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Tag Archives: Medicare

If you have regular pathology tests, here is something you should know

A little back story may be appropriate. In February 2015 I looked at Medicare. It was noticeable that pathology services constituted a large percentage of the total services. I doubt the proportion has dropped since. I contribute to that proportion: I have auto-immune conditions. I spend considerable time and money ensuring they are kept under control. Well, as under control as possible. I’m under the care of three specialists and a general practitioner. Every now and then extra specialists get involved, such as a skin specialist or an ophthalmologist. One of these days I’m going to have a medical party for them all.

As we all know, blood tests are very useful to medical professionals. At one stage I was having regular blood tests under Rule 3X due to the risk of possible rather nasty side effects of a drug I was on. As a patient, I don’t know the finer details of Rule 3X, but I do know it allowed me to have regular tests based on the one pathology request. Necessary in many medical situations and very useful.

At one point in time, early in my “what is wrong” phase, I happened to have medical appointments scheduled in the same week with different specialists. The week before the appointments I went into the pathology collection point with two pathology requests. I later received an invoice for one of the tests. At the time, I paid little attention. I knew my gastroenterologist had ordered a non-rebateable test at some point so assumed it was that and just paid it. As you do, in most cases.

Some time later I again had coinciding appointments and again attended the collection point with two pathology requests. All my specialists monitor my thyroid function. I was told if I had the two pathology requests done on the same day, one would not be bulk-billed. Naturally, I asked why not. Surely, I suggested, only one test was needed and then the result could simply be shared. Same blood, same day, same test. Seemed logical to me. More than that, it seemed cost-effective.

The technician was only able to advise those were the directions from head office, but she believed Medicare wouldn’t pay a second rebate on the same day. Neither should Medicare pay two rebates for the same test on the same day, I thought to myself. By this stage I had been made redundant, so time was really not a major issue, however money was, so I went on two different days to have the blood tests.

When I saw one of my specialists, I mentioned the situation to him. He was in such a state of disbelief, he called a contact within the pathology company. The conversation went something like this:

Specialist: Explains what I have described above and asks if this is correct.

Pathology: “How do you know that?”

Specialist: “Because a patient is sitting in my office telling me!”

My explanation was confirmed by the contact. However, if the specialist hand-wrote a lengthy instruction on the pathology request to share the results of duplicated requests, then they (the pathology company) would do it. My specialist, dear caring man that he is, was sure this was because they were caring for the patients, to ensure the right doctors got the right results. Rubbish, I countered, the rebates are their revenue stream. It was a light-bulb moment for the doctor. That, I said, is why I am the accountant and you are the doctor!

For a few months my appointments didn’t coincide so I really didn’t worry about it. Then the week before last, I got hammered. Now I am working and studying and driving a lot. In what little time remains I sleep, exercise – or visit doctors. As it happened, I had all three appointments close together and the way my schedule went that week I had one opportunity to get the blood tests done. Three pathology requests. Thyroid function on all three, plus some other duplicates.

I was warned I would get billed for the thyroid function test TWICE and some others singly. Wouldn’t I prefer to come back tomorrow and the next day? That is, get the three requests done on three consecutive days so all the tests could be bulk-billed. No, I wouldn’t prefer that at all, I simply do not have the time, was my somewhat irritated response. Of course the aforementioned lengthy handwritten share request was not written on any of the forms this time. Not my doctors’ fault, they shouldn’t have to do that in the first place. So I’ll be paying.

I discussed the situation with my other two specialists. One was aware of the practice and our discussions I shall keep confidential. The other crossed some tests off the new form he gave me for my next visit. We are all going to co-ordinate and share a little better!

Without the operational and administrative cost details I can’t be sure, but I propose running the test once and sharing the results would be cheaper than running the test three times and generating an invoice (maybe two invoices) to me. The company may be “protecting” the revenue stream (Medicare rebates) without looking at the impact of actions on gross margin. Of course, it is a fair bet I am billed more than the Medicare rebate. When I receive the invoices I will compare.

I am told not all pathology companies operate this way, something I am going to put to the test in the coming months. After all, like many other patients, I have years ahead of me to investigate this issue! I would be interested to hear of others’ experiences.

Do you think changes should be made to the system? My specialists should not have to have a conference call to check each others’ test plans: imagine if they had to do that for many patients? I should not have to go on three separate days to have my blood tests. I specifically try to get my appointments all on the same day as this minimises disruption to other parts of my life and time off work. Consequently I am trying to have my blood tests in one hit. When it works out: if one condition flares or requires closer monitoring for a period of time, then my plans don’t work out and then the whole duplication of bloods isn’t a problem. At the moment, with everything running smoothly and in what I call “management mode” I can co-ordinate. Many other patients I am sure are in the exact same situation.

The taxpayer should not have to pay rebates for the exact same test to be performed three times on the same day. Nor should the patient.

 

Labor’s Scurrilous Lie On Medicare!

Ok, we all know that if Labor is elected that our borders will be weaker, the deficit will blow out, the tax cuts for companies won’t go through, it’ll rain all day except in drought areas and the chooks will stop laying. Not only that, we won’t have the stability that we now have because Labor changed Prime Minister twice in six years and the Liberal have only done it once in three years.

However, it’s the Labor Party who are running a scare campaign on Medicare. The Liberals have no plan to privatise it. Didn’t Malcolm say “never ever” and while some people are reminded of John Howard’s “never ever” on the GST or Tony Abbott’s “ironclad guarantee” on the Medicare safety net before the 2004 election, that’s rather unfair on Mr Turbull. He’s not the sort of man to say one thing one moment, and another the next. He said that he supports same sex marriage and the Republic and action on climate change, and he still supports all those things. Ok, he may not do anything about them but that’s because he’s been busy with the job of being PM. It’s a big job which involves working very, very hard to ensure that Labor isn’t elected because they’ve promised action on all the things that Turnbull supports, and if that happened there’d be nothing left for Turnbull to do if he ever actually gets into power instead of just being the figurehead.

Some people have unkindly suggested that the Brexit vote should be good for Labor because it should show the people the consequences of not thinking before you vote and just blindly taking your lead from the Murdoch papers. Only after the vote to leave the EU, the argument goes, did Rupert’s papers start to explain what the consequences of leaving would be. Surely it should be a wakeup call to the people of Australia. However, this overlooks the fact that most people who read Andrew Bolt will hardly be aware that the vote took place, let alone the fact that many of the “Leave” voters are rather unhappy now that they’re discovering that it may have consequences that they hadn’t considered. Not only that, but the leaders of the “Leave” campaign, such as UKIP’s Nigel Farrage now saying that they never promised that there’d be oodles of extra cash for spending on Health… Somebody else painted that “promise” on the side of buses.

But let me be quite clear here. Labor’s suggestion that just because the Liberals have a Medicare Privatisation unit set up is no reason to think that Medicare would ever be privatised. If you’ve still got doubts I suggest that you read this article from “The Guardian” written last year:

There now, what could be clearer than that. They don’t want to privatise anything. They just think it would be better if the whole thing were opened up to competition from the private sector. I mean, look how long you spend waiting to speak to someone at Centrelink, whereas when you ring any private company, your call is answered by the next available operator.

No, there’s no doubt at all. The Government has given us their assurance and they know that if they lied to us, there’d be consequences. Why just remember how people over-reacted when Tony Abbott’s “No cuts” statements were misinterpreted as meaning that they wouldn’t cut spending. People got very cross and they had to change Prime Ministers. If Turnbull was lying, why the Liberals would just have to change leaders again to appease people. And Malcolm certainly doesn’t want that. As he keeps saying, “It’s a very exciting time to be Australian now that I’m PM and anybody who isn’t saying how lucky they are is just an ungrateful whinger!”

So vote Liberal this Saturday. You know that Medicare is safe and will “never ever” be privatised and that the plan to let Telstra manage the data has been shelved and was never a real plan like the one where they support jobs and growth. You know the one; if we create enough jobs at $4 an hour then there’ll be a really big growth in the bank balances of the people employing them.

Why isn’t the Medicare rebate freeze a major issue?

By Ken Wolff

Although the former Abbott government dropped its $5 co-payment for Medicare it retained and extended a freeze on Medicare rebates that has the potential to introduce a co-payment by stealth.

Wayne Swan in his last budget in 2013 changed the timing of the annual indexation of Medicare rebates from 1 November to 1 July — effectively a freeze from November 2013 to 30 June 2014. In his first budget Hockey extended that to 2016 and then in December 2014 it was extended again to 30 June 2018 (also including some other health services and specialists from 1 July 2015), potentially saving the government between $1.3 billion and $2 billion. This basically means that the Medicare rebate has not increased since the November indexation in 2012 although the costs in medical practices obviously continue to rise.

The rebate for a GP visit for a standard (classification B) consultation remains at $37.05. This applies to patients who are not bulk-billed and is the fee the doctor receives for bulk-billed patients. So as medical practice costs will have gone up since November 2012, and will again by 2018, medical practices are under pressure to increase their consultation fees but the doctor or the patient will still receive that $37, leaving larger out-of-pocket expenses for the patient and a potential increase in the difference between costs and income for the doctor. It was estimated that this could cost the average fulltime GP $9600 in 2015 rising to $29,500 by 2018.

Research reported in the Medical Journal of Australia in 2015 suggests that the average difference in patient cost by 2018 (assuming medical practice costs rise at the inflation rate) would require a co-payment of slightly more than $8 from each bulk-billed patient, higher than what was proposed by the original $5 co-payment.

Already in 2013, the average out-of-pocket cost across all doctors was $52.06, to see a GP was $30.34 and for specialist services up to $227.68 for obstetrics: those costs for non-bulk-billed patients will have increased and will obviously increase significantly more by 2018 if the freeze continues.

While doctors’ income from Medicare is frozen, other costs for running a medical practice continue to rise: wages for receptionists and nurses, rent, medical equipment, cleaning, electricity, computers, insurance and so on.

The potential impact of these changes was spelled out by Associate Professor Brian Owler, President of the Australian Medical Association (AMA):

If the rebates don’t rise those costs have to be passed on in out-of-pocket expenses — we will see less bulk-billing, and there is the possibility of seeing a co-payment by stealth as has been alluded to by some.

I think there is a real issue for private health insurers, they’re going to have to pass on higher private health insurance premiums to people, or, there is a real chance that out-of-pocket expenses for specialist costs are going to rise significantly.

The Doctor’s bag site in August 2015 listed five reasons why the freeze is bad policy:

  1. Many practices will stop bulkbilling. … As a result fewer people will visit the doctor in the early stages of a disease. This will often make treatment later on more difficult, more stressful and more expensive.
  2. The policy disproportionately affects disadvantaged people who cannot afford a co-payment.
  3. The freeze undermines important Australian values such as equity of access and therefore encourages a two-tier health system.
  4. It is likely that more people will visit places where healthcare is free, such as already overloaded public hospitals and emergency departments.
  5. Practices continuing to bulkbill will have to change their business model: doctors will need to see more patients per hour, or practices will have to hire less staff which will affect service. Some practices will close their doors.

