Wednesday, June 11, 2014

Review Of The Ongoing Post - Budget Controversy 11th June 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has not settled by a long shot.
Here are some of the more interesting articles I have spotted this fourth week since it happened. Since the budget was handed down all hell has broken out in the Health Sector and has been continuing.
Senate Estimates on E-Health was on 2nd June - Late in day and we provided coverage last week
We sure do live in interesting times!
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General.

Science going back to dark ages

Date May 28, 2014

Ian Berryman

The Climate Commission has gone. The carbon tax is to be rescinded. The Australian Renewable Energy Agency is to be abolished. The promise of a "Million Solar Roofs" is broken. And in what can only be described as an ideological move, the Abbott government introduced bills to abolish the Clean Energy Finance Corporation, despite it making a profit last year. The Prime Minister has declared war on the Australian renewable energy industry, the environment and science itself.
The overwhelming scientific consensus on global warming is based on evidence, whether Tony Abbott chooses to act on it or not. A sceptic is someone who doubts accepted opinion; a denier is someone who refuses to accept fact. Scepticism is healthy, denial is dangerous, and intentionally dismantling the entire renewable energy industry of a country that is not only wealthy, sun blessed and windswept but also has the highest per capita CO2 emissions in the OECD is criminally reckless. Furthermore, it will cripple our future economic growth.
The global economy has embraced the renewable energy industry. Last year wind power grew by 25 per cent worldwide and solar power by 30 per cent. On May 11, Germany met 74 per cent of its electricity demand with renewable energy.
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Tony Abbott is gutting science just when we need it most

Date June 1, 2014

Ian Dunlop

Australia has an enviable reputation for scientific research, extending long before the heyday of the CSIRO in the 1950s under the visionary leadership of Sir Robert Menzies and Sir Ian Clunies-Ross. On the hottest and driest continent on Earth, our prosperity would be non-existent had it not been for the enlightened application of science. So it has been of mounting concern over recent years to see governments of all persuasions adopt increasingly anti-science agendas.
The federal government is taking anti-science to new heights. Its scorched earth approach discards virtually everything not in line with narrow, free-market ideology, centred on sustaining Australia’s 20th century dig-it-up and ship-it-out economic growth model.  
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Is it time for Medi-change?

Vlado Perkovic, Fiona Turnbull and Andrew Wilson
Med J Aust 2014; 200 (10): 566-567.
doi: 10.5694/mja14.00427
As Medicare turns 30, it is timely to reflect on how well it is delivering on its original principles and what needs to change
Australians are justifiably proud of their health care system. For 30 years, its main pillar has been Medicare, providing free access to public hospitals and subsidised primary and specialist care. In that time, the range of health care interventions available, the way care is delivered and the range of providers have changed dramatically. Moreover, the success of Medicare in supporting access to care has escalated community expectations. It is timely to consider how well our health system is achieving the original principles of Medicare, and the future of Australian publicly funded health care.
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‘Two tier US-style health system’ claim

Joanna Heath

Key points

  • Plans to allow private health insurers to play a bigger role in covering cost of GP visits.
  • Health department asked to provide advice on changes to existing private health insurance arrangements.
Private health insurers could be allowed to play a bigger role covering the cost of visits to GP doctors under plans being considered by the Abbott government.
Department of Health officials told a Senate committee they had been asked for advice on changing the parts of the Private Health Insurance Act covering insurers and primary care.
Health Minister Peter Dutton has previously refused to rule out changing the law, which prevents insurers from paying for services like GP visits which are already eligible for Medicare payments.
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Dutton proved wrong on prevention

4 June, 2014 Michael Woodhead
When he announced the abolition of the Australian National Preventive Health Agency (ANPHA), Health Minister Peter Dutton justified it by claiming the agency was wasting money on sponsoring the Summernats burnout festival.
“Somehow that was going to provide an improvement to our health system,” he sneered in Parliament.
Well this week the head of ANPHA, Louise Sylvan, told the Senate Estimates Committee that the Summernats project was one of the most cost effective health prevention projects she’d been involved with. It succeeded in getting 90,000 downloads of a MyQuit Buddy app , an award-winning smoking cessation initiative.
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Private insurer access to general practice back on agenda

