Friday, March 27, 2015

The Progress With EHRs Still Has A Good Way To Go But The Signs Are Good.

This appeared a little while ago.

EHRs: Expecting Too Much, Too Soon?

by Peter Kilbridge and Doug Thompson
In 2014, health care record-keeping and communication are finally emerging from the Stone Age and entering the 21st century, moving away from the pen-and-paper processes abandoned by the rest of the modern world decades ago.
This revolution is driven primarily by the HITECH Act and accompanying meaningful use program. These initiatives drove greater adoption of electronic health records by doctors and hospitals in the last five years than in the previous 40. According to one estimate, EHR adoption by physician practices rose from 17% in 2008 to 48% in 2013 and hospital EHR adoption increased from 13% to 70% during the same time period. These EHRs will play a central role in the move to accountable care and population health management.
A principal HITECH objective was to improve patient care, but a number of recent publications challenge the program's success and EHRs' value -- from both the perspectives of physicians using EHRs and researchers who are decrying a high level of patient safety events across the industry. One article points out that a substantial minority of physicians are dissatisfied with the effect of the EHR on office operations; others suggest EHRs are failing to live up to their promise of reducing patient harm.
Should we be disappointed that this technological revolution hasn't yielded all the anticipated benefits? We think this would be premature. Here's why -- and who's doing it right.

Managing Expectations for the EHR

EHRs can facilitate patient care improvements through three basic mechanisms:
  • Better information capture and documentation;
  • Better sharing of information across settings; and
  • Most importantly, application of computerized clinical decision support (CDS) and data analysis.
The early literature supporting the value of CDS -- on which the meaningful use criteria were largely based -- was derived mostly from a handful of academic institutions with custom-built EHRs that they had constructed and tuned over decades.
It is unreasonable to expect that the majority of organizations that have implemented commercial EHR products in recent years will achieve the kinds of care improvements in a short period of time (two to five years, or "overnight," in health care industry terms) that took the early academic centers many years to achieve.
While in recent years we have learned more about how to design and implement effective CDS, most organizations have neither the staff expertise nor the budgets to commit to drive changes of this magnitude in a short time. Commercial EHR products are equipped with many of the ingredients needed to support clinical workflows and build robust CDS, but they bring with them their own inherent constraints.
Perhaps more importantly, we know that driving rapid technologic and workflow change in organizations is both difficult and hazardous. One way hazards can manifest is through unintended consequences of computerization. Sometimes problems arise from improperly designed or coded software containing errors; however the great majority of unintended consequences arise from the gap between vision for the system as designed and the reality of the system as used. It is virtually impossible to anticipate the full spectrum of individual human and workflow interactions with the system and the resulting manner in which the system gets used.
Some good examples of what has really seemed to have worked and the implementation issues can be found here:
If you consider each of the 3 mechanisms to make things better you can see that we are by no means at the end of the journey. Information capture is not all that efficient and easy, interoperation is still a work in progress and decision support is not universally working as we might hope.
In summary - we are getting there - but more effort is needed for a good while yet!
David.

Thursday, March 26, 2015

Review Of The Ongoing Post - Budget Controversy 26th March 2015. Last Sitting Week Before 2016 Budget.

Budget Night was on Tuesday 13th May, 2014 and it is still not finalised. Not much time left before 2016 Budget is upon us.
Both major health and education changes as well as pension changes seem to have been knocked back stuck and we have a new Families Package being floated for the Budget. Also we have less than no sitting weeks in Parliament before the next Budget - due to be  handed down Tuesday 12th , May 2015.
From what we have heard in the last week or so the Government has gone ‘off the reservation’ and decided all Budget issues are now pretty much solved and not even those assembling the Budget know what is going on! I wonder that Abbott, Hockey and the Fixer are thinking?

Thursday Update: Sadly the 2016 Budget confusion appears to have got worse with no one actually clear what the Budget Strategy will be - except not the 'frighten the political horses'! There is a lot of huffing and puffing from all sorts of lobbies - some who want a harsher Budget and others who want much more spending. I don't envy anyone who is involved in this - it must be a nightmare!
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Articles this week include.

