Wednesday, May 28, 2014

Post - Budget Review Of The Health Sector Outcomes- 28th May 2014.

Budget Night was on Tuesday 13th May, 2014.
Here are some of the more interesting articles I have spotted this second week since it happened. Since the budget was handed down all hell has broken out in the Health Sector and has been continuing.
I am told The House of Reps and Senate Estimates are on this week so it may be quite a big week we will see in the current week.
We sure do live in interesting times!
-----

General.

Budget austerity angers sector

May 19, 2014
Budget cuts strike at heart of ICT innovation ecosystem
The coalition’s first budget was pre-advertised to deliver cuts across the economy, but the severity of budget measures has surpassed industry expectations and shocked many industry commentators and ICT businesses. The cuts come after the government and technology minister had publicly supported the potential of the sector and its future significance to the Australian economy, both in opposition and since coming to office, and committing their support for ICT Innovation. The headline reductions were:
  • The Government will discontinue eight programs including Commercialisation Australia – a $213 million grants program for start-ups – and the Innovation Investment Fund, which co-invests in venture capital funds.
  • CSIRO will lose 500 jobs.Its funding has been cut by $26-28 million a year to save a total of $146.8 million over four years.
  • The Department of Communications and the Australian Research Council will continue to jointly deliver $89.4 million worth of funding to NICTA over the next two years before the institution must transition to a “self-sustaining funding model”. NICTA produces around a quarter of all Australia’s PhD students in ICT every year.
-----

Budget 2014: Is this the Australia we really want to be?

Date May 16, 2014
  • 590 reading now

Hugh Mackay

How you responded to last Tuesday night’s budget speech would depend on your point of view, your preoccupations and your prejudices – political and otherwise.
If you were a clinical psychologist, you might have been disturbed by signs of the Prime Minister’s short attention span. Chatting to his colleagues, giggling, looking distractedly about, he seemed unable to concentrate even for 30 minutes while his Treasurer made the speech of his life.
If you were a spin doctor, you’d have been deeply impressed by the whole thing. Knowing that governments generally benefit from an air of crisis, you’d have applauded the creation of ‘‘budget emergency’’ as a slogan (derided by economists at large, but what would they know about winning?) You’d have loved the many euphemisms for tax, especially ‘‘budget repair levy’’ – quite possibly the basis for a whole new chapter in the spin doctor’s manual, that one.
-----

Less to budget than meets the eye

Date May 19, 2014

Ross Gittins

The Sydney Morning Herald's Economics Editor

The more of the budget's fine print I get through, the less impressed I am. It's not a budget so much as a flick-pass.
On its main goal of returning to surplus, you can accept the plausibility of its projections that budget balance will achieved by 2018-19 without being terribly impressed by the quality of its claimed ''structural'' savings.
The policy changes proposed yield savings over the four years to 2017-18 totalling $38 billion (on an accruals basis). Contrary to all the government's rhetoric, almost a quarter of these savings come from increased tax collections.
But get this: fully 46 per cent of the total savings come in the fourth year. Until then, net savings are quite modest. There are various reasons for this delay. One is political: Tony Abbott is keeping some core promises by not breaking them until after the 2016 election.
-----

'Missing' figures show poor are hit

Date May 19, 2014

Peter Martin

Economics Editor, The Age

Information withheld from the budget shows high income couples may suffer scarcely at all while low income families on benefits could lose as much as 10 per cent of their incomes.
The information, normally included in the budget, calls into question the Treasurer's claim that "everyone is being asked to make a contribution".
Inserted into the 2005 budget by treasurer Peter Costello and included in every budget since, the table is usually titled "Detailed family outcomes".
It sets out the way in which the budget measures make different types of families better or worse off. In 2005 Mr Costello displayed the results for six family types at 15 different levels of incomes.
-----

How the budget pain is unfairly shared

Date May 19, 2014 - 7:01AM

Peter Whiteford and Daniel Nethery

Treasurer Joe Hockey has once again declared the age of entitlement to be over. In his budget speech he said ''it is only fair that everyone make a contribution'' to reduce the deficit.
Most households will contribute through the $7 charge for standard GP consultations. Pharmaceutical co-payments will also increase. People earning more than $180,000 a year will see their marginal tax rate increase by 2 per cent for the next three years, and fuel excise tax indexation will be reintroduced.
Changes to government benefits will also deliver significant savings, but unlike the ''temporary budget repair levy'', these changes will be permanent. Some measures will affect relatively well-off families receiving Family Tax Benefits (FTB). Other changes will affect all benefit recipients. The government proposes to freeze all income-test thresholds for most benefits for three years, and FTB payment rates for two. Freezing payment rates is regressive, since lower-income families bear proportionally higher cuts.
-----

