It Looks Like All Is Not OK In The Private Hospital Sector!

This appeared last week:

Ramsay calls for insurance shake-up as hospital bailout hopes sink

Michael Smith Health editor

Oct 24, 2024 – 5.37pm

Ramsay Health Care has called for health insurance funding to be automatically linked to cost inflation. The head of its Australian hospital operations said the company was prepared for a “fight” if insurers did not agree to do more to cover unexpected surges in staff wages.

Ramsay, the country’s largest private hospital group, also said it was not expecting the Albanese government to bail out struggling facilities or deliver any solutions to the sector’s crisis as it prepares to release the findings of a Department of Health review into the $22 billion sector.

The closure of a private maternity ward in Gosford on the NSW Central Coast announced this week triggered warnings on Thursday of more hospital closures unless insurers tipped more money into the system or Health Minister Mark Butler takes action to prop up loss-making facilities.

“I am not expecting solutions from the government, but I think there is a bit of pressure on [them] from the closure of maternity services like Gosford. You would imagine there would be MP pressure in some of those regions which will necessitate some thought,” Ramsay’s Australia boss Carmel Monaghan told analysts on Thursday.

“I don’t think there is a bailout coming for hospitals that aren’t doing so well. I can’t see that happening.”

While Ramsay is more profitable than other big private hospital groups, its margins are under pressure from soaring wages. Ms Monaghan told investors the company was in talks with a number of health insurers to address funding shortfalls from cost inflation. She said while there had been “some recent success” she would not rule out further disputes with insurers if they did not come to the party.

“There are quite a number of negotiations underway. I hope we don’t have to bash them up but if we have to, we will. I can’t say there won’t be a fight but if that’s what it comes to...,” she told analysts after a site inspection of Ramsay facilities in Perth.

She said Ramsay wanted “automated indexation” when health inflation was higher than expected. That model would automatically link future funding to cost inflation compared to the current system, where funding is negotiated in contract talks with each insurer.

However, health insurers said a tax hike on NSW health insurance passed by parliament on Thursday meant there was no money left to increase funding for hospitals.

“To date, health funds have provided multiple voluntary payments to private hospitals to help them survive tough financial conditions. However, the Minns government’s tax hike will cannibalise any reserves to do this in future. There is nothing left,” Rachel David, chief executive of Private Healthcare Australia, which represents health insurers, said.

Ramsay on Thursday outlined plans to expand its hospital network and invest in emergency departments and other outpatient services despite the pressure on the sector due to inflation and lacklustre patient numbers. It also said it was confident of getting more work from state governments paying for public patients to use private hospitals, although company data showed this had dropped off in the last two years.

“New South Wales have turned off the tap for a while, but they have a big waiting list … there will be pressure at some point and the pressure valve will have to be released,” Ms Monaghan said.

Ramsay is under pressure to improve its operational performance with the value of its shares down 20 per cent so far this year. The company has appointed Woolworths’ former head of supermarkets Natalie Davis as its new chief executive. She is expected to formally take on the role at the end of this year.

Some investors are disgruntled with the company’s rejection of a $20 billion takeover bid from private equity firm KKR in 2022 of $88 a share. Ramsay shares closed down 4¢ at $41.77 on Thursday, valuing the company at $9.7 billion. The stock has lost 20 per cent of its value so far this year.

“I do think the company is undervalued, given no market value being placed for Ramsay Sante, but for the market to get confident, Ramsay needs to improve operational performance,” said Blackwattle Investment Partners portfolio manager Ray David, an investor who has been calling for a change of strategy at Ramsay. Sante is the company’s European operations.

Preliminary findings of the Butler hospital review obtained by The Australian Financial Review in July revealed a government warning that some hospitals would close in the next 12 months with a shift from overnight stays to same-day procedures harming profit margins. It said the private sector was “uninvestable”.

Insurers and hospital groups had been expecting a summary of the report to be released this week, two months later than originally expected.

Michael Smith is the Health Editor for The Australian Financial Review. He is based in Sydney. Connect with Michael on Twitter. Email Michael at michael.smith@afr.com

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/ramsay-calls-for-insurance-shake-up-as-hospital-bailout-hopes-sink-20241024-p5kkzu

This is more useful information on the Private Hospital sector which, I suspect, is really struggling and needs a proper plan for co-existence with the public sector. It seems clear that both mental health and acute care are in some difficulty.

The system has always been a bit ‘Micky Mouse’ and the time has come to get it back on a sustainable footing.

A good few hard heads need to give this some careful thought! If Ramsay is struggling there will be some smaller entities in deep 'do-do'!

David.

It Will Be Interesting To See Just How Well This Key Recommendation Flies With The Docs.

This appeared last week:

25 October 2024

Here’s what’s in the scope of practice report

By

Holly Payne

The controversial review has now signed and sealed its final report, which is on its way to Health Minister Mark Butler.

Patient registration will be central to the reforms recommended by the scope of practice review in its final report, according to committee lead Professor Mark Cormack.

Speaking on a workforce panel at Rural Medicine Australia 2024, ACRRM and the RDAA’s annual conference, Professor Cormack disputed the notion that the review would promote a fragmented system.

“Our review will strongly recommend the centrality of the Strengthening Medicare policy framework and the centrality of patient registration with a [GP] practice,” he said.

“The funding, payment and other reforms that we’re proposing – and of course, we’re proposing others that have got nothing to do with payment – will be built around the centrality of Strengthening Medicare and MyMedicare.

“[It will] in many ways provide a forcing function for multidisciplinary approaches to care in the primary care sector.”

