Thursday, August 07, 2014

Review Of The Ongoing Post - Budget Controversy 7th August 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs.
Here are some of the more interesting articles I have spotted this tenth  week since it was released.
Parliament has now got up for the Winter Recess we can take a breath and see where we are.
The AMA has been out recently suggesting ideas and worrying about just what the Government’s health agenda actually is. Prof Owler does not seem happy with the apparent directions.
We sure do live in interesting times!
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General.

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Enough is enough, say doctors’ groups

1 August, 2014 Amanda Davey
Doctors groups have expressed alarm at reports of serious and prolonged health issues affecting asylum seeker children.
This follows evidence at the National Inquiry into Children in Immigration Detention that the government has been hiding the true extent of mental health issues among children,
The AMA, RACGP and the RACP (Royal Australasian College of Physicians) responded to the allegations made by psychiatrist  Dr Peter Young, by calling for immediate policy reform, starting with the removal of children from immigration detention.
Comment: I totally support the views expressed. What is being done here is a total abomination in my view and betrays the natural humanity the vast majority of Australians share.
See here also:
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Six steps to meaningful health reform

Policy
Terry Barnes
In the three-year federal political cycle, year one is for announcing tough decisions, year two is for implementing them and year three is for “removing barnacles” for the next election.
Health Minister Peter Dutton will start his second year from behind. The Abbott government’s $7 co-payment on bulk-billed GP services most likely won’t survive the Senate, consuming precious political capital for no return. States and territories have been ­provoked over the Commonwealth’s long-term public hospital funding effort. And there’s still no definitive over-arching health policy narrative to place tough measures like the GP and increased Pharmaceutical Benefits Scheme co-payments in a broader strategic context.
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Liberals trying to unpick Medicare says shadow health minister King

SHADOW health minister Catherine King has accused the Abbott government of trying to “unpick Medicare” and create a healthcare system in which low income patients would eventually be “bumped out of appointments”.
Ms King said the government’s proposed Medicare copayment undermined the universality of Australia’s healthcare system.
“(The government) is clearly trying to say it wants a two-tiered system and it is clearly trying to transfer costs onto patients,” Ms King told Sky News yesterday morning.
Ms King said co-payments were a “really bad policy idea” which would undermine Australia’s ability to create a strong primary healthcare system.
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Health reforms would ‘bump low-paid out of appointments’

OPPOSITION health spokeswoman Catherine King has accused the Abbott government of trying to “unpick Medicare”.
Ms King said the Coalition wanted to create a healthcare system in which low-income ­patients would eventually be “bumped out of appointments”.
Ms King, the member for Ballarat in Victoria, said the gov­ernment’s proposed Medicare co-payment undermined the universality of Australia’s healthcare system.
“(The government) clearly is trying to say, ‘We want to have a two-tiered health system.’ .
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Efficiencies to be found in health system

Joanna Heath’s article “Health insurers push GP clinics” (AFR, July 26) raises the issue of who is accountable for the financial issues that are looming on health. There is general recognition the current system is unsustainable.
The fact is there is plenty of money in the system, and there are plenty of efficiencies to be found.
When Health Minister Peter Dutton raises the spectre of $7 co-payments for GPs the “managed scare” campaigns start. But we have co-payments of $200 or more already with specialist consultations. Many GPs remind me of this contradiction, and there is significant efficiency to be found in this issue alone.
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Crisis rhetoric is overplayed in healthcare

Mark Eggleton
Wander into most companies in the world and the word from senior management and the human resources department is usually something along the lines of “We’re all about our people”.
Whether they really are “about the people” is a moot point but it ­contrasts nicely with the healthcare debate in Australia where the people rarely get mentioned.
What we do get is constant references to budget crises and the need for Australians to shoulder more of the health cost burden. Yet beyond the ­crisis rhetoric we don’t get a lot of ­reasoned debate. Politicians on all sides tend to trot out the same emotive tropes about hospital waiting lists, lack of beds, nurses and access to GPs or rising costs.
Finding actual solutions or trying to uncover the real problems associated with the nation’s health sector requires a deeper discussion and that’s what the Healthcare 2.0 initiative has en­deavoured to do over the past 20 weeks.
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Andrew 'Twiggy' Forrest call to manage welfare payments

