Showing posts with label costs. Show all posts
Showing posts with label costs. Show all posts

Thursday 9 February 2023

MEDICARE 2023: three perspectives


"Australians enjoy access to a world class health system with primary care at its centre. Our vital and valued primary care workforce includes Australia’s hard working general practitioners, allied health professionals, primary care nurses, nurse practitioners and midwives, pharmacists, Aboriginal health workers, practice managers and other practice staff. Primary care provides the foundation for universal health care, working hard to keep all Australians healthy and well in the community, and to deliver care that meets the needs of people and communities at all stages of life, no matter where they live.....


Modernising primary care

Recommendations

Modernise My Health Record to significantly increase the health information available to individuals and their health care professionals, including by requiring ‘sharing by default’ for private and public practitioners and services, and make it easier for people and their health care teams to use at the point of care.

Better connect health data across all parts of the health system, underpinned by robust national governance and legislative frameworks, regulation of clinical software and improved technology.

Invest in better health data for research and evaluation of models of care and to support health system planning. This includes ensuring patients can give informed consent and withdraw it, and ensuring sensitive health information is protected from breach or misuse.

Provide an uplift in primary care IT infrastructure, and education and support to primary care practices including comparative feedback on their practice, so that they can maximise the benefits of data and digital reforms, mitigate risks and undertake continuous quality improvement.

Make it easier for all Australians to access, manage, understand and share their own health information and find the right care to keep them healthy for longer through strengthened digital health literacy and navigation." 

[Strengthening Medicare Taskforce Report December 2022, Introduction opening sentences, p.2 & Modernising primary care, one of four recommendation clusters, p.9]



Last week I 'phoned the GP practice I normally attend when I am unwell seeking an appointment.


Rather than the expected two to three week wait for an appointment I was given a choice of appointment dates that week.


When I entered the four-doctor practice it only had two patients sitting in the waiting room and I made a third.


The situation was almost self-explanatory when I read the signs at reception. The practice was now charging fees payable at time of visit.


A Standard Consultation is $84 (which includes a $10 medical centre facility fee). There is a federal government rebate of $39.75 for patients with a Medicare Card – payable electronically after the $84 is handed over.


The Facility Tax For Professional Services also includes as or when required – a medical centre treatment room fee of $20 and a medical centre consumables fee of $20. There may also possibly be a surcharge applied for public holidays.


There is no bulkbilling of DVA Gold Card Holders and Pension Card Holders until they are over 75 years of age.


As the The Australian Government Actuary is currently not expecting the average 67 year-old to live more than somewhere in the vicinity of another 20.1 years, it would appear that a number of GPs are now willing to lock a significant number older patients out of bulk billing for all but the last 12 years of their remaining lifespans.


So is it any wonder that everyone from the prime minister & state premiers to patients are wondering just how far this corporatisation of primary health care will go and, what workable solutions might be found to correct a dysfunctional primary care system.


An excerpt from The Sydney Morning Herald Economics Editor Ross Gittens’ perspective on the recently updated final report of the Strengthening Medicare Taskforce, 8 February 2023:


According to the doctors’ union, the AMA, the reason GPs have become so hard to find is that the federal government isn’t paying them enough. Whereas in the old days half of all medical graduates became GPs, now it’s down to about 15 per cent.


So, pay them more. Problem solved.


What the report’s saying is: sorry, not that simple. It’s true the Coalition government inherited a temporary freeze in Medicare rebates – the amount of a doctor’s bill that’s paid by the feds – in 2013, and continued it until 2018. And although the schedule of rebate payments has been increased annually since then, the increases have been much smaller than inflation.


Why? Partly because the Liberals were trying to prove they could cut taxes without damaging “essential services” such as Medicare.


But also because they knew something was wrong with the way general practice works. They needed to pay GPs differently to do different things. Rather than pay more and more the old way, they’d hold back until they – or some future government – worked up the courage to make changes.


Over the almost 40 years of Medicare, there’s been a big change in the problems people bring to their GPs. Because we’re living longer, healthier lives, much more of our problems are chronic – someone with heart trouble or diabetes has to wrestle with it for the rest of their lives – rather than acute: something that’s easily and quickly fixed.


But the present (subsidised) fee-for-service way of remunerating doctors is designed to suit acute problems, not chronic conditions. It involves waiting for problems to arise, not early diagnosis or stopping chronic conditions getting worse.


It encourages GPs to keep consultations short, avoiding long discussions of multiple problems.


A change no one wants to talk about is the way sole practitioners or partnerships of doctors are giving way to companies owning chains of practices staffed by doctors they employ.


