Thursday, December 01, 2016

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

December 1  Edition.
Again, only one real bit of news dominated again this week, and continued to rattle around was the election of President Trump. We
Our parliament finishes up today until some-time in February 2017, which will be after President Trump is inaugurated.
We all now need to take a Christmas Break and see just what happens in the US in first six months of next year. I am sure it will be interesting.
Closer to home there also seems to be some emerging evidence all might not be all that well in OZ.
This one says it all….

$24 billion budget blowout. MYEFO to confirm the worst on December 19

Peter Martin
Published: November 21, 2016 - 12:15AM
Much lower than expected wage growth has knocked a hole in the government's budget projections, blowing out deficits right through until 2019-20.
The worse position, confirmed by Treasurer Scott Morrison, comes despite a doubling in the price of coal and a 50 per cent jump in the price of iron ore.
It will unveiled in a mid-year budget update to be released on December 19.
Mr Morrison said the government would adopt a "cautious" approach to commodity price assumptions in the update, allowing projections of weaker personal and company taxes from weaker wage growth to overwhelm projections of improved company tax revenue from better resource prices.
Backed by this:
  • Updated Nov 21 2016 at 6:40 PM

Scott Morrison is going to have to hit the reset button on the budget

There is a certain inexorability to the fact the Coalition is going to have to hit the reset button on its budget rhetoric.
The only problem is that, having persisted too long with the argument that there was no revenue problem in the budget, the government is now stuck somewhere between ratings agencies breathing down its neck over the size of the budget deficit and the changed dynamics of an international tax debate anticipating lower tax rates from a Trump US presidency.
For a long time, Treasurer Scott Morrison told us there wasn't a revenue problem in the budget, just a spending problem.
Here are a few other things I have noticed.

Trump Election Issues.

Getting the measure of Trump is a short-term game for investors

Mark Bouris
Published: November 20, 2016 - 12:15AM
The biggest news last week was the election of Donald Trump, and the second biggest news were the gains seen in the American markets after Trump won.
After shaky starts, the major Wall Street indices surged as markets backed Trump's policies for the US economy. 
By the end of election week, $US1 trillion was wiped off the US bond market and invested in equities.
Australia had an initial downturn before our markets stormed back. 

The moment the US gave the world to China

Peter Hartcher
Published: November 22, 2016 - 12:00AM
The Chinese didn't imagine that the US would walk away from global leadership so readily.
But it has happened, in plain view.
On Friday. In Peru, of all places.
In April, Barack Obama said: "If we don't write the rules, China will write the rules out in that region," the Asia-Pacific.

National Budget Issues.

End the age of entitlement: cut tax perks for seniors, says Grattan Institute

Peter Martin
Published: November 20, 2016 - 9:00PM
Australia's tax system has become skewed towards a growing and apparently untouchable group of "taxed nots": older Australians who pay about $1 billion a year less tax than younger ones with identical incomes, according to a Grattan Institute report.
"It used to be that between one-quarter and one-third of seniors paid tax," said the report's author John Daley. "Now it's half that. We gave them a Low Income Aged Persons Rebate, then we gave them a Senior Australians Tax Offset, then we made their super tax-free, and hey presto, they dropped out of the tax system."
Mr Daley said many of the changes took place during the prime ministership of John Howard, while Peter Costello was treasurer.
  • Updated Nov 20 2016 at 9:00 PM

Grattan Institute push to end the age of entitlement for over 65s

The age of middle-class welfare entitlement is coming to an end – unless you're well off and over 65, according to a Grattan Institute call to scrapping of unjustified age-based tax breaks that cost the budget $1 billion a year.
With the government already crunching working-age households by curbing benefits such as family payments and baby bonuses, the institute argues that keeping similar perks for older but very comfortable "taxed-nots" is patently unfair.
It warns that with the population ageing rapidly, government will need to act fast on curbing these breaks or face a growing block of older voters reluctant to help with budget repair.

