Thursday, October 06, 2016

The Macro View – Health And Political News Relevant To E-Health And Health In General.

October 6  Edition.
Parliament has now risen and won’t be back until next week. (Back October 10, 2016).
The world economy is still feeling a little fragile with concerns regarding Europe and China.
Australia is seemingly pretty good at present, while subject to global winds
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Here are a few other things I have noticed.
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Budget Issues.

Christian Porter flags replacing family benefits with tax breaks

  • The Australian
  • 9:34AM September 25, 2016

Sarah Martin

Social Services Minister Christian Porter has flagged replacing family welfare payments with direct tax breaks when technology improves, saying the current system has “deep structural inefficiencies” that must be addressed.
Mr Porter said there were “hundreds of thousands” of families paying about $12,000 in tax each year, who were then receiving the same amount back in family tax benefits.
“You can imagine that that is an extremely inefficient and costly system to, in effect, draw money from one group through tax to give it straight back to them, with all of the administrative costs and loss that occurs in moving that money through government back to the pockets of the people from whom you took it in the first place,” he told Sky News’ Australian Agenda.
“So there are quite deep structural inefficiencies in the system that has kind of grown in an ad hoc way.”
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Australia has knowledge and means to overcome social inequality

  • Michael Marmot
  • The Australian
  • 12:00AM September 24, 2016
What do Tanzania, Paraguay, Latvia and the top 25-earning hedge fund managers in the US have in common? The answer is that the 48 million people of Tanzania, the seven million people of Paraguay, the 2 million people of Latvia and the top 25 hedge fund managers each have an annual income of between $US21 billion and $US28 billion.
If the 25 hedge fund managers gave up their income for one year and transferred it to Tanzania, population 48 million people, it would double the income per person. The hedge fund managers wouldn’t feel it, because they will get $US1bn the next year. I am not suggesting that you simply give the money to each individual Tanzanian, but think of clean water that could be supplied, the clean cook stoves, the teachers and nurses that could be employed.
The point is that we have a great deal of money sloshing about.
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RBA may be forced to cut rates further: Lowe

  • The Australian
  • 12:00AM September 26, 2016

David Uren

Reserve Bank governor Philip Lowe believes Australia’s economy does not warrant lower rates, but he has left open the possibility that he may be forced into it by the monetary policy action of central banks elsewhere.
The Bank of Japan’s vow last week to maintain its extraordinary monetary policies until its inflation rate is in excess of 2 per cent shows the offshore pressures on the Reserve Bank will keep on coming. It also shows why the US Federal Reserve choked yet again at the cusp of a decision to raise rates.
Lowe is optimistic about the Australian outlook. Commodity prices have been firmer this year and the wind down of investment in the resources sector will be completed early next year.
“If we are seeing the end of the mining investment fall and if we have got some stability in the terms of trade, I think there are reasonable prospects that we will continue to see good activity in the non-mining economy that will see a stabilisation and even a gradual pick-up in wage growth. That will feed through in time to inflation,” Lowe told the House of Representatives economics committee last week.
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  • September 25 2016 - 9:00PM

Global leaders change direction while we play games

Ross Gittins
It's strange the way Malcolm Turnbull and Scott Morrison keep shooting off overseas to compare notes with world economic heavies, but come back none the wiser.
Fortunately, the wonders of the internet allow us to read for ourselves what they're being told by the trumps at the Organisation for Economic Co-operation and Development and the International Monetary Fund.
It's clear those at the leading edge are getting increasingly worried about the outlook for the world economy and are urging a marked change of policy direction.
But while the trumps see a need for policy to swing back to the centre, our unruly Coalition is intent on drifting off to the far right.
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Everyone to blame for our budget spiral of hopelessness

  • The Australian
  • 12:00AM September 26, 2016

Phillip Hudson

Fixing the federal budget is turning into a ridiculous game of inches. No dollar of spending will be easily surrendered. Every cut is taking money away from some vested ­interest.
Even when Labor and the ­Coalition agree and have the ­numbers, as they did during the last sitting of parliament to pass the $6.3 billion omnibus package of cuts, it took more than six hours of debate to navigate through the Senate.
One measure, which Finance Minister Mathias Cormann told the Senate was an “absolutely minuscule” saving worth $3.6 ­million over four years to veterans ­affairs, was the subject of a 55-­minute argument as Jacqui ­Lambie and the Nick Xenophon Team’s Skye Kakoschke-Moore passionately fought the move. That is their right. They never had a hope of winning, but would not yield quietly.
As the clock ticked past 11pm, Derryn Hinch asked Cormann to concede the government was pushing ahead too quickly.
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Coalition backs down on $500m backpacker tax, cuts proposed rate

