Thursday, October 13, 2016

The Macro View – Health And Political News Relevant To E-Health And Health In General.

October 13  Edition.
Parliament has now come back and there will be a lot of things being discussed on the economic front. The scale of Australian and Global debt is certainly getting attention from all sorts of people including the IMF and the BIS.
The world economy continues to feel a little fragile with concerns regarding Europe and China certainly uppermost.
Australia is seemingly pretty good at present, while subject to global winds and who knows where would wind up if some wheels come off overseas.
Most useful this week has been the following from Croakey.

7 key messages from the AIHW Health Expenditure Report

Editor: Jennifer Doggett Author: Jennifer Doggett on: October 07, 2016
This week the Australian Institute of Health and Welfare released its Health expenditure Australia 2014–15 report.
This document contains a wealth of information about the way in which we allocate resources across our health system.
There are many interesting stories in this data which can help us understand how our health system works and what we can do to improve it.
In the piece below, Croakey moderator Jennifer Doggett identifies seven key points from the report that are relevant to current health policy issues.

Jennifer Doggett writes:

  1. We care about health care: The overall expenditure data shows that we spent $161.6 billion on health goods and services in 2014–15. This represents 10% of our GDP. Internationally this puts Australia as just over OECD median for health expenditure (as a percentage of GDP).
We don’t have a mechanism for assessing whether this level of expenditure reflects the priorities of the Australian community so it is impossible to know whether or not current expenditure levels are in line with community expectations.
But it’s fair to say that anything we spend 10% of our collective resources on represents a high priority for our community and, given this, it is important to make sure we are allocating these resources to achieve the best possible outcomes.
  1. There is no spending crisis: While governments like to talk about a ‘crisis’ in health spending, the data shows that we are easily managing the growth in health spending.
The $161.6 billion that we spent in 2014-15 is $4.4 billion (2.8%) higher than in the previous year. This is a relatively small increase and the third consecutive year that growth was below the 10-year average of 4.6%.  In fact, the ratio of government health expenditure to tax revenue remained relatively stable over the 3 years to 2014–15, increasing only by 0.2 percentage points to 24.8%.
  1. “Private” health care is not really private. Governments are the source of funding for around 67% of the Australian health system (41% Commonwealth and 26% States and Territories) and this funding flows through to both public and private health services.
Most “private” health services in our health system e.g. GPs, many allied health providers and private hospitals, receive substantial amounts of funding from public sources (including via Medicare and the private health insurance rebate).
Politicians and the media like to talk about a ‘public’ and a ‘private’ health system as though they were two separate entities. The funding data in the AIHW report demonstrates just how linked these two ‘systems’ are.
Lots more follows and it is a useful summary.
On the world front…

Global Economy Remains Mired in Swamp of Low Growth

Eswar Prasad and Karim Foda Sunday, October 2, 2016
Editor's Note:
This commentary is based on research and analysis from the October 2016 update of Tracking Indexes for the Global Economic Recovery (TIGER) interactive map, which appears on the Financial Times Web site.
In true Sisyphean fashion, the world economy is faltering yet again, unable to gain much elevation and sliding back into the low growth morass it has been stuck in for some time. Major advanced and emerging market economies appear to be converging to a low growth environment characterized by weak investment, stagnant productivity, and tepid private sector confidence.
The Brookings-FT Tiger index presents a picture of general despondency in the global economy that more than offsets isolated signs of strength in some economic indicators in a few countries. A strong adverse feedback loop has set in with low growth, fragile business and consumer confidence, low interest rates, financial system stresses, trade tensions, and political instability feeding into and reinforcing each other.
----- Enough said.
Here are a few other things I have noticed.

Budget Issues.

  • October 3 2016 - 5:52AM

How Treasury could help the government be smarter

Ross Gittins
Has it occurred to you that, with the Reserve Bank now run by Dr Philip Lowe and his deputy Dr Guy Debelle, Glenn Stevens may have been the last governor we'll see without a PhD?
All Stevens and his predecessor, Ian Macfarlane, could manage was a master's degree.
Of course, nothing is certain. After Dr Ken Henry was succeeded as Treasury secretary by Dr Martin Parkinson, I convinced myself the era of PhD-only secretaries had arrived at Treasury.
Wrong. It didn't occur to me that Tony Abbott would intervene, sacking Parkinson and replacing him with John Fraser (honours degree), a throwback to Treasury's (John) Stone Age.