Why special tax breaks for seniors should go

November 20, 2016 9.01pm AEDT


  1. John Daley
  2. Brendan Coates
  3. William Young
The federal government could save about A$1 billion a year by winding back three tax breaks for older Australians that are unduly generous and have no sensible policy rationale, according to our new Grattan Institute report.
Many seniors pay less than younger workers on the same income as a result of the Seniors and Pensioners Tax Offset (SAPTO) and a higher Medicare levy income threshold. They also get a higher rebate on their private health insurance than younger workers on the same income.
The tax-free thresholds for seniors and for younger people have diverged over the last 20 years. Seniors do not pay tax until they earn A$32,279 a year, whereas younger households have an effective tax-free threshold of A$20,542.

'That's simple maths': Scott Morrison signals another surplus delay on the cards

James Massola, Chief Political Reporter
Published: November 21, 2016 - 9:40AM
Treasurer Scott Morrison has signalled a return to budget surplus in 2020-21 could again be delayed, with low wages growth holding back government revenue.
The warning from Mr Morrison comes as Deloitte Access Economics' Budget Monitor predicted a $24 billion blowout in the deficit over the next four years ahead of the mid-year budget update on December 19.
The latest blowout will put further pressure on Australia's AAA credit rating, with ratings agencies closely monitoring the Turnbull government's ability to strike deals in parliament that cut government spending and raise revenue.
8:41am November 21, 2016

Company tax cuts will boost growth: govt

Finance Minister Mathias Cormann has rejected suggestions now is not the right time to introduce tax cuts for Australian companies.
A $50 billion government plan over 10 years would boost investment, productivity, growth and over time wages, he said.
The planned 25 per cent tax rate - down from 30 per cent for companies with a turnover of more than $2 million - was middle of the pack by international standards.

Former minister Craig Emerson urges inquiry into LNG tax revenue hole

Heath Aston, political correspondent
Published: November 20, 2016 - 11:45PM
One of the architects of Australia's tax system on natural resources, Craig Emerson, has backed calls for a parliamentary inquiry into why the boom in liquefied natural gas exports is failing to deliver any meaningful contribution to the public purse.
Mr Emerson – who designed the petroleum resource rent tax with economist Ross Garnaut in the Hawke government – believes particular scrutiny should be given to extra concessions won by the oil and gas sector since the tax was first imposed on offshore projects in the mid-1980s.
Fairfax Media has revealed over recent months that just 5 per cent of 150 oil and gas ventures are paying any PRRT, despite Australia being poised to eclipse Qatar as the world's single biggest exporter of LNG by 2020.

Voters losing faith in Turnbull’s capacity to steer the economy

  • The Australian
  • 12:00AM November 22, 2016

Phillip Hudson

The Turnbull government desperately needs to show voters it is in charge, that it has a credible economic plan and can win ­battles on the floor of parliament.
The Coalition enters the final fortnight sitting of parliament with its ministers comfortable on the Treasury benches but voters ­unsure about the government’s authority.
As the latest grim news from Deloitte Access Economics suggests the budget deficit is getting worse, Malcolm Turnbull finds he needs to build up his economic credibility, which has tumbled below 50 per cent for the first time since he became Prime Minister as the government continues to languish behind Labor in two-party terms.
With the Prime Minister ­defiantly trading on his election slogan of “jobs and growth”, today’s Newspoll showing only 48 per cent think he is the most capable of handling the economy will be a worrying sign inside the government.

Morrison sticks with $50b company tax cuts

- on November 22, 2016, 6:44 am
Scott Morrison has vowed to press ahead with $50 billion worth of company tax cuts while conceding the Federal Budget is bleeding revenue and is unlikely to reach the Government’s latest target date to get back to surplus.
Amid warnings the Government has increased the risk of losing the nation’s AAA credit rating, Mr Morrison said the tax cuts — facing opposition in the Senate — were the best way to improve the Budget.
Figures from Deloitte Access this week suggest the Budget bottom line has deteriorated by $24 billion since May on the back of record slow wages growth and a stagnant full-time jobs market.

