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."

Thursday, February 23, 2017

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

February 23  Edition.
It has been a slightly quieter week with a bit less Trumpian drama but ongoing apparent instability in the US is just below the surface. Financial markets seem to be unconcerned but there are some signs this may be changing.
In Australia the biggest issue has been around the National Energy Market, the place of coal and keeping the lights on. Avoiding major climate change seems to have slipped of the agenda – sadly.


Thursday Update - basically it feels like pretty much everything has got worse with Trump going for mass deportation apparently and the energy debate in Australia becoming utterly farcical. It is all pretty sad.
A worrying article this week was this one.

What if the nerds are reading Donald Trump right?

Peter Martin
Published: February 19, 2017 - 12:00AM
The January meeting of the American Economic Association is to economics nerds what Star Wars conventions are to George Lucas fanatics. It's an opportunity for more than 13,000 of them to cram into one hotel to swap ideas, make new friends and catch up on research.
Justin Wolfers prowled the halls. An Australian expatriate who's professor of economics at Michigan University, he told the Australian forecasting conference in Sydney this week: "There are more handsome people blessed with amazing social skills in that one building than you'll ever see anywhere else."
He asked them what was going on.
"Over the course of four days I literally did not meet a single North American economist who thought that anything good for the US was going to come out of the Trump administration," he said. "Not one."
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This is really scary stuff:

Wave of leaks against Donald Trump stirs fears of a US 'deep state'

Amanda Taub and Max Fisher
Published: February 18, 2017 - 3:21AM
Washington: A wave of leaks from government officials has hobbled the Trump administration, leading some to draw comparisons to countries like Egypt, Turkey and Pakistan, where shadowy networks within government bureaucracies, often referred to as "deep states," undermine and coerce elected governments.
So is the United States seeing the rise of its own deep state?
Not quite, experts say, but the echoes are real – and disturbing.
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In Australia the worst news is reviewed here. We have all clearly failed here:

Hard-headed approach is needed to close the gap

  • The Australian
  • 12:00AM February 15, 2017
There can be no more bracing reality, no statistic that conjures more pathos, than the brutal fact that indigenous children are dying before reaching the age of five, sometimes at double and even three times the rate of non-indigenous children in our nation. If anyone feels the need to question the focus or wonder about the imperative of the Closing the Gap initiative, then the cruelty of young lives lost before they have had the chance to blossom provides the bottom-line reference point for a country where equality of opportunity, let alone equality of outcome, simply does not yet exist. Putting aside all the worthy debates about policy, process, discrimination and personal responsibility, it must be out nation’s greatest shame that in life expectancy, health, education and employment, indigenous Australians are left considerably behind their compatriots.
Across the nation the child mortality rate is less than 100 deaths per 100,000 children under five years old. But for indigenous children the rate is almost double that and in the Northern Territory it is three times as high. In cold hard numbers this amounts to as many as 100 extra deaths: 100 or more indigenous children dying each year because of the impact of their family’s disadvantage. Over recent decades there has been improvement, especially by boosting access to care and education for expectant mothers, reducing the numbers of mothers smoking during pregnancy and improving immunisation rates. But there is much further to go in closing the gap; the aim set in this area in 2008 was to halve the difference in mortality rates between indigenous and non-indigenous children by 2018. We are failing that task.
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Here are a few other things I have noticed.
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National Budget Issues.

Reserve Bank chief Dr Philip Lowe gently reproves Turnbull's failings

Ross Gittins
Published: February 12, 2017 - 9:39PM
Reserve Bank governor Dr Philip Lowe's economic policy to-do list for 2017 contains a lot more implied criticism of the Turnbull government's weak performance than it has suited some in the national press to report.
It's true that, in his speech last Thursday, Lowe was clear in his support for a cut in the company tax rate and, by implication, the government's plan to cut the rate from 30 per cent to 25 per cent over 10 years, at a cumulative cost to revenue of $48 billion, and then a continuing net cost of $8 billion a year.
Last among the four items on Lowe's to-do list was "rebuilding our fiscal buffers", by which he meant getting the budget back into surplus.
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The great coal hoax

  • The Australian
  • 6:50AM February 13, 2017

Alan Kohler

In a way, the Coalition’s final transformation into fervently pro-coal evangelists is the predictable destination of the journey they have been on since 2009, when they sacked the then pro-emissions-trading Malcolm Turnbull in favour of the zealot Tony Abbott.
Even so, last week’s performance by the Treasurer of the nation, Scott Morrison, waving a piece of coal around in Parliament and ranting that since coal has been the past source of Australia’s advantage, it must be in future, and anyone who disagreed with that madness was “coalophobic”, was pretty disheartening.
The development presents a difficult but important challenge for Australia’s corporate leaders, but if they respond to it properly, last week’s episode could be a turning point for energy policy.
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Listen to the RBA on tax, Morrison urges crossbench

