Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, October 27, 2017

Researchers Suggest The Value In Hospital System Implementations Is Hard To Pin Down And Failures Are Common!

This appeared last week:

The impacts of eHealth upon hospital practice: synthesis of the current literature

17 Oct 2017
CREATORS
The aim of this brief is to provide policy-makers with an analysis of current literature relating to the effects to be expected from hospital implementation of eHealth technologies.

Description

To increase value from health-care expenditures, governments worldwide are increasingly adopting (or planning to adopt) eHealth technologies (e.g. Electronic Medical Records (EMR), Computer Provider Order Entry (CPOE), ePrescribing, and Computerised Decision Support Systems (CDSS)). The US government devoted $34 billion to this effort, and as a result, over 75% of US hospitals have now implemented EMRs. Alternatively, the UK National Health Service suspended their digitization efforts in 2011 after spending approximately £12 billion, but in 2016 dedicated a further £4.2 billion to digitise healthcare. The Queensland Government has budgeted $1.26 billion in an ambitious attempt to digitally transform the state’s public hospitals and similar initiatives have also been undertaken by other Australian states. Investing in eHealth is largely viewed as a means for the healthcare industry to improve financial and clinical outcomes. However, some of these outcomes are yet to be fully realised7 and effects of digitisation reported in the literature are often conflicting.
While many US hospitals have implemented eHealth technologies, their early experiences are not necessarily generalizable to today’s environments because digital systems are rapidly evolving. Because of this, and the heterogeneity of effects reported in past literature, it is important to provide up-to-date assessments of the currently available evidence. The aim of this brief is to provide, for policy-makers, an analysis of current literature relating to the effects to be expected from hospital implementation of eHealth technologies.

PUBLICATION DETAILS

Resource Type: Briefing paper
APO URI: http://apo.org.au/node/115061
Publication Place: Canberra
Series Title: Deeble Institute Evidence Brief
Series Volume/No.: 16
Copyright: Deeble Institute, Australian Healthcare & Hospitals Association 2017
More here:
The study conclusions are as follows:

What Does This Mean For Policy Makers?

On aggregate, the evidence implies three issues for policy makers:
1.  Implications from evidence of wide-ranging impacts:
The studies show significant impacts from eHealth technologies on different stakeholders (patients, clinicians, hospitals, and health services) and of different outcomes (efficiency, effectiveness, short-term, long-term). This implies the need for policy makers to adopt a comprehensive perspective when assessing success of eHealth implementations and consider both quantitative and qualitative data. Policy- makers also need to take a very inclusive approach when detailing expectations regarding the future success of proposed implementations.
2.  Implications from evidence of emerging impacts:
The studies reveal new evidence about specific impacts that have emerged over time (e.g. clinical judgement, changing practices, staff movements). Given that transformation of hospital practice is ongoing and inherently unpredictable, policy- makers need to keep policies open and flexible enough to allow for innovation and which encourage stakeholders to act on opportunities as they emerge rather than being constrained by pre-existing expectations.
3.    Implications from evidence of uncertain impacts:
The studies show that success from eHealth is not guaranteed, as implementations vary widely in terms of positive and/or negative outcomes. This suggests that rather than simply supporting eHealth projects per se, policy makers need to identify and support the drivers of successful outcomes. It is not currently clear which particular drivers are most critical, and resolving this uncertainty constitutes a pressing research need.
Synthesis
The wide-ranging, emergent, and uncertain nature of eHealth impacts implies that policy-makers and hospital administrators are unlikely to succeed with eHealth initiatives if they assume that the sole aim is to achieve pre-conceived organisational goals and metrics. Rather, they should consider eHealth implementations to be an opportunity to fundamentally rethink what it means to be a high value hospital and redefine the metrics used to assess their performance. This approach will motivate all stakeholders to leverage new opportunities as they emerge and allow governments to reap the transformational benefits that these technologies have the potential to confer on patient care.
----- End Extract.
What is really good about this study is that the authors recognize that data that is more than a few years old is probably not all that useful.
Also good it that the recognize to capture real benefits you have to do more than just automate the ‘status-quo’.
What is missing is a sufficiently large number of high quality comparable studies to derive firm evidence of benefits and what really works!
We have to wait a little longer I guess.
Comments welcome.
David.