General Budget Issues.

Labor will support 'sensible' budget moves

  • March 15, 2015 2:17PM
  • AAP
FEDERAL Labor has issued Treasurer Joe Hockey a note of advice for his second budget - save wisely and we'll support you.
POLITICIANS are heading to Canberra for the final fortnight of parliamentary sittings before Mr Hockey hands down his second budget on May 12.
His first budget proved highly controversial with its key planks now either dumped or stuck in the Senate, like the pension and university reforms.
Mr Hockey is now putting together his budget against the backdrop of a sluggish economy, high unemployment, falling commodity prices and low confidence.
But the budget still faces big deficits and growing debt.
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A surplus in five years? Tony Abbott's commitment is not very clever

Date March 17, 2015 - 7:02PM

Peter Martin

Comment
How's he going to do it? It's easy for the Prime Minister to say he'll get the budget back on track.
His Treasurer Joe Hockey tried it after Labor's last budget, saying that based on the numbers at the time he and Tony Abbott would "achieve a surplus in our first year in office and a surplus for every year of our first term". They've since discovered that's difficult to do.
It's not only because of the Senate, which the Intergenerational Report indicates has knocked back or delayed about half of the government's long-term budget savings.
It's also because of the collapse in commodity prices. They've slid 27 per cent since Labor's last budget, squeezing government income. Much of the slide has taken place since the Coalition took office.
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Tony Abbott's promise to balance budget in five years raises prospect of new cuts

Date March 18, 2015 - 7:44AM

Heath Aston, James Massola

Prime Minister Tony Abbott has insisted the federal budget will be be back in balance within five years, even as the government's higher education reforms were defeated in the Senate and clear signs emerged that Treasurer Joe Hockey will not pursue big structural reforms after his bruising first budget.
Mr Abbott's bullish prediction, made during a joint meeting of the Liberal and National parties on Tuesday, has raised the prospect of future deep spending cuts to replace blocked measures in the Coalition's first budget.
In the lead-up to the next budget, structural cuts and savings in areas such as health, education and the pension that were attempted in the first budget have been put on the backburner and the government is likely to seek one-off savings from changes to programs.
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Tony Abbott claims Australia was heading for a 'Greek-style future'

Date March 18, 2015 - 10:25AM

Latika Bourke

National political reporter

Labor has condemned Prime Minister Tony Abbott's claim that Australia was heading for a "Greek-style economic future" as inflammatory, irresponsible and capable of harming economic confidence.
The Prime Minister should be far more responsible than this constant scaremongering which is having a clear impact on confidence in the community 
Mr Abbott made the remark during a radio interview in which he pledged he would not fix the federal budget this year at the expense of households but predicted a "broad budget balance" within five years.
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Mixed messages on budget plans

Niki Savva

Abbott says to expect a dull budget

SEVEN weeks away from the next budget, the Abbott government is consumed not with laying the groundwork for it in any kind of coherent way but with fighting the unresolved battles from the previous one.
Joe Hockey’s second budget on May 12 promises to go the way of the first, unless the government adopts (as is sometimes suggested, depending on the time and place) a more timid approach to savings and structural reform in the hope it sinks without trace — which would create a whole new set of problems — or there is an overnight revolution in the way it goes about its business.
The frustration over the lack of signals, or more to the point their obvious incompatability, was clear when Foreign Minister Julie Bishop wondered out loud at Monday night’s full ministry meeting where the budget was headed, pointing out the Howard government’s budgets usually came with recognisable, saleable themes. It was a subtle way of saying: what the hell are we doing? While mentally concurring, fellow cabinet ministers knew as soon as she said it that it would leak, such is the climate they operate in.
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  • Updated Mar 20 2015 at 3:57 AM

