Tag Archives: Health

Saturday salon 17/12

1. Do we need a new conservative party?

One Nation would tell us we’ve already got one, but Essential Report has now conducted a poll about an Abbott-based party, asking the question:

    If a new conservative party was formed and included people like Tony Abbott, how likely would you be to vote for them?

Overall the answer is ‘not very likely’ with ‘Total unlikely’ at 58% and ‘Total likely’ at 23%. However the Lib/Nat preference is evenly split at 41% each way. Continue reading Saturday salon 17/12

Saturday salon 15/10

1. Australian managers are second rate

Martin Parkinson, head of the PM’s department, told CEDA what we need to do to become truly innovative.

What caught my eye was what he said about Australian management in manufacturing:

Moving beyond Mediscare

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One of the reasons Mediscare worked, if it did, was because of the Abbott government’s record on broken promises. After being in government for eight months, by May 2014, the Abbott government had chalked up at least nine broken promises. Abbott had promised no cuts to the ABC or SBS, no cuts to education, no cuts to health, no shutting any Medicare locals, no one’s personal tax will go up, no changes to pensions, foreign aid would go up in line with the CPI, on Indigenous affairs Closing the Gap activities would be sustained at former levels, and ARENA (the Australian Reneweable Energy Agency) would have over $2.5 billion in funds to manage. Continue reading Moving beyond Mediscare

The giant Medicare scare campaign

Back on 22 May I did a post Labor makes health central in its election bid:

    In revving up his election spiel Shorten said spending on health was an investment, not a cost. He says investment in health is basic to economic growth. It would be an important battleground if Turnbull would engage. The pointy end is that Labor is choosing to invest in Medicare and the Pharmaceutical Benefits Scheme rather than spending money on company tax relief. Continue reading The giant Medicare scare campaign

Saturday salon 21/11

1. Brazil dam burst could devastate the environment for years

River Doce translates as “Sweet River”. After two tailings dams burst the focus was on the local town of Mariana, much of which was swept away. Now the concern has shifted to downstream where 500 km of river is becoming biologically dead, the silt is affecting nearby farmlands and is expected to contaminate fishing grounds when it reaches the sea. Continue reading Saturday salon 21/11

Climate clippings 155

1. Climate change affects the brain

    In a landmark public health finding, a new study from the Harvard School of Public Health finds that carbon dioxide (CO2) has a direct and negative impact on human cognition and decision-making. These impacts have been observed at CO2 levels that most Americans — and their children — are routinely exposed to today inside classrooms, offices, homes, planes, and cars.

Continue reading Climate clippings 155

Climate clippings 144

1. Business, investor, environment, research and social groups look for climate consensus before Paris

    Business, investor, environment, research and social groups have formed an unprecedented alliance to establish common ground on which the climate debate can be conducted, as the Abbott government finalises the position it will take to Paris climate talks later in the year.

    The Australian Industry Group, the Business Council of Australia, Investor Group on Climate Change, the Australian Aluminium Council and the Energy Supply Association of Australia have joined forces with the Australian Conservation Foundation, WWF Australia, the Australian Council of Social Service and the Australian Council of Trade Unions to set down some basic markers on climate policy which they hope will allow for future political consensus on the issue.

Continue reading Climate clippings 144

Climate clippings 141

1. Indian heat wave

At Climate Progress Extreme Heat Wave In India Is Killing People And Melting Roads. Temperatures have reached 122°F (50°C), that’s 1°F less than the all-time record. Continue reading Climate clippings 141

Climate clippings 137

1. Unburnable Carbon: Why we need to leave fossil fuels in the ground

That’s the title of a new report from the Climate Council.

    To have a 75% chance of meeting the 2°C warming limit, at least 77% of the world’s fossil fuels cannot be burned.

Real health policy required

The federal Government’s forays into health policy show no signs of becoming realistic. The 2014 budget foreshadowed that the Commonwealth might get out of the funding of hospitals in favour of the states accepting a higher and broader GST.

The problem here, as Gillard pointed out in her book, is that health expenditure expands faster than the GST revenue.

Then we had $7 co-payments for GP visits in an effort to keep poor people out of doctors’ surgeries.

This was followed by the fiasco of proposing and dumping the $20 cut to the rebate for short GP visits. According to recent news reports, the plan was originally opposed by Joe Hockey and then health minister Peter Dutton. Abbott insisted and then unaccountably backflipped.

Now Joe Hockey reckons we are living too long. Some kid just born somewhere is bound to live to 150.

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John Dwyer, Emeritus Professor of Medicine at the University of NSW, has long been an advocate for preventative health care. He says in a paywalled article in the AFR that many hospital admissions (costing $5000 each) could be prevented by primary care intervention in the three weeks prior to admission.

