Category: Health Reform

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Other insights from the health budget include:

• $1.3 billion over 10 years to establish a National Health and Medical Industry Growth Plan.
• $2.2 million in 2018-19 for the operational costs of the Australian Breast Device Registry and the Cardiac Devices Registry. The registries contribute to the long-term sustainability of the health system by supporting improved clinical care and better patient outcomes. This measure further extends the 2017-18 Budget measure titled Operational Costs for Cardiac and Breast Device Registries — extension.
• $2.4 billion for the Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS over five years from 2017-18 to fund more medicine listings, including $241 million for SPINRAZA, a medicine to treat Spinal Muscular Atrophy (SMA), and $703.6 million for breast cancer treatment Kisqali.
• $338.1 million for mental health funding, focusing on suicide prevention, research and older Australians.
• Additional $10 million for the BioMedTech Horizons program.
• $40 million for whooping cough immunization.
• $25.4 million over four years for new and amended Medicare Benefits Schedule and Veterans’ Benefits items.
• $83.3 million for mental health nurses in rural areas.
• $106.8 million over four years to modernise health and aged care payments systems.
• $30 million over four years to the Australian Institute of Health and Welfare to improve accessibility to health information and statistics, including better data sharing capability and information and communications technology upgrades.
• help women take advantage of opportunities in the health care and social assistance industry by providing $64.3 million to establish a Jobs and Market Fund to grow the National Disability Insurance Scheme’s workforce.
• $37.6 million over four years from 2018-19 to improve follow-up care for people discharged from hospital following a suicide attempt — the highest at risk group in Australia — including:
  • $10.5 million for beyondblue to provide national support and oversee the implementation of the Way Back Support Service (WBSS) in Primary Health Networks.
  • $27.1 million for Primary Health Networks to commission services to be accessed by WBSS clients (contingent on co-contributions from States and Territories).
  • $33.8 million funding boost for Lifeline will enable the mental health helpline to continue to save lives every day.
  • $12.4 million over four years from 2018-19 to strengthen the National Mental Health Commission.
• As expected no announcement related to the Prostheses List or private health insurance.

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Budget Reply

The opposition used their budget reply speech to promise voters that, if elected, Labor would be able to deliver a larger tax break for low and middle-income earners than a coalition government. The opposition’s Working Australians Tax Refund, delivered at a cost of nearly $6 billion over four years, equates to $928 per year, which the opposition says would represent a tax refund of $400 more than offered in the budget.

The opposition is trying to position itself as the party of health and education by outlining a number of key policy announcements including a promise to reverse the government’s policies on hospitals by creating a $2.8 billion Better Hospitals Fund.

Opposition Leader Bill Shorten has said the funding would mean more beds to reduce emergency room wait times, a reduction in waiting lists for elective surgery, and upgrades to emergency departments in the suburbs and regions.

Stakeholders welcomed the opposition’s promise to provide new MRI machines to 20 hospitals and imaging centres in the regions and outer suburbs, giving Australians with cancer a better level of care. Worth noting is that while 40 per cent of cancer cures involve radiation therapy, only nine cents in every dollar for cancer treatment is spent on radiation therapy. Promising $80 million to pay for the machines if Labor won the next election, MR Shorten said Medicare would cover the costs of 500,000 more scans for cancer sufferers.[/vc_column_text][/vc_column][/vc_row]

[vc_row][vc_column][vc_column_text]One of the biggest advancements in medical technology is in the diagnostic assessment of patients through Magnetic Resonance Imaging technology or the MRI scan as it is more commonly known.

The history of MRI can be traced all the way back to 1971 when physician and experimenter Raymond Damadian discovered that the hydrogen signal in cancerous tissue is different to that of healthy tissue because tumours contain more water.

Jump forward a few years and in 1977 Raymond Damadian built the first MRI scanner and achieved the first MRI scan of a human body. A truly amazing technological achievement.

As with most medical technology, questions of cost and access are always at the forefront of public debate and a constant challenge for policy makers to be able to meet public expectations.

Recently, the Senate Community Affairs References grappled with this very issue through its’ inquiry into access to diagnostic imaging equipment around Australia.

A key focus of the inquiry was how are MRI licences granted and who gets them. What is the process and how does it work?

Unlike with pharmaceuticals which is subject to a rigorous process of independent assessment via the pharmaceutical benefits advisory committee (PBAC) no such process exists for a sponsor wanting to apply for a full Medicare rebate able MRI licence.

MRI licences are granted solely by the Minister for Health of the day. Consequently, successive Governments have been left open to the accusation that MRI licences are granted to meet political objectives as opposed to patient need based on such key criteria as population growth and changing demographics.

To emphasise the importance of this point the Senate Committees first recommendation was that:

“…. the Commonwealth Government immediately implement an application process with clear, objective and transparent assessment criteria to permit hospitals and radiology practices to apply for licences for Magnetic Resonance Imaging machines”.

With Australia facing an increasing ageing demographic and the welcome fact that we are all living longer, community expectations will always be a constant challenge for policy makers when it comes to access to medical technology.

Access to diagnostic imaging services like MRI scans is but one example of this constant challenge.

Financial resources are always limited and finite, yet Government will always face the constant demand to fund more health services, more pharmaceuticals and new medical technology.

For any Government allocating scarce resources, particularly in health then transparency should be welcome and more help than hinderance.

While there are regular complaints with the speed at which some new and innovative drugs get listed on the PBS, the independence of the PBAC is never called into question, for the simple fact that it is an independent process.

For diagnostic imaging services and in this case access to MRI licences, the lack of an independent process for allocating those licences, will leave the Government of the day open to criticism as to the allocation of those licences.

With the Senate Report now handed down, the ball is now in the Governments court as to how they respond to the recommendations.

The community should know in the next few months what the Government response will be to this challenging issue.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”1915″ img_size=”full”][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Jody Fassina is the Managing Director of Insight Strategy and has been an strategic adviser to MedTech and pharmaceutical stakeholders.[/vc_column_text][/vc_column][/vc_row]

[vc_row][vc_column][vc_column_text]Last year the medical device industry signed an agreement with the Commonwealth Government to deliver $1.1 billion in benefit reductions for private health insurers in exchange for various reforms intended to provide patients better access to life-changing and life-saving technology.

The Australian’s story has highlighted evidence that private patients in public hospitals is costing the private health system $1 billion. This is further evidence of real “fat in the system” including the more than $1.6 billion a year in uncovered gap payments.

The revelations support an earlier report from Catholic Health Australia which showed public hospitals were encouraging patients to ‘go private’, allowing the hospital to bill the patient’s health insurance and Medicare, at a cost of $1.1 billion per year.

Australian Private Hospitals Association CEO, Michael Roff, raised concerns about the increasing number of private patients in public hospitals as a result of active recruitment of the privately insured patients by the public system.

“Around Australia people are being left languishing on waiting lists while those with private health insurance are cajoled into using their insurance in the public system and jumping the public queue. It’s time for states to be held to account and for Australians to get the health system they deserve,” Mr Roff said.

“If this practice did not occur it is estimated health insurance premiums would be at least six percent lower.”

Queensland Minister for Health and Minister for Ambulance Services, Steven Miles said profit driven rent-seeking was nowhere more obvious than in the private hospital industry.

“Its [the private hospitals industry] latest attempt to secure monopoly billing rights for private patients demonstrates it is unwilling to compete with public hospitals and has no concern for the ongoing viability of private health insurance Privately insured patients pay a lot for their insurance, and they should be able to choose the hospital they want to use,” Mr Miles said.

“The entire premise of taxpayer subsidised private health insurance is to take pressure off the public system.

“Increasingly, private patients want to be treated in public hospitals. They should be able to use their insurance — which they pay thousands of dollars for.

“If the private hospitals succeed in their campaign they will drive even more Australians to desert private health insurance.”

The recent Heads of Agreement put forward by the Commonwealth seeks to tackle this issue directly by ensuring “the information and process for patients electing to use private health insurance in public hospital emergency departments is appropriate, robust and best supports consumer choice.” This week Tasmania and the Northern Territory signed up to the Heads of Agreement, leaving only Queensland and Victoria to commit.

The medical technology industry has always maintained – given it represents 10% of private health insurers overall costs – real savings would come from other areas of the health system including private hospitals and medical services.

CEO of the Medical Technology Association of Australia (MTAA), Ian Burgess, said the MedTech industry is incurring a $1.1 billion cut which is going directly to the private health insurance companies to improve the affordability of their insurance products.

“We’re the major reason this year’s average private health insurance premium increase was the lowest in 17 years,” Mr Burgess said.

“MTAA strongly supports the need for a healthy and viable private health insurance sector in Australia.

“Our dual public and private healthcare system means reform is complex and challenging but to ensure it’s sustainable all stakeholders need to be held to a level of transparency.”

Reform in healthcare is clearly a hot issue and will continue to be as we hurtle towards the next Federal election.[/vc_column_text][/vc_column][/vc_row]

[vc_row][vc_column][vc_column_text]Some of the key issues the Agreement Workplan seeks to address includes:

• Support sector stability and sustainability
• Reduce the time to market for medical devices
• Ensure Australian patients have access to safe, effective, and cost effective innovative medical devices in the private sector
• Improve the transparency and efficiency of the Prostheses List arrangements
• Recognise superior clinical performance
• Support Australian medical technology innovation

“The release of the Agreement workplan and industry working groups terms of reference is important to ensure transparency around this process and the delivery of reforms that are in the Agreement,” said Ian Burgess, Chief Executive Officer of the Medical Technology Association of Australia.

“Under this Agreement, the MedTech industry is incurring revenue cuts of $1.1 billion which goes directly to the private health insurance companies to improve the affordability of their insurance products.

“We are the major reason that this year’s average private health insurance premium increase was the lowest in 17 years.

“Full implementation of the reforms contained in the Agreement is essential to ensure that patients benefit from improved access to medical technology.”

Under the Agreement, three Industry Working Groups (IWGs) have been established each with a specific focus.

The most challenging of the three includes developing a revised framework for benefit setting and benefit review reflecting the use of health technology assessment (HTA) including evaluation of the value, cost-effectiveness and innovation of medical technology.

The second involving reducing red tape to improve the transparency and efficiency of the Prostheses List (PL) arrangements through the quality and content of the information contained in the Guidelines and the Prostheses List Management System (PLMS).

Lastly, the Cardiac Technical Support Services has been tasked to make recommendations and provide advice on how technical support services for active implantable cardiac devices should be funded to ensure the Australian healthcare system and privately insured patients receive maximum benefit from this technology.

“The Prostheses List (PL) ensures privately insured patients continue to access safe and clinically effective prostheses however this Agreement will provide the PL with much needed reform,” said Mr Burgess.

“For example, the removal of two-year follow-up clinical data as an unnecessary and standard requirement for assessment of some devices will greatly improve access to market.

“Sufficient clinical evidence, appropriate to the device, will still need to be submitted to enable a comparative assessment of clinical performance for the purposes of setting benefits on the PL.

“This will ensure the PL remains robust but recognises the quantum of follow-up data required will vary with the type of prosthesis, its intended use and the quantity of other relevant clinical evidence available or previously assessed.”

The Workplan makes it clear the Agreement will review ways to list new targeted devices on the PL that do not meet the current criteria for listing by 30 June 2020.

“Further, as reiterated by Hearts4Heart – Time to Change the Beat report non-implantable devices such as catheter ablation need to be included on the PL to relieve pressure on public waiting lists for patients with atrial fibrillation, said Mr Burgess.

“Inequity of treatment is not in the best interest of private health insurance policy holders.

“We believe access to a full range of medical technology is the most valuable component of a private health insurance policy and we’re committed to doing what we do best – assist patients lead healthier and more productive lives.”[/vc_column_text][/vc_column][/vc_row]

[vc_row][vc_column][vc_column_text]It seems like a week doesn’t go by when healthcare costs aren’t the front of the news.  Late last week the Consumer Health Forum of Australia released its national survey of out-of-pocket costs from some 1,200 patients. It highlights that specialist fees and critical services are becoming unaffordable to Australians raising further pressure on the private health insurance and the private health system more broadly.

 The survey report Out of Pocket Pain and a companion report Hear Our Pain containing scores of personal stories of people’s experience with treatment costs.

“The responses to the survey give a disturbing insight into the high costs of medical care and challenge the notion that everyone can access the care they need in Australia,” the CEO of the Consumers Health Forum Leanne Wells, said

“We have heard from pensioners and single mothers who have foregone recommended care because of cost, from many people exasperated to find that the insurance they have held for many years will not cover gaps of thousands of dollars, from patients who learn belatedly of unexpected extra costs for junior surgeons, anaesthetists and MRI scans, and from people who have had to call for special access to their superannuation funds to cover the bill.” Leanne Wells, said

Among key results of the survey are:

• More than a quarter of respondents treated for breast cancer incurred out of pocket costs of more than $10,000;
• More than a third of respondents with chronic conditions like multiple sclerosis reported out of pocket costs of more than $10,000;
• One in six respondents said that out of pocket costs had a significant impact on their lives;
• A frequently-expressed view that using private health insurance would expose people to more costs; and
• A third of respondents said the out of pocket costs were not explained to them before treatment.

This comes as the second meeting of the Ministerial Advisory Committee on Out-of-Pocket Costs, chaired by Australia’s Chief Medical Officer, Professor Brendan Murphy recently took place.

The meeting was attended by the Minister for Health, the Hon Greg Hunt MP who reinforced that a healthy and stable private health insurance system is essential for the stability of Australia’s overall health care system.

Minister Hunt spoke about the Government’s commitment to work with the stakeholders to address community concerns around large unexpected out-of-pocket costs and the need for a transparent model to ensure consumers have the ability to make an informed decision on their medical treatment.

Breast Cancer Network Australia CEO Kirsten Pilatti said: “BCNA has been outraged by a number of our members reporting extreme variations in out of pocket costs. Only full disclosure will ensure consumers can make the right choice for themselves.”

The CEO of CHOICE, Alan Kirkland said: “It can be completely perplexing and sometimes impossible for patients in need of surgery to work out how much they will be out of pocket. What’s worse, this often occurs when you are at your most vulnerable and least able to bargain over costs.”

“It’s not surprising that so many patients have reported significant out-of-pocket medical costs, even when they have private health insurance, Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said.

“As the private healthcare system, its out-of-pocket costs and increasing confusion continue to run away from us, we reiterate our own call for a Productivity Commission review of the health system, including an appropriate and affordable balance between private and public healthcare that is patient-centred rather than provider-centred.”

Rachel David from Private Healthcare Australia said: “While we can’t discount the very real concerns reported to the CHF, we need to be very careful about drawing conclusions about the extent of the problem from a survey that essentially solicits complaints.”

PulseLine will be interested to see if the Government’s forthcoming private health reforms deliver the much-needed transparency for consumers and puts downwards pressure on healthcare costs. Reform in healthcare is clearly a hot issue and will continue to be as we hurtle towards the next Federal election in the first half of 2019.[/vc_column_text][/vc_column][/vc_row]