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."

Saturday, January 21, 2017

Weekly Overseas Health IT Links – 21st January, 2017.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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NIST updates outline first-ever cybersecurity measurements

Jan 13, 2017 11:10am
NIST's updated cybersecurity framework includes new metrics to quantify the impact of cybersecurity efforts.
For the first time, organizations seeking an objective way to quantify cybersecurity performance can use updated federal guidelines aimed at measuring the impact of cybersecurity interventions and business objectives.
The updated draft guidelines (PDF) released this week by the National Institute for Standards and Technology (NIST) include specific updates regarding cybersecurity metrics, considerations supply chain risk management and common terminology used to communicate with outside partners and vendors.
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EarlySense, ResMed share promising data on digital health sleep monitoring

January 12, 2017
Two digital health companies focused on sleep published data this week that highlighted the efficacy of their respective platforms, bringing continued attention to the space after a CES week where sleep was a major focus. A whitepaper by Pricewaterhouse Cooper showed that ResMed’s myAir improved CPAP adherence while a paper in the Journal of Clinical Sleep Medicine found that EarlySense’s new consumer system EarlySense Live performed comparably to polysomnography.
ResMed’s myAir is an app that launched last year allowing CPAP users to track their treatment via an app and giving them access to their daily sleep patterns and coaching tips. The new whitepaper looked at data from over 23,000 patients in Germany and the United Kingdom, 1,800 of whom used myAir. 
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ONC Announces Phase 2 Winners of Consumer, Provider App Challenges

January 12, 2017
by Rajiv Leventhal
The Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 2 winners for the Consumer Health Data Aggregator Challenge and the Provider User Experience Challenge. 
ONC designed these challenges last year to "spur the development of market-ready applications that would enable consumers and providers to aggregate health data from different sources into one secure, user-friendly product."
Challenge submissions were required to use Fast Healthcare Interoperability Resources (FHIR) and open application programming interfaces (APIs), which are both strongly supported by ONC. Phase 1 winners of the challenges were announced last summer; applicants were required to submit a series of plans for their proposed apps, including designs or screenshots, technical specifications, business/sustainability plans, and proposed provider and/or electronic health record (EHR) vendor partners to test their work. Both challenges then moved Phase 2, where the apps themselves were evaluated.
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The policy implications of using big data in healthcare

01/12/2017 05:52 pm ET
Adi Gaskell A London-based innovation scout
The growing importance of big data in healthcare is something I’ve touched on a lot in the last few months. It should perhaps come as no surprise therefore, that the European Commission have recently released a paper that examines the issue in depth, including the key areas it is being used, and some of the policy implications involved.
The paper looked at a number of solutions in key policy areas, including:
  • supporting the sustainability of health systems
  • improving the quality and effectiveness of treatment
  • combating chronic disease
  • supporting healthy lifestyles.
One of the more well known examples analyzed by the researchers was the E-Estonia national identity scheme, which includes within its remit a digital patient record.
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Health information exchange: E pluribus unum?

Can one model for health data exchange emerge from the diverse HIE ecosystem that exists?
January 11, 2017 03:17 PM 
The state of health information exchange (noun and verb) is complex, to say the least. The past decade-plus has given rise to a patchwork of approaches: public and private exchanges; statewide, regional and local networks; national vendor-based interoperability groups such as CommonWell and Carequality. And more.
If it's a bit of hodgepodge – and far from the seamlessly interconnected "learning health system" aspired for in ONC's Shared Nationwide Interoperability Roadmap – this cobbled-together system is a whole lot better than the shelves of dusty manila folders that represented the health data ecosystem in the not-too-distant past.
But there's always room for improvement. John Kansky, president and CEO of the Indiana Health Information Exchange, said there's a better way forward from the existing conflicting and confusing state of HIE in the U.S. 
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Digital Health at CES 2017, Las Vegas

Digital Health News' US correspondent Lindsey Birnsteel, provides a hands on report on the very latest digital health trends from the Consumer Electronics Show, 2017, Las Vegas.
Lindsey Birnsteel
9 January 2017
If you are into the very latest consumer technology and gadgets, then CES is the big one. The 2017 show boasted more than 177,000 attendees and nearly 4,000 exhibitors.  And once again technologies, apps and sensors to support health and fitness were a key trend.
Digital health technologies have grown dramatically at CES as wearables and smart health technologies have taken centre stage in the consumer market. Digital Health News combed through the crowds to find what’s trending in digital health and which companies are leading in their field.
From a quick glance digital health companies from the US, France and not surprisingly Asia (Korea, Singapore and China) dominate the floor.
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May announces £67.7 million for digital mental health

Laura Stevens and Ben Heather
9 January 2017
Prime minister Theresa May has announced £67.7 million of funding for digital mental health services.
May made the announcement in a speech at the annual Charity Commission lecture in London on Monday, which outlined a broader package of funding and policy aimed at improving support for people suffering from mental health problems.
This would include new mental health support within secondary schools, in the community and within the workplace.
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mHealth roundup: Health apps to cut costs, improve care

by Judy Mottl 
Jan 12, 2017 9:05am
Mobile apps are ubiquitous in wellness and healthcare, driven by consumers eager for healthcare information at their fingertips. Hospitals, health systems and health insurance companies have embraced them as a way to provide better, faster and more cost-effective care and treatment.
A top focal point for app makers has been management of chronic illness, such as diabetes, as the population of patients diagnosed with Type 2 diabetes swells. Health and fitness are also a prime focus for payers and providers and are popular with consumers.
But app makers are working to expand beyond those entry-level functions to tackle everything from patient care and management to back-end operations and streamlined business processes.
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Why healthcare organizations and vendors need to embrace APIs

