Thursday, February 12, 2015

Review Of The Ongoing Post - Budget Controversy 12th February 2015. The Co-Payment Causes Big Trouble!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot. Indeed more than a few commentators are now wondering out loud if the Abbot Government will last for a second term - indeed until next week might be tricky after the Spill etc..
The modified Medicare co-payment plan - announced late last year  - has now gone very quiet with the Government disarray of the last 3 weeks. The Queensland election has hardly helped!
Now part of Co-payment Plan B is gone,  but some extreme nasties still remain, i.e. the rebate cut for short consults has been abandoned but the freezing of rebate levels until 2018 and a plan for a co-payment are still live. Consultation proceeds!
Seems there are lots of broader problems also. See here:
It is also amazing that with the 2014 Budget still not passed we are seeing submissions regarding the 2015 Budget.
Other articles this week.

General Budget Issues.

Voters trusting eclectic Senate to save them from budget's worst measures

Date February 1, 2015 - 11:00PM

Latika Bourke

Voters appear to be trusting that the eclectic mix of crossbenchers who control the balance of the power in the Senate will continue to block unpopular budget moves with a new survey showing voters concerns about their financial comfort easing.
Concerns about the negative financial impact from the federal budget fell from its high of 67 per cent in June last year by 15 points in December, according to ME Bank's survey of 1500 voters.
But worryingly for the government, more than half or 52 per cent of those surveyed still fear the budget will impact on their financial comfort with concern highest amongst those who receive government support including retirees who are usually considered traditional Coalition supporters.

Abbott leadership facing toughest test

Updated: 12:20 pm, Monday, 2 February 2015
Tony Abbott's address to the National Press Club is being seen as a leadership make or break event, as the prime minister urges colleagues not to 'navel-gaze' after the shock Queensland election result.
The routing of the Liberal National Party in Queensland is a further blow to Mr Abbott's grip on the top job, already weakened by his controversial decision to award Prince Philip a knighthood.
But in the wake of the disastrous state poll a determined prime minister defended his leadership.
Government wasn't a popularity contest but 'a competence contest', he said on Sunday.
'I don't say for a second that we haven't made mistakes. I don't say for a second that we can't do things better,' he said.
2 February 2015, 3.19pm AEDT

What ails Abbott is but a symptom of disease of government today

Author Shaun Carney

Adjunct Associate Professor, School of Social Sciences at Monash University
If a single speech is regarded as a make-or-break event for an Australian prime minister, then that prime minister faces an uncomfortable future. That’s because the “make” part is a fraud. Tony Abbott could have finished himself off with a dreadful performance at his appearance at the National Press Club on Monday. But he never stood a chance of restoring his prime ministership simply by putting on a decent or even a brilliant showing.
That’s because once the make-or-break tests begin, they never stop. Get through this announcement, this parliamentary showdown, this interview and there’ll always be another one. That’s the zone Abbott will now inhabit for as long as he remains prime minister or until the next election, should he still hold the position then. He’s only ever one more blunder away from collapse.

Why the rate cut exposes Abbott’s bigger mistakes

10:21pm, Feb 4, 2015
Rob Burgess Economics commentator
The Coalition administered a ‘shock-and-awe strategy’ that disproportionately hurt the lower socio-economic groups.
In the lead-up to the 2013 election, a News Corp columnist with whom I worked at the time returned from a Coalition briefing and wrote: “If the Coalition win, they are planning a once-in-a-generation culture change for the nation. It’s never been attempted before.”
With hindsight, it’s clear that it will never be attempted again.
It is sad, in a way, that the nation is in uproar over Prime Minister Tony Abbott’s decision to knight Prince Philip – sad because it is a distraction from more important failings.
Mr Abbott achieved a historic victory in 2013 because he had crafted deadly political weapons, none of which had much bearing on economic growth.
Foremost among them were “stop the boats”, “end the debt and deficit” and “axe the carbon and mining taxes”.

Joe Hockey’s budget backdown

Laura Tingle and Jacob Greber
The Abbott government has ­abandoned the search for big May budget savings, will not meet its ­forecast 2018 return to surplus and is privately acknowledging collapsing revenue means it is highly unlikely to offer tax cuts at the next ­federal ­election.
The dramatic dumping of ­long-standing goals came as a two-day meeting of the federal cabinet heard a gloomy update from Reserve Bank of Australia governor Glenn Stevens and Treasury secretary John Fraser.
There has been a major shift in ­economic rhetoric from embattled Prime Minister Tony Abbott and ­Treasurer Joe Hockey in recent days, to a focus on “growth and jobs”.