  • Simon Benson
  • The Australian
  • 12:00AM February 13, 2017
Scott Morrison has seized on the Reserve Bank’s backing of company tax cuts in a letter sent to Senate crossbench members over the weekend, ramping up the pressure to win their support and isolate Labor over its opposition to the bill.
With the Enterprise Tax Plan Bill set to pass the lower house tomorrow, the Treasurer has sought to use an implicit endorsement last week by RBA chief Philip Lowe in the government’s campaign to sway independent Nick Xenophon and his two fellow Senate colleagues, who have said they were “open to talks but yet to be convinced”.
Mr Morrison took the unusual step of emailing all non-Coalition members of parliament a copy of Mr Lowe’s speech, which also referenced the independent central banker’s calls for “fiscal buffers”, which Mr Morrison argued was a compelling case to support the government’s $13.2 billion worth of savings measures still before the parliament. “I urge all members of the parliament, of the House of Representatives and in the Senate, no matter which state you come from or which political party you represent, to carefully consider this contribution by the governor of the Reserve Bank and to support the government’s Enterprise Tax Plan and budget repair legislation ... that are necessary to protect our standard of living,” the letter said.
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Memo Treasurer Scott Morrison: there ain't no NDIS jam jars

Peter Martin
Published: February 13, 2017 - 6:57PM
What's this about a "locked box"? Treasurer Scott Morrison says the savings that'll be made from cutting unemployment and other benefits will be put into the modern-day equivalent of a jam jar - "a locked box for which the Social Services Minister has full visibility and accountability to ensure that the money that will come from making these changes will go to ensure that the National Disability Insurance Scheme continues to be funded".
It came across as a threat: if the Senate didn't support the $3 billion of spending cuts in the clumsily named Omnibus Savings and Child Care Reform Bill, the National Disability Insurance Scheme mightn't be properly funded.
In reality there are no locked boxes. Clause 81 of the Constitution says "all revenues or moneys raised or received by the executive government of the Commonwealth shall form one consolidated revenue fund, to be appropriated for the purposes of the Commonwealth in the manner and subject to the charges and liabilities imposed by this Constitution".
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Analysis doesn't change Labor's tax view

- on February 13, 2017, 3:15 pm
New research showing company tax rate cuts over the past three decades resulted in increased budget revenue hasn't changed Labor opposition to the Turnbull government's 10-year reduction plan.
An analysis by the Australian Chamber of Commerce and Industry looks at the business tax cuts implemented in 1988 and 1993 under Labor governments and in 2000 and 2001 under the coalition.
In both cases the cuts were followed by a rise in tax revenue.
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Scott Morrison cautious on iron ore budget fix

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

Michael Roddan

Scott Morrison says iron ore ­prices have markedly improved since last year’s budget forecasts, but argues structural improvements will need to be pursued in order to bring the national accounts into shape.
Speaking on Sky News Business’ Ticky program last night, the Treasurer said the government would reassess its forecasts for the price of iron ore if the improved price was sustained and there was a view among Treasury’s economists that it will be sustained.
“With commodity prices back in December (for the Mid-Year Economic and Fiscal Outlook) we took a fairly modest view about how that was going to play out,” Mr Morrison said.
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Government threatens tax increases if welfare spending cuts are not passed

Fergus Hunter
Published: February 15, 2017 - 10:27AM
The government has raised the prospect of increasing taxes if Labor and the Senate crossbench continue to obstruct its cuts to family tax benefits, paid parental leave and unemployment payments. 
Treasurer Scott Morrison and Finance Minister Mathias Cormann have made the threat as the $4 billion "omnibus" bill, the savings of which they have linked to funding of the National Disability Insurance Scheme, appears to have failed to attract the necessary support in the upper house.
"If you don't [make savings], you've either got to have higher debt, which is a tax on your children, or you have to deal with other revenue measures," Mr Morrison told Sky News on Tuesday night.
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  • Updated Feb 15 2017 at 11:00 PM

Plan to cut capital gains tax discount for property investors, not negative gearing

The Turnbull government is planning a crackdown on capital gains tax concessions for property investors to seize the mantle on housing affordability and provide revenue to help replace soon-to-be dumped budget cuts.
The policy backflip, to be unveiled in the May budget, comes after more than a year of savaging Labor's proposal to halve the capital gains discount as an assault on badly needed investment.
It is understood the policy being worked on within government would be confined to property investment, and not apply to all investments such as shares, as Labor's plan would. Neither would the Coalition policy target negative gearing, as Labor is doing.
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Morrison says May budget could raise taxes to protect AAA, if it must

James Massola
Published: February 16, 2017 - 8:10AM
Treasurer Scott Morrison has linked potential tax rises to protecting Australia's AAA credit rating, while also signalling the government is preparing for the Senate crossbench to water down its $50 billion company tax cut plan.Mr Morrison has indicated that while the government still wants the Senate to pass its proposed 10-year, $50 billion company tax cut in full, it will accept a negotiated outcome with the Senate crossbench.
Labor and the Greens only support tax cuts for companies with a turnover of up to $2 million a year; One Nation backs the cut for companies turning over up to $50 million, while the Nick Xenophon team backs a cut to 27.5 per cent for companies turning over up to $10 million.
The Xenophon option is considered the most likely outcome, though the government is hopeful of securing more.
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PM defiant on capital gains

