Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts

Tuesday 30 August 2016

Medicare: what a difference two years, two unpopular budgets and a close run federal election make to ministerial attitudes


THEN it was a bad, bad thing….

The Sydney Morning Herald, 4 January 2014:

Health Minister Peter Dutton has predicted an overhaul of Medicare, saying spiralling costs will make the system ''unmanageable'' without change.
In an interview with Fairfax Media, Mr Dutton gave the strongest signal yet that the Abbott government may adopt a politically explosive proposal to charge a $6 fee to visit the doctor…..
Annual spending on Medicare climbed from $8.1 billion in 2002-03 to $17.8 billion, an increase of 120 per cent. Growth in Medicare spending was faster than growth in the total health budget of 104 per cent over the decade, and Pharmaceutical Benefits Schedule spending, which rose 79 per cent over the same period.

News.com,au, 18 March 2015:

A NEW report has found 880,000 Australians see their GP more than 20 times a year and account for 17.1 per cent or $2.8 billion of the nation’s non hospital Medicare spend.
These people receive more than $3,200 a year each in non hospital Medicare payments and nearly half of them were also admitted to hospital, the National Health Performance Authority says.
There are 2.3 million Australians who see their doctor more than 12 times a year and they are eating up forty one per cent (16 billion) of the Medicare budget.
These patients received on average $1,850 in non hospital Medicare payments.

NOW it is something to celebrate….

Liberal MP for Farrer and Australian Minister for Health and Aging, Sussan Ley, media release, 28 August 2016:

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.
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…..
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.

I suspect that  a number of government MPs will be making appointments with their local chiropractor after repeating this spectacular backflip.

Friday 29 July 2016

The casual cruelty of the Turnbull Government can leave one speechless


@bamboozled3 tweeted this snapshot on 24 July 2016 from Sue Robinson's Facebook page entry of 21 July:


The Australian Health Minister is reported as stating that we are now working through her situation in a bid to address her concerns.

A statement which does not deny that Ms. Robinson was refused this diagnostic test on the basis that she had no money to pay upfront.
News.com.au reported on 25 July 2015:
On Monday afternoon, Ms Robinson posted an update to say thank you for the support and revealed Ms Ley had made contact.
“It looks as if there might be some action on it, and that is a direct result of your response,” she wrote.
“As a result of the number of ‘shares’ and responses, the office of the Federal Health minister, Sussan Ley posted with contact details asking me to call.
“I did and was put through to a young man called Alex. We established two things. Alex assures me that the guidelines for bone scans haven’t changed since the election (I didn’t think they had, but I thought they might have since the last budget).
“He says there should have been no recent changes at all, and if I was eligible, for example, last year, I should still be eligible as I am still on the meds that compromise my bone density.
“However, according to the Medicare website I was shown this weekend my meds are on the list of those for which a bone scan is recommended, but not one for which it is reimbursed.
“There doesn’t seem to be any justification for this and it does specifically exclude cancer patients because the meds concerned are for cancer.
“I also asked Alex why are there guidelines at all? Surely if a cancer specialist regards such a test as necessary for a patient, that should be enough? After all, every case is different and the referring doctors are the only ones who can really know what is required in each case. Alex said that was a good question, but didn’t answer it, though he did tell me that these exclusions are worked out by a medical services advisory committee.
“We agreed that he would investigate further and I am sending him a link to the Medicare website so he may check the guidelines for himself.
“I also have a little more information on the charging system being used for these tests. I called other local practices who do such scans here and asked about bulk billing. They all had the same reply ... It’s complicated. It seems they can’t tell if you are eligible until you go in and then fill in a form.
“It is your answers in this form, and not the referral, which determine if you are eligible, so they say. They can’t tell you before you arrive whether or not you will be asked to pay. But if you are, the charges vary from practice to practice.
“For those of you who posted saying you are in the same boat, here are the costs you might have to pay if you are excluded from bulk billing. PRP will charge a $60 fee, Erina Radiology charges $85. Medical Imaging at Erina charges $50 for pensioners and $100 for the employed, but also states that they do whatever they can to bulk bill you. This practice was also recommended by one of my Facebook friends Maryellen Golden who said she had been bulk billed for a bone scan there herself. (Thank you Maryellen)
“I guess this isn’t unaffordable (unless you are on a limited income like a pension), and as long as you know it, you can save up. But I can’t help but wonder why it should be costed at all. I’m hoping this will be treated by the government as an unfortunate oversight that will be corrected.
And if it is, it will be your overwhelming response that brought it to their attention. Thank you again.”
For all low-income patients there are other pitfalls awaiting the unwary no matter what the diagnosis.