Published January 12 2017, 2:51pm EST
Application programming interfaces give access to data created by others, enabling a computer programmer or someone working on a computer to call up another program and get it to do a particular task, explains Brian Murphy, an industry analyst at Chilmark Research.
It is a technology the healthcare industry desperately needs and is slowly moving toward, he contends.
APIs are not new, having been invented in the 1950s. But Google, Facebook and other social media put them on the map in recent years. Most notably, APIs power all the apps on your smartphone.
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What providers can learn from 2016’s security incidents

Published January 12 2017, 3:03pm EST
Cue the year-end articles saying that this was the worst year to date for data breaches. Follow that with more dire predictions for 2017. Layer in one-size-fits-all recommendations to mitigate these risks. And finish with technology solutions that you must have.
If you read all of this you might come away thinking that if your company is not using AI and machine learning, buying threat intelligence, building a threat-hunting team, installing a next-generation antivirus solution, deploying an endpoint product and reducing your attack surface, all of those bears people talk about outrunning may already be in your network.
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Use of mobile EHR apps can boost productivity

January 12, 2017
Many primary care physicians mainly rely on desktop computers, taking time during or between patients to sit at their desks to enter data, according to healthcare IT consultant Rick Shepardson.
Mobile, however, could help physicians boost their productivity, he and other experts said.
“It can help make better use of a physician’s time,” said Amelia Coleman, M.Ed., director of the practice management consulting group at MBA HealthGroup, who added a growing number of physicians are interested in using mobile devices at their practices.
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Proof-of-concept for VA’s Digital Health Platform leverages analytics

Published January 10 2017, 6:52am EST
Healthcare analytics vendor Apervita is participating in a proof-of-concept to demonstrate the viability of a Department of Veterans Affairs Digital Health Platform (DHP), designed to integrate veteran data from VA, military and commercial electronic health records—as well as apps, devices, and wearables— so that the information is available to providers in real time.
Managed by Georgia Tech, the VA proof-of-concept seeks to demonstrate the power of real-time analytics to deliver higher quality, more efficient and flexible care as part of the envisioned DHP architecture. The cloud-based platform is meant to create a new paradigm for the delivery of healthcare services with a modern, integrated system that incorporates best-in-class technologies and standards.
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HHS Sec. Burwell's advice to Dr. Tom Price: Prioritize cybersecurity

Written by Tamara Rosin (Twitter | Google+)  | January 10, 2017 | Print | Email
In her farewell remarks at the National Press Club Monday, HHS Secretary Sylvia Mathews Burwell warned Republican lawmakers that repealing the ACA could be "a step backwards" for the U.S. healthcare system. She had more pointed advice for nominated HHS Secretary Rep. Tom Price, MD, R-Ga., regarding the issue of cybersecurity.
"This is very important and I would tell my successor it has to be prioritized," she said in response to a question on how to address cyberattacks in the healthcare industry. "People don't want to spend money on it. They don't want to spend time on it. It is extremely important that you put in place the protections as much as you can."
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IBM Watson, FDA to explore blockchain for secure patient data exchange

The initial focus for blockchain will be oncology-related data exchange

Senior Writer, Computerworld | Jan 11, 2017 5:01 AM PT
IBM's Watson Health artificial intelligence unit has signed a two-year joint-development agreement with the U.S. Food and Drug Administration (FDA) to explore using blockchain technology to securely share patient data for medical research and other purposes.
IBM Watson Health and the FDA will explore the exchange of patient-level data from several sources, including electronic medical records (EMRs), clinical trials, genomic data, and health data from mobile devices, wearables and the "Internet of Things." The initial focus will be on oncology-related information.
"The healthcare industry is undergoing significant changes due to the vast amounts of disparate data being generated. Blockchain technology provides a highly secure,
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Patient advocate: caregiver's viewpoint as critical as the doctor's

Kristina Sheridan is among the growing legion of caregivers who have come to believe that involving input from patients and their families can be a game-changer when it comes to diagnosis and treatment. 
January 10, 2017 07:02 AM
When it comes to managing chronic conditions, healthcare providers are often missing incisive input from two very important sources — the patient and caregiver.
“It’s interesting what perspective we’ve gained — it is realizing that patients and caregivers are the true experts in managing chronic conditions,” said Kristina Sheridan, who left her engineering job in the aeronautics industry to become a healthcare advisor and today is a department head for McLean, Va.-based MITRE Corp. “My 12-year-old daughter Kate (now 21) was the only one who could explain what she was going through.”
When Kate was 12, in fact, the situation became complicated such that even repeated visits to doctors did not get them any closer to finding the root cause of what was bothering her. 
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Hospital Impact: Trump policies could escalate EHR privacy fears, threaten quality and patient safety

Jan 11, 2017 11:41am
When patients are afraid to share information, it creates inaccurate and incomplete data, affecting care quality or even causing harm.
One of the biggest EHR-related issues of 2016 has been cybersecurity. The industry has been plagued with ransomware attacks, hacked EHR systems, threats to networked medical devices and sloppy internet use that leaves patient records vulnerable and exposed to the public. 
All of which has made patients leery of the ability of EHR-using providers to keep their records confidential, and understandably so. While even the most careful of entities can be hit with a security breach, all too many of them have been careless, not taking even some of the most basic safeguards. 
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Detailed EHRs offer opportunity for personalized care