Andrew Tillett, Canberra
Friday, February 17, 2017 3:25AM
Malcolm Turnbull has ruled out changes to capital gains tax, denying reports the Government had been looking at the option in its desperate hunt for cash for the Budget bottom line.
Government ministers were quick to stamp out suggestions capital gains would be reformed as part of the reboot for the Budget amid signs a hostile Senate would not yield on $13 billion of cuts to welfare, health and education.
Fairfax Media reported the Government was canvassing following Labor’s approach and reducing the 50 per cent discount on capital gains tax, potentially by half, or staggering the discount so that it increased incrementally the longer a property was held.
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Calm down, housing affordability not that bad, says RBA

Peter Martin
Published: February 17, 2017 - 8:20AM
Declining rates of home ownership aren't necessarily a bad thing, according to the Reserve Bank.
Addressing a conference of housing researchers in Melbourne, the Bank's head of economics, Luci Ellis, said participation in the housing market "need not be about owning your own home".
"Many people rent, someone else has to own those dwellings as well," she said. "In Australia, most private rental properties are owned by other households."
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Malcolm Turnbull caves in after flirting with capital gains tax backflip

Mark Kenny
Published: February 16, 2017 - 9:10PM
Close, but no cigar. Unless you're a real estate agent that is. Or a landlord, or a property developer, in which case a whole box of cigars might be in order. Who knows, you might even get away with charging the purchase price against the unit's rental income?
It was nearly different.
In the presumed security of razor gang deliberations, it seems, Malcolm Turnbull and his team went tantalisingly close to alchemising two metals rarely seen in Canberra these days: political courage, and policy heft.
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The national electricity mess is another example of why voters have lost faith in politicians

John Hewson
Published: February 17, 2017 - 12:00AM
The NEM has become the National Electricity Mess, nee Market – more broadly, power mess – a national embarrassment.
The market is clearly failing and its management rules are archaic. Major players are gaming the system, exploiting the consumer by "gouging" excessive prices and profits, while supply is no longer guaranteed. Genuine reform is being undermined by incessant, irresponsible, short-term, partisan politics. It cannot just be patched up. Reform must begin with a blank sheet of paper, preferably with bipartisan support.
It was based on the British system of some 20 years ago, which has since been jettisoned. It didn't contemplate renewables, storage, or disseminated distribution. The current political debate is riddled with opportunistic, often factually incorrect, political comment and point-scoring. Yet, reform is fundamental to our essential "transition" to a low-carbon society.
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It may take a shock to budge Senate

Paul Osborne, AAP Senior Political Writer, Australian Associated Press
February 16, 2017 12:43pm
index&t_product=HeraldSun&td_device=desktopThere's a growing sense within government and its allies in the Senate that it may take a crisis to break the deadlock over getting the federal budget back into the black.
Senate crossbenchers don't doubt Malcolm Turnbull and Scott Morrison's determination to balance the books and shore-up Australia's prized triple-A credit rating.
As a fortnight of parliament wrapped up, Liberal Democrats senator David Leyonhjelm told AAP it isn't that the government lacks direction.
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Senate’s threat to nation’s rating, Turnbull’s stance

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

Paul Kelly

The reality of an untenable fiscal position and parliamentary deadlock is about to break over the Turnbull government. In the process, the crisis of the Australian system — driven by cultural complacency and partisan polarisation — is about to extract its latest price.
Australia is a country brawling its way towards big trouble. Because it is rich and adept at avoiding recession, this will be a long, debilitating and agonising drift. There is some sentiment at large for a new spirit of bipartisan co-operation but politics is locked in a prison of ideological conflict, brazen self-interest and short-term populism.
Malcolm Turnbull and Scott Morrison face the exhaustion of palatable options, trapped between the budget and the parliament. The Treasurer’s frustration was apparent in parliament when he said he could “understand” suspicions that Labor was putting at risk Australia’s AAA credit rating and it would be “a pretty dog act’’ to pursue “their own cynical political objective of trying to force a downgrade of the AAA credit rating”.
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Health Budget Issues.

GP rebate: What I do for the $37.05 that no one wants to pay

Elizabeth Oliver
Published: February 13, 2017 - 12:00AM
The builder chatted while I checked his blood pressure, waist circumference, cholesterol, fasting glucose and urine protein. We discussed bowel and prostate cancer screening in detail and I gave him written information as we were out of time. As I signed his script for blood pressure medication he winked.
"That was easy money for you, wasn't it?" 
$37.05. That is the value the government places on up to 20 minutes of my time. This figure, the amount a practice receives from Medicare for a standard consultation, hasn't changed in four years. Under the rebate freeze, it won't change for another three. But are the pennies well spent? Let's see.
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Health department’s advice to curb foreign doctor influx ignored