What it does not state is that the Medicare treats a patient’s claim involving multiple services differently from a claim involving a single health item and therefore the dollar amount a patient is reimbursed can be much lower.

As much as $65 lower in the instance of which I am aware, leaving the pensioner $125 out-of-pocket in total.

One of the more bizarre positions that the federal government takes is that the patient (or presumably the patient's estate if they left one) is responsible for the cost of the death certificate issued by an attending doctor - Medicare specifically includes this certificate in items not eligible for a rebate.

"Although Medicare benefits are not payable for the issue of a death certificate, an attendance on a patient at which it is determined that life is extinct can be claimed under the appropriate attendance item. The outcome of the attendance may be that a death certificate is issued, however, Medicare benefits are only payable for the attendance component of the service."

Medicare Benefits Schedules (Complete MBS and MBS by Category) operating from 1 July 2016 can be found here.

Friday 3 June 2016

Major parties accused of ignoring radiology in rebate freeze debate as patient gaps hit $100 on average


Medianet Logo
AAP Logo
 Medianet Release
31 May 2016 2:29 PM AEST

Rebate freeze debate ignores radiology as patient gaps hit $100

 Radiologists have accused both sides of politics of ignoring a looming health emergency, with patient gaps for scans such as X-rays, Ultrasounds, CTs and MRIs now averaging $100.

 While election debates focus on rebates for GP visits and pathology tests, the Australian Diagnostic Imaging Association (ADIA) says vital diagnostic imaging services are becoming more unaffordable for everyday Australians.

 "We've hit a regrettable milestone in Australia, with gap payments for diagnostic imaging services now averaging $100," said ADIA CEO Pattie Beerens.

 "People are rightly upset about the three year freeze on Medicare payments to GPs, but no-one is discussing the fact that patient rebates for diagnostic imaging have been frozen since 1998.

 "Bill Shorten is now on record saying that the Liberals' plan will jeopardise Medicare, bulk billing and the ability for people not to have to pay up front fees when they need a mammogram or x-ray - and that Labor will put people first.

 "That is encouraging in theory, but in practice neither side of politics has made a commitment that addresses the enormous squeeze on millions of patients needing scans."

 Ms Beerens said practices across Australia remained extremely concerned that the freeze on patient rebates for diagnostic imaging – which have been stagnant for 18 years and are scheduled to continue past 2020 – will continue to drive more patients away from essential diagnosis and treatment.

 "The fact is that most radiology practices are local businesses operating on thin margins. This squeeze has been going on for two decades, and it has to end," Ms Beerens said.

 "Patients don't just decide to have a scan, they have to be referred, but governments have cut so much money from the system that average Australians are being priced out of health care.
 "Sick people will avoid getting diagnosed, and that will create huge long-term problems for our health system."

Wednesday 13 January 2016

Sixteen parternalistic buybodies delivered a report to the Turnbull Government which may change your relationship with your GP


The Daily Telegraph, 4 January 2016:

LAST year was the year we avoided a $7 GP fee and a $5 prescription medicine price hike but six major reviews are plotting other major changes to the health system for 2016.

Primary health care, Medicare rebates, private health insurance, prescription medicine payments, mental health care and electronic health records are all slated for major changes under these reviews.

These and other health reforms, to be rolled out from 2016, will push up the cost of blood tests and scans, change your relationship with your GP, see you dragooned into an e-health record and increase your private health insurance costs — but might save you $1 on your prescriptions.

Seven million Australians with chronic and complex illness like diabetes, heart disease, arthritis, asthma and mental illness will be asked to enrol with a single GP practice.

The practice would receive an annual budget to keep them well under major reforms to primary health care being considered by the government.

The government is also considering changing the way GPs are paid.

The current fee for service model might only apply for acute health problems like visits for the flu or accidents.

Doctors might receive a fixed budget to treat chronically ill patients and could be paid for performance on reducing hospital admissions or improving blood sugar, blood pressure or cholesterol readings in patients.

A new class of salaried care co-ordinators could be paid to help patients navigate the health system under the system proposed and reduce the red tape burden on doctors.

The government’s Primary Health Care Advisory Group, headed by former Australian Medical Association chef Steve Hambleton, which proposed these measures handed its report to government early this month…… [my red bolding]

Who on earth came up with the damn stupid notion that my choice as both a patient and consumer should be limited or removed by tying me to using one particular medical practice? A practice which in all likelihood will not receive maximum recompense from the federal government unless it also strong arms its patients into staying in the opt-out eHealth system.

Ah yes, it was these sixteen paternalistic busybodies.

