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Sustainable Health Review Report – A Summary and Background

Posted on November 10, 2020

Read the Sustainable Health Review Report

The Final Report for the Sustainable Health Review was released on 10th April 2019 after around 18 months of work.

  • The Full Report is available here for download.
  • The Executive Summary is available here for download
  • And the Recommendations are available here for download

There are some bold targets and exciting opportunities in the Sustainable Health Review:

  • Increasing the spend on preventative health from its current level of about 1.1% to 5% by 2029,
  • Telehealth consultations for 65% per cent of outpatient services for country patients by July 2022 (almost unthinkable before COVID-19)
  • Working outside of the health system, across human services sectors to better address social determinants of health is a key underpinning strategy
  • Recommendation Four – Citizen and Community Engagement is a key lever for ongoing development of greater engagement with consumers, carers and the community

These two pages are key:

 

Four Projects announced with Report Launch

When the Sustainable Health Review was launched in April 2019, as well as a commitment for the move of the King Edward Memorial Hospital to the QEII site, there were four projects funded:

  1. The Home First model of care supporting people who do not require an acute hospital bed to return home for assessment by the right type of clinician at the right time;
  2. A ‘one-stop-shop’ for children, young people and their families where they can access child health, development and mental health services, as well as other government agencies such as education and community services;
  3. A 20-bed medical respite centre to provide clinical care to homeless people who may otherwise be admitted to hospital; and
  4. A Safe Café where people with non-acute mental health issues can receive support and advice in a supportive environment, after hours.

Interesting Reading:

  • Summary of the predecessor report, the Reid Report and its implementation which you can read here
  • A report on the interface between aged care, disability and mental health services which you can read here

HCC Consumer Engagement Project

In addition to the engagement undertaken by WA Health, we were funded to undertake a range of engagement activities. We ran a survey through social media. We also held sessions in Perth  with community members from culturally and linguistically diverse communities, and were welcomed by the Langford Aboriginal Association to talk about the Review. We visited three regional areas in person, and 15 virtually through our state’s Community Resource Centre network. The data collected from these engagements was developed into this report for the Sustainable Health Review Panel to inform its final report.

Pip Brennan, Executive Director, Health Consumers’ Council, Panel Member, Sustainable Health Review

2019 Winners

Posted on April 22, 2020

The 2019 Health Consumer Excellence Award winners were announced on 30th April as part of Patient Experience Week.

Health Organisation Award

This category is for working effectively with consumers to improve services. The Award recognises health organisations that demonstrate an ongoing partnership with health consumers to improve health outcomes and the patient experience.

Finalists:

  • Nidjalla Waangan Mia (GP Down South)
  • Peel Youth Medical Service
  • Te Urupu IMPI

WINNER: Nidjalla Waangan Mia (GP Down South)

Click here to see all the Health Organisation Award nominees for 2019

Health Professional Award

This category is for demonstrating excellence in patient care. The Award recognises health professionals who demonstrate ongoing commitment to improving health outcomes and/or the patient experience.

HIGHLY COMMENDED:

  • Dr Andrew Leech (Queensgate Medical Centre)
  • Dr Nathan Highton (Royal Perth Hospital – Emergency Department)
  • Dr Nick Gottardo (Perth Children’s Hospital – Head of Department of Paediatric Oncology and Haematology)
  • Linda Kuuse (Stirling Community Care Day Clubs – Senior Coordinator)
  • Nicole Pates (Paediatric Physiotherapist – Director)

The judging panel felt all finalists were of a very high standard and as such all were highly commended.

Click here to see all the Health Professional Award nominees for 2019

Health Consumer Award

This category is for demonstrating excellence in contributing to the improvement of the patient experience.  The Award recognises a health consumer who demonstrates commitment to improving health outcomes and/or the patient experience.

Finalists:

  • Carissa Wright
  • Tina Tuira-Waldon
  • Melissa Dimitru

WINNER: Tina Tuira-Waldon

Click here to see the Health Consumer Award nominees for 2019

Rosemary Caithness Award

This award is to acknowledge outstanding service to health consumers. This award is highly selective and typically the recipient has supported health consumers over many years. The Health Consumers’ Council will only award the Rosemary Caithness Award should there be a worthy recipient in any given year.