Budget goes backwards by at least $80 billion since Coalition elected

The government has pushed back at suggestions it had dropped the ball on budget repair. Andrew Meares
by Laura Tingle and Phillip Coorey
The federal budget's forecast bottom line has gone backwards by at least $80 billion since the Coalition came to office, challenging the Prime Minister's promise that a tough budget is not needed this year because the nation's finances are under control.
The estimate by The Australian Financial Review covers the period to the end of last year. It therefore does not include around two-thirds of total announced cuts and tax increases of $28 billion that have have been abandoned by the Coalition, rejected by the Senate or are likely to be dumped.
Prime Minister Tony Abbott this week dumped the last remnants of tough rhetoric about budget savings, and instead promised voters they did not have to be alarmed about this year's "dull" budget "because we have got the budget situation from out of control to manageable".
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Federal Treasurer Joe Hockey rules out changes to super or the GST in the next six months

  • Jeremy Pierce
  • The Courier-Mail
  • March 20, 2015 12:25PM
FEDERAL Treasurer Joe Hockey has ruled out any changes to superannuation or the GST in the next six months as he prepares for a second budget.
Speaking at The Tax Institute of Australia Conference on the Gold Coast this morning, Mr Hockey revealed the Federal Government would release a tax discussion paper on March 30 in the lead-up to May’s budget.
He said tax reform was inevitable, as “the status quo is not an option”, but stopped short of calling for wholesale changes.
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Intergenerational report has hidden gift

Date March 21, 2015 - 9:00PM

Peter Martin

Who wouldn't want high earners to pay more tax than low earners?
It’s one thing to ensure that future generations will be no worse off than us, it’s another thing to make them much better off. 
The treasurer. It's spelled out in his intergenerational report.
The relatively low earners are most of us, today. We make an average of $58,700.
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Political Instability.

Abbott ready for poll fight on unis

Sarah Martin

PRIME Minister Tony Abbott has reaffirmed his commitment to the government’s university reform package and planned curtailment of growth in pension spending, as well as the crackdown on local Islamist extremism foreshadowed last year.
In a wideranging exclusive interview with The Australian on Sky News yesterday that included a defence of his style of government, Mr Abbott also defended his doubts on funding remote indigenous communities.
He said his Coalition government’s resolution mattered rather than its struggle for strong support as measured in opinion polls.
The Prime Minister told editor-at-large Paul Kelly and foreign editor Greg Sheridan of The Australian that the higher-education funding reforms were very important to universities, which needed regulatory strings loosened if they were to be among the best in the world.
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Scott Morrison's pension changes look set to fail as crossbenchers dig in

Date March 19, 2015 - 7:35AM

Judith Ireland

National political reporter

Another landmark policy loss is looming for the Abbott government, as Senate crossbenchers firm in their resolve to sink a $22 billion cut to pensions. 
Just days after the Coalition's defeat on its higher education reforms, Palmer United Party's Zhenya "Dio" Wang and independent senator Glenn Lazarus have signalled their opposition to Scott Morrison's fresh bid to change pension indexation - where a lowering of the indexation rate would be accompanied by regular reviews of pension adequacy. 
Senator Wang and Senator Lazarus' opposition follows that of independent senator Jacqui Lambie and strong reservations expressed by South Australian senator Nick Xenophon. 
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Broken system can’t fix nation’s problems

Paul Kelly

THE fiasco over higher education reform reveals not just chronic ­ineptitude by the Abbott government but something deeper — a failure in Australia’s political ­system born of a cultural and structural malaise.
The foundational points in this debate are that the status quo is untenable and current government funding of universities is inadequate for the needs of students, families and employers. This is the platform on which to negotiate an outcome.
While the Senate has twice voted down the reform, this is not a negotiation conducted in good faith. Indeed, there has been insufficient real negotiation. It is too easy to say the reform is unpopular. Most reform is unpopular.
The key to this defeat does not lie in public opinion but in a ­dysfunctional and irresponsible political system.
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Tony Abbott's government by shambles: something has to change

