The European Union’s  general government expenditure on health was 7.2% of GDP in 2015.

Australia’s government expenditure on health was 6.4% of GDP (in 2013/2014).  That puts Australian government spending higher than Spain but less than Croatia as a percentage of GDP.

References:

External link Eurostat news

Australia’s government health expenditure is derived from Australian Institute of Health and Welfare “Australia’s Health 2016”.

Note this document adds in individual and private health insurance expenditure to claim Australia’s expenditure at 9.4% as near to the OECD average of 9.3%.

In Australia’s case the public directly pay 18%.

Private insurance, pays 8.4% of health expenditure, much of which could be significantly cheaper if provided through Medicare.  The public of course pay premiums to fund this expenditure plus profits, advertising etc.

Its not clear where highly privatised dental is accounted for.

A new study by the New England Journal of Medicine reports that  high body weight contributed to 4 million deaths globally — or 7 percent of the deaths from any cause — in 2015.

More detail, external link MSN

Here in Australia obesity costs us over $5 billion per year.

While overseas cities, states and countries are trying many solutions, the Australian government has done little to prevent this national heavy financial burden but fights tenaciously to retain the GST on tampons and seems obsessed with terrorism.

Multinationals reap huge profit returns from sugared drinks while many Australian farmers who produce healthy foods struggle to survive.

The disability toll from obesity is also significant, for example, “in 2012–13, there were 3,570 lower limb amputations (major and minor) provided in hospital to admitted patients with a diagnosis of diabetes.” ref AIHW

The government’s trumpeted investment in infrastructure is little different to previous Prime Ministers, per annum, it is “only offering $7.5 billion a year, much of it already in Hockey’s numbers and a fair swag of that dating from Labor government commitments. …If the Abbott government had kept … promise, it would have averaged $8.3 billion a year.” (Michael Pascoe, SMH 10/5/17) and Rudd/Gillard infrastructure investment was higher.

Set against the Federal budget, the NSW government sold/leased ~$34 billion of electricity infrastructure and services which, using Professor John Quiggan’s general privatisation cost estimate, will cost the public a 10% return to the purchasers ie $3.4 billion  a year while reducing services by more than that amount.

Hence just one state disposing of one asset area has committed Australia to annually spend nearly half of the Federal budget’s  annual infrastructure investment, as a return to purchasers.

The national outflow and redirection of funds away from delivering critical services in privatised/leased State government infrastructure and services massively dwarfs any planned Federal infrastructure investment in Budget 2017 making it almost irrelevant.

Pascoe also mentions that Infrastructure Australia ranks the cost benefit ratio of one $10 billion rail project “marginal” and IA have “a list of projects that score much more highly”.  The budget items are a clear benefit to politicians re election ambitions but include some questionable returns to the taxpayer and overall questionable, if any,  stimulus to the economy.

On the other hand, investment in human infrastructure, or human capital as economists say, is whittled down at any opportunity. Seemingly considered “bad” using the government’s newly minted good and bad investment criteria.

Tertiary education funding cuts for example will impact a system already poorly funded: “Australia is pulled down (by) the low ranking of 44 out of 50 for government expenditure on higher education…student contributions to higher education were the sixth highest in the world…” (Universitas 21 analysis, Julie Hare, The Australian 5/5/17)

Still no recognition that efficient primary health care reduces later higher costs and unnecessary disabilities with a fudged response to freezes of Medicare rebates impacting GPs, Optometrists etc.    “GP…rebates have fallen 120% behind practice costs over the last 25 years” (Paul Mara, theguardian 23/5/17)

The same lack of recognition exists for investing in public education to deliver positive long term impacts on low income and disadvantaged children and citizens which will uplift Australia’s future performance.

In an environment where:

• disposable income per capita has been falling since 2011
• household debt is the fourth highest in the OECD
• underemployment plus unemployment wavers up to 20%
• education outcomes are deteriorating, 24th out of 37 OECD countries – UNICEF
• health care is deteriorating, 27th out of 35 OECD countries – UNICEF

the budget does not respond to these challenges.

The budget fails to reap the many opportunities for substantial long term gains and reduced social costs available from investing in human capital.

