Wednesday, May 21, 2014

Post - Budget Review Of The Health Sector Outcomes- 20th May 2014.

Budget Night was on Tuesday 13th May, 2014.
Here are some of the more interesting articles I have spotted this week since it happened. Since the budget was handed down all hell has broken out in the Health Sector. I will try to get the main themes.
They seem to divide into two big areas.
First the immediate changes - the co-payments on GP visits and increase in PBS co-payment, rationalising of a range of administrative and support functions and major changes to Medicare Locals and continued PCEHR Funding.
The bigger hit seems to come in a few years to all the State Hospital Funding - from 2017 on there is about $50B extra to States have to find.
The Senate may have a lot to say about some of the early planned changes - and the State Governments are pretty grumpy about the later changes.
We sure do live in interesting times!


Budget impacts on the economy, tax and markets

Australian budget
Here are:
Westpac on the Budget.
NAB on the Budget.
COMMSEC on the Budget.
PWC on tax implications.
KPMG on business implications.
JP Morgan on market implications.
12 May 2014, 5.22am AEST

Australia’s ‘unsustainable’ health spending is a myth

Jeff Richardson

Professor and Foundation Director, Centre for Health Economics at Monash University
The unsustainability of government health expenditure in Australia is a myth that has been carefully nurtured to justify policies to transfer costs from government to the public.
Tomorrow’s budget is expected to introduce co-payments for visits to the doctor and other ways to reduce health spending. The government argues that it must do this because health spending is out of control and the new measures are necessary to make Medicare sustainable.
But evidence contradicts this argument.

Budget 2014: How you are affected

14th May 2014
THE federal budget amounts to the "murder of Medicare" and the end of bulk-billing, according to detractors who are not placated by the surprise announcement of a $20 billion Medical Research Future Fund.
As predicted, Treasurer Joe Hockey last night confirmed that most MBS rebates will be cut by $5, and a $7 co-payment will apply to GP visits from 1 July next year. 
Previously bulk-billed patients will make a contribution of at least $7 to the cost of most visits to the GP and out-of-hospital pathology and diagnostic imaging services.
Concessional patients and children under 16 will have their $7 contribution capped at 10 visits. 

Health budget full of hurt for patients – AMA

THE 2014 federal health budget is full of pain for patients, says the Australian Medical Association (AMA).
The association’s vice-president, Professor Geoffrey Dobb, says patients – especially vulnerable patients such as the chronically ill, the elderly, Aboriginal and Torres Strait Islanders, and low-income families – will pay more for their health care.
“Many Australians already pay a co-payment, and there is a place for co-payments for patients with the right model – but this is not the right model,” Professor Dobb says in a statement.
“It does not have the right protections.”

Budget: Health highlights

By Natasha Egan on May 14, 2014 in Government, Industry
At a glance:
·         Boost to medical research, with $200 million for dementia 
·         Funding to continue for PCEHR
·         Medicare Locals replaced 
·         HWA rolled into department of health
Fulfilling a pre-election commitment, last night’s Federal Budget 2014-15 provided $200 million over five years for research to improve treatment for dementia in Australia. Funding will go towards establishing a National Institute for Dementia Research, which will bring together existing resources and infrastructure to coordinate research priorities and translate existing dementia research into policy and practice.
The funding also delivers $9 million for Brisbane’s Clem Jones Centre for Ageing Dementia Research, which focuses on the prevention and treatment of dementia, as per a previous commitment.
Medical research in the medium to long term will get $276.2 million over three years from 1 July 2015 from the Medical Research Future Fund. In the long term the fund will provide a sustained funding stream for medical research with payments growing to around $1 billion per year from 2022‑23.
The government is continuing to fund the Personally Controlled Electronic Health Record (PCEHR) for another year with $140.6 million allocated for 2014-15 while it finalises its response to the review of the PCEHR.

Budget 2014: the good, the bad and the ugly (but mostly the ugly….)

