Sections

Services

Information

UK United Kingdom

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 biggest and fastest-growing spending category in health is hospitals. Image from shutterstock.com

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 in costs – but warn governments must make some tough decisions.


Health spending is eating up more and more of government budgets, both state and federal. In fact, government health spending grew 74% over the past decade, far faster than GDP, which grew by 46% above CPI.

Health spending started from a large base too. Australian governments are spending almost A$42 billion more this year in real terms on health than they did a decade ago, compared to A$28 billion more on welfare and A$22 billion more on education.

For government budgets, health is a big deal and getting bigger. Grattan Institute’s new report, Budget Pressures on Australian Governments shows that health expenses are 19% of Australian government budgets (state and federal), compared to 17% in 2002 to 03.

Although all categories of government health spending are growing, some are growing faster than others.

Change in total government health payment expenditure by sub-category, 2002-3 to 2012-13, % change above CPI. Grattan Institute

The biggest and fastest-growing spending category in health is hospitals – they get almost A$18 billion in real terms more than in 2002-03, an increase of over 95%.

The next biggest category is primary care and medical services, which includes Medicare. It has grown by over 60%, accounting for a further A$11 billion increase.

Other areas of health, such as pharmaceuticals and subsidies for private health insurance, have grown substantially but off much smaller bases.

Why are health costs rising?

Received wisdom is that rising health costs are all about demographic change, but this is not true. Together, population growth and the ageing population structure accounted for only a quarter of government expenditure growth above CPI since 2002-2003. A further 5% of the growth comes from health inflation growing faster than CPI.

Drivers of change in government health expenditure, 2002-03 to 2012-13 (A$bn in real terms). Grattan Institute

The rest of the increase is due to people of all ages getting more and more expensive services per person. On average, a 50-year-old now is seeing doctors more often, having more tests and operations, and taking more prescription drugs, than a 50-year-old did ten years ago. The quality of the treatment they are getting has improved in many cases, and there are new treatments that did not exist in 2003.

There’s no reason to think that this trend will slow down in the next ten years without major policy reform. Government health spending now consumes an additional 1% of GDP compared to a decade ago; this is projected to increase to 2% in the next ten years.

Both costs and benefits

Spending more on health is not necessarily a bad thing – in fact, it’s exactly what you would expect an advanced, prosperous economy to do. The international evidence shows that as economies grow, so too does health spending.

We can treat all sorts of conditions more effectively now than we used to, and it’s having an impact. Life expectancy for those aged 65 has been rising rapidly since 1970. Death rates from conditions where health care might make a difference are going down.

But someone is going to have to pay for the better treatment that benefits us all. Tough policy choices will need to be made to either increase government revenues, or keep a lid on costs.

How to reduce health spending

Reducing health spending growth will not be easy. As Grattan’s Game-changers report last year showed, Australia already has one of the OECD’s most efficient health systems, in terms of life expectancy achieved for dollars spent.

Sweeping cuts to health funding, or shifting costs to consumers, could have serious consequences. Blunt cost-cutting risks reducing health and well-being, and could ultimately lead to higher government costs due to illness, increased health-care needs and lower workforce participation.

But not every dollar we spend on health care is well spent and the best way to start is by focusing on efficiency. One area we do know that there’s room for improvement is pharmaceuticals. As Grattan’s report Australia’s Bad Drug Deal shows, Australia’s Pharmaceutical Benefits Scheme pays at least A$1.3 billion a year too much for prescription drugs.

Australia wastes A$1.3 billion a year on overpriced drugs. Image from shutterstock.com

There are real savings to be made from reforming our drug purchase process, bargaining harder on generic drug prices, and encouraging drug substitutions.

In terms of hospital efficiency, which varies greatly across the country, governments have agreed to introduce a new funding formula, based on paying for hospital activity using a “national efficient price”. This is a good first step to reduce waste, but there is more room for reform.

Under current public hospital funding arrangements, the “national efficient price” pays extra for complex patients, regardless of whether the complexity is caused by things that happened after the patient was admitted or whether they arrived at the hospital in that condition. Why do we still pay more to hospitals which have higher rates of mistakes or mishaps?

Getting rid of waste sounds easy, but every dollar of health spending is someone’s dollar of income, and there are plenty of vested interests who want to keep their revenue stream.

Of course, not all health spending is waste, not by a long shot. But even if we make tough choices about waste, we might still be left with the next choice. Do we want to put our hands in our pockets to fund more health care with increased taxes, or will something else have to give?

