Showing posts with label Health Services. Show all posts
Showing posts with label Health Services. Show all posts

Thursday, 20 June 2019

Tears before bedtime under The National Strategic Action Plan for Pain Management?

Painaustralia says of itself that it is “Australia’s leading pain advocacy body working to improve the quality of life of people living with pain, their families and carers, and to minimise the social and economic burden of pain on individuals and the community”.

On 11 June 2019 it released a copy of The National Strategic Action Plan for Pain Management having convinced the Morrison Coalition Government that this plan is the bee knees when it comes to pain management.

If the following article is anything to go by it will be tears before bedtime for many chronic pain suffers as the plan does not contain any mention of actually increasing the number pain specialists practicing in Australia or of attempting to lower wait times to see such specialists.

Currently NSW Health only lists 35 pain management services in the state and most of these are attached to metropolitan public hospitals.

Instead people experiencing acute and chronic pain are to be offered 10 Medicare-funded group services and 10 individual services each calendar year, with access to telehealth pain management advice for regional areas where pain management services are not available.

As for pain management using prescribed medications – that is apparently going to be more difficult to access as Painaustralia and the Morrison Government are alarmed that opiate prescriptions in rural & regional Australia have risen in the last ten years. 

Seemingly conveniently blind to any relationship between increased prescribing and low GP numbers, smaller often poorly resourced public hospitals, a reliance on what might be termed 'flyin-flyout' medical specialists who prefer not to live in those rural or regional areas their patients inhabit and the economic tyranny of distance for the patient.

The Daily Examiner, 18 June 2019, p.8:

Doctors will be sent back to school to be re-educated about treating chronic pain and patients given a Medicare boost under a new national strategy.

The first national pain strategy launching today also calls for a national one-stop website to be set up to educate people about how to manage pain without drugs and where to find help.

“There is a screaming need here because pain is a significant burden on the economy, on society and the health system,” Pain Australia chief executive Carol Bennett said.

More than 3.24 million Australians are living with chronic pain and many are becoming addicted to opioid medications while they wait up to four years to see a pain specialist for help.

Last year Australians paid $2.7 billion in out-of-pocket expenses to manage their pain and missed 9.9 million days of work because of the condition.

The new strategy funded by the Federal Government and developed by Pain Australia wants pain to be treated in the same way as mental health, with Medicare funding up to 20 medical and group sessions to help people get it under control. It also calls for a new certificate in pain medicine for GPs and other health professionals that would require six months of study.

The consultation work that took place around the development of the new plan found doctors’ knowledge about the latest pain management techniques was out of date.

“For lower back pain people are popping pills and having surgery but for the last 15 years we’ve known you’ve got to get moving and rehabilitate yourself with physical management,” Ms Bennett said.

Anti-inflammatory medications should not be used for more than a few days and long-term strengthening of the muscles, good nutrition and sleep were the key to treating the problem rather than drugs, she said.

Instead of helping patients manage pain in this way, doctors were prescribing increasing amounts of dangerous and addictive opioid medicines.

Tuesday, 4 June 2019

The National Disability Insurance Scheme continues a bumbling problem-filled roll out during which its clients suffer

Newcastle Herald Sun, 31 May 2019:

AT least 3000 NDIS recipients from regional NSW and Victoria will have to find new care providers after mutual company Australian Unity decided to cut back on disability services to concentrate on aged care in Sydney.

Australian Unity confirmed the decision after concerns were raised with the Newcastle Herald by the Public Service Association.

It did not dispute an assertion by PSA regional organiser Paul James that the decision was a consequence of the financial pressures facing NDIS providers.

The decision comes just three years after Australian Unity bought the NSW Government's Home Care agency in February 2016, picking up 4000 former government employees and 50,000 aged care and disability clients.

Australian Unity said it would "work closely" with the National Disability Insurance Agency (NDIA) to ensure NDIS participants found "another service provider of their choice".

It said 57,000 clients on aged care packages would not be affected. 
It did not expect the NDIS decision to cause job losses but Mr James questioned how this could be.

"Even if they say the majority of their clients are unaffected, there's still 3000 people in regional areas who will have to find new providers," Mr James said.

"The NDIS was originally supposed to be helping people with disabilities into work, but instead it's become an opportunity for the states to ditch their responsibilities for disability services."

Australian Unity said the decision to "scale down" its NDIS services came after a review of its "Home and Disability Services" business - as it renamed the former Home Care agency.

According to the Dept. of Human Services (recently renamed Services Australia) In NSW as of 31 March 2019:

101,963 people have a NDIS service;
4,219 initial plans have been approved; and
34,397 people will be receiving services for the first time.

