Friday, November 27, 2015

It Seems It Is Government Policy Not To Actually Let We Mug Punters Know What Is Going On.

Two articles appeared this week to confirm the impression.
First we had:

Media consultants paid big money to train bureaucrats for Senate hearings

Date November 22, 2015 - 12:15AM

Adam Gartrell

National Political Correspondent

Federal government departments have paid external media consultants hundreds of thousands of dollars to train bureaucrats how to "perform" in Senate estimates hearings.
The consultants, who can be paid up to $30,000 a month, insist the training is not aimed at teaching public servants how to spin or avoid scrutiny – but some senators are not so sure.
While a search of government contracts suggests departments have spent about $160,000 on the training in recent years, the true cost is believed to be much higher but concealed through a sometimes opaque tender process.
For example, one major provider of Senate estimates training – Melbourne-based consultancy Media Manoeuvres – has been awarded at least $1.9 million in government contracts in recent years, according to the publicly accessible Austender website.
The contracts are typically for "media training" or "media awareness training". None mention Senate estimates training, even though that is a significant part of Media Manoeuvres' business.
On its website, Media Manoeuvres says it offers two levels of Senate estimates training: "awareness" and "performance skills". The latter involves simulations and role-playing scenarios.
Chief executive Sam Elam said the company regularly provided the training to various agencies. It was aimed at giving public servants the confidence to deal with what could be a very stressful experience when confronted by aggressive senators.
"It's high pressure and that can turn some people to water," she said. "It's about giving people the confidence to actually speak up."
Canberra-based consultant Laurie Wilson has delivered Senate estimates training to the Australian Public Service Commission and a wide variety of government departments over the past decade.
Last year, he was paid about $60,000 to deliver an extensive two-month training course to the Department of Finance.
More here:
We all remember NEHTA and DoH at Senate Estimates when asked re: e-Health. Stonewall training is what I would call it.
In the same week this popped up.

DTO snubs advice from peak industry bodies

The Government’s much vaunted Digital Transformation Office (DTO) closed door policy is rankling peak industry bodies that want access to the agency.
Laurie Patton, CEO Internet Australia (IA), the peak body representing Internet users claims a number of civil society and industry groups are apparently finding the door to the DTO firmly shut or are being left out of the loop when it comes to stakeholder engagement.
“We asked for a meeting and were told to come back next year”, Patton said. “They said they were too busy to see us”.
He believes the Australian Communications Consumer Action Network (ACCAN), the peak body representing all consumers on communications issues, also had appointments ‘bumped’ to next year because the DTO is “too busy”.
[At the time of writing this ACCAN was unable to be contacted for comment.]
“Expert organisations such as ourselves will be better able to assist if we’re involved from the outset, in the formative stages of the DTO's operations, rather than down the track when their plans and initiatives have been locked in,” Patton said.
“Our concerns were raised when a visiting expert from the UK highlighted the downside from the work of the UK DTO. “The message was that they’ve ended up with a two-class system. It’s fine for people who have access to the Internet and are digitally savvy, but disadvantaged groups and individuals who are not connected are now struggling to get access to essential government services”. “
IA approached the DTO offering to provide advice and assistance to ensure that everyone benefited and nobody was left behind as a result of its work.
More here:
So no talkies to anyone who might know something in technology while doing an innovation statement!
This all really just confirms what we are all becoming pretty used to. The bureaucrats etc. simply just roll on and ignore any external advice - while overestimating just how knowledgeable and informed they are.
It really gets very, very tiring  to see the same mistakes made over and over again!

Thursday, November 26, 2015

The Macro View - General And Health News Relevant To E-Health And Health In General.

November 26 Edition
The big macro issue at present is a discussion around just how complex, useless and expensive health insurance is and how the tax system is to be reformed in an era of ruling nothing in or out. It also now seems housing is now also being discussed, with older people being offered encouragement to downsize.
Pollies are back this week for a week or so - so we can expect more budget news and more moves on health policy. I wonder will we have some more e-Health thought bubbles
Here is some other of the recent other news and analysis.

The Political Scene.

Tax incentives eyed for home downsizers

  • The Australian
  • November 20, 2015 12:00AM

Gretchen Friemann

David Uren

Scott Morrison is canvassing bold tax reforms designed to persuade retirees to downsize to smaller homes and plough more money into retirement-income products in a move that would boost the housing supply for younger families and create a boom in the use of annuities.
The plan would include a one-off exemption from stamp duty on the purchase of a smaller house.
As an extra incentive, profits from the sale of the family home would be excluded from the Age Pension assets test provided they were channelled into an ­approved retirement product such as life annuities and aged-care bonds.
Since being appointed Social Services Minister late last year, the Treasurer has argued that the burden of the Age Pension could be reduced by allowing retirees to tap the wealth captured in their homes.