When you separate the person delivering the care from the person watching the bottom line, you increase the likelihood doctors are pressured to keep consultations short and order many tests – a further reason to be cautious about reinforcing GPs’ dependence on fee-for-service.


The report wants to move to “blended” funding, with acute consultations continuing to be fee-for-service, but GPs paid lump sums for developing and managing “care plans” for particular patients with chronic conditions.


While it’s true fewer medical graduates are becoming GPs, it’s not the whole truth. As the Grattan Institute reveals, “Australia has more GPs per person than ever before, more GPs than most wealthy countries, and record numbers of GPs in training”.


How do other countries with good healthcare get by with fewer GPs? By making sure their GPs can’t insist on doing things that could be done by other health workers – nurses, nurse practitioners (nurses trained to do some of the more routine things doctors do), pharmacists and physios.


This is what “co-ordinated, multidisciplinary team-based care” means. Changing GPs’ surgeries into more wide-ranging “primary care clinics” is also about making it easier for patients to move between different kinds of care, with GPs taking more responsibility for the total package, and all the various doctors and paraprofessionals having access to a patient’s medical history.


There’s nothing new about this. Federal governments have been trying to improve the performance of primary care for decades – with little success. Why? Because they’ve had so little co-operation from the premiers and the GPs themselves.


The true message of the latest report is: Medicare reform must not just be about more money to do the same things the same way.


The full 10-page plus cover sheets Strengthening Medicare Taskforce Report can be found at:

https://www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf


The taskforce was formed by the Albanese Labor Government and has 17 members. Its first meeting was held on 29 July 2022 and the taskforce has issued 6 communiques containing meeting minutes.


Monday 31 January 2022

Byron Bay area's median house price was up $550,000, the largest price hike in dollar terms and topping Sydney's record $1.6 million median - up 33.1 per cent last year.

 


Australia-wide House & Unit purchase price growth December Quarter 2021



















DailyTelegraph, 28 January 2022:


House prices in pockets of regional NSW are rising at a faster rate than in Sydney, as ongoing demand from sea and tree changers pushes prices to record heights.


Prices across a string of local government areas have jumped by more than a third year-on-year, new Domain figures for the December quarter reveal.


The Snowy Monaro Regional Council area recorded the largest gain, with the median house price climbing 50.8 per cent to $585,000.


It was closely followed by the Kiama and Byron local government areas, where house prices rose about 48 per cent, to respective medians of $1.495 million and $1.7 million. The Byron area's median was up $550,000, the largest price hike in dollar terms and topping Sydney's record $1.6 million median - up 33.1 per cent last year.


Kiama's neighbouring council area of Wingecarribee, which takes in Bowral, was also among the strongest performing markets, with the median up 37.2 per cent to $1.18 million. As were the Ballina, Tweed and Lismore regions, which all saw prices rise at least 32 per cent over the year, as the rapid price gains seen in Byron rippled out across the state's north east.


Domain's chief of research and economics Nicola Powell said regional NSW price rises had picked up momentum last quarter, with house prices up 12.5 per cent to $720,000 - taking annual growth to 27.5 per cent. It marked regional NSW's strongest quarterly price rise on Domain records and was also more than double the growth seen in the previous three months.


An increase in sea and tree changers looking to leave city living behind during the pandemic, and the rise in remote working, had been driving strong demand and price growth in regional markets, Dr Powell said. As had an increase in cashed-up buyers looking to purchase holiday homes, while international travel remained off the table.


A post-lockdown spike in market activity was likely key to the record growth seen over the past quarter, Dr Powell added.


Tree and sea changers, who had been renting in regional areas, may also have opted to buy as time passed and they committed to a permanent relocation.


Increased demand has seen houses in the Snowy Monaro Regional Council area - including towns such as Jindabyne, Thredbo, Berridale and Cooma - jump $197,000 year-on-year to a median of $585,000 recorded over the six months to December. Prices there have now more than doubled over the past five years.


First National Real Estate Kosciuszko principal Gordon Jenkinson said an influx of tree changers and holiday home buyers from Sydney and Canberra had been the key driver of rapid growth. However, Snowy 2.0 and a shortage of new homes and land in Jindabyne, as developers await a new master plan for the Snowy Mountains precinct, were also playing a role.


"COVID-19 has been a huge influence ... we're getting heaps of the younger demographic, especially guys into outdoor activities, who can now work remotely," he said. "If you're really keen on a sea change there are plenty of coastal towns that offer that beachy feel but alpine and subalpine areas are few."


