“Doctors having to write sick certificates and repeat scripts, as well as provide patients with routine test results, have emerged as priority areas for reform of the $21 billion Medicare Benefits Schedule.
The Turnbull government has been told health professionals question the value of largely routine or administrative consultations, raising the potential for funding and workforce changes to make better use of limited resources.”
An interim report from a government-commissioned MBS review has also highlighted unnecessary diagnostic imaging as a concern, with a quarter of all patients consulted claiming to have been sent off for tests and scans they felt they didn’t need. The increase in referrals has caused Medicare expenditure to surge in recent years.
Health Minister Sussan Ley commissioned the review after the Coalition ditched the concept of a Medicare co-payment. The review, headed by former Sydney Medical School dean Bruce Robinson, is examining the evidence base and usage of about 5700 MBS items.
When health professionals were asked to identify areas of “low-value patient care” that should be prioritised as part of the review, administrative GP consultations were mentioned the most, and 50 per cent more than the second most mentioned area (the range of allied health providers covered by the MBS).
The burden of administrative tasks and paperwork, which could be reduced or given to non-medical staff, included providing certificates for patients to take time off work, repeat scripts for those on medication, and extended referrals for those being treated by a specialist. The review heard emails and text messages could be a more efficient way of dealing with such matters.
An increase in chronic illness — and of consumers, especially older people, seeking to take better care of themselves — has raised the risk of over-servicing. In 2013-14, for every 100 patient encounters, there were 49.1 pathology referrals (an increase from 36.7 in 2004-05) and 10.9 referrals for diagnostic imaging (an increase from 8.3 in 2004-05).
Inappropriate diagnostic imaging was the third most often cited area of low-value care by health professionals — four times the rate for pathology — and 24 per cent of consumers reported themselves, or their acquaintances, being referred for unnecessary care. One consumer reported having multiple blood tests ordered by different doctors due to a breakdown in communication between clinics and the laboratory, while a parent said “my son has had an X-ray for a chest infection four times (and) also had four hip X-rays — he is only 20 months old”.
The government still plans to remove bulk-billing incentives from diagnostic imaging and pathology services next year as it seeks savings across portfolios.
Despite initial scepticism from the Australian Medical Association, a survey found 93 per cent of health professionals believed parts of the MBS were outdated and changes were necessary.
Ms Ley has promised to consider lifting the contentious freeze on Medicare rebate indexation if sufficient savings could be identified through the review and elsewhere.
Despite a torrid election campaign, the Coalition has avoided giving a timeframe for the freeze being lifted, and the interim review demonstrates line-by-line spending reviews are complex. While the review has identified obsolete MBS items, bringing savings of $5.1m over four years, the Department of Health has had to spend $4.95m hiring management consulting firm McKinsey to assist the review.
In stakeholder forums, the issue most raised was “factoring in the costs of delivering a service” — rebates too high or low, depending on the circumstances — with “outcomes-based reimbursement” the third most commonly raised issue.
The second most common area raised was “transparency surrounding usage, variation and fees”, which corresponds with the Health Department’s push for better data collections and analysis to allow officials to identify trends and potential concerns. Asked about MBS rules and regulations, 37 per cent of health professionals believed the entire list, and 60 per cent of individual items, needed attention.
With Malcolm Turnbull in China for G20 talks, Bill Shorten yesterday sought to reignite the Medicare debate, repeating his claim that Labor would protect Medicare but the Coalition would destroy it.
Ms Ley said last night said the review demonstrated that “Labor’s insistence on blocking any changes to Medicare is out-of-date and will only harm Medicare in the long run”.
” An extra 17 million GP services were bulk billed under the Coalition last year compared with Labor following another year of record Medicare investment by the Turnbull Government, as Bill Shorten’s Mediscare lies “crumble around him” and leave the credibility of his leadership in tatters.
Minister for Health and Aged Care Sussan Ley today revealed a record 123 million out of 145 million GP services were fully-funded by the Turnbull Government at no cost to patients through Medicare during 2015-16.”
“Record bulk billing as Shorten’s Mediscare lies crumble ” Minister for Health and Aged Care Sussan Ley
“The Government’s triumphalism about today’s bulk billing figures shows how out of touch they are on Medicare.
As the Royal Australian College of General Practitioners has said previously, the statistics the Government is using are “misleading” and “should be rejected”.
That’s because they measure the number of services that are bulk billed, not the number of patients. So they hide the fact that millions of Australians are no longer bulk billed.
Malcolm Turnbull has confirmed that his Government remains committed to its six year freeze on Medicare rebates.”
“Government out of touch on Medicare ” Catherine King Opposition spokesperson Health and Medicaresee Part 2 Below
“Labor is in damage control over their Mediscare lies, this morning caught out claiming official bulk billing figures they trumpeted in Government now don’t apply because they are in opposition, in another major gaffe.
Bill Shorten and Labor made their bed with Mediscare. The question is whether they can stop lying in it.”
Gaffe-prone King in Mediscare damage controlLey Press Release Part 3 Below
This saw GP bulk billing hit a historic high of 85.1 per cent under the Turnbull Government – up from 84.3 per cent in 2014-15 – and follows the Coalition’s record $7.1 billion investment in general practice via Medicare last year.
The number of Australians accessing Medicare-funded GP services was also up by nearly half-a-million to 20.9 million last year, while the average number of services and spend per GP patient grew to 6.9 and $344 respectively.
The figures are a far cry from Labor’s Mediscare lies over the past year and raise serious questions for Mr Shorten:
‘Just weeks after it was introduced that freeze is already wreaking havoc on patients, with doctors forced to raise fees, cut bulk billing…” – Catherine King – 15 September 2015 – Media Release
Ms Ley said the figures were “good news for Australians and bad news for Labor”.