Date: September 27 2016
James Massola
The federal government has backed down on its proposed $500 million backpacker tax in a deal that will please Nationals MPs who had campaigned against the measure.
Under a deal hammered out by Treasurer Scott Morrison and Nationals leader Barnaby Joyce, the plan to impose a 32.5¢ tax rate on backpackers from the first dollar they earn while working in Australia has been scrapped, and instead the rate will be set at 19¢.
The 19¢ rate will apply up to $37,000, and then normal tax rates will apply.
And Mr Morrison trumpeted the fact that the change would "wash its face" and be revenue neutral, with the cost of the foregone made up by a $5 increase in the Passenger Movement Charge (PMC) that applies when people leave Australia, from $55 to $60, and by an increase in the tax on working holidaymakers paid on their superannuation payments to 95 per cent when they leave Australia.
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  • Updated Sep 28 2016 at 11:45 PM

Australia has just five years to prepare for risks from China debt: Morrison

Australia has five years to make its budget more resilient to a potential economic shock from booming debt levels in China, Treasurer Scott Morrison says.
His warnings came after the release of the latest World Economic Outlook from the International Monetary Fund on Wednesday, which said China must allow its economy to slow to stop a "disorderly deleveraging", triggering contagion in emerging markets, and hitting asset prices in advanced economies.
The IMF said China's financial links with the rest of the world were now sufficient for a major shock to affect global stock prices, debt markets and currencies, particularly for Beijing's major trading partners such as Australia.
"Adverse shocks in China reduce equity prices both in advanced and in emerging market economies, with stronger effects on countries with higher trade exposure to China," the IMF said.
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  • September 30 2016 - 12:00AM

Scott Morrison's blunt warning: embrace immigration and trade, or face 'great danger'

James Massola
Australia must embrace immigration, trade and foreign investment - or risk the prosperity of future generations, according to Treasurer Scott Morrison.
In his third and final post-election headland speech, to be delivered at the Lowy Institute in Sydney on Friday, Mr Morrison will argue Australia has built its wealth on the back of freer trade and that, for two centuries, it has relied on the influx of foreign capital to fund domestic investment and grow the overall size of the economy.
At the same time, the nation's targeted immigration program has been a prime driver of population growth and, therefore, economic growth, while the "composition of our immigration intake has been equally important. Our immigration program sets itself apart from other countries, as it is built on attracting people and families to Australia who want and are able to make a contribution, rather than take one".
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Health Budget Issues.

Government is paving way to private Medicare: Catherine King

  • AAP
  • 2:54PM September 25, 2016
The federal government has rejected claims frontline Medicare services will be shut down, causing delays to rebate repayments.
Human Services Minister Alan Tudge said there had been some consolidation of shopfronts over the past years but most people are still able to find a service centre within a few kilometres of their home.
Rebates are now being processed in one of 17 centres nationwide, but from the patient’s perspective there is no change, Mr Tudge told reporters today.
“Every single aspect of Medicare which is currently operated by government will continue to be operated by government, including the processing of the Medicare rebate,” Mr Tudge said.
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Leaked documents reveal long Medicare delays

Updated: 7:34 pm, Sunday, 25 September 2016
Leaked Medicare documents have revealed patients who don't process their claims online, are facing long delays.
Whistleblower public servants have told News Corp they had been told by December there will no longer be any face-to-face Medicare services and they had been banned from telling patients their Medicare claims will be sent off-site for processing.
Patients undergoing expensive medical treatments could be left out of pocket for weeks after the documents revealed the federal government has outsourced processing to new centres and closed Medicare shopfronts.
Human Services Minister Alan Tudge said back of house processing had been consolidated due to a huge reduction in demand for face-to-face claiming and services for people who are unable to use digital services will remain the same.
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Health Minister Sussan Ley has denied reports of changes to Medicare

September 25, 20167:51pm
Charis Chang and AAPnews.com.au
HEALTH Minister Sussan Ley says there’s no truth to claims people will have to wait longer for their Medicare refunds.
She told SkyNews today that people would be able to claim their Medicare refunds in exactly the same way as before.
In explaining what was changing, Ms Ley said instead of being processed at every single office that they were collected, Medicare forms would instead be processed through 15 centralised hubs.
She said there would be no job losses and no employees would be forced to move.
Ms Ley described reports that processing of Medicare claims would be slowed down as “alarmist nonsense”.
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Issues of price exposed by knee replacements’ $1.2bn bill