The impact is worsened by wider cuts in the commonwealth’s health budget, such as the reduction in funding to the states for hospitals (although an increase of $2.9 billion over three years was promised at the 2016 COAG — only a partial reimbursement of previous cuts).

In the December 2015 MYEFO the Turnbull government also announced a $650 million cut from Medicare rebates for pathology and diagnostic imaging.

Blood tests, urine tests, pap smears and tests for STIs will no longer be able to be bulk billed and patients will be forced to pay upfront.

Under Medicare rules, any patient charged these fees will have to pay the entire amount upfront and then claim a rebate back later — and the costs are not inconsiderable. It’s estimated that patients may have to pay $93 for an X-ray and more than $30 for a pap smear. And if you are unlucky enough to require a PET scan to assess cancer or a brain disease, you could be hit with a cost of $1,000. If you have a serious condition, where you need regular check-ups and tests you pay over and over again.

Health Minister Susan Ley has not ruled out lifting the freeze but gives no timeframe.

I announced when I talked about the co-payment being removed that the pause on indexation of rebates would remain but I wouldn’t like that pause to be there a day longer than it needs to be, and I recognise that essentially what it’s doing is freezing an inefficient MBS structure.

The fact that Ley can refer to the freeze as a ‘pause’ is disconcerting. I don’t think a freeze over almost six years can truthfully be called a ‘pause’.

Australian Institute of Health and Welfare (AIHW) figures up to 2012‒13 showed that individuals already paid 17.8% of overall health costs (which had risen from 16.6% in 2002‒03) and when it came to specialist (or ‘referred’) services, patients contributed 16% of the costs. If that was the situation three years ago, it can only be anticipated that the freeze and other recent changes are increasing those proportions and will continue to do so.

So the impact of the freeze could be substantial but it is no longer a major news item although it deserves to be.

<strong>What do you think?</strong>

What effect do you think the freeze is having? Are you already paying more for your medical services?

Why isn’t the freeze a more significant issue? Is it likely to become more important as the election campaign gets under way?

This article was originally published on TPS Extra.

 

Vote for Tony

By opposing same sex marriage, Tony Abbott has reinforced the notion that homosexuality is “queer” – that members of the LGBTI community are a threat to our society.

By indefinitely incarcerating asylum seekers in offshore detention camps he has reinforced the idea that refugees are not victims but criminals who pose another threat to our society.

By labelling us as lifters or leaners he has reinforced the perception that those on welfare are bludgers, scamming the system because they are too lazy to get a well-paying job.

By calling women who receive maternity leave from their employer “double-dippers” who are committing fraud, he has failed to appreciate the disadvantage women face in the workplace and denied them their workplace entitlements.

By saying he wants Sydney house prices to go up – if people are buying them they must be affordable – he shows an unbelievable ignorance of the housing affordability crisis.

By his perpetual dog-whistling about imminent terror threats from an apocalyptic death cult, as well as brief flirtations with banning cultural dress, he has alienated the Muslim community and made them the target of suspicion and abuse.

By ignoring all scientific evidence about climate change and the dangers of burning more coal, he has destroyed the renewable energy industry and damaged the global effort to avoid catastrophic weather events.

By proposing the deregulation of university fees, despite receiving the benefits of a free education and several of his ministers campaigning against fees when student politicians, he is potentially saddling our children with a huge debt before they even begin their working lives thus precluding large numbers from even considering a tertiary education.

By dismantling FttP NBN, he has made Australia an information backwater, ranked 44th and falling for internet speed. While the rest of the world moves to fibre, we are paying a fortune for Telstra’s copper network.

By stripping people of their citizenship, he is breaking up Australian families and leaving people homeless.

By demonising unions he has robbed workers of their collective voice in preparation for the resurrection of workchoices and the demise of penalty rates.

By slashing over $500 million from Indigenous funding, combined with intemperate comments about uninhabited Australia and lifestyle choices, he has shown a blatant disregard for our First People, their culture, the crisis of Aboriginal incarceration, and our failure in closing the gap.

By defunding NGOs, charities and community groups, he has caused the closure of refuges, crime prevention and mentoring programs, and domestic violence support groups.

By introducing metadata retention and criminal charges for disclosure, he has sanctioned spying on all citizens and overridden the public’s right to know what is done in our name.

By refusing to release government advice and modelling, he is robbing us of the chance to make informed decisions.

By slashing funding to the States he is making it basically inevitable that the GST will go up, greatly increasing the cost of living.

By freezing the indexation on Medicare payments, he will force doctors to make up the lost revenue – a co-payment by stealth. He has also almost entirely dismantled Australia’s national preventive health system.

By slashing funding to the CSIRO and other research bodies, he has caused many promising programs to be abandoned and we are losing our brightest researchers to other more enlightened countries who understand the value of their work.

By being unwilling to undertake economic reform, he has overseen a deterioration in all economic parameters with no upturn in sight.

By insisting on captain’s picks, usually advising his colleagues via the Murdoch press, he has alienated his Cabinet, his party room, the Parliament and the people.

By abrogating our global responsibilities towards asylum seekers and credible action on climate change, combined with gaffes too numerous to mention, he has trashed our international reputation.

But hey, he gave up billions in revenue from the carbon and mining taxes and stopped talking about the boats. And IS haven’t invaded us yet. Surely that’s enough reason to want him as our leader?

Scrap the Medicare Levy, increase GST

We have to think outside the square. I am not suggesting this concept is THE answer, by any means. I’m merely suggesting we need to look for alternative solutions and encourage ideas and discussion.

I recently suggested scrapping the Medicare Levy totally on the basis it leads politicians to focus on the wrong aspects of Medicare. “Medicare is not sustainable” they cry, yet primary care accounts for only 10.2% of the health budget. An admission to hospital costs, on average, $5,000 – even 20 GP visits a year times the rebate is a lot cheaper than $5,000. In 2012 the University of Melbourne completed a study which showed there were 7,000,000 bed days in hospital that could have been prevented (Source: Prof John Dwyer, Insight, at 27 min mark). What a saving that could be to the health budget (although there would be costs associated with the prevention).

I’m not suggesting the nation forgo the Medicare Levy revenue stream. I am suggesting we stop allowing it to divert attention from the real areas of potential cost savings. Aside from the 7,000,000 bed days, do you know that doctors have to get a new provider number when they relocate? Think of the administrative costs. What is the rationale? What is the benefit? Isn’t Dr J. Smith the same doctor irrespective of whether she or he is located in Euroa or Williamstown? Doesn’t this make reporting and auditing of a doctor’s performance or claiming patterns over his or her career more difficult and possibly expensive?

Subsequent to my admittedly rather off-the-cuff suggestion of scrapping the Medicare Levy, I was reminded that a number of our working population still have access to forms of salary sacrificing that have disappeared for many of us due to Fringe Benefits Tax (FBT). About twenty years ago we could salary sacrifice a car, private school fees, health insurance premiums and a number of other expenses. When FBT was introduced, the salary sacrificing of old virtually disappeared. Of course CEOs still receive shares and other “indirect” remuneration, but the average management level employee suddenly had to pay their own health insurance premiums. For a while I was lucky and worked for an international company that had a global policy of paying health insurance premiums, irrespective of FBT in Australia, but it is no longer the norm for the majority of workers.

FBT doesn’t apply to all employees the same way. Not-for-profits have certain concessions, enabling them to provide salary sacrificing the commercial world no longer offers. Government department employees and politicians, for example, can take advantage. In June 2013, 16.4% of the working population in Australia were employed in the public sector. Not all of them would have access to salary sacrificing, but possibly enough to make a dint in the Medicare Levy revenue stream.

We are know there are various ways of reducing taxable income and minimising income tax. Those who have higher earnings have more opportunities to do so than the average wage earner or salaried middle manager.

When income tax in minimised, so is the Medicare Levy. After all, it is assessed on taxable income. Get taxable income below the magic threshold and receive a higher rebate for private health insurance or avoid or reduce the Medicare Levy Surcharge.

Yet there is no reduction in rebate for those who may be shirking their fair contribution. Surely a better collection mechanism would be via the GST system, for the same reasons GST was implemented in the first place: those with a higher disposable income spend more and therefore pay more in GST.

There are, therefore two major problems with the Medicare Levy as it stands. First, it is distracting, as stated above. Secondly, it can be minimised by the very taxpayers who can most afford it. Increasing the Levy places the burden on those who can least afford it and does nothing to address the question of focus.

The challenge with the concept of moving the collection to the GST collection method is that we have a massive, expensive bureaucracy “managing” the collection and claiming back of GST by business. The businesses would not, I suspect, be overly thrilled with the idea of being expected to contribute to the universal health system when paying GST that is not claimable as a tax credit under the GST legislation. Edited to clarify – I am only referring to any GST that did not qualify as a tax credit under current policy. There is no suggestion the increase would be treated any differently. Yet why not? Is it not in the interests of business to have a healthy workforce? What is the impost on business of GST not able to be claimed as a tax credit? The costs of compliance could well be higher, although I’ve never set about analysing it. The end consumer is the one paying the bulk of the GST, as illustrated very nicely by the manufacture and sale of a table on the Australian Tax Office web site. An awful lot of toing and froing for $30, if you ask me. We have some very inefficient systems, we do. That is a debate for another day.

eHealth and the silo culture of medicine

In February SBS Insight broadcast Saving Health. If you missed it, it is worth watching given recent Medicare funding discussions.

As a patient seeing multiple health professionals and having registered, in great hope, for eHealth, I was very interested to hear the doctors thoughts about their own profession. I understood the patients’ perspectives all too well.

There was a general consensus from the medical personnel about the silo culture of medicine in this country. As Dr Ranjana Srivastava said (in relation to repeat testing), “when doctors work in silos, you kind of don’t want to get into other people’s way”: we see this in many walks of life, not just medicine. Dr Charlotte Hespe spoke about the difficulties of getting results across barriers of fragmented communication, Dr Nick Bretland spoke of having to fax (yes, fax) forms to a public hospital to get x-ray results. I had an MRI and the films were available on my smartphone 5 minutes after the scan. Yet the GP has to fax forms to get the results? Bureaucratic red tape forms many of those barriers.

Professor John Dwyer stated ” … we do not have a patient focused health care system.” Assoc. Prof. Terry Hannan of Launceston General Hospital said, “patient centred care is the patient having their own record.”

This is where eHealth comes in. Two people in the studio audience had signed up for eHealth. TWO! Once I discovered I was unwell, I signed up for eHealth. The driver for my doing so was a very embarrassing discussion with my gastroenterologist.

“Have you had a colonoscopy before?”

“Yes, I have, years ago.”

“Who did it?”

“Ummmm, I’ve forgotten.”

“Where did you have it done?”

“Ummmm, I’ve forgotten.”

eHealth would solve that problem, nicely, wouldn’t it?

Not so much. Watching the above Insight episode, I learnt I actually have to have my GP upload some sort of summary, and according to Dr Bretland he had initially had to fill out paper forms to send in to establish his patients’ eHealth records. That will explain the scanty nature of my own eHealth record – I’ve not discussed it with my GP at all.