Mr Jenkinson said land had been selling for outrageous amounts, noting two vacant blocks in Jindabyne recently sold for more than $650,000 and had traded for between $220,000-$240,000 about two years ago. A waterfront block in East Jindabyne that traded for $650,000 18 months ago had resold for $1.455 million.


Sunday 8 August 2021

Nationals Senator Matt Canavan from Yeppoon near Rockhampton shows his distasteful and offensive political persona to the world


From 25 January 2020 when the national confirmed cases count began in Australia to 15 June 2021 (the day before the Delta Variant outbreak began) the COVID-19 pandemic had infected 30,274 individuals, At that point 910 people or 3 per cent of all those infected had died.


www.health.gov.au/sites/default/files/documents/2021/06/coronavirus-covid-19-at-a-glance-15-june-2021.pdf

















New South Wales was in Day 51 of the Delta Variant Outbreak with 4,610 people having been infected between 16 June to 5 August 2021 and 22 people dead as a result, when The Financial Review published the results of sums done on the back of an envelope by former & short-lived Executive at KPMG, former & short-lived Director at Productivity Commission, former Chief of Staff to Barnaby Joyce & a current Nationals Senator for Qld, Matt Canavan (left).



In this opinion piece Canavan states that; Each life saved by the Sydney lockdown costs $330 million. It’s an unjustifiable expense that imposes large and disproportionate burdens on small business and the less well off. [my yellow highlighting]



The reason for this "Sydney lockdown" is hard to ignore. On 16 June 2021 the NSW SARS-CoV-2 Delta Variant Outbreak began with 2 daily cases of local community transmission reported. On 13 July NSW Health reported 97 daily cases of community transmission and at the end of the month that number had risen to 239 cases of community transmission reported in the last 24 hours. On 5 August there were 291 daily cases of community transmission reported and the cumulative number of confirmed locally acquired COVID-19 infections had risen by 4,610 people since the outbreak began, including 22 who had died from this variant infection. However, Canavan does his best to ignore those particular numbers. 



Leaving his dodgy costings aside, Canavan appears to firmly believe Scott Morrison’s position that the best way forward to ‘open up’ the economy and he wants us all to learn to live with the SARS-CoV-2 virus despite low vaccination rates.



Or as he expressed himself on 5 August; We should end the lockdowns and replace them with sensible social distancing requirements and testing and tracing.



All his latest opinion piece proves is that Canavan did not understand the implications of what little he actually read in The Peter Doherty Institute for Infection and Immunity modelling report.



It was made very clear that the report assigns a Transmission Potential (TP) to the Delta Variant of 3.6. It is also observed in its pages that the ability to reduce this variant’s TP to less than 1 needs both to contain community transmission in the current suppression phase (A) and to prevent cases from exceeding health sector capacity in phase B. Currently personal risk reduction behaviours and constraints on social mixing known as Public Health and Social Measures (PHSM) are the levers employed to manage TP in response to incursions and outbreaks [Doherty Modelling Report for National Cabinet 30 July 2021, pp. 7, 10].



However, the report also points out that in the four scenarios with only baseline levels of social and behavioural restrictions in place (ie minimal density/capacity restrictions), epidemic growth is still expected at the yet to be reached 50%, 60%, 70% and 80% national vaccine coverage. In these scenarios reduced effectiveness of the public health ‘test, trace, isolate, quarantine’ (TTIQ) response is anticipated due to high caseloads [Doherty Modelling Report for National Cabinet 30 July 2021, p.10].



In all four vaccination scenarios coming out of lockdown and having only baseline density/capacity restrictions operating across the population, leaves Australia still facing a predominately Delta Variant epidemic. One where the Transmission Potential is likely to be a problematic 2.0, due in part to fading of vaccine efficacy in vaccinated individuals and the need to rollout a national vaccine booster program – which on past performance will possibly be as chaotic as the original vaccine rollout.



The vacillating Morrison Government's two most favoured vaccination coverage scenarios now appear to be the 70% and 80% of all adults. These graphs show epidemic growth to 180 days given transition to Phase B leading to established community transmission:


Epidemic growth to 180 days given transition to Phase B leading to established community transmission for the threshold coverage targets of 70 and 80%, with vaccine allocation according to the ‘All adults’ strategy  [Doherty Modelling Report for National Cabinet 30 July 2021p.14]












This is not helping Australia’s economy get back on its feet in the foreseeable future. Neither is it likely to reduce the real cost to federal and state governments or to society generally of this COVID-19 global pandemic.



