Friday, June 27, 2014

Review Of The Ongoing Post - Budget Controversy 26th 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 sixth week since it happened. Since the budget was handed down all hell has broken out in the Health Sector and has been continuing.
We have both the Senate and the House of Representatives sitting in the 2 weeks starting 16th June - so it will be very interesting to see just what the debate on specific health measures looks like.
It was interesting to see the AMA President come out so strongly against the co-payment. Does not bode well for success in the Senate when it changes on July 1.
Amazing that Mr Hockey has decided to give up selling the Budget in the last week of Parliament for ages and go meet with the Chinese on trade.
We sure do live in interesting times!
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General.

Can we sustain health spending?

Jeffrey R Richardson
Med J Aust 2014; 200 (11): 629-631.
doi: 10.5694/mja14.00564
Australian governments currently spend relatively little on health. Are cutbacks really what's needed?
The assertion that health spending is unsustainable has been made with remarkable regularity, most recently by the Federal Minister for Health, Peter Dutton.1 Despite publication of a major review by the National Health and Hospitals Reform Commission2 less than 5 years ago, the Minister has called for a far-reaching debate about the health system.3 Consistent with the rhetoric, the recent federal Budget has introduced copayments and foreshadowed cutbacks that are expected to reduce federal health spending by $8.6 billion over the 4-year forward estimates.4
The evidence usually cited to demonstrate the unsustainability of health spending is its impact on government finances. Between the 2001–02 and 2011–12 financial years, health expenditures by all levels of government rose from 19.8% to 25.6% of total tax revenues,5 and projections by the National Commission of Audit prior to the recent Budget suggested that federal spending alone could rise from $65 billion in 2013–14 to over $120 billion in 2023–24.6 These trends are commonly linked to the ageing of the population to conclude that significant structural reforms are needed to reduce spending on health services, and the recent budget measures may be seen as a first step in this direction.
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Saving Joe Hockey: the budget we should have had

Date June 20, 2014

Michael Pascoe

COMMENT
Ask not what the Treasurer can do for you, but what you can do for the Treasurer – as he obviously needs all the help he can get.
The whole nation suffers when consumers lose heart. Thus Joe Hockey's spectacularly unpopular first budget is proving economically damaging as well. While the Reserve Bank's verdict is out on the implications of the sharp consumer confidence dive, the budget itself features a sharper fiscal contraction than the central bank expected.
So, for the sake of the nation, here are a few steps that could restore a little confidence by removing some of the budget's more contentious aspects and improving the communication.
A few of the fixes are relatively easy, but the bigger issues will require an injection of political courage to deal honestly with the electorate. First the easy stuff:
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GP incentive scheme poorly devised, rural docs say

16th Jun 2014
A NEW $52.5 million incentive program for rural GP infrastructure is marred from the start by rules that will discourage benefits going to areas where they are needed most, rural doctors say.
The scheme, adopted in the 2014–15 budget to provide taxable infrastructure grants of up to $300,000 to match practices’ spending on facilities to expand their training capability, is being touted by government MPs as a leg-up for rural health and investment.
Before applications have opened, however, the program is coming in for criticism as another poorly thought-out health budget measure. 
Rural Doctors’ Association of Western Australia president Dr Mike Eaton said the matching contribution required from rural practices would be too much for them, and the scheme did not take into account the unusually high building costs in areas where support was needed most.
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National Partnership Agreement on Improving Public Hospital Services: Performance report for 2013

Michelle Hughes | Jun 20, 2014 8:09AM | EMAIL | PRINT
Today the National Partnership Agreement on Improving Public Hospital Services: Performance report for 2013 has been made public. For this Victorian, the results were certainly disappointing.  Below is the full media release from the COAG Reform Council. I would also encourage you to look at the full report here. We have a long way to go.
Media release from the COAG Reform Council
The COAG Reform Council’s second report on the National Partnership on Improving Public Hospitals shows that despite some improvements in performance, most states have failed to meet agreed targets for elective surgery and hospital emergency departments.
Chairman of the COAG Reform Council, John Brumby said that the hospitals report assesses whether specific targets have been met under the National Partnership Agreement. Each state and Territory has negotiated its own specific targets with the Commonwealth and some targets are higher than others.
“In emergency departments, while NSW, Victoria and Western Australia partially achieved their targets, no state or territory fully achieved its target for the proportion of people treated, discharged or referred within 4 hours” said Mr Brumby.
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Health Minister Peter Dutton threatens to cut financial incentives to parents who don’t immunise children