  • The Australian
  • 12:00AM February 13, 2017

Sean Parnell

The federal Department of Health had internal support from the employment and industry departments to stop the flow of foreign doctors into Australia but its proposal was watered down.
The Australian revealed last year that the Health Department had sought to remove 41 health roles from the Department of Immigration’s Skilled Occupation List because domestic graduates were struggling to find training places and jobs, but only four roles were cut in the 2016-17 review and eight others, including GPs, were flagged for future removal.
Documents obtained under Freedom of Information laws show an interdepartmental committee was told the review would be subject to a “new whole-of-government approach”, where fewer ministers would be engaged and departments would make submissions privately.
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13 Feb 2017 - 4:10pm

Govt open to reviewing GP freeze: Turnbull

Malcolm Turnbull says the government is in discussions with doctors about how lifting the Medicare rebate freeze can be achieved.
Source:  AAP
13 Feb 2017 - 4:10 PM  UPDATED 29 MINS AGO
Malcolm Turnbull insists the government is open to reviewing the controversial freeze on Medicare rebate for GPs that almost cost the coalition the 2016 election.
The prime minister told parliament on Monday Health Minister Greg Hunt was in discussions with the Australian Medical Association and colleges as to how it could be achieved.
The freeze, which pauses rebates for standard GP visits at $37 until 2020, has angered doctors who warn patients will be forced to pay more to see a doctor as a result.
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Medicare rebate: PM gives strongest indicator yet the doctors' long winter is almost over

Amy Remeikis
Published: February 13, 2017 - 7:42PM
Prime Minister Malcolm Turnbull has given the strongest signal yet the government may move to head off its politically damaging feud with the medical profession by lifting the Medicare freeze.
Speaking in Parliament, Mr Turnbull said the government was "open to reviewing" the indexation clause, which began in 2013 under the Gillard government but was extended to 2020 under the Coalition.
"The Minister for Health is having productive discussions with the AMA and the colleges as to how that can be achieved, but clearly we are managing a very tight budgetary position," he said.
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Nick Xenophon outlines his Medicare levy hike

  • Simon Benson
  • The Australian
  • 11:00AM February 16, 2017
Senate powerbroker Nick ­Xenophon has claimed that his proposal for a hike in the Medicare levy to fund the National Disability Insurance Scheme would hit only middle to high income families to the tune of up to $600 a year.
The South Australian Senator said that while he hadn’t specified at what rate he believed the levy should rise to when proposing the tax increase, he told The Australian this morning that his suggestion was a rise of between 0.25 per cent and 0.5 per cent.
The Australian has modelled a one per cent rise in the Levy. This is what would be required to plug the $7 billion gap in the cost of the NDIS by 2028. At this rate, high income families would pay an extra $2600 a year while average families would pay around $600 extra.
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AMA public hospital report shows 'woeful' and underfunded system

February 17, 2017
An Australian Medical Association report on the nation's public hospitals shows that emergency wait times, surgery wait times and bed capacity cannot keep pace with population growth, as the system goes backwards.
The report shows the performance of the hospitals is virtually stagnant despite an increasing and ageing population and this is keeping facilities in a constant state of emergency.
Bed number ratios have remained static and there has been no improvement in waiting times over the past three years.
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17 Feb 2017 - 4:44pm

Australian hospitals in constant state of emergency, AMA says

The federal government has defended its public health funding following a new report from the AMA claiming hospitals across the country are over-stretched and over-stressed.
By Nina Stevens
17 Feb 2017 - 12:50 PM  UPDATED 13 MINS AGO
The Australian Medical Association said its 2017 report card, released on Friday, painted a bleak picture of public hospitals choking under the weight of demand.
“It paints a picture of a system that is, at best, plateauing and, according to many metrics, going backwards,” AMA President Dr Michael Gannon said.
“What we’re dealing with are doctors, nurses, [and] other health professionals that are being asked to do more with less. They can’t do that, and that’s reflected in this data," he said.
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2:17pm February 18, 2017

More than 140,000 families cut off from childcare payments for not vaccinating their kids

By nine.com.au staff
More than 140,000 families have been cut off from receiving childcare benefits for failing to vaccinate their children.
The first figures from the Federal Government’s “No jab, no pay” policy show parents in Adelaide city and the Gold Coast Hinterland were most likely to not vaccinate their children.
Federal Health Minister Greg Hunt told TODAY this morning the controversial policy had seen a lift of 200,000 more children being vaccinated.
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Health Insurance Issues.

