Tuesday, March 10, 2015

The AMA President Makes The AMAs View On The PCEHR Very Clear. Hardly Positive.

This appeared a few days ago:

Health Policy Stagnation

Published: 02 Mar 2015
Brian Owler
As Health Minister Sussan Ley engages in consultation with health and consumer groups about the Government’s GP co-payment and other Medicare changes, work on other areas of the health system is in stagnation. There is a vacuum as far as health policy is concerned.
The co-payment has sucked the life out of health policy development, discussion, and debate. This has not only been detrimental to the Government, it is also harmful for the practice of medicine and for our patients.
The Personally Controlled Electronic Health Record (PCEHR) was not that long ago touted as the most important initiative in health. Today, all we hear about is the massive waste of taxpayer money in its development. The Abbott Government commissioned a review but, 14 months later, is yet to respond to the review’s recommendations. The PCEHR remains in limbo, a very large white elephant.
More here:
This is a very interesting article that reviews an amazing list of issues where we are suffering from what has to be described as ‘policy paralysis’. At least some of this is due to the policy vacuum we had with Mr Dutton for so long - up until December and the reshuffle that give is Minister Ley.
With the list of policy problems including:
- Hospital Funding.
- Primary Health Network Start-up
- Health Budget Control and Activity Based Costing
- Indigenous Health and Closing The Gap.
- Agency Abolition for Prevention etc.
- Mental Health and more recently the issues emerging with
- Sixth Community Pharmacy Agreement. (see below)
There is a fair bit to sort out as well as the PCHER!

Scathing audit threatens multi-billion dollar pharmacy deal

Joanna Heath
Health Minister Sussan Ley has threatened to blow open negotiations for a fresh five-year multi-billion dollar deal with pharmacy owners for distributing subsidised drugs, which could substantially weaken the influence of one of the most powerful lobby groups in Canberra.
On Thursday the Auditor-General published a scathing report into the administration of the Fifth Community Pharmacy Agreement struck in 2010, finding it failed to deliver forecast $1 billion savings to the government and was beset with administrative errors.
The Pharmacy Guild, which represents pharmacy owners, is well-known in Canberra for its hardball lobbying tactics and grassroots electoral campaigns against parliamentary critics. Negotiations for the sixth agreement to come into force in July this year have only just begun.
Ms Ley said she was deeply concerned by the findings of the report and threatened an inquiry if a full explanation of the shortcomings was not given.
More bad news for the Pharmacy Guild here:
Of course while the Co-Payment issue is still not resolved - as we are told here - and the rest of the list above the chance of the PCEHR getting focus and decisions seems to be pretty unlikely.

Coalition working on fifth incarnation of Medicare policy after co-payment killed

Prime minister tells question time the latest attempt to introduce a co-payment is ‘dead buried and cremated’ and a new ‘value signal’ would be developed
The Abbott government is now working on a fifth version of its Medicare policy after the prime minister declared its latest attempt to introduce a co-payment “dead buried and cremated” but the health minister said she had not finalised an alternative to achieve the same policy aims.
The government is retaining a freeze on the Medicare rebate that would force doctors to abandon bulk billing over time unless they finally agree to alternative budget savings – and it says its policy goal to restrict bulk billing to the “vulnerable” remains.
The health minister, Sussan Ley, said she was still negotiating with doctors about alternative Medicare savings as she abandoned the fallback policy of a $5 rebate cut announced by the prime minister last December and “put on hold” in January.
More here:
It really feels like no one is on top of all this just yet.
I guess we will wait a little longer!


Bernard Robertson-Dunn said...

I suggest that the root cause of this "Health Policy Stagnation" is Federal/State relations.

The Federal government can do little, if anything, in the way of health service delivery. All it can do is try and leverage the power it has that is associated with funding.

If you look at "the list of policy problems", they are all funding related. Medicare, PBS, Aged Care etc, are all funding mechanisms.

It's up to the states to deliver health care, often linked to health funding but not completely controlled by it.

The Federal government is desperately trying to change citizen's behaviour through funding mechanisms - hence things like the co-payment proposal.

Now they are trying to change GP behaviour with a modification of the same thing.

They developed the PCEHR in order to change the behaviour of health care professions when it comes to data sharing. A pathetic attempt, that hasn't worked and won't work.

Federal politicians and public servants hate it when they can't control the states when it comes to national issues.

But when it comes to expenditure on pharmaceuticals, where they do have control, according to this program:
http://www.abc.net.au/radionational/programs/healthreport/some-prescription-drugs-may-be-of-no-benefit-or-even-harmful/6290944 they are making a mess of it.

Peter Gotzsche: I am saying that we could save more than 95% of our drug expenditure and yet have healthier populations.