This is the first part of our series Health Rationing. Stay tuned for more articles in the lead up to the May budget and click on the links below:

Part two: Explainer: what is health rationing?
Part three: A conversation that promises savings worth dying for
Part four: Phase out GP consultation fees for a better Medicare
Part five: Focus on prevention to control the growing health budget

Join the conversation

54 Comments sorted by

  1. Michael Guy

    Clinical Psychologist

    I read many years ago of a Productivity Commission report that identified duplication between State and Federal Governments as the biggest inefficiency in the health system. I believe it was proposed that the Federal Government directly fund Area Health Services on a pay per service basis. This removes State Governments from the blame game and defines their role in the efficient operation of the hospitals.

    A few years ago in following the debate over Obamacare in the US I read about the German…

    Read more
  2. Sean Lamb

    Science Denier

    How to rein in Australia’s rising health bill: Bring Back Smoking!

    report
  3. Colin MacGillivray

    Architect, retired, Sarawak

    One aspect of health care that seems to get insufficient attention is keeping people healthy.
    How about KHC's- Keep Healthy Centres, perhaps staffed by retired health professionals where people get their weight, waist measurement, eating and exercise and not smoking habits, blood pressure, confirmed each quarter? Those who attend KHCs could carry a card and be first in line for the best treatment when sick.

    report
  4. ian cheong

    logged in via email @acm.org

    i remember listening to an abc broadcast of a conference in the early 1990s describing the problem of fragmented health care - state vs federal funding and therefore inability to manage system costs . so in 20 years, we have made no progress on this problem. pitiful.

    what is the demand for a "free" service? unlimited. thats what bulk billing has done to healthcare. thats where the waste is and thats where corporates are making profit. thanks dr edelsten for showing the way.

    to really fix the health problem, people need to be making economic choices betweem healthy behaviours, unhealthy behaviours, and self management of easy self limited problems.

    bulk billing is economically unsound but no politician is game to touch it.

    report
    1. Steve Hindle

      logged in via email @bigpond.com

      In reply to ian cheong

      You make some good points.
      Making any service completely free (Bulk billing) always ends in waste. There should always be some small cost to the patient, then the consumer of medical services has more incentive to question its value. (Some doctors are churning through over 80 patients a day in some super clinics)

      report
    2. Robert Tony Brklje
      Robert Tony Brklje is a Friend of The Conversation.

      retired

      In reply to Steve Hindle

      Then it would be far wiser to create competing government GP services. So people choose weather to attend a government clinic or a private clinic. To say people must pay, equates to, no many for an ambulance - crawl, no money for treatment - suffer.
      There are members of society who can not care for themselves effectively and of course children should never ever be punished for the choices of the parents.
      The whole idea of ending bulk billing is not about reducing waster but all about people putting off getting treatment until it is too late and the condition kills them, woo hoo, right wing solution.

      report
    3. Ulf Steinvorth

      Doctor

      In reply to Steve Hindle

      Abuse of our system has to be curbed, both by patients and doctors. But whether or not our health system is abused by practitioners spending too little time with their patients to deliver quality care has little to do with medicare - the same thing happens in private practice, maybe even more so there because time equals money as any economist will agree - and 'consumer choice' is sadly of little concern in the medical market - too little is known about the qualities of doctors, hospitals and procedures to allow really informed decision making about where to go when it hurts.

      report
    4. Tony Grant

      Student

      In reply to Steve Hindle

      Correct and methadone describers are up there with the most "over-servicing" and what happens when caught out...nothing a smack on the wrist.

      Many have literally made millions out of the "Alice's Restaurant Syndrome"...you can get anything you want...and have caused the massive on the street sale of prescription drugs i.e. Valium $5 in the burbs and $ 10 in the city area sold by the "shop a doc junkies"!

      One case I know of they finally threw this "aging ethnic methadone prescriber out" and punished him with fly in/out country psychiatric work...now that's cream...holidays every week paid for by the tax-payers that have been ripped off and have caused the "street drug problems...codependent!

      report
    5. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to ian cheong

      Actually Ian I find the idea of a market in health care rather dreadful - leads to very bad outcomes all round. Not much choice involved and very often the folks with the greatest demand have the least means.

      My concern with administration is more systemic - and isn't confined to health actually. It has to do with the value of States in service delivery - or the lack of it.

