Thursday, May 08, 2014

Pre - Budget Review Of The Health Sector - 8th May 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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General.

Liberal base ‘angry’ over debt tax, says former Howard minister Peter Reith

FORMER Howard government minister Peter Reith has warned the mooted deficit levy is scaring Liberal voters as a “whopping great big new tax” going against the Abbott government’s election promises.
Speaking on Sky News’ Australian Agenda this morning, Mr Reith said the proposed tax might be economically necessary but its handling was causing major political problems for the government.
Mr Reith said he had received angry phone calls from Liberal supporters last week as plans for the levy were revealed.
“People were not happy, I mean they were angry and I’m talking about solid Liberal party people who have supported the party for years,” he said.
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Budget in a bind if Joe Hockey and Tony Abbott are both serious

Date April 28, 2014 - 10:08AM

Michael Pascoe

What a curious bind the government has managed to get itself into ahead of releasing the Commission of Audit's report on Thursday and its first budget tomorrow fortnight: on one hand the Treasurer been screaming "budget crisis" with an increasing note of urgency for the past year and more, but on the other, the Prime Minister keeps promising to keep his election promise not to surprise or disadvantage anyone or cut back on the most expensive programs of pensions, health and education.
Treasurer Hockey has promised that "everyone" will feel pain from his first budget. Last week he further stoked the fires of anticipation of a tough love budget, warming up the crowd with a little Commission of Audit preview ahead of the weekend's supposed leaks, inspired and otherwise, suggesting there will everything from a tax increase (but called a "levy")  to a squeeze on stay-at-home spouses through scrapping Family Tax Benefit B.
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Sunday Explainer: What's worse for the budget? Super or pensions

Date April 25, 2014
Category Opinion

Peter Martin

Economics Editor, The Age

Over the next 40 years, the number of Australians aged 65 or over will double.
Is the cost of the pension really soaring beyond control? Or is that just the sort of talk we hear in the lead-up to every tough budget? Isn't the cost of superannuation growing even faster? And why all the talk about super and pensions after the Coalition won office promising no change to neither?
IS THE PENSION THE CAUSE OF JOE HOCKEY’S BUDGET WOES?
It doesn’t help. At present, the age pension accounts for 9.6 per cent of government payments. It is expected to climb to 10.6 per cent over the next four years but, after that, the Commission of Audit says it’ll stay steady at 10.6 per cent for the rest of the next decade.
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In outsourcing, both sides of the coin need viewing

Date May 2, 2014

Peter Martin

Economics Editor, The Age

A few years back a Canberra man stole tens of thousands of dollar coins from the Royal Australian Mint. He worked there. He smuggled them out in his shoes and lunchbox.
How much easier would it be to spirit away coins if you owned the mint and ran it?
Owning and running the mint is now a real prospect for anyone who’s keen on money. The Commission of Audit wants it privatised after 2016.
It’s easy to imagine the worst. The mint can churn out up to 10 million coins a week. The new owner might get a request from the government for 7 million and churn out a few million extra. They could leave through the loading dock. There would no need to pack them into shoes.
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Retirement age rise to 70 by 2035, Joe Hockey announces

Date May 2, 2014

James Massola

Political correspondent

Australians born after 1965 will have to work until they are 70 before they are eligible for the age pension, Treasurer Joe Hockey has announced, as he warned there was "no such thing" as a free visit to a doctor or free welfare.
Mr Hockey confirmed on Friday that while nobody currently on the pension would be hit by a rise in the pension age, the Abbott government would raise the retirement age in coming years.
The Treasurer called on the Labor opposition to offer bipartisan support for the move.
In what is expected to be his final major speech before handing down his first federal budget on May 13, Mr Hockey said the Coalition would deliver a document that is "not going to be an austerity budget, but it is going to be a prudent budget" which would prepare Australia for the demographic challenges posed by an ageing population.
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Let the states ‘get on with the job’

