Thursday, April 10, 2014

Pre - Budget Review Of The Health Sector - 10th April 2014.

As we head towards the Budget in Early to Mid-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 13th May, 2014.
Here are some of the more interesting articles I have spotted this week.
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Everyone must bear budget burden: Hockey

Jacob Greber Economics correspondent
Treasurer Joe Hockey has ramped-up warnings that all parts of the community and business must contribute to the budget repair task or risk having the burden fall on a few.
With the government now considering the second and final report of its Audit Commission, Mr Hockey said without swift action Australians could expect to see standards of living fall.
“What we need to do is ensure the whole nation helps to do the heavy lifting to make the budget repair work, so we can not just maintain our quality of living but maybe improve our quality of living into the future,” he said on Monday.
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Finding savings in healthcare: moving from theory to reality

Jennifer Doggett | Apr 06, 2014 8:47AM
With a tough federal Budget fast approaching, many in the health sector are offering up suggestions for where the Abbott Government might find savings. Some of these options were outlined in an article published in Croakey earlier this week. They include:
  • cutting the price paid for generic drugs and encouraging substituting brand name drugs with generics,
  • expanding the range of tele-health services that can be funded under Medicare,
  • ensuring treatments listed on the Medical Benefits Schedule are effective and offer value for tax-payers, reducing use of those that are wasteful, and  
  • reducing the price paid for prosthesis, such as hip and knee replacements.
These options and more were discussed in detail at a roundtable, hosted by the Australian Healthcare and Hospitals Association (AHHA), on options for finding savings in health and improving quality in health care. Dr Anne-marie Boxall, Director, Deeble Institute for Health Policy Research at the AHHA and co-author of Making Medicare, provided the following report from the Roundtable.
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Worse alternatives than higher GST

Date April 6, 2014

Peter Martin

Economics correspondent

So you’re frightened by the prospect of a higher GST? You shouldn’t be. The alternatives are worse.
One of them, outlined by Treasury secretary Martin Parkinson on Wednesday, is deceptively painful.
It’s doing nothing – just leaving the tax system on hold for 10 years and letting climbing revenues eat away at the projected deficits as inflation pushes more of our incomes into higher tax brackets.
It’s called “bracket creep”, although it can happen even if inflation doesn’t push your wage into a higher tax bracket. Every time your wage goes up, a greater proportion of it becomes taxed (above the tax-free threshold) rather than untaxed (below the threshold). It means that by doing nothing other than accepting ordinary annual wage rises, each of us is made to pay an ever increasing proportion of our income in tax.
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Funding for Mental Health

The Australian Government has provided $170 million for the continuation of 150 programs as part of its ongoing commitment to mental health.
Page last updated: 04 April 2014
4 April 2014
The Australian Government has provided $170 million for the continuation of 150 programs as part of its ongoing commitment to mental health.
The Minister for Health Peter Dutton said the funding would see the projects continue their work through 2014-15.
“It is essential to ensure the continuity for mental health services, suicide prevention and postvention programmes while the National Mental Health Commission undertakes its review of all existing services,” Mr Dutton said.
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Changes to Qld doctor contracts passed

4th Apr 2014
GOVERNMENT concessions made in the long-running dispute over senior doctors’ contracts have been passed in Queensland's parliament.
The changes passed on Thursday night mean senior medical officers will be offered life-long contracts that can't be varied to negatively affect doctors without an act of parliament.
It also limits the Queensland Health director-general's powers so directives can't affect a doctor's contract except when increased remuneration or improved benefits are offered.
However, the concessions may not be enough to resolve the dispute, with assistant health minister Dr Chris Davies on Thursday threatening to resign if the dispute was not resolved by the 30 April contract deadline.
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Qld govt takes doctors to court

2nd Apr 2014
THE feud between Queensland doctors and the state government over contracts is moving to a new battleground.
Lawyers for the state were due to appear before the Federal Court on Wednesday to try to stop doctors' groups and others spreading "misinformation" about proposed new contracts.
Some doctors and unions claim the contracts will strip employment protections and potentially compromise patient care.
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Greens move to stop IPN-Medibank deal