While according to the National Disability Insurance Scheme (NDIS), 12 April 2019:

There are now 250,000 participants nationwide;
Almost one in three of these participants are receiving disability supports and services for the first time; and
Costs to NDIS clients for individual service delivery have risen between 10.9 per cent and 20.4 per cent from 1 July.

This price rise will include a minimum rise of almost $11 per hour for therapists, and up to a 15.4% price increase to the base limit for attendant care and community participation and appears to be driven by the demands of service providers.

The number of NDIS participants is set to rise to 460,000 at full roll-out in 2020.

Due to the demand for home care packages, for most people, the expected wait time for approved packages is:

The expected wait time for the level of interim package you agree to receive (while waiting for your approved level to be assigned) is:
In May 2018 the Commonwealth Ombudsman investigated the National Disability Insurance Agency (NDIA) handling the annual reviews of those already receiving service under a NDIS plan after around one-third of all complaints he received about the scheme related to review issues.

The conclusions drawn was that the NDIS scheme was administratively under-resourced for the rollout task, however there were a number of areas where NDIA could improve its administration of participant-initiated reviews. Otherwise the review process would remain unwieldy, unapproachable and the driver of substantial complaint volumes.

If you are in New South Wales and have a complaint about a support or service you have received under the NDIS, you can contact the NDIS Quality and Safeguards Commission.

Wednesday, 29 May 2019

AMA accuses Morrison Government of deliberately constraining supply of public hospital services

ABC News, 24 May 2019:

"Have you got insurance?"

It is one of the first questions any patient is asked when they walk into an emergency room in the United States, no matter how sick they are.

And now Australian doctors are warning our own health system is shifting towards a similar US managed care model — a patchwork of private and public systems, where health insurers hold an increasing amount of power.

The president of the Australian Medical Association (AMA), Dr Tony Bartone, made the comments as he addressed the group's national conference in Brisbane on Friday.

It was the first time Dr Bartone has spoken since the Coalition was returned to power, and he gave an unusually scathing assessment of Australia's health system and the Federal Government.

He called for further private health reforms, telling doctors the increasing corporatisation of the private health system had given insurers unprecedented power within the health sector.

Dr Bartone warned that could lead to a system similar to the model in the US, where patients experience significant variations in care depending on their insurance cover.

"Insurers should not determine the provision of treatment in Australia, they should not interfere with the clinical judgement of qualified and experienced doctors," he said.

"Australians do not support a US-style managed care health system, and neither does the AMA."

The AMA has consistently called for more money for public hospitals, and on Friday Dr Bartone went even further as he accused the government of "making a choice" to constrain the supply of public hospital services.

"Let me be clear. Public hospital capacity is determined by funding," he said.

"The consequences are significant. They can include increased complications, delayed care, delayed pain relief, and longer length of stay for admitted patients."

Dr Bartone said the system was "stretched so tight" elective surgeries were being cancelled.

"Our public health system should be better than this. It is unacceptable our public hospitals have been reduced to this," he said.

"Our public hospitals are struggling and require new funding to be better tomorrow.....

Friday, 24 May 2019

The 2019 federal election is over - so now the Morrison Government cuts are on again

Patient to GP Ratio [RACGP, General Practice: Health of the Nation,  2018]

Having waited until the 18 May 2019 federal election was over, Prime Minister 'Liar from the Shire' Morrison 7 his cronies are rolling out the funding pennypinching once more - and it's no surprise that it's the very young, very old and the poor who are the targets again.

ABC News, 22 May 2019:

Bulk billing of children and pensioners, as well as home visits to elderly and dying patients, could be scrapped in outer metro areas across Australia because of cuts which doctors say they will not be able to afford.

An incoming change to bulk-billing incentives has pushed GPs to breaking point, medical groups have warned, requiring them to provide crucial primary health services for less than the cost of a barber's cut.

The Federal Government has changed a key geographical classification, scrapping some outer suburban zones of incentives intended for rural areas.

From January 2020, the bulk-billing incentive in outer metro areas will be reduced from about $10 to $6 per patient, per visit.

The changes will affect GP practices in as many as 13 outer metro regions, including in Canberra, Adelaide's south, the New South Wales Central Coast, Geelong and the Mornington Peninsula.

The Australian Medical Association SA president, Dr Chris Moy, said many of the affected regions are low socio-economic areas.

He said the changes could put more pressure on already costly hospital systems, because patients could no longer afford to visit their GPs regularly.

"This is an example of a just a small change. It's not a huge change, but it's enough to break the camel's back," he said.