Morgan Stanley warns Australia's economy may have gone backwards

Jessica Sier
Published: November 24, 2016 - 4:19PM
While markets including the ASX have shot higher following Donald Trump's surprise election win in the US, some economists suggest Australia might be in for a rude shock.
A continued unwind in resource investment, contracting activity in the housing sector, and weaker household incomes are on track to push Australia's economy to shrink over the three months to September 30, argues Morgan Stanley.
"We have been arguing that Australia's 'real GDP' of 3.3 per cent year-on-year feels overstated," say the team of analysts, led by equity strategist Chris Nicol, who suggest Australia's GDP growth may come in at -0.3 per cent over the June quarter – well below the consensus forecast for 0.5 per cent growth. It would also be just the fourth quarter in the past 100 to post a contraction.

Scott Morrison in caged fight to save AAA credit rating

  • The Australian
  • 12:00AM November 26, 2016

Alan Kohler

Scott Morrison is in a kind of cage fight with Standard & Poor’s.
The ratings agency is itching to downgrade Australia from AAA. Its competitors, Moody’s and Fitch, are more relaxed — they both have Australia on AAA “stable” — but S&P has us on a “negative watch” and is looking sternly over its glasses at the government.
This week, the head of sovereign ratings for S&P Australia, Craig Michaels, delivered another stiff lecture.
The problem, he said at a conference on superannuation in the Parliament House theatre, is not the government’s balance sheet, which is strong, but the economy’s balance sheet, which is very weak indeed — “one of the weakest we look at globally”.

Australia's budget repair problem can't be swept under the carpet

Simon Cowan
Published: November 26, 2016 - 12:15AM
Peter Costello delivered the last federal budget surplus on May 8, 2007. The following year, new Labor treasurer Wayne Swan promised a $20 billion surplus, which turned out to be a nearly $30 billion deficit. One decade and one day later, on May 9, 2017, Treasurer Scott Morrison will almost certainly deliver a budget deficit at least as large as Swan's first.
Throughout the past 10 years, politicians on both sides have claimed they were fixing Australia's fiscal problems. Both have relied on budget trickery, pretending the deficit was a short term problem that would be fixed by future revenue growth.
Even in the supposedly horror 2014-15 budget, revenue increases were almost twice as large as the projected reduction in expenses. The extent of "austerity" in Australia has been limited to arguing over the size of the increase in spending – large or very large.

Health Budget Issues.

Government Medicare watchdog threat to GP home visits

index&t_product=DailyTelegraph&td_device=desktopSue Dunlevy, National Health Reporter, News Corp Australia Network
November 21, 2016 12:30am
index&t_product=DailyTelegraph&td_device=desktopEXCLUSIVE: They are the after hours lifesavers beloved by families and emergency departments alike — but a government crackdown could make it harder for a GP to make a house call in the dead of night.
There could also be increased pressure on hospital emergency departments, a doctor’s group has warned.
A quadrupling in after hours visits over recent years to 2.8 million has caused a Medicare cost blowout as bulk billing services target working families who can’t get to a GP during working hours.

Rational testing vital to improved GP care

Authored by Joseph Ting
BETWEEN 2000 and 2008, the number of Medicare funded pathology tests increased 54% in Australia, a volume increase from 62.1 million to 95.7 million tests. Over this period, pathology costs increased from $1.2 billion to $1.9 billion.
However, 25–75% of tests are not supported by evidence. Inappropriate testing increases health care costs, wastes resources and incurs further costly delineation of incidentalomas that may also bring on harmful treatment. Excessive reliance on testing has been allowed to supplant clinical acumen. It is crucial that GPs identify patient concerns and address expectations on the rationale for individual test ordering.
Although GPs experience pressure to comply with parent or patient requests for diagnostic tests to preserve good relations and avert medicolegal liability stemming from missed or delayed diagnosis, there are risks and harms associated with ordering tests that are not clinically appropriate.
  • Updated Nov 22 2016 at 10:14 PM