2 April, 2014 Paul Smith
The Greens have stepped in to try to ban Medibank Private from paying a GP corporate to offer bulk-billed Medicare services to its customers.
It emerged this year that private health insurer Medibank Private had agreed to pay an "administration fee" to IPN for doctors at six of of the corporate's clinics to offer so-called priority access.
It translates into about 4500 Medibank policyholders having access to guaranteed appointments and bulk-billed services — including after-hours care.
But Greens Senator Richard Di Natale has introduced an amendment bill that would make it illegal for private health insurers to team up with primary care providers to provide preferential treatment for some patients.
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Federal Health Minister Peter Dutton urged to step in to resolve Queensland doctors' contract row

March 31, 2014
The Federal Opposition says Health Minister Peter Dutton should help resolve Queensland's doctors' contracts dispute.
Federal Opposition health spokeswoman Catherine King says there does not appear to be a back-up plan if Queensland doctors carry out their threat to resign en masse over the State Government's public hospital employment contracts.
The Federal Court will this week hear an application by Queensland Health to try to stop unions from allegedly misrepresenting proposed employment contracts for doctors.
Queensland Health is seeking an injunction to stop the circulation of documents that it claims misrepresents the State Government contracts.
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Australian Medical Association says push to stop union advice a grim prognosis for nation

Date March 31, 2014

Anna Patty

Workplace Editor

The Australian Medical Association fears the Queensland government's unprecedented attempt to stop unions from providing advice to members and its introduction of individual contracts for public hospital doctors could embolden other states to follow its example.
This week, Queensland Health will launch legal action in the Federal Court to stop the AMA, the Australian Salaried Medical Officers Federation (ASMOF) and Together, another union representing senior doctors, from passing on what is says is inaccurate information to its members.
It is unheard of for an employer to assert that a union, by talking to its members ... is engaging in misleading and deceptive conduct. 
The unions have provided advice to senior salaried doctors about the government's introduction of individual contracts to override collective bargaining agreements.
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Cancer treatment funding under threat

HEALTH officials are in crisis talks after discovering certain cancer treatments have not been properly costed for a new national funding scheme being implemented in July.
The much-heralded introduction of activity-based funding, one of the key Labor health reforms, has come with a last-minute challenge for policymakers that appears to threaten the availability and affordability of radiotherapy.
The Australian Health Ministers Advisory Council — comprising the heads of commonwealth, state and territory health departments and key agencies — recently discussed the issue and agreed “further costing work should be undertaken as a matter of urgency”.
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Hockey is right, GST is worth talking about

Date April 3, 2014

Peter Martin

Economics correspondent

Treasurer Joe Hockey was aware of the broad content of Martin Parkinson's speech before he delivered it. His personal position on the goods and services tax remains unchanged.
Along with Tony Abbott, Hockey spent the entire election campaign never entirely ruling out an expanded GST. Why would he when he was about to commission a tax review that would examine everything?
Hockey has had the report of the National Commission of Audit for six weeks now. If it too has suggested an expanded GST it is something we are going have to take seriously.
At 10 per cent, Australia's GST is embarrassingly low by international standards. New Zealand started at 10 and went to 12.5 and then 15.
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Pharmacy jobs losses likely: Guild

2 April, 2014 Nick O'Donoghue
Almost 9000 pharmacy jobs are set to be lost in the next 12 months as a result of increasing financial pressures, according to a survey carried out by the Pharmacy Guild of Australia.
The Guild’s Employment Expectations Report, released today, revealed that the pharmacy workforce is set to shrink by up to 14% in 2014, as the impacts of price disclosure and the loss of trading terms hit owners.
The survey found that pharmacy owners expected to lay-off more than 2200 pharmacists, 4400 pharmacy assistants and 2300 other staff members during the course of the year, due to growing financial pressures.
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Health plan launched in WA

10:38am April 1, 2014
The federal government has set aside $56.3 million for regional health and hospital services in Western Australia.
Federal cabinet is meeting in Perth on Tuesday ahead of Saturday's WA Senate election re-run.
Federal Health Minister Peter Dutton said new agreements would provide extra funds for kidney dialysis treatment, pathology and dental care.
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Health academic says $140m could be saved by following drug advice