  • The Australian
  • 12:00AM September 26, 2016

Sean Parnell

Knee replacements cost the health system more than any other procedure, amounting to well over $1.2 billion a year.
But there are concerns that inflated prices for manufactured knee parts on the federal Pros­theses List are adding to the cost burden in the private sector, where some patients may also be having procedures they don’t need.
Among the 10 items on the Prostheses List that cost the most overall last year were two different brands’ components for total knee arthroplasty, priced at $2550 and $3650, making up $13,027,950 and $15,330,000 of the total spend.
Also in the top 10 was another company’s separate component for knee arthroplasty, priced at $4100 and making up $11,270,900 of the total spend. Health Minister Sussan Ley reportedly pushed for Prostheses List price cuts earlier this year but the Coalition instead opted for further committee talks.
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EXCLUSIVE
  • September 26 2016 - 6:00AM

Families to save hundreds of dollars under PBS changes

·         James Massola, Fergus Hunter
Australians will be able to save hundreds of dollars a year from October 1 as prices are cut for more than 2000 medicines covered by the Pharmaceutical Benefits Scheme.
And people will now be able to go online and calculate their savings, with non-concessional patients and those with multiple chronic conditions set to benefit most from the changes.
The cuts to the price of medicines, one of the largest ever, has been driven by a shift to greater use of generic brands and the savings will multiply for people taking drugs for multiple conditions.
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  • September 26 2016 - 9:17AM

Five ways that the $160m same sex plebiscite could be spent in health

Harriet Alexander
Public health experts have called for the same-sex plebiscite to be abandoned, arguing that it will incite community conflict and the $160 million would be better invested in health.
The Public Health Association of Australia (PHAA) and Chronic Disease Network of the Northern Territory became the latest groups to add their displeasure over the plebiscite at their combined annual conference, with a unanimous resolution to call on Parliament to can the plebiscite.
Malcolm Turnbull spoke of the societal benefit of more marriages in Australia while introducing the contentious same-sex marriage plebiscite bill on Wednesday.
PHAA chief executive Michael Moore said the money should be funnelled into areas that would benefit the community such as health and education instead.
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Bulk-billing rates stay high for poor, increasing for wealthy

The 10 electorates with the highest rate of bulk-billing have held steady over the past three years.
  • The Australian
  • 12:00AM September 27, 2016

Sean Parnell

Bulk-billing remains high in lower socio-economic areas and is ­increasing in wealthier electorates where patients have traditionally paid to visit a GP, according to Medicare figures.
In trends that undermine Labor’s so-called “Mediscare” campaign, the 10 electorates with the highest rate of bulk-billing have held steady over the past three years despite a Turnbull government freeze on rebate ­indexation.
The electorates where bulk-billing is most prolific are mostly held by Labor MPs, including Chris Bowen, Tony Burke, Jason Clare and Ed Husic. Each has a rate of bulk-billed GP services above 95 per cent.
Yet the biggest shift, albeit off a lower base, comes among the 10 electorates with the lowest rate of bulk-billing. Curtin in Western Australia, held by Foreign Minister Julie Bishop, had a rate of 55 per cent in 2013-14 but last year it had climbed to 58.8 per cent.
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Mediscared government delays $30 fees for blood tests until next year

September 28, 20167:32pm
Sue Dunlevy News Corp Australia Network
PATIENTS have won another temporary reprieve from a new $30 charge for a blood test but only until January as the government reels from Labor’s powerful Medicare election campaign.
Days before the axe was due to fall on Medicare bulk billing incentives for blood and other pathology tests the government has backed off.
The cuts were due to take effect on Saturday and pathology companies had warned they would see an end to free blood tests with a new fee of up to $30 per test likely.
But the reprieve is only temporary with industry sources now expecting the cuts to take effect on January 1.
And the delay will add to the government’s budget woes, adding more than $2.3 million a week to the budget deficit.
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GP bulk billing only applies to two out of three consults: survey

index&t_product=AdelaideNow&td_device=desktopSue Dunlevy, National health writer, News Corp Australia Network
September 30, 2016 12:30am
index&t_product=AdelaideNow&td_device=desktopONE in three GP consultations are not being bulk billed and these patients are paying an average $48 out of their own pocket to see the doctor a startling new survey shows.
The Royal Australian College of General Practitioners (RACGP) commissioned the research to gauge the impact of the Turnbull government’s six year freeze on GP rebates and found 31.4 per cent of GP consults were not bulk billed.
Fifty per cent of these patients were left more than $40 out of pocket after receiving their Medicare rebate and the average out of pocket expenses was $48 the survey found.
This contrasts with the Federal Government’s own Medicare data that states a record 83.7 per cent of GP services are bulk billed.
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Sussan Ley attempts to make peace with GPs