5th Jun 2014
PRIVATE insurer access to general practice is back on the agenda, with the health department admitting it has advised the government on changes to the Private Health Insurance Act.
Dr Richard Bartlett (PhD), first assistant secretary at the department of health, confirmed in Senate estimates proceedings this week that his team had given advice on changes to services covered by private health insurance. 
However, when pressed on whether it was about allowing private health insurers to cover primary care, Dr Bartlett said he could not be specific. 
“I was asked to provide a comment about whether advice had been provided on primary care and private health insurance. I said I had. That is all I said. It went no further and I can go no further,” he said.
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6 June 2014, 6.40am AEST

Federal-state health relations: can anything be salvaged?

T

Author

Director, Health Program at Grattan Institute
The federal budget reignited debate over federal-state relations with a decision to cut $80 billion funding for the state responsibilities of schools and hospitals over the coming years. So how can federal-state co-operation in health make Australia a better country?

Maybe there is a parallel universe where the Commonwealth and states work in harmony to improve the health and health care of Australians. But that is a vision unlikely to be realised in Australia for years to come, after the 2014 federal budget took a wrecking ball to trust in Commonwealth-state relations.
Instead, the blame game is back, and the states can now blame Commonwealth cuts for service shortfalls. But what if we could start again and redesign Australia’s system for delivering health care?

What do health professionals want?

Ask clinicians and they will give you a litany of Commonwealth-state disjunctions that they see in day-to-day practice. Their panacea is often that a single level of government should be responsible for the whole health care system. That is usually the Commonwealth because of its access to more secure revenue growth. The benefits of state responsibility in terms of potential for innovation and local political accountability are forgotten.
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Federal health cuts will hurt ACT, Chief Minister Katy Gallagher warns

Date June 5, 2014 - 10:23PM

Natasha Boddy

Canberra Times reporter

Chief Minister Katy Gallagher says the ACT government will not savage the territory's health system to fund a $47 million budget black hole caused by federal funding cuts, but has warned those losses will need to be made up somewhere.
Ms Gallagher warned budget cuts by the federal government would leave the ACT's health system about $240 million worse off over the next four years. 
"These are cuts that we can't absorb, but we're certainly not going to cut services that impact on families here in Canberra," she said. "We are not prepared to savage our health system to recoup those cuts."
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What's behind the AMA’s silence on rebate cuts?

2 June, 2014 Paul Smith
The Federal Government’s co-payment plan will mean more than a billion dollars coming out of GP Medicare rebates.
But does the AMA care? Australian Doctor investigates.
Federal Health Minister Peter Dutton is just getting to the end of his speech to the AMA faithful.
We are in Canberra for the association's national conference and we have been listening to a lot of scary statistics about the impending financial obliteration of Medicare unless it is "strengthened".
This word is the minister's euphemism for the Federal Government's co-payment plan, which is in turn the euphemism for slashing billion of dollars in rebates for patients to see their GP.
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Fears of US-style health system by stealth

Date June 8, 2014

Jonathan Swan and Fergus Hunter

An Abbott government push to allow private health insurers to cover GP visits would create a US-style two-tier health system and drive up doctors' fees, experts have warned.
TheSunday Age has learnt Health Minister Peter Dutton has told senior health sector sources in private meetings that he is keen to allow private insurers into GP clinics. However, any change would require amendments to legislation.
Under the existing Medicare system all Australians can expect similar quality of care when they visit their doctor. Changing this to create two classes of GP patients would revolutionise Australian healthcare and potentially undermine Medicare more than the proposed $7 co-payment policy, experts say. The revolution has begun quietly with controversial trials undertaken in Queensland. Medibank Private members are receiving guaranteed appointments within 24 hours and after-hours home visits. An expansion of such trials - with superior GP services given to private patients - could endanger Australia's world-class healthcare system, said Australian Medical Association president Professor Brian Owler.
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Medical Research Fund.