      Increasingly States are becoming metropolitan governments - concerned predominantly with servicing the sprawling metropolises…

      Read more
    6. ian cheong

      logged in via email @acm.org

      In reply to Peter Ormonde

      the present system excluding bulk billing is a subsidised market. safety nets reduce marginal costs for those in need. i think it works but has anyone actually done that research on subparts f our current system???

      report
  5. Sunny Sharma

    logged in via Twitter

    How about:

    1. Paying for quality outcomes in health rather than the current "fee for service" model which encourages volume and throughput
    2. Rationalising "Professional Development Allowances" in the Public Health System. $20 000 a year for staff specialists sounds a bit rich. To quote one "I buy a laptop every year but I don't know what to spend the other $18 000 on...maybe I will go to that conference in Las Vegas". This will also have the effect of reducing the fee's associated with educational…

    Read more
    1. Sue Ieraci

      Public hospital clinician

      In reply to Sunny Sharma

      Hi, Sunny,

      For public hospital specialists, self-education expenses have been negotiated in lieu of salary dollars. The majority of public hospital specialists don't spend all their entitlements - often because there isn;t enough back-fill in the system to cover their absence.

      Some jurisdictions pay out those expenses as salary, which leaves the self-education funding up to the practitioner, but means all the money gets spent - ultimately costing the system more.

      report
    2. Cameron Beh

      Workhorse

      In reply to Sunny Sharma

      $3000 is a lot of money for any course - agreed. However, if you think $3000 for Surgical Skills is bad, you should see what govt departments and private companies (who are foolish enough to do so) pay for training supplied by multi-national enterprise software vendors: $5400 for a 5-day course is typical.

      My view is that such courses in general are 2nd-rate (at best) and very poor value for money. With just a little effort and self-motivation and self-belief, course attendees can self-educate much more quickly and effectively.

      I shudder to think at what the national bill would be for this "professional development" racket - at least in the case of IT. How many doctors and nurses could be employed with that money?

      Tip: last time I checked the price of a typical 5-day course for my profession, it was cheaper to do it in NZ - and that was including the cost of flights, hotel and meals. Another example of an Oz rip-off.

      report
  6. George Harley

    Retired Dogsbody

    Knock the private health insurance rebate on the head, pinch the Kiwi's PBS payments scheme and don't reward iatrogenesis. Then on the second day...

    report
  7. ian cheong

    logged in via email @acm.org

    I should also say that to focus on rising costs is probably not the way to find the current problems in healthcare.

    Public hospitals are dogged by insanely long waiting lists. Queueing is the only way to manage demand for a free service. The fact that government expenditure to try to fix a problem has resulted in increased costs does not necessarily mean that the increase is the problem. Underfunding is the problem.

    Pharmaceuticals are funded by the feds on the basis of economic analysis. Drugs…

    Read more
    1. ian cheong

      logged in via email @acm.org

      In reply to ian cheong

      Forgot to mention that pharmaceuticals is probably the only area where economics is routinely applied. Health research and so called" evidence-based" medicine concentrates on the science without reference to the economics. Without a culture of economic analysis, healthcare professionals will always strive for "best" while government tries to keep the lid on - a bit like the technocrat culture that tends to drive waste and failure in large IT projects.

      report
    2. Stephen Duckett
      Stephen Duckett is a Friend of The Conversation.

      Director, Health Program at Grattan Institute

      In reply to ian cheong

      Hi Ian

      Economic evaluation is also applied to new items on the Medicare schedule. There is no reason why activity based funding should require a large bureaucracy. Aside from getting the classifications right, setting prices even at the national level will involve a trivial proportion of the money allocated by the system

      Stephen

      report
    3. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      stephen, so where economic evaluation of procedures is done, then resulting increases in costs, like rising pharmaceutical costs, are efficient. do we know which cost increases are inefficient?? how does activity based costing result in ongoing efficiencies and price reductions due to progress?? is there a sufficient body of evidence to enable "efficient" pricing rather than "technocrat" pricing??

      Medicare currently pays specialists a price premium for an activity. efficiency means that the throughput of an expert is higher. collecting a double benefit of high pricing for both expertise and speed hardly seems sensible to me from a business/economic perspective of the government or consumer.

      how will activity based costing fix that???

      report
    4. Stephen Duckett
      Stephen Duckett is a Friend of The Conversation.

      Director, Health Program at Grattan Institute

      In reply to ian cheong

      The current national approach to activity based funding sets the 'national efficient price' at the average of observed prices so that, at least, identifies those hospitals working at above the average as 'inefficient'.

      Re your comment: 'efficiency means that the throughput of an expert is higher'. Not sure what the evidence is on this.