Jan 11, 2017 10:50am
Kaiser Permanente and Geisinger Health System are in the early stages of incorporating and utilizing detailed patient information that can inform future treatments.
Health systems around the country are incorporating new patient information into electronic health records in an effort to provide more customized patient care as the healthcare industry attempts to keep pace with a constant stream of potentially useful health data.  
Kaiser Permanente and Geisinger Health System are in the early stages of incorporating and utilizing detailed patient information that can inform future treatments, according to NPR. Kaiser is working toward a system in which physicians can pull up information about a disease based on specific factors such as age. Although currently operating as a prototype, the system is looking to incorporate patient reported information that can offer a more complete perspective of different treatment options.
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Secondary commercial market for patient data rife with privacy concerns

Jan 11, 2017 11:02am
Data “re-identification” is a growing threat as cybersecurity concerns continue to plague the healthcare industry.
By signing a privacy form at their doctor’s office, patients often assume their medical data is protected. In fact, it’s often redirected into a commercial market where data miners resell that information for marketing purposes.
The influx of computerized patient data has fueled this “health data bazaar” over the last decade, allowing wholesalers to buy and sell information collected from various medical sources, according to a report released by The Century Foundation. The practice is legal because patient data is stripped of any identifying information, which meets the privacy requirements outlined under the Health Insurance Portability and Accountability Act (HIPAA).
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Privacy, security issues cause consumers to distrust HIT

Published January 09 2017, 7:25am EST
A new survey of more than 12,000 Americans has found that 57 percent of consumers are skeptical of the overall benefits of health IT such as electronic health records, mobile apps and patient portals, in light of recent high-profile data breaches and a perceived lack of privacy protections by providers.
The national survey, conducted from September to December by market research firm Black Book, also revealed that 70 percent of Americans distrust health technology. That’s significantly lower than a 2014 survey by the Office of the National Coordinator for Health Information Technology, in which only 10 percent by respondents said they distrusted HIT.
“We saw that distrust number in particular with consumers and mental health records and pharmacies,” says Doug Brown, managing partner at Black Book. “They feel that there’s some kind of leakage of information, even if it’s not cybersecurity-related.”
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C-suiters: Keep an eye on these technologies in 2017

Jan 10, 2017 1:44pm
From Pepper, the emotional interactive robot, to the new da Vinci Xi Integrated Table Motion to pipeline vaccines, ECRI Institute highlights 10 healthcare technologies C-suiters should keep an eye on in 2017.
The organization's annual watch list outlines technologies that hospital leaders should bring into their hospitals—and which ones to keep out. But separating the facts from the hype isn't easy, they note.
Pepper, for example, might be a pass thanks to its hefty price tag. But other emerging technologies, such as vaccines for chronic conditions such as diabetes, hold promise.  
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DirectTrust outlines health IT uncertainties in 2017

Jan 10, 2017 7:01am
Uncertainty is the only given that 2017 will bring for health information technology, according to a new report from DirectTrust.
The organization, an alliance of participants in the Direct Exchange network for health information exchange, pointed to five health IT trends to watch in 2017, with a focus on the possible repeal of the Affordable Care Act.
Republican promises to repeal ACA will fuel that uncertainty, especially if months of debate and controversy ensue without a replacement plan, writes president and CEO David C. Kibbe, MD.
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Mon Jan 9, 2017 | 6:35pm EST

St. Jude releases cyber updates for heart devices after U.S. probe

Abbott Laboratories (ABT.N) moved to protect patients with its St. Jude heart implants against possible cyber attacks, releasing a software patch on Monday that the firm said will reduce the "extremely low" chance of them being hacked.
The company disclosed the moves some five months after the U.S. government launched a probe into claims the devices were vulnerable to potentially life-threatening hacks that could cause implanted devices to pace at potentially dangerous rates or cause them to fail by draining their batteries..
The Food and Drug Administration and the Department of Homeland Security said that St. Jude's software update addresses some, but not all, known cyber security problems in its heart devices.
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How best to include patients in clinical communications

Published January 10 2017, 4:04pm EST
Maintaining effective communication across the spectrum of care is crucial to the quality and efficiency of care delivery, yet communication disconnects plague the healthcare industry.
Poor clinical communication has been a prime cause of medical errors as detailed in successive Institute of Medicine reports. The problem may be far worse—a report by Johns Hopkins School of Medicine lists medical errors as the third leading cause of death in the U.S.
Medical communications are a generation behind any other mature industry. It is a crippling industry-wide flaw that has consequences for workflow, duplication and waste. It is a leading contributor to medical errors, care mis-coordination, and provider and patient frustration. It consumes scarce capital. And it is preventable.
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How to mitigate middleware security vulnerabilities

Published January 06 2017, 3:40pm EST
Middleware has great potential for mitigating healthcare IT interoperability issues. However, because it mediates network services to applications, middleware can also create major security issues—possibly enough to offset any benefits.
A need for healthcare providers to have easy access to patient data fueled the push for the widespread adoption of electronic health records (EHR) systems. In the days of paper records, patients would often show up at doctors’ offices or, worse yet, hospital emergency rooms with no paper trail; if they had never been to that facility before, their medical records were not available, leaving their new providers scrambling to treat them with an incomplete or non-existent medical history.
The goals of EHR systems were to increase the quality of patient care and reduce medical errors and costs by making patient medical data accessible to all healthcare providers they saw, regardless of where they were located or whether the patient had seen them before.
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IBM names 5 game-changing innovations

Big Blue casts the annual crop of 5 in 5 promising tech’s as breakthroughs expected to change the world as we know it.
January 05, 2017 02:13 PM
IBM revealed its roster of emerging technologies poised to have considerable impact on the world within five years. And three of them are healthcare-related.
The tech stalwart said it bases the 5 in 5 market and societal trends as well as technologies from IBM’s Research labs around the world that can make these transformations possible.
1. With AI, our words will be a window into our mental health. In five years, what we say and write will be used as indicators of our mental health and physical wellbeing. Patterns in our speech and writing analyzed by new cognitive systems will provide tell-tale signs of early-stage developmental disorders, mental illness and degenerative neurological diseases that can help doctors and patients better predict, monitor and track these conditions.
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HL7 CTO: How to set healthcare on FHIR