I refuse to have my personal medical data inserted into digital government records vulnerable to hackers, I need a care co-ordinator like a hole in the head and, I want to retain the freedom to change doctors without delay if I so wish and without a mountain of paperwork to negotiate before I do.

So Prime Minister Malcolm Bligh Turnbull and Minister for Health & Aging Sussan Ley, I don’t want what you you will try to spin as the best thing to happen to the health system since antibiotics. It’s just too Orwellian for me.

Primary Health Care Advisory Group Discussion Paper [August 2015] here.

Monday 4 January 2016

Australian Health Minister and Liberal MP Sussan Ley has some explaining to do


It is bad enough that women in rural and regional areas comprise one third of all female cancer suffers and have on average poorer cancer survival rates than their metropolitan counterparts, now they face this as well...........


Perth Now, 27 December 2015:
WOMEN with breast cancer are being denied a Medicare rebate for expensive MRI scans which others with football injuries, headaches and back pain receive.
The rebate — rejected recently by the government’s Medical Services Advisory Committee (MSAC) — contributes to the bills of up to $30,000 many women face for their breast cancer.
“MSAC did not support public funding for these indications due to of uncertain clinical effectiveness, cost-effectiveness and financial impact” the committee ruled.
It reckoned approving a rebate for the test — worth up to $2000 — would cost the health system around $9 million.
It’s the latest example of Medicare failing cancer patients when they need it most….
Breast surgeon Professor Christobel Saunders one of the surgeons trying to obtain a Medicare rebate for MRIs says around one in 10 women have tumours that can’t be properly seen on mammograms or ultrasound….
“About 10 per cent of women require it and it helps us plan surgery and determine whether we need to do a lumpectomy or a mastectomy.”
“We know breast MRIs work. We have been using them for 20 years they are the most efficient way of telling the full size of the tumour,” she says.
Professor Saunders was part of a group of surgeons who made an application to the governments Medicare services advisory committee which determines which medical procedures attract a Medicare rebate.
She believes MSAC may have over-estimated the number of women who would get an MRI when deciding to reject the rebate.
MSAC granted a Medicare rebate for breast MRIs for just two of the eight indications requested.
It is recommended for women whose cancer had spread to the lymph nodes where conventional scans failed to show the source of the tumour.
And MRI guided biopsy is also recommended in patients with suspected breast cancer where the tumour only identifiable by MRI.
But it rejected breast cancer MRIs for six other indications.

Besides breast MRIs the Turnbull Government has slated another 22 Medicare items for removal from the rebate list in this round of cuts: another 6 diagnostic imaging items, 9 items in ear, nose, and throat surgery; 5 items in gastroenterology services, 1 obstetrics item and 1 thoracic medicine item.

Health Minister Sussan Ley is telling all and sundry that doctors themselves recommended these items, however the medical profession does not appear to be so uniform in opinion as Ley implies.

Given that December 2015's MYEFO contained more health funding cuts, the Liberal-Nationals ideological attacks on Medicare and free access to public health services appears set to continue until they have dismantled enough of the safety net system as will enable their MPs to commence creating an inequitable U.S. style health care system.

This is the type of medical treatment just such a system delivers:
Barbara Dawson via Twitter

Tuesday 20 January 2015

And we wonder how Tony Abbott gets away with it?


For those among us still wondering how Australian Prime Minister Tony Abbott manages to convince Coalition backbenchers to toe the line with regard to his punitive policies, here is the answer – by and large they are stupid.

Take Kevin Hogan the Nationals MP for a large federal electorate on the NSW North Coast, who on the morning of 15 January 2015 was quoted in The Daily Examiner:

Member for Page Kevin Hogan said the policy would not affect Clarence Valley residents because, in the majority of cases, doctors in the region saw patients for over 10 minutes.
"I don't support the city-based corporate six-minute medicine model of healthcare where doctors churn through 10 patients every hour as a policy," Mr Hogan said.

The policy to reduce the Medicare refund by $20.10 for GP visits under 10 minutes duration would not affect Clarence Valley residents?

The estimated resident population of the Clarence Valley is in excess of 51,000 persons.

Research done at the Family Medicine Research Centre in conjunction with the Sydney School of Public Health, University of Sydney reviewed data from BEACH (a continuous national study of GP activity) and reported in June 2014 that between 1 April 2012 to 31 March 2013 only 10% of GP visits were timed as 6 minutes or less while a total of 12% were less than 10 minutes duration1.

So if every person visited the doctor only once a year it is likely that an estimated 6,120 visits to local doctors in the Clarence Valley would have been short consultations – leaving non-concessional patient(s) around $33-$38 out-of-pocket on each of these visits.