Thursday, October 26, 2017

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

October 26, 2017 Edition.
It has been an amazing week globally.
President Xi has told us how China is going to return to its original glory by 2035 or so and Trump has been giving himself 10/10 for his fabulous hurricane response in Puerto Rico!
Elsewhere Brexit is going very badly and NZ has shocked us all by putting the Labour Government into power.
Will amazement and wonders never cease!
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In Australia the Energy Crisis has been solved by the NEG (National Energy Guarantee) and everyone is thrilled this week – next week who knows.
Victoria seems to be moving towards legal euthanasia and the SSM vote seems to just roll on. 
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Time to be at least alert if not alarmed!
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Here are a few other things I have noticed.
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Major Issues.

Goldman Sachs CEO Lloyd Blankfein told Australia's treasurer he's baffled by global politics right now

Oct 16, 2017
When Treasurer Scott Morrison met Goldman Sachs chief executive Lloyd Blankfein in New York late last week, the Wall Street banker was baffled.
Blankfein was searching for answers. Why, at a time when most economies were generally performing reasonably, had politics become so difficult in many countries?
“He does find that perplexing because their view is [economic] things are a lot better than the politics reflect,” Morrison told The Australian Financial Review in Washington on Friday.
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What global finance chiefs are saying about the world economy

Published: October 16 2017 - 8:46AM
Don't celebrate too soon. That was the key message as policy makers and investors left Washington on Sunday after attending the annual meetings of the International Monetary Fund and World Bank.
For once the mood was upbeat. The IMF bumped up its forecast for global economic growth this year and next. Stocks are surging, credit spreads are tight and market volatility is low.
Still, the fund's policy panel warned its 189 member countries that there's "no room for complacency". The recovery is still a work in progress with inflation below target in most rich nations, productivity sluggish and many not feeling the benefits of stronger demand.
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Why do we have the world’s most expensive superannuation?

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

Adam Creighton

Peter Costello was right to highlight the gross inefficiency of our superannuation system last week in a speech he delivered in ­Melbourne. It was timely in a week when US economist Richard ­Thaler, who highlighted the folly of forcing people to choose ­privately managed retirement plans, was awarded the Nobel Prize for Economics.
Here’s a fun fact: a family in Australia with a combined superannuation balance of $300,000 is paying more in fund management fees than it is on electricity — even after the latest 20 per cent price jump in power prices.
You might expect electricity to be expensive: fossil fuels need to be extracted and refined, sent to costly generators and then pumped around vast distribution networks. And that’s before the cost of administering customers’ accounts.
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Ten lessons from three decades of investing in the markets

  • The Australian
  • 6:12PM October 13, 2017

James Kirby

In the unlikely event you’ve missed it, we’re close to the 30th anniversary of Black Monday — October 19, 1987, when we saw the biggest one-day sharemarket crash in history.
It’s also a personal landmark for this columnist because it happened just days after I started work as a financial reporter in Melbourne.
Today I want to try and list some of the personal investment lessons I’ve learnt since that momentous period, both for the markets and myself in late 1987.
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Why Ben Bernanke is worried

October 15 at 7:16 PM
Ben Bernanke is worried — and perhaps we should be, too.
As chairman of the Federal Reserve from 2006 to 2014, it was Bernanke, along with others, who prevented the worst recession since World War II from becoming the Great Depression 2.0. Now he fears that, should another sharp recession occur, the Fed won’t be able to contain it.
Traditionally, the Fed has sought to influence the economy by changing short-term interest rates. If a recession looms, the Fed cuts the “fed funds” rate to stimulate demand. If the danger is inflation, the Fed raises the rate to relieve wage and price pressures. Changes in the fed funds rate are assumed to nudge rates on mortgages, corporate bonds and Treasury securities in the same direction.
But there’s a practical limit to this approach: Once the Fed has cut the rate to zero, it can’t do much more. If the recession is deep, it may outlast the Fed’s therapy. To many economists, failure portends dire consequences: deflation (falling prices). Too little demand chases too much supply.
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BIS says Australia's 55-year house price 'upswing' the longest in the world