The Australian Treasury has costed nationally applied Strict public health order restrictions to cost $3.2 billon a week. Mild nationally applied restrictions are costed at $2.35 billion a week, Low restrictions at $0.65 billion and Baseline at $0.1 billion a week.



Treasury’s financial analysis of the four vaccination scenarios in the Doherty Institute modelling report appears somewhat superficial  - given it refused to model the economic implications of predicted overstretched test, trace and quarantine systems in order to produce these optimistic key findings for the National Cabinet:


  • Continuing to minimise the number of COVID-19 cases, by taking early and strong action in response to outbreaks of the Delta variant, is consistently more cost effective than allowing higher levels of community transmission, which ultimately requires longer and more costly lockdowns.


  • As vaccination rates rise, significantly less lockdowns and other restrictions will be required to continue to minimise cases of COVID-19, reducing the economic cost of managing the virus.


      • Moderate or strict lockdowns are still expected to be necessary to continue minimising outbreaks until Australia reaches 70 per cent vaccination rates for Australian adults (16+). As a result, the costs of managing COVID-19 will remain high.


  • At 50 per cent vaccination rates, and based on the assumptions outlined in this paper, the direct economic cost of minimising cases is estimated to be around $570m per week. At 60 per cent, the estimated cost remains high, but falls to around $430m per week.


  • Once 70 per cent of Australian adults (16+) are vaccinated, and assuming the spread of COVID-19 is minimised, it is expected that outbreaks can be contained using only low level restrictions, with lockdowns unlikely to be necessary. This will significantly reduce the expected economic cost of COVID-19 management to around $200m per week.


  • At 80 per cent vaccination rates, these direct economic costs are expected to fall further still, to around $140m per week, and costs are lower under all scenarios.


  • Treasury has not modelled the economic costs of a severe and widespread outbreak that breaches Australia’s health system capacity. It is expected that such a situation would carry very significant economic costs. International experience indicates that it would lead to significant behavioural changes regardless of the level of official restrictions, and longer outbreaks. [my yellow highlighting]



From 25 January 2020 to 5 August 2021 the national percentage of confirmed COVID-19 deaths was 2.63 per cent of the infected population or 927 people. During that same period the NSW percentage of confirmed COVID-19 deaths was 0.77 per cent of the infected state population or 79 people.



Senator Canavan can play with all these numbers all he likes, it doesn’t make his devaluing of potential lives saved and actual lives lost any less distasteful nor make his ‘politiking’ any less offensive.



Monday 14 June 2021

That "massive failure in public administration" of Australia's social security scheme, by way of the creation of the unlawful 'Robodebt' automated data matching program, has to date cost the Morrison Government: (i) est. $8.4M in Federal Court applicants' awarded legal costs; (ii) approx. $751M in debt repayments to applicants; (iii) a further $103.6M in settlement distribution costs; (iv) the forced abandonment of recovery of up to $1.01 billion in debts claimed by Centrelink but not yet realised; and (v) government having to absorb its own legal costs as well as the former unlawful program's multimillion dollar administration costs.

 

ABC News, 11 June 2021:


A Federal Court judge has delivered a withering assessment of the unlawful Robodebt recovery scheme, calling it "a shameful chapter" and "massive failure in public administration" of Australia's social security scheme.


He also ordered the Commonwealth to pay costs of $8.4 million to Gordon Legal, which brought the class action against the Commonwealth on a no-win, no-fee basis.


"This has resulted in a huge waste of public money," he said.


Justice Murphy's judgement gave legal effect to a settlement reached between the Commonwealth and people wrongly pursued for debts last year.


The Commonwealth agreed to fund compensation, pay back wrongly raised debts and drop debt recovery actions, but has not admitted liability.


Robodebt was an automated debt collection system in place between July 2015 and November 2019 that used data-matching in an attempt to identify the overpayment of social security benefits.


More than $750 million wrongfully recovered


The court heard that as part of the scheme, the Commonwealth had unlawfully raised $1.73 billion in debts against 433,000 people.


Of this, $751 million was wrongly recovered from 381,000 people.


"The proceeding has exposed a shameful chapter in the administration of the Commonwealth social security system and a massive failure of public administration," Justice Murphy said.


Justice Murphy said he "could not help but be touched" by the "heart-wrenching" stories of people who had suffered as a result of the scheme.


"One thing … that stands out … is the financial hardship, anxiety and distress, including suicidal ideation and in some cases suicide, that people or their loved ones say was suffered as a result of the Robodebt system, and that many say they felt shame and hurt at being wrongly branded 'welfare cheats'," he said.