There were no nominees for this award in 2019.

Aboriginal/Torres Strait Islander Health Award

This award is to acknowledge outstanding service to Aboriginal/Torres Strait Islander health consumers. The candidates can be an Aboriginal/Torres Strait Islander person or organisation. They can be a health professional, consumer, other individual or organisation.

Finalists:

  • Jodie Jackson (Mawarnkarra – WA Country Health Service)
  • Yura Yungi Medical Service
  • South Metropolitan Health Services – Aboriginal Health Champions Program

WINNER: Jodie Jackson (Mawarnkarra – WA Country Health Service)

Click here to see the Aboriginal and Torres Strait Islander Award nominees for 2019

Compassionate Care Award – Sponsored by the WA Department of Health

This award is to acknowledge people providing direct patient care who demonstrate compassion. We are looking for compassionate individuals working in any capacity in the health service or organisation. We are also looking for compassionate teams of health care providers who demonstrate effective multi-disciplinary care. Evidence of compassionate care in the form of feedback letters from consumers and cares will strengthen the nomination.

Finalists:

  • Carissa Wright (Mental Health Advocate at Our Voice 4 Change)
  • Carli Beange (Clinical Midwife – Armadale Kalamunda Group)
  • Dr Andrew Leech (Queensgate Medical Centre)

WINNER: Dr Andrew Leech (Queensgate Medical Centre)

Click here to see the Compassionate Care Award nominees for 2019

Digital Health

Posted on February 18, 2020

There is so much going on in the digital health space. It is a complex area and difficult to know what issues need to focus on. People are rightly concerned about their data and its privacy. But being able to share your health information quickly could mean the difference between life and death. Queensland Health developed a Consumer Charter on Digital Health which aims to reflect consumer priorities and needs in relation to digital health.

In WA the Digital Health Strategy 2020-2030 was released, and a key initial deliverable will be creating a statewide electronic medical record in our hospitals. This may seem confusing, given that the My Health Record was implemented nationwide in 2019. As at December 2019, 22.68 million Australians had a My Health Record, with 2.4 million of those in WA. (See here) A key thing to remember is that:

  • An electronic health record is designed to have a more overall view of someone’s health, across hospitals, GPs, pharmacists etc.
  • A medical health record tracks medical care usually within one hospital.

We are currently working with the WA Department of Health to develop a Consumer Charter which focuses on digital health. HCC are convening 10 Kitchen Table Discussions on the topic and is currently seeking Discussion Hosts. The Kitchen Table Discussion comments will be used to form a Consumer Charter – this will include non-negotiable principles to guide future direction.

My Health Record Resources

In 2019, the Australian Digital Health Agency released a number of new resources, and we partnered with them to share them on our website and through social media. We also undertook a Consumer Survey – you can find the full report of our work here.

If you are using My Health Record, we recommenced you log in to take a look at your information and update your privacy settings. These brochures provide further information on how to use your My Health Record now that it has been set up.

How can I find out more?

Check out these Frequently Asked Questions

What is My Health Record?

My Health Record is an online storage and management system for each individual’s health information, such as prescriptions, vaccinations, allergies, and results of pathology tests. My Health Record only contains a summary of your health information, not a detailed record like your GP would keep. My Health Record is administered by the Australian Digital Health Agency (ADHA).

My Health Record does not replace records currently held by your health providers, such as your GP or hospital; it is an additional collection of health summaries. You control what appears in your My Health Record, and who can see the information contained in it.

Summary information flows into an individual’s My Health Record from Medicare, GPs, public and private hospitals, specialists, pathology, diagnostic imaging, allied health, and aged care. If you have a My Health Record created, the last 2 years of information from your Medicare record will be added to your My Health Record. No past information from other sources will be added. For example, any hospital visits you have had prior to your My Health Record being created will not appear.

Many people already have a My Health Record already as it’s been available for several years. It was previously known as a Personally Controlled Electronic Health Record (PCEHR) or eHealth record. However, now all Australians will have a My Health Record made for them automatically unless they opt out by 31 January 2019.

