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Analysis and Comment (40)

Replacing registered and enrolled nurses with lower-skilled workers leads to poorer patient outcomes. Replacing registered and enrolled nurses with lower-skilled workers leads to poorer patient outcomes. DIBP images

Replacing registered nurses isn’t the answer to rising health costs

A shortage of qualified nursing staff and rising health costs have led to an increase in the employment of unregulated nursing workers. In 2012, the average weekly salary for full-time nursing professionals…
It passes the ‘milk bar test’ but once you look behind it, big risks emerge. It passes the ‘milk bar test’ but once you look behind it, big risks emerge. AAP Image/Dave Hunt

Save now, spend later: why co-payments for GP visits are a bad idea

Like a movie zombie, a policy idea that should have died has arisen from the dead and is likely to feature as a cost-savings measure in next month’s budget. The idea is simple: most GP patients should…
With the right training and supervision, assistants could safely take on 15% of nurses' workloads. With the right training and supervision, assistants could safely take on 15% of nurses' workloads. John Keith/Shutterstock

Hospital workforce reform: better jobs and more care

Employees are the public hospital system’s most valuable resource, and its biggest cost. Wages account for nearly 70% of recurrent hospital spending. To keep hospital care affordable in a time of rising…
There is no publicly available, solid evidence to show that such outsourcing generates savings for governments. But it could. There is no publicly available, solid evidence to show that such outsourcing generates savings for governments. But it could. Alexander Tihonov/Shutterstock

Does contracting public care to private hospitals save money?

In the lead-up to the budget on May 13, the Tony Abbott government is looking for ways to make the health dollar go further. In 2011-12 the federal government spent A$14.4 billion on public and private…
‘Going private’ may speed up your time to treatment, but Medicare shouldn’t pick up the tab. ‘Going private’ may speed up your time to treatment, but Medicare shouldn’t pick up the tab. Shutterstock

Want Medicare savings? Stop paying for private hospitals

The polls this week suggest half of Australians think the Abbott government should reduce the cost of Medicare. My solution? Claw back some of the A$9 billion the government pays to private hospitals…
Finding ways to deliver high-quality care at an affordable cost to the nation is just as important as finding cures for diseases. Finding ways to deliver high-quality care at an affordable cost to the nation is just as important as finding cures for diseases. DWaschnig/Flickr

Digital tools for a better, more sustainable health system

It seems that almost every politician, health economist, policy expert and health-care worker has a different take on the state of the nation’s health system and ways to make it more sustainable. But notably…
The cost of operations varies from hospital to hospital but a higher price doesn’t equal better care. The cost of operations varies from hospital to hospital but a higher price doesn’t equal better care. TheTun/Shutterstock

Public hospital efficiency gains could save $1 billion a year

Public hospital spending has been the single fastest-growing area of government spending over the past decade. As governments, policymakers and economists put health spending under the microscope, it’s…
Rather than looking back, we need to decide on the future foundations of Australia’s health system. Rather than looking back, we need to decide on the future foundations of Australia’s health system. Image from shutterstock.com

On being treated well: reforming Medicare after 30 years

Treasurer Joe Hockey and health minister Peter Dutton have been in overdrive this past week lowering expectations for the May budget and reminding Australians that its 30-year-old Medicare system is “unsustainable…
Government spending is already targeted toward poorer households. Government spending is already targeted toward poorer households. AAP Image/Dave Hunt

Making the rich pay more isn’t the answer to a better Medicare

Should the rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options…
Big announcements aren’t the answer – the health system needs a long-term plan. Big announcements aren’t the answer – the health system needs a long-term plan. AAP Image/Quentin Jones

Mr Abbott, make 2014 a year of health reform, not regression

This year is crunch time for Prime Minister Tony Abbott’s health policies. The financing and policy changes from the Rudd-Gillard government are finally taking effect and the National Commission of Audit…
Medicare guarantees free public hospital care and funds a range of primary care and other health services. Medicare guarantees free public hospital care and funds a range of primary care and other health services. Image from shutterstock.com

Explainer: what is Medicare and how does it work?

Medicare is Australia’s universal health scheme. It is a Commonwealth government program that guarantees all citizens (and some overseas visitors) access to a wide range of health services at little or…
Some Australians are struggling to get timely access to affordable health care. Some Australians are struggling to get timely access to affordable health care. AAP Image/Dave Hunt

Medicare turns 30 and begins to show signs of ageing

Tomorrow marks an important Australian milestone: 30 years of Medicare and the guarantee of universal access to health care. Before Medicare, it was not that uncommon for people to avoid using health-care…
Medicare Locals plan for better, tailored health services by drawing on local knowledge. Medicare Locals plan for better, tailored health services by drawing on local knowledge. Image from shutterstock.com

