Category: Patients

PRIVATE HEALTH INSURANCE REFORM – WILL IT DELIVER?

Posted on | by Team

[vc_row][vc_column][vc_column_text]The PHMAC was tasked with developing easy-to-understand categories of health insurance, standard definitions for medical procedures across all insurers for greater transparency and simplified billing, as well as ensuring private health insurance meets the specific needs of consumers living in rural and remote Australia.

While the PHMAC’s measures are expected to be in place by next year’s premium increase, scheduled for 1 April 2019, the questions on everybody’s mind is: will this reform help to deliver lower premium increases or will it only serve to heighten people’s frustration with private health insurance companies?

Consumer advocacy group CHOICE has urged the federal government to scrap its plan to allow health insurance companies to offer discounts to people aged 18 to 29, arguing the move will lead to health funds luring young adults into buying low-value ‘junk policies’.

“While the cost of private health insurance is one of the top concerns that needs to be addressed, cost cannot be looked at in isolation. Discounted private health insurance cover isn’t worth it if you don’t need the cover in the first place,” says CHOICE Campaigns and Policy Team Lead, Katinka Day.

“A cheap policy that adds little or no tangible value is a poor outcome not only for the individual, but also for taxpayers who are subsidising a private system.”

This was reinforced by former chief of the health insurers lobby group and board member of a not for profit health fund Russell Schneider in his submission to the Senate inquiry. He claims that unless 100,000 extra young people buy health insurance, premiums will rise for everyone else to cover the discounts.

The Consumer Health Forum remains concerned the discounts on health insurance premiums for young people under 30 will erode the community-rating principles and further entrench a two-tiered system.

“Such changes to health insurance rules seem designed largely in the health funds’ interests to shore up declining member numbers but go nowhere far enough to respond to the frustration and concerns many consumers have about their health cover,” the CEO of the Consumers Health Forum, Leanne Wells, said.

“The latest statistics showing a significant year-on-year overall fall in health insurance members, particularly the 5.3 per cent drop among those in their 20s, highlights the need for a searching examination of Government assistance and regulation of health insurance.”

The Medical Technology Association of Australia supports the Government’s private health insurance reforms and its intent to address the issues of value, affordability, simplification and transparency of health insurance for Australian consumers.

But its submission focused on concerns around the product categorisation issue of gold, silver, bronze and basic policies. It believes the proposed categorisations would negatively impact on consumers, leaving them worse off compared to the current system.

“The exposure draft released by the Department of Health proposes restricting coverage for some surgical interventions that consumers commonly rely on such as spinal fusion, joint replacements, insulin pumps (for which there is no public hospital alternative), pain therapies such as spinal cord stimulation, hearing implants and intraocular lenses. Under the Department’s proposed model, all of these procedures would require the highest and presumably most expensive level of cover despite many of these procedures being available today to people holding lower levels of cover,” the CEO of the Medical Technology Association of Australia, Ian Burgess, said.

“We have expressed to the Health Minister our concerns that insurers will choose to no longer offer these services on the lower categories. This could lead to a further retraction in the numbers of people with PHI in total, or a reduction in the number of people covered by effective health insurance which covers them for their needs. In either case there is a risk that further burden would be placed upon public health services for elective surgery and increased waiting lists for common procedures such as joint replacements.”

“We are discussing with Minister Hunt the need to protect consumers to ensure they are not required to pay higher premiums just to maintain existing levels of insurance coverage as a result of the product categorisations.”

With these reforms due to come into play from 1 April 2019, at the same time as premium increases and the likelihood of a Federal Election in May 2019 you can be certain health will be a major factor in the campaign.[/vc_column_text][/vc_column][/vc_row]

COCHLEAR CHOOSES QUEENSLAND

Posted on | by Team

[vc_row][vc_column][vc_column_text]Cochlear is a global leader in implantable hearing devices and has completed the final phase of redevelopment at its Newstead site.

“Cochlear has transformed the lives more than 475,000 people across 100 countries and now they will continue their great work with Queensland-built technology,” Mr Dick said.

Cochlear’s Newstead base currently employs 200 people with more to follow, plus ongoing training and upskilling for staff currently employed.

“This investment has enabled Cochlear to re-direct more than $20 million of work from overseas to Queensland, so not only is our state supporting people experiencing hearing loss but additional staff will be recruited as the facility ramps up,” Mr Dick said.