Across the entire Page electorate those GP consultations affected would have numbered over 15,994. More if one considers that Australians go to the doctor on average between 3.73 to 3.78 times a year and in NSW the figure is probably slightly higher.

Even leaving aside concessional patients within those 15,994 plus visits, that’s possibly in excess of $200,000 extra per annum that people in the electorate would have been paying from 19 January 2015 - before national outrage forced a government backdown on 15 January.

This backdown didn’t include the planned $5 across the board Medicare rebate cut for all visits to the local doctor from 1 July 2015.

This measure will see in excess of $765,000 come out of combined local pockets each year for GP visits within the Page electorate. Across the Northern Rivers region it will total an est $4.7 million per annum.

The Member for Page is clearly wrong in his assumptions.

Of course the Clarence Valley is affected by the Abbott Government’s attempts to dismantle Medicare and the health care universal safety net. His entire electorate will suffer.

Given the the last national census revealed that the Clarence Valley continues to have a higher proportion of households with incomes below $600 per week (33.8%) than New South Wales (21.7%) or Australia (21.1%) it is possible that this area will be affected more than most.

Kevin Hogan has obviously taken the Prime Minister’s word as gospel and not bothered to do any independent research himself, which given the prime minister’s track record, makes the Member for Page a very stupid politician.

1. Australia-wide in 2013-14 only 8 doctors referred to the Professional Services Review by the Department of Human Services (DHS) were the subject of "inappropriate practice" findings. In that financial year no referrals to DHS for suspected fraud were recorded.

Monday 15 December 2014

Tony Abbott's Real Christmas Message: Over 15 million Australians likely see the cost of their GP increase by at least $5 and perhaps much more


It’s December 2014 and Australian Prime Minister Tony Abbott didn’t release his real Christmas Message on YouTube this year – he used a 9 December media release announcing he had cut Medicare rebate payments for standard GP visits by $5 and that there would be no Medicare fee increases for all services provided by GPs, medical specialists, allied health practitioners, optometrists and others until July 2018.

An est. 8 million patients, including children, pensioners, veterans, nursing home residents and others with concession cards would be exempt from the $5 co-payment.

That leaves over 15 million other Australians who are likely to find they have to pay extra to see their local doctor, even if the practice has a general policy of bulk billing patients for the current $37.05 Medicare standard consultation fee.

Given there is now also a requirement that general practitioners spend more time with patients to qualify for the standard consultation fee, many doctors may make the decision to abandon bulk billing altogether and charge an upfront fee of at least $60.

Medicare data for 2010-11 reveals that on the NSW North Coast an est. 83.9% of all medical services were bulk billed in the federal electorate of Richmond, 81.4% in the Cowper electorate and 72.6% in the Page electorate.

UPDATE

The Daily Mail 14 December 2014:

The Australian Medical Association (AMA) recommends GPs charge $75 for such consultations, meaning patients without concessions are usually out of pocket $37.95. But Dr Costa told The Newcastle Herald that because some doctors were already charging $80, it was likely some would be charging at least $100 by 2016.

Tuesday 3 April 2012

Abbott the Boastful forgets his own Medicare safety net history




This is a typically inaccurate statement by Abbott. There was a safety net written into the Australian Medicare universal health care scheme before he became Federal Minister for Health and Ageing in the Howard Coalition Government. A position he held from 7 October 2003 until 3 December 2007.

In November 2003 the Extended Medicare Safety Net was proposed. It came into effect in March 2004 and, provided for safety net thresholds of $300 for concession card holders and low income families and $700 for all other individuals and families. In other words, after thresholds had been reached Medicare paid for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year.

In the lead up to the October 2004 federal election Health Minister Abbott was interviewed by ABC TV Four Corners on 6 September and gave a guarantee that the safety net threshold would not be changed:

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, REPORTER: 80 per cent of out-of-pocket expenses rebatable over $300, over $700?
TONY ABBOTT: That is an absolutely rock solid, ironclad commitment.


However, just six months later in April 2005 the Howard Government was announcing that Medicare Safety Net threshold levels would increase from $306.90 to $500 for concession card holders and other low income families, and from $716.10 to $1000 for all other families and individuals from 1 January 2006.


By 1 January 2007 Tony Abbott had again raised the safety net thresholds to $358.90 (from $345.50) for the Original Safety Net category and $519.50 (from $500.00) for the lower Extended Safety Net category and $1,039.00 (from $1,000.00) for the upper category.

All of which can hardly be characterized as Howard or Abbott being fiscally responsible in relation to health care policy and doesn’t support Abbott’s present boastful tone.

