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, September 28, 2017

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

September 28th , 2017 Edition.
Internationally things looked better with no new hurricanes for at least 72 hours and then the nit-wit threatened to explode an H-Bomb in the Pacific! The usual brief reaction as seen, the adults managed it and Trump wandered off to comfort Maria victims. Situation as normal as possible with Trump in the White House. The real worry is Puerto Rico which seems to have suffered catastrophic damage – so bad we have yet to get a full damage assessment. 3+ million people are in dire straits.
I liked the suggestion we call ‘Rocket Man’ ‘Missile Boy’ instead! I note the NK Foreign Minister has now become even more hyperbolic on Sunday in his comments on Trump – if that were possible!
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In Australia the energy farce continues and we will all pay for this political nonsense. Parliament is away till med October and AGL is showing journalists how the Liddell power station will be unlikely to last into next week.  This is a grade one mess no matter how you look at it!!!
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Here are a few other things I have noticed.
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National Budget Issues.

$100 billion wipeout: one in four workers set to lose from wage attacks

Adele Ferguson
Published: September 18 2017 - 5:32AM
Wage fraud, wage freezes, cuts to penalty rates and companies scrapping enterprise agreements will reduce the retirement savings of millions of workers by $100 billion by the time they retire, a report has found.
The report, the Consequences of Wage Suppression for Australia's Superannuation System by the Australia Institute's Centre for Future Work, says the government will pick up more than one third of the cost, equivalent to $37 billion in lost taxes due to lower super contributions and higher age pension payouts.
It estimates that three million people, or one in four workers, have experienced some form of wage suppression, which will adversely impact their super payout.
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AGL turns into Australia's most monstered company as Turnbull needs scapegoats

Elizabeth Knight
Published: September 16 2017 - 1:30AM
Any attempt by the Turnbull government to weaponise the competition regulator to force or even threaten energy giant AGL into splitting its power generation and retail power businesses would be a serious case of overreach.
It's far too convenient for the government to seize on comments from the Australian Competition and Consumer Commission that the vertically integrated nature of power companies like AGL is responsible for the energy supply and pricing crisis.
To the extent that this is a factor in the mix, most experts don't think it's the primary one. It's more the successive inaction by state and federal governments over the past ten years to formulate and stick with a comprehensive energy policy that deals with emissions and provides energy companies with investment certainty.
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How did we get into this energy mess, and how do we get out of it?

Tony Walker
Published: September 17 2017 - 11:00PM
Let's start with the smelly, dead chicken the Turnbull government is seeking to hang around the Shorten opposition's neck.
In a variation of the children's party game, pass the parcel, or, should we say, pass the chicken, Malcolm Turnbull and his Energy Minister, Josh Frydenberg, are seeking to impose on their political opponents responsibility for an energy mess, including crippling power bills.
This is self-serving politics.
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We've turned our unis into aimless, money-grubbing exploiters of students

Ross Gittins
Published: September 17 2017 - 10:14PM
Of the many stuff-ups during the now-finished era of economic reform, one of the worst is the unending backdoor privatisation of Australia's universities, which began under the Hawke-Keating government and continues in the Senate as we speak.
This is not so much "neoliberalism" as a folly of the smaller-government brigade, since the ultimate goal for the past 30 years has been no more profound than to push university funding off the federal budget.
The first of the budget-relieving measures was the least objectionable: introducing the Higher Education Contribution Scheme, requiring students – who gain significant private benefits from their degrees – to bear just some of the cost of those degrees, under a deferred loan-repayment scheme carefully designed to ensure it did nothing to deter students from poor families.
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Why Australia shouldn't count on China for growth and profits

Peter Hartcher
Published: September 19 2017 - 12:00AM
Counting on China to deliver endless growth and profits? Then you need to know about the news item last week announcing that a big international conglomerate was forced to sell one of its businesses in China.
At first blush it seems to be just another of the ups and downs of the business world. The sixth-biggest South Korean conglomerate, Lotte, said that it had decided to sell its hypermart chain in China.Lotte is mainly a retailer, with sales worth about the same as Woolworths'. A year ago it had a thriving business with 99 hypermarts in China. But today 87 have shut down, so there isn't much of a business left to sell.
So is Lotte just a hopeless retailer? Or is there some other explanation?The Chinese authorities say that Lotte has a bad record of fire inspections, forcing the closure of one store after another. But, mysteriously, the extra rigorous fire inspections were targeted at Lotte not following a fire but after a defence event in South Korea.
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Australians stuck in a debt trap with wages having risen by just $3 a year over the past decade

Michael Heath
Published: September 19 2017 - 6:39AM
Australians' average weekly household income grew by $213 between 2004 and 2008. Since then, it's increased by a total of just $27.
The extremes roughly reflect a surge and fall in export income -- as industrialising China sent demand for iron ore and coal rocketing. But despite their stagnant wages, just over a quarter of Aussies have amassed debts equal to three times their income - mostly as housing surged during a central bank easing cycle designed to cushion the end of the mining investment boom.
"Wages growth was very, very strong, but there weren't the productivity gains to match it, so now it's very weak because we're simply not competitive," said Alex Joiner, chief economist at IFM Investors. "So there needs to be a longer adjustment period, and that's why you're probably going to see wage growth only start to bottom out in the next few quarters." Currency depreciation has helped, he said, but not enough to restore competitiveness.
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How artificial intelligence is changing personal finance