Candice Kriewaldt, a patient with rheumatoid arthritis, spoke of having to navigate the system herself and collate her own medical record. She highlighted the difficulties of getting medical records from one specialist to pass on to a new specialist and the problems that lead to in her treatment. I do exactly the same as Candice. I have a pretty pink folder I carry around with pathology requests pending, results, imaging CDs and details of medications.

The programme makes it reasonably clear the medical profession in Australia is still very paper based, despite the availability of technology. It appears some 4% of Australian’s surveyed expressed concerns about privacy, so eHealth is not yet where it could be or should be. May I suggest we let the 4% opt-out if they so wish and let the rest of us have our eHealth fully functional!

Here is a screen shot from my eHealth record.

No data about my MRI

No data about my MRI

The eHealth website says:

Your eHealth record allows you and your doctors, hospitals and other healthcare providers to view and share your health information to provide you with the best possible care.

I had taken “share your health information” to mean all my recent scans and blood test results would be there. After all, I had scans available on my mobile phone five minutes after I had the scans! Surely they would be on the big fancy new eHealth web site? Well, actually, no, they are not there. I dug a little deeper into the FAQs (that means Frequently Asked Questions for the uninitiated) and found out why.

It is expected that you may start to see your pathology and diagnostic imaging reports in your eHealth record from mid-2015, once the Clinical Information Systems used by healthcare providers have been upgraded with the functionality to upload these reports to your eHealth record.

My pathology page looks equally empty.

Pathology

I have had SO many pathology tests! Both my endocrinologist and my rheumatologist test my thyroid function. Sometimes I have managed to co-ordinate the testing so I get one test and it gets shared to the two specialists, but that is me, the patient, doing the co-ordinating, not the doctors. I also ask for the results of tests to be sent to all three specialists and my GP – when I remember. In my view, eHealth should solve these issues. Unnecessary testing is estimated to be worth about six or seven billion dollars a year. This would sure help fight the funding “shortfall” of Medicare!

As for any actual medical information, the claims via Medicare are there too, but not much information that would be useful to a consulting specialist. If I look at the record for my last specialist appointment it says:

Consultant Physician (other than in Psychiatry) Review of Referred patient treatment and management plan – Surgery or Hospital

and gives the provider’s name. There is information about me (name, gender, age, date of birth, ID number) and not much else. In fact, it has my name, age, gender, ID number and date of birth in the header of the record and in the detail of the record. We call that data redundancy. I’m looking at my records, surely I only need to be told all that once. Even if a new doctor was looking, I think a doctor is probably smart enough to read it once and “get it”. There may be a reason for this duplication: I’d love to hear what it is! At the very least it would tell a new doctor who to contact if he needed more details, so that is something although there are no contact details for the doctor. I don’t know how many doctors have the same name, but I assume there may be more than one called Mary Jones. I tried Yellow Pages to prove my point, but couldn’t sort or filter by name. The joys of technology.

Have you ever noticed that referrals are still paper based? Dr Hespe raised the point that none of the specialists she refers to can accept electronic communication. The medical profession can do some of the most amazing things with imaging our bodies and surgical techniques have improved dramatically – but the same specialists can’t accept electronic referrals?

I can understand sharing information without a central system is difficult. Doctors work in various locations: their office, the public system, the private system, they are in theatre or on ward rounds. It is not always easy to just pick up the phone and say, “Hey Fred, we have this mutual patient….”

I expected I would be able to log on to eHealth and nominate my doctors to have access so they could all see everything. I still hope we get there. This would help break down the fragmented communication and the silos.

My son had bi-lateral de-rotation osteotomies at the Royal Children’s Hospital. The hospital has gone electronic: we have an xray and when we go upstairs to see the Professor, the xrays are on his computer screen. Yet they sent a paper letter to us to give to our GP. There is no record on eHealth that my son had this major surgery and has metal plates in both legs. I was showing the GP photos of the xrays on my phone the other day.

We have recently had endless discussions about Medicare being unsustainable. How much could we save by modernising what appears to be very outdated systems, processes and procedures? What could we achieve by eliminating some of the unnecessary red tape the doctors referred to? These are the questions we need to be asking. We need politicians with vision.

On a technical note, there are a multitude of systems involved and most of of them don’t “talk” to each, other however this is not insurmountable. It is not necessary to have real time interfaces to eHealth from the various systems in use by the many, many health providers. Most doctors (even specialists) do have their patient records on computers these days. These could be exported in a predefined format, transmitted and uploaded nightly or weekly. It is possible to achieve more detail than is currently there without massively expensive upgrades to every providers’ systems. Scandinavia can do it. Why is Australia lagging behind?

Sadly it looks as if we may now have an uphill battle to save eHealth. Pulse+IT Magazine reports momentum for the system has stalled.

Ms Powell provided a breakdown of where funds from the $140 million provided in the 2014-15 budget were allocated. $82m went to DoH to operate the system, $21.8m went to the Department of Human Services, and $2.3m to the Office of the Australian Information Commissioner. The federal government’s contribution to NEHTA for the year was $34.4m.

This isn’t a cheap system, but it does need a usability overhaul. How can we get this back on track?

We need politicians with vision

One of the things that bothers me about the current Australian government is lack of vision, lack of the ability to think outside the square or to challenge the status quo.

I’m going to illustrate with an example built around our health system (on which I have written voluminously lately), the horrific domestic violence record in this country, auto-immune conditions and food.

A little background to set the scene. As you may know I am learning the ropes of living with a chronic illness. Trust me, it isn’t as easy or simple as seeing a specialist who gives you a prescription and reviews you once a year. Partly as a result of my own personal experience, I got involved in the Medicare changes debate, while also following research about food and chronic illness. I watch as the Minister for Women remains silent on the continuing violence against women in this country and noticed the financial cost of family violence to the nation.

I see links between all of these, yet I don’t see our politicians acknowledging any connections at all, much less driving any investigations or research. They are much too busy restricting our freedoms, completely contradicting their pre-election stance on the question of individual freedoms.

As a starting point, let’s look at one of the findings from my Medicare analysis. Readers may remember this graph from an earlier article.

PopulationServices

This graph compares the number of primary care medical services to the population by gender and by age bracket. What is this telling us? It is telling us women between the ages of twenty-five and seventy-four are the highest users of our primary care medical services. To read about this in the broader context of our health system costs, read Medicare is not the problem. For now, I am only interested in the disproportionate need for medical services of the adult female population and what factors may be driving this. If we could reduce this demand, we’d not only have healthy women, we’d save tax dollars. We can take into account prescriptions for the contraceptive pill as being gender specific, but that is not twelve visits a year. Not all women attend an obstetrician for pregnancy and child-birth, so we can allow a few visits from some women for obstetrics reasons as well. Neither of those gender specific medical needs explain the graph. Edit: After publication I was reminded by a doctor of the reluctance of men to seek medical help as pro-actively as they should, which contributes to the gender differences above. This is a factor that should be considered when considering introducing value signals financial barriers to early detection.

Family violence is estimated to cost Australia $16.2 billion. If domestic violence was eradicated from the community, the health costs for women would drop accordingly. Not all of the $16.2 billion are health costs, but they are costs that are considered to flow from domestic violence crimes. If we eradicate domestic violence, not only do we save lives and families, we have $16.2 billion to put towards unavoidable health costs. We also reduce the demand for health service resources, allowing deployment to alternative health areas.

Violence is more damaging to the health of Victorian women aged 15–44 years than any other well-known risk factors, including high blood pressure, obesity and smoking.

Source: VicHealth

At least one of my medical conditions is an auto-immune condition. There is considerable research being undertaken into the increase in incidence of auto-immune diseases. Many of the auto-immune diseases affect predominantly women: seven out of eight suffers of systemic lupus, for example, are women. Auto-immune diseases are one of the top ten causes of death of females aged up to sixty-four.

Sexratio
We have increasing incidence plus a predominance of women: the graph above starts to look more realistic now, doesn’t it? Many of the auto-immune conditions can take some time to diagnose, requiring more visits. As our testing technology improves, so we are able to diagnose some conditions more promptly than in years gone by, but that doesn’t apply to all conditions. For some conditions there are no simple or single positive or negative tests and diagnosis can take time. Even once diagnosed, establishing the correct treatment regime can take quite a while. I’ve been to both my GP and my rheumatologist so far this week, dosages and drugs will be tweaked in another three weeks. It isn’t a perfect science.

We need to be investing into research to find out why the incidence of auto-immune conditions is increasing. That will have long term benefits: improved health and reduced health care costs. There may be no solution to the gender bias, but if we understand the gender connection, we may be able to manage it.

One possible cause of the increase is the food we eat, which I looked at in some detail yesterday in The dose makes the poison. There is work currently being done looking at the relationship between gut bacteria and rheumatoid arthritis. That article also talks about a possible link between asthma and bacteria.

Some research indicates that the bacteria may reduce the risk of asthma, perhaps by curtailing the body’s immune response to airborne stimuli. Blaser suspects that asthma is one of the illnesses affected by our changing microbiome: Rates in the U.S. have been climbing for three decades, and grew by more than 28 percent between 2001 and 2011.

Restaurant Dessert Tray

Yet we happily continue to ingest food that has been processed and modified to excess. I was actually surprised at the low interest shown in yesterday’s article. Do we not want to face the fact we could be poisoning ourselves, or effectively altering our bodies’ natural functions? Is this too confronting in our fast-paced world where flying through the supermarket to grab a TV dinner is the only way we can find time to hit the gym?

The oft-cited reasoning around additives that are KNOWN to be toxic is something along the lines of “in small does it is OK”. Perhaps we could make that “ALONE in small doses”. The levels of toxicity we are exposed to in 2015 in just getting from home to work is nothing like it was in 1815. Way, way higher. A little bit of toxicity in your drink, a little more in your pre-packaged pudding and what is in your toothpaste and nail polish that is being absorbed by your body? What are the possible long term effects on the human body of  an accumulation of these approved small doses of toxicity in combination with each other and/or external toxins we are exposed to daily such as carbon monoxide? Or even just some human bodies if some of us are immune (or just tougher).

I’ve written before about the relationship between stress and AI conditions. Perhaps we are reducing our body’s ability to deal with stress effectively. The possibilities are endless.

80% of auto-immune condition sufferers can describe a major stressful event in their lives prior to the onset of the condition. While a causal link is yet to be established, it is definitely worth the research being undertaken. Maybe our food reduces our body’s ability to process stress (perhaps in conjunction with our social constraints) or these toxins directly change our immune systems in some way.

These are only the few correlations I have considered over the last month. There are many more. What I don’t see is a government with vision, a government looking to enable investigation of these correlations. I see a government who doesn’t appoint a Science Minister, a government that guts our CSIRO and is now attempting to make changes to our universal health system that are neither sensible nor substantiated.  A government who is looking in the wrong place for dollars and a Minister for Women who ignores the domestic violence epidemic.

Our politicians need to open their eyes. For all our sakes. We, the voting public, need to support our scientists and medical researchers to get the message across. Don’t leave it to the experts to battle on alone: it is YOUR body!