Medical research spending at $2.8b

Joanna Mather
Spending on medical research is triple that of other fields, according to official data that scientists said put pressure on the federal government to justify its focus on research while cutting other science programs.
Spending on research and development devoted to medical and health sciences totalled $2.8 billion in 2012, according to the Australian Bureau of Statistics. This represented 29 per cent of spending by universities on research and development and was almost triple the value of the next highest field of research, engineering, at $955 million. The 2012 figures are the latest available.
Research leaders urged the government to concede that medical breakthroughs are underpinned by work in the basic sciences, such as physics and chemistry, while the social sciences enable these breakthroughs to be translated into improved healthcare.
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National Health and Medical Research Council did not provide advice on $20 billion research fund

Date June 4, 2014 - 10:21AM

Dan Harrison

Health and Indigenous Affairs Correspondent

The federal government's main medical research agency provided no input into the Abbott government's budget centrepiece, a $20 billion medical research endowment, despite being its primary intended beneficiary.
National Health and Medical Research Council chief executive Warwick Anderson told a Senate hearing on Tuesday that his organisation had not provided any advice to the government in relation to the creation of the Medical Research Future Fund, which was announced in the May budget.
The Abbott government plans to invest savings from health measures – including the $7 Medicare fee and cuts to hospital funding – into the medical research fund until it reaches a balance of $20 billion, which is expected in 2020.
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Don’t trash medical research fund

IT took 16 years and $1 billion from lab to jab to develop and market the human papillomavirus vaccine, Gardasil.
Since 2006, 144 million doses have been distributed for total worldwide sales of about $13bn. Australia, through CSL and the University of Queensland — where a team led by professor Ian Frazer made the discovery — has so far reaped $800 million in royalties.
Funding for the early stages of Frazer’s research into the human papillomavirus — a trigger for cervical as well as other types of cancers and genital warts — came from the taxpayer.
Between 1986 and 1990 the Nation­al Health and Medical Research Council supplied five grants totalling $156,133. Global reach for the vaccine came via the pharmaceutical giant Merck.
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GP Co-payment.

Doctors under pressure to bear cost of scheme, AMA warns

Date June 2, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

EXCLUSIVE
Doctors could be forced to churn through patients more quickly in order to absorb cuts to their income linked to the proposed $7 Medicare fee, the new federal president of the Australian Medical Association has warned.
Brian Owler, a Sydney neurosurgeon widely known as the face of the ''Don't Rush'' road safety campaign, said he was concerned the introduction of the fee could hurt the quality of care delivered by doctors, particularly those serving poorer communities where patients would not be able to afford to pay.
From July next year, the government plans to cut the Medicare rebate for a GP consultation by $5, and encourage doctors to charge a $7 fee. As part of the changes, the $6 incentive currently paid to a doctor whenever they bulk-bill a patient will only be paid when the doctor charges the $7 fee, and only when the patient is a child or concession card holder.
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Co-payment overhaul a priority for AMA

2nd Jun 2014
THE Australian Medical Association is working on proposals for a more equitable model of the proposed $7 co-payment for medical services to negotiate with the government before the budget legislation goes to the Senate.
Prime Minister Tony Abbott said on the weekend that the government would be open to “refinement” of the co-payment policy. This was the first confirmation that the headline budget measure could be negotiable, after Health Minister Peter Dutton last week gave the opposite impression. 
“It’s a good sign that he will be flexible,” the AMA’s Council of General Practice chair, Dr Brian Morton, told MO. 
“I think there needs to be an overhaul of the proposal, and we’ve said in principle we are not opposed to a co-payment, but it needs to be refined so there is a greater safety net for the vulnerable and disadvantaged. We are in the process of putting together alternative proposals.”
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Invest co-payments in better healthcare: Hawke minister

FORMER Labor health minister Brian Howe has defended his decision to introduce a co-payment for GP consultations in 1991, arguing it was part of a broader health strategy and savings were to be reinvested into a reformed health system.
Mr Howe told The Australian a $3.50 co-payment introduced in the Hawke government’s 1991-92 budget was aimed at addressing an ageing population and encouraging a greater focus on preventive health and chronic disease management by increasing funding to the states.
The Abbott government has announced a $7 co-payment for GP consultations but is facing ­opposition from crossbench senators. Mr Howe yesterday criticised the current plan for failing to inject funds back into the health system, instead being used to create a $20 billion research fund.
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GP tax fraught with snags