      Stephen

      report
    5. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      one can try to assume average is "efficient", but it will be argued against with claims of compexity and manipulated by case selection.

      the evidence for experts being more efficient is the general effect of skill and training in any area of human endeavour. i expect medicare data would reveal the specific evidence you require.

      report
  8. Stephen Duckett
    Stephen Duckett is a Friend of The Conversation.

    Director, Health Program at Grattan Institute

    Thanks everybody for taking time to comment. Reining in health costs is really complex because you don't want to do it in a way which impinges on equity, which is one of the strengths of the current system.

    You also have to be sure that you are targetting your incentives at the right place. To give you two (unrelated) examples. We're doing some work at Grattan for a future report looking at hospitals. As we said in The Conversation piece, this is the biggest category in terms of spending growth…

    Read more
    1. Sue Ieraci

      Public hospital clinician

      In reply to Stephen Duckett

      Stephen - while it's a no-brainer that prevention in areas like quit-smoking is a good thing, it's a common myth that concentrating more on preventative measures will save acute care costs.

      This could only work if we agreed that acute care should - and could - be capped where it is today. That would mean no more new ICU beds, no new procedures, no new vaccines, no better anti-psychotics or chemotherapy. Outcomes for childhood leukaemia, stroke and spinal cord injury would be capped at today's…

      Read more
    2. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      As hospitals continue to reduce their workload of "easy" things, costs per patient may well rise because they are treating sicker people.

      Costs incurred in public hospitals by clinicians are not made under market conditions and as i said before, economics is not a feature of mainstream clinical research.

      so without a consumer with money, nor a market, there are no good incentives for shieving efficiency in a free hospital. a fixed total budget may well be better or at least as good and less costly. UK used to have the cheapest (6%gdp) and probably worst health system.

      there is no question activity based costing creates perverse incentives, as everybody from management down knows what they need to do to get enough resources under whatever bureaucratic scheme is in operation.

      can some genius please find a better way to manage demand in a free system without queueing?? maybe a system of healthcare credits inversely allocated with means??

      report
  9. Peter Ormonde
    Peter Ormonde is a Friend of The Conversation.

    Farmer

    I'm not too sure about this whole approach actually. Given the outcomes we achieve - living longer and better than most if not all - we seem to be getting a pretty good bang for our bucks - especially when compared with other OECD countries. [http://www.oecd.org/australia/BriefingNoteAUSTRALIA2012.pdf].

    This little paper gives a neat snapshot of how our health spending rates:

    "Total health spending accounted for 9.1% of GDP in Australia in 2009-10,
    slightly lower than the average of 9.5…

    Read more
    1. Stephen Duckett
      Stephen Duckett is a Friend of The Conversation.

      Director, Health Program at Grattan Institute

      In reply to Peter Ormonde

      Peter

      The Grattan paper which this piece hangs off was explicitly about government budgets, state and federal. I don't think the main report was superficial at all. It was very very detailed, and the first time these data had been put together.

      However, you are right in saying that the critical issue for health is total spending, including consumer out-of-pockets. Australia has a very high proportion of out-of-pocket costs in terms of international comparisons. This is the approach we re taking in our health specific reports.

      AIHW does have info on costs of administration spending in their health expenditure series but I don't think it provides a reliable measure of administration per se e.g. hospital administrative costs are reported in hospitals pending not administrative spending

      Stephen

      report
    2. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Stephen Duckett

      Thanks for clarifying and correcting that for me Stephen. Not fair of me to go leaping into shallow conclusions based on an 800 word article, so I apologise if I've offended.

      I must admit in reading up on some of this stuff that I was most concerned by the absence of "administrative" costs available in the routine measurement process of our health system. It is essential to understanding efficiency and effectiveness in any sort of spending.

      Must be in there somewhere - but it's very well…

      Read more
    3. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Stephen Duckett

      I wonder how the yanks and Kanuks do it?

      I'll have a hunt about - the US Office of Management and Budget does some very clever stuff. I'll let you know if I find anything.

      Few months back I tried doing some digging about looking for the effects of Schoolies Week on alcohol related hospital presentations on the Queensland Gold Coast... they just didn't record anything remotely useful. Neither do the coppers.

      This whole area of what we record and where it's kept needs some serious work. Must drive health researchers nuts. If we don't measure it - how do we know if anything is getting better?

      report
    4. Sue Ieraci

      Public hospital clinician

      In reply to Peter Ormonde

      Mr O - the cost of "administrators" has to be taken with some caution. Many administrative tasks are essential to support clinical work - whether it be front-line reception clerks or back-room data compilers. They are not all pen-pushing middle-managers.