Rose Powell
Published: September 17 2017 - 12:15AM
There seems to be an app for everything these days, except for one that can make you a millionaire. Yet.
Less than a decade ago, it was unimaginable that an app might be able to sort through millions of songs to create playlists of ones you've never heard of that you might actually enjoy, like Spotify does. Or that Microsoft would be working on a fridge that puts together shopping lists based on what you have run out of, and might even be able to plan meals for you. Or self-driving cars that improve their performance as they spend more time on the roads.
But the emergence of technology from science-fiction to real life is increasingly common and many of these leaps forward share a core feature: they are powered by self-learning software that wrangles huge volumes of data and keeps improving its performance.
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Coal not even popular in coal-dominated electorates

Mark Kenny
Published: September 18 2017 - 11:28PM
Voters situated around the Liddell power station are already looking beyond coal to cleaner power sources and tend to blame the federal government for the current state of energy policy.
All but a few believe pressuring AGL to keep its ageing power station operating is the wrong way to go.
A ReachTEL survey of voter attitudes in the blue-collar Labor strongholds of Hunter and Shortland has found that 30 per cent of voters blame the Coalition for the ongoing electricity policy malaise, around twice the number who hold Labor responsible.
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Survey shows Australians are working harder — for good reason

MORE Aussies are putting in extra effort at work compared with their international counterparts. And for a good reason.
Charis Chang@CharisChang2  news.com.au September 18, 20173:36pm
AUSTRALIANS are working harder as the hopes for a pay rise climb to a six-year high.
A new survey has shown the numbers of workers putting in extra “discretionary effort” grew 5 per cent between the first quarter of this year (starting January) and the second.
About 23 per cent of Australians said they go above and beyond for their jobs, compared to the international average of 17 per cent, according to a CEB Global Talent Monitor survey.
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Post-boom towns falling behind on mortgage repayments

  • The Australian
  • 12:00AM September 19, 2017

Michael Roddan

Signs of rising mortgage stress have emerged as the rate of missed home loan payments across Australia hits a five-year high and more than $26 billion worth of mort­gages have fallen behind.
Even with the official cash rate sitting at a record low, mortgage delinquencies hit record highs in the mining downturn hit states of Western Australia, Northern Territory and South Australia, where unemployment is squeezing more borrowers, according to figures tracked by Moody’s.
The apartment hot spots of Sydney, Melbourne and Brisbane have relatively low rates of late mortgage payments, showing buyers are largely on top of loans.
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A lot rides on how Sydneysiders react when the housing boom ends

Published: September 20 2017 - 12:15AM
Sydney's traditional spring property trading season is well under way but there are signs the city's five-year housing boom is losing steam.
Last weekend's auction clearance rate dipped to 67 per cent according to preliminary Domain Group data, the lowest since December 2015.
In another sign the market is coming off the boil, the number of houses being sold prior to auction is on the rise as vendors lose confidence that auctions will deliver a higher price.
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New renewables energy rules package launched to halt blackouts

Cole Latimer
Published: September 20 2017 - 11:14AM
The Australian Energy Market Commission (AEMC) has released what it calls a "last line of defence" against blackouts - a package of new rules that incorporate renewable energy sources.
The energy market regulator's chairman, John Pierce, said the latest rules were designed to address "risks to energy security created by the power system's changing generation mix" with its rising proportion of renewable energy such as wind and solar power.
The Australian Energy Market Operator (AEMO), which runs the nation's largest gas and electricity markets, is forecasting more than 19,000 MW of proposed new energy capacity for the coming years, with nearly two-thirds of that coming from wind power as costs of renewable technologies are falling.
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The young are mostly right, they are getting a bad deal

Ross Gittins
Published: September 19 2017 - 5:44PM
When they look at the economy that older generations are leaving for them, young Australians have a lot to be angry about. Some of their fears and resentments are misplaced, but most aren't.
Oldies who should know better have, for their own reasons, given them an exaggerated impression of the likely extent and timing of digital disruption in the jobs market.
There's much resentment of the higher education tuition fees the young have to repay, but I've never thought it unreasonable to ask them to contribute about half the cost of their qualifications, which will greatly increase their lifetime incomes – especially when repayments are geared to the size of that income and the loan carries a real interest rate of zero.
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  • Updated Sep 20 2017 at 11:00 PM

Interest rate rises to trigger $1.6trn debt bomb

It's springtime here in Australia and there's clearly something in the air.
In contrast, Westpac still expects there will be no change to interest rates next year, thanks to the ongoing weakness in household income growth, while the Commonwealth Bank doesn't think the RBA will lift the cash rate until late next year.
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Death Spiral: why electricity prices are set to climb ever higher

Peter Martin
Published: September 21 2017 - 2:15AM
What's most terrifying the electricity industry isn't the threat of price control or a clean energy target or even being forced to keep open power stations that have long since ceased to work properly.
It's not even the government's inability to come up with a clear set of rules.
It's a fear more primal – the same one gripping the national broadband network, public schools, and private health funds.
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Australia ranked as one of the world's major small arm importers and exporters