Date March 19, 2015 - 1:37PM
The government must think people are mind-readers or, worse, plain gullible.
EDITORIAL
This "being in government" business is proving to be all too hard for Prime Minister Tony Abbott and his ministers.
Too hard to frame a fair budget. Too hard to make tough decisions to place government finances on a sustainable path. Too hard to negotiate with a "feral" Senate. Too hard to be civil and constructive on policy options. Too hard to explain to voters the need for reform. Too hard to find a consistent message.
And way too hard to provide the sort of "stable, no surprises" government Mr Abbott promised just 18 months ago.
The Herald said then that voters would get to judge Mr Abbott on trust and stability "in three years or, should he prove unable to manage a democratic parliament, much sooner".
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Abbott and Hockey scramble to survive a political train wreck

Date March 20, 2015 - 12:26AM

Mark Kenny

Chief political correspondent

Surprisingly close to the last election, Tony Abbott and Joe Hockey were still promising a golden age for Australia's finances. "Our commitment is emphatic. Based on the numbers published today, we will deliver a surplus in our first year and every year after that," Hockey told the ABC's AM program in January 2013, just eight months before the poll.
Not any more. Now it's more like, "Meh! near enough is good enough".
The result is that the 2016 election (there will be no double dissolution this year) will be preceded by two pre-election budgets focused on political consolidation – unkindly called vote-buying – rather then fiscal repair. 
After dialling in some $30 billion in savings, and being blocked on measures totalling about the same amount, Abbott said on Wednesday that the nation's fiscal outlook can be viewed as a glass half full rather than half empty.
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Health Budget Issues.

Millions cut costs by dumping their health insurance policies

Sean Parnell

MORE than 2.5 million health insurance polices have been dumped or downgraded over the past three years as Australians cut costs amid premium rises and erosion of the government rebate.
While the proportion of the population with insurance has ­remained steady, data collected by industry group Private Healthcare Australia reveals 1,576,409 policies were dumped and 985,281 downgraded between February 2012 and last December.
The industry regulator rec­orded just over 5.4 million policies with ­hospital cover at the end of December.
Private Healthcare Australia chief executive Michael Armi­tage yesterday blamed the churn on the former federal Labor ­government, which introduced a means test for the rebate, stripped it from the Lifetime Health Cover surcharge and tied it to inflation, not the rate of premium increases.
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Australia too slow to approve life-changing drugs, companies say

Sean Parnell

Sid Maher

THE debate over access to new cancer drugs has escalated with pharmaceutical companies labelling Australia’s approval process one of the slowest in the developed world, while health officials accuse the companies of trying to game the system.
Industry group Medicines Australia will today release a ­report showing Australia ranks 18th out of 20 OECD countries in access to new medicines, with cancer patients waiting an average 573 days for new drugs that have received approval by a recognised regulator. “This is not good enough and I’m sure I share the same views as patients when I say access to medicines needs to be modernised,” Medicines Australia chairman Martin Cross said.
Health Minister Sussan Ley is due to speak at a Medicines Australia dinner tonight where the only other speaker, John Zalcberg, head of cancer research at ­Monash University, will join calls for reform. “We have moved past the time of incremental differences that are hard to justify,” Professor Zalcberg said yesterday. “More and more now we are seeing new drugs that are game changers, drugs that change people’s lives dramatically.”
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Members ready to dump private health insurance

Sean Parnell

HEALTH: Private health funds that have allowed members to downgrade their level of cover to cut costs may soon run out of alternatives to the policies being dumped altogether.
The Australian this week revealed industry group Private Healthcare Australia had data showing 1,576,409 policies had been dumped and 985,281 downgraded in three years.
While the Department of Health admits to not fully understanding the shift, industry regulator the Private Health Insurance Administration Council has monitored the downgrade trend since 2012. PHIAC initially noted that full cover products appeared to have “reached their price/value limit”, prompting members to choose policies with less cover, and then warned that members may be opting for exclusions and restrictions without comprehending the risks.
PHIAC subsequently noted an increase in complaints to the Private Health Insurance ombudsman about exclusions and restrictions, prompting warnings that health funds were setting members up for disappointment.
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Consumers squeezed as private health funds cut 'lifestyle' benefits while raising premiums