General Budget Issues.

  • Nov 17 2015 at 12:55 PM

Treasurer Scott Morrison hints at lower trend economic growth rate

Treasurer Scott Morrison has hinted the economy is unlikely anytime soon to return to the historic pace of growth that would deliver easy budget repair.
Mr Morrison suggested growth needs to rebound to "slightly above" 3 per cent, but effectively conceded it was likely to fall short of that pace.
"We are growing at 2.3 [per cent] and we will look to get ourselves back to about a 3 per cent [rate] which is just under trend.
"Now that's where we need to get to," Mr Morrison said.
Asked whether growth of 3 per cent would generate enough revenue to cover the government's needs, Mr Morrison conceded "you'd need to be slightly above that".

Wage growth hits record low as Scott Morrison tries to lift incomes

Date November 19, 2015

Peter Martin

Economics Editor, The Age

We were preparing for a wages explosion.
Two years ago, in his first major speech as workplace relations minister, Eric Abetz warned of "something akin to the wages explosions of the pre-Accord era" if employers and unions didn't rein in their deals.
Even as he spoke, wage growth was plummeting to new lows, heading down from its long-term average of between 3 and 4 per cent into the twos.
Since the minister spoke wage growth has plunged lower still, hitting 2.1 per cent for private sector wages in the year to September, the lowest result in records spanning back 18 years.

No Morrison mini-budget mid-year

Published: 9:18 am, Friday, 20 November 2015
Don't expect some sort of fiscal extravaganza when Scott Morrison releases his first mid-year budget review.
The treasurer has made it clear that he won't be making the mid-year economic and fiscal outlook some sort of mini-budget for the government's new leadership.
'MYEFO is a budget update ... I have no ambitions for it to be more than that,' Morrison said in a recent interview.
However, he set down some markers in a speech this week, in tune with his predecessor Joe Hockey.
That is, the budget deficit will be reduced by around 0.5 per cent of GDP, expenditure will begin to decline next year from its present peak and net debt will start to decline the year after next.

Health Budget Issues.

Quality of care in Australian hospitals lacks oversight

Date November 16, 2015 - 12:00AM

Jane Lee

Australia needs to collect more information to measure the quality of care that hospitals provide to patients nationally, an OECD report says.
The OECD's review of Australia's health system, to be released on Monday, said that it was performing "remarkably well" despite its "fragmented nature" and "sometimes strained" relationship between federal, state and territory governments over health funding. Australia was the OECD's fifth most obese country, it said, and its health system would in future have to deal with an increasing number of patients with diabetes and other chronic conditions. 
While Australia had improved its national standards for health care, it said: "A surprising lack of data on the quality and outcomes of care marks out Australia from its peers."
"This is particularly the case for primary health care, which has an under-developed pay-for-performance scheme, and for rural and remote health care. There are few indicators promoting quality of clinical care and patient outcomes, and there is little opportunity for GPs to be benchmarked against their peers."

Australia must protect the foundations of its healthcare system

Date November 13, 2015

Brian Owler

What do we want our healthcare system to look in 10 years? The federal government's vision for Australia's healthcare system currently lacks clarity, let alone consensus. 
The Medicare Benefits Schedule (MBS) Review, the Primary Care Review, and now a review of the private health insurance sector are set against the background of reform of the federation and federal-state health-funding arrangements. In the midst of these reviews is a debate about tax reform, including the potential application of a 15 per cent GST on health. 
Is it no wonder that complaints to the health ombudsman are at an all time high, and that the largest source of complaints is patients who do not understand their policies and are unaware of their exclusions? 

Removing natural therapies ‘too costly’, says health review

  • The Australian
  • November 16, 2015 12:00AM

Sean Parnell

Removing unproven natural therapies from the scope of the health insurance rebate is unlikely to deliver sufficient savings to warrant the cost of doing so, Health Minister Sussan Ley says.
The Australian has obtained the final review of natural therapies, commissioned by the former Labor government to ensure taxpayers were not subsidising bogus medicine, confirming there is insufficie­nt evidence to say the treatments benefit patients.
Chief Medical Officer Chris Baggoley chaired a specially convened committee of experts and tasked the Office of the National Health and Medical Research Council with examining the published evidence on 17 natural therapies.
“Overall, there was not reli­able, high-quality evidence available to allow assessment of the clinical effectiveness of any of the natural therapies for any health conditions,” the report concludes.