States stoush gets ‘uglier by the day’, premiers say at Sydney summit

STATE and territory leaders have united to reject Canberra’s $80 billion funding cuts, saying the dispute is “getting uglier by the day”.
All premiers and chief ministers — barring WA premier Colin Barnett, who was absent — “firmly and unequivocally” rejected the Abbott government’s cuts to health and education funding, and have called for an urgent COAG meeting to resolve the dispute.
They said there would be “immediate” impacts to critical services should the budget measures be passed.
Queensland Premier Campbell Newman said the state and territory leaders were “firm in our resolve” to reject the funding arrangements.
-----

Coalition ridiculed over 'bad policies'

Date May 20, 2014

Gareth Hutchens

Three measures in the Abbott government's budget have been described as ''crude'' and ''too harsh'' by public policy experts, with one measure in particular being ridiculed for having a ''bush economists' logic''.
The chief executive of the Grattan Institute, John Daley, said on Monday that the Abbott government's controversial $7 medical co-payment plan, its decision to introduce uncapped fees in the university sector, and its work for the dole scheme were bad policies that would not help to fix the structural budget deficit.
Ben Phillips, a research fellow from the National Centre for Social and Economic Modelling, said the severity of the budget overall was ''beyond common sense''.
The criticism came on the same day as Prime Minister Tony Abbott suffered a historic plunge in the post-budget polls.
The Fairfax/Nielsen poll showed a record number of Australians believed the Abbott government's first budget was unfair, contributing to a 12 percentage point jump in Mr Abbott's personal disapproval rating.
-----

Health system will return to blame shifting

May 21, 2014
Stephen Duckett
The 2014 budget transforms Commonwealth–state relations in health. It is a setback for good policy and a major breach of faith. It will make it harder for the Commonwealth and states to work together for decades.
The government has unilaterally cut $1 billion a year from state budgets from 2017. It has torn up the 2011 National Health Reform Agreement that set a new framework for Commonwealth–state funding, under which the Commonwealth would pay for some growth in hospital services, but only based on an efficient cost set by an independent body. That was good for two reasons. It rewarded efficiency and made the Commonwealth’s contribution transparent and fair.
Second, it helped to align the interests of the Commonwealth and the states.
By sharing the costs of growth, the Commonwealth was exposed, for the first time in 40 years, to the challenges states face in managing their hospital systems. Paying part of the hospital bill was a good reason to keep hospital costs in check. The Commonwealth could do this by making primary care work better. That’s the part of the system, largely controlled by the Commonwealth, that keeps people healthy enough to stay out of hospital.
-----

Surprising economic news necessitates a view change

Wed, 21 May 2014| Stephen Koukoulas
I am very, very surprised at the extent to which some key drivers of the Australian economy have hit a brick wall.
It is increasingly clear that this means the RBA is on hold for a while longer and my earlier view that the economy would sustain a period of strong growth was probably wrong. This upbeat view has been superseded by a strange and disconcerting run of economic news.
Consumer sentiment has been smashed, with the ANZ-Roy Morgan measure dropping a tub-thumping 14 per cent in a month. With interest rates obviously on hold, stock prices sort of flat and no other significant factor about, it must be reaction to the budget that is driving this collapse in sentiment. It is a similar story with the Westpac-Melbourne Institute measure of consumer sentiment which dumped 6.8 points in May to be at levels associated with very weak growth in consumer spending.
Why the fall in sentiment matters is that it is reasonably closely correlated with consumer spending. The rampaging retail sales growth of the last 9 months or so is therefore under serious threat.
-----

Abbott and Hockey pressed to soften federal budget

Date May 24, 2014

Mark Kenny Matthew Knott Dan Harrison

Pressure is building on Tony Abbott to water down key aspects of the budget and even to consider bringing forward the promise of income tax cuts to soothe jangling marginal seat nerves.
Senior ministers are flagging a preparedness to compromise in their portfolios in the face of entrenched opposition from interest groups and minor party or independent senators.
Two of the biggest spending ministers, Education Minister Christopher Pyne, and Health Minister Peter Dutton have signalled that negotiations would see some ground given.

Medical Research Fund.