Joe Hockey fends off questions about troubled budget strategy as $40 billion hit looms

Date February 5, 2015 - 5:38PM

Gareth Hutchens

Treasurer Joe Hockey has fended off questions about his troubled budget strategy, insisting he has a "steely determination" to keep making difficult decisions despite reports the government has abandoned the search for big savings in its next budget.
Mr Hockey was briefed on the state of the global economy this week by Reserve Bank governor Glenn Stevens and Treasury secretary John Fraser, and was told about significant economic problems in Europe that threaten Australia's economy.
Speaking on Thursday, Mr Hockey admitted a huge write-down in iron ore prices, weaker-than-expected economic growth and an expected increase in unemployment will hit government revenue much harder than predicted.

Medicare, uni policies falling to backbench revolt?

5th Feb 2015
CONTROVERSIAL federal government changes to Medicare and universities look set to be dumped or radically altered as Prime Minister Tony Abbott tries to ward off a backbench-led leadership coup.
Trade Minister Andrew Robb, who was involved in a two-day cabinet strategy meeting this week, said backbenchers’ concerns were “legitimate” and the prime minister and his ministers were listening.
“We allowed some surprise policies to be dropped out in the budget last year to do with education and to do with health,” Mr Robb told ABC radio today.
While the policies had merit, they had not been properly discussed within the party and the government had allowed Labor to “frighten people” about them.

Health Budget Issues.

2 February 2015, 6.07am AEDT

Shaping 2015: Time to go back to the drawing board on health

Author Suzanne Robinson

Associate Professor of Health Policy and Management at Curtin University
Australia does well in terms of health outcomes and ranks high internationally. However, the health system faces a number of pressures. These include rising demand due to an ageing population, increasing consumer expectations and growing burden of complex chronic health conditions.
All of this is leading to rising expenditure on health and increasing pressure on government budgets. Commonwealth health expenditure is estimated to increase by 3.9% in real terms from 2014-15 to 2017-18.
Australia also faces equity issues. Disadvantaged groups such as Indigenous Australians, those on low incomes and people who live in rural and regional areas are often unable to access high-quality care in a timely fashion.

Ebola treatment centre company Aspen Medical donated $30,000 to Liberal Party

Date February 3, 2015 - 6:09PM

Dan Harrison

Health and Indigenous Affairs Correspondent

The company awarded a $20 million contract to operate an Ebola treatment centre on behalf of Australia donated $30,000 to the Liberal Party last financial year.
Political party financial disclosure documents published by the Australian Electoral Commission this week show Aspen Medical gave $30,000 to the federal division of the Liberal Party in 2013-14. 
The return for the ACT Liberal Party also shows the party received $15,000 from Aspen, but says this money was "incorrectly paid" into the party's account, and was returned to the company in June last year.

Queenslanders delaying doctor visits due to cost, despite high bulk-billing rate

  • Damon Guppy
  • The Courier-Mail
  • February 04, 2015 12:15AM
HUNDREDS of thousands of Queenslanders are putting off seeing a doctor because they cannot afford it, despite the state having one of the highest bulk-billing rates in Australia.
The report on the nation’s healthcare systems also shows almost 10 per cent of people aged over 15 are delaying getting prescription medication because of the costs.
The Productivity Commission report, released today, is part of a seven-volume document that provides analysis of government services using comparative data dating as far back as 2002.
“The report helps to drive improvements in the effectiveness of services, providing benefits to those who use them,” Productivity Commission chairman Peter Harris said.

Why reform is difficult. Health ministers are in office but not in power.

Melissa Sweet | Feb 04, 2015 11:21AM | EMAIL | PRINT
Hopefully, someone, somewhere – whether in the Federal Coalition or in the ALP – is putting some serious thought into community-centred health reform. As health leaders have suggested, it’s well past time to move past “thought bubbles” masquerading as policy.
In the article below, experienced policy analyst John Menadue (pictured below) identifies some of the challenges and blockages facing serious reformers, in the second of a three-part series on health reform which is being cross published at Croakey from his blog.
(See also the first article: A refresher course: why health reform is needed).
 John Menadue writes:
There is a major barrier to health reform. It is the power of providers or at least their assumed power. When I was asked by the National Hospital and Health Reform Commission to describe in a sentence or even one word the obstacles to health reform I said ‘power’, the power of providers. I don’t the Commission got what I was driving at!
A succession of Australian health ministers may have been in office but they have not been in power.
5 February 2015, 2.58pm AEDT

Why the government would have us pay more for poorer health

John Attia
Professor of Medicine and Clinical Epidemiology at University of Newcastle
John Duggan
Conjoint Professor at University of Newcastle
The Coalition government has been claiming that Australia’s public health system is unsustainable since the 2014 budget. But its plans for the health system actually reflect the underlying belief that user-pays health systems are better – despite evidence to to contrary.
Less than a year and a half into the Abbott government’s first term, we’re on our second health minister and the third iteration of some kind of plan to introduce a co-payment for seeing a doctor. Despite widespread and vocal opposition to its plans, the government remains committed to introducing this price signal into the public health system.
Underpinning this move is the government’s commitment to a user-pays health system. But there’s now a large body of evidence showing such systems not necessarily great for the nation’s health. Here are four common ideas about market-based health systems and why they are not true.