If you or someone you know is impacted by sexual assault or family violence, call 1800RESPECT on 1800 737 732 or visit http://www.1800RESPECT.org.au. In an emergency, call 000

This article was originally published on Robyn’s blog, Love versus Goliath.

If I were Bill Shorten – on healthcare

This is the first in a series on policy by respected blogger Ad astra; policy that might improve this nation’s situation, policy that Bill Shorten and Labor ought to consider. This first article looks at healthcare policy.

While it’s easy for Bill Shorten to sit back and watch Tony Abbott and his government self-destruct, he could accelerate that process by presenting the electorate with alternative policies, visionary policies, policies that had more appeal than the Coalition’s, more inherent merit, more chance of solving our nation’s problems.

As yet, Labor has not provided a convenient forum for those who have a view on policy to contribute to its policy formulation. This is my way of having my say.

I begin with healthcare, an area with which I am familiar.

Australia has an excellent healthcare system, not perfect, but one of the best in the world, and one of the most cost effective. Here we spend about 9.5% of GDP on healthcare; the US spends 17.7%, yet has much inferior heath outcomes.

Its backbone is its primary care services, provided by well-trained general practitioners, or family doctors, as we prefer to call them. To provide specialist services we have some of the most expert consultants in the world. They work in hospitals and in private practice. They are equipped with the highly sophisticated technology. We have a splendid hospital system, a network of nursing home facilities, and a sterling coterie of allied health professionals: nurses, therapists of many kinds, and paramedic personnel.

The pressing question is what will we need in healthcare in the years ahead, and how we might pay for it.

Everyone knows that our population is ageing. Life expectancy at birth is now over eighty-four for women, and over eighty for men. We have a lot of living to do.

Ageing brings in its wake physical and mental illness, dementia and disability. Obesity has become a national epidemic, even among the young. It predisposes to type 2 diabetes, heart disease, stroke, and even some cancers. Dementia is on the increase, filling our aged care facilities and using more and more healthcare resources. Mental illness and disability are becoming increasingly prevalent.

Medical science and therapeutics are advancing rapidly. They offer more and more sophisticated therapy every year, but at a cost. Telemedicine is coming into its own, offering as it does many benefits, but again at a cost.

Ask people in the street if they believe we deserve the sophisticated healthcare system we have, and see how many say ‘no’. We all want the very best for ourselves, and for our own when they are ill, disabled and demented. Ask how we might pay for it, and wait patiently for the answers.

Clearly the cost of healthcare will rise and rise and rise because excellent healthcare is what the people want and feel they deserve. There is no value in thinking about rationing healthcare – the people simply will not buy it.

Given that our nation, through its governing bodies, has an obligation to provide healthcare to all who need it, how might they pay for it, as indeed they must?

The Abbott government acknowledges the problem, but unsurprisingly has taken its own idiosyncratic approach to financing it. As with so many other areas of government, austerity is its focus. Spending less is seen as the answer; raising more revenue seems to be off the agenda.

Without consulting stakeholders: the AMA, doctors, healthcare workers, patients, or anyone who might have had a worthwhile opinion, then Health Minister Peter Dutton, rated overwhelmingly by over a thousand doctors surveyed by Australian Doctor magazine as ‘the worst health minister in living memory’, thrust his $7 co-payment for GP consultations on an unprepared audience. It was to give them a ‘price signal’, one designed to discourage patients making ‘unnecessary’ visits to their GP.

The reaction was predictable. The AMA, doctors, the public, and most notably the Senate, rejected the idea as poorly thought-through, impractical, and perhaps most importantly, poorly directed. GPs, the core of the healthcare system, became the main target; they were the ones put under the pump. After the patients, the group that would lose the most would be general practitioners, who provide most of the preventive care and chronic disease management and thereby contribute most to keeping people in optimal health and out of the very expensive hospital system. Laudably, the AMA was strident in its resistance to measures that targeted GPs, and insistent that general practice must be supported. It insisted that rather than directing the proceeds of the co-payment to a medical research fund, it should be directed into general practice.

When the Senate rejected this proposal, Abbott ditched the $7 co-payment scheme and unveiled another policy that would see a co-payment of up to $5 levied against patients over the age of 16 who did not have a concession card. Doctors would have the ‘discretion’ to raise prices by up to $5 to cover the reduced rebate. Thereby, costs would be guaranteed to rise. Next, Dutton proposed that there be a lower rebate paid to GPs for consultations under 10 minutes, resulting in less income for short consultations; the $37.05 rebate currently claimed for 6 – 19 minute consultations would be changed so that for consultations under 10 minutes doctors would receive only $16.95 for concessional patients and $11.95 for other patients, an unacceptable and arbitrary reduction of GP income for short consultations, which comprise a substantial proportion of their income.

These proposals cascaded one on top of the other, leaving those affected angry, and the public bewildered. It was a disastrous comedy of errors.

The Royal Australian College of General Practitioners, who train and certify GPs, made its position quite clear in a considered statement: “Many patients are in a position to make a contribution to the cost of their healthcare, and the RACGP believes general practitioners should be able to determine a fair and equitable fee for their services.

“The RACGP therefore supports the right of GPs to set fees that ensure the viability of their practices whilst acknowledging the Government’s right to set the patient rebate for medical services.

“The Government should not determine fees, or mandate out-of-pocket costs, for patient services.”

So where are we at?

Many practices set their fees at a level above the Medicare rebate, and patients attending those practices pay the gap between the fee and the Medicare rebate or what they might receive from their health insurer. Why the government sought to interfere with this system, which has been in place for years, could be attributed to the government’s ideological position of user-pays, ‘price signals’, and of course saving money. The fact that, as with the 2014 budget, those least able to pay the co-payment were the most heavily penalised seemed quite acceptable to this government.

There is nothing inherently wrong with a co-payment, provided it targets those who can afford to pay and are willing to do so. The existing system was working; why change it?

There is a cogent argument that millionaires ought not to be able to avoid paying for medical services simply by attending a practice that bulk-bills every patient. Such a practice seems unfair. Yet such millionaires might claim that since Medicare is at least partly funded from the Medicare levy, and since the levy is a progressive tax that penalises most heavily the higher earners, they are entitled to free healthcare as they have paid for it via their Medicare levy payments. That seems like a good topic for a debate on ethics!

So where is the solution?

In my view, what is needed is increased revenue to fund healthcare, not punitive cuts to GP payments (specialists were not affected at all), not ‘price signals’ to patients to inhibit visits to their GPs. Sussan Ley the new Health Minister has now ‘solved’ the awkward notion of ‘price signals’; they are now ‘value signals’, which she hopes will immediately shift public opinion in their favour!

At present the 1.5% Medicare levy on income covers 55% of healthcare costs. It could cover more; even all costs were it to be increased. The public seems less averse to paying a higher levy or more tax when what it is delivering is apparent. If the public wants the sort of healthcare system we have and will need in the years ahead, are advised what it will cost, are asked to contribute via a higher Medicare levy, and are shown where their money is being spent and on what, in my view the majority would be amenable to such a change.

Of course income tax could be increased to cover the cost of healthcare, but taxpayers resent seeing their taxes disappear out of sight into a black hole; on the other hand, so-called ‘hypothecated’ taxes, where their purpose is clear, such as the Medicare levy, are much more acceptable to them.

They would realise that because the Medicare levy is a progressive tax based on income, it takes more from higher income earners than the lower, and the very lowest earners are exempt. It is a fair tax, as is our progressive income tax system.

Were the levy to be increased gradually, say by one quarter of one per cent per year or two until it reached a level that could properly fund healthcare, which by the way is estimated to climb from $19 billion per year today to $34 billion a year in the next decade to 2024, it might not be felt too acutely by the taxpayer. Most of us can adapt to gradual changes; it is the sudden, unexpected, excessive and unfair changes that people resent and reject.

Do glance through Robyn Oyeniyi’s comprehensive article in the AIMN: Medicare is the wrong target particularly the revealing graphs, one of which shows that GP consultations account for only 10% of healthcare expenditure, yet this sector is what our government targeted! She suggests the Medicare levy be doubled from 1.5% to 3%: “… the easiest solution would be to increase the Medicare levy to 3%…

So if I were Bill Shorten, I would completely abandon the Coalition ploy of penalising patients and their doctors to save money. I would put aside all the apprehension about tax increases that so scare politicians, firmly grasp this prickly nettle, lay out the case for properly funding healthcare to meet our needs, needs that will magnify as we age, explain carefully what benefits will be offered to all who live in this country, then with the help of actuaries spell out what it will cost now and in the years ahead, and finally make clear how gradual increases to the Medicare levy would cover that cost. That would take courage, but the people just might buy it.

But I’m not Bill Shorten; I’m not up for election in 2016; I haven’t got a vindictive opponent waiting to stoke up his ‘Great Big New Tax’ manta to tear Labor down.

Have you got the courage Bill?

Ad astra is a retired medical academic who, after a 14 year period in rural family practice, became intensely involved for the next 35 years in undergraduate, vocational and postgraduate medical education for family medicine.

This article was first published on TPS Extra.

Medicare is the wrong target

This article continues from Sussan Ley updates the nation on Medicare.

I spent several hours Friday night looking at the Medicare statistics. I came to a conclusion which may send a few readers reaching for their smelling salts. I ask that after you’ve taken a whiff, you stick with me. My conclusion may seem radical a first, but I believe there is method in my madness.

Taxes

Australia has to make a decision on a very simple question. Do the majority of Australians want universal health care? I believe the answer is yes, on the basis over 80% of Australians support Medicare. As we can see above, this country’s largest single expense line is Health. 17.8% of the taxes you and I pay is spent on Health. If we group all the Welfare lines together, Welfare accounts for 36.8%, more than  double Health.

The Medicare ruckus has focussed on general practitioner services. Although broken into several sub-categories in the Medicare report, I have grouped them into Primary Care below. That category accounts for 33% of Medicare expenditure. This sounds like a lot – until we factor in total Health expenditure of $62 billion. Medicare is only 30.8% of total Health costs. Put another way, the government is making a massive fuss over 10.2% of our Health expenditure. The most concerning aspect is that front line primary care is vital. Ample evidence has been provided by the experts showing that early detection of health concerns allows for early intervention resulting in lower health costs overall. Yet this is the very area of medicine the government want to make less accessible for sections of the community.

Yes, I agree, if we look at Medicare alone primary care is the largest category. Even of I grouped the specialists, obstetrics and anaesthetics categories together, primary care would still be the area of highest financial outlay. It is understandable that the government look at the information and leap to the conclusion the area that has to be tackled is primary care. Pathology, while a high number of services, is financially efficient per service: the bean counters would be happy to leave it alone.

The trigger for the government’s focus is possibly the Medicare Levy itself. In round numbers, the Medicare Levy contributed $10 billion against a services outlay of $19 billion – just over half. We all know that if we earn $1,000 a week we can’t continually spend $1,900 a week or we will be in major financial strife. But we can’t peg back $62 billion by focussing on only 10.2% of the costs.