Corruption in daycare costs taxpayers $1bn

  • The Australian
  • 12:00AM October 4, 2016

Rick Morton

Corrupt family daycare providers have defrauded taxpayers of more than $1 billion in just two years through systemic rorting that Education Minister Simon Birmingham has compared with Labor’s failed home insulation and school halls stimulus schemes.
Leaked documents obtained by The Australian reveal for the first time the state of crisis in family daycare, which is unfolding at such speed that Victoria proposed stopping all new federal government subsidies in a bid to get on top of the issue.
A copy of an agenda item from the most recent education ministers’ council reveals that 15 people have been arrested, 13 of whom have been charged, in relation to alleged fraud in the past 10 months, with fears stolen money could have been sent to ­Islamic State and other terrorist groups.

NSW debt-free after surprise budget revision

  • The Australian
  • 12:00AM October 6, 2016

Mark Coultan

NSW is officially debt-free, following a revision of the state’s budget surplus.
The NSW government’s surplus has been revised upwards by $1.3 billion to a record $4.7bn for the past financial year, the general government state accounts will reveal today.
That means the general government sector was cash positive by $57 million at June 30. The state’s improved financial position is due to a series of privatisations, including the sale of ports, desalination plant, and the electricity business Transgrid, by the O’Farrell and Baird governments.
The state’s financial position should further improve if the Baird government can sell 50 per cent of its electricity distribution business Ausgrid, the tender for which was blocked by federal Treasurer Scott Morrison over concerns about Chinese bidders.

Big four underpin resilience, says Scott Morrison

  • The Australian
  • 12:00AM October 7, 2016

Adam Creighton

Scott Morrison has heaped praise on Australia’s big four banks in a speech to finance professionals in New York, declaring them crucial to Australia’s economic success in a speech that made no mention of their parliamentary grilling in Canberra.
Visiting New York ahead of International Monetary Fund meetings in Washington, the Treasurer told an elite audience of financiers and businesspeople that Australia’s banks were among the best capitalised and regulated in the world, highlighting a 7.4 per cent jump in loans to businesses over the past year. “The major Australian banks … have remained profitable — far preferable to the alternative — and significantly more so than most of their inter­national peers in the US, Japan and Europe,” he said.
He told The Australian later: “They’ve never been popular, but if you had to point to something that’s underpinned our resilience in times of deep stress … it was those banks.

Health Budget Issues.

Taskforce’s Medicare payments review ‘ready within weeks’

  • The Australian
  • 12:00AM October 5, 2016

Sean Parnell

The Turnbull government will be able to make a decision on the future of the Medicare payments system within weeks, according to newly released briefing notes.
Departmental briefing notes, prepared for Health Minister Sussan Ley and obtained under freedom-of-information laws, provide fresh insight into the work of the secretive Digital Payments Services Taskforce.
The taskforce, aided by PricewaterhouseCoopers and Boston Consulting, has been examining how the government should make various health and aged-care payments, given existing computer systems are prone to failure and stifle reform efforts.
But the taskforce’s existence fuelled Labor’s “Mediscare” campaign, as the Liberals dubbed it, and opposition warnings that Medicare would be sold, privatised or destroyed by the Coalition.
Media release Thursday, 6 October 2016

Funding challenge shadows Health Care Homes

The impact of the extended Medicare freeze is adding to uncertainty about the feasibility of the Government’s Health Care Homes (HCH) plan, the Consumers Health Forum says.
“We have strongly welcomed the Government’s announcement of a “revolution” in primary care enabled by Health Care Homes because it holds the promise of better integrated, patient-focused care.  This shift in the way primary care is coordinated and delivered will also benefit the sustainability and effectiveness of our health care arrangements in the longer term: countries with the highest performing health systems have a strong primary health care backbone.  
However we are concerned that the level of funding to support service delivery as well as the changes required to put in place this new model and the risk of a decline in bulk billing caused by the Medicare freeze combine to pose barriers to the success of the scheme,” the CEO of the Consumers Health Forum, Leanne Wells says.