Jennifer Doggett | May 14, 2014 12:57PM
With the bulk of the Health Budget already in the public domain, last night’s Budget speech was less about new announcements and more about selling the already unpopular measures to the Australian public.  Attempting to convince consumers to cough up more for their health care is not an easy task and in spinning the new payments as “opportunity not austerity”, Joe Hockey brought political performance art to a new level.  Indeed, with his love of a clich├ęd image (“we all need to share the heavy lifting”), the smoke and mirrors acts (pay more for GPs but get a cure for cancer!) and a show stopper of a stunt (the world’s biggest medical research fund!), the Treasurer seemed at times only one bearded transvestite away from a winning Eurovision entry.  
The much debated GP co-payment, along with an additional $5 for non-concessional PBS prescriptions, were predictably the focus of much media and stakeholder attention. The net impact of these additional co-payments will be to increase the cost burden on people who are poor, sick and vulnerable, creating additional access barriers to cost-effective preventive care and potentially increasing downstream health care costs.  The small reduction in the Medicare safety-net thresholds, to start in 2016, is woefully inadequate to support the increased numbers of people who will have difficulty meeting their health care expenses. 

Dutton’s post-Budget speech

Jennifer Doggett | May 16, 2014 10:24AM
In Health Minister Peter Dutton’s first speech post-Budget speech he outlines the Government’s approach to health funding cuts and spending measures, including the following four principles:
1. that we must spend taxpayer funds on programmes and services that improve health outcomes for Australians;
2. that bureaucracy and red tape should be cut, and efficiencies and productivity improvements continually found;
3. that people should take more responsibility for their own health, including through modest contributions to the cost of care; and
4. that we must set up the health system for the future.

Weighing up the cost of the health of a nation

Date May 16, 2014

Peter Martin

Economics Editor, The Age

Imagine for a moment the government is serious about reining in health costs. What should it do?
Should it invest heavily in preventive health, trying to change lifestyles so more people don’t get ill in the first place, or should it amass billions for medical research?
A government concerned about pay offs will do the first. Or it may decide to do both, investing in preventive health while also putting aside funds for medical research. What it won’t do is shut down existing attempts to prevent illness in order to fund research. That’s if it is serious.

A fib too far: the death rattle of political trust

By ABC's Jonathan Green
Updated Thu 15 May 2014, 10:39am AEST
This Budget reveals a government that prioritises, then rations, its truthfulness, and does it with a brazen sense of self confidence, writes Jonathan Green.
"Is it liberating for a politician to decide election promises don't matter?"
7:30's Sarah Ferguson stopped Joe Hockey in his tracks with that one, a question that went beyond the superficial cut and thrust of the political exchange to something rather closer to its inner psychology.
A key question though, for if this Budget marks anything it is another decisive step in the distancing of the political class from the interests of the public it nominally serves, another step toward politics' slow conversion into pure performance.

Axe falls on health agencies

15 May, 2014 AAP
The axe is starting to fall on federal health agencies set up by Labor governments.
Health Minister Peter Dutton on Thursday introduced legislation to abolish the Australian National Preventive Health Agency (ANPHA) and Health Workforce Australia (HWA).
"In health there has been too much officialdom, too much duplication," he told parliament.

Labor blocks path to fiscal fix

BILL Shorten has dared Tony Abbott to force an election over the federal budget by vowing to vote down measures worth ­almost $18 billion, including new medical charges, education reforms and cuts to welfare.
He warned of a $6000 hit to families from the budget, in a ­policy ­assault aimed at derailing the most contentious elements of the government’s economic platform.
In his first budget reply as ­Opposition Leader, Mr Shorten accused the Prime Minister of misleading voters while imposing harsh cuts on the basis of the “myth” of a budget emergency.
“If you want an election, try us,” Mr Shorten said. “If you think Labor is too weak, bring it on.”

GP Co-payments.

Health Minister Peter Dutton says Medicare fees will improve health outcomes

Date May 15, 2014 - 10:23PM

Dan Harrison

Health and Indigenous Affairs Correspondent

Health Minister Peter Dutton has predicted the introduction of a fee to visit the doctor will improve health outcomes by making it easier for patients to get an appointment and for doctors to spend more time with patients.
In an interview with Fairfax Media on Thursday, Mr Dutton said some medical practices had used bulk-billing as a "business enhancement technique" and the fee would create an incentive for doctors to charge all but the most needy patients for their care.
"It becomes a true safety net," he said. "At the moment, practices in capital cities are bulk-billing to gain market share."