Sinclair Davidson
When Julia Gillard imposed a price on carbon, most people recognised this as being a broken tax promise. Notwithstanding the professed nobility of her cause, few could credibly justify the breach of trust that had occurred, and Gillard suffered the consequences.
The problem for Tony Abbott is that his proposed Medicare co-payment is a tax, and constitutes a broken promise as well.
As with the carbon price, the intentions behind the broken promise are noble. Zero-price at point of sale government services tend to be over-used. Federal governments of both persuasions have long attempted to restrict GP services; co-payments have been suggested before, putting restrictions on the number of foreign doctors, rationing provider numbers, and so on.
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When deep cuts are not healthy

Date June 3, 2014

Peter Martin

Economics Editor, The Age

It took Mark Latham to say the unsayable. “If a cure to cancer is to be found, most likely it will happen in Europe or the United States,” he wrote in the Weekend Financial Review. Spending scarce funds to find a cure ourselves is a waste of money, a political fig leaf to cover the electoral pain of the GP co-payment.
Anyone who doubts that the Medical Research Future Fund is a fig leaf or an afterthought, needs to only look at the pattern of leaks and speeches leading up to the budget. Ministers spoke often about the need to restrain the cost of Medicare, scarcely at all about the need to boost medical research.
They weren’t able to prepare the way for the medical research future fund because it didn’t come first. It isn’t that pharmaceutical benefits, doctors rebates and future hospital funding are being cut to pay for the fund. It’s that the fund was evoked late in the piece to smooth the edges of the cuts.  
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Opposition Continues To Grow To $7 Medicare Co-Payment

By Kristen Ochs
As protests continue to grow over the Abbott Government's proposed $7 Medicare payment, Kristen Ochs looks at the industry response to a policy that will impact most on the poor and unwell.
Thousands of Australians took to the streets last weekend to demonstrate against health spending cuts announced in the recent federal budget. The introduction of a co-payment for out-of-hospital medical services has raised fears that the age of universal health care is over.
From July 1, 2015 a $7 fee will be charged for all GP consultations, including childhood immunisation appointments and nursing home visits, as well as blood tests and x-rays. This will be capped at 10 payments per year for concession card holders and children. There are no family-caps, so a single parent with three children would still have to pay up to $70 per child, per year.
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GP co-payment will prevent two-tiered health system that favours the rich, Joe Hockey says

By political reporter Latika Bourke
June 3, 2014
Treasurer Joe Hockey has warned Australians to expect a two-tiered health system that will favour the rich if the $7 GP co-payment is not passed.
The Government is battling to find support for its GP fee in the Senate because the Greens and Labor oppose it.
Under the Government's proposal, doctors would be paid $2 and the remaining $5 would be poured into the $20 billion Medical Research Fund.
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No modelling undertaken to determine co-payment impact on EDs

3rd Jun 2014
THE government undertook no modelling on whether a co-payment would impact hospital emergency departments, health officials revealed during a Senate budget estimates grilling.
"You asked whether we had modelled what might occur with the introduction of a co-payment. We have not done that," said Health Department deputy secretary Kerry Flanagan in response to questions from Greens' Senator Richard Di Natale on Monday. 
Ms Flanagan said the department had relied on "past evidence of what may occur with attendances if you introduce a change either in an emergency department or in the GP space", including the four-hour target in emergency departments. 
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Nursing homes residents to be adversely affected by GP co-payment plan

The Abbott government is facing intense scrutiny of its cuts to Medicare benefits for GP visits.

