Friday, May 26, 2017

Thoughts On Creating EHRs That Clinicians Are Actually Reasonably Happy To Use And Don’t Burn Them Out.

We had two relevant articles (and an extra) appear this week. First we had:

Physicians dream up a better EHR

May 22, 2017
When the American Medical Association (AMA) last year announced study results that found physicians spend nearly half their office day entering data into electronic health records (EHRs) and handling other administrative deskwork, the organization said poorly designed EHRs were part of the problem.
“If you were to start from scratch, you wouldn’t come up with the systems we have today,” said Jesse M. Ehrenfeld, MD, MPH, an associate professor of anesthesiology, surgery, biomedical informatics and health policy at Vanderbilt University School of Medicine who was elected to the American Medical Association Board of Trustees in 2014.
The AMA developed a list of eight items it believes vendors need to improve or develop to make EHRs better for physicians and their staff.
The list starts by saying systems should
1.     enhance physicians’ ability to provide high-quality patient care;
2.     support team-based care; and
3.     promote care coordination.
The AMA also asks vendors to
4.     offer product modularity and configurability;
5.     reduce cognitive workload;
6.     promote data liquidity;
7.     facilitate digital and mobile patient engagement; and
8.     expedite user input into product design and post-implementation feedback.
“If all vendors took these to heart, things would really improve,” Ehrenfeld said. “We want tools that help us provide high quality care and make the process of care easier and more efficient. Mobile technologies, voice recognition, imaging and sensing are all things we see in the world around us, but we don’t see that happening in the EHR space yet.”
Every physician likely has his or her own thoughts about how to improve EHRs. Ehrenfeld and others offered several additional ideas, from practical improvements to solve today’s problems to visionary suggestions that could dramatically change how they practice:
 Lots more here:
Second we had this covering the same material:

Want a better electronic health record system? Ask a doctor

May 17, 2017 12:35pm
Doctors have plenty of ideas for how to improve electronic health records.
Poorly designed electronic health records (EHRs) are the bane of many doctors’ existence.
They’re blamed for an increase in physician burnout and a decrease in physician satisfaction.
“If you were to start from scratch, you wouldn’t come up with the systems we have today,” Jesse M. Ehrenfeld, M.D., an associate professor of anesthesiology, surgery, biomedical informatics and health policy at Vanderbilt University School of Medicine, told Medical Economics.
Yet those EHRs dominate doctors’ work hours. For every hour physicians spend in exam room visits with patients, they spend nearly two hours on EHRs and desk work during office hours, a study funded by the American Medical Association found.
So it’s no surprise that doctors say they can easily come up with ideas for how to improve EHRs to make them better for them and their staff.
More here:
Both articles are worth a look as they take slightly different looks at the same issue.
The link between HER use and clinician burnout is especially troubling.
A more detailed coverage of this issue is found here:

Workplace Factors Contribute to Burnout in Family Physicians

Diana Phillips
May 10, 2017
Family physicians who work in a hectic or chaotic environment, those who report high rates of job-related stress, and those who spend time at home working on electronic medical record (EMR) tasks may be particularly vulnerable to burnout, researchers report.
In a study designed to assess workplace factors associated with burnout among family physicians, Monee Rassolian, MD, from Michigan State University, Flint, and colleagues administered an abbreviated burnout survey to a random sample of family physicians applying to take the 2016 American Board of Family Medicine Certification Examination. They report their findings online May 8 in JAMA Internal Medicine.
Twenty-five percent of the final survey sample of 1752 physicians reported symptoms of burnout on the basis of the 10‑item Zero Burnout Program survey, also referred to as the Mini Z survey, developed from the Maslach Burnout Inventory. The Mini Z survey enables the assessment of burnout with a single item that correlates with the emotional exhaustion subscale of the Maslach Burnout Inventory.
Although substantially lower than physician burnout estimates in studies using the Maslach Burnout Survey, the burnout prevalence in this study is similar to that observed among academic general internal medicine physicians using the Mini Z survey, the authors note.
Of those with burnout (n = 441), 57.1% reported working in a hectic, chaotic atmosphere compared with 26.5% of those without burnout, 91.4% reported feeling a great deal of job stress compared with 38.4% of the physicians without burnout, and 62.1% spent excessive time on EMR tasks at home compared with 38.7% physicians without burnout, the authors write.
The workplace factors addressed by the survey include:
·         job satisfaction;
·         job-related stress;
·         control over workload;
·         sufficiency of time for documentation;
·         the atmosphere of the work area on a 5-point scale, where 5 is hectic/chaotic;
·         alignment of professional values with those of department leaders;
·         ability of care team to work together efficiently;
·         time spent on the EMR at home; and
·         proficiency of EMR use.
Bivariate analysis identified associations between burnout and all the work-related factors except proficiency with EMR use, which was similar among physicians with and without symptoms of burnout, the authors report.
More here:
I wonder how the myHR would fit in here, given it is hardly user-friendly etc.
David.