You can read more here

Do I already have a My Health Record?

All Australians now have a My Health Record, unless they chose to opt out before 31 January 2019 or have since deleted their My Health Record.

You can find out how to access your My Health Record here.

How can I be sure information about My Health Record I'm reading is reliable?

When assessing any information about health, some of the key questions to ask yourself are:

WHO WROTE THIS?

Reliable sources of information include government publications, peak bodies, and government-endorsed sites. If it is not clear who is running or funding the site you are looking at, visit the About Us or Contact Us pages to find out. If you still don’t find an answer there, consider looking for another site altogether. A reliable source of information will be transparent about their who they are and their sources of funding.

WHAT IS THE EVIDENCE FOR WHAT THEY ARE SAYING?

Information is likely to be trustworthy if is based on reputable research or official documents you can refer to. Testimonials or opinion are not reliable sources of health information.

IS IT AN OBJECTIVE VIEW?

Does the information seem balanced? If the site is published by a private company or special interest group, consider also seeking out another point of view to see if there are other ways to think about the issue.

IS IT UP TO DATE?

Some of the information about My Health Record has changed rapidly. Make sure the information you read to inform your decision has been published recently.

Read this Health Direct information sheet about health information or this one from the Children's Hospital, Westmead

Is there a list of terms and definitions to help me work out what it's all about?

See this glossary of terms from the Australian Digital Health Agency website

What about privacy?

If you have concerns about the security of your information, increasing the security restrictions on your account may be enough to satisfy you. The security settings allow restrictions on which individuals (such as family members) can see your information, and what information your healthcare providers can access, and more. For example, you may not want your pharmacist to view information about a mental health condition. You also have the option to lock individual documents held on the system, so information you feel is sensitive can be restricted. Setting a passcode on these documents means you can control who sees them, and when. See here for more information about how to set privacy and security controls.

See here for the My Health Record Privacy Policy

Can I set controls on my own My Health Record?

Yes you can. You can set a PIN on your whole My Health Record so that your health provider has to have you in the room before they can access it. You can also lock down individual documents.

My Health Record's security settings allow restrictions on which individuals (such as family members) can see your information, and what information your healthcare providers can access, and more. For example, you may not want your pharmacist to view information about a mental health condition. You also have the option to lock individual documents held on the system, so information you feel is sensitive can be restricted. Setting a passcode on these documents means you can control who sees them, and when.

See here for more information or check this Privacy Fact Sheet from the Office of the Australian Information Commissioner.

Can I see who has viewed my record?

Yes you can, although it is usually at the health service level, it won't give you the name of the individual health professional who has viewed your record. Have a look here to find out more.

What about young people?

As a protection for the privacy of young people, parents are currently not able to access the Medicare information of a child over the age of 14. However, a parent is able to access their child’s My Health Record until the child turns 18 unless the child chooses to take control of their own record. Young people can take control of their own record from the age of 14.

Follow the links below for some further information that young people and their carers may wish to read.

The Conversation - Freezing Out the Folks

You Can Take Control of Your My Health Record from 14 Years of Age

What about family and domestic violence?

People vulnerable to domestic and family violence, who wish to keep their location details secure, may need to consider whether having a My Health Record presents a risk to them. You may choose to use My Health Record anonymously, or using a fake name (known as a pseudonym)

See this brochure here from the Australian Digital Health Agency on their webpage

See also this resource form the Women's Legal Service Queensland - Women and My Health Record

What if I'm worried about stigma? I have a sensitive health issue

If you have a health issue or life circumstance that you consider sensitive, you may wish to investigate the potential implications of sharing your health information via My Health Record. The risk of stigma and discrimination by health care workers may be a worry for some people, such as those carrying a blood borne virus, or those who have been affected by the justice system. The potential of a data breach that exposes personal information is also a serious concern for some people.

Sensitive issues or circumstances may include:

  • sexual health
  • mental health
  • degenerative disease
  • health care worker
  • drug use
  • criminal record
  • blood borne virus
  • sex worker
  • lesbian, gay, bisexual, transgender, or intersex
  • pregnancy, or termination of pregnancy

If you are in any doubt, you may want to consider opting out, or setting higher privacy controls such as a PIN for the whole Record

Can I use a fake name to protect myself?

