Sharing by default legislation is going back before parliament via a committee recommendation which seems to indicate its ideas are, more or less, bipartisan. Still, a contingency plan wouldn’t hurt.
We wrote last week that the Coalition was pretty thin on the ground when it came to understanding all the work and investment that has gone on in healthcare over the past couple of years, including a pretty bold and complex digital health agenda.
Coalition voters hated the article in general, although if any of them had read into it far enough – as usual it’s way too long – there is a slam dunk election policy in there to win over most voters on health and Medicare.
Insiders who have managed to talk to the powers-that-be in the Coalition have come back with a view that no one at the top understands what is going on, especially about digital health.
That wouldn’t be good because if the government changes at the next election, which feels entirely possible, and no one really understood the agenda of various government departments and agencies, especially the “sharing by default” work, you might end up with a bunch of giddy winners cutting some important stuff accidentally.
We already know that the Coalition has said it will hack as far as it can into the public service to “remove waste”. A bit ironic given how much waste we all now understand was created by outsourcing huge amounts of said public service to the consulting industry over the past 10 years. The Department of Health and Aged Care has even been directly mentioned in this respect by the shadow minister for health Senator Anne Ruston. She said the Coalition won’t cut Medicare but will cut DoHAC.
Anyway, as I’ve been warned a lot now: don’t, if possible, appear to be taking a side in the upcoming election, as politics is visceral and nasty (maybe genetic even?) and you don’t want to be upsetting approximately half of your readership, even if all you are trying to do is point to some evidence and logic and what might result from that.
In other words, definitely don’t point out that:
- So far the Coalition has no substantive position on health to speak of policy-wise, other than they promise they won’t defund Medicare – but they don’t have to defund Medicare to marginalise it going forward unfortunately, they just need to lean more into the rapidly emerging privately funded non-Medicare provider economy, including helping the private health insurers fund members for general practice gap costs.
- It hasn’t shown any interest or understanding in what is the most substantive and sensible digital health agenda the country has had in a long time.
- In campaigning terms it is so far mostly relying on disinformation and misinformation (not that the government doesn’t resort to the same from time to time, of course) and slagging off everything that the current government has done. For example, in an interview with Australian Doctor last week Senator Ruston said:
“Under every metric that you could measure health, the current government has got the worst record”, and
“Whether that be an 11% drop in bulk-billing rates since they’ve been in government, or the fact that we have had the greatest or highest level of out-of-pocket costs that have ever been seen before.”
Which is a tad over the top given that last year the government invested more in healthcare and Medicare than in any year of the previous 20 in real terms, and the 11% figure compares the peak of covid bulk billing – when everyone had to go to a GP to get their vaccination – with today, which is substantively misleading.
Before rusted-on Coalition readers stop reading here, or stop writing in to say this is all biased and political, the point of highlighting this stuff is for everyone who has a vested interest in a better healthcare system (whether they are on board with the past few years of work or not) to call Peter or Anne and have a good chat to them about what you think before the election.
Big emphasis on before here, and, remembering that if the Reserve Bank cuts interest rates on 17 February, the election might be here by 12 April, so get your skates on everyone.
If you don’t do it before, you aren’t going to get much of chance after, especially if the Coalition gets a clear majority – which again, looks entirely feasible.
If they win and do anything really stupid (and I’m not implying here in any way that the new president of the US has done anything stupid because he won with such a big mandate and doesn’t get subtleties … ditching WHO was fine right? … we will only have ourselves to blame.
To be clear, I’m not saying one party is worse than the other in health (get me in the pub and I’ll say it).
I am saying that, perhaps being out of government for a few years and missing a few good advisors who dropped off at the last election, and health not being one of their pillars of re-election campaigning (so far anyway), the Coalition may need the odd bit of “cramming” so we are all a bit more confident that it has its head around important nuances in current health system thinking before it governs (if it does).
This is called a contingency plan. You suspect a lot of groups in the US didn’t have one.
This week we learnt that Coalition understanding of digital health might not be as bad as I’m suggesting it could be.
A parliamentary committee, consisting of three Labor, two Coalition and two Greens (which isn’t exactly conservative heavy, we know) seemed to be unanimous in recommending that the “sharing by default” legislation, which went to parliament before Christmas last year, and got kicked to the Committee sidelines before a vote, be passed.
Here’s the actual documentation of the recommendation from the parliamentary Committee report, which we love, because there’s not much room for interpretation:
Hint: Recommendation 1 is the only recommendation. Don’t you love it when politicians are actually clear in their communication.
This surely suggests the Coalition isn’t entirely in the dark on digital health policy. Someone knows what is going on and is on board – that would be Senator Hollie Hughes (NSW) and Senator Maria Kovicic (NSW).
Which is interesting in one way because the legislation isn’t entirely friendly to big business – in particular, big pathology.
The Explanatory Memorandum with the Committee reported notes that “Medicare benefits for specific health services will be conditional upon upload of information about those health services”.
The so-called “no play, no pay” threat to the big pathology companies.
There is of course a long way to go, and likely a lot more nuance to be explained to Peter and Anne, even if this is bipartisan support for this Bill.
What the Bill doesn’t do, which a lot of people think needs to be done, and quickly, is what the US government did to transform interoperability in that dysfunctional system, and mandate standards of data sharing between healthcare providers, and through that, all healthcare software platform vendors.
That legislation in the US, The 21st Century Cures Act, essentially gave the major technology vendors five years to re-architect their software, or provide appropriate work arounds, so at every point of the system meaningful patient data could be shared relatively seamlessly and as close to real time as possible.
In the US, nearly 100% of major medical software vendors are compliant to the legislation now, which means nearly 100% are able to share meaningful health data seamlessly via the cloud.
If you are wondering, in Australia, something like 85% of our major software vendors are not cloud enabled yet – which in this day and aged just seems odd and wrong if you think about it.
Such legislation would force all vendors to get their act together and become cloud enabled – given the right amount of time, as its complex and expensive.
Among a million other things, this would make our whole healthcare data ecosystem generationally more cyber secure.
If either party in government introduced such legislation, things would change and substantively as far as efficiency and security of the system, and patient centricity, were concerned.
I’m not sure Peter and Anne understand this nuance yet, but I guess, sharing by default is a good start.