Thursday, May 25, 2017

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

May 25, 2017 Edition.
Nothing this week but Trump and his travails after really seeming to be not really clear how a President should behave and seemingly being rather too friendly with the Russians. 
The most interesting thing in the next few weeks with the testimony from the fired FBI director. He could literally sink Trump if that goes badly for him.
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Here are a few other things I have noticed.
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National Budget Issues.

Federal budget 2017: Why Scott Morrison's bank levy doesn't go far enough

Analysis
By business editor Ian Verrender
For years banks have managed to simply pass on all costs, including the cost of extra regulation.
Remember that phone call? You know, the one from the bank manager about a decade ago.
"Hi, I know things have been tough out there for a while so I was just calling to let you know that we've decided to help you out with fee insurance and cut price rates.
"And listen, if you get into strife, you know, like lose your job or something and can't repay your mortgage, we'll pick up the tab for as long as you need until you get back on your feet."
Sound implausible? Let's face it, no commercial operation, and especially not an Australian bank, would ever even consider extending such generosity.
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Newspoll: Malcolm Turnbull didn’t budget on such failure

  • The Australian
  • 12:00AM May 15, 2017

Dennis Shanahan

Malcolm Turnbull and Scott Morrison concocted the 2017 budget unashamedly as a political document. It has failed.
With barely a nod to real economic issues, the Prime Minister and Treasurer ditched decades of Liberal precepts and principles with the aim of lifting Coalition two-party-­preferred support in today’s Newspoll. The headline figure is the Coalition’s two-party-preferred support dropping back to 47 per cent compared with Labor’s 53 per cent and delivering Turnbull his 12th consecutive loss to Labor — almost halfway to the death sentence “30 losing Newspolls” he delivered Tony Abbott.
The size of the gamble, the further alienation of the Liberals’ traditional base and proof that those parking their votes with One ­Nation or other independents are no longer listening makes the judgment of failure ­inescapable.
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  • Updated May 14 2017 at 11:00 PM

Negative gearing 'scalpel' will cool apartment demand: experts

New limits to the way expenses can be deducted against negative geared properties will prove a turning point in the investment property market, experts say.
The federal government's "scalpel rather than a sledgehammer" changes to negative gearing announced in last week's budget will hit investor demand because plant and equipment depreciation deductions are often the difference between a tax refund or an expense for investors.
The changes mean owners of any property not bought brand new will no longer be able to depreciate items like air-conditioners, cooktops and dishwashers, or shared equipment such as lifts and gyms in apartment complexes. Quantity surveyors and analysts said these form up to 50 per cent of depreciation deductions for investors.  
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Vaccination refusers: No Jab No Pay requires scrutiny, immunisation experts warn

Kate Aubusson
Published: May 15 2017 - 12:00AM
The jury is still out on the Turnbull government's landmark No Jab No Pay policy, with immunisation experts warning policies targeting vaccine refusers may have unintended consequences.
Australia's vaccination rates are relatively high and at least comparable with similar developed countries, said researchers at the National Centre for Immunisation Research and Surveillance.
Parents who actively refuse to vaccinate their children were on the "extreme end" and a small proportion of the remaining 7 per cent of the population, they wrote on Monday in the Medical Journal of Australia.
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As banks and government go to war over new tax, shareholders will be the losers

Clancy Yeates
Published: May 13 2017 - 12:15AM
As Treasurer Scott Morrison and the bank bosses traded public barbs this week, the lenders' bean counters got to work dealing with the sobering reality they find themselves in.
Whether banks like it or not, the budget's $6.2 billion bank tax looks almost certain to go ahead. It is not up for negotiation.
This blunt message was delivered ahead of high-level meetings between Treasury officials and bank finance chiefs in government offices in Sydney and Melbourne, two days after the budget.
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Budget 2017: What Scott Morrison’s moves could mean for investors