Date July 31, 2014 - 8:55AM
Millions of welfare recipients could be told what they can and can't buy if the federal government accepts a new plan.
A proposal to roll out income management to all 2.5 million people on working-age welfare - including disability support pensioners and carers - is reportedly contained in a review led by mining magnate Andrew Forrest.
Mr Forrest wants all welfare recipients including non-indigenous Australians to be included in the scheme.
Only age pensioners and veterans would be exempt.
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Clive Palmer hits out at 'failed' budget, calls for double dissolution

Date July 31, 2014

James Massola, Latika Bourke

Exclusive
Clive Palmer says the federal government's budget has crashed and he has challenged Prime Minister Tony Abbott to hold a double dissolution or implement a mini-budget.
The leader of the Palmer United Party also accused Treasurer Joe Hockey of lying by suggesting Australia could lose its AAA credit rating, and while he declared his in-principle support for the work-for-the-dole program, he was ''totally opposed'' to job seekers having to apply for 40 jobs a month.
Key crossbench senator David Leyonhjelm also lashed the government's proposal to toughen work-for-the-dole requirements as bordering on exploitation. He called for ''proper'' industrial relations reform instead.
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Time to prescribe Healthcare 2.0

Australian Financial Review
Nothing has driven up government spending over the past decade faster than healthcare. It now consumes a quarter of all state and federal tax revenues, and is outpacing the growth of the rest of the economy at 5.4 per cent of GDP over the past decade, against 3.1 per cent for growth in GDP itself. It is doing so for the best of reasons: better technology and drugs that help us to live longer. Much of the rise of spending has come in hospitals, happily because a population of healthier oldies are more likely to be considered viable for operations and other treatment. Moreover, Australia usually spends its health dollars better than its peers, with lower outgoings and better outcomes than many other developed countries.
But we will have to do better if the rise in spending is to be contained. The Coalition played down the need for health system reform at last year’s election, no doubt to avoid controversy. And Health Minister Peter Dutton, a participant in The Australian Financial Review’s Healthcare 2.0 program, has yet to set out a clear reform agenda. That has robbed the federal budget proposal for a $7 co-payment for visits to the local doctor of political context, other than to help fund a $20 billion medical research fund. But as the Healthcare 2.0 series has shown – with the support of GE Health but with content determined by this newspaper – there is no shortage of ideas to improve and reform the sector.
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AMA intent on changing govt policy

29th Jul 2014
The recent confusion over counting practice nurse time for health assessments is indicative of how the medical profession is assessing the federal government’s approach to general practice — and it is not good.
Associate Professor Brian Owler
President, AMA
It is all the more surprising given that both the prime minister and health minister expressed full commitment to promoting general practice, both before and since the election.
In March, Health Minister Peter Dutton told GP registrars: “I can say unequivocally that general practice will be at the front and centre of our plan. The Australian government is committed to rebuilding general practice and putting GPs back at the centre of our healthcare system.”
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Research Fund.

Getting the research funding balance right

Innovation
Prue Moodie
Warwick Anderson wants to dispel some of the suspicion surrounding the government’s mooted Medical Research Future Fund. “We’ll be arguing for our existing endowment pool and the new funding from the medical research future fund to be set up separately,” said Anderson, who is CEO of Australia’s peak government medical funding body, the National Health and Medical Research Council.
Anderson confirmed that the NHMRC will ask to be the body responsible for dispersing the Medical Research Future Fund money. If the two pools are kept separate, “that allows us to do things we can’t do with our current endowment fund,” he said.
“We envisage that the new funding should be available for such things as the infrastructure around research, registers of diseases, collection of specimens, development of ideas and a degree of commercialisation assistance. I think the population has an expectation of both health and wealth from medical funding.”
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Out Of Pocket Expenses.