For the record. Under the Gillard Labor Government Medicare benefits for out-of-hospital services are usually 80-85 per cent of the schedule fee, except for GP consultations where the Medicare rebate is 100 per cent of the schedule fee.
In 2012 the Original Safety Net threshold for all Medicare card holders is $413.50 and the Extended Medicare Safety Net threshold for concession cardholders and people who receive Family Tax Benefits (Part A) is $562.90. For all other singles and families the annual threshold is $1,198.

Saturday 4 February 2012

Ochre Health's Grafton GP Super Clinic raises questions about equity and access


Here is a thumbnail sketch of general practioner medical services in Australia:

Australian Government expenditure on general practitioners in Australia was $6.4 billion, or $287 per person, in 2010-11. Australian Government expenditure on the PBS was around $7.3 billion, or $326 per person, in 2010-11. Total expenditure by all governments on community and public health was around $7.9 billion in 2009-10. [http://www.pc.gov.au/__data/assets/pdf_file/0007/114847/11-government-services-2012-factsheet-chapter11.pdf]

Nationally, there were around 2.1 million GP-type presentations to public hospital emergency departments in 2010-11…..
GP-type presentations to emergency departments are presentations for conditions that could be appropriately managed in the primary and community health sector
(Van Konkelenberg, Esterman and Van Konkelenberg 2003). One of several factors contributing to GP-type presentations at emergency departments is perceived or actual lack of access to GP services……
GP visits that are bulk billed do not require patients to pay part of the cost of the visit, while GP visits that are not bulk billed do…..
Reduced competition for patients can also reduce bulk billing rates……
Deferring or not visiting a GP can result in poorer health. Nationally, in 2010, 8.7 per cent of respondents reported that they delayed or did not visit a GP in the previous 12 months because of cost. [Australian Productivity Commission, Report on Government Services 2012]

Here is one example of how it is working on the NSW North Coast:

The Grafton GP Super Clinic will offer the community a compliment of general practitioners, practice nurses, physiotherapy, audiology, podiatry, chronic disease care managers and dietitians. The GP Super Clinic will also bring together visiting specialists and other allied health professionals to meet the needs of the local community.
With a specific focus on chronic and complex disease management, our team uses a single shared electronic medical record system and takes a team-based approach to healthcare. The GP Super Clinic aims to develop a health partnership with each and every patient, ensuring that we work in a preventative mode to reduce the chance of patients developing complex or chronic preventable illness. [Ochre Health website]

Grafton Super Clinic stated over the telephone on 2 February 2012 that bulk billing is not the norm for the clinic.

Ochre Health needs to respond to the questions raised in the letter below and, explain why it should continue to charge low-income individuals/families for basic consultations on everything from earache to influenza - given that the federal government paid in excess of $5 million to build this particular super clinic and set up the private medical practice in order to offer bulk billed services for concession card holders, children under 16 and patients with chronic conditions and complex care needs under Enhanced Primary Care Medicare item numbers, with a view to taking the burden of non-urgent free health care delivery off the sholders of public hospital Accident and Emergency departments.

GP Super Clinic

I WOULD like to see the Examiner do a story on the GP Super Clinic in Grafton.
The super clinic was built and paid for by the government to reduce the strain on the public hospital system by giving patients somewhere else to go.
However, due to the greedy nature of doctors in Grafton, of course, this is the only GP Super Clinic that does not bulk bill its patients.
Thus, the people still go and sit in the waiting room at the hospital for up to three and four hours at a time just to see a doctor.
You can go and see a doctor and be bulk-billed by Medicare in any other city in Australia, except Grafton.
This is what is known as price fixing and it is illegal in Australia. Yet, no-one seems to want to do anything about it.
The money promised to the City of Grafton by the Australian Government was to build a GP Super Clinic for all the people of the area to use and alleviate the pressure on the over-strained hospital system.
However, the greed of doctors in this area has ruined what should have been a great thing for Grafton. We should shame these doctors into running our super clinic properly and to bulk bill patients, like every other super clinic in Australia.
KEN HINTON
Grafton

[Letter to the editor in The Daily Examiner Feb 2012]

Tuesday 16 March 2010

Is this an example of Rudd's future local health service delivery? GP Super Clinic causing stress in Grafton


No-one would deny that the 2007 Federal Labor general practice super clinic election promise was very welcome in the Clarence Valley. However, it has been a rather strange affair as reflected in The Daily Examiner letters to the editor columns over recent months, in light of the fact that this proposed clinic is a taxpayer-funded project though a $5 million federal capital grant for land purchase, building design, construction and equipment purchase.