Premiums should be set freely

  • The Australian
  • 12:00AM February 13, 2017
Less than a month into his new job as Health Minister, Greg Hunt has signed off on a 4.8 per cent average increase in private health insurance premiums for 2017. It should be the first and last time he does so. Ministerial interference in the setting of private health insurance premiums is no more logical than having ministers tamper with private school fees. The federal government provides subsidies to private health insurers in the hope of reducing the strain on the public system, but that doesn’t negate the virtues of competition to reduce costs. The Private Health Ministerial Advisory Committee, a laudable legacy of Mr Hunt’s predecessor, Sussan Ley, is considering recommending that this power be scrapped. Healthcare is plagued with perverse incentives, but if the Coalition wants to make a serious attempt to reform it in a way that lowers costs for 13 million policy holders, it’s advice worth taking. Mr Hunt said this year’s annual increase would be the lowest in a decade, but that misses the point. The latest increase comes after a decade of 5 per cent increases every year, around triple the pace of overall inflation. This isn’t acceptable.
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13 Feb 2017 - 8:06am

One-in-four plan to drop health insurance

Nearly a quarter of Australians are set to dump their private health cover while one third are considering switching insurers, a survey has found.
Source:  AAP
13 Feb 2017 - 8:06 AM  UPDATED 39 MINS AGO
Almost one-in-four Australians are considering dumping their private health insurance after the federal government gave the go ahead for premium hikes.
One-in-three people with private health cover are also considering switching insurers before the price hikes hit on April 1, a survey by online comparison website finder.com.au shows.
Spokeswoman Bessie Hassan said the cost of private health insurance was outweighing the benefits for thousands of policyholders.
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Labor’s Mediscare campaign cut into private surgery

  • 12:00AM February 14, 2017

Sarah-Jane Tasker

Public hospitals are increasingly competing with the private sector for insured patients, a trend set to be in focus when listed healthcare companies report their results.
A quarterly review of private hospitals by UBS shows that in the September 2016 quarter, a period when private hospitals reported weak volumes, benefits paid to public hospitals increased by 4.9 per cent. Public waiting lists expanded in the same period.
The Australian Private Hospitals Association said patients with private health insurance were being encouraged to use their private health insurance in public hospitals, which pressured insurance premiums and worsened waiting lists.
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Pressure on private health as thousands dump hospital cover

  • The Australian
12:00AM February 15, 2017

Sean Parnell

The number of Australians with hospital cover continues to ­decline, adding pressure on the health insurance industry and the federal government to respond to value-for-money concerns.
Only days after Health Minister Greg Hunt announced premiums would rise by an average 4.84 per cent in April, figures from the Australian Prudential Regulation Authority showed 7785 people dumped their hospital cover in the December quarter.
The key indicator, the proportion of Australians with hospital cover, was 46.6 per cent in the quarter, a 0.2 percentage point ­decline on the previous quarter and 0.6 percentage points down from the same quarter last year. The most recent peak was June 2015 with 47.4 per cent. Cash-strapped members have sought to reduce their premiums by adding restrictions, exclusions and excess payments but may now be quitting altogether.
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Moves to scrap cover for natural therapies set to fail

  • The Australian
  • 12:00AM February 13, 2017

Sean Parnell

The push to strip natural therap­ies from taxpayer-subsidised health insurance policies looks set to fail, with an expert advisory committee unable to agree on the issue.
Efficiency and efficacy have become key drivers of health policy­ and will remain so with insurance­ premiums set to rise by 4.84 per cent on average in April.
Amid concerns the $6 billion health insurance rebate was being used to subsidise low-value care, the former Labor government initiat­ed a review of natural therapies covered by many insurance policies.
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Health insurance premiums should be falling, not rising

New Health Minister Greg Hunt was quick to champion last Friday that the average increase in health insurance premiums of 4.84% was the “lowest increase in a decade”. And he is right - the 4.84%, to take effect from 1 April, looks positively modest compared to 5.59% in CY16, 6.18% in CY15 and 6.2% in CY14.
But the stock market celebrated the outcome for the listed insurers Medibank Private and nib, the first and fourth ranked insurers by number of policyholders, who together cover 36% of the market. Both companies rose by more than 2% following the announcement.
While Medibank’s average premium increase of 4.60% and nib’s 4.48% are below the industry average, what does the stock market know that the Minister or his Department doesn’t appear to understand?
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  • Updated Feb 17 2017 at 2:41 PM

Medibank CEO Craig Drummond worried by insurance lapse rates

Medibank Private chief executive Craig Drummond says there are two pieces of data about movements in health insurance membership that sum up the burning structural problems facing the industry.
In the December quarter 7700 people cancelled their health insurance while, at the same time, 17,500 people aged between 70 and 75 years old took up private health insurance.
Drummond says the conclusions to be drawn from these stats are obvious – a growing number of young people are falling out of health insurance and a cohort with much higher propensity to seek health care is joining the private health insurance system.
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Pharmacy Issues.

One in three pharmacists recommend herbal remedies with little scientific basis

Lucy Cormack
Published: February 13, 2017 - 5:56PM
One in three Australian pharmacists recommend alternative medicines that have little to no scientific evidence of working, an investigation by consumer group Choice has found.
Choice conducted a "shadow shop" of 240 pharmacies around Australia, where it asked consumers to request a pharmacist's advice for treating symptoms of stress.
The surveyed pharmacies included Priceline, Terry White Chemmart and Chemist Warehouse.
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Concern as two pharmacies go under administration

17 February, 2017 Heather Saxena 
The collapse of the two Queensland pharmacies this week has prompted warnings of more failures to come as PBS reforms and high rents bite.
The Terry White and Priceline pharmacies — owned by the same in Rockhampton operator -- are now being operated under administration.
The exact causes of the failures are not clear, but PBS reforms and high rents, coupled with a downturn in the local economy, likely contributed, says administer Andrew Schwartz.
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Superannuation Issues.