AMA rejects call for more fee disclosure

Date July 30, 2014

Dan Harrison and Daisy Dumas

The Australian Medical Association has rejected calls for greater transparency on surgical fees, saying it was not possible for patients to compare prices for operations in the same way they might shop around for a dishwasher.
Appearing at a Senate hearing on Tuesday, AMA president Brian Owler, who is a neurosurgeon, said his organisation did not support the charging of excessive fees, but said the appropriate fee for a procedure depended on the patient's condition.
''It is not possible to put up on a website all of our fees … and be able to go, like you're buying a dishwasher, and be able to work out which doctor you're going to on the basis of the fee that they charge,'' Associate Professor Owler said.
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AMA rejects PM's health system changes as poorly designed

30th Jul 2014 6:00 AM
THE Australian Medical Association says the government's push to revitalise the nation's health system was poorly designed and could create even greater demand for more expensive health services in the future.
The peak-medical body claims controversial measures, announced in this year's budget, were driven by ideology and made no attempt to refine and shape the Australian health care system to cope with future demands.
The AMA, in its submission to a Senate inquiry into out-of-pocket costs in Australian health care on Tuesday, argued the $5 cut to rebates for private patients, the $7 co-payment for bulk-billed patients plus changes to the Medicare Safety Net and the Pharmaceutical Benefits Scheme will cost about $8.4 billion in the next four years.
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Cost of Surgery.

College raises concerns at 'extortionate' fees of some surgeons

Date July 29, 2014
The professional body for surgeons has expressed concern about the ''extortionate'' fees being charged by some specialists, including some of its own members.
Royal Australasian College of Surgeons president Michael Grigg said the college would take action against any of its members found to have charged ''exploitative and unethical'' fees, and could expel members from the college, which would have ramifications for their professional registration.
''[The college] believes that extortionate fees, where they are manifestly excessive and bear little if any relationship to utilisation of skills, time or resources, are exploitative and unethical. As such, they are in breach of the college's code of conduct and will be dealt with by the college,'' Professor Grigg said.
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Ouch, that's expensive! The lowdown on the high cost of surgical specialists

Date August 3, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

Are surgeons fees a reasonable reflection of skills and professionalism or are they extortionate and unethical? Dan Harrison takes a patient look at operational matters.
Why the fuss about surgeons fees this week?
The issue hit the headlines after the Royal Australasian College of Surgeons issued a strongly worded statement taking aim at some surgeons, including some of its own members, for charging “extortionate” fees, and threatening to take action against those found to be acting unethically. The college’s intervention coincided with a hearing in Canberra as part of a Senate inquiry into the broader issue of out-of-pocket health costs. The inquiry, which was initiated by Greens Senator Richard Di Natale, partly as a way of scrutinising proposals for fees to visit GPs, is due to report on Friday.
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GP Co-Payments.

29 July 2014, 6.28am AEST

Higher health co-payments will hit the most vulnerable

MMany poor families already pay a significant proportion of their household income on health care co-payments and will face increasing financial pressure with a proposed additional A$7 charge, according…

Author Stephen Duckett

Director, Health Program at Grattan Institute
Many poor families already pay a significant proportion of their household income on health care co-payments and will face increasing financial pressure with a proposed additional A$7 charge, according to new Grattan Institute research I’m presenting today to the Senate Inquiry into out-of-pocket costs.
The Abbott government announced the A$7 charge for all visits to general practitioners and pathology tests and X-rays they order in the May budget, along with significant increases to co-payments for pharmaceuticals. But the legislation is yet to be considered by the Senate.
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Abbott Government to consider altering proposed $7 GP co-payment