Of course we should use all these treatments that prolong life, no question about it, but in very many cases we use drugs that are at least 20 times more expensive than similarly effective drugs.

It looks to me as though the Feds are banging their heads against a brick wall when it comes to things like the PCEHR, but not solving problems that are totally within their control.

If anyone is holding their breath hoping that Sussan Ley will ride over the horizon disguised as the Lone Ranger and fix the PCEHR, my advice is - start breathing again, you're in for a long and fruitless wait.

My advice to the Feds is this:

Stop trying to solve problems that are not in your area of direct responsibility.

Fund health on a per capital basis, with an adjustment based upon rural/indigenous populations.

Gather health statistics and publish high quality analytic reports that shows what's going on.

If the states want a centralised approach to any particular issue/initiative, they commission it and pay for it through COAG.

So, Sussan Ley should hand NEHTA and the PCEHR (along with the review etc) over to COAG and tell them to sort it.

But it won't happen. The Feds just can't resist the urge to interfere. And the one lesson they refuse to learn, in spite of all the supposed listening, is that whatever they do, won't work.

Dr Ian Colclough said...

Let me add to Bernard's excellent appraisal with John Menadue's observations that:

- to achieve community-centred health reform vested interests [the rent seekers] must be bypassed


- those on the "inside" find it hard to imagine any significant departures from existing policies and procedures

Anonymous said...


It appears on face value that you do not understand and appreciate the present COAG funding model...

The C'th cannot handover anything to the States through COAG without any funding strings attached, especially as with NEHTA where they have a 50% stake!

Anonymous said...

ahhh yes --- especially as with NEHTA where they have a 50% stake .... which they can decline to fund leaving it all to the states!!! As I understand it none of the stakeholders has a binding obligation to keep putting up money to support NEHTA. In fact if the excellent National Audit Office team looked into NEHTA the outcomes of the 5CPA Audit would be mild by comparison.

Bernard Robertson-Dunn said...

The Feds can hand over anything they like to the states. Although maybe not through existing COAG mechanisms.

In 1988, I worked with others on a new funding model for the Rural Assistance Scheme. Instead of the Federal Government funding specific projects through a complex bidding and approval process they implemented a radically different scheme.

They agreed a set of guidelines, handed over the money to the states and then said - you decide how you are going to spend it, all you have to do in return is tell us how you've spent it.

It put decision making much closer to the problem.

From a NSW Bill in 1993 updating some of the details, but not the funding mechanism.

"The 1988 rural adjustment scheme was the Commonwealth's main instrument for providing broad-based structural adjustment and income assistance to farmers in financial difficulty. The scheme was administered by the States under guidelines agreed with the Commonwealth in accordance with the States and Northern Territory Grants (Rural Adjustment) Act, 1988 and agreements with individual States ..."

They may not be able to use the COAG, but they certainly could do it if they wished.

Anonymous said...


Your words:

”If the states want a centralised approach to any particular issue/initiative, they commission it and pay for it through COAG.

So, Sussan Ley should hand NEHTA and the PCEHR (along with the review etc) over to COAG and tell them to sort it.”

No doubt COAG is have an existential threatening moment with themselves handing over to themselves and telling themselves to sort it!

Is a consistent reminder of the not yet forgotten illegitimate “Prof. Jane Halton” consistently referring to NEHTA throughout Senate Estimates hearings as “THEM” when she was at the same time the longest standing and original member of NEHTA’s Board since its inception, betraying the schizophrenic nature of her maladministration for DOHA and NEHTA at the same time…

Is there something disturbing down there in the waters of Lake Burley Griffin as the behaviour and mindset of its surrounding inhabitants seems all the more bizarre and peculiar as time goes by!

Bernard Robertson-Dunn said...

Maybe this lot will come up with some good ideas:

Health leaders unite for think tank on federalism and health

Australian Healthcare & Hospitals Association
10/03/2015 2:42:43 PM

More than 100 health leaders, including Federal Health Minister the Hon Sussan Ley MP, will converge on Old Parliament House in Canberra next week (16 March) for the Australian Healthcare and Hospitals Association’s (AHHA) Think Tank on Reform of the Federation and Health.

AHHA Chief Executive Alison Verhoeven said the Think Tank, which will examine issues to be addressed in the Australian Government’s Reform of the Federation White Paper, would see a rare coming together of leading politicians, clinicians, academics and administrators from across the country.

.... etc

The terms of reference are here

The White Paper will be delivered by the end of 2015

I wonder if the PCEHR will be fed a minimal life support while the white paper is developed, then considered, then initiatives proposed and debated?

Say another two to three years?

By then it should be clear just how much the PCEHR has been used and if any of the supposed benefits predicted by those highly paid consultants at Delloite have been realised.