One has to wonder why Rudd, Roxon and Dept of Health & Aging are allowing a private company Ochre Health (30 percent-owned by global investment bank Lazard through Lazard Carnegie & Wylie which in turn is connected with former Labor PM Keating) to set the agenda in this rather highhanded manner. After all, this clinic is supposed to provide another free health service as an adjunct to the public health/hospital system.

Even if it is apparently a joint venture agreement between Ochre and the Commonwealth, the company appears to outlay next to nothing and it will obviously be well-paid for any ongoing state-level service delivery if past contracts of over $1 million per annum are any indication and, the contracts Ochre usually has with its own doctors are based in part on expectations of the patient volume they attract with practitioners turning over to the company 40% of any Medicare bulk billing payment received.

It is understood that the property eventually reverts to Ochre ownership outright, which would mean that the land and building containing this conveyor-belt medical clinic would be able to be sold on for non-medical purposes in 2031 without penalty.
As the only consolation objecting neighbours have concerning this development is that it would provide a permanent super clinic for the local community, I wonder what they will think if any change of business type came to pass.

A brief history 29 January 2009 to 15 March 2010:

Super clinic site

NO doubt that the Valley is in great need of improved medical services.
Sixty-four people submitted written objection to (Clarence Valley) council regarding the location for the proposed (medical) super clinic (in Grafton).
I objected to the location of the super clinic in a residential area. I was one of many who gave a deputation at the site meeting with council's environment, economic and community committee, and the committee meeting on Tuesday. For three weeks I tried to contact Peter Bailey, of Ochre Health, to discuss my concerns. My calls went unanswered and unreturned. It has been very difficult for residents to get answers to their concerns.
At the site meeting citizens/voters were forbidden to ask any questions. At the site meeting Mr Bailey finally admitted that allied health service includes drug and alcohol treatment at the clinic, to be located in a residential area.
However, when asked by a councillor, Mr Bailey would not reveal why the site was the most suitable out of the other 15 sites allegedly considered.
The committee chair, Des Schroder, advised councillors that the developer's traffic study concluded 'no traffic issues'.
The DA reports an increase of an estimated 300 cars at this location, to begin with.
Ochre Health's report states 30,000 patients in year one, building to 60 by year eight. It is obscured to say the least to suggest such a significant increase in pedestrian and vehicle traffic will have no impact on the area, residential or otherwise.
The DA, and council, does not intend to put basic safety initiatives in place such as a pedestrian crossing or refuges at the site. Despite one councillor's concerns about site selection criteria, including river views for clinic staff, the matter will proceed to council vote this week.
This leaves very little time to exercise our democratic rights and speak out against the location of the super clinic as residents and voters of the Clarence Valley.
K VINCENT, Grafton.
- I WAS present at both the on-site meeting and the meeting of the CVC Environment, Economic and Community Committee meeting relating to DA 2010/0009 on Tuesday.
My strong impression was that I was witnessing a fairly elaborate charade with the issue at stake considered a foregone conclusion. It was deeply disappointing to me, as owner of 5 Fitzroy Street, Grafton, to hear Councillor Ian Tiley moving and Councillor Pat Comben seconding a motion that the DA be recommended for approval at the council meeting of Tuesday, March 16. Both councillors gave 'the greater good' as their justification. Surely 'the greater good' is that Grafton has secured the GP Super Clinic, a good not dependent on site chosen. Please note in this respect that 63 submissions made against the DA were objections to the location only (as compared to one submission of support).
Matters of concern:
(A) It is apparently indisputable that the DA could not be approved under the CVC's own existing 5(a) special uses (school/church) public purposes zoning arrangements. However, we are told that under clause 8 of the infrastructure SEPP if there is an inconsistency between the policy and any other environmental planning instrument, the policy prevails. My reading is that the EEC Committee therefore chose to avail themselves of the opportunity to over-ride their own council policy and the interests of affected ratepayers and residents in order to accommodate a large-scale commercial enterprise, something they concede is not generally referred to as a community purpose. Why? Why not adhere to council's own policy and leave it to the applicant/developer to respond? This would guarantee confidence in transparency and accountability. There are definitely other sites where the clinic could be more appropriately located.
(B) The chairman of the EEC Committee stated at the committee meeting of March 9 that there was only one DA relating to the super clinic for consideration at the meeting and that consideration of other sites was therefore irrelevant. Please consider these points. (i) There was, as far as I know, no community consultation re possible sites for construction of clinic. (ii) There was, as far as I know, no public call for expressions of interest. (iii) There was, according to Peter Bayley of Ochre Health Ltd, an understanding between St Mary's Parish (vendor) and Ochre Health (purchaser of site) that no contact with press or community be made until such time as a joint announcement be agreed. (iv) Well before this announcement was made on January 11, 2010, a DA had been lodged on Christmas Eve 2009. (v) The first communication I received came in a letter from Clarence Valley Council dated January 12, 2010 (received January 14) with an initial deadline for submissions of January 28. It is not surprising therefore that no other DA was before the committee. Further, an examination of the preceding points lends credibility to my impression that I have been participating in a charade.
(C) At both site and committee meeting some vital matters were dealt with cursorily or not at all: (a) The first of these is traffic. In my view, a GP Super Clinic means delay, congestion, frustration, an accident waiting to happen. (b) The second is the disregard for council's own policy re buildings and sites of historic interest. I have been in contact with the National Trust of NSW and the matter was considered by their advocacy unit. At present the Trust prefers not to be involved unless a building listed on their Special Register (there are two in this historic precinct) is threatened with demolition. However, they have asked to be kept informed.
- Edited for length.
KAY ALDEN, Grafton.