Clancy Yeates
Published: October 16 2017 - 2:55PM
The long-term rise in Australian house prices since the early 1960s has been the most sustained property market upswing in the world in recent decades, new research says.
Researchers at the Switzerland-based Bank for International Settlements have analysed long-run trends in house prices across 47 countries, as part of a paper exploring how interest rates affect the price of real estate.
The paper, which finds short-term interest rates are a "surprisingly important" driver of house prices, also includes extensive data that underline the sheer size of the boom in house prices here and elsewhere.
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Treasury's John Fraser sees 'welcome signs of slowing' in house prices

Clancy Yeates
Published: October 17 2017 - 10:19AM
Treasury secretary John Fraser has welcomed the cooling off in the country's biggest housing markets, saying there are early signs the curbs on riskier bank lending are doing their job.
In an upbeat speech on the domestic and global economy, Mr Fraser acknowledged the build-up in household debt that had accompanied strong house price growth in recent years, but signalled he was not "too alarmed" by the trend.
After "rapid" growth in Sydney and Melbourne prices in recent years, Mr Fraser said the market appeared to be slowing, and there were also signs homebuyers were responding by moving to lower-priced cities and regional centres.
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Reserve Bank still worried about household debt, minutes show

  • Robb M Stewart
  • The Australian
  • 12:36PM October 17, 2017
Australia’s central bankers expressed increasing confidence in the economic outlook during their latest policy meeting, although they remain watchful of risks due to high household debt levels.
The Reserve Bank of Australia has shown it is in no rush to shift interest rates, having left the benchmark cash rate unchanged for a 14th month running at the meeting earlier this month, as wages and inflation have remained subdued.
That despite growth in major advanced economies having strengthened since last year and a number of central banks either starting or indicating a move toward reducing monetary stimulus.
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Cautious consumers tipped to drag on economy

Clancy Yeates
Published: October 17 2017 - 11:00AM
Now is undoubtedly a tough time to be in the retail business – and that's before even thinking about the future threat of Amazon.
Retailers have suffered their worst two months since 2010, and there is a growing view among economists that it reflects a broader pattern of consumers becoming more cautious with their money.
If that turns out to be true, it's important not just for retailers, but for the whole economy. Why?
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It's been a bad hangover but pay rises are coming

Jessica Irvine
Published: October 21 2017 - 12:57AM
It's the biggest challenge bedevilling the Australian economy today: why is wage growth so low?
Australia's jobless rate has tumbled to a fresh low of 5.5 per cent, we learnt this week, but signs of life in pay packets have yet to emerge.
It's too dramatic to say that wages have stagnated. Pay packets are still growing, by a bit under 2 per cent a year.
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A stock market panic like 1987 could happen again

Robert J. Shiller
Published: October 21 2017 - 11:24AM
October 19, 1987, was one of the worst days in stock market history. Thirty years later, it would be comforting to believe it couldn't happen again.
Yet that's true only in the narrowest sense: regulatory and technological change has made an exact repeat of that terrible day impossible.
We are still at risk, however, because fundamentally, that market crash was a mass stampede set off through viral contagion.
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RBA calls out Brisbane apartment glut risk

Clancy Yeates
Published: October 20 2017 - 2:00PM
A senior Reserve Bank official has flagged concerns about the "awful lot" of apartments due to flood the Brisbane property market, and the potential hit facing investors who had bet on making capital gains.
Michele Bullock, assistant governor for the financial system, on Thursday signalled that the RBA's long-running worries about an oversupply of apartments were most acute in relation to Brisbane, but it was more comfortable with the wave of high-rise construction in the other east coast capitals.
The central bank had previously warned Melbourne's apartment market was also a risk, but Ms Bullock said fast growth in the city's population was likely to absorb the extra supply of units.
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Lessons from the past: 1987 sharemarket crash and the GFC