Yes you can. The technical term for a fake name is a pseudonym. You can use a pseudonym for privacy reasons, for example you can use a different name for you or your children when you get healthcare.

To do this, you need to apply for a pseudonym Individual Healthcare Identifier (IHI) through the Department of Human Services (DHS). You can then use this name to register for a My Health Record.

Your pseudonym IHI isn’t linked to your Medicare information, so this information will not be available in your record.

You will not be identifiable or traceable through your pseudonym.

You can choose to have a My Health Record using your real name as well as a fake name (known as a pseudonym), and you have the option to merge these two records at any time.

To apply for a pseudonym IHI, you can call DHS on 1300 361 457.

What if I don't speak English, or am not confident with language?

Languages other than English can be accessed here

The My Health Record website contains a number of plain text and easy to read fact sheets for people who have difficulty reading and understanding written information. Some of these fact sheets are specifically designed for Aboriginal and Torres Strait Islanders. Interpreting assistance in languages other than English is available by calling 131 450.

Many sections of the My Health Record website contain videos which explain the information on the page.

See the Accessible Information page on the Australian Digital Health Agency page

What if I don't have internet access or am not internet savvy?

Each individual is responsible for setting the level of security on their Record, and ensuring that information on your Record is accurate and up to date. This information includes your contact details, and ensuring that you agree with the contents of information uploaded by others. Anyone who is not able to do this may wish to consider whether this is a risk to them. However, if you don’t have internet access, you can call the My Health Record helpline on 1800 723 471 to access your information. Helpline staff can tell you which documents are in your My Health Record but not what each document contains.

Who will benefit most from My Health Record?

My Health Record will give your healthcare provider a clear and complete record of your tests, medicines, and treatments, without you having to record this yourself, or communicate it to your provider. This could be particularly helpful to people who:

  • Are elderly
  • Have communication difficulties
  • Have English as a second language
  • Have cognitive or memory difficulties
  • Have severe allergies or other conditions
  • Take multiple medications
  • Have complex health conditions
  • See multiple healthcare providers
  • Live in a rural or remote area

A central record of your medical history means that you do not need to be responsible for remembering all of your health information, and your history is available to health professionals in a medical emergency.

Should I opt out or opt in??

Take the time to read about the factors that matter to you so that your decision is well informed.

  • Are you clear about the risks and benefits of each option? If not, do you know where to find more information?
  • Are you clear about the aspects of the decision that affect you personally?
  • Do you need advice and support to make this decision? If not, what reliable sources of advice and support are available to you?
  • Do you need help to opt out if you choose to? If so, who can you go to for help?

If you have weighed up the options and are still unsure, the Ottawa Personal Decision Guide may be a useful tool to guide you through the process.

The Case to Opt In

The Case to Opt Out

If I opt out, is my decision final?

If you opt out of My Health Record before the 31 January 2019, you can then decide to opt in at a later date. If you do not opt out, but later decide that you no longer wish to have a My Health Record, you can choose to have your record deleted. Cancelling your record will permanently delete your My Health Record.

How do I opt out?

If you decide you would like to opt out, you can do that on the My Health Record website or by calling the Helpline on 1800 723 471 or you can click this link

You can check the Help Line wait times here

To opt out of My Health Record, you need to verify your identity.

You will need:

  • your Medicare Card, or Department of Veteran’s Affairs (DVA) card, and
  • one of the following forms of Australian identification:
    • your driver licence; or
    • your passport; or
    • your ImmiCard

Please email us if you have any concerns regarding the My Health Record and we will ensure you are given access to the information you need.

Digital Health – where are we at?

Posted on January 14, 2020

By Pip Brennan, Health Consumers’ Council Executive Director

My Health Record

Since January 2019 when the opt-out period ended, 90% of Australians have ended up with a My Health Record. Like all our state counterparts, we were funded by the Australian Digital Health Agency to circulate information materials on My Health Record via our networks. We have noted that some social media posts have attracted concerns from consumers, and have communicated these to the Australian Digital Health Agency.