  • Will Hamilton
  • The Australian
  • 12:00AM May 16, 2017
Federal budgets have two elements: first, political discussion; and second, how does this affect me as an investor?
Let’s look chiefly at the actual measures that affect investors — keeping in mind at this stage they are proposals only and individual measures may or may not be passed by parliament.
Superannuation
After last year’s dramatic changes few measures were announced that further affect superannuation.
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It may be an ‘honest’ budget, but it’s built on rubbish forecasts

  • The Australian
  • 3:17PM May 15, 2017

Graham Richardson

I must have forgotten the Bob Hawke mantra that you should never underestimate the combined intelligence of the Australian electorate.
Like most observers, I had expected that the budget brought down by the Treasurer last week, a budget that Kevin Rudd, Julia Gillard and Wayne Swan would have happily signed up to, would have given a boost for the government in the next Newspoll. I could not imagine that the government would drop in Newspoll.
I was wrong.
Despite all the giveaways, Australians don’t believe in the integrity of the government because they have long lost faith in that very government.
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Federal budget 2017: the illusion of action, in the absence of thoughtful policy

Nicholas Stuart
Published: May 16 2017 - 12:15AM
Let's begin with a pie in the face, because we had two of these last week. The physical one, with its cream and meringue, was delivered by hand to Qantas's Alan Joyce. The metaphorical one, with added lashings of vitriol, was thrown at the bankers. Both events created headlines; neither will change a thing.
A former farmer, 67-year-old Tony Overheu, might feel better for having smeared cream over Joyce's face. However, the reality is he simply exposed the growing impotence and incoherence of the anti-gay marriage lobby. He's angry because his world's changing around him.
Overheu heard Peter Dutton telling chief executives to "mind their knitting" and stop their "social activism". And, critically, Overheu thought he was part of the moral majority, because that's the way the conservatives have defined Australia.
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Budget 2017: Consumers aren't buying it, Westpac says

By business reporter Stephen Letts
The federal budget has failed to fire up consumers' flagging spirits with confidence slipping in its immediate aftermath.

Key points:

  • Consumers sunk deeper into pessimism in May
  • Only 7pc of said the budget would improve their financial situation, 33pc said things would be worse
  • Housing sentiment slips to second lowest reading since 2008
The Westpac-Melbourne Institute's respected monthly survey of consumer confidence found a further deterioration of sentiment in its May survey, and a pronounced slip in a second round of interviews after the budget.
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S&P backs budget, consumers uninspired

  • Colin Brinsden, Aap Economics Correspondent
  • Australian Associated Press
  • 4:49PM May 17, 2017
Treasurer Scott Morrison can breathe a sigh of relief after a global credit rating agency gave Australia a tick of approval to retain its triple-A rating after last week's budget.
As important as it was that other agencies - Moody's Investors Service and Fitch Ratings - were quick to give the budget the nod last week, S&P was the only one that has Australia on a negative outlook, a view it retains.
"The negative outlook on Australia reflects our view that if downside risks to government revenue materialise, then budget deficits could persist for several years with little improvement unless the parliament implements more forceful fiscal policy decisions," it says.
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Why the bank levy is a good idea, not just a populist tax grab

Jessica Irvine
Published: May 14 2017 - 11:03PM
Good economic policies are not always popular. Dismantling tariff barriers, unwinding middle-class welfare and deregulating wage bargaining were all met with uproarious opposition.
So it is a nice thing, indeed, to see a policy proposal which is not only outrageously popular, but also makes good economic sense.
The bank chiefs have greeted the Turnbull government's proposed $1.5 billion a year big bank levy with the usual outrage, as is their duty to their shareholders. They are keen to mark the levy as the "Mining Tax 2.0" – a poorly constructed tax, announced with no prior consultation with industry and ultimately defeated by a vociferous public campaign.
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Forget the banks, check the $150 billion the ATO is not collecting locally

Michael Pascoe
Published: May 18 2017 - 9:17AM
If it wasn't for the massively disproportionate coverage of the "Big New Bank Tax", early indications are that the nation would barely notice it and we could move on to pursuing genuine tax reform.
 As Jacob Greber has reported, the market has reacted to the budget by reducing the banks' cost of funds, apparently assuming the tax makes explicit the long implicit "too big to fail" guarantee. Wholesale funding costs for the big banks have fallen by between one and three basis points since the budget. [ A basis point is equivalent to 0.01 per cent.]
Let's call it two points – that's a third of the new 0.06 per cent tax. If shareholders have to absorb a third, they'll barely notice – it would dint profits by about 1 per cent. Even subdued system growth should make up for it. If dividends are frozen at their present high level for a year, no harm will be done and we could all move on. (Disclosure: the Pascoe family super fund is overweight bank stocks.)
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Turnbull government hit with triple blow of bad economic news