“More than 27,000 Queenslanders have severe to profound hearing loss, more than 2100 have a Cochlear implant, and we hope to see many more Queenslanders benefitting from this incredible innovation now happening right here in our state.”

Mr Dick said Cochlear is the perfect example of Australian-headquartered, globally competitive exporters choosing Queensland to base their manufacturing operations.

“This is an important step for the development of advanced manufacturing capabilities in our state, with our growing manufacturing sector already employing 170,000 Queenslanders and consistently contributing nearly $20 billion a year to Queensland’s economy,” he said.

“This is what our government is focused on creating: the high-tech, high-paid jobs of the future for Queenslanders manufacturing products that create high-value exports for our economy.

“We want manufacturing businesses in Queensland to set their sights on delivering not only for domestic markets, but also for global markets, and Cochlear is one company grasping that vision with both hands through their Newstead operations.”

Member for McConnel Grace Grace said: “It’s a great source of pride for me knowing that thousands of people the world over are benefitting from the gift of sound thanks to a fantastic Australian-headquartered company producing these innovative products right here in my community.

“I can’t wait to see what this business achieves next from its Brisbane base.”

Cochlear has invested more than $15 million in capital, plant, equipment and labour to enable the Newstead facility to manufacture the latest electronic components used in their implants.

This is in addition to products and components used in the external parts of the cochlear implant system like sound processors.

In 2017-18, the facility manufactured 1.2 million parts and 550,000 finished products for global export.

Over 475,000 people of all ages across more than 100 countries now hear because of Cochlear.[/vc_column_text][/vc_column][/vc_row]

CHRONIC PAIN THE FOCUS OF THE WEEK

Posted on | by Team

[vc_row][vc_column][vc_column_text]More than 6.9 million Australians live with a musculoskeletal condition, and around 81,200 Australians visit their GP everyday for a pain-related issue.

According to Painaustralia – the national peak body working to improve the quality of life of people living with pain – there has been a rise in opioid prescriptions for treating pain, increasing by 24% between 2010-11 and 2014-15.

The recognition of the need to tackle opioid addiction is something that has been widely accepted by state and federal government.

However, concerns have been raised over the government’s plans to limit chronic pain management options through the new private health insurance categorisation reforms. Under new categorisations – gold, silver, bronze and basic – chronic pain therapies would only be available for consumers who can afford to be on the highest ‘gold’ level category.

It would mean any moves to limit access to therapies such as spinal cord stimulators for the management of chronic pain would work against any efforts to arrest the increasing opioid dependency among chronic pain sufferers.

Current spinal cord stimulators use novel waveforms that are paraesthesia-free, meaning patients can drive and sleep with the therapy. This has led to improvements in quality of life measures.

A January 2017 study, sponsored by MedTech innovator Abbott, found average daily opiod use declined or stabilised for 70 percent of chronic pain patients who receive a stimulator, compared to opioid use before the implant.

Restricting insurance coverage for proven chronic pain therapies will undermine the value of private health insurance for consumers, as well as push the issue of chronic pain down the track.

Painaustralia has developed a National Pain Strategy to serve as a framework for best practice pain management. The Strategy has been given broad endorsement by an eminent group of experts from pain medicine, allied health, drug and addition medicine, mental health, rural health, general practice, pharmacy and rheumatology, as well as consumers.

Painaustralia CEO, Carol Bennett said the issue was attracting bipartisan support from both the Minister for Health, Greg Hunt MP, and the opposition’s health spokesperson, Catherine King MP.

“There has been unprecedented level of support for the issue of chronic pain in Australia recently, and we appreciate the support of the Australian Government”, Ms Bennett said.

“This long misunderstood and neglected health issue is now receiving the attention it deserves from all sides of politics, a positive move towards ensuring the best possible outcomes for individuals, families, communities, workplaces, as well as the Australian economy.”[/vc_column_text][/vc_column][/vc_row]

J&J DIGITAL SURGERY PLATFORM GROWS WITH 360 KNEE SYSTEMS

Posted on | by Team

[vc_row][vc_column][vc_column_text]360 KNEE SYSTEMS is a known innovator of software-enabled digital solutions that personalise total knee replacement surgery. Under the agreement, 360 KNEE SYSTEMS will be available with DePuy Synthes’ ATTUNE Knee System in both Australia and New Zealand.