Wayne Kubick addresses the need for healthcare industry leaders to think differently and create a defense mentality to support FHIR’s power. And the biopharma industry just might be the best place to start.
January 06, 2017 07:25 AM 
HL7’s CTO Wayne Kubick said that the challenges FHIR faces are more cultural than technological. 
The current state of healthcare and the way clinical studies are conducted exists in separate systems and paper-based processes. And the datasets compiled from older systems are difficult to read or gather any tangible information.
FHIR can eliminate many of these issues, but the industry is reluctant to embrace change, according to HL7’s Chief Technology Officer Wayne Kubick.
“The FHIR platform is robust and I don’t think we’ve seen limitations to what FHIR can do," Kubick said. "The real challenge is to identify what it can do and what will give the industry the greatest benefits."
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Obama disappointed in medical data-sharing progress

Jan 9, 2017 10:37am
In a video interview, President Barack Obama says sharing data from electronic medical records is an area that hasn’t improved as much as he would have liked.
President Barack Obama says interoperability and data-sharing efforts haven’t gone as well as he had hoped they would under his signature healthcare reform law.
In a video interview with Vox, Obama said efforts to cut healthcare costs by reducing readmissions have been a success, fueled by financial incentives, common-sense, low-tech interventions such as follow-up phone calls and bipartisan support for value-based care efforts.
We’ve started to see “some real movement” when we pay for outcomes, he said. 
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What an interoperability leader predicts for 2017

Published January 09 2017, 3:15pm EST
David Kibbe, MD, CEO at DirectTrust, which offers the Direct Project secure messaging software, believes five overarching trends will influence the health information technology industry during 2017. His opinions are personal and do not reflect those of member organizations within DirectTrust.
Policymaking: Efforts to repeal the Affordable Care Act and move Medicare toward fixed contributions could lead to months of inaction, during which investments in health IT and new innovations may lag.
IT momentum remains: While uncertainty discourages change, Kibbe doesn’t see major shocks to the health IT economy. “The themes of using health IT to improve care coordination, to manage patient populations through better collection and data use, and the value of advances in telemedicine will continue to be heard and supported by both the private sector and the federal government in a bipartisan fashion,” he says. Further, the newly enacted 21st Century Act will increase the transparency of health IT vendors and their products, while also discouraging the blocking of health information.
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How to make sure a telehealth program pays off

Published January 09 2017, 3:27pm EST
As the cost of healthcare increases and access decreases, hospitals and healthcare providers are searching for alternative methods of care delivery to supplement the existing care pathways. Over the last decade, telehealth technologies have emerged as a means to solve many of the concerns around access and cost.
Despite various barriers to growth – from reimbursement and regulatory barriers, to concerns around adoption, or lack of evidence to support the effectiveness of telehealth programs—data indicates that telehealth adoption is on the rise and shows no signs of slowing down.
As investors continue to fund the development of telehealth technologies, the number of hospitals using telemedicine is also increasing. According to the 2016 HIMSS Analytics Telemedicine study, about 45 percent of existing hospitals use some form of telehealth, which is expected to increase to about 53 percent by 2020. Still, many healthcare providers across the country are struggling to demonstrate both the financial and clinical value these programs bring to their hospitals and patients.
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EHR usage still too slow

Long-term care providers are feeling pressure to implement an EHR, despite facing hurdles like costs and resources. Many complain about a lack of options allowing interoperability with hospitals and o
Nursing homes and their counterparts in assisted living and other senior living settings may be sluggishly dipping their toes into the waters of electronic health records. 
But that hasn't stopped a highly motivated and, arguably, savant-level vendor community from building what many see as a linchpin of the new caregiving world.
Despite the bells, whistles and some amazing new features and efficiencies, however, adoption is not going fast enough for many.
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US IoT Working Group: IoT personalizes care, reduces cost in healthcare

Written by Jessica Kim Cohen | January 06, 2017 | Print | Email
The Internet of Things Working Group, co-chaired by U.S. Representative Bob Latta (R-Ohio) and U.S. Representative Peter Welch (D-Vt.), has released its year-end report.
The working group was established to identify benefits and challenges facing IoT consumers and stakeholders, issues affecting deployment of IoT technologies and the potential role of the federal government in advancing IoT technology. In off-the-record roundtables, the working group determined IoT can personalize patient care, increase healthcare access and reduce overall costs.
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Physicians, patients at odds over value of health data

Jan 6, 2017 9:51am
Physicians and patients are at odds over the value of personal health data.
It’s a big disconnect: The vast majority of physicians say healthcare data is overwhelming, redundant and doesn’t make a difference in care quality. But most patients say their primary care physician's office should store any personal health data they ask them to.  
That’s according to a new Black Book research survey in which 94% of physicians said they’re deluged with what they think is useless data, while 91% of their tech-savvy patients want them to have more of it.
The survey also found that patients don't completely trust the privacy and security of health information technology such as electronic health records and patient portals.
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2017 emerges as pivotal year for FHIR interoperability standard

Published January 05 2017, 7:09am EST
Health Level Seven International’s Fast Healthcare Interoperability Resources (FHIR) application programming interface is moving closer to becoming a mature standard, with the “normative” version slated for release sometime in 2017.
Standards are widely perceived as providing the greatest potential for achieving national health IT interoperability in the near future. In particular, FHIR is seen by industry stakeholders as a promising solution to the complex interoperability challenges that are confronting healthcare organizations.
Standard for Trial Use (STU) 3 is the next release of the FHIR specification before it reaches a normative level, which is defined by HL7 as content that has been subject to review/production implementation in a wide variety of environments, has been “frozen” and is considered to be stable.
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Patients don't trust health information technology