Natural therapies: no clear evidence of health benefits, government review finds

Date November 16, 2015 - 5:56PM

Jane Lee

There is no clear evidence that natural therapies are effective, a government review says, prompting calls for taxpayers and private health insurers to stop paying for them.
A Department of Health review of 17 therapies covered by private insurance released on Monday stated it could not conclude that any worked.
While there was "low to moderate quality" evidence that some therapies – for example, massage therapy, yoga and tai chi - may have some health benefits, overall "there was not reliable, high-quality evidence available to allow assessment of the clinical effectiveness of any of the natural therapies for any health conditions", the report, by Chief Medical Officer Chris Baggoley, said.

Fears Medicare safety net changes will hit most vulnerable

Date November 16, 2015 - 7:55PM

Jane Lee

A plan to cap rebates for out-of-hospital costs will lead to higher hospital admissions and suicide rates, rather than save the public money, doctors warn.
The Turnbull government had hoped its changes to the Medicare Safety Net would take effect from the start of next year. They are expected to save $266.7 million over five years, which would be put into the Medical Research Future Fund.
The changes will lower the spending thresholds required for patients to access benefits, but cap the benefits payable for individual medical services once this has been reached.
Psychiatrists and oncologists renewed their calls for changes to the legislation, which they say will make life-saving services more expensive for people who need them most.

Medicare: Government 'may face political crisis' over rebate freeze

Date November 17, 2015 - 7:15PM

Gareth Hutchens

The federal government may face a "political crisis" in a few years if it does not reverse the freeze on the indexation of Medicare rebates, the deputy director of the Menzies Centre for Health Policy has warned.
Associate Professor James Gillespie says voters need to realise that Medicare is an industry, GPs are running businesses and that co-payments are here to stay.
But general practitioners may be forced to increase co-payments at some stage, to cover for lost income, if the Medicare rebate freeze continues "for the foreseeable future", he said.
Mr Gillespie told a forum at the Australian National University on Tuesday that Australia's health debate was finally recovering after the damaging row over GP co-payments.

GP-ordered tests and scans a drain on Medicare budget

  • The Australian
  • November 21, 2015 12:00AM

Sean Parnell

GPs putting patients through ­extensive health assessments, or sending them off for sleep studies, iron tests, thyroid examinations or various leg scans, are responsible for some of the biggest increases in Medicare expenditure in recent years.
An expert taskforce reviewing the Medicare Benefits Schedule has been given access to data ­revealing increases by service, specialty­ and demographic, amid a clear trend for Australians to average more medical interventions each year.
The previously unreleased Medicare data gives some insight into the push for patients with chronic illness to be funded outside the traditional MBS system, and the need for clinicians to be compelled to follow evidence-based guidelines to avoid over-servicin­g or poor practice.
But it will only fuel the debate over the reason for the increase in Medicare-funded services per capita and whether doctors are respond­ing to patient concerns or profiteering.

Better protection for consumers of complementary medicines

Date November 20, 2015

Amy Corderoy

Health Editor, Sydney Morning Herald

Australians who use complementary medicines could be protected from dodgy claims and products that don't contain what they say they do under proposals in a landmark review.
The independent review of medicines and medical devices should also please the fast-growing complementary medicines industry, as it also recommends more self-regulation and cutting red tape.
Complementary and alternative medicines are thought to be used by two in every three Australians, generating $3.5 billion in revenue each year in Australia alone, despite a poor evidence-base for many heavily advertised products and federal reviews that have found repeated breaches of advertising regulations. 

Health Insurance Issues.

Let health insurers cover GP visits: Victoria University report

Date November 16, 2015 - 6:11PM

Julia Medew

Health Editor

Health insurers should be allowed to cover more health services, including GP visits, under a more privatised Australian health system, an independent report says.
Victoria University's Australian Health Policy Collaboration is calling for one of the greatest overhauls of Australia's health system since Medicare was introduced to offer universal access to healthcare in 1984.
In a report released on Monday, the group said a national system of mandatory insurance with regulated competition would motivate health services to limit costs.
At the moment, health insurers are not allowed to cover primary care services such as GP visits, radiology and pathology, or outpatient visits to specialist doctors such as endocrinologists or orthopaedic surgeons.
This means healthcare, particularly for people with chronic disease, is fragmented with many different providers and funders, including federal and state governments and health insurers that try to shift costs onto each other. The result is that no one carer or service provider takes responsibility for a patient with incentives to keep them well or to get them better efficiently when they are sick.