Super clinic for Grafton 29 January 2009

Provider chosen to run GP super clinic 15 July 2009

Super Clinic site a secret 17 November 2009

Site announced for new GP super clinic 13 January 2010

No methadone for super clinic 23 February 2010

GP says support for local doctors needed 24 February 2010

Sth Grafton calls for medical clinic 11 March 2010

Thursday 28 January 2010

e-Health: something's rotten in the State of Kevin


"The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care.
In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.
The security controls and awareness levels found in these assessments have been varied."
{NEHTA - HI Service Security and Access Framework 13/11/09 PUBLIC}

The Medicare smart card and national health information database rolls on.
According to the National e-Health Transition Authority this is its board which is facilitating the progress of this giant collection of the nation's most personal information:

David Gonski AC - NEHTA Chair
Australian public figure and businessman.
Dr David Ashbridge
Chief Executive of the Northern Territory Department of Health and Families.
Mark Cormack
ACT Health Chief Executive.
Dr Peter Flett
Director-General of the Department of Health of WA.
Jane Halton
Secretary of the Australian Department of Health and Ageing.
Prof Debora Picone AM
Director-General of NSW Health.
Mick Reid
Former chief of staff for Federal Health Minister Nicola Roxon, now the Director-General of Queensland Health.
David Roberts
Secretary with the Department of Health & Human Services in Tasmania.
Dr Tony Sherbon
Dr Tony Sherbon is the Chief Executive of the South Australian Department of Health.
Fran Thorn
Secretary of the Victorian Department of Human Services.

Notice the complete absence of anyone from a consumer health lobby group in the key positions of importance?
No, the board is full of former bankers, accountants, bureaucrats, and gawd help us, a couple of individuals who helped drive the North Coast Area Health Service into the dismal state it's in today.
It is only in a list of organisations invited to attend the NEHTA Stakeholder Reference Forum that one consumer health group is invited inside the tent.
I imagine it's no coincidence that this single consumer organisation in that 33 strong group is an organisation which is firmly guided by government, receives funding from the Dept. of Health & Aging, was actively engaged in creating a so-called consumer demand for e-health and remains committed to the database scheme regardless of emerging concerns.
Even this feeble form of consumer protection is not participating in each internal working group.

NEHTA's Stakeholder Reference list:
Jurisdictions
ACT Health Department
Department of Health and Ageing
Northern Territory Department of Health and Community Services
NSW Health
Queensland Department of Health
South Australia Department of Health
Tasmanian Department of Health and Community Services
Victorian Department of Human Services
Western Australia Health Department
Industry Associations and Peak Bodies
Aged Care IT Council
Allied Health Professions Organisation (AHPA)
Australian Association of Pathology Practices (AAPP)
Australian Association of Practice Managers (AAPM)
Australian Commission on Safety and Quality in HealthCare (ACSQH)
Australian General Practice Network (AGPN)
Australian Health Insurance Association (AHIA)
Australian Information Industry Association (AIIA)
Australian Medical Association
Australian Medical Association (AMA)
Coalition of National Nursing Organisations (CONNO)
College of Nursing (CON)
Consumers Health Forum (CHF)
HCF Australia
Health Informatics Society of Australia (HISA) and Coalition for e-health
Medical Software Industry Association (MSIA)
National Coalition of Public Pathology (NCOPP)
Pharmacy Guild of Australia
Private Hospital CIO Forum
Private Hospital CIO Group
Royal Australasian College of Physicians (RACP)
Royal Australasian College of Surgeons (RACS)
Royal Australian and New Zealand College of Radiologists (RANZCR)
Royal Australian College of General Practitioners (RACGP)

Monday 2 November 2009

Does Federal Health & Aging Minister Nicola Roxan believe that some eyes are more equal than others?


