Thursday, February 27, 2014

Pre - Budget Review Of The Health Sector - 26 February 2014.

As we head towards the Budget in Late May 2014 I thought It would be useful to keep a closer eye than usual on what was being said regarding what we might see coming out of the Budget.
According to the Australian Parliament web site Budget Night will be on Tuesday 26th May, 2014.
Here are some of the more interesting articles I have spotted this week.

Health policy expert sets agenda

17 February, 2014
The Abbott Government was elected with “almost no health policy” according to a leading academic who says it must focus on three key areas as a matter of urgency.
Professor Stephen Duckett (pictured), a health policy expert at La Trobe University and a director at the Grattan Institute, said despite an apparent health policy deficit coming into the job, the government now needs to set policies and priorities and make sure they are more than “just one-term quick fixes”.
At the very least, he says it must keep the Medicare promise, think beyond services by addressing the social determinants of health, and get governance right if it is to succeed.
Writing in the Medical Journal of Australia, he said it was critical to address the financial barriers to seeking healthcare and waiting times at public hospitals.

The Trans Pacific Partnership Agreement negotiations and the health of Australians

17 February 2014
The Trans Pacific Partnership Agreement has the potential to negatively impact the health of Australians by raising the cost of medicine and limiting the government's ability to regulate tobacco and alcohol, argues this policy brief based on publicly available and recently leaked negotiating documents.
Executive summary
The purpose of this policy brief is to inform the debate from a health perspective in the final stages of the negotiations on the Trans Pacific Partnership Agreement (TPPA), particularly during meetings of chief negotiators and ministers in February 2014.
This policy brief outlines the evidence about the potential health effects on the Australian community of actions related to the TPPA, based on publicly available and recently leaked negotiating documents. The purpose of the TPPA is to enhance each of the countries’ economic development and that this may lead to improved social and health development. However, although there may be positive impacts on the health and wellbeing of Australians resulting from economic growth, there are also many ways in which the TPPA has the potential to have negative impacts on the health of Australians. This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs.

Modelling finds GP fee no money-saver

Date February 23, 2014

Bianca Hall

Political Correspondent

A proposed $6 ''co-payment'' for a GP could add $2 billion to the states' and federal government's health bills, modelling shows.
The South Australian Health Department has estimated that the co-payment proposal would lead to 4 per cent of patients forgoing their GPs and instead attending their emergency departments to seek help for minor health complaints.
This proposal's going to greatly increase total health costs. 
The modelling showed that this would double the number of people presenting at emergency departments for minor ailments, tripling waiting times and costing an extra $145 million. Extrapolating the increased costs to the South Australian health system across the country, based on population, showed it would add $1.99 billion to the country's health costs. The Greens and Labor seized on the figures.

GP co-payments? Don’t save on primary care

As the saying goes: a fool and his money are soon parted. We’ve all paid for super clinics, the PCEHR, Medicare Locals, phone lines – you name it. Unfortunately, all these ideas have yet to bear fruit. Some say we should have spent our precious health dollars more wisely, especially in the current climate of ever-increasing health care costs.
Many GPs warned that spending too much money on these and other (non-proven) novelties would eventually come back to bite us. I tend to agree. For example, instead of building expensive, non-viable super clinics, we should have improved access to care by expanding existing GP infrastructure.

Pay-your-way overhaul of health

THE Coalition has vowed to maintain universal healthcare but says individuals will have to pay their way as part of a whole-of-government efficiency drive that's set to reshape Medicare and the federal health bureaucracy.
As the government builds its case for a major overhaul of health spending, Tony Abbott promised the overall pool of health funding would remain but it would be "crazy" not to improve the way funds were spent. The health industry is bracing for wide-ranging changes, including measures to allow private insurers to take stake in the primary care sector by allowing them to cover GP visits.
But a proposed $6 co-payment for bulk-billed GP visits is being dismissed as a "distraction", despite Health Minister Peter Dutton's support for the proposal.
Joe Hockey said Medicare was unsustainable, with its budget slated to rise by 15 per cent to $75 billion over three years.