The most significant ask in the report will be on payment models.

“Payment mechanisms drive and restrict scope unnecessarily, more than any other policy setting,” Professor Cormack said.

“The work that the [Department of Health and Aged Care] … has done through the GP Incentives Review is absolutely fundamental, not only to achieving the 2032 vision for primary care, but also for enabling health professionals to work to their full scope of practice.

“Put simply: if there’s not a payment available for a healthcare worker to work at their full scope of practice … they won’t do it.”

The review of WIP and PIP payments caused a stir earlier this year, when its draft report recommended that the payments be phased out in favour of a simplified GP architecture, which itself required practices to participate in MyMedicare.

While some of the more controversial aspects were ultimately walked back in the final report, it still recommended that non-fee-for-service Commonwealth payments to general practice (i.e. block funding) should increase from 10% to 40%.

“Health professionals are far more likely to be working at full scope of practice in the context of a multidisciplinary care team in a blended payment, block payment or salaried environment than they are in fee-for-service arrangement,” Professor Cormack said.

“It’s absolutely clear cut.

“The payment mechanism drives behaviour, and there needs to be a concerted focus on addressing that.”

Professor Cormack said Aboriginal Community Controlled Healthcare Organisations were the “stand out model” for primary care.

The second consultation paper from the review, which was released in April, put forward reform options like allowing allied health professionals to write referrals to non-GP specialists directly and opening up the MBS to non-doctors.

Professor Cormack said the report will recommend a harmonisation of legislation and regulatory arrangements.

“Many of the reforms that are happening at a state-by-state level are enabled by virtue of the states having their own Drugs and Poisons Act, and the same for the Radiation Safety Act and Mental Health Act,” he said.

“At system level, we need to focus on harmonising where it makes sense and where there’s a common goal of health professionals working at full scope of practice in the context of a multidisciplinary care team.”

He also said the report would propose a formal mechanism be put in place to assess and evaluate significant changes to workforce models and scope of practice, in the same way that the PBS considers requests for new drug listings.

Rural Medicine Australia 2024 was held at Darwin Convention Centre between 24-26 October.

Here is the link:

https://www.medicalrepublic.com.au/heres-whats-in-the-scope-of-practice-report/111956

I will be interested to see just how far they (The Federal Government) get with these changes – which really look rather like a form of creeping nationalization to me – and a move to practice operation rather like that found in the NHS.

I will keep an eye out for reaction!

David.

There Might Be Big Trouble Coming Over The Next Few Years I Fear….

This appeared a few days ago:

The mental health crisis gripping Australia’s private hospitals

Some health insurers say stand-alone mental health hospitals are unlikely to exist in 10 years’ time given the challenges they face.

Empty mental health wards are at the heart of the financial challenges facing the struggling $22 billion sector. Robert Duong

Jemima Whyte and Michael Smith

Oct 25, 2024 – 9.48am

Psychiatrist Angelo Virgona is grappling with a paradox in the Australian health system.

Demand for mental health treatment is at a record high. It is the top reason for patients to visit a GP and is the top reason for people aged under 60 to end up in hospital, insurance data shows. Staff at public hospital emergency wards say they are overwhelmed with cases.

But Virgona says, despite the mental health crisis in Australia, particularly among younger people, private hospital psychiatric wards are empty. He says they have been forced to turn patients away for years because they cannot find the staff willing to work on the wards.

Now, Virgona, who is a director of the Royal Australian and New Zealand College of Psychiatrists and has run rural and city clinics, says no one even calls him any more looking for mental health admissions in private hospitals because they know it’s an impossible task.

“People just give up on ringing you up for admissions, we don’t have a doctor who can admit you,” he says. This means the psychiatric wards in private hospitals are sitting empty, leaving Virgona to question how long hospitals can keep the wards open.

“We don’t have enough psychiatrists who want to work in the private hospital system now,” he says.

Empty mental health wards are at the heart of the financial challenges facing the struggling $22 billion private hospital sector, which is the subject of an Albanese government review. The private hospital health check, ordered by Health Minister Mark Butler in June, which collated data from hundreds of hospitals around the country has been completed, but it has not been made public.

However, a summary of the findings from the Department of Health review obtained by The Australian Financial Review singled out declining mental health and maternity services as two key problems for the nation’s 650 private hospitals. While the data on maternity makes sense given the decline in the nation’s birth rate, the opposite is true for mental health.

Soaring healthcare costs are shaping up as a key headache for the Albanese government ahead of the next election. The latest The Australian Financial Review/Freshwater Strategy poll shows health was the third-highest rated concern, with 27 per cent saying it should be a focus for the government. Insurers are also preparing to ask for a big hike in premiums from April next year.

While rising demand for healthcare as the population ages is putting a strain on all parts of the system, the surge in mental health is the area most concerning medical practitioners.

Demand for treatment has never been higher, but wards are closing because psychiatrists do not want to work there. They earn more by treating patients in their own clinics or online. They also blame insufficient rebates from private health insurers.

The Albanese government says more than 3000 lives are lost to suicide each year with demand for treatment higher than ever. Mental illness is also topping private health insurance claims and was the main reason people under 60 spent time in hospital last year, industry data shows.

Beds but no staff

Private hospital operators such as Ramsay Health Care and Brookfield-owned Healthscope say they have the facilities to treat patients but not the staff.

“The maximum hourly earning capacity of psychiatrists treating outpatient and low complexity patients is much greater than those psychiatrists treating the most acute and high-risk patients admitted to hospitals,” says Carmel Monaghan, the head of Ramsay Health Care’s Australian private hospital network, which is the largest in the country.