Jan 5, 2017 11:03am
A whopping 96% of consumers worry about the security of their financial information as data passes from providers to payers.
More than 50% of consumers are skeptical about the benefits of healthcare information technologies, including patient portals, mobile apps and electronic health records. And fully 70% of Americans distrust health technology, up sharply from just 10% in 2014.
High-profile cybersecurity incidents were part of the reason patient respondents don’t think providers are keeping their information private and secure, the Black Book research survey of more than 12,000 adults found.
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Global telemedicine market to hit $113B+ by 2025: 4 trends to note

Written by Anuja Vaidya (Twitter | Google+)  | January 03, 2017 | Print | Email
The global telemedicine market is anticipated to grow rapidly through 2025, according to a Grand View Research report.
Here are four market trends to note:
1. The global telemedicine market is expected to reach $113.1 billion by 2025.
2. Increasing incidences of chronic conditions and the rising demand for self-care are boosting market growth.
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The global state of eHealth: emerging trends and regulatory developments

What developments are shaping the interactions between technology and health? A look at how the rapidly growing E-Health space is advancing human welfare

Health and medicine specifically, have always been a domain at the forefront of human technological advancement, as motivated by the need to survive and adapt to infirmity.
The field is then understandably flourishing more than ever upon exposure to the new levels of innovation that the digital age brings, as evidenced by the rapid emergence of eHealth as a definitive startup category in its own right with an industry valuation of just over $85 billion in 2014.
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Enjoy!
David.

Friday, January 20, 2017

I Really Wonder How This Nonsense Proposal Ever Saw The Light Of Day.

I spotted this last week.

Trial to give pharmacists more power over scripts

| 12 January, 2017 |  
Pharmacists will be free to change medication doses, issue repeat scripts and perform point-of-care tests for patients with chronic diseases under a trial starting this year.
Running for 18 months, the Victorian trial is a way of freeing up GP time to deal with complex clinical issues, according to the state government.
Supporters argue the trial will not fragment care and GPs will retain control over what happens to patients.
The GPs taking part will write shared care plans that will guide pharmacists in monitoring and refining the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, and those on anticoagulation medications.
Only pharmacists with an established relationship with a GP clinic will be able to take part.
But under the trial, they will perform blood pressure, spirometry, INR and lipid panel tests to monitor patients’ conditions.
They will be expected to report regularly to GPs and refer the patient back if their condition changes.
The state government says many GP visits for patients with chronic diseases merely involve renewing prescriptions or making dose adjustments, a view the Pharmacy Guild of Australia claims is supported by research.
AMA Victoria described the proposal as risky when it was first flagged in 2015.
Members of the AMA have since worked on the government’s advisory group to work out details of the trial, including the four chronic conditions considered suitable.
The trial will start off with just three pharmacies and three GP clinics, with one trial site in Melbourne and two in rural areas, and a cap of 30 patients at each site involved. 
More here:
The proposal is so controversial that it attracted 34 on-line comments in only 3 days!
To me the huge issue is just how complicated it will become when something goes wrong. Who is to blame and which insurer is liable.
Secondly with a tiny trial it might just work – but the scalability has to be pretty dubious.
Thirdly how will all this work with electronic medication record and dispensing systems? – there has to be a lot of risk for mistakes in this area.
This really should just be stopped before it starts in my view. If the pharmacist has an issue with a script – simply ring the prescriber!
David.

Thursday, January 19, 2017

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

January 21  Edition.
The macro view is dominated this week by the inauguration, on Jan 20, of the new US president.
There is no doubt this is a biggie with the evolving Russian bromance and the systematic poking of the Chinese Dragon.
FWIW my view is that the game has been changed in a set of rather unpredictable and sinister ways.
This does not bode well:

Trumponomics gets the thumbs down from Nobel-winning economists

Rich Miller
Published: January 8, 2017 - 12:09AM
A pack of Nobel Prize-winning economists gave Donald Trump and his policy plans the thumbs-down on Friday, with one saying the president-elect's programs could lead to a deep recession.
Speaking on a panel during the first day of the annual American Economic Association meeting in Chicago, the Nobel laureates voiced a variety of concerns about the billionaire developer's stance, from his haranguing of US companies about their outsourcing plans to the risk that his tax and spending proposals could lead to run-away budget deficits.
"There is a broad consensus that the kind of policies that our president-elect has proposed are among the polices that will not work," said Joseph Stiglitz, summing up the views of the panel that included his fellow Columbia University professor Edmund Phelps and Yale University's Robert Shiller.
Such disapproval though is likely to fall on deaf ears. Trump rode to victory on the back of an unconventional campaign that was short on advice from PhD economists -- relying more on a team of wealthy businessmen -- and there's no indication that's about to change.
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Also, read this superb report to see what I mean:
This also points at the world in flux:

Davos Wonders If It’s Part of the Problem

Did the global elite’s devotion to borderless capitalism sow the seeds of a populist backlash?
by Matthew Campbell and Simon Kennedy
13January,2017, 11:00 am AEDT
Kenneth Rogoff can pinpoint the moment he started to grow concerned Donald Trump would be the next U.S. president: It was when Rogoff’s fellow attendees at the World Economic Forum’s annual meeting last January said it could never happen. “A joke I’ve told 1,000 people in the months since leaving Davos is that the conventional wisdom of Davos is always wrong,” says the Harvard professor and former chief economist of the International Monetary Fund. “No matter how improbable, the event most likely to happen is the opposite of whatever the Davos consensus is.”
The repeated failure of business and political elites to predict what’s coming—last year, that included the U.K.’s vote to leave the European Union—doesn’t strike those returning this month to the Swiss Alps as very funny. After a year in which political upsets roiled financial markets and killed off the careers of once-dominant Davos-going politicians, the concern for delegates attending this year’s meeting isn’t that their forecasts are often wrong, but that their worldview is.
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Note as I type there are rumours of the British PM (Theresa May) planning a very hard Brexit which will surely cause trouble this week as well.
Locally we seem to have been careless enough to lose our senior Health Minister to a touch of abuse of public funds – although the amounts were trivial compared with the financial abuse on us all of the myHR!
For mine 2017 is shaping up as being way too interesting!
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Here are a few other things I have noticed.
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National Budget Issues.