Bernie Fraser review into industry super funds rejects 'independence' quotas

Georgia Wilkins, Peter Martin
Published: February 16, 2017 - 5:30PM
A long-awaited review into the governance of industry super funds by former Reserve Bank governor Bernie Fraser has found no grounds for legislation that would force boards to have a minimum number of "independent" directors.
The review, commissioned by industry groups Industry Super Australia and Australian Institute of Superannuation Trustees, said mandating a quota of independent directors would not necessarily deliver "best practice" and instead recommended a mandatory code of conduct be introduced across the sector.
The Coalition tried unsuccessfully in 2015 to introduce new laws requiring super funds to appoint one third independent directors, including an independent chair.
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I look forward to comments on all this!
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David.

The Scope Of Digital Health Seems To Be Widening In All Sorts Of Interesting Ways.

This appeared last week.

Five digital health trends investors are watching in 2017

February 16, 2017

Digital health technologies will transform healthcare. Mobile phones have given health care providers the ability to engage with patients 24-7 and patients are able to capture and share data that may be helpful in tracking and personalizing their health care. Genomics, analytics, artificial intelligence and deep learning technologies are all making inroads in this emerging sector. Although the amount of money invested in the sector slightly decreased from last year, according to Rock Health, venture capital interest in the digital health sector is still significant with $4.2 billion invested in 2016.  
It’s a very diverse sector that spans from general wellness applications targeting consumers to highly clinical solutions that typically require FDA approval. At AMV, we focus more on clinically oriented digital solutions tackling healthcare problems and have invested in dozens of early-stage companies since we began looking at digital health in 2003.
The healthcare market is enormous with over $3.2 trillion of annual spend in the United States in 2015, and the sector has had significant regulatory changes over the past seven years largely driven by the Affordable Care and HITECH Acts.  Most observers are expecting further significant changes as the new administration pursues legal and regulatory reforms.
We expect more regulatory changes but we believe the dramatic shift towards industry digitization and value-based care will continue unabated. We will begin to see the next wave of technology innovation, such as Internet of Things (IoT), Machine Learning and Artificial Intelligence (AI) move from consumer and commercial use into healthcare applications. As the digital health industry moves into the second wave of innovation, we see the following as exciting areas that entrepreneurs are focused on.
1. Digital Interventions
We’ve seen a wave of new apps that seek to improve patient health in ways that are clinically demonstrable. These digital interventions use health, behavioral and contextual data -- such as glucose levels, sleep, weight, food, activity, time of day and weather -- to improve patient treatment plans. Interesting companies in this sector target diabetes prevention (Omada Health), Type 2 diabetes (WellDoc), mental health (Pear Therapeutics) and respiratory illness (Propeller Health). In some cases such as WellDoc, these interventions are FDA-approved therapeutics. These apps have such compelling clinical efficacy that insurance companies are starting to pay for them due to improved patient outcomes at reduced cost. 
Pharmaceutical companies are also interested in integrating digital interventions with their drugs to improve outcomes, differentiate their products, and engage directly with patients. For example, Proteus Digital Health, which manufactures an FDA-approved sensor that is embedded in pills and tracks medication adherence, is working with Otsuka on a bundled solution that treats bipolar disorder and schizophrenia.

2. Provider Workflow Solutions (or Healthcare Scalability Solutions)
In the United States we have a problem efficiently delivering care. It often takes weeks or months for patients to schedule an appointment. Physicians are often rushed when providing care and, according to a study by the AMA, spend twice the time entering patient data into electronic medical records that they do seeing patients. I believe digital technologies can help give our time-crunched healthcare professionals the ability to see more patients in less time, while delivering a better patient experience, by using data analytics for decision support, more efficient workflow and different forms of mobile communication.
Additionally, we can shift the cost curve to less expensive labor. Given decision support tools, artificial intelligence and data analytics, primary care physicians should be able to do some of the work specialists currently do. Nurses and case managers will be able to reduce a physician’s workload and, increasingly, patients will be able to administer self-care at home with mobile devices.
In this sector I’d keep my eyes on companies like HealthTap (enabling patient/physician interaction outside of the office), Augmedix (utilizing Google Glass to enable remote scribes to enter patient data into the EMR) and Welkin Health (tools to improve communication with patients.)
3. Data Integration and Analytics
In the past few years we’ve seen a dramatic increase in the amount of digitized health data stored in EMRs, health data captured from smartphones, and genomic data.
There are many uses for these new healthcare datasets. For example, insurance companies and companies that pay for employees’ health care directly, can use additional data to help refine actuarial models. Physicians can use analysis of this data for diagnosis and decision support. Lastly, patients may benefit from the mining of data for predictive prognosis. Consequently, real-time alerts to patients and healthcare professionals are becoming feasible.
Lots more here:
A useful detailed article that is well worth a browse.
David.

