Tuesday, January 20, 2015

Some Interesting Views On What To Do Next With The Health Sector. There Are Options Beyond Co-payments!

After the debacle of the changes to the Medicare Rebate back down there have been some interesting suggestions on what should happen next with health funding.
First we had the Health Editor of The Australian identifying the Government has been actively developing many options other than those the Government had been insisting were the only way to go. He provided two articles:

Health eyes $15bn payoff from war on waste

Sean Parnell

Health Editor
TEN per cent of all health expenditure — as much as $15 billion a year — could be saved through a concerted effort to reduce wasteful programs, marginal treatments and avoidable errors, senior officials in the Department of Health have revealed.
The department’s Strategic Policy Group was examining large-scale savings — including an evidence-based campaign of “disinvestment” in low-value programs, drugs and therapies — long before the Abbott government committed to its unpopular GP co-payment.
Documents obtained by The Australian under Freedom of Information laws show the group of deputy secretaries and other officials wanted to reduce spending on low-value interventions and get serious about combating avoidable side-effects, mistakes and infections.
“Members expressed strong interest in holding further discussions on the impact of waste and adverse events,’’ minutes from a November 2013 meeting state.
“The discussions could be informed by work already under way in the department on disinvestment and by ongoing work by the Australian Commission for Safety and Quality in Health Care.”
Out of the public eye, the group — which reports directly to the secretary of the department — ­established an Optimising Value in Health Investment Working Group and talked with Treasury officials. The bureaucrats were keen to redirect money away from areas where there was minimal benefit and potential harm.
More here:
and here:

Health policy ‘blinkered’ to greater risks for poor, jobless

Sean Parnell

Health Editor
THE greater risk of disease and death if you are poor or unemployed in Australia was spelled out in detail by health officials in a paper prepared five months ago — ostensibly for then health minister Peter Dutton.
While the Abbott government has largely ignored a global push for policies to address the so-called social determinants of health, those issues were being discussed in-depth by the Health Department as early as August last year.
According to documents ­obtained under Freedom of Information laws, assistant secretary David Cullen briefed one meeting on a “preliminary research paper produced by the Strategic Policy Unit at the request of the Secretary and Minister Dutton on socio-economic gradients in health”.
The paper showed how morbidity, or disease, occurs more often in: poor households (the rate in the poorest households is 2.6 times the rate in the richest); communities with no education (the rate in the least educated communities is 1.2 times the rate in the most educated); unemployed groups (the rate for those out of the labour force is 3.1 times that of those who have jobs); remote areas (the rate in remote and very remote Australia is 1.4 times the rate of those living in major cities); and among indigenous Australians (3.7 times the rate of kidney disease, 3.3 times the rate of diabetes).
Premature death is also more common among those groups. By way of example, every percentage point difference between areas in the number of adults facing financial stress corresponds to an increase of about four premature deaths for every 100,000 people.
The documents state the paper was commissioned by Mr Dutton, and would be sent to his office, but a spokeswoman for the department suggested that was incorrect.
Lots more here:
Rather undermines the Government’s story about lack of choices!
Second we had an economist remark just how dodgy Minister Dutton had been with his claims:

Medicare change Mark II could be dead on arrival

Judith Sloan

Contributing Economics Editor
AT the end of last year I went to see my GP. I think I should have paid him double because I spent quite some time picking his brains about the government’s proposed changes to GP payments, both versions. The first was announced in May last year and the second in December.
The practice I attend has a mix of payment arrangements. For those with concession cards, children and for rapid return visits (to check on test results, for example), the doctors have taken the decision to bulk-bill. For other patients, the standard fee is $70, with just over $37 reimbursed by Medicare. I personally think that’s just fine.
My well-intentioned doctor conceded that Mark II of the policy was slightly better than Mark I, but he still had concerns. Having looked into the details, I share his disquiet. The changes have not been properly considered. They are a classic case of the tail wagging the dog given the requirement that the large dollar figure in savings announced in the budget (about $3.5 billion) must be retained.
Recall that the first version involved a compulsory co-payment of at least $7 for all patients, including concession-card holders and children (for the first 10 annual ­visits). In this version, pathology and imaging were also subject to the co-payment.
Let’s face it, this package of measures went down like flat warm beer with the electorate. And the bizarre decision of the government to bank some of the savings to create a super-duper (or should that be fair-dinkum?) medical research fund was similarly discounted as too cute by half.
But the next version, imposed, it would seem, without any real consultation, has about as many downsides as the first. The package involved three distinct parts. The first cuts the standard GP consultation fee rebate by $5 (from July) while exempting concession card holders, children under the age of 16, veterans and residents of aged-care facilities. This is set to save the taxpayer about $800 million over the forward estimates.
The second freezes all MBS rebates until 2018 — a saving of $1.35bn. The third and the most radical change involved a reduction in the rebate on consultations of between six and 10 minutes to $16.95 from January 19 — yes, this Monday — and $11.95 from July 1 — a total saving of $1.35bn.
Now, according to then health minister Peter Dutton’s glib and completely uninformative press release, “the troublesome issue of ‘six-minute medicine’ will be addressed by encouraging doctors to spend more time with patients”.
Whoever dreamt up the fee change for short consultations is both innumerate and ignorant of incentives. As one GP put it: “I am a practitioner in an efficient, organised practice with an average consultation time of around 12 minutes. Average time means a large portion of consultations are in the range of 6-12 minutes. The $5 co-payment is much less significant than the $20 gap would have been. This would inevitably have led to greater cost (to the patients) and less access to the GP.”
More here:
Interesting to have a senior commentator from The Australian pointing out the poor way all this has been designed and thought through.
Last I spotted this:

New paper offers alternatives to co-payment and rebate cuts

| Jan 15, 2015 5:04PM | EMAIL | PRINT
The announcement by Health Minister Sussan Ley that she has abandoned the planned Medicare rebate cut, flagged by her predecessor Peter Dutton, and is going to “pause, listen and consult” with the health sector and cross-benchers makes both political and policy sense. 
The rebate cut was unlikely to pass the Senate and had been widely criticised by a broad spectrum of health groups, damaging the Government’s relationship with the sector.  Ley’s move gives the Government the opportunity to re-group and re-think its approach to health financing and to repair its relationship with key health groups before the next federal election.
Despite claims by the Government that its plans to cut Medicare rebates and introduce co-payments are the only options being put forward to meet the challenge of rising health care costs, there are a wealth of other ideas being proposed to improve the way in which we manage our health budget (some of which have been suggested by the Government’s own Department). 
One of the most recent contributions to this debate is a new paper by Dr Lesley Russell, from the Menzies Centre for Health Policy at the University of Sydney and myself.  This paper outlines some of the key health funding challenges facing our health system and proposes some alternatives to rebate cuts and co-payments to improve the management of health expenditure and rising out-of-pocket health care costs. The paper is intended to prompt further discussion on these important issues for the future of our health system, rather than provide definitive solutions.
An overview of the paper follows, with the full version available on Scribd.
Read a summary here:
The paragraph in bold gives a taste of more sophisticated thinking that it seems clear we need at this juncture.
I sure hope the new Minister can hear and respond to some better and fairer approaches to Budget Repair!

1 comment:

Terry Hannan said...

David, with the "war on waste" I feel it is an important time to list what we already know and how some solutions actually work. Of interest is the time span of this knowledge.
1. MacDonald CJ, Tierney WM, Overhage JM, Martin DK, Smith B, Wodniak C, et al. The Regenstrief Medical Record System--experience with MD order entry and community-wide extensions. Proc Annu Symp Comput Appl Med Care. 1994:1059. Epub 1994/01/01.
2. McDonald CJ, Overhage JM, Tierney WM, Abernathy GR, Dexter PR. The promise of computerized feedback systems for diabetes care. Ann Intern Med. 1996;124(1 Pt 2):170-4. Epub 1996/01/01.
3. Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff (Millwood). 2004;23(4):184-90. Epub 2004/08/21.
4. Rind DM, Safran C, Phillips RS, Wang Q, Calkins DR, Delbanco TL, et al. Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med. 1994;154(13):1511-7. Epub 1994/07/11.
5. Staes CJ, Evans RS, Rocha BH, Sorensen JB, Huff SM, Arata J, et al. Computerized alerts improve outpatient laboratory monitoring of transplant patients. J Am Med Inform Assoc. 2008;15(3):324-32. Epub 2008/03/01.
6. Tierney WM, Martin DK, Hui SL, McDonald CJ. Using clinical data to predict abnormal serum electrolytes and blood cell profiles. J Gen Intern Med. 1989;4(5):375-83. Epub 1989/09/01.
7. Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107(4):569-74. Epub 1987/10/01.
8. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990;322(21):1499-504. Epub 1990/05/24.
9. Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269(3):379-83. Epub 1993/01/20.