Federal Budget: Doctors vow to fight hospitals introducing co-payment for emergency department care

Date May 14, 2014 - 7:12AM

Julia Medew and Richard Willingham

Victorian doctors have slammed the new $7 co-payment for GP visits and medical tests and say they will fight hard to prevent Victorian hospitals from introducing similar fees for emergency department care. 
State and territory governments will be able to charge people for emergency department services after the Commonwealth announced that from July next year, Australians would be charged a $7 co-payment for GP visits, including imaging such as X-rays, and pathology such as blood tests.
Australasian College for Emergency Medicine spokesman Simon Judkins said the new fees could prompt more patients to go to emergency departments instead of their GPs because hospital treatment is free. 

Doctors baulk at 25pc income cut if they don’t charge

May 15, 2014
Joanna Heath
GPs are rebelling against a 25 per cent cut in their income if they refuse to charge patients a $7 payment, which Treasurer Joe Hockey has hinted may be increased as a revenue-raising measure if the budget demands.
There is also concern about a lack of detail on how a $20 billion medical research fund, which will be given the money from the payments, will have its funding allocated.
Tuesday’s budget allows for GPs to waive the co-payment if they see fit, and expects patients with chronic illness not to be charged for visits.
But GPs who continue to provide visits free will miss out on a $6.20 incentive payment, and will also receive $5 less in Medicare rebates from the ­government.

Joe Hockey challenges GPs over $7 co-payment

JOE Hockey has responded to criticism of the $7 co-payment for routine GP visits by saying doctors could instead take a cut to their Medicare rebate without requiring patients to make up the shortfall.
In one of the more controversial measures in the budget, the standard Medicare rebate would be cut by $5, and doctors encouraged to charge patients $7, which would provide them with an ­additional $2 towards the costs of running a practice.
Government surveys show many patients defer medical care due to cost, and a health department spokesman said the co-payment was estimated to cause a “slowing in the amount of times some people will visit their GP of around 1 per cent in the first year” but diminish over time.

GP co-payment to hit indigenous population hard

Date May 18, 2014

Gareth Hutchens and Jonathan Swan

The largest Aboriginal medical service in the Northern Territory has slammed the Abbott government's $7 GP co-payment policy. And medical experts say the policy could widen the gap between indigenous and non-indigenous health.
On another front, the nation's peak body for Aboriginal health - the National Aboriginal Community Controlled Health Organisation (NACCHO) - says it is unsure if some of its 150 medical centres will lose tax-exempt status when the co-payment policy is introduced in July next year.
It said the Abbott government had failed to consult them about the policy and has not ''thought through'' its consequences.

Co-payment unlikely to pass through Senate

15th May 2014
THE federal opposition has said it won't “horse-trade” over the government's planned Medicare co-payment, which looks unlikely to pass through the Senate.
Labor, the Australian Greens and the Palmer United Party have all declared they will oppose the $7 co-payment, which is supposed to help pay for the government’s new medical research future fund.
Prime Minister Tony Abbott says he is open to "horse-trading" to get his government's first budget through the Senate.
But opposition health spokeswoman Catherine King dispelled any thoughts Labor may be willing to negotiate on the co-payment, which it has dubbed a "GP tax".

NSW Health Minister says state will force health costs back onto the Commonwealth

Will Ockenden reported this story on Saturday, May 17, 2014 08:04:00
ELIZABETH JACKSON: The New South Wales Health Minister says if the Federal Government pushes ahead with a $7 co-payment for the doctor, the state will consider allowing GPs into hospitals to force the Commonwealth to pick up the costs.
New South Wales Health Minister Jillian Skinner says a medical co-payment will force more people into hospitals, but New South Wales will not charge patients who show up at emergency.

Health funds like BUPA to pay doctors to keep patients out of hospital

  • May 17, 2014 12:00AM
  • SUE DUNLEVY National Health Reporter
  • News Corp Australia
HEALTH funds want to pay general practitioners to keep patients out of hospital in a health care revolution they claim will deliver “mind boggling savings” for our health system.
The insurers have presented a plan to Health Minister Peter Dutton that would see them sign doctors up to treat their members according to set clinical guidelines.
One major insurer, BUPA, is exploring the possibility of funding palliative care for dying patients in their own homes to cut costs and make patients more comfortable.
“For me dying with dignity is something everybody’s keen about,” BUPA managing director Dwayne Crombie told News Corp Australia.