Eryk Bagshaw, James Massola
Published: May 17 2017 - 5:57PM
In a triple blow to the Turnbull government, a global ratings agency has cast doubt on the promised return to surplus, consumer confidence has fallen and wage growth has stalled at an all-time low.
The news puts the government's budget forecasts at risk in a week when it expected a bounce from its big spending federal budget.
On Wednesday, ratings agency Standard and Poor's confirmed Australia's AAA credit rating but left the nation on negative watch and suggested the Turnbull government might struggle to return to surplus by the forecast date of 2020-21.
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  • Updated May 19 2017 at 12:00 AM

Budget 2017: Scott Morrison's large-bank levy is an arbitrary money grab

by The Australian Financial Review
More than a week on, the one argument that might justify the budget's shock tax on the big five banks is the one argument rejected by Scott Morrison. It's not some "too big to fail" levy for the implicit government guarantee the banks may enjoy, the Treasurer says. It's just "a fair additional contribution" to fixing up the budget deficit mess created by the politicians. And, by penalising the bigger banks, it could make the smaller banks more competitive.
The seemingly small impost of 0.06 per cent on the $2.5 trillion of big bank liabilities or funding, amounts to a trashing of what's left of Australia's tax reform agenda. As we editorialised last week, it undercuts the Coalition's core jobs and growth measure of reducing Australia's uncompetitive 30 per cent company tax rate. It complicates a tax system crying out for simplicity. As former Treasury secretary and NAB chairman Ken Henry told The Australian Financial Review this week, the new tax recalls the Financial Institutions Duty, one of the inefficient state taxes that were abolished as part of the Howard government's GST-base tax reform.
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RBA will have to cut rates multiple times this year, says Credit Suisse

Narayanan Somasundaram
Published: May 19 2017 - 12:35PM
The Reserve Bank of Australia will need to cut interest rates several times this year as this week's labour report understates the slack in the economy, Credit Suisse predicts.
While jobs growth in April surpassed expectations and the unemployment rate fell to a four-month low, the number of actual full-time jobs fell and the weakness in the data's detail would have been bigger if it hadn't been for statistical distortions, Credit Suisse analysts led by Damien Boey said in a note to investors.
The Credit Suisse team's rate cut prediction contrasts sharply with collective market wisdom, which expects the RBA to stay pat at a record low cash rate of 1.5 per cent for the rest of the year.
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Jobless rate down, but Australians are working fewer hours

Peter Martin
Published: May 19 2017 - 12:49AM
Australians are working less, even as more of us get jobs.
The latest labour force figures show an extra 97,400 Australians found work in March and April – 60,000 in March and 37,400 in April.
Over the two months taken together, the majority of the new jobs were full time – 62,400 versus 35,000 part time. Yet the number of hours worked per month fell by 1.1 million.
The change appears to have been caused by both full-time and part-time workers putting in fewer hours rather than a substitution of full-time for part-time jobs.
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Health Budget Issues.

  • Updated May 14 2017 at 11:00 PM

Budget 2017: Greg Hunt's health policy buys off the sector, pretends nobody pays

by Terry Barnes
Health Minister Greg Hunt is a big budget winner. Handed a political hospital pass after the hapless and scandal-tainted Sussan Ley resigned in January, Hunt secured a $10 billion health package in the wake of the Labor "Mediscare" that almost sank the Turnbull government.
Mediscare resonated because the Coalition, spooked by the political failure of its 2014 budget, effectively went to last year's election with no health policy at all. Labor filled the vacuum gleefully and mendaciously, and sold it to voters willing to believe it.
With Prime Minister Malcolm Turnbull's blessing, Hunt systematically cauterised the Coalition's suppurating political wounds. Thawing the Medicare indexation freeze Labor first imposed in 2013: tick. More public hospital funding: tick. Expensive Pharmaceutical Benefits Scheme listings and more mental health money: tick. Honouring pre-election deals with pathology and diagnostic imaging, despite their perfidious alliance with Labor: tick. Screwing the pharma industry to book PBS savings by increased prescribing of generic over name-brand medicines: tick again.
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Newspoll: strong support for Medicare levy, says Hunt