Let Medicare Locals find their feet and improve primary care

Primary health care in Australia is a messy beast, with many heads and all sorts of body parts. But it’s centrally important because it plays a major role in achieving public health outcomes, such as better…
Co-payments are an unfair tool for reducing health costs. Co-payments are an unfair tool for reducing health costs. Alex E. Proimos

Six dollar co-payment to see a doctor: a GP’s view

As a GP, when I prescribe a drug, I need to know its likely benefits and risks, and I need to base my decision-making on the best available evidence. I’d like to think the same principle applies to the…
Innovative health policy solutions could help the health budget and improve patients' health. Innovative health policy solutions could help the health budget and improve patients' health. Image from shutterstock.com

Paying doctors to keep patients healthy – if the price is right

Consensus and evidence suggests a compulsory co-payment of A$6 for a visit to the general practitioner will reduce population health but might save some money. Can we not try a bit harder and think of…
The financial pain of a A$6 co-payment won’t increase health literacy or self-management. The financial pain of a A$6 co-payment won’t increase health literacy or self-management. Image from shutterstock.com

Mind the gap: $6 GP visit proposal ignores the evidence

Incremental creep and massive holes in universal health coverage (think dental care) have left many Australians questioning whether there’s any such thing as “free health care”. One recent study estimated…
GPs and hospitals aren’t incentivised to properly manage demand, which has contributed to the crisis in Accident & Emergency. GPs and hospitals aren’t incentivised to properly manage demand, which has contributed to the crisis in Accident & Emergency. PA/Stephen Kelly

A&E is in crisis because we all take it for granted

Our increasing use of hospital services is out of control and unsustainable and is contributing to the current crisis in accident and emergency (A&E). But the problem isn’t new and 30 years of NHS…
Based on current evidence, expanding these services is the right thing to do. Based on current evidence, expanding these services is the right thing to do. Image from shutterstock.com

A rational expansion of breast cancer screening

In the ninth part of our series Health Rationing, Stephen Duckett examines the government’s decision to extend the breast cancer screening program. As one of many pre-budget teasers, Health Minister Plibersek…
Health rationing assessments compare different aspects of health such as pain, anxiety, mobility and social interactions – but what’s more important? Health rationing assessments compare different aspects of health such as pain, anxiety, mobility and social interactions – but what’s more important? Image from shutterstock.com

Comparing apples, pears and hips: health rationing at work

In the seventh part of our series Health Rationing, Richard Norman and Rosalie Viney explain the controversial system governments use to decide what will and won’t be covered under Australia’s universal…
The health budget isn’t limitless: decisions have to be made about to how to allocate funding between competing choices. The health budget isn’t limitless: decisions have to be made about to how to allocate funding between competing choices. AAP/Dave Hunt

Health funding under the microscope – but what should we pay for?

In the sixth part of our series Health Rationing, Mark Mackay examines the latest think tank blueprint to rein in Australia’s rising health costs. But he warns that before funding models are adjusted…
The current fee-for-service model makes it difficult to contain costs and boost the quality of care. The current fee-for-service model makes it difficult to contain costs and boost the quality of care. Image from shutterstock.com

Phase out GP consultation fees for a better Medicare

In the fourth part of our series Health Rationing, Peter Sivey explains why it might be time to abandon Medicare’s fee-for-service model. Teachers aren’t paid a fee for each lesson they teach, nor are…
We need a more rational debate about how and where we spend our finite health budget. We need a more rational debate about how and where we spend our finite health budget. Image from shutterstock.com

Explainer: what is health rationing?

HEALTH RATIONING – a series which examines Australia’s rising health costs and the tough decisions governments must make to rein them it. Any mention of the “R” word in health care immediately brings to…
The biggest and fastest-growing spending category in health is hospitals. The biggest and fastest-growing spending category in health is hospitals. Image from shutterstock.com

Tough choices: how to rein in Australia’s rising health bill

With health costs rising and costly medical innovations on the horizon, it’s crunch time for health funding. In the lead up to the May budget, The Conversation’s experts will explore the options for reining…
The broad economics of the scheme and the fine details of its implementation remain unclear. The broad economics of the scheme and the fine details of its implementation remain unclear. Image from shutterstock.com

We have an NDIS but what does this mean for disability care?

