This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Wednesday, January 15, 2014
The Healthcare Cost And Fees Debate Rolls On. This Will Be Hard To Calm This Down I Suspect.
Again this week we had a heap of commentary appear.
Federal Health Minister Peter Dutton has told Fairfax Media he fears the cost of Medicare will become “unsustainable” without change. Dutton mentioned the impact of dementia and diabetes as potential areas of concern.
Without change to current policy settings, health costs are set to grow from about 9 per cent of GDP now to 12 per cent in 20 years. This is not necessarily a bad thing. There are many areas of the economy besides health where we choose to spend more as we become wealthier and the economy grows. The critical issue is whether we as a community are benefiting from the increased spending and whether the benefits are being spread fairly. This is the way the debate about cost growth should be phrased, not in terms of sustainability panic.
Mr Dutton’s comments follow the proposal to impose a $6 out-of-pocket fee for visits to general practitioners, a proposal condemned by virtually every health sector group, from the Australian Medical Association to consumers.
Former Liberal health minister Kay Patterson says people must be educated about the cost of health services they use, warning the government faces tough choices as the health budget comes under ''enormous'' pressure.
Dr Patterson, who was health minister for almost two years immediately before Tony Abbott, said many changes, including ageing, increased obesity, new drugs and technologies, and antibiotic resistance, had combined to place ''enormous demands'' on the budget.
''If we want to have the level of healthcare we have now, we need to make choices,'' she said, adding she sympathised with the cabinet.
Dr Patterson would not comment on a proposal by a former adviser to Mr Abbott as health minister, Terry Barnes, for a $6 fee to visit a doctor.
"Rebates for specialist services have increased at least as fast as GP services since 2007 and cost about the same but have been ignored in the proposal." Photo: Jim Rice
The recent proposal to introduce a co-payment for GP visits has ignited debate about the financing of - and principles underlying - the health system.
The unambiguous aim of the proposal, prepared by a previous adviser to then health minister Tony Abbott, is to reduce or significantly slow the growth in medical benefit schedule outlays.
Despite targeting only GP visits, no mention is made of the fact that GP Medicare rebates constitute less than one third of such rebates, the rest being for specialist and other services. Rebates for specialist services have increased at least as fast as GP services since 2007 and cost about the same but have been ignored in the proposal. The estimated savings are less than $200 million a year.
There is something odd about the plan to charge $6 (''the price of two cups of coffee or a Big Mac with a side of fries'') for previously free bulk-billed visits to the doctor.
The Australian Centre for Health Research has told the Coalition the fee would make us ''think twice about going to the doctor about minor ailments''. But it also says we could buy private health insurance to cover the fee, meaning those of us who did would not need to think twice at all.
It is less odd when you realise the centre was set up with a grant from a private health insurance fund, Australian Unity.
Other things are odd about the proposal as well. At first glance it is simple economics. If we are charged for a product, we will want less of it than if it is free.
The cost of seeing a doctor would soar if private health insurers were allowed to cover GPs' fees, a health economist has warned. And consumer advocates say such a change would erode the universal access to basic healthcare supposedly guaranteed by Medicare.
On Friday Health Minister Peter Dutton opened the door to lifting the long-standing ban on private health insurers paying for GP services.
''I want every Australian to have a good relationship with their GP, so I wouldn't rule out any changes,'' Mr Dutton said in a statement.
The largest insurer, Medibank Private, has been pushing for several months for the change, arguing that treating medical conditions at an earlier stage would reduce the need for more expensive hospital care later.
Former UK prime minister Tony Blair once said that it was impossible to have a serious discussion about the future solvency of Western governments without putting greater personal responsibility for health costs at the front and centre of the debate. Unfortunately, Blair said this after he was safely retired from politics and didn’t have to cop any political flak for questioning the sustainability of a “free”, taxpayer-funded health system.
This appears to be the lesson of the debate over the proposed Medicare co-payment, which interest group after interest group has lined up to condemn, despite out-of-pocket contributions for GP services featuring in public health systems in social democratic countries, including New Zealand and Sweden.
At this stage, the Abbott government appears to be seriously contemplating the proposal, with the Minister for Health, Peter Dutton, signalling in-principle support for greater cost-sharing as a way to start getting on top of the ever-increasing cost of health to the budget. This is despite the opportunistic campaign launched by the federal opposition, which is keen to portray the idea of a co-payment with income-based exemptions as a mortal threat to Medicare.
The summary - other than the obvious conclusion that politics and ideology become entwined very quickly with such debates - is that the solution to a rising healthcare costs is much harder than a 6% surcharge and that great care is needed if a load of unanticipated consequences are to be avoided.
Of interest was that in all the commentary I have seen e-Health has not really been mentioned as a possible solution. Send along links if you have spotted this view being put!