We also undertook a survey to explore the issues important to consumers, and gain an understanding of real-life experiences of using My Health Record. We are currently compiling the results of this survey, and you will be able to find them on our My Health Record web page soon.

On 11 December the CEO of the Australian Digital Health Agency, Tim Kelsey, announced his resignation. A new appointment will be made early next year.

WA’s new Digital Health Strategy

As noted elsewhere in this edition, this strategy was released in October 2019, almost a year to the day of the last stakeholder engagement HCC was able to be part of. Now the Strategy has been released, it’s clear that the main goals require an electronic medical record. The scale of this undertaking is not to be under-estimated. The WA Health Information and Communication Technology Consumer Reference Group re-convened in November 2019 and there are hopes for more robust engagement and a co-design process with consumers, clinicians and administrators to drive this project forward in the way it needs to go.

Data and Privacy

Meanwhile, WA’s Department of Premier and Cabinet has completed the Privacy and Responsible Data Sharing consultation, and submissions received are now being analysed and legislation drafted. It may surprise you to know that we are the only state without privacy legislation.

I contributed to an independent submission which was supported by Professor David Watts, former Victorian Privacy Commissioner, and Dr Bridget Bainbridge, whose inputs were kindly supported by the Minderoo.

The submission argued for an innovative approach to the drafting, rather than merely “cutting and pasting” other state’s legislation, first written in the 1980s. Our world has changed beyond recognition since then, and Europe has led the way in developing the General Data Protection Regulations which seek to uphold civil rights. Th argument was made to aim for something along these lines that will allow us to more easily participate in international research.

Data is the new oil

It has often been noted that three enormous enterprises, Amazon, Google and Facebook, do not charge for their products. That is because the data they harvest from their platforms is far more valuable and marketable than membership fees. It is vital that as citizens we do not “give away the farm” when it comes to our health data. There have been alarming precedents in other countries where health data has been swapped for “innovation” – so that the costs of developing a platform, for example, are not met by the public purse. But what is the cost of this in terms of loss of privacy, in leaving ourselves open to having our data re-packaged and sold back to us?

Meanwhile, there is a confusion in the public mind about how much data is shared between government agencies. There is an expectation that data is shared much more than it really is. The excuse of “privacy” is often invoked by government agencies keen to control what information is shared and avoid contentious issues reaching the light of day, or stymie the ability of people to seek redress.

While in WA it was noted that our lack of privacy legislation is hampering data sharing, in all other jurisdictions where privacy legislation exists, it is invoked as a reason not to share data. As always, culture is a key driver of how policy and legislation is enacted.

In Australia there is no independent, publicly funded app for My Health Record. There are three commercial providers who provide apps, and as we saw in 2019 with the Health Engine debacle, in some states our data was being on-sold to third parties – which consumers had consented to with one click, without any real understanding of what we were consenting to. The phenomenon of signing away our rights is endemic. The Norway Consumer Council worked out that it would be quicker and faster to read the New Testament than it would be to wade through the terms and conditions of 33 apps on your average smart phone.

What to do?

As always, a “buyer beware” approach is important. If something is free (Facebook for example), then you’re for sale. Many of us make this call because what we receive is worth the (largely invisible) cost of obtaining something we want right now, which is the functionality of what the app offers.

 

Does this topic interest you? Would you like to stay in touch with projects and initiatives in data and IT, email us at info@hconc.org.au with Digital Health as the subject line.

You might also want to listen to this episode of Big Ideas exploring this complex topic.

 

Giving Feedback

Posted on June 22, 2019

Care Opinion

In 2020 the Patient Opinion platform, an independent, moderated place for people to provide feedback, was renamed to Care Opinion. This platform is now one portal for people to provide feedback on health and social services. It mirrors the same platform available in the UK, which uses the power of story to transform health and human services.

A non-profit organisation moderates the platform, and services subscribe to be able to receive notifications, reports etc. WA is the first state to have every public hospital as a subscriber. You can find out more or post a story here.