Medicare architect suggests making business pay for sick certificates

Date February 7, 2015 - 10:35PM

Dan Harrison

Health and Indigenous Affairs Correspondent

Employers, not employees, should pay for medical certificates because it is employers who need them, academic says.
Medicare architect John Deeble has suggested a new way of funding healthcare as an alternative to charging patients to see the doctor: making business pay for medical certificates.
Professor Deeble, who co-wrote proposals that formed the basis of Medicare, suggested the certificates employers require to verify a worker's illness should be billed separately by Medicare, and the amount then recouped through a levy on business.
"It's got nothing to do with healthcare, so why not?" Professor Deeble said.

Medicare Co-payment Issues.

Short GP visits back on agenda despite data

Sean Parnell

HEALTH Minister Sussan Ley is forging ahead with plans for a new price structure for GP visits and reforms to discourage short consultations, despite researchers finding no link between bulk-billing and the duration of appointments.
When Tony Abbott and then health minister Peter Dutton announced the government’s second co-payment policy in December, they unexpectedly included cuts to the Medicare rebate for short consultations to combat so-called “six-minute medicine’’ and the “patient churn’’.
The Prime Minister said the rebate change was “actually a quality measure which has been widely welcomed by medical groups’’ but it nonetheless sparked a doctors’ revolt that led to Mr Dutton being moved and the policy shelved.
According to an article in today’s Medical Journal of Australia, patients who are bulk-billing usually share common characteristics such as a chronic disease, being a concession-card holder and, surprisingly, having private health insurance.

Study finds no bulk-billing link to short visit to doctor despite federal government concerns

Date February 1, 2015 - 11:15PM

Kate Hagan Health Reporter

Bulk-billing doctors are no more likely to have short consultations with their patients, a study has found, casting doubt on federal government claims that current subsidies encourage "six-minute medicine".
In a study of 2500 Australians, researchers found patients who had a short consultation with a general practitioner at their last visit were no more likely to be bulk-billed than those who had longer consultations.
The finding comes as Health Minister Sussan Ley continues to talk to doctors and the community about options to reform Medicare.
She said the Medicare schedule favoured shorter consultations and was "driving some doctors to provide 'six-minute medicine' rather than more comprehensive care".

Tasmanian doctors vow to resist Federal Government's GP co-payment policy

Mon 2 Feb 2015, 7:41am
Tasmanian doctors have told a meeting in Hobart they feel under siege by the Federal Government's attempts to introduce a GP visit co-payment.
National Medical Association representatives at the forum are vowing to take their messages back to Federal Health Minister Sussan Ley.
Associate Professor Tim Greenaway from the Australian Medical Association said Tasmanian GPs had become unlikely political activists.
"This issue has mobilised doctors, this is a direct attack on primary care," he said.

Perverse copayment effects

Sarah Colyer
Monday, 2 February, 2015
NEW research reveals surprising findings about which patients are most likely to be bulk-billed by GPs, as the backlash continues against the federal government’s plans to impose a copayment.
The MJA study examined factors influencing GP bulk-billing, finding practices with just one or two doctors were more likely to bulk-bill than those with more practitioners, defying the stereotype of big corporate practices driving high bulk-billing rates. (1)
Also unexpectedly, patients with private health insurance were more likely to be bulk-billed than patients without cover, after adjusting for income and presence of a chronic disease.
The study was based on an online survey of more than 2000 Australians, with 71% saying they were bulk-billed at their last GP visit.

The full story...

Many high income earners benefiting from bulkbilling, study reveals

Rachel Carbonell reported this story on Monday, February 2, 2015 12:45:00
5 February 2015, 6.02am AEDT

$5 Medicare rebate cut could cost patients up to $40 more

Author Stephen Duckett

Stephen Duckett is a Friend of The Conversation.
Director, Health Program at Grattan Institute
The Christmas-New Year silly season gave Australia three health policies. At the start of December, the policy from the 2014 budget was still on life support. But in mid-December, then-health minister Peter Dutton announced a new rebate reduction policy. This survived less than a month.
In January, the new health minister, Sussan Ley, dumped the minimum time requirement for a level B consultation – the most common type of patient visit – and promised to consult on what should replace it.
Two other elements of the government’s revised co-payment policy remain: a A$5 cut to GP funding for each service a GP performs for patients who are over 15 and don’t have a concession card; and a freeze on Medicare rebates until 2018.