  • STEFANIE BALOGH and SEAN PARNELL
  • The Australian
  • May 02, 2014 12:00AM
FORMER prime minister Kevin Rudd threatened to take over the public hospital system but ended up with reforms that “over-complicated” the health system, audit commission chairman Tony Shepherd said yesterday.
Mr Shepherd said the audit commission had examined the system in great detail and recommended giving the states more responsibility and authority so they could “just get on with the job’’.
“I think again we just get back to this fundamental thing — the states provide the hospital services, the commonwealth assists with some capital injection.’’
While the commission recommends Health Minister Peter Dutton develop his own blueprint for reform over the next 12 months, it backed the work of Labor’s National Health and Hospitals Reform Commission and said one option was to move to universal health insurance.
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Expect stricter pension rules

Date April 30, 2014

Noel Whittaker

The eligibility age, assets and income are in the Federal government's sights.
Australia is between a rock and a hard place. Rising life expectancies mean our present age pension system is unsustainable, yet any attempt to change it will be met with strong resistance from the over 65s - the fastest growing group in the community.
The present income and asset tests are generous. A homeowning couple can have assets of about $1,126,000, plus their home, before losing eligibility to at least a part pension under the assets test. For the income test, the cut off for a couple is $73,247 a year.
It's hard to make an argument that people whose assets and income are in range of these figures should be receiving assistance from the government. Expect to see the limits reduced - the big question is when.
The possibility of raising the pensionable age even further is making headlines and on first glance it would appear an easy option. It would have no impact on today's retirees and the government tells us how many billions of dollars would be saved in years to come.
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Why the next few days are crucial to our future

Chris Richardson
The federal budget is Australia’s social compact with itself – as a nation, we raise taxes on companies and workers to spend on subsidies for the young, the old, the sick and the poor.
If we do that job well, then we are all better off. But typically we don’t do it well. Bismarck is often said to have remarked that you should never watch either laws or sausages being made, so perhaps it is no surprise that at any given time the budget is not the carefully thought-out masterpiece of good governance that you might hope.
Rather, it is the leftover mess resulting from coincidence, compromise and convenience.
Mistakes linger, bureaucracies have babies, and good policy gets buried under ever deeper layers of past politics.
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Medicare after the national audit

Alan Mitchell
“Our biggest costs are also our fastest growing,” laments Treasurer Joe Hockey.
“Let’s think about the implications of that. If the biggest programs are growing more quickly than the economy, then how will we find the money to pay for them?”
Among the programs that are eating their way through the budget are healthcare and education.
Presumably, the Commission of Audit has given the government a roadmap to both reduce production costs and impose fair and efficient user charges.
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Debt Levy.

New deficit levy would hit consumer sentiment but effects on spending unknown, say economists

Date April 29, 2014 - 3:17PM
The Abbott government's proposed "deficit levy" expected to be introduced in the May budget will hit consumer sentiment at a sore time for Australian retailers.
But the likely impact on retail spending is harder to know, economists say.
The Abbott government plans to introduce a "deficit levy" in the May budget to help to bring the budget back to surplus sooner, according to news reports on Tuesday.
The office of Treasurer Joe Hockey will not confirm or deny the reports.
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Politically palatable threshold of pain

THE only excuse for a deficit levy is that the pain of the government’s spending cuts would otherwise be focused overwhelmingly on the poor.
The $100,000 a year threshold, which Tony Abbott appears to be marking out as the upper limit for receipt of benefit payments, includes millions of households for whom government payments currently represent a significant share of their income.
For example, a family with one parent earning $65,000 and another earning $35,000, with three children under the age of 10, would be receiving about $8000 a year in family benefits at present, the loss of which would be a significant blow.
The details of just what the government is proposing will emerge with the budget, but the Prime Minister’s speech last night has made it clear that eligibility and indexation will be tightened across most government transfer payments.
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Australian workers earning over $80,000 set to feel debt tax pain

·         Terry McCrann, AAP
·         Herald Sun
AUSTRALIANS earning $80,000 or more will be hit with a debt tax of at least $800 a year in a bid to bring the nation back into the black.
And Treasurer Joe Hockey’s “sharing the pain’’ deficit levy will be tiered so that higher income earners will pay significantly more than other taxpayers.
The new tax to be imposed in the Treasurer’s first budget on May 13, will be a levy on taxable income — similar to the Medicare surcharge.
It will only apply to workers on incomes of $80,000 and above and the rates will increase in line with tax brackets.
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Commission of Audit and Health.