  • Laura Chalmers
  • The Courier-Mail
  • June 17, 2014 12:00AM
Australia's anti-vaccination movement has been caught out promoting a parody image on social media that was designed to mock the movement but instead has drawn widespread criticism
PARENTS who fail to vaccinate their kids could lose financial incentives under measures being considered by the Federal Government.
Health Minister Peter Dutton today will urge parents not to be complacent about the eradication of diseases such as polio, measles and whooping cough, as he opens a Melbourne immunisation conference.
Mr Dutton said it was concerning that in some communities, more than 7 per cent of parents were actively deciding not to vaccinate.
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Public hospital cuts could boost $4 billion float of Healthscope: analysts

Jessica Gardner
The Coalition government’s move to limit funding to public hospitals could provide an unexpected boost to the $4 billion float of Healthscope, with analysts expecting lower standards of care and long waiting lists to drive patients to the private system.
Reports from five brokers hit the desks of fund managers on Monday morning, kicking off marketing for what would be the biggest float of the year in July. If the listing of Healthscope goes ahead – save for a last minute trade buyer – it will the largest since the 2010 float of $4.6 billion rail group QR National, now known as Aurizon.
Comprehensive research, first published by Street Talk Online on Monday morning, came from three of the five lead managers – Credit Suisse, Goldman Sachs and Macquarie Capital. Co-managers CBA Equities and CIMB/Morgans also added their thoughts to the mix.
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Big contracts beckon if Primary Health Network outsourced

Date June 17, 2014 - 3:45PM

Jessica Gardner

Lucrative contracts could be on offer to the country's two largest health insurers with the government considering outsourcing the Primary Health Networks program that will replace Labor's Medicare Local.
Medibank Private and Bupa, which collectively control about 60 per cent of the health insurance market, have both said they would consider tendering for the work.
A spokesman for Health Minister Peter Dutton confirmed the running of PHNs could be outsourced to the private sector "subject to an open tender process to identify the most suitable entities" but would not comment further. "We are not preempting that process," the spokesman said.
Labor set up 61 Medicare Locals - government funded non-profit organisations - to plan and co-ordinate services between general practitioners, allied health and hospitals around the country. The initiative was set to cost $1.8 billion over five years and employs 3000 people. The Coalition proposed a smaller number of PHNs aligned with state-run local hospital networks, which will perform a similar function. The cost of the initiative will be met from existing resources, the government said in the May budget.
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Federal health cuts pose long-term threat to NSW AAA rating

Geoff Winestock
Ratings agency Standard & Poor’s has refused to take NSW’s AAA credit rating off negative outlook, warning the state still has not felt the full impact of the federal budget cuts.
After NSW on Tuesday released a budget that predicted a return to operating surpluses in two years, the ratings agency said in a statement that the AAA was still under threat because federal cuts will only take effect after 2018.
“We expect that the cuts could create longer-term budget pressure for the state, in the absence of commensurate policy measures to increase other funding sources or dampen growth in demand for services.”
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Australia ranks highly in Commonwealth Fund health care report, but cost issues are a sore point

  • June 18, 2014 10:11AM
  • JAMES LAW
AUSTRALIA has been given a healthy prognosis in a new report, but there are signs the condition of our health care system could be worsening.
The Commonwealth Fund has compared 11 developed nations’ health care systems and Australia has ranked fourth overall behind the UK (1st), Switzerland (2nd) and Sweden (3rd).
While the high ranking is something to be celebrated, the report shows Australia has dropped two spots over the past decade, having been placed second overall in 2004.
When stacked up against the 10 other counties studied in the report — Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the US — Australia performed strongly in quality of care, but fell down on cost-related issues.
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Australian health system as bad as US on some indicators: study

June 17, 2014

Michael Koziol

Journalist

Australia's health system delivers high-quality care but is let down by accessibility factors including cost and lack of timely access, a new report has found.
An international comparison of 11 health systems shows a high proportion of Australians report problems paying their medical bills and experience delays accessing treatment.
The fifth edition of Mirror, Mirror on the Wall, a report by private health researcher The Commonwealth Fund, suggests Australia is plagued by similar problems as the US in terms of accessibility.
But the US, which ranked last overall, was marked down on equity and efficiency. It spends far more on health than any other OECD nation, but delivers medium-quality outcomes for the average user. The report notes that the impact of 'Obamacare', President Obama's reforms to expand health insurance coverage, has not yet been realised.
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Wonky Health: It’s just not fair!!