“Last year the Turnbull Government invested over $21 billion into Medicare as part of our commitment to ensuring all Australians have access to affordable universal healthcare – that’s about $60 million every day,” Ms Ley said.
“Across Australia, there were 17 million more bulk billed GP attendances in the last 12 months under the Turnbull Government compared to Labor’s last full year in office.
“These figures expose the blatant and remorseless Mediscare lies Labor – under Mr Shorten’s leadership – have been telling the Australian public over the past 12 months.
“There’s no doubt we still have work to do, but Australians should take assurance from the fact no government has invested more into Medicare than the Turnbull Government.
“And no Government has consistently overseen higher bulk billing rates than the Turnbull Government.”
Ms Ley said the Turnbull Government would increase investment in Medicare by another $4 billion over four years.
“And we’re backing that up with nearly $120 million to begin rollout out our GP-focused Health Care Homes – a better way of delivering Medicare for Australians with chronic illness.”
Overall, the number of Medicare services increased to 384 million in 2015-16 – more than one million per day – at a total cost of $21,107,750,246 – an increase of nearly $1 billion on 2014-15 – with the overall Medicare bulk billing rate also increasing to 78.2 per cent in 2015-16 from 77.6 per cent the year before.
Neither the Rudd-Gillard, nor Hawke-Keating, Labor Governments have ever delivered higher rates of Medicare investment or bulk billing than the Turnbull Coalition Government, Ms Ley said.
“This is possible because the Turnbull Government is committed to delivering a strong budget and economy that ensures we can also afford to continue investing in services important to Australians like Medicare.
“We will continue to work closely with health professionals across the board to ensure we deliver a health and Medicare system that is not only fair and focussed on quality, but efficient and sustainable for generations to come.
“In contrast, Bill Shorten’s Mediscare lies have left Labor exposed by a Leader whose credibility is now terminally damaged with the public and has weighed down his party with billions of dollars of promises they cannot afford.
“Labor is now going to have to make some tough savings decisions if they want to match the Turnbull Government’s record investment in Medicare, while at the same time building a strong economy and repairing the budget.”
” The Government’s triumphalism about today’s bulk billing figures shows how out of touch they are on Medicare. ” King
As the Royal Australian College of General Practitioners has said previously, the statistics the Government is using are “misleading” and “should be rejected”.
That’s because they measure the number of services that are bulk billed, not the number of patients. So they hide the fact that millions of Australians are no longer bulk billed.
These statistics also ignore the fact that out-of-pocket costs have more than doubled.
GPs have the best interests of their patients at heart, and many continued to bulk bill in 2015-16. They had been assured the freeze would be lifted in the Budget, and were watching the outcome of the election.
But now that it’s clear that Malcolm Turnbull’s Medicare freeze is an ice age, practices around Australia are abandoning bulk billing.
For example, the only practice on Magnetic Island in Queensland has advised the Island’s residents that it is abandoning bulk billing due to “Medicare restrictions and cuts”.
Similarly, the Collins and Grosvenor Street General Practices in Hobart have scrapped bulk billing due to the freeze.
Australians know that Malcolm Turnbull’s six year freeze on Medicare rebates is driving bulk billing down and out-of-pocket costs up.
The Government’s insistence otherwise only shows how out of touch they are.
GOVERNMENT REMAINS COMMITTED TO MEDICARE FREEZE
Malcolm Turnbull has confirmed that his Government remains committed to its six year freeze on Medicare rebates.
In an interview in today’s Australian, Mr Turnbull said the Government had “not decided to change the policy”.
This is in spite of Mr Turnbull’s comments, in the same interview, that “what we have to do this term is categorically reassure Australians about our commitment to universal health and Medicare”.
Mr Turnbull’s comments echo his claim, made immediately after the election, that he would learn the lessons of the election and address Australians’ concerns about his deep cuts to health.
But two months later, nothing has changed. As Mr Turnbull has confirmed today, the Government remains committed to:
Driving bulk billing down and co-payments up via the freeze on Medicare rebates, a GP Tax by stealth;
Cutting Medicare bulk billing incentives for vital tests and scans;
Increasing the price of prescription medicines by up to $5, even for concession card holders; and
Cutting hundreds of millions from Medicare via changes to the Medicare Safety Net.
Softer rhetoric won’t change the harsh reality of these cuts. Mr Turnbull’s “reassurance” is worth as much as Tony Abbott’s promise of “no cuts to health” – nothing.
In contrast, during the election campaign Labor committed to ending Mr Turnbull’s Medicare freeze, scrapping his cuts to vital tests and scans, reversing his price hikes to Medicines, and protecting the Medicare Safety Nets.
On health, look at what Mr Turnbull does, not what he says.
Gaffe-prone King in Mediscare damage controlLey Press Release
Labor is in damage control over their Mediscare lies, this morning caught out claiming official bulk billing figures they trumpeted in Government now don’t apply because they are in opposition, in another major gaffe.
Annual Medicare figures today show that an extra 17 million GP services were bulk billed under the Coalition last year compared with Labor following another year of record Medicare investment by the Turnbull Government.
This saw GP bulk billing rates hit a record high of 85.1 per cent in 2015-16, higher than both the Rudd-Gillard or Hawke-Keating Labor Governments.
Yet it’s clear Labor’s Mediscare know no bounds, with Shadow Labor Health Spokesperson Catherine King now trying to spin the Australian public that “the statistics the Government is using are “misleading” and “should be rejected”.
Except Ms King clearly forgot to check with her Deputy Labor Leader Tanya Plibersek, who was more than happy to stand by the official bulk billing statistics when she was Health Minister during the Rudd-Gillard Government.