She says there are patients who are “unable to access the necessary care or languishing in emergency departments and medical wards” because psychiatrists are financially incentivised to assess and treat patients as outpatients, especially for enrolment in the National Disability Insurance Scheme (NDIS).

Treating hospital patients, who are usually admitted for at least 21 days, is also harder work. The psychiatrists in those cases are on call 24 hours a day, seven days a week.

“Psychiatrists appear financially incentivised to favour telehealth and rooms-based work over work in hospital-based settings,” the preliminary findings of the Butler review says. It also says doctors have “limited ability” to charge out-of-pocket fees in hospitals, which was also driving them away.

Department of Health data shows the number of people receiving Medicare-subsidised psychiatric sessions has increased 18.9 per cent from 2019 to 2022. But over the same period, the number of services delivered in private hospitals has fallen 15 per cent.

Pay disparity

Virgona says he earns up to 30 per cent more in his own rooms than when he works at a private hospital.

In the hospital, the doctors aren’t paid for time spent travelling to and from hospitals, talking to nurses, a patient’s family or for taking calls in the middle of the night.

“It’s the worst remunerated role in all of psychiatry. As an in-patient, it’s almost uneconomical,” he says. “But it’s also wonderful, challenging work, providing continuity of care to people in ways not seen in other parts of the mental health sector.”

Many in the industry believe staffing is not the only problem, but that it is time to rethink the old model of care centred around long hospital stays. More people are being treated online or at home.

Patrick McGorry, a former Australian of the Year and mental health expert says home-based care can be managed safely with teams of experts visiting patients two or three times a week, making it a less traumatic experience than staying in hospital.

“You end up getting things like medication reviews which could easily be done on an outpatient basis if there was better infrastructure between the isolated private psychiatrist and the hospital, like a team-based community mental health model. Maybe the insurers and the hospitals need to be wrangled by the government around that,” McGorry says.

Private health insurers, which fund the hospitals, also argue the old model is flawed, with one executive saying there is no future for stand-alone medical facilities. In February, the 75-bed Bethesda mental health facility in Perth shut down after a year of operation. The West Australian government took over the lease.

“We will always need hospitals for people experiencing severe illness and those needing medical support to detox from alcohol and other drugs,” says Rachel David, the chief executive of Private Healthcare Australia, which represents the major health insurers.

“But the evidence is increasingly showing that people recovering from alcohol and drug addiction do better if they receive ongoing treatment at home and in the community so they can continue to live a productive life and overcome environmental triggers for their condition.”

“For these reasons, stand-alone mental health hospitals are unlikely to exist in 10 years’ time,” she says.

The insurance question

Australian Institute of Health and Welfare data shows health insurance funded 54 per cent of all mental health hospital admissions in 2022-23.

Mental health hospital admissions are expensive for health funds because the average length of stay is 27 days, which means admissions can cost more than $10,000.

Ramsay says both mental health and maternity are only included by health funds in gold cover policies which are increasingly unaffordable for young people who are the largest users of these services.

However, insurers dispute this saying a government mental health waiver means a person with basic cover can be upgraded to gold cover if they are admitted to a mental health facility where they will be covered during their stay.

An annual survey released by the Royal Australian College of GPs (RACGP) showed a sharp rise in the number of patients seeing a GP with mental health concerns. About 71 per cent of GPs report mental health as the top reason for patient consults, up from 61 per cent when the survey started in 2017.

“GPs from across Australia have told us that they’re seeing more patients with multiple, complex health issues including mental health, and that many can’t afford to see specialists or allied health professionals privately,” RACGP president Nicole Higgins says.

“After decades of underfunding and the Medicare freeze, we need meaningful investment in patients’ rebates to make essential healthcare affordable for all Australians. With the current cost-of-living crisis, this is more important than ever,” she says.

Some healthcare providers are looking at new models that combine hospital care with more out-patient services.

IMH Deakin Private Hospital is a joint venture between insurer Medibank and Aurora Healthcare that has a model of shorter stays, 14 days instead of 21 days, for young people seeking mental health treatment.

Anna Smith, the hospital group’s director of clinical services, says the model which seeks to get people home sooner and into out-reach programs has led to reduced readmissions.

As the private sector is forced to close down unprofitable operations and reassess the way it treats one of the country’s fastest-growing illnesses, many believe home and online care is the way forward although some GPs are concerned as patients still need supervision and the experts to help them remain in short supply.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/the-mental-health-crisis-gripping-australia-s-private-hospitals-20240906-p5k8hp

I have to say this all paints the picture of a system that is on the edge and is struggling to meet the demand it is faced with while knowing there is a a large backlog of unmet need.

This is surely not a stable and satisfactory situation – and so it seems likely we will see problems break out all over in the next few years.

I wonder what solutions will emerge. We sure need some smart thinking to bolster this aspect of the system! Right now it all sounds petty grim!

Any clever ideas?

David.

I Hope People Have Taken Steps To Move Forward To 4G Etc. By Now!

This reminder appeared a day or so ago:

Warnings for older mobile phones, medical devices as 3G shuts down

By Mary Ward

October 27, 2024 — 5.00am

Tens of thousands of older mobile phones and other devices will cease to work from Monday, when the nation’s 3G network is shuttered.

Australians are being urged to help older family members or neighbours check devices, amid concerns about people losing access to triple-zero services and medical monitoring equipment.

When will Australia’s 3G network be turned off?

Telstra and Optus will switch off their 3G coverage from Monday, affecting mobile phones, tablets and medical devices that still use the older network.

