Health & Environment

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Bill Wyatte is now contributing to a Challenge Dispersed Expertise

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Bill Wyatte commented on the Challenge Dispersed Expertise

Perhaps more exploration of the problem may confirm that there are many pathways towards solutions.

Bureaucracies are advantaged by power funnelled to them via delegation.  People in advantaged groups tend to defend and bolster the status quo and discourage alternatives.  This can create boundaries to inputs, thinking and behaviours.  In Government, this is the disconnect from the diversity of knowledge and awareness of the people it serves.

I believe permeability and diversity are antidotes, but require conscious choices that have not yet been made. 

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James Dowsett is now contributing to a Challenge Dispersed Expertise

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Peter Grimbeek commented on the Challenge Dispersed Expertise

I immediately envision an on-line democracy not only with instant crowd-sourced votes but also with in-depth crowd-sourced discussion of policy options.

Some would say that this envisioned world might move a bit too quickly. Perhaps we need non-online deliberations at a slower pace.

In some ways, this is an Obama vs. Trump kind of moment. Obama deliberated slowly and possibly painfully about how to proceed but his actions were fruitful. Trump on the other hand favours instant responses that might or might not be fruitful (except in a bitter way). 

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Peter Grimbeek is now contributing to a Challenge Dispersed Expertise

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Richard Ferrers is now contributing to a Challenge Dispersed Expertise

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Richard Ferrers commented on the Challenge Dispersed Expertise

As a value researcher, I am interested in what people value, and how it changes over time. 

The digital revolutions have empowered and connected adults this century, in the way widespread education did in the 20th Century. Yet government in Australia has barely if at all changed since Europeans came to Australia.

I think there is a lot to learn from the Swiss who are experimenting with several attempts at more direct democracy. Government moves far too slow for a always connected, wikipedia and google at our fingertips, open data type world.

If government was to ask what do people need, it is an ongoing consultation with their representatives, rather than every three years. Government should tap the crowd for ideas, priorities, and time to reduce services we don't need, and prioritise those we do.

We need an ongoing community discussion about reinventing government for a new century, for a always connected, data deluge world.

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Ed Bernacki is now contributing to a Challenge Dispersed Expertise

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Gail Fairlamb is now contributing to a Challenge Dispersed Expertise

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Sharon Zivkovic is now contributing to a Challenge Dispersed Expertise

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A new Solution was published Dispersed Expertise

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Bruce Muirhead is now contributing to a Challenge Out of Pocket Medical Expenses

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Vern Hughes is now contributing to a Challenge I am that girl

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A new Solution was published Out of pocket medical expenses

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Rosie Odsey is now contributing to a Challenge I am that girl

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Peter Grimbeek commented on the Challenge Out of Pocket Medical Expenses

Relevant extracts from the ABC article identified by William Bell, include the following: 

Because most clinical services outside of public hospitals operate as private markets, specialists are free to charge what they like — and they do. This means the gap payment (between what the specialist charges and what Medicare covers) can be significant — hundreds or sometimes thousands of dollars.

In addition to doctors' fees, some specialists also charge what's variously known as a "booking" or "administration fee". This fee is on top of the payment they receive from you or your health fund to cover the gap costs, and is not covered by insurance.

Another reason for high fees may be that some specialists benefit from established referral patterns from local GPs or hospitals, so they have little incentive to keep their prices competitive.

Then there are specialists who charge a supposed skill-based premium. Some doctors say the reason they charge a lot of money is because they're better than all the other doctors, but, of course, there's no published information which allows us to verify that claim.

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William Bell is now contributing to a Challenge Out of Pocket Medical Expenses

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William Bell commented on the Challenge Out of Pocket Medical Expenses

The following ABC article is relevant.

http://www.abc.net.au/news/health/2018-05-28/how-out-of-pocket-medical-costs-can-get-out-of-control/9592792

 

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David Thomas is now contributing to a Challenge Out of Pocket Medical Expenses

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David Thomas commented on the Challenge Out of Pocket Medical Expenses

The link between tax and private health insurance is a rort - I am forced into paying for private health insurance that I hardly use because I'd pay more tax if I didn't (with no guarantee that the extra tax I pay goes into the public health system). This just fuels the private health insurance industry.

The lack of transparency and consistency over bulk billing is also bizarre - some GPs do, some don't; some GPs do sometimes... all for the same service (presumably).

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Peter Grimbeek commented on the Challenge Out of Pocket Medical Expenses

Lloyd Taylor, when you talk about the AMA as Australia's most successful trade union, I'm reminded of the pilot's strike by the Australian Federation of Air Pilots (AFAP) in 1989. That union was beaten down by the Government but up to that point might also have been described as a very successful trade union. So, things can change.

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Peter Grimbeek commented on the Challenge Out of Pocket Medical Expenses

Jayd Moore, I assume that when you say: "that specialists can only charge a capped out of pocket expense. Patients should be informed of their out of pocket expense immediately and options if they cannot afford this," that this is in fact the regulatory change that you have in mind?

Is there more?