Date April 1, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

The Abbott government could save more than $140 million over the next eight months simply by adhering to a recommendation from the expert body that advises it on medicines, a health expert says.
In 2012, the Pharmaceutical Benefits Advisory Committee recommended that the price difference between the cholesterol-lowering drug simvastatin and a newer cholesterol-lowering medicine, atorvastatin, should, on average, be 12.5 per cent.
But the recommendation was not implemented. Simvastatin is one of scores of drugs that will drop in price by an average of 40 per cent from Tuesday under a policy limiting drug costs according to the market price.
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Medibank sale raises members’ rights

Ben Potter
In the four years since the Rudd ­government converted Medibank Private into a profit-making insurer, the Commonwealth has peeled off $1.366 billion in dividends and taxes. Profits after tax for Medibank Private have totalled just $964 million, and the he alth fund’s net assets have been whittled down from $1.72 billion in 2010 to $1.4 billion at June 30.
The Commonwealth’s haul amounts to a 16-fold return on the $85 million it put into Medibank, and revives an old debate over whether any prior rights of the 1.8 million members to the net assets have been trampled in the process.
The Abbott government has kicked off a sale process aimed at pulling in as much as $4 billion to help cut federal deficits. Lazard Australia – whose directors include former Labor prime minister Paul Keating, former finance minister Lindsay Tanner and former Victorian treasurer Alan Stockdale – is advising the government.
The position of members – whose con­tributions have overwhelmingly funded Medibank Private since 1976 – was widely debated when the Howard government tried to sell it in 2006 .
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Backlash looms on health funding

RISING insurance premiums are funding more services in public hospitals, a sign that cost-shifting and budgetary pressures are altering the experience of universal health cover.
As insurance premiums today rise an average of 6.2 per cent, consumers and health industry stakeholders await the federal government’s response to the Commission of Audit to determine the future of hospital, primary and preventive care funding.
Health Minister Peter Dutton has used several recent speeches to suggest governments stop paying almost 100 per cent of public medical bills “when the patient is prepared to contribute to their own costs”. “To build a health system that is sustainable, the Coalition is interested in policies which offer longer-term system reform, making smarter use of funds to provide better care,’’ Mr Dutton said last week.
“The universal health system means that there will always be value in leveraging people into supporting their own health needs in the private sector.’’
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Proposals for health budget savings

Jennifer Doggett | Mar 31, 2014 11:59PM
It’s fair to say that Peter Dutton has one of the more difficult jobs in Federal Parliament – particularly at the moment, with just over a month to go before the Federal Budget.  Under pressure from a Treasurer desperate to deliver Budget savings, the Health Minister will need to offer up something in his rapidly growing portfolio.  Luckily for him, there is no shortage of helpful advice from experts across the sector on how to achieve savings within the health sector.
While there appear to be a number of options for saving health dollars, many of the proposals may not offer the short-term budgetary impact that the Government seeks.  Others are unlikely to deliver sustainable savings over the longer term while ensuring our health system remains fair and viable.   Some may be politically or practically unrealistic or simply unethical.  Finding one or more options which will deliver the savings required without losing the support of crucial stakeholders is the Government’s challenge.  
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Comment:
The drumbeat suggesting a tough budget has been building. The final report of the Commission of Audit (COA) has been handed to Government and I am sure the leaks will start soon.
Economically we have both the Reserve Bank Governor and the Secretary of The Treasury saying we have very serious budgetary problems - and we can be sure they have seen the COA.
Really it seems to me the only question is just how big the cuts are and where they will fall. I suspect the answer is pretty big and everywhere!
To remind people there is also a great deal of useful discussion here from The Conversation.
As usual - no real news on the PCEHR Review.
More next week.
David.

13 comments:

Anonymous said...

Be interesting to see if these design chiefs at NEHTA are worth keeping on, it has been a year in the making http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1830:pcehr-release-five-planned-for-may&catid=16:australian-ehealth&Itemid=327

Anonymous said...

However, NEHTA says there are some “constraints” with the information that will be available that may have implications for safety, including variability in test names and in the names of pathology or diagnostic disciplines.