The 360 KNEE SYSEMS platform empowers patients to participate in and personalise their own treatment plan before, during and after total knee replacement surgery. It features smart technologies such as wearable devices to help surgeons plan the treatment pathway with their patients. This includes mapping each patient’s kinematic (body motion) data and preparing a 3D model of the knee to create a virtual surgery plan unique to them. Post-surgery, the 360 KNEE SYSTEMS platform provides the patient with a personalised rehabilitation and monitoring program.

Managing Director of Johnson & Johnson Medical Devices Companies in Australia & New Zealand, Sue Martin, said the company was excited about the ways digital health will help J&J redefine success is surgery and improve outcomes in addition to the company’s products and other solutions.

“Our agreement represents an exciting opportunity to provide an end-to-end digital solutions and surgical platform that brings the individual needs of patients right into the heart of decision making for their total knee replacement”, Ms Martin said.

The agreement will allow this technology to be used to provide further potential benefits for patients undergoing knee replacement surgery with the ATTUNE Knee, which is designed to work in harmony with a patient’s anatomy and deliver what they want from the procedure: stability in motion during daily activities.

To-date, the ATTUNE Knee has bene used for more than 650,000 knee replacements in 44 countries.

DePuy Synthes’ President of Global Joint Reconstruction, Tim Czartoski, said J&J Medical Devices has a proven track record in developing meaningful innovation, and he the company expects to be investing locally with 360 KNEE SYSTEMS.

“We are building a digital ecosystem where technologies are connected before, during and after surgery, in line with our aim to improve outcomes for patients as well as increase their overall satisfaction with their healthcare experience.[/vc_column_text][/vc_column][/vc_row]

PARTNERSHIP DELIVERS NEW FIRST NATIONS HEALTH APPROACH

Posted on | by Team

[vc_row][vc_column][vc_column_text]The new Family Health and Wellbeing Framework, known as Health in the Hands of the People, along with Johnson & Johnson’s Innovate Reconciliation Plan (Innovate RAP) were launched in Sydney today.

“Funding this new framework and our Innovate RAP are examples of the Johnson & Johnson Credo which challenges us to put the needs and wellbeing of the people we serve first,” Johnson & Johnson Pacific Managing Director Doug Cunningham said.

“Our Innovate RAP is an opportunity to deepen our engagement with Aboriginal and Torres Strait Islander communities through improved cultural awareness. Supporting Children’s Ground and its development of Health in the Hands of the People demonstrates our strong commitment to close the gap in health outcomes for Aboriginal and Torres Strait Islander people.

“At Johnson & Johnson our vision for reconciliation is that Aboriginal and Torres Strait Islander people live longer, healthier and happier lives. Both the Innovate RAP and our partnership with Children’s Ground demonstrate our vision in action.”

Health in the Hands of the People is a framework for health promotion that embraces First Culture, Children’s Ground co-founder and CEO Jane Vadiveloo said.

“The framework is built with the community, from community-owned knowledge. In First Nations culture, health is always interconnected with all aspects of wellbeing.

“We know that the devastating health outcomes of First Nations people in this nation are due to the cumulative effects of the social, cultural and economic determinants of health.”

In this new work, supported by Johnson & Johnson, Children’s Ground integrates a First Nations wellbeing knowledge system with the western health approach. We anticipate that by applying this in a whole-of-community way, in community, that health outcomes and indicators of wellbeing in general will be improved in the long term.”[/vc_column_text][vc_single_image image=”2213″ img_size=”full” add_caption=”yes”][vc_separator][/vc_column][/vc_row]

GOLD, SILVER, BRONZE AND BASIC IS IT JUST A BRANDING EXERCISE?

Posted on | by Team

[vc_row][vc_column][vc_column_text]Earlier this week Minister Hunt invited stakeholders to comment on the exposure draft of the Private Health Insurance (Reforms) Amendment Rules 2018 (the Rules). The measures contained in the Rules will give effect to elements of the private health insurance reform package.

One industry with a keen interest in ensuring consumers continue to receive access to life saving and life changing medical treatment through their private health insurance is the medical technology (MedTech) industry.

Speaking on behalf of MedTech innovators, Medical Technology Association of Australia (MTAA) CEO, Ian Burgess, said that while MTAA supports the intent of the government’s reforms, there was still concern as to whether complex health insurance policies being peddled by private health insurance providers would continue due to the differences in coverage across a large number of hospital treatment categories.