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Peter Grimbeek commented on the Challenge Out of Pocket Medical Expenses

With reference to Chris Oldham Dept of Transport & Main Roads's comment about how difficult it is to compare health funds, I've had a similar experience. It looks as if the kinds of sales people that stock supermarkets, telephone & Internet connections, electronic goods, etc, are now shaping up the presentation of health care products.

In other words, the opacity that Lloyd Taylor also focuses on is a deliberate ploy and unlikely to go away unless regulated in some way. I realise that in Australia we deride and at the same time expect Governments to fix things (by regulation) but self-regulation of industries does not work.

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Peter Grimbeek is now contributing to a Challenge Out of Pocket Medical Expenses

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Peter Grimbeek commented on the Challenge Out of Pocket Medical Expenses

"There has always been a tension at the heart of medicine between caring for patients and making money" (Henry Marsh, Admissions; Weidenfeld & Nicolson, p.72, 2017). Henry Marsh, a retired neurosurgeon, focuses most specifically on neurosurgery in the UK, Nepal, and the Ukraine, but one assumes the same tensions are at work in other areas of medicine, and in a larger range of countries including Australia.

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Kathryn Hedley is now contributing to a Challenge Out of Pocket Medical Expenses

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Kathryn Hedley is now contributing to a Challenge I am that girl

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Lloyd Taylor commented on the Challenge Out of Pocket Medical Expenses

Chris Oldham Dept of Transport & Main Roads I concur with the comments and perhaps the 'opacity' of costs/charges needs to be something address by both specialist medical practitioners and health funds.  If keeping costs down is an issue there needs to be available benchmarks/baselines for comparison.  Similarly the issue of informed consent as opposed to implied consent based on a referral needs to be addressed as a triage between patient, medical practitioner and health fund provider (public and private.)

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Chris Oldham Dept of Transport & Main Roads commented on the Challenge Out of Pocket Medical Expenses

I watched the program last night and was a little disappointed in the coverage.

 I like some of what Lloyd Taylor talks about above. I am unsure that a list of scheduled fees will do the trick as there seems to be a need for each patient to be treated uniquely to their circumstances. I worry about a patient looking at a list of scheduled fees and thinking that they understand the end product. Also, unlike legal, could we get a contract for total fees when each patient may react differently.

A number of issues come to my mind.

1. Constant refrain of "only a few" overcharging.

I wonder what the facts are here? Surely it is a gradient ranging from the Medicare amount up to the maximum charged. What should be done? Should anything be done? It's not clear that a free market should be interfered with. The suggestion that the information should be made more available makes sense to me. However, if it is modelled off the information model used by the health insurance providers then this will not be useful as that is entirely too complex to allow any sort of comparison.

2. The gap between Medicare and charged fees.

From the first days of Medicare I believe that fees charged exceeded the Medicare allowance. It is not clear to me whether it is possible for a doctor to pay for all the equipment, training and ancillary costs, as well as make an income commensurate with the commitment involved in becoming a doctor, by charging the Medicare fees. If not, then what do the Medicare fees represent? A government-set fee being squeezed to minimise budget? I would need to better understand how the Medicare fee is established.

3. The opacity of 'total" charge for a procedure or service.

The story last night raised the issue of no single exorbitant fee, just a constant stream of charges adding up to a significant impact. I'm not clear where the responsibility for this lies. It suggests that a medical professional needs to be assigned as the primary advisor to give a holistic forecast of what will be involved. How reliable would this approach be? How variable are the paths followed by each individual patient? What if it is wrong?

4. Vulnerable patients.

The issue was raised last night of the state of mind that the patients were in. They had a significant, life-threatening illness and have an imperative to fix it. Money really becomes the focus once you are in recovery. Possibly this could be improved by a mandatory 'three quotes' model, but how this would work given the waiting periods for specialists I do not know.

5. Is it unreasonable for life-threatening illness to drain your savings?

Admittedly there is a difference between having to pay to get serious issues addressed versus being gouged because you are vulnerable, but the question of who should pay, the individual or society, must be allowed.

6. The 'opacity' of health insurance.

I have found the exercise of comparing health funds to determine which fund to choose nearly impossible. Recently a standard definition of flood insurance was developed. I would hope that one of the drivers for this was for individuals to simply assume that flood cover meant water in the home. While this may not have been the outcome from flood cover, perhaps a similar standardising approach should be taken for health insurance. I assume that this would reduce flexibility, but with the current system being impenetrable, that may not be a poor trade-off.

 

 

 

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Lloyd Taylor is now contributing to a Challenge Out of Pocket Medical Expenses

 
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The Commonwealth Department of Industry and Science recently identified Health and Environment on a list of nine top priorities. Decisions relating to these policy fields require objectives that have real longevity. In such sensitive areas, broad consultation and community participation are essential.

The growth of digital enterprises, coupled with Government initiatives to promote democracy in policymaking processes, is a phenomenon that will shape the identity of Australia as a science nation. A shift of this nature has a real ability to transform Healthcare and Environmental policy and strategy development into ‘for-the-public’ and ‘by-the-public’, empowering Australians in a way that would positively impact Australia’s population.

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