal the true disparity in disposable income between people who worked full-time and those who received welfare.
The figures show that singles earning $80,000 a year have less disposable income than a single parent with two kids earning $30,000 when welfare is factored in.
And a double-income family earning $100,000 is in some cases paying no net tax when childcare assistance and middle class welfare are offset against income tax.
Mr Hockey has demanded that the Budget papers reveal for the first time the disposable ­income, tax contribution and welfare bill for households to help voters understand where their tax is going.
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Health Budget Issues.

Federal budget 2015: Nearly $2 billion in cuts to health system

Date May 12, 2015 - 8:41PM

Amy Corderoy, Dan Harrison

The Abbott government will cut nearly $2 billion from the health system over the next five years, while pushing ahead with controversial changes to the way it funds state-run public hospitals.
After angering voters last year with proposals for a Medicare co-payment, Health Minister Sussan Ley has looked for savings from a range of little-known programs, including grants for preventative health research, chronic disease prevention and rural outreach. 
Ms Ley says the budget still represents a "sensible and moderate" increase in funding – to more than $69 billion next financial year. Health spending is projected to increase by 3.2 per cent in real terms over the next four years.
The government is proceeding cautiously on Medicare reform, allocating $34 million to support the work of taskforces which will examine elements of the system and present reform blueprints to the government by the end of the year.
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Govt looks to health dept for savings

  • AAP
  • May 12, 2015 9:30PM
An efficiency drive in the health department will save more than one billion dollars, the federal government says.
Finance Minister Mathias Cormann already has announced $113 million in health savings over five years as part of the coalition's Smaller Government efficiencies.
However, Tuesday's budget also includes savings of $962.8 over five years, as part of a government push to streamline and rationalise funding for health programs.
The savings include the scrapping of Labor's GP Super Clinics, changes to preventative health programs, and redesign of a rural relocation scheme for dentists.
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Federal budget 2015: 'No jab, no pay' tipped to save $500 million

Date May 12, 2015 - 7:23PM

Amy Corderoy and Dan Harrison

Budget 2015: How will it affect your hip pocket

Matt Wade outlines the likely impact of Joe Hockey's budget measures on Australian families.
The government estimates it will save more than $500 million from its "no jab, no pay" policy, which will stop families of unvaccinated children from accessing family and child care benefits.
It is estimated this "stick" to punish parents who refuse to vaccinate their children will affect at least 10,000 families in the 2016/17 financial year alone, saving $142 million and totalling $508 million over the next four years.
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Budget cuts $1.8bn from health to pay for medical research fund and PBS drugs

‘Rationalising’ grant programs and preventative health research to cover first Medical Research Future Fund grants and new subsidised treatments
Daniel Hurst Political correspondent
The Abbott government has outlined more than $1.8bn in health cuts, including “rationalising and streamlining” grant programs and preventative health research.
Budget papers published on Tuesday said the savings would be redirected to other health initiatives or channelled into the controversial Medical Research Future Fund that was one of the centrepieces of last year’s budget.
Big new spending measures in the health portfolio include $1.58bn for new and amended listings of medicines on the Pharmaceutical Benefits Scheme (PBS).
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Medicine prices will rise by up to $5 a script from January next year

  • May 12, 2015 9:03PM
  • Sue Dunlevy

Budget 2015: GP fee gone, but prescription fees up

MEDICINE prices will rise by up to $5 a script from January next year as the government announced spending cuts to health worth more than $2 billion.
Among measures struck by the budget axe are rebates for dentist services for children, GP health checks for young kids and financial incentives for rural doctors.
Funding for a new cervical cancer test means women will only need to be screened every five years instead of the current two years.
In good news for cancer patients and the elderly the government will subsidise $1.3 billion worth of high cost new medicines.
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Federal budget 2015: Health groups kept in the dark on funding cuts

Date May 13, 2015 - 10:44AM

Amy Corderoy

Health Editor, Sydney Morning Herald

Health groups have been left scrambling after the federal budget revealed plans to cut nearly $2 billion from the health system, but gave little detail about which programs would be cut.
Fairfax Media understands many of the groups who had travelled to Canberra for the budget  announcement were furious about the lack of information provided, with those in the official "lock-up" for hours being given a short summary of the changes rather than the official budget papers.
The government has said it will make nearly $1 billion of its savings by "rationalising and streamlining funding across a range of health programmes", primarily through cuts to the Health Portfolio Flexible Funds.
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Budget Rips Another $2B from Health - Labor