WA Health Complaint Policy Review

The Department of Health (DoH) consulted on a revised version of the WA Complaints Management Policy and these new versions appear below. We undertook a series of consultations to support the work survey and have collated this feedback.

WA Health Review of the complaints and feedback process

Following on from this consultation and the release of the new complaints guidelines, DoH consulted about the process of making a complaint and giving feedback. We heard about the many barriers to giving feedback, including concerns about what might happen to the feedback. This was especially prominent in the discussions we had with Aboriginal people. It was also raised that there is no easy way to give feedback about the whole system, not just one health service.

Read the full report here

Celebrating people who make a difference…

Posted on May 16, 2017

Have you ever encountered a person who absolutely stands out in the way they approach the work they do? There is a noticeable difference in attitude and energy between those who are truly engaged in their role and those who are not… and how difficult must it be to face up every day to something you are not enjoying and you don’t believe in?

This year I have been working with someone who I have never met face to face. We communicate via email and phone and have glimpsed each other once via video conferencing. Why haven’t we met? Because this wonderful person lives in Katanning. Her name is Karen and she has been incredible in her enthusiasm and energy around engaging with people from diverse cultural backgrounds.

Briefly, Katanning is home to people from many different countries, some quite newly arrived while others have become long term residents. It is known as a town that supports cultural diversity and which has been highly successful in doing so. Karen works for the Department of Health in two roles, as a Health Promotion Officer – Culturally and Linguistically Diverse (CaLD) and as a Project Officer, Sexual Health and Blood Borne Virus.

In her role/s Karen has encouraged and supported people from CaLD backgrounds to engage with the health sector with the result that there is now a Multicultural DHAC (District Health Advisory Council) in the Great Southern Region. I suspect this may be the first of its kind in WA and is a fantastic achievement that needs to be celebrated and acknowledged.

Beyond that I would like to say, ‘thank you’ to Karen for the level of interest she has shown in and her support for the work that I do and to acknowledge those things. Also for her willingness to be involved in HCC’s Refugee and Asylum Seeker Health Research Alliance (RAHERA) and her participation in other activities this Program undertakes.

You are really appreciated Karen, thank you. We really value your support.

Footnote: On May 11, I travelled to Katanning and ran information sessions and workshops, also the following day. There I met Karen and she is as dynamic as I suspected!

Click here to read about the work Health Consumers’ Council did with Katanning Senior High School.

Louise Ford | Consumer and Community Engagement Manager

Image Source: https://smallbiztrends.com/2016/11/ways-to-thank-customers.html

Your Say on Cancer WA

Posted on February 15, 2016

A recent state-wide survey shows that many people don’t know that 30 – 40% of cancer cases in WA are preventable. With almost 12, 000 Western Australians diagnosed with cancer every year, this is both shocking and heartbreaking.

 

This information comes from a report recently released by the Department of Health entitled Priorities and Preferences for Cancer Control in Western Australia

 

This report summarises responses to an online public consultation conducted last year on the seven cancers which have the greatest impact on the WA community and greatest opportunity for prevention: bowel, breast, cervical, lung, melanoma, prostate and oesophageal/stomach cancer. The report has revealed that a third of participants were unaware that much could be done to prevent cancer.  In particular, many people were not aware of the dietary risk factors for bowel cancer and that cervical cancer is almost entirely preventable.

 

A poor understanding of the preventability of cancer is not necessarily surprising as historically, much of the discussion about cancer in the community has focused on treatment, sometimes to the detriment of prevention messages.  However, it does highlight the potential for reducing the pain, anguish and cost associated with treating cancer.

 

The value of this new report is that, in seeking out community views on priorities and preferences for cancer control it has identified some clear areas for increased action in the immediate future, including: Increasing the number of Western Australians participating in the National Bowel Cancer Screening Program; Strengthening health promotion messages around recommended red meat intake; reducing processed meat consumption; reducing alcohol consumption; and reducing salt intake, as well as links between obesity and cancer risk; Working to raise the profile of cancer prevention and early detection; and Building on gains made in tackling harm caused by smoking, exposure to ultra violet radiation and asbestos, as well as exploring new and innovative programs to reach vulnerable groups and address emerging issues.

