Wednesday, July 16, 2014

Review Of The Ongoing Post - Budget Controversy 16th July 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 eighth  week since it was released.
To me the biggest news is just how messy the new Senate is turning out to be now it has arrived.
Trying to predict just what the outcomes will be with the budget is a mug’s game I suspect - but I can confidently predict we will need to get used to expect the unexpected.
We sure do live in interesting times!


Bust the Budget rallies draw thousands around Australia

Rally-goers protest budget measures, including cuts to health, education and the ABC as well as changes to jobless benefits
More than 2,000 people have turned out in Sydney's CBD to protest the federal government's budget.
The protest – billed as Bust the Budget – began forming shortly after midday on Sunday at Sydney Town Hall.
Rally-goers, waving trade union flags and budget-protest placards, planned to converge on St Andrews square on George Street.
Greens leader Christine Milne told reporters on the scene the protest was borne out of frustration against planned federal cuts to health and welfare spending.

The Economist explains

How to compare health-care systems

Jun 29th 2014, 23:50 by A.McE.
BRITAIN'S National Health Service (NHS) was recently judged the “world’s best health-care system” by the Washington-based Commonwealth Fund in its latest ranking of 11 rich countries’ health provision. The Commonwealth Fund tends to give the NHS a pretty clean bill of health in its assessments (it also scores Switzerland, Sweden and Australia highly). Other rankings reach different conclusions. How do you compare something as complex as a national health-care system with its peers?
The Commonwealth Fund makes quality, access, value for money and equity the leading criteria for judging which countries perform well. Its emphasis on access and per-capita spending mean that America, struggling to extend its insurance coverage, while committing a large amount to overall health-care spending, regularly comes bottom of the Commonwealth Fund table. But that judgment overlooks what American health care delivers well: it scores highly on preventative health measures, patient-centred care and innovation, for instance. It has led the way in reducing avoidable harm to patients, with Seattle’s Virginia Mason hospital delivering “near zero harm”, something many systems, including England’s, are seeking to emulate.

New-fangled personal health cures cost the whole nation says Health Minister Peter Dutton

  • Renee Viellaris
  • The Courier-Mail
  • July 07, 2014 12:00AM

Private health insurance push

A HEALTHCARE blowout looms as more Australians pay to map their DNA and embark on preventive interventions such as mastectomies based on the findings.
Health Minister Peter Dutton said the emerging technology had not been factored into Medicare costs. He said it underlined the need for the Abbott Government’s proposed $7 Medicare co-payment.
Australians can now find out whether they are at risk of inherited diseases or cancers for as little as $1000. And “personalised medicine’’, through blood or tumour tests, can reveal what type of drug or treatment is best suited for patients, depending on age and how long they have been ill.

Clive Palmer to block $8b in budget savings

Joanna Mather
The Palmer United Party will help the Abbott government tear down the mining tax but only if the School kids Bonus and a number of associated measures are maintained, throwing up to $8 billion in savings into doubt.
The School kids Bonus is the largest single savings measure in the Coalition’s Minerals Resource Rent Tax repeal bill, estimated at over $3.9 billion over four years.
Other measures that PUP founder Clive Palmer and his balance-of-power senators will vote to maintain are the low-income superannuation guarantee and support for veterans’ orphans.
“You’ve got to look at the Schoolkids Bonus and some of these things affecting families and we’re the only people that can provide some sort of respite,” Mr Palmer told the National Press Club on Monday.

Poor policy to blame for problems in health sector

Mark Eggleton
Closing down hospital beds and boosting access to primary care rather than slugging consumers with a co-payment might be a better way to ensure the long-term viability of our health system, say a number of the nation’s leading health professionals.
This was just one idea floated at the recent Healthy Ageing Round Table held by The Australian Financial Review in partnership with GE in Sydney.
The purpose of the round table was to discuss how we best cope with a quickly ageing population considering the “ageing tsunami” is constantly trotted out as a key reason for the budget emergency in the health sector.
Yet while the federal government tells us we’re living beyond our means and the health system is unsustainable, the real problem lies in policy development or, more pertinently, lack of policy according to round table participants.

