Wednesday, February 05, 2014
The Discussions Of Healthcare Financing Roll On - Interesting Views Emerging But Still Too Simplistic.
There has been a lot of discussion on the way we will see healthcare funding treated in the May Budget this week.
First we have an interesting view from Ross Gittins.
Date January 29, 2014
If you had a problem that required an operation and the doctor offered a procedure with a 90 per cent success rate or one with a 10 per cent failure rate, which would you pick? Most people say they prefer the one with the high success rate but, of course, they're both of equal risk. Point is, we can react quite differently to the same information depending on how it has been ''framed'', as the psychologists say.
When politicians engage in ''spin'' they're framing a problem or a solution in a way they hope will maximise the public's sympathy, a way that highlights those aspects the pollies want to draw attention to and draws attention away from aspects they don't want us to think about.
As Tony Abbott and Joe Hockey soften us up for an especially tough budget in May, we'll be subjected to much spin. Already the idea of imposing a $6 patient co-payment on GP visits has been floated, to which the federal Health Minister, Peter Dutton, added the comment that the growth in the cost of Medicare was ''unsustainable''.
Spending on healthcare is highly germane to Treasury's projections that, if no changes are made to present policies, the federal budget is likely to stay in annual deficit for the next 10, even 40 years.
But let me frame the projected growth in spending on healthcare in a way you won't hear from the pollies. It's a safe prediction that the real incomes of workers and households will continue growing by a per cent or two each year over the coming 10 or 40 years, just as they have over the past 40.
Second we have a senior Liberal noticing there is a bye-election next week end and reducing the news on extra costs in health for all.
Date January 29, 2014 - 1:16PM
The Abbott government is distancing itself from a controversial proposal to charge bulk-billing patients a $6 fee every time they visit their doctor.
In the strongest comments made so far by a senior minister about the GP fee proposal, Foreign Affairs Minister Julie Bishop said the government had "no plan for co-payments".
The remarks come from the deputy leader of the Liberal Party at the same time as a government backbencher has supported the proposal, saying the charge was not much more than a cup of coffee.
Ms Bishop described the GP co-payment plan, which was proposed to the Commission of Audit by Tony Abbott's former health adviser Terry Barnes, as "scaremongering on Labor's part".
"I'm in the cabinet," Ms Bishop said. "This has never been proposed. This is not before the cabinet.
"It was a submission made to the Commission of Audit by an entity … We have no plan for co-payments".
The idea that the Coalition supported the co-payments plan was "nonsense," Ms Bishop added. Nonsense that Labor had "mischievously, dishonestly, attribute[d] to the government".
The Foreign Affairs Minister was speaking in Brisbane on Wednesday, where she is campaigning for the Liberal National Party candidate Bill Glasson, who is running in the by-election for Kevin Rudd's former seat of Griffith.
Labor has been attacking Dr Glasson in the campaign for his apparent support for the GP fee proposal, but the former Australian Medical Association president also retreated from the contentious idea.
"I've made it very clear that there is no plan, no plan, by the current Coalition government to introduce a co-payment on Medicare or on bulk billing," Dr Glasson said.
There is more discussion of the potency of the issue here:
Date February 1, 2014 - 6:12PM
Tony Abbott has moved to pour cold water on speculation about a bulk billing co-payment fee for patients as the Griffith byelection enters its final week, but for the Labor opposition the Prime Minister's comments took the cake.
The Griffith ground campaign has been dominated by the controversial proposal, put to the federal government's Commission of Audit, to end free doctor visits and charge patients $6 per visit.
Liberal National Party candidate Bill Glasson, a former president of the Australian Medical Association, came out in favour of the proposal last month but has since backed away from his comments.
Speaking after Dr Glasson's campaign launch on Saturday, Prime Minister Tony Abbott was keen to draw a line through the issue ahead of next week's poll.
Lots more here:
Father 1 of Medicare contributed on the Medicare 30th Birthday.
Grattan Institute health program director Stephen Duckett says Medicare has served us well but we should not be complacent about its future.
Medicare is 30 years old this week. When its predecessor, Medibank, was introduced 40 years ago the big issue was extending access to the health system by removing financial barriers to hospital and medical services. The Fraser government’s winding back of Medibank meant the same problem had to be fixed again with the introduction of Medicare.
