Dying well – Grattan Institute – 28 September 2014
by Hal Swerissen and Stephen Duckett
“Seventy per cent of Australians want to die at home yet only 14 per cent do so. Despite their wishes, about half of people die in hospital and a third in residential care. Dying in Australia is more institutionalised than in most countries. Medical and community attitudes plus a lack of funds for formal, home-based care mean that Australians die at home at half the rate that people do in New Zealand, the United States, Ireland and France.
More than at any time in history, most people die when they are old, and are more likely than past generations to know when in the near future they are going to die. That gives us a great opportunity to help people plan to die well. Policy and attitudinal change could enable more people to die comfortably at home and in home-like environments, surrounded by family, friends and effective services.
Dying Well finds that because most people do not speak up about the way they would like to die, they often experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals.
The report recommends more public discussion, including an education campaign, about the limits of health care as death approaches and the need to focus on end-of-life care.”
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Stephen Duckett and Peter Breadon
“Enabling less highly-trained hospital workers to play a bigger role could improve jobs for doctors and nurses, save public hospitals nearly $430 million a year and fund treatment for more than 85,000 extra people.
Doctors, nurses and allied health professionals such as physiotherapists and occupational therapists are all squandering their valuable skills on work that other people could do.
It doesn’t take 15 years of training to provide light sedation for a stable patient having a simple procedure, or a three-year degree to help someone bathe or eat – but that is the situation in Australian hospitals today. This mismatch of skills and jobs is putting heavy pressure on hospitals when there are already long waiting lists for many treatments and demand is growing fast.
The report suggests three ways – among many – that hospitals can get a better match between workers and their work. Nursing assistants could free up nurses’ time by providing basic care to patients. Specialist nurses could free up doctors’ time by doing common, low-risk procedures now done by doctors. More assistants could be employed to support physiotherapists and occupational therapists.”
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Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014
by Stephen Duckett and Peter Breadon
“A better pricing system for public hospital treatment would show where costs are too high, and free up $1 billion for more and better health care.
The gulf between treatments in high and low-cost hospitals in Australia is vast, with no good reason for such variation. In New South Wales, for example, the difference in the cost of a common gall bladder treatment between the highest and lowest-cost hospitals is more than $4,000, and the difference in the cost of a hip replacement more than $16,000. In many states the gap between the most and least expensive hospitals is more than $1,500 for every admission — and in some states it is much greater — even when all legitimate funding differences among hospitals that we can measure are taken into account.
This money is not being used to provide better care – it is simply being spent inefficiently and could be used for much better ends.
To achieve the savings, the report urges state governments to make three reforms. They should pay hospitals for treatments on the basis of an average price once all avoidable costs we can measure have been removed.
Second, they should make data available to hospitals so they can compare themselves to their peers and see where they can cut costs. Third, governments need to be tougher and hold hospital boards to account when they fail to control costs. But even with these changes, it is up to hospital leaders, managers and doctors to find the best ways to improve.
Hospital spending is the fastest growing area of government spending, and is projected to increase with new technologies and an ageing population. We have to keep health care affordable and the health budget under control. Rooting out inefficiencies in public hospital systems is a good place to start.”Read Full Post | Make a Comment ( Comments Off on Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014 )
Poor pricing progress: price disclosure isn’t the answer to high drug prices – Grattan Institute – 1 December 2013
“While the wholesale price of seven medicines fell by about a third today, Australia has a long way to go before consumers pay fair prices for pharmaceuticals.
Even after today’s reductions, Australian prices for the seven drugs are on average 14 times higher than prices for the same medicines in the United Kingdom.
Australia’s “price disclosure” policy was introduced in 2007 in a bid to cut costs. But drugs that have just been through this process have wholesale prices that are on average over 16 times the lowest price in New Zealand, the UK and the Canadian province of Ontario.
Under price disclosure, pharmacies are forced to reveal discounts on drug prices that manufacturers provide them, and the Government accordingly reduces the amount paid to pharmacies for each drug.
But Grattan Institute’s earlier report, Australia’s bad drug deal, revealed that if the Government benchmarked the prices of generic drugs against prices paid overseas it could save more than $1 billion a year in payments to manufacturers.
The Government’s purchasing policy needs to be much tougher on manufacturers and much fairer for consumers. It is not just a matter of saving money: nearly one in 10 Australians doesn’t take medicines a doctor prescribes because of cost.
For six of the seven drugs with price cuts today, benchmarking would save patients nearly $20 more for each box of pills, on average.”
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Access all areas: new solutions for GP shortages in rural Australia – Grattan Institute – 29 September 2013
by Stephen Duckett and Peter Breadon
“This report outlines a plan for the parts of rural Australia with the lowest access to GP services. We don’t aim to bring these areas up to the national average, just to end the most extreme shortages. To achieve this, we have to make the most of scarce resources, while keeping GPs at the centre of the system.
The first step is to make much better use of pharmacists’ skills. Pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia. But their role is far more limited in Australia than in many other countries.
With the agreement of GPs and patients, pharmacists should be able to provide repeat prescriptions to people with simple, stable conditions. They should also be able to provide vaccinations and to work with GPs to help patients manage chronic conditions.
We also need to increase access to other services, including diagnosis, which currently only GPs can provide. Australia should introduce physician assistants, health workers who practise medicine under the supervision of a doctor. There is good evidence that physician assistants could expand the care available in under-served areas, without compromising quality or safety, and at an affordable cost.
The proposals in this report only apply to the seven rural areas with the worst shortages of GP services. They can be in place within five years. In 2011-12, they would have resolved the worst shortages for just $30 million. The costs would mostly have been offset by fewer, or less costly, hospitalisations as a result of better population health.”Read Full Post | Make a Comment ( Comments Off on Access all areas: new solutions for GP shortages in rural Australia – Grattan Institute – 29 September 2013 )
Ending Australia’s bad drug deal: the three elements of pharmaceutical pricing reform – Grattan Institute – 17 March 2013
“Australia’s Pharmaceutical Benefits Scheme pays at least $1.3 billion a year too much for prescription drugs. New Zealand, which has capped its budget and appointed independent experts to make decisions, pays a sixth as much as the PBS for the same drugs. This report proposes three ways Australia can regain its lost leadership in pharmaceutical pricing.”
Grattan report misses point on PBS reforms – Medicines Australia – 18 March 2013
“Patients would be worse off if Australia adopted a New Zealand-style access to medicines policy, Medicines Australia chief executive Dr Brendan Shaw said today.
Responding to a report on pharmaceutical prices published today by the Grattan Institute, Dr Shaw said proposals to cap spending on the Pharmaceutical Benefits Scheme would limit patient’s access to medicines.
“If you want a how-to guide for turning your health system into that a third-word country, this report would be it,” Dr Shaw said.
“Capping the PBS would kill consumer access to new therapies as the experience in New Zealand proves.
“It undermines the fundamental principal of universal and affordable access to medicines that underpins the Pharmaceutical Benefits Scheme and has done for 60 years.
“Anyone who wants to emulate the New Zealand model of medicines policy should remember that New Zealanders have access to less than half the number of new medicines that Australians have and that New Zealand is stone motherless last in the OECD access to medicines rankings.
“So much so that when New Zealanders can’t access a variety of new medicines in their country they come over here.”
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