01.Budget 2014: $7 GP co-payment plan criticised

The Royal Australian College of General Practitioners (RACGP) has criticised the Abbott government for forcing GPs to either charge vulnerable patients a co-payment or absorb the cost in their take-home pay. 
The government has announced a raft of cuts to health care and health insurance in the 2014 Budget. Under the co-payment plan, all Medicare Benefit Schedule (MBS) rebates for GPs will be reduced by $5 – including for surgery consultations, after-hours consultations, home visits and visits to aged-care homes. While GPs will have the choice to absorb the reduced rebate, they would take a cut to their income if they decide not charge patients the $7 co-payment.
The co-payment is proposed to come into effect on 1 July 2015 but will face difficulty in securing Senate approval, with Labor, the Greens and Palmer United Party all opposing the plan.
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Co-pay is antithesis of ‘closing the gap’

5 June, 2014 Dr Justin Coleman
As part of Australian Doctor's Stop the Co-pay Cuts: GPs Make the Difference campaign, we are asking doctors to share their stories of how the Federal Government's budget proposals will affect them and their patients.
Here Dr Justin Coleman shares his fears.
Imagine yourself in charge of Australia’s health budget — heaven forbid!
On your desk are two cash-filled buckets, marked ‘primary care’ and ‘specialist/hospital care’. Your job is to remove some money from one or the other bucket, to be spent elsewhere.
Unrestrained by short-term political gain and beholden to no interest groups (we are only imagining), your decision requires going back to basics.
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16, 17, 19: the three numbers that undermine the co-payment plan

4 June, 2014 Paul Smith
This is an argument by numbers against Peter Dutton's co-payment plan.
The numbers come from a survey of sick Australians who were asked whether they avoid taking medications, seeing their doctor or skipping tests or follow up consults because of cost.
Compiled by the Commonwealth Fund, the results are not about future impact of a policy yet to be implemented but the effects of the system in the here and now.
It shows that Australia is doing worse than 11comparable countries bar the international health system's basket case - the US.
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Co-payments will kill us all! Well, some of us, anyway……

Jennifer Doggett | Jun 06, 2014 10:38AM |
GP and writer Dr Justin Coleman makes a case for re-allocating funding from specialist services to primary care………….oh and along with Dr Tim Senior, Professor Stephen Duckett, Dr Lesley Russell, Professor Jeff Richardson, the AMA, CHF, AHHA, AHCRA, ANMF, and many others he also doesn’t think the GP co-payment is a good idea. He writes:
Imagine yourself in charge of Australia’s health budget – heaven forbid! On your desk are two cash-filled buckets, marked ‘primary care’ and ‘specialist/hospital care’. Your job is to remove some money from one or the other bucket, to be spent elsewhere. Unrestrained by short-term political gain and beholden to no interest groups (we are only imagining), your decision requires going back to basics.
Basics, of course, means health consumers. Patients. People. You reckon doctors can generally look after themselves, so you are only interested in patient outcomes. Which pile of cash is currently giving patients the most ‘bang for their bucket’?
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Co-payment policy 101

Jennifer Doggett | Jun 03, 2014 5:28PM
The Government has been strongly criticised for its selling of the GP co-payment policy but many experts and stakeholder groups would disagree that the problems with the proposed $7 bulkbilling co-payment are merely cosmetic. 
The following 8-step guide highlights some key pre-requisites for the development and implementation of a new health care co-payment.  It should assist in assessing whether or not the proposed Budget initiative is fundamentally bad policy or just suffering from a poor sales pitch. 
8 Steps to a Successful Co-payment    
1.       Reflect community views
Find out what the community thinks about health care funding BEFORE attempting to introduce any new co-payments.  Are Australians concerned about our level of health care expenditure or are we comfortable with spending around the OECD average on health services?  Do we want to fund health care completely through progressive taxation or are we happy to contribute a certain component of health funding through direct payments?  If so, what proportion of health expenditure should be made up of out-of pocket payments, given that we already pay for a higher proportion of our health care costs through direct payments than do citizens of most other countries? Finding out community values and priorities for health funding before introducing a new payment will help avoid nasty shocks at the polls later on.
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Hospital Impacts.