Nick O'Malley
Published: September 21 2017 - 12:15AM
Australia is now ranked as one of the world's major gun importers, coming sixth in the United Nations-sponsored annual global Small Arms Survey, high enough to see it categorised in the top tier of gun importers.
Australia was also revealed to be the 13th-largest exporter in the world and ranked 25th in the transparency of its arms trade, scoring 12 out of a possible 25 in the survey's transparency barometer.
As an importer Australia came in behind the United States, Canada, Indonesia, Saudi Arabia and Germany, but ahead of Iraq, France, the Netherlands and Britain.
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Reserve Bank: Economy has reached a 'turning point'

Eryk Bagshaw
Published: September 20 2017 - 7:01PM
The global economy has reached a turning point, the Reserve Bank says, on the same day as the OECD has lifted its forecast for global growth thanks to a co-ordinated economic recovery.
The interim report from the intergovernmental economic organisation re-affirms the central bank's view that the global economy is looking much better than a year ago, but the OECD has warned Australia an interest rate rise could trigger a sharp correction.
In a speech to the Australian Business Economists forum on Wednesday, the Reserve's assistant governor Luci Ellis said economic language had become a self-fulfilling prophecy for global growth.
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Australia blessed with more than 22,000 possible pump storage sites, ANU finds

Peter Hannam
Published: September 21 2017 - 7:09AM
Australia has more than 22,000 sites around the country that could be suitable for pumped hydro storage, according to a study by the Australian National University.
The report, details of which were obtained by Fairfax Media ahead of a public release on Thursday, extends work published last month. That partial study found 5000 suitable sites in Queensland and Tasmania.
The additional data shows that NSW has the most prospective locations in the country, with about 8500 identified by the ANU team led by Professor Andrew Blakers. Victoria had about 4400 sites, placing it second among the states.
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Market pricing in two RBA rate hikes over the next year

Jessica Sier
Published: September 20 2017 - 3:36PM
The Australian market is pricing in two rate hikes by the Reserve Bank of Australia over the next 12 months, despite the bank calling the top of the iron ore cycle in a surprise to some market watchers.
Options traders around the world are ramping up their expectations for central bank tightening, as global investors await the US Federal Reserve's unwinding of its huge bond buying program.
Twenty-five per cent of market participants expect the RBA to hike interest rates as soon as February and, over the past two weeks, the odds of the US Fed hiking rates again as soon as December have doubled. The market also expects there is a 73 per cent chance the Bank of England will hike by November. 
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RBA governor Philip Lowe signals the end of the road for interest rate cuts

Peter Martin
Published: September 21 2017 - 5:52PM
Reserve Bank governor Philip Lowe has handed over the baton of economic management, declaring in a speech titled The Next Chapter that there's not much more he can do to boost the economy.
Delivering the speech in Perth, Dr Lowe said "other forces" were likely to be more important than Reserve Bank decisions about interest rates from here on.
"Monetary policy has an important role to play in supporting the economy as it goes through the current period of adjustment," he said. "It can also help stabilise the economy when it is hit by future shocks. It can make for a more predictable investment climate by keeping inflation low and stable."
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Consumers left behind by designers of power system

Ross Gittins
Published: September 23 2017 - 12:15AM
The soaring price of electricity is testament to the disastrous failure of a major item on the 1990s agenda of micro-economic reform – establishing a national electricity market.
In practice, nothing worked out the way the reformers' economic textbooks told them it would.
The failure occurred because the people charged with implementing the reforms – governments and their bureaucrats – did so in ways that defeated the object of the exercise.
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Why the next rate hike is such a big deal

  • The Australian
  • 12:00AM September 23, 2017

Alan Kohler

Reserve Bank governor Philip Lowe and his board are approaching the biggest decision since the RBA gained full independence in 1996 and started making its own decisions.
That is, do they keep worrying about low inflation, like the European Central Bank did last week, or give up on it and focus on employment, as the US Federal Reserve decided to do this week?
And why is that such a big deal this time? Because household debt is 190 per cent of income and we’re in the midst of an energy shock.
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  • Updated Sep 22 2017 at 5:10 PM

Australia's next boom has barely started

Australia is on the cusp of the biggest wave of public infrastructure spending in at least three decades and has already ensured a record proportion of construction workers have found jobs.
In a shift that has been overlooked amid the focus on negatives such as high household debt, weak consumer sentiment and low wages growth, research published this week shows almost $100 billion in local, state and federal government spending will hit the economy this year financial alone.
According to a chart presented by Reserve Bank of Australia governor Philip Lowe in a speech in Perth this week, public infrastructure work "yet to be done" will be just under 6 per cent of nominal gross domestic product in 2017. 
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Health Budget Issues.