Daryl Dixon
Published: October 20 2017 - 8:35AM
Thirty years after the 1987 sharemarket crash, and 10 years since the global financial crisis savaged world economies, presents a timely opportunity to review lessons from the past. As substantial as both market collapses were, the reassuring fact is that share and financial markets recovered relatively quickly both times.
While investors suffered all the losses in the 1987 crash, the GFC resulted in large costs for many governments forced to outlay huge amounts to ensure the survival of financial institutions and, in the case of the US, mortgage and other insurance companies. Even today, several governments retain ownership stakes in companies they were forced, or chose, to assist.
The 1987 sharemarket crash was a totally different situation caused by overvalued booming sharemarkets buoyed by high levels of gearing, even on newly floated speculative investments. In Australia, about three out of four recently floated companies did not survive the crash and investors could sell the higher quality stocks only at depressed prices to obtain cash.
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Politics makes a mess of essential services

  • The Australian
  • 12:00AM October 21, 2017

Alan Kohler

In a press release last Monday, ACCC chairman Rod Sims said: “Consumers and businesses are faced with a multitude of complex offers that cannot be compared easily”.
He was talking about electricity, but he could easily have been referring to the NBN and superannuation as well.
Each of these essential services — energy, retirement savings and communication — have been mangled by politics, and as a result are hopelessly confusing and expensive.
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National Budget Issues.

Network costs the main driver of electricity prices, consumer watchdog finds

Adam Gartrell
Published: October 16 2017 - 6:47AM
A huge increase in electricity network costs - driven by regulation and over investment - has been the number-one cause of rising household power bills over the last decade.
A lack of competition in both generation and electricity retail markets, the recent closures of coal-fired power stations and the growing cost of environmental schemes have also contributed to "severe" price rises since 2007 that have put homes and businesses under "unacceptable pressure".
These are the preliminary findings of a major Australian Competition and Consumer Commission inquiry ordered by the Turnbull government.
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Malcolm Turnbull prophet of his own doom on energy policy

Jessica Irvine
Published: October 16 2017 - 12:00AM
It's been 10 years since the US sub-prime crisis began ripping a gaping hole through the fabric of the global financial system.
And nearly 10 years since the Kevin07 hurricane ripped its way through Australian politics, destroying with it the tenure of a fresh-faced minister for the environment, Malcolm Turnbull.
When Rudd's signature carbon pollution reduction scheme was put to Parliament two years later, Turnbull – by then a backbencher relieved by his colleagues of the burden of leading the Opposition – spoke in favour of the bills, bravely crossing the floor to vote with the government on the legislation, which ultimately failed in the Senate.
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Bill shock: PM warned on energy prices

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

David Crowe

Malcolm Turnbull faces a crucial cabinet debate today with a new warning from voters against schemes that pass hidden power costs on to households, with ­almost 60 per cent of Australians saying they will not pay a cent more for clean energy policies.
The warning, in a special Newspoll survey, comes as the consumer watchdog prepares to release extraordinary research today showing households are paying $103 every year on average for environmental schemes.
The Australian Competition & Consumer Commission will warn today of “unacceptable pressure” on households from the spike in energy prices, which have soared 43.7 per cent in a decade — an average increase of more than $500 per bill — as a result of network costs, retail margins and climate-change targets.
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Malcolm Turnbull's new energy policy aims to cut costs and mandate minimum 'reliable' coal, gas production

Mark Kenny
Published: October 17 2017 - 8:23AM
The Turnbull government is set to announce a major repositioning of Australia's energy and emissions policy after cabinet signed off on a plan to scrap all renewable energy subsidies in future, mandating instead the use of sufficient "reliable" energy like coal and gas to avoid blackouts.
Fairfax Media understands the government believes it will be able to do this while still meeting the nation's emissions reductions targets under the Paris Agreement.
The plan relies on a growing market uptake of clean energy due to a combination of consumer preference, falling renewables costs, and technological advances in power storage.
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Out of the ashes of failed attempts, finally a chance to put the climate wars behind us