I suggest we scrap the Medicare Levy as a separate revenue stream altogether. It is misleading and encourages policy makers to focus in the wrong area. Medicare has been around for forty years, let’s just accept we have a universal health system and be done with it. I am not suggesting we forego the income stream from the Medicare Levy, simply absorb it into the income tax system. Alternatively, absorb it into an increase in the GST rate. There are options here and our policy makers should be considering a range of ideas. The GST increase option may be a better alternative as the Federal Government makes grants of GST proceeds to the states and makes health grants to the states. Those who have more disposable income would contribute equitably to our health system costs. An increase to the marginal tax rates may be harder to sell.

While such a strategy will remove the focus from that $9 billion “shortfall”, it won’t reduce the proportion of our taxes that go towards providing a universal health system. Several commentators and experts focus on health expenditure as a percentage of GDP. One such expert is Professor Jeff Richardson, Foundation Director, Centre for Health Economics at Monash University. Here is an extract of a recent article on The Conversation:

As a percentage of GDP, Australian government spending on health is the tenth lowest of the 33 countries in the OECD database and the lowest among wealthy countries.
The 8.3% of GDP spent by the US government, for instance, is higher than the 6.4% spent by the Commonwealth and state governments in Australia.
Nor is it true that total health expenditure – government plus private spending – are unsustainable. Australia spends about 9.5% of GDP on health services; the United States spends 17.7%. And while US spending may or may not be good value for money, it hasn’t undermined its economy or sapped the vitality of the country.
Source: The Conversation

It is interesting that Professor Richardson uses the term “value for money” given Sussan Ley has taken to using the term “value signals” rather than price signals. Value must be considered an easier word to sell to the electorate than price.

I spent considerable time massaging numbers to see if I could find a way to have bulk-billing of children and the retired continue, require a reasonable co-payment from those of us earning an income (we already do pay, as discussed in my previous article) and have Medicare break even without sending doctors to the poor house. I ignored the NDIS in that exercise. I looked at such options as increasing the rebate to 100% of the scheduled fee for concessional patients, and a $20 co-payment for the rest of us with our rebate remaining at 85%. With a workforce of 11,666,000 (as at January 2015) this just wasn’t going to work. There are other more sophisticated approaches that could be considered but all would make Medicare more complex to administer (and were too complex for me to model at the dining room table on a Friday night). Such options could be to have a scale of rebates and co-payments linked to annual income or to have marginal levy rates. These options all make the system more complex to administer and where is the value-add in that? I don’t see it. Complexity for no real health benefit would surely lead to a situation of diminishing returns.

Without boring everyone to tears with spreadsheets, it is suffice to say the easiest solution would be to increase the Medicare levy to 3%. Based on our work force and the average weekly wage, the revenue from the Medicare Levy should be closer to $13 million than $10 billion, but I’ll leave it to the ATO to work out where the other $3 billion is – the health insurance rebate, perhaps? Setting the levy to 3% means many of us would be paying a considerable amount per year. Check your ATO assessment notice and double the amount.

It has been suggested that the burden of our ageing population’s health costs, especially once we start living to 150 years old, will be one of the factors that will lead to Medicare becoming unsustainable. I compared the services age brackets with our population.

PopulationServices

Blue for the males, pink for the females. Don’t go getting all feminist on me for that, it was convenient and I like pink. Sue me. As we can see, it really isn’t the aged members of our community that are highest users of services. Remember, we are looking at only 30.8% of our total Health expenditure here, not the $62 billion. Women between the ages of twenty-five and seventy-four are the highest users of Medicare services. I don’t believe we are all hypochondriacs. When I was researching my own medical conditions I discovered many medical conditions occur more frequently in women that men. Hyperthyroidism is one such condition and many of the eighty plus auto-immune conditions affect women more than men. Auto-immune conditions are also worryingly on the rise.

Interesting learnings, too. Studies have shown up to 80% of patients who develop auto-immune condition can describe a major stressful event in their lives prior to developing the condition. Smoking is also implicated in combination with genetic predisposition for rheumatoid arthritis and yes I smoked. Studies show about 25% of patients with an auto-immune condition develop more than one. The incidence of auto-immune conditionsin the population is increasing – the question is why? The health costs to the community are huge and auto-immune disease is one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age. Auto-immune conditions are more common in women than men. Why? Gender specific hormone factors?

Source: Love versus Goliath

If we want to reduce our Medicare costs and I suggest our Welfare costs, we need to be looking at why adult women are needing more health care and finding solutions. We also have to accept there may be no solutions. I cite auto-immune conditions because I’m personally impacted and therefore have done more research on the topic, but there may well be other drivers to women needing more medical care. Obviously having children is one driver, but we see in the second graph above obstetrics is not a major category of Medicare services. I am currently under the care of three specialists and my general practitioner. During 2014 I had a high number of Medicare services so I certainly fit the statistical profile. I had umpteen blood tests and the gambit of imaging (MRI, CTs, ultrasounds, nuclear scans). The comments on my previous article indicate I am not the only one under the care of more than one specialist.

The rate of bulk-billing still stuns me and comments from readers on both The Australian Independent Media Network publication and on my site produced very little evidence of patients being consistently bulk-billed. I thought perhaps pathology and imaging services were distorting the overall average, but close examination of the statistics revealed this was not the case. It remains an aspect to this whole debate that I have trouble accepting. I’ve even considered there is a flag in the computer systems not getting checked, but then our Medicare statements wouldn’t be accurate and my recollection is mine generally has been. So I have to accept the 77.2% bulk-billing rate on face value.

To summarise:

  • Primary care is only 10.2% of Australia’s total health bill.
  • To ensure early detection and intervention it is vital patients are not deterred from seeking treatment.
  • If Australia is concerned that 17.8% of government expenditure is allocated to health, look into the other 89.8% of health expenditure for cost savings. Simplifying administration could save billions, I have no doubt.
  • Research why women between the ages of twenty-five and seventy-four are the highest users of Medicare services.
  • Accept Australia is a nation that wants to retain a universal health system in line with the initial objectives: universal in coverage, equitable in distribution of costs, and administratively simple to manage.
  • As a percentage of GDP, we are performing better than the USA.

Related:


Notes:

Population statistics sourced from the ABS.

Medicare statistics sourced from The Department of Health.

Allocation of government expenditure from my personal Tax Assessment Notice.

All graphs developed by the author.

This article was first published on Robyn’s blog Love versus Goliath

Sussan Ley updates the nation on Medicare

As any regular reader of my work is aware, I have been very vocal about the various changes to Medicare proposed by the LNP government. A list of past articles is provided at the end of this article should you have missed out. I also appeared on the ABC News supporting the RACGP in their “You’ve Been Targeted” campaign.

Earlier this week I wondered what was happening. Minister Ley had promised to consult with doctors before making any changes. I’d suggested Ley not forget about the most important demographic: the patients. I Googled and didn’t find much. I checked Ley’s Twitter feed and found the odd tweet about consulting with doctors.

https://twitter.com/MalBrough_MP/status/563504992078688257

Meeting with doctors and

more doctors.

Where are the meetings with PATIENTS? This one, maybe?

Possibly, but they look suspiciously like more medicos to me. I was becoming a little depressed. Yesterday Ley finally held a press conference. The full transcript is available: Update on nationwide Medicare policy consultation.

Craig Laundy: It’s great to have the Health Minister, the Honorable Sussan Ley and my good friend the Member for Lyne Dr David Gillespie here in Reid for an afternoon of consulting with local GPs so without further ado Sussan welcome.

Not one word about PATIENTS! More doctors! Yes, doctors are voters, just like you or I. Yes, doctors pay the Medicare levy just like you or I. Yes, doctors have a vital voice in any changes to Medicare. You and I have a far greater voice and we must not let Ley forget that.

I’ve just come from breakfast this morning on the Central Coast. There were 40 doctors and lots of different views in the room and the same for last night and I’m on my way to another part of the country to do something similar.

Still no mention of PATIENTS. *sigh*

…accept that unless you’re in a vulnerable category maybe those services don’t come absolutely for free and that where there is an ability to pay that you value the high quality service that you receive that you do indeed pay something. When I look at the number of bulk-billed consultations across the country 76 per cent of all episodes of care are bulk-billed to non-concessional patients.

No, Ley, any bulk-billed service to a non-concessional patient is certainly not for “absolutely free” as most non-concessional patients are working and paying the Medicare Levy! Or are the children of people paying the Medicare Levy. That’s not “free”, we pay an insurance premium. I’ve heard it said there are medical practices that bulk-bill 100% of their consultations. I’ve yet to actually attend one, but I have no doubt there are some. There are also practices that bulk-bill only those holding a Health Care Card.

The practice I go to has a policy of bulk-billing walk-ins (see first available doctor) between 7 am and 6 pm. Appointments are not bulk-billed, nor are consultations after 6 pm or on weekends or public holidays. I think there are many practices with similar policies. How often am I a walk-in? Not too often. I work full-time and also have medical conditions which I prefer to have overseen by a regular doctor. Consequently most of my consultations are either by appointment or outside of the bulk-bill hours, even if I am walking in with a child that needs a stitch in a toe – no appointment, but 8 pm at night. $90 payment, $49 rebate. My co-payment is already $41, thank you very much. The average patient contribution for out-of-hospital services for patients who pay is $51 (including specialists visits).

My GP visit

I wanted to see proof of this 76%. I thought the annual report might be a good place to start, but as Medicare has been absorbed into the Department of Human Services, there doesn’t seem to be much Medicare detail in that report. The Department of Human Services ended the 2013-14 year with an operating SURPLUS.

In 2013–14 the department administered an estimated $159.2 billion in payments or around 38 per cent of government outlays. Financial performance targets were met, for the most part, and the department reported an operating surplus of $132.6 million after adjustment for unfunded depreciation and the revaluation of assets. This compares with a deficit of $7.7 million in 2012–13.

Source: Department of Human Services Annual Report

That doesn’t tell me anything about bulk-billing though, interesting as the information may be. Further research found bulk-billing statistics. Click the image to go to the full table. According to the Medicare statistics, 77.2% of consultations were bulk-billed for the 2013-14 year, but there are vast differences across services. GP visits are bulk-billed 82.2% of the time, whereas specialists a mere 29.2%. No clear differentiation is given in the report between concessional and non-concessional patients, so are we to assume only 1.2% of consultations were for concessional patients?

Clearly doctors in Canberra don’t believe in bulk-billing politicians.

I am struggling to believe the rate is this high. If you want to delve into the full statistics yourself, the spreadsheet available is very useful.

Why is the rate of bulk-billing so high? Based on my own personal experience and that of friends, family and co-workers, my guess would have been less than 50%. The history of Medicare may have something to do with it. I found this interesting snippet. Read very carefully.

Levels of bulk billing for unreferred GP attendances have been declining in recent years after reaching a high of 79.7 per cent in1996-97. By the December quarter 2002 bulk billing for unreferred GP attendances had declined to 68.8 per cent, but by June 2004 this had improved to 70.2 percent.

Source: APH

The decline in bulk-billing had been viewed as a negative! Incentives of $7.50 to encourage doctors to bulk-bill were introduced in 2004.