The pension is a victim of the great Australian muddle

Emily Millane
Published: January 3, 2017 - 12:00AM
In 1966, Richard Downing, professor of economics at the University of Melbourne, appeared on an ABC television forum on whether the pension means test should be retained. With high levels of old age poverty, there was much debate at the time about the design of the age pension and whether the means test should be abolished. Downing was an advocate for retaining the means test, where "benefits go to the poor and the benefits are paid for by the people who are not so poor, because they are rich enough to pay taxes".
This is one view of how the social security means test is intended to work. The changes to the means test that took effect on January 1 are to bring the reality closer into line with the intention of the system. 
There are two deeper stories going on here, not that you would know it from the media maelstrom and the unedifying spectacle of the ACTU's robocalls to pensioners who stand to lose their benefits. 
Firstly, the means test changes are imperfect and result in some unintended consequences. 
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Rent or buy? The evidence is in

Jessica Irvine
Published: January 9, 2017 - 12:00AM
There is perhaps no question more vexing for young Australians today than the decision whether to buy or rent a home.
Of course, for many, there is no choice at all. Lacking the substantial deposit required to enter the property market in many Australian cities, they rent by default.
But for many, the logic of home-ownership is unquestionable. Rent money is dead money. Why pay off someone else's mortgage? Property prices always go up.
But this one-eyed view of property ownership overlooks some of the substantial costs involved. There's stamp duty, maintenance, local council charges, water bills and strata levies to consider. Plus the hundreds of thousands of dollars in interest payments.
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Retirement will disappear like the fax machine

Elizabeth Henderson
Published: January 9, 2017 - 12:00AM
My children and I were born into different technological worlds but one thing we have in common is none of us had heard of a fax machine until our early teens. My daughter once asked "Mum, what's a fax?" I could've asked the same question at her age. Although 1990s office workers couldn't imagine working without one, in truth barely a generation relied on the fax for any meaningful period.
Australians today can't imagine working without retiring, spending decades of healthy, active years not needing to work. A century ago retirement barely existed. In the late 19th century, half of American men aged 80, and three-quarters of British men over 65, worked and only a minority lived that long to begin with. Most people worked until they died. A recent ad features a child and his grandfather visiting a museum exhibit of a couple driving in a convertible. "What are they doing grandpa?" the child asks. "They're in retirement," grandpa responds longingly. Grandpa may well have had to explain the exhibit to his own grandfather too.
Australia introduced the aged pension in the early 1900s when life expectancy at birth for men was 55 and for women, 60. If you made it to pension age, and most didn't, you'd expect to live on the pension for no more than a decade.
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Morrison rejects IMF, OECD calls to use boost debt spending

The IMF is also pushing Australia to increase its budget spending.
  • The Australian
  • 12:00AM January 9, 2017

David Uren

The OECD believes falling interest rates have given the Australian government the scope to more than double its net debt to stimulate the economy, while it calculates that it could spend an additional $8 billion a year on ­infrastructure for about two years without affecting the long-term trajectory of its debt.
Both the OECD and the IMF have been urging the Australian government to ease up on budget repair and lift spending as part of their global campaign to lift ­economic growth.
They are using the concept of “fiscal space”, or the ability to raise additional debt without ­provoking an adverse market ­reaction, to argue that governments, particularly in the ­advanced world, should be using fiscal policy rather than relying on central banks to support their economies.
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GOLDMAN SACHS CHIEF ECONOMIST: There are 3 big risks for 2017

Jan 10, 2017, 7:11 AM
LONDON — The second half of 2016 will probably be remembered for its geopolitical shocks and uncertainty rather than as a period of benign economic data.
But to do so would be to only have one half of the story.
According to Goldman Sachs’ measures of economic activity, the last two quarters of 2016 were really pretty encouraging.
“If you look at economic data for the past few months, there’s been an impressive acceleration in growth,” Jan Hatzius, chief economist at Goldman Sachs, said in a speech in London on Monday.
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Governments are bystanders as inequality festers

Tracey McNaughton
Published: January 10, 2017 - 12:00AM
It is ironic that just as governments around the world are coming to the realisation that large portions of their populous have been left behind as a result of rising income and wealth inequality, the political capital needed to do anything about it has been depleted.
Voters worldwide are increasingly turning to non-mainstream parties that promote a more nationalistic agenda. With so many disparate parties winning support, the formation of a stable, effective government has become more difficult.
Globalisation, free trade, large-scale immigration programs, and free-market ideologies in general have produced the most rapid progress in living standards that the world has ever seen. Millions have been raised out of poverty.
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Goldman Sachs tips three key areas for equity investors