Peter Martin
Published: October 17 2017 - 10:02PM
Out of the ashes of repeated failed attempts to give us cleaner and more reliable electricity – the emissions trading scheme, the emissions intensity scheme, and the clean energy target – has come something surprisingly good.
The national energy guarantee will do more or less what each of the other schemes would have done. It will make the electricity system cleaner (in accordance with the Abbott government's commitments under the Paris climate agreement) while giving investors the certainty they need to work out what kind of power stations to build and when.
Because most of the other schemes were never implemented and the one that was (the renewable energy target) wasn't made permanent, investors have been denied that certainty until now.
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How maths killed the company tax cut

Peter Martin
Published: October 19 2017 - 9:26AM
The company tax cut is dead. Maths killed it, last week.
It happened with the release of an innocuous-looking report from the Parliamentary Budget Office entitled Changes in average personal income tax rates: distributional impacts.
Those changes were baked into, but not spelled out in, the May budget.
They are needed for it to whirr back into surplus by 2020-21 as promised.
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Turnbull government's $2.8 billion university funding cuts shot down by the Senate

Eryk Bagshaw
Published: October 19 2017 - 4:53PM
The Turnbull government's landmark higher education reforms have been killed off in the Senate, with the Nick Xenophon Team rejecting key elements of the $2.8 billion package and calling for a "Gonski style" review of the university sector. 
The reforms would have led to university fees increasing by 7.5 per cent, the HECS repayment threshold falling from $52,000 to $42,000 and university funding being cut by 2.5 per cent through a new "efficiency dividend".
The government wanted to raise minimum fees by $2000 to $3600 per year for a four-year degree with a maximum payment of $50,000.
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Health Budget Issues.

Changes to lure young people into private health insurance won’t slow increase in premiums

October 13, 2017 11.50am AEDT
The federal government has announced over a dozen changes to private health insurance. from shutterstock.com

Author Stephen Duckett

Director, Health Program, Grattan Institute
Australians will be able to choose lower premiums for higher excess, and insurers required to more clearly categorise their policies, under the federal government’s shake up of private health insurance announced today.
The package of more than a dozen changes to the sector is designed to help reduce costs to government in the medium term and establish processes to identify further reforms in the longer term. The dominant strategy here is to draw more young people into buying health insurance.
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Ordinary people to pay more for aged care under proposed reforms

Noel Whittaker
Published: October 13 2017 - 11:39AM
Aged care remains a moving target. The aged care reforms introduced in 2014 have just been reviewed, with a brief to examine the effectiveness of the changes, and to make recommendations for future reform to the aged care system.
The review report is a comprehensive analysis of what is working, and what is not – along with 38 recommendations to the government for improvements.
The review included the financial arrangements, and the clear message is that consumers should pay more. Recommendations include:
  • Assessing the full value of the former home for means testing (except when a protected person is living there). Currently a cap of $162,815 is applied to the home.
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Health Reforms Unlikely To Dent The Trend

Australia | 2:04 PM
The Australian government's changes to health insurance centre on prostheses and addressing the decline in the insured 20-30-year olds. Overall, brokers are sceptical the reforms will be enough to make a dent in the trend.
-Health insurance likely to continue to be a discretionary item for many
-Reduction in claims likely to be partially offset by lower premium growth for insurers
-Improved access to mental health services and travel & accommodation benefits to add costs to the system
By Eva Brocklehurst
The long-awaited reform package for Australia's private health insurance industry has been delivered by the Australian government. The proposed changes should result in up to $1bn in claims savings across the system over four years of operation, mainly via reductions in the prices paid for medical devices and prostheses. Brokers generally believe the reforms are a net positive for the industry but suspect they will go only a small way to turning around the declining trend in participation.
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  • Updated Oct 16 2017 at 3:00 PM