  • The Australian
  • 8:47AM May 15, 2017

Rachel Baxendale

Health Minister Greg Hunt has downplayed the latest Newspoll result, which shows the Coalition trailing Labor 53-47, instead highlighting the fact that the poll showed very strong support for the government’s 0.5 per cent increase in the Medicare levy to pay for the National Disability Insurance Scheme.
Today’s Newspoll showed 54 per cent of Australians approved of the Medicare Levy increase, while 36 per cent disapprove.
A Fairfax Ipsos poll also showed Labor ahead 53-47 two-party preferred — an improvement for the Coalition on the dire 55-45 polling when Ipsos was last published on March 26.
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Unsocial budget fails health test

Amy Coopes |  14 May 2017

Next year marks four decades since promulgation of the seminal Declaration of Alma Ata, which declared health — complete physical, mental and social wellbeing — to be a fundamental human right requiring government action across a range of policy areas.

Alma Ata laid the foundations for what are now widely championed as the social determinants of health; the economic and social conditions underpinning the wellbeing of individuals, communities and nations.
Without action on the social determinants, the so-called 'causes of the causes', health policy — and indeed health expenditure — can be a little like that joke about the cyclopean orthopod who, when confronted with a patient suffering fatal internal bleeding, is interested only in fixing their broken leg.
So it is with the 2017-18 Federal Budget. Touted as a signal moment for health, and a principled exercise in fairness by Treasurer Scott Morrison, the budget promises much but delivers little.
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Agreements between doctors' groups and the government are the most extraordinary documents I’ve seen in 30 years'

15 May 2017

COMMENT

What are we to make of this odd game of charades, asks former AMA secretary-general and one-time advisor to former Health Minister Sussan Ley, Dr Bill Coote.
It’s taken a few days, but I’ve now had a detailed look at the Federal Budget.
And what it tells me is this: after 1 July, if you bulk bill three patients in the morning, the extra money you’ll earn from re-indexation will just about cover one of those tiny tomato sauce sachets to go with your lunchtime pie.
This is an odd Budget — one that reads like a pre-election effort designed to quieten everyone.
Perhaps the Federal Government has an eye on the 2019 election, considering most of the extra MBS money comes in a couple of years time, by which point rising costs will have already absorbed the further minor increases in GP rebates.
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Don't be fooled—the Medicare Guarantee Fund provides no real guarantee

15 May 2017

COMMENT

Treasurer Scott Morrison pulled a health-related rabbit out of his hat on budget night, announcing the government will “guarantee” the future of Medicare. The Conversation
It will do this by allocating revenue from the recently increased (from 2% to 2.5%) Medicare levy, after paying for the National Disability Insurance Scheme (NDIS), into a Medicare Guarantee Fund.
The government will then cover the shortfall to cover the costs of Medicare – defined in these budget announcements as a combination of expenditure from the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). In Morrison’s words:
Proceeds from the Medicare levy will be paid into the fund. An additional contribution from income tax revenue will also be paid into the Medicare Guarantee Fund to make up the difference.
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Budget ‘back on track with doctors’

  • The Australian
  • 12:00AM May 16, 2017

Rosie Lewis

The Turnbull government’s second budget “signals a pivot” in the Coalition’s commitment to preventive health and has “reset” its relationship with doctors, the Royal Australian College of General Practitioners declared.
The president of the key health lobby group, Bastian Seidel, also suggested the increased 2.5 per cent Medicare Levy — 1 per cent of which will go towards fully funding the National Disability ­Insurance Scheme — could be ­renamed the “NDIS levy” to prevent confusion about the purpose of the tax.
Writing in The Australian, Dr Seidel said the government ­delivered a “staggered but clear ­reversal” of what he called an ­“appalling decision” to maintain the Medicare rebate freeze until 2020. From July 1, the government will resume indexation of its bulk-billing incentive payment and over two years extend the thaw to consultation fees for GPs and specialists, as well as specialist procedures and allied health.
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Medicare rebate thaw covers only a fraction of scans