Leading scientists cautious about $20bn medical research future fund

Acclaimed medical researchers, cited by the government as potential beneficiaries, say research fund needs to be rethought
The budget centrepiece – a $20bn “medical research future fund” – won’t improve the nation’s health unless the government broadens its brief beyond finding cures for diseases, leading health researchers and academics have warned Tony Abbott.
The prime minister has described the fund as a “fine piece of policy” that would “double our nation’s investment in finding cures for disease and better medical treatments so we can all live healthier and happier lives”.
But acclaimed medical researchers, cited by the government as examples of the people it wants to encourage with the money, said it needed to be rethought.
Many have said they are torn by a budget that provides the new pot of money, in part by charging people to visit the doctor, but also cuts $80m from co-operative research centres, $111m from the CSIRO and $75m from the Australian Research Council.
-----

GP Co-payments.

$7 fee likely to skyrocket, GPs caution

Joanna Heath
Co-payments for GP visits could end up far higher than the mandatory $7, doctors warned, as bulk-billing clinics recoup costs caused by having to charge patients for the first time.
And non-concessional patients already used to paying more could see their fees hiked even higher, as doctors seek to make up for the losses incurred by waiving the co-payment in compassionate cases.
Bulk-billing rates in some areas, including western Sydney, are as high as 99 per cent and many clinics do not have existing facilities to collect cash or take card payments.
University of Western Sydney’s medical school Professor Jennifer Reath said there was a danger of smaller GPs moving out of areas where bulk-billing rates were high as a result of the co-payment requirement.
-----

Copayment debate needs leadership

Cate Swannell
Monday, 19 May, 2014
STRONG, “thoughtful” leadership from stakeholders such as GPs and specialists can ensure the $7 Medicare copayment for GP visits is not a fait accompli and does not make it through the Senate, say health policy experts in the wake of the federal Budget.
Professor Geoffrey Dobb, AMA vice-president, said copayments would “change the culture of Australian health care to a huge degree”.
“It is the end of universal health care when even the poorest people and children are liable for up to 10 copayments a year”, Professor Dobb told MJA InSight.
He said it was the AMA’s job to help minimise the adverse impacts and unintended consequences of the federal Budget’s health measures, “particularly in terms of the impact on services for poorer people and children”.
-----

Co-payments likely to compromise health system

May 19, 2014, 7 a.m.
THE Federal budget will impact most on those least advantaged in our community.
That’s the message from Southern NSW Medicare Local chairman Dr Martin Carlson, a GP in Moruya, who says the new $7 co-payment to visit the doctor from July 2015 will increase barriers for people who need health care the most.
“This co-payment will impact our most disadvantaged patients – the homeless, people with drug and alcohol addiction, the chronically unwell, people with a mental illness – and of course that growing demographic, the working poor.
“In a region where 67 per cent of GP visits are bulk billed, my concern is that many people will delay or avoid a general practice visit because they can’t afford the extra costs.
-----

Govt says GP revenue up 4% under co-pay

19 May, 2014 Paul Smith
The $7 co-payment plan will mean an extra $468 million flooding into general practice, according to Federal Health Minister Peter Dutton.
But is he correct?
The minister has been doing the media rounds since last week's federal budget, talking up a "significant windfall for general practice".
He pointed to an analysis released after the budget suggesting that revenue for general practice would increase by 4% — in spite of the $5 cut to MBS attendance items, reducing GP Medicare funding by about $500 million a year.
-----

Medicare fee could make many skip diagnostic tests

Date May 20, 2014

Dan Harrison, Lucy Carroll

A $7 fee for Medicare services could add hundreds of dollars to what families spend each year on healthcare and make it more difficult for GPs to manage patients with complex chronic conditions.
From July next year, the federal government is proposing that patients pay $7 for each GP visit, pathology service or X-ray.
While contributions for concession card holders and children are capped at $70 per person per year, there is no limit to how many times other families can be required to pay the fee. Families receiving Family Tax Benefit Part A are entitled to some relief for their out of pocket costs after they spend $700 in a year, but the $7 fee does not count towards this threshold.
-----

Who pays the $7 GP fee - the Prime Minister and the Treasurer don’t understand their own policy

  • May 22, 2014 12:30AM
  • SUE DUNLEVY NATIONAL HEALTH REPORTER
  • News Corp Australia Network
EMBARRASING bloopers by Prime Minister Tony Abbott and Treasurer Joe Hockey have revealed they don’t understand who will be forced to pay their controversial new $7 GP fee.
And their mistakes have undermined the government’s attempt to sell a tough budget to angry voters.
Prime Minister Tony Abbott told Melbourne radio listeners yesterday an average person would only have to pay the $7 GP fee ten times and then they would be bulk billed.
In fact the government has put no limit on the number of times an ordinary worker will pay the $7 charge, however, there is a ten visit safety net just for pensioners and children.
-----