Julie Verhage
Published: January 10, 2017 - 7:09AM
Goldman Sachs has identified three big items that will shape the equity landscape this year - and they all hinge on the impact of President-elect Donald Trump's policies.
Tax reform, the strength of the US dollar and the pace of wage gains stand to set the tone on the American market this year, chief US equity strategist David Kostin and his team at the investment bank wrote in a note to clients. Here's why:
Tax Reform
"Corporate tax reform represents key source of hope,'' the strategist wrote. That's especially true for sectors that tend to have higher tax rates, such as brick-and-mortar retailers, energy producers and makers of consumer products.
It's not yet clear how Trump's proposed measures will look when they come out of Congress, so Goldman ginned up a table on how various scenarios would impact earnings for S&P 500 companies. A cut to 25 per cent from the current 35 per cent statutory rate on domestic income, for instance, would boost profit in the large-cap benchmark by 8 per cent.
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Savings account interest rates dip below inflation

Clancy Yeates
Published: January 10, 2017 - 2:40PM
A handful of banks have cut the interest rates paid to savers over summer, as average returns on a key type of savings account dipped below the rate of inflation.
In a sign of the miserable returns being paid to many savers, including retirees, analysis shows several banks, including ANZ Bank and Westpac, cut interest rates on savings accounts in December.
Canstar, an interest rate comparison website, said there had been 13 cuts in savings account interest rates across its database of banks in December, compared with only two increases. There were also 16 cuts in savings account rates in November, compared with one increase.
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Scott Morrison’s targeted tax strike on digital economy

  • The Australian
  • 12:00AM January 11, 2017

David Crowe

David Uren

The federal government is ­urgently preparing new budget measures to deal with the explosive growth of the online economy, as Scott Morrison vows to confront the growing pressure on tax revenue.
The plans include a pilot program to put more government services online as Australians increase their digital payments to more than 10 billion transactions a year, while scaling back their use of cash and cheques.
After creating a “Google tax” to stamp out tax avoidance and a “Netflix tax” to capture more ­online purchases, the government is drafting a wider digital agenda for the year ahead in the hope that the shift away from cash could shore up the integrity of the tax system.
“You’ve got to make sure your tax base is just not comprehensive but make sure it is modern,” the Treasurer told The Australian.
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Pensioners' payments reduced amid anger over politicians' entitlements

Bianca Hall and Naomi Neilson
Published: January 12, 2017 - 7:47PM
Judith Daley is one of the unlucky ones. Amid simmering anger over politicians' entitlements and the government's Centrelink debt clawback, the Sydney retiree is one of about 327,000 pensioners to have had her pension reduced or cut altogether this year.
Ms Daley, 72, has lost her part pension and health benefits under changes to the aged pension introduced on January 1.
"I have lost the health benefits that come with the age pension card," Ms Daley said. "I don't quite know at this stage what that means. I have serious ongoing health issues and they will be degenerative as I age."
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We haven't learnt anything from the rise of Trump and Brexit

John Hewson
Published: January 13, 2017 - 12:00AM
German philosopher Georg Hegel once remarked: "Rulers, statesmen, nations are wont to be emphatically commended to the teaching which experience offers in history. But what experience and history teach is this – that people and governments never have learned anything from history, or acted on principles deduced from it."
The key question for 2017 is just how much have the "elites" learnt from recent experience? How have they actually responded to Brexit, Trump, Hanson, and so on.
The obvious answer, so far, is that the "elites" have simply not learnt anything: they have not responded substantially, rather attempting to close ranks against the "outsider", treating such events as but a mere aberration to their social agenda, soon to return to their "normal". This will not, and cannot, be a sustainable response.
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Why we can't be sure we are in a housing bubble

Michael Potter
Published: January 13, 2017 - 11:20AM
House prices are out of control in some Australian capitals. And this week comes a proposal that this should be countered by halting interest rate cuts, a move that would not only fail to solve the problem but also have detrimental impact on the rest of the country, where housing is not booming.
In 2016, the prices of dwellings rose by 16 per cent in Sydney, 14 per cent in Melbourne and 11 per cent on average across all the capitals, according to CoreLogic, but prices fell by 4 per cent in Perth.
The ABS has capital city prices almost doubling since 2003, with Sydney prices increasing by 50 per cent since 2013.
Certainly, this rate of increase cannot be sustained. House prices in the booming cities are growing much faster than incomes, and are either going to slow or fall. It may not happen soon, but it will happen.
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Lessons still to learn as 10-year anniversary of GFC approaches

Jessica Irvine
Published: January 14, 2017 - 2:15AM
Where does the time go? This year will mark the 10th anniversary of the onset of the global financial crisis.
By the middle of 2007, the wheels had well and truly started falling off the US sub-prime mortgage market, eventually prompting the collapse of US investment bank Lehman Brothers in September 2008.
As the world financial system froze over, the Rudd government unleashed the biggest fiscal stimulus in Australian history.
Two major packages totalling almost $100 billion were announced, including cash cheques, pension boosts, first-home buyer incentives, local council grants, school halls and pink batts. Everything but a kitchen sink.
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Health Budget Issues.

Health Minister Sussan Ley apologises for Gold Coast trip, agrees to repay expenses

Matthew Knott
Published: January 8, 2017 - 6:09PM
Embattled Health Minister Sussan Ley has admitted she made an "error of judgment" by charging taxpayers for a trip to the Gold Coast in which she bought a $795,000 apartment and will repay the cost of four taxpayer-funded trips.
Ms Ley's decision followed a conversation with Prime Minister Malcolm Turnbull in which he said she had not met the standards he expects of ministers. 
Ms Ley had come under intense pressure to provide a full explanation of the May 2015 trip or resign from the ministry since it was revealed on Friday. Government records show Ms Ley has frequently visited the Gold Coast on taxpayer-funded trips over recent years. 
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Maternity services bundled payments ‘will put mums at risk’