Adam Gartrell
Published: May 16 2017 - 4:32PM
The Medicare rebate thaw will not apply to 93 per cent of scans, including the X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer.
Health Minister Greg Hunt's staged four-year thaw has been widely welcomed by doctors' groups such as the Australian Medical Association and the Royal Australian College of GPs. Under the plan, indexation will gradually be reapplied to bulk-billing incentives, visits to the doctor and allied health services. On budget night, the Turnbull government said the final stage of the thaw, due in July 2020, would lift the freeze on "targeted" radiology and diagnostic imaging services - the first indexation since 2004.
But new Department of Health figures reveal precisely how "targeted" the changes will be: the freeze will be lifted on 59 of the 891 radiology items listed on the Medicare Benefits Schedule - just 7 per cent.
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Hospital waiting list queue jumpers outrage

May 16, 20179:37pm
Sue Dunlevy News Corp Australia Network
RICH people are using their private health insurance to jump the waiting lists for surgery at public hospitals in breach of Medicare rules.
For the first time ever, shocking new government figures reveal health fund members wait just 20 days for elective surgery in a public hospital compared to the 42 days public patients wait.
Privately insured people can get a coronary artery bypass in just 7 days in a public hospital while those without insurance wait 14 days, data from the Australian Institute of Health and Welfare shows.
Health fund members can get a hip replacement within just 46 days in a public hospital but a public patient waits 125 days.
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Medicare freeze fails to stop doctor price rises in Queensland

Matthew Killoran, The Courier-Mail
May 16, 2017 8:49am
THE cost to see a doctor in Queensland has jumped 20 per cent — or $7 a visit — since the Medicare freeze came into place four years ago, while new “unfreeze” measures announced in the budget are likely to provide less relief than a 20c coin.
Out-of-pocket costs to see a specialist jumped even higher — up almost $20 or 27 per cent.
New figures released yesterday revealed the average gap paid by non-bulk billed patients when seeing a GP.
Meanwhile, analysis of the unfreezing of the Medicare benefits scheme shows it will provide a saving of just 12.3c per visit to the GP in its first year.
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Health Insurance Issues.

Health funds accused of 'obscene' profit

Heath Aston
18 May 2017, 12:37 a.m.
The Age, News, 18/01/2017
Skyrocketing profits for insurers have been branded "obscene" by sections of the health industry, coming just months after health funds secured another government-approved increase in premiums well above inflation.
Health funds made post-tax profits of $1.3 billion in the year to April 1, an annual increase of 18 per cent.
That followed quarterly profit increases of 11.5 per cent and 28.5 per cent, according to figures released by the Australian Prudential Regulation Authority.
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Higher charges if health fund members treated in public hospitals

  • The Australian
  • 12:00AM May 18, 2017

Sean Parnell

The cost of treating health fund members in public hospitals is 12 per cent higher than the cost of treating uninsured patients, complicating efforts to make the system more efficient and save consumers and taxpayers money.
As public hospitals seek more than $1 billion a year from insurers to cover members who might otherwise be treated without charge, new data provides further evidence of the two-tiered system emerging in state-run hospitals.
Elective surgery patients have shorter waits if they use their insurance in public hospitals, while women who bill their insurer for the cost of having a baby stay longer than uninsured mothers.
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How public hospitals are raising your health fund premiums by $330 a year

Sue Dunlevy, National Health Reporter, News Corp Australia Network
May 20, 2017 12:00am
EXCLUSIVE
PUBLIC hospitals are hiring workers whose sole job is to persuade patients to get their health fund to pay for their hospital care and it’s adding $330 a year to your insurance premiums.
Hospitals are also putting advertisements on the back of hospital toilet doors to urge people to get their health fund to pay for their hospital care.
It’s all part of a deliberate policy by state and territory governments that is seeing up to four in ten patients at some public hospitals charged for treatment that should be free under Medicare.
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International Issues.

'Flagrant menace': US calls for tougher sanctions against North Korea

Adam Gartrell, Kate Aubusson
Published: May 14 2017 - 4:23PM
The United States has called for tougher international sanctions against North Korea in the wake of its latest ballistic missile test, which Australia described as a "reckless and provocative" act that would fuel regional instability.
The missile was fired from the Kusong area north-west of the capital Pyongyang early on Sunday and flew about 700 kilometres before landing in the Sea of Japan, the South Korean military said. It was the first such provocation since South Korea's new President Moon Jae-in took office last week and called for dialogue with the North.
The White House issued a sharp rebuke over the test, saying North Korea had been a "flagrant menace for far too long".
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James Clapper says US institutions 'under assault' from Donald Trump