The telcos had intended to start their 3G shutdown earlier this year, but concerns about hundreds of thousands of users still on the network led both to delay the change.

Which devices will be affected by the 3G shutdown?

As of last week, there were 18,000 3G and 70,000 4G non-VoLTE Telstra mobile phones, both of which use 3G for calls, representing 0.3 per cent of the telco’s handsets.

A further 58,000 4G VoLTE phones that use 3G for triple-zero calls will be blocked when the network is shut down, as a safety measure. These phones are older devices often purchased overseas.

Telstra and Optus users can text “3” to 3498 to see if their handset will be affected. Affected Telstra customers have heard a pre-recorded message before outgoing calls, and both telcos have sent warning text messages and emails.

Federal Communications Minister Michelle Rowland urged people to “check their tech now”.

“This is a commercial decision taken by the network providers and industry has undertaken significant efforts to identify and contact potentially affected customers and share critical public information about the 3G switchover,” she said.

“Our focus is that the switchover takes place in a safe way.”

The Therapeutic Goods Administration has said the shutdown may affect medical devices including personal medical alarms, glucose data transmitters, pacemakers, fall monitors and telehealth devices.

It said some devices imported from overseas suppliers or bought online may not work as promised once the 3G network is switched off.

“Even if they claim [to use] 4G, some of these devices may not work on Australian networks,” it said.

Who may be left offline by the 3G shutdown?

Advocates for older Australians have expressed concern about the impact of the 3G shutdown on the elderly, who are more likely to rely on home medical devices or own older mobile phones.

Council of the Ageing (COTA) Australia chief executive Patricia Sparrow urged people to ask older family members or friends about whether they knew if the shutdown would affect their devices.

“If you have an older neighbour or someone you think may need assistance with working out what the switch away from 3G will mean for them, please help them out,” she said.

“Changes of this scale can be anxiety-inducing for many people; it’s crucial people are given the support they need.”

Why is the 3G network being shut down?

First announced in 2019, the 3G shutdown is designed to free up the radio spectrum for higher speed 5G networks.

Here is the link:

https://www.smh.com.au/national/warnings-for-older-mobile-phones-medical-devices-as-3g-shuts-down-20241025-p5klc6.html

Its rather a situation of “Coming Ready Or Not!” at this point!

David.

AusHealthIT Poll Number 770 – Results – 27 October 2024.

Here are the results of the poll.

Are You Noticing More Usage Of myHealthRecord Information In General Practice These Days?

Yes                                                                               4 (13%)

No                                                                              27 (87%)

I Have No Idea                                                            0 (0%)

Total No. Of Votes: 31

A very clear vote, with the feeling being that we are seeing little more use of the myHR over the last few months than previously.

Any insights on the poll are welcome, as a comment, as usual!

A better voting turnout. 

0 of 31 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many special thanks to all those who voted! 

David.

I Hope This Will Be Seen As A Step Forward Towards An Australian Health Information Exchange

This popped up last week:

16 October 2024

ADHA releases draft HIE architecture and roadmap

By Jeremy Knibbs

Software vendors across the country just got sent quite a bit of weekend homework: the ADHA’s updated take on the national HIE architecture.

Software vendors around the country who have been crying out for a little bit more guidance on how they might better prepare to get involved in what is shaping up  as the country’s largest digital health infrastructure project since the My Health Record, will likely be spending this weekend poring over today’s release of a Draft of the Australian Digital Health Agency’s Health Information Exchange Architecture and Roadmap.

Announcing the release of the draft document earlier today, ADHA Chief Digital Officer Peter O’Halloran said that the agency was releasing the draft document early with the intent of better engaging stakeholders in helping “craft the vision of the HIE into a final state”.

The agency is seeking immediate feedback via an online survey HERE (last day to participate is 8 November ) and a free webinar on the topic on 28 October from 11.30am, which you can register for HERE.

O’Halloran neatly summarises what the agency is trying for with HIE the project as follows:

“The HIE will play a central role in facilitating person-centred, connected healthcare across the country by ensuring seamless information flow between various healthcare settings.
 
“[It] will deliver a set of national capabilities using a consistent approach, based on agreed standards, to facilitate the sharing of health information across existing systems such as My Health Record and other data sources. It will evolve and deliver new functions over time to meet the continuous changing needs of clinicians and consumers.”

Which doesn’t tell us a lot given that if you substituted HIE for My Health Record in the first sentence, you might have read the same sentence 10 years ago.

Notwithstanding, there is a lot of detail in this document which confirms we are witnessing a pretty significant pivot from the agency towards trying to introduce a significant new capability for the system to poll distributed data in real time as a means of facilitating data sharing.

This is of course on top of our current centralised infrastructure in the My Health Record.

That the My Health Record looks like it is going to become a subset of the HIE capability in that as well as talking to every other meaningful health provider database distributed across the country, it will also be talking to the My Health Record, feels like the nub of the change we are witnessing.

Reading between the lines?

The HIE is the main game from here on in for data sharing, so vendors best get their head around what the agency is thinking fast, both so they can participate going forward in any related upcoming contracts (some vendors already believe that the recent My Health Record FHIR upgrade tender is setting parameters for the HIE work), and so the agency doesn’t do anything silly from a technical perspective as far as local vendors are concerned.

Excited vendors wanting to get into the gory detail on actual architecture will probably just want to turn to page 38 of the draft document and start reading furiously (or you could try to interpret the diagram below which isn’t a bad attempt at showing vendors everything they are thinking in colour pictures).

