Tuesday, September 01, 2009

Australian public health insurance system in a mess

Quick summary for non-Australian readers: Australia's Medicare is a government-run health insurance program that covers ALL Australians out of tax revenues. About 40% of Australians, however, want higher quality care than what Medicare will fund so take out private insurance and go to private hospitals. People with private insurance get a tax rebate in recognition of their reduced use of the public system

MEDICARE has been stretched to the point where it risks putting more into doctors' pockets than into care of the chronically ill. A major government-backed report has singled out poorly targeted payments for patient "care plans" as symptomatic of a primary health system fraying at the edges and in need of funding reform.

The long-awaited report into frontline healthcare, including GP services, was launched by Kevin Rudd and Health Minister Nicola Roxon yesterday with a promise to retain the Medicare Benefits Scheme at its core.

But the Primary Health Care Reform in Australia report warns that Canberra is expecting too much of Medicare by extending it beyond simple fee-for-service reimbursements to fund GP care plans for patients with complex, long-term health problems such as diabetes, heart disease and mental illness.

The costly expansion raised concerns that "the quality of care provided is unknown and that the objectives of co-ordination and continuity of care may not be being achieved", it said. Ten per cent of GPs, for example, claim 54 per cent of all Medicare items for chronic disease management care plans, leaving the program's impact across the population "open to question", the report noted. Payments to doctors for CDM care plans cost taxpayers $204million in 2007-08 alone.

A Medicare Australia audit found that more than one-third of care plan items claimed did not comply with MBS requirements.

The Professional Services Review, which investigates potential Medicare abuses, has also written to the federal Health Department about the risk the claims could be driven more by business than clinical imperatives, the report revealed. "In particular, the PSR is concerned that plans are being opportunistically generated, based on system-driven templates that do not reflect patients' actual needs and that are not necessarily shared with or even provided to the patient," it said.

In the May budget, the Rudd government used excessive doctors' fees as justification for cuts to reimbursements for IVF, obstetrics and cataract operations, claiming the most prolific 10 per cent of eye specialists earned $1m through Medicare last year.

The latest report opens the door to further payment reforms, breaking away from fee-for-service arrangements towards salaries, pay-for-performance or other incentives.

The centrality of GPs' role in patient care could also be eroded in favour of giving people more direct, affordable access to allied health workers, using pharmacies to assess risk factors, and workplaces to deliver healthy lifestyle programs. "There is widespread agreement that the Australian healthcare system, in common with many other countries, does not provide the highest quality care for the money spent," the report noted.

But AMA president Andrew Pesce warned that patients' health would suffer if they lacked a doctor to co-ordinate overall treatment. "Unfortunately, there are some danger signs in this draft strategy and in the National Health and Hospitals Reform Commission Report that the government is planning a lesser role for GPs under the guise of 'health workforce reform'," he said. "The AMA must oppose any diminution of the role of the GP in primary care, and so should the whole community."

The government will not, however, finalise the draft primary healthcare strategy released with the report until late this year at the earliest. Despite receiving the report a month ago, the government will defer decisions on which proposals it will pursue until it strikes agreement with state and territory governments on how Australia's future healthcare system will be funded.

Relations between the government and the AMA have been strained by sharp policy differences on issues ranging from GP super-clinics to budget cuts to private health insurance and the Medicare safety net.


Some twitches of economic rationality within the Labor Party

Despite the huge hit to productivity delivered by its recent pro-union laws

IT’S a crucial time for the Rudd government’s policy direction. Does it believe in the Hawke-Keating model of enterprise-driven opportunity and prosperity? Or has it regressed to its base interventionist instincts, blending misplaced Whitlamesque idealism with the cynical politicking of modern Labor?

The global crisis provided the expedient cue for interventionism, validated as government spending to plug the hole left by a feared collapse of private demand and rhetorically justified by Kevin Rudd’s rants against excess finance capitalism. Now it is being exposed for building taxpayer-funded Labor monuments at primary school polling booths.

The next totemic issue may be the cabinet split over removing territorial copyright restrictions on book imports which, among other things, push up the price of student textbooks. The case for book imports is headed by Competition and Small Business Minister Craig Emerson, an economist and a former adviser to Bob Hawke. Yesterday Emerson declared that “Labor is the party of competition”. “It is in the interests of working people, the poor and the vulnerable that business is under strong, competitive pressure,” Emerson said in a speech. “Competition exerts downward pressure on consumer prices.