Published: May 15 2017 - 3:24AM
Washington: Former US director of National Intelligence James Clapper warned on Sunday that the nation's institutions were being undermined by President Donald Trump after his decision last week to fire FBI director James Comey.
Citing Russian influence in the US election, Clapper told CNN's Jake Tapper on State of the Union that outside forces were responsible for weakening the US government. He also added that "our institutions are under assault internally."
"Internally from the president?" Tapper asked.
"Exactly," said Clapper. "I think the Founding Fathers, in their genius, created a system of three coequal branches of government and a built-in system of checks and balances. And I feel as though it's under assault and eroding."
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Republican senators have 'a lot less fear of' Donald Trump

Jennifer Steinhauer
Published: May 15 2017 - 10:37AM
Washington: Senate Republicans, increasingly unnerved by President Donald Trump's volatility and unpopularity, are starting to show signs of breaking away from him as they try to forge a more traditional Republican agenda and protect their political fortunes.
Several Republicans have openly questioned Trump's decision to fire FBI Director James Comey and even lawmakers who supported the move have complained privately that it was poorly timed and disruptive to their work. Many were dismayed when Trump seemed to then threaten Comey not to leak negative information about him.
As they pursue their own agenda, Republican senators are drafting a health care bill with little White House input, seeking to avoid the public relations pitfalls that befell the House as it passed its own deeply unpopular version.
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Donald Trump must be impeached. Here's why.

Laurence Tribe
Published: May 15 2017 - 9:59AM
The time has come for Congress to launch an impeachment investigation of President Donald Trump for obstruction of justice.
The remedy of impeachment was designed to create a last-resort mechanism for preserving our constitutional system. It operates by removing executive-branch officials who have so abused power through what the framers called "high crimes and misdemeanors" that they cannot be trusted to continue in office.
No American president has ever been removed for such abuses, although Andrew Johnson was impeached and came within a single vote of being convicted by the Senate and removed, and Richard Nixon resigned to avoid that fate.
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Sacked FBI chief Comey plots strike at Trump in congress

  • Toby Harnden
  • The Times
  • 12:00AM May 15, 2017
James Comey, the FBI director sacked, then vilified and threatened by Donald Trump last week, is poised to exact his revenge on the US President by testifying against him publicly before congress.
Although Mr Comey has declined to appear before the Senate intelligence committee at a closed hearing this Wednesday, he has made clear via friends that he wants to strike back against Mr Trump in an open session that could be one of the most-watched events in US political history.
The President said yesterday he hoped to name a successor by the end of this week.
Mr Trump, living in a White House bubble in which few aides are willing to contradict him, was apparently surprised by the furore his brutal ejection of Mr Comey triggered.
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Has the mantle of global leadership passed from the US to China?

Peter Hartcher
Published: May 16 2017 - 12:15AM
Barack Obama last year told his fellow Americans: "If we don't write the rules, China will write the rules out in that region," the Asia-Pacific. And that's exactly what's happening.
Obama was speaking of trade rules in particular, but it's increasingly clear that China has an historic opportunity to write the rules for much more than just trade. While Donald Trump is busy trying to shrink the US down to the size of his myopic vision, he has handed China an invitation to become the leader of Asia. 
It's already one of the leaders of the world. It is the second biggest economy on earth, it's a nuclear power and a veto-wielding permanent member of the UN Security Council. With Trump taking America out of the global leadership business, is the time at hand where we declare that the mantle of global leadership has passed? 
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Donald Trump ‘revealed classified information to Russians’

  • Eli Stokols
  • The Wall Street Journal
  • 10:49AM May 16, 2017
The White House was thrown on the defensive late Monday as it scrambled to respond to news reports that President Donald Trump revealed “highly classified information” in a meeting with Russian officials last week.
The Washington Post reported that during last Wednesday’s Oval Office meeting with Russian officials, Mr. Trump revealed highly classified intelligence information about the fight against Islamic State that jeopardized the foreign source who provided it. Additionally, the report states that Tom Bossert, a national security adviser, called the directors of the Central Intelligence Agency and National Security Agency to alert them to the president’s conversations.
National security adviser H.R. McMaster on Monday evening told reporters gathered outside the White House that the Post’s report was “false.”
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James Comey memo says Donald Trump asked him to end Michael Flynn probe