In terms of what it set out to achieve, Medicare has been a great success. All Australians have access to public hospitals without charge. The vast bulk of general practice consultations also don’t require any upfront payment.
Overall, Australia spends at the low end of the range of what developed countries spend on health care. So Medicare is demonstrably affordable for the taxpayer. We also get good outcomes for our spending – Australia has better life expectancy than other similar countries.
But that doesn’t mean we have grounds for complacency, nor that we have no room to improve.
There are still financial barriers to access. One in 20 people who need to see a general practitioner either delay going or don’t go at all because of cost, according to a recent Australian Bureau of Statistics survey. Financial barriers aren’t the only problems. Waiting times for both elective procedures and in emergency departments are too long.
Lots more here:
Stephen Duckett does have some serious improvement targets:
“Overall system efficiency can also improve. Grattan reports in 2013 showed that we pay way above international benchmarks for pharmaceuticals, and that we can extend primary care access in rural and remote Australia cheaply if we better use the skills of health professionals. Forthcoming Grattan work will look at ways of improving hospital efficiency, too.”
Father 2 of Medicare has the following contribution.
Date February 1, 2014
John Deeble: Said health costs would become ''unmanageable'' without change.
One of the architects of Medicare has called for an increase in the Medicare levy, warning Australians will not accept any change that restricts access to healthcare to those who can pay for it.
John Deeble, who co-authored proposals for Medibank and then Medicare, dismissed as a ''furphy'' suggestions by Health Minister Peter Dutton that Medicare risked becoming unaffordable.
Marking the 30th anniversary of the establishment of the scheme, he said: ''In an advanced society, anything is sustainable if the society says it is.''
He said health costs would become ''unmanageable'' without change. He said figures showing an escalation in health spending per person underlined the need to cut ''waste''.
Lots more here:
Lastly we have vested interests and the pollies having their say!
29 January, 2014 Nick O'Donoghue
Suggestions made by an anonymous blogger that the PBS is ripe for further cost cuttings are misguided, the Pharmacy Guild of Australia says.
Writing on Croaky, a health policy analyst who went by the pen name of “William Foggin” described the “pharmaceutical supply” system as one area where the National Commission of Audit could find savings for the Government when it makes its recommendations for cost cutting in the health budget.
In the blog, Mr “Foggin” also called on the Government to open up pharmacy ownership to the supermarket sector to boost efficiency, but warned that the Guild would oppose any such move.
“Contestability for the pharmaceutical supply and diagnostic services should be recommended, but the forces of reaction embodied by the Pharmacy Guild and the diagnostic industry group may well prevent the recommendation, and will almost surely block implementation,” he said.
and we have Mr Dutton stirring the debate a bit with absolutely nothing new I could spot.
Date January 30, 2014
Health Minister Peter Dutton says new figures showing an escalation in health spending demonstrate why the government must cut ''waste'' in health.
Figures to be published by the Productivity Commission on Thursday show that between 2002-03 and 2011-12, federal government spending on health grew at an average of 4.9 per cent a year, while state government spending grew at 6.8 per cent a year, and non-government spending - by individuals and insurers - grew by 5 per cent a year. Health spending per head by all governments rose 37 per cent over the period in real terms, from $4474 to $6230. Adjusting for inflation, non-government health spending per person rose from $1259 to $1802 over the same period.
Mr Dutton said the figures demonstrated the challenge the government faced in placing the health system on a stable financial footing. ''It is the reason we have to cut waste in health and invest in areas that provide the greatest benefits to patients.''
Earlier this month, Mr Dutton flagged an overhaul of Medicare, warning spiralling costs would make the system ''unmanageable'' without change.
''In the end, we want to strengthen Medicare and we want to strengthen our health system, but we can't do that if we leave change to the 11th hour,'' he said.
Overall we still seem to be seeing the same old debate as we were having a decade and a decade before that.
It is interesting that a key cost driver in the sector is increasing use of clinical technologies (MRI, CAT Scans, Ultrasound, artificial joints, smarter pacemakers and so on and so on.) which are meant to offer efficiencies but seem often to be used as add ons to the usual costs sadly rather than replacing older approaches or more expensive variants of already great treatment.
Also we seem to have no commentary I have spotted on how e-Health can help.
I hope the quality of the discussion ramps up as the Budget approaches!
Posted by Dr David More MB PhD FACHI at Wednesday, February 05, 2014