Supplements scandal: Change to Medicare policy could cost millions

Date July 11, 2014 - 7:47PM

John Stensholt and Samantha Lane

The fallout from the Essendon drugs scandal could end up costing professional sports clubs and athletes millions of dollars through a recent change in government policy regarding Medicare claims and rebates. 
Medicare, through Health Minister Peter Dutton, recently enacted  legislation that will require clubs and sports groups  to bear the full costs of operations and other medical procedures that would previously have at least been partly covered by Medicare. 
One senior figure from an AFL club predicted on Friday that the move posed an astronomical threat to clubs’  annual medical bills.   
Another senior AFL club figure estimated that the additional cost would be between $100,000 and $150,000 annually per club. He  said his estimate was conservative, however, and that the move clearly had the potential to affect poorer clubs far more profoundly than  wealthier outfits. 

GP Co-Payments.

GP co-payments – deregulation of the bulk billing market.

Marie McInerney | Jul 09, 2014 6:17PM | EMAIL | PRINT
In this second of a series of posts about Medicare, Margaret Faux  looks at how perverse financial incentives, the increased financial pressure applied to pensioners and GPs and the lack of supporting infrastructure make the Federal Government’s $7 GP co-payment proposal a high risk venture.  See her first post here.
Margaret Faux writes:
The full impact of adding another layer of complexity (co-payments) to Medicare’s already labyrinthine structure is unknown. But one such impact may be that Tony Abbott’s co-payment plan will effectively deregulate the bulk billing market and no one will benefit: not doctors, nor patients, nor the Government. 
Medicare claiming is complex and there is already considerable confusion about co-payments, with many mistakenly believing that GPs will be required to collect $7, pass $5 to the Government, keep $2 and the Government will then deposit the $5 to the new Medical Research Future Fund. The parliamentary budget papers reveal a much more cleverly crafted plan which is really quite simple: the Government will take away $5 from the GP and allow the GP to collect $7 back from the patient.

News in brief

Monday, 7 July, 2014
Data estimate true cost of copayments to patients
AN INDEPENDENT assessment of the federal government’s proposed $7 patient copayment on GP and diagnostic services has estimated that patients with type 2 diabetes could add an extra $120 a year to the cost of their GP consultations, with those holding a concession card paying an extra $70. The Bettering the Evaluation and Care of Health (BEACH) findings used 2013‒2014 BEACH data to estimate the additional out-of-pocket costs to general practice patients resulting from the proposed $7 copayments for GP, pathology and imaging Medicare services; the proposed $5 increase in the Pharmaceutical Benefits Scheme (PBS) copayment; and the combination of both policies. The assessment found more than a quarter of adult GP consultations involved at least one investigation (total added cost for the consultation of at least $14), with about 3% of adult GP consultations including imaging and pathology tests (copayment = $21).

Sue Ieraci: Unnecessary questions

Sue Ieraci
Monday, 7 July, 2014
AN abundance of words have been written about the proposed copayment for some Medicare services, with views ranging from outrage to praise.
The federal government’s Commission of Audit makes this assertion: “Co-payments send a clear price signal to all consumers that medical services come at a cost, which may reduce demand for unnecessary or overused services.”
This statement begs two important questions: How do we judge (prospectively) what services are “unnecessary”? What do we know about how price signals work?

Beach report further evidence that proposed co-payments hurt the most vulnerable

AMA President, A/Prof Brian Owler, said today that the highly-respected Byte from the Beach report from the University of Sydney provides further evidence that the Government’s proposed co-payment for GP, radiology, and pathology services, and increased co-payments for medicines, will hit vulnerable patients the hardest.
A/Prof Owler said the Byte from the BEACH report is the first to clearly quantify the likely impact of the Government's Budget measures for health.
“This is the sort of research that the Government should have conducted before the Budget,” A/Prof Owler said.

