Sunday, May 17, 2015

Mea Culpa! I Fell For Government Spin. They Are Pretty Sneaky! The Parentheses Matter!

Looking at  reports of the Health Budget on Wednesday I noticed the following (note the bolded text):
From the Guardian:

Budget cuts $1.8bn from health to pay for medical research fund and PBS drugs

‘Rationalising’ grant programs and preventative health research to cover first Medical Research Future Fund grants and new subsidised treatments
Daniel Hurst Political correspondent
Big new savings measures, totalling $1.8bn, include:
· $963m from rationalising and streamlining health programs, including health portfolio flexible funds, dental workforce programs, preventative health research, and GP super clinics that have not yet started construction
· $252m from amending the prices of certain medicines currently listed on the PBS
· $214m from cuts to previously allocated funding for electronic health records, which the government labelled as “a new direction”
· $145m from removing duplication between health assessments under the Medicare benefits schedule (MBS) and child health assessments already provided by the states and territories
· $126m from changes to indexation under the child dental benefits schedule
· $113m from “smaller government” in the health portfolio
The budget papers said the “smaller government” plans include “rationalising” the Department of Health’s structure, reducing its property footprint, ending departmental work that mirrors the activities of specialist agencies, and absorbing the corporate and legal services of the Therapeutic Goods Administration.
Much more here:
From the SMH.

Federal budget 2015: Nearly $2 billion in cuts to health system

Date May 12, 2015 - 8:41PM

Amy Corderoy, Dan Harrison

The Abbott government will cut nearly $2 billion from the health system over the next five years, while pushing ahead with controversial changes to the way it funds state-run public hospitals.
The government has committed $485 million to reform the system of electronic health records, which it says was mishandled by the former Labor government. The revised scheme is expected to cost about $200 million less than had been previously allocated. An opt-out model will be trialled to overcome disappointing levels of take up. 
Full article here:
Given the way this had all been publicised as a $485M boost / new funding I wondered what had been happening.
This time last year we had this:

Tuesday, May 13, 2014

Government Continues Funding Of the PCEHR For One Year While Decides What To Do!

From Budget Papers:

"The Government will provide $140.6 million in 2014-15 for the continued operation of the Personally Controlled Electronic Health Record (PCEHR) system while the Government finalises its response to the review of the PCEHR.

This measure supports the Government’s commitment for a shared electronic health record for patients."
Here is the link:
So it seemed earlier that there was a big boost but, with more hunting I found this:

Implementing My Health Record

The Government has allocated $485.1 million for eHealth, including the redevelopment and continued operation of the Personally Controlled Electronic Health Record. This will be redeveloped to improve its usability and clinical utility, and renamed My Health Record. The Government will also trial new participation arrangements, including an opt-out system, to inform future strategies for increasing uptake and meaningful use of the My Health Record. Increasing the number of participants through the opt-out approach is expected to make My Health Record more useable, credible and reliable, increasing uptake by both patients and doctors so that the benefits of eHealth are fully realised.
Security and privacy of patients’ information will continue to be paramount. The patient will still have control over what information goes on their individual My Health Record, and who can access it. The Government will consider the future national participation arrangements for the My Health Record based on the outcomes of the trials.
Table 1.2: Department of Health 2015-16 Budget Measures (continued)

Outcome 7: Health Infrastructure, Regulation, Safety and Quality

My Health Record - a new direction for electronic health records in Australia2









The point to note is that these are negative sums (parentheses) - suggesting there was more planned to be spent - but for some reason this was not mentioned in the Budget last year.
Just what is going on with this cut of apparently $219.4 Million is not at all clear. One suggestion is that the spending was held in a non-disclosed contingency fund, and has now been grabbed back.
This all adds to the sense that all this may be more temporary than many think and that the Government may not be all that committed to the new plan!
Time will tell.
Sorry I missed this cut and fell - for a day or so - for their spin!


Anonymous said...

Are the Health Journalists asleep at the wheel?

How could any self respecting journalist:
1. not HIGHLIGHT ALL the cuts to health and then point out

2. HOW MUCH MONEY is being thrown at the useless PCEHR system

and then point out to the PUBLIC TAXPAYER that a lot of those cuts would not have been made had the Government had the balls to CUT $400 million of the PCEHR funding.

Do the journalists not understand what is happening? Please bring back Karen Dearne.

Bernard Robertson-Dunn said...


The government budgeting process is an exercise in wishful thinking.

For a start, a budget statement is meaningless until legislation is passed, which is when expenditure is allocated, i.e. authorised by parliament.

What "$214m from cuts to previously allocated funding for electronic health records... " means is that there exists legislation that has been passed by parliament authorising the expenditure of certain funds. The intention is to reduce this allocation by $214m, hence it is included in the budget as a saving. It's actually being reallocated. I don't know if this is subject to legislation, or if it can be done by regulation - i.e. the minister just tells parliament that it is happening.

What it most definitely is not is a "non-disclosed contingency fund".

However, having said that about the arcane art of government budgeting and accounting, what it means is that the government plans to make the PCEHR do more than intended, to wind up an existing agency and create a new agency, all with significantly less money and in an unknown time-frame.

Either there's more to this than they are saying, or they have completely lost the plot or maybe both.

I'll leave you to decide which.

Another observation is that they are spending less on the PCEHR, just not as small an amount as many would like to see being spent - the minimum being the wind-up costs.

And one final point, as economist Dr Richard Denniss has been pointing out in the Fairfax media recently, it's not the absolute amount being spent that matters, it's the per capita amount. Given Australia's population growth, the amount being spent on health is decreasing significantly over time, even more than it would appear by just looking at dollar cuts.

You've heard of mushroom management; IMHO we are currently experiencing mushroom government.

Dr David More MB PhD FACHI said...

What it most definitely is not is a "non-disclosed contingency fund".

Bernard - when asked this is what the Department said!


Bernard Robertson-Dunn said...

David, in which case I'm even more baffled than you.

Terry Hannan said...

David, Bernard & Anonymous, keep this discussion going as it is enjoyable reading and makes a great start to the day. The insightful comments and critical analysis means I can just sit back and enjoy the read!!

Anonymous said...

Here's one for you Terry, Captain Chaos strikes again!

Anonymous said...

Hey look the nehta exec team has posted to NOT replace nehta in the latest poll!!!

Anonymous said...

I always wondered what the 'T' in NEHTA stood for -did they mean to transition everything to ehealth? Or was NEHTA itself a transitional body that was always meant to become something else? Like a grub that turns into a butterfly?