And in a double blow for Ms King, Ms Plibersek’s media release is another reminder that GP bulk billing rates were lower under Labor than the 85.1 per cent recorded under the Turnbull Government today.
Ms King’s gaffe today will only continue to fuel concerns in Labor’s party room that Bill Shorten’s Mediscare lies will hurt the party’s trust with the Australian people in the long run.
Particularly after it was Ms King herself who, during the election campaign, was forced to admit Medicare bulk billing rates were higher under the Turnbull Coalition than under Labor:
KELLY: Bill Shorten is saying we want to campaign about bulk billing but in actual fact the Government’s performance is better than Labor’s.
KING: Well certainly. Well I’d welcome that. I’d welcome that bulk billing remains high – that’s a good thing, we want to preserve that.
And let’s not forget what Ms Plibersek had to say when Labor first introduced the Medicare pause on indexation, which runs completely counter to Bill Shorten’s Mediscare lies today:
Doctors earn enough money to bear the Federal Government’s controversial freeze on MBS rebates, Health Minister Tanya Plibersek says.
Ms Plibersek dismissed concerns that the freeze — which will remove $664 million from the MBS over four years — will pressure doctors to compromise care.
“I understand that GPs have all sorts of expenses in running their surgeries and employing staff and so on, but the average billing from Medicare is more than $350,000 a year.”
Bill Shorten’s Mediscare lies have left Labor exposed by a Leader whose credibility is now terminally damaged with the public and has weighed down his party with billions of dollars of promises they cannot afford.
Bill Shorten and Labor made their bed with Mediscare. The question is whether they can stop lying in it.
“The Australian Government is inviting you to contribute to the reform of the health system and delivering a Healthier Medicare.
One of the priority areas is better supporting people with chronic and complex health conditions, including mental health conditions, through primary health care.
This survey has been announced alongside the release of a Discussion Paper by the Primary Health Care Advisory Group, to examine options for health reform and provide a report to the Australian Government in late 2015. Your responses to this survey will inform the Primary Health Care Advisory Group and help determine how to best improve the primary health care system.”
The Healthier Medicare initiative includes three priorities: the Medicare Benefits Schedule (MBS) Review Taskforce; the Primary Health Care Advisory Group (PHCAG) and a review of Medicare compliance rules.
The Australian Government wishes to work hand-in-hand with health professionals and patients to deliver a healthier Medicare to ensure Australians continue receiving the high-quality and appropriate care they need as efficiently as possible.
To that end, the Australian Government has developed the ‘Healthier Medicare’ initiative to review three priority areas:
Medicare Benefits Schedule (MBS) Review Taskforce
Led by Professor Bruce Robinson, Dean of the Sydney Medical School, University of Sydney, the MBS Review Taskforce will consider how services can be aligned with contemporary clinical evidence and improve health outcomes for patients.
Primary Health Care Advisory Group (PHCAG)
Led by the former Australian Medical Association President, and practising GP, Dr Steve Hambleton. The Advisory Group will investigate options to provide: better care for people with complex and chronic illness; innovative care and funding models; better recognition and treatment of mental health conditions; and greater connection between primary health care and hospital care.
The Advisory Group is undertaking a comprehensive national consultation process to hear the views and experiences of people living with chronic and complex conditions, and people engaged in the care and management of these patients, across the health system. This will inform the advice that the Advisory Group will provide to Government in late 2015.
The Australian Government is inviting you to contribute to the reform of the health system and delivering a Healthier Medicare.
One of the priority areas is better supporting people with chronic and complex health conditions, including mental health conditions, through primary health care.
This survey has been announced alongside the release of a Discussion Paper by the Primary Health Care Advisory Group, to examine options for health reform and provide a report to the Australian Government in late 2015. Your responses to this survey will inform the Primary Health Care Advisory Group and help determine how to best improve the primary health care system.
Additional information on Healthier Medicare, the Primary Health Care Advisory Group and this survey are available via the Department of Health website.
Thank you for taking time to participate in this important opportunity to shape Australia’s future health system.
This survey is hosted by ORC International, an independent research company. In the course of this research, ORC International will store data in Australia and the United States on secure servers that comply with Australian Privacy Law.
At any time during the survey, you may select to save your responses to return to at a later time. To do this, click the ‘Save to return later’ button located towards the bottom left of the page. You will be asked to provide an email address, to which a return link will be sent.
Throughout the survey, blue font indicates that a definition is provided. Hover over a phrase in blue to display its definition.
Where comments are requested, please limit each of your responses to 2250 characters or less (approximately 300 words). However, up to 3750 characters (approximately 500 words) can be entered in the final question which provides you with an opportunity to add any additional comments you may have.
Formal feedback should be provided via the Online Survey which will be open from Thursday 6 August to Thursday 3 September.
3.Medicare compliance rules and benchmarks
The Government will also work with clinical leaders, medical organisations and patient representatives to develop clearer Medicare compliance rules and benchmarks. The use of new techniques such as analytics and behavioural economics will provide more information to clinicians to enable them to better manage appropriate practices. As well, more information will be available to patients about fees charged by health professionals so they can make informed choices about their health care.
For further information, please refer to these two media releases:
“Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent.
If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today.”
Minister for Health Peter Dutton Speaking on ABC 7:30 report , read full transcript below
According to reports in the Guardian the federal health minister, Peter Dutton, has signalled dramatic changes to Medicare to address “staggering” increases in health spending, confirming the Abbott government would consider a new fee for visits to the doctor.
Laying the groundwork for politically sensitive reforms, Dutton said he wanted to “start a national conversation about modernising and strengthening Medicare”. He said the health system was “riddled with inefficiency and waste” and warned that doing nothing to address the long-term budget burden was not an option.