  • Updated Sep 17 2017 at 6:30 PM

The crisis of costs in health insurance

Gavin from Health Deal has stopped calling me. I don't blame him. I had only found him by idly filling in an online form saying I would like a better deal on private health insurance and might consider switching funds. Within a day, he had called, found out the details of my current insurance and come up with a modestly cheaper alternative.
I had accidentally become a participant in yet another booming services industry, part of the consumer revolution that relies on more information to help people compare offerings. In this case, health funds pay up-front commissions to such agencies for getting people to move to them. Health Deal is one of the smaller ones relative to groups like iSelect which also encourages consumers to compare everything from electricity providers to car insurers.
Some private health funds get around a third of new members via this route. Gavin still assures me any advice is completely impartial with Health Deal advisers having no knowledge of the commissions paid by participating funds. But I still think, hmm, there's a financial advantage to them as well as – presumably – to me if I switch.
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Junk health fund policies may survive reforms

Sue Dunlevy, National Health Reporter, News Corp Australia Network
September 19, 2017 10:00pm
JUNK health fund policies that only cover public hospital treatment are likely continue under the government’s health fund reforms because axing them will increase premiums by up to 16 per cent.
But there could be new restrictions on using the policies in public hospitals with patients required to sign contracts with the hospital 24 hours before they receive treatment.
Health funds say public hospital only policies are valuable for pensioners and young people who can’t afford comprehensive policies but want to choose their own doctor.
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Sharri Markson: Preying on taxpayers is just a sick joke

SHARRI MARKSON, The Daily Telegraph
September 22, 2017 12:00am
QUITE rightly, the federal government pays 100 per cent of the medical bill for a doctor to visit your home at night time, on weekends and on public holidays if you have an urgent medical crisis when no doctor’s surgery is open.
The after-hours service at home, at $130 a pop, is bulk-billed and has been part of Medicare since its inception in 1984. It’s a wonderful and important service.
But just five years ago private equity firms entered the market seeking to profit from this potentially lucrative business model.
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Australia’s health system is enviable, but there’s room for improvement

September 22, 2017 5.40am AEST

Author

  1. Stephen Duckett  Director, Health Program, Grattan Institute
This article is part of our global series about health systems, examining different health care systems all over the world.
Australia’s health system is unique – much like its fauna. It has been shaped by the nation’s colonial history – the first hospitals were provided by the colonial administrations – and, of course, politics. It’s a curious blend of public and private funding and delivery of health care, with the Commonwealth (national) and the state governments both having significant roles in what has been described as an example of “marble cake federalism”.
In brief, all Australians are covered by the universal, national, tax-financed health insurance scheme, Medicare, which provides rebates against the cost of medical fees.
About 80% of GP visits incur no out-of-pocket costs because the bill is paid directly by the government. But doctors are allowed to charge what they like, with no real cap on fees. And out-of-pocket costs remain a significant problem, with many people saying they defer going to a doctor because of the out-of-pocket expenses involved.
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22 September 2017

Hunt’s ‘moment of reckoning’ for NHDS

Posted by Julie Lambert
Federal Health Minister Greg Hunt has announced a “moment of reckoning” for the country’s largest after-hours home-doctor provider after a newspaper published a string of complaints about poor treatment by “unqualified” doctors.
 Responding to the Sydney-based Daily Telegraph’s front-page story lashing the National Home Doctor Service, Mr Hunt said he had ordered the Department of Health’s Medicare integrity division to investigate the group.  
He also gave a strong hint that a change of rules could limit after-hours home visits to GPs only, as has been urged by the RACGP, a step that could knock the larger part of the NHDS workforce out of action. 
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Private health insurance policy: a dog’s breakfast?

Editor: Melissa SweetAuthor: Margaret Fauxon: September 21, 2017In: Croakey longreads, health reform, private health insurance
(Introduction by Croakey)
Health and consumer groups have called for a comprehensive Productivity Commission inquiry into Government assistance to the private health insurance industry, to investigate its overall costs and benefits.
They want private health insurance reforms that centre equity and the public interest, rather than industry profits and inequitable policies.
The call – from the Consumers Health Forum, Australian Healthcare and Hospitals Association, CHOICE, Public Health Association of Australia and the National Rural Health Alliance – follows media reports suggesting the Federal Government is unlikely to end so-called “junk” policies.
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International Issues.

Tillerson says US may close Cuba embassy over 'sonic' health attacks

Gardiner Harris
Published: September 18 2017 - 10:50AM
Washington: The Trump administration is considering closing the recently reopened US Embassy in Havana after 21 Americans associated with the embassy experienced a host of unexplained health problems.
Secretary of State Rex Tillerson said  on Sunday that such a closing was "under evaluation".
"It's a very serious issue with respect to the harm that certain individuals have suffered," he said. "We've brought some of those people home. It's under review."
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Donald Trump mocks Kim Jong-un as 'Rocket Man'

Darlene Superville
Published: September 18 2017 - 6:19AM
Somerset: US President Donald Trump has mocked the leader of nuclear-armed North Korea as "Rocket Man" while White House advisers say the isolated nation would face destruction unless it shelves its weapons programs and bellicose threats.
The warnings came a day after Kim Jong-un pledged to continue those programs, saying North Korea is nearing its goal of "equilibrium" in military force with the US.
North Korea will be high on the agenda for world leaders this coming week at the annual meeting of the UN General Assembly.
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Julie Bishop vows further United Nations pressure on North Korea

David Wroe
Published: September 19 2017 - 8:13AM
Foreign Minister Julie Bishop has said "further pressure" will be brought on North Korea through United Nations sanctions, effectively brushing aside Trump administration remarks that the UN route has been exhausted.
Speaking from the UN General Assembly gathering in New York, Ms Bishop held fast to her long-standing view that sanctions can be effective and, combined with other forms of pressure, can still deter North Korea from its nuclear path. She said it could take "weeks or months" for the sanctions to make their full impact.
"United Nations economic and diplomatic pressure on North Korea is one element of a broader strategy to compel Pyongyang to the negotiating table with the intention to abandon its illegal weapons programs," Ms Bishop told Fairfax Media.
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Malcolm Turnbull says North Korea will be 'wiped out' if regime attacks US