  • The Australian
  • 12:00AM January 11, 2017

Sean Parnell

A landmark bid to save money in public hospitals by bundling government payments for maternity services has gained support, but not from obstetricians and gynaecologists, who fear it will put vulnerable mothers at risk.
The Australian last year ­revealed the Independent Hos­pital Pricing Authority, which ­advises governments on activity-based funding, wanted to introduce a package deal for treating expectant mothers to encourage providers to look for more ­efficient models of care.
For example, a hospital might be paid a set amount to cover all staff, interventions and accommodation, thereby encouraging hospital managers to negotiate better deals with clinicians.
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Linking hospital funds to error rate raises fears of secrecy over bungles

  • The Australian
  • 12:00AM January 12, 2017

Sean Parnell

A plan to penalise public hospitals financially for procedures that resul­t in errors or avoidable side effects is proving more difficult than governments first thought.
Some jurisdictions are concerned that hospitals might be more reluctant to admit to mistakes if they will lose money as a result, while others question what it means for an adverse outcome to be considered preventable.
The Council of Australian Governments agreed last year to work on new hospital funding mechanisms that penalise unnecessary or unsafe care, with federal Health Minister Sussan Ley putting the Independent Hospital Pricing Authority in charge.
But the first round of IHPA consultation has elicited a cautious response from state and territory governments, even if the federal Department of Health is in favour, and suggests implement­ation will be a slow process.
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Sussan Ley: Where it all went wrong

  • The Australian
  • 3:08PM January 13, 2017

Sean Parnell

All Sussan Ley had to do was calm the health stakeholders and leave the big decisions to others. Yet she spooked everyone with her expenses, becoming a symbol of what is wrong with governments everywhere, and lost her job before she could do anything with it.
Ley was elevated to cabinet just before Christmas 2014, the then prime minister Tony Abbott recognising her potential and the health sector welcoming a pleasant change from her predecessor, the abrasive Peter Dutton.
The new minister set about consulting stakeholders and was forgiven for some early misunderstandings about health. Being a cabinet newcomer, Ley was also forgiven for lacking the authority that comes with big portfolio experience; it would come in time.
The key policies – largely consolidation and prioritisation of spending – were already in place, and Ley just had to keep things ticking over. The former punk rocker, waitress, cleaner, farmer, air traffic controller and commercial pilot settled into her new role and knew her place. Even after Malcolm Turnbull took the leadership, Ley remained health minister.
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Superannuation Issues.

Barriers to home ownership the real hurdle to a comfortable retirement

John Collett
Published: January 10, 2017 - 2:01PM
Our super system is not in need of restructuring as some commentators suggest.
But millennials worried about whether they will ever save enough to afford a comfortable retirement should be giving priority getting into the housing market. Property owners retire wealthier than renters.
It's not only that capital city property prices have risen strongly leaving renters in the shade, the family home is exempt from assets test applied for the age pension.
No capital gains tax payable on the sale of the family home and, given the political sensitivities of the issue, that's not likely to change.
There's also peace of mind that comes with home ownership.
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Health Insurance Issues.

Arthur Sinodinos moves into health hotseat on insurance premiums

  • The Australian
  • 12:00AM January 10, 2017

Sean Parnell

One of the first tasks Arthur Sino­dinos will have in the health portfolio is deciding how much health insurance premiums should rise this year and what the government can do to help cash-strapped consumers.
Sussan Ley stepping aside as minister comes at a challenging time for the Turnbull government, which was expected to spend the year on policy after the Coalition’s first term of spending cuts ended in the so-called “Medi­scare” election.
Ms Ley had been more consultative than her predecessor, the abrasive Peter Dutton, and has major stakeholders more willing to discuss issues than debate them. Nonetheless, Treasury still has a heavy influence on health decisions — Ms Ley said as much during the election campaign — and the arrival of former assistant treasurer Sinodinos may be met with suspicion.
Among the first tasks for Senator Sinodinos is deciding the level of insurance premium increases for April 1.
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Private health insurance nears crisis point as costs soar

  • The Australian
  • 12:00AM January 14, 2017

Sarah-Jane Tasker

Health insurance chiefs have warned that the issue of affordability is close to crisis point as the head of the industry body argues reform will take “more courage” from the Turnbull government than it has previously shown.
HBF boss Rob Bransby, president of Private Healthcare Australia, said 2017 had to be the year when the government showed it was serious about putting a brake on the rising health costs that were forcing up insurance ­premiums.
The call for reform comes as Malcolm Turnbull is forced to find a new health minister after Sussan Ley resigned yesterday following her travel expenses scandal.
Ms Ley’s replacement will be taking on the portfolio at a crucial time for the sector, with a number of reviews under way and this year’s annual premium increase close to being finalised. The rise will increase affordability concerns and sector heads have warned they expect downgrades and almost no growth this year.
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Aussies paying more but getting less cover from their private health insurance

http://pixel.tcog.cp1.news.com.au/track/component/article/f520ec95ee04c82cf08e447a20c92fb4?esi=true&t_template=s3/chronicle-tg_tlc_storyheader/index&t_product=HeraldSun&td_device=desktopSTEPHEN DRILL AND KAREN COLLIER, Herald Sun
January 14, 2017 8:00pm
AUSTRALIANS are paying more but getting less cover from their private health insurance.
The latest Australian Prudential Regulation Authority report into health funds shows a drop in payouts for dental, chiropractic, physiotherapy and optical extras of up to six per cent.
iSelect Health spokeswoman Laura Crowden said some private health insurers were reducing benefits in new policies to rein in rising costs.
Pregnancy, spinal and brain surgery were increasingly excluded from mid-range cover.
Cover for insulin pumps, cochlear implants, dental implants and weight loss surgery were also being removed from more products.
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I look forward to comments on all this!
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David.