Preserve equality, don’t compromise

1st Jul 2014
Since the announcement of a no-exceptions $7 co-payment for general practice attendances, with a corresponding $5 cut in the current Medicare rebate, there has been much confusion.
Dr Liz Marles
President, RACGP
PART of the confusion is the way the government is selling its message. We have heard Health Minister Peter Dutton state: “We will retain bulk-billing”, “GPs have discretion to waive the payment for those in need” and “a $500 million dollar windfall for GPs”. All of this suggests GPs will be better off and the public will still be able to access bulk-billing.
In reality, these statements cannot coexist. Any ‘windfall’ to GPs relies on NO bulk-billing and NO costs associated with collecting the co-payment, while assuming the same patient load. Waiving the co-payment for a concession card holder will mean a cost shift of $11 ($14 in rural areas) from the government to the GP to enable bulk-billing.

Many patients will pay more than $7 fee

7th Jul 2014
A QUARTER of adult GP consultations will cost patients $14 or more in co-payments, and patients with type 2 diabetes will pay an average of $120 extra a year, according to new data from general practice research program Bettering the Evaluation and Care of Health (BEACH).
The research, which does not account for additional costs associated with decreased Medicare rebates or GPs who choose not to bulk-bill, shows that the co-payment will for many create a far less modest “price signal” than the cost of “two middies of beer”, as Treasurer Joe Hockey put it.
The average impact would increase with patient age, from $35 dollars per child per year to $94 for patients older than 65.

GP co-payment would increase emergency department wait times

fronjacksonwebb | Jul 11, 2014 10:39AM |
Mark Mackay, Campbell Thompson, Dale Ward, David Green, Don Campbell, Geoff McDonnell, Leonid Churilov, Malgorzata O’Reilly, Mark Fackrell, Nigel Bean, Peter Taylor, Robert Adams, Shaowen Qin and Keith Stockman write:
The introduction of a GP co-payment could see average emergency department visits increase by between six minutes and almost three hours, our modelling shows, as more patients opt for free hospital care rather than paying [...]trans  to see their local general practitioner.
Based on an average emergency department (ED) visit of 5.6 hours, one extra patient per hour would make the visit marginally longer – an average of 5.7 hours, which includes waiting times and treatment, or admission to a bed. An additional four patients per hour, however, would lengthen the queue and result an average visit of 8.5 hours.
The new Australian Senate will soon be asked to vote on legislation for the proposed A$7 GP co-payment but the Department of Health hasn’t provided any modelling of its impact.


Vaccinations by pharmacists spark unease among doctors in Australia

Concerns that pharmacists will be unable to cope with an allergic reaction to whooping cough and measles jabs
Australian Associated Press
Pharmacists in Queensland will become the first in Australia allowed to administer whooping cough and measles injections, to the chagrin of doctors.
Doctors and trained nurses are currently the only medical staff who can inject these vaccines but this will change from September.
The Australian Medical Association fears pharmacists are not properly trained to deal with allergic reactions. "We are concerned that if a patient may have a serious reaction, which is rare, that the pharmacy may not be able to cope with that," the AMA's Queensland president, Shaun Rudd, said. "It's not necessarily 100% safe.

AMA rallying hard against pharmacy vax

The Queensland Government is set to expand the current pharmacy-administered flu immunisation trial to include pertussis and measles, much to the AMA’s chagrin.
The trail has already seen more than 10,000 people successfully vaccinated by pharmacists, but the AMA continues to rally hard against the program arguing vaccinations should be performed by “adequately trained and accredited health professionals”.
“They’re going to come back and say we’re just trying to protect our turf but it’s not about that. It’s about protecting the patient,” says Dr Brian Morton, chair of AMA Council of General Practice.
“This is just more fragmentation of care and it really has nothing to recommend it,” he told 6minutes.
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out.
The crucial New Senate is sitting for only a few more so anything may happen!
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:

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