Stephanie Peatling
Published: September 20 2017 - 9:06AM
Prime Minister Malcolm Turnbull has backed US President Donald Trump's fiery language on North Korea, saying "the whole country will be wiped out" and "many, many thousands of innocent people will die" if the regime attacks the United States or its allies.
In his sternest warning yet to North Korea, President Trump told the United Nations General Assembly the United States will be forced to "totally destroy" North Korea unless Pyongyang backs down from its nuclear challenge, and mocked North Korean leader Kim Jong-un as a "rocket man" on a suicide mission.
At President Trump's first appearance at the assembly's annual gathering of world leaders, he emphasised it was against the interest of the entire world for North Korea, which he called a "band of criminals", to obtain missiles and nuclear weapons.
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Donald Trump wheels contradictions onto world's stage at UN

Paul McGeough
Published: September 20 2017 - 10:50AM
Washington: March into the United Nations, name-calling and threatening destruction, and the chances are there'll be push-back.
Going one up on George W. Bush's three-strong "axis of evil", US President Donald Trump went after a four-strong "small group of rogue regimes" in his first speech to the UN General Assembly on Tuesday.
The inward rhetoric of his campaign notwithstanding, Trump issued a contradictory demand for patriotism and sovereignty for all nations that would be policed by his administration.
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The mystery of the illness at US embassy in Havana may spoil flowering diplomacy

Paul McGeough
Published: September 21 2017 - 9:42AM
It's the stuff of a diplomatic thriller, but it's real. 
Washington is threatening to shutter the US embassy in Havana because diplomats are keeling over, suffering strange symptoms in what Washington believes is a clandestine attack on its recently re-opened mission in the Cuban capital.
More than 20 diplomats and/or their spouses have been repatriated or are being treated in Havana for what their staff association describes as "mild traumatic brain injury and permanent hearing loss, with ... loss of balance, severe headaches, cognitive disruption, and brain swelling."
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Former top US naval leader says North Korea 'won't denuclearise', warns of 'miscalculation'

David Wroe
Published: September 20 2017 - 11:51AM
One of the United States' most senior retired military officers has warned during a visit to Australia that North Korea will not wind back its nuclear program and will need to be strongly deterred, including possibly through nuclear weapons positioned in Asia.
"I am not optimistic that we're going to be able to take the existing goals that we've had for the peninsula and move to a denuclearised state," Patrick Walsh, a retired four-star admiral who commanded US naval forces in the Pacific, told Fairfax Media in an interview.
"I think the prevailing view will be that North Korea is now a nuclear state and it will require a much stronger deterrence posture on the part of allies in the region," he said.
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North Korean fuel ships dodge sanctions on the way back from Russia

Polina Nikolskaya
Published: September 21 2017 - 2:36PM
Moscow: At least eight North Korean ships that left Russia with a cargo of fuel this year headed for their homeland despite declaring other destinations, a ploy that US officials say is often used to undermine sanctions.
US officials say that changing destination mid-voyage is a hallmark of North Korean state tactics to circumvent the international trade sanctions imposed over Pyongyang's nuclear weapons program.
Changing course and the complex chain of different firms - many offshore -  involved in shipments can complicate efforts to check how much fuel is supplied to North Korea and monitor compliance with a cap on fuel imports under UN sanctions.
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  • Updated Sep 21 2017 at 12:33 PM

Janet Yellen pulls trigger to reverse QE but we're now in uncharted waters

by Ambrose Evans-Pritchard
The US Federal Reserve and its fellow central banks can be forgiven for telling us a white lie: nothing would be gained from admitting that they do not know how to extricate the world safely from their extreme monetary experiment.
Fed chief Janet Yellen has finally pulled one major trigger after countless retreats. The long-awaited reversal of quantitative easing will kick off in October.
It is a sea-change for the world. Deutsche Bank calls the start of the "Great Central Bank Unwind", candidate "Number One" for the world's next financial crisis.
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US President Donald Trump orders new sanctions to tighten screws on North Korea nuclear program

Published: September 22 2017 - 6:49AM
US President Donald Trump has announced sanctions on North Korea that open the door wider to blacklisting people and entities doing business with the rogue nation, including its shipping and trade networks, further tightening the screws on Pyongyang's nuclear and missile program.
In New York on Thursday, local time, Trump also said that Chinese President Xi Jinping had ordered Chinese banks to stop conducting business with Kim Jong Un's regime, a crucial step by North Korea's largest trading partner.
Trump praised Xi, calling it a "very bold move" in acting to cut off financial ties with North Korea and said it was "somewhat unexpected".
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Hurricane Maria 'destroyed us' say Puerto Ricans

Published: September 22 2017 - 8:51AM
New York: Puerto Ricans were confronted on Thursday with their first clear view of the crushing devastation wrought by Hurricane Maria -- splintered homes, crumbled balconies, uprooted trees and floodwaters coursing through streets.
The storm cut a path through the island Wednesday and 100 per cent of the territory remained without power. Officials predicted that it could take months to restore electricity.
Puerto Rico faces numerous obstacles as it begins to emerge from the storm, including the weight of an extended debt and bankruptcy crisis and a recovery process begun after Irma.
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North Korean leader threatens 'to tame mentally deranged US dotard with fire'