Leaving a sick feeling

Date May 17, 2014 - 1:15AM

Amy Corderoy, Dan Harrison

The new Medicare co-payment will hit the poor hard.
Carter Moore had a stomach ache. A trip to the GP and pathology test provided no answers, and later that night the pain became excruciating.
"I was in horrible pain, so I took myself to my local hospital," the former US resident explains. More tests.
A drip, and an overnight stay. The doctors decided it was probably dehydration. "I ended up paying between $450 and $500 all up, just because I was dehydrated," says the policy officer for the Consumers Health Forum of Australia.

GPs told: use windfall to help needy

DOCTORS and healthcare providers will get a $468 million “windfall” under the Abbott government’s co-payment plan, giving them the capacity to continue treating poor and vulnerable patients without charge.
As debate over the contentious budget measure continued, Health Minister Peter Dutton revealed government modelling had guided the decision to set the co-payment at $7 to achieve both a pricing point and a “change in people’s behaviour”.
The modelling reveals the measure will slightly reduce the growth in GP visits and that the $2 doctors will receive each time a co-payment is made will deliver them $468m over the next four years. Supporters of the $7 co-payment argue that unless the growth in spending on doctor visits is curtailed, savings will have to be found in other areas of the health system including public hospitals.

New $7 GP visit fee will not be a 'windfall', say doctors

Date May 17, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

Doctors have rubbished claims by Health Minister Peter Dutton that a $7 fee for GP visits will improve health outcomes by allowing doctors to spend more time with patients and make it easier for people to get an appointment with their doctor when they need one.
Australian Medical Association president Steve Hambleton also dismissed Mr Dutton's suggestion that the fee would provide a ''windfall'' to doctors that they could then spend to treat the most needy patients for free.

Doctor’s fee is the iceberg’s tip

May 17, 2014
Medical expenses
Sally Patten
Households must absorb a myriad of small changes to medical expenses and rebates, and health insurance thanks to this week’s federal budget.
The $7 fee for doctor visits, which was dismissed by Treasurer Joe Hockey as the cost “of only a couple of beers or one-third of a packet of cigarettes”, is just the tip of the budget iceberg.
“It is going to be so difficult for people to keep up with all the little changes, but the little bits add up,” says Bryan Ashenden, head of technical at BT Financial Group, the wealth arm of Westpac Banking Corp.

Co-payment $20bn line in sand

FUNDS generated by the Coa­lition’s medical co-payments and script increases will be returned to the health system once the new ­research fund has reached its $20 billion target.
Joe Hockey expects the new Medical Research Future Fund, proposed in the budget, to be fully funded in about six years.
Its financial investment strategy will be set by the current guardians of the Future Fund while the National Health and Medical Research Council will distribute grants to researchers. The fund is expected to generate $1bn a year in grants once it is fully funded.

No way! GPs reject co-payment move

16th May 2014
A GRASSROOTS campaign has been backed by the RACGP which also launched its own against the government’s embattled $7 Medicare co-payment plan.
The college has launched the #CoPayNoWay public awareness campaign and backed another, #CoPayStories, which is the brainchild of David Townsend, the architect of last year’s successful Scrap the Cap campaign.
RACGP president Dr Liz Marles said a $5 cut to MBS rebates was designed to strong-arm doctors into charging the $7 fee. But in reality GPs would sometimes be forced to forgo it and take the hit, she said.

Government may negotiate on $7 co-payment

May 16, 2014
Joanna Heath

Key points

  • GPs have the ability to waive the fee for needy patients if they want to.
  • Labor and the Greens have indicated they will not vote for a co-payment.
Health Minister Peter Dutton may be willing to negotiate the $7 ­payment for visits to doctors to appease the Senate and avoid a ­double-dissolution election.
Mr Dutton said he was confident the government could pass a law that would impose a $7 charge for GP visits, tests and imaging services. The money is earmarked for a $20 billion medical research future fund.