Medicare expenditure of $19 billion each year is dwarfed by hospital expenditure of $60 billion.

There is now an abundance of evidence that a focus on prevention in a personalised health system improves outcomes while slashing costs. Some systems have reduced hospital admissions by 42 percent over the last decade.

The Brits have just been presented with a review that concluded that an extra $132 million (in our money equivalent) spent on improving primary care would save the system $3.5 billion by 2020.

Worth a look, I would think!

There is another problem in the works. Only 13% of young doctors express any interest in becoming a GP.

The discrepancy in income potential for GPs when compared to that of other specialists is now huge. Young doctors looking at the professional life of our GPs are uncomfortable with the current “fee-for-service” model that encourages turnstile medicine that is so professionally unfulfilling. Many GPs join corporate primary care providers preferring a salary.

New Zealand has facilitated 85% of GPs away from fee-for-service payments. The same is true in the US for 65% of primary care physicians.

Finally, says Dwyer, we could take the $5 billion cost of the private health insurance rebate and spend it on all of the above.

Once again we are embarrassed by the incompetence of our politicians.

The threat of US style managed health care

I’ve been cracking my brain over one of Getup’s latest campaigns – keeping medical insurers out of the direct provision of primary health care.

The issue has come to a head with the federal government’s review of the $1.8 billion Medicare Local scheme. In brief, the 61 existing Medicare Locals are to be consolidated into 30 Primary Health Networks (PHNs), with geographic boundaries aligned with the existing Local Hospital Networks. The Government is about to call tenders for the provision of PHN services, with private medical insurance companies able to tender.

The Government does appear to have crossed a line, which is a concern, but my question is what does it mean to me, my relationship with my GP, and will it constrain her in pathways to care and access to specialist services? Getup’s concerns:

This means insurance companies, and not your GP, could end up making critical decisions about who gets treatment and how we’re treated, with health groups already raising the alarm. It’s the very system that’s crippled American healthcare, driving up costs and leading to less care for fewer people.

Profit-driven healthcare threatens the very foundation of our universal Medicare system, restricting access and quality of care, especially in areas where insurers don’t stand to make money.

Frankly, I can’t see that Medicare Local meant anything to my healthcare and I doubt that anything will change with the introduction of PHNs in July next year.

I’m struggling to understand what a Medicare Local does. This is from Professor John Horvath’s review (p. 8):

As part of the Council of Australian Governments’ (COAG) National Health Reform Agreement (2011), the Commonwealth Government agreed to fund Medicare Locals to improve coordination and integration of primary health care in local communities, address service gaps, and make it easier for patients to navigate their local health care system. Medicare Locals are expected to fully engage with the primary health care sector, communities, the Aboriginal Community Controlled Health Service (ACCHS) sector, and Local Hospital Networks (LHNs). Their establishment was built on the foundations of Divisions of General Practice (DGPs).

According to Horvath Medicare Locals also struggled to know what their role was. A critical phrase is “address service gaps”. Horvath says Medicare Locals were never intended to offer services in competition with existing services, but in fact that is what many did.

Medicare Locals were established in three tranches from 2011 as not-for-profit companies. Horvath says the PHNs should be contestable, transparent and accountable. He says that they should be be companies incorporated under the Corporations Act 2001, have skills based boards and should “establish a Clinical Council and a Community Advisory Committee in each LHNs (or clusters of LHNs) with which they are aligned as ‘operational units’” (p.17 of his Review). I suspect the involvement of for-profit health insurance companies would surprise him.

In Horvath’s “vision and design principles” statement (p.16) the closest PHNs would come to the direct provision of services is this:

Not all regions across Australia are equally serviced. The role of the PHO is to work with the GPs, Commonwealth and state health authorities, LHNs, and communities to identify gaps in health services and work in partnership with these organisations to source the appropriate services.

Yet in this article it is clear that Medicare Locals are providing services in remote areas that otherwise would be unserviced. And then this:

The Federal Assistant Minister for Health, Fiona Nash, said Primary Health Networks will not be providers of services, as some Medicare Locals have been.

The Young based Senator said a problem with Medicare Locals was a lack of direction but PHNs will have a clear set of guidelines.

“They’re going to be regional purchasers of health services and providers only in the exceptional circumstances,” Senator Nash said.

I remain confused.

It seems to me that Horvath saw PHNs as supportive rather than supervisory. Yet purchasing services does put them in the authority line in the provision of services. If so, there is a conflict of interest problem with the involvement of for-profit medical insurance companies.