AMA president Steve Hambleton says co-payments and means testing for GP visits a 'distraction'

Date February 22, 2014
The federal government should abandon any discussion of means-tested access to GP services and medical tests and look at more promising policies that will save money and improve people's health, the Australian Medical Association says.
During the week, federal Health Minister Peter Dutton questioned whether people on high incomes should be paying more for health services, including GP visits, blood tests and X-rays. While he refused to say how actively the government was considering a means-tested payment for healthcare, any such move would eliminate universal access to free services.
In an interview with the ABC, Mr Dutton said: ''I want to make sure that, for argument's sake, we have a discussion about you or me on reasonable incomes, whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test, should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill? I think these are all reasonable discussions for our population to have.''
21 February 2014, 6.19am AEST

Making the rich pay more isn’t the answer to a better Medicare

SShould The rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options…


Stephen Duckett
Director, Health Program at Grattan Institute
Should the rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options – including a $6 co-payment for general practice visits – to get a hold on the rising health budget.
The argument is that government benefits should be tightly targeted to those who can’t pay. But there are a number of weaknesses with it.
Australians already pay comparatively high rates of health costs, either directly or via health insurance. Increasing out-of-pocket expenses will make us a real international outlier in terms of equitable financing and have significant consequences for many poorer households. About 16% of households report deferring visits to the doctor or not filling prescriptions because of costs; additional co-payments will worsen their plight.

Medicare unsustainable, govt says

21st Feb 2014
FEDERAL Treasurer Joe Hockey has warned that Australia will run out of money to pay for Medicare and its welfare and education systems unless the government takes a hard look at the costs.
Mr Hockey said he was "ringing an early warning bell" about the sustainability of federal funding for vital programs, saying hard work will be needed in the future just to maintain the quality of life expected by most Australians.
"The starting point is if our health and welfare and education systems stay exactly the same, Australia is going to run out of money to pay for them," Mr Hockey told the Seven Network on Friday.
"We'll either have to have a massive increase in taxes, and that means fewer jobs at the end of the day, or we're going to have to look at ways we can restructure the system to make it sustainable."

Bulk-billing limited to low-income earners under radical Medicare plan

February 21, 2014 8:21AM
Sue Dunlevy, Jennifer Rajca
News Limited Network
MEDICARE would be means-tested with access to bulk-billed doctor’s visits and medical tests limited to those on lower incomes under a radical plan being considered by the Abbott Government.
In an exclusive interview with News Corp, Health Minister Peter Dutton has questioned if high income earners should be able to see a doctor without dipping into their pocket.
“I question whether someone on an income of $200,000 can have an expectation of going to the doctor for free, that is one of the discussions, one of the conversations we have to have,” he said.
The minister’s proposal for means-testing on bulk-billing extends beyond GP visits and also includes blood tests, X-rays and other diagnostic services.

Government flying a kite on GP tax

  • Editorial
  • Herald Sun
  • February 20, 2014 8:56PM
WHENEVER governments decide to fly a kite about a potential new tax people need to worry.
It’s too easy for state, federal and local governments to simply hit up taxpayers as they look to cover black holes dug through excessive spending by previous administrations.
We see it every year with new and higher government charges, additional taxes, increased permit costs, licence fees and parking fines.
All this while consumers pay double-digit increases in energy prices, the forecast CPI reaches beyond 3 per cent and unemployment kicks up to 6.4 per cent.
Now Health Minister Peter Dutton is fuelling speculation that a co-payment of about $6 for doctor visits may be used to reduce the heavy burden of an “unsustainable” Medicare budget, which has risen 124 per cent in a decade.

Hockey flags changes to Medicare, pensions in tough budget

February 21, 2014
Jacob Greber Economics correspondent
Treasurer Joe Hockey has ramped up warnings about the need for budget spending reform, flagging changes to Medicare, pensions and education.
Speaking a week after receiving the first report from his Audit Commission into the budget, Mr Hockey said without changes to the current system of funding for health, education and welfare, Australia “will run out of money to pay for them”.
“We will either have to have a massive increase in taxes – and that means fewer jobs at the end of the day – or we are going to have to look at ways that we can restructure the system to make it sustainable,” Mr Hockey told Channel Seven on Friday.
The Treasurer indicated the budget for Medicare was slated to rise 15 per cent to $75 billion over three years.