      Guess what happens in the system when there is a freeze on recruiting to "admin" positions? Clinical staff get to do the admin tasks as well as see the patients.

      There may, however, be a cultural problem within health system management - accountability without freedom and trust can lead to extreme risk-aversion, conservatism and micro-management. Not a great culture for professionals to work in - in whatever field of endeavour.

      report
    5. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Sue Ieraci

      Couldn't agree more Ms I ... but that US figuring showing 32 cents in every health dollar goes on administration is deeply concerning.

      Good effective admin is essential in any system - but it is not the desired product of the system - not an end in itself. Bureaucracy should help not hinder health workers. And you only need as much as is actually useful - and no more.

      The sort of administration I'm thinking of doesn't even get near hospitals or the pointy end of health care. I'm not talking…

      Read more
    6. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      Stephen, both red tape and accountability arrangements are non-productive and unnecessary in proper markets.

      report
    7. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      Agreed that consumers are not well placed to assess quality. But government could have a hand in enhancing the capacity of consumers to understand the market for health services. the big problem is that government is too busy hiding surgical waiting lsts under outpatient waiting lists to get a booking for sugery under the queue to get allocated an appointment date in the first place. government has no incentive to be honest about its poor service.

      but consumers coud be given more access to treatment guidelines in a frendly from; more access to oucome data; more access to pricing information and so on to improve the efficiency of the "market" for health services.

      as you agree, market accountability is cheap (requiring negligble unproductive bureaucracy).

      report
    8. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      i didn't think buyers are expected to have the same knowledge as sellers. they only need to know enough to be clear on the value of what the seller offers and how much they are prepared to pay for it.

      either way, we are both arguing for government intervention in a failed market. i am arguing that addressing information asymmetry would be more productive than price fixing because it permits market mechanisms to operate in the longer term where ongoing innovation can increase efficiency and lower prices rather than just increasing profit. the evidence of less than efficient PBS pricing is a clear example of the latter.

      report
  10. Sue Ieraci

    Public hospital clinician

    "Australia already has one of the OECD’s most efficient health systems, in terms of life expectancy achieved for dollars spent.""

    So, can we now stop repeating that "the system is in crisis"?

    report
    1. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Sue Ieraci

      I've managed to find a bit of data from NSW - well sort of - buried away on page 35 of NSW Health's Annual Report for 2012 is a single line table: NSW Public Health System Clinical Staff Ratio June, 2009-2012

      Where it says:

      Medical, Nursing, Allied Health, Other Health Professionals, Scientific and Technical Officers,Oral Health Practitioners and Ambulance Clinicians as a proportion of all staff %
      2009: 72.7%
      2010: 72.8%
      2011: 73.1%
      2012: 73.4%

      What that means is that some 27% of NSW Health employees are sort of administrative - maybe. That's it. That's the entire discussion of administrative costs and resources consumed by "non-core tasks". And this in no way captures the resources actually consumed by administration - eating into the time of nurses, doctors and others who could and should be doing useful things.

      Hmmm.

      report
    2. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Stephen Duckett

      Totally agree Stephen ... there's a big difference between support staff and bureaucracy - and we don't measure or even identify the latter at all.

      In fact wading through the NSW Health Annual Report I was near concussed by the managerial obfuscation throughout ... lots of goal setting, conceptualising, bedding down.... piles of gibberish. Not written by cleaners or nurses I'd be thinking. I wonder where they are in the system these scrutinisers and conceptual facilitators - can't find them at all. I reckon they're hiding behind the cleaners myself.

      Reminds me of this:
      As I was walking down the stair, I met a man who wasn't there.
      He wasn't there again today. I wish that man would go away.

      report
    3. William Raper

      Retired

      In reply to Peter Ormonde

      Another thought - the need for administrative effort (and hence personnel) I believe should be decided by the senior professional staff and the funding authority together - not by the bureaucrats.

      My experience as a senior researcher for instance was that crazy administrative decisions resulting from government "efficiency dividends" led to well paid professionals doing clerks and typists work, while the number of unnecessary forms to be filled in multiplied, further degrading professional output.

      It is so much easier to measure and compare administration performance that this could be done by the same professionals, perhaps advised by bureaucrats (but not decided by them!).