Contra Getup, I don’t have an objection to for-profit companies providing health care. We have shares in a company called Ramsay Health Care which owns and runs hospitals. The provision of quality service seems to be their niche. As it happens I’ve had operations in two Ramsay hospitals as well as one owned by a bunch of specialist doctors, plus The Wesley, which is Uniting Church. Only in the one owned by doctors did I have concerns about the service, and then not all that serious.

Nevertheless we need to be alert and perhaps alarmed about situations where bean counters have undue influence on the provision of medical services. That can happen in the public sphere as well as the private.

Certainly in this case alarm is not confined to Getup. Nurses are also concerned.

Elsewhere Croakey consults the experts.

Ebola: how bad will it be?

In Guinea, Sierra Leone and Liberia, three neighbouring West African countries, Ebola seems to be out of control. This is a graph of the numbers of new cases with projections for the next four weeks in lighter blue:

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So far there have been about 8,400 cases and some 4,000 deaths. There are claims that cases in Liberia are doubling every 15-20 days while those in Sierra Leone are doubling every 30-40 days. By the end of the year there could be as many as 18,000 new cases weekly.

I’m impressed though that there has been no spread to other African countries other than Nigeria, where it appears to have been contained. One case surfaced in Lagos in July with 19 subsequent infections. However, the chain of contagion seems to have been broken.

On the other hand subsequent infections in the US, where a second health care worker has tested positive, and Spain are cause for concern.

You can read very different views of the potential impact of the disease worldwide. This Nature article is quite definite that the Ebola does not represent a global threat. The virus is too hard to catch and advanced country health systems are too sophisticted. By contrast this New York Times piece worries about the virus gaining a foothold in a mega-city somewhere else in the developing world. I’d worry about India and the capacity of its health system to cope.

The current outbreak is the first time the disease has gained a foothold in urban areas.

A second worry is that the virus may become airborne. C Raina MacIntyre, who is Professor of Infectious Diseases Epidemiology and Head of the School of Public Health and Community Medicine at UNSW, points out that experienced health care workers who have contacted the disease have not been able to identify how they caught it. The assumption is simply that there has been a breach in protocol. We keep being assured that the disease is hard to catch. While the long incubation phase, up to three weeks, does not help memory, the fact that it keeps happening in ways that can’t be precisely pinpointed is troubling.

Still, the circumstances that saw the disease take hold in West Africa are unlikely to be repeated. This Vanity Fair article explains how the spread of Ebola was assisted by unique circumstances.

Firstly Ebola was not identified for three and a half months. The disease was virtually unknown in West Africa; earlier outbreaks had been in central and east Africa. At first cholera, then Lassa fever were suspected. By the time Ebola was identified the disease had already spread to a number of towns, including a bustling trade hub.

The reaction of first world agencies was swift. After identification in late March, Guinea was invaded by strange robotic white people who came in space suits and took ill people away.

The foreigners had come so fast that they had actually out-run their own messaging: there were trucks full of foreigners in yellow space suits motoring into villages to take people into isolation before people understood why isolation was necessary.

To a villager, the isolation centers were fearsome places. They offered a one-way maze through white tarpaulins and waist-high orange fencing. Relatives or friends went in and then you lost them. You couldn’t see what was happening inside the tents—you just saw the figures in goggles and full-body protective gear. The health workers move carefully in order to avoid tears and punctures; from a distance, the effect is robotic. The health workers don’t look like any people you’ve ever seen. They perform stiffly and slowly, and then they disappear into the tent where your mother or brother may be, and everything that happens inside is left to your imagination. Villagers began to whisper to one another—They’re harvesting our organs; they’re taking our limbs.

The people in Guinea were as frightened by the response to Ebola as they were by Ebola itself. By May the cases dried up and the aid agencies started to relax. In fact the sick were hiding, as soon became apparent.

Rather than under control the reverse was true, the epidemic was completely out of control. While new strategies are gaining the trust of the people, the disease has outrun attempts to contain it.

There must be a huge effort to contain the disease within the three countries where then disease is endemic while a vaccine, currently under development, is fast tracked. As to Guinea, Liberia and Sierra Leone, we can’t just write off a combined population of over 20 million people. Health workers are in the front line and these countries human health worker resources are being depleted by the disease. Liberia has only 250 doctors left for 4 million people, that’s one for every 16,0000 people.

Yet Australia has seen no great obligation to help. Officially I understand we have supplied about $18 million in aid, a pathetic amount, while our fearless prime minister has said that it is too dangerous for us to put boots on the ground. Yet there is work to be done out of direct contact with patients, in building temporary field hospitals, for example. Our PM could show just a bit of compassion and genuine humanitarian concern.