While the Labor party’s misguided leadership coup hogged the limelight last Thursday, the National Disability Insurance Scheme (NDIS) Bill passed through parliament. The government also announced the name…
There’s no reason the Australian taxpayer should pay such high prices for medicines when our overseas cousins don’t. There’s no reason the Australian taxpayer should pay such high prices for medicines when our overseas cousins don’t. Image from shutterstock.com

Fixing Australia’s bad drug deal could save $1.3 billion a year

The Commonwealth could save A$1.3 billion each year by reforming the Pharmaceutical Benefits Scheme (PBS), according to a report released today by the Grattan Institute. The report, Australia’s bad drug…
It’s time to rethink Australia’s specialist-driven health workforce and rise to the challenge of chronic disease management. It’s time to rethink Australia’s specialist-driven health workforce and rise to the challenge of chronic disease management. Hands image from shutterstock.com

Hike in health costs should prompt workforce rethink

Data released recently by the Australian Institute of Health and Welfare shows the nation’s health care bill is rising rapidly, from $77.5 billion in 2000-2001 to $130 billion in 2010-11. The largest increases…
Research should be routinely translated into clinical practice. Research should be routinely translated into clinical practice. Flickr/cstmweb

McKeon review: we need to integrate research and health services

Last year the federal government asked my colleagues and I to investigate the state of health and medical research in Australia and make recommendations about the strategic direction of the sector. After…
Health services are ripe for evidence-based reform. Health services are ripe for evidence-based reform. www.shutterstock.com

Six easy ways to improve health services

Each year $120 billion is spent on health services in Australia. But hardly any research is done to investigate whether this money is being used wisely. Only 2.8% of the funding for NHMRC project grants…
Aged-care residents are among the most vulnerable in our society, with many reliant on pensions. Aged-care residents are among the most vulnerable in our society, with many reliant on pensions. Kariobinja/Flickr

It’s complicated: why aged-care funding is still a problem

Recent media reports have highlighted an anomaly in residential aged-care funding in Australia: that day-to-day operations of facilities are governed by both Commonwealth and state government policies…
The package should reduce waiting times for people who are eligible for publicly-funded dental care. The package should reduce waiting times for people who are eligible for publicly-funded dental care. Luke Siemens

The $4b dental care program will tackle inequity but funding still in question

Since the government announced its $4 billion dental care program, attention has focused on how it will be funded and whether it is affordable. But if and when it is funded and implemented, the package…
The poor suffer the greatest burden of disease but are less able to deal with the costs. The poor suffer the greatest burden of disease but are less able to deal with the costs. Brooks Elliott

Next steps in health care reform

Australia is facing an epidemic of chronic lifestyle-related diseases, including type 2 diabetes, heart disease, stroke and chronic lung disease. We have many treatments for these that aren’t necessarily…
Australia has failed as a nation to properly consider the root causes of most illness and disease. Australia has failed as a nation to properly consider the root causes of most illness and disease. Keoni Cabral

Closing the gap between rich and poor could save billions in health-care costs

A person’s health is strongly influenced by that person’s wealth. In the past, we thought this was because higher incomes meant better access to health care; we thought this was why the rich lived longer…
At the end of the four years, only 5% of Australians with a disability will be covered. At the end of the four years, only 5% of Australians with a disability will be covered. Flickr/afri

NDIS funding a start but limited trial means a long wait for most

Last night’s budget contained an important step towards realising a National Disability Insurance Scheme (NDIS), with $1bn allocated over the next four years. Of these funds, $342.5 million will pay for…
We need to rethink our aged care workforce and funding for dementia patients. We need to rethink our aged care workforce and funding for dementia patients. Alex E Proimos

Improving care for dementia patients in our ailing aged care system

Last week, Alzheimer’s Australia released a report that was highly critical of the way Australia’s aged care sector responds to the needs of dementia suffers and their families. It’s an issue that demands…
Plain packaging is one of many health reforms to enter or pass through parliament last week. Plain packaging is one of many health reforms to enter or pass through parliament last week. AAP

Plain packaging wraps up a big year for health legislation in 2011

The final sitting of federal parliament last week lacked no drama, ending with the sudden induction of Peter Slipper as speaker. It was also a mammoth week for health legislation, with the passing of the…
If the government wants to support private health, it should fund the system directly. If the government wants to support private health, it should fund the system directly. Robin Thom

Means testing is a start but private health rebates should be scrapped

The government’s plan to means test the 30% private health insurance rebate faces an uncertain future after yesterday’s scheduled parliamentary debate was delayed. Under the scheme, singles with health…
Preventive health is the the biggest loser in the health deal. Preventive health is the the biggest loser in the health deal. AAP

Can we now close the book on health reform? Not quite

The deal’s been done and health reform is in the bag. It may not be quite as bold as originally planned by then prime minister Rudd – there’s even been a fair amount of watering down on Julia Gillard’s…
Home help is much more effective than written instructions from a doctor. Home help is much more effective than written instructions from a doctor.

Why home help is the best bang for our health buck

The new Victorian Health Plan 2012-22 offers a bleak prognosis: forever rising medical costs, doctors in the wrong places, hospitals overwhelmed. To make matters worse, it claims that patients can’t be…
The government has made a mistake by not listing pain drug Targin on the PBS. The government has made a mistake by not listing pain drug Targin on the PBS. J Hawk

Scrimping on pain drugs is bad medicine and worse economics

In an attempt to contain growing health costs, the Australian Government has resisted recommendations to subsidise the pain medication Targin on the Pharmaceutical Benefits Schedule. Not only is this a…

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