Patients are skipping GP appointments because of Federal Budget co-payment confusion

  • Cayla Dengate
  • Manly Daily
  • May 22, 2014 12:01AM
Confusion is running rife in medical centres and pharmacies on the northern beaches as people wrongly believe co-payments announced in the budget are already in place.
Sydney North Shore and Beaches Medicare Local chair Dr Harry Nespolon said he had several GPs reporting patients were not showing up for appointments over concerns they’d have to pay a $7 co-payment, flagged to be introduced in July 2015.
 “What concerns me is the number of patients who are already not turning up to appointments,” Dr Nespolon said. “I think this is probably because they mistakenly believe the co-payment has already been introduced — people are confused.
-----

Fear of GP fee already biting, says doctors' association

Date May 22, 2014 - 10:29AM

Matthew Knott

Communications and education correspondent

Doctors are already reporting a drop in visits because of concern about a $7 GP visit fee, according to the Australian Medical Association (AMA).
AMA President Steve Hambleton said there was widespread confusion about the fee, which will not be introduced until next July at the earliest.
"We already have some feedback, certainly from Western Sydney, there are practices that are saying that attendances have dropped and now we are getting reports from other part of the country as well," he said.
"Certainly the timing has been a concern and some practices have said in the first few days they have had about a 50 per cent reduction in the first few days.''
-----

GP visits dive ahead of looming $7 co-payment

MEDICAL practices are already reporting plunging demand for GP consultations, with one surgery in western Sydney reporting a 50 per cent drop in appointments in recent days, the Australian Medical Association says.
AMA president Steve Hambleton said that practice, in Mount Druitt, resorted to sending out SMS messages to patients to inform them that the Coalition’s $7 co-payment for GP visits is not slated for introduction until July next year.
The measure, described by the government as “a modest price signal”, is designed to dissuade patients from claiming Medicare benefits for unnecessary consultations.
-----

Doctors say not happy to the Federal Govt

Alexandra Kirk reported this story on Thursday, May 22, 2014 18:10:00
MARK COLVIN: Doctors' groups have spent the day working on a detailed response to the Federal Government's GP $7 co-payment plan.

For now the message is "the doctors aren't happy".
Last night on PM the Health Minister Peter Dutton defended the co-payment, saying some GPs were using bulk billing to attract patients from fellow doctors.
But those with an eye to history are recalling that a decade ago it was Tony Abbott, as health minister, who made a concerted effort to lift flagging bulk billing rates.
-----

AMA President: co-payment will not enable GPs to continue bulk billing

22/05/2014
Last Friday, AMA President, Dr Steve Hambleton, spoke to ABC News Radio, saying that the government’s assumption that GPs would receive $468 million over four years, allowing them to continue to bulk-bill poorer patients, is not true. 
Speaking from Toronto, Dr Hambleton highlighted the extra costs that would be required for bulk billing practices to collect the co-payment, which would absorb any potential gains. 
“If a bulk-billing practice moves to a $7 co-payment there’d be no net benefit,” Dr Hambleton said.
In addition, he said that GPs would be 25 per cent worse off by bulk billing patients under the co-payment scheme, as the rebate will be lower and there would be no low co-payment incentive.
-----

Co-payment scheme not backed by evidence

23rd May 2014
EXPERTS have said there is no scientific evidence that co-payments have any benefit on people’s health, and implementing one without a properly resourced trial could lead to many costly and avoidable outcomes.
In an opinion piece in The Australian, UNSW academics John Kaldor, professor of epidemiology, and Nicholas Zwar, professor of general practice, said only 50 studies looking at the impact of co-payments have been conducted, mostly in Western Europe and Canada.