“Competition makes business tough and resilient, better enabling them to employ people through the good times and the bad. Competition drives innovation, which in turn drives productivity growth. “Business managers will have strong incentives to innovate - boosting productivity growth and future prosperity - when they are under competitive pressure from rivals who adopt and adapt the latest technologies and who develop and apply their own best ideas.”

This is the language of the Hawke-Keating reforms of the 1980s which, for instance, dismantled import protection on the argument that it was not in the interests of poor and working Australians to be forced to pay more for clothes, shoes and cars. Two decades later, Emerson suggests that most demands for new regulation come from business seeking protection from competition, including supposedly unfair big business competition against small business.

Emerson is not against regulating for competition, such as through Labor’s criminal sanctions and jail terms for collusive business cartels. But his message to his small business lobby is blunt. Often big business undercuts smaller competitors simply because of the cost efficiencies from being big. Treating this as anti-competitive would simply result in higher prices for consumers.

Moreover, collusion is not restricted to big businesses such as cardboard box makers. Cartels also have been run by small petrol stations in country towns. “When it comes to collusion, you don’t need to be big to be bad,” hesays. Ouch! And Emerson warns that even proposals to curb apparent market power should be rejected if they simply impose another layer of costly red tape, make it riskier for business to invest and so increase prices for consumers.

Such talk is guaranteed to stir up the small business lobby, the so-called consumer lobby and, in the case of books, the cultural protectionists. And Labor has only itself to blame for whipping up small business and kitchen-table protectionism with its populist opposition campaign against grocery prices, petrol prices and interest rates charged by big supermarkets, big oil companies and big banks.

This has encouraged even more wackiness such as the so-called Blacktown amendment to the Trade Practices Act, introduced by independent senator Nick Xenophon and Nationals senator Barnaby Joyce in cahoots with University of NSW legal academic Frank Zumbo. Zumbo claims Woolworths, Coles and the big petrol companies engage in “geographic price discrimination”. Their prices are lower in suburbs where there is more competition from independents. That’s supposedly because they seek to drive out the independents so they can then raise their prices again.

Named in honour of an independent petrol retailer in Sydney’s Blacktown, Marie El-Khoury, the truly bonkers amendment would require retailers to sell their products at the same price at all their outlets within 35km of each other. Ponder for a moment how this could possibly work for fruit and vegetables, groceries, liquor, petrol and so on.

Yes, the weather is not always perfect and business can be tough. But is supermarket competition between Woolies and Coles, and now between new entrants such as Aldi, Costco, FoodWorks and so on, really weakening? And would the “guaranteed lowest prices bill” really make groceries cheaper? Emerson calls it the Vaucluse amendment, which would require Toorak prices for goods sold in Footscray. [Rich suburb versus poor suburb]

So, given the competition and consumer affairs portfolio in June, Emerson quickly dumped Labor’s useless GroceryWatch stunt. He pulled business-to-business dealings out of the national consumer contract legislation just as it was about to be introduced to parliament.

A new legal notion of “unfair” business contracts would put the terms of bank loans to small businesses more at risk of being overturned by the courts. The banks would have to price in this increased lending risk, which would hurt, not help, small business.

But needing political cover, Emerson instead is looking to reduce barriers to new competitors, such as government zoning restrictions on retail development and restrictive leasing covenants required by Woolworths and Coles before they agree to become anchor tenants in shopping centre developments. A Woolies lease would keep Coles out of the centre, and vice versa. Action here may help consumers, unless it makes it harder to develop new shopping centres. But small retailers should really aim their ire not at Emerson but at Julia Gillard.

The main thing the big supermarket chains offer consumers is one-stop shopping for fresh food, packaged food, toiletries, liquor and even petrol, and in the evenings, weekends and public holidays.

Gillard’s labour market reregulation [pro-union laws] will make it even harder for smaller retailers to compete on convenience. The big supermarket chains are better placed to cope with her unfair dismissal laws and to absorb the increased penalty rates imposed by her award “modernisation”. This will hinder competition but that’s what Australia’s industrial relations system has always aimed to do. And it will push up supermarket prices for working families, but Labor no doubt will have a press release ready for that.