Soft drinks tax would raise $520m and cut obesity, says Grattan Institute

A tax on sugary drinks would add 15¢ to the price of a 375ml can and 80¢ to a 2 litre bottle, slugging the $4.4 billion industry $520 million a year, a new report says.
Sugary drinks should be hit with the special tax to reduce their role in soaring obesity rates, especially among children, the Grattan Institute report says.
Obesity – the number-two health risk after tobacco – is linked to higher rates of type 2 diabetes, heart attack, stroke, high blood pressure, cancers, sleeplessness, cholesterol and fatty liver. These diseases increase absenteeism and reduce job prospects, incomes and wellbeing.

A $520 million soft drink tax will probably make us less fat. But here's what it will do to prices

Peter Martin
Published: November 23, 2016 - 6:17AM
Soft drinks should be taxed in the same way as cigarettes and leaded petrol to boost the budget by $520 million per year and tackle Australia's obesity epidemic, according to a new report.
The supertax, to be applied to the sugar content of non-alcoholic water-based drinks in addition to the GST, would be set at 40 cents per 100 grams of sugar.
Unless it spurred manufacturers to cut the sugar content of their drinks, it would add 80 cents to the price of a 2 litre soft drink, 15 cents to the price of a 375ml can, 14 cents to the price of a 600ml sports drink, and 11 cents to the price of a 250ml energy drink like Red Bull.

AAMRI’s Tony Cunningham says medical research fund can fill gaps

  • The Australian
  • 12:00AM November 23, 2016

John Ross

The federal government’s $20 billion Medical Research Future Fund could help resolve the sector’s two overriding issues: subterranean grant success rates and inadequate funding of indirect research costs.
But, to do so, it will have to overcome clunky funding mechanisms and align itself more closely with the National Health and Medical Research Council’s administrative settings, according to the peak body for medical research institutes.
Tony Cunningham, who assumed leadership of the Association of Australian Medical Research Institutes two weeks ago, said ensuring complementarity between the NHMRC and MRFF would be one of the big planks of his presidency.

A vision for a high performing and sustainable health care system

by Martin Bowles
The Manderin
SPEECH: Australians are yet to realise the nation-changing potential from parts of the health reform agenda. This future-proofing is complex, and requires political vision, bureaucratic capability, and stakeholder consensus.
Australia,  the United States – and many countries across the globe –face similar issues with their health systems.
We have ageing populations, and rising life expectancy – in Australia, it’s 80 for Australian boys, mid-80s for girls.

Health Care Homes 'will mean 10% funding boost'

23 November 2016
THE Health Department is batting away concerns that the Health Care Homes trial is being done on the cheap, asserting that participating practices will receive more funding for chronic disease care than they do at present.
In stage one of the trail — due to start in 200 practices in mid-2017 — practices will receive bundled payments of up to $1795 annually to manage enrolled patients with complex chronic conditions.
In a major reengineering of funding, practices will then use the money to bankroll a GP management plan that is not tied to MBS items.

Health care homes — 11 key questions answered

23 November 2016

It's peddled by ministers as a once-in-a-generation reform that will revolutionise the treatment chronic diseases. But many fear the journey to come. Here's what we know about Health Care Homes.

How will it work?