Commission of Audit: From crazy brave to politically suicidal, no easy options for Federal Government

May 1, 2014
The Commission of Audit's recommendations fall roughly into three categories.
There is the brave: cutting 22 industry assistance programs.
The crazy brave: imposing a Medicare co-payment of $15, and picking a fight with the powerful Pharmacy Guild by exposing chemists to competition.
And there is the politically suicidal: breaking a pledge by including the family home in a pension means test.
But this is not the Government's plan. What matters is what happens next. How it responds in its budget, due in just 12 days.
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Families should pay $15 to see a doctor: Audit Commission

  • May 02, 2014 12:00AM
  • Sue Dunlevy National Health Reporter
  • News Corp Australia
MEDICARE as we know it would end, with bulk billing scrapped and those earning over $88,000 denied benefits under a health revolution proposed by the government’s Audit Commission.
Families and general consumers would pay $15 to see a doctor, have a blood test or x-ray under the audit commission’s reforms to rein in the cost of health care.
Pensioners and concession card holders would be charged $5 for these services.
After 15 services a year the charges would drop to $7.50 for general consumers and $2.50 for pensioners.
Under the proposed changes a visit to the doctor, a blood test to diagnose the illness and a prescription to cure it would burn a $72 hole in the pocket of a general consumer.
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National Commission of Audit recommends health cuts and mergers

The National Commission of Audit report released by the Abbott government today recommends a wave of public sector cuts including abolition and merger of key health agencies.
The report recommends that two health agencies – the Health and Hospitals Fund Advisory Board and the Anti-Doping research panel – be abolished outright, that twelve more be merged into other bodies and a range of others consolidated under further arrangements.
The report argues that various benefits would accrue from the sweeping reforms. It claims that embedding health and medical research within the health system would improve patient outcomes and deliver efficiencies; and improved data collection and analysis would result from reducing the number of agencies collecting data and reporting on health outcomes.
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Audit Commission’s sweeping reforms for health, welfare – worrying signs for the future and some scare tactics?

Marie McInerney | May 01, 2014 5:36PM | EMAIL | PRINT
Croakey readers will no doubt be aware of the sweeping changes to health, welfare and other services that have been proposed by the Federal Government’s Commission of Audit, including an end to universal health care and a much tougher GP (and Emergency Departments) co-payment scheme than previously touted.
Further on health, it recommends “requiring” high income earners to take out private cover, and dropping the rebate that encourages them now, plus deregulating private health insurance so health funds can charge people for certain “lifestyle factors”, such as smoking, and allowing pharmacists to set up in supermarkets.
Released today, two months after it was handed to Treasurer Joe Hockey, the Commission’s report also recommends huge changes to other benefits and services in Australia, including a slower rollout of the National Disability, scrapping the Family Tax Benefit Part B payment, and forcing young job seekers to move to better employment areas.
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More strong verdicts on the Audit Commission’s “cruel, unfair, ignorant” proposals on health

Marie McInerney | May 02, 2014 12:03PM | EMAIL | PRINT
This post compiles further reaction to health related recommendations of the National Commission of Audit, whose report to the Federal Government was released yesterday.
First up is an impassioned response from Tim Woodruff, vice president of the Doctors Reform Society, on expansion of private health insurance and the proposals to impose a $15 GP co-payment and to increase the costs of prescriptions.
These co-payments are killers. But they won’t stop politicians, newspaper proprietors, CEOs, or mining magnates getting whatever care they want or need.  This is a recommendation to return to class warfare, to beat the weak and reward the rich.  These are cruel and heartless recommendations designed to get Aussie battlers to do the heavy lifting whilst the wealthy complain about the cost of good home help.
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Experts sceptical about Health Minister Peter Dutton's health funding 'crisis'