Australian Federal Minister for Health and Aging Nicola Roxon has made much of what she describes as technological advances and efficiencies reducing straightforward cataract removal to minor eye surgery requiring a lower Medicare rebate (ophthalmologists are already subject to an individual Medicare annual cataract surgery quota according to one local optometrist).

Sounds reasonable, doesn't it? If it takes less time and effort to perform this surgery it makes sense that the operation is worth less than the $650.25 2008 Medicare scheduled fee - it's not just a government cost cutting measure hitting the low-income elderly the hardest by reducing this fee to $350.95 per No. 42698 procedure.

Except that according to the Australian Medical Association, a higher existing cataract surgery scheduled fee will still apply to operations performed on returned service personnel.
This fee being set independently of Medicare Benefits Schedule and the Rudd Government obviously wary of taking on the RSL has left it intact - improved medical procedures it seems in this case are besides the point.

Here is how this new schedule appears to work for all other Australians accessing eye surgery through Medicare:

On 28 October 2009 the Senate passed a motion to disallow MBS items 42698, 42701, 42702 and 42718 relating to cataract surgery, from the Health Insurance (General Medical Services Table) Regulations 2009 . This effectively meant there would have been no Medicare rebates available for those services from 1 November 2009. On 29 October 2009, the Minister for Health and Ageing the Hon Nicola Roxon MP, signed a Determination, in accordance with section 3C of the Health Insurance Act 1973 reinstating those items. As such, rebates will be available from 1 November 2009 at the following rates:
























The NSW Combined Pensioners and Superannuants Association media release on 31 October 2009:

"Fee-free access to cataract surgery will remain available to veterans, but pensioners and others on low incomes will have to pay hundreds of dollars extra for their treatment," said Antoine Mangion, CPSA Policy/Research Officer. "One has to wonder what makes a procedure on a veteran so special as to warrant maintaining the current rebate if the Government finds it so justifiable to slash the rebate for others, especially pensioners."

The Minister needs to explain to low-income families, pensioners and retirees living on the NSW North Coast and across the rest of Australia why she considers that some people's eyesight is worth more than others. ?

Cataract remains the leading cause of blindness globally
[World Health Organisation, May 2009]

Monday 12 October 2009

Is Nicola Roxon suffering from a lack of foresight?


Maud up the Street is one of many in New South Wales who were diagnosed with cataracts in both eyes this year.
Like a large number of other pensioners she will have to go on the Medicare waiting list as there's no money in the pot for private surgery of any sort.
Maudie's livid over reports that Federal Health Minister Nicola Roxon has stated that if the Senate doesn't agree to pass legislation introducing a reduced Medicare benefit for all cataract surgery, the government will automatically cancel the whole rebate anyway leaving those with diminished eyesight to find the entire cost of this operation and presumably both the pre-op and post-op visits.
Maudie reckons Roxon classing retaining your eyesight as a "minor surgical procedure" misses the point entirely.
Reasonable eyesight is one of the main supports of autonomy and independence for those getting on in years, so I agree with my friend that Ms. Roxon is getting a little too uppity in how she approaches the matter.
If saving health care dollars is such a big issue, perhaps the Minister should consider proposing a lesser reduction in the rebate to meet the ophthalmologists halfway - before Oz turns into a land where the poor are distinguished by higher levels of blindness than the general population.
How about it, Nic?

Thursday 11 June 2009

Stop it or they'll go blind!


Now I've heard everything! The Rudd Government is reducing the Medicare rebate for cataract surgery from $831.60 to $409.60, according to the Minister for Aging and Member for Richmond Justine Elliott.

There are already quite a few worrying out-of-pocket expenses associated with eye surgery for those pensioners without savings or investments (as well as waiting lists which can still see a older person wait up to a year for publicly-funded eye surgery) and now the federal government is about to put such surgery almost out of reach for people living below the poverty line.

Right now if you have the money up front or private health insurance a cataract operation can usually be performed within 6 to 8 weeks on the NSW North Coast (by the same specialists and hospitals which make the poor wait and wait for exactly the same medical procedure), so the health system is already biased against those poor sods with no money in the bank.

Bluddy Kevin Rudd and his merry troop have just made this unfair state of affairs even worse and their piddling little national grant for rural & regional areas will go nowhere.
This counter-productive cost cutting stupidity ranks alongside the Clayton's public dental system - obviously those in power won't be happy until pensioners and those on low incomes are blind as well as toothless!