“MTAA has already played a significant role in addressing the rising financial burden of private health insurance, particularly in terms of value and affordability. Our industry agreed to a reduction in the benefits paid by insurers for devices on the Prostheses List. These actions resulted in savings to insurers of around $1.1 billion, over four years, and underpinned the lowest premium increase in 17 years,” Mr Burgess said.

“The longer and more specific the list of services for inclusion/exclusion in the insurance product tiers, the more complicated the insurance product will be and lead to continued consumer confusion about what they are purchasing.

“Many of the hospital treatments that are flagged to be exclusive to the gold category are associated with clinical conditions with a high and/or growing prevalence. If insurers do not maintain existing coverage for patients with these conditions who are currently covered by low and mid-tier insurance products, consumers will be required to upgrade their cover to ensure they maintain existing levels of coverage, thereby increasing the cost of premiums at the household level.”

Australian Private Hospital Association CEO, Michael Roff, said that while the categories have the potential to make the system easier to understand, there remain concerns about the retention of junk policies.

“It’s disappointing. Not only has the government not addressed the issue of junk policies, it has, in fact, entrenched them with the new ‘basic’ category. Junk policies are a major cause of consumer dissatisfaction when they discover they don’t have cover for private hospital treatment when they need care,” Mr Roff said.

Despite the concerns raised by other industries, Private Healthcare Australia – representing the private health insurance industry – welcomed the government’s announcement saying the new system marks a major improvement to how consumers choose and use their private health insurance.

“Over a two-year period, we have gone through health fund products line by line to classify them into Gold, Silver, Bronze and Basic categories depending on the cost of the product, and the level of cover provided,” Private Healthcare Australia CEO, Dr Rachel David, said.

“This has been a complex process and a balancing act, because we need to ensure consumers have access to products which are both affordable and provide value for money across all life-stages.

“We have been careful not to unintentionally increase complexity, or introduce product changes that would either increase premiums or reduce coverage unnecessarily,” Dr David said.

Many in the industry will continue to look closely at these reforms to see whether they will help stem the flow of consumers opting-out of the private healthcare system, in favour of the public healthcare system.[/vc_column_text][/vc_column][/vc_row]

SETTING THE FACTS STRAIGHT | LEADING CARDIOLOGIST DR DAVID O’DONNELL

Posted on | by Team

[vc_row][vc_column][vc_column_text]A disturbing and incorrect supposition has developed that doctors are not choosing the appropriate device for their patients and that patients outcomes are affected because of this.

Some important points need to be clarified:

1. Private patients in a Private hospital in Australia have world’s best procedural outcomes. Recent data from the GenesisCare network (Australia’s largest private cardiology group) has shown 30 day device complication rates that are up to 7 times lower than in the US or Europe and significantly better than the published complication rates in Australian public hospitals;

2. Private patients in a Private hospital in Australia have access to the best possible cardiac devices. The prosthesis list contains all of the currently available cardiac devices and the implanting cardiologist is free to choose any of these devices;

3. The implanting cardiologist in a Private hospital is responsible for the choice of device. I have not had any discussion with management about which device I implant and certainly no pressure by management to implant a specific device. This is not the case in many public hospitals where a tender process is typically conducted and a limited choice of devices is available;

4. The choice of cardiac device for a particular patient is complex and the implanting cardiologist considers many factors. The basic function of the device as a pacemaker, a defibrillator or a Cardiac resynchronization device is the fundamental decision. Beyond this, the extra features of the device are important – MRI conditional, Wireless, Remote Monitoring capable, multipolar leads, published reliability of the device and leads. Implantation and follow up of cardiac devices can be technically demanding and familiarity with implant tools and availability of technical support are important factors. Patient preference may also contribute to the decision;

5. It is not only ethically wrong but also against the recognized codes of conduct for an implanting cardiologist to choose a device based on pressure by hospital management or financial incentives. Each year as part of our registration, all doctors sign the Medical Board Code of Conduct, which states that good medical practice involves:

“Not asking for or accepting any inducement, gift or hospitality of more than trivial value, from companies that sell or market drugs or appliances or provide services that may affect, or be seen to affect, the way you prescribe for, treat or refer patients.”

A similar code of conduct from the MTAA prohibits device companies from offering incentives to implanting cardiologists.