The health care revolution that will see Aussies enrol with a GP for all their medical needs — but not everyone is happy about it

Sue Dunlevy, National Health Reporter, News Corp Australia Network
October 2, 2016 10:00pm
DOCTORS will be paid just $8.90 extra per patient per month to deliver a revolutionary new system of care that will see patients enrolled with a single medical practice.
The health care home model being touted as the solution to Medicare’s woes is so underfunded GPs will need an extra $100,000 per practice per year to make it work, doctors say.
Royal Australian College of General Practitioners president Dr Bastian Seidel says the $21 million budgeted for the program isn’t even new money, it is being taken from other GP payments.
“For $8.90 I get a pack of Band-Aids but I can’t comprehensively look after my patients, how am I meant to do that?” he says.

Improving general practice: the self-care model

Authored by Joseph Ting
GPs are widely used in Australia and are the first point of contact for health issues including short term illness, preventive health care, childhood vaccination, and management of chronic disease. They provide health education, advise on healthy living, deal with illness that can be managed at home and do minor surgical procedures.
A patient-centred care model requires GPs to be well placed to implement public health and preventive strategies that will reduce the 40% premature mortality determined by unhealthy lifestyle choices and the 15% attributable to adverse psychosocial and family factors. As GPs are central to ambulatory and long term care of their local communities, they need to understand and address the upstream determinants of downstream sickness.

TGA boss warns about streamlining approvals

Health Minister Sussan Ley plans extensive reforms
  • The Australian
  • 12:00AM October 4, 2016

Sarah-Jane Tasker

The head of the Therapeutic Goods Administration, John Skerritt, has warned that federal government reforms to streamline approvals of medicines and medical devices will be “harder than we think” to implement, as he argues other countries are yet to agree to share information to aid faster domestic approvals.
Professor Skerritt, a deputy secretary at the federal Health Department, said implementation of the reforms, announced last month by Health Minister Sussan Ley, would be “complex”.
“It won’t be impossible, but we need to think it through,” he told device manufacturers at a recent industry event in Sydney.
He said moving from a couple of different pathways to bring products to Australia to many different pathways, which the reforms proposed, created complexities that had to be managed.

Spike in aged care complaints

- on October 5, 2016, 5:36 pm
There have been over 2000 formal complaints about Australia's aged care system within six months.
It's taken just six months for the new aged care complaints commissioner to be inundated.
More than 5000 people contacted the office with concerns between June 30 and January 1 when it was established, according to its annual report on Wednesday.
About 1600 related to matters outside the commissioner's function, including complaints about retirement villages regulated by the states.

No blowout in healthcare spending, government data shows

Antony Scholefield | 6 October, 2016 |
Federal Government claims that Medicare spending is unsustainable are again under fire, with figures showing the rise in health costs is slowing dramatically
The average increase in the government’s health spending over the past decade has been 4% a year. But between 2013/14 to 2014/15 that increase was just 2.4%.
The amount that Australia as a whole spends on health – including cash from governments, patients and health insurers – was 9.7% of GDP in 2014.
The Australian Institute of Health and Welfare, which compiled the figures, says this compares with 9.4% of GDP in New Zealand, 9.9% in the UK and 10% in Canada.
The US remains the outlier among OECD countries, spending 16.6% of its GDP on health.

Personal health spending: boom in vitamins, supplements, painkillers

Health supplements and vitamins make up a large part of the personal health spend.
  • The Australian
  • 11:59AM October 7, 2016

Sean Parnell

Almost a third of personal health spending is on vitamins, supplements, over-the-counter painkillers and other unsubsidised drugs, according to new figures that chart Australia’s self-medication boom.
The latest expenditure report from the Australian Institute of Health and Welfare reveals spending on the ‘all other medications’ category hit $9,323 million in 2014-2015, with an unrivalled growth rate of 7.1 per cent a year over the past decade.
The category is responsible for 32.4 per cent of individual spending, more than combined expenditure on dental (19.2 per cent), hospitals (10.6 per cent) and unreferred GP visits (2.4 per cent), which can benefit from government and insurance subsidies. Spending on drugs listed on the Pharmaceutical Benefits Scheme made up 5.3 per cent of individual expenditure, while other health practitioners, including homeopaths, made up 8.7 per cent.

Health Insurance Issues.