In a speech in Brisbane on Wednesday, the minister flagged a greater role for the private sector and private insurers in primary care as the government wanted to “grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs”.
But Labor seized on his comments of evidence that the government planned “to destroy universal healthcare in Australia” by making people pay more to access services.
The shadow health minister, Catherine King, said Dutton’s claims about rising health costs were “hysterical” as Australia spent 9.1% of its gross domestic product on health compared with 17% by the United States.
Dutton followed up his speech with an interview on the ABC’s 7.30 program in which he said the country should debate how governments and consumers paid for health services. He said the discussion should include payment models for people who had “a means to contribute to their own healthcare”.
A discussion about who pays for our health system and how is what Federal Health Minister Peter Dutton has flagged, suggesting those with a mean to contribute may have to pay more.
SARAH FERGUSON, PRESENTER: Federal Health Minister Peter Dutton today called for a fearless, far-reaching debate about Australia’s health system, saying that current spending is unsustainable. He’s now flagging major changes to health services, with Australians who can afford it paying more for healthcare and medicines.
The minister has revealed he’s looking at a potential Medicare co-payment, which some argue could mean the end of universal healthcare. It comes after a controversial week in the Health portfolio, with junior Health Minister Fiona Nash accused of doing the bidding of the junk food industry, pulling down a healthy consumers’ website years in preparation. Peter Dutton joined me earlier from Brisbane.
Peter Dutton, thank you very much for joining us.
PETER DUTTON, HEALTH MINISTER: Pleasure. Thank you, Sarah.
SARAH FERGUSON: You said in your speech today that in the past 10 years the cost of Medicare has increased by 120 per cent, the Pharmaceutical Benefits Scheme by 90 per cent, hospital care by 80 per cent. You say that’s not sustainable and something must be done. What exactly is it that you are planning to do?
PETER DUTTON: Well the first thing that we have to do is have a conversation with the Australian people to say that we want to strengthen and modernise Medicare. It’s a system that, obviously, all Australians, including myself, hold near and dear. But it’s a system that was set up in the 1980s and we have to accept the changing and ageing demographic of our society, we have one of the highest obesity rates in the world, we have cancers that if early detection takes place, we can help those people if we have better connections between people and their GPs – all of those things are great, but they have to be paid for. So we have to look at where it is we’re spending money at the moment, whether or not that’s the most efficient way to spend the money so that we can strengthen and sustain our system into the future.
SARAH FERGUSON: Now, does that include increasing the costs of healthcare for those who can afford to pay more?
PETER DUTTON: Well I think it does and at the moment government pays about 70 per cent of that which we spend on health each year, and I know these figures sort of gloss – are glossed over or go over people’s heads, but $140 billion at the moment we’re spending each year on health that we raise about $10 billion a year out of the Medicare levy. There is enormous amounts of money to be spent. There are lots of technologies coming through, and as a First World country, we want to adopt those early and we have to have a conversation about how we pay for those and those that have a capacity to pay in many cases are already paying within the system, but we have to have a discussion about how it is that payment model works going forward.
SARAH FERGUSON: Individuals are already contributing about 18 per cent of the cost of their own health care. Are you saying those payments are going to have to go up?
PETER DUTTON: Well I’m saying when you look at the fact that over the course of the next four years the funding is projected to go up in public hospitals by 50 per cent. If you look at over the course of the last 10 years where payments have gone up under Medicare Benefits Schedule where we pay the doctors and pay for pathology and diagnostic tests and whatnot, it was $8 billion a year 10 years ago; it’s $18 billion a year today. We have to look at the next 10 years where we we’re going to have millions of people who will go onto the age group of over 65. I want to make sure that we can provide for those and we do have to have a national discussion about who pays for what and how the Government pays going forward and how consumers pay for those health services.
SARAH FERGUSON: Specifically, for example, are you in favour of introducing a Medicare copayment. A figure of $6 a visit has been touted already?
PETER DUTTON: Well there are suggestions that have been made both in favour and against this particular proposal, but it’s one aspect that the Government will need to consider. The Commission of Audit obviously …
SARAH FERGUSON: And what’s your own view – what’s your own view on that? Excuse me.
PETER DUTTON: Well my own view is that people at the moment pay a co-contribution through when they buy their medicines, regardless of their income. People pay as little as $6 for a $17,000 prescription, a single prescription. People pay a copayment at the moment for their private health insurance. 11 million Australians have private health insurance. Many Australians already pay a copayment when they go to see the doctor. Now, the issue is how you guarantee access, particularly for those who are without means, and how you don’t deter people from going to see a doctor if there is some sort of a payment mechanism in place.
SARAH FERGUSON: You also raise the issue today of the ageing population. Is your government going to be forced to make older people who have more resources pay more for their healthcare?
PETER DUTTON: Well, I don’t want to single anybody out, but what I would say is that as a general principle, in a society where we have an ageing of our population, regardless of people’s age, if they have a means to contribute to their own health care, we should be embarking on a discussion about how that payment model will work.
SARAH FERGUSON: And is that going to require a new form of means testing to make that possible?
PETER DUTTON: Well, not necessarily, and again, this is the recommendations that we’ll wait to see from the Commission of Audit. I want to make sure that, for argument’s sake, we have a discussion about you or me on reasonable incomes whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test, should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill. I think these are all reasonable discussions for our population to have.
SARAH FERGUSON: Now, you set out as the key rationale for your speech today the dramatically rising rates of obesity and diabetes in society, yet your own junior minister, Fiona Nash, shut down a website which was designed to help prevent those scourges. Was that a mistake?