From 1 May a $7.50 incentive paid to GPs for bulk-billed GP consultations with concession card holders and children under 16 in non-metropolitan areas (RRMAs 3-7) and Tasmania introduced. This incentive replaces the earlier $5 incentive in these areas.

As of 1 September eligibility for the $7.50 incentive payment to GPs extended to eligible urban areas and large regional centres.

Clearly bulk-billing was encouraged in more ways than one.

Between 1992 and 2003 the Scheduled Fee rose 26%. The CPI rose 31%. Doctors were taking a pay cut.

Interestingly, during the 2004 election campaign, the Coalition proposed to increase the rebate to 100% of the scheduled fee. Different captain at the same helm eleven (eleventy?) years later wants to cut the rebate.

Proposals for changes to Medicare were announced by the Coalition during the 2004 election campaign. These include from 1 January 2005 increasing the Medicare rebate for all GP services to 100 per cent of the Schedule fee…

Source: APH Library Archive

When did the big clinics emerge? Edelsten opened the first after Medicare came into being in 1984. We now have very professional corporate medical businesses, minus the chandeliers and gawdy trimmings.

Reading through the history, it is clear Medicare has been tweaked many times over the years. The practice of medicine has evolved. We no longer visit our local family doctor in the front room of his residence as in days gone by. The economies of scale from multi-disciplinary and multi-doctor practices would, I think, be necessary in circumstances where fee increases were running well behind CPI increases AND bulk-billing was being encouraged.

The HICAPS system has been a great innovation. The doctor gets paid at the time of service and the patient receives the rebate overnight in their bank account. As noted in the past, I’ve actually received the rebate credit before the payment debit hit my bank account. For patients this saves considerable time. In the last twelve months I’ve only visited one medical provider (and we know I’ve visited a few) that had not yet moved to HICAPS. Gone are the days of lining up in a Medicare office to claim medical bills.

The medical profession was initially resistant to Medicare. The medical profession today is a very different beast to the medical profession of forty years ago. Many practitioners are not as politically right wing as their predecessors. Free university education saw many from different backgrounds obtain degrees.

Forty years is a long time. You may be reading this on a smartphone. Medicare was launched three years before Telstra launched the first mass mobile network in Australia.The phone cost $5,200. Technology, medicine, society: all have changed.

How much revenue does the Medicare Levy raise? That seems to be the greatest secret, as despite considerable research, I can’t find the answer. The spreadsheet I referred to above analyses the costs of Medicare to the nth degree, sliced and diced to within an inch of the core and tells me the benefits paid were $19.1 billion. Not a revenue number in sight.  Nor, for that matter the infrastructure, staff and other costs (such as HICAPS).

Was Medicare ever intended to be completely self-funding?

The objectives of the original Medibank were summarised by R. B. Scotton (1977) as universal in coverage, equitable in distribution of costs, and administratively simple to manage.

That statement doesn’t really specify self-funding. As it turns out, the original funding bills weren’t passed and the funding came from general revenue. The levy came later.

“Equitable in distribution of costs” doesn’t mean the same thing as self-funding. In any case, what was appropriate forty years ago may not be appropriate today – and that could be either way.  How do we assess “equitable”? These are social questions, not medical questions, yet I see Ley focussing on the medical profession and not the people.

To be continued . . .

Previous Medicare related articles by the author:

This is a slightly edited version of the article originally published on Love versus Goliath

Medi-wedon’t-care

In February this year, while refusing to confirm his government was considering introducing GP co-payments, Tony Abbott said, “As a health minister in a former government, I used to say that government was the best friend Medicare has ever had.  This leopard doesn’t change his spots and I want this government, likewise, to be the best friend Medicare has ever had.”

History tells us that this leopard does in fact change his spots when it becomes politically expedient to do so and that the Coalition were dragged kicking and screaming to Medicare.

Originally, the scheme was called Medibank and was a major plank in Whitlam’s 1972 election platform. The coalition Liberal and National parties opposed Medibank. The legislation to implement it was twice rejected by the Senate. Following the 1974 double dissolution election, the legislation was again rejected by the Senate but passed at an historic joint sitting of the parliament. Medibank came into operation on July 1, 1975.

The Fraser Coalition government neutered Medibank, with taxpayers able to opt out of paying an increased levy in favour of private insurance.

The Hawke government reintroduced Medibank, rebadging it as Medicare. Financing arrangements were modified but the scheme was effectively the same as the one introduced by Whitlam. Throughout the 1980s, Medicare continued to be criticised by the Coalition. Whilst the 1993 election is remembered as a referendum on John Hewson’s GST, changes to Medicare were also an issue. For many years, bulk billing seemed to be at risk from a change of government. The 1993 election effectively led to bipartisan support for Medicare.

After Howard was elected, membership of private health funds fell to just over 30% in December 1998. With a mixture of financial carrots and sticks, private insurance peaked at 46% in December 2000 – and has remained at around this level ever since. This also generated a largely new for-profit private hospital industry.

By late 2003, bulk billing had fallen to 66%, from its peak of 80% under Paul Keating’s Labor government (1991 to 1996). These rising out-of-pocket costs for visiting a GP fuelled discontent with the government. Tony Abbott was appointed Health Minister and, to address this problem, promptly increased rebates to GPs.  This quickly changed the trend.  By 2004, bulk billing rates were back over 70% and Abbott declared the government was now “Medicare’s greatest friend”.

True to his highly political approach to the portfolio, the reforms Abbott can claim were driven by election timing.

Colorectal (bowel) cancer screening had a substantial amount of research and successful pilot schemes behind it. It was added to the Coalition’s 2004 election promises, partly to meet the attractions of Labor’s Medicare Gold – which promised to end waiting lists for over-75s. At the same time, the government subsidy to cover private health insurance premiums was increased for members over 65 and even higher for those over 70.

Out-of-pocket costs were also hitting consumers who used specialist services – again through charges well above the rebate offered by Medicare. The Medicare Safety Net – which gave an additional subsidy if costs of specialist in-hospital services passed a threshold – was intended to fix this problem. With no control over specialists’ fee-setting, this proved a recipe for further fee inflation and much of the benefit went to those who were better off. The 20% of Australians living in the wealthiest areas received 55% of Safety Net benefits, whereas those 20% living in poorest areas received less than 4% of benefits, largely due to wealthy people being more likely to see specialists.

The Safety Net reduced the competitive pressures that some doctors faced and increased their ability to charge higher fees, particularly in specialty areas such as private obstetrics and assisted-reproductive technology services. For every dollar the government spent on the Safety Net, around 43 cents went towards increased doctor fees and 57 cents went towards reducing patients’ out-of-pocket costs.

During the 2004 election, Tony Abbott used a Four Corners interview to give his “absolutely rock-solid, ironclad commitment” that the Government would not, after the election, lift the thresholds for the Medicare rebates.

TICKY FULLERTON: Will this Government commit to keeping the Medicare-plus-safety-net as it is now in place after the election?

TONY ABBOTT: Yes.

TICKY FULLERTON: That’s a cast-iron commitment?

TONY ABBOTT: Cast-iron commitment. Absolutely.

TICKY FULLERTON: 80 per cent of out-of-pocket expenses rebatable over $300, over $700?

TONY ABBOTT: That is an absolutely rock solid, iron-clad commitment.

However, in 2005, Tony Abbott and the Howard Government raised the Medicare Safety Net threshold from $300 to $500 for lower income families, and $700 to $1000 for everybody else.

When speaking to Laurie Oakes, Abbott said the Government was being responsible because it was changing opinions when circumstances changed.

TONY ABBOTT: Laurie, again, I can understand your dwelling on this. But, but sometimes governments have to choose between a range of unpalatable alternatives. Now…

LAURIE OAKES: One of the unpalatable alternatives is telling the truth, presumably.

TONY ABBOTT: We set up this safety net back in March of last year. Thinking that it was going to cost $440 million.

LAURIE OAKES: You knew by the election it was $1.3 billion.

TONY ABBOTT: We, we discovered in September-October that it was going to cost a lot more. We made a decision in a budget context that the best thing we could do for the long-term health of the economy, and indeed for the long-term health of the Medicare system, to change the thresholds.

LAURIE OAKES: And con the people through the election.

Speaking to The Weekend Australian, Abbott confessed, “Plainly it’s good to honour the last syllable of the last pledge but it’s also good to honour the team. So I’ll be supporting the team.”

Tony made changes that drove up fees, gave doctors and wealthy people more, made promises he couldn’t keep in an election campaign, and then hit low income earners in the budget to pay for the cost blowout, justifying it with team solidarity – sound familiar?

Abbott is an interesting individual because he is one who can say “sorry” when required. In this case, he states, “I made a categoric statement that turned out not to be true”. But sorry to whom? The political team he plays for or the ordinary followers who support the team and performances he has led them to expect?

Tony Abbott, as Health Minister, was unsympathetic to the new public health push from the World Health Organization, aimed at the social determinants of health. He saw health as a matter of individual choice, and ill-health in medical terms around the prevention and cure of particular diseases.

In 2006, Abbott rejected a half-hearted push from Labor state health ministers for restrictions on junk food advertising to children as a move to the “nanny state”.

Apparently individual choice for women was a different matter when it came to the availability of the abortion pill, RU486. Abbott fought to keep ministerial discretion over the availability of such drugs – making the much-quoted observation he would have to be convinced that doctors were not presenting abortion as an “easy option” before prescribing a “backyard miscarriage”.

His veto powers were removed after a major revolt led by women parliamentarians from all parties.

Abbott ended his term of minister as he began – focused on politics rather than substantive policy. As Labor’s demands for a more national approach to hospital policy mounted, Abbott responded by upping the ante, declaring that:

the only big reform worth considering is giving one level of government – inevitably the federal government – responsibility for the entire health system.

He was quickly silenced on this by Howard, who had no intention of entering the mire of federal state relations and the management of hospital systems.

In the 2010 Budget, the Rudd government introduced Safety Net caps for a small number of Medicare services where there was evidence of high Safety Net expenditure and doctor fee increases. The caps placed limits on the amount a patient can claim under the Safety Net.  Government expenditure on the Safety Net fell by a dramatic 42% that year.

Despite promising before the 2013 election not to cut money for health, the Coalition will dramatically shrink the Commonwealth’s share of hospital funding, cutting its annual contribution by $15 billion by 2024, with the deepest cuts beginning in 2017. In the meantime it will cut more than $200 million in reward payments for hospitals meeting federally-imposed performance targets for surgery and emergency treatment.

They have once again fiddled with the Safety Net.  If you spend over the relevant threshold amount on out-of-pocket costs for eligible out-of-hospital services, Medicare will soon pay 80% of any subsequent out-of-pocket costs, but only up to an amount totalling 150% of the scheduled fee (not 300% as it is now under the Extended Medicare Safety net for many services). The spending threshold for relief under the Medicare safety net will be lowered, but the benefits payable will be capped, a change that is expected to produce more than $260 million in savings.  This shifts more of the risk of excessively high fees onto individuals rather than the government.

Not only has the government slashed funding to hospitals and tried to send “price signals” to discourage people from seeing a GP or having tests, they have also attacked preventative health measures.