Citi analysts say private health insurers will woo young customers

The government's shake-up of the private healthcare sector, which is tipped to save insurers $1 billion over four years, should make the system more attractive to young people and reduce risks to earnings.
That is the view of Citi analyst Nigel Pittaway, who told investors in a research note that the government's reforms would encourage a fierce battle for the hearts and minds of millennials.
"The reforms seem likely to initiate a bout of intense competition for younger members. From April 1, 2019, discounts of 10 per cent will be possible for 18 to 25-year-olds, with this falling by 2 per cent for each year of age above 25 through to 30," he said.
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Health insurance still expensive despite reforms: analysts

  • The Australian
  • 12:00AM October 17, 2017

Sarah-Jane Tasker

The federal government’s list of private health insurance reforms, lauded as the most significant in almost 20 years, will not solve the affordability issues driving consumers out of the sector.
That is the view of industry analysts after reviewing the reforms announced last week by Health Minister Greg Hunt. The reforms included categorising policies as gold, silver, bronze and basic bronze, a discount for young people, more power for the Private Health Insurance Ombudsman and a reduction in prices insurers must pay for medical devices.
Credit Suisse analysts said that while the overall impact of the reforms would not be known for years, they would fix the current private health insurance affordability issues.
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  • Updated Oct 16 2017 at 11:00 PM

AMP backs medical treatment payment plan

AMP head of life insurance Megan Beer says it wants to be more involved in its customers' health recovery and return-to-work plans, calling on the government to allow it to fund medical and psychological treatments for unwell workers.
The Financial Service Council wrote to Minister of Financial Services Kelly O'Dwyer this month asking the government to lift regulatory constraints stopping insurers from funding certain medical treatments.
"Life insurers wish to make targeted rehabilitation payments for medical treatment or therapy that they determine to be relevant, appropriate and necessary to return the claimant to work," the letter said.
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Private health insurance changes - snake oil or miracle cure?

By Andrew Main

Health Minister Greg Hunt’s recent moves to make Australia’s private health cover slightly more affordable have had the effect of lifting the bonnet on the system, and what they show is that there’s a mutual reliance between the health insurers and the government that’s something of a tightrope act.

In simple terms, the health insurers will be allowed to discount premiums by 2% for each year by which a person is younger than 30 years old, to a maximum of 10%.

The insurers have all stated that they will pass the savings directly on to clients, which they will have to do anyway to lift membership numbers at the lower end of the age spectrum.
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John Menadue: PHI wasteful, unfair, $11 billion boon for health insurance lobby

Posted by Sandi Keane | Oct 19, 2017 | Featured, Government
The Government’s latest attempt to prop up the profits of the private health insurance funds, courtesy of federal Health Minister Greg Hunt’s reform package, will achieve little for members, says John Menadue who argues the case for abolishing the $11 billion a year Private Health Insurance subsidy.
THE WASTEFUL and unfair $11 billion per annum cost to taxpayers of the subsidy to Private Health Insurance (PHI) should be abolished and the savings used in two possible ways — part funding a Medicare dental scheme and/or part funding private hospital care through a Hospital Benefit Scheme. In that Hospital Benefit Scheme, individuals could choose to access either a public or a private hospital in the same way that veterans do today.
We have just had another futile attempt to tinker and prop up the profits of the private insurance funds. It will achieve little for members and will not address the fundamental flaws in PHI.
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After-hours home doctor industry should be stopped from exploiting Medicare, says taskforce

Esther Han
Published: October 19 2017 - 3:11PM
The booming after-hours home doctors industry has been slammed for deploying under-qualified doctors, disrupting a regular GP's continuity of care and demonstrating a "pricing failure", and may soon face new restrictions.
In a scathing report, the Medicare Benefits Schedule Review Taskforce concluded the after-hours industry was a drain on the health system and recommended changes that would stop it from exploiting four Medicare items.
But the industry has warned such changes would "shut it down" and "leave patients stranded".
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International Issues.