PETER DUTTON: It wasn’t a mistake. The Government obviously has a number of people who were advising us in these particular areas. The issue that you speak of is a reasonable discussion to take place. But to put this issue into perspective, there was a system that was proposed in relation to a star rating that people could assess whether or not they purchased particular foods based on that system or that star rating system. The system hasn’t started, and as I understand the minister’s position, she said that the website shouldn’t proceed until there had been a rolling out of this system or a better understanding …
SARAH FERGUSON: But that wasn’t the view of those people who had been involved in putting that website together; they said it was ready to go.
PETER DUTTON: Well again, I mean, you’ve got Labor premiers sitting around the table in South Australia and Tasmania, two of the worst-performing health systems in the country. I don’t place much credibility in what might have been leaked by Labor ministers out of that meeting. I find Fiona Nash not only to be an effective minister, but a very decent person. I think she’s served her constituency well.
SARAH FERGUSON: That’s not actually the question here. Excuse me, minister, …
PETER DUTTON: Well it goes to credibility and the credibility that I place in this debate is with Senator Nash and I think she has done the right thing here. We’ll have a proper discussion about what we should do in terms of food labelling and the rest of it, but we aren’t going to be cajoled or bullied by people like SA or Tasmania or indeed the ACT, who have very poor performing health systems.
SARAH FERGUSON: Forgive me for interrupting. It doesn’t just go to the credibility of the minister. I’m asking you for your opinion. These are exactly the tools that public health experts say the public needs to fight diabetes and obesity. Do you still maintain that website should be taken down?
PETER DUTTON: If the system hasn’t started, I don’t see an argument for the website being up in place and that’s the decision rightly that the minister took.
SARAH FERGUSON: Did you know that her chief-of-staff was a lobbyist for the food and soft drink industry?
PETER DUTTON: Well, again, Sarah, these are matters that have been trawled over.
SARAH FERGUSON: What’s the answer to the question, if you would?
PETER DUTTON: Well I knew of course, as everybody else did, Mr Furnival’s history, but today is our opportunity to talk about ways in which we can strengthen Medicare going forward and that’s the speech I gave today and I think that’s the discussion the public wants to hear about, about how can we provide …
SARAH FERGUSON: Except that you’re – minister, if I may say, you’re the person that raised the issue of obesity and diabetes, that wasn’t me.
PETER DUTTON: Sure.
SARAH FERGUSON: You made that the centrepiece of your speech, the opening lines in fact.
PETER DUTTON: Sure.
SARAH FERGUSON: You’re saying you knew that Mr Furnival was a lobbyist for the food and drink industry. Doesn’t that mean there was a clear conflict of interest between his past and the actions of your minister?
PETER DUTTON: No, the appropriate, the appropriate – as I’m advised, the appropriate declarations were made and signed, and as I say, Mr Furnival now has moved on. Our discussion today was about the fact that we have one of the highest obesity rates in the world. About two in three Australians have – are either overweight or obese. We now have about 2,200 young children and youngsters who are identified as having Type 2 diabetes. That’s what I was speaking about today and frankly I think that’s a much more substantive discussion to have with the public and if we do that then we can talk about the ways that we can make our system sustainable going forwards.
SARAH FERGUSON: Thank you very much indeed for joining us, Mr Dutton.
PETER DUTTON: My pleasure. Thank you.
NACCHO needs to improve how we connect, inform and engage into the Ifuture.
“In the first instance, delivering good health will drive increases in workforce participation and productivity, simultaneously boosting the economy and easing pressures on the healthcare system. The loss to the workforce of people suffering from chronic illness and their carers has been estimated at 537,000 full-time and 47,000 part-time person years; the costs run into many billions of dollars. Doing prevention, early intervention and chronic disease management well may mean spending even more in Medicare, but the savings will show elsewhere in the healthcare system and the economy generally.”
Dr Lesley Russell is a Research Associate at the Menzies Centre for Health Policy at the University of Sydney
NACCHO welcomes comments from members and stakeholders in COMMENTS below
This month marks the 30th anniversary of the introduction of Medicare and a timely opportunity for all Australians to consider the importance of this iconic program. Recently mooted proposals such as co-payments and private health insurance to cover gaps for doctors’ services have given rise to concerns about the future of Medicare. In the absence of clear policy directions from the Coalition government, short-term budget imperatives seem to be the prime drivers for decisions that could have long-term repercussions.
The government’s mantra is that Medicare costs are out of control and not sustainable. Annual spending on Medicare has grown 120 per cent in the past decade, faster than growth in the total health budget of 104 per cent and Pharmaceutical Benefits Schedule spending, which rose 79 per cent over the same period.
This concern for healthcare expenditures apparently does not extend to the rising cost of private health insurance which has been around 5.4 per cent annually – well above CPI – and this year, with ministerial approval, will rise by an average of 6.2 per cent. Every such rise also means that taxpayers foot a growing bill for the private health insurance rebate, which will cost $5.4 billion this financial year. At the same time, out-of-pocket costs for patients have almost doubled over the decade.
The Parliamentary Library estimates that since its inception in 1984, Medicare has paid $235 billion in benefits for more than five billion health services. In that time, the population has grown from 15.5million to 23 million, the median age has increased by seven years, average full-time earnings have increased from $18,990 to $73,980, and new medications and technology have extended life expectancy from 75.8 to 82.1 years – and added significantly to healthcare costs.
A recent Productivity Commission report shows while spending on GP services grew from $6.2 billion in 2006-07 to $7.4 billion in 2012-13, GP spending per person increased little, from $301.60 in 2006-07 to $304.40 in 2011-12.
The worrisome issue is that this static spending likely reflects the increasing numbers of Australians who defer seeing a doctor because of cost and the failure of many people with mental illness to get the treatment they need.
