Quote Of The Year

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

or

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

Friday, October 03, 2014

Review Of The Ongoing Post - Budget Controversy 3 October 2014. It Just Rolls On!

Budget Night was on Tuesday 13th May, 2014 ( a very long time ago) and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs. Some more this week.
Here are some of the more interesting articles I have spotted this 18th week since it was released.
Parliament is continuing with no e-Health news I have spotted, but lots on Health Expenditure and the Budget.

General.

Joe Hockey plays down speculation of budget cuts to pensions and family benefits

Date September 21, 2014 - 2:01PM

Latika Bourke

National political reporter

Treasurer Joe Hockey has played down a report the government is preparing to abandon key budget cuts to pensions and family benefits.
News Corp is reporting the government is facing a $9 billion black hole because it has shelved its plans to index future family and pension payments, which are being blocked by Labor, the Greens and the Palmer United Party.
But Mr Hockey on Sunday appeared to be still clinging to hope that he could strike a deal with enough senators, as seen with previously contested measures such as the mining tax and changes to financial governance laws which were passed with the support of PUP senators.
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Don’t believe everything you read on pension changes, says Joe Hockey

Sid Maher

JOE Hockey has dismissed suggestions he is about to back down on changes to aged-pension indexation post-2017 but the government looks set to do a deal with Labor on tougher means-testing for family tax benefits.
It will introduce a new $100,000 means test for family tax benefits, with Social Services Minister Kevin Andrews listing the legislation for debate in the Senate this week. If successful, this would cut the means test from its current $150,000.
Mr Andrews is also set for negotiations this week with Clive Palmer and his Palmer United Party senator Jacqui Lambie on the rest of his social services bill, which includes the tougher earn-or-learn measures and changes to pension indexation.
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Health spending growth slowest in decades

Date September 23, 2014 - 1:06AM
Health spending has grown as its slowest rate in almost 30 years, new figures show.
Expenditure on health reached $147.4 billion in 2012/13, up 1.5 per cent from $142 billion in the previous year, the Australian Institute of Health and Welfare (AIHW) says.
As a percentage of GDP it came to 9.67 per cent in 2012/13, up from 9.55 per cent in the previous year.
"This is the lowest growth the AIHW has recorded since it began the Health expenditure Australia series in the mid-1980s," AIHW director David Kalisch said in a statement.
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Budget based on health spending lies says Australian Medical Association

AAP
A report showing health spending has grown at its slowest rate in almost 30 years makes a mockery of the Abbott government's claims that expenditure is out of control, says the Australian Medical Association.
Expenditure on health reached $147.4 billion in 2012-13, up 1.5 per cent from $142 billion in the previous year, according to an Australian Institute of Health and Welfare (AIHW) report.
It's the lowest growth the AIHW has recorded since it began the Health expenditure Australia series in the mid-1980s.
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23 September 2014, 6.28am AEST

Health spending growth at 30-year low

Fron Jackson-Webb

Interviewed

Glenn Salkeld

Stephen Duckett

Despite the Commonwealth government warning the nation’s health bill is spiralling out of control, a new report shows Australia’s growth in health expenditure is the lowest since the mid-1980s.
The Australian Institute for Health and Welfare (AIHW) report, released today, shows the average health expenditure per person fell from $6,447 in 2011-12 to A$6,430 in 2012-13.
Australia spent a total of A$147.4bn on health goods and services in 2012-13, up from $145.2bn in 2011-12. This represents a growth rate of 1.5% – three times lower than the average growth over the past decade (5.1%).
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Health budget is not the problem: AMA

23 September, 2014
A report showing health spending has grown at its slowest rate in almost 30 years makes a mockery of the Abbott government’s claims that expenditure is out of control, says the AMA.
Expenditure on health reached $147.4 billion in 2012/13, up 1.5% from $142 billion in the previous year, according to an Australian Institute of Health and Welfare (report).
It’s the lowest growth AIHW has recorded since it began the Health Expenditure Australia series in the mid-1980s.
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Governments spend less on health, while out-of-pocket costs highest in a decade

Date September 23, 2014

Amy Corderoy

Health Editor, Sydney Morning Herald

Australians' out-of-pocket healthcare costs are the highest they have been in a decade, while growth in spending from state and federal governments is at a record low. 
A report from the Australian Institute of Health and Welfare released on Tuesday shows growth in health spending fell to 1.5 per cent last year – its lowest level in 30 years – while individual Australians' share of spending on health reached its highest level in a decade.
"This is the lowest growth the institute has recorded since it began the Health Expenditure Australia series in the mid-1980s, and more than three times lower than the average growth over the last decade," institute director and chief executive David Kalisch said.
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Analysis of 2014-15 health budget: unfair and unhealthy