Labor 'won't compromise' on co-payment

Updated: 7:54 am, Thursday, 15 May 2014
The federal opposition has warned it won't horse-trade over the government's planned Medicare co-payment, which looks unlikely to pass through the Senate.
Labor, the Australian Greens and the Palmer United Party have all declared they will oppose the $7 payment to see the doctor, which the coalition says will help pay for its new Medical Research Future Fund.
Prime Minister Tony Abbott says he is open to 'horse-trading' to get his government's first budget through the Senate.
But opposition health spokeswoman Catherine King dispelled any thoughts Labor may be willing to negotiate on the co-payment, which it has dubbed a 'GP tax'.

Medicare Locals.

Medicare Locals to be replaced by Primary Health Networks

15 May 2014 | Published by Michael Gorton, Jonathan Teh

The day before the Federal budget, Professor John Horvath’s Review of Medicare Locals was quietly published on the Department of Health’s website. The Review recommended the creation of Primary Health Organisations to replace 61 Medicare Locals and the Australian Medicare Local (AML) Alliance.

Unsurprisingly, the Federal budget broadly adopts the Review’s recommendations with a measure to replace the Medicare Locals with “fewer but larger” Primary Health Networks from 1 July 2015. 
For those who haven’t followed their development, the Medicare Locals were established under the 2011 COAG National Health Reform Agreement.  They replaced the GP dominated Divisions of General Practice Program which had operated for decades. 
Medicare Locals were established in three tranches from July 2011, mostly as amalgams of existing GP divisions or associations.  In some cases, the Medicare Locals were new companies created by primary health stakeholders from the region.

Nervous wait for Medicare Local staff as details on alternative system remain elusive


May 16, 2014, 4 a.m.
UNCERTAINTY lies over the future of Orange Medicare Local staff and their colleagues from several offices in the region, after the announcement in the federal budget Medicare Local is to be axed.
Almost 150 staff and 50 contractors across the region are nervously waiting details of the changes planned by the government to set up an alternative to Medicare Local.
Chief executive officer of Medicare Local Western NSW, Doctor Jenny Beange, said the organisation is proud of its record of working with regional health groups, doctors and hospitals to provide specific services for communities.

Medicare Locals ponder their future as Budget axes network

May 15, 2014
The Federal Government has cut specific funding for the network of 61 Medicare Locals around Australia, from the middle of next year.
Medicare Locals were established under Labor, to fill gaps in services, including mental health, GP and nurse primary care, after hours clinics and allied health like physiotherapists.
Andrew McPherson, the chief executive of the Grampians Medicare Locals in Victoria, says the future is uncertain.
"The Federal Government will cease funding us and 60 others from June next year.
"What will be put in place is primary health networks, which is pretty much what Medicare Locals are already.
"We think we're pretty well placed to participate in that transition."
Australian Medicare Local Alliance chair Dr Arn Sprogis says the government has made a shocking decision, which will affect frontline health services and the health and wellbeing of Australians around the country.

AMA slams Medicare Locals

13 May, 2014 Amanda Davey
The future is not looking bright for the much-maligned Medicare Locals with the AMA now coming out in support of a damning federal government-commissioned review released this week.
Led by former chief medical officer, Professor John Horvath, the review of 61 Medicare Locals found they should be scrapped in their current form because they are failing to deliver, lacked direction and were duplicating existing services.
Now the AMA has weighed in on the issue calling for fundamental changes to the operation.


Coalition highlights healthy payments

CO-PAYMENTS have been required for the Pharmaceutical Benefits Scheme since 1960 — when patients were asked to pay five shillings for a script — and now make up 14.4 per cent of the cost of government-listed medi­cines.
Amid continuing debate over plans for a $7 co-payment for standard Medicare consultations, such as a routine visit to the doctor or test, government figures show the contribution Aus­tralians are already making to the sustainability of the PBS.
In 2012-13, patients contributed 14.4 per cent, or $1.511 billion, to the PBS, with the government picking up the remaining 85.6 per cent ($8.996bn).
Health Minister Peter Dutton said the existing PBS co-payment of $36.90, or $6 for people with a concession card, demonstrated why the Medicare co-payment plan would work.
Over to you to decide what you think. Seems to me a lot of this is going to struggle in the Senate (both old and new versions)
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:

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