The levels of healthcare spending are highly germane to Treasury’s projections of future budget deficits. But they are hardly out of control, even if GDP growth has slowed. The options for action have been presented simplistically as ration or reform but the reality is that we must do more to make the healthcare system work smarter.
There are two key areas for action: giving greater support to prevention and managing chronic illnesses effectively in the community, and addressing current waste and inefficiencies.
In the first instance, delivering good health will drive increases in workforce participation and productivity, simultaneously boosting the economy and easing pressures on the healthcare system. The loss to the workforce of people suffering from chronic illness and their carers has been estimated at 537,000 full-time and 47,000 part-time person years; the costs run into many billions of dollars. Doing prevention, early intervention and chronic disease management well may mean spending even more in Medicare, but the savings will show elsewhere in the healthcare system and the economy generally.
There are large offsets to be gained by reducing waste and inefficiency which could account for as much as 30 per cent of healthcare expenditure. The causes are adverse events, unnecessary duplication of tests, inability of patients to comply with treatment and medication regimens, and failure to ensure that best practice is followed.
It is estimated that patients receive appropriate care or best practice less than 60 per cent of the time, and adverse events result in approximately 4550 unnecessary deaths a year and add a cost of around $2 billion annually to the healthcare budget.
There are 5700 items on the Medicare Benefits Schedule but only 3 per cent of these have been formally evaluated for evidence of their efficacy and cost-effectiveness. Recently Australian researchers flagged 150 Medicare services as potentially unsafe, ineffective or otherwise inappropriately applied. On the other hand a groundbreaking study funded by the National Health and Medical Research Council has evaluated the cost-effectiveness of 150 preventive health interventions, identifying where more and less should be done to achieve a healthier community and a health system that delivers better value.
While adding new Medicare services is easy, the process of disinvestment (the withdrawal of resources from health care practices, procedures, technologies, and pharmaceuticals that are deemed to deliver no or low health gain for their cost, and are thus not efficient health resource allocations) is not work for budget slashers in a hurry but rather for those who wield a budget scalpel with surgical precision.
There is also a raft of approaches to healthcare reform and sustainability included in the report of the National Health and Hospital Reform Commission. To date, despite their expert provenance, these have barely been considered.
Finally, based on the relationship between government health expenditures and GDP, the Medicare levy should be at least 2.5 per cent by now. Raising it by 1 per cent would generate a further $7 billion each year. There are likely many people who would be happy to pay that or more for well-funded health services – if only the government would engage them in the discussion.
“Lack of an effective infrastructure to help us avoid illness is a serious flaw in our healthcare system that needs urgent attention. Its establishment will require more money for Medicare but save us a fortune and provide us with a healthier population. We are frustratingly insular when it comes to introducing the changes contemporary Australia needs to meet health-related demands”.
John Dwyer emeritus professor of medicine at the University of NSW writing in THE AUSTRALIAN
THERE is a lot that is disturbing about the federal government’s flirtation with a $6 co-payment for a service from a GP. Certainly no signal to the community that healthcare is expensive is needed. Last year we spent more than $29 billion from our hip pockets to subsidise our taxpayer-funded health system.
Most commentators have criticised a co-payment, as it will act as a further deterrent for poorer Australians to seek the care they need, yet provide only paltry savings in a $120bn-a-year health system. Studies show that already too many patients delay seeking help and fail to take prescribed medications because of the costs involved. With the exception of illness caused by excessive alcohol consumption, all risk factors for serious disease are more prevalent in less advantaged Australians. Healthcare in our wealthy country is distressingly and increasingly inequitable.
However, the major frustration with the current debate is associated with the lack of political understanding of the changes we do need to make to provide better health outcomes from a system that is financially sustainable. We do need to extract far more health from the dollars we invest in our health system but cost-effectiveness can only be tackled with a whole-of-system analysis not just a focus on the federally funded Medicare program that supports the delivery of primary care.
If the government were serious about reducing the cost of our health system while improving outcomes and equity, it would start by tackling the appalling waste and inefficiency associated with having nine departments of health to care for 23 million people. Not only does this result in duplication costs estimated to be between $3bn and $4bn annually, the associated jurisdictional mess that sees states responsible for hospitals and the federal government responsible for primary care perpetuates all the inefficiency associated with a lack of patient-focused integrated services. We are the only OECD country so burdened.
This compartmentalisation is represented by Health Minister Peter Dutton’s focus on the cost of Medicare. Hospital expenditure dwarfs primary care expenditure. In the real healthcare delivery world, the success or otherwise of our Medicare-funded primary care system has a significant influence on how much we need to spend on hospital care. Indeed the pertinent truth is that hospital funding into the future will be manageable only if a modernised and remodelled primary care system can reduce the demand for hospital admissions.
The Productivity Commission reports that between 600,000 and 750,000 public hospital admissions could be avoided annually with an effective community intervention in the three weeks prior to hospitalisation. An average hospital admission costs at least $5000 while a community intervention to prevent that admission would cost about $300. Better quality control and attention to the evidence base supporting procedures to avoid unnecessary interventions would also save us billions of dollars.
Most of the $18bn provided annually by Medicare is utilised for treatment available from our GPs. Primary care is doctor-centric and sickness-orientated. We visit our GP because we have a problem, not to get help to stay well. GPs are swamped with patients with chronic and complex diseases most of which could have been avoided or minimised as they are related to unhealthy lifestyle practices.
Lack of an effective infrastructure to help us avoid illness is a serious flaw in our healthcare system that needs urgent attention. Its establishment will require more money for Medicare but save us a fortune and provide us with a healthier population. We are frustratingly insular when it comes to introducing the changes contemporary Australia needs to meet health-related demands.