“This will result in the inconsistent representation of pathology and diagnostic imaging report information, requiring clinicians to interpret this variability to ensure safe clinical decision making,” the documents say.

Sounds like they got off to a bad start, panicked midway and stuffed the whole design up. I take my hat off to the ass covering being attempted here, but NEHTA put in place the right people, IT architects maybe great designers and advisor but can be dangerous if not managed

Anonymous said...

NEHTA is simply raising their concerns, the minister and his department are the ones that will authorise the implementation not NEHTA. I am more interested in why this has been leaked to the press, is the department willing to implement an unsafe product just to stay relevant? Or is the minister desperate to make the PCEHR his own?

Anonymous said...

Unbelievable.
In short it means ... Clinicians will be required to GUESS whether the inconsistent information is reliable enough to use .... !!!!! HELLO Medical Defense warn your members.

“This will result in the inconsistent representation of pathology and diagnostic imaging report information, requiring clinicians to interpret this variability to ensure safe clinical decision making,” the documents say.

K said...

This is merely a statement of truth about the current state of play in pathology reporting, and an acceptance that NEHTA and/or DOH is unable to convince/cajole/bribe/blackmail the pathology industry into doing anything about it.

K said...

... well, at least, as part of the pcEHR. To be fair, the pathology industry is running the PITUS project, which is the underpinnings of the solution in this space, but it remains to be seen whether this is just an in principle thing, or whether it will be given the teeth to make it solve this problem. Perhaps Assoc Prof Legg might like to comment on this?

Anonymous said...

Or K, is this yet another sign that clinical needs and health informatics are being ignored internally at NEHTA? Time to move the infrastructure chaps to one side and get some fresh leadership, it is obvious the national design manager and Head of Architecture are not up to the job

Dr Ian Colclough said...

K 4/12/2014 01:33:00 PM said... NEHTA and/or DOH is unable to convince/cajole/bribe/blackmail the pathology industry into doing anything about it.

I would suggest that if that is the approach being used [cajoling' bribing/ blackmailing] it will never work. In truth, that isn't the way to effect the required change. A carefully crafted strategic change management approach will get the required results.

Dr David More MB PhD FACHI said...

"A carefully crafted strategic change management approach will get the required results."

And just what such a strategy look like? I am sure NEHTA / DoH are keen to know!

David.

Andrew McIntyre said...

The pathology system has by far the best eHealth implementations in the country and contributed significantly to the development of Australian HL7 Standards, albeit most before they were sold to corporate owners.

This was largely done off their own initiative and to suggest they are the problem is unfair. The current owners are less likely to spend money on standards compliance but in reality pathology can be held up as an example of what can be done without government "help" rather than a target for criticism. There is a lot of room for improvement, but compared to every other sector pathology is light years ahead.

A simple notice that they were required to be AHML compliant about 5 years ago (ie some governance) would have been a cheap but effective policy initiate that would have taken them to higher heights today, but they are still a long way in the lead.

K said...

Actually, I mostly agree with Andrew, but better than everyone else isn't the same "can't be better". I think that the warning about interpretation required due to variability applies to all of the exchanged data, just that pathology is further ahead, and that the problems are recognised.

Happy thought...

On another subject:

"is this yet another sign that clinical needs and health informatics are being ignored internally at NEHTA"

...ignored, no. But they aren't the only things at the table, that's for sure. Budget realities, political timelines, large projects, etc. If only everything were perfect. I saw pigs flying last night too.

"It is obvious the national design manager and Head of Architecture are not up to the job"

oh? Well, opinions vary, and it's a hypothetical, but I don't think that anyone else trying to do those jobs would have a much different outcome. The kind of outcomes that can be achieved are decided much higher up the hierarchy. I'm sure that said parties higher up are happy to see their underlings being the scapegoats.

Anonymous said...

David More said - And just what would such a strategy look like? I am sure NEHTA / DoH are keen to know!

I doubt they will ask - too confronting.

Anonymous said...

May will be interesting, I for one am very excited to see all these additional features and valuable information.

K, yes you are correct, the outcomes come from higher up, however I doubt the outcomes included a collection or poorly designed outputs, at least it sounds like the builds will be ready to assist the long awaited inclusion of NT healthy system.