Health insurance premiums to rise more slowly in 2016

Date November 17, 2015 - 3:46PM

Jessica Gardner

Companies & Markets Deputy Editor

Next year's health insurance price hike will be slightly lower than previous years, but nib boss Mark Fitzgibbon says customers need to "get used to the idea" of annual premium increases in the region of 5 to 6 per cent.
The push to rein in the rising cost of private health cover is an aim of Health Minister Sussan Ley's review into the $19 billion sector, which heats up this week, but Mr Fitzgibbon played down expectations it would deliver real change.
"I don't think there will be any initial big bang," he said.
Mr Fitzgibbon, speaking at a conference organised by investment bank UBS, said spending on health care across the country had run at about 6 per cent a year for the past 10 years. 

Health insurers slam ‘rampant’ cost variations

Sarah-Jane Tasker

Australia’s top private health insurers are to reveal they are paying $800 million more each year on prosthetic devices compared to what public hospitals pay as they push for change under a federal government review.
NIB Holdings chief executive Mark Fitzgibbon said the insurer and the country’s other top funds had joined forces to engage a consultant to prepare a report on the international benchmarking price for prosthetic devices.
Health funds and hospitals met health department representatives yesterday as part of the government’s consultation on the private health insurance sector and the paper on prosthesis was expected to form part of the industry’s submission.
Mr Fitzgibbon said it was “outrageous” that insurers were forced to spend $800m a year more on prosthetic devices in the private system than they should.

Want real health reform? Integrate public and private health into one mandatory insurance system

20 November 2015, 06:54 CET


  1. Francesco Paolucci
Associate Professor; Head of Health Policy Program, Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University
  1. Manuel García-Goñi
Associate Professor of Applied Economics, Universidad Complutense de Madrid
Health Minister Sussan Ley is considering applications from private health insurers to increase premiums by 6-7% in 2016, four times higher than the rate of inflation. Rising premiums and better value for consumers are on the agenda at Ley’s private health insurance reform consultations this month.
But while health-care costs are growing – due to an ageing population with higher rates of chronic diseases and greater use of health technologies – rising premiums are also the consequence of structural system design flaws.
To make the system sustainable in the long term, our report, released this week by Victoria University’s Australian Health Policy Collaboration, proposes a model that integrates public and private health expenditure into a universal, mandatory health insurance scheme.
Consumers would have the choice between private health insurers and at least one government-run provider (which could be a version of Medicare or an insurer as was Medibank). All insurers would have to provide a comprehensive set of health services to their customers, covering all essential aspects of their health care.
It has been an interesting time with the new Government settling in and all sorts of options now back on the table, including the Harper Competition Review - pharmacy might be worried, as well as a review of Health Insurance.
Health is also clearly under review as far as its budget is concerned with six reviews underway. Lots to keep up with here! Enjoy.

Wednesday, November 25, 2015

Is The Health Minister Following The Evidence With Respect To E-Health In Mental Health?

This appeared last week:

E-health key to mental health reform: Ley

Serkan Ozturk | 17 November, 2015 |
The Federal Government wants digital programs to play a central role in reforming mental health care, despite growing concerns over the efficacy of treatments such as online CBT.
Speaking in Federal Parliament late last week, Health Minister Sussan Ley signalled that the eagerly awaited report into the country's mental health system by her appointed expert reference group would be released before the end of the year.
Foreshadowing the report's contents, Ms Ley told parliament the recommended reforms contained within it would be "significant, far-reaching and very important".  
A key part of that would be the far greater use of online mental health programs, she said.
"The opportunity for digital engagement, the great advances that have been made in communicating via a self-help app, a digital gateway and counselling online — a lot of young people put their hands up and said that is a preferred method for them," Ms Ley said.  
"If we know we can intervene early and get the right assistance for that cohort, we can save our resources for the people who need complex care later on in the cycle."
Her comments come at the same time as concerns were raised over the effectiveness of e-mental health treatments following the publishing of a randomised controlled trial bringing their widespread use into question.
The study by UK researchers concluded that online CBT programs provide "modest or no benefit over usual GP care and suggests that the routine promotion and commissioning of computerised CBT be reconsidered in light of our findings".
However Kate Carnell, who is leading the Mental Health Expert Reference Group, refused to comment on questions about the findings when contacted by Australian Doctor on Tuesday.
"Our job with an expert panel was to look at what implementation would look like that, which bits should be implemented and how they would be implemented," said Ms Carnell who was formerly CEO of beyondblue.
"I'm not going to make a comment on a report that hasn't been released yet and I'm not the expert on digital mental health services."
Associate Professor Nick Titov, project director of online mental health program MindSpot based at Macquarie University, said e-mental health should not be seen as a "panacea" for mental health care.
More here:
Interestingly we had this appear in the same week.