Health reform and activity-based funding

Shane Solomon
Med J Aust 2014; 200 (10): 564.
doi:  10.5694/mja14.00292
Independent evidence-based evaluation will determine the success of activity-based funding in Australia
In August 2011 the National Health Reform Agreement (NHRA) was signed by the Council of Australian Governments. New financial arrangements to enable the federal, state and territory governments to work in partnership were a key component of the NHRA,1 with one aim being to “improve patient access to services and public hospital efficiency through the use of activity based funding (ABF) based on a national efficient price”.2
The NHRA established the Independent Hospital Pricing Authority (IHPA) to determine a national efficient price (NEP) for public hospital services that are able to be funded on an activity basis (see http://www.ihpa.gov.au). The NEP underpins activity-based funding and is used by the states and territories as an independent benchmarking tool to measure the efficiency of their public hospital services.
Activity-based funding is payment for the number and mix of patients treated, reflecting the workload and giving hospitals an incentive to provide services more efficiently. Most countries that have introduced activity-based funding systems have done so with two broad aims: to increase the transparency of how funds are allocated to services; and to give hospitals incentives to more efficiently use those funds.3
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Hospital funding uncertainty

Nicole MacKee
Friday, 30 May, 2014
THE federal government’s plan to abandon activity-based funding for payments to state hospitals from 2017–2018 in favour of indexation has been cautiously welcomed by a health funding expert.
Professor Johannes Stoelwinder, professor and chair of health services management at Monash University, said while he reserved judgement on the amount the federal government contributed to state hospital funding, the new funding mechanism was an improvement on the previous government’s reforms.
  
“It clearly places the states in the role of purchasing hospital services and removes the Commonwealth from duplicating that role”, Professor Stoelwinder told MJA InSight.
He was commenting on an MJA article by Shane Solomon, chair of the Independent Hospital Pricing Authority (IPHA), which said significant progress had been made in establishing activity-based funding since the National Health Reform Agreement was signed in 2011. (1)
Mr Solomon described activity-based funding as payment for the number and mix of patients treated, reflecting the workload and giving hospitals an incentive to provide services more efficiently.
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Pharmacy.

The discount threat

2 June, 2014 Chris Brooker
Are discounters the biggest threat facing community pharmacy?
One Pharmacy News reader thinks so. In response to a recent story, he sent the following comment:
Forget Government Policy Changes for a while and consider Discounters, they are the enemy here.
Go to websites of discounters and check on say Ramipril 10 mg, Rosuvastatin 40mg, Atorvastatin 40mg,Clopidogrel 75mg and Atenolol 50mg for their general price to customers.
I think you should be a very concerned proprietor?
The discounters have seen an opportunity to slash general prices but still get the full return from PBS concessional scripts, while trying to drive us to the wall and build their market share. Much like Coles/Worth have done to other markets.
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Discounters driving down pay: survey

3 June, 2014 Chris brooker
Some discount pharmacy chains may be paying pharmacists lower than average wages, driving down pay across the sector according to Professional Pharmacists Australia.
A PPA survey of employed pharmacists showed that pharmacists who said they were working for Chemist Warehouse were earning substantially less on average than other community pharmacists.  
While findings were not definitive for other discounters, PPA said the figures, from their annual pharmacy remuneration report, “confirm the suspicion within the industry that discount pharmacy is driving down wages”.
The responses indicated that pharmacists working at Chemist Warehouse seem to be earning on average $5.61 an hour less than the average rate of pay in community pharmacy across pay classifications, said Dr Geoff March, President of Professional Pharmacists Australia.
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Co-payment impact on pharmacy not considered: Government

4 June, 2014 Chris Brooker
Changes to the PBS co-payment system proposed in the 2014 Federal Budget were included without any modelling or research on their impact on pharmacists, Department of Health officials have admitted.
Under questioning by the Senate Estimates Committee on Monday, Felicity McNeill, first assistant secretary, Pharmaceutical Benefits Division said no modelling or research had been undertaken on the impact of the increased safety net on pharmacists.
It was one of a series of admission of a lack of pre-Budget research on PBS related measures, which prompted Senator Jan McLucas (ALP) to comment: “It is a bit troubling that not a lot of work has been done that will tell us what might happen with the public - in terms of access to and compliance with their medication regime”.
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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! It is clear the GP co-payment issue is red-hot and right now it is hard to see how this measure will pass.
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.

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