Around the world the trend is to establish primary care systems that encourage citizens to enrol in a wellness maintenance program and benefit from the delivery of healthcare by teams of health professionals working as “first among equals” in the one practice, integrated primary care. Medicare would cover the services provided by the team.
The psychology associated with voluntary enrolment is important. The philosophy involves acceptance of the concept that we need to take more responsibility for our own health but, when necessary, with personalised and ongoing assistance from appropriate health professionals. The infrastructure involves having such a prevention program available from one’s primary care practice and is not necessarily delivered by doctors.
Contemporary primary care should also provide earlier diagnosis and intervention in potentially chronic conditions, team management for established chronic disease, and care in the community for many who are currently admitted to hospital.
The benefit of spending more on Medicare to reduce hospital admissions is a no-brainer if one is looking at the cost of the entire system but, of course, our governments don’t do this. The savings would more than cover the expense of introducing integrated primary care into Australia.
The Abbott government will probably govern us for six years. It should commit to taking us on a health reform journey so that in six years the above changes and the introduction of a single funder for our health system are providing us with far more health from the available healthcare dollars. To be talking about $6 is to trivialise a major policy challenge.
John Dwyer is emeritus professor of medicine at the University of NSW.
Speaking at the Australian Medical Association (AMA) conference in Sydney on Friday, opposition health spokesman Peter Dutton said questions remained over the role of Medicare locals, the 61 organisations set up by Labor to co-ordinate primary care.
“Some Medicare locals appear to be doing a good job,” Mr Dutton said.
“But in some cases, health professionals have expressed their frustration, or indeed indifference, to their existence.”
Response from AML Alliance CEO Claire Austin is in the comments below
Mr Dutton has previously criticised Medicare Local, labelling it a bureaucracy that has not improved health services.
On Friday, he said he was concerned Medicare Local could act as a commonwealth-subsidised competitor that disrupted other health services, rather than raising the level of care.
“Contracts have been signed secretly, and the government refuses to provide any further detail about 3000 people now employed across the Medicare Local network,” Mr Dutton said.
He said the coalition would consult experts including general practitioners and clinicians in its review.
The Australian Healthcare and Hospitals Association (AHHA) called on the coalition to reveal its plans for Medicare Local ahead of September’s election.
“Deferring decisions until after the election leaves patients, families, communities and health service providers in limbo,” AHHA chief Prue Power said.
“The health sector is a complicated system and changes in one area can have significant implications for the rest of the system.
“The coalition need to be upfront about their plans for Medicare locals and for primary health care more broadly.
“Health and access to health care services are important issues for all Australians and they have a right to know what is planned before the election so they can make an informed decision on election day.”
AML Alliance, the peak body for Medicare Local, said it would welcome the opportunity to outline to the coalition how Australia’s primary health care system was improving.
“We have a wealth of data available to inform the opposition about the Medicare Local sector and I look forward to the opposition actively seeking this information from us,” AML Alliance chief executive Claire Austin said in a statement.
“Medicare Locals are … ensuring better management of chronic diseases such as diabetes, heart disease, smoking cessation programs and asthma, for example.”
Ms Austin said AML Alliance would treat a review as an opportunity “to fill in the information gaps the coalition seems to have about Medicare locals”.
NACCHO Affiliates are being informed of this initiative, so they can choose to take up the opportunity to work with the Department and the dedicated workforce to offer Assisted Registration to their member health service patients.
The Department of Health and Aging is currently conducting an initiative to register people to the Personally Controlled Electronic Health Record (PCEHR) using a dedicated Assisted Registration workforce (Aspen Medical) supplied through McKinsey and Company (National Change and Adoption Partners).
They will concentrate on conducting Assisted Registration activities, until 30 June 2013, in a variety of healthcare settings across the country.
To ensure that this initiative meets the needs of our Sector, Winnunga Nimmityjah Aboriginal Health Service in Canberra has piloted with Aspen Medical a very successful campaign which has to date registered over 260 Winnunga clients and staff for an eHealth record.
As such, NACCHO Affiliates are being informed of this initiative, so they can choose to take up the opportunity to work with the Department and the dedicated workforce to offer Assisted Registration to their member health service patients.
This will be of significance to health services with larger centralised populations with access to a waiting room area, aged care facility or groups of patients where Aspen staff are able to inform and register patients individually.
The Assisted Registration process offers patients a quick, personalised and well-informed way of applying to register for a national eHealth record.
Previous to this process, consumers seeking to apply to participate in the PCEHR, would either do so on the internet, by post, by phone call or at a Medicare office.
The Assisted Registration process allows patients of a health service to fill in a one page application form, and have their identity verified either using a 100 point documentary ID check, or by being a known customer of the health care service. Patients have the opportunity to ask the trained Aspen staff members about the PCEHR and what it would mean for them.
The experience at Winnunga is that patients are quick to see the benefits of having an eHealth record, and are keen to opt in to the system.
The dedicated Aspen workforce tailor their approach to each setting. All staff deployed will have undergone cultural competency training, and will work with the Affiliates and the service to understand the local context and needs of their patients. The staff would be happy to sign a client confidentiality agreement. Male and female staff members can be deployed if requested. In fact, where there are vacancies, Aspen are open to employing people recommended by the health service to be Assisted Registration staff.
Using Aspen Medical authorised staff members to assist your patients to register does not alter your connectivity with your patients. PCEHR compliant practice software will flag who has an eHealth record (provided the patient has chosen to allow access to clinicians in your service).
Please note that Aspen Medical is not in a position legally to provide a list of patients who have registered through them to a service, however they are more than willing to provide you with data on registration numbers.
Greg Henschke (Acting NACCHO eHealth Project Manager) will be contacting NACCHO Affiliates, with the aim of identifying services that would be interested in participating in this PCEHR consumer registration program.