Wednesday, February 22, 2017

We Are Not The Only Ones Who Noticing That Digital Health Is Struggling To Deliver.

This appeared at a New England Journal Of Medicine sub-site.

Why Real-World Results Are So Challenging for Digital Health

Article · February 8, 2017
Joseph C. Kvedar, MD & Alexander L. Fogel, MBA
Partners HealthCare
Stanford University School of Medicine
Companies should look for lessons in other industries, create products that are tailored to population subsets, develop synergistic partnerships, and understand the performance characteristics of products in the real world.
Despite years of hype in the field of digital health products — a term that we use here to describe technologies that are designed to have clinical impact on disease — fewer products than expected are being deployed in real-world clinical settings. Many digital health products that demonstrate impressive results in clinical trials often fail to do so in real-world settings.
Why? Much of the success of digital health products is predicated on patient engagement, and clinical trials are among the most engaging environments in health care. Clinical trials involve the use of a variety of tools (e.g., training, close monitoring, payments) to ensure that patients use the technologies appropriately, but few of these tools are used in the real world. In order to cross the chasm from success in clinical trials to success in practice, digital health companies need to focus on patient engagement.
Digital Health Hinges on Engagement
Engagement is so important because many digital health products are designed to achieve behavioral changes for the purpose of preventing or treating chronic diseases. For patients who are at risk for, or are living with, a chronic disease, successful prevention or management requires minute-to-minute, day-to-day changes in decision-making. Patients need to be highly motivated to make behavioral changes, they need to be praised when they follow through, and they need guidance when they slip up. The process needs to be sticky and self-reinforcing in order to maintain patient interest. In a nutshell, patients need to be engaged.
Patients need to be highly motivated to make behavioral changes, they need to be praised when they follow through, and they need guidance when they slip up. The process needs to be sticky and self-reinforcing in order to maintain patient interest. In a nutshell, patients need to be engaged.”
Engagement is important not only for clinical results, but also for the business models of many digital health companies, which frequently incorporate pay-for-performance contracts. Digital health companies need to track data continuously in order to demonstrate their value to the purchaser or user. Products that do not engage patients drag down performance metrics and reduce the viability of the company.
Contrast this with pharmaceuticals: payors pay for drugs before patients take them, and pay-for-performance contracts are the exception; this is part of the reason why nearly 50% of medications for chronic disease are not taken as prescribed.
The Gap Between Clinical Trials and Real-World Results
Successful clinical trials of both digital health products and pharmaceuticals are engaging by definition. In order for a trial to demonstrate significant results — and in order for the results of the trial to be published — the attrition rate for participants needs to be very low. The entire endeavor is designed around ensuring that patients use the product or service appropriately and follow up regularly.
A clinical trial is designed as follows: an artificial scenario is crafted, willing participants volunteer, participants are carefully selected on the basis of optimal criteria, staffers are thoroughly trained, measurements are taken like clockwork, and participants are induced (by means of monetary payments or a barrage of phone calls, emails, and texts) to use the product or service as directed. As a result, the experience of individuals who are involved in a clinical trial typically is much more engaging than that of patients who use the technology in real-world scenarios.
Tools to Drive Engagement
Extending the engagement-boosting practices from a clinical trial to a much larger population of patients in the real world is not feasible because of cost and logistical complexity. As a result, different approaches are needed to facilitate engagement.
(lots omitted) …...
Making the Leap from Novelty to Necessity
Clinical trials are a critical process in the evolution of digital health products. Evidence is an important means for convincing health care executives to buy these products. However, simply learning that an intervention was successful in a clinical study is not enough. Real-world validation is also important as digital health companies own the validation process from product development to scale. Once clinical validation is achieved, real-world evidence must be gathered to justify success at scale. In order for digital health products to make the leap from novelty to necessity, manufacturers will need to focus on driving patient engagement in real-world settings. Engagement will require taking lessons from other industries, creating products that are tailored to population subsets, developing synergistic partnerships, and understanding the performance characteristics of products in the real world.
The full article is here:
What this article says very clearly to me is that digital health initiatives have both to be proven to work in controlled carefully managed trials and then also shown to work in the field before a full blooded roll out is undertaken.
We really do have to stop assuming that so called ‘good ideas’ are guaranteed to work and be useful. We need evidence both in trials and then in the ‘wild’ before rushing in and then being disappointed – slow may this process be!
This has to be one area that needs extreme rigor in evaluation!