Date May 2, 2014

Jonathan Swan and Fergus Hunter

Health Minister Peter Dutton has misled Australians with exaggerated claims about the unsustainability of the healthcare system, say economists and public health experts.
Contrary to claims by Mr Dutton, four health and economics experts interviewed by Fairfax Media said there was little evidence that Australia's healthcare costs were unsustainable.
And patient advocates warned the adoption of the National Commission of Audit's recommendations – including compulsory fees for doctor visits, emergency hospital charges and relegation of Medicare to only the needy – would bring about the end of universal healthcare.
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Audit Commission endorses health system run by – and for – bean counters, says AMA

THE health recommendations proposed by the Abbot government’s Commission of Audit would put health, medical and pharmaceutical care out of reach of families, says the Australian Medical Association (AMA).
The association’s president Steve Hambleton says the commission’s proposed health system undermines the principle of universal access to health care.
“It is clear that the commission’s recommendations have been put forward by business leaders and bureaucrats with no input from people with health and medical expertise,” Dr Hambleton says in a statement.
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Guild rejects ‘glaringly bad’ policy options proposed by Commission of Audit

2 May, 2014 Christie Moffat
The Pharmacy Guild of Australia has swiftly rejected the recommendations of the National Commission of Audit in relation to community pharmacy and the PBS, referring to the document as an “attack” on pharmacy.
In a statement, the Guild said the Commission’s recommendations were “glaringly bad”, a “litany of economic rationalist ideas”, and that targeting existing pharmacy regulation would “destroy a system which enjoys the overwhelming support of Australian consumers”.
The Commission of Audit report, released yesterday, outlines a number of proposed changes to pharmacy regulation in Australia, including ownership and location rules.
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Health experts respond to Commission of Audit recommendations

2nd May 2014
ROD Moodie, Stephen Duckett, Philip Clarke, Anthony Harris and more give their verdict on the report's recommendations.
By Anthony Harris, Monash University; Jim Hyde, Deakin University; Karen Soldatic; Philip Clarke, University of Melbourne; Rob Moodie, University of Melbourne, and Stephen Duckett, Grattan Institute
The National Commission of Audit has made 86 recommendations with a focus on the federal government’s 15 biggest and fastest-growing areas of spending. Health is near the top of the list, with the Commission recommending sweeping changes such as a slew of co-payments and a delayed roll-out of the NDIS.
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At a glance: What’s in store for health?

2nd May 2014
THE Australian health system faces major surgery if the National Commission of Audit’s (NCOA) recommendations are taken up by the government.
It says it will not respond to each recommendation immediately and all will be revealed in next week’s budget.
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Doctors urge Tony Abbott to ditch health reform 'fantasies' that could endanger patients

Date May 1, 2014 - 5:42PM

Amy Corderoy

Health Editor, Sydney Morning Herald

Lives would be put at risk by "radical" National Commission of Audit reforms to Australia's health system that would begin an Americanisation of Australia's health system, furious doctors say.
They have warned the Abbott government not to go ahead with proposals such as compulsory fees for visiting the doctor, which they say would lead to a massive worsening of the burden of chronic disease in Australia.
They have described other proposals, such as asking busy hospital emergency departments to charge fees, as "fantasies" that could not possibly work.
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GP Co-payments.