This resource is currently available until 30th June 2013 and deployment will be managed nationally through DoHA.
It is important to note that the dedicated workforce are not unlimited and we will need to move quickly to identify where we could best use them for our sector.
As more consumers and healthcare practitioners become registered and use the eHealth record system, benefits of the system will be realised through efficiency in healthcare services and increased access to health information.
To this end, I would strongly encourage you to consider working with the Department and the dedicated workforce to offer Assisted Registration to our sector.
For more information on the PCEHR and Assisted Registration,
Over the past few weeks, authorities have released a number of reports about the performance and expenditure of our national health system, and some of these relate directly to efforts aimed at improving the health of Aboriginal and Torres Strait Islander people.
This might seem a good thing on face value, as we need to know whether our efforts are making any difference, and where to direct resources in future to ensure ongoing outcomes.
But if this information is used without the appropriate context, it may be used as a means of reducing expenditure on Aboriginal and Torres Strait Islander health, in the name of creating ”efficiencies”.
This presents a significant risk for Aboriginal and Torres Strait Islander communities, as we continue efforts in improving the health of our people, while remaining at the whim of Ministers and government officials who rely on this information to determine policy priorities and resource investments.
What is needed now is for governments to re-think how we analyse, interpret and use data to inform ongoing priorities, practice and future innovation.
This report clearly demonstrated that the most significant gains in access to care and improvement of outcomes is and continues to be achieved through the national network of community controlled health services.
Upward of 75% of health improvements outlined in the report were directly attributed to the community controlled sector, and clearly justifies the increased investment into community controlled services as the most appropriate provider of healthcare for Indigenous people as they are making the best health gains.
Secondly, let’s consider the most recent Indigenous Expenditure report of 2012 produced by the Productivity Commission, that averages overall Medicare expenditure on Indigenous people as 60 cents in the dollar compared to the rest of the Australian population.
As many readers would be aware, Medicare was created as a safety net to ensure that all Australians get access to required care and benefits through quality primary health care services.
With community controlled services focused on providing comprehensive primary health care to our people, efforts in increasing access to an individual’s entitlements through Medicare can and will be best achieved by our organisations.
In spite of this data, we now have more recent releases stating the overall expenditure of the National health budget is 1.5 times greater for Indigenous people than the broader population.
Additionally, we have received further datastating that mortality rates for certain illnesses are only reducing by slight amounts and chronic diseases are still high placing burden upon the public health system.
Although much of this information is already 2 years old by the time it is released, it fails to identify why much of the burden is borne by secondary and tertiary public health systems, as access to comprehensive primary health care is still limited for our people nationally.
Consequently, when you don’t have access to quality primary health care, many of our people will present at secondary and tertiary facilities when their issues have escalated to a point where hospital is the last resort, requiring treatment for not only one health condition, but generally 2 or 3 issues.
Even though we have over 150 community controlled organisations across the country, our services do not exist in every corner of the nation, and fundamentally this would be impossible to achieve without enormous costs involved.
Alternatively, what we should be aiming to achieve is to have a strong community controlled presence providing quality care to our communities in all areas with populations greater than 900 residents focused on increasing access to comprehensive primary health care.
Why primary health care? Current and historical research by credible researchers have proven that the most effective means of delivering care and improving outcomes for Indigenous people is through community controlled services.
Health economists such as Professor Theo Vos and colleagues identified this in their work in assessing cost effectiveness of primary prevention activities across all health providers. This work clearly highlighted that compared with government-run, mainstream and private services, community controlled organisations achieve close to 50% better outcomes than other providers in delivering care to our own people.
Although this method was documented to be more expensive than other models, the focus on outcomes should not be lost, as the only variable included in his analysis that increased the overall expenditure against the model was transportation services for clients.
Due to the implementation of a comprehensive primary health care model, transport services are a core component and will always be included within the community controlled delivery of care, which does not diminish the model but does and will continue to achieve far greater outcomes.
Unfortunately, the notion of ‘If you build it he will come..’ only works for Kevin Costner in the movies, and does not work to improve health outcomes for our people.
With all this data now publicly available for all to review and analyse, we must hope that in determining future policy and funding priorities for Indigenous health care, consideration is given to understanding the context and reliablity of the information.
Importantly, there already exists some credible evidence that encapsulates comprehensive primary health care delivery into a set of core functions. This research was conducted and undertaken as a partnership between all healthcare providers, and should be the central component of any current and future policy debate about improving the health of Indigenous people, as it is widely accepted within the community controlled sector as the gold-standard in health service delivery for our people.
This work is the Core Functions of Primary Health Care in the Northern Territory, and with minimal adjustments to ensure local contexts are considered can and is applicable across all parts of the country. Utilising the Core Functions as a means to support improving outcomes goes a long way to encapsulate high quality service delivery standards with current data and information to ensure that we are all targeting the right priorities, through appropriate mechanisms.
This was not evident at start of the COAG investment to support overall Indigenous improvements, which saw over 65% of the entire $1.6B commitment channelled into mainstream and government-run service providers, as it was determined the most effective way to improve outcomes. Data was used showing that 70% of our people access care through government-run and mainstream services.
New data and information available now rebuts this myth that community controlled services have struggled with over the last 4 years.
Information now available within the community controlled sector shows that over 40% of Indigenous Queenslanders access care regularly through community controlled services, yet we are not in every part of the state.
With the end of the current Indigenous Health National Partnership Agreement set for 30 June 2013, we need to ensure that all of the relevant information and context is considered as part of ongoing discussions, policy setting and resource allocations to improve the health of our people.
Consequently, we are confident that this evidence will lead to what we have been seeking for many years – an increased investment in those services known to make a difference to the health of our people. That is community controlled organisations.