School bullying shame: three children a class bullied daily

But all schools have "policies" about it -- policies that are a vacuity in the absence of significant disciplinary powers

BULLYING has become such a "pervasive problem" in schools that three children in each class are bullied daily or almost daily. Startling research, held by Queensland's Education Department, shows another five children per class are bullied in some way weekly. Education Department assistant director-general of student services Patrea Walton told a community forum at the weekend that bullying was a "pervasive problem in schools" and had been identified as "one of the biggest fears parents have for their children".

The State Government has hired national bullying expert Professor Ken Rigby to help address the scourge.

Up to 70 per cent of suspensions currently handed out in Queensland schools relate to bullying. The horrific death of year 9 Mullumbimby student Jai Morcom, who suffered massive head injuries after he was allegedly targeted during a schoolyard brawl on Friday, has reignited the debate on student cruelty and violence.

Rising school violence continues to dog Education Minister Geoff Wilson, who is trying a raft of measures to tackle the problem, including hiring Prof Rigby. [Ken Rigby is a nice guy but there are severe limits on what psychology can do]

Australia's largest study of school bullying, released two months ago, showed Queensland had among the highest levels of bullying in the country. The forum, organised by the Queensland Council of Parents and Citizens Associations Metropolitan West Regional Council, heard terrifying accounts of cyber bullying in which students spoke of killing peers. Speakers also told of messages in which students wrote of hurting students' families.

Ms Walton said research showed bullying victims were more likely to be depressed, anxious, have low self-esteem, exhibit medical problems and talk about suicide than their peers. But she said it was not a recent phenomenon and not confined to schools.

Tullawong State High School principal Leonie Kearney, credited with turning her Caboolture school around through a tough stance on bullying and bad behaviour, said 70 per cent of suspensions she administered related to bullying.

Ms Walton said she didn't believe the proportion of suspensions for bullying would be as high across the state, but was unable to provide a figure, citing no agreed definition. More than 50 per cent of the 55,000 suspensions handed out to state school students in 2008 were for physical, verbal and non-verbal misconduct.


Australian immigration rules set for revamp

889,722 people in one year coming into a country with a total population of not much more than 20 million sure is one heck of an influx. No wonder even a Leftist government is beginning to show concern

AUSTRALIA'S immigration policy is set for an overhaul amid concerns that it is failing to meet the nation's long-term needs, with a record influx of more than 600,000 temporary residents adding to the strain of a growing population. In a significant shift, Immigration Minister Chris Evans told The Age that cabinet had approved the development of a five to 10-year plan that would consider the types of migrants that Australia needed, where they should settle, and the extra need for housing, transport, water and other resources to accommodate more people.

New figures to be released today show that Australia's official migration program recorded an intake of 171,318 permanent migrants in 2008-09. When the 13,500 refugees and the 47,780 New Zealanders who settled permanently in Australia are included, the migration program saw 232,598 people arriving in the past year, a 12.8 per cent leap from the previous year's record high of 219,098 people. But according to figures obtained by The Age, a further 657,124 temporary migrants with the right to work arrived in Australia during the past year. The 11 per cent surge in temporary migrants was fuelled by big increases in foreign students (up 15 per cent to 320,368) and working holiday visas (up 22 per cent to 154,148). This compensated for a 9 per cent drop in 457 visas - an employer-sponsored visa for temporary skilled labour introduced in 1995 - to 101,280.

The surge in temporary migrants with a right to work has created an unprecedented, unplanned migration wave. Senator Evans said Australia needed a rational immigration debate, beyond the hysteria about the few hundred boat people who arrive each year. ''The annual figure this year [for skilled permanent migration] was, say, 115,000, but more than 500,000 came into the country. They came in as students, temporary workers, working holidaymakers … but the public still focuses on the 115,000 as if it's got anything to do with reality and my attempts to have a more sophisticated debate about this have totally failed.''

Senator Evans said immigration should be the nation's labour agency, meaning a continued high intake of migrants, especially younger, skilled workers. But the desires of migrants - including overseas students who came in on temporary visas in order to gain permanent residency - should not be driving Australia's immigration policy.