Paul Smith | 29 September, 2016 | 
Minister for Health and Aged Care Sussan Ley has told the RACGP's annual conference that she has no views “one way or another” on whether GPs are providing low-value care, such as writing repeat scripts or giving patients trivial test results, in return for Medicare funding.
The health minister fronted the RACGP conference in Perth on Thursday to declare that general practice and the government were “working in partnership” with each other.
But she also attempted to cool the fires sparked by claims quoted in last month’s MBS Review Taskforce Interim Report that some GPs were offering low-value services in return for Medicare.
Responding to the angry backlash from the specialty, which saw the lauch of the #justaGP Twitter campaign, Ms Ley said: “Despite the inaccurate and misleading claims of some, I do not hold a view on these individual items one way or another — and will not, until I receive the expert advice from the MBS review committee on general practice.
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Health Insurance Issues.

  • Updated Sep 26 2016 at 11:45 PM

Why Medibank spends $30m a year on taxis, handrails and talking scales

Medibank Private says better management of chronic disease patients is showing early signs of reducing unnecessary hospital visits through tailored care plans, but has found that some measures are as simple as ensuring patients don't miss their specialist appointments.
The $7 billion health insurer has been running its CareComplete program since mid 2014 in an attempt to take better care of its sickest members and reduce the number of times they visit hospital. After kicking off with a 100 person pilot, the program now covers 5000 of Medibank's 4 million members and costs about $30 million a year.
Dr Andrew Wilson, Medibank's group executive, provider networks and integrated care, says investing in chronic disease patients makes strategic sense because "it combines health outcomes and fiscal responsibility".
The Australian Institute of Health and Welfare estimates that of the 10 million hospitalisations each year –1.2 million of which Medibank funds – about 6 per cent are unnecessary or preventable. Many of these admissions are likely to come from chronic disease patients and could have been prevented "through people receiving better care in the home and in primary care", Dr Wilson said.
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Medical device-makers hit back on prices

  • The Australian
  • 12:00AM September 28, 2016

Sarah-Jane Tasker

Johnson & Johnson Medical’s Australian head, Gavin Fox-Smith, has defended his sector, which is facing intense scrutiny over the price of devices, saying it is at the centre of the most important health policies and has earned its seat at the table.
Mr Fox-Smith, managing director of US giant Johnson and Johnson’s Australian subsidiary focused on medical devices, called on the sector to unite as one voice to fight what he said was a push by private health insurers to cut the price of the devices they sell.
“It is more important than ever that industry comes together and speaks with one voice to our stakeholders, including government, patients and clinicians,” he said.
“We continue to face a private health insurance industry actively demanding the government make cuts to the benefits on the Prostheses List. We remain optimistic that decision-makers have listened to our evidence-based arguments that put patient welfare first. But we do know the government is committed to looking at the benefits on the Prostheses List.”
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Health insurers’ promises of quick premium relief ‘are fantasy’

  • Andrea Kunca
  • The Australian
  • 12:00AM September 28, 2016
It has been a clever and well-funded campaign by the private health insurers. They’ve turned the focus of the government private health insurance consultations — initially to investigate the high cost of premiums — towards an attack on the medical device industry.
Why would the health funds choose to focus on medical device reimbursement, given it represents only 14c in every dollar that private health insurers pay out under hospital cover policies?
The medical technology industry delivers life-changing and lifesaving medical devices through its innovative technology. And the Australian public agrees.
Four in five Australians support clinician choice for medical technology. We support this.
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Medicines and medical devices reform