Doubt cast on value of computerised CBT

Thomas Meek
17 November 2015
Computer courses to treat depression are likely to be ineffective, according to research by the University of York.
A study published in the British Medical Journal says that participants offered computerised cognitive behaviour therapy experienced “no additional improvement in depression” when compared with patients who received their usual care from a GP after four months of treatment.
The two-year REEACT trial included 691 patients with depression selected from 83 general practices across England.
Patients were randomised to receive 'usual GP care for depression' or 'usual GP care plus' one of two computerised CBT programme recommended by the National Institute for Health and Care Excellence.
These were the commercially produced Beating the Blues or the free to use MoodGYM developed at the Australian National University Centre for Mental Health Research.
Previous, developer-led trials for both systems have demonstrated the products have been able to reduce symptoms of depression. However, the York research suggests their impact is less clear in a real world setting.
The study’s authors noted: “Patients generally did not engage with computer programmes on a sustained basis, and they highlighted the difficulties of repeatedly logging on to computer systems when clinically depressed.”
However, there have been recent studies suggesting that electronic CBT tools can have some benefit, at least when combined with other services.
This month, the Canadian Medical Association Journal published an evidence review that shows internet-delivered CBT combined with clinical care can support people with depression, anxiety and emotional distress from illness.
More here:
I find it interesting that there were different findings reported from different countries and this compares with most of the evidence from Australia that suggests a positive effect with e-Mental Health.
It seems to me what we need here is to try and understand just what has led to difference in findings before making any decisions as to where the Government should make its Mental Health investment.
There is no doubt that Prof. Titov is right and that e-Mental health should be seen as a part of but by no means the whole story.

Tuesday, November 24, 2015

If It Was This Easy, How Come E-Health Has Not Already Demonstrated The Scale Positive Differences Often Claimed? Maybe In A Few More Years!

This report appeared last week:

PANEL: How collaboration on data and technology is making medicine smarter

Chris Pash Today at 9:00 AM
Big data is more commonly associated with helping business make more profit but researchers are reaping enormous benefits  in health care and medicine.
The convergence of technology and healthcare is creating opportunities across disciplines, creating partnerships and breakthroughs.
Professor Ewa M. Goldys, a physicist working in the medical field, says big data is a key to the emerging field of personalised medicine.
“Individuals are different, the biochemistry,” says the Deputy Director of the Australian Research Council Centre of Excellence for Nanoscale Biophotonics.
“This is related to the problem big data. The human body has about 20,000 genes but there are a lot of proteins in the human body, in the millions, many of them undiscovered.
“So to actually understand what a body is doing at a particular instance in time, that requires big data.”
The CSIRO’s David Hansen sees a huge opportunity in big data as Australia moves to electronic medical records for everyone.
“What I find particularly interesting about this whole area is how technology can actually improve health performance of health services, health costs, and as well to improve patient outcomes,” says Hansen. “There is a great synergy between health services and technology.”
The CEO of the Australian e-Health Research Centre says the federal department of Health has been looking at how a good electronic record can improve the health system and improve patient care.
Using this data set, it will be possible to make our health system more efficient and cost effective while at the same time improving services to patients. The federal government has just appointed a board to oversee the new Commission for eHealth.
Patrick Brennan, the Co-Director of BREAST and a professor at the University of Sydney, says data entry and data quality control are really important.
He agrees with the CSIRO’s David Hansen that a centralised electronic health record will be a huge help.
“The problem is that in Australia we’re not that good at it yet,” Brennan says. “If you go to Taiwan, every patient’s record is stored in a single database. And we can go in there and suddenly we can find out that this woman had breast cancer but then she smoked 20 cigarettes and she had a mammographic density of this. In this country it is much, much more difficult. Technology is helping us a lot but there is still some way to go.”
The full article - and others in the series - are found from here:
I love reading this sort of material because the closer you read what people are saying the further you realise the contributors are away from their nirvana. It always seems to be so easy in theory but the reality somehow the reality always seems to be a good deal harder.
I have to say talk of huge centralised electronic health records covering the whole nation being mined by experimenters and government makes me just a trifle nervous. I also wonder just what the quality of governance will be around this sort of initiative.
I just have the feeling, while in very constrained domains benefits may be found, it will be tricky to see the scale of impacts the discussants are imagining anytime soon. Time will tell I guess. I was glad to see there was a mention of the barriers such as data quality and data integrity - these will be major issues going forward I am sure!