As far as hardcore architecture ideas go, the document starts by softly outlining key philosophical shifts across the system the project is going to attempt. These are summarised pretty well in the diagram below.

In one way it’s a good way to create a framework for the changes coming, but it’s also a pretty classic piece of consultant work (good work) dealing mostly largely with the political PR framing the project as opposed to the actual technical architectural issues in play.

The document does get to some of those real structural issues too to an extent – more for sure than the Agency has let go up until now.

Under section 5.2 in Conceptual Future State, the agency outlines the broad view of what the key technical capabilities in play will likely be and how they should be interacting as the project unfolds. The chart below summarises the Agency position.

In what is a pretty comprehensive approach to helping everyone understand how the Agency got to the above position the document also outlines what current technology they feel is play that is most relevant in achieving the HIE goals and what assumptions and decisions they are making around that technology.

Key among these elements include:

• That the project expects to follow the Platform as a Service (PaaS) model, with new application(s) deployed on top of the platform (if appropriate). 
• Integration will play a major component, to ensure that there is a clear separation between the systems with a view to insulating the project against technology changes that will inevitably occur during the life of the project. 
• That health information and how we manage it, which might normally be considered separately from a project like this, and which is currently being spearheaded by the CSIRO through its Sparked program, will be tightly aligned into the project.
• Security is critical (okay so LOL on this point, but obviously very important and needs to be said).
• The whole project will be tightly aligned with standards around technology which everyone already understands is in play, and which may have to be mandated at some point by government.
• The project must continually contemplate the acquisition, development and maintenance of comprehensive information about stakeholders, including providers, consumers, and vendors.

In this last respect the Agency has already started on aligned information and directory infrastructure projects.

Importantly, the document says that the HIE will be actively involved in supporting the management of the information of all these stakeholders and the relationship between each stakeholder. The document goes on to outline its wish list of technical capabilities for the HIE, all 23 of them, and by the time you get to number 23 you do start to wonder whether the timeline that the document provides for the project early on – seven years all up – might be a bit ambitious.

Some aspects of the document do feel a tad deja vu certainly, but overall, it’s a very comprehensive attempt at putting some meat on the bones of what so far has been a pretty bold vision.

It’s worth the weekend read.

Here is the link:

https://www.dermatologyrepublic.com.au/adha-releases-draft-hie-architecture-and-roadmap/3048

What is clear is that this is a very small step – only getting the HIE specification to Version 0.2!

It really feels like a repeat of much I have seen before so I am not sure how much progress is represented here.

Will look forward to comments on this rather long document!

David.

The Australian Population Seems To Be Heading For A Slide – Saved Only By Migration!

This appeared last week:

Australia’s baby drought is driven by housing and cost-of-living worries

Stephen Lunn and David Tanner

16 October,2024

KPMG urban economist Terry Rawnsley puts the baby drought down to cost-of-living and housing pressures.

Cost-of-living pressures and unaffordable housing have been blamed for driving Australia’s fertility rate down to 1.5 births per woman in 2023, its lowest level since records began in 1935.

The falling birthrate will leave the nation increasingly reliant on migration to deliver population growth, experts say.

New Australian Bureau of Statistic data reveals the national fertility rate dropped from 1.63 births a woman in 2022 to 1.5 last year, putting Australia right at the average of OECD countries and sitting alongside Germany, Sweden and The Netherlands.

The total number of babies registered as born in Australia in 2023 – 286,998 – was the lowest in 17 years, almost 14,000 fewer than in 2022.

A jump in births during 2021, in the midst of Covid lockdowns, has been wiped out, with last year’s fall continuing a trend since 2008, the last year when the fertility rate was above 2.

With 2.1 births a woman required to maintain a natural population balance through births alone, declining fertility feeds into the current migration debate. Migration is the only other lever available to influence population, a key pillar of economic growth.

The ABS data shows women are having children later, with the fertility rate of women aged 40 to 44 years almost doubling over the past 30 years.

“The long-term decline in fertility of younger mums as well as the continued increase in fertility of older mums reflects a shift towards later child-bearing,” ABS head of demography statistics Beidar Cho said.

“Together, this has resulted in a rise in median age of mothers to 31.9 years, and a fall in Australia’s total fertility rate.” (The median age for fathers is 33.8 years.)

KPMG urban economist Terry Rawnsley puts this down to cost-of-living and housing pressures.

“The cost-of-living crunch is coming through in these numbers,” he said. “People finding it hard to pay their rent or their mortgage are delaying having that first child, which in turn delays subsequent children.

Australia experiencing its biggest baby recession since 1970s

A new analysis of population and birth data by KPMG has found Australia is in a baby recession not seen since the 1970s.

“With the extra government investment in childcare and paid parental leave over the past two or three years, you’d have hoped that this might have started to shift that fertility rate but clearly cost-of-living pressures are outweighing the impact of those benefits.

“Housing affordability issues over the last 10 years are also having an impact on couple ­decision-making around having babies. Where they previously could have afforded a three-­bedroom home, allowing space for two children, now it’s a two-bedroom apartment and one child.”

Demographer Simon Kuestenmacher said despite the downward trend of the fertility rate, it wasn’t time for radical policy steps. “I’m afraid people will now call for baby bonuses. They don’t work,” Dr Kuestenmacher said.

“The small increase in total fertility rate after the Costello baby bonus (a one-off payment to parents brought in by former treasurer Peter Costello) had nothing to do with the handout but was the result of the mining boom.

“To increase the fertility rate, we must give young people a sense of optimism, a confidence they can financially handle a family,” he said, adding that part of this would revolve around “making housing cheaper”.