Australia September 26 2016
The Australian Government has released its response to the Review of Medicines and Medical Devices Regulation, with reforms to be progressively rolled out over the next 2 years.
Background and scope of review
An independent review of medicines and medical devices regulation by an expert panel was announced in October 2014.  The expert panel reports on Medicines and Medical Device Regulation were published in July 2015 (available here), including 58 recommendations for reform.
The scope of the review was to benchmark TGA regulatory requirements against international authorities, to ensure there is an appropriate balance between risk and benefit in the regulation of prescription, over-the-counter, complementary medicines and medical devices and to simplify and streamline the approval processes undertaken by the TGA.
The Review did not concern any aspect of the Pharmaceutical Benefits Scheme or reimbursement or subsidy of medicines and medical devices.
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$1bn saving goes begging in public-private health cost shift

State governments are encouraging public hospitals to identify patients with ­insurance and convince them to bill their health fund. Picture: Mitch Bear
  • The Australian
  • 12:00AM September 29, 2016

Sean Parnell

Health Minister Sussan Ley is under pressure to intervene in a $1 billion cost-shifting dispute ­involving public hospitals admitting patients, often through emergency departments, and having them bill their insurer for treatment.
In another illustration of the complexity of healthcare funding arrangements, state governments are encouraging public hospitals to identify patients with ­insurance and convince them to bill their health fund, even though Australians have a right to be treated publicly for free.
Patients are under no oblig­ation to declare insurance status. However, hospital administrators now offer to pay their ­excess and, in some cases, offer additional incentives such as free parking and meals for family members. But the practice is helping to drive up insurance premiums and has inflamed tensions between health funds and hospitals.
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‘Aggressive’ stance to health reform will backfire, warns Ley

  • The Australian
  • 12:00AM September 29, 2016

Sarah-Jane Tasker

Federal Health Minister Sussan Ley has warned private health stakeholders, in a veiled threat, that they will be worse off if they gamble on an “aggressive” strategy in reform talks with the government.
Ms Ley, speaking at the Medical Technology Association of Australia’s annual conference in Sydney yesterday, said it was not surprising there had been the usual politics and posturing played out in public view by those trying to get the best deal for members.
Private health insurers and device manufacturers have been lobbying the government over plans to reform the Prostheses List, which regulates the price of medical devices in the private system.
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Public hospitals face penalties for medical blunders

  • The Australian
  • 12:00AM October 1, 2016

Sean Parnell

Public hospitals would be forced to repay money to the commonwealth if staff commit any of a ­series of catastrophic mistakes, under a funding model being ­developed on the orders of the Turnbull government.
Health Minister Sussan Ley has quietly given a regulatory ­directive to the Independent Hospital Pricing Authority to look at financial penalties for so-called sentinel events, such as surgery on the wrong body part, the suicide of a patient, or a newborn being given to the wrong parents.
The most recent data on sentinel events, for 2013-14, details 102 such reports across Australia, ­including 36 patient suicides, 27 instances where instruments or other material were left inside a patient after surgery, and 20 medication errors leading to the death of a patient.
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Pharmacy Issues.

These 10 medicines are about to get much cheaper in Australia

Medicinal price discounts encourage savings for both consumers and taxpayers alike.

From 1 October, more than 2000 medicines listed on the Pharmaceutical Benefits Scheme (PBS) will incur price reductions, saving consumers up to $20 per script and taxpayers $900 million over four years.
The reductions were delivered through the PBS Access and Sustainability Package reforms, which passed Parliament last year.
Australia's minister for health Sussan Ley says more than 80% of price markdowns will result in direct saving for consumers, while the remaining 20% - those priced above the general PBS co-payment of $38.30 – will save taxpayers big bucks.
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Superannuation Issues.

$66 billion blowout in the cost of public service super scheme

David Uren

Falling world interest rates have pushed up the cost of servicing the lucrative public service ­defined-benefit superannuation pensions by $66 billion over the past year.
The final budget outcome for 2015-16 shows a sum of $314bn would be required to cover public sector superannuation liabilities at the government bond rate of 2.7 per cent, up from $248bn a year ago.
The government’s deteriorat­ing financial position is also shown by the rise in net debt, up by 18.5 per cent to $296bn over the past year.
The final budget outcome shows the overall deficit for 2015-16 was $39.6bn, worse than the $35.1bn predicted when it was announced by Joe Hockey in May last year but $300m better than the most recent Treasury update in this year’s budget ­papers.
Both spending and revenue dipped in the final six weeks of the financial year; however, the gains on the spending side of the budget were largely one-offs, such as Victoria’s failure to get its application for funds from the asset recycling fund in on time, whereas weakness in revenue will carry into this year’s budget.
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I look forward to comments on all this!
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David.

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