Melissa Sweet | Jun 19, 2014 9:17AM | EMAIL | PRINT
In the second edition of Wonky Health, Dr Tim Senior explains why Health Minister Peter Dutton should be telling his Cabinet colleagues that they are making his job much harder – Budget policies that promote inequality are also likely to be harmful for the community’s health.
Whether politicians are as clever as children, who grasp the basic concept of fairness from about age three, is another matter…
Listen! That strange clanking noise you can hear around the budget is the changing of gear.
Instead of debates about how many promises were broken, or debates about whether there really is a budget emergency, the real discussion now is about fairness.
In a country whose unofficial motto might be “A fair go,” much of the unpopularity of the budget is because people think it is unfair. Last week Joe Hockey tried to defend the budget on the grounds of fairness.
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“Don’t write crap” – at least I think that’s what the AMA meant……

Michelle Hughes | Jun 19, 2014 9:30AM | EMAIL | PRINT
One of the positives (yes I found one) out of the Federal budget this year has been the increasing number of groups raising their voices to articulate the case for ongoing, high quality public health services and public health initiatives accessible to all. In particular, I have observed with some joy that these voices have been raised using clear evidence to separate fact from fiction in the ongoing debate.
Notable amongst the fray has been the AMA leading the charge against the GP co-payment (and again today) . Now it seems that dodgy policy is not the only thing in their sights. Yesterday the AMA bared its teeth again, taking aim at The Australian’s coverage of plain packaging for cigarettes (for examples see here and here).
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Liberal MP Angus Taylor in a muddle over Medicare fee exemption

Date June 17, 2014 - 3:30PM

Dan Harrison

Health and Indigenous Affairs Correspondent

A Liberal MP incorrectly told his constituents the Coalition's proposed $7 Medicare co-payment would not apply to those who could not afford to pay it.
In an email about the budget sent to his electors on Sunday, the member for Hume, Angus Taylor, wrote: "GP co-payments will not apply to those who cannot afford to pay." When asked by Fairfax Media what he meant by the statement, Mr Taylor, whose NSW seat includes the towns of Goulburn and Cowra, said GPs would retain "the option to bulk-bill for those most in need".
While doctors would be allowed to waive the $7 fee under the Abbott government's proposal, a doctor in a country area who did so would receive $14 less than they would for bulk-billing the same patient today. This is because the Medicare rebate for GP consultations would be cut by $5, and the current bulk-billing incentive payment, worth $9 in regional areas, would only be paid when the doctor collects the $7 fee.
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Economy on a AAA high, but consumers just aren't buying it

Date June 21, 2014

Jared Lynch

Business reporter

On the surface, life in Australia doesn't seem so bad - economically speaking.
Interest rates are low, the economy appears to be weaning itself off the dying mining boom, Australia's AAA credit ratings remain in place and business sentiment is holding up.
Major retailers are reporting that earnings are on the slide.
Yet consumer confidence is at dire levels.
More than half-a-dozen retailers, including Pacific Brands, Super Retail Group, Funtastic, footwear chain RCG Group, and Noni B have downgraded earnings forecasts in the past month after sharp falls in sales.
''At the moment, the perfect storm has been a surprising shift in consumer sentiment, more than I would have expected,'' Pacific Brands boss John Pollaers said this month. ''And it's affecting everybody.''
So why the long faces?
While confidence had been tracking down before the Abbott government's ''hard-hitting'' budget, its release in May triggered a deep dive on the back of cuts to pensioners, health and family payments. ANZ's consumer sentiment measure fell at the fastest rate since the financial crisis.
The government says it is trying to hoist the country back to surplus - which it argues will be better for the nation in the long run.
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Funding cuts blamed for job losses at Medicare Local

July 17, 2014
Hunter Medicare Local says it has been forced to cut staff due to Commonwealth budget cuts, but the community will not be impacted.
About nine staff have been made redundant, but the organisation says they are not staff from front line services.
CEO Carol Bennett says the Federal Government has cut funding to all Medicare Locals by about 10 per cent.
"So we are not unique and we have had to be directed by the Commonwealth about what activities we can and can't undertake in the coming years," she said.
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Push for pharmacy students to train to give vaccinations criticised by AMA