"It's more difficult for individuals to pay a gap in those situations so it's unfortunate this has happened."

Royal Australian College of General Practitioners president Harry Nespolon said general practitioners in the city and in the country were effectively being asked to work for free.

"The Medicare rebates are insufficient to provide the care that patients need," Dr Nespolon said.

"I don't think people want their GPs to do work for nothing but that's effectively what we're being asked to do.

"If the services become marginal in the sense they don't cover their costs, then they've got a choice — they can either go out of business or charge a fee.

"GPs in practices everywhere, rural or otherwise, are considering whether or not the current amount of rebate if they do bulk bill a patient is able to keep them in business."…….

Quick explanation of rebates:

·       The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate.

·        Each MBS item has its own scheduled fee — this is the amount the Government considers appropriate for a particular service (e.g. getting a blood test or seeing a psychologist).

·        Rebates are typically paid as a percentage of the Medicare scheduled fee. In the case of GP consultations, the rebate is 100 per cent of the schedule fee.

·       This means that bulk-billing GPs agree to charge patients the Medicare schedule fee ($37.60 for a standard appointment) and are directly reimbursed by the Government, and there is no cost to the patient.

·        GPs who don't bulk bill charge a fee higher than the Medicare schedule fee, meaning patients must pay the difference between the schedule fee and the doctor's fee — out of their own pocket.

·       For example, if your doctor charges $75 for a standard consultation, you'll pay $75 and receive a rebate of $37.60 — leaving you $37.40 worse off.

According to the federal Dept. of Health areas which will be losing the higher bulkbilling incentives (for treatment of patients with concession cards and children under 16 years) include:

Mandurah (WA)
Mornington Peninsula (Vic)
Canberra (ACT)
Newcastle (NSW)
Central Coast (NSW)
Queanbeyan (NSW)
Maitland (NSW)
Sunshine Coast (Qld)
Gawler (SA)
Geelong (Vic)
Melton (Vic)
Pakenham (Vic)
Ellenbrook (WA)
Baldivis (WA).

However the existing patient to GP ratio in an area is not necessarily the primary factor in determining who is on or off this list.

It seems you only have to live in an area where the local town/city has grown to over 20,000 residents since 1991 to find GPs being deprived of the full incentive payment per concession card/child patient seen.

Anyone living in the regions mentioned will know that what can appear to be a comfortable patient to GP ratio is not always evenly spread and in some areas certain GPs have already closed their books and are not taking new patients or are having difficulty attracting new GPs to established practices to fill unmet needs.

Just to make matters clear. some of the named places which will see GP incentive payments reduced on 1 July fall into the categories of regional or peri-urban area and, as at 30 June 2018 Australia-wide there were only 6,994 GPs in Inner Regional areas and 3,285 GPs in Outer Regional areas, according the the federal Dept. of Health statistics.

Monday, 25 February 2019

Yet another Australian health data base compromised

The Age, 20 February 2019:

A cyber crime syndicate has hacked and scrambled the medical files of about 15,000 patients from a specialist cardiology unit at Cabrini Hospital and demanded a ransom.

The attack is now the subject of a joint investigation by Commonwealth security agencies.

Melbourne Heart Group, which is based at the private hospital in Malvern, has been unable to access some patient files for more than three weeks, after the malware attack crippled its server and corrupted data.

The malware used to penetrate the unit's security network is believed to be from North Korea or Russia, while the origin of the criminals behind the attack has not been revealed.

The online gang responsible for the data breach demanded a ransom be paid in cryptocurrency before a password would be provided to break the encryption.

The Age understands that a payment was made, but some of the scrambled files have not been recovered, among them patients' personal details and sensitive medical records that could be used for identity theft.

Some patients were told that their files had been lost but were not given any explanation. Others have turned up for appointments for which the hospital had no record.

The Australian Cyber Security Centre, which is part of the Australian Signals Directorate – the government agency responsible for Australia's cyber warfare and information security – said it was assisting the hospital with cyber security advice.
The Australian Federal Police has also been briefed.

A Melbourne Heart Group spokeswoman said it was working with government agencies to resolve the issue.

Monday, 21 January 2019

Australian Royal Commission into Aged Care Quality and Safety now underway

Commencing in 2016-17 when Australian Prime Minister and Liberal MP for Cook Scott Morrison was then just the Federal Treasurer he cut $472.4 million from Aged Care funding over four years, then followed that up with a $1.2 billion cut over the same time span.

When deteriorating conditions in nursing homes around the country began to be reported in the media and the Oakden scandal came to light in 2017, concerned citizens began to call for a royal commission.