Posted: Wednesday, May 13, 2015 - 10:51
The Federal Budget has cut a further $2 billion from health funding forcing front-line NFPs to close their doors, according to the Federal Labor Opposition.
Shadow Minister for Health Catherine King said the Abbott Government appears determined to inflict even more pain and chaos on a health sector already reeling from last year’s cuts.
“Despite Tony Abbott’s solemn election promise of “no cuts to health” he has now cut around $60 billion since he was elected,” King said.
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Doctors warn of GP co-payment by stealth

14 May, 2015 0 comments
The freeze on the Medicare rebate is effectively a GP co-payment by stealth, says the AMA.
Modelling has shown the indexation freeze could force doctors to pass on out-of-pocket expenses to patients, says the organisation’s president, Associate Professor Brian Owler (pictured).
And there is no indication in the Budget that the freeze will end before 2018.
That could result in a patient co-payment of as much as $8, more than the $5 proposed by the government before it dumped its plan.
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Budget 2015: Sussan Ley to act on AMA fears over cuts to health

Sean Parnell

Health Minister Sussan Ley has agreed to go through the budget “line by line” with the head of the Australian Medical Association amid concerns the Abbott government is interested only in cuts.
AMA president Brian Owler was one of several stakeholders on budget night to criticise the lack of detail on various cost-savings measures. The budget included a range of smaller cuts totalling almost $1.9 billion and intended to either be returned to the health portfolio or the planned Medical Research Future Fund.
While the controversial co-payment has been dumped, the Medicare freeze remains, and increased drug co-payments are still on the table along with drug pricing reforms and a yet-to-be finalised pharmacy agreement.
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  • May 14 2015 at 8:58 PM

Health funding: Hospital funding cuts strain Fed-state relations

by John Daley
In all the noise about last year's budget, and the less noise about this year's budget, the biggest change is one of the least discussed. In 2014 the Commonwealth cut the funding it had promised to the states for hospitals under an agreement signed in 2011.
The cuts are huge – $4 billion in 2017-18, and $11 billion by 2024-25. They improve the Commonwealth's budget balance by 1.4 per cent of gross domestic product by the end of the intergenerational report projections. The proposed changes to age pension indexation in 2014 were politically big news, but in the long run the hospitals cuts were 50 per cent larger.
Of course, the cuts don't solve the budget problem, they merely transfer it. In effect they make the states pay for all the real increases in hospital spending. Health spending for a person of a given age grew at 3 per cent a year in real terms over the past 20 years – much faster than GDP per person. Health spending already consumes a quarter of state budgets.
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GP visit costs tipped to rise because of budget benefits freeze

Date May 14, 2015 - 1:02AM

Craig Butt

Australians could face the introduction of a GP co-payment by "stealth" as fewer practices are predicted to offer free "bulk-billing" services because of budget measures, doctors warn.
The budget made no changes to a freeze in Medicare rebate increases for doctor's visits, which Australian Medical Association president Brian Owler said would result in additional costs having to be passed on to patients.
"We will see less bulk-billing and there is the possibility of seeing a co-payment by stealth, as has been alluded to by some," he said.
The proposed GP co-payment plan, which would have added $5 to the cost of a consultation, was jettisoned by the Abbott government in March.
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Budget 2015: Research undermines claim of $8 ‘co-payment’

Sean Parnell

Health Department modelling of the Medicare freeze imposed by the Abbott government undermines claims it will force GPs to impose an $8 co-payment.
Having dumped plans for a co-payment, the government is now saving money by keeping the freeze on Medicare rebate indexation introduced by the former Labor government.
Under a measure announced before the budget, the government will hold back $1.3 billion in rebates that would otherwise have flowed to doctors by 2018.
Opposition health spokeswoman Catherine King and Australian Medical Association president Brian Owler have both sought to highlight University of Sydney research suggesting the freeze would force GPs to recover up to $8.43 a patient in 2018.
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What's in the budget for health?

13 May, 2015 Paul Smith
This year's federal budget for health is a lot like an iceberg — plenty to see on the surface, but what lurks beneath?
The visible bit is that the after-hours Practice Incentives Program payment is coming back in July.
Followers of the often-repetitious narrative of medico-politics will remember that the money for the PIP payment — worth around $60 million a year — was taken away by the previous government in 2013 and handed to Medicare Locals.
We don’t know how the new-old PIP will be structured. It used to pay at three tiers, depending on the level of after-hours services provided by the practice.
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Doctors paid after hours incentives without ever seeing a patient

  • May 16, 2015 12:00AM
  • Sun Dunlevy
EXCLUSIVE: Doctors were claiming taxpayer funded incentive payments for after hours care without providing any services, a due diligence study has found.
Others charged such exorbitant fees no patient would be able to afford a call-out. The intent: On-call doctors never had disrupt their leisure time to make an after hours visit.
This is the deeply flawed scheme the Federal Government has announced will be reintroduced after Medicare Locals are axed on June 30.
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Medical Future Fund.