Demographer Peter McDonald said Australia was not facing population declines like some other countries “because births will remain above deaths due to the impact of migration”.

“Keeping net migration at around 200,000 a year, similar to recent history, is easily enough to compensate for falling fertility.”

Professor McDonald said if the federal government wanted levers to try to stabilise the birthrate, childcare and affordable housing should be considered.

“It doesn’t have too many levers around affordable housing, but it does for affordable childcare, so it wouldn’t surprise me to see some announcement in this regard ahead of the next election.”

The ABS data shows Western Australia had the highest total fertility rate in 2023 (1.57 babies per woman) closely followed by NSW and the Northern Territory (1.55 babies per woman).

The ACT had the lowest total fertility rate with 1.31 babies per woman. Only Tasmania saw an increase, growing from 1.49 to 1.51 babies per woman.

Here is the link:

https://www.theaustralian.com.au/nation/australias-baby-drought-is-driven-by-housing-and-costofliving-worries/news-story/75dbc5c18dff41d335f2b8c024619db7

The bottom line seems to be that we are so busy with life we are forgetting what causes it to go forward and grow!

I wonder what has to change to reverse the trend we are now seeing?

David.

I Am Not Sure Mr Butler Has A Clue About Health Information Management And The Utility Of The myHR!

This appeared last week:

Minister for Health and Aged Care, speech - 17 October 2024

Read Minister Butler's speech at the Victorian Healthcare Week 2024: Digital Healthcare

The Hon Mark Butler MP
Minister for Health and Aged Care

Media event date:17 October 2024

Date published:17 October 2024

Media type: Transcript

Audience: General public

I would like to acknowledge the traditional custodians of the lands on which we meet, the Wurundjeri Woi-wurrung and Bunurong peoples of the Kulin nation.

I pay my respects to Elders past and present.

Today I’d like to give you a glimpse into the Government’s vision for how upgraded digital health systems will underpin a stronger Medicare and better patient care.

In the past year, our investments in digital health, along with a collaborative engagement with clinicians and software providers, are driving an upgrade to My Health Record that will improve patient care and shift provider behaviour.

Because in Medicare's 40th year, a quiet revolution is underway in digital health, both in approach and in outcome, after a decade of inaction.

Since Medicare was introduced 40 years ago, technology has advanced immeasurably.

Back in 1984, "cutting edge" meant a Sony Walkman in your pocket, an Apple Macintosh on your desk, and a fax machine in your office.

Walk into so many health settings today, you'll find a smartphone in your pocket, a fitness tracker on your wrist, and in the corner where the fax machine used to sit is another fax machine.

That's right: a technology first invented in 1964 - 20 years before Medicare - is still frustratingly, maddeningly, all too common in Australian healthcare settings.

Why is this still the case?

When we came to government, My Health Record was in dire need of an upgrade.

It was still using the old PDF format that Labor installed when we were last in government.

It was cutting edge then, but it is beyond clunky now.

For almost ten years, nothing was done to upgrade the technology that underpinned it.

While the broader economy went through a digital revolution that reshaped industries, My Health Record just sat there, gathering dust.

Without investment, My Health Record remained little more than a shoebox of PDFs - the kind of shoebox every accountant has nightmares about.

You know the one: it came with your running shoes about ten years ago and now is stuffed to the brim with receipts.

Just hundreds and hundreds and hundreds of receipts.

When we came to Government, we discovered that it wasn’t even funded beyond June 30 last year.

On July 1, My Health Record was due to be switched off.

Unplugged. Gone.

So too, the Digital Health Agency.

Lucky we never sold that fax machine, eh?

For the past 10 years, Australia has not kept pace with international best practice to create consistent health information capture and exchange standards.

Instead of playing a coordinating role to allow a patient’s health information to follow them throughout the health system and their life, the former government vacated the space.

Without clear leadership, clinical information systems were built using licenced frameworks that didn't talk to each other.

With many different systems across public hospitals, private hospitals, aged care facilities, general practices and allied health clinics, patient data became effectively siloed behind a wall of proprietary frameworks.

Unsurprisingly, there isn’t much confidence in such an outdated system.

In the most recent Health of the Nation survey by the Royal College of General Practitioners, 31% of GPs said they rarely, or never, use My Health Record.

Even fewer specialists use it: half of them haven’t even registered with it.

Dr Ramya Raman explained to me how frustrating using My Health Record can be, as a GP.

She said - quote - "Every blood test is a separate file. Every scan is a separate file. They're just labelled 'pathology' and it opens up in a window. And the most frustrating thing about it is: you close one window, the whole thing closes".

We have to do better.

There is no reason why Australia can't make My Health Record interoperable with the clinical systems that Dr Raman and other healthcare providers actually use.
 
That clinical software should be able to draw upon the data in My Health Record directly, and publish back to it seamlessly, without any additional data entry required of the healthcare practitioner.

I said as much at the National Press Club in May last year.

And if a patient gets a diagnostic scan or pathology test, then those results should be uploaded.

A week after that Press Club speech, in the 2023 Budget, we announced almost $1.1 billion in new funding to modernise the digital health infrastructure and upgrade My Health Record to a data rich platform.

A bit over one year on, and Australia is seeing the most substantial digital health reforms in more than a decade, across three major areas:

• 1) standards
• 2) medicines
• 3) tests and scans.

First, standards...

Last year, we funded the CSIRO to lead a partnership across the digital health sector called the “Sparked” initiative to deliver a national set of data and exchange standards.