At heart, medical device prices in Australia ‘are unhealthily high’

  • Sarah-Jane Tasker
  • The Australian
  • 12:00AM October 4, 2016
Australian health insurance funds spent $13.5 million over the past year on a heart pacemaker installed in about 250 patients because the country pays the highest price in the world for that device, produced by US giant Medtronic.
Queenslander John Winsbury is thankful his health fund, Defence Health, picked up the $88,500 bill for his surgery to have a pacemaker and defibrillator installed but is outraged the cost is factored into rising premiums.
Mr Winsbury, a retiree who was previously a member of the army reserves, said it concerned him that the government was not doing enough to force down the costs of devices.
“They are letting us down in a big way … they only look after who is directing them, which is the big companies, big investors or the unions. We are the pawns in the whole thing.”

Health insurance costs ‘distorted’ by structural problems

The growth of older policyholders is greater than young policyholders.
  • The Australian
  • 11:43AM September 30, 2016

Sarah-Jane Tasker

The high number of young people ditching private health insurance is fuelling structural issues in the system, analysts warn, as they argue that government policy is needed to stop the decline.
Macquarie’s healthcare analysts have warned that the current decline in young policyholder participation was not sustainable in a community rated system — where everyone is entitled to buy the same product at the same price, regardless of age and health — in the medium to long term.
The growth of older policyholders is greater than young policyholders, putting pressure on the community rated system. Participation among people below 65 years old has declined in each of the past three quarters.
“Combined with average premium rate increases more than double the rate of income growth, policyholders under 55 years old are paying more and an increasing proportion of all premiums is funding persons over 55 years old,” the investment bank’s team said.

Private health insurers paid hospitals $1 billion

A new report by the Australian Institute of Health and Welfare, to be released today, reveals the latest health spending figures, pointing to an increase in spending by private health insurers.
  • The Australian
  • 12:00AM October 6, 2016

Sarah-Jane Tasker

Australian private health insurers paid more than $1 billion to public hospitals last year, a jump of almost $100 million on the previous year.
A new report by the Australian Institute of Health and Welfare, to be released today, reveals the latest health spending figures, pointing to an increase in spending by private health insurers.
The report comes as funds battle to keep annual premium increases down in the face of rising affordability concerns by members.
Health insurers have warned federal Health Minister Sussan Ley about cost-shifting from public to private hospitals, which they argue is adding to affordability pressures.

Pharmacy Issues.

“Convenience and accessibility”

An evaluation of the first pharmacist-administered vaccinations in WA has shown positive results for patient and practitioner

A team from Curtin University’s School of Pharmacy has evaluated the first run of influenza vaccinations administered by pharmacists in WA between March and October of 2015.
They approached the study using mixed methods including: surveys; analysing pharmacy computer records; and conducting interviews with immuniser pharmacists.
Between March and October 2015, 15,621 influenza vaccinations were administered by pharmacists at 76 WA pharmacies.

PPA challenges Guild control of CPA negotiations

Professional Pharmacists Australia has called for a new industry-wide panel to take over from the Pharmacy Guild in negotiating future Community Pharmacy Agreements (CPAs).
The panel should consist of representatives from the PPA, the PSA, Guild and the Consumer Health Forum, says the union in its submission to the King Review.
But the Guild is opposed to the idea of opening up negotiations.
In its submission it argues that it is the recognised representative of the majority of community pharmacy owners. And pharmacy owners fund and manage the infrastructure to deliver PBS medications to patients.

Pharmacists defend selling vitamins and supplements

  • The Australian
  • 12:00AM October 5, 2016

Sean Parnell

The Pharmacy Guild is staring down critics who claim there is a conflict of interest when vitamins and supplements are sold alongside more rigorously tested and regulated medicines, arguing that consumers want natural therapies and pharmacists should provide them.
In defending the right of pharmacy owners to stock and sell such products, the guild is at odds with the Australian Medical Association, which maintains pharmacists should not be “distracted by retail imperatives, including the sale of comple­mentary medicines that have no basis in evidence”.
The Australian revealed in July the federal government’s Review of Pharmacy Remuneration and Regulation had heard concerns that pharmacists’ professional responsibilities clashed with their role as shopkeepers. The guild, an influential lobby group representing pharmacy owners, insists that doubts over the efficacy of complementary medicines should be addressed by the Therapeutic Goods ­Administration.
I look forward to comments on all this!

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