THE federal Health Minister will consider a plan to soften the controversial $7 co-payment that could see the fee applied to a family rather than each individual.
Australian Medical Association president Brian Owler will meet Health Minister Peter Dutton in Brisbane today to offer him an alternative plan to Government reforms he says will cost patients $8 billion over four years.
As it stands, the Government’s co-payment will not get through the Senate, with the ALP, the Greens and key crossbenchers, including Clive Palmer’s senators, saying they will not vote for the measure.
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AMA, crossbenchers will have say on co-payment

Sean Parnell

Health Editor - Brisbane
LEGISLATION enabling a $7 co-payment will not be introduced until the Abbott government has held talks with the Australian Medical Association and Senate crossbenchers, Health Minister Peter Dutton said yesterday.
But the government is not independently working on any alternatives — despite facing a likely Senate defeat — and is refusing to release the modelling and options paper behind its controversial budget measure.
Initial talks last night between the minister and AMA president Brian Owler made little headway, with the AMA still insisting the government abandon its plan to cut $5 from the standard Medicare rebate. Mr Dutton had earl­ier described the AMA as “the doctor’s union” and suggested it would always put members first.
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Secret co-pay plan calls for halt to rebate cuts

29 July, 2014 Paul Smith
A secret AMA plan to fix the Federal Government's $7 GP co-payment proposal will demand that cuts to GP attendance item rebates are abandoned.
Details of the plan are still under wraps, with the AMA claiming it is bad strategy to share information with the profession before speaking with the government.
The plan will be presented to Health Minister Peter Dutton later this week.
It is a high-stakes game for the AMA, with internal concern that the negotiations could blow up in its face if the government's eventual revamp fails to find favour with the majority of GPs.
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Alternative co-pay model considered

1st Aug 2014
THE federal government has signalled it is willing to make concessions on its controversial $7 co-payment plan and committed to considering an alternative model proposed by AMA president Associate Professor Brian Owler during a two-hour meeting last week.
“[The AMA] made some suggestions that I want to go away and look at the modelling on, and see what impact that would have on the system,” Health Minister Peter Dutton told Radio 4BC in Brisbane on Friday.
“If there are improvements to be made, we’d be foolish not to listen to them,” Mr Dutton said.
Professor Owler previously flagged that the AMA would take an alternative co-payment proposal to government, saying it would send a “price signal” but “have protections for the most vulnerable in the community, those that truly can’t afford to pay a co-payment, and encourage people to see their doctor for preventive healthcare”.
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Peter Dutton says crossbenchers and doctors will come round on $7 fee

The health minister is confident he can reach a deal, despite staunch opposition from Labor, Greens and Palmer United
Daniel Hurst, political correspondent
The health minister, Peter Dutton, has expressed confidence in his ability to reach a deal with doctors and crossbench senators over his Medicare co-payment plans, but there are no clear signs of a breakthrough in the budget stalemate.
Dutton emerged from talks with the Australian Medical Association (AMA) saying he was willing to compromise if amendments improved the government’s proposal, yet he reaffirmed his belief that $7 was “a reasonable price for people to pay when they go to see a doctor”.
The Palmer United party (PUP) leader, Clive Palmer, poured cold water on the prospect of a deal. He told Guardian Australia on Friday his senators were firmly against any Medicare co-payment, ruled out agreement on any possible changes, and said the government was engaged in “wishful thinking” for believing the measure would pass the Senate.
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Peter Dutton softens stance on $7 Medicare co-payment

Politics
Phillip Coorey Chief political correspondent

Key points

  • Government considers exemptions following talks with the AMA.
  • Senator Lambie gives Treasurer cool welcome.
The federal government is considering exemptions for pensioners and other low-income earners from the $7 Medicare co-payment as it strives to salvage the controversial budget measure.
Following consultations with the Australian Medical Association, which has been severely critical of the health impacts of the levy, Health Minister Peter Dutton said the government was modelling the budgetary impacts of AMA proposals.
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Medicare Locals.