Michael S. Schmidt
Published: May 17 2017 - 8:02AM
Washington: US President Donald Trump asked the FBI director, James Comey, to shut down the federal investigation into Mr Trump's former national security adviser, Michael Flynn, in an Oval Office meeting in February, according to a memo that Mr Comey wrote shortly after the meeting.
"I hope you can let this go," the president told Mr Comey, according to the memo.
The existence of Mr Trump's request is the clearest evidence that the president has tried to directly influence the Justice Department and FBI investigation into links between Mr Trump's associates and Russia.
Mr Comey wrote the memo detailing his conversation with the president immediately after the meeting, which took place the day after Mr Flynn resigned, according to two people who read the memo.
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The 25th Amendment solution to remove Donald Trump

Ross Douthat
Published: May 17 2017 - 4:10PM
It was just three days and a lifetime ago that I wrote a column about Donald Trump's unfitness for the presidency that affected a world-weary tone. Nothing about this White House's chaos was surprising given the style of Trump's campaign, I argued. None of the breaking scandals necessarily suggested high crimes as opposed to simple omni-incompetence. And given that Republicans made their peace with Trump's unfitness many months ago, it seemed pointless to expect their leaders to move against him unless something far, far worse came out.
As I said, three days and a lifetime. If the GOP's surrender to candidate Trump made exhortations about Republican politicians' duty to their country seem like so much pointless verbiage, now President Trump has managed to make exhortation seem unavoidable again.
He has done so, if several days' worth of entirely credible leaks and revelations are to be believed, by demonstrating in a particularly egregious fashion why the question of "fitness" matters in the first place.
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Trump troubles extend to allies

Mark Kenny
Published: May 18 2017 - 7:57AM
Imagine if you read this news story: Malcolm Turnbull has sacked the Commissioner of the Australian Federal Police for continuing investigations into past links between Mr Turnbull's office and a foreign government.
The extraordinary move coincides with explosive new revelations of impromptu intelligence sharing with that same government, by the Prime Minister himself.
The unprecedented use of executive power to terminate the services of an independent statutory officer has sent shockwaves through the political, defence, and security establishments. Powerful security agencies are now in open conflict with the Turnbull government amid concerns about the administration of justice and the integrity of Australia's secret intelligence arrangements.
This fictional rendering conveys the gravity of events now swirling around Donald J Trump's idiosyncratic administration: what would happen if an Australian PM leant on the AFP to forget past links with a foreign government; extemporised on sensitive intelligence (gained from a trusted partner country) with a hostile government; and dumped the equivalent of the FBI boss without due cause?
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  • Updated May 18 2017 at 9:26 AM

The US government is at a dangerous impasse, but the Republicans will do nothing

by Edward Luce
If America's political system were working as it should, Donald Trump would be in serious trouble. Either Congress would be taking steps that could ultimately lead to impeachment, or people around the president would have concluded him unfit for office.
But Mr Trump retains an ace up his sleeve. No elected Republican dares cross him. Any who think of standing up to him know they would risk an electronic lynching that could finish their career. Just ask Jeb Bush.
America's government is at a dangerous impasse. Most people know Mr Trump is unfit to be commander-in-chief. But nobody with the power to redress it has found the courage to act.
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Suddenly, this is a President staring down the barrel of impeachment

Waleed Aly
Published: May 18 2017 - 12:07PM
It is significant that the fledgling Trump presidency has been brought to the brink of serious crisis, not by his lies, but by his truths.
The president's aides have tried to help. They pretended, for instance, that Trump's reasons for sacking James Comey as FBI director had nothing to do with the ever-tightening investigations into the president's connections to Russia. Then Trump went and blurted out that it really was all about "this Russia thing", breezily blowing his own cover. Same thing this week when Trump's team denied he had leaked sensitive, classified information to the Russian government, only to see Trump himself confirm defiantly that he did.
It would be one thing if this pointed to an austere and honourable (if self-destructive) honesty. But Trump is a man who has no trouble lying to exaggerate the scale of his election victory, or accusing Barack Obama of wiretapping his home without evidence.
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  • Updated May 19 2017 at 11:01 PM

The Trump White House is spinning out of control

Trump calls Russia probe a 'witch hunt'
Donald Trump's early presidency is bordering on crisis point.
For any objective observer, it seems premature to rush to judgement over whether a besieged Trump is, or isn't, guilty of claims that would warrant the US President's dismissal.
To be sure, the mounting circumstantial information is disturbing, especially as Russia is repeatedly linked to nearly every major firestorm engulfing the President.
What is no longer in doubt, however, even for some Trump loyalists, is the former celebrity television star is in charge of a White House that is hurtling out of control.
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I look forward to comments on all this!
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David.