Link to Resource:

24 September 2014
This analysis looks at the health and related provisions in the Australian Government’s 2014-15 Budget.  This is done in the light of current and past strategies, policies, programs and funding, and is supported, where possible, by data drawn from Medicare, the Pharmaceutical Benefits Scheme, reports and published papers.
This year’s analysis has been delayed, due in large part to the constantly changing political landscape as the Abbott Government struggles to sell its policies. This delay does mean that new information about federal health expenditures and the impact of the proposed changes can be included. However at the time of completion, the future for major policy initiatives such as co-payment changes remains uncertain.
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THE HON PETER DUTTON MP

23 September 2014

LABOR HYPOCRISY EXPOSED

The Australian Institute of Health and Welfare Report released today shows the absolute hypocrisy of the Labor Party.
For years the white-coated Kevin Rudd and Julia Gillard and their incompetent side-kicks Nicola Roxon and Tanya Plibersek wandered hospitals near and far telling Australians they were spending more and more money on health.
Like so much of Labor’s time in office – that wasn’t true.
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Health expenditure growth slowing: report

23 September, 2014 Christie Moffat
Australia’s health expenditure has slowed to its lowest point since the mid-1980s, according to a new report from the Australian Institute of Health and Welfare (AIHW).
The Health expenditure Australia 2012-13 report, released today, indicated that government spending on health overall had fallen by 0.9% in 2012-13 to a total of $147.4 billion (9.67% of GDP).
The estimated health expenditure per person fell $17, to $6430.
This was compared to the previous decade, where the Australian Government’s spending on health grew an average of 4.4% annually.
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Joe Hockey says $30b overestimation has left 2013-14 in deficit by $48.5b

Date September 26, 2014 - 1:16AM

Lisa Cox

National political reporter

The final budget deficit for the 2013-14 financial year has come in at $48.5 billion - $30 billion more than forecast, Treasurer Joe Hockey has said.
Mr Hockey, who said the deficit was Australia's second largest in dollar terms, attacked the previous Labor government for the deterioration in the country's debt levels.
But, speaking in Canberra on Thursday, Mr Hockey and Finance Minister Mathias Cormann said the government had been able to "stabilise" the situation and believed challenges facing the global economy could be beaten.
The opposition rejected the Treasurer's remarks on Thursday, saying the Coalition was to blame for a large portion of the deficit after it transferred almost $9 billion to the Reserve Bank late last year.
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New report undermines Federal Government claims about a crisis in health system sustainability

Melissa Sweet | Sep 23, 2014 10:02AM |
“Health spending growth slowest since the 1980s” says the headline on a media release issued by the Australian Institute of Health and Welfare today about a new report, Health expenditure Australia 2012-13.
The report shows total spending on health goods and services in Australia was estimated at $147.4 billion in 2012-13 (9.67% of GDP). This was just 1.5% higher than in 2011-12.
“This is the lowest growth the AIHW has recorded since it began the Health expenditure Australia series in the mid-1980s, and more than three times lower than the average growth over the last decade (5.1%),” said AIHW Director and CEO David Kalisch.
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GP Co-Payment.

Govt lied on need for co-payment: Labor

A NEW report showing health spending has grown at its slowest rate in 30 years "bells the cat" on claims a GP co-payment is needed to make Medicare more sustainable, Labor says.
THE Australian Institute of Health and Welfare says expenditure on health reached $147.4 billion in 2012-13, up 1.5 per cent from $142 billion in the previous year.
On average $6430 is spent on the health needs of every Australian each year - $17 less per person than in the previous year.
It is the lowest growth the institute has recorded since it began the health expenditure Australia series in the mid-1980s.
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There's a price to be paid for GP co-payment and higher uni fees