      My suggestion could lead to real improvements in efficiency and/or sheet home the real effect of "efficiency dividends" as staff would have to be reduced across the board in already efficient organisations.

      report
    4. ian cheong

      logged in via email @acm.org

      In reply to Stephen Duckett

      Can't say that i agree that admin is not waste. core business s service delivery. anything else should be reduced if possible. admin to collect admin data will certainly partly be waste which could be eliminated by automating data collection. clinicians collecting admin data to feed a bureaucracy is also waste.

      businesses know to increase profitability by eliminating waste. bureaucracies are not so good at that - trying to eliminate management jobs. the federal government management bloat is clear evidence of that.

      report
  11. John Kelmar

    Small Business Consultant

    The Australian Government needs to stop offering free health care to non-Australian citizens, who should take out insurance, just as I have to do if travelling overseas.

    Furthermore, those people who contract illnesses caused by their own habits (smoking, alcohol, illegal drugs, reckless behaviour etc), should have to pay a much higher premium and not take advantage of the free health services.

    report
    1. Emma Douglas

      Health Administration Officer

      In reply to John Kelmar

      As far as I'm aware, the government does not offer free health care to most non-Australian citizens. International students are required to take out Australian health insurance as a condition of their student visa, and many of the overseas health professionals at the hospital I work at are not eligible for Medicare-funded treatment. Looking at the Medicare site, it seems that Medicare eligibility extends to citizens, permanent visa holders, and permanent visa applicants. Presumably permanent visa…

      Read more
  12. Mark O'Connor

    Author

    Thanks for much useful information, and in particular for your remark that "Received wisdom is that rising health costs are all about demographic change, but this is not true. Together, population growth and the ageing population structure accounted for only a quarter of government [health] expenditure growth above CPI since 2002-2003."

    This helps refute the myth that we should accept a much larger population in order to "reduce ageing". In fact Jane O'Sullivan has pointed out that if one notes…

    Read more
    1. Dianna Arthur

      Environmentalist

      In reply to Stephen Duckett

      Interesting article, thank you.

      My GP is frustrated at time wasted on paper work, but also the manner in which some of his work is evaluated - now everyone sit down; being overvalued and overpaid.

      For example, a few years ago I had a frozen shoulder, in order to assist with exercises I could do with no cost at home I required some physio therapy sessions. People on low income can (or could) have 4 sessions bulk billed if referred by their GP. Along with a lot of form filling and other bureaucratic…

      Read more
    2. Dianna Arthur

      Environmentalist

      In reply to Dianna Arthur

      I probably should've added that the fee my doctor received from the government for simply filling in some forms was $200. This was 6 years ago and may be different now.

      My point is not to castigate doctors - this is tax money handed to doctors for a diagnosis already made - the only extra work was the bureaucratic time spent on crossing 'T's and dotting 'i's. That $200 would've paid for at least an extra 4 visits to the physio.

      Similar referrals are made to psychologists (psychiatrists can choose to bulk bill), again only funding for 4 visits is provided - I assume that a similar fee is paid to doctors' as described above. I believe that doctors should be received appropriate remuneration for additional services, however as someone who has struggled to pay for additional health services or forgone them completely, the amount paid to doctors could be better spent.

      report
  13. Robert Tony Brklje
    Robert Tony Brklje is a Friend of The Conversation.

    retired

    Seriously want to save money in health expenditure, focus on reducing or eliminating 'PROFIT'. Audit all private health services, focus in on patent costs, review all salaries, examine all medical equipment supply and review administration costs.
    So really it's all about reviewing how much profit the system is generating and whether the rise in 'cost' is in reality simply gouging on a government funded essential service by corrupt corporations.
    So taking a deep breath and sticking the knife in, should not focus on patients but on mansions, yachts, super cars, opulent holidays and how much tax payer dollars are funding those. Is it really acceptable for elements of society to extort enormous profit margins from health services and for governments to fund it.
    So either reduce 'HEALTH' or reduce 'PROFIT', choose and be damned.

    report
    1. Ulf Steinvorth

      Doctor

      In reply to Robert Tony Brklje

      Good call Robert - problem is of course if we privatize health it has to produce profit to make it, well, profitable...

      report
  14. Elliot Rubinstein

    Anaesthetist

    If one puit a reasonable quality business executive or two into an operating theatre for a few days to look at the incredible waste of resources when they stopped crying they could readily show the health beaureaucrats how to save MILLIONS of $$$$'s every year

    report
  15. Geoff Taylor

    Consultant

    Well, the discovery that antibiotics may be able to deal with up to 40% of spinal pain may really assist our health budget.

    report