6. It is my understanding that the price paid by a Health Fund for a cardiac device is set from Canberra via the prosthesis list. In this case, the commercial relationships between device companies and private hospitals would have no direct impact on device costs.

7. There is an underlying suggestion that doctors are upselling or inappropriately implanting cardiac devices. This is factually incorrect and distorts the most pressing issue related to cardiac devices. Most patients in Australia who are eligible for life saving cardiac devices do not receive these devices. Our implant rate is 40% of the US implant rate per million population and below many European countries. Whilst our overall implant rate is remarkably low, the situation is even worse for women, migrants, indigenous patients and patients of lower socioeconomic status who are consistently under implanted. From a medical viewpoint, the discussion on implantation of cardiac devices should focus on ensuring education and referral so that appropriate patients can access cardiac devices that have definitively been shown to prolong life.

A private patient in a private hospital in Australia receives the best possible cardiac device and has world best outcomes. The implanting cardiologist chooses the specific cardiac device and ethically and legally, this decision must be made in the best interests of our patient. Currently, the most pressing issue in Australia is the inappropriate lack of referral for implantation of life saving devices in eligible patients.[/vc_column_text][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”2165″ img_size=”full”][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Dr David O’Donnell is a founding partner and the Chairman of Heart Care Victoria. David graduated from the University of Melbourne in 1993 and trained as a Cardiologist in Melbourne before undertaking a fellowship at Freeman Hospital, Newcastle Upon Tyne, England. He returned to Melbourne in 2002 working at Austin Health as an Interventional Electrophysiologist, becoming Director of Electrophysiology in 2012.

David’s hospital career has focused on the newer techniques for ablation of atrial fibrillation and ventricular tachycardia. In recent years his clinical and research emphasis has been in the device management of heart failure, pioneering a number of novel techniques for cardiac resynchronization. As a previous high performance athlete he has maintained a close involvement with elite athletes with heart conditions and has affiliations with a number of sporting clubs and organizations.

David has a passion for education and frequently lectures, educates and performs surgery around the world.[/vc_column_text][/vc_column][/vc_row]

UNDERSTANDING THE DIFFERENCES – PUBLIC & PRIVATE MARKETS

Posted on | by Team

[vc_row][vc_column][vc_column_text]Australia’s healthcare system is one of the world’s best, providing a range of services from population health and prevention, through to general practice and community health; emergency health services and hospital care; and rehabilitation and palliative care.

What makes Australia’s health system different compared to other countries, is its voluntary private healthcare system which helps complement and supplement the country’s public system.

This means Australians have the option of being covered by the public Medicare system (which provides access to free treatment and accommodation in a public hospital), or they can choose to be covered by a combination of Medicare and private health insurance.

Australians with private health insurance are eligible to receive funding to cover some of the costs of their care in a private hospital. They are also able to use a public hospital, although they may be charged for it.

The complexity of Australia’s healthcare system has played a considerable role in influencing the cost of medtech devices between the public and private healthcare systems. These complexities include:

  • The purchasing arrangements and level of segmentation of the market;
  • The level of technical manufacturer support required; and
  • The level of regulatory hurdles and market delays.

Unlike in the public system, choice of surgeon and choice of medical device is a fundamental benefits of private health insurance cover and we need to work towards ensuring that value remains a cornerstone of our private healthcare system.

The fragmentation of the private healthcare system however, means achieving the same level of efficiencies of the public system challenging.

Take for example the approximately 630 private hospitals that purchase resources such as medtech devices on an as-needed basis, compared to the public sector (i.e. hospitals administered by the state and territory governments) which utilise their public tendering process to drive down prices and choice of devices available in their 695 public hospitals.

As a result, public hospitals can meet the delivery requirements of certain services through their funding arrangements. Whereas private hospitals, due to the lack of infrastructure required to deliver the same services, must rely on the device supplier to cover the costs, causing differences in prices between the public and private sector.

These factors mean comparing prices across public and private hospitals or across international jurisdictions can be problematic or in some cases not appropriate.[/vc_column_text][/vc_column][/vc_row]

National Diabetes Week 2018

Posted on | by Team

[vc_row][vc_column][vc_column_text]Too many Australians are being diagnosed with diabetes too late. The is true for both type 1 diabetes and type 2 diabetes. The delay in diagnosis is putting many people at risk of major life threatening health problems.

To find out more visit itsabouttime.org.au.[/vc_column_text][/vc_column][/vc_row]