So that the clinical software a health professional uses stores health data according to common standards, enabling sharing across platforms, practices and professional disciplines.

The standards will use the Fast Healthcare Interoperability Resources  framework – or FHIR – that is used widely in the United States, UK and Europe.

The “Sparked” initiative launched in August last year with all Australian governments as founding partners and more than 500 participants comprising technology vendors, provider organisations, consumers, peak bodies and health practitioners.

The first goal was to develop standards for core patient health information covering Procedures, Allergies, Medicines, Problems, Immunisations and Results.

In just 10 months, that goal was achieved.

In June this year, Australia’s first ever national information sharing standard was published and can now be built into clinical systems.

This represents more progress in 10 months than in all of the previous 10 years, combined.

The strength of “Sparked” lies in its bottom-up process of community consultation and consensus, with more than 500 participants rallying  each other toward a common goal.

Now, “Sparked” is looking at how to digitise Chronic Condition Management Plans, capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes needed for a national patient summary record.

This is just one small part of the revolution in digital standards underway across the health system.

Work is also underway to develop a national directory of healthcare providers.

To do that, we’re enhancing the national healthcare identifiers, so that whatever the health setting, all jurisdictions can accurately identify individuals, healthcare providers and organisations.

We’re also working hard with our state and territory colleagues to drive the nationally consistent and timely supply of quality hospital discharge summaries into primary care.

This has been a recurring critical gap that causes needless hospital readmissions and poor health outcomes.

It has been called out time and again through numerous reviews, including the Aged Care Royal Commission and the mid-term review of the National Health Reform Agreement.

Shared national standards will enable My Health Record to become the data-rich platform that Australia needs.

And a few weeks ago, the Digital Health Agency put out a large tender to do just that: to fundamentally transform the interoperability capability of My Health Record.

This is a critical piece of work that will enable clinicians and consumers to discover and access healthcare information where and when it is needed, in a standardised structured format.

The second major area of digital revolution underway is in medicines.

With electronic prescriptions, we have transitioned to a single national prescription delivery service, streamlining the delivery of more than 300 million prescriptions each year between doctors and pharmacists.

More than 100,000 prescribers across the country already use e-Prescriptions, and after extensive engagement across the health system, we are now on track to introduce them to public hospitals.

Each year, a quarter of a million hospital admissions result from medication-related problems and half of them are considered preventable.

We’re working on a framework to enable the rollout of electronic medication charts to more settings beyond the successful roll out in aged care, where nearly 80 percent of facilities have received a grant to adopt them.

The third, and perhaps the biggest, revolution underway in digital health is in the availability of scans and tests in My Health Record.

All states and territories are now sharing pathology and diagnostic imaging reports to My Health Record, with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months.

By the end of the year, for the first time, client support plans will be able to be shared from My Aged Care to My Health Record.

Patients expect their diagnostic scans and pathology tests to be uploaded.

This only happens by exception. It is not the rule.

At the National Press Club in May last year, I said that I intended to make it the rule.

Since that announcement, the number of private radiology clinics connected to My Health Record has more than doubled.

Australia’s largest private radiology provider, I-MED has started sharing by default from all their Western Sydney clinics.

In the ACT and southern New South Wales, Capital Pathology is sharing by default from every one of their clinics.

The third largest private radiology provider, Lumus, is the first to share by default nationally.
 
And since one private pathology provider in Western Australia started sharing by default earlier this year, they now field around 150 fewer calls per day from patients looking for test results.

Over 10 million pathology and nearly 1 million diagnostic imaging reports are being uploaded each month.

In May last year, just one in five diagnostic imaging reports were being sent to My Health Record.

A year later, and one in three reports are now being uploaded.

While this is an improvement, it is still too low and too slow.

Which is why I will soon introduce legislation that will mandate “sharing by default” for all tests and scans in near real-time. 

To enable faster access, I am looking to remove the 7-day delay that prevents patients from seeing their results sooner. 

While near real-time access will be the new standard, in some cases a clinically appropriate delay may remain if appropriate.

Before agreeing an approach, I will consider advice from the Clinical Reference Group, co-chaired by former AMA President Dr Steve Hambleton and Conjoint Associate Professor Carolyn Hullick, the Chief Medical Officer at the Commission on Safety and Quality in Health.

The Clinical Reference Group will provide me with strategic and clinical advice to ensure implementation is aligned with consumer needs and preferences, and healthcare provider clinical workflows.

Test results and scans belong to patients, not providers, and they need to be shared to a patients' My Health Record.

To show that we're serious, the laws will include consequences for companies that do not share.

And let’s be clear about why our government is so committed to this.

Yes, it will make healthcare professionals’ lives easier, by helping them to be more efficient and effective.

Yes, there will be flow on benefits across the system, helping to ensure that every precious dollar in the Medicare system goes to patient care.

Sure, those are important.

But the reason we are driving so hard toward that digital future is not provider benefit or system benefit, but patient benefit.

Patient benefit is – and always will be – our North Star.

Patients find this so frustrating, because every lost test result means another day off work, another waiting room, another procedure and yet another gap fee.

Patients desire and deserve access to their own health data, and agency over how it is used and shared.
 
Digital health technologies should empower patients to monitor and take charge of their health and wellbeing, so they can interact confidently with healthcare providers and build their health literacy.

It moves patients from the periphery of a too-often fragmented system, and puts patients right of the heart of a better connected and more personalised health system.

This is what drives our government’s efforts.

And it’s why the “sharing by default” framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan.

Withhold a patient's results and we will withhold the Medicare payment.