Ref

• Disposable income per capita
• external link OECD household debt chart
• external link Roy Morgan underemployment plus unemployment table
• external link UNICEF education and health

I hope all Australians have a Caring Christmas and a Healthy New Year.

Thank you to everyone who has in some way supported a stronger Medicare, even if it was just by chatting among friends.

During this festive time let us not forget Rural and Regional Australians:

• They have worse health outcomes than their city cousins, have to suffer Fires, Droughts and Floods that impact whole communities and some have to travel huge distances to access needed health services.
• Family Doctors and other health professionals battle rising costs to maintain bulk billing and purchase up to date equipment in the face of the rebate freeze.
• Some Family Doctors will be impacted by the new rent controls restricting the rent they can charge the few large pathology companies that dominate the industry. The AMA says “The changes are being reported as saving pathology companies around $150 million a year, with most of this money being taken out of general practice”
• After recent rebate changes some pregnant women may have to pay upfront  for pathology and diagnostic imaging to check their unborn baby before they get some refund.  Dont forget those with serious ageing and health issues who need many tests.
• Some of the taxes paid by Rural communities (who include some of the poorest electorates in the nation) are used to subsidise the private health industry, whose services unfortunately tend to cluster around  wealthier city areas.

We have a huge challenge ahead, to have Medicare fully funded in the future, to give Australians confidence that the public health system will look after them and their children, in the times ahead.

I think early attention to health problems is a critical priority, before  those problems grow to clog hospitals and swamp other health services.

I also think properly addressing mental health and addiction issues are core needs of a revised funding strategy.

Mark Rogers

In November … 17.6% of the workforce, were either unemployed (1,199,000) or under-employed (1,100,000).

http://www.roymorgan.com/

By themselves, unemployment figures are deceptive, just part of a bigger iceberg.

The government rarely acknowledges underemployment  levels (typically part time workers who cant get enough hours and people forced into part time work) because they are higher than in many other OECD countries .

From an OECD report 2014

It is interesting that at face value, the Eurozone have less of their workforce “without enough work”

Department of Health figures released today prove that only 64.7% of patients were fully bulk-billed for all of their GP services in 2015-16, according to the Royal Australian College of General Practitioners.

Full details, external link RACGP media release 6th Dec 2016

Kate Aubusson (external link) Sydney Morning Herald, 7th Dec:   A report released in September suggested 69 per cent of GP consultations were bulk-billed, and patients were paying an average of $48.69 in out-of-pocket fees.

Further RACGP Comment, external link RACGP media release 12th Sept 2016

Out of pocket costs for patients visiting a GP have increased by 6% in the last year and by 89% over the last 10 years.

My wife and I need glasses to see properly and to drive.

At our age we also need tests so Glaucoma doesn’t suddenly blind one of us.

Yesterday, for the first time, our Optometrist was forced to charge my wife one of the Abbott government’s copayments because he can no longer absorb rising costs with the government rebate frozen for years and other rebates cut.

We can afford to pay the copayment but the impact obviously falls on people with less money who will defer eye tests and hence: not change to better suited lenses and also will risk irreversible damage from Glaucoma, Macular Degeneration etc.

You and I will be at risk when drivers with unnecessarily impaired vision cause car crashes.

Potentially they will also run down school children walking home and its very unlikely governments will ever give us honest feedback: $x rebate saved, y school children hospitalised etc.

At the end of the day you and I pay for state government hospitals treating the many impacts of this freeze whether its people with irreversible eye damage, or the consequences of people with impaired eye sight.

We also pay the increased welfare bill for debilitating loss of sight and pay for other impacts which are wide ranging.

Its not your Optometrists fault, if you have a good Optometrist I suggest you pop in next time you walk by and tell them that you understand what they trying to deal with.

Christmas is close, it would be a nice thing to do.

Mark Rogers

Editor

Obesity costs Australian taxpayers more than $5.3 billion a year. Obese people are more likely to go to doctors and be admitted to hospital more often than other people. They are also more likely to be unemployed and therefore paying less tax than the rest of the population but the costs are borne by the whole community.

A report by highly credentialed Stephen Duckett and Hal Swerissen (published by the Grattan Institute) proposes that the best option is an excise tax of 40 cents per 100 grams of sugar, on all non-alcoholic, water-based drinks that contain added sugar.