$15 co-payment recommended by Commission of Audit report

1st May 2014
THE National Commission of Audit has sensationally recommended a $15 co-payment for GP visits and Medicare services.
The commission's report, containing 86 recommendations aimed at saving the budget up to $70 billion annually, was released in Canberra on this afternoon. 
The big savings focus on health, the ageing and education.
Recommendations also include lifting the pension age to 70 by 2053, increasing the superannuation preservation age to 62 by 2027, slowing the rollout of the National Disability Insurance Scheme, and requiring high-income earners to take out private health insurance. 
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Labor frontbencher Andrew Leigh shifts position on previous support for a GP fee

Date April 28, 2014 - 10:41AM

Matthew Knott

Communications and education correspondent

Labor's shadow assistant treasurer Andrew Leigh was once a strong supporter of a compulsory fee for visits to the doctor - a policy now slammed by the opposition as a “GP tax” that would hurt the community’s most vulnerable.
The Abbott government is expected to introduce a $6 Medicare co-payment for bulk-billed GP visits in the May budget, capped at 12 visits a year, in a bid to save $750 million over four years. The idea is opposed by Labor, the Australian Medical Association and other health groups, who say a fee would deter poor patients from seeking treatment.
But in a 2003 Sydney Morning Herald article Dr Leigh, then a PhD student in economics at Harvard University, argued a Medicare co-payment was “hardly a radical idea”.
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Medicare Locals.

Big tick for new health initiatives

April 30, 2014.
Medicare Local says new initiatives underway to help ease the burden on public hospital emergency departments on the New South Wales Central Coast are saving money and improving the standard of patient care.
A free mobile x-ray service, which has been available to aged care residents over the past 12 months, has seen 92% of patients avoid being transferred to hospital.
There has also been direct savings of almost $1.5 million dollars.
Central Coast Medicare Local's Chief Executive, Richard Nankervis says another trial, which gives ambulance paramedics the option of transferring patients to their GP rather than hospital is also proving successful.
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A smart government would strengthen, rather than weaken, primary health care

Melissa Sweet | Apr 27, 2014 7:22PM
Uncertainty about the future of Medicare Locals must be having a negative impact upon those involved with these organisations as well as those using their services. At least one Medicare Local (Country North SA) has felt the need to reassure its community that it is still open for business.
In the article below, Carol Bennett, CEO of the Hunter Medicare Local, says there is strong evidence to support a continued investment in Medicare Locals.
“Unless we are prepared to invest in specialist primary care organisations like Medicare Locals, we risk leaving our children a health legacy that may mean their life expectancy is less than ours,” she says.
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Pharmacy.

Budget measures could have big consequences: pharmacy leaders warn

30 April, 2014 Chris Brooker
The Federal Government needs to consider the bigger picture when looking at further PBS cuts, pharmacy leaders are warning, saying a number of other mooted health budget cuts may already impact medicines expenditure.
The flow-on impact of policies like the GP co-payment will most likely lead to reductions in PBS levels anyway, says Anthony Tassone (pictured), president, Pharmacy Guild of Australia (Victoria).
“There’s lots of speculation of what’s going to happen in the Budget, but the government does need to be mindful that other policies, such as the GP co-payment, will already affect PBS growth as there is no doubt it will lead to a reduction in GP visits, and a reduction in scripts.”
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Services to go as confidence collapses: Guild

29 April, 2014 Christie Moffat
A recent survey conducted by the Pharmacy Guild of Australia has found a “disturbing collapse in business confidence” among pharmacy owners, as a result of increasing pressure on revenue from PBS cutbacks.
A quarter of respondents to the Pharmacy Services Expectations Survey said they would reduce their opening hours over the upcoming financial year by an average of 5.4 hours a week. In addition, one in ten pharmacies will drop at least one trading day per week.
The survey of 548 pharmacies found that pharmacists were concerned about their ability to continue offering a full range of health services to their clients.
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Comment:
The drumbeat suggesting a tough budget continues to build. The final report of the Commission of Audit (COA) has been handed to Government and released with a lot of possible impacts on health.
We already know for certain the pension age will be 70 by 2035.
The new idea to scare the public this week is a so called  ‘debt levy’ - read income tax increase. The political fallout with this idea seems likely to be intense if the News Limited press over last weekend can be believed.
Interesting to see Community Pharmacy is really in the COA gun.
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. Just a vague comment.
Thank heavens the next report will be the post-budget report.
David.

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