Bulk billing is dead. Not a good time to be in Australia if you are sick

[caramac]

But it's not free healthcare for all at the moment, is it??

 

So yeah, I'd leave it as is, and make savings elsewhere.

 

Cutting out unnecessary prescribing costs associated with prescribing non generics or unnecessarily expensive drugs (if a proven and valid alternative exists) would be a good start.

 

Cutting out the practice of specialists requiring new referral letters each year for ongoing chronic disease would be another.

 

Exerting pressure on doctors to reduce unnecessary prescribing of antibiotics, statins, PPIs etc would be another.

 

Negating the need for people to require a medical certificate from their GP for a day off sick from work would be another.

 

Discouraging the practice of GPs making patients return to discuss their entirely normal results would be another.

 

Do you see my point? There's lots of ways to save money, rather than just picking on the weak and defenceless

 

 

There is certainly a culture of return consultations which could probably be cut.

My oh trains junior drs (psychs) for their membership/fellowship exams and the emphasis in Aus is that patients are brought back every four to six weeks to review (with another swipe of the Medicare card), rather than the focus being on getting them well and independent. It's set up for private practice really.

A much better approach is to use a multidisciplinary team, so that time and resources are more efficiently used. You would have an initial consultation with the consultant (and follow up if necessary), but then have nurses, psychologists, social workers, healthcare assistants doing the follow up care where appropriate.

There are places using this model in Australia, but it's not widespread as there is much greater use of private drs. Mind you, with the cuts in the NHS, it may not be around much longer here either. Very shortsighted, as it has been shown to improve outcome and costs.

Edited May 26, 2014 by caramac

[Harpodom]

OK! Drug prescribing - little saving there. Savings CAN be made, but not that great.

I'd like to see proof that curbing out of control prescribing habits by GPs and specialists wouldn't create significant savings

 

BTW, the pressure on GPs to prescribe said drugs comes from the population, which demands an antibiotic for a viral infection, and will travel to another doctor to get them. Losing revenue for the GP, of course - not a big deal, but the real issue is the word of mouth - "that bloody doctor didn't take my cold seriously, I'll never go back there ..." you get the picture.

I agree but the GP needs to show some leadership by saying NO when the situation requires it. Part of the job of a good GP is actually to sometimes tell their patient exactly the opposite of what they want to hear

 

results - they can be given over the phone, and are, if all is normal

Actually I'd say that's not normally the case, too many patients are ask to return to discuss their normal results, attracting an (IMO all too) easy fee for the GP

 

But what you are highlighting is a tinkering with the existing (failing) system. The gains are there, but minor. It is the system which is collapsing, and needs a radical overhaul.

I disagree that it is failing. I agree that costs are rising, as they are worldwide, due to rising expectations, more expensive drugs, an ageing population meaning more chronic disease and cancer etc. Not sure it needs a radical overhaul, but rather than introducing more charges to the consumer, I think the fault lies at the door of the 'fee for service' model of service delivery.

you need to get government approval from a person at the end of a phone - waiting time can be 5-10 minutes - for a box to be ticked by a non-medical office person. You pay for the consulting time lost, the salaries of the box-tickers and the administration of a system designed to save money but which costs money instead.

excellent example of needless wasteful expensive bureaucratic bollocks, get rid of it.

[GreatToBeBritish]

Question to the gallery. Should pensioners and concession card holders be forced to pay a co-payment?

 

Simple yes or no

 

yes

[GreatToBeBritish]

In what way will charging a co payment to those who can't or don't want to pay it reduce attendance at an ED?

 

You having a dog is your choice - him or her being healthy has no advantage to society. Having a healthy workforce does.

 

Perhaps instead of coming to ED with a rash that you have had for 3 weeks, an ingrown toenail, a mild headache, back ache etc the list is endless. All minor stuff can be sorted out at a pharmacy, or the GP?

 

However, if I felt like popping into ED to seek professional help then it would be appropriate to pay $7! And while I am waiting I could get myself a coffee, sandwich and bar of chocolate for $10. But this would be ok as I'll be too busy stuffing my face to think about the amount that I've just spent on food but never mind I'll still moan about paying a low fe of $7!!!!!!

[flag of convenience]

Perhaps instead of coming to ED with a rash that you have had for 3 weeks, an ingrown toenail, a mild headache, back ache etc the list is endless. All minor stuff can be sorted out at a pharmacy, or the GP?

 

However, if I felt like popping into ED to seek professional help then it would be appropriate to pay $7! And while I am waiting I could get myself a coffee, sandwich and bar of chocolate for $10. But this would be ok as I'll be too busy stuffing my face to think about the amount that I've just spent on food but never mind I'll still moan about paying a low fe of $7!!!!!!