15 June, 2014
The Australian Medical Association has criticised a move for pharmacy students to train in administering vaccinations, saying it would raise major issues of patient safety.
It comes after the Western Australian Pharmacy Guild asked Curtin University to make vaccination training a part of its undergraduate pharmacy course.
Chairman of the AMA WA Council of General Practice Dr Steven Wilson said if pharmacists want to administer vaccinations they should get a medical degree.
"You need to then be able to perform all necessary, life-sustaining medical care, and you need to be set up to be able to do that properly," he said.
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Emerald after-hours clinic to close as trial fails

Di Stanley | 18th Jun 2014 3:13 PM
A LACK of patients and a loss of patience are the reasons for the closure of the Emerald After Hours GP Practice at the end of June.
CQ Medicare Local chairman Bruce Elliot said the 12-month trial was in the red to the tune of just shy of $100,000, and the lack of patronage meant it was unsustainable.
The clinic was co-located in the Emerald Hospital, and offered the option of GP services for people presenting to the emergency department.
"The modelling we did was based on the premise we would get about five patients per session and we were offering sessions every day of varying hours," Mr Elliot said.
"We were setting up the program as a cost-neutral exercise, but unfortunately what we were seeing was on average between two and three patients per shift and quite often they were the GP's own patients coming to see them.
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Medical Research Fund.

Medical research too crucial to risk on budget politicking

Date June 16, 2014 - 5:13AM

Phil Hogg

For want of a better cliche, the proposed $20 billion Medical Research Future Fund really could be a "win-win" for Australia. But only if its architects get it right.
As a cancer researcher, I have experienced first-hand the frustrations that drive important Australian medical discoveries offshore, or leave them stranded in the lab.
If we want to develop and deliver new lifesaving Australian drugs, therapies and diagnostics tools – and build a home-grown, high value Australian biotechnology industry in the process – we need to take a long, well-informed look at the barriers along the arduous pathway from the lab to the clinic. That is, the point at which new drugs, therapies and diagnostics start to save and improve lives and to generate financial returns.
Australia has no shortage of insightful, creative researchers who are producing a steady stream of promising basic medical research outcomes. And although access to research funding through the federal government-supported National Health and Medical Research Council is increasingly competitive, much important early stage research does secure support.
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US cancer tie-up to boost research

David Crowe

Political Correspondent
Canberra
AUSTRALIAN cancer research is being linked to the world’s biggest medical centre in a global deal that sets an example for Tony Abbott’s mooted medical research fund.
The Prime Minister visited the centre in Texas on the weekend to see the sort of research he wants to support with a new fund that might one day amass $20 billion.
He spoke to researchers, including expatriate Australian Richard Gibbs, a world leader in genomics.
While the business delegation accompanying Mr Abbott has tended to focus on infrastructure investment and the resources industry, it has also included healthcare experts and visits to medical research centres. The visit on Saturday was to the Texas Medical Centre in Houston, which has more than 100,000 staff across 54 institutions, including eight major hospitals. It treats seven million patients a year and conducts 40 per cent of all of the clinical trials for cancer treatments in the US.
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GP Co-payment.

Medical co-payment belongs on scrap heap

Date June 18, 2014

Brian Owler

The health measures in the federal budget are almost universally opposed by the people who provide health services in Australia. The Australian Medical Association is at the forefront of this opposition.
The message is clear: the measures add up to bad health policy. The health of Australians is too important for healthcare to be an ideological toy.
While the AMA strongly represents the interests of doctors, we will always put the interests of our patients first. This is our professional obligation. It is why we oppose the budget measures. They will hurt our patients, especially the sickest and most vulnerable.
The AMA is supportive of some co-payments, but not the one proposed by the government.
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AMA wants GP fee gone

Date June 19, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

The Australian Medical Association has demanded Tony Abbott scrap his proposed $7 GP fee, accusing the Coalition of treating healthcare as ''an ideological toy''.
In an article published by Fairfax Media on Thursday, AMA president Brian Owler branded the proposed fee ''unfair and unnecessary'' and said it deserved to be voted down in the Senate.
He wrote that the fee would hurt the sick, the poor and indigenous people, hamper preventive health efforts such as vaccinations, and be difficult for doctors in some settings, such as nursing homes, to collect.
''Ideology has pushed this proposal too far,'' he wrote.
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Co-payment won’t kill Medicare