It's as simple as that.

This is not a drastic position for a government to take.

In the United States, for instance, the 21st Century Cures Act requires the portability of health records with open access for consumers to their health information.

Under the legislation, providers that do not have modern cloud-based systems in place to enable this sharing could even be sent to jail.

While our health systems are different, since the U.S. laws were introduced in 2016, study after study has shown a range of benefits to consumers and health providers after the removal of delays to patients viewing their results.

The "sharing by default" legislation will be introduced to Parliament next month.

I'd like the laws to be passed and in place by the middle of next year.

It's clear that we cannot leave patients to rely on the benevolence of private providers.
 
In the financial year to June 2023, Australia's second largest private pathology provider, Healius, had a 25 per cent market share and received almost a billion dollars in Medicare benefits.

In August of that year, Healius was uploading over 800,000 pathology reports a week to My Health Record.

The following month, on the 11th of September, we released for public consultation our intent that pathology companies would share by default by June, with a legal obligation by the end of this year.

No sooner had we released that proposal for public consultation, that very same day, Healius wrote to the Department of Health and Aged Care to say that it would imminently suspend the upload of pathology reports.
 
Despite previously having received close to half a million dollars from the Digital Health Agency to subsidise its connection into My Health Record, Healius stopped uploading pathology reports less than 24 hours later.

With each week that passed, another 800 thousand patient results were not uploaded to My Health Record.

Letters were sent, meetings were sought, and then held, without resolution.

Weeks went by, and still Healius hadn’t resumed uploading patient test results.

Patients were starting to ask the Digital Health Agency why their results weren't in My Health Record.

On 27 November, in response to questions from media and after making no progress convincing the company to reverse its decision, I went public with my deep disappointment that Healius was withholding patient data.

Thankfully, 12 weeks after Healius stopped uploading pathology results, on the 5th of the December, it finally resumed.

By that point, an estimated 10 million test results were missing from My Health Record.

10 million test results that will never be readily accessible to patients or their health providers.

It’s impossible to determine if any of those missing results have since led to additional or duplicate tests.

If even 1 in 20 of those 10 million results need to be re-ordered, then patients and the health system are on the hook for another half a million tests.

Half a million needless Medicare payments.

Half a million times that patients have to take leave from work to give up their time and, in all likelihood, take yet another blood test.

Half a million re-ordered tests may be a conservative estimate.

Studies from the UK’s National Health Service indicate that up to a quarter of all pathology requests may be duplicates or unnecessary.

Now credit where credit is due.

Since it resumed uploading in December last year, Healius has consistently been uploading pathology reports to My Health Record by default, with uploads continuing to grow.

Under its new management, Healius has engaged very constructively in the government's digital health reforms and upgrades to My Health Record.

The government has had no issues with Healius since that time.

However, to be perfectly frank, patients should not have to rely on the goodwill or good management of private providers to be able to access their own health data.

Companies that have built their business model on channeling and control of a patient's health data will have to find a new way to drive profit margins for shareholders.

Let me be clear: withhold a patient's results and we will withhold the Medicare payment.

As well as being better for consumers, a sharing by default scheme that enables patients to access their information in near real time, is also better for the bottom line for healthcare providers.

Because every dollar that goes to a needless or duplicate test or scan, is a dollar that doesn't fund lifesaving medicines or our hard-working doctors, nurses and health professionals.

Every minute a GP doesn't spend searching through My Health Record for a result that may or may not be stuffed into the PDF shoebox, is a minute they can spend with a patient.

Every minute a practice nurse doesn't have to spend manually entering a patient's data into their My Health Record, is a minute that they could be administering a childhood vaccination.

Every minute a practice manager isn't held up on a phone call with a patient chasing up their results, is a minute that another patient doesn't have to wait on hold to make an appointment.

The Productivity Commission estimates more than $5 billion a year could be saved by reforming Australia's digital health infrastructure.

Beyond the savings, it is - quite simply - what patients expect and deserve.

People now routinely view their test results in My Health Record more often than they did at the absolute peak of the COVID-19 pandemic, when they were viewing 700,000 reports each week.
 
Near-real time availability will see an uplift of digital health literacy, better informed consumers and better management and care coordination of chronic conditions.

Just what a stronger Medicare needs to be able to deliver for the patient profile of 21st century Australia.

A bit over a year after the announcement of $1.1 billion in funding, this quiet revolution in digital health is delivering more progress in a single year than in the previous ten years, combined.

By driving revolutionary changes in standards, medications, and tests and scans, a modernised and upgraded digital health infrastructure will deliver a My Health Record that is data-rich, real-time and complete.

Consumers will be able to trust the system, access their information at all times, and won't have to repeat their medical history every time they see a clinician.

By the time Medicare reaches its next milestone birthday, we can confidently expect that the humble fax machine will no longer clutter the offices of health settings.

Like the Sony Walkman or Apple Macintosh, the fax machine will finally become little more than a museum relic.

I'm sure I speak for patients everywhere when I say: that day can't come soon enough.

Thank you.

Here is the link:

https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-17-october-2024?language=en

It really is bizarre that Mr Butler thinks that the data for patient care is all up there somewhere and patients can just get on with downloading it.

I have just had a look at myHealthRecord – given I have had some admissions and treatment in the last few months.

There is a collection of useless junk in the record and zero clinically relevant that I can detect but an amazing list of things done to me – all of which is a variety of item numbers!

The record is a collection of “data junk” and is non-sensical and useless.

The fiasco continues and the myHR is as useless as ever – despite what the Minister says!

David.