Scientists cheer vow to establish $20bn medical research fund

Rosie Lewis

Scientists have applauded the ­Abbott government for sticking to a pledge to establish the $20 billion Medical Research Future Fund.
The government will introduce legislation to parliament in coming weeks and — pending Senate approval — plans to have it established on August 1. The budget will also reveal an initial $10 million from the fund will go towards medical research in 2015-16. The MRFF was one of the ­Abbott government’s big ­announcements in last year’s budget but its future had been uncertain after one of its major funding mechanisms, the $7 GP co-payment, was scrapped. It was meant to have been established on January 1.
The MRFF action group’s spokesman, Brendan Crabb, a former president of the Association of Australian Medical Research Institutes, said the lengthy delay was not a major concern: “This is a very, very bold policy and the fact that it took nine months-plus to get there is really neither here nor there with something this big. It’s very easy not to do this, it’s very easy not to do things that are going to have benefits in a decade or two, and yet they are doing it, and they deserve enormous credit for that.”
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Budget 2015: Hockey links pharmacy reforms to research fund

Sean Parnell

Joe Hockey has linked massive changes to pharmaceutical drug pricing to the flagship medical ­research fund from the last budget, declaring the Coalition will ­continue to pursue breakthrough treatments.
In the budget handed down last night, the Abbott government has remained firm in its commitment to push drug companies to provide savings for patients, though it has yet to finalise a dispensing agreement with pharmacists.
New and amended listings on the Pharmaceutical Benefits Scheme amounted to $1.6 billion over five years, while price amendments will return $252.2 million over five years, the government determined to find savings at every point of the supply chain.
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Pharmacy Issues.

Pharmacists offered $3bn boost in funding

Sean Parnell

Pharmacists have been offered a $3 billion increase in commonwealth funding to dispense medicines and run programs over the next five years, despite significant drug reforms, a Medicare freeze and concerns over the health ­budget.
As the Abbott government shifts the focus from higher co-payments to more complex drug subsidy and listing reforms, The Australian has learned that an $18.9bn package has been placed on the table for the next community pharmacy agreement.
The current $15.7bn agreement, negotiated under Labor, expires at the end of next month and has been heavily criticised by the Australian National Audit Office, health economists and consumer groups for its lack of transparency and accountability.
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Budget 2015: Your earnings not our job, Ley tells pharmacists

Sean Parnell

Health Minister Sussan Ley has rejected Pharmacy Guild concerns about the “bankable” level of a proposed five-year dispensing agreement, saying it is not the government’s job to guarantee their future earnings.
The Australian revealed yesterday that the Abbott government had offered an $18.9 billion community pharmacy package, but the guild was holding out for higher block funding rather than have certain funds tied to performance.
The Pharmacy Guild yesterday released a statement confirming the proposal, but argued that broader drug chain reforms would leave chemists worse off in real terms than under the $15.7bn package negotiated five years ago.
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Health Minister Ley confirms 6CPA rumours

12 May, 2015 Meg Pigram 0 comments
Federal Health Minister Sussan Ley has confirmed that the rumoured 6CPA figures are within the “ballpark” of the agreement offer.
Speaking with The Conversation, Ms Ley says the parties are nearing the final stage of their robust negotiations.
“$18.9bn is in the ballpark. Finance works closely with costing and I am certainly not in the business of presenting amounts that are not real,” she says.
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Budget 2015: Cost-cutting a bitter pill for pharmacists

Sean Parnell

After the Abbott government sought to increase patient co-payments for scripts, then boldly suggested pharmacists absorb part of that themselves, Catherine Bronger didn’t know what to expect from last night’s budget.
There were the previously announced changes to drug subsidies and pricing, and confirmation of delays to safety net changes, but nothing to show the government valued the work of pharmacists.
The Sydney pharmacist last night could only hope the government finalised the next five-year Community Pharmacy Agreement soon — with a comprehensive response to the challenges in the sector.
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Pharmacy spared excessive budget pain

13 May, 2015 Chris Brooker
Presenting the Budget yesterday, Federal Treasurer Joe Hockey (pictured)announced that the government was lifting the PBS patient co-payment and safety net thresholds, as had been first suggested in the 2014 Budget.
The Budget papers however, contain no mention of widely touted possible measures such as the $1 co-payment discount at pharmacists’ expense.
There had been much talk in the lead-up to the Budget about pharmacists and pharmaceutical industry groups mobilising to combat suggested measures that would result in savings of up to $5 billion from the PBS over the next five years.
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Enjoy.
David.