A new tax is not a “silver bullet” solution, that would require a suite of new policies and programs. But the proposed tax would encourage healthier lifestyles.

The many countries that already have or are planning to introduce a tax on soft drinks include France, Belgium, Hungary, Finland, Chile, the UK, Ireland, South Africa and parts of the United States.

The Australian government would raise about $500 million a year.

One of the report’s key points:

• Many factors are contributing to the rising prevalence of obesity in Australia. But the primary cause is excessive consumption of unhealthy processed food. This is, in part, driven by ‘market failures’, including consumers having a limited understanding of processed foods and behavioural factors that can limit self- control, and people not bearing the full costs of over-consumption of unhealthy foods.

Australia’s Pathology industry is dominated by a few big players.

The government is moving forward with plans to introduce rent control to protect Pathology companies ie pathology collection centres located in general practices and other medical facilities.

“….saving pathology companies around $150 million a year, with most of this money being taken out of general practice.

GPs are already heavily burdened by a range of funding cuts….”

external link AMA Demads Fair Go for GPs with Pathology

16th May 2016

“..the Coalition’s announcement of a backroom deal to cap rent will create further strain on the ability of general practice to keep their doors open and provide patient services.

“…create an anti-competitive environment, where multi-national corporations who make hundreds of millions of profit each year are propped up, while GPs running small businesses lose funding.

Royal Australian College of GPs

16th Feb 2016

“Since deregulation the number of pathology collection centres has more than doubled from 2500 to more than 5000.

“It’s a substantial cost burden.

“The number of collection rooms has gone well beyond what would be regarded as reasonable access.

“…..There is “a degree of hypocrisy” in pathology companies complaining about the problem they created

news.com.au

Extracts from fact sheet 13/5/2016:

• There is a total health deficit in rural and remote areas of at least $2.1 billion a year.
• This equates to a shortage of 25 million services, …
• Adding the Medicare, PBS and ‘other primary care’ deficits …, rural and remote aged care deficit of some $500 million. ….
• The total rural primary and aged care deficit is therefore likely to be around $3.0 billion.

external link National Rural Health Alliance Inc fact sheet 27

Extracts from fact sheet 23/6/2016:

The death rates for a range of diseases is higher in remote Australia.

Death rates from the major causes of death in Australia are significantly higher in remote communities when compared with major cities:

• Land transport accidents – almost five times more deaths
• Diabetes – three times the number of deaths
• Suicide – twice the number of deaths
• Chronic obstructive pulmonary disease – 60% higher death rate
• Coronary heart disease – 40% more deaths
• Lung cancer – 40% more deaths

People in remote Australia die around three years earlier than people in the city, this is despite there being fewer older people living in remote communities.

Accessing health care

• General practitioners

Access to a GP is one of the services that people living in remote Australia value as vital .. .there is around 20% less Medicare funded GP activity compared with the same population in the city.

• Specialists

There are 80% less Specialists in remote Australia when compared to the major cities.

• Dental workforce
Remote Australia has access to only one third of the number of dentists of major cities.

• Allied health professionals

Access to allied health professionals is also an issue in remote Australia, particularly with regard to ongoing treatment and management of chronic diseases and for rehabilitation and recovery from significant illness or injury.

Per 100,000 population, there are:
42% fewer pharmacists, psychologists (65% fewer), podiatrists (68% fewer), physiotherapists (51% fewer), optometrists (68% fewer) and occupational therapists (65% fewer)

• Nurses
In contrast to the poor distribution of most health professionals in remote Australia, nurses are fairly evenly distributed across major cities, remote and very remote Australia.

Difficulty accessing health professionals can have serious consequences.  Using diabetes as an example, we know that the role of allied health practitioners, particularly podiatrists, in preventing hospitalisations and amputations due to diabetes is critical.

Without access to health professionals, people in remote Australia may need lengthy stays away from home and may also jeopardise continuing recovery after returning home creating a vicious cycle of increasing ill health.

external link National Rural Health Alliance Inc The health of people living in rural Australia

Fact sheets on an extensive range of health topics, external link National Rural Health Alliance Inc