He said ministers and public servants should have known the method of using taxation income records to estimate a welfare recipient's average income was flawed.


"However, it is quite another thing to be able to prove to the requisite standard that they actually knew that the operation of the Robodebt system was unlawful," he said.


"There is little in the materials to indicate that the evidence rises to that level….


In settlement of Prygodicz v Commonwealth of Australia the Morrison Government made no admission of legal liability with regard to any aspect of the unlawful Centrelink debt collection program.




BACKGROUND


Prygodicz v Commonwealth of Australia (No 2) [2021] FCA 634 (11 June 2021)

Monday 10 May 2021

Post February-March 2021 flooding repair bill estimates for Clarence Valley road infrastructure

 

Video showing log removal from bridge in February 2021 flooding


 The Daily Telegraph, 7 May 2021:


Although the recent floods weren’t the worst in history, it has left authorities with a large amount of damage to clean up.


Clarence Valley Council general manager Ashley Lindsay said the total cost of the repair bill may be up to $7-8m, of which much would be paid for by Essential Public Asset Restoration Works funding.


The flood, which reached major levels on the Clarence and Orara, caused damage to 103 roads in the Clarence Valley.


There were three major storm water systems that needed replacing at Wooli Road (pictured), Kangaroo Creek Road and Shipmans Road, costing an average of $320,000 each.


Mr Lindsay said the most significant damage was at the Tallawydja Creek bridge approach where the creek’s water course had dramatically altered.


Among the many issues, an inspection with Transport for NSW engineers determined that if left unchecked, a 15-20m section of road formation would be lost in the next flood event, closing the road and possibly damaging the bridge.


The cost of a long-term solution would be well over $1m pending review of proposed concept options for the restoration.


Mr Lindsay said that EPAR funding would also be sought for Six Mile Lane, Patemans Road, Sandy Swamp Road and Gorge Road causeways, which were heavily impacted after each flood event and improvements were required to provide resilience for local assets and the community. Other repairs included in the costs were drainage clean-up, waste pick-up and unsealed road repairs.


 

Tuesday 13 April 2021

Scott Morrison & Co went on a spending spree at taxpayer expense after he became Australian Prime Minister


The Sydney Morning Herald, 11 April 2021:


Flying politicians and dignitaries around the country on VIP jets cost taxpayers almost $20 million in two years up to June 2020, new flight records show.


Federal politicians ordered 1940 VIP flights between July 2018 and June 2020, at a cost of $17,177,562, an analysis by The Age and the Sydney Morning Herald of RAAF flight data found. The governor-general and other dignitaries including Prince Harry pushed that bill up by $2 million to $19,577,402, adding 395 flights.


The new flight data shows during the peak of the 2020 black summer bushfires, then-defence minister Linda Reynolds travelled from Perth to Canberra twice in five days, costing taxpayers $69,000 for her flights alone.


Ms Reynolds returned early from a holiday in Bali on January 3, 2020, having departed Australia quietly a week after Prime Minister Scott Morrison came back from his Hawaiian holiday amid public outrage at his absence during the bushfires.


Ms Reynolds chartered a VIP plane that can carry 30 passengers to fly her and two others from Perth to Canberra on Saturday, January 4, 2020, for a press conference to announce the rollout of 3000 army reservists to help with the bushfire crisis…...






The use of VIP jets has been controversial recently as Mr Cormann was flown around Europe in a RAAF VIP jet that costs about $4000 an hour to operate as he campaigned (successfully) to be the new secretary-general of the Organisation for Economic Co-operation and Development. Prime Minister Morrison defended Mr Cormann clocking up more than 20,000 kilometres campaigning for the job at taxpayers’ expense.


In February, the Herald and The Age revealed then-home affairs minister Peter Dutton charged taxpayers more than $36,000 to charter a jet to Tasmania to announce $194,000 worth of grants for CCTV systems for two councils during the 2018 Braddon byelection campaign.


Mr Morrison, Mr Dutton, Stuart Robert and Josh Frydenberg billed taxpayers almost $5000 in December 2019, for a private jet trip to Sydney on the night of Lachlan Murdoch’s Christmas party, the Guardian reported in December last year.


The group left Canberra after 6pm, attended the party at Bellevue Hill then returned to Canberra before 9am the next day.


And during the last federal election campaign, Mr Morrison’s bus tour of Queensland was not as grounded as it seemed after it was revealed he and his staff were using VIP jets to cover large stretches of the journey to Townsville.


The election campaign bill for VIP jets for both parties, between April and May 2019, cost taxpayers $6,645,318 for 444 VIP flights.