Quote Of The Year

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

or

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

Friday, September 29, 2017

Artificial Intelligence And Medicine - A View From The Conversation And Another Perspective.

This appeared last week.

Artificial intelligence won’t replace a doctor any time soon, but it can help with diagnosis

September 19, 2017 2.16pm AEST

Author Luke Oakden-Rayner

Radiologist and PhD candidate, University of Adelaide
In the next few years, you will probably have your first interaction with a medical artificial intelligence (AI) system. The same technology that powers self-driving cars, voice assistants in the home, and self-tagging photo galleries is making rapid progress in the field of health care, and the first medical AI systems are already rolling out to clinics.
Thinking now about the interactions we will have with medical AI, the benefits of the technology, and the challenges we might face will prepare you well for your first experience with a non-human health care worker.

How AI can diagnose illness

The technology behind these advances is a branch of computer science called deep learning, an elegant process that learns from examples to understand complex forms of data. Unlike previous generations of AI, these systems are able to perceive the world much like humans do, through sight and sound and the written word.
While most people take these skills for granted, they actually play a major role in human expertise in topics like medicine. Since deep learning grants computers these abilities, many medical tasks are now being solved by artificial intelligence.
In the last 12 months, researchers have revealed computer systems that can diagnose diabetic eye disease, skin cancer, and arrhythmias at least as well as human doctors. These examples illustrate three ways patients will interact with medical AI in the future.
The first of these three ways is the most traditional, and will occur where specialised equipment is needed to make a diagnosis. You will make an appointment for a test, go to the clinic and receive a report. While the report will be written by a computer, the patient experience will be unchanged.
Google’s diabetic eye disease AI is an example of this approach. It was trained to recognise the leaky, fragile blood vessels that occur at the back of the eye in poorly controlled diabetes, and the AI is now working with real patients in several Indian hospitals.
The second way of interacting with medical AI will be the most radical, because many diagnostic tasks don’t need any special equipment at all. The Stanford team that created a skin cancer detector as accurate as dermatologists is already working on a smartphone app.
Before long, people will be able to take their own skin lesion selfies and have their blemishes analysed on the spot. This AI is leading the race to become the first app that can reliably assess your health without a human doctor involved.
The third method of interaction is somewhere in between. While detecting heart rhythms requires an electrocardiogram (ECG), these sensors can be incorporated into cheap wearable technology and connected to a smartphone. A patient could wear a monitor daily, record every heartbeat, and only occasionally see their doctor to review their results. If something serious occurs and the rhythm changes suddenly, the patient and their doctor could be immediately notified.
Many groups are working to bring medical wearables to the clinics now.

What are the benefits?

These systems are incredibly cheap to run, costing a fraction of a cent per diagnosis. They have no waiting lists. They never get tired or sick or need to sleep. They can be accessed anywhere with an internet connection.
Medical artificial intelligence could lead to accessible, affordable health care for everyone.

What are the downsides?

The largest concern is probably unrealistic expectations, created by the hype surrounding the technology. The enormous volume of carefully and expensively curated data required to train a system that can do everything a doctor can is currently far beyond our reach. Instead, we will see narrow systems performing individual tasks for the foreseeable future. To counter these inflated expectations, we need to promote informed voices in these discussions.
The privacy of our medical data will also be a challenge. Not only will many of these systems run in the cloud, but some forms of useful medical data are inherently identifiable. You can’t blur out a patient’s face, for instance, if the system analyses the face for signs of disease. High profile data breaches will be inevitable and will harm confidence in the technology.
The other major issue is the problem of accountability. Who is responsible for a medical error if no doctor is involved in the diagnosis, and we can’t even tell why the system got it wrong? Who do we blame when a doctor accepts the wrong recommendation of an AI? Patient advocates, doctors, governments, and insurance companies are wrestling with this issue, but we don’t have good answers yet.
Medical AI is coming, and you will experience it soon. Most of it will be invisible, working behind the scenes to make your care cheaper and more effective. Some of it will be in your hands, assessing your health at the touch of a button. The best thing to do right now is think about the various challenges, and be prepared for your first appointment.
The full article is here:
This is clearly one man’s view of medical AI but I would suggest is might be a little limited.
IBM’s Watson – while controversial in some quarters – is having a direct impact in the personalisation of cancer therapy among other things.
The following explores some additional areas:

HIT Think 5 components that artificial intelligence must have to succeed

Published September 20 2017, 3:25pm EDT
It seems like it was only a few years ago that the term “big data” went from a promising area of research and interest to something so ubiquitous that it lost all meaning, descending ultimately into the butt of jokes.
Thankfully, the noise associated with “big data” is abating as sophistication and common sense take hold. In fact, in many circles, the term actually exposes the user as someone who doesn’t really understand the space. Unfortunately, the same malady has now afflicted artificial intelligence (AI). Everyone I meet is doing an “AI play.”
AI is, unfortunately, the new “big data.” While not good, it is not all bad either. After all, the data ecosystem benefited from all of the “big data” attention and investment, creating some amazing software and producing some exceptional productivity gains.
The same will happen with AI—with the increased attention comes investment dollars which in turn will drive adoption—enhancing the ecosystem.
But the question should be raised—what qualifies as AI?
First, the current AI definition is focused on the narrow, application specific AI, not the more general problem of artificial general intelligence (AGI), where simulating a person using software is the equivalent of intelligence.
Second, the vast, vast majority of the data that exists in the world is unlabeled. It is not practical to label that data manually, and doing so would likely create bias anyway. Unlabeled data presents a different challenge, but the key point here is that it is everywhere and represents the key to extracting business value, or any value.
Third, we are not producing data scientists at a rate that can keep pace with the growth of data. Even with the moniker as the “sexiest job of the 21st century,” the pace at which data scientists are created doesn’t begin to approach the growth rate we are seeing in data.
Fourth, data scientists, for the most part, are not UX designers or product managers or, in many cases, even engineers. As a result, the subject matter experts—those that sit in the business—don’t have effective interfaces to the data science outputs. The interfaces that they have—PowerPoint, Excel or PDF reports—have limited utility in transforming the behavior of a company. What is required is something to shape behavior and applications.
So what does qualify as intelligence? Here is a take for what AI should display, and it encompasses a framework. While some of these elements may seem self-evident, that is because they are taken as a single item. Intelligence has a broader context. All the elements must work in conjunction with each other to qualify as AI.
Discover
Discovery is the ability of an intelligent system to learn from data without upfront human intervention. Often, this needs to be done without being presented with an explicit target. It relies on the use of unsupervised and semi-supervised machine learning techniques (such as segmentation, dimensionality reduction, anomaly detection and more), as well as more supervised techniques where there is an outcome or there are several outcomes of interest.
Usually, in enterprise software, the term discovery refers to the ability of ETL/MDM solutions to discover the various schemas of tables in large databases and automatically find, join keys etc. This is not what we mean by discovery. We use the term very differently and has important implications.
In complex datasets, it is nearly impossible to ask the “right” questions. To discover what value lies within the data, one must understand all the relationships that are inherent and important in the data. That requires a principled approach to hypothesis generation.
One technique, topological data analysis (TDA), is exceptional at surfacing hidden relationships that exist in the data and identifying those relationships that are meaningful without having to ask specific questions of the data. The result is an output that is able to represent complex phenomena, and is therefore able to surface weaker signals as well as the stronger signals.
This permits the detection of emergent phenomena. As a result, enterprises can now discover answers to questions they didn’t even know to ask and do so with data that is unlabeled.
Lots more here:
My feeling is that AI is going to make all sorts of impacts, some we have yet to recognise of even imagine. Keeping a watching brief for the serious trials and clinical outcomes is vital!
David.

The ADHA Publishes Board Notes From Early August At The End Of September 2017.

For your reading pleasure over the long weekend:

Board Meeting 10 August 2017 - Board Papers (Download)

Have fun reading and comments welcome! I wonder what Items 1-4 are all about?

David

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.