Promise check: No Medicare local closures

Posted Sun 27 Jul 2014, 6:03pm AEST
In the final leaders debate between Tony Abbott and Kevin Rudd on August 28, 2013, Mr Abbott made an unexpected health care commitment.
"We are not shutting any Medicare locals," the then opposition leader said.
His promise came days after he had refused to say that "absolutely no Medicare local would close" at the launch of the Coalition's health policy on August 22.
"There will be a review and the object of the review will be to try to ensure that we maintain the actual health services that are being provided by Medicare locals while minimising the bureaucracy associated with them," he said at the policy launch.
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Audit finds Medicare Locals misspent funds

29th Jul 2014
MEDICARE Locals made critical accounting errors, failed to inform the Department of Health of conflict of interest concerns and in some cases used federal funds to pay speeding fines and entertainment costs, according to an audit released under Freedom of Information laws.
Deloitte examined six of Australia's 61 Medicare Locals and found scores of potential breaches of the deed with the government that regulates what their funding can be spent on. 
Parking and speeding fines, entertainment and functions, employee farewells and gifts, company director courses and office amenities had been paid for out of federal funding, according to the report. 
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Hospital Impacts.

AMA slams $8b burden of PM Tony Abbott’s ‘bad health policy’

  • Renee Viellaris
  • The Courier-Mail
  • July 29, 2014 12:00AM

SA's public hospitals at the heart of Labor's latest campaign

DOCTORS will today warn that patients will be slapped with $8 billion in healthcare costs in just four years because of controversial Abbott Government Budget changes.
The Australian Medical Association will tell politicians at a public hearing in Canberra that doctors will not be able to absorb costs, which could become a financial disaster for families, the elderly and those with chronic illnesses.
The lobbying from the powerful doctors’ union will make it even harder for the Government to get its reforms through Parliament. The ALP, Greens, the Palmer United Party and crossbench senators have said they would not support the health overhaul.
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Pharmacy, PBS and Medicine Issues.

Guild rejects claims location rules are anti-competitive

30 July, 2014 Christie Moffat
The Pharmacy Guild of Australia has rejected claims that pharmacy location rules are “perniciously anti-competitive” and are creating “local monopolies”.
The Guild’s response followed an article published in the Australian Financial Review today, where health economist Professor Philip Clarke said the ownership and location rules made it very difficult for new players to enter the industry, including pharmacy graduates.
“The current location rules prevent new entrants, denying many of Australia’s pharmacy graduates the opportunity to set up their own businesses, and they also create local monopolies,” Professor Clarke said.
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6CPA may feel force of Budget blues

31 July, 2014 Chris Brooker 1 comments
Ensuring an equitable payment for dispensing remains the key item on the agenda at the upcoming Sixth Community Pharmacy Agreement negotiations, says David Quilty, executive director of the Pharmacy Guild of Australia.
In his latest column in Guild newsletter, Forefront, Mr Quilty says anxiety levels across the profession are rising as 6CPA negotiations near, and the Federal Governments’ budgetary situation sours.
“While the negotiations have not yet commenced, the Guild is ready and will not leave a stone unturned in striving to achieve the very best result for our community pharmacy members,” he said.
Mr Quilty said the Guild’s negotiating team was putting together “a compelling proposition that convinces the Government that the next Agreement is an opportunity to make a strategic investment in addressing Australia's major health challenges by fully utilising the unique attributes of the community pharmacy network.”
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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, with the AMA suggesting alternatives, in secret, to Mr Abbott. I wonder why not to Mr Dutton? Also we see Mr Hockey wandering around the country trying to drum up support for his budget. Thus far he seems to be struggling.
In the news this week we have the Paid Parental Leave scheme legislation apparently on the back-burner - maybe a sign of how hard this has all become for the Government.
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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