 

This is the first time the Chief Health Officer of WA has asked the community for feedback in a report and the first time (to my knowledge) an online forum has been used to gather community opinion on cancer prevention in WA. As a co-author on the report it was a privilege to bear witness to the frank, open and creative ideas for cancer prevention from our consultation participants.  We are very grateful for their input and the time they devoted to answering our questions.

 

The report was prepared in collaboration with a number of agencies including the Health Consumers’ Council WA, Cancer Council WA, Public Health Advocacy Institute of WA, Curtin University and WA Clinical Oncology Group.

 

To read more about the findings of the consultation and how the Department of Health is responding, you can access the full report here:

 

www.healthywa.wa.gov.au/~/media/Files/HealthyWA/Original/Your-say-on-cancer-wa/13009-chief-health-officer-report.ashx

 

As a project team we also had a lot of fun planning and putting together a consumer website with a range of supporting material including a summary of the report findings, some innovative infographics of cancer data, and expert videos.

 

Check out the website for yourselves here:

www.healthywa.wa.gov.au/yoursayoncancerwa

Guest Blogger: Dr Jennifer Girschik

Pap smear costs- a storm in a teacup?

Posted on January 7, 2016

The announcement slipped in easily enough just before Christmas. On December 15, in its mid-year budget update, the Federal Government announced that they would scrap the incentive payments for pathologists for bulk billing of tests, because the rate of bulk billing had not increased. In other words, the measure appeared to have failed.

This announcement reflects the work being undertaken in the Medicare Benefit Schedule (MBS) reform process which was established in April 2015. The MBS is a list of more than 5,500 item numbers against which medical practitioners can bill the federal government for payment. It is the basis of business models for public, private and not for profit health services. It includes clinical items as well as this type of incentive payment.

Queue then the entrance of the Royal College of Pathologists, and the Australian Medical Association. In other words, organisations whose bottom line is affected by this change. In some online and newspaper reports, figures were put on the cost to consumers of a pap smear  at around $30. On 6th January an article appeared on Mamma Mia’s website, and a petition about the cost of Pap Smears and pathology tests was launched by Change.org. Signatures are nudging very close to 150,000, and rising as this blog is being written. Yet the incentive payment being scrapped was in the region of $1.30-$1.40 according to the Federal Government. In the short discussion I just had with the media spokesperson for the College of Pathologists, the position of the College seems to be a reluctance to nominate an actual figure to be passed onto consumers. So is this an issue, or isn’t it?

I would venture to suggest that it is not. Change is always a difficult phenomenon to manage, and communication seems to have contributed to the backlash the Federal Government is experiencing. The real story is the reason behind the MBS Review and why it is so important for Australians that this happens. Here are some terrifying facts and figures about the MBS provided by our national body The Consumers Health Forum:

  • Until 1 January 2010, there was no clear process for adding new items to the MBS.
  • There was also no clear, consistent system for identifying and removing items from the MBS when they were no longer considered best practice or effective.
  • There was no consistent and formal process in place to test or review items already on the MBS, or new items coming onto it, to ensure they were doing what they were intended to do and were safe and cost effective.
  • Only three percent of items have been assessed for safety, effectiveness and cost-effectiveness. 

You read that right. Only three percent.

So the MBS Review team are carrying on their work, amidst the media cacophony. They are still very keen to hear from the community, but many people find the topic inaccessible and can fail to see how this may affect them. Perhaps this controversy will raise awareness of this enormous and much-needed reform currently unfolding. It is unfortunate that this Review is always going to get caught up in economic rationalist arguments and the undeniable need for our country to reduce its health costs. Public scrutiny will be important to ensure that the focus is on eradicating inefficiencies, duplication and waste rather than diminishing access to quality health services. But let’s ensure that this is a patient centred discussion, not a vested interest centred discussion.

Just before Christmas the MBS Review Taskforce released a new consultation has to look at obsolete MBS items, with feedback invited until 8th February 2016. If you are brave to work your way through the consultation documents, feel free to have your say.

Written by Pip Brennan, Executive Director of the Health Consumers’ Council of WA.