Patients with chronic conditions will be encouraged to enrol with a GP practice. Practices taking part will receive “bundled payments” to provide non-acute GP care to that patient. The argument being made in its favour is that fee-for-service fails to support chronic disease management. Policymakers often refer to the numbers of potentially preventable admissions to hospital in Australia — more than 600,000 a year. Many of these admissions are for chronic disease complications, particularly diabetes.
In return for these bundled payments, practices and GPs will no longer be restricted in terms of what they do by the dictates of the MBS schedule. In theory, the money can be used to fund non-face-to-face care. Care can be carried out via email or over the telephone. Practice staff will be freed up to work to their full scope of practice. In theory, practices could make greater use of technology, make improvements in wound care management or point-of-care testing where current MBS items offer nothing. This is, however, in theory — because all this still requires money to make it real.
25 Nov 2016 - 12:08am

Labor to hold health reform summit

Labor will bring together patients, providers and stakeholders for a national health reform summit.
Source:  AAP
25 Nov 2016 - 12:08 AM  UPDATED 6 HOURS AGO
Labor will convene a national summit on health policy to fill what it says is a reform void by the Turnbull government.
Opposition Leader Bill Shorten says the forum, to be held in early 2017, will bring together patients, providers and stakeholders to contribute to the health debate.
It'll be announced by opposition health spokeswoman Catherine King at the national primary health care conference in Melbourne on Friday.

Malcolm Turnbull has no health policy, says architect of the GP co-payment

Latika Bourke
Published: November 25, 2016 - 4:26AM
The architect of the GP co-payment has it out at the Turnbull government, accusing it of having no health policy. He also savaged the performance of Health Minister Sussan Ley and her predecessor, Peter Dutton, saying the latter should have been sacked for bungling the policy.
In a scorching address to the policy think tank the Centre for Independent Studies (CIS), Terry Barnes said the government had brought the so-called Mediscare campaign on itself by failing to set out its own plans for the healthcare sector. He said the coalition showed no sign of learning the lessons of the election campaign, despite it almost costing the government office.
He also suggested further radical reforms to the idea of universal healthcare, saying drunks, smokers and diabetics did not deserve free treatment because of their lifestyle choices.

Wealthiest Aust postcodes the healthiest

November 24, 201612:18pm
Sarah Wiedersehn Australian Associated Press
Australia's wealthiest postcodes are the healthiest postcodes.
A new online health tool, Australia's Health Tracker by Area, has localised the state of our nation's health postcode by postcode.
It shows West Australians have relatively low rates of high blood pressure, at 9.3 per cent; Tasmania is soaring with 12.1 per cent have high blood pressure; and the Northern Territory has the highest rates of diabetes in the country at 7.1 per cent.
The sunshine state, Queensland, has topped the table for a high rates of obesity, 30.4 per cent, in Australia.

Health Insurance Issues.

AMA At The Table On Health Insurance Reforms

21 Nov 2016
The Federal Government continues with its reforms to health care, shifting focus to the private health sector.
Health Minister Sussan Ley has recently established a Private Health Ministerial Advisory Committee (PHMAC) to develop recommendations across a range of policy areas relevant to private health.
The PHMAC follows on the work earlier in the year of an industry working group on reforms to the Prostheses List. The Prostheses List sets out the reimbursement amounts for thousands of prostheses used in the private health system.

Sussan Ley told to take on states over public-private billing

  • The Australian
  • 12:00AM November 21, 2016

Sean Parnell

An advisory committee will urge Health Minister Sussan Ley to do battle with the states over public hospitals billing health funds more than $1 billion each year for care provided to their members.
The Australian ­revealed last month that the Private Health Ministerial Advisory Committee had unexpectedly made private ­patients in public hospitals a prior­ity issue for reform.
With premiums set to rise by 5-6 per cent next year, and members clawing back their level of cover to save money, Ms Ley has moved to reform prostheses pricing but is under pressure to enable further cost-cutting.

HBF warns of health stress

- on November 22, 2016, 12:40 am
The head of WA’s biggest health fund has warned that the Federal Government needs to do more to make premiums affordable, as new figures show the percentage of West Australians with cover has fallen for the first time in 15 years.
HBF boss Rob Bransby is worried the Government is making only a “token gesture” to take pressure off premium increases and seeking to shift blame elsewhere for rising costs.
He said that overburdened public hospitals would face further stress as people abandoned private health insurance in the absence of reform.