Judith Sloan

Contributing Economics Editor
Sydney
MY grandson Joe’s favourite song is Miss Polly had a dolly who was sick, sick, sick. You know the one — it ends with the doctor coming back in the morning with the bill, bill, bill.
Joe doesn’t seem to get too fazed by the co-payment in the ditty. But for many Australians, Labor parliamentarians and doctors, the sky is about to fall in as a result of the government’s decision to impose a $7 co-payment on visits to the GP, on diagnostic tests and on imaging.
Let us clear up one issue before we discuss the topic. Imposing a co-payment is not a tax. A tax is an unrequited obligation on an individual or other entity to pay a certain amount.
In the case of a visit to the doctor, patients will be required to make a financial contribution for a service they receive. In other words, it is not unrequited. A GP co-payment is no more a tax than buying a train ticket is a tax, even though the train trip is highly subsidised.
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Call to pay back pensioners for $7 GP fee

Date June 17, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

Pensioners should get a pay rise to compensate them for the proposed $7 Medicare fee to shepherd the controversial measure through a hostile Senate, according to the man who restarted the debate about free healthcare.
Terry Barnes, a policy consultant who worked for Tony Abbott when he was health minister, proposed a $6 fee to see the doctor in a submission to the Commission of Audit last year.
The Abbott government's proposal to charge patients $7 for GP visits, pathology and diagnostic imaging was influenced by Mr Barnes' proposal but differs in several respects.
Mr Barnes told Fairfax Media that just as previous governments had compensated vulnerable groups for tough changes such as the GST and the carbon tax, the government should consider boosting the payments of carers and age and disability support pensioners to soften the impact of the Medicare fee.
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Sydney GP shares co-payment hometruths on national TV

17th Jun 2014
TALK of a cross-party ‘bromance’ between MPs Josh Frydenberg and Ed Husic on Monday night's Q&A program was briefly interrupted by a south-west Sydney GP with some home truths about the $7 co-payment's effects on his predominantly disadvantaged patient group.
"I'm a GP. I've been practising for 29 years looking after the mentally ill, frail, lone patients living at home, nursing home patients, children with foster parents," Dr Hamdy Boulis told the audience. 
"I assure you, these patients are the first to be hit and disadvantaged by the budget, even with the proposed allowances in place."
The Campsie GP said he accepted the need for a tough budget but that it would have been "appropriate" to consult relevant health groups before handing it down. 
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Hospital Impacts.

Wait times to double as health funding axed

  • June 16, 2014 12:02AM
  • Political Reporter Sheradyn Holderhead
  •  The Advertiser
ESSENTIAL services will be cut and waiting times for elective surgeries could more than double as the State Government is forced to pass on Federal health cuts.
Almost 100 mental health beds and access to hospital beds for elderly South Australians waiting to enter nursing homes face the axe unless the State Government can cover the funding for programs the Federal Government canned.
The State Government has calculated that the Federal Government’s cuts to specific programs and general hospital total $655 million for SA over the next four years.
Its modelling has revealed that elective surgery waiting times would blow out within three years if the cuts were passed on in full to that area of the state’s health budget.
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Qld Health Minister Lawrence Springborg defends meeting one public hospital target in COAG report

By Jonathan Hair
June 20, 2014
The latest review of Australia's public hospitals shows Queensland has met just one target, but the state's Health Minister Lawrence Springborg says a lot of the issues have already been addressed.
The COAG Reform Council report looked at elective surgery and the performance by emergency departments in 2013.
It found Queensland had met just one target by reducing the number of patients in the top 10 per cent of those who had been waiting longest for elective surgery.
The report outlines a number of failures, including the time frame for treating semi-urgent and non-urgent patients and seeing those who present to emergency departments in four hours.
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Pharmacy.

Next wave of price disclosure cuts announced

20 June, 2014 Chris Brooker
The October price disclosure schedule has been released, the first to incorporate the ‘simplified’ price disclosure regime, introduced by the previous Labor Government.
Some of the biggest selling drugs will experience large drops in PBS price from the Government, with atorvastatin price decreasing by 45.9% from 1 October, and Rosuvastatin declining by 36 per cent.
The accelerated price disclosure plan was announced last year to much opposition from pharmacists, and in contravention of the Community Pharmacy Agreement, the Pharmacy Guild of Australia believed.
As yet, no compensation for the impact of the move has been forthcoming from the Federal government.
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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 next 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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