 

It is not the cost of the visit in my mind but once a fee is introduced there is nothing to hold it there. It is but a blanket introduction to a user pay medical system. Saying that I pay $75 per short visit up front as no bulk billing anywhere remotely close to me.

[Katie22]

The fact of the matter is, however, that the health care system is just not affordable to government. As a business model, it has increasing costs with reducing revenue, and as such, it MUST fail. From a political perspective that is disastrous - it loses votes. So the governments are trying to prop up an unsustainable industry using more of the same methods which are already failing. It requires a new approach, and such an approach will not come from people who can only think in terms of the past.

 

If we, as a people, were to approach health as a responsibility, not a right, then we would stop smoking, stop or greatly reduce drinking, stop drugs, lose weight, exercise more, treat each other gently, reduce stress, drive carefully, sleep more, drink more water, eat unprocessed foods. We would cut pollution. We would look at "Wellness" and not absence of diagnosed disease as a parameter of health.

 

Attaining better health, we would then decide on the need to spend huge amounts of money on keeping elderly alive for that extra six months. We would decide to defund treating self-inflicted illnesses - drug overdoses, alcohol overdoses. We would limit legal attacks on healthcare practitioners, reducing the cost of providing healthcare by removing all the extraneous paperwork devised with the sole aim of reducing exposure to legal complaints, and freeing up time for patients to be cared.

 

Such an approach (and there is much more to be done) would result in a dramatic lowering of healthcare costs, would make the general population healthier (and wealthier) and allow funds to be freed up to support welfare for the genuinely needy.

 

But, waiting for the outcry now about to follow, the measures will be deeply unpopular for a majority of the population, hence politically unviable, hence the status quo. Hence the programmed failure of the current health service.

Most definitely a Utopia world you are describing and funnily enough you didn't last 5 mins yourself with the "treat other people gently" one so just goes to show how hard it is to follow those guidelines in life!

 

Sure the whole public system needs to be looked at and savings can be made. Don't see how the copayment of $7 is going to help though when it's going into medical research and not back into the hospitals. I know in one public hospital when elective surgery is routinely cancelled, patients brought in, got ready for theatre, waited 6 hrs then told no can do, off you go home and we'll contact you with new date. Why? Bringing them in when you're very confident there will be no beds and also allowing theatre lists to be organised EVEN knowing there is a high likelihood of the list not being completed. The surgeon comes in, changes the order because he knows he won't finish it and wants the big case first. Why won't he finish it, because he needs to be somewhere else by 1 pm. Why won't anyone say anything to him - because he'll make your life a misery if you dare to question him. Thousands of dollars are wasted in unnecessary cancellations.

 

Defunding drug and alcohol services as it's self-abuse. Bit mean, especially not nice for innocent people whose loved ones have been affected by substance abuse. The majority of this country's expenditure on drugs is spent policing it, a small proportion is spent on prevention, education and rehabilitation. Helping people get off drugs will decrease hospital admissions, decrease crime, decrease drug related deaths and decrease suicides. Drug abuse causes mental illness - yes. Mental illness causes drug abuse - yes. Mental illness can cause drug addiction. Many poeple who have serious mental illnesses, schizophrenia and bipolar, often turn to drugs and alcohol to escape the turmoil in their heads, they represent a lot of the homeless.

 

Money can be saved from the public health system and from the welfare system without taking away from the low paid.

 

Tell you what, you could take the $245 he's set aside for a school chaplaincy programme.

[Katie22]

Most definitely a Utopia world you are describing and funnily enough you didn't last 5 mins yourself with the "treat other people gently" one so just goes to show how hard it is to follow those guidelines in life!

 

Sure the whole public system needs to be looked at and savings can be made. Don't see how the copayment of $7 is going to help though when it's going into medical research and not back into the hospitals. I know in one public hospital when elective surgery is routinely cancelled, patients brought in, got ready for theatre, waited 6 hrs then told no can do, off you go home and we'll contact you with new date. Why? Bringing them in when you're very confident there will be no beds and also allowing theatre lists to be organised EVEN knowing there is a high likelihood of the list not being completed. The surgeon comes in, changes the order because he knows he won't finish it and wants the big case first. Why won't he finish it, because he needs to be somewhere else by 1 pm. Why won't anyone say anything to him - because he'll make your life a misery if you dare to question him. Thousands of dollars are wasted in unnecessary cancellations.