Is the investment in private health insurance worthwhile?

November 22, 2016 6.24am AEDT
It’s basically impossible to tell the difference between various policies and levels of cover. from


Lesley Russell
Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney
A frequent topic of conversation at any social or workplace gathering is the cost and unfairness of private health insurance. Despite guaranteed free treatment in public hospitals, we are both conditioned and persuaded to purchase a costly product that too often fails to deliver value for money or provide the expected choices and peace of mind.
Now, for the first time in 15 years, as premiums and complaints rise, the proportion of the population with private health insurance is declining. And recent polling shows 20% of those who have private health insurance (46.8% of the population) expect to downgrade or drop their cover in the next six years.

Private health insurers should wind back 'aggressive tactics' – AMA head

Australian Medical Association chief calls on insurers to stop selling inappropriate policies and says behaviour of some risks undermining system
In 2016 the private health insurance industry ‘successfully lobbied this government to increase their premiums by a weighted industry average of 5.59%’, said the head of the Australian Medical Association. Photograph: Dan Himbrechts/AAP
The head of the Australian Medical Association, Dr Michael Gannon, has called on private health insurers to stop selling inappropriate policies and to wind back “aggressive tactics” that undermine doctors and consumers.
“We continue to be concerned by the behaviour of the larger insurers,” Gannon told a conference of senior health insurance fund staff, representatives from the Australian Prudential Regulatory Authority and senior staff from the Department of Health in Melbourne.

Pharmacy Issues.

Govt working to ‘reconcile’ risk sharing arrangements

The federal government is confident agreement will be reached with pharmacists over risk sharing arrangements, the Prime Minister believes.

Speaking in Canberra last night at the Pharmacy Guild’s annual Parliament House dinner, PM Malcolm Turnbull said Minister for Health Sussan Ley was working with the Guild “to reconcile these issues in a timely manner”.
The issue relates to a shortfall in estimated PBS expenditure in 2016. The Guild believes this should trigger a risk sharing clause in the 6CPA that allows pharmacies to be reimbursed for the shortfall.

New website offers prescription drugs at cost prices, undercutting pharmacies

November 24, 20168:42pm
Rebecca Sullivan
authorBlockSingle“WHEN a patient comes to us for help, money is the last thing on our minds,” is how, a new online subscription pharmacy service which launched this week, sells itself to consumers.
The members-only service provides prescription medications at cost price in exchange for an annual subscription fee of $99, $199 or $449 a month, depending on how many extras you want.
“We’re a platform that gives Australians an opportunity to purchase pharmacy items without paying a profit margin to the pharmacy. We are all about making medications affordable,” the site promises.

Sussan Ley aims to remove red tape for pharmacies

24 November, 2016
It will be much easier for PBS pharmacists to move to alternative premises after a fire or flood under changes to the law proposed by Health Minister Sussan Ley.
The proposed changes, which were read in parliament on Thursday, would allow a pharmacy's PBS approval number to be used at nearby premises for up to six months.
The average number of pharmacies affected by disaster is three a year, says the minister. However, seven have been affected in the past year, one by storm damage and six by fire.

Superannuation Issues.

Getting a handle on looming superannuation tax changes

  • Bruce Brammall
  • The Australian
  • 12:00AM November 26, 2016
Now we know the sweeping super changes are to become law, you need to understand superannuation tax. And for those who do have a good grasp, you need to understand how things will change in relation to tax from July next year.
The basics
When you earn money outside of super, you pay tax at your marginal tax rate. This ranges from zero per cent to an effective rate of 49 per cent, which kicks in once you earn more than $180,000 a year.
Superannuation, however, is taxed concessionally. This means, in a general sense, it is taxed less than if you had the same investments outside of super.
Superannuation is taxed at no more than 15 per cent to encourage people to put money away for their super.
I look forward to comments on all this!

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