Australia’s health system funding is beginning to exhibit signs of stress.
Is this by accident or by deliberate design?
Health out of pocket expenses are beginning to climb and many common medical procedures are now funded by drawing down from a patient’s superannuation fund -sufficient monies to cover costs.
Health advocates are concerned about the rising number of Australians dipping into their superannuation to pay medical bills.
In 2000-01 $42m was released early under compassionate grounds, and by 2016-17 that number had increased to $290m, with most of those funds being spent on bariatric surgery and IVF.
Nearly three-quarters of those funds were spent on medical treatment and transport, with about 15,000 Australians accessing their superannuation early for such purposes.It is not good planning when superannuation is needed to fund health costs.
But it is in line with the stealth approach being taken by the Australian government as it moves towards the ultimate goal of privatising the bulk of health care costs.
i2P has previously predicted that this would happen wilt PBS and Medicare being substantially replaced by Patient Benefit Managers (PBM’s are US style health solutions).
For Australians and their universal access to quality healthcare, it is essential for clinical decisions to be made at “arms-length” from financial considerations.
What we are currently seeing is a superannuation system that will not be self-funding when it comes to retirement.
And that will create a two-tier health system with retirees being unable to fund living costs and future health costs, at a stage in their life when they will need increasing access to health systems.
The Consumers Health Forum has commented that this trend highlighted an increase in out-of-pocket costs for healthcare, and that early super draw-downs are not the right mechanism to subsidise healthcare.
A better solution has to be devised.
Finance Minister Kelly O’Dwyer has ordered a review into the early release of superannuation, with a report due in March, 2018.
There may be a restriction placed on early superannuation draw-downs that could herald a funding crisis.
In parallel with the above trend is the fact that health insurance/funds have been progressively not delivering a quality product, with poor value for the premiums paid.
These entities have been manipulated by government and it would seem that cynical policies have taken away their ability to fund out of pocket expenses (including prescriptions) creating a flawed system, and one without universality.
Will government tidy up these third-party funders, or will we see separate Patient Benefit Managers (PBM’s) start to emerge?
As there is a gap to be filled, PBM’s are likely to be the proposed solution.
If the concept of a Patient Benefit Manager (PBM) is unavoidable, then the best strategy is to develop an Australian version controlled by Australian health professionals.
And because of its community pharmacy network, community pharmacists are best placed to organise and manage a home-grown version before global competitors can put one in place.
An early contender for a PBM is Amazon.
Amazon is best known for its embrace of disruptive technology, its strong online retail logistics and its current interest in pharmacy.
i2P has estimated that ownership rules for pharmacy will be rolled back around 2026 and most global pharmacy entrants will be progressively increasing their footprint in Australia and pacing themselves as they adapt to the unusual marketing terrain of large empty spaces, long distances between pharmacies and smaller populations than those experienced in Europe and the Americas.
That means in eight year’s time, unless there is an Australian version of a PBM then the pharmacy market will default to global competitors who will arrive with their own versions, fully tested in their home countries.
An Australian-owned PBM that is pharmacy controlled would help to underwrite private prescriptions and professional services.
In the US the stronger PBM’s dominate where patients can spend their dollars and can cause massive market disruption even to the largest chain pharmacy groups.
The concept of a PBM does not necessarily mean that population health will have optimum outcomes compared, say, to the earlier models of Medicare or the PBS.
Global drug companies have vested interest in perpetuating their illness model of health that focuses only on patented drug solutions.
So they dominate by investing and controlling US models of PBM’s.
They talk in illness management – never a cure, with as many competitive interests disrupted as possible (natural medicines-including medical cannabis, clinical nutrition, dietary aids and supplements and pharmacist compounded medicines).
An Australian pharmacy controlled PBM would ensure the survival that these wellness components, unique to Australian community pharmacy, could actually survive.
So those of you who have funds to invest, look to your future and make a New Year resolution to design a functional model of a PBM.
It will actually replace (or substantially reduce) a franchised market group activity for pharmacy’s professional core business.
And it already has a budget attached that can be transferred to the running costs of a PBM.
There’s not much time to make a decision – so just do it!