Decisions about who came to Australia would be increasingly left to employers although, conversely, Australia would also be competing for the most highly skilled migrants. Senator Evans said to do that successfully the impacts of record high immigration on our liveability had to be tackled. ''In Australia we've got this sense of, 'Well, we're the lucky country' and … people will naturally come here, and that's still true to an extent. But other countries … are increasingly marketing themselves too.''

He said immigration policy would remain non-discriminatory and that Australia's Muslim communities posed no fundamental threat - despite the arrest of five Melbourne men on terrorism charges, three from Somalia and two from Lebanon. ''I don't want to downplay terrorism … It is a serious public policy challenge that has to be tackled … But there's also been this slightly irrational fear and debate about people who arrive unauthorised as possibly posing some sort of threat.''


The never-ending NSW government transport mess

They sure know how to get people out of their cars!

The NSW Government has baptised its new public transport ''super-agency'' with a shiny name - NSW Transport and Infrastructure - and will soon unveil a plan for Sydney's transport. Yes, another new plan. The office of the Transport Minister, David Campbell, this week promised the 2031 Transport Blueprint by year's end. Campbell recently wrote: ''It will not only look at what we need to meet current demand but also to cope with the expected population growth.''

The blueprint is an attempt by Campbell and the Premier, Nathan Rees, to put their stamp on future transport options for Sydney. But as the baseball legend Yogi Berra so memorably remarked: ''It's like deja vu all over again.''

The archives of assorted NSW transport agencies are awash with discarded plans to improve Sydney's sclerotic train and bus networks. Schemes remain just dreams and Sydneysiders have had to endure nearly a century of arthritic transport planning much like the train system at its worst: promises and cancellations, tentative starts, shuddering stops and diversions to nowhere.

Sydney's ghost train history goes back a century but real stagnation set in the 1970s, when Sydney's population boomed without commensurate expansion of transport corridors. In just the past 15 years, at least $28 billion in rail infrastructure was promised by state governments but never delivered. Thirteen projects alone would have extended the rail service by more than 1000 kilometres of track and provided dozens of new stations in areas forced to depend more and more on the family car. Consequently, the city's roads seize with overload as peak periods extend and frustrations overflow.

The blame is mostly levelled at Labor, which has governed NSW for 26 of the past 34 years. Its leaders have made much of their support for public transport to areas that house Labor voters. Their failure to deliver, however, has only heightened the social inequity they complain so loudly about.

Sydney's rail system has changed little since John Bradfield - designer of the Sydney Harbour Bridge - first articulated his vision in the 1930s (it was updated in 1956). Western Sydney's population has increased fivefold since 1940 but its rail lines have extended just 20 kilometres....

Neville Wran won a narrow state election victory in 1976, based largely on a promise to improve public transport. He famously took an early-morning campaign trip from Gosford to Sydney to highlight overcrowding. He finished the eastern suburbs line between Martin Place and Bondi Junction but the extension south to Maroubra was abandoned.

The Greiner government embarked on a public-private partnership to build the underground line to Sydney airport, with stops at Green Square and Mascot, where big housing developments are planned. But the line has been a disaster, with low patronage because commuters find ticket prices too expensive.

Rail plans that would have connected the north-west and south-west with the city - and introduced links between suburban centres such as Hurstville and Strathfield - were abandoned through lack of money or absence of political will. There is now so much cynicism about government proposals - particularly unfulfilled plans by Labor governments, which are supposed to be committed to the provision of public goods and services - that the latest Rees-Campbell blueprint, however well intentioned, is unlikely to convince voters.....


More QANTAS gloom

I've returned from overseas having flown Qantas to and from Singapore from Perth. The flight there was suddenly cancelled with no explanation after numerous people had already checked in, the next available flight was five hours later, which was so packed that they had business class passengers in the front of economy getting champagne and the better meals but still sitting with masses! The return journey actually left roughly on time, but the Q video system was broken. I might as well have been on Jetstar at a fraction of the price, I'm sure I would have got a better meal for just a few dollars. Needless to say I will try another airline next time I go overseas. No wonder their profits are down, people are voting with their feet.

SOURCE (Via email)

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