The results of these studies consistently showed lower levels of service usage when co-payments were introduced, and that people on lower incomes were particularly affected.
-----

#copaynoway: GPs turn to social media in budget fightback

Joanna Heath
The words “white coat lobby” can strike fear into the hearts of politicians of all stripes.
Whether you are a patient in need or a politician, you tend to follow what the doctor orders.
That is why the importance of the conciliatory tone of outgoing Australian Medical Association president Steve Hambleton on the most controversial healthcare reform in recent years, the $7 medical co-payment, should not be underestimated.
-----

Australian Medical Association seeks change in co-payments

By Primrose Riordan

May 25, 2014, 12:22 a.m.
Doctors in the Australian Medical Association have voted to oppose the co-payment system as it is laid out in this month's federal budget, which outgoing AMA chief Steve Hambleton said is "game-changing" for public hospitals.
Doctors at the conference also expressed concern over the effect co-payments could have on those on low incomes and Aboriginal and Torres Strait people.
Victorian doctor Gerald Segal told the conference on Saturday he was not opposed to co-payment as an idea, but "it’s going to be a huge problem for about 15 per cent of my patients, who might bring a couple of their children to see me and at the end of the consultation say, 'Well that’s OK, doc, but which script is the most important?' "
-----

Hospital Impacts.

Premier Mike Baird warns federal budget cuts could force 300 hospital beds to close

Date May 19, 2014

Anna Patty

NSW hospitals would be forced to close about 300 beds from July 1 because of federal budget cuts which Premier Mike Baird warns will slash $2 billion from the state budget each year.
Mr Baird said that while the state government had managed to make efficiency savings to date without affecting front-line services, those services were directly in the firing line.
He said NSW stood to lose more than $1.2 billion from the health budget through scaled-back national partnership arrangements to fund hospital services. About 300 hospital beds would need to close in July unless the federal funding cuts could be absorbed elsewhere in the state budget.
-----

Tony Abbott now admits $1.8bn in hospital cuts will begin from July

Prime minister backs down on claim that cuts to public hospital funding agreements would not take effect for three years
Tony Abbott has conceded the government is cutting a hospitals funding agreement with immediate effect, contrary to his weekend claim that the cuts did not take effect for years.
On Sunday Abbott said: “We’re not talking about next week or next month or even next year; we are talking about changes in three years' time”.
But Abbott now agrees the national partnership agreement on public hospitals, which begins on 1 July, has been cut. Budget documents say it has been cut by $1.8bn over the next four years.
The prime minister says the reductions should be blamed on Labor because the former government had previously revised the agreement.
-----

Tasmania's health sector to bear brunt of 'tough love' federal budget

May 19, 2014
Tasmania's health system faces a $27 million shortfall next financial year as a result of federal budget cuts.
Premier Will Hodgman has come away from a crisis meeting with other state leaders more pessimistic than ever about the budget's local impact.
The leaders are demanding an urgent Council of Australian Governments (COAG) meeting with the Prime Minister.
Mr Hodgman has toughened his stance against the budget, describing the cuts to health as 'untenable and unsustainable'.
"When the budget was released we described it as the good, the bad and the ugly, its getting uglier by the day," he said.
"What we are seeing is something that is untenable, that is unsustainable and I will not allow the rope to be pulled out from underneath us," he said.
Tasmania's already struggling health system will be hit first and hardest hit, losing $27 million next financial year.
-----

Medicare Locals.

Axe Falls On Medicare Locals

May 19, 2014
The Federal Budget announcement that the 61 Medicare Locals across Australia will be scrapped has been greeted with equanimity by the Darling Downs South West Queensland Medicare Local team.
“While the announcement has been unsettling for our staff and community, it will not detract from our commitment to support and strengthen primary health care across the Darling Downs, South Burnett and South West Queensland regions,” DDSWQML chairman Dr Graham Baker said.
DDSQQML chief executive officer Andrew Harvey said it was still too soon to see the full ramifications of the announcements made in the Federal Budget.
-----

Pharmacy.

Pharmacy owners ‘winners’ as budget clings to generics pricing policy

Federal Health Minister, Peter Dutton, deserves applause for resisting proposals that would lead to the collapse of the current pharmacy model, the Pharmacy Guild of Australia believes.
A Guild spokesperson was responding to a report in the Herald Sun, where health economist Stephen Duckett said medicine prices could have been cut by up to $26 per script, and up to $1 billion saved a year, if the government had revised the payment model for generic medicines.
“I think essentially the government has not done the heavy lifting that it claims. It could have adopted a simple policy that would have saved the consumer and the budget bottom line,” said Mr Duckett, from the Grattan Institute.
-----
Comment:
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out. Parliament this week will be very interesting indeed!
I wonder will I need to do another week of this summary.
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:
Enjoy.
David.

1 comment:

Terry Hannan said...

David, I have been looking at the research in copayments and access to care and quality in the literature. Most (if not all) produce negative outcomes. So rather than people offering their individual or combined 'ideas' they should just read the research. That is why we do research-to test hypotheses and protocols. If the government does not take heed of research outcomes what chance have the populous got in achieving change? Terry