Hospitals forging patient experience of the future with voice AI technologies

Commonwealth Care Alliance and Penn Medicine are already putting Amazon Alexa to work in early-stage projects that promise to reshape the patient experience. 
February 13, 2017 07:40 AM
Commonwealth Care Alliance chief of clinical innovation John Loughnane, MD, said the industry is on the verge of voice technologies that can be used to tailor individualized care regimens. 
“Alexa, when will you be in my doctor’s office?”
“Silly human — I already am!”
Okay, so Alexa’s response might not be that sassy precisely, but you get the picture. Artificial intelligence voice technologies are on the verge of changing the dynamics of how we interface with machines and, consequently, how humans interact with each other.
Artificial intelligence voice technologies are on the verge of changing — not to be overzealous here — but just about everything.
We’ve all witnessed how the smartphone has had an impact on society and, similarly, voice technologies are poised to effectively and strategically enchant the human psyche to accept them as humanlike companions.
And healthcare is ripe for artificial intelligence — perhaps even more than other industries when it comes to voice-interaction AI — because of the potential for improving care delivery, optimizing processes and improving the patient experience.
“We’re on the cusp of voice systems and voice learning tools that can tailor individualized care,” said John Loughnane, MD, chief of clinical innovation at Commonwealth Care Alliance.
It’s not just CCA either. Penn Medicine is also starting the voice AI trek.
Lots more here:
Things are really moving along at some considerable speed!
David.

The Story Of The NBN Seems To Be Unravelling At Worryingly High Speed. A Bit Of A Shame.

We had two bits of very worrying news.
First we were told the NBN would not be able to deliver for our future by the CEO.

Bill Morrow's 'alternative facts' about the NBN

Australia is unique in many ways but today one more attribute of this country now falls into that class: we are the lone nation to be building a broadband network that cannot give us affordable super-fast connections.
Yes, you heard right. And you can't question the source, for these words come from the chief of NBN Co, Bill Morrow, the man who earns $3.3 million an annum (that's $9041 a day, a little less in leap years) to push the build of the National Broadband Network that has become both a joke and a national shame.
After Morrow suffered from an attack of loose lips and told a crowd at the release of NBN Co's half-yearly results last week that Australians, bunch of chumps that they are, did not want super-fast broadband even if it came gift-wrapped and hand-delivered with no money asked, he must have felt some amount of blowback.
So on Wednesday, Morrow decided that he had to provide some "facts" to try and change the narrative. So his narrative was that this NBN build could not provide super-fast broadband — and by that he means 1Gbps — at an "affordable" price.

But then who decides the wholesale price? Why, the same NBN Co. It is based on this price that retailers decide how much to charge the public. Retailers are upping prices to compensate for the insane rates they pay NBN Co. At the end of line is Joe Public who gets stung as usual.
Morrow's logic is that when something is priced out of reach, if people do not buy it, then they are telling the seller that they are not interested. Which sounds something like the "alternative facts" that Kellyanne Conway (of Trump administration fame) came up with last week.
His plan is that the NBN should be built as soon as possible and then it should be rebuilt as and when higher speeds become necessary. Yeah, sure. We need another decade of political wrangling with every two-bit politician throwing in their opinion like we need a bullet to the head.
The statement that takes the cake is this: "Rather than build for a demand that may materialise in 10 years, we are constructing a national network capable of continuous upgrading to meet market needs as and when they arise."
Lots more here:
And then we were told it was going to cost more for the services we presently have:

NBN switch will cost users up to 20% more

The NBN is starting to make inroads into the capital cities, with construction in Sydney, the nation­’s biggest consumer market, to begin later this year.
  • The Australian
  • 12:00AM February 13, 2017

Chris Griffith

Supratim Adhikari

Households face a price hike of nearly 20 per cent on internet servic­es, on average, as they are required to sign up to the National Broadband Network when it arrives in their neighbourhood and the ­existing service is switched off.
The NBN is starting to make inroads into the capital cities, with construction in Sydney, the nation­’s biggest consumer market, to begin later this year.
Until now the more than 70 per cent of NBN’s rollout happened in regional and rural areas, but the switch to the metro will gather pace this year, especially if the company rolling out the network, NBN Co, wants to hit its target of having 5.4 million premises ready to receive a service by June 30.
NBN Co has spent $22 billion on the project so far and with the Coalition government lending the company an extra $19.5bn in Novem­ber, it has the money to complete the rollout. But with users required to move to an NBN service, there are concerns about prices­ they may pay for services that may not be that much better than their existing ADSL set-up.
Ovum principal analyst Craig Skinner said consumers should avoid paying for more than what they need for NBN services and shop around retailers before enterin­g into a long-term contract.
“Unless you’re watching multiple videos at once, you don’t need a higher speed. Unless you have a large family you shouldn’t need to pay more,” Mr Skinner said.
Technology research firm Telsyte’s managing director Foad Fadaghi said while research showed that consumers were prepared to pay more for the NBN, they expected more.
“Our research has shown that the average price of plans this year has come down, but the expectation of what people expect to pay in future is actually up on previous years,” he said.
The high prices currently charged by NBN Co for wholesale access is also seen as a problem, with retail service providers looking to pass some of the cost on to consumers.
Lots more here:
It rather looks like we have all be sold a pup, stepping back a very long way from the K Rudd vision of a decade or so ago.
What a pity. I am sure it would not have cost that much more to have done it once, properly and right!
David.