 

Defunding drug and alcohol services as it's self-abuse. Bit mean, especially not nice for innocent people whose loved ones have been affected by substance abuse. The majority of this country's expenditure on drugs is spent policing it, a small proportion is spent on prevention, education and rehabilitation. Helping people get off drugs will decrease hospital admissions, decrease crime, decrease drug related deaths and decrease suicides. Drug abuse causes mental illness - yes. Mental illness causes drug abuse - yes. Mental illness can cause drug addiction. Many poeple who have serious mental illnesses, schizophrenia and bipolar, often turn to drugs and alcohol to escape the turmoil in their heads, they represent a lot of the homeless.

 

Money can be saved from the public health system and from the welfare system without taking away from the low paid.

 

Tell you what, you could take the $245 he's set aside for a school chaplaincy programme.

 

$245 million I meant!

[Harpodom]

 

@docboat, what are your views on methadone programs?

[docboat]

@docboat, what are your views on methadone programs?

 

In my experience they are pretty poor.

[Harpodom]

In my experience they are pretty poor.

Would you agree that they help people opioid addiction, stabilise their lives, get them back to work etc?

[docboat]

Most definitely a Utopia world you are describing and funnily enough you didn't last 5 mins yourself with the "treat other people gently" one so just goes to show how hard it is to follow those guidelines in life!

 

Sure the whole public system needs to be looked at and savings can be made. Don't see how the copayment of $7 is going to help though when it's going into medical research and not back into the hospitals. I know in one public hospital when elective surgery is routinely cancelled, patients brought in, got ready for theatre, waited 6 hrs then told no can do, off you go home and we'll contact you with new date. Why? Bringing them in when you're very confident there will be no beds and also allowing theatre lists to be organised EVEN knowing there is a high likelihood of the list not being completed. The surgeon comes in, changes the order because he knows he won't finish it and wants the big case first. Why won't he finish it, because he needs to be somewhere else by 1 pm. Why won't anyone say anything to him - because he'll make your life a misery if you dare to question him. Thousands of dollars are wasted in unnecessary cancellations.

 

Defunding drug and alcohol services as it's self-abuse. Bit mean, especially not nice for innocent people whose loved ones have been affected by substance abuse. The majority of this country's expenditure on drugs is spent policing it, a small proportion is spent on prevention, education and rehabilitation. Helping people get off drugs will decrease hospital admissions, decrease crime, decrease drug related deaths and decrease suicides. Drug abuse causes mental illness - yes. Mental illness causes drug abuse - yes. Mental illness can cause drug addiction. Many poeple who have serious mental illnesses, schizophrenia and bipolar, often turn to drugs and alcohol to escape the turmoil in their heads, they represent a lot of the homeless.

 

Money can be saved from the public health system and from the welfare system without taking away from the low paid.

 

Tell you what, you could take the $245 he's set aside for a school chaplaincy programme.

 

Utopia world - if you notice, the actions I recommend are all simple, easy to understand approaches for improving health and reducing the burden of chronic disease, and depend only on the individual accepting responsibility for making healthier choices. The savings that can be achieved from such simple - free - measures are huge. BUT - it depends on people making simple choices for a healthier life, so perhaps, yes, it is utopian.

 

You might also note I did not recommend defunding drug and alcohol services. As a personal aside, I believe in decriminalising drugs - it would empty the jails, remove a lot of crime from society, and free up a huge amount of money for other services. On the other hand, if the people who currently abuse drugs took responsibility for the correct use of the drugs they obtain (they currently do not ...) then there would be a lot less overdoses in the first place. I am glad you also recognise that it is not a simple matter of mental illness causing drug or alcohol dependence, therefore by analogy ALL drug and alcohol abusers are mentally ill. Patently they are not.

 

As for school chaplaincy programme - are you aware of how much good work is actually done by school chaplains to rescue young people from the catastrophes they are currently experiencing in society? We in our church are thankful that we have people who go into such schools, experience abuse from many children and their parents, and still persevere to reach out to the desperate, lonely, frightened abused kids who are suffering so terribly. Paid for by us, the congregation. No tax break either.

[docboat]

Would you agree that they help people opioid addiction, stabilise their lives, get them back to work etc?

 

In my experience, again, very little. I personally think the naltrexone program is better. YMMV

[caramac]

Utopia world - if you notice, the actions I recommend are all simple, easy to understand approaches for improving health and reducing the burden of chronic disease, and depend only on the individual accepting responsibility for making healthier choices. The savings that can be achieved from such simple - free - measures are huge. BUT - it depends on people making simple choices for a healthier life, so perhaps, yes, it is utopian.

 

You might also note I did not recommend defunding drug and alcohol services. As a personal aside, I believe in decriminalising drugs - it would empty the jails, remove a lot of crime from society, and free up a huge amount of money for other services. On the other hand, if the people who currently abuse drugs took responsibility for the correct use of the drugs they obtain (they currently do not ...) then there would be a lot less overdoses in the first place. I am glad you also recognise that it is not a simple matter of mental illness causing drug or alcohol dependence, therefore by analogy ALL drug and alcohol abusers are mentally ill. Patently they are not.

 

As for school chaplaincy programme - are you aware of how much good work is actually done by school chaplains to rescue young people from the catastrophes they are currently experiencing in society? We in our church are thankful that we have people who go into such schools, experience abuse from many children and their parents, and still persevere to reach out to the desperate, lonely, frightened abused kids who are suffering so terribly. Paid for by us, the congregation. No tax break either.

 

Hmmm, so, these kids can access a religious chaplain, but not free healthcare? What are 'such schools'? Surely you're not suggesting that abuse only goes on in certain demographic groups?

Certainly chaplains/pastoral care personnel have a place, as a first port of call and as a link between themselves and other professional groups, but increasing funding to them and cutting it from the services they can refer to is madness.

[Sammy1]

[/b]

 

Hmmm, so, these kids can access a religious chaplain, but not free healthcare? What are 'such schools'? Surely you're not suggesting that abuse only goes on in certain demographic groups?

Certainly chaplains/pastoral care personnel have a place, as a first port of call and as a link between themselves and other professional groups, but increasing funding to them and cutting it from the services they can refer to is madness.

 

Oh my, I didn't think it would happen, but I do have to agree with Docboat.

School chaplains in public schools are there in a non religious capacity and do a HUGE amount of good. I see it every single day. It is an incredibly important pastoral role. Trust me, the kids that receive some help or guidance, whether that be with personal difficulties or other, benefit from it.

Edited May 27, 2014 by Sammy1

[caramac]

Oh my, I didn't think it would happen, but I do have to agree with Docboat.

School chaplains in public schools are there in a non religious capacity and do a HUGE amount of good. I see it every single day. It is an incredibly important pastoral role. Trust me, the kids that receive some help or guidance, whether that be with personal difficulties or other, benefit from it.

 

 

I'm honestly not denying they do a good job, and not only in schools (I had fantastic support from the one in hospital when my daughter was in ITU and I will never forget him), but giving them extra funding and cutting it from health/social budgets isn't the best idea.

What do the chaplains do where children are being abused, or are showing symptoms of mental illness? They must refer on to the appropriate professionals? If those services are cut, or not accessible due to cost, it doesn't matter how great the chaplains are, the children are being failed.

[Sammy1]

I'm honestly not denying they do a good job, and not only in schools (I had fantastic support from the one in hospital when my daughter was in ITU and I will never forget him), but giving them extra funding and cutting it from health/social budgets isn't the best idea.

What do the chaplains do where children are being abused, or are showing symptoms of mental illness? They must refer on to the appropriate professionals? If those services are cut, or not accessible due to cost, it doesn't matter how great the chaplains are, the children are being failed.

 

I absolutely agree with you.

[Harpodom]

I'm honestly not denying they do a good job, and not only in schools (I had fantastic support from the one in hospital when my daughter was in ITU and I will never forget him), but giving them extra funding and cutting it from health/social budgets isn't the best idea.

What do the chaplains do where children are being abused, or are showing symptoms of mental illness? They must refer on to the appropriate professionals? If those services are cut, or not accessible due to cost, it doesn't matter how great the chaplains are, the children are being failed.

not forgetting the rather dodgy track record of religious organisations in their dealings with vulnerable children.

[sueandave]

If we, as a people, were to approach health as a responsibility, not a right, then we would stop smoking, stop or greatly reduce drinking, stop drugs, lose weight, exercise more, treat each other gently, reduce stress, drive carefully, sleep more, drink more water, eat unprocessed foods. We would cut pollution. We would look at "Wellness" and not absence of diagnosed disease as a parameter of health. There is a lot of abuse of Medicare, some from the medical profession which has been acknowledged by this and previous governments, The way I see it is in any society we have people who for what ever reason will need Government - tax payers help from time to time. I can not begin to imagine a society that would say " I would never see that type of patient because they do not fit into the criteria of user pays.

[Katie22]

Oh my, I didn't think it would happen, but I do have to agree with Docboat.

School chaplains in public schools are there in a non religious capacity and do a HUGE amount of good. I see it every single day. It is an incredibly important pastoral role. Trust me, the kids that receive some help or guidance, whether that be with personal difficulties or other, benefit from it.

 

I agree but disagree too. The school chaplain at my son's previous school is currently facing charges for sexual abuse, but innocent until proved guilty I suppose. When my son was facing adversity he had fantastic support from non religious organisations such as Mission Australia - fantastic non-judgemental bunch of people and government funded too

 

However, I might give this argument a miss. You know what they say about talking about sex, politics and religion. I'll gladly talk about politics, sex probably not great idea on an Internet forum but I'm steering clear of religion. The only thing I will say is I expect Tony is having to confess his sins on a daily basis.

[Sammy1]

I agree but disagree too. The school chaplain at my son's previous school is currently facing charges for sexual abuse, but innocent until proved guilty I suppose. When my son was facing adversity he had fantastic support from non religious organisations such as Mission Australia - fantastic non-judgemental bunch of people and government funded too

 

However, I might give this argument a miss. You know what they say about talking about sex, politics and religion. I'll gladly talk about politics, sex probably not great idea on an Internet forum but I'm steering clear of religion. The only thing I will say is I expect Tony is having to confess his sins on a daily basis.

 

The chaplains are supposed to be ( and definitely should be) non religious in public schools. I do understand caution though and rightly so in view of what has happened over a number of years.

The work I have seen done by government funded female and male chaplains in schools is far removed of what people assume or expect.I am speaking from an educational and pastoral care viewpoint and know what they add to the school community.

 

It is far removed from the classic interpretation. It's not something I would argue about though, merely that I have seen a lot of good done, especially in challenging and low socio economic schools.

[Katie22]

Utopia world - if you notice, the actions I recommend are all simple, easy to understand approaches for improving health and reducing the burden of chronic disease, and depend only on the individual accepting responsibility for making healthier choices. The savings that can be achieved from such simple - free - measures are huge. BUT - it depends on people making simple choices for a healthier life, so perhaps, yes, it is utopian.

 

You might also note I did not recommend defunding drug and alcohol services. As a personal aside, I believe in decriminalising drugs - it would empty the jails, remove a lot of crime from society, and free up a huge amount of money for other services. On the other hand, if the people who currently abuse drugs took responsibility for the correct use of the drugs they obtain (they currently do not ...) then there would be a lot less overdoses in the first place. I am glad you also recognise that it is not a simple matter of mental illness causing drug or alcohol dependence, therefore by analogy ALL drug and alcohol abusers are mentally ill. Patently they are not.

 

As for school chaplaincy programme - are you aware of how much good work is actually done by school chaplains to rescue young people from the catastrophes they are currently experiencing in society? We in our church are thankful that we have people who go into such schools, experience abuse from many children and their parents, and still persevere to reach out to the desperate, lonely, frightened abused kids who are suffering so terribly. Paid for by us, the congregation. No tax break either.

You seem to be a deeply religious man, which surprises me from some of your previous posts but I think I'll stop there!

 

I do have personal experience of youth drug addiction myself so am well aware of the people out there who help, religious and non religious. - they're all great people.

[Freckleface]

I agree but disagree too. The school chaplain at my son's previous school is currently facing charges for sexual abuse, but innocent until proved guilty I suppose. When my son was facing adversity he had fantastic support from non religious organisations such as Mission Australia - fantastic non-judgemental bunch of people and government funded too

 

However, I might give this argument a miss. You know what they say about talking about sex, politics and religion. I'll gladly talk about politics, sex probably not great idea on an Internet forum but I'm steering clear of religion. The only thing I will say is I expect Tony is having to confess his sins on a daily basis.

 

 

I would say Mission Aust is non-affiliated rather than non religious and Govt supported rather than Govt funded.

 

I agree they do a great job.

[Katie22]

I would say Mission Aust is non-affiliated rather than non religious and Govt supported rather than Govt funded.

 

I agree they do a great job.

 

You know what I'm getting at!

[Chortlepuss]

My daughter's school had a school nurse who did an excellent job - not sure whether the nursing roles are being scaled back but far more preferable having someone like this giving advice and guidance to kids than someone with a religious agenda. While areas of the church do an excellent job, I do not trust them to take the risk of abuse seriously and am spalled that Abbot has pushed his particular religious beliefs at the taxpayers expense.

[Tina2]

Another area of concern is the aged pension. Abbott says "we are not cutting pensions" this is what I dont like about Abbott he always bends the truth. What is happening is that all the discounts that go with the age pension are being handed to the states to fund which they say they cant. SO if you remove discounted, electric, gas, water, rego, even free dog registration, that equals a decrease of cash to spend on other things like food or heating.