When the cost of something rises, demand falls. So the Medicare co-payment and university deregulation may mean people are a little sicker and a little more ignorant
There is no doubt that in economics, price signals work. When the price of something increases, demand falls. The evidence is in on the markets for electricity and tobacco where government-imposed price hikes have seen consumption fall sharply. There are clear implications from these economic laws with the government’s proposed Medicare co-payment and higher university fees that will mean less use of health services and fewer people going to university as those price hikes impact on demand.
The price on carbon, the colloquially named “carbon tax”, saw electricity prices rise 10% when it was implemented in July 2012. One of the many objectives of the price on carbon was to give a financial incentive for consumers to curb their consumption of electricity. This was seen to be through a combination of switching to more energy-efficient appliances, self-generation (solar panels on the roof), and better insulation so that the length of time heaters and airconditioners were on was reduced.
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Tony Abbott attacks AMA over co-payments

24 September, 2014 Michael Woodhead
Prime Minister Tony Abbott has rejected AMA claims that there is no crisis in health spending and no need for GP co-payments, pointing out that the body backed a co-payment in its alternative plan.
In Question Time in Parliament on Tuesday, Mr Abbott accused the AMA of being inconsistent in calling for co-payments to be dropped after earlier supporting them in principle.
Mr Abbott was responding to statements by AMA president Professor Brian Owler over new figures showing a slowing in growth in Medicare spending.
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Govt's co-pay claims untrue: AMA

23 September, 2014 Sam Worrad and AAP
The Federal Government’s justification for introducing a $7 GP co-payment and a $5 cut to Medicare rebates for GP visits has been branded a lie after a new report revealed growth in health spending is at a record low.
Health spending grew by just 1.5% in real terms during the past financial year — three times lower than the average growth over the past decade — the report released Tuesday by the Australian Institute of Health and Welfare shows.
This is the lowest growth the AIHW has recorded since it began its health expenditure series in the mid-1980s, according to institute director and CEO David Kalisch.
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Tweed MP denies $7 doctor fee in pipeline

Luis Feliu
Tweed MP Geoff Provest says his government has ‘comprehensively’ ruled out charging a $7 emergency-department co-payment or ‘doctor tax’ for people seeking medical help at NSW public hospitals.
But his Labor challenger Ron Goodman claims the National Party MP failed to stop the contentious fee in a vote in parliament this month and the co-payment is still on the cards.
Ballina shire councillors seem to think so too.
A majority of  councillors voted yesterday to write to the Federal minister for Health, the Opposition leader and all cross bench senators to express the council’s opposition to the proposed Medicare GP co-payment.
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Pharmacy Related Articles.

Guild rejects senator’s 'pharmacy fantasy'

22 September, 2014 Christie Moffat
The Pharmacy Guild of Australia has hit back at claims by a NSW senator that pharmacy owners are protected and enriched by “anti-competitive” regulations and subsidies.
The original letter, penned by NSW Senator David Leyonhjelm, was published in the Australian Financial Review last Friday (19 September) and took aim at the location rules surrounding community pharmacy.
Referring to the Guild as “the most feared lobby group in Canberra”, Senator Leyonhjelm noted that “No previous health minister has been able to cut the taxpayer funds flowing to pharmacy owners, or remove the anti-competitive regulations that grant them protection”.
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Call for changes to trading hours and pharmacy ownership in landmark competition review

Date September 22, 2014 - 5:28PM

Jared Lynch

Business reporter

Sweeping changes to retail trading hours, pharmacy ownership, land zoning and federal government services have been proposed in a landmark competition review.
The inquiry's chairman, economist Ian Harper, said competition reforms in the 1980s and '90s help strengthen Australia's economy. But he said more changes were needed amid increasing globalisation, an ageing population and a rapid expansion in online shopping.
Professor Harper said bans on retail trading hours should be scrapped and be "strictly limited" to Christmas Day, Good Friday and Anzac Day morning.
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Does the Coalition have the balls to take on pharmacies?

Australian Economy 14 comments
You can’t keep a good rent-seeker down. Following the release yesterday of the Draft Report of the Harper Competition Policy Review, which sensibly recommended the government free-up rules restricting the location of pharmacies and preventing non-pharmacists from owning a pharmacy, the Pharmacy Guild has hit back, rejecting the Draft Report’s recommendations and warning that it would endanger health care consumers:
The Pharmacy Guild of Australia rejects the Competition Policy Review’s draft recommendations that regulations governing the ownership and location of pharmacies be removed.
The Federal Government has made its position clear on this issue both before and since the election – expressly supporting the current pharmacy ownership model and the Location Rules.
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Chemists warn personal touch will be lost when drugs sold with beer