David Nakamura and Anne Gearan
Published: September 22 2017 - 8:56AM
North Korean leader Kim Jong Un has escalated the war of words with US President Donald Trump, declaring, "I will surely and definitely tame the mentally deranged US dotard with fire." 
Mr Trump on Thursday announced new financial sanctions targeting North Korea as his administration seeks to build international support for more aggressively confronting the rogue nation, whose growing nuclear and ballistic missile capabilities have reached what US officials consider a crisis point.
The new penalties seek to leverage the dominance of the US financial system by forcing nations, foreign companies and individuals to choose whether to do business with the United States or the comparatively tiny economy of North Korea. US officials acknowledged that like other sanctions, these may not deter Kim's drive to threaten the United States with a nuclear weapon, but is aimed at slowing him down.
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  • Updated Sep 23 2017 at 4:16 AM

Fed boss John Williams says 2.5 per cent is the 'new normal' for key rate

US central banker John Williams said he does not expect any market turbulence as the Fed gets under way with reducing the huge balance sheet built during its campaign to stimulate the US economy.
"I don't anticipate any sudden or large effects on rates or spreads or things like that as we normalise," Williams, president of the San Francisco Federal Reserve, told reporters in Zurich.
"Obviously we've talked about this endlessly. We've announced it and the markets have taken totally taken this in stride. But it's still an open question as we actually implement this next month and over the next several years - 'how will markets react?' We'll obviously be following that very carefully."
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North Korea says rockets to United States 'inevitable' after Trump comments

Published: September 24 2017 - 6:23AM
North Korea said on Saturday firing its rockets at the US mainland was "inevitable" after US President Donald Trump called Pyongyang's leader "rocket man", in a further escalation of rhetoric between the two countries over the North's nuclear weapons and ballistic missile program.
North Korean Foreign Minister Ri Yong-ho's remarks before the United Nations General Assembly came hours after US Air Force B-1B Lancer bombers escorted by fighter jets flew in international airspace over waters east of North Korea in a show of force the Pentagon said demonstrated the range of military options available to Trump.
Ri's speech capped a week of escalating rhetoric between Washington and Pyongyang, with Trump and Kim Jong-un trading insults. Trump called the North Korean leader a "madman" on Friday, a day after Kim dubbed him a "mentally deranged US dotard."
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Torching of Rohingya villages continues in Myanmar despite denials

Lindsay Murdoch
Published: September 23 2017 - 2:21PM
Bangkok: New evidence shows that Rohingya Muslim villages continue to be torched in Myanmar's strife-torn Rakhine state, despite denials by the government of Nobel laureate Aung San Suu Kyi.
Eyewitnesses, photographs and multiple reports also show that Myanmar security forces continue to plant internationally-banned anti-personnel mines that are blowing up Rohingya people fleeing to Bangladesh.
Ms Suu Kyi claimed in a speech on Tuesday that her country's security forces ended what she called "clearance operations" in the state on September 5.
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I look forward to comments on all this!
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David.

A Bit Of A War Seems To Have Broken Out Regarding Provision Of GP Services On Line!

First we have had articles like this:

Online GP and pharmacy services “second best”

Doctor and pharmacy groups criticise websites that offer online consultations, scripts and medication delivery

Following the announcement that Qoctor – formerly known as Dr Sicknote – is now expanding its services, the RACGP has stated that the increasing prevalence of medical online services fragments care.
Qoctor is an online medical hub that offers medical certificates, specialist referrals and online consultations, and this week announced it is expanding into providing online prescriptions for STIs, contraception and erectile dysfunction, as well as an online pharmacy and medication delivery service.
RACGP President Dr Bastian Seidel says patients should not be able to access prescriptions, referrals and/or medical certificates through online systems unless they are being provided by the patient’s usual GP, or a GP in the patient’s usual general practice.
More here:
Then the inevitable response here:

Don't be so quick to dismiss online GP clinics

21 September 2017

OPINION

Qoctor, an online GP clinic, has caused a stir in the medical community. Here, Dr Aifric Boylan, a GP and the clinic's CEO, tells her side of things.
The art of being a good listener has always been central to practising good medicine. From their first days in med school, students are taught that a thorough history will reveal the patient’s diagnosis in most cases, without a need for examination or tests.
But as information technology advances, and pervades all aspects of healthcare — from people Googling their symptoms, to remote diagnostics, cloud-based digital health records, and online consulting — the standard physical consultation between doctor and patient is now only one of many ways people seek answers to their health problems.
It’s relatively easy to define and understand what ‘good listening’ means in the traditional doctor-patient scenario.
But how do we define it in a more virtual environment? How can we effectively listen to our patients online? Can artificial intelligence (AI) be a ‘good listener’?
Medical knowledge may have advanced exponentially in the past 50 years, but doctors still, by and large, learn to consult in the traditional manner, adhering to traditions that go back to the teachings of the godfather of modern medicine, Sir William Osler.
There is a vast amount of wisdom in these practices. But things are changing. People are conducting so many aspects of their lives online and are seeking answers to their health-related questions in a different way.
For doctors to listen to (and learn from) their patients, there is now a need to listen ‘online’.
Lots more here:
And the most recent summary I have seen here:

Online doctor services pose a serious risk to patient safety, GPs claim

Lynne Minion | 22 Sep 2017
Australian GPs have slammed the rise in popularity of online doctor services, claiming websites offering medical certificates, specialist referrals and prescriptions fragment care and pose a serious risk to patient safety.
Online GP Qoctor has launched a pharmacy and medication delivery service, adding to its clinical offerings, but the Royal Australian College of General Practitioners claims patients should only access online services provided by their GP.
“The big risk with online services performed outside of the usual patient–doctor relationship is that they fragment care and do not provide continuous, comprehensive general practice care to patients,” RACGP President Dr Bastian Seidel said.
“They provide patients with prescriptions, referrals or medical certificates without sufficient understanding of their medical history and social context, which is a safety issue and may also affect quality of care.”
According to Qoctor, the “convenient, quick, safe, inexpensive, effective and very thorough” service is run by a team of GPs and has saved $305,762 in costs to Medicare. The online doctor fee is $19.99.
Responding to criticism, Director at Qoctor Dr Aifric Boylan told the Australian Journal of Pharmacy it is not always necessary for a patient to see a doctor in person.
More here:
It will be interesting to see how all this plays out and whether the AHPRA becomes involved.
We watch and wait with interest. There are two sides to this I believe.
David.

Wednesday, September 27, 2017

Despite All The Bluff And Bluster Not Everyone Is Convinced Regarding The Security Of The MyHR.

This appeared last week:
20 September 2017

Fresh fears raised over MyHR security

Posted by Julie Lambert
IT experts have challenged assurances that an alleged theft of Medicare numbers has no bearing on the security of the My Health Record. 
Monash University lecturer Robert Merkel, a specialist in software testing and fault analysis, told a parliamentary inquiry last week that he believed the most likely source of the breach was the Department of Human Services’ HPOS system, which doctors log into via the PKI or PRODA channels.  
He said he was concerned that ease of access for health practitioners had taken priority over security in the design of the health IT system, leading to the breach which resulted in Medicare numbers being offered for sale on the internet.  
“Without going into the details of the weaknesses, both of those systems are less secure than they should be, and in the case of PRODA, the weaknesses are a plausible means by which criminals could gain illegitimate access to Medicare details,” he said.  
Dr Merkel said the HPOS system seemed to demonstrate a “disconnect” between decision-makers and IT security expertise.  
“Secondly, it prioritises convenience for healthcare providers over IT security,” he said. 
“So I’m concerned that these two factors are likely to apply, or are, indeed, already baked into the design of the My Health Record. I think that serious security and privacy problems with My Health Record are inevitable.”
Paul Power, an IT consultant and principal of eHealth Privacy Australia, said reliance on a centralised data base with more than 100,000 legitimate access points made the MyHR system difficult to defend. 
“The possibility of securing over 100,000 GP PCs is close to zero, which means the probability of it being hacked is close to 100%,” he said. 
Officials from the Australian Digital Health Agency and the DHS also gave evidence at Friday’s hearing of the Senate Finance and Public Administration References Committee.
They said the data breach, revealed in the media in early July, had no relationship to the MyHR.  
Caroline Edwards, deputy secretary of health and aged care at DHS, said the intrusion appeared to be the work of “person or persons” illegally tapping into the channel used by doctors to access Medicare numbers.  
More here:
The article is based on submissions to the Senate Inquiry on the Medicare Data Breach:
Here is the link to the enquiry home page:
The submissions make interesting reading as does the transcript of the questioning by the Senators
Here is the overall link and those who responded:
1              Centre for Internet Safety (PDF 47 KB)          
2              Office of the Australian Information Commissioner (PDF 4429 KB)            
3              RACGP (PDF 380 KB)      
4              Australian Digital Health Agency (PDF 153 KB)    
5              Dr Culnane, Dr Rubinstein, Dr Teague  (PDF 388 KB)        
6              Professor Danuta Mendelson and Dr Gabrielle Wolf (PDF 907 KB)            
7              Department of Human Services (PDF 390 KB)     
8              eHealth Privacy Australia (PDF 423 KB)  
9              Future Wise Australia (PDF 2040 KB)       
10           University of Newcastle Legal Centre (PDF 132 KB)          
11           Australian Medical Association (PDF 149 KB)       
12           Dr David Glance (PDF 203 KB)    
You can download as a single .zip file and browse at your leisure or click the hyperlinks.
The Committee reports October 16. It will be fascinating to see what they make of all the submissions and testimony.
David.

It Seems To Have Hit The Fan Again In South Australia And An Election Is Coming Soon!