Terminating a partnership agreement with the states on preventive health will save $368 million, while $3 million will be cut from anti-smoking campaigns, and the National Preventive Health Agency will be abolished.

This is all the more galling when we read that more than half a million dollars is being splurged on focus groups to help spruik uncapping university fees.

If you visit the Liberal Party facebook page you will find several graphics designed to convince us that Medicare is unsustainable no doubt in an attempt to get us to agree to some iteration of the GP co-payment.

Mr Dutton said: “The Coalition is the greatest friend Medicare ever had, and with millions of Australians facing the challenges of obesity, diabetes and dementia into the next generation, our task now is to make sure we strengthen and improve our health system into the future.”

John Deeble, who in 1968 co-authored proposals that formed the basis of the Whitlam government’s Medibank and the Hawke government’s Medicare, dismissed as a “furphy” suggestions by Peter Dutton that Medicare risked becoming unaffordable.

“In a rich country, in an advanced society, anything is sustainable if the society says it is.”

He suggested raising the Medicare levy to 2.75 per cent to help meet growing health costs, saying such a change would raise more revenue every year than would be yielded once through the sale of Medibank Private.

Neal Blewett, who was health minister when Medicare was introduced, said the Abbott government would pay heavily if it undermined Medicare.

“The Liberals never managed to win an election in the 1980s and 1990s until they committed themselves to Medicare,” he said. “[They] need to remember that; that there’s a very strong commitment in the community to Medicare.”

Let’s remind them.

Hockey’s lazy, lying helpers

It disturbs me that this email is hitting the in-box. Disturbing in that there appear to be a high number of Australians who are satisfied with the cruelty this government is dishing out to the nation’s underprivileged.

The email:

Subject: Written by a 21 year old female . . . Make her PM

“The problems we face today are there because the people who work for a living are outnumbered by those who vote for a living”.

This was written by a 21 yr old female who gets it. It’s her future she’s worried about and this is how she feels about the social welfare system that she’s being forced to live in! These solutions are just common sense in her opinion.

Put me in charge . . .

Put me in charge of Centrelink payments. I’d get rid of cash payments and provide vouchers for 50kg bags of rice and  beans, blocks of cheese, basic sanitary items  and all the powdered milk you can use. If you want steak, burgers, takeaway and junk food, then get a job.

Put me in charge of Medicare. The first thing I’d do is to get women to have birth control implants. Then, we’ll test recipients for drugs, alcohol, and nicotine. If you want to reproduce, use drugs, drink alcohol or smoke, then get a job.

Put me in charge of government housing. Ever live in military barracks? You will maintain our property in a clean and good state of repair. Your “home” will be subject to inspections anytime and possessions will be inventoried. If you want a plasma TV or Xbox 360, then get a job and your own place.

Put me in charge of compulsory job search. You will either search for employment each week no matter what the job or you will report for community work. This may be clearing the roadways and open spaces of rubbish, painting and repairing public housing, whatever we find for you. We will sell your 22 inch rims and low profile tires and your dooff dooff stereo and speakers and put that money toward the “common good”.

Before you write that I’ve violated someone’s rights, realise that all of the above is voluntary. If you want our hard earned cash and housing assistance, accept our rules. Before you say that this would be “demeaning” and ruin someone’s “self-esteem,” consider that it wasn’t that long ago that taking someone else’s money for doing absolutely nothing was demeaning and lowered self-esteem.

If we are expected to pay for other people’s mistakes we should at least attempt to make them learn from their bad choices. The current system rewards those for continuing to make bad choices.

AND While you are on Centrelink income you no longer have the right to VOTE! For you to vote would be a conflict of interest . . . If you want to vote, then get a job.

Now, if you have the guts – PASS IT ON.

You may wonder why I’m giving publicity to this disgraceful email when the best option would have been to send it straight to the trash bin. Well, there’s a message in it. Not to the recipient, but to those low-life individuals who have it in their small minds that it should be, according to their wish, passed on. Instead, you can pass it back. I’m hoping that if you too receive the email you might have the urge to let the sender know about this:

Has anyone else seen this ???   It was sent to me today by an old friend .  I call it “PUT ME IN CHARGE” and its message can be summarized by the final quote:

“The problems we face today are there because the people who work for a living are outnumbered by those who vote for a  living.”

For me, this message  beautifully addresses the ‘entitlement attitude’ that seems so common today amongst the electorate and it does so in a very interesting and forthright manner – somewhat blunt, maybe, but still an appropriate message just the same.

This was written by a British 21 yr old female who “gets it”.

Yes, a British girl. Note too the date: July 2012.

How she ended up being British I will never know. She used to be American. Well she was in 2011.

And how about “The problems we face today . . . “? Well they certainly weren’t written by a 21 year old girl from America, Britain, Australia or wherever the right-wingers wish to dig one up from. They can be credited to a fellow called Dan Cofall and I can assure you he definitely wasn’t referring to those damn Aussie welfare bludgers when he penned it.

The email itself isn’t as important as the knowledge that there are people in Australia who not only hold this opinion, but actually want to believe it. And if ‘believing’ it means they have to resort to perpetuating what is clearly a fabricated piece, then either they’ve bought the government’s line that the age of entitlement is over, or they have an inherently morbid attitude towards disadvantaged Australians that I am unable to comprehend.

And they resort to lies to promote it.

Let’s expose them.

More articles by Michael Taylor:

This government is now officially obscene

Can ‘The Australian’ stoop any lower?

Just a quick question; has the line been crossed?

GP Co-Payment: Policy Analysis

Even Tony Abbott and Joe Hockey seem confused about their Great. Big. New. Tax on doctor’s visits, as announced in their horror budget two weeks ago. It’s still not clear exactly how this policy will be applied and who it will be applied to. While the government who introduced the tax go back to the drawing board to try to work out how it actually works, I thought it might be useful to do some policy analysis of my own, by interviewing my brother-in-law. I know this is a radical idea and one Abbott and his government clearly haven’t considered, but let’s throw in some facts from an expert. My brother-in-law can provide these facts in an expert manner since he is a GP:

Peter Dutton has said he decided the government should introduce the Medicare co-payment while visiting his doctor. Dutton explained that people should contribute to visits to a GP because this would make the health care system more financially sustainable. This doesn’t strike me as a consultative policy analysis process. If Dutton had chosen to investigate the effect of this policy in a more consultative way, who should he have spoken to?

Changes to the Medicare architecture should be undertaken through liaison between the Department of Health, the AMA [Australian Medical Association], the College of General Practice and State Health Departments.

As a practicing GP, what is your opinion of the Abbott government’s proposed Medicare $7 GP co-payment policy?

The proposed Medicare co-payment and its associated changes to Medicare have the potential to be very destructive to patient care for a couple of reasons.

Firstly, it will deter people from discussing minor symptoms that they have with their GP, which often are a warning sign of more serious illness.  This can lead to patients presenting with more advanced or severe disease, which may ultimately present a higher cost burden for the government.

Secondly, the capacity for general practices to be flexible in their billing to patients with limited financial resources is significantly reduced under the proposed changes.

Thirdly, hospital emergency departments will see a major increase in the volume of people with minor ailments presenting for care. Already, approximately 30% of patients presenting to an emergency department are non-urgent or semi-urgent conditions that could be managed in a GP setting. I suspect this proportion will increase significantly after the introduction of the co-payment.

Finally, the co-payment may influence doctors to manage their patients in a less-than-ideal manner, as GP’s may try to protect their patient from additional fees. For example, the GP may not undertake a planned review of an infected wound the next day to see if the antibiotics are helping.  Or the GP may defer referring the patient for pathology tests that might have picked up the serious electrolyte abnormality. There is a significant potential for the quality of care to deteriorate.

What influence will the $7 Medicare GP co-payment have on the total price GPs will need to charge their patients rather than bulk-billing? Will there be an administration fee charged on top of the $7 fee?

This will vary depending on the way the practice currently bills.  Some practices charge all patients a fee with a gap. The proposed Medicare changes will reduce the amount that patients get as a rebate and they will therefore have a larger gap (however, the co-payment per-se won’t be paid).

It is practices that bulk-bill patients who will see the most impact. For example, a general practitioner that chooses to bulk-bill a pensioner for a standard consult will have a 24% decrease in their income for that patient, and if they charge the co-payment without an additional fee on top, then their income will drop by 11%.

For example, here is the current situation where a standard consult for a pensioner is conducted:

Medicare Rebate ($36.30) + bulk-billing incentive ($6.60) = $42.90

And here are the proposed changes:

If no co-payment is charged then total income for consult is:

Medicare rebate ($31.30) = $31.30

If co-payment is charged:

Medicare rebate ($31.30) and low-gap incentive ($6.60) and co-payment ($2.00) = $39.90

As a general practitioner who runs a small business, these reductions in income have the potential to make the business unviable. My practice is considering its options but it is likely that we will simply have to charge concessional patients a gap of approximately $11 to maintain business viability (this will essentially keep our income stable). We are exploring other options such as reducing the duration of consults from 15 minutes to 12 minutes or reducing the number of supporting staff, but these options all have a negative impact on patient care.

What types of patients will this co-payment affect the most? Do you expect certain types of patients to visit their doctor less often?

This will have the most impact on patients who have chronic illness. In particular; the elderly, those with mental illness, diabetes, high blood pressure and children with recurrent infections. The impact will depend on how the medical profession and medical practices change their fee structure after the changes are introduced. It is unclear whether the large bulk-billing organisations such as Primary Health Care will continue to bulk-bill or whether they will charge the co-payment. I suspect that the overall impact of these changes will be much more severe than expected as many general practices like mine will change from conducting ‘mixed-billing’ (bulk-billing concessional patients and charging gap for non-concessional patients) to conducting private (gap) billing for all patients.

What types of illnesses and conditions will people suffer from more severely if they don’t see their GP as often?

Chronic illnesses such as diabetes, hypertension, asthma, heart disease and those with mental illness are likely to be the hardest hit.

I also expect that some diseases will be picked up later. For example, a woman with a minor breast symptom who delays having it checked and it ultimately is found to be a breast cancer.

Another example is that if a patient reports an unusual mole early and it is excised and found to be an early melanoma, there is very little risk of the cancer spreading and cure is usual. However, if the melanoma is diagnosed after spreading, it is generally regarded as incurable and the costs of newer chemotherapies for melanoma are astronomical in comparison.

What affect do you think the GP co-payments will have on the overall health of the community and on the health budget bottom line?

There is likely to be a negative effect on general health in the community. I suspect that we will see some diseases that have been declining in severity, such as heart attacks or advanced breast cancer, either plateau or even increase in frequency.

I suspect the health budget will largely be unchanged, as while there will be a reduced number of general practice consultations and pathology/imaging rebates, there will be an increase in the number of more advanced diseases. There will probably be some cost-shifting as the more advanced cancers and heart disease will be cared for through the hospital system, whereas there will be less costs coming from general practice.

Do you think it was responsible of the Abbott government to use the revenue from the GP co-payment to build a future fund to fund scientific health research?

Increased funding for research is sorely needed. If there is a co-payment then I would support its proceeds going to research, however, I believe this funding should go to non-corporate research such as through the CSIRO or universities.  I am concerned that corporate grants will be given for research by pharmaceutical companies that do not need government support.