Sarah Elks

PHARMACIST  Greg McGilvery does not want to see prescription drugs being sold by supermarket giants.
For Mr McGilvery and other owners of the nation’s 5450 community pharmacies, that would be the inevitable and worrying outcome of the deregulation of pharmacy ownership, as recommended in yesterday’s Harper review of competition policy.
Currently, pharmacies must be wholly or majority-owned by pharmacists.
Panel chair Ian Harper recommended the removal of such a barrier.
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Peter Dutton says pharmacy ownership and location laws should stay

Federal health minister rejects government-commissioned review’s recommendations that restrictions change
The federal health minister, Peter Dutton, said pharmacy ownership and location laws should stay the same, despite a government-commissioned competition review which calls for the scrapping of special protections that allow only pharmacists to own stores.
The Competition Policy Review’s draft recommendations for pharmacies states that current restrictions on their ownership and location were not necessary to ensure quality advice and care to patients.
“Such restrictions limit the ability of consumers to choose where to obtain pharmacy products and services, and the ability of providers to meet consumers’ preferences,” the landmark review says.
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Current pharmacy model draws political support

24 September, 2014 Christie Moffat
An independent senator has added his voice to the chorus of support for existing community pharmacy ownership and location rules, vowing to block any proposed deregulation.
Following the release of the Competition Policy Review’s Draft Report this week, South Australian Senator Nick Xenophon said the panel’s recommendations to deregulate community pharmacy were “bizarre” and would hurt the industry.
“Pharmacists have to run a business with very little price-setting ability for prescription drugs. As many as 10% of community pharmacies are known to be only marginally financially viable,” Senator Xenophon said.
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I can own a hospital. So why can’t I own a pharmacy?

Brendan Earle
The Harper review has found restrictions on pharmacy ownership and location are unnecessary to uphold quality advice and care. This view is clearly right and builds on findings of several other reviews, most recently the Commission of Audit.
The Pharmacy Guild has rejected the Panel’s views and seeks a greater role for pharmacists in delivering primary healthcare services. This builds on the guild’s public narrative pharmacists are more than specialised retailers; they are healthcare professionals. But these comments should come with a disclaimer: we are healthcare professionals when funding is being discussed, but not when it comes to governance.
The guild has been testing its lines before negotiations start with the Commonwealth for a new community pharmacy agreement.
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Price disclosure: What you can do to minimise the impact

With the advent of Simplified Price Disclosure (SPD) on 1 October, it is vitally important that pharmacies understand its impact and take early action to secure the future of their businesses.
There is no point sugar-coating the challenges that pharmacies face over the coming months.
The Guild estimates that, without rectifying action, the average impact of price disclosure on pharmacy bottom lines will be $90,000 this financial year.
The two imminent hits will be from 1 October and 1 April 2015 when the second round of SPD occurs.
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Medicare Locals.

Freeze on mental health services by Medicare Local

By Elise Fantin
A South East mental health service provider says it's not taking any new patients until at least next month.
Country South SA Medicare Local has put a freeze on new clients accessing the mental health programs it provides, with an exception for its suicide prevention services.
It says a loss of funding and difficulties attracting and retaining staff in the South East have prompted the move.
Waiting lists for its programs reached capacity last week.
The freeze will be in place until late next month, when a review of its clinical capacity and waiting list will be undertaken.
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Medicare Locals wind-up will cost $100m: Labor

25 September, 2014 Sam Worrad
The phasing out of Medicare Locals will cost primary care $100 million, the Opposition alleges, as rural branches reveal “grave concerns” for the future of services for vulnerable patients.
Shadow health minister Catherine King (pictured) presented the figure in the lower house on Wednesday, which she calculated after meeting with more than 20 Medicare Locals from around the country.
The figure covers how much money each Medicare Local will require for forgone contracts, rental fees and staff entitlements when they are replaced by Primary Health Networks in July next year.
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Comment:
I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day. Now parliament is back we may get some clarity, but there really has not been much so far.
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:
Enjoy.
David.

Thursday, October 02, 2014

Article Draft: The Standards Setting Processes In Australian E-Health Are Broken and No One Seems To Care.