Doctors management of viruses, diabetes and asthma and elderly found wanting

  • February 04, 2015 9:00PM
  • Sue Dunlevy National Health Reporter
  • News Corp Australia Network
GPs have been exposed as slackers with a new report showing they are prescribing antibiotics for viruses, failing to properly care for asthma and diabetes patients and the elderly.
As the government locks heads with doctors over a planned $5 cut to the Medicare rebate, the Productivity Commission’s Report on Government Services raises questions about the current standard of general practitioner care.
It reports that one in three GPs are prescribing antibiotics for upper respiratory viruses even though they don’t work on viruses and their over use is breeding deadly resistant bugs.
Only a quarter of asthma patients have an asthma action plan drawn up by their GP which outlines what medication to take, how to manage an attack so patients reduce hospital visits and take fewer days off work.

Productivity Commission gives thumbs-up to GPs

5 February, 2015 Amanda Davey
General practice is the most efficient and cost-effective part of the Australian health system, says AMA head Associate Professor Brian Owler.
Citing the latest Productivity Commission report, Dr Owler says general practice costs the government a “modest” $299 per person a year.
“The Productivity Commission has provided further evidence that the government’s budget measures for general practice are unwarranted and ill-directed,” Dr Owler says.
“It’s bad health policy to create disincentives for people to go to their GP by making healthcare more expensive for the people less able to afford it.”

Patients face $1,000 out of pocket expenses for surgery as a result government Medicare cuts

  • February 05, 2015 6:18PM
  • Sue Dunlevy National Health Reporter
  •  News Corp Australia Network
THE government’s Medicare cuts will not only affect GP visits but drive up costs for private health fund members who face new $1,000 out-of-pocket fees for surgery, the AMA has warned.
The government’s four year freeze on Medicare rebates for specialists would undermine health fund no-gap schemes and force patients out of health insurance, AMA president Professor Brian Owler warned.
One example, he told a Senate committee in Canberra, was that patients who now paid no gap fee for brain surgery would face an out-of-pocket charge of $1,114.
“If the schedule for specialists continues to be frozen it will mean less people will participate in no-gap schemes, that means the out-of-pocket expenses for patients will skyrocket,” he said.

Health Department admits lack of in-depth analysis of Medicare co-payment

Senate committee forces concession there was no evidence-based advice given to Coalition ministers on the co-payment policy
The federal Department of Health has admitted that it failed to conduct in-depth analysis or research on the social impact of Medicare co-payments before the government announced its policy.
Representatives from Treasury and the departments of Health and Finance were pressed by a Senate committee on Thursday about what advice they had provided to the government on the implications of increasing costs for GP consultations.
“You haven’t done any specific research on co-payments, is that correct?” Labor senator Doug Cameron asked the panel of eight senior public servants.

Co-payment lambasted at Senate hearing

5th Feb 2015
THE government’s claim its co-payment policy would protect Medicare and strengthen the health system has been roundly rejected by doctors and experts speaking at a Senate Select Committee on Health in Canberra today.
AMA president Associate Professor Brian Owler told the inquiry that the government had not consulted with the medical profession, and said the co-payment was not health but fiscal policy. 
“Anecdote, personal assertion, and in particular, ideology” had driven the past year of health policy, Professor Owler said. 

Listening, but no Ley-way on co-pay

30th Jan 2015
HEALTH Minister Sussan Ley gave no ground on her government’s GP co-payment policy when she met doctor groups in Canberra this week.
But the doctors who attended say she was “open and receptive” and has already outshone her predecessor by consulting them. 
RACGP president Dr Frank Jones said Ms Ley had been “very much in listening mode” when she met for an hour in Canberra on Wednesday with representatives from the seven medical associations comprising United General Practice Australia.
“We discussed how we could help her look at the rest of the health system, rather than looking at a price signal on general practice,” Dr Jones said. “But she’s obviously concerned with introducing a price signal. That’s political.”

Medical Research Fund:

Future medical fund an ‘accounting trick’

Rosie Lewis

THE Abbott government’s $20 billion Medical Research Future Fund “seems to be an accounting trick” to make the nation’s debt look more desirable, according to the Australian Medical Association.
Speaking at a Senate committee yesterday, AMA president Brian Owler said the announcement of the MRFF in last year’s budget had led to a “terrible episode”, pitting GPs and researchers against each other.
The MRFF is meant to be largely financed by the controversial GP co-payment but with the measure still unlegislated the fund’s future remains uncertain.
I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget (or the Government) at the end of the day.
As pointed out on Insiders last year the next chance to have progress  in February, 2015 when Parliament comes back! Right now there is a lot of planning going on behind the scenes.
One wonders for how much longer this will go on and just what impact a change of leader might have?

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