Trump's trifecta: thoughtless Iran folly strains his partners' patience

Mark Kenny
Published: October 16 2017 - 6:05AM
Perhaps it is his progress in fixing the North Korea crisis via Twitter, that has emboldened Donald Trump to choose now of all times, to ratchet up tensions with Tehran.
Trump's derision of what he has previously called the "worst deal ever" is characteristically inconsistent.
Even the good bit. For example, balance his contemporary position on Iran against his contention that the crisis with Pyongyang should have been resolved before the rogue state had a nuclear capability. This makes sense. Yet Trump is blind to the argument's obvious application to Iran – a country that was on the path to a nuclear capability but has agreed to stop, in exchange for sanctions being lifted, and its international bank accounts unfrozen.
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'Until the first bomb drops': Rex Tillerson says North Korea diplomacy to continue

Paul Kane
Published: October 16 2017 - 3:38AM
​Washington: US Secretary of State Rex Tillerson said on Sunday that President Donald Trump had instructed him to continue diplomatic efforts to calm rising tensions with North Korea, saying "those diplomatic efforts will continue until the first bomb drops."
Speaking on CNN's State of the Union, Mr Tillerson downplayed messages that Mr Trump had previously posted on Twitter suggesting the Secretary of State was wasting his time trying to negotiate with "Little Rocket Man," a derogatory nickname Mr Trump has coined for North Korea's leader Kim Jong-un.
Mr Trump "has made it clear to me to continue my diplomatic efforts," Mr Tillerson said.
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Islamic State fighters evacuate Raqqa city

Published: October 15 2017 - 5:45PM
Ain Issa: A group of Islamic State fighters has evacuated the Syrian city of Raqqa overnight, taking civilians with them as human shields, a militia spokesman says.
The US-backed Syrian Democratic Forces , an alliance of Kurdish and Arab militias, continues to battle Islamic State jihadists who remain in the city, SDF spokesman Mostafa Bali said. Foreign fighters did not leave under an earlier withdrawal deal, he added.
"The operations has finished and the battle continues," Bali said. "Last night, the final batch of fighters (who agreed to leave) left the city."
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If Donald Trump strikes North Korea there is only one outcome

Peter Hartcher
Published: October 17 2017 - 12:05AM
Seven members of the US Congress met for an informal dinner last Wednesday. They took off their jackets and ties and ordered Chinese takeaway. While the ambience was relaxed, the topic was deadly serious. They'd invited two American experts on the North Korean nuclear confrontation to brief them.
The congressmen and senators were all from the Democratic Party, but the experts were drawn from both main parties. The Republican briefer was Randy Schriver, who is expected to be appointed by the Trump administration as the senior Asia policy official in the Pentagon shortly. Schriver is a Harvard-trained national security expert with nearly 30 years' experience in the US Navy, State Department and Defence Department, specialising in Asia-Pacific Affairs and a protege of former US deputy secretary of state Richard Armitage.
The Democrat was Wendy Sherman, who negotiated with the North Koreans as an official in the Clinton administration. More recently she was the lead US negotiator in crafting the nuclear deal with Iran.
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Iraqi forces sweep into Kirkuk, checking Kurdish independence drive

David Zucchino
Published: October 17 2017 - 10:23AM
Kirkuk, Iraq: After weeks of threats and posturing, the Iraqi government began a military assault on Monday to curb the independence drive by the nation's Kurdish minority, wresting oil fields and a contested city from separatists pushing to break away from Iraq.
In clashes that pit two crucial US allies against each other, government troops seized the vital city of Kirkuk and surrounding oil fields, ousting the Kurdish forces who had controlled the region for three years in their effort to build an independent nation in the northern third of Iraq.
The Kurds voted overwhelmingly in a referendum three weeks ago for independence from Iraq. The United States, Baghdad and most countries in the region condemned the vote, fearing it would fuel ethnic divisions, lead to the break up of Iraq and hobble the fight against the Islamic State.
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Islamic State defeated in de facto Syrian capital Raqqa

Louisa Loveluck and Liz Sly
Published: October 18 2017 - 4:24AM
Beirut: US-backed forces in Syria claimed they had full control of the Islamic State's onetime capital of Raqqa on Tuesday, suggesting an end to the militants' presence in their most symbolically important stronghold.
Talo Silo, a spokesman for the Syrian Democratic Forces, or SDF, said that military operations had halted and that members of the joint Kurdish-Arab force were clearing the city of explosive devices and hunting for sleeping cells.
It was still unclear whether some Islamic State pockets remained, but the SDF portrayed the battle for Raqqa as effectively over.
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The dominance of Xi Jinping at Chinese Communist Party's national congress