The Liberal Minister for Aged Care and Liberal MP for Hasluck Ken Wyatt was of the opinion that such an inquiry would be “a waste of time and money”.

Once Scott Morrison realised that ABC Four Corners was about to air an exposé on aged care provision he quickly changed his mind and announced the Royal Commission into Aged Care Quality and Safety on 16 September 2018.

The Royal Commission into Aged Care Quality and Safety was established on 8 October 2018 by the Governor-General of the Commonwealth of Australia, His Excellency General the Honourable Sir Peter Cosgrove AK MC (Retd).

The Honourable Richard Tracey AM RFD QC and Ms Lynelle Briggs AO have been appointed as Royal Commissioners…

The Commissioners are required to provide an interim report by 31 October 2019, and a final report by 30 April 2020…
The Commissioners were appointed to be a Commission of inquiry, and required and authorised to inquire into the following matters:
a.    the quality of aged care services provided to Australians, the extent to which those services meet the needs of the people accessing them, the extent of substandard care being provided, including mistreatment and all forms of abuse, the causes of any systemic failures, and any actions that should be taken in response;
b.    how best to deliver aged care services to:
                i.        people with disabilities residing in aged care facilities, including younger people; and
               ii.        the increasing number of Australians living with dementia, having regard to the importance of dementia care for the future of aged care services;
c.    the future challenges and opportunities for delivering accessible, affordable and high quality aged care services in Australia, including:
                i.        in the context of changing demographics and preferences, in particular people's desire to remain living at home as they age; and
               ii.        in remote, rural and regional Australia;
d.    what the Australian Government, aged care industry, Australian families and the wider community can do to strengthen the system of aged care services to ensure that the services provided are of high quality and safe;
e.    how to ensure that aged care services are person‑centred, including through allowing people to exercise greater choice, control and independence in relation to their care, and improving engagement with families and carers on care‑related matters;
f.     how best to deliver aged care services in a sustainable way, including through innovative models of care, increased use of technology, and investment in the aged care workforce and capital infrastructure;
g.    any matter reasonably incidental to a matter referred to in paragraphs (a) to (f) or that [the Commissioners] believe is reasonably relevant to the inquiry.

A preliminary hearing was held in Adelaide on 18 January 2019.

At this hearing the Commissioner Tracy stated in part:

The terms direct our attention to the interface between health, aged care and disability services in urban, regional and rural areas. These issues necessarily arise because of Australia’s changing demography. We are also required to look at young people with disabilities residing in aged care facilities and do our best to deliver aged care services to the increasing number of Australians living with dementia. Part of our task is to examine substandard care and the causes of any systemic failures that have, in the past, affected the quality or safety of aged care services. We will consider any actions which should be taken in response to such shortcomings in order to avoid any repetition. This will necessarily involve us in looking at past 25 events. There have been a number of inquiries which have considered matters that, in certain respects, fall within our terms of reference. We are not required by the Letters Patent to inquire into matters which we are satisfied that have been, is being or will be 30 sufficiently and appropriately dealt with by another inquiry or investigation or a criminal or civil proceeding. As a general rule, we do not intend to re-examine matters which have been specifically examined in previous inquiries. We do, however, expect to examine the changes and developments which have followed previous inquiries, as well as the extent to which there has been implementation of recommendations from those inquiries. Where we have different views, they will be made known.

According to ABC News on 18 January 2018: Out of almost 2,000 Australian aged care providers invited to shed light on the sector ahead of the royal commission, only 83 have been forthcoming with information, the Adelaide inquiry was told.

The Guardian on 18 January reported: Counsel assisting Peter Gray said the commission had received more than 300 public submissions since Christmas Eve and 81% concerned provision of care in residential facilities, with staff ratios and substandard care the most common themes. The federal health department has also passed on 5,000 submissions it received before the commission’s terms of reference were set.

Interested members of the public can still make submissions as the Royal 
Commission will continue to accept submissions until at least the end of June 2019.

Details on how to make a submission can be found here.

Wednesday, 9 January 2019

The bad news for NSW North Coast regional communities just never ends

According to the Berejiklian Coalition Government’s Transport for NSW  website: The Community Transport Program (CTP) assists individuals who are transport disadvantaged owing to physical, social, cultural and / or geographic factors.  Individuals who do not qualify for other support programs may be eligible for community transport. CTP is funded by the NSW Government and aims to address transport disadvantage at the local level via community transport organisations.

In the Clarence Valley medical specialist services are rather thin on the ground and residents are frequently referred to medical practices and hospital clinics hundreds of miles away.