The funding to the states for the provision of hospital care should also be increased if the co-payment is introduced as the further demand will outstrip already limited services in our public hospitals.

So there we have it. Not only some much needed facts, but clear analysis that shows the government haven’t thought through this policy. Either that, or they have and they don’t care about the detrimental impacts on our community. Sigh.

[twitter-follow screen_name=’Vic_Rollison’ show_count=’yes’]

The Ides of March

Image courtesy of theaustralian.com.au

Image courtesy of theaustralian.com.au

On the 15th of March 44BC Julius Caesar was murdered, in an act reminiscent of the ritual slaughter of a sheep made to the god Jupiter during the Ides of March.

In 2014 on the Ides of March, Tasmania and South Australia are up for a state election. As is expected by the renowned Australian tradition for voting governments out, rather than voting them in, and by most indicators both the progressive Labor governments are set to be sacrificial Pharmakos.

The trouble with this strange form of political punishment is that it often hurts the citizen voter far more than the purged politicians.  As has been evidenced recently in NSW, QLD and federally, the triumphant conservative governments that have been beneficiaries of this disengaged democracy are rarely interested in what voters need, and more interested in what their corporate backers want.

Getting upset at the nightly news, or posting your ire on social media does not a good democracy make.  Progressive parties like the ALP and the Greens were built on mass movements that banded diverse people together in a fight for a better life, or to build a better balance between our industries and our environment.  As such, for these parties to function at their best requires community involvement.  Failing to get involved with, and then voting out such an elected government is like distaining to train your dog and then getting upset when it soils the carpet.

The conservative Liberal party, and their National party enablers, on the other hand is a party for the corporate and wealthy elite.  They do not need mass support, only your vote come election time.

Of course getting involved in politics is not very Australian, and many voters do not want to be interested.  Australians never had to fight for its democratic freedoms, and so are fairly blaze and ignorant about how it all works.  The result is that voters come to polls every three to four years, having put little thought into what they actually want from their government, complaining about missing out on their Saturday morning and muttering “I just don’t know who to vote for”.

Tasmania and South Australia are faced with a choice to re-elect incumbent progressive governments that they may have genuine grievances with, or bringing in libertarian conservative governments. There would seem to be little choice between the two.  However there are very large differences that a cursory look at the state and federal Liberal parties will clearly illustrate.

For those seeking to convince fellow voters, or those who may themselves be unsure, to assist you I have made a small list below of the kind of thing you can expect under a conservative government.  This list is by no means comprehensive and I am sure that most readers will be able to find far more to add:

In Queensland, the Liberal National government . . .

Cancelled the building of a new Children’s hospital, and will instead be changing it into a five-star hospital “hotel” where family members will be responsible for tending to patients around the clock.

Established a Commission of Audit to rationalize massive cuts to services, health, education, and support a program of extensive privatization.

Refused to sign up to education reform and Gonski co-funding.

Lost thousands of jobs, with unemployment up to 6.1% and rising.

Closed public schools and then sold the land to private developers.

Approved an electricity price rise of 22.6%.

Approved dredging onto the Great Barrier Reef.

Campbell Newman gave himself a pay rise, so that he is now paid the same as the President of the United States.

Established draconian “Anti-bikie” VLAD laws in an attempt to undermine social clubs associated with unionized workers in the building industry.  An industry that Campbell Newman has family ties and personal interests in.

Passed laws that allow police to enter a home without a warrant, arrest and fine a host of party $12,000 if three of his or her guests are intoxicated or use “indecent” language.

Changed Workcover laws to prevent injured workers from claiming health costs associated with an injury at work.

Sold social housing for a profit while increasing costs to the average family to the tune of $600 a year through direct and indirect taxation.

In Victoria, the Liberal Coalition government . . .

Changed protest laws so that the government can decide what a legitimate protest is, and force people to move with threat of arrest or an immediate fine of $500.

Is building a road tunnel, instead of additional and much needed public transport, that will result in huge increases in traffic congestion.

Cut $290 million from TAFE training in 2013, and is planning to cut millions more.

Cut $616 million from health funding, leading to the longest waiting lists for surgery ever – with some 55,000 people waiting months for treatment in 2013.

Courted the vote of disgraced MP Geoff Shaw by assisting him to repeal 2008 law that decriminalized abortion.

Has seen massive increases to wait times at hospital emergency rooms.

Has closed down over 2,000 beds in Victorian hospitals.

Has seen tolls, water, gas and electricity, and property rates increase at a faster rate than anywhere else in the country.

Is continuing to cut Ambulance services and is now attempting to replace trained paramedics with partly trained volunteers.

Unemployment is up to 6.4%, the worst since 2002.

In Western Australia the Liberal National Coalition . . .

Instituted a mindless Shark cull, despite being told it was a bad idea by scientists and fishermen – killing dolphins, seals, sealions, etc and attracting international derision.

Increased electricity prices 45% higher than CPI.

Cut hundreds of support staff from public schools and introduced further funding cuts to public schools.

Established an economic audit to justify cuts and privatization.

Continue to cut health funding and services.

Refused to sign up to education reform and Gonski co-funding.

Cancelled promised public transport improvements and expansions.

Continuing increases in unemployment, jumping from 4.6 to 5.1% in January 2014.

Oversaw an increase in state debt from $3.6 Billion in 2008 to over $18 Billion in 2013, all while overseeing a massive mining boom.

In NSW, the Liberal Coalition government . . .

Made massive cuts to emergency services, leading to closure of Fire Stations and longer wait times for emergency care.

Introduced laws to stop wage increases for public sector workers (including police, fire services and nurses).

Obeyed mining lobby groups and cancelled funding to environmental lawyers, and forbade any state agencies from “providing legal advice to activists and lobby groups”.

Has changed laws, at the behest of big miners like Rio Tinto, giving preference to the ‘economic benefits of coal mines over environmental and social impacts’.

Has opened up national parks to casual hunters and shooters, now wants to roll back marine parks to allow open season on fish reserves.

Sold public owned assets including electricity utilities, ferry services, and ports, leading to higher prices for consumers and huge cuts to services.

Nationally, the Federal Liberal-National government . . .

Has stated it will be pushing for the states to privatize more of their utilities, water, public transport, ports, and services – despite a recent reports from around the world that privatization has been a complete failure.

Established a Commission of Audit to rationalize massive cuts to services, health, education, and support a program of extensive privatization.

Is currently attempting to sell Medibank Private, a government corporation that actually makes money for tax payers, by hiring $2000-a-day spin doctors.

Tried to force SPC management to cut workers wages by up to 40% and cancel all conditions in return for any federal funding assistance.

Cancelled Gonski and education reform, and now Christopher Pyne currently has 2 men reviewing a curriculum that took 6 years and over 20,000 submissions to develop in order to reintroduce a more Christian education.

Has cancelled future Trades Training Centres across the nation.

Is signing up to the Trans-pacific partnership, which will give corporations the right to sue Australian state or federal governments if any changes to health, environment or any law impinge on their profits.

Apparently cancelled climate change, and tried to shut down the Clean Energy Finance corp, which is making $200 million per year for the tax payer, while contributing “more than 50 per cent of the emissions abatement that’s required for the bipartisan 2020 target”

Cancelled Equal access fibre-to-the-home NBN, and now cities, suburbs, regional centres and the bush are going to miss out on the economic and social benefits of broadband infrastructure.

Has broken 25 promises in 150 days; after spending 3 years hounding PM Gillard for breaking 1.

In conclusion

In Rome the death of Caesar saw the end of the Roman Republic and the rise of the non-democratic Roman Empire.  This Ides of March sees similar creeping imperial forces on the warpath against the foundations of Australian democracy.  If Liberal-National parties are elected in the upcoming state elections the voters will suffer similar fates to those listed above.

It has fallen to the voters in Tasmania and South Australia to not simply ‘punish’ the Labor governments; but rather consider the very real difference between a progressive parliament or a regressive conservative one.

You get out of government what you put in.  Just ask any lobbyist.

More robust public debate brings more transparent and effective government.

More community involvement and regular petitions brings better policy development.

More awareness of the impact of public policy brings better economic growth and social progress.

Unlike their Liberal opponents, progressive Labor governments will listen to their electorates.

Don’t vote away your freedoms.  Let them know what you want – and get them to do it.

Then… And Now OR And Now For Something Completely Different!

 

February, 2012

Mr Abbott said the rebate ”is an article of faith for the Coalition. Private health insurance is in our DNA.”

”Support for people who want to get ahead – it is our raison d’etre,” he told Sydney radio.

But in May, 2013

THE Coalition has walked away from a promise to scrap means testing of the private health insurance rebate, with Joe Hockey confirming it will have to stand in the face of the budget “emergency”.

 And Now For Something Completely Different:

Mr Dutton said one of the Coalition government’s important tasks was ”to grow the opportunity for those Australians who can afford to do to contribute to their own health care costs”.

There ya go! Remember the “Hope, Reward, Opportunity” badge that appeared on all that pre-election stuff from the Liberals that was shoved in your letterbox prior to the election? (No, not Amway’s “Freedom, Family, Hope, Reward”) See, they haven’t forgotten about their slogan.

I’m sure some of you thought that the OPPORTUNITY thing was just some empty rhetoric, but no. People on the dole are being given the OPPORTUNITY to develop much needed skills in picking up rubbish. And many manufacturing workers are being given a tremendous OPPORTUNITY – to quote Mr Abbott, “many of them will probably be liberated to pursue new opportunities and to get on with their lives”.

And now they’re planning to grow the OPPORTUNITY for people to contribute to their own health care costs. This is exactly the sort of opportunity I’ve been waiting for. When I had a recent test, I was bulk-billed, I asked the person doing it if there was some way I could contribute to the cost, but they said no. I asked if, perhaps, I could empty their bin or mop their floor. Again no. Because of some ridiculously complicated system, they apparently had cleaners who were paid money to do such things.  But, soon, I may have the opportunity to contribute to my own health care costs. Opportunities like that don’t come along under every government.

I certainly HOPE that the opportunity doesn’t stop there. After all, there are so many other ways Australians who can afford it could be given “opportunities to contribute”.  For example, perhaps, when people wish to report a crime, they could be asked for a small co-contribution to cover the police time in writing out the report. For a slightly larger co-contribution, the police will investigate the crime and – in the event of it being solved – you could pay them a REWARD.

And let’s not forget Parliament. At the moment, politicians pass legislation for free. Maybe there should be some form of co-contribution – from those who can afford it – to pass the sort of legislation that they require. After all, not all taxpayers benefit from certains laws, so why should we all pay? Yes, I’m sure that some will say that this happens with parties REWARDING people and organisations who contribute to it, but that’s a very inefficient system. There’s no guarantee that the party won’t take money from almost everyone, then just make up its own mind when in government.  In my proposal, it would be totally based on individual Bills – a “user pays” system.

No, I can see that OPPORTUNITY will continue to grow under this government. REWARD will go to those who deserve it. And as for HOPE, well, that’s the entire basis for our economic policies.

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