Paying for your health

18th Feb 2014
A CO-PAYMENT for bulk-billing threatens the concept of free healthcare. How ready are we to let go of this service?
It started as little more than a footnote in a largely overlooked policy paper from a little-known think tank and ended with a full-bodied interception from an irate Cabinet minister.
But in the three months in between, it became one of the hottest medico-political stories of the summer.
It was, of course, the end of Medicare as we know it, specifically the introduction of a $6 compulsory co-payment for every bulk-billed GP visit.
This small but significant change, which would rank among the biggest in Medicare’s three decade history, would save $749,000,070 over four years by discouraging people from going to the GP, without preventing them outright.

Abbott pledges to be Medicare’s ‘best friend’

February 20, 2014
Joanna Heath
Prime Minister Tony Abbott has signalled caution on the potential for major Medicare reform, saying he wants his government to be “the best friend Medicare has ever had”.
“Obviously the budget generally is under pressure and it’s very important that we do what we can to fix the Budget as quickly as we can but we’ve got to do it in ways which are consistent with our pre-election commitments and don’t forget I said we were going to be a no-surprises, no-excuses government,” Mr Abbott said.
“As the Health Minister in a former government I used to say that that government was the best friend that Medicare had ever had. This leopard doesn’t change his spots. I want this government to be likewise the best friend that Medicare has ever had.”

Doctors warn: restricting GP access may cost more

  • Jared Owens and Sean Parnell
  • The Australian
  • February 20, 2014 10:05AM
Peter Dutton has been accused of softening up voters for the introduction of a GP co-payment.
DOCTORS have backed Health Minister Peter Dutton’s call for a “national conversation” about Australia’s rising health costs, but warned restricting access to GPs could ultimately cost even more.
Mr Dutton yesterday declared the nation’s primary-care and hospital system was unsustainable in its present form, indicating baby boomers were set to pay higher out-of-pocket costs for medical treatment.
Mr Dutton has refused to quash speculation that the government could impose a $6 co-payment on general practice visits, prompting Labor spokeswoman Catherine King to accuse him of plotting to “dismantle” Medicare.

Co-payments problematic, inquiry told

  • AAP
  • February 18, 2014 11:40AM
GP co-payments won't lead to worthwhile budget savings and will force the less well off and chronically ill to delay visiting their doctor, health groups have told an inquiry into the government's commission of audit.
Co-payments of up to $6 have been flagged as one way to tackle rising health costs, sparking widespread concerns the Abbott government will target Medicare in the May budget.
Prime Minister Tony Abbott has labelled talk of a co-payment a scare campaign, but others such as Health Minister Peter Dutton have refused to rule it out.
Chief of the Australian Health and Hospitals Association Alison Verhoeven said co-payments would make healthcare unaffordable for the most vulnerable, particularly those with chronic illnesses.
Appearing at the Senate inquiry in Canberra, she said hospital emergency departments could become clogged with those avoiding the GP fees.
"Requiring a more costly intervention," she told the hearing.
The administrative costs of co-payments would cancel out many of the savings, she said.
18 February 2014, 6.44am AEST

Commission of Audit should know costs but appreciate value

Author:  Jane Hall
Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation at University of Technology, Sydney
The Commission of Audit is holding its third Hearing in Canberra today. Witnesses include the Consumers Health Forum and Australian Health and Hospitals Association, so health is clearly the order of the day.
Instituted by the Abbott government soon after it came to power, the Commission is charged with finding savings by eliminating waste and duplication of functions, and the consolidation of Commonwealth agencies. And the Australian National Preventive Health Agency (ANPHA) is widely held to be an easy target for it.
The agency was established as part of the raft of reforms under the 2011 National Health Reform Agreement, to lead in preventive health through surveillance and monitoring, policy advice, national social media campaigns, and by sponsoring research.
Eliminating the ANPHA would, of course, look like a positive contribution to the savings and agency reductions needed to justify the Commission of Audit. But the 40 or so ANPHA staff will not contribute significantly to the Commission’s targeted reduction of 12,000 public servants.
It seems clear there is a significant change coming on the basis of this week’s news. The best suggestion I have heard so far is that there will be a degree of means testing on access to bulk billing - and a tighter means test on access to the Senior’s Health card.
More next week.

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