Before discussing the present issues in Australian E-Health setting a little background in two areas seems justified. We can consider these issues by responding to two questions.
1. Why do Standards matter?
Standards are important in all industries to ensure the quality, safety and predictability of all goods and services. We have food Standards to help prevent food poisoning and building Standards to help ensure buildings are safe, fit for purpose and proof to reasonable environmental impacts (earthquake, bushfire etc.). Another vital function of standards is to permit safe interchangeability and interoperability, think of things like screw threads etc.
E-Health has, as its primary concern, the safe and secure transmission of clinical information between healthcare providers and between providers and their patients. To this end Standards have been developed covering such things as electronic health records, secure health communication, health data and information Standards and so on.
You can see the scope of the various Standards that have been developed for Australia (in association with the IT-14 Committee of Standards Australia) on this web-page:
 Interestingly the Australian Institute of Health and Welfare (AIHW - www.aihw.gov.au) also has a role in developing a range of data definitions and the National E-Health Transition Authority (NEHTA) has also had a role in clinical terminologies as well as attempting to manage / interfere with (depending on your perspective) the Standards development process over the last few years.
Before discussion processes it is also important to point out that Standards adoption by commercial and government entities can minimise risk and reduce the costs of bringing new services and products to market while also assisting in broadening the capabilities that may be offered. It is quite usual for companies to find that there are distinct advantages in Standards adoption and use - not the least in facilitating future-proofing development efforts. Of course, for some Standards adoption is compulsory and enforced by laws (e.g. food Standards)
2. What is the present process in Australia for their setting?
In ordinary times - and the last few years in e-Health can hardly be seen as ordinary - there was a stable and well thought out, consultative and inclusive process for e-Health Standards development. Work began seriously on the Health Informatics domain around 20 years ago with Standards Australia creating a steering committee (to become termed IT-14) to develop and implement a work plan. Key to this plan was to leverage all available international work (especially EU and USA) and to only develop new Standards if international approaches could not be reasonably adopted. The intent was to maximise the level of international engagement of the local development committees.
IT-14 has a range of sub-committees and a wide range of members. This page provides a useful collection of links:
Once a work plan is developed for a period the chairs of the various sub-committees - facilitated by Standards Australia staff convene meetings of volunteer experts representing a full range of stakeholders to develop a draft Standards document. The draft is then workshopped as needed and a balanced consensus document is developed. Only once this is fully agreed is an Australian Standard, Technical Report or Technical Standard published.
The keys to the process are seeking conscious involvement of as many interested parties and technical experts as possible and a consensual open way of working and document development.
3. What has changed and what has gone wrong?
By my reckoning the system of e-Health Standards setting was working pretty well until around 2010. Most needed Standards were being developed with reasonable speed and quality with the help of a large and expert volunteer workforce and reasonable support from Standards Australia. The Commonwealth Department of Health was funding access to the relevant Standards for no charge and providing funds to ensure Australian experts were able to attend relevant major international meetings of bodies like HL7 and the ISO-TC-215 Committee so Australia was well linked into international trends and contributing where appropriate.
In 2010 the then Government announced it was going to implement a National Personally Controlled Electronic Record (PCEHR) and that it was going to be operational 1 July, 2012. In an attempt to have all the needed Standards in place well before the deadline (so they could be actually implemented)  many of the usual processes were abandoned with NEHTA led ‘Tiger Teams’ developing specifications which were then to be signed off by the volunteers. Not surprisingly there was considerable dissension and friction with many of the volunteers simply walking away and being replaced by NEHTA Staff. Additionally there was quite substantial funding provided by Government in this period to shape what activities were ramped up and what were deferred.
Also there were a range of quite fundamental technical directional choices where the was considerable disagreement between NEHTA staff and many of the volunteers and many of the volunteers felt they were being ignored and so became rather disillusioned.
To make matters worse NEHTA continued to pressure the acceptance of untested and unimplemented specifications which rather went against the usual standardisation approach of incremental development, testing and proof of concept and then implementation. Only when successful would further development take place.
In more recent times we have seen an accelerating loss of volunteers, failure to develop, agree and fund the 2014-2016 Work  Program for IT-14. As of the time of writing (Oct 2014) there has been no update of the Standards Australia e-Health site since May 2014 and most funding for meeting travel has been curtailed or cancelled.
Also as of the time of writing the fate and plans for the PCEHR are still in limbo with no outcome after a consultation period which closed late August 2014.
It would be fair to say, I believe, that for the present the Australian e-Health setting system is essentially ‘down for the count’. Whether it will ever recover in any useful form would have to be a completely open question. Essentially a working an valuable system has been damaged out of recognition by Government / NEHTA blundering, impatience and incompetence. Sad that!

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Comments welcome!

David.