This appeared last week:

Shock resignation of SA Health Minister catches government and healthcare off-guard

Lynne Minion | 19 Sep 2017
Just two weeks after the opening of the new Royal Adelaide Hospital, embattled South Australian Health Minister Jack Snelling has quit cabinet, announcing he will leave parliament at next year’s state election.
Snelling’s resignation was followed hours later by the announcement by Mental Health Minister Leesa Vlahos that she would be stepping down from the ministry for “personal health” reasons.  
Both ministers were responsible for the state-run Oakden nursing home, where poor treatment of dementia patients led to the closing down of the facility and an anti-corruption inquiry, which is soon to deliver its report.
Claiming his decision to walk away from politics was due to family reasons, Snelling’s departure from his contentious tenure in the health minister’s role “caught people unawares” in the party, according to Labor Whip Tom Kenyon.
First term MP Peter Malinauskas will move from police and correctional services to take on health and mental health, assuming roles besieged by controversy.
South Australia’s new flagship $2.4 billion hospital opened earlier this month after a decade of controversy, including a 17-month delay, cost blowouts, political infighting and construction fatalities.
The hospital is also the subject of a $185 million lawsuit in the Federal Court, with builders claiming delays in the implementation of the electronic patient records system — EPAS — at the new RAH made it “impossible” for the project to be completed on time.
In Parliament last month, Snelling downplayed the problems with EPAS while conceding paper records would also be used at the new hospital “to make the move as simple for our clinicians as is possible”.
SA Health has been rolling out EPAS across all its public hospitals and healthcare agencies since 2013. More than 2000 staff use it each day and over 1.29 million inpatient, outpatient and emergency department visits have been registered in the system.
But according to the state’s AMA, a survey of medical staff found they viewed the system as “not fit for purpose”.
Pathology mix-ups, prescribing mishaps and trouble finding records when they are urgently needed were some of the problems identified by users of the system in a questionnaire.
Lots more here:
What a saga and an election due in March I believe. It seems the troubles just pile up for SA Health.
David.

Tuesday, September 26, 2017

The Evidence That The My Health Record Architecture Is Flawed Just Keeps Piling Up! Here Is This Week’s News!

It was only a week or so ago I was pointing out that the world was abandoning centralized patient databases at a national or even regional level and moving to structures where the interested patient can directly access the health records.
Well what do you know? It has popped up again! First we have an example from the UK.

Health and medical app goes live with three major GP suppliers

Shireen Khalil

13 September 2017
A mobile app that allows patients to access all their medical information has now integrated with three major GP suppliers, making it available to more than 98% of England. 
Evergreen Life first went live with EMIS last August and more recently TPP in June 2017 and Vision in July.
The service, which is on the NHS App Store, was developed by national healthcare company Evergreen Life which acquired PAERS Ltd, pioneers in online patient record access, and was accredited by the NHS in March this year.
Apps labelled ‘being tested in the NHS’ or ‘NHS Approved’ are part of an NHS programme. The Evergreen app is on the NHSD Framework, part of GPSoC Lot 1.
The app links a personal health record (PHR) with patient-facing services (PFS).
Brian Fisher, semi-retired GP and clinical and strategy director for Evergreen, said the aim is to help give patients more control, within the law, to own their own records.
He said since launching the app and going live with the suppliers, they have received good feedback from both patients and GPs.
“They say that the look and feel of the website and app are clean and simple and that using the app is straightforward and saves time and effort”, Fisher said.
----- Material Omitted – See Link Below
A target of one million users by July 2018 has been set by the company. “We listen to what our users are telling us, both GPs and patients, and we constantly improve our design and our delivery. The larger our population, the better we are going to serve them.”
Currently there are a total of over 250,000 users and 49,932 downloads of the app. Roughly the app gains about 3000 people a week on average.
Key benefits (Source: Evergreen Life)
  • saves time and appointments
  • robust – During the recent Wannacry cybercrisis, when many GP practices could no longer access their data, patients using our app and website were still able to access their data – and share it with their GPs and consultants
  • safer for everyone –  data can be securely shared and the patient can become the glue that holds the NHS together
  • Offers the prospect of a holistic patient-centred record – we hope to bring together all your relevant health and care data in one place: your primary, secondary care and social care data
The full article is here:
And in Australia we have:
21 September 2017

A step forward for e-health data sharing

General Practice Technology
Posted by Julie Lambert
A Sydney PHN is devising a system to pull data from GPs’ desktop software for viewing by clinicians at local hospitals and to share patients’ hospital discharge summaries with GPs.
The South Western Sydney PHN’s Project iRAD will focus initially on providing essential clinical information from common GP desktop systems to hospitals. In the second phase, the pilot project will send back data from discharge summaries uploaded to the My Health Record. 
“In achieving this we will enhance a clinician’s capability to make informed decisions, reduce duplication and optimise communications between healthcare providers,” SWSPHN Chief  Executive Keith McDonald said.  
For the project, the PHN has engaged international IT vendor Allscripts to adapt its interoperability platform, called dbMotion Solution, to transfer and view information between primary and acute care settings. 
Five general practices in the PHN area will be selected to take part in the project, with a pilot site expected to go live in July next year.   
Initially the project will use minimal data sets based on the NSW Agency for Clinical Innovation’s safe clinical handover resource, including test results, medications, reasons for referral and medical history.  
Phase two of iRAD – which stands for Integrated Real-time Active Data – will widen the applications, introducing a shared-care planning tool and a patient portal.  
More here:
Note carefully the need for currency and for as much accuracy as the GP can provide.
A great big centralized database is not the answer for concerned patients – given its lack of completeness and currency – to say nothing of the huge cost.
Things are shifting and the myHR is a moribund initiative whose time has pretty much passed.
David.