For communities in the Lower Clarence where a high percentage of the population are elderly people on low incomes this can frequently present a transport problem, as often there is no family member living close by to assist or the person’s peer friendship group doesn’t include anyone capable of driving long distances.

Community transport has been the only option for a good many people.

Until now…..

The Daily Examiner, 8 January 2019, p.3:

The thought of paying $200 for a trip to see her specialist about her medical condition made Yamba pensioner Gloria George glad she was sitting down when she made the call.

The 80-year-old said when she contacted Clarence Community Transport and was told the price to be taken by car to the Gold Coast for a Wednesday appointment, it could have brought on a heart attack.

Mrs George said CCT told her there was a bus service to the Gold Coast that ran on Monday, Wednesday and Friday for $70.

“My appointment was on Tuesday and the clinic I was booked into was not available on the other days,” she said.

“They said they had made cutbacks and the price to be driven to the appointment was $200.

“I’ve got a bad heart problem and I nearly fell over when they told me.
“Who can afford $200 to go to an appointment?”

Mrs George said she still has a licence, but would not feel safe driving to her appointment.

“I think I’ll be able to get a friend to drive me there and take me home again. I hope so,” she said.

The manager of CCT, Warwick Foster, said the price rise for services had come in when the government cut $250,000 from CCT’s funding when the NDIS came in last year.

“We could no longer afford to operate the bus five days a week,” he said. “And we can’t afford to drive people to appointments for the same fee we charge for the bus service.”

Mr Foster said the government subsidy for transport of $31 a trip created a juggling act for CCT to afford its services.

“Each trip, no matter the distance, is subsidised at $31,” he said.

“It doesn’t matter if the trip is across town or to Brisbane, the subsidy is the same....

Monday, 20 August 2018

Medicare Australia State of Play 2016-2018

The Australian Minister for Health and Liberal MP for Flinders Greg Hunt tweeted this on 16 August 2018:

So what is all this self-congratulatory chest-beating about?

According to the Department of Human Services in 2016–17 a total of 24.9 million people were enrolled in Medicare.

In 2017-18 Medicare recorded a total 419,852,601 Schedule Items on which Medicare benefits were paid.

This figure represents on average 1,672,091 items per 100,000 people.

According to Heath Minister Hunt the Medicare bulk billing rate in 2017-18 stood at 86.1 per cent of the total number of Medicare benefits claimed, leaving 13.9 per cent of Medicare benefits to be claimed by the patient.

Based on 2016-17 figures this would indicate in excess of 13.3 million of these Medicare benefits were claimed online by the patient.

Medicare also recorded 3,318,396 payments of Schedule Item 3 General Practitioner Attendances To Which No Other Item Applies, which is a medical service for which there is a 100% Medicare benefit.

That’s an average 13,216 items per 100,000 males and females between 0-4 years and 85 years or over.

However, none of these statistics reveal the number of GP or specialist doctor medical practices which charge patients an upfront amount above the scheduled Medicare benefit amount.

According to the Royal Australian College of General Practitioners (RACGP) the real percentage of patients who had all their GP visits bulk billed during 2016–17 was an est. 66 per cent.

Which meant that an estimated 34 per cent of GP patients in that financial year paid an upfront cost that might not have been able to be fully claim from Medicare.

The Australian Medical Association (NSW) in a 2018 statement suggests that these patients are likely to be paying an average of $48.69 in out-of-pocket fees.

The Australian Institute of Health and Welfare states in its Health Services Series Number 80  that in 2016-17 there were 7.8 million attendances at public hospital emergency departments and “at the conclusion of clinical care in the emergency department, 61% of presentations reported an episode end status of Departed without being admitted or referred”, which indicates that this percentage may contain an unspecified number of individuals who attended a public hospital emergency department because a bulk billing GP was not practicing in their local area and they were not able to readily afford an upfront fee or additional out-of-pocket expenses.

ABC News reported* on 17 August 2018 that:

> 1.3 million people delay seeing a doctor because of the cost;
1 in 2 Australian patients faced out-of-pocket costs for non-hospital Medicare services, with the median cost sitting at $142 per person;
almost 35 per cent of out-of-pocket expenses were spent on specialist services, while almost 25 per cent went to GP gap payments; and
> a further 12 per cent was spent on diagnostic imaging services, like radiology.

Greg Hunt's tweet has definitely avoided facing the Medicare elephant in the room. 

* Based on MyHealthyCommunities: Patients' out-of-pocket spending on Medicare services 2016–17 released August 2018.