Nicholas Stuart
Published: October 18 2017 - 12:15AM
Don't believe everything you hear. News reporters will insist that the 19th national congress of the Chinese Communist Party, held every five years and beginning in Beijing on Wednesday, is a thrilling opportunity for its cadres to decide the future of China. The reality is very different. Everything's been decided and the fix is in.
What we will witness instead is a different, but truly remarkable, event: the first festival of Xi Jinping.
Xi is, by any standards, an extraordinary leader. He has imposed his personal will and style on China in a way no other leader has managed since the death of Mao Zedong, 51 years ago last month. There's no need to recite the turmoil that resulted from Mao's 27-year reign and the ensuing struggle for control of the party; the point is that, in the mid-1980s, it adopted a smooth process of renewal. Leadership positions were turned over every decade. Space was left for an orderly succession process, banishing the myth that any individual leader was irreplaceable.
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  • Updated Oct 19 2017 at 10:13 AM

How long before Donald Trump withdraws from the World Trade Organisation?

by Edward Luce
How many poison pills does it take to kill a trade deal? Three, according to Donald Trump. Mexico and Canada are bending over backwards to preserve the North American Free Trade Agreement. But their tolerance for Mr Trump's demands is wearing thin. It seems a matter of time before he declares America's exit from "the worst trade deal ever".
The temptation to withdraw from the World Trade Organisation will grow as Mr Trump's term wears on. Anyone who thinks he has dropped his vow to rip up the global trading system has not been paying attention.
Reporters used to joke that "Worthwhile Canadian trade initiative" was the dullest headline ever written. Mr Trump has made it exciting. A year ago it would have been hard to imagine Canada and Mexico teaming up against the US. Mr Trump has driven them together. One such poison pill is the demand that NAFTA "sunset" every five years, which is like putting a recurring expiry date in a marriage agreement. Divorce becomes inevitable.
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George W. Bush delivers scathing rebuke of Trump presidency

John T. Bennett
Published: October 20 2017 - 6:13AM
Washington: Former President George W. Bush has delivered a scathing warning about Donald Trump, saying his "America first" philosophy portends a dangerous inward turn that is eroding democracy at home and threatening stability around the world.
"The health of the democratic spirit is at issue," the 43rd president said during a speech in New York on Thursday, local time. "And the renewal of that spirit is the urgent task at hand.
"Since World War II, America has encouraged and benefited from the global advance of the free markets, from the strength of democratic alliance and from the advance of free societies," Bush said.
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'A free and open Indo-Pacific': US flags pact with Australia-Japan-India

Peter Mitchell
Published: October 19 2017 - 12:07PM
Los Angeles: US Secretary of State Rex Tillerson has raised the prospect of Australia joining the US, Japan and India in a powerful strategic alliance to promote "a free and open Indo-Pacific".
Mr Tillerson, in a speech and question-and-answer session at the Centre for Strategic and International Studies in Washington DC on Wednesday, described threats faced in the region from cyber attacks, North Korea and China's provocative and undermining actions.
America was benefiting from a US-Japan-India trilateral agreement, but he said there "is room to invite" Australia to anchor the relationship between the democratic nations.
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Catalonia leader will be removed, Spains prime minister announces

Published: October 22 2017 - 2:43AM
Madrid: In a first for Spain, Prime Minister Mariano Rajoy announced on Saturday that he would remove the separatist government of the independence-minded region of Catalonia and initiate a process of direct rule from Madrid.
The announcement, made after an emergency Cabinet meeting, was an unexpectedly forceful attempt to stop a years-long drive for secession in Catalonia, which staged an independence referendum on October 1, even after it was declared illegal by the Spanish government and courts.
Rajoy took the steps with broad support from Spain's main political opposition, and will almost certainly receive the required approval next week from the Spanish Senate, where his own conservative party holds a majority.
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I look forward to comments on all this!
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David.