Date March 22, 2015 - 1:00AM

Dan Harrison

Two of Australia's biggest health insurers are cutting the amount they will refund patients for alternative therapies and gym memberships at the same time they are raising the cost of insurance.
For years, insurers have been locked in a price and service war to woo customers by offering to pay a share of the costs of many "extras", including more unconventional treatments such as reiki and Alexander technique.
But now NIB has cut the amount it will pay by $250 - from $400 to $150 - for "healthier lifestyle" benefits under its wellbeing extras cover.
The cuts come as NIB, the country's fourth-biggest health insurer, joins other funds in lifting its premiums on April 1. NIB premiums will rise by an average 6.55 per cent.
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Co-Payment Issues.

Those who visit GPs the most are old, sick and poor, new data finds

Date March 19, 2015 - 8:17AM

Dan Harrison

Health and Indigenous Affairs Correspondent

The Australians who visit the doctor most often tend to be older and poorer than those who visit their GP less, and would be hardest hit by the introduction of a "price signal", new data has found.
The data, to be released on Thursday by the National Health Performance Authority, suggests this group are twice as likely as the average to delay or decide against seeing a GP due to cost.
While Health Minister Sussan Ley two weeks ago dumped plans to cut Medicare rebates by $5 and allow doctors to charge patients this amount, she is continuing to explore options to make more people pay to see the doctor.
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Pharmacy Issues.

MEDIA RELEASE
Sunday, 15 March 2015

Minister: fix pharmacy flaws before new deal

In light of the serious deficiencies exposed by the audit into the community pharmacy agreement, the Consumers Health Forum has written to the Health Minister, Sussan Ley, urging her to overhaul arrangements for remuneration of pharmacy owners.
CHF has today (Sunday) released an overview of deficiencies exposed in the audit into the administration of the Fifth Community Pharmacy Agreement giving nine examples of the disturbing flaws in the way the $15.4 billion deal was agreed and administered.
“The Australian National Audit Office report and subsequent media reports expose how large amounts of money have flowed to pharmacy owners and the Pharmacy Guild with little apparent regard for improving the health outcomes of patients and consumers,” the CEO of CHF, Adam Stankevicius, said.
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Ownership ‘monopoly’ makes pharmacists millionaires: report

15 March, 2015 Christie Moffat
Strict ownership and location rules in community pharmacy are responsible for pharmacists making millions of dollars in profit, a new report claims.
A News Limited article has taken aim at regulations surrounding the ownership and location of pharmacies, and says that successive Community Pharmacy Agreements are allowing pharmacists to profit while “hurting consumers and taxpayers”.
The author pointed to the recent audit report, which revealed that 951 pharmacies in Australia were receiving more than $1 million in remuneration each year.
The owners of chain pharmacies such as Terry White Chemists and Chemist Warehouse were also subject to scrutiny, with the article referencing recent profits and homes owned on ‘millionaire’s row’ on the Gold Coast.
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Pharmacy taking hits over audit report

16 March, 2015 Christie Moffat
Community pharmacy continues to feel the impact of the 5CPA audit report, as a major consumer group calls for a government overhaul of the Agreement.
In a statement, the Consumers Health Forum announced it had written to Health Minister Sussan Ley, calling for changes to be made to remuneration arrangements for pharmacy owners.
To support their argument, CHF also released an overview of nine “fatal flaws” in the way that the 5CPA was agreed and administered, as highlighted in the Australian National Audit Office (ANAO) report.
The named flaws included failing to deliver on key government goals, no Health Department records of the negotiations, no competitive tenders and an inflated fees forecast.
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Drug cartel injects cash for pharmacists

Janet Albrechtsen

READING the sharply worded national audit released this month into the so-called Fifth Community Pharmacy Agreement is like reading a biting review of a really rotten taxpayer-funded Australian movie. Except that reality about this protection racket is stranger than fiction. You couldn’t make it up if you tried.
Here’s the plot so far. Imagine that a bolshie and powerful union is allowed to dictate to government the terms of its own self-serving, competition-free cartel with no input from outside stakeholders. This union calls itself a guild because that sounds more polished than a union.
Imagine that long after the country has undertaken sweeping competition reforms ending cartels in other industries, owning a pharmacy remains exempt from the realities of the market. In 2015, outdated location rules still protect the cartel, meaning an ambi­tious young pharmacist looking for a career path can’t open a new pharmacy within 1.5km of an existing one. The union and the government call the cartel deal the “community pharmacy” agreement to dispense Pharmaceutical Benefits Scheme drugs to customers, except the community that benefits the most is the tiny one of pharmacy owners in Australia. And every five years the union of pharmacy owners signs a similar cartel-enforcing agreement with the government of the day.
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Pharmacists must prepare to fail on primary care networks

18 March, 2015 Chris Brooker
Pharmacists need to proactively engage with, and take roles on, the new primary health network committees if they are to make an impact, pharmacy leaders believe.
Speaking at APP2015, Mark Booth, first assistant secretary of the primary health division of the Department of Health, outlined the latest developments in the implementation of the PHN, which are due to begin operation from 1 July 2015.
Designed by the current government to replace the ALPs Medicare Local program, there are 30 primary health networks around Australia, with each to be administered by a clinical council led by a local GP, and a community advisory committee.
Mr Booth said while the clinical council would be GP led, it was open to pharmacists and other allied health professionals to stand for election.
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Minister looks to pharmacy for PBS sacrifices

20 March, 2015 Chris Brooker
Federal health minister Sussan Ley remains adamant that the pharmacy sector will need to make further sacrifices for the sake of the health budget.
Speaking at the Medicines Australia annual parliamentary dinner, Ms Ley reiterated her comments from APP2015 that the recent PBAC approval of $2.5 billion in new medicines listings would create problems for health spending.
Coming on top of another $1.5 billion in approvals recommended in PABCs November 2014 meeting, the minister’s views have caused further disquiet among pharmaceutical industry and community pharmacy leaders. Both groups have repeatedly pointed to nearly $20 billion in PBS cuts through price disclosure.
Ms Ley told pharmacists attending the APP2015 conference last week that pharmacy and the pharmaceutical industry should prepare for some “tough decisions” in the future.
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Where are the missing employees the Pharmacy Guild should have employed with $30 million of taxpayers money?

  • March 22, 2015 12:00AM
  • Sue Dunleavy
EXCLUSIVE
The Pharmacy Guild of Australia was paid $29.3 million in administrative fees by taxpayers and refuses to say how many staff it employed with the money.
The money was to administer just $67 million worth of professional programs relating to rural pharmacy, Aboriginal pharmacy services and research under a $15 billion government agreement.
The staggering administrative costs mean taxpayers paid 43 cents for the Pharmacy Guild to administer every dollar spent.
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Doctors call for revamp of ‘unacceptable’ pharmacy agreement

20 March, 2015 Amanda Davey
Patients and not pharmacists should be the priority in any future pharmacy funding agreements, says the Royal Australian College of General Practitioners.
The group says the controversial Fifth Community Pharmacy Agreement does not have the patients’ best interests at heart and is due for a “thorough review”.
The college has joined forces with the Royal Australasian College of Physicians and the Consumers Health Forum and has written to the federal Health Minister, Sussan Ley, outlining key concerns.
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Comment:
I also have to say reading all the articles I still have no idea what is actually going to happen with the 2015 (or the 2016) Budget (or the Government) at the end of the day. With the Co-Payment gone - but muttering about other ideas growing louder - but the continuing need for Budget savings continuing we have to ask what next?
One wonders for how much longer all this will go on and just what impact a apparently almost inevitable change of leader might have? I think that change is still coming.
It is interesting to see the Pharmacy Guild under pressure from a recent audit of the Community Pharmacy Agreement and where money was spent. It very much looks like News Limited